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THE NEW SYDENHAM 
 
 SOCIETY. 
 
 INSTITUTED MDOCCLVIII. 
 
 VOLUME 156. 
 
A COLLECTION 
 
 THE PUBLISHED WEITINGS 
 
 WILLIAM WITHEY GULL, Bart., M.D.,F.E.S. 
 
 PHYSICIAN TO GUY'S HOSPITAL. 
 
 EDITED BY 
 
 THEODOKE DYKE ACLAND, M.D., 
 
 PHYSICIAN TO ST. THOMAS'S HOSPITAL. 
 
 MEMOIR AND ADDRESSES. 
 
 LONDON: 
 
 THE NEW SYDENHAM SOCIETY. 
 
 MDCCCXCVI. 
 

 (yn\ 
 
 PBINTED BY AD1ABD AND SON, 
 BABTHOLOMEW CLOSE, E.O., AND 20, HANOYEK SQUABE, W. 
 
CONTENTS. 
 
 
 
 PAGE 
 
 Preface ....... 
 
 vii 
 
 Memoir : 
 
 
 I. Early Life and Education 
 
 ix 
 
 II. Professional Life 
 
 
 XV 
 
 III. Character and Daily Life 
 
 
 xxxiii 
 
 IV. Notes and Aphorisms 
 
 
 . xlvii 
 
 V. Conclusion . 
 
 
 . lxix 
 
 Addresses : 
 
 
 Guiding thoughts to the Study of Medicine . 
 
 3 
 
 Hunterian Oration 
 
 
 ! 7 
 
 Medicine in Modern Times 
 
 
 36 
 
 Harveian Oration 
 
 
 61 
 
 President's Address, Clinical Society, 187 1 
 
 
 81 
 
 » » ., 1872 
 
 
 91 
 
 The Study of Medicine . 
 
 
 107 
 
 Address at Medical Congress, London, 1881 
 
 
 127 
 
 The Collective Investigation of Disease 
 
 
 !3S 
 
 The International Collective Investigation of Disease . 
 
 150 
 
 The Ethics of Vivisection 
 
 
 167 
 
PEEPACE. 
 
 Some apology is due to the members of the New 
 Sydenham Society for the inevitable delay which has oc- 
 curred in the issue of the present volume. 
 
 It was hoped that Sir Henry Acland would have written 
 the memoir of his old friend Sir William Gull, and indeed 
 he commenced the task, but owing to failing health he was 
 compelled to relinquish it before it was completed. 
 
 In the following brief account of Sir William Gull's 
 life, full advantage has been taken of Sir Henry Acland's 
 "work. The writer wishes to acknowledge his indebtedness 
 to Dr. Pye-Smith, the author of the obituary notice of Sir 
 William Gull in the ' Guy's Hospital Reports,' of whose 
 article he has freely made use, and to other friends whose 
 help has made the work possible. 
 
 An attempt has been made to give a simple portraiture 
 of Sir William's life and ways of acting in it, and rather to 
 describe what manner of man an acknowledged great 
 Physician of our day was, than to discuss the mere 
 extent of professional knowledge which obtained universal 
 recognition. 
 
 T. D. ACLAND. 
 
 November 5th, 1 896. 
 
MEMOIR 
 
 I. EABLY LIFE AND EDUCATION. 
 
 There is no portion of the history of men of power more 
 interesting than that which tells how and when they first 
 showed their strength. This interest is not lacking in Sir 
 William Gull's early life. 
 
 William Withey Gull was born at Colchester, in the parish 
 of St. Leonard's, on December 31st, 1816. His father, John 
 Gull, was a barge owner and wharfinger, and was thirty-eight 
 years old at the time of William's birth. His mother's 
 maiden name was Elizabeth Chilver. He was the youngest 
 of eight children, two of whom died in infancy. Of the 
 remaining six, three were sons and three daughters. 
 
 When the boy was about four years old his father 
 removed to Thorpe le Soken, in Essex. He was an honest, 
 upright man, devoted to his children. His mother was a 
 person of remarkable character, and of clear sound judg- 
 ment; industrious, persevering, and possessed of great 
 ability. Her husband looked to her for advice in every 
 important matter. They were deeply attached to each other, 
 and most anxious for the welfare and good education of 
 their children. A scholarship at Christ's Hospital was 
 offered by a friend to John Gull for his eldest son, but it 
 was somewhat indignantly refused because, he said, none 
 of his children should ever be dependent upon charity. He 
 died of cholera in London in 1827, when William was ten 
 years old, and was buried at Thorpe. 
 
