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SOCIETY OF T R O P I C A L

A N D H Y G I E N E .

M E D I C I N E

VOLUME XIX. No. 4.

Proceedings of the Opening Meeting of the Nineteenth Session of the Society, held on Thursday, 15th October, 1925, at 8.15, at 11, Chandos Street, Cavendish Square, London, preceded by a Demonstration of interesting works on tropical medicine and hygiene, dating from the middle of the eighteenth century onwards, kindly lent by H. E. POWELL, Esq., Librarian of the Royal Society of Medicine, P. MINTER, Esq., Acting Librarian of the Medical Society of London, and the PRESIDENT.

DR. ANDREW BALFOUR, C.B., C.M.G. ( P r e s i d e n t ) , in the Chair.

SOME B R I T I S H A N D A M E R I C A N P I O N E E R S IN T R O P I C A L MEDIC N E A N D H Y G I E N E .

PRESIDENTIAL ADDRI~SS

BY

ANDREW BALFOUR, C.B., C.M.G., M.D., Director, London School of Hygiene and Tropical ~[edicJne.

" On and on the compact ranks, With accessions ever waiting, we must'never yield or falter,

Through the battle, through defeat, moving yet and never stopping, Pioneers ! 0 Pioneers ! '"

- - W a l t Wkitman.

I have alreadyl I trust in fitting terms, expressed my sincere appreciation of the honour done me by the Fellows of this Society in electing me its President. That, however, carries with it certain responsibilities, and not the least onerous of those is the delivery of a presidential address. Such an address may, I think with advantage, differ a little from the type of paper usually read at our meetings. Hence, I propose to delve into the past. There is nothing to compare with the historical perspective as a means of adjusting our ideas, of clarifying our conceptions, of stimulating our flagging energies. In addition, a survey of

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190 SOME OF OUR PIONEERS.

those who have led the way in almost any branch of scientific work, and a consideration of what they accomplished, cannot fail to impress useful lessons on the receptive mind. One of these lessons is very likely to be that of humility, and this is specially true in the case of medicine. When we consider all the aids to knowledge which now exist, the extensive armamentarium at our dis- posal, the valuable literature to which we are the heirs, we cannot but wonder at some of those clinicians of former days who, relying mainly on " the seeing eye and the understanding heart ," grappled successfully with intricate problems and handled disease in a manner which, to this day, commands respect. Indeed, I very much doubt if, in certain directions, the modern doctor, with the laboratory at the back of him and his brain often crammed with scientific or semi- scientific knowledge, is as good at the bedside, or can use his remedies so effectively, as those who had to trust to their powers of observation, tO their reasoning faculties and to that intimate acquaintance with the materia medica which they had usually gained in the pursuit of their studies and during their careers as apprentices in practice.

What is true of general medicine is true also of what is called tropical medicine although, owing to the nature and severity of many of the maladies commonly encountered in hot climates, the efforts of the physicians in olden days too often failed to avert a fatal issue. Still, the following note, kindly supplied me by Colonel W. G. KINC, to whom I am also indebted for some valuable information regarding India, is likely to surprise you. In 1838, JorIN MURRAY, Deputy-Inspector-General , used warm saline enemata in cholera, apparently with satisfactory results, in preference to the formerly-employed method of injecting salines intravenously. The criticism of the period was as follows : The previous method was " to inject saline solution into the vein from its having been discovered by chemical tests that the serum of blood in cholera patients is deficient in some of its natural saline ingredients; and the operation was certainly attended with astonishingly restorative effects; but, situated as we generally are in this country, this plan is impracticable."

Where symptomatology, gross pathology and prognosis were concerned, the training and experience of the physician in the tropics stood him in good stead. This is clear from a study of the literature, for, let it not be forgotten that, long before the days of LAVERAN and MANSON, a vast deal of work was done upon diseases of the tropics, and numerous papers and treatises were written, many of them by men whose names are now forgotten. Some of you are doubtless familiar with the books of JOtINSON and HILLARY, but I wonder how many of you have come across COCKBURN'S volume on " Sea Diseases," dated 1736, or have heard of CHISI-1OLM'S " Essay on the malignant fever introduced in the West Indies," published in 1801, or have studied HUNTER'S "' Diseases incident to Indian Seamen, or Lascars, on Long Voyages," which saw the light in 1804. Then there is REECE'S " Medical Guide for Tropical Climates," 1814, ]~OYLE'$ " Le t t e r s" on diseases peculiar to hot climates, 1823, MCCAvE's

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SOME OF OUR PIONEERS. 191

Military Medical Reports of the same year, on similar diseases, and a host of others, some of which, but by no means all, figure in the Iong list given by CASTELLANI and CHALMERS in their " Manual." I have twenty quarto sheets of typed references to such publications, ranging from 1568 to 1894, chiefly in English and French, the great majority of which I have never seen. It is by no means compIete, but the mere mention will serve to show you how busy were men's brains and pens with tropical problems or ever the new pathology came into being. It is, in my opinion, quite wrong to speak of PATRICK MANSON as the " Father of Tropical Medicine." He was the Father, most undoubtedly of modern Tropical Medicine, but he would have been the last to relegate the other term to himself, for he was well versed in the ancient writings and knew, none better, that many men had laboured devotedly to throw light upon those problems in which he was so interested, and some of which he solved or helped to solve. Possibly an Egyptian priest, steeped in the lore of the temple, pondering upon the mysteries of life and death, grappling with sickness and misery, may have deserved the title, but we may with safety merge it in that of the Father of Medicine and hail Hippocrates as the progenitor. After all, there is in one sense no such thing as tropical medicine, and in any case many of the most erudite writings of Hippocrates are concerned with maladies which now-a-days are chiefly encountered under tropical or sub-tropical conditions.

What is true of tropical medicine is true of tropical hygiene. The two are, of course, inextricably mingled, and long ago medical men concerned themselves with the preservation of health in hot climates and laid down rules about it, and fought about it very much as they do to-day. Here, again, Hippo- crates gave us a lead, for the great Greek was a hygienist as well as a physician.

In the British Medical Journal for 1913 there appeared a paper on " The Knowledge of Tropical Diseases in 1813," a paper to which I will again refer. (Page 209). Its writer relates that the study of tropical diseases was obviously in its infancy in 1813. It may have been in one sense, but certainly it was not if judged by the attention which had been devoted to it and the amount which had been written about it. Tropical medicine was a very well-grown stripling two years before Waterloo was fought.

In considering " Some of our Pioneers " I am not going to trace forgotten or unforgotten worthies from the days of Hippocrates onwards. That would be a task utterly beyond me and, even if I were capable of it, would necessitate a presidential address continued throughout the .whole session and rightly drawing anathemas on my devoted head. No, I propose to confine myself to men of our own race and lineage, men who, one and all, their work accomplished, their labours at an end, have passed to their rest. Moreover, I com- mence at a time not very far distant, but a time of stress and difficulty which, as ever, in the case of a virile people, brings out the best that is in them and spells, in some directions at least, progress and development. War means a sword at the throat of the nation, and serious war demands special efforts

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in every direction. War wipes out the amenities of civilization and drags man closer to Nature and the primitive. War herds men together and favours filth and vermin. In our island story war has usually meant service abroad, frequently in hot climates, and hence it is not surprising that I should begin with a period when this country and much of Europe was convulsed, and take, as the first of my pioneers, the great army physician, Sir JOHN PRINCLE. I propose to deal with him in more or less the same manner as I treat the others. Where a portrait is available, as in PRINCLE'S case, I shall in most cases, try to draw from it some idea of the man it represents. Where no representation can be shown I shall merely mention, as indeed will be done in every case, a few salient features in the life of the pioneer, and discuss very briefly what he did or tried to do. I cannot do justice to my subject for, even with the limitations I have imposed upon it, a long series of names comes under consideration, but I have thought it well to err on the liberal side, if only to show you how many have trod the path we tread, and how many examples exist which we can recall for our own benefit and the chastening of our spirits. Dr. WENYON'S kindness and courtesy enable me to show you lantern slides of many of those who figure in the gallery at the Wellcome Bureau of Scientific Research, and, in this connexion, I am also greatly indebted to Dr. DAUKES. The International Health Board of the Rockefeller Foundation kindly supplied me with some portraits and useful notes. Colonel MEGAW has been good enough to send me two lantern slides from India, and, as I have said, Colonel KINC has aided me in several directions. So has Mr. CLIFFORD DOBELL, while Mr. TROY, my Secretary, has exercised his detective powers to good effect. My thanks are due to them and also to the Librarians of the Royal Society, the Royal Society of Medicine, the Royal College of Surgeons, the Royal College of Physicians of Edinburgh, the Royal Colonial Institute, the British Medical Association and the Well- come Bureau of Scientific Research for valued assistance. Such portraits as I have recently been able myself to secure have been converted at the Wellcome Bureau into lantern slides for the occasion by our indefatigable senior Secretary. I might have grouped the pioneers. I might have formed an Army group, a Navy group, a Missionary group, and so forth, but I have preferred to take them more or less in chronological order and, beginning, as I have said, with Sir JOHN PRINCLE, to end with the greatest of them all, the first President of this Society and, to many of us, master and revered friend, Sir PATRICK MANSON.

Sir d0hn Pringle (1707-1783). To me he looks a man both pursy and peppery. Note his puckered mouth, observe the set of his chin and the grim glint in his eye. Whatever may be said about his pursiness, there was plenty to make him peppery, for he lived in strenuous times and the path of a pioneer is never easy. Imagine what he must have been up against in the British Army of the mid-eighteenth century ! Those of us who served in the Boer War remember some of our trials and tribulations, and these were not altogether lacking even in the last great cataclysm. PRINGLE, however, had no statistics

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i 7 : : " "

JOHN PRINGLE~ 1707-1783.

JAMES LIND, 1716-1794.

GILBERT BLANE~

1749-1834.

~tlOM,\S TROT FER,

1760-18a$. ROBERT JACKSON,

1750-1827. WILLIAM WEIGIIT,

1735-1819.

JAMES McGRIGOR, 1771-1858.

To face Pa~e 192.

13ENJAM1N RUSH,

1745-1813. WILLI IM BURNE"

17'79d861.

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as weapons, he could not point with pride to what had been accomplished by medical science. He had to create an atmosphere, he had to found military hygiene which, prior to his time, was well nigh non-existent. He was opposed to indifference, ignorance and barbarity, and he had to grope his way in the dark and trust largely to the results of his personal observations in the field, in barracks, on board transports and ships of war, in jails and mines, and amongst civilian surroundings. Like many of the pioneers, PRINGLE was a Scot. He was born at Stobs, in Roxburghshire, and was educated at Edinburgh and Leyden. After acting as a Professor in non-medical subjects at Edinburgh University and practising as a physician in the city, he went to Flanders with the Earl of Stair, and eventually became Physician-General to His Majesty's Forces in the Low Countries and Physician to the Royal Hospitals there. Later he served in Scotland with the Duke of Cumberland and then returned to the army on the continent. Eventually he settled in London and became President of the Royal Society. Despite the pugnacious aspect of his portrait PRINGLE, in addition to being a great leader, is known to have been charitable and in every respect a good man. HOWELL, who wrote a short article about him for the Journal of the Royal Army Medical Corps, speaks of his sterling integrity and honesty. He was a strong friend, a man of firm character, with a clear and logical mind and pronounced views.

I possess a copy of the seventh edition (1775) of his most famous work, " Observations on the Diseases of the Army." This is the book which Sir JOHN SIMON, himself the writer of a classic, described as one of the classics of medicine. Considering the period when it was penned, it is certainly a remarkable volume and, from our point of view, the chapters dealing with malaria and dysentery are especially enticing. Incidentally one notes how common helminthiasis was in those days, and realizes how widely read was PRINGLE, and how careful and accurate are his clinical descriptions. Like others of his day, he favoured bleeding in malaria before the exhibition of bark, and I am not at all sure that he was wrong. Anyone who has passed through the furnace of a severe attack of acute malaria, with throbbing temples, congested face, and splitting headache must, I think, have felt that a little " tapping of his claret " might have brought relief. NO doubt PRIN~LE confused enteric fever with malaria and tried in vain to unravel some of the clinical mysteries which beset him, but he wrote clearly and well on the bloody flux, gave an excellent account of typhus, and named influenza. He is, however, best remembered as a hygienist. He traced a connexion between foul straw, filthy privies and dysentery, discoursed on climatology, pleaded for ventilation and cleanliness, and did not forget to deal with what is perhaps the most important branch of army hygiene, at least during active service, the rationing and diet of the soldier. I would fain linger over PRINGLE, read you some quotations from his great book and discuss some of his experimental work, but time presses and we must pass to the sister service where another Scot, a little later than PRINGLE, was blazing a trail.

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James Lind (1716-1794) did for the Navy what PRINGLE did for the Army. He was the founder of naval hygiene, and his fame rests secure on his book dealing with that subject and on his treatises upon scurvy and tropical medicine. I do not know that there is much to be gathered from his portrait. He looks much better tempered than PRINCLE and has an intelligent and benevolent aspect. There is a trace of humour about his mouth, and assuredly he had need of humour in days when the navy answered to the terrible descriptions given of it by TOBIAS SMOLLETT. I may be wrong but, judging from his writings, I cannot help feeling that LIND was even a greater man than PRINOLE. He was obviously a very clear thinker, an accurate observer, and a sound clinician, and I fancy he possessed more originality of mind than the army physician. Remember, however, that he probably benefited from PRINGLE'S work for, roughly speaking, he was about ten years after his compatriot. Like PRIN~LE, he was a fine man ; wise, sagacious and broad-minded, courageous also, and with a great heart. When reading his essay on the preservation of the health of seamen one almost forgets that he lived and worked more than a century and a half ago, and is startled by coming across ideas which we are apt to regard as distinctly modern. How correct he was when he wrote " For the number of seamen in time of war who die by shipwreck, capture, famine, fire and sword, are but inconsiderable in respect of such as are destroyed by the ship diseases, and by the usual maladies of intemperate climates." From ou(/s tandpoint LIND had one advantage over PRINGLE in that he served in the tropics, both in the West Indies and off the African West Coast, and gained some first-hand knowledge of tropical disease. Moreover, he had all kinds of cases under his charge when physician to the Royal Naval Hospital at Haslar. I t is necessary to link up LIND with ]~LANE and TROTTER, for these countrymen of his were his chief disciples.

