468 



NATURE 



[October 5, 1911 



RESEARCH IN MEDICINE.' 

 THE object of research is to discover something which 

 was not previously known, or to correct or to con- 

 firm some previous observations. There are two methods 

 of research — one by observation, the other by experi- 

 ment. In medical research the method by observation is 

 much out of fashion ; it is slow, and may be often inter- 

 rupted for want of material. The imperfection of the 

 material is often very disappointing. The method by 

 experiment (not by any means limited to experiments on 

 animals), on the other hand, is the fashion of the day ; it 

 is quicker, less liable to be interrupted, and may yield 

 brilliant results in a very short space of time. But it is 

 a two-edged weapon, and needs to be used, and its results 

 to be accepted, with great caution. Mr. Hunter, who was 

 a confirmed and most ingenious experimenter, said in the 

 course of his evidence at the trial of Captain Donellan : — 

 " I apprehend a great deal depends upon the mode of 

 experiment ; no man is fit to make one but those who have 

 made many and paid attention to all the circumstances 

 that relate to experiments." 



Let me give you my experience of the two methods in 

 the investigation of cancer. Many years ago there was 

 great confusion in the minds of pathologists and surgeons 

 regarding the differences and resemblances between sarcoma 

 and carcinoma. I made a diligent study of them by 

 observation of the cases at my hospital, the cases at other 

 hospitals, and the cases recorded in the literature of many 

 countries. The research was very long, very tedious, and 

 very disappointing by reason of the small number of cases 

 which were sufficiently recorded to be available for use. 

 The results formed the subject of the Erasmus Wilson 

 lectures thirty years ago, and proved that the life-history 

 of the varieties of malignant disease does not depend merely 

 on their structure, but upon their seat of origin, and that 

 the varieties of malignant disease of every part of the body 

 must be separately studied if they are to be treated with 

 success. Observations of a similar kind have been made 

 by other clinical pathologists, with the result that the most 

 successful operations for cancer at the present time are 

 based on the results of clinical pathology. For no part 

 of the body has this been done with greater success than 

 for the breast. Charles Moore and Mitchell Banks urged 

 the importance of very large operations many years ago ; 

 but surgeons fought shy of them, because they lacked that 

 which was supplied many years later by Heidenhain and 

 Styles — a scientific basis. Recently Handley has again 

 added valuable information on the same subject, founded 

 on clinical and microscopical observation. 



I have never engaged personally in experimental investi- 

 gation on account of the difficulty of doing so thirty years 

 ago. But I have been associated with the Imperial Cancer 

 Research, and in touch with its staff from the foundation 

 of the research, and have been a member of the publica- 

 tion committee of all its scientific reports. It has done 

 nothing on the lines in which observation has been so 

 useful. It has not unfolded the life-history of a single 

 variety of cancer so that we can base our operations on the 

 information. It has not even discovered whether spon- 

 taneous cancer of a particular part of the body in the ral 

 or mouse runs a similar course to spontaneous cancer of 

 the same part of the body in the human subject. These 

 problems are not suited for experimental investigation ; the") 

 are determined by observation. On the other hanr , ( , within 

 the space of eight or ten years it has definitely settled a 

 matter of dispute which was discussed and fought long 

 before I became a student, perhaps for centuries. It has 

 proved, beyond the possibility of doubt, that cancer in its 

 early stages is a local, not a constitutional or blood, disease. 

 It is impossible to overrate the value of this knowledge to 

 the surgeon. So long as he believed that cancer is in the 

 blood, and that an operation only removes the local mani- 

 festation of it, he was hopeless of the results of his opera- 

 tions, and removed the tumour solely to afford the patient 

 temporary relief. Now he goes to his operation filled with 

 hope that; if the disease is limited and in nn early stage, 

 and his operation is well designed and skilfully carried 



1 From the introductory address delivered :it the opcninc of the winter 

 ession, Otntiet 2. at the London School of Medicine for Women, by Sir 

 Henry T. l'.utlin, Hart. 



