the medical man, we cannot fail to be struck by the great increase
in the number of things that have come to be regarded as within his
sphere. It is a commonplace that he has in large part taken the place
of the parson. But he has also made encroachments on the functions of
the lawyer, the legislator and the judge, of the schoolmaster, the
architect and the statistician. He has assumed some of the duties of
the parent and guardian, while even the soldier and the policeman are
to some degree under his control. In the ordering of their lives,
and even in the regulation of their vices and the reform of their
shortcomings, men and women are far more willing to seek the advice and
help of the medical man than once they were. The reason is, without
doubt, that his advice is much more worth having than it once was.
The organization of research, the systematized record of experience,
the improved intercommunications of our time, have combined to
increase vastly the medical man’s sources of information and to make
his application of them more accurate and more scientific. Moreover,
there are factors in our social life itself that have tended not only
to deepen the physician’s knowledge but to widen his experience. His
effective working-day has greatly lengthened. No doubt, the motor car
and railway train are important elements in this extension of the
doctor’s day, but a far more fundamental element is the advent of the
skilled nurse. Many tasks which occupied the time of the doctor in the
old days are now relegated to her. The result is that the doctor sees
a far greater number of patients and has a much greater experience of
actual sickness than was formerly possible.
But after we have discussed all those factors which have gone to
the increase of the power of Physic we have still to consider the
philosophical basis which has conditioned this increase. Men do not
willingly accept that in which they do not believe. The shifting of
men’s trust implies a shifting in their faith. In truth the triumph
of Physic has underlying it a subtler triumph, that of Scientific
Determinism. The great increase in the detailed knowledge of Nature has
led to a great increase in the belief in the Reign of Law. Disease and
death were once thought to be the special acts of Providence. They are
now widely held to be illustrations of determined natural laws. Men
of science in general, and medical men in particular, are not wont to
profess themselves philosophers, but, in fact, much of their work is
done in a spirit which would have us believe that these determined laws
are universal and are wholly outside ourselves. Has there not arisen a
school that would claim that our thinking is but a seeming, and that
we do but behave as though we thought? Three centuries ago Descartes
conceived that the animal might be treated as a machine. If man be
but an animal, consequences are entailed from which Descartes shrank,
for the watchword of his philosophy was ‘Cogito, ergo sum’, _I think,
therefore I am_. There is a newer school whose work is intimately
bound up with the progress of Medicine that would abandon this basic
doctrine of the father of modern Philosophy, who is also the founder
of Physiology, as a separate discipline.
The position as it stands appears as a dilemma. The triumphs of
Science have been secured by disregarding Mind, and yet they cannot be
appreciated or advanced without invoking Mind. Unless we accept the
full conclusions of the Determinist Philosophy, we are forced to the
conclusion that Mind must do something to the animal body. If Mind
holds the reins, there must be a point at which Mind pulls the reins.
The matter ever in dispute is where that point may be. If life and
growth are bound up with an Entelechy, as seems to the author of this
work to be the case, there must somewhere and somehow be a level in the
organism at which the laws of physics and chemistry are transcended by
some other mode of action.
It is no part of our task to provide a Philosophy which will resolve
all the problems that our subject raises. Nevertheless, in the presence
of this dilemma, such a work should not close on too optimistic a note,
in the department either of medical thought or of its application. Even
if looked at merely as an interpreter of its own terms, determinist
thought, which lies at the basis of modern medical developments, has
not been quite so universally successful as is often supposed, and as
the preceding pages of this book may lead the reader to think. While
enormously increasing the sum of our knowledge of Nature, it has also
tended more and more to separate the parts of that knowledge from each
other. It is clear that no such way of thinking can ever give us a
survey of Nature as a whole. It can never enable us to ‘think things
together’, and without such thinking together our life is and must
remain a contradiction and a muddle.
For a real survey of Nature we must look to another Philosophy and
another Method. We are in this matter but just entering on a new era,
and may it not be that some sort of solution will be provided by a
better study of the Mind itself? Only by our minds can we know that
Nature presents us with any order at all. It therefore behoves us to
search out most diligently all that we can learn about our minds, to
see whether, on the one hand, this determined order, which has so
impressed our age, is in any degree within us and part of our observing
instrument, or whether, on the other hand, it is wholly without us.