Sir Gilbert Blane (1749-1834) looks what he was, a wise and urbane administrator. He has, I think, a handsome face, and it appears that he possessed courtly manners. At the same time he had driving power and exercised great influence upon naval medical matters, so much so that it was owing to him that lemon juice became a regular issue, and scurvy vanished. He wrote on Diseases of Seamen, tropical maladies amongst them, and was a worthy follower of LIND. Of a very different type was Thomas Trotter (1760-1832), a regular sea-dog in his way, fearless and rugged without BL,~NE'S urbanity, but fully his equal in untiring energy and loftiness of aim. I have h i s" Medicina Nautica " in three volumes, and its perusal enables one to recognize the diligence and pertinacity of the man. There he is, a sturdy looking doctor, obviously very much alive, without the fine features which characterise many of the pioneers, but with an open and honest countenance and a wide and lofty brow. He looks a bit of a warrior, and that is exactly what he was, but he warred in a good cause and for the benefit of his fellow men.

They were a wonderful trio, LIND, BLANE and TROTTER, men thrown

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S O M E O F O U R P I O N E E R S . 195

up by the ever-recurring wars with France to initiate, guide and control medical and hygienic progress in the Navy. TAYLOR, the American, rightly dubs them heroes and says of them : "They struggled against stupidity, ignorance, prejudice, and indifference in high places and low, the Admiral ty and the forecastle ; they had the hard task of seeking to break down immemorial cus tom; dared to challenge t radi t ion; hammered at the walls of a hierarchy as soul-chilling, as rigorous, as i ron-bound as any Brahmin caste ; preached seemingly frivolous novelties to insular conservatism that held hardships essential for hardihood." Yet, in the end, they tr iumphed, and it is no wonder that their names are written in the book of fame.

Dysentery bulks largely in all the medical writings of this period, and it is interesting to note that there might have been another pioneer to add to our list, earlier than any of those mentioned, had Dr. WILLIAM COCKBURN (1669-1739) made known, according to the honourable tenets of the profession, his secret remedy for the flux. I t was tried on seventy patients aboard the " Sandwich " and proved brilliantly successful. In the form of an electuary it was largely used for forty years throughout the British fleet, and its intro- ducer was thanked for it by Will iam I I I . He became a Fellow of the Royal Society, but is generally regarded as a quack, and so we will leave him to his ill-gotten gains.

While some military and naval men were making good use of their opportunities, certain civilians, under different conditions, were adding to our knowledge. The West Indies were a fruitful field for the young practitioner in those days, and not infrequently he added to the literature which had already accumu- lated about the diseases of these outposts of Empire, as, for example, TRAPHAM'S curious book on Jamaica (1679), HANS SLOANE'S mighty compilation (1707-1725) and TOWNE'S " Treatise " (1726). I think we must hail Wil l iam Hillary as something of a pioneer, for not only did he gain his M.D. at Leyden for a dissertation on intermittent fevers, but, as a result of his sojourn in Barbadoes from 1752-1758, he wrote on yellow fever, and was undoubtedly something of a climatologist carefully correlating weather conditions with the prevailing diseases. I have no portrait of him and do not know when he was born, but understand he died in 1763.

A more worthy pioneer than HILLARY, however, was Dr. James Grainger of St. Kitts. _I came across his book in the Library of the Colonial Office, rather a mine of wealth and, I fancy, rather an unexplored mine, so far as old Colonial medical works go. I t is entitled " A n Essay on the more common West Indian Diseases, and the remedies which that country itself produces. To which are added some hints on the management of the negroes." I t was published in London, in 1764, and is full of wisdom. This GRAINGER, who was probably born at Dunse, in Berwickshire, and who received his medical education at Edinburgh University, has quite a good deal of print devoted to him in the Dictionary of National Biography, that storehouse of useful biographical facts.

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He became an Army Surgeon and then settled in London, where he had a poor time of it and kept himself alive by writing. He embarked for St. Kitts in 1759 and died there, of fever, in 1767. He must have been an enlightened man, and SAMUEL JOHNSON said of him that he was one " who would do any good that was in his power." Described as tall and " of a lathy make," plain featured and deeply marked with the smallpox, his conversation is stated to have been very pleasing. Certainly his book is, for it shows him to have been far in advance of his day and generation. I t is perhaps uncharitable to suggest that some of his interest in these subjects may have been due to the fact that he invested his savings in what used to be called " black ivory." He concerned himself with the question o f " Sick Houses " or estate hospitals, and drew plans of them. Not only so, but he actually advocated the provision of isolation and venereal wards. He anticipated BALLIZ~GAL5 by distinguishing two distinct types of dysentery, and he wrote well and learnedly on the diseases of negroes and the hygiene of negro slaves. I am sorry that I cannot show you a picture of his pock-marked face.

PRINeLE, like LIND, had followers, and one of the most notable was Donald Monro (1727-1802), the distinguished son of a distinguished father, for he owed his being to the famous anatomist, Monro Primus, of Edinburgh. DONALD MONRO was a man of varied attainments who became a Fellow of the Royal Society and was a physician at St. George's Hospital. He served for a time with the Army on the Continent and published an adcount of the " Diseases most frequent in British Medical Hospitals in Germany," 1761-63, and, of greater interest now-a-days, an amazingly modern essay on the " Means of preserving the health of ~ ld ie r s and conducting military hospitals." He discourses on privies, pit latrines, the purification of drinking water, and camp hygiene generally, and sometimes it is hard to believe that he was not an A.D.M.S. Sanitation and did not wear khaki. I regret I cannot exhibit him either in uniform or mufti.

Considerably later came Robert Jackson (1750-1827), a stormy petrel, full of fervour, a masterful man who Alan Breck would have called " a bonny fechter." He fought, however, to good purpose, for it was his trenchant criticism of the organisation of the Medical Department of the army/which led to the changes that were introduced after the disastrous Walcheren Expedition. To us he appeals chiefly because of what he wrote about fevers and the preservation of the health of soldiers in hot climates. His views were sound in many respects and, doubtless, exercised a useful influence. His portrait gives a good idea of the type of man he was. He has a large, square head, a lofty forehead, a clear direct gaze, a strong mouth, and the lower jaw of a pugilist. A stout fellow, JACKSON, to whom the British army owes a great deal and tropical medicine not a little.

About this time there was quite a number of lesser pioneers, each of whom contributed his mite, and all of whom helped on the great cause even if some

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like Benjamin Moseley (1742-1818), at one time Surgeon-General in Jamaica, were rather poor specimens. He opposed vaccination and had an unscientific and rather superstitious cast of mind. Still, his chief work on tropical diseases was translated into German, and he wrote specially on tetanus and dysentery.

John Rollo, who died in 1809, was a better man, who gained his experience in St. Lucia and Barbadoes. I must say I rather like his slim volume on how to take care of yourself in the West Indies. It has plenty of sound common- sense and must have been a useful vade-mecum in 1783.

Then there was John Hunter who, born in Perthshire, Was Superintendent of Military Hospitals in Jamaica from 1781 to 1783. He wrote on typhus fever in London, and dealt at some length with various West Indian diseases, amongst them what he called the dry belly-ache, a term which leaves something to the imagination.

There were many others, Colin Chisholm, who was a surgeon in Grenada, John Clark, of Roxburgh, the Newcastle philanthropist, a surgeon's mate in the East India Company's service who wrote on the diseases seen in long voyages to hot countries (1773), MeArthur and Fergusson, who described yellow fever and the former of whom gave an account of its gross pathology, Cleghorn, who wrote a book on the Epidemical Disease in Minorca which had a great vogue in its day, and Bissett, whose Medical Essays on West Indian fevers and other conditions possess some interest. I cannot mention them all, still less quote from their works, but I show you a portrait with which, I fancy, few, if any, of you are familiar.

The original was William Wright, who was born at Crieff, in 1735, and died at Edinburgh, in 1819, where he rests in the famous Kirkyard of Grey- friars with an inscription a yard long commemorating his virtues. He looks a shrewd and thoughtful man. Presumably his lengthy nose indicates benevolence, and from all accounts this was a feature of his character. A Memoir of his life and works was published in 1828. He served an apprenticeship to a surgeon at Falkirk, studied medicine at Edinburgh, made a voyage to Greenland, jour- neyed by sea from Leith to London, and passed an examination for the Naval Medical Service at Surgeons' Hall. He had to enumerate the contents of the thorax and answer questions on burns of all degrees. He passed, and was soon afloat on the " Intrepid," a plaguey old hulk in which he contracted typhus. He was in several naval engagements, cruised in the Mediterranean, and saw service in the West Indies. After leaving the Navy he proceeded to Jamaica, where he settled for a time as a private practitioner and where he suffered from malaria. There can be no doubt these pioneers had great opportunities of studying the symptoms of communicable diseases in their own persons. Indeed, at a later period, WRIGHT had an opportunity of treating himself for some obscure febrile condition by having buckets of salt water thrown over him which occasioned him immediate relief. He certainly had the courage of his convictions, and it was he, apparently, who introduced the use of the

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cold bath in tetanus, a practice commended by LIND. There is nothing new under the sun. As some of you know, Dr. BURKITT, Of Nairobi, is an ardent advocate of the treatment of febrile conditions by cold water. WRIGHT was a learned botanist and made a fine collection of plants in Jamaica. Returning eventually to England, he became a regimental surgeon, sailed for abroad, was captured by the French and Spaniards, was a prisoner in Spain for some time, where he practised his profession both amongst his fellow prisoners and in Spanish circles and, after getting back to England, sailed again for Jamaica, where once more he had fever and ague. He returned home, but later proceeded to Barbadoes, where he had charge of the military hospitals.

WRIGHT, it will be seen had a busy and adventurous career, but that he made good use of his time is shown by the fact that he was elected a Fellow of the Royal Society, by the large and valuable natural history collections he made, by his "Account of the Medicinal Plants growing in Jamaica," and by his papers on various diseases. Amongst them is an interesting dissertation on yaws, which he distinguishes from syphilis. His " Directions to Officers going to the West Indies " are very sound, especially his injunction " Be sure to draw down the mosquito-net close all round, and brush well inside with a large towel to kill such mosquitoes as may still be there." He was a scientist to his finger tips, and his " Instructions for a Person about to sail for the East Indies and China " are all of this nature : " Preserve flying-fish by drying ; also the heads, jaws and teeth of any large fishes caught in the voyage " . . . " Provide yourself with fly-flappers, pins and proper boxes and drawers, for putting up insects " . . . " Write as exact an account as you can of the mon- soons and of everything respecting the productions of China." Rather a tall order, this last, but I fancy it was whole-hearted devotion to his profession and natural history which caused him to die a bachelor and occasions this curious entry in the Memoir : " In the intimate, uninterrupted and confidential correspondence which Dr. WRIGHT maintained with his brother from the earliest period there is, strange to say, not the slightest trace of his having ever been under the influence of the tender passion. He had always, indeed, a keen relish for a good-natured joke, and was as ready to receive, as to re~urn, a little well-meant raillery on a subject to which a bachelor of twenty-eight is peculiarly subject." With that, I think, we may take leave of Dr. WRIGHT, one of the worthiest of our pioneers, even if he did not add to medical lore anything of lasting value.

WRIGHT rests forgotten and has no monument save the tombstone with the long Latin inscription, but a fine statue at Millbank and an imposing obelisk at Aberdeen do honour to the memory of one who was to Wellington what Larrey was to Napoleon and whose services to the British Army and to military hygiene can never be forgotten. As you see, Sir James McGrigor (1771-1858) was a handsome man but, what is more to the point, he was exceedingly capable, long-headed, careful, diligent, and conscientious. These qualities, coupled

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with experience gained in Flanders, at Walcheren, in the East and West Indies, Egypt, and the Peninsula, made him an ideal Director-General of the Army Medical Department at the time when that Department was sorely in need of a reliable leader. You can read all about him in his modest Autobiography, or in the excellent article by RUSSELL in the Journal of the Royal Army Medical Corps for August, 1909. Here is what Dr. SCOTT and I had occasion to say in our" Health Problems of the E m p i r e " : " Firm, yet friendly, qulck-tempered, but of a kindly nature, honest and fearless in the discharge of his duties, with a very proper Highland pride and a great spirit of camaraderie, McGRmoR is an engaging figure and he breathed the breath of life into an effete and discredited, organisation." But he did more than this and, for my purpose this evening, it is well to recall that he was the author o f " Medical Sketches of the Expedition to Egypt from India, 1804," and of the " Report of Sickness, Mortali ty and Invaliding in the Army in the West Indies, 1838," as well as the founder of the Museum of Natural History and Pathological Anatomy and also of the library at Fort Pitt, Chatham, the home of the Army Medical Service before Netley.

" Men of our race and lineage," I have said, and, therefore, I do not hesitate to include a few Americans in this series. The United States has contributed notably to the list of pioneers, and some of those who claimed and, probably, like many of their countrymen, were proud to Claim British descent, merit our attention.

I-show you Benjamin Rush (1745-1813), a thoughtful figure. He reminds one a little of the great JOHN HUNTER in appearance, but perhaps that is due to his attitude more than to his features. He came of English Quaker stock and was a distinguished physician with much originality of mind. He comes into our purview because he was one of the first to describe dengue, and wrote a striking account of the terrible epidemic of yellow fever which scourged Philadelphia in 1793. In 1794 he proclaimed that the disease was not con- tagious. He also wrote on the hygiene of troops and on the diseases of North American Indians, while he was one of those who signed the Declaration of Independence.

I think you should see that fine-looking man, Sir Will iam Burnett (1779- 1861), Medical Director-General of the Navy for many years, because he was an enlightened person and stimulated research upon tropical diseases. He was also a hygienist, and some of you will remember that, for examination purposes, we were supposed to know the composition of BURNETT'S disinfecting fluid.

