Augnsi II, 1881] 



NATURE 



343 



furnish the normal and typical characters of the species ; and, as 

 such, they are the subject matter of ordinary biology. 



Outride the range of these conditions, the normal course of 

 the cycle of vital phenomena is disturbed ; abnormal structure 

 makes its apj earance, or the proper character and mutual 

 adjustment of the functions cease to be preserved. The extent 

 and the importance of these deviations from the typical life may 

 vary indefinitely. They may have no noticeable influence on 

 the general well-being of the economy, or they may favour it. 

 On the other hand, they may be of such a nature as to impede 

 the activities of the organism, or even to involve its destruction. 



In the first case, these perturbations are ranged under the 

 wide and somewhat vague category of "variations"; in the 

 second, they are called lesions, states of poioning, or diseases ; 

 and, as morbid states, they lie w ithin the province of pathology. 

 No sharp line of demarcation can be drawn between the two 

 classes of phenomena. No one can say where anatomical 

 variations end and tumours begin, nor where modification of 

 fimction, w hich may at first promote health, passes into disease. 

 All that can be said is, that whatever change of stiucture or 

 function is hurtful belongs to pathology. Hence it is obvious 

 that pathology is a branch of biology ; it is the morphology, the 

 physiology, the distribution, the aetiology of abnoiinal life. 



However obvious this conclusion may be now, it was nowise 

 apparent in the infancy of medicine. For it is a peculiarity of 

 the physical sciences, that they are independent in proportion 

 as they are imperfect ; and it is only as they advance that the 

 bonds v\hich really unite them all become apparent. Astronomy 

 had no manifest connection with terrestrial physics before the 

 publication of the "Principia" ; that of chemistry with physics 

 is of still more modem revelation ; that of physics and chemistry, 

 with physiology, has been stoutly denied within the recollection 

 of most of us, and perhaps still may be. 



Or, to take a ease which affords a closer parallel with that of 

 medicine. Agriculture has been cultivated from the earliest 

 limes ; and, from a remote antiquity, men have attained con- 

 siderable practical skill in the cultivation of the useful plants, 

 rnd have empirically established many scientific truths concerning 

 the conditions under which they flourish. tut it is within the 

 memory of many of us that chemistry on the one hand, and 

 vegetable physiology on the other, attained a stage of develop- 

 ment such that they were able to furnish a sour.d basis for 

 scientific agriculture. Similarly, medicine took its rise in the 

 practical nteds of mankind. At first, studied without reference 

 to any other branch of knowledge, it long maintained, indeed 

 still to some extent maintains, that independence. Historically, 

 its connection with the biological sciences has been slowly 

 established, and the full extent and intimacy of that connection 

 are only now beginning to be apparent. I trust I have not been 

 mistaken in supposing that an attempt to give a brief sketch of 

 the steps by which a philosophical necessity has become a 

 historical reality, may not be devoid of interest, possibly of 

 instruction, to the members of this great Congress, profoundly 

 interested as all are in the scientific development of medicine. 



The history of medicine is more complete and fuller than that 

 of any other science, except perhaps astronomy ; and if w-e 

 follow back the long record as far as clear evidence lights us, 

 we find ourselves taken to the early s.tages of the civilisation of 

 Greece. The oldest hospitals were the temples of .-Esculapius ; 

 to these Asclepeia, always erected on healthy sites, hard by fresh 

 springs and surrounded by shady groves, the sick and the 

 maimed resorted to seek the aid of the god of health. Votive 

 tablets or inscriptions recorded the symptoms, no less th.an the 

 gratitude, of those w ho were healed ; and, from these primitive 

 clinical records, the half-priestly, half-philoscphic, caste of the 

 Asclepiads compiled the data upon which the earliest generalisa- 

 tions of medicine, as an inductive science, were based. 



In this state, pathology, like all the inductive sciences at their 

 origin, was merely natural history ; it registered the phenomena 

 of disease, classified them, and ventured upon a prognosis, 

 w herever the observation of constant co-existences and sequences, 

 suggested a rational expectation of the like recurrence under 

 similar circumstancts. 



Further than this, it hardly went. In fact, in the then state 

 of knowledge and in the condition of philosophical speculation 

 at that time, neither the causes of the morbid state, nor the 

 rationale of treatment, were likely to be sought for as we seek 

 for them now. The anger of a God was a sufficient reason for 

 the existence of a malady, and a dream ample warranty for 

 therapeutic measures ; that a physical phenomenon must needs 



have a physical cause was not the implied or expressed axiom 

 that it is to us moderns. 



