Philip Henry Pye-Smith

“ We know that the real difficulty is to ascertain the nature and origin of our patient’s disorder; when that is done, the treatment in most cases is obvious, and in many effectual; when it is not done, our treatment is vacillating, and either futile or mischievous. We have already ample means at our disposal for influencing almost every organ of the body. A new tool is occasionally offered us which deserves proving, but what we want far more is knowledge how to use the tools that we have. ”

“ Again, we can most of us remember using very imperfect physiological knowledge to fix, more or less successfully, the locality of an organic lesion in the brain. I also remember such attempts being described as a mere scientific game, which could only be won after the player was beaten, since when the accuracy of diagnosis was established, its object was already lost; but who would say this now, when purely physiological research and purely diagnostic success have led to one of the most brilliant achievements of practical Medicine, the operative treatment of organic diseases of the brain? ”

“ I would, moreover, exhort Fellows of the College to see that, while all the new methods of Experimental Pathology and of Pharmacology are carried out by duly trained physiologists, we do not neglect the fundamental method taught and practised by Harvey of inspecting the bodies of those who have died of disease. It was this union of Morbid Anatomy with Clinical Observation which made the discoveries of Laennec and of Bright really fruitful. Without these autopsies, clinical medicine is but an empirical art, diagnosis a sham, and treatment little better than quackery. ”

“ With regard, for instance, to the physiology of the circulation, it is not only curious but instructive to follow its gradual growth from Galen and Vesalius, Columbus, Caesalpinus and Servetus, to Harvey and Lower and Malpighi, to Hales and Vierordt, to Ludwig, to Chauveau and Marey, to Gaskell, and Roy. The only true scientific method is the historical one. If we only know the results of a science without the steps by which they have been reached, we have indeed its practical use, but lose half its educational value. ”

“ For physiology is the study of natural conditions, and must first be studied by physicians, inasmuch as what is normal is healthy, and the rule for its own rightness, as well as for every abnormal deviation therefrom. But when deviations from health, or any abnormal conditions are defined by the light of healthy structures, then pathology, the science of disease, becomes intelligible. Then also from a knowledge of pathology the practice and art of healing, and numberless new methods of treatment, will naturally spring. ”

“ Now, the ambition of every intelligent student—and in Medicine we are life-long students—is to fix upon the most objective, certain, and important of the symptoms of a patient, to follow out this clue, to determine the organ affected and the nature of the affection, so that in his mind’s eye the tissues become transparent and he sees the narrow orifice for the blood-stream and the labouring muscle behind it ”

“ If Harvey’s doctrine of the circulation was not new, why was it opposed by men in the position of Riolanus and Hoffmann, and welcomed as a discovery by Bartolinus and Schlegel and Descartes? Surely his contemporaries were better judges of the novelty of his views than we are!
2nd. Admitting that Servetus and Columbus taught the doctrine of the lesser circulation, we need but a moment’s thought to convince us that no complete knowledge of this part of the subject was possible until the existence of a systemic circulation was established; for the one is physically impossible without the other. ”

“ Morbid Anatomy not only teaches us what lesions we have to discover, but also their true pathological relation. We learn that every disease does not affect every part of the body. If we make a horizontal list of all the organs and tissues, and a vertical one of all the known morbid changes, according to Rokitansky’s laborious and thorough-going method, we find the table almost useless, since the blanks are more numerous than the entries. ”

“ But even such a broad and liberal education, even familiarity with the daily advances of medical science recorded in periodicals and archives and year-books, or transmitted by telegraph to the wondering readers of the daily newspapers, is not all that is needful to make a learned Physician. We know well the difference between reading of an experiment, or even seeing it performed, and doing it with our own hands. ”

“ True, there are functional disorders and others which are toxic or parasitic; but it is the object of the study of Morbid Anatomy to limit, and, as nearly as may be, to abolish the former group by tracing disordered functions to structural changes or to poisonous or parasitic influences. We may measure the progress of medical science during the present century by the fact that Fever, Dropsy, Paralysis and Apoplexy are for us no longer diseases but only symptoms which leave us unsatisfied till we have traced them to their origin. ”

“ The strong intellect will absorb and digest all that we put before it, and will be all the better fitted for independent research. The less powerful will at least be kept from false discoveries, and will form (what genius itself requires) a competent and appreciative audience. Even the dullest scholars will be respectable from their learning, and if they cannot make discoveries themselves, can at least enjoy the delight of intelligently admiring the discoveries of others. ”

“ No one would easily believe how greatly the viscera are altered by disease, particularly in chronic cases, and how extraordinary the anatomical effects of prolonged sickness often are. Indeed, I am confident that the opening and thorough inspection of one dead body, which has been wasted by slow disease or by infection, is of more real service to the art of healing than the dissection of ten corpses of healthy criminals. ”

“ Treatment without diagnosis, besides its inefficiency, brings us for the time unpleasantly near to the charlatan who, whatever title he may assume, is always therapeutical and never pathological. Rational, bold, and effectual treatment, whether preventive or curative, must always depend upon accurate diagnosis and sound pathology, and the power of diagnosis depends upon that systematic inspection of the bodies of diseased persons which was recommended and practised by Harvey. ”