There is much evidence that it is not wholly without us, and that
Determinism is a habit in our method of thinking on certain topics, and
that the emphasis on the ‘primary qualities’ (see pages 106-8) which we
inherit from Galileo is by no means justified. It may be that what we
think and feel and see is not only as real as what we weigh and count
and measure, but that weighing, counting, and measuring are but forms
of thinking, feeling, and seeing. In this connection the reader should
turn over again in his mind the implications of the ‘Law of Specific
Nerve Energies’ enunciated by Johannes Müller (see pp. 212-13).
Nor must we end on too optimistic a note as to the actual achievements
of Science. Advances in our knowledge have certainly been very great,
but they may be and often are exaggerated. We must always guard
ourselves against considering mere accumulation of detail as an
advance. The collection of data is but a means to an end, and if that
end is not reached they are a very weariness and vexation of the
philosophic spirit. Real advance in knowledge can only be tested by
effective advances in theory, and thus judged the cost of progress--the
cost in the brute accumulation of facts--has increased far more rapidly
than progress itself. What is wanted is not so much new data as
correlation in their accumulation. The increase in medical specialism
is not so much evidence of advance as it is of the heaping up of
uncoordinated observations.
Works on Medicine intended for popular consumption are often couched
in the jubilant terms of victory. Yet there are whole departments in
which no progress whatever has been made. We pride ourselves on the
advance in knowledge of infectious disease which the germ theory has
brought us, and yet we are utterly and completely ignorant of the two
things about infectious disease which are the two things most worth
knowing on that topic. Firstly, no man has conceived the way in which
the parasites of disease first fastened themselves on the animal body,
a specific parasite to a specific animal. In other words, we have not
the least idea how diseases first begin. Secondly, no man has conceived
a reason why diseases, distributed over a wide area and in many bodies,
should vary in virulence from time to time, why, for instance a
relatively mild condition, such as influenza, should suddenly devastate
the world. It is easy to say that human resistance varies, but that is
only to restate the problem in terms of which we know nothing. On these
high topics of Medicine we know as much and as little as Hippocrates.
Moreover, if we turn to definite diseases, there are many conditions,
and those among the most important, of which our ignorance is almost
complete. Thus of the very common and painful diseases, muscular
rheumatism and rheumatoid arthritis, we know hardly more than
Hippocrates and our remedies are but little more effective than his.
The common cold--economically the most important of all diseases, not
excluding Cancer and Tuberculosis--has a vast literature, but the
physician is almost helpless in its presence and can but let it run
its course. Measles, Whooping-cough, and Influenza have become more
deadly of late years. We have still no clear line of treatment for
them. Nor have we any real insight into the nature of Cancer. Those
who reach advanced age have no better chance of life than they had
two hundred years ago (p. 177). Above all, it must be remembered that
the great majority of deaths are caused by diseases theoretically
preventable. There is a natural term to life which it is desirable that
all should attain. Yet most of us will surely die a violent death as
truly as though struck down by a felon’s hand. Death from disease is an
unnatural and a violent death.
Faced by facts of this order there are those who constantly urge
increased activity in medical ‘research’. But research can only be
prosecuted by those whose talents specially fit them for the work.
With reason it may be and is doubted whether there are many in Western
Europe or America who could profitably be employed on medical research
who are not already so employed. It is easy to make investigations
on a certain level, but those best qualified to judge are of opinion
that the general level of medical research has fallen, not risen, of
late years. The number of publications has multiplied manyfold, but
there are those who doubt if there is much increase in investigation of
the first order. The increase in specialism and the extremely narrow
outlook of some workers has stultified much investigation, since with
his decreased range the researcher is often less able to perceive the
bearings of his own work. Thus he may labor for years elaborating a
technique by means of which he may collect facts without that guiding
wisdom or judgment that is the mark of genius. It must ever be borne
in mind that the object of fact-collecting is the deduction of law.
Not all facts can be collected, for facts are infinite in number, and
it is therefore necessary to select. Selection involves _judgment_,
the final and indefinable property of Mind; for, if from the facts no
laws emerge, the facts themselves become an obstacle, not an aid, to
scientific advance.
All who have to read systematically large masses of modern scientific
literature have been unfavorably impressed by its absence of form. It
is evident that a large proportion of scientific workers lack adequate
literary training and never acquire a proper sense of literary form.