I now propose to modify a little the plan I have followed and to take in sequence a number of men whose names are associated with India, from the beginning of the nineteenth century down to comparatively recent times. The Indian record of research is a very fine one and, of course, it is intimately linked up With that of the Indian Medical Service which, founded as the Bengal Medical Service in 1763, might well claim as its motto, so far as tropical medi-

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~00 SOME OF OUR PIONEERS.

cine and hygiene are concerned, that borne on the standards of a famous cavalry regiment " Nulli secundus." I begin with James Johnson (1777-1845), not that in the way of research, or as a clinician, or as an administrator he was anything out of the common. Indeed, not long ago, in this very room, Sir LEONARD ROGERS damned him heartily because it was his advocacy that caused cinchona bark to be replaced by calomel in the treatment of remittent malaria in Bengal, a change which wrought infinite harm and occasioned many deaths. _At the same time Sir LEONARD was perhaps not quite fair to JOHNSON, for he dismissed him as a man who was only a few months in the tropics and whose opinion was worthless. Now JOHNSON, with all his faults, had considerable experience, not only in the case of other people, but in his own vile body, for he went down with ague at Walcheren and suffered severely in the Indian Ocean from amcebic dysentery and liver abscess. As a matter of fact, he was nearly four years in the East as a naval surgeon, but he enters the ranks of the pioneers as a book maker, for, in 1812, he published his chief work, " The Influence of Tropical Climate on European Constitutions," which, with its appendix on Tropical Hygiene, ran through edition after edition until finally it changed its author, if not its title, and appeared with the name of JAMES RANALD MARTIN, a greater man that JOHNSON, on the title page.

JOHNSON merits the title of a pioneer because he compiled, with great diligence and a good deal of acumen, a work which had a very stimulating influence upon the study of tropical medicine. I t was the " Chalmers and Castellani " of its day but, while full of facts, these were not always well digested or substantiated, and were certainly not always correct. Yet it contained a great deal of information, some of it exceedingly useful, some of it the reverse. I t must be admitted that great parts of it were cribbed, though with due acknow- ledgements, from other writers, but the cribbing was judiciously done and made available valuable papers which otherwise the British doctor in the tropics would never have seen. To compare small things with great, JOHNSON'S book had some of the elements of the Tropical Diseases Bullet in in it. There are very suggestive passages here and there. Listen to this one in the translation of the article " Malaria in Italy " by REGAUD DE L'IsLE :

/

" During my residence near the marshe.s of Languedoc I lived near a very fine building, formerly the convent of Franquevaux, erected on the very border of the marshes. The monks in this house were per- fectly healthy all the year round, though few of tile inhabitants of the environs escaped disease in summer or autumn. Tradition, nevertheless, relates that they were accustomed in hot weather to sup on a terrace contiguous to the convent--a sure method of exposing themselves to disorders ; bu: they were sheltered by a tent of double or triple canvas, and this simple precaution, requisite against the mosquitoes, proved, unknown to them, a still more certain protection against miasmata."

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JAMES JOHNSON,

1777-1845.

JAMES RANALD MARTIN~

1793-1874.

JAMES I~ANALD MART

at an ear l ie r age.

2AME~q ANNESLEY~

1780-18~,7.

.x~" OR M A N CHEVERS~

1818-1886. To face t~a#e 200.

GEORGE BALLINGALL,

1780-1855.

EDWARD WAILING,

1819-1891,

CHARLES ~¢[ OREItE~

1807-1882.

VqlLLIAM ROBERT CC

1827-1897.

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JOHNSON was Of Scotch descent, but was born in Ireland. He had a hard struggle in London before he got a post, in 1798, as surgeon's mate in the Navy. He cruised in the Mediterranean and was invalided from Egypt. In 1803 he sailed for eastern waters, and was in or about India till 1806. Later, as I have said, he was in the ill-fated Walcheren Expedition. After his magnum opus was written he retired on half-pay and settled in practice, at first in Ports- mouth and then in London. He had the reputation of being a sound physician and was evidently held in great respect by MARTIN and others of his acquaintance. Although a compiler rather than a composer, JOHNSON deserves some credit, and the evil which he unwittingly perpetrated and to which Sir LEONARD ROGERS feelingly referred was in some measure counterbalanced by the fillip he gave to the study of tropical maladies, while his diligence, perspicuity and dignified diction command respect. Happily I have a portrait of him. He has rather an attractive countenance, but does not strike one as an outstanding personality.

I t seems fitting that, as in life, so here, MARTIN should follow JOHNSON. Sir James Ranald Martin (1793-1874) came from the misty Isle of Skye, and, as you see, even when well stricken in years, had a striking and attractive physiognomy. His face is, I think, an index to an alert mind, while he possesses a firm mouth and determined chin. There he is, at an earlier period, obviously a man of energy and keen perceptions. I t is interesting to compare the portraits at two periods of his long life. He began his medical career as a student at St. George's and, in 1817, became a surgeon on the Bengal Medical Establishment of the East India Company. In 1837 appeared his valuable " Notes on the Medical Topography of Calcutta," which treats largely of its sanitation, or rather insanitation, from the days of JoB CHARNOCK'S famous banyan tree, under which the white citizens of Calcutta used to meet after the rains and congratulate themselves that they were still alive. MARTIN wrote various other articles and did much for the service to which he belonged, but is now remembered by his edition of JOHNSON'S book. This is a most interesting volume, well worth reading, even though it treats of the vanished past and is too fond of calomel. Sir JAM~S became a Fellow of the Royal Society and was well known in his day but, like so many others, his name has tended to pass into that oblivion which, despite Mark Antony's oration, shrouds both faults and virtues. Sir JOSEPH FAYRER, however, wrote his " Life," and this may serve to keep his memory / green.

Sir James Annesley (1780-1847) has, I am sure you will agree, a dignified appearance. He suggests, perhaps by reason of his dress, which is of a type some of our pioneers might with advantage have abolished, a doctor of the old school. If you examine the portrait with a lens you will find that his eye is remarkably intelligent and that his mouth suggests a sweetness of disposition combined with firmness. He came from Ireland, being a son of the Hon. Marcus Annesley, and was born in County Down. He studied medicine at Trinity

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~0~ SOME OF OUR PIONEERS.

College, Dublin, and in London and, having obtained anappointment in India, sailed for Madras in 1800. There he saw active service, was invalided home, but, returning became Garrison Surgeon of Masulipatam. In this position he had great opportunities of studying tropical diseases, both in the European and the native, and that he took every advantage of them is evident from this passage in P~TTmREW'S " Medical Portrait Gallery , , e

" He has never treated a case, either in public hospitals or in private practice, without recording minutely the symptoms of the disease, the remedies employed and the results of the application. His attention has always been particularly directed to the effects and the operation of medicines, with reference to particular symptoms ; and, in the event of casualties, the post-mortem appearances have been looked to, with reference both to the symptoms of diseases and the remedies used."

There, in a nutshell, we have the secret of his success ; care, energy and accuracy in the pursuit of his profession. He was in the Java expedition, saw further field service in India, and thereafter gained wide clinical experience in Madras. He was given administrative work and never spared himself as a public servant. Indeed, it was his devotion to duty which helped to occasion the ill-health that led to his leaving India after thirty-seven years of distinguished service. He wrote a treatise on cholera, but his m a g n u m opus was h i s" Researches into the Causes, Nature and Treatment of the more Prevalent Diseases of India and of Warm Climates generally." This remarkable book, illustrated by forty coloured engravings, was published as two large quarto volumes in 1828, and, though overladen with details, was a mine of wealth in its day, and did not neglect the preventive side of tropical medicine.

ANNESLEY was a competent physician and pathologist, and, undoubtediy one of our foremost pioneers, though, so changed are the times, no one now-a-days thinks of consulting those ponderous tomes, the compilation of which was to him a labour of love, and on which he must have spent much time and infinite trouble.

We may take Sir George BaUingall (1780-1855)]- next, who, born in Banff- shire, ended his days as Regius Professor of Military Surgery in Edinburgh University. He went to India in 1806 and owes his place amongst the pioneers to the work he did there and to his " Observations on the Diseases of Europeain Troops in India." As has been mentioned, he differentiated clinically two forms

I'ETTIOREW'S publication is :

~ " Biographical Memoirs of the most celebrated Physicians, Surgeo~ls, etc., who haw~ contributed to the Advancement of Medical Sciellce." (Medical Portrait Gallery. Vol. I I I , 1839.)

~ Basu, R. D. Various Biographical Sketches in Medical Reporter, Calcutta. 189t. (These include references to BALL1NGALL~ CHf~VERS, t~IDIE and VANDYKI~ CARTNR.)

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SOME OF OUR PIONEERS. ~03

of dysentery. He looks a man of strong and firm nature, accustomed to lead and direct ; I gather that his portrait does not belie his character.

Of John Peter Wade I know little, but he is entitled to rank as a pioneer if only because a note in CRAWFORD'S " History of the Indian Medical Service "

indicates that, in 1788, when he was an Assistant Surgeon, he advocated the formation of medical libraries in Bengal ; a large one at Calcutta, and smaller ones at the headquarters of Brigades. The cost of maintenance was to be met by subscriptions of two rupees a month from each Surgeon, one rupee from each Assistant Surgeon. The scheme was not adopted but, as CRAWFORB says, was probably the first suggestion put forward in India of any combined action for professional improvement. But WADE, if he never got a chance of contribut- ing twelve rupees a year to libraries, made contributions to the literature which doubtless found their way into such repositories. In 1791 there appeared his " Select evidence of a successful method of treating Fever and Dysentery in Bengal," while in the same year he wrote a paper, published in 1793, on the " Prevention and Treatment of the Disorders of Seamen and Soldiers in Bengal." Somewhat later another product of his brain and pen saw the light, to wit, " Nature and effect of, emetics, purgatives, mercurials and low diet in disorders of Bengal and similar lati tudes." He is mentioned by GARRISON in his " History of Medicine," and I gather was somewhat of an authority in his day. Certainly he was one of the leaders in the discussion on Indian fevers, which continues to the present time. He studied at Edinburgh but, curiously enough, his only licence to practise emanated from the Queen and Minister of Portugal.

Wil l iam Twining (1790-1835) e was a Nova Scotian who studied at Guy 's under Sir ASTLEY COOPER, served in Portugal with Wellington, was present at Waterloo, went to Ceylon and then to India, and wrote, amongst other books, one which was described as " the most valuable contribution to the scientific knowledge of Indian diseases so far published." This was the once famous " Clinical Illustrations of the more important Diseases of Bengal," published in 1832. TWINING died in Calcutta when Senior Assistant Physician to the general hospital there. I have been unable to procure his portrait.

I have not discovered where and when John Grant Maleolmson was born, but he died in 1844. His name betrays his nationality but, despite considerable efforts, I have been unable to get full particulars of his life and career, though he duly figures in GARRISON'S " History of Medicine," and was a Fellow of the Royal Society. I knew something of MALCOLMSON'S association with beri- beri, which is the reason for his inclusion in our list, and fortunately Colonel KING, always zealous for the honour of Madras, and always willing to help, kindly came to my assistance. From him I learned that MALCOLMSON, who entered the Madras Medical Service in 1823, was an Assistant-Surgeon of the Madras European Regiment, gained, in 1833, the prize offered by the Madras

• GOODEVlg, H. H. Memoir of the late W. Twining, Esq. Trans. Med. and Phys. Soc, of Calcutta. 1836. viii.

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..qO04 SOME OF OUR PIONEERS.

Medical Board for an essay on (1) the disease called beri-beri and (2) rheumatism and the neuralgic affection occasionally a sequel of it called by the natives burning in the feet; In 1835 the winning essay was published in book form as "A practical essay on the history and treatment of beri-beri ." I t was a remarkable production, a piece of very carefully weighed evidence and judicious reasoning. While by no means adverse to the idea of beri-beri being a deficiency disease, MALCOLMSON argued that some local factor was also operative, and thereby anticipated views which quite recently have been advanced regarding this mysterious disease. He realized that in all probabili ty several different conditions were grouped under the name beri-beri and directed attention to the use of grain damaged by the attack of animal or vegetable parasites. One would like to know more about MALCOLMSON, for he was clearly of the order of sound research workers and must also have possessed some literary sense, for on the fly-leaf of his book he caused to be printed this quotation from BtraxoN's "Anatomy of Melancholy.":

" The same disease 3~ields diversity of symptoms which, however they be diverse, intricate and hard to be confined, I will adventure yet, in such a vast confusion and generality, to bring them into some order."

I t will be admitted that MALCOLMSON adventured to good purpose, though he himself has been more or less forgotten. Not altogether, however, for the Bombay Branch of the Royal Asiatic Society founded a medal in his honour and paid testimony to his high integrity of character, generosity, warmth of heart, and zeal in the promotion of science. He was a man of wide and varied acquirements and might have left a greater name had he not left the Medical Service, in 1840, to become a partner in the firm of Messrs. Forbes and Co., Madras. He was upon a geological expedition in Gujarat and Khandesh when he contracted the hepatitis which proved fatal at Dhulia. In this connexion it is of interest to note that some of MALCOLMSON'S contributions to the literature were concerned with enlarged liver and hepatic abscess.

Charles Morehead (1807-1882) was born in Edinburgh, studied medicine there and in Paris, and joined the Bombay Medical Service in 1829. He was a pioneer in several directions, for not only did he write a standard work entitled, " Researches upon the Diseases of India " (1856) and oppose the excessive use of mercury in tropical maladies, but it was to him that the Grant College, of which he was the first Principal, owed its establishment. Indeed, he was called the pioneer of medical education in India. He looks rather a shy man, but has a fine, thoughtful face, framed in silvery hair. His mouth and chin show evidence of determination and he has long, and probably flexible, fingers, ~ which one can easily imagine percussing out a splenic or hepatic margin. There is a good Memoir of him edited by Hermann Haines and printed for private circulation (1884). I t refers to his extreme delicacy of touch and indicates that he was a skilful draughtsman.

e On /y par t ly shown in the reproduction.

