August 6, 1891] 



NATURE 



331 



be a matter of life or death, for upon the medical view pre- 

 vailing at the moment medical practice is apt to depend, and 

 erroneous views may lead to the death of many patients. So 

 long as practice depends upon theories, unchecked by experi- 

 j ment, so long will medical practice prove fluctuating, un- 

 \ certain, and dangerous. One of the greatest gains of the last 

 five-and-twenty years is the general introduction of the ex- 

 perimental method, and the habit which has been growing up 

 during it of accepting no statement unless based upon experi- 

 mental data. Speculations such as those in which I have 

 been indulging in regard to blisters and blood-letting are use- 

 ful as indicating lines of experimental research, but until 

 these have been thus tested it is foolish and may be danger- 

 ous either to accept and act upon them as true or to scout them 

 entirely as false and absurd. Imperfect knowledge is almost 

 sure to lead to one-sided practice, and thus, diverging further 

 and further from the truth, ends at last in falsehood and 

 folly. 



Antisepsis. — Perhaps no better example of this can be found 

 than antiseptic surgery, from the time of the good Samaritan 

 down to Ambroise Pare and Sir Joseph Lister. The good 

 Samaritan bound up the wounds of the poor traveller, pour- 

 ing in oil and wine, which, only a few years ago, was recom- 

 mended in an Italian journal as an excellent antiseptic. Am- 

 broise Pare, when his ointments ran out, could not sleep for 

 thinking of the miserable soldiers to whom they had not been 

 applied, and was greatly astonished to find in the morning 

 that these wretched neglected ones were better and happier 

 than their comrades who had been treated secundum artem. 

 I have no doubt that Fare's predecessors, in trying to improve 

 upon the methods of the good Samaritan and upon the still 

 useful friars' balsam, which is a powerful antiseptic but 

 stings the wound or sore, had tried to make their applications 

 more and more irritating, not knowing that it was the anti- 

 septic power and not the irritant qualities which were desired. 

 Pare abolished the ointments with the irrritation they caused, 

 and thus did great service to surgery. But a greater one yet 

 was rendered by Lister when he recognized that the danger 

 of operations was due to the entrance of germs, and by pre- 

 venting this has completely revolutionized surgical practice ; 

 nay, more, he has to a great extent revolutionized medicine, 

 for the diseases of the internal organs, which were formerly 

 entirely under the physician's care, are now becoming amen- 

 able to surgical treatment, and diseases of the stomach, in- 

 testine, liver, kidney, and lungs, and even of the brain and 

 spinal cord, are now successfully treated by surgery when 

 medicines are powerless to help. The most remarkable of all 

 the recent triumphs of surgical operations upon the brain in 

 which Mr. Horsley has gained such well deserved fame, would 

 have been impossible without Ferrier's localization of cortical 

 centres, and would have been equally impossible but for 

 Lister's antiseptic method. 



Disitifecticn. — But it is not only in surgery that recognition 

 of diseased germs as a source of danger to the organism has 

 led to their destruction outside the body, and insured safety 

 from their attack. This occurs in all infective diseases, and 

 this term now includes many which were not formerly regarded 

 as such, for neither consumption nor pneumonia was formerly 

 regarded in this light ; but just about twenty-five years ago 

 tul)ercle was shown to be inoculable, and since then the dis- 

 covery of the bacillus of tubercle by Koch, and of pneumonia 

 by Friedliinder, has caused us to class both these diseases as 

 not only infective, but as caused by definite organisms. 



P7-evention of Epidemic Diseases. — So long as people were 

 ignorant of the causes of epidemic diseases, they were utterly 

 unable to combat them, and they either in fury slew defenceless 

 people for poisoning the wells, as in the Middle Ages, or 

 appointed days of fasting and prayer, as in our own times. But 

 once an epidemic is known to depend upon the presence of a 

 certain organism, precautions can be taken for destroying the 

 organism outside the body by means of disinfectants, or for 

 lessening the susceptibility of the organism to its ravages inside 

 the body by inoculation, or combating its effects by means of 

 antipyretics. A knowledge of the life-history of microbes has 

 enabled us to ascertain the power of different substances, 

 either to destroy them completely or to arrest or retard their 

 germination and growth, and in this way to prevent the occur- 

 rence of the diseases which these microbes might otherwise 

 produce. . . . 



Antivivisection. — Every now and again a loud outcry is raised 



NO. I I 36. VOL. 44] 



against this method, partly from ignorance and partly from pre- 

 judice. Many— probably most— of the opponents of experiments 

 on animals are good, honest, kind-hearted people, who mean 

 well, bat either forget that man has rights against animals as 

 well as animals against man, or are misled by the false state- 

 ments of the other class. These are persons who, blinded by 

 prejudice, regard human life and human suffering as of small 

 importance compared with those of animals, who deny that a 

 man is better than many sparrows, and who, to the question 

 that was put of old, " How much, then, is a man better than a 

 sheep?" would return the reply, "He is no better at all." 

 Such people bring unfounded charges of cruelty against those 

 who are striving, to the best of their ability, to lessen the 

 pains of disease both in man and also in animals, for they, like 

 us, are liable to disease, and, like us, they suffer from it. I 

 may perhaps be allowed to quote two sentences from a paper 

 which I wrote twenty-four years ago, and therefore a consider- 

 able time before any antivivisection agitation had arisen, for 

 they expressed then, and they express now, the objects of ex- 

 perimental pharmacology : — "Few things are more distressing 

 to a physician than to stand beside a suffering patient who is 

 anxiously looking to him for that relief from pain which he feels 

 himself utterly unable to afford. Hi-; sympathy for the sufferer, 

 and the regret he feels for the impotence of his art, engrave the 

 picture indelibly on his mind, and serve as a constant and 

 urgent stimulus in his search after the causes of the pain, and 

 the means by which it may be alleviated" (Zaw^i-/, July 27, 

 1867). 



Gains by Experiment on Animals. — It is said that our mouths 

 are full of promises, but our hands are empty of results. The 

 answer to this is, that anyone who doubts the utility of experi- 

 mentation upon animals should compare the Pharmacopceia of 

 1867 with our present one. To it we owe, in great measure, 

 our power to lower temperature, for to it is due not only the 

 introduction of new antipyretics, such as salicylate of soda, 

 aiitipyrin, antifebrin, and phenacetin, but the extension of 

 the use of quinine from a particular kind of fever — malaria — 

 to other febrile conditions. To it also we owe our greatly 

 increased power to lessen pain by the substances just men- 

 tioned, which have not only an antipyretic but an analgesic 

 action, and give relief in the torturing pains of neuralgia and 

 locomotor ataxy when even morphine fails to ease, unless 

 pushed to complete narcosis. The sleeplessness, too, which 

 is such a frightful complication in some fevers, can now Le 

 combated by other remedies than opium and antimony ; and 

 we have the bromides, chloral, sulphonal, paraldehyde, 

 urelhane, chloralamide, and others, which, either by them- 

 selves or added to opium, enable us to quiet the brain 

 instead of exciting it to further action, as opiuin alone so fre- 

 quently does. Our whole ideas regarding cardiac tonics also 

 have undergone a complete revolution within the last quarter 

 of a century, for I was told, when a student, that digitalis was 

 a cardiac sedative, and was apt to depress the heart, whereas 

 now we know that it and its congeners — strophanthus and 

 erythrophlcEum and spartein — increase the heart's strength, 

 raise the vascular tension, and are useful not only in sustain- 

 ing the circulation, but in aiding elimination. This view of 

 the action of cardiac tonics, which has revolutionized the 

 treatment of heart disease, we owe chiefly to the experiments 

 of Traube, although my own experiments, made in the labora- 

 tory of Sir Douglas Maclagan under the direction and by the 

 help of my teacher and friend, Dr. Arthur Gamgee, may have 

 helped towards its general acceptance in this country. 



Future of Pliarmacology. — But perhaps the most promising 

 thing about pharmacology is that we are now just beginning 

 to gain such a knowledge of the relationship between chemical 

 structure and physiological action that we can, to a certain 

 extent, predict the action of a drug from its chemical structure, 

 and are able to produce new chemical compounds having a 

 general action such as we desire ; for example, anaesthetics, 

 soporifics, antipyretics, analgesics, although we have not yec 

 arrived at the point of giving to each one the precise action 

 which would make it most suitable in any particular case. 

 Even when we do not know the chemical structure of a drug, 

 we may be able, from noticing one of its actions, to infer that 

 it possesses others. We are, indeed, getting a knowledge of 

 the action of drugs both of known and unknown chemical struc- 

 ture, and a power of making new remedies which will, I believe, 

 enable us within the next five-and-twenty years to cure our 

 patients in a way that at present we hardly think. . . . 



