J04 



NATURE 



[November 6, igig 



years, thoug-h for no small part of that time the 

 so-called " practical man " was accustomed to 

 make light of it. By the middle of last 

 century the importance of some knowledge of 

 stratigraphy was beginning to be generally 

 realised in regard to coal-mining; yet cases 

 sometimes occurred such as making boreholes in 

 search of that material in hopeless places, or 

 carrying a shaft down into the Wenlock Lime- 

 stone in the hope of striking a valuable seam, 

 which, as the result of an unconformity, had never 

 been deposited. Much information, however, has 

 been obtained about underground stratigraphy by 

 some of these borings for minerals or for water, 

 even when they proved fruitless in themselves. 

 Shafts also for coal and for metals have been 

 carried to much greater depths than formerly, one 

 or two even going down to as much as 5000 ft. 

 below the surface. But the late war repeatedly 

 proved the practical value of a good knowledge 

 of geology, in the cutting of deep trenches, in 

 driving tunnels, mines, and counter-mines, and 

 in constructing underground shell-proof shelters, 



so that we may now reasonably hope that our 

 military and political authorities will recognise the 

 importance of geology as a subject of education. 



This increase of knowledge is not without its 

 attendant drawbacks. The microscopic study of 

 rocks and minerals, the minute observance of the 

 variations in closely allied species, the distinction 

 of geological areas, tend to foster specialism. 

 In the present age the emergence of men like 

 Darwin, Hooker, and Huxley, men with far- 

 reaching views and wide outlook, who make great 

 forward steps, has become increasingly difficult, 

 while the literature of all the subjects, though it 

 aids, also lays a heavy burden on the student. 

 Much time has often to be spent in searching 

 through many volumes, for fear of overlooking 

 some fact which may have an important bearing 

 on a special investigation ; in short, there is some- 

 times a great danger in being unable to " see the 

 wood for the trees." But we may hope that 

 these obstacles will in due time be overcome, and 

 details be regarded in their right relation to 

 piinciples. 



THE NEW BIRTH OF MEDICINE.^ 



By Sir T. Clifford Allbutt, K.C.B., F.R.S. 



WITHIN the period of fifty years during which 

 Nature has been published, medicine has 

 undergone a revolution. It has become enlarged 

 from an art of observation and empiricism to an 

 applied science founded upon research ; frpm a 

 craft of tradition and sagacity to an applied 

 science of analysis and law ; from a descriptive 

 code of surface phenomena to the discovery of 

 deeper affinities ; from a set of rules and axioms 

 of quality to measurements of quantity. When 

 I turn back to the medical text-books of my pupil- 

 age, to the wise and scholarly Watson or the 

 respectable Alison, and contrast them with the 

 text-books of to-day, I marvel that a change so 

 vast, so profound, so revolutionary, should have 

 come about in one lifetime ! Many a generation 

 had to pass before Harvey's researches estab- 

 lished animal mechanics ; many again before the 

 half-lights on animal heat of Willis, Mayow, and 

 Boyle were brought to quantitative verifications. 



In medicine, observation cannot carry very far 

 ■ — not so far, let us say, as in astronomy ; while 

 skill and sagacity, if they do not die with the 

 individual, keep in the axioms and exercises of the 

 school but a transitory life. No observation of 

 a thunderstorm could unravel its affinities to the 

 action of a loadstone on a scrap of iron ; no 

 observation on diet could reveal the relation of 

 food protein, by way of the amino-acids, to the 

 tissues ; no observation bestowed on scurvy or 

 beri-beri could detect the occult and elusive but 



J Abstracted from an address by the author to the Scientific Meeting of 

 the British Medical Association in April, 1919. 



NO. 2610, VOL. 104] 



all-potent influence of the vitamines ; no observa- 

 tion of secretory and muscular action could reveal 

 the play of surface-tension in muscular contrac- 

 tion, or its relations to lactic acid and oxygen. 

 By what sagacity could the shrewdest observer, 

 let us say of heart disease, perceive the likent>ss 

 of the formations of a soap bubble, or a raindrop, 

 to the contraction of a muscle-fibre in terms of its 

 length ; or that muscular contraction is not so 

 much a chemical as a physical system with a nega- 

 tive temperature coefficient? Again, the relation 

 of sexual hormones to the development of men 

 and women, and to the phases of their respective 

 organs of reproduction, is an issue of the academic 

 laboratory. The prodigious harvest medicine has 

 reaped in the recent operations of war was derived 

 from the original researches of a chemist into the 

 occult causes and laws of fermentation by 

 microbes, and from a field apparently so alien as 

 of the silkworm disease. 



One of the main lessons of our history has been 

 that, in neglect of research into truths below the 

 surface, medicine, for lack of a deeper anchorage, 

 has always sunk back into empiricism and routine. 



Research is the salt of the most practical train- 

 ing ; it cannot begin too soon ; it is the light of 

 the wisdom of the man, of the mind of the boy, of 

 the heart of the child. Education has lingered on 

 Hellenistic and scholastic ways, on the systems of 

 abstract notions unvexed by verification, so long 

 that the hard-shell practical man is still occupied 

 by the notions of antiquated theory and the 

 phrases of a dead or moribund nosology. The 