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Norman Chevers (1818-1886) was a man of great activity and a most astute clinician. Born at Greenhithe, in 1818, he became a student at Guy 's Hospital, and obtained a commission in the Bengal Army in 1848. In 1876, ten years before his death, he retired with the rank of Deputy-Surgeon-General . CHEWRS had an arduous career in India and was Secretary to the Medical Board, Bengal, during the trying time of the Mutiny. From 1861 to 1876 he was Principal of the Calcutta Medical College, Professor of Medicine and Firs t Physician of the College Hospital. There he acquired that great clinical experience which was eventually enshrined in his " Commentary of the Diseases of India ," a work of outstanding merit. But CHEVERS was versatile, and wrote on the means of preserving the health both of soldiers and sailors, produced a great book on " Medical Jurisprudence in India ," described the fever of the Burdwan districtl contributed largely to current literature, and was a co-editor of the Indian Annals of Medical Science. Though, possibly, not in the first rank as a pioneer, there can be no doubt that CHEVERS threw light on the symptomatology of tropical diseases and broke fresh ground in his volume on Medical Juris- prudence. Moreover, he advanced the cause of scientific medicine in India and furthered medical education in Calcutta. He was a well-known and most respected figure in his day, and has been described as gentle, genial and generous, though, when occasion demanded, he could be adamant and had at his service a gift of sarcasm which, however, was free from gall.

I suppose the irreverent in these flippant days would call CHEVERS a " Bea- ver." I t is true that his very ample beard gives him rather a peculiar look to modern eyes, but, if a high and domed forehead betokens intellectuality, CHEVlmS possessed it in full measure, while if the eyes are indices of the brain, CHEVERS was a clear thinker and was full of mental vigour. We know this to have been the case, and, though his portrait may not reveal it, his writings show that he was blessed with the saving gift of humour.

Edward Waring (1819-1891) deserves a place because of his work on the indigenous medicinal plants of India. Many of you must be familiar with WARING'S " Bazaar Medicines of India ," but he wrote also on other subjects and, indeed, had marked literary tastes. Sir JOSEPH FAYRER spoke of him as " a great author and physician and a man who has conferred infinite benefits on his profession," He hailed from Shropshire and visited Sierra Leone, Jamaica, Australia, the Cape of Good Hope, and other parts of the world before going to Madras, in 1849, as an Assistant-Surgeon in the Honourable East India Company's service. He was sent to a lonely out-station in Burma and there, far from all help, compiled his " Manual of Practical Therapeut ics ," a famous and successful book in its day. Later we find him at Travancore, colla- borating with PhaKES in a work on liver abscess, and busy in many directions. He returned to England in 1863, was editor of the Indian Pharmacopoeia, and wrote a genial, chatty little book called " The Tropical Resident at Home." Some years before his death he presented his large and valuable l ibrary to the

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Army Medical School. In 1881 he was made a Companion of the Indian Empire, sharing this distinction with three of his Indian Colleagues, a happy event celebrated as follows in Punch :

" T h e Ind ian Empi re O r d e r may r ight well the gue rdon be O f gallant m e n who worked full ha rd beyond the Eastern sea ; A n d Doctors do s tern du ty there, a t housand dangers shar ing , So here ' s a health to Morehead , Chevers, Barnet t and to W a r i n g . "

There he is, beaming as though he had just received the C.I.E., obviously a kindly man, a fine old English gentleman, and one who, we know, was full of knowledge, especially concerning those remedies which have been used from time immemorial in India and the East.

Will iam Robert Cornish (1827-1897) was another of these fine men, in the moulding of whose character both this country and India played a part. He was a student at St. George's Hospital and went to Madras as an Assistant- Surgeon in 1854. There he soon made his mark and, in the fullness of time, became the first Sanitary Commissioner for the Presidency. He had written on dysentery, on enteric fever, on cholera, and on prison dietaries, and his ripe experience now found a congenial field where he rendered most valuable service, He led the way in sanitary organization owing to the arrangements he made for enabling District Civil Surgeons to tour their areas on sanitary duties. I t was he, also, who introduced such changes in famine administration that mortality was greatly reduced, and it was he who, in Madras, revolutionized jail dietaries. He became a Surgeon-General and retired, in 1885, after a most honourable and useful career. Had he been a combatant o~cer and done similar good work he would almost certainly have reaped many rewards. As it was, he got a C.I.E., and now few people remember much about him. Yet CORN:SH had a noble record and he was a splendid man, a mighty worker, of fine build and imposing presence, hospitable and specially helpful to young officers in his service. He was one of the builders of British India in his own line, and he has also built for himself a place in the annals of preventive medicine. I owe this portrait of CORN:SH to Colonel KINO. I t represents a man of striking appearance. The heavy beard masks his features to some extent, but there is evidence of ability in his fine forehead while, as you see, he has rather remarkable eyes and a nose suggesting determination. No weak man ever possessed a physiognomy of this type and, as we have seen, CO~N:SH was a strong man as regards both body and mind.

George Bidie (1830-19t3) came from Banffshire, studied at Edinburgh and Aberdeen, entered the I .M.S. in 1856, and left it as a Surgeon-General in 1890. He seems to have had a kind of encyclopaedic knowledge, for he wrote on natural history, botany, economic products and coinage, while in 1867 he was decorated for the discovery of a preventive against an insect pest which threatened to wipe out the coffee plantations of South India, but his pioneer work lay in three direct ions:

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GEORGE BIDIE~

1830-1913. EDMUND ALEXANDER PARKES s

1819-1876.

N EDWARD JENNER,

1749-1823.

~LOEENCE NIGHTINGALE,

1820-1910. ~{ARY KINGSLE¥~

1862-1900. ~LXRY SLESSOR~

1848-1915.

DAVID LIVINGSTONEy

1813-1873. :e Page 206.

JOHN SNOW~ 1813-1858,

WILLIAM ALEXANDER FRANC

1805-]885.

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(1) In 1859-60 he combated the air-borne theory of cholera and showed how its spread was linked up with human intercourse, and, in I861, he instituted a system of hygiene designed to prevent pollution of Water which, like SNOW, he believed to be due to infected cholera discharges. By so doing he freed of cholera for eight years an area where formerly 4 to 5 per cent. of the inhabitants had perished from that grim destroyer.

(2) He introduced the humane treatment of the insane into India, and his recommendations actually went beyond the measures then in force in Great Britain.

(3) Finally, throughout the Presidency of Madras he instituted, in 1886, the systematic medical inspection of schools.

He must have been a very remarkable man, and probably was as strong physically as mentally for, despite his reforms and the climate of India, he lived to be eighty-three and to serve three Sovereigns as Honorary Surgeon.

There is an amusing story of how he put his botanical knowledge to good use. Natives were wont to resort to a special spot in order to obey the calls of nature. This spot was so situated in relation to a water supply that the native practice endangered the purity of the latter. Remembering that the devotees of Cloacina were bare-legged, BIDIE planted the spot and its approaches with a peculiarly venomous form of stinging-nettle which he introduced for the purpose and which saved the situation.

Like CORNISH, he is bearded, but his beard cannot hide the distinction of his countenance. I do not think that, now-a-days, we see many men of this type. No wonder that India was the brightest jewel in the British Crown when its destinies, medical or military, to say nothing of its civil, lay administration, were controlled by pioneers of the class to which Surgeon-General BII)IE belonged.

The last of the group with which I deal here, though I must perforce return to India, is, undoubtedly, the most illustrious, indeed, an outstanding figure, to whose memory Baron MUND¥, Professor of Military Hygiene at Vienna, paid this remarkable tribute : "All the armies of the Continent should at parade lower their standards craped, if only for a moment, because the founder and best teacher of military hygiene of our days, the friend and benefactor of every soldier, EDMUND PARKES, is no more."

Edmund Alexander Parkes (1819-1876) was born at Bloxham, in Oxford- shire, and was a student at University College Hospital. He went to India in 1842 and was there less than three years, but saw much dysentery, hepatitis and cholera, diseases on which he wrote, putting forward advanced views on the pathology of dysentery and hepatitis, suggesting the presence of healthy carriers in cholera and advising protection and disinfection of water supplies, as they might be contaminated by virus-containing human excrement. He retired from the Army in 1845 and became a noted teacher in clinical medicine at University College. But he was not done with a r m y work, for he was

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9'08 SOME OF OUR PIONEERS.

summoned to Turkey during the Crimean War and we can imagine how his soul, like that of FLOUNCE NIOHTINGAL~, must have been harrowed by what he saw. He realized, at least, that prevention is better than cure and, forsaking clinical medicine, became Professor of Hygiene in the new Army Medical School at Fort Pitt, Chatham. He was the soul of that School, a graceful speaker and interesting lecturer, giving life to what used to be erroneously regarded as the dry, dull and none too proper subject of sanitation. His famous " Manual of Practical Hygiene," on which book after book has been modelled, is well described as a monument of industry, research and clearness. There seems something tragic in the fact that this great hygienist died of general tuberculosis. You can see for yourselves what manner of man he was. His nobility of character is reflected in his face, He has a thoughtful brow, eyes full of intelligence, and a resolute chin. Looking at his portrait one can easily imagine that he was an impressive lecturer and that he commanded respect and homage from his students and his colleagues.

Now we swing back to one whose picture I must show you, whose faithful disciple PARKES was, as indeed every sane medical man and hygienist must be, and whose great discovery d id more for the tropics than can well be estimated. Need I say that you are looking at Edward Jenner (1749-1823), and i:n this Society need I say any more ? I think not, for those of us who have lived and worked in the tropics know what smallpox is, and realize that vaccination remains our sure shield against the pestilence.

I am going to group names again, for if the ladies cannot come first they can at least be considered together, and two of them met and warmly appreciated each other in the wilds of savage Africa. Not one of the three women I shall mention was a doctor, but the first of them in her day was worth a regiment of the medical men of her period ; the second did for West Africa what no medical man had been able to do, and the third in her own line was a kind of doctor, nurse, midwife and health visitor rolled into one. Thei r lives taken together span nearly a century, for FLORENCE NIGHTINGALE was born at Florence in 1820 and MARY SLESSOR died at Use in Nigeria, in 1915.

Florence Nightingale (1820-1910), " the Lady of the Lamp," deserves mention here, not because she revolutionised army nursing and, indeed, nursing generally, though tropical medicine benefited materially thereby, but for her campaign against the abominably insanitary conditions amongst which cholera, enteric fever and dysentery ran rife, and for her ceaseless efforts to improve the hygienic state of the British soldier both at home and abroad. We are apt to forget that she wrote " Observations on the Sanitary Conditions of the British Army in India," (1863), and that her observations were very much to the point, Owing to the unique position she had obtained as a result of her denunciations of t h e follies and shortcoming in the Crimea, and because her work in the hospitals at Scutari and elsewhere had made her a heroine in the eyes of the British public, her observations could not well be relegated to obscurity. Hence,

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SOME OF OUR PIONEERS. 2 0 9

FLORENCE NIGHTINGALE, was a very effective pioneer, and I fancy that many altered their ideas regarding her when they read what Strachey has to tell them in " Eminent Victorians." I know I did. There is her picture. ~ Let it speak for itself.

Though her dress may look old-fashioned there was nothing old-fashioned about the ideas of the intrepid Mary Kingsley (1862-1900)t what t ime she wan- dered in West Africa, often in peril of her life, but always amassing information and realising how opportunities were being lost and possibilities overlooked. She realized, none better, how the unhealthiness of the West Coast hampered progress, but she saw no way out, though she did comment caustically on the bad living conditions and noted sadly that " no trouble is taken to pull the death-rate down by Science." She did not live long enough to see the great change, but she did much, indeed more than anyone else, to dispel the apathy with which our West Coast Colonies were regarded, and drew attention to the absolute necessity of taking steps to lessen their morbidity. A medal of the Liverpool School of Tropical Medicine commemorates the life work of this friend of Africa.

Mary Slessor (1848-1915)~ was quite a different type. She is the first missionary I have mentioned and she was not a medical missionary. Yet she was a life-saver, for in Calabar, where she laboured for nine and thirty years, she weaned the negro from many superstitions and deadly practices, put a stop to infanticide, and introduced humane methods. She was a pioneer in public health education and a very remarkable one, for she had a strange influence with the native and was indeed known as Ma Akamba, the " Great Mother ." There is the portrait of this amazing woman, who began life as a poor factory girl in Scotland, was imbued with the true missionary spirit, was exceedingly practical, had a heart of gold, and of whom Sir Frederick Lugard said : " Her death is a great loss to Nigeria." Many are the stories told of MARY SLESSOR.

I believe she would say to that mighty potentate, the Governor " G a n g awa ben the hoose and sit ye doun. When I ' m finished I ' l l attend to ye," or words to that effect.

Now we must hark back to some men who were young when the last century was in its teens. This being so, it would appear to be a fitting place for the consideration of that article in the British Medical Journal to which I have already alluded (page 191), and which deals with our knowledge of tropical diseases in 1813. I t mentions a paper published early in that year by George Playfair of Bengal, who advocated a combination of ipecacuanha and laudanum in dysentery. He admits, however, that he was not a pioneer in this treatment, yet it is good to find a writer of that period, like W. C. MACLEAN of Netley at a

* STRACHE¥, LYTTON (1918). " Eminen t Vic tor ians . "

"~ F r o m a por t ra i t in the L ib r a ry of the Royal Colonial Inst i tute .

LIVINCSTONE, W . P . (1918). " M a r y Slessor of Calabar , a Pioneer Mis s iona ry . "

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later date, extolling the virtues of emetine, for that, in effect, was what he was doing. Papers of even greater importance, which appeared at the same time, are those by Tymon and Shoolbred on cases of hydrophobia treated by massive bleedings. I t is interesting to note that the Medical Board of Madras, comment- ing on these cases, two of which recovered, cited BURTON and RUSH of Philadel~ phia, who, in 1805, cured a case of human rabies by this method. There seems no doubt that SI~OOLBRED'S case was true rabies, and had I known about it when proceeding from Khartoum to Cairo for the Pasteur treatment, three weeks after having run the risk of infection with the rabic virus, I might have felt that there was at least a fighting chance for me, did I develop the dread disease, if only I could be bled white. Bleeding until syncope ensued has long been abandoned as a curative method in rabies, and it is difficult to see how it could be effective, but it seems that, if carried out early in a case, it can now and then save a patient.