 After her husband's death, Elizabeth Gull devoted herself 
 
x MEMOIR. 
 
 entirely to the bringing up of her children. She was left 
 with very small means, but none the less were the surround- 
 ings of the home those of refinement and care. She taught 
 her children to be self-reliant, to do everything for them- 
 selves, and to do whatever they did well ; for she would say, 
 " Whatever is worth doing is worth doing well." Thus she 
 instilled into them habits of perseverance and industry. 
 These early lessons from a loving mother were never 
 forgotten, and may truly be said to have been the key-note 
 of Sir William's suecess. In looking back to his childhood 
 he would often say that his real education had been given 
 him by his mother. To the end of his life he would quote 
 a little nursery rhyme, learned in infancy : 
 
 " If I were a tailor, I'd make it my pride 
 The best of all tailors to be ; 
 If I were a tinker, no tinker beside 
 Should mend an old kettle like me." 
 
 Adding to it in later years, the more classical quotation — 
 
 " If thou dost purpose aught within thy power, 
 Be sure thou do it, though it be but small. 
 Constancy knits the bones and makes us stour." 
 
 Elizabeth Gull was an earnest Churchwoman of an old, 
 but then not common type. On Fridays the children had 
 fish and rice pudding for dinner ; in Lent she wore black, 
 and the Saints' days were carefully observed. 
 
 As a boy William Gull went with his sisters to a school 
 kept by two old ladies, and he used to say that on his 
 return home his mother never allowed him to play until he 
 had done a certain number of rows of knitting, and he 
 would sit on a stool and look at the clock to see how fast 
 he could accomplish this appointed task. Thus he knitted 
 the first pair of stockings he woi-e. When too old to go 
 with his sisters to their school, he attended another in 
 the same parish, kept by the clergyman. At this school 
 William was a day-boy until he was fifteen, at which 
 age he became a boarder, and continued so for two 
 years. It was at this time that he first began to study 
 Latin. The learning, however, that the clergyman was able 
 to impart appears to have been very limited ; and at seven- 
 
EARLY LIFE AND EDUCATION. XI 
 
 teen William announced that he would not go any longer, 
 as he had learned all that his master could teach him. 
 Shortly after this he became a pupil-teacher in a school 
 kept by Mr. Abbott at Lewes. He lived with the Abbotts, 
 who were kind, cultivated people, as one of their family, 
 and received such education as the school could give, and in 
 return he helped in the teaching. He now began to study 
 Greek, which, for the most part, he taught himself ; and 
 before long he was desired by Mr. Abbott to teach it ; he 
 .was unwilling to undertake the task, - feeling how little 
 he knew, but Mr. Abbott reassured him, saying, "Directly 
 you begin to teach you will begin to learn ; " so he began to 
 teach Greek. Whilst at Mr. Abbott's he became acquainted 
 with the well-known botanist, Mr. Joseph Woods, and with 
 him he used to wander over the downs at Lewes, and study 
 the flora and fauna of Sussex. 
 
 After being with Mr. Abbott for about two years he again 
 became unsettled, feeling that the opportunities he had of 
 acquiring knowledge were not equal to his powers. He 
 would in after years refer to the anxiety and distress he 
 experienced at this period of his life, owing to the inade- 
 quate means at his disposal for satisfying the desire for 
 knowledge, and the capacity for learning of which he felt 
 himself to be possessed. 
 
 The influences of his early life had led him to wish 
 to go to sea. Finding himself disappointed in the 
 endeavour to obtain the education for which he longed, 
 his mind reverted to this desire, but his mother would 
 not give her consent. At this time Mr. Harrison, 
 nephew of the Treasurer of Guy's Hospital, was rector of 
 Beaumont, a parish adjoining Thorpe, on the estate of 
 Guy's Hospital, to which in 1 832 Elizabeth Gull had moved 
 her home. Mr. Harrison took a kindly interest in his 
 pai'ishioners, and specially in William Gull's widowed 
 mother. To him she related her trouble as to her son's 
 desire to go to sea. Mr. Harrison then proposed that the 
 boy should come to the rectory every other day, and with 
 him resume his classical and other studies ; and this for a 
 year he did. On his days at home he and his sisters would 
 row down the estuary to the sea, watching the fishermen, and 
 
XU MEMOIE. 
 
 obtaining the mysterious living treasures that teem in the 
 nets of the dredgers on all our coasts. The specimens thus 
 obtained, as well as any others of the fauna of the district 
 which he could collect, were carefully examined and studied 
 with the aid of such books as he could then procure. This 
 time was always looked back upon as one of the happiest 
 periods of his youth, satisfying and yet kindling his longing 
 for knowledge, and opening to him new interests and new 
 views of life. 
 
