September 17, 1914] 



NATURE 



77 



on a lower animal before he administered it to 

 man. 



It mav, in short, be taken as an axiom of medical 

 science that everything of value in medicine and 

 surgery has arisen from the applications of experi- 

 mental research. Nor can future advance be made 

 bv any other method than the research method. It 

 is true that accident may teach occasionally, as it 

 did, for example, in the dreadful burns unwittingly 

 inflicted on themselves and patients by the early 

 experimenters in X-ray therapy and diagnosis. But 

 accident is only the most blundering type of experi- 

 mentation, and results obtained by its chance agency 

 do not really invalidate the universal law that man 

 only learns by experience, or, in other words, by 

 research. Research is, after all, only the acquisition 

 of fresh experience by the trained expert, usually led 

 on to his experiment by inductance from other known 

 facts. 



It has been said above that all that is valuable in 

 medical science has been acquired by research ; the 

 converse may now be pointed out, that much that 

 was valueless, dangerous, and even disgusting in 

 medicine in earlier days was incorporated into the 

 medical lore of the time, and often remained there 

 for generations, stealing lives by thousands, because 

 physicians had not yet adopted the research method, 

 and so based their practice upon ignorant and un- 

 founded convention. It is noticeable in literature that 

 up to somewhere in the beginning- of the nineteenth 

 century physicians and surgeons were often as a class 

 looked upon by scholars and educated people with a 

 certain amount of contempt. There were notable and 

 fine exceptions in all ages, but, taken as a whole, the 

 profession of medicine was not held in that high 

 esteem and admiration that it is amongst all classes 

 to-day. Take, for example, Burns's picture of Dr. 

 Hornbrook, or Sterne's account of Dr. Slop in 

 Tristram Shandy," and similar examples in plenty 

 are to be foimd in the Continental literature. 

 The reason for the change is to be found 

 in the comparative growth of medical science 

 as a result of the research method. The 

 physicians of those days were very often ignorant 

 quacks employing the most disgusting- and dangerous 

 remedies, or methods of treatment, based upon no 

 experimental knowledge and handed down in false 

 tradition from ignorant master to ignorant and often 

 almost illiterate apprentice. It is only necessary to 

 peruse the volumes written on materia medica of this 

 period to shudder at the nature of the remedies appar- 

 ently in common use ; the details are unfit for modern 

 publication. 



Even in the first half of the nineteenth century 

 patients were extensively bled almost to exhaustion in 

 a vast variety of diseases in which we now know- 

 with certainty that life would be endangered~t)y such 

 treatment and chance of recovery diminished. Thus, 

 in a te.\t-book published in 1844 by the professor of 

 medicine in the most famous university in medicine 

 of our country, and a physician in ordinary to her 

 Majesty Queen Victoria, it is said that in the treat- 

 ment of pneumonia " the utmost confidence may be 

 placed in general blood-letting, which should always 

 be large, and must almost always be repeated some- 

 times four or six times, or even oftener. BHstering: 

 and purging-, under the same cautions as in the bron- 

 chitis, are to be employed ; and two other remedies 

 have been much recommended— opium, especially 

 combined with calomel, and the solution of tartar 

 emetic." It seems scarcely credible to us nowadays 

 that about this same period a low diet, blood-letting, 

 emetics, and purgatives were employed as a treat- 

 ment in phthisis; yet such is the case. It is in 



NO. 2342, VOL. 94] 



keeping with the above, and in strange contrast to 

 modern treatment, to find it recommended that if the 

 patient cannot winter abroad he is ordered " strict 

 confinement within doors in an artificial climate, as 

 near as possible to 60° Fahr., during at least six 

 months of the year in Britain." From the text-books 

 of medicine of this period, only seventy years back, 

 instances of wrongful and even dangerous treatment 

 in most of the important diseases might be produced. 

 There is no basis of accurate scientific knowledge of 

 physiology, biochemistr>-, or bacteriology underlying 

 the visionary notions about disease. The real causes 

 of the diseases being obscure, they are commonly set 

 down to so-called diatheses or habits such as the 

 " haemorrhagic diathesis" or the "scrophulous habit." 

 Also, the action of infective organisms and the in- 

 timate relationships in regard to infection of members 

 of the same family being unknown or forgotten, such 

 "habits" are erroneously set down as hereditarv. 

 When there is no other channel of escape, the word 

 " idiopathic " is coined to cover the ignorance of .the 

 learned. 



If now we pass onwards about thirty years in time, 

 halving the distance between the above period and 

 our own time, and consult an important te.xt-book 

 of medicine published in 1876 by a fellow of the 

 Royal College of Physicians, a physician and lecturer 

 at a famous London medical school, and a lecturer 

 on pathology and physiology, we find that the pro- 

 gress attained by research in physiology and physio- 

 logical chemistry, and a growing belief in the 

 possibility of infection in many diseases by the micro- 

 organisms, now demonstrated so clearly in certain 

 cases by Pasteur and his followers, have commenced 

 to do their beneficent work in medical practice. The 

 heroic bleedings and leechings and the scarcely less 

 violent druggings with strong drugs have dis- 

 appeared. The patient is less harassed by his doctor, 

 who is more content to assist the natural processes 

 of recuperation as his knowledge of applied physiology 

 and hygiene teach him, rather than to thwart them and 

 to lessen resistance as his predecessor often did a gene- 

 ration ago, when he knew no physiology and less 

 hygiene. Still, the comparison between the text-book 

 of even forty years ago and one of the present day 

 shows a wonderful advance, all flowing from the use 

 of the research method in the intervening years, both 

 in knowledge of the origins and in the treatments 

 of the diseases. 



Time and space forbid going into details, but the 

 whole of serum-, vaccine-, and organo-therapy were 

 unknown, w-ith the single exception of vaccination 

 for variola. Enteric fever has been separated from 

 typhus, but its etiology is still obscure, and, to a 

 large extent as a consequence, the mortality from it 

 is 15 to 16 per cent., or quadruple present-day figures, 

 and it is one of the commonest of diseases. The 

 cause of diphtheria is unknown, although it is now 

 recognised as a "contagious" disease, and as yet 

 research in bacteriology has supplied no cure for it. 

 The unity of the various forms of tuberculosis is un- 

 suspected, the infecting organism is unknown, and, 

 as a result, it is not even recognised as an infectious 

 disease, and heredity figures most strongly in a 

 dubious etiology, leading up to a vacillating treat- 

 ment. Pneumonia is not recognised as due to a 

 micro-organism, and is described as one of the " idio- 

 pathic " diseases. The cause of syphilis, and its 

 relationship to tabes dorsalis, and general paralysis 

 are unknown, and generally it may be said that the 

 causes of disease are either entirely unknown or 

 erroneously given in at least three-quarters of the very 

 incomplete list of diseases that are classified and 

 described. 