I t was in the above year, 1813, that one of the greatest and finest men that ever " fared foreign " from these islands saw the light. There is no need to tell the story of David Livingstone (1813-1873), which now-a-days has found its way into the film world and provides an infinitely better subject than half the trash which thrills a decadent public. We are, however, apt to think of LIVINGSTONE as the explorer or the missionary rather than as the physician and as a pioneer in tropical medicine. I t is true he was unable to make the best use of his opportunities. Given a microscope and some biological training, what might not LIVINGSTONE have accomplished in the way of put t ing the hands of the clock forward, abolishing the terrors of African travel a n d settlement, and saving human and animal life ? Still, with all his limitations, he added to our knowledge. Look at a copy of his " Travels," published in 1857, and you will see whiit purposes to be a picture of a tsetse fly on the title page. The figure is sufficient to turn cold the blood of Major AUSTEN or Professor NEW- STEAD, yet it emanated not from LIVINGSTONE but from the British Museum. LIVINGSTONE'S account of Glossina morsitans is very accurate, and so is his descr ip t ionof nagana. He realized that there was some blood poison at work, though of course, he was ignorant of its nature. All he says about the fly and the disease is worth reading. Throughout his writings there is evidence of the trained scientific observer, whether he is discoursing on fever, on native remedies, or on the diseases with which he came into contact.

No portrait is better known than that of the rugged, swarthy Scot, whose dark complexion possibly enabled him to withstand the rigours of Africa better than many of his fellows. Be that as it may, DAVID LIVINGSTONE opened up tropical Africa, not only to the missionary, the trader, the soldier, and the administrator, but to the scientific enquirer, and, more especially, the tropical diseases expert. True, it was long after he was laid to rest in Westminster Abbey, that DAVID BRUCE carried a microscope with him into Zululand and solved the mystery over which the other David had puzzled, but if LIVINGSTONe

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had not lived and laboured, much of Africa might have remained a terra incognita for years after the date of his death. He did more than anyone to bring the Dark Continent into the limelight, and for that reason alone deserves a place amongst our pioneers. He had all the qualities of one, as a glance at his strong, resolute, and courageous face will show. We may well be proud that DAVID LIVINGSTONE was a member of the medical profession.

Let rae take, as a contrast, two men who never lived and worked in the tropics and yet seem fitted to take their places in this company, for the one put his finger unerringly on the chief source of infection in the most deadly malady of warm climates, and the other was the first to point out that there occurred in this country cases of a disease which, if not strictly tropical, had been always associated with countries wherein high summer temperatures were common. I show you a portrait Of John Snow (1813-1858). e He has a sagacious countenance and he must have possessed marked sagacity, for ten years before he died, in the midst of a busy life, he solved the problem of cholera. It was JoHN SNow, a native of York and the son of a farmer, JOHN SNOW, who had been through the terrible visitation of cholera, at Newcastle, in 1831-32, who by careful reasoning came to the conclusion that the poison of cholera was to be found in human excrement, and that water contaminated by such infected excrement was the chief medium through which infection was conveyed. SNOW was cautious as well as wise, and it was not until he felt sure of his ground that he published his pamphlet on " The Mode of Communication of Cholera." He was able to put his views to the test in the London outbreak of 1854, throughout which he worked unceasingly, careless of risk, heedless of gain. Everyone knows, or should know, the tale of the Broad Street pump and Dr. SNow's prescription : " Remove the pump handle." SNOW made other investigations, but these we need not consider. He was a genial and gentle man with a great devotion to duty and the soul of an enquirer. It was long before his views on cholera gained acceptance and, as a result, many died who might have lived, but SNOW led the way long before KOCH discovered the vibrio and pointed the path t o safety and immunity from a disease which, more than any other, was a cause of panic and dire dismay.

Here we have a portrait of William Alexander Francis Browne (1805- 1885), a well-known alienist in his day, who introduced into Scotland the humane treatment of the insane. It would never do for me to try to read his character from his face, for it so happens that he was an uncle of mine by marriage, although I have but a dim recollection of him as an old and blind man, for he unhappily lost his sight owing to glaucoma. Born at Stirling and educated at Edinburgh University, he studied on the Continent and was a pupil of ESQUIROL, the famous French authority on mental diseases. He became physician to Montrose Lunatic Asylum and afterwards Medical Superintendent of the Royal

" JOHN SNOW, M.D., a Representative of Medical Science and Art of the Victorian E r a . " The dscIepiad. I886-1887. Vols. 3-4.

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9,12 SOME OF OUR PIONEERS.

Crichton Institution at Dumfries. He was a distinguished man in several directions, but comes into our purview because he was the first to recognize that pellagra occurs in this country. His observation was contained in a letter he wrote to Dr. E. BmLOD, in 1860, and is mentioned in that author's " Trait6 de la pellagre."

Passing mention should, I feel, be made of Josiah Clark Nott (1804-1873) of South Carolina, who, in 1846, suggested that mosquitoes might be responsible for the spread of yellow fever. He had other pioneering instincts, for he founded a Medical College at Mobile, Alabama, in 1836, and wielded a busy pen. Here is a description of him taken from the Transactions of the American Medical Association, Philadelphia, 1878:

" Dr. NOTT was tall and thin, over six feet and not weighing more than 140 pounds. His stature was erect, his head large and forehead h igh ; his face was strongly marked and noble in expression. In an assemblage of academic scholars, he would have been noted and singled out as a man of remarkable character. Among his professional brethren in Mobile, he acquired in the latter years of his life the soubriquet of " The old Roman." His health was never robust, but his habits were so plain and simple that he was enabled to do a vast amount of work without being exhausted. During Yellow Fever epidemics, he ~vas riding day and night for two months at a time, and yet preserved his health and spirits."

There he is.. He may have been an " old Roman," but he looks to me un- commonly like a typical Uncle Sam.

As we are on this subject I may abandon the chronological order for a moment and take a group of distinguished men, most of them Americans, all of them associated with the question of the transmission of disease by mosquitoes. Albert Freeman Afrieanus King (1841-1914) receives a meed of praise from Sir RONALD ROSS for the able paper which he wrote, in 18831 setting forth his views as to the transmission of malaria by mosquitoes, and adducing no less than nineteen reasons in support thereof. He was born in England, in 1841, but received his medical education in America. He appears to have been a quiet and modest type of man whose close and excellent reasoning on the mosquito- malaria question did not bring him into prominence. At the same time, as you see, his portrait indicates rather a striking personality. He has a good forehead, a prominent nose, and a masterful chin. One would certainly credit him with an active and vigorous intelligence after a s tudy of his features.

Following him we come to Carlos Juan Finlay (1833-1915) who, despite his Christian names, was of British stock. He has, as you see, rather the hall mark of the scientist about him. I t is easy to associate his facies with a microscope and with the consideration of weighty tomes. He looks studious and intellectual, an impression possibly heightened by his side whiskers and his spectacles. FINLAY was a far-seeing man with respec t to yellow fever, for he

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JOSIAII ~LARK NOTT,

180~-187&

ALBERT FREEM~N AFRICANUS KING,

1841-191~.

: ? ( ~ : i ( i

CARLOS JUAN FINLAY,

1833-1915.

~,V~.L rER REED,

1851-1902.

TIIOMAS SPENCER COBBOLD,

1828-1886. To face Page 212.

HENRY ROSE CARTER,

1852-1925.

TIMOTHY RICHMOND LEWIS,

1841-1886.

VV~ILLIAM C. GOEGAS,

1854-1920.

DAVID DOUGLAS CUNN1NGHAM

1843-1914.

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actually indicated Stegomyia fasciata as the vector of the virus of that disease. Ross regards him as better than a mere theorist, for FINLAY carried out experiments to test the truth or otherwise of his hypothesis. I t is true these led him to wrong conclusions, but he is a pioneer worthy of respect and his memory is rightly held in esteem in his island of Cuba.

It is not, however, until we come to Walter Reed (1851-1902), that we begin to get accurate scientific work done in connexion with that " Yellow Jack " which had for years periodically scourged South American ports, the West Indies, Bermuda, and the eastern seaboard of the United States. REED came from Virginia and studied under WELCH in Baltimore. He was of English extraction on both sides, and from his portrait one should judge that he had the fighting qualities of his race. His mouth looks pugnacious and is coupled with a shrewd and humorous eye and a straight, determined-looking nose. KELLY has written his life, so I need not give you many details. Everyone knows, or should know, the history of the work of the Commission of which he was the Chief, the carefully controlled experiments carried out near Quemados, in Cuba, at the Camp named after the martyr of the mission, Dr. LAZEAR. The labours of REED and his colleagues were crowned by complete success and much of it must be attributed to REED'S personality and his early scientific training. He was a fine type of man, with lofty ideals and great devotion to duty. I t is sad to think that he fell a victim to appendicitis, at a comparatively early age, and that his last days were sorely troubled by the thought that he might be leaving his wife and family in poverty. Happily, some provision was eventually made for them, but it seems strange that a man who did for humanity ~vhat REED accomplished, and ran the risks which he cheerfully faced, should have received so little of this world's favours.

Henry Rose Carter (1852-1925). I t was only the other day that news reached this country of the death of Assistant-Surgeon-General CARTER of the United States Public Health Service. CARTER graduated from the University of Virginia in civil engineering in 1873, and from the University of Maryland School of Medicine, Baltimore, in 1879. Entering the United States Public Health Service he continued in it until his death at the age of seventy-three. Closely associated with the control of yellow fever and malaria in the Southern States, he must have found his engineering training of signal service in connexion with the latter disease. But it was in yellow fever work that CARTER made his mark, and a paper which he published in 1900 on the interval between infecting and secondary cases of that disease gave REED the idea that there must be an inter- mediate host, probably a mosquito, concerned in its spread. So 'valuable were CARTER'S observations found in Cuba that, in 1904, Sir RONALD Ross recommended him for the Nobel prize in medicine. In that year he went to Panama and was director of hospitals in the Canal Zone till 1909. At a later date he wrote ably on malaria, and in 1916 proceeded to Central and South America as a member of the Rockefeller Foundation Yellow Fever Commission. In 1917

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~)]4 SOME OF OUR PIONEERS.

and 1918 we find him busy at malaria control and, thereafter, acting as sanitary adviser to the Peruvian Government, where he found ample scope for his yellow fever activities and contributed important and exceedingly interesting papers to the literature. He was a member of the Yellow Fever Commission of the International Health Board from 1920 onwards. This bare recital of facts regarding his life and work gives but little idea of the type of man he w a s .

I had the privilege of meeting him in Washington early in 1924 and, although he was in bad health and obviously had not got very long to live, he impressed me by his vitality, his keen interest in everything connected with public health work, his wide knowledge of malaria and yellow fever problems, and the freshness of his ideas. Only once had I come across a similar type of intellect, that of Sir PA'rR~CK MANSON. These two men had much in common, for they were gifted with scientific imagination and at the same time had an abundance of common-sense.

CARTER'S unfailing interest in the fight against disease is shown in the historical articles he contributed to Hygeia in January and February of this year, while there was evidence of his courage and devotion in the fact that, ill though he was, an old and stricken man, he went to Jamaica to attend the Congress convened by the Medical Department of the United Frui t Company.

His portrait, taken from the Journal of the American Medical Association, shows him before his infirmities aged him. There is, perhaps, not much to be gleaned from it, but anyone who ever talked to CARTER on yellow fever will recall how his face lighted up and will testify to his personal magnetism.

The name of Wil l iam C. Gorgas (1854-1920), who was an Honorary Fellow of this Society, is intimately associated with that of REED. I t was GORGAS who applied the knowledge gained by REED and his co-workers, it was GORGAS who cleaned up Havana and rendered the construction of the Panama Canal possible. He looks a strong, hard-bit ten man, but even with all his drive and persistence he would have failed at Panama had not THEODOR~ ROOSEVELT been behind him. Still, GORGAS was a fine administrator and, as I can testify, he had a very winning and attractive manner. I have always thought it fitting that, in 1920, when his coffin was borne up the aisle of St. Paul's Cathedral and the greatest tribute was being paid to his memory that Great Britain could pay, the only wreath which rested on the coftSn lid was that sent by Sir PATRICK MANSON, who was so soon to follow him into the shades.

And now the pace must quicken somewhat, for there are still many pioneers and time is fleeting.

I will take COBBOLD next, Thomas Spencer Cobbold (1828-1886) who, born in Suffolk, died in London, and earns his place here on account of his work on helminthology. His portrait shows a bright, vivacious face. I t is different from that which Professor NUTTALL reproduced when he wrote about COBBOLD in Parasitology, where he states that he was held in high esteem both as a man

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SOME OF OUR PIONEERS. "215

and as a scientist. Timothy Richard Lewis (1841-1886) may well follow COBBOLD. He was a Welshman who had a distinguished career as a student at University College and at Aberdeen. In 1868 he entered the Army Medical Service, and it is of interest that he and DAVID CUNNINGHAM were sent to the Continent to study there before going to India, whither they proceeded to investigate cholera. They did so, and LEWIS found amoebae in cholera stools, and gave the first authentic account of amoebae from the human intestine. He it was who discovered " Filaria sanguinis horninis," as he named the nematode now known as F. bancrofti, and he traced its relation to chyluria. He it was who, in 1878, published a famous memoir on " The microscopic organisms found in the blood of man and animals and their relation to disease," wherein he discourses on the spirochaetes of relapsing fever and on the rat trypanosome which bears his name. There was more from his pen and full justice has been done to him and his work in the admirable biographical sketch by Mr. CLIFFORD DOBELL. LEWIS, as a Surgeon-Major, left India for England in 1883 and became Assistant Professor 9 f Pathology at Netley. There is no saying what he might have accomplished in this position had not a pneumonia, possibly the result of a laboratory infection, brought his life and labours to an untimely close. DOBELL compares him with MANSON and says : " If MANSON is t h e ' Father of Tropical Medicine, ' then assuredly LEWIS is at least its Godfather ." N o t only did he make valuable, we might almost say invaluable, contributions to science, but, to use DOBELL'S words, " he founded, both in India and at Netley, a school and a tradition whose fruits are now visible to all the world in the researches and discoveries of the officers of the Indian Medical Service and the Royal Army Medical Corps." LEWIS, in his portrait, looks like a man of quick intellect, but he is not an impressive figure. Yet he appears to have been most amiable and estimable, and perhaps the outstanding feature of his character was his sterling honesty, which is reflected in his works. He was a great worker and a great pioneer, and though his services were not recognized during his lifetime, his place is secure in the Valhalla of those who have shed light in dark places and aided in the conquest of disease.