 From the nature of these studies, and probably from his 
 intercourse with Mr. Harrison, the thougbt of a sea life 
 faded away, and the wish to study medicine became the 
 fixed desire of his life. There appeared, however, no 
 prospect of obtaining the means to enable him to under- 
 take the long and necessarily expensive education that such 
 a career would involve. 
 
 About this time Mr. Benjamin Harrison, the Treasurer 
 of Guy's Hospital, came to stay with his nephew, the rector 
 of Beaumont, who, having become deeply interested in 
 young Gull, spoke to him about the boy, and took him to 
 see Gull's mother. Being satisfied that he was possessed of 
 unusual ability, Mr. Harrison invited him to go to Guy's, and 
 in September, 1837, * ne autumn before he was twenty-one, 
 William Gull left his home and entered upon his life's work. 
 
 Formerly students of medicine went to the hospital 
 chiefly as "apprentices." By the Treasurer's kindness 
 Gull shared all the advantages of an apprentice ; he gave 
 him two rooms in the hospital with £50 a year, and every 
 opportunity of study. 
 
 " I can help you if you will help yourself," was Mr. 
 Harrison's wise saying, and this advice Gull determined 
 to act upon. On one occasion, anxious to make some 
 return to the Treasurer for his friendship and kindness 
 Gull resolved to try for every prize which could be competed 
 for in the hospital in the course of that year. He succeeded 
 in gaining every one. 
 
 During the first year of his residence at Guy's, together 
 with his other studies he carried on his own education in 
 Greek, Latin, and Mathematics, and in 1838 he matriculated 
 at the University of London, then only recently founded. 
 
EAKLY LIFE AND EDUCATION. xm 
 
 In 1 841 he took his M.B. degree, and gained honours in 
 Physiology, Comparative Anatomy, Medicine, and Surgery. 
 
 Throughout his early career at Guy's, he owed much 
 not only to the Treasurer, who through life continued one 
 of his firmest friends, but also to Mr. Stocker, then 
 apothecary to the hospital, with whom he was closely 
 associated in his work, and who aided him in every way 
 in his power. He also received from various members of 
 the medical staff, much kind encouragement and help, 
 which were never afterwards forgotten. Amongst these 
 friends may be specially mentioned Dr. Babington, whose 
 memory Sir William always cherished with feelings of deep 
 admiration and gratitude. 
 
 In 1842 Gull was appointed to teach Materia Medica at 
 Guy's Hospital, and the Treasurer gave him a small house 
 in King Street, with a salary of £100 a year. 
 
 In 1843 he was appointed Lecturer on Natural Philo- 
 sophy. He also held at this time the post of Medical 
 Tutor at Guy's, and, in the absence of the staff, shared with 
 Mr. Stocker the care of the patients in the hospital. 
 In the same year he was appointed Medical Superin- 
 tendent of the wards for lunatics, and it was largely due 
 to his influence that these cases shortly ceased to be 
 treated at the hospital, and the wards were converted to 
 their present use. 
 
 Through all these years Gull continued to observe, to 
 study, to practise, and to teach, without intermission. 
 His various duties gave him unrivalled opportunities for 
 becoming acquainted with every form and variety of 
 disease, and of these he availed himself to the full. His 
 life, as he himself used to say, was at this time lived 
 within the wards of the hospital, and at all hours of the 
 day, and often at night also, he might be found by some 
 bedside seeking patiently to unravel the mysteries of 
 disease. 
 
 In 1846 he took his M.D. degree at the University of 
 London, and gained the gold medal, the highest honour 
 in medicine which the University can confer. 
 