The growing interest in Science has had an unfavorable effect on
Education in the direction of early and intensive specialization. The
result is that many scientific publications are but semi-literate,
they are often incoherent in presentation and even more frequently
unnecessarily diffuse. Nor is it merely a matter of form. Language is
but the outward and visible sign of which Thought is the inward and
spiritual reality. Confused writing usually indicates and always leads
to confused thinking. Thus the unliterary character of scientific
writing bids fair to pass from being a mere nuisance to become a great
scientific evil. Good and effective writing implies a broad and solid
literary background, just as good and effective scientific research
implies a broad and solid scientific background. The fact is that the
Humanities and the Sciences are far from being as independent of each
other as many suppose. If literary studies lead to clear and effective
expression and clear and effective thinking in the domain of Science,
scientific studies ventilate and inform and vitalize Literature. The
separation of the two disciplines, especially in the adolescent stage
of mental development, does an injury to both. The concentration of the
endowments of Learning on the scientific departments and especially on
the departments of applied science has given rise to a very widespread
evil which is none the less evil because it is subtle.
Within the sphere of the specifically medical sciences themselves there
are tendencies which are open to somewhat similar criticism.
The great fallacy from which scientific Medicine has suffered in the
past, and still to some extent suffers, is the ‘direct attack’. We
have come to look upon the animal organism as an immeasurably complex
machine. For its elucidation knowledge from the most diverse quarters
is therefore demanded. The physical chemist, the organic chemist,
the physicist, the mathematician, the protozoologist, the systematic
biologist, the botanist, the spectroscopist, the geologist, and a host
of others are following callings which have no obvious bearing on the
study of disease. Yet the results obtained by them, and by men of
science in many other departments, must be utilized in the study of
disease. Our knowledge of health and of disease thus depends on the
sciences as a whole--nay, on Knowledge as a whole. Those who would
promote the health of mankind would do well if they sought to encourage
not so much the medical sciences as Science as a whole, or rather
Learning as a whole, for Science is a way of life which may penetrate
into all departments of Learning, and is something far greater than
those discrete accumulations of knowledge that we call ‘the sciences’.
The Sciences, working out their destiny, must in the end come together
again.
If that consummation be reached we may expect improvement in health and
prolongation of life to a degree greater than any previous ages have
seen. We may indeed expect something yet better, for we may hope for a
philosophy of the mind that shall make life better worth the living.
Medicine cannot give immortality, but it should enable us all to live
out our full lives. Death, coming in due and not undue time, is shorn
of all his terrors, when every man and every woman
Shall come to his grave in a full age,
Like as a shock of corn cometh in, in his season.
_Job_ v. 26.
[Illustration: FRIENDLY DEATH]
INDEX
Abdominal Surgery, 243-8
Achondroplasia, 17
Adrenals, 325
Aesculapius (Asklepios), 4, 7, 8, 11, 49, 51
Ague, _see_ Malaria.
Air, Nature of, 151-6
Air-Pump, Boyle’s, 125-6
Albinus, Bernard Siegfried (1697-1770), 140-1
Albucasis the Moor (11th cent.), 67, 70
Alchemy, 122-6
Alcoholism, 291
Alexander the Great, 27, 36
Alexandria, 52
Alexandrian School, 36-41
Alkaloids, 325-7
Almond Oil, 322
Aloes, 322
Alum, 322
American Civil War, 300
Ammoniacum, 322
Amputation, 240, 336
Amyl nitrite, 329
Anaerobic bacteria, 257
Anaesthesia, 162, 235-7
Analgesia, 237
Anatomy, 122, 138;
of Galen, 55-6;
Medieval, 72-6;
Renaissance, 82-92;
earlier 19th cent., 204;
Morbid, 156-9
Anatomy Act (1832), 193
Aneurysm, 166
Animal Spirit, 58
Animism, _see_ Nature-Worship
Aniseed, 322
Ann Arbor, 328
Anthrax, 229-34, 250-1, 261
Antibodies, 262, 268-9, 330, 333
Antidiphtheritic serum, 264
Antirachitics, 312-13
Antiseptic Surgery, 235, 237-43.