David Douglas Cunningham (1843-1914) was the friend and colleague of LEwis and shared many of his scientific tr iumphs with him. Some have apparently thought that his right to pioneer rank rests almost wholly on this association. This is not the case, for it was CUNNINGHAM who gave the first accurate and recognizable description of Endamoeba coli, Trichomonas intestinalis and Chilomastix mesnili. To him also must be attributed the first recognition of the parasite of oriental sore. He was, also, to some extent a leader in connexion with the manufacture of quinine, and, indeed, acted occasionally as Government Quinologist for Sir GEORGE KING, to whom he rendered great assistance, for, amongst other things, he had a very considerable knowledge of botany. For the rest, CUNNINGHAM w a s an able and sound scientist, most accurate, honest and careful, but with a critical faculty perhaps unduly developed. He was

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~ t 6 SOME OF OUR PIONEERS.

Professor first of Physiology, then of both Physiology and Pathology in Calcutta Medical College, and will always remain not only one of the leading names in the annals of the Indian Medical Service, but a pioneer to whom great credit is due for his painstaking researches. I owe this portrait of CUNNINCHAr~, with a dog, which presumably is not a laboratory animal, to Colonel MEGAW. His features betray his nationality. He has the high cheek-hones of the Scot and there is a look about his face often seen in the visages of North Britons. The picture suggests a quiet, kindly and humorous man, gifted with shrewdness and power of application.

After writing these remarks I came across an account of CUNN1NGI-IAM

which shows that the diagnosis is correct. Amongst other things it says : " He was a typical Scotsman in feature, physique, disposition, character

and mental traits. Reserved and difficult of approach but, friendship once gained, he was warm hearted and staunch." This is the type of man who often *' gives his heart to a dog," to use a phrase of Kipling's, so the photograph would appear to be peculiarly apposite. Sir DAVID PRAIN wrote an excellent memoir of CUNNINGHAM in the Proceedings of the Royal Society for January, 1916. Mr. CLIFFORD DOBELL drew my attention to it, and there you will find much more about this Edinburgh student and learn how, in his early days at Prestonpans, on the Fir th of Forth, the harvest of the sea exercised its fascina- tion upon him and whetted that curiosity and zeal in matters zoological which were to bear such good fruit in India. The climate of Calcutta and the conditions of his work there ruined his health, and it was as an invalid that he retired to Torquay in 1898, and devoted himself to his garden, his books and, doubtless, to some canine friend like that which sits beside him in the picture.

Sir Joseph Fayrer (1824-1907) ~ is a great and honoured name in Indian annals, and he made his mark both in literature and science. The son of a naval officer, he was born at Plymouth and received his medical education at Chafing Cross Hospital. He entered the Royal Navy, being posted as Assistant- Surgeon to H.M.S. " Victory," in 1847, for service at Haslar Hospital. Then he had some interesting experiences on the Continent as the private medical attendant of Lord Mount-Edgcumbe. He left the Navy in 1847 and not long afterwards obtained a commission as Assistant-Surgeon in the Bengal Medical Service. He served in India and so distinguished himself in Burma that he was appointed to one of the plums of the service, the Residency Surgeonship at Lucknow. He was through the siege and it was in his house, a house in the remnants of which no man of British blood can stand without emotion, that Henry Lawrence died. FAYRER was reported as killed in the Mutiny but, like Paul Jones when the Serapis asked if his ship had struck, he might have replied, " I have not yet begun to fight," at least so far as war against disease was concerned. He became Professor of Surgery at Calcutta and then turned his attention

~ " Recollections of nay L i f e , " by SIR JOSEPH FAYRER. 1900.

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J o.5 EPH FAYRER,

1824-1907.

GEORGE LAMB,

1869-1911.

( : • : 'i

I~IENRY VANDYKE CARTER,

1831-1897.

ANDREW DUNCAN

1850-1912.

GEORGE MICItAEL JAMES GILES,

1853-1916.

CHARLES PARDEY LUKISy

1857d917.

ANDREW DAV1DSON,

1836-1918. To / a c e PaRe 215.

I~UBERT ]~OYCE~

1863-1911.

JOHN EVERETT DUTTON~

1877-1905.

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to the subject which ranks him with the pioneers, that of Indian snake poison. His great work, the " Thanatophidia of India," beautifully illustrated, a classic for all time, appeared in 1872, and this was the year in which he left India never to return, save as medical officer to the Prince of Wales when the latter was on his Indian tour. Settling in London success continued to attend him, both as a physician and in scientific circles. In 1877 he was elected a Fellow of the Royal Society. Although he was a voluminous writer on professional subjects, FAYRER was not a pioneer of the order of LEWIS or MANSON or others I have mentioned, but he did pioneer work on snake venoms and for the rest advanced the cause of research in India and elsewhere. He wrote in an attractive way and was full of diligence and zeal. A very popular man, he was of a most generous disposition, while, throughout his long career, he seems always, to use a vulgar phrase, to have fallen on his feet, a good fortune he fully deserved. The portrait shows him as a man well stricken in years, grave and courteous, a man with a wise face, an experienced man of the world and of affairs. The fire of youth has fled but we may be sure it existed in no small measure and played its part in placing JOSEPH FAYRER high in the ranks of those who served in India.

Because he was engaged on similar work to that of FAYRER I will take George Lamb (1869-1911) next, though he belonged to a much later generation. Unhappily one cannot show LaMB as an old man, for he was cut off in the prime of life, but not until he had given evidence both of brilliant promise and sound achievement. He looks what he was, a quiet, solid man, but intelligence beams from his eyes and there is a kindliness in his face which had its counter- part in his nature. LAMB was a Scot and a Glasgow student. Passing top of the Iist into the Indian Medical Service, he came under the influence of Sir ALMROTI-I WRIGHT and, after gaining first place at Netley, he went to India in 1894. I t was not until after further study at Netley, and also at the Pasteur Institute in Paris, that he was able to devote himself to those scientific pursuits which his soul desired, but his chance came when, in 1898, he was made Assistant to HAFFKINE at Parel. I t was there he carried out the investigations for which he is chiefly famed, those on Indian snake venoms, and in the course of which, having been bitten by a cobra, he narrowly escaped death. I t is splendid work, that from LAMB'S pen, enshrined in the Lancet and the Scientific Memoirs of the Government of India, but it was by no means all he accomplished, and he rendered notable service in directing the researches of the Advisory Committee upon plague. Many amongst us will remember the shock we received when we heard he had been cut off in the plenitude of his power and activities, but he left his mark, and, while we mourn his loss, we cherish his memory.

There is a tale told of him which indicates that he had a dry humour of his own. One day when, attired in a shabby old coat, he was working at his microscope in his laboratory at Kasauli, his privacy was invaded by a gay young spark of a cavalry subaltern who, flicking his smart legging with his riding switch, asked in an off-hand manner if he could have a look round the place. LAMB

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paid no attention. " I say, can I have a look round the place," repeated his interlocutor rather angrily. LAMB withdrew his eye from the ocular and fixed the intruder with it. " I t 's no a circus," he remarked.

Henry Vandyke Carter (1831-1897) takes us back to an earlier period, but he was also an Indian pioneer, a scientist and an accomplished artist. Those of us who were reared on " Gray's Anatomy " will remember his clear and clever drawings. As Assistant-Surgeon in the Bombay Medical Service he set foot in India in 1858 and he left it in 1888, having reached the rank of Deputy- Surgeon-General in the Indian Medical Service. We need not fully follow his meritorious career, but it will be remembered that he was the first to find the spirochaete of relapsing fever in India. In addition to this outstanding discovery made, let it be recalled, in the late seventies of the last century, CARTER studied to good purpose all kinds of tropical pathological conditions, and more especially oriental sore, leprosy and mycetoma. Let it be noted that he proposed the segre- gation of lepers to the Bombay Government in 1876, but unfortunately in vain. He was always up-to-date, and as soon as LAVERAN'S discovery had been given to the world he set to work and proved that the three types of the malaria parasite existed in India. In this work he ploughed a solitary furrow and no one apparently followed him. CARTER was undoubtedly a leading pioneer in tropical pathology and he was as modest and unassuming as he was able and diligent. Few honours and little in the way of pecuniary reward came his way, but his name is enshrined in the annals of tropical parasitology. He died of phthisis at the age of sixty-six.

CARTER'S portrait does not seem to me to indicate his artistic temperament. He has a thoughtful, studious type of face, which I find a little baffling, but I can well believe that he worked quietly and thoroughly, content to add to the sum of human knowledge.

A year after LAMB died the London School of Tropical Medicine had to deplore the death of Andrew Duncan (1850-1912). Like LAMB, he was a very brilliant student, and he would have had a very brilliant career in the Indian Medical Service, which he entered in 1879, had he not been a pioneer. But he was a pioneer, possibly not a tactful or a discrete one, but undeniably a courageous one. While yet young i n the service, convinced that certain views and practices were entirely wrong, he boldly challenged them. I t is scarcely conceivable that after the work of SNOW, CORNISH , BIDIE and PARKES, medical men holding high positions in India still clung to the idea of telluric influence in cholera or the air-borne theory, but so it was, and upon this and other matters, DUNCAN wrote in such a way that he was thought to reflect upon some of his superiors in rank (they were his inferiors in intellect and reasoning power) and he was doomed. I t is mental brilliancy, his hard work, did not help him. He was under the ban of the type which Kipling satirized as " heavy sterned old men," heavy of hand at least, and heavy of comprehension, and never got a fair chance. I have heard him tell the tale and it made one's blood boil. After he left india he took up work in London and was a Lecturer at the London School of Tropical

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Medicine. His delivery was dull but his matter excellent. He endured a painful and distressing disease with great fortitude, and a medal commemorates his memory and the high regard in which he was held by his colleagues. I show you a good picture of him. He looks fearless and, coupled with courage, he had a great spirit of hospitality. DUNCAN was a fine man whose life was embittered by the results of what some might stigmatize as a false step, but which was the action of a pioneer. For the very views which brought condemnation on his head in India he received the Parkes Memorial Prize in England. Such is the irony of fate !

Those of us who plunged into tropical medicine some five and twenty years ago will remember that we found comfort in a certain " Handbook of the Gnats or Mosquitoes," which was more within our reach than T~IEOBALD'S fat volumes. The author was George Michael James Giles (1853-1916), an officer of the Indian Medical Service. I wish merely to mention his name and show you the portrait of a man with a good, strong face. He was a clever natural- ist and, though only a lesser pioneer, merits mention for the work he did on mosquitoes when these insects were coming into prominence in a manner they had not hitherto achieved and which, could they have foreseen the results, they would probably not have appreciated.

The last of the Indian group is one I had the privilege of meeting at Delhi and for whom I had a great respect and esteem. Sir Charles Pardey Lukis (1857-1917), a Director-General of the Indian Medical Service, was a Bart. 's man who entered the Service in 1880. I t is as a wise and far-seeing administrator that Sir PARDEY, as he was always called, enters the ranks of the pioneers. True, he had scientific ability (he took a gold medal for pathology after twenty-five years' service in India) and wielded an excellent pen, but his main abilities were in the direction of advancing medicine, and more especially hygiene, in India. Amongst other feats he was largely instrumental in developing opportunities for research and was a kind of foster parent to the Calcutta School of Tropical Medicine. I t would take long to recount all Sir PARDEY'S good works, many of which live after him. His portrait recalls him, showing the massive head of a calm, astute man, a politician and diplomatist, but one who did not work for selfish ends and had at heart the welfare of the service for which he did so much and the honour of the profession of which he was so distinguished and capable a member.

Leaving India, which is still a home of pioneers, despite the troubles which have overtaken its famous medical service, I may say that it was not until I began to collect information about Andrew Davidson (1836-1918) that I realized how easily a distinguished man might be forgotten. Before MANSON returned to England, ANDREW DAVtDSON'S name was probably the best known in connexion with tropical medicine. Yet I could find no obituary notice Of him in the British Medical Journal or the Lancet, while the biographical section of the Index iFIedicus recorded him as still alive, and enquiries at Edinburgh and at

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220 SOME OF OUR PIONEERS,

the Colonial Office proved fruitless. Probably the oversight was due to the fact that he had been in retirement at Ilkley for a long time before his death at eighty-one, and that the Great War was still in progress in 1918, the year of his decease. I got most of my details eventually from the Biographisches Lexicon, thanks to the kindness of Mr. HONEVMAN, the Librarian of the British Medical Association. DAvmso~ was born at Kinneff, Kincardineshire, in 1836, studied and graduated at Edinburgh University, and began his tropical career, in 1862, as Resident Medical Officer to the Royal Court in Madagascar. From there he found his way, in 1877, to Mauritius where, in 1921, I discovered many traces of his activities, and more especially an account of his polemic on malaria with his countryman, Meldrurn the meteorologist. He was a hard worker, a sound reasoner, and had a ready pen. Moreover, he was a linguist of note, and actually wrote a medical book on the diseases of Madagascar in Malagassy. He did other pioneer work, for he established the first hospital in Madagascar, prepared text-books in Malagassy for the native students of medicine, and carried out investigations into rinderpest, malaria and leprosy in Mauritius. He was a man of much ability in his profession and, after leaving the Colonial Service, became Medical Adviser to the Crown for the Colonial ONNce in Scot- land, and was appointed Lecturer in Tropical Diseases at Edinburgh Univer- sity. He was the author of two standard works, " Geographical Pathology," a most"interesting and learned book, and " Hygiene and Diseases of Warm Clim- ates," the volume which MANSON'S " Manual " replaced, and he engaged in other literary activities. There is no doubt that DAVIDSON did much to advance the knowledge of tropical diseases as he knew them. One wonders if, in his old age, he was able to appreciate the great transition which had taken place since he wrote text-books for Malagassy students and fought malaria with drugs in the old Isle de France. Anyhow, I happen to know that at fourscore years this indefatigable veteran had a book in course of preparation. Here we have a portrait of him at an earlier age. I owe it to the courtesy of Sir NORMAN WALKER and of Mr. T. H. GRAHAM, Librarian of the Royal College of Physicians, Edinburgh. I t suggests that he was kindly and sagacious as well as diligent and erudite. He certainly deserves to be held in remembrance.