 Notwithstanding his great ability, he had at this early 
 period of his career a remarkable lack of confidence in 
 
Xiv MEMOIR. 
 
 his own powers, as is shown by the following incident. 
 During the examination he was about to leave the room, 
 saying that he knew nothing of the case proposed for 
 comment ; fortunately a friend persuaded him to return, 
 with the result that the thesis he then wrote gained for him 
 his Doctor's degree and the gold medal. 
 
 From 1846 to 1856 Dr. Gull held the post of Lecturer 
 on Physiology and Comparative Anatomy at Guy's. 
 
 In 1847 he was elected Fullerian Professor of Physiology 
 at the Eoyal Institution of Great Britain, a post which he 
 held for two years, during which time he formed a close 
 and intimate friendship with Michael Faraday, at that time 
 Fullerian Professor of Chemistry. 
 
 In 1848 he was elected a Fellow of the Royal College 
 of Physicians. He was also appointed Resident Physician 
 at Guy's, and came to reside in the house now occupied 
 by the Chaplain. And here his preparatory training was 
 brought to a close, his full professional habits were formed, 
 and his life responsibilities fairly undertaken. 
 
 Dr. Gull married in 1848 Susan Ann, daughter of Colonel 
 Lacy, of Carlisle. Of several children two only survive, 
 a son and a daughter. 
 
PROFESSIONAL LIFBI. XV 
 
 II. PROFESSIONAL LIFE. 
 
 When, after taking his M.B. degree in 1841, Gull became 
 medical tutor at Guy's, his professional career had fairly 
 begun. 
 
 The secret of his success as a physician is well summed 
 up in the words of the inscription to his memory on the 
 tablet in the Chapel at Guy's Hospital ; — Instinctive insight, 
 unwearied patience, exact method, ready resources, and 
 above all hearty sympathy. Each and all of these brought 
 their influence to bear on his work and on his life, and 
 made them what they were. 
 
 " If I am anything," he once said late in life, when 
 some speech he had made had been misunderstood, " I am 
 a clinical physician." That remark was the key to the life of 
 a powerful, thoughtful, cultivated man, whose chief interest 
 lay in the treatment of disease and the alleviation of suffer- 
 ing, and who brought into play the keenest power of obser- 
 vation, based on scientific scrutiny of the minutest facts which 
 could affect the question before him. 
 
 He had a retentive memory and vast knowledge, — 
 scientific, clinical, and pathological, — acquired by many 
 years' residence at Guy's, and constant study at the bedside 
 of the sick. Added to this he had a peculiar capacity for 
 appreciating each detail of the case before him at its 
 proper worth ; not being led away by symptoms which, 
 though prominent, might be of little importance, and 
 finding not unfrequently the key to the solution of a 
 problem in some circumstance or detail which had attracted 
 but little attention. 
 
 If a case was not clear to him, he did not hesitate 
 to say, " I do not know." He writes : " Acquaint yourself 
 with the causes that have led up to the disease. Don't 
 guess at them, but know them through and through 
 if you can ; and if you do not know them, know that you 
 do not, and still inquire. ' Cannot ' is a word for the idle, 
 
xvi MEMOIR. 
 
 the indifferent, the self-satisfied, but it is not admissible in 
 science. 'I do not know' is manly if it does not stop 
 there." He acted on Newton's words, which he often 
 quoted : " If I do not understand a thing, I keep it before 
 me and I wait." He never wearied of inculcating the 
 principle that it is more important to study than to explain 
 the phenomena of disease. One of his favourite sayings 
 was, " Fools and savages explain ; wise men investigate." 
 
 It has been said of Sir William by one of his most 
 distinguished contemporaries : " Science and sympathy were 
 in complete agreement in him." He possessed in a marked 
 degree those characteristics which inspire trust and exercise 
 a powerful influence over others ; and to a profound know- 
 ledge of his profession, Sir William added a profound 
 knowledge of mankind. 
 
 A passage from the ' Guy's Hospital Eeports ' x admir- 
 ably describes him. 
 
 " His striking presence, his searching scrutiny, his 
 miuute and deliberate examination of every case, and the 
 few carefully and slowly uttered words in which he delivered 
 his judgment, sometimes with epigrammatic pungency, often 
 with encouragement, and never without sympathy — all 
 combined to give him an almost unequalled ascendancy over 
 his patients. His manner was his own, and sprang naturally, 
 from the habit of his mind. It was just the same in a 
 hospital ward as in a palace, and the poorest of his patients 
 leaned on his oracular statements, sometimes with hope and 
 sometimes with resignation, but always with comfort ; while 
 the richest were taught to restrain loquacity, to answer 
 truthfully, and to follow out directions implicitly. 
 
