562 



SCIENCE. 



[N. S. Vol. XX. No. 513. 



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 aetiology of diseases 

 revealed and, continue to reveal many of 

 the foreign originators of disease, the ani- 

 mal and vegetable invaders of the living 

 organism. This new and lucid knowledge 

 led again to some effective measures in 

 the treatment of diseases, 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 rnost diseases are something more 

 than mechanical disturbances, or exclu- 

 sively anatoijiical changes. There is, in the 

 first place, that large group of so-called 

 functional diseases which has no patholog- 

 ical anatomy, and for which clinicians have 

 very littler interest. But even those nu- 

 merous 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 disturb- 

 ances of a functional character, in reac- 

 tions to foreign causes, reactions of living 

 energies, the physiology of which we have 

 possibly as yet not even an inkling of. The 

 so-called organ physiology which appears 

 to the teachers of physiology to be so ex- 

 tensive that it can hardly be taught to stu- 

 dents of medicine in one year's lectures, 

 is of astonishingly modest assistance to the 

 understanding of the actual processes of 

 disease. For instance, in the present knowl- 

 edge of the entire section of the diseases 

 of the respiratory tract, physiology has 

 hardly any share. The knowledge of the 

 few physiological principles which are ap- 

 plied there can be acquired in one hour's 

 instruction. The extensive knowledge in 



this chapter of pathology is essentially of a 

 morphological nature. Do the functions of 

 the involved organs take no part in these 

 pathological processes?' Most certainly 

 they do; but we know too little of it, and 

 the clinician passes over the gap with some 

 makeshift mechanical explanations. The 

 same is true in neurology ; in fact, in nearly 

 every chapter of internal medicine. It is 

 impossible to dwell here on the particulars 

 of our subject. What is the result ? First- 

 class clinicians employ their brilliant f acid- 

 ties in continually developing the morphol- 

 ogy' of diseases and their diagnosis. But 

 treatment ? There is either a nihilism pure 

 and simple, or some sort of a symptomatic 

 treatment is carried on with old or new 

 drugs upon a purely empirical basis. Or 

 there is a great deal of loose writing upon 

 diet, air, water, psychotherapy and the like, 

 and a great deal of semi-popular discus- 

 sion in international, national and local 

 meetings and popular prize essays on the 

 best methods of treatment — with a net re- 

 sult of only a very modest actual benefit 

 for the poor patient, wdio in addition to 

 his affliction has now to feel the tight grip 

 of the modern health officer. There is no 

 efficient treatment of internal diseases in 

 any way comparable with the specific sur- 

 gical treatment of mechanical diseases, no 

 sj)ecific quelling, correcting or curbing of 

 primarily functional disorders. And there 

 never will be such a specific functional 

 therapy before there will be a physiology 

 which, like physics, will be only too glad to 

 meet with many exceptions in order to 

 properly understand all the rules by which 

 the energies of all grades of living phenom- 

 ena are guided. S. J. Meltzer. 



EOCKEFELLER INSTITUTE. 



SCIENTIFIC BOOKS. 



Blood ■ Immunity and Blood Relationship. 

 By George H. F. Nuttall, M.A., M.D., 

 ,Plj.D., University Lecturer in Bacteriology 

 and Preventive Medicine, Cambridge., In- 



