January 6, 192 1] 



NATURE 



611 



Birth and Growth of Science in Medicine.* 

 Bv Sir Frederick Andrewes, F.R.S. 



THE aim of science is to discover the "laws of 

 Nature," and in its truest, though narrowest, 

 sense it is the pursuit of this knowledge for its own 

 sake, irrespective of any practical use to which it may 

 be put. The primary aim of medicine is the practical 

 one of healing the sick or of preventing disease, and 

 therefore, in the narrower sense, medicine is not a 

 science, but an art. Physiology, pathology, and 

 pharmacology are sciences in the strictest sense ; 

 medicine is the art of applying the laws established 

 by these sciences to the prevention or cure of disease. 

 More than this, it is the very human art of treating 

 the patient as well as his disease. But in a broader, 

 and surely more natural, sense we may regard 

 medicine as a science. Pathology may, it is true, be 

 pursued as an abstract subject, but in real life it is 

 inseparable from medicine. Treatment and prevention 

 are so intimately based upon a right understanding 

 of the nature of disease and of the laws which govern 

 its course that I refuse to separate pathology and 

 medicine. It has too long bee.T the fashion to limit 

 the sphere of pathology to the dead-house and the 

 laboratory; its field is equally at the bedside, and, 

 indeed, 1 would assert that there is no method of 

 stu<lying the natural history of disease which patho- 

 logy may not claim as its proper province. Bv 

 Harvey's injunction I am to admonish you to seefe 

 out the truths of Nature by observation and by experi- 

 ment. These are two different ways of pursuing a 

 subject, and, indeed, the concrete sciences have been 

 divided into the "observational" and the "experi- 

 mental " ; anatomy is an observational science, physio, 

 logy an experimental one. The observational sciences 

 long preceded the experimental, and in pathology and 

 medicine, which partake of the nature of botri, the 

 experimental method is of late growth. 



My aim is to trace, so far as I may in the allotted 

 span of time, the influences which have governed the 

 growth of our knowledge of disease ; to pursue them 

 to their beginnings rather than to record their final 

 - 'lilts. I cannot, indeed, hope to say anything new; 

 in onlv endeavour to place before you the facts 

 ,-. t)e gathered from literature in the way in which 

 Ihev group themselves in mv own mind. 



In his suggestive little book entitled "The Revolu- 

 tions of Civilization " Prof. Flinders Pelrle has polnte<l 

 out that culture Is an intermittent phentimenon. No 

 civilisation in the past has proved permanent, and he 

 •climates the average duration of any given period 

 of culture at about 1500 years; in Egypt he traces 

 eight such perio<l«. In Europe we are aware of three 

 great perio<ls of civilisation during the past five 

 thousand vears — the Mediterranean or Minoan, with 

 headquarters in Crete, from 3000 to 1200 B.C. ; the 

 '-.sical, of which Greece was the intellectual foun- 

 n-head ; and the Modem or Western, in which we 



still living. 



^1) far a< we are aware, the earliest attempts at 



■nre began in Ionia some six centuries before 



irist, and the name which I would first com- 



morate as n spiritual benefactor of this college is 



:...it of Thales if Milr.nn. I might have chosen 



Empedorles or P- . but we mav let Thalen, as 



the first of the - m of early Greek thinkers, 



stand as the prototyp<- of the group of men who laid 



the foundations upon which science was to be built 



ilw future generations. Doubtless they had acquired 



I'M • rrom ■)>< Harvnan oniilon A'Wtmi b«for« tb* Rajral Calt*(t of 

 IVhyMcUnt <A XMti^Mn on OctnWr il, loso. 



NO. 2671, VOL. 106] 



what they might of the lore of older civilisations, 

 but they seem to have been the first to pursue abstract 

 knowledge. Until their day men had been content to 

 accept any foolish myth about the nature of the 

 world and of the things they saw around them. The 

 service which Thales and his successors rendered to 

 mankind was that they rejected all fabulous tales and 

 began to think for tliemselves how things had become 

 such as they saw, definitely reaching out after the 

 laws which they felt sure must govern Nature. Their 

 great contribution to science was to establish that 

 atmosphere of intellectual liberty which rendered 

 science possible. It says much for the liberal spirit 

 of that age that these men, who broke with all the 

 cherished traditions of the past, were not, as a rule, 

 reviled for impiety, but received universal honour. 

 Thales was accounted one of the Seven Wise Men 

 of Greece. 



But let me now consider what the earlier Greeks 

 did for medical science. Medicine of a sort and rude 

 surgery must have been transmitted even through 

 the dark ages, handed down, it is said, by special 

 families, the .^sklepiadae, just as the epic tradition 

 was passed along by the Homeridae. Certain rules 

 of surgery and the practices of blood-letting and 

 purgation are known to be of immemorial antiquity, 

 but for the most part the medical practice of those 

 times seems to have been bound up with fetish wor- 

 ship and superstition. There is no evidence that 

 '^fiypt had any true medical science to impart, and 

 our knowledge of Minoan medicine is limited to the 

 single fact that in the great palace at Cnossus there 

 existed a system of sanitation so good that it was 

 never equalled until the reign of Queen Victoria. 

 We may be (^uite sure that the inquisitive and recep- 

 tive Greek mind was quick to pick up what it could 

 from the older civilisations, and then, in accordance 

 with its peculiar genius, it proceeded to develop it 

 out of all recognition. 



Medicine entered upon its first scientific stage with 

 the Greeks ; it became an observational science. More 

 than this ; just as in other matters the philosophers 

 had put away (he mvths and fairv tales of their ances- 

 tors, so, too, in medicine they rejected the magic and 

 fetish worship which had hitherto formed so large 

 a part of practice. This was one of the greatest 

 services rendered by the Greeks to medical science. 

 .'PIsculapius was worshipped at numerous temples, 

 and thither the sick were brought to receive such 

 benefit as they might from the rites of the god. But 

 at such health resort?, they were also subjected to 

 other influences— careful dirt, pure water, rest, and 

 cheerful associations- -and when improvement occurred 

 the physicians had the acutexicss to perceive that this 

 simple treatment had probably more to do with the 

 result than the religious rites. 



This brings me to the second name which I 

 naturally commemorate to-<lav — that of Hippocrates 

 of Cos — the first great clinician of whom we have 

 any knowledge, and one whose name will always be 

 associated with the phase which Greek medicine had 

 now reached. 



When Hippocrates was born, about 460 B.C., ob- 

 servational medicine had attained a considerable pitch 

 of excellence. He doubtless imbibed tl>e teachings of 

 Other good physicians who had gone before him, but 

 the veneration in which Hippocrates was held by the 

 Greeks themselves assures us that he was a man of 

 outstanding character .in. I ittainments. W'c ran, 