 " The merit of Gull, as of Stokes, Oppolzer, Trousseau, 
 and other great physicians, was that he added to the 
 methodical investigation of facts the insight and judgment 
 without which a man may be an admirable clinical teacher, 
 and yet entirely fail in the diagnosis of really difficult cases, 
 in the estimation of probabilities, and in wise therapeutics. 
 For practical medicine is an art ; and when all the facts 
 which the most elaborate examination of the patient's actual 
 state can supply have been brought in due order before us, 
 
 1 Vol. xlvii. 
 
PROFESSIONAL LIFE. xvu 
 
 and the seat and nature of the anatomical lesion has been 
 accurately determined, there still remains the due apprecia- 
 tion of its significance in that particular case, of the proba- 
 bilities of its future progress, and of the most suitable 
 methods of meeting it. Indeed, in many cases the result of 
 physical diagnosis is little more than negative, and we have 
 to depend entirely upon the same half -unconscious use of 
 experience in combination with slight and almost inde- 
 scribable indications, which is depended upon in critical 
 moments by the physician no less than by the engineer, 
 the seaman, the statesman, and the general. 
 
 " While not inferior to the best modern teachers in 
 accuracy and thoroughness of searching for physical signs of 
 disease, Gull added to this the vision and the faculty which 
 depends upon long and well-used experience, combined with 
 a certain happy mixture of boldness and caution like that 
 which decides a doubtful field of battle." 
 
 There was no detail which concerned the comfort or 
 well-being of the patient which was too minute for his 
 attention. He knew the relief which might be gained by 
 change of posture, by altering the position of a limb, and 
 not only saw that it was done, but frequently did it himself. 
 His ready tact in dealing with the whims and sufferings of 
 the sick often called forth more admiration, from patients 
 and friends, than even the exercise of his professional skill. 
 In dealing with disease he never lost sight of the personality 
 of the patient ; each case, he would say, should be con- 
 sidered as "the disease, + the person." 
 
 Visiting one day an hysterical lady whom he had seen 
 previously, and who was causing great anxiety to her 
 friends and medical attendant, he reassured them, saying, 
 " There is nothinsr really wrong ; Mrs. X. is herself 
 multiplied by four." An over-anxious patient was 
 encouraged and cheered by being told that he was " a 
 healthy man out of health." 
 
 In many instances he did more for the cure of those 
 under his care by saying little and doing nothing than 
 could have been effected by much treatment. 
 
 On one occasion a lady suffering from an obscure skin 
 disease was brought to him for an opinion. He examined 
 
xvm MEMOIR. 
 
 her, picked a minute fragment of canthai'ides from, one of 
 the sores, placed it under the microscope and showed it to 
 her, with the assurance that she would get well. He did 
 nothing more, and the cure was complete. 
 
 On another occasion at a consultation 200 miles from 
 London, he refused, to the dissatisfaction of his colleague, 
 to write a prescription, because, he said, the patient only 
 required the encouragement of being convinced that he did 
 not need drugs for his recovery. 
 
 Every consideration that did not relate to " what is best 
 for the patient " was dismissed. This was Sir William's 
 professional axiom. How hard it is fully to act on this 
 seeming truism amid all the complexities of human life — 
 moral, physical, social, financial — this is not the time or 
 place to discuss. But the carrying of it out not un- 
 frequently involved him in difficulty, and led occasionally to 
 his being misunderstood. The story already told of his 
 travelling to the north of England and returning without 
 writing a prescription for his patient, may be instanced ; 
 and he would frequently refuse to repeat a visit or con- 
 sultation on the ground that he wished the sufferer to feel 
 that it was unnecessary. 
 