NO. 2l88, VOL. 87] 



out, it may be quite successful. Thus it will be seen that 

 the two methods, observation and experiment, have their 

 special values in relation to cancer, that each is supple- 

 mentary to the other, and that neither is fitted to take the 

 place of the other. 



It will be noticed that I have dwelt on the use to which 

 these researches have been put in the treatment of cancer 

 and of the value of them to human beings. You may fairly 

 think these ought to be the immediate objects of all re- 

 search in medicine, and that researches which are not likely 

 to be immediately useful should be discouraged. But while 

 I freely admit that my sympathy is in favour of this view, 

 I am bound also to admit that it is wholly erroneous. The 

 investigator should be solely interested in discovering the 

 truth, and his attention should not be diverted and his 

 judgment warped by the desire that his research should 

 terminate in a particular manner because that might seem 

 likely to be more useful to medicine and surgery. It is 

 notorious that some of the researches which have seemed 

 to fulfil no useful purpose have yielded the most valuable 

 practical results, while other researches, pursued with a 

 useful end in view, have furnished nothing good. If a 

 utilitarian value were considered essential to research, many 

 voung investigators who have later produced the most 

 brilliant work would have been discouraged, so that they 

 might never have persevered in original research. 

 I need only give two illustrious examples, Pasteur 

 and Lister. 1 Their first researches had no utilitarian 

 object. What a lamentable thing it would have been if 

 they had been discouraged from research on that account. 

 The great thing is that young people who are fitted to 

 do so should be encouraged to search. What they search 

 for is of comparatively small consequence. On the other 

 hand, I would not have it supposed that a utilitarian re- 

 search is derogatory to the dignity of the worker or neces- 

 sarily damages his moral. Sir Humphry Davy deliberately 

 worked out the problem of coal gas and explosions, and 

 invented a safety-lamp at the urgent request of the 

 coal-owners. Pasteur investigated the nature of the 

 Pfibrine disease of silkworms at the request of Dumas, 

 and moved by pity at the wretched condition into which 

 the silkworm industry had fallen. He discovered that it 

 depended on a parasitic protozoon, and devised a successful 

 method of stamping it out. 



Just a few words on the cost of research. Dr. Leonard 

 Hill" pointed out some years ago what great results could 

 be achieved by an able worker with the simplest materials 

 and at the smallest cost, and that fine laboratories and 

 costly apparatus are not essential to research in medicine. 

 All this is very true, just as it is true that David killed 

 Goliath with a stone cunningly hurled from a sling. I 

 do not think David at the present day would sally forth 

 with a sling to oppose a foreign host ; and our profession 

 is continually urging on the wealthy public the financial 

 claims of research. 



In order to determine whether women are likely to be 

 useful and successful in research, it is necessary to consider 

 the qualities which should be looked for in an investigator — 

 I mean in an investigator who has the sole charge of a 

 research, even though it be carried out in a laboratory 

 where other persons are at work. I am not speaking of 

 an expert assistant or even of a joint investigator. 



For (1) experimental research (including experiments on 

 animals) I should set down : dexterity and neatness in 

 manipulation : a knowledge not only of the principles, but 

 of the practice, of aseptic and antiseptic surgery : and 

 certainly humanity, so that the experiments which are 

 necessary should be performed with as little suffering to 

 the animals as possible. 



For (2) every hind of research I should look for personal 

 cleanliness; cleanliness of habit; industry, which must be 

 extended to mean continued industry ; patience, and a large 

 stock of it ; perseverance, and a determination to pursue 



1 The first re earches of Pasteur were on the crystallisation of tart.-i'V 



acid and its salts The first researches of Lister were on the contractile 



in the muscular tissue of the skin. 



- Brit. Med. four . 1O07, vol. i.. p. "60. " Men of si ience ar- not made 



by institutes, mi | iratu Helmholt* did his best work on 120/. a 



in ..I -oectaclelenses and hiswife' 

 pear. Faraday did his epoch-making work with bits of indwire. 



Claude Herna'rd filled Lis pupils with enthusiasm in a laboratory little better 

 than a cellar.*' 



