Joseph Payne and Clifford Allbutt

“ Perhaps no advance in medicine has done so much as the study of tuberculosis to educate the public in the methods and value of research in medical subjects, for the results, and even the methods, of such labours have been brought home not only to patients and their friends, but also to the farmer, the dairyman, the butcher, the public carrier, and, indeed, to every home in the land. ”

“ The character of modern medicine cannot be summed in a word, as, with more or less aptness, that of some previous periods may be. Modern medicine, like modern science, is as boldly speculative as it has been in any age, and yet it is as observant as in any naturalistic period ”

“ Among the drawbacks of this temper, which on the whole made for progress, was the rise of a school of excessive scepticism, which, forgetting the value of the accumulated stores of empiricism, despised those degrees of moral certainty that, in so complex a study and so tentative a practice as medicine, must be our portion for the present, and even for a long future, however great the triumphs of medicine may become. ”

“ A conspicuous example of the incalculable evil wrought by lack of integration is well seen in the radical divorce of surgery from medicine, which is one of the most mischievous legacies of the middle ages—one whose mischief is scarcely yet fully recognized, and yet which is so deeply rooted in our institutions, in the United Kingdom at any rate, as to be hard to obliterate. ”

“ According to Sydenham, a disease is nothing more than an effort of nature to restore the health of the patient by the elimination of the morbific matter. The extent to which his practice was influenced by this and other a priori conceptions prevents us from classing Sydenham as a pure empiric; but he had the rare merit of never permitting himself to be enslaved even by his own theories. Still less was his mind warped by either of the two great systems, the classical and the chemical, which then divided the medical world. Sydenham’s influence on European medicine was very great. ”

“ We thus see that, while the great anatomists, physicists and chemists—men of the type of Willis, Borelli and Boyle—were laying foundations which were later on built up into the fabric of scientific medicine, little good was done by the premature application of their half-understood principles to practice. The reform of practical medicine was effected by men who aimed at, and partly succeeded in, rejecting all hypothesis and returning to the unbiassed study of natural processes, as shown in health and disease. ”

“ If we look at the work of the Alexandrian schools in medicine as a whole, we must admit that the progress made was great and permanent. The greatest service rendered to medicine was undoubtedly the systematic study of anatomy. It is clear that the knowledge of function (physiology) did not by any means keep pace with the knowledge of structure, and this was probably the reason why the important sect of the empirics were able entirely to dispense with anatomical knowledge. ”

“ Disease (see Pathology) is the correlative of health, and the word is not capable of a more penetrating definition. From the time of Galen, however, it has been usual to speak of the life of the body either as proceeding in accordance with nature (κατὰ φύσιν, secundum naturam) or as overstepping the bounds of nature (παρὰ φύσιν, praeter naturam) . Taking disease to be a deflexion from the line of health, the first requisite of medicine is an extensive and intimate acquaintance with the norm of the body. The structure and functions of the body form the subject of Anatomy (q.v.) ”

“ Mead, a man of great learning and intellectual activity, was an ardent advocate of the mathematical doctrines. “It is very evident,” he says, “that all other means of improving medicine have been found ineffectual, by the stand it was at for two thousand years, and that, since mathematicians have set themselves to the study of it, men already begin to talk so intelligibly and comprehensibly, even about abstruse matters, that it is to be hoped that mathematical learning will be the distinguishing mark of a physician and a quack.” ”

“ We see now that the practice of the experimental method endows with a new vision both the experimenter himself and, through his influence, those who are associated with him in medical science, even if these be not themselves actually engaged in experiment; a new discipline is imposed upon old faculties, as is seen as well in other sciences as in those on which medicine more directly depends. ”

“ Among the achievements of the medicine of the 19th century the growth of the medical press must not be forgotten. In England, by the boldness of the Lancet (founded in 1823) , the tyranny of prescription, inveterate custom, and privilege abused was defied and broken down; freedom of learning was regained, and promotion thrown open to the competent, independently of family, gild and professional status. For the record and diffusion of rapidly growing knowledge, learned societies, universities and laboratories, greatly increased in number and activity, issue their transactions in various fields ”

“ In this we see a spirit very different from the enthusiasm of the humanists for a purer and nobler philosophy than the scholastic and Arabian versions of Greek thought. There is no record of Paracelsus’ knowledge of Greek, and as, at least in his student days, the most important works of Greek medicine were very imperfectly known, it is probable he had little first hand acquaintance with Galen or Hippocrates, while his breach with the humanists is the more conspicuous from his lecturing and writing chiefly in his native German. ”

“ Yet it was scarcely until the last quarter of the 19th century that the apprenticeship system, which was a mere initiation into the art and mystery of a craft, was recognized as antiquated and, in its virtual exclusion of academic study, even mischievous. In place of it, systematic clinical classes have become part of the scheme of every efficient school of medicine. A condition of this reform was the need of a preliminary training of the mind of the pupil in pure science, even in physics and chemistry ”

“ Galen was as devoted to anatomical and, so far as then understood, physiological research as to practical medicine. He worked enthusiastically at dissection, though, the liberty of the Alexandrian schools no longer existing, he could dissect only animals, not the human body. In his anatomical studies Galen had a twofold object—a philosophical, to show the wisdom of the Creator in making everything fit to serve its purpose; and a practical, to aid the diagnosis, or recognition, of disease. ”