 The severe illness of H.E.H. the Prince of Wales from 
 typhoid fever in 1871, gave Sir William an exceptional 
 opportunity for the exercise of his varied powers as a 
 physician ; and the following passage which appeared in 
 the ' Times/ December 1 8th of the same year, is of interest. 
 It not only marks the estimation in which his services were 
 held by those who watched by the sick bed at Sandringham, 
 but it gives a striking illustration of that minute care in 
 detail which was so characteristic of his treatment of the 
 sick. " In Dr. Gull were combined energy that never 
 tired, watchfulness that never flagged ; nursing so tender, 
 ministry so minute, that in his functions he seemed to 
 combine the duties of physician, dresser, dispenser, valet, 
 nurse, — now arguing with the sick man in his delirium 
 so softly and pleasantly that the parched lips opened 
 to take the scanty nourishment on which depended the 
 reserves of strength for the deadly fight when all else 
 failed, now lifting the wasted body from bed to bed, 
 
PROFESSIONAL LIFE. XIX 
 
 now washing the worn frame with vinegar, with ever 
 ready eye and ear and finger to mark any change and 
 phase, to watch face and heart and pulse, and passing at 
 times twelve or fourteen hours at that bedside. And when 
 these hours were over, or while they were going on — what a 
 task for the physician ! — to soothe with kindest and yet not 
 too hopeful words her whose trial was indeed great to bear, to 
 give counsel against despair, and yet not to justify confi- 
 dence/' After the recovery of the Prince, Sir William 
 remarked, " He was as well treated and nursed as if he had 
 been a patient in Guy's Hospital." 
 
 As a clinical teacher (reference may again be made to 
 the memorial inscription) " few have excelled him in the 
 depth and accuracy of his knowledge, in the lucidity and 
 terseness of his language, in the effect produced upon his 
 hearers." 
 
 His influence over his pupils was great, not only from 
 the extent of his knowledge and the originality of his views, 
 but also from his personal character. He seemed to feel 
 instinctively what was the condition of the student mind, — 
 its wants, and its capabilities ; and how its faculties should 
 be nourished and augmented. He presupposed very little 
 knowledge on the part of the students, and he was clear, 
 precise, and suggestive. 
 
 He endeavoured to cultivate in them the same pains- 
 taking habit of mind, the same care for detail, which so 
 remarkably distinguished the character of his own work. 
 He writes, 1 "The student of medicine can no more hope 
 to advance in the mastery of his subject with a loose and 
 careless mind than the student of mathematics. If the laws 
 of abstract truth require such rigid precision from those 
 who study them, we cannot believe the laws of nature 
 require less. On the contrary, they would seem to require 
 more ; for the facts are obscure, the means of inquiry 
 imperfect, and in every exercise of the mind there are 
 peculiar facilities to err." 
 
 At the same time he sought to impress upon them the 
 need of broad views and high ideals : 1 " The scope of 
 Medicine is so wide as to give exercise to all the faculties 
 
 1 ' Study of Medicine.' 
 
 b 
 
xx MEMOIR. 
 
 of the mind, and it borrows from the stores of almost every 
 form of human knowledge — it is an epitome of science ; its 
 operations are so benevolent, that our Divine Master Himself 
 assumed its offices as a type of His spiritual ministrations ; 
 it has in it the very quality of mercy, and — 
 
 ' Is twice bless'd ; 
 It blesses him that gives, and him that takes.' 
 
 " Medicine holds a foremost rank amongst the natural 
 sciences, and can only reach its full development as they 
 advance to perfection. It is the centre to which some of 
 their brightest rays converge ; for where beside can we Jook 
 for such illustrations of the highest expression of natural 
 laws as are found in the structure of the living body ? It 
 has been well said : 
 
 ' Man is one world, and hath 
 Another to attend him.' 
 
 " The first principle for the student to recognise, and one 
 to which in after life he will often have to recur, is that his 
 work lies not in the fluctuating balance of men's opinion, 
 but with the unchangeable facts of nature." 
 
 The following passages, although not primarily addressed 
 to students, further illustrate Sir William's views on this 
 point : 
 
 1 " The distinction of medicine, as a study, lies in its com- 
 prehensiveness. The student of physical science admits 
 that he has to deal with but one half of that truth which is 
 expressed in man. The student of medicine cannot so limit 
 himself. The facts of sensation, whether pleasurable or 
 painful ; the influence of the mental emotions, whether ex- 
 citing or depressing ; the dominion of the conscience, 
 approving or disapproving, are for him facts due to the 
 operation of laws into which he must inquire. Looked at 
 from the point of view which the student of medicine occu- 
 pies, these higher facts of man's nature are as essentially 
 parts of one law, and control and modify human existence 
 equally with those lower conditions with which physic alone 
 is concerned. This constitutes the unspeