PHYSIOLOGY AND ITS RELATION TO MEDICINE 401 



recent brilliant additional departments of medicine, in bacteriology 

 and chemistry, the research work is, as already stated above, for the 

 most part of a morphological stamp. It is true that a few men of 

 genius in medicine, Cohnheim, for instance, broke their acquired 

 chains and made an attempt to study pathology from a functional 

 point of view. Such attempts, however, were not many, and their 

 permanent influence is not extensive. What is now termed general 

 pathology or even pathological physiology consists, in the first place, 

 of a collection of histological, bacteriological, and chemical facts of 

 a general but essentially of a morphological nature, including at the 

 same time the applications of a few well-established physiological 

 facts to pathology and a few results from direct experimentation in 

 pathology. That is not a study of physiology under pathological con- 

 ditions, and certainly not a study of general physiological laws which 

 can be stimulated by and derived from a study of pathological pro- 

 cesses. And it is just this kind of study which is missing, and which 

 could be developed only by a purposeful and concerted action of the 

 men who have a training in the study of the functional side of life, 

 among whom there are surely many who have a natural endowment 

 for such studies. 



The following review of the present situation in medicine will show 

 us the place left vacant by physiology, and the disastrous consequences. 

 The studies of pathological anatomy extend over all divisions of 

 medicine, are lucid and nearly complete. Diseases which are exclu- 

 sively due to palpable anatomical changes are "quite well understood. 

 Their harmful effects are, for the most part, of a mechanical nature. 

 In proportion as they are understood, these forms of disease become 

 amenable to an efficient treatment; it is mechanical, it is surgery. 



The studies of the etiology of diseases revealed and continue to 

 reveal many of the foreign originators of disease, the animal and 

 vegetable invaders of the living organism. This new and lucid know- 

 ledge led again to some effective measures in the treatment of dis- 

 eases, it led to clear plans in preventive medicine, it gave means to 

 the surgeon to enter with impunity into the interior of living organisms, 

 and in a few instances it discovered actual remedies for non-surgical 

 diseases. 



But most diseases are something more than mechanical disturb- 

 ances, or exclusively anatomical changes. There is, in the first place, 

 that large group of so-called functional diseases which has no patho- 

 logical anatomy, and for which clinicians have very little interest. But 

 even those numerous diseases in which the post-mortem examination 

 revealed distinct anatomical changes were only results of the advanced 

 stage of the disease. The disease during life consisted primarily 

 surely in disturbances of a functional character, in reactions to foreign 

 causes, reactions of living energies, the physiology of which we have 