I t is at least conceivable that the work of DAVIDSON paved the way in some measure for the establishment of Schools of Tropical Medicine in this country. Be that as it may, I propose to take Sir Rubert Boye0 (1863-1911) next, a man whose name will ever be associated with the great institution at Liverpool. BogcE was energy incarnate. I remember him in the early days of modern tropical medicine and how vehemently he dunned one for specimens for his School. He looks keen and active with his thin face, clear eyes and mobile mouth, and he was keen and active up to the day of his untimely death, and that despite the fact that he had already suffered severely from the condition which ended his useful career. He was a man gifted with the spirit of progress and with much insight. He saw the great future that awaited the new developments

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SOME OF OUR PIONEERS. 9.~1

in tropical medicine and hygiene, and threw himself whole-heartedly into the fray. He wrote " Mosquito and Man" ; he wrote on the West Indies ; he wrote on yellow fever ; and he worked like a Trojan till he died at forty-eight. Whoever penned his obituary notice in the Annals of Tropical Medicine and Parasitology struck the right note when he said : " There are many in the Tropics who will mourn the toss to the Empire ; there are many who will miss his most cheery optimism ; there are many who will never know what they have owed to him." A very magnetic personality and a very fine pioneer was lost when RUBERT BOYCE answered the call.

As Liverpool has been mentioned it seems fitting to consider two other men who were associated with its School of Tropical Medicine. There you have John Everett Dutt0n (1877-1905). I never met him, but from his photograph I should think that something of what Henley wrote of Stevenson might well apply to him :

" T h i n legged, th in chested, sl ight unspeakably , Neat-footed and weak-f ingered ."

but " neat-fingered " would, I fancy, have better fitted DUTTON, who was a skilled technician. He was a graduate from the Liverpool Medical School, where he had a distinguished career as a student. Having a strong bent towards research, he accompanied Dr. ANNETT to Nigeria in 1900. Two reports, one on malaria, one On filariasis, were the results of this expedition. In 1901 he was elected Walter Myers Fellow of the Liverpool School of Tropical Medicine, a nd proceeded to the Gambia, where he reported on anti-malarial measures. Then it was that FORDE showed him the blood of a European with what was thought to be a ffiaria in it, but which the trained observer at once recognized as a trypanosome. He described and named it. Thereafter he found other cases infected with T. gambiense and discovered other trypanosomes new to science. In 1902 he was in Senegambia with Dr. TODD and then with TODD and CHRISTY he took his last journey, this time to the Belgian Congo. It was there he, together with TODD, did his great work on African tick fever, describing the spirochaete of the disease and proving independently of Ross and MILNE that Ornithodorus moubata was its vector. Unfortunately, he acquired infection, probably when making a post-mortem, and his strength was not sufficient to overcome the malady, to which he succumbed in his thirtieth year. Sir RONALD ROSS called him a true Knight of Science, the Galahad of the group of young and enthusiastic men who were exploring the mysteries of tropical pathology. Fie was as modest and courteous as he was able and sincere and there can be no doubt that, had he been spared, he would have written his name large on the roll of fame.

Albert J0hll Chalmers (1870-1920), though of Scotch descent, was also a student of the Liverpool Medical School and of its School of Tropical Medicine. He has some claim to be considered a pioneer, not so much by reason of his actual scientific achievements, though he was a most diligent and enthusiastic worker, but because he had a great power of stimulating work in others, of

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¢2,22 SOME OF OUR PIONEERS.

organizing and of gathering and imparting information. He had a wide experience in Ashanti, in Ceylon, in the Anglo-Egyptian Sudan, and elsewhere, and his vast fund of knowledge found expression in the well-known " Manual "

which bears his name and that of CASTELLANI. He devoted himself heart and soul to his profession, and was a hearty, hospitable and generous man, who was rarely perturbed and had a great fund of patience and tenacity. His memory is very fittingly kept green by the Chalmers Medal of this Society.

At one period the work of the Liverpool School received signal help and encouragement at the hands of a man who was a pioneer of a special type, for he was both a scientist and a lay administrator. Sir RONALD ROSS tells how, in 1901, he was met at Lagos by its Governor, attired, amongst other things, in a white pith helmet, his ribbons, and a kilt of the MacGregor tartan. He tells also how that Governor aided him, and his description of Sir Will iam MacGregor (1846-1919) is so admirable and taking, and fits so well the portrait which I now throw on the screen, that I quote it in full :

" Wise, grave, but humorous, bearded, thlck-set, with wrinkled forehead and a high and somewhat conical bald head, his low voice and kindly manner filled all with trust in him. He drank no wine and did not smoke, but was no fanatic in these respects, and kept a hospitable table. Every night he read from his Greek Testament, and was also skilled in French and Italian, and knew something of many barbarous tongues. He was a mathematician, a practised surveyor, a lapidary, and a master of many arts, but always proud of his medical upbringing and of his nationality. Simply dignified, he did not allow his dignity to obscure his personality, and had no trace of that meanest and most mischievous vice, jealousy. He was not a politician, but a genuine administrator, careful of all the interests of all the people entrusted to him--st~ll more, a scientific administrator who added knowledge to his solicitude. He went minutely into every question submitted to him, and it would have been impossible for him to deal with our deputation as Chamberlain had done-- in fact he would have made a much better Secretary of State for the Colonies. The only medical man who has been a British governor of recent years (and there ought to be many more medical governors), he recognized the superlative value of sanitation in the development of a colony, and was, I think, the only high British official who ever grasped the real importance of the general anti-malaria scheme which I proposed in 1899."

This official, whose name figures on our list of Honorary Fellows, was a man of whom the British Empire, and Scotland more especially, may well be proud. He was the son of a farm labourer and was born at Fowie, Aber- deenshire, in 1846. Helped by himself, the best kind of help, and assisted by a few friends, he studied medicine at the Anderson College, Glasgow, and

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.~LBERT JOIIN CHALMERS, 1870-1920,

WILLIAM MACGREGOR, 1846-1919.

JoltX ASIIBURTON THOMP: 1846-1915,

FLEMING MANT SANDWITH,

1853-191S.

PATRICK ~'[ ANBON, 1844-1922,

\\'ILLIAM CARNEGIE B 1859-1913,

CHARLES FORBES HARFORD, AR'rHUR VV-ILLIAM BACOT, ~AMUEL "I'AYLOR D)

1864-1925. 1866d922. ~872-1925.

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SOME OF OUR PIONEERS. 22~

graduated a{ Aberdeen University. After holding some house appointments he went to the Seychelles, as Assistant Government Medical Officer, in 1873. The next year we find him at Mauritius, and the year after he became Chief Medical Officer at Fiji. His foot was on the rungs of the ladder and he was mounting rapidly. " Quickly, however, he transferred from the medical to the administrative ladder, for it was seen that he was specially well fitted for administrative duties. He mounted that ladder with like rapidity, being in turn High Commissioner and Consul-General for the Western Pacific, Administrator and then Lieutenant-Governor of British New Guinea, where he accomplished wonders, Governor of Lagos, Governor of Newfoundland, and Governor of Queensland. He retired, in 1914, full of years and honours and wisdom. A powerful man physically, he showed his courage in Saving life at sea and his moral courage on many occasions. He was a pioneer in the way of advancing the cause of tropical medicine, and particularly hygiene, in our Colonies, and because, at an early period, he realized the necessity of providing facilities for training natives in medicine. In Fiji he took the lead in this matter, but it may be said that he was a man of great versatility who, if he had not been a great Governor, would have been a great doctor in one sense or another. I have always regretted the fact that I never met him. I would like to have listened to the address he gave at the London School of Tropical Medicine, when he amazed his audience by the wealth and facility of his quotations from the classics. Let us hope that we may yet see many Colonial Governors imbued with the spirit of Sir WILLIAM MAcGREeOR, and possessing his breadth of view and clarity of vision as regards questions of health preservation and the prevention of disease.

Queensland has associations with another fine man who deserves a place in our list. Joseph Banoroft (1836-1894), of whom I have not a portrait, emigrated from England and settled in Brisbane in 1864. Apart from his discovery in 1876 of the adult worm which COBBOLD named Filaria bancrofti in his honour, a discovery the result of deliberate search on lines indicated by COBBOLD himself, BANCROFT, in the spring of 1877 expressed in a letter to COBBOLD # his belief that mosquitoes would be found to transfer to man the embryos in the blood of infected persons. His examination of the insects failed, however, to verify his ingenious hypothesis. I t was, as you know, MANSON, who, having come to the conclusion that the mosquito must serve as a host for the filarial larva~, furnished the necessary proof, but BANCROFT is entitled to much credit for his intuition and also for the ardour with which he pursued his helminthological studies. He was a learned man, with wide and varied interests, a true scientist, with a marked bent towards public health work and his name is rightly held in esteem both here and in the land of his adoption.

*Quoted in the Journal of the Quekett Microscopical Club, Vol. VI. No. 43. p. 58. (1880.) Reference kindly supplied me by Professor R. T. LEIPER.

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9'24 SOME OF OUR PIONEERS,

The mention of Queensland recalls Australia, and Australia recalls a man who, unti l quite recently, did not receive the general recognition due to him as an undoubted pioneer. As you see, John Ashburton Thompson (1846-1915), born the same year as Sir WILLIAM MACGREGOR, had a handsome and striking face. I t suggests vitality, a strong will, a type of man who would go straight to the heart of things and would exercise a cool and sound judgment. I t would seem that this reading is not far from the truth, to judge from what ARMSTRONG has written about him in H e a l t h , under the title "An Eminent Epidemiologist " (1925). Long before anything had been written about him I remember being impressed by his reports and his work on plague. He was a student of Guy's and took the M.D. of Brussels. His real life's work was done in Australia, and extended in various useful directions which we need not here consider. What gives him rank as a pioneer is the fact that, after experiments had failed to support the rat-flea theory in plague, after both the German Plague Commission in 1899 and the first Indian Plague Commission of 1901 had thrown cold water upon it, THOMPSON, as ARMSTRONG put it, " from a very careful analysis of the epidemiological facts observed by him in the Sydney outbreak, reached the definite conclusion that plague in rats always preceded plague in human beings, and that infection was transferred from rat to rat and from the rat to man by means of the flea and in no other way." His reports on the subject are classical, and the second Indian Plague Commission established the correctness of his reasoning and gave him the credit he deserved. After twenty-eight years of devoted and distinguished service in New South Wales, this experienced and able epidemiologist retired, and, two years later, i .e. , in 1915, he died in London.

And now I near the end, and take a small group of three men who were intimately associated with the work of this Society, and one of whom acted as its President. Fleming Mant Sandwith (1853-1918) was a student at St. Thomas's Hospital and, after qualifying, served in the Turko-Serbian war as an ambulance surgeon, and immediately thereafter in the Russo-Turkish campaign. In 1883 he proceeded to Egypt to help in the fight against cholera, and he was ere long appointed Vice-Director of the Sanitary Department of the Egyptian Government, where his energy and straightforwardness soon got him into trouble. As LORD MILNER says, " he was got rid of by a rather ignoble intrigue due to the excessive zeal he had shown in the dismissal of corrupt sub- ordinates." SANDWITH deserves recognition as a pioneer of sanitary reform in Egypt and, later, as one who, by his work and writings, threw fresh light on the diseases of Egypt. He had a wealth of clinical material at his command as Senior Physician to the Kasr-el-Ainy Hospital in Cairo, and took most careful notes of his cases. Although SANDWITH hated war he had an adventurous spirit and was ever keen on serving the Empire, so that we find him both in South Africa during the Boer War and in Egypt from 1915 onwards. The progressive spirit which characterised him was shown by the way in which he got together a library at Alexandria for the use of medical officers. Mr. STEPHEN PAGET

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SOME OF OUR PIONEERS. 9,9,5

paid so fine a tribute to his memory in the Lancet, a tribute incorporated in the obituary notice which appeared in our TRANSACTIONS for 1918, that I feel I cannot do better than refer you thereto. His portrait will recall him to many here, an energetic man with plenty of humour, a kindly man of great thorough- ness, above all I think a very brave man who suffered many things silently and was content, provided he could do his duty. He looks old and worn in the picture, which must have been taken not long before his death. PAGET calls him one of our leaders, and he was a leader because he had the spirit of a pioneer, coupled with those other qualities which gave him a place in our affections and enabled him to make his mark.

As you must have noted, our pioneers are of various types. I am not dealing solely with scientists who made great discoveries, but with men and women who, by their lives and labours, led the way in some direction which spelled advance in tropical medicine or tropical hygiene, or both. Hence there is good reason for including the names of Will iam Carnegie Brown (1859-1913) and Charles Forbes Harford (1864-1925), both Secretaries of this Society and both of whom, and more especially CARNEGIE BROWN, had much to do with its early success. I need not summarize their careers, but I would remind you that both had sound scientific work to their credit. I t was CARNEGIE BROWN who drew attention to a form of insidious myocarditis occurring in old tropical residents ; it was HARFORD who wrote on blackwater fever at a t ime little was known about it. Apart from his work for the Society, HARFORD was a pioneer in another direction, for he played a great part in the foundation of the Living- stone College and was its first Principal. This was an entirely new development, and the medical training of lay missionaries, especially in tropical diseases and their prevention, has had a very considerable influence in improving health conditions abroad. CARN~GIa BROWN was popular with his colleagues, while HARFORD, who so recently and so suddenly passed from amongst us, was a man greatly beloved, while he was respected for his sincerity and lofty ideals.

I show you a portrait of Samuel Taylor Darling (1872-1925), an Americ~/n of good English stock, an Honorary Fellow of the Society, and one who was not only a pioneer in some ways but a martyr for, as you know, he was killed when on duty, being one of the victims of the motor car accident which over- took some of the members of the Malaria Commission of the Health Section of the League of Nations near Beirut in Syria. The portrait is quite a good one, showing DARLING in one of his thoughtful moods, but giving evidence about the mouth of that humour which tempered his idealism. He and I were felIow prisoners for a few days in the quarantine station at Co!on, in 1914, and I reniember his remarks when I presented him with a Stegomyia fascists t had captured on the premises. Still better do I recall a tale of the outbreak of so-called pneumonic plague in Colombia, which he told rne at Santa Marts , and which I wish I could retail. DARLING was a brilliant and versatile man, as someone has said, '"always scientific, careful, imaginative and honest." He was

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more than a mere follower in the tracks of others, for some of his work on malaria and ankylostomiasis had the pioneer element in it, more especially his method of mass treatment for hookworm. A brief account of his career appears in the last number of our TRANSACTIONS, and it is sad to think that DARTING recovered from a long and serious illness only to perish through a deplorable mishap. He was the outstanding tropical parasitologist and pathologist of the United States, and by his work and character has given a fine example, not only to his countrymen, but to all who are concerned with those problems which he spent his life in trying to solve and in the solving of which he lost it.