Antiseptics, 162
Antitoxins, 264-5, 325
Antoninus, Emperor, Statute of (160), 46
Apertorium, the, 164
Aphorisms, the, 256
Appendicitis, 336
Aqueducts, Roman, 46
Arabic Drugs, 323
Arabic Medicine, 66-8
Aricia, 12
Aristophanes, 29
Aristotle (384-322 B.C.), 1, 14, 27-35, 37, 69, 86
Arles, 42
Arsenic, 331
Asclepiades of Bithynia (d. _c._ 40 B.C.), 41-2
Aseptic Surgery, 235, 237-43
Asklepios, _see_ Aesculapius
Aspirin, 327
Assyria, 6;
Medical Tablets in, 322
Astigmatism (Irregular Sight), 317-19
Astrology, 54
Astronomy, 103-5, 122, 135-6
Atomic Structure, 37, 126
Atropine, 326
Auenbrugger, Leopold (1722-1809), 160
Augustus, Emperor (reigned 27 B.C.-A.D. 14), 42
Aural Surgery, 188
Avicenna, the Persian (980-1036), 67, 70, 72, 74, 82, 180
Avignon, 76
Babylonians, the, 6-7
Bacon, Roger (1214-84), 318
Bacteria, 120, 121, 227
Bacteriology, 249-53
Bacteriolysins, 269
Baer, Karl Ernst von (1792-1876), 204
Bagdad, 66
Baillie, Matthew (1761-1823), 158
Balfour, Francis Maitland (1851-82), 204
Bayer, 205, 332
Beaumont, William (1785-1853), 148
Bedlam, 286
Behring, Emil von (1854-1917), 264, 266
Bell, Sir Charles (1774-1842), 145, 207, 213
Belladonna, 322
Bentham, Jeremy (1748-1832), 178, 190-2, 192-3
Bergmann, Ernst von (1836-1907), 248
Beri-Beri, 272, 313
Berlin, 222, 230, 248, 321
Bernard, Claude (1813-78), 213-15, 229, 326
Bethlem Hospital, 286
Biggs, Hermann M., 202
Binz, Karl (1832-1912), 328
Biology, 132, 139
Bismuth, 325
Bitumen, 322
Black, Joseph (1728-99), 151-3
Black Death, the, 80-1
Blood, Circulation of, 111-20, 146
Blood-letting, 39
Blood-poisoning, 239
Blood-pump, mercurial, 218
Board of Health, 194-6
Boerhaave, Hermann (1668-1738), 122, 139-42, 151, 156-7, 169-70
Bologna, 71-4, 76, 116, 149
Bonn, 205, 222
Bordeaux, 42
Bordet, Jules (1870-), 269
Borelli, Giovanni Alfonso (1608-79), 39, 129-31
Boston, Mass., 198
Botany, 95-6, 138
Boyle, Robert (1627-91), 35, 101, 124-6, 151
Brahe, Tycho (1546-1601), 103, 135
Brain, Aristotle on, 29-30
Bretonneau, Pierre (1771-1862), 185, 253
Broca, Paul (1824-80), 211
Brownlee, John (1868-1927), 348-9
Bruce, David (1885-), 255
Bruno, Giordano (1548-1600), 102-3
Brunton, T. Lauder (1844-1916), 329
Brussels, 85
Bubonic Plague, 201
Caesar, Julius (102-44 B.C.), 45, 46
Caesarean Section, 45
Caffeine, 326
Cambridge, 111, 311
Camomile, 322
Canada, 290
Cancers, 223-4, 337-9, 359
_Cannabis indica_, 322
Caraway, 322
Carbohydrates, 311
Carbolic Acid, 239-40
Carbon dioxide, 153, 155-6
Cardamoms, 322
Carpenter, Mary (1807-77), 300
Carrel, Alexis (1873-), 248
Carrier Problem, 269-70
_Cassia fistula_, 322
Castor Oil, 322
Cataract of the Eye, 320-1
Catechu, 322
Cattle-plague, 344
Cavendish, Henry (1731-1810), 153, 156
Caventou, Joseph (1795-1878), 326
Cell Theory, 219-24
Cellular Pathology, 219-24
Celsus, 43-4, 320
Census system, 168
Cerebral Haemorrhage, 338, 340
Cerebrospinal Meningitis, 269-70
Chadwick, Edwin (1800-90), 171, 178, 193-6, 202
Charcot, Jean Marie (1825-93), 211
Charles V, Emperor, 88
Chemotherapy, 329-33