“ Although no system or important doctrine of medicine was originated by the Roman intellect, and though the practice of the profession was probably almost entirely in the hands of the Greeks, the most complete picture which we have of medical thought and activity in Roman times is due to a Latin pen, and to one who was, in all probability, not a physician. ”

“ Hippocratic Medicine.—The first grand characteristic of Hippocratic medicine is the high conception of the duties and status of the physician, shown in the celebrated “Oath of Hippocrates” and elsewhere—equally free from the mysticism of a priesthood and the vulgar pretensions of a mercenary craft. So matured a professional sentiment may perhaps have been more the growth of time and organization than the work of an individual genius, but certainly corresponds with the character universally attributed to Hippocrates himself. ”

“ The doctrine of heredity in disease thus took a larger aspect; the view of morbid series was no longer bounded even by the life of the individual; and the propagation of taints, and of morbid varieties of man, from generation to generation proved to be no mere repetition of fixed features but, even more frequently, to be modes of development or of dissolution betraying themselves often in widely dissimilar forms, in series often extending over many lives, the terms of which at first sight had seemed wholly disparate. ”

“ To know the nature of man and how to deal with it, the physician should study, not anatomy, which Paracelsus utterly rejected, but all parts of external nature. Life was a perpetual germinative process controlled by the indwelling spirit or Archeus; and diseases, according to the mystical conception of Paracelsus, were not natural but spiritual. Nature was sufficient for the cure of most diseases; art had only to interfere when the internal physician, the man himself, was tired or incapable. ”

“ By his eminent labours in cellular pathology, Virchow, and Metchnikoff later, gave the last blow to the mere humoral pathology which, after an almost unchallenged prevalence for some two thousand years, now finds a resting-place only in our nurseries. Now the cellular pathology of the blood, investigated by the aid of modern staining methods, is as important as that of the solid organs; no clinical investigator—indeed, apart from research, no practitioner at this day—can dispense with examination of the blood for purposes of diagnosis ”

“ It was the concepts derived from the experimental methods of Harvey, Lavoisier, Liebig, Claude Bernard, Helmholtz, Darwin, Pasteur, Lister and others which, directly or indirectly, trained the eyes of clinicians to observe more closely and accurately; and not of clinicians only, but also of pathologists, such as Matthew Baillie, Cruveilhier, Rokitansky, Bright, Virchow—to name but a few of those who, with (as must be admitted) new facilities for necropsies, began to pile upon us discoveries in morbid anatomy and histology. ”

“ Soranus is known by a work, still extant in the Greek original, on the diseases of women, and also by the Latin work of Caelius Aurelianus, three centuries later, on acute and chronic diseases, which is based upon, if not, as some think, an actual translation of, the chief work of Soranus, and which is the principal source of our knowledge of the methodic school. The work on diseases of women is the only complete work on that subject which has come down to us from antiquity, and shows remarkable fullness of practical knowledge in relation to its subject. ”

“ That the methods and the subject-matter of surgery and of medicine are substantially the same, and that the advance of one is the advance of the other, the division being purely artificial and founded merely on accidents of personal bent and skill, must be insisted upon at this time of our history. The distinction was never a scientific one, even in the sense in which the word science can be used of the middle ages ”

“ In the department of abdominal disease progress has been made, not only in this enormous extension of means of cure by operative methods, but also in the verification of diagnosis. The first recognition of a disease may be at a necropsy, but then usually by irresponsible pathologists; it is another matter when the physician himself comes under rebuke for failing to seize a way to cure, while the chance remained to him, by section of the abdomen during life. ”

“ In the middle part of the century, by a natural exaggeration of the importance of newly-discovered local changes in the pelvic organs, much harm was done to women by too narrow an attention to the site, characters and treatment of these; the meddlesomeness of the physician becoming in the temperament of woman a morbid obsession. ”

“ At any rate the mean standard of health will be raised, perhaps enormously.
In the tropics, as well as in Europe, such methods and such researches threw new light upon the causes and paths of the terrible infections of these climates. In 1880, two years before Koch discovered the bacillus of tubercle, C. L. A. Laveran (b. 1845) discovered the parasite of malaria, and truly conceived its relations to the disease; thus within two years were made two discoveries either of which was sufficient to make the honour of a century. ”

“ It is needless to point out the influence of the crusades in making Eastern ideas known in the Western world. The influence of Arabian medicine soon began to be felt even in the Hippocratic city of Salerno, and in the 13th century is said to have held an even balance with the older medicine. After this time the foreign influence predominated; and by the time that the Aristotelian dialectic, in the introduction of which the Arabs had so large a share, prevailed in the schools of Europe, the Arabian version of Greek medicine reigned supreme in the medical world. ”

“ He professed to base medicine entirely on a knowledge of symptoms, regarding all investigation of the causes of symptoms as useless. While thus rejecting all the lessons of morbid anatomy and pathology, he put forward views respecting the causes of disease which hardly bear to be seriously stated. All chronic maladies result either from three diseases—psora (the itch) , syphilis or sycosis (a skin disease) , or else are maladies produced by medicines. Seven-eighths of all chronic diseases are produced by itch driven inwards. ”