The great man, whose name is inseparately connected with the 

 foundation of medicine, Hippocrates, certainly knew very little, 

 indeed [ractically nothing, of anatomy or physiology; and he 

 w'ould profiably have been perplexed, even to imagine the possi- 

 bility of a connection between the zoological studies of his 

 contemporary, Democritus, and medicine. Nevertheless, in so 

 far as he, and those who worked before and after him, in the 

 same spirit, ascertained, as matters of experience, thatJ a w ound, 

 or a luxation, or a fever, presented such and such symptoms, 

 and that the return of the patient to health was facilitated by 

 such and such measures, they established laws of nature, and 

 began the construction of the science of pathology. — All true 

 science begins with empiricism — though all true science is such 

 exactly, in so far as it strives to pass out of the empirical stage 

 into that of the deduction of empirical from more general tmths. 

 Thus, it is not wonderful that the early physicians had little or 

 nothing to do with the development of biological science ; and, 

 on the other hand, that the early biologists did not much concern 

 themselves with medicine. There is nothing to show that the 

 Asclepiads t ok any prominent share in the work of founding 

 anatomy, physiology, zoology, and botany. Rather do these 

 seem to have sprung from the early philosophers, who were es- 

 sentially natural philosophers, animated by the characteristically 

 Greek thirst for knowledge as such. Pythagoras, Alcmeon, 

 Democritus, Diogenes of Apollonia, are all credited with ana- 

 tomical and physiological investigation ; and though Aristotle is 

 said to have belonged to an Asclepiad family, and not improbably 

 owed his taste for anatomical and zoological inquiries to the 

 teachings of his father, the physician Nicomachus, the " Historia 

 Animalium," and the treatise " De Partibus Animaliuro," are as 

 free from any allusion to medicine, as if they had issued from a 

 modern biological laboratory. 



It may be added, that it is not easy to see in what way it could 

 have benefited a physician of Alexander's time to know all that 

 Aristotle knew on these subjects. His human anatomy was too 

 rough to avail much in diagnosis-, his physiology was too 

 erroneous to supply data for pathological reasoning. But when 

 the Alexandrian school, with Erasistratus and Herophilus at 

 their head, turned to account the opportunities of studying 

 human structure, afforded to them by the Ptolemies, the value of 

 the large amount of accurate knowledge thus obtained to the 

 surgeon for his operations, and to the physician for his diagnosis 

 of internal disorders, became obvious, and a connection was 

 established between anatomy and medicine, which has ever be- 

 come closer and closer. Since the revival of learning, surgery, 

 medical diagnosis, and anatomy have gone hand in hand. Mor- 

 gagni called his gieat work, " De sedibus et cansis morborum per 

 anatomen indagatis," and not only showed the way to search out 

 the localities and the causes of disease by anatomy, but himself 

 travelled wonderfully far upon the road. Bichat, discriminating 

 the grosser constitutents of the organs and parts of the body, one 

 from another, pointed out the direction which modern research 

 must take ; until, at length, histology, a science of yesterday, as 

 it seems to many of us, has carried the w'ork of Morgagni as far 

 as the microscope can take us, and has extended the realm of 

 pathological anatomy to the limits of the invisible world. 



Thanks to the intimate alliance of morphology with medicine, 

 the natural history of disease has, at the present day, attained a 

 high degree of perfection. Accurate regional anatomy has 

 rendered practicable the exploration of the most hidden parts of 

 the organism, and the determination during life of morbid 

 changes in them ; anatomical and histological post-mortem 

 investigations have supplied physicians with a clear basis upon 

 which to rest the classification of diseases, and with unerring 

 tests of the accuracy or inaccuracy of their diagnoses. 



If men could be satisfied with pure knowledge, the extreme 

 precision with w hich, in these days, a sufferer may be told what 

 is happening and what is likely to happen, even in the most 

 recondite parts of his bodily frame, should be as satisfactory to 

 the patient, as it is to the scientific pathologist who gives him 

 the information. But I am afraid it is not ; and even the 

 practising physician, while no wise underestimating the regulative 

 value of accurate diagnosis, must often lament that so much of 

 his knowledge rather prevents him from doing wrong, than 

 helps him to do right. 



A scorner of physic once said that nature and disease may be 

 compai-cd to two men fighting, the doctor to a blind man with a 

 club, who : t'.ikes in'o 'he wc/tv, sometimes hitting the disease. 