Chester, 182
Cheyne-Stokes Respiration, 25-6
Chicago, 248
Child Life, 18th c., 180-1
Children in Factories, 191, 194
Chloroform, 235, 236
Cholera, 194-5, 198, 201, 234;
chicken, 234, 261
Cholestrol, 312-13
Christianity, 61-2
Chyle, 56
Cinchona, 95, 281-2, 323, 326, 330
Cinnamon, 323
Claudius, Emperor (reigned 41-54), 49
Cleopatra, 36, 41
Clinical Medicine, 100;
Methods and Instruments, 159-61;
Teaching, Rise of, 138-42
Clinical Thermometer, 159
Cloaca Maxima, 45
Cnidus, 8
Cocaine, 236-7, 326
Coffee, 326
Cohnheim, Julius (1839-84), 238
Colchicum, 323
Colocynth, 323
Constantine (d. 1087), 64-5
Constantinople, 183
Consumption, 234
Contagious Diseases in 19th cent., 201
Cook, James (1728-79), 170
Cope, E. D. (1840-97), 204
Copernicus, Nicholas (1473-1543), 88, 102
Coriander, 322
Corning, J. L. (1855-), 236
Cos, 8, 14
Cretinism, 304
Crile, G. W. (1864-), 237, 310-11
Crimean War (1854), 298
Crocus, 323
Curve of Error, 345-9
Cushing, Harvey (1869-), 236, 249
Cushny, A. R. (1866-1926), 329
Cuvier, Georges (1769-1832), 204
Cytology, 223
Cyto-Pathology, 223
Darwin, Charles (1809-82), 204, 227, 293
_Datura stramonium_, 322
Daviel, J. (1696-1762), 320
de Baillou, Guillaume (1538-1616), 96, 98-9
de Chauliac, Guy (1300-68), 76-7
Delirium, early case of, 25
Dementia praecox, 292
Democritus (_c._ 400 B.C.), 37
Demography, 188
de Mondeville, Henri (_c._ 1270-1320), 72, 74
Dengue, 272
Derosne, Charles (1780-1846), 326
Descartes, René (1596-1650), 39, 103-4, 127-9, 207-8, 355
Diabetes, 306
Diarrhoea, 347
Diderot, D. (1713-84), 131
Digestion, 146-8, 214-15
Digitalis (Foxglove), 323, 328
Dill, 322
Dioscorides, 43, 322
Diphtheria, 24, 185, 201, 253;
immunization, 262-7
Dispensary Movement, 178, 180
Dix, Dorothea Lynde (1802-87), 290
Donders, Frans Cornelis (1818-89), 319, 320
Dorians, the, 4
Dorpat, 328
Drugs, 95, 322-33
Ductless Glands, 302-8
Dürer, A., 83
Düsseldorf, 50
Dumas, Jean-Baptiste (1800-84), 326
Dysentery, 271, 330
Eberth, Karl Joseph (1835-1927), 258
Edinburgh, 235
Egyptian Civilization, 7
Egyptian Medical Papyri, 322
Ehrlich, Paul (1854-1915), 269, 330-1
Electricity, 149-51
Elements, the Four, 34, 124
Embryology, 30-2, 110, 117-18, 120-1, 204
Emetine, 330, 332
Emphysema, 158
_Encyclopédie_ (1751-72), 130
Endotoxins, 260, 266
Entelechy, ix, x, 33, 356
Epicurus (342-270 B.C.), 37
Epidaurus, 11
Epidemics, 182-5, 198, 200-1, 342-50
Epidemiology, 138
Epileptics, 292
Erasistratus of Chios (_c._ 300 B.C.), 36, 37-40
Erysipelas, 239
Esquirol, Jean Étienne D. (1772-1840), 288-9
Ether, 235, 237
Evolution, Organic, 27, 31
--, theory of, 204
Exotoxins, 260, 266
Experimental Medicine, 211-19
Eye, the, and its Disorders, 313-22
Fabricius, Jerome, of Aquapendente (1537-1619), 109-11
‘Far Sight’, 316-18
Farr, W. (1807-83), 343-5
Fat, 311
Federal Health Service, 200
Fennel, 322
Fermentation, 225-8, 230, 239
Ferrier, D. (1843-), 211
Fevers, 67, 101, 169, 171-2, 174, 185, 194, 200-1, 243, 254-5, 258-9;
_see also specific fevers_ (Malaria, Typhoid, Yellow, &c.)
