October 7, 1897] 



NATURE 



557 



at the present time is that of a science, explaining the action and not only valuable in themselves, but so important in the light 

 interaction of the organs and tissues, and the forces of the body, they throw on pathological changes occurring in the nervous 

 which is the true foundation of scientific medical knowledge — system, and in the body generally, that the use of this instrument 

 the Institutes of Medicine. The rise of physics and chemistry | has become a necessity of practical medicine, 

 in the seventeenth and eighteenth centuries contributed greatly | The laryngoscope perfected by Czermak has given a pre- 

 to the progress of medicine by increasing our powers of i cision to the diagnosis and treatment of diseases of the throat 

 " searching out the secrets of nature " by methods and instru- | not otherwise attainable, and which has important bearings on 



ments of precision 



Of any one influence that has helped the advance of scientific 

 study and the progress of medicine probably the increasing per- 

 fection of the microscope has Ijeen the greatest. With each new 

 development of this instrument a greater range has been given 

 to our researches, and with the assistance of chemistry it is con- 

 tinuing to reveal to us fresh facts that have created new branches 

 of science. 



Starting from the observations of Bichat on the minute 

 anatomy of the tissues in 1801, the microscope has enabled 

 us to understand the details of structure which were essential 

 to complete anatomy. Until the microscope was capable of 

 practical use the capillaries could not have been discovered 

 by Malpighi, nor the composition of the blood understood ; 

 the mechanism of renal secretion could not be worked out 

 until the minute structure of the kidney was known ; the 

 functions of glands, the process of digestion and secretion ^ 

 could not be understood until the histological details of the j precision, they have influenced our whole mode of thought, 



general medicine, by the recognition of paralyses of the muscles 

 that move the vocal cords in aneurism and in disease of the 

 central nervous system 



The sphygmograph, the cardiograph, the arteriometer, and, 

 the latest invention of this class, the sphygmometer, have 

 enabled us to ascertain the e.xact condition of the circulatory 

 system, of the greatest service not only in studying the pro- 

 l>lems of normal and abnormal physiology, but in the recog- 

 nition of disease and its tendencies, and in the influence of 

 remedies. 



All the branches of scientific knowledge we have been con- 

 sidering — anatomy and physiology, chemistry and physics, 

 morbid anatomy and pathology, therapeutics and preventive 

 medicine — have helped us to the knowledge we at present 

 possess. But they have rendered a further aid to medicine 

 than the mere knowledge they enabled us to acquire. Them- 

 selves scientific studies utilising methods and instruments of 



parts concerned were ascertained ; the mechanism of light 

 and hearing, of taste and smell were not revealed until the 

 ultimate details of the structures involved had been inves- 

 tigated ; tlie marvellous complexity of the nervous system, 

 whether in the delicate though comparatively coarse structure 

 of the nerves, the higher intricacy of the spinal cord, and the 

 marvellous details of the arrangement of ganglionic cells and 

 communicating fibres of the cerebral tissue, which by improved 

 methods of preparation and staining are being revealed to us at 

 the present time, could not have been worked out without its 

 aid. Just as anatomy had to reach a certain stage before physi- 

 ology and morbid anatomy became possible, so normal histology 

 had to advance before pathological histology could come into 

 existence ; and as knowledge advances from the special to the 

 general, special pathological histology had to reach to a very 

 high point before we could reach that knowledge of general 

 pathology on which our conceptions of the nature of disease are 

 at present based. 



The microscope again has introduced us to a new world, 

 revealing minute organisms that play a great part in the plan of 

 nature, and which are largely concerned in the production of 

 disease. It has led to a new department of science, bacterio- 

 logy, which has taught us how bacteria enter the body, how they 

 increase and multiply therein, and how the tissue reacts for 

 for self-protection. Chemistry has shown how the poisons 

 formed by such organisms act in the body, and supplied us with 

 means — as yet only in their infancy— for counteracting their 

 effects or guarding against their exclusion and by protec- 

 tive inoculation. The microscope has further furnished us 

 with evidence of parasitism other than bacteria in the blood, in 



the muscles, in the skin and hair, and on the mucous membranes. | self the results obtained with it, he finds the remedy of actual 

