July 5, 1877] 



NATURE 



189 



leave, in order to devote a few minutes to our subject in its 

 relation to medical science. 



The Medical Part: 



The influence which sanitation will exert in the future 

 over the science and ai t of medicine promises to be momen- 

 tous. It promises nothing less than the development of a 

 new era ; nor is it at all wide of the mark to say that 

 such new era has fairly commenced. The greatest of the 

 world's philosophers, the philosopher whose thoughts 

 cover the world of science as with a garment, I mean Lord 

 Bacon, said of the medicine, of his day, that it stood for 

 judgment on quite different merits than did other learned 

 pursuits. " Other arts and sciences," he argued, " are 

 judged of by the power and ability exhibited in the conduct 

 of them by their professors, and not by success or by events. 

 The lawyer is judged by the skill of his pleading, not by 

 the issue of the trial ; the pilot by his skill in directing 

 the course of the ship, not by the fortune of the voyage. 

 But the physician can perform no particular act by which 

 his ability can be directly demonstrated, and therefore he is 

 principally judged by the event, which is very unjust. For 

 who shall decide, if a patient die or recover, whether the 

 good or the evil is brought about by art or by 

 accident ? Whence," says he, " imposture is frequently 

 extolled, and virtue decried. Nay the weakness and 

 credulity of men is such, that they often prefer a mounte- 

 bank or a cunning woman to a learned physician. So 

 the ancients made Esculapius and Circe brother and 

 sister, and both children of Apollo. Hence," he adds, 

 •'physicians say to themselves in the words of Solomon, 

 ' If it befall to me as befalleth fools, why should I labour 

 to become more wise?' And therefore one cannot 

 wonder that they commonly study some other art or 

 science more than their profession, because they find that 

 mediocrity and excellency in their own art makes no 

 difterence in profit or reputation ; for man's impatience 

 of diseases, the solicitude of friends, the sweetness of life, 

 and the inducements of hope, make them depend upon 

 physicians with all their defects." 



Had Bacon spoken these sayings in the present day, he 

 had spoken, with one or two exceptional errors, as truth- 

 fully as he spoke in his own time. Had he been a 

 physician, he might indeed have gone further than he did. 

 He might have urged his too frequent inadequacy himself 

 to decide whether his own success rested, in particular 

 instances, on skill or on accident. He might further 

 have added how oftentimes the cheek of the right-minded 

 physician pales or burns with doubt as he hears his 

 own praises declared for skill which he himself cannot 

 for a moment take credit to his own heart. This has 

 been the fate of medicine until our day. On such fate 

 all the quackeries have flourished ; on it all the " pathies " 

 and dogmatic systems of medicine have flourished ; on 

 it the idea of cure has found too willing acceptance and 

 belief. 



At last a change has come over the science of medi- 

 cine. With true nobleness of purpose, true medicine has 

 been the first to strip herself of all mere pretences to cure, 

 and has stood boldly forward to declare as a higher philo- 

 sophy the prevention of disease. The doctrine of abso- 

 lute faith in the principle of prevention indicates the 

 existence of a high order of thought, of broad views on 

 life and health, of diseases and their external origins, of 

 death and its correct place in nature. The doctrine of 

 absolute faith in curative medicine, of power vested in the 

 hands of a distinct sect or class, and exercised by them 

 as by regal right and without the assistance or interfer- 

 ence of those upon whom it is exercised, indicates a low 

 standard of knowledge ; a too confiding spirit in the wis- 

 dom of a minority ; a departure too wide from the safe 

 law of self-preservation ; and an ignorance of the avoidable 

 causes of diseases ; a blindness and therefore an unneces- 

 sary exposure to danger ; an overweening and sudden fear 



of dangers of all kinds little and great, and a hasty and 

 thoughtless pursuit after that mode of rescue from dangers 

 of disease which claims for itself the greatest pretensions 

 and boasts the greatest successes. 



It shall remain as one of the glories of medicine that 

 she herself has first seen these truths, and, willing to 

 sacrifice her own interests to truth and light, has put them 

 forward without fear, without reward. In the science of 

 prevention medicine takes in fact all the world with her. 

 The science becomes a political, a social, as well as a 

 medical study. It appeals to every mind. When it once 

 is so set forth it fills all men with its teachings. It models 

 itself into household truths and commingles with the 

 moral and even religious elements of life. Admitted for 

 a season into the household, it steps forth again to find 

 its way into the legislature. It becomes eventually a 

 governing science — a law. 



This scientific course commenced, must needs go on. 

 But in its going it must needs also change greatly the old 

 face of medicine, and remove in the change the Baconian 

 reproach. I do not think there is much difficulty in fore- 

 seeing what in the main the change will be like. 



I need not say that the "pathies" will go. The 

 pathies of all kinds are as dead as door-nails, and 

 wait only to be decently interred in a common grave. 

 In time the word cure will go altogether. It is clear 

 already that there is indeed no such thing. A man 

 born to live through a given cycle lives through it 

 free of disease, unless he be stricken from with- 

 out. If he be stricken, and by the stroke the natural 

 functions, by the exercise of which he lives, are not so 

 disturbed but that they can swing back again in due 

 order, he may recover ; if he be stricken beyond this, he 

 will die. Nature will pursue her course undisturbed by 

 either event. She will make no special effort to kill, and 

 assuredly she will put out no special hand to save. A 

 man may intervene, and may, by knowledge, put the 

 stricken body into such a condition that it may swing 

 back into natural course whereby he will have put it 

 into a condition in which it will not die. This is the very 

 highest development of medical art resting on science. 

 But it is not cure, in the common meaning of that term. 



By the progress of sanitary science and by its influence 

 on practical medicine we shall attain these perfect rules 

 of management after the infliction of the stroke of dis- 

 ease ; and I do not doubt that the art of placing the 

 stricken under such conditions that they may not die will 

 for ever afford scope for the inventive genius of man. 

 The more immediate triumphs will, however, come in that 

 part of the work which is purely preventive. Down from 

 the skies comes the forked lightning and lays a man 

 prostrate. It is a question for the ages who shall place 

 that man in a condition under which he shall certainly swing 

 back again into life. But the preventive art that puts up a 

 metallic rod to divert the lightning from other men, that 

 is the present triumph of human skill ; skill which, car- 

 ried to perfection, shall prevent the stroke and put out 

 the second art by removing the necessity for its applica- 

 tion. 



With the progress of sanitary science we must expect 

 to see preventive medicine taking the ascendancy. Cure 

 will cease, prevention will grow. Humanly-made epi- 

 demics, like the great plague of London, which was 

 planted and reared in the rush-covered floors of domi- 

 ciles saturated with the organic refuse of years, or like 

 the modern typhoid, which is fed by streams of drinking 

 water uncleansed from human excreta, such self-made 

 epidemics will be prevented by simple mechanical skill. 

 Diseases imposed by indulgence in harmful pleasures and 

 appetites, or by physical overwork and shock, will be re- 

 moved by the effect of moral influences and knowledge 

 of cause ; and gradually, I beheve, those persistent evils, 

 which, like the lightning-stroke, come without human 

 ordinance or fault, will be placed also under some pro- 



