76 



NATURE 



[September 17, 1914 



between individual patient and individual doctor. Re- 

 search into diseases of unknown causation cannot be 

 subsidised upon such individualistic lines, and in the 

 case of diseases of known etiology and modes of pro- 

 pagation, the passage of disease from individual to 

 individual cannot be controlled by such private methods 

 as that of the afflicted individual subsidising the doctor 

 for his own protection. Cost what it may, a healthy 

 environment must be produced for the whole mass of 

 the population, and the laws of physiology and hygiene 

 must be taught not only to medical students, but to 

 every child in every school in the country. People 

 cannot live healthy lives in ignorance of the funda- 

 mental laws of health merely by paying casual visits 

 to physicians, and no one class in the community can 

 be healthy until all classes are healthy. 



The problem of national health is one of peculiar 

 interest to physiologists, and to the exponents of those 

 experimental branches of medical science which have 

 sprung from the loins of physiology, for it was with 

 them that the new science of medicine of the last 

 fifty years arose, and they ought to be the leaders of 

 the world in this most important of all mundane 

 problems. 



It is well worth while to consider our opportunities 

 and responsibilities and raise the question whether our 

 present system and organisation are the most suitable 

 for attaining one of the most sublime ambitions that 

 ever appealed to any profession. By definition, our 

 science studies the laws of health and the functions 

 of the healthy body, therefore it is ours to lead in the 

 quest for health. Is this object best achieved if we 

 confine ourselves to research in our laboratories, and 

 to the teaching of the principles of physiology to 

 • medical students, while we leave the community as a 

 whole uninstructed as to the objects of our research 

 and its value to every man, and trust the medical 

 students w^hom we turn out to communicate, 

 or not communicate as they choose, the results 

 of their training and our research to the world at 

 large ? 



There is little question that much of the ignorance 

 abroad in the world, and much of the fatuous opposi- 

 tion to our experimental work and research, arise 

 from this aloofness of ours. Here also lies the cause 

 of much of the latent period in the application of 

 acquired knowledge to great sociological problems, 

 and the presence of untold sickness and death which 

 could be easily prevented if only a scientific system 

 of dealing with disease could be evolved. 



The position occupied by men of science in medicine 

 at the present day is largely that of schoolmasters to 

 a medical guild, and even at that, one constructed 

 upon lines which have grown antiquated by the pro- 

 gress of medical science. It ought now to become 

 the function of the man of science to re-model the 

 whole system so as to fight disease at its source. The 

 whole situation at the moment calls out for such a 

 movement. On the one hand, there exists a wide- 

 spread interest on the part of an awakened community 

 in health questions, evidenced by recent legislation 

 dealing with the health of school children, with the 

 health of the worker, with the sanitary condition of 

 workshops, with the questions of maternity and infant 

 mortality, and with the communication of infectious 

 diseases. On the other, there is chaos in the 

 medical organisation to meet all these new demands, 

 and the ample means recently placed at the command 

 of the nation and of municipal authorities are being 

 largely wasted by overlapping and misdirection for 

 lack of skilled leadership. Surely it is a time when 

 those who have laid the scientific foundations for the 

 new advances should take counsel together, assume 

 some generalship, and show how the combat is to be 



NO. 2342, VOL. 94] 



waged, not as a guerilla warfare, but as an organised 

 and coordinated campaign. 



There are two essentials in the inception of this 

 organised campaign against disease on a scientific 

 basis. The first is to demonstrate clearly to the public 

 mind that modern scientific medicine arose from the 

 experimental or research method, that it was only 

 when experimental observation of the laws of health 

 and disease, in animals and man, commenced on an 

 organised and broadcast basis that medicine and 

 surgery leaped forward and the remarkable achieve- 

 ments of the past fifty years began. Also that it is only 

 by the organisation and endowment of medical research 

 that future discovery and advancement are possible. 

 The second essential is to convince the public that a I 

 national system must be evolved placing medical I 

 science and medical practice in coordination, so that 

 the discoveries of science may be adequately applied 

 in an organised scheme for the prevention and treat- 

 ment of disease. The method in which discoveries 

 have been made in the past suggests an amplification 

 and organisation along similar lines for the future, 

 and the banishment of many diseases by public health 

 work in the past suggests that it is more efficiently 

 organised and widespread public health work in the 

 future, extended from the physical environment to the 

 infecting individual, that will be most fruitful in 

 banishing other diseases. 



If it be queried by anyone here, what has physiology 

 to do with disease, it may be replied that the question 

 comes at least fifty years too late. The methods 

 evolved first by physiologists in experimentation upon 

 animals have become the methods of all the exact 

 sciences in medicine. Bacteriology is the physiology 

 of the bacterium, and the study of protozoan diseases 

 the physiology of certain groups of protozoa. Organo- 

 therapy had its origin in phj-siology, and many of its 

 most brilliant discoveries were made by physiologists, 

 and all by men of science who used physiological 

 methods. Serum therapy, experimental pharmacology, 

 and the great problems of immunity all arose from 

 the labours of men with expert training in physiology 

 who branched out into practical applications achieved 

 by the extension of the experimental, or research, 

 method. The modern methods of medical diagnosis 

 and the brilliant technique of contemporary surgery, 

 what has opened the door to these but the experi- 

 mental method? From the days of the first success- 

 ful abdominal operation to the present day, research 

 in laboratory or in the operating theatre has pioneered 

 the way, and the sooner this simple truth is known 

 to all men the better for medical science. Every time 

 any surgeon first tries a new operation there is in 

 it an element of experiment and research of which the 

 ethical limits are well known and definable, and any 

 person who logically thinks the matter out must see 

 that it is the research method which has placed the 

 science and art of surgery where it stands to-day. 

 Exactly the same thesis holds for medicine. How 

 could any physician predict for the first time, before he 

 had tried it experimentally on animal or man, the 

 action of any new drug, the efTect of any variation in 

 dosage, the result of any dietary, of the employment 

 of any course of physical or chemical treatment, or of 

 anything in the whole of his armamentarium? Yet 

 the public are rarely told any of these wholesale truths, 

 but are rather left to speculate that each medical and 

 surgical fact sprang forth as a kind of revelation in 

 the inner consciousness of some past genius in medi- 

 cine or surgery, who, in some occult way, knew of his 

 own certain foreknowledge what would be the definite 

 effect of some remedv or course of treatment before he 

 tried it for the first time on a patient, or perhaps had 

 the ethical conscience and genuine humanity to test it 