 By its aid we are able to diagnose and watch the course of value, and in 1785 publishes it, with the results of his own- 

 several primary diseases of the blood. It has enabled us to | cases, and so introduces it into practice. 



differentiate the various new growths that develop in our bodies. I It is extremely interesting that even the action of many of 

 So much does the microscope constitute a necessary means of I the chemical elements has been made use of in the form of 

 research that it would be impossible to perform our daily medical , the simplest house remedies. The ashes of the ordinary 



and made us exact and precise in our observations and investiga- 

 tions of disease. We may paraphrase an expression of Burdon 

 Sanderson's: "The history of modern medicine is largely the 

 history of scientific method." So when we are taunted with the 

 assertion that medicine is not a science, we can reply that 

 medicine utilises the knowledge gained in every branch of 

 science, and is scientific in its method of research into the nature 

 and treatment of disease. If its results are not so exact as in 

 some other branches of knowledge, this is not due to any want 

 of scientific method and care in its investigations, but to the 

 very complicated phenomena with which it has to deal, whilst 

 the investigator has not the same unfettered freedom of dealing 

 with his subject that the investigator into chemistry or physics 

 has. By a continuance of the same methods and exact research, 

 we cannot for a moment doubt that the progress that has been 

 so manifest in the past will be exceeded in the future. 



The Influence of Chemistry upon Medicinal Treatment.^ 



We must recognise that until the most recent times all 

 remedies were borrowed from the purest empiricism. Un- 

 prejudiced physicians, armed with the weapons of scientific 

 criticism, disentangled popular observations from superstitious 

 and mystical ideas, and put to actual clinical test measure* 

 vaunted by their conservative colleagues, in order to ascertain 

 whether in reality any use could be made of them. In con- 

 sequence of the early state of scientific knowledge their judgment 

 had necessarily to be based entirely on the results of practical 

 experience without any experimental assistance. In this con- 

 nection the history of digitalis is most instructive. Withering 

 finds an old family recipe for dropsy ; he does not keep to hir 



duties conscientiously without its aid. 



The thermometer, again, has been of invaluable aid in the 

 study of disease, allowing of our measuring and recording the 



marine sponge have, for example, been much employed on 

 account of their curative properties. When, however, chemical 

 analysis found that they only contained soda, this valuable 



degree of fever, and of watching its progress with such a 1 remedy, which had also found its way into medical practice, 

 degree of accuracy as to furnish us with evidence of the ! was for some decades laid aside. For in that period of 

 greatest value in the diagnosis, prognosis, and treatment of [ chemical knowledge the mistake began of relying too much 

 disease. upon analytical results and of disregarding the strong evidence 



Electricity, by the laborious and complete investigations of ! of clinical experience, because analysis did not necessarily 

 Du Bois-Reymond, has revealed to us the mode of action of j detect powerful substances to explain the action of remedies, 

 nerve and muscle that would have been impossible to obtain | Owing, however, to the valuable discovery of Courtois, the 

 in any other way. Though the hopes at first entertained of ; soap-boiler, who separated iodine from the soda-lye of his 

 its value in the treatment of disease have not been altogether 1 factory, it was easy to demonstrate this element in sea sponges 

 I ilfilled, it is still of much service in this respect, and perhaps ! as well, and it had in consequence to be admitted that 

 till more valuable as an aid in diagnosis. | the results recorded with them were neither due to 



The ophthalmoscope, introduced by Helmholtz, has enabled ' error nor to suggestion. And how noteworthy is it that in 

 us to understand diseases of the interior of the eye, which, opotherapy also iodine was first discovered long after its value 

 without its assistance was impossible. It has admitted of the j , ^^ ^^^^ ^„ ^^^^^^^ ^„ ,,,^ ^5^^ ^^ j^,^^^^^ U.^,c^n^\ Treat- 



exact examination of refraction, and has revealed changes in 1 ment, delivered at the Fifteenth Congress of Clinical Medicine at Berlin 

 the termination of the optic nerve, in the retina and choroid, by Prof. Dr. Oscar Liebreich. 



NO. 1458, VOL. 56] 