“ Let us hope that on the one hand increasing humanity and gentler manners will extend compassion for the lowest of God’s creatures from the educated classes of England and America until it permeates all ranks and all nations ; and that on the other full liberty will be given to the prosecution of researches, laborious and thankless in themselves, but of the utmost value for the relief and prevention of disease in man and brute alike. ”

“ Cruelty is utterly repugnant to our calling; and it seems absurd that men, who will with just confidence entrust themselves and the lives of those nearest to them to our protection and care, should yet so far distrust us as to shackle attempts to improve our knowledge and our power by cumbersome and ridiculous restrictions. ”

“ The experiments on blood-pressure begun by Hales, and carried to a successful issue in our own time by Ludwig, have led to knowledge which we use every day by the bed-side, and which only needs the discovery of a better method of measuring blood-pressure during life, to become one of our foremost and most practical aids in treatment. ”

“ A perusal of Harvey’s own statements makes it plain, it seems to me, that having gained his knowledge of the anatomy of the heart and of the current hypotheses of its function from his Italian masters, he reasoned thus:—First, that the cardiac valves must be intended for such physiological service as their construction would indicate. He believed that every part of this human microcosm has a meaning; that it is by no chance result of blind forces that an organ is adapted to its end. ”

“ A crowd of idle philosophers, discussing all things in Heaven and Earth through the long summer days and balmy nights of Attica, must sometimes have hit on a true opinion, if only by accident; but Thales, or whoever broached the heliocentric dogma, had no reason for his belief, and showed himself not more, but less reasonable than his companions. ”

“ Nor is it here alone that we may congratulate ourselves upon the liberal and cordial feelings which happily prevail. The same may, I believe, be said of our sister college, with which we are so happily united, not only in the necessary duties of examination, but in the nobler union of joint endeavours to search out the secrets of Nature by way of experiment. ”

“ The very notion of Diagnosis in our modern sense of the word depends upon Morbid Anatomy. The older physicians seldom attempted to determine the seat of an ailment. [8] Disease was looked upon not as a condition depending upon disordered physiological functions, but as something external, attacking a previously healthy person, disturbing, and, if not expelled by art, finally destroying him; while any structural changes which were found after death were regarded rather as the effects than the causes of the symptoms during life. ”

“ These were Harvey’s methods, as they must be the methods of all Natural Science. First, observation; next, reflection; then experiment. “Don’t think; try,” was Hunter’s advice to Jenner; an advice that is often needed by an acute and speculative genius like his; still more often by sheer idleness, that will never bring its fancies to the test of fact. [2]
Experiments without hypotheses are often fruitless, but hypotheses which are never brought to the test of experiment are positively mischievous. ”

“ Exclusive attention to Therapeutics is apt to bring a man dangerously near to Homoeopathy and other pretended Systems of treatment, but sound pathology, and diagnosis controlled by post-mortem inspection, give positive knowledge and that union of modest self-confidence and prudent enterprise which become the physician. ”

“ For maintaining and strengthening this spirit of concord and good feeling, we depend upon each one of our Fellows, but especially on the example and authority of our Head—an example and authority which, as the College well knows, are worthily maintained by the untiring devotion to its best interests of our honoured President. ”

“ This question has been often discussed, and it has even been maintained that he is most likely to search out "the secrets of Nature by way of experiment,” who comes fresh to the task with his faculties unexhausted by prolonged reading, and his judgment uninfluenced by the discoveries of others. This, however, is surely a delusion. Harvey could not have discovered the circulation of the blood had he not been taught all that was previously known of Anatomy. True, no progress can be made by mere assimilation of previous knowledge. ”

“ But the records of such inspections in the 17th century by Bartolinus, or Tulpius, or Bonetus, or, in our own country, by Mayerne, or Bate, or Morton, are fragmentary, their object being limited to the individual case. There was no attempt to search out the secrets of Nature in disease by a systematic observation of the state of the organs after death, nor was there for more than a century after Harvey’s death. ”

“ Doctrina sed vim promovet insitam;" and few things are more deplorable than to see talent and industry occupied in fruitless researches, partially re-discovering what is already fully known, or stubbornly toiling along a road which has long ago been found to lead nowhither. We must then instruct our students to the utmost of our power. Whether they will add to knowledge we cannot tell, but at least they shall not hinder its growth by their ignorance. ”

“ The countless experiments on living animals which were carried out during the 17th century in all civilised countries—in Italy, Holland, Denmark, France, Germany, and England—bore a rich fruit of physiological knowledge. ”

“ Moreover, such concomitant variations as hypertrophied left ventricle, and granular kidneys, basal meningitis and caseous lymph glands, visceral abscess and ulceration of the cardiac valves teach us much more than anatomy or diagnosis. They throw a clear light upon the nature and the origin of diseases, and hence upon their prevention and cure. ”