6o4 



NA TURE 



[October 19, 1891 



leseaich ar.d purely disgroslic success have led to one of the 

 most brilliant ochievemtnts of practical medicine, the operative 

 Ireatmtnt oforgrric diseases of the brain ? 



It has often been questioned whether the study of morbid 

 anatomy has net withdrawn atlenlion from morbid physiology ; 

 and, again, whether the time employed upon pathological 

 researches would not have been better spent in directly ihera- 

 putical inquiry. To both these questions I take leave to answer. 

 No. Anatomy must precede physiology, whether in the nor- 

 mal or the diseased state. The humoral physiology of the 

 ancients did infinite mischief (mischief not yet exhausted), be- 

 cause it lacked the sound basis of anatomy ; and experimental 

 pathology, necessary and important as it is, and valuable as 

 even its first endeavours have proved, was impossible without 

 previous knowledge of the anatomy and histology of disease. As 

 to therapeutics, 1 hold that for the successful cure of a patient 

 it is far bell er that his physician .should have a thorough and 

 extensive knowledge of morbid anatomy, than that he should be 

 acquainted with all the baths and waters, the hotels and lodging- 

 houses throughout the world,orfamiliar with the barbarousnames 

 and pretended virtues of all the advertised nostrums that deface 

 the fair English fields from London to Oxford. The public 

 suppose tha: it is their business to know what is the matter, and 

 the doctor's to find the remedy ; if so, our art would be confined 

 to learning the name of the patient's disorder by letter, post- 

 card, or telegram, and looking up in an index of remedies the 

 twenty or thirty drugs which are "good" for that particular 

 complaint. We know that the real difficulty is to ascertain the 

 nature and origin of our patient's disorder ; when that is done, 

 the treatment in most cases is obvious, and in many effectual ; 

 when it. is not done, our treatment is vacillating, and either 

 futile or mischievous. We have already ample means at our 

 disposal for influencing almost every organ of the body. A new 

 tool is occasionally offered us which deserves proving, but what 

 we want far more is knowledge how to use the tools that we 

 have. Treatment without diagnosis, besides its inefficiency, 

 brings us for the ti.-ne unpleasantly near to the charlatan who, 

 whatever title he may assume, is always therapeutical and never 

 pathological. Rational, bold, and effectual treatment, whether 

 preventive or curative, must always depend upon accurate diag- 

 nosis and sound pathology, and the power of diagnosis depends 

 upon that systematic inspection of the bodies of diseased persons 

 which was recommended and practised by Harvey. 



"Ad hanc inspectionem, cum Heraclito apud .\ristotelem, 

 in casam furnariani (sic dicam) introire si vultis, accedite : nam 

 neque hie Dii desunt immortales. Maximusque omnipotens 

 Pater in minimis et conspectior vilioribus quandoque est.' 



Suffer me, then, Mr. President and Fellows of this College, 

 to obey the instructions of the founder of this lecture, by ex- 

 horting my hearers, and especially those Fellows who are 

 junior to myself, to emulate, according to the varied talenis 

 entrusted to each, the example of Harvey in these three par- 

 ticulars : — 



(i) In investigation by experiment, whether by pathology or 

 physiology. 



We have now difficulties unknown to Harvey in carrying out 

 this duty, for duty it cerlainly is, incumbent upon all who have 

 the opportunity and the necessary training. The countless 

 experiments on living animals which were carried out during 

 the :7th century in all civilised countries — in Italy, Holland, 

 Denmark, France, Germany, and England — bore a rich 

 fruit of physiological knowledge. If the anatomy of the 

 human body was thoroughly ascertained by the great men of 

 the l6th century, by Vesalius, Sylvius, and their successors, 

 it is no less true that to the 17th century is due the discovery 

 of the elements of physiology. The action of the heart 

 and the circulation of the blood, the absorption of chyle by the 

 lacteals and thoracic duct, the mechanism of respiration and 

 some knowledge of its chemical effects, the function of secre- 

 tion by glands, the minute structure of the eye and ear, and of 

 the reproductive apparatus, and a knowledge — imperfect, but 

 true as far as it went — of the functions of the brain and nerves, 

 these were the achievements of the 17th century due to 

 Harvey, Glisson, Willis, and Mayow, among our own country- 

 men, and to Pecquet, Malpighi, Leuwenhoeck, De Graaf, 

 Swammerdam, Aselli, Redi, and Bartolinus. In all this bril- 

 liant advance of knowledge, experiment upon the lower 

 animals was the method used, and the method is as indispen- 

 sable now. 