Possibly I should ere this have mentioned another American, Howard Taylor Ricketts (1870-1910), but had I included RICKETTS then assuredly I could not have omitted Arthur Will iam Baeot (1866-1922), but there must needs be some gaps, and I have tried to confine myself almost wholly to those associated with tropical disease and its prevention. In this connexion I feel, however, that I should show you BACOT'S portrait, and remind you of what was undoubtedly pioneer work on the bionomics of fleas and the fate of plague bacilli ingested by these insects; work carried out by him in conjunction with C. J . MARTIN o f the Lister Institute. BACOT, who was not a medical man, was a very skilled entomologist and technician, a devotee of Science, who laid down his life for the sake of advancing knowledge and helping his fellow men. He looks there a somewhat shy and thoughtful man. The lofty forehead betokens intellectual powers and there is humour in his eye. The many tributes paid to his memory showed how highly he was held in esteem, not only for his masterly work, but for those traits of character which endeared him to his friends and which induced GREENWOOD, when writing of him, to quote from Plato's account of the death of Socrates.

One may have hesitated to include certain names in the long list of pioneers, but there can be no hesitation when we come to the last and greatest of them all.

I t is curious how many people think that Sir Patrick Manson (1844-1922), was an Irishman. No doubt this is due to his Christian name, and the fact that, during his later years, he had a retreat in County Galway where he practised ardently the gentle art of Izaak Walton. MaNSON was a Scot, born in Aberdeen- shire, educated at Aberdeen University, and full of that ingenium prcefervidum Scotorum, to use the famous words of George Buchanan. I t would surely be a work of supererogation in this Society to tell anew the story of the life and v~ork of MANSON. It was that great-hearted Frenchman, RAPHAEL BLANCHARD who first acclaimed him " the Father of the modern science of Tropical Medicine," and never was title more fittingly bestowed for, to quote from the eloquent eulogimn which Colonel ALCOCK contributed.to o u r TRANSACTIONS, ~ " That discovery " - -he is referring to MANSON being the first to track a specific

Trans. Roy. Soc. Trop. Med. and Hyg., 1922, xvi. 1-15.

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parasite from the blood of man into a specific blood-sucking insect, to have shown by experiment what becomes of it there, and to have proved that what happens to it there is one of the necessary conditions of its continued existence as a pathogenic species--" That discovery," wrote ALCOCK, " merely as a scientific achievement, laid open a large new territory to investigation, started a flood of new ideas and thus paved the way for fresh conquests over ignorance." It was the new conception in parasitology which was to revolutionize much of the pathology and hygiene of the tropics and be a sign-post and a beacon-light to anxious enquirers. Hence, MANSON was our pioneerpar excellence and the spirit of the pioneer was evident in other phases of his work, in his inductive reasoning upon the malaria-mosquito theory which led to the crowning achievement of Ross, in his establishment of the London School of Tropical Medicine, in the sage counsel he gave the Colonial Office, in the way he roused enthusiasm in the minds of his students, in the interest he took in the foundation of this Society. What a record of work MANSON left behind him, and what a host of admirers, of disciples, of friends I Here I would merely mention one or two episodes which I recall, and which show, in some measure, what manner of man he was. ALCOCK speaks of his large-heartedness, and it was to me that MANSON said he looked upon the peoples of the British Empire, be they white or black or brown or yellow, as " a' John Tamson's bairns." ALCOCK says of him : " His bearing had rather the patriarchal touch, always tempered with a humour which, like his speech, was kindly, seasoned with the old-fashioned pungent savour of his native north." To that native north of his he was ever true, and at the end he was laid to rest in its friendly soil. Elsewhere I have told of how I first met him and how he asked me if I was a good Scotchman, which he seemed to regard as the most important thing on earth. He then proceeded to show me that I was not as good as I might have been because, though destined for the Tropics, I had not immediately enrolled as a student at the Albert Docks. I remember my last interview, not long before death claimed him. I had, I think, satisfied him that I was a good Scot, and so he talked to me about Scottish literature and the books he liked. " Man," said he, " have you ever read Johnny Gibb of Gushetneuk ? " I had sorrowfully to confess that, although I knew the name of this classic, I was not familiar with its contents. " Man," he said, " this'll never do," and there and then he presented me with the slim volume I show you, on the fly-leaf of which he had traced my name with tremulous fingers and added:

" from a brlther Scot frae Aiberdeenshire."

I need scarcely say it is one of the most prized of my possessions, though it takes a MANSON, with his knowledge of the old Aberdeenshire dialect, to fathmn all its passages.

Between that first meeting and that last one I only saw him occasionally, but every occasion was a red-letter one, for MANSON had a way of bringing

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~C2~ SOME OF OUR PIONEERS.

fresh light to bear on problems, and was flfll of new ideas and fruitful sugges- tions. Of course, he was not always right, but he was always stimulating, always helpful, always patient, always hopeful. It was an education to sit at his feet, a still greater education to hold converse with him. Colonel JAMES says in his " Malaria at Home and A b r o a d " : " I know no man so bdnigne as Sir PATRICK," and I can well believe it. The portrait does him justice. Note his fine, capacious head, his shaggy eyebrows, his straight, clean-cut nose, and the curve of his firm chin. He looks a man of weight and substance, a man to inspire confidence, a leader it were well to follow. And so it was, and though we are the poorer because he has gone from amongst us, yet we are rich in the knowledge which he and those who followed him wrested from Nature, and we may say, as did one who wrote feelingly after his death : " He has left behind a great inspiration to all who had the good fortune to be closely associated with him. How much we owe to this great man it is difficult to estimate. His monument is in our heaits."

My review, such as it is, incomplete and imperfect, is at an end. Incom- plete, because though the majority of medical men entitled to the title of pioneer have been considered, nothing has been said about the lay community save for Mr. BACOT and the three women who have claimed attention. And yet, just as the lawyer, CHADWICK, laid the foundations of sanitary reform in this country, just as the good Lord SHAET~SBURY was the prime mover in remedying the appal- ling conditions of factory labour, so laymen have played a great part in the advancement of tropical medicine and hygiene. What of JOSEPH CHAMBERLAIN, what of Sir ALFRED JONES, to mention only two of them ? Not infrequently neither the laboratory worker nor the hygienist could make much progress were it not for the administrator, the merchant prince, or the philanthropist. The same is true also of men in other walks of life. Now and again, not so often as might be wished, the engineer has led the way in hygienic advance. Let me mention one only, Major BAIRD SMITH and his work on irrigation in Italy and India, which, away back in the middle of the nineteenth century, had an important bearing on malaria in its association with rice fields. Again, there must have been some, if not many, who conceived and put forward ideas in advance of their time, but which attracted little or no attention, and passed into the limbo of forgotten things. Ot: this order was Surgeon-Major T. E. DEMSTER of the Hon. East India Company, who, as Colonel K l y a has told me, introduced, in 1848, the " spleen index " test as a guide to the prevalence or otherwise of malaria, estimated its value both in children and adults, and defined its limitations. Here is another case in point. ROBERT CHRISTISON, the famous medical jurist and Professor of Materia Medica in the University of Edinburgh, gave an address on public health in 1863 and, amongst other subjects, spoke of ague in Scotland. Incidentally, we may note that he pointed out how prevalent malaria was in the colonies and said : " It can scarcely be that a successful enquiry into the agencies by means of which ague has been

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SOME OF OUR PIONEERS. ~9,9

extirpated from Scotland should fail to be of service to our countrymen towards freeing also from that scourge the lands of their adoption." That is interesting, but the special point I wish to make is that CHRISTISON quotes the opinion of a Scotch country doctor to the effect that the chief factor in diminishing ague in Scotland was, not drainage, but improved living among farm Iabourers. There is little doubt that this now unknown surgeon was correct, though even if his view had been accepted, it is very unlikely that any light would have been thrown upon the transmission of the disease.

My review is incomplete, and it is also imperfect, for how can a bald narra- tive of lives and labour, even if enlivened somewhat by the exhibition of portraits, bring home to us the reality and the romance of our subject ? We talk of LIND and TROTTFR, but it is only faintly we can picture them working and reasoning and writing in the bilge-smelting bowels of battleships. Those of you who have been on the " Victory," at Portsmouth, will recall the conditions between decks, and that was in an empty ship in harbour. Again, consider the difficulties with which some of those pioneers had to grapple in India and elsewhere. Sir RONALD ROSS has given us a graphic picture of his trials when solving the malaria problem, but many of our pioneers lived in the olden days in India when, though there was, doubtless, a certain measure of comfort, there were few facilities of any kind for scientific investigation. TIMOTHY LEWIS must have worked under numerous disadvantages, MANSON was far from help and advice in China. Knowing the discomforts, disappointments, isolation, ill-health, and other disabilities under which many such devoted men laboured, we can only marvel at their courage, tenacity and success.

It is not for me to point the lessons accruing from this study. Each one of you must lay them to heart according to your lights, according to your necessi- ties, according to your temper. Yet there is one thing which strikes me, and which I would like to mention, even if it be already in your minds. So far as I can tell, few, if any, of these pioneers worked wholly, or even chiefly, for selfish ends. In the case of many, no doubt a laudable ambition was present - - a man without some ambition is usually an unsatisfactory type of animal-- but the true motive power in most instances was a love of science and desire for knowledge, a devotion to duty, or an anxiety to help humanity or the country to which they owed allegiance. In some also, as in LIVINGSTONE and MARY SLESSOIq religion played a part but, truth to tell, every form of this zeal for research and high sense of duty was of the nature of a religion. These pioneers consecrated themselves to their work and, scorning delights, lived laborious days and passed the torch one to another. That torch, still alight, still glowing, is now in our hands and in the hands of those who are working overseas. It is our duty, it is our privilege, to cherish that light, to tend it carefully, to hand it on to those who will succeed us, so that now and for all time this Society may Iive up to the proud motto which it bears and which it has earned through the labours ,of our pioneers : " ZONAE TORRIDAE TUTAMEN."

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SIR WILLIAM LEISHMAN: It has fallen to me, as the senior past- president of the Society here to-night, to have the task of trying to express all our thanks to our new PRESIDENT for the address to which we have had the great pleasure of listening. I am sure every one of us came here to-night with high anticipations of what we were going to hear, and I am equally certain that the realisation has proved far in excess of anything we anticipated. DR. BALFOUR'S introductory address, if it has left us a little breathless, will make a permanent mark on the history of our Society, and I am sure that many, like myself, have made a firm determination to read carefully every word of it when it appears in our " TRANSACTIONS," when we shall be able to benefit more than was possible to-night on first hearing, the immense mass of learning and information which he has unravelled for our benefit. We have listened to a series of biographical gems on the pioneers in our subject, and a wonderful bit of critical analysis of the lives of men. It is a most remarkable performance, and we who have listened to it in person and heard his witty and penetrating comments on these photographs, have had a great experience and privilege to-night.

At the same time, while listening to it, I have had a sort of vision of what might possibly happen, say fifty years hence, when the PRESIDENT of the Royal Society of Tropical Medicine of that day might be seized with the same inspiration which seized Dr. BALFOUR, probably some months ago, namely, to review the history of those who, at that later date, might be added to the rank of pioneers. And I can imagine that worthy gentleman going through a list of names which we, at the moment, may think of some importance, and coolly putting down names like Ross, LEISHMAN and others to the modest position they deserve to occupy. I can also conceive him coming to the name "ANDREW BALFOUR," and I can then see his eyes light up, rejoicing in this chance of doing a brilliant bit of writing, and his sitting down to describe him as a man who had been one of the most powerful influences in tropical medicine of his day, and one most beloved by his contemporaries. I am, however, a little nervous lest the future chronicler should attach as much importance as Dr. BALFOUR has done to the length of the nose, the height of the forehead, the absence or" a beard, and so on. I am anxious on that account for the sake of Dr. BALFOUR'S future reputation. If I might, I would counsel him to have the best artistic advice before he has the portrait or photograph taken by which he would wish to be remembered.

I propose a most hearty vote of thanks to Dr. BALFOUR for his most valuable introductory address.

SIR WILLIAM SIMPSON: I should like to second this vote of thanks to our PRESIDENT, and to express my admiration for the very stimulating, brilliant and witty manner in which he has treated his subject, and I hope that the publication of it will not be confined to our TRANSACTIONS. It is an address

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that should be read by every medical man, not only those interested in tropical medicine, but in medicine generally. We are all proud of our PRESIDENT. He has a world-wide reputation, and I have watched his career with the greatest interest and pleasure, and there is one thing I feel about him, and it is this : that he has not only exercised, as has been said, a powerftfl influence on the advance of tropical medicine and hygiene, but that now in his position, as PRESIDENT of this Society, and also as head of the chief British School of Hygiene and Tropical Medicine, he will certainly bring his power and his influence to bear so as to advance, in a much greater degree than ever has yet been done, the science of medicine and hygiene. I have not the eloquence of Sir WILLIAM LEISHMAN, but I do feel that Dr. BALFOUR is a man who will make history, has in fact done so already. I have great pleasure in seconding this proposal.

THE PRESIDENT: My great anxiety has been to get through before refreshment time arrived, hence I am sure you will excuse me if I do not rep ly at any length to the very kind words which have been spoken by S i r WILLIAM LEISHMAN and Sir WILLIAM SIMPSON. This is an address which has not entailed very difficult work. I t has not necessitated poring over the microscope ; in fact, it is quite different from Sir WILLIAM LEISHMAN'S or Sir WILLIAM SIMPSON'S notable achievements. I t is really more like the work of that Dr. JAMES JOHNSON, who was condemned by Sir LEONARD ROGERS and is far removed from Sir ImONARD'S own researches. Therefore, I would merely thank most sincerely, those gentlemen who have so k ind ly - - I might almost have said so mendaciously--made these remarks about me. I must not, however, say that, for I know they were seriously meant. I have also to thank you for the very kind way in which you have listened to the description of the pioneers. After all, I am afraid there were many pioneers I did not mention, both British and American, but we may be thankful that those mentioned did exist, and I hope there will be many more before this old world comes to an end.

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