the evolution of modern medicine-第40节
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es very different from those which surrounded my generation in the seventies of the last century； when Virchow and his great contemporaries laid the sure and deep foundations of modern pathology。 Which of you now knows the 〃Cellular Pathology〃 as we did？ To many of you it is a closed book；to many more Virchow may be thought a spent force。 But no； he has only taken his place in a great galaxy。 We do not forget the magnitude of his labors； but a new generation has new problemshis message was not for youbut that medicine today runs in larger moulds and turns out finer castings is due to his life and work。 It is one of the values of lectures on the history of medicine to keep alive the good influences of great men even after their positive teaching is antiquated。 Let no man be so foolish as to think that he has exhausted any subject for his generation。 Virchow was not happy when he saw the young men pour into the old bottle of cellular pathology the new wine of bacteriology。 Lister could never understand how aseptic surgery arose out of his work。 Ehrlich would not recognize his epoch…making views on immunity when this generation has finished with them。 I believe it was Hegel who said that progress is a series of negationsthe denial today of what was accepted yesterday； the contradiction by each generation of some part at least of the philosophy of the last； but all is not lost； the germ plasm remains； a nucleus of truth to be fertilized by men often ignorant even of the body from which it has come。 Knowledge evolves； but in such a way that its possessors are never in sure possession。 〃It is because science is sure of nothing that it is always advancing〃 （Duclaux）。
History is the biography of the mind of man； and its educational value is in direct proportion to the completeness of our study of the individuals through whom this mind has been manifested。 I have tried to take you back to the beginnings of science； and to trace its gradual development； which is conditioned by three laws。 In the first place； like a living organism； truth grows； and its gradual evolution may be traced from the tiny germ to the mature product。 Never springing； Minerva…like； to full stature at once； truth may suffer all the hazards incident to generation and gestation。 Much of history is a record of the mishaps of truths which have struggled to the birth； only to die or else to wither in premature decay。 Or the germ may be dormant for centuries； awaiting the fullness of time。
Secondly； all scientific truth is conditioned by the state of knowledge at the time of its announcement。 Thus； at the beginning of the seventeenth century； the science of optics and mechanical appliances had not made possible （so far as the human mind was concerned） the existence of blood capillaries and blood corpuscles。 Jenner could not have added to his 〃Inquiry〃 a study on immunity； Sir William Perkin and the chemists made Koch technique possible； Pasteur gave the conditions that produced Lister； Davy and others furnished the preliminaries necessary for anaesthesia。 Everywhere we find this filiation； one event following the other in orderly sequence〃Mind begets mind；〃 as Harvey （De Generatione） says； 〃opinion is the source of opinion。 Democritus with his atoms； and Eudoxus with his chief good which he placed in pleasure； impregnated Epicurus； the four elements of Empedocles； Aristotle； the doctrines of the ancient Thebans； Pythagoras and Plato； geometry； Euclid。〃＇2＇
＇2＇ Works of William Harvey； translated by Robert Willis； London； 1847； p。 532。
And； thirdly； to scientific truth alone may the homo mensura principle be applied； since of all mental treasures of the race it alone compels general acquiescence。 That this general acquiescence； this aspect of certainty； is not reached per saltum； but is of slow； often of difficult growth；marked by failures and frailties； but crowned at last with an acceptance accorded to no other product of mental activity；is illustrated by every important discovery from Copernicus to Darwin。
The difficulty is to get men to the thinking level which compels the application of scientific truths。 Protagoras； that 〃mighty…wise man；〃 as Socrates called him； who was responsible for the aphorism that man is the measure of all things； would have been the first to recognize the folly of this standard for the people at large。 But we have gradually reached a stage in which knowledge is translated into action； made helpful for suffering humanity； just as the great discoveries in physics and chemistry have been made useful in the advance of civilization。 We have traced medicine through a series of upward steps a primitive stage； in which it emerged from magic and religion into an empirical art； as seen among the Egyptians and Babylonians； a stage in which the natural character of disease was recognized and the importance of its study as a phenomenon of nature was announced； a stage in which the structure and functions of the human body were worked out； a stage in which the clinical and anatomical features of disease were determined； a stage in which the causes of disorders were profitably studied； and a final stage； into which we have just entered； the application of the knowledge for their prevention。 Science has completely changed man's attitude towards disease。
Take a recent concrete illustration。 A couple of years ago in Philadelphia and in some other parts of the United States； a very peculiar disease appeared； characterized by a rash upon the skin and moderate fever； and a constitutional disturbance proportionate to the extent and severity of the eruption。 The malady first broke out in the members of a crew of a private yacht； then in the crews of other boats； and among persons living in the boarding…houses along the docks。 It was the cause of a great deal of suffering and disability。
There were three courses open： to accept the disease as a visitation of God； a chastening affliction sent from above； and to call to aid the spiritual arm of the church。 Except the 〃Peculiar People〃 few now take this view or adopt this practice。 The Christian Scientist would probably deny the existence of the rash and of the fever； refuse to recognize the itching and get himself into harmony with the Infinite。 Thirdly； the method of experimental medicine。
First； the conditions were studied under which the individual cases occurred。 The only common factor seemed to be certain straw mattresses manufactured by four different firms； all of which obtained the straw from the same source。
The second point was to determine the relation of the straw to the rash。 One of the investigators exposed a bare arm and shoulder for an hour between two mattresses。 Three people voluntarily slept on the mattresses for one night。 Siftings from the straw were applied to the arm； under all of which circumstances the rash quickly developed； showing conclusively the relation of the straw to the disease。
Thirdly； siftings from the straw and mattresses which had been thoroughly disinfected failed to produce the rash。
And fourthly； careful inspection of the siftings of the straw disclosed living parasites； small mites； which when applied to the skin quickly produced the characteristic eruption。
SANITATION
WHEN the thoughtful historian gets far enough away from the nineteenth century to see it as a whole； no single feature will stand out with greater distinctness than the fulfilment of the prophecy of Descartes that we could be freed from an infinity of maladies both of body and mind if we had sufficient knowledge of their causes and of all the remedies with which nature has provided us。 Sanitation takes its place among the great modern revolutions political； social and intellectual。 Great Britain deserves the credit for the first practical recognition of the maxim salus populi suprema lex。 In the middle and latter part of the century a remarkable group of men； Southwood Smith； Chadwick； Budd； Murchison； Simon； Acland； Buchanan； J。W。 Russell and Benjamin Ward Richardson； put practical sanitation on a scientific basis。 Even before the full demonstration of the germ theory； they had grasped the conception that the battle had to be fought against a living contagion which found in poverty； filth and wretched homes the conditions for its existence。 One terrible disease was practically wiped out in twenty…five years of hard work。 It is difficult to realize that within the memory of men now living； typhus fever was one of the great scourges of our large cities； and broke out in terrible epidemicsthe most fatal of all to the medical profession。 In the severe epidemic in Ireland in the forties of the last century； one fifth of all the doctors in the island died of typhus。 A better idea of the new crusade； made possible by new knowledge； is to be had from a consideration of certain diseases against which the fight is in active progress。
Nothing illustrates more clearly the interdependence of the sciences than the reciprocal impulse given to new researches in pathology and entomology by the discovery of the part played by insects in the transmission of disease。 The flea； the louse； the bedbug； the house fly； the mosquito； the tick； have all within a few years taken thei