NO. I 25 I, VOL. 48] 



Anyone conversant with a single branch of natural science 

 is aware that experiment, as well as observation, is necessary. 

 Who would expect discoveries in physic*, or in chemistry, 

 without laboratories and experiments? Do not botanists in 

 vestigate the functions of plants by dissection, by microscopic 

 and chemical investigation, and by f.r/t'm;/c7//.' Have we not 

 this very year celebrated the important results of fifty years' 

 f.xfcrivienlal researches into the life and growth of plants by 

 Law es and Gilbert ? And is it not obvious that the same 

 necessary well tried and indispensable method of inquiry must 

 be continued in the case of animals? Happily the same ex- 

 perimental science has discovered the means of abolishing the 

 tribute of suffering which the brute creation paid in the hands 

 of Harvey and Hales, of Haller, Magendie, and Sir Charles 

 Bell. By means of chloroform and other anaesthetics, and by 

 means of the antiseptic methods which we owe to Sir Joseph 

 Lister, the subjects of experiment are spared the pain and shock 

 of an operation, and the pain which used to follow an opera- 

 tion. In fact, almost the only experiments upon the lower 

 animals which involve distress are those which are most imme- 

 diately and directly useful to ourselves and to them ; inocula- 

 tions, namely, with a view to reproduce diseases, and the direct 

 therapeutical testing of drugs. Cruelty is utterly repugnant 

 to our calling ; and it seems absurd that men, who will with 

 just confidence entrust themselves and the lives of those nearest 

 to them to our protection and care, should yet so far distrust us 

 as to shackle attempts to improve our knowledge ard oor 

 power by cumbersome and ridiculous restrictions. Let ui hope 

 that on the one hand increasing humanity and gentler manners 

 will extend compassion for the lowest of God's creatures from 

 the educated classes of England and America until it permeates 

 all ranks and all nations ; and that on the other full liberty 

 will be given to the prosecution of researches, laborious and 

 thankless in themselves, but of the utmost value for the relief 

 and prevention of disease in man and brute alike. May I also 

 express a hope that those who administer our laws will take 

 heart of grace, and in this, as in other matters, try whether 

 Englishmen do not prefer the conscientious maintenance of a 

 statesman's own judgment before a time-serving submission to 

 ignorant clamour. 



(2) In the second place, I would exhort my brethren, and es- 

 pecially the members of this College, to cultivate learning. 

 Harvey went to study in Italy, then the nursery of scieince as 

 well as of art, and he was familiar with the writings of Plato and 

 Aristotle and Virgil, as well as with those of liis immediate 

 predecessors, Fabricius and Columbus. So in that golden time 

 which comes to most of us, between taking the academical 

 degree and becoming immersed in the daily duties of hospital 

 life, I strongly advise a visit to one of the German universities, 

 or 10 Paris, to acquire the key to the two languages in which the 

 best modern books are written ; and to widen the mind by see- 

 ing the aspect of science and affairs from a continental stand- 

 point. It is lamentable that there is so little professional inter- 

 course between the students of one of our London schools and the 

 teachers of another. The laudable energy which has made each 

 of them complete, and well-equipped colleges has had this draw- 

 back, that at the present day the attention of a diligent student is 

 more confined to the teaching and practice of his own school than 

 it was sixty or seventy years ago.' The narrowness and pre- 

 judice bred by this isolation may be corrected by a visit to the 

 famous sister universities of Edinburgh or Dublin ; for their 

 complete removal no prescription is so efficient as a prolonged 

 Slay in continental laboratories and hospitals. But even such a 

 broad and liberal education, even familiarity with the daily 

 advances of medical science recorded in periodicals and archives 

 and year-books, or transmitted by telegraph to the wondering 

 readers of the daily newspapers, is not all that is needful to make 

 a learned physician. We know well the difference between 

 reading of an experiment, or even seeing it performed, and doing 

 it with our own hands. We know the difference between 

 studying a pathological atlas, or even a cabinet of histological 

 slides, and seeing and handling morbid tissues and roakinc 

 sections for oneself. So also is there all the difference betweer 

 learning the present conclusions as they stand recorded in thf 



1 Let us hope that the University of LontJon when reconstituted by tli' 

 labours of the Royal Commission, which is now preraring its report to th' 

 Ciown, may provide by the regulations of its medical faculty; for mori 

 community of leaching .-ind learning among students of medicine in thi 

 city. 