Fliedner, Frederica (1800-42), 297
Fliedner, Theodor (1800-64), 297
Floyer, Sir J. (1649-1734), 159
Foxglove, _see_ Digitalis
Fracastoro, Girolamo (1483-1553), 96, 98
Fractures, 246-8
Frankfurt, 330
Franklin, Benjamin (1706-90), 171
Freud, S. (1856-), 293
Fry, Elizabeth (1780-1845), 171, 297
Galbanum, 322
Galen of Pergamum (130-200), 1, 39, 50-3, 320;
his Medical System, 53-60;
in the Renaissance, 82-90
Galilei, Galileo (1564-1642), 103, 104-8, 108-9, 115, 135-6, 138,
159, 356
Galls, 323
Galvani, Luigi (1737-98), 149-51
Galvanism, 149-51
Gastric Juice, 148, 303
Gay-Lussac, Joseph (1778-1850), 326
Gegenbaur, Karl (1826-1903), 204
Geneva, 300
Gengou, O. (1875-), 269
Gentian, 323
Gerhard, William (1809-72), 258
Germ Origin of Disease, 224-37
Giessen, 205
Gilbert, W. (1544-1603), 103
Ginger, 323
Glands, Ductless, 302-8
Glasgow, 249
Glucosides, 327-8
Glycogen, 214
Godlee, Rickman (1849-1925), 248
Goitre, 303-4
_Golden Bough, The_, 12-13
Gorgas, William C. (1854-1920), 279
Gout, 99
Graefe, Albrecht von (1828-70), 320-1
Gravity, 136
Greek Medical Lore, 322
Greek Medicine, 1-13
Guayaquil, 273
Haffkine, Waldemar (1860-), 266
Hales, Stephen (1677-1761), 145-6, 147, 171, 180
Hall, Marshall (1790-1857), 207, 208
Haller, Albrecht von (1708-77), 139, 142-5, 151
Halley, Edmund (1656-1742), 167
Halsted, W. S. (1852-), 236, 248
Hartford, Conn., 237
Harvey, W. (1578-1657), 32, 103, 111-15, 135
Hashish, 322
Health of Towns Association (1840), 194
Heart, Aristotle on, 29, 31
Heberden, W., the elder (1710-1801), his _Commentaries_, 22
Helmholtz, Hermann von (1821-94), 213, 319-20
Herbs, 322-3
Hering, E. (1834-1918), 212
Herophilus of Chalcedon (_c._ 300 B.C.), 36-7
Hippocrates, 1, 8, 14-18, 102, 267, 342, 358-9
Hippocratic Collection, 9-10, 13-18, 22-3, 26, 95, 256, 342
_Hippocratic facies_, 26
Hippocratic Oath, 17-18
Hippocratic Practice, 18-26
Hippolytus, 11
Histology, 219, 222
Holmes, Oliver Wendell (1809-94), 237, 243
Hong Kong, 253
Hopkins, Sir Frederick Gowland, 311
Hormones, 307-8
Horsley, V. (1857-1916), 248
Hospital Gangrene, 239
Hospitals, 48-50, 77-81, 178-80, 198, 200
Howard, John (1726-90), 171, 180, 182
Humors, the Four, 34
Hunter, John (1728-93), 162, 165-6
Hunter, William (1718-83), 158, 165
Hunterian Museum, 166
Hygiene, 40, 169-72;
Roman, 45;
Medieval, 77-81;
18th cent., 174 sqq.;
19th cent., 192-203;
Tropical, 270 sqq.
Hyoscyamus, 323
Hypodermic Syringe, 329
Iatrochemistry, 127, 131-2
Iatrophysics, 127-31
Imhotep, 7, 8
Immunity, 184, 234, 252, 259-70, 276
Indian Hemp, 322
Indian Medicine, Early, 322
Industrial Revolution, 172-81
Infantile Paralysis, 270, 274
Infectious Diseases, 96, 98, 102, 201, 234-5, 358
Infirmaries, Roman, 49
Inflammation, 238-9
Influenza, 270, 280, 349, 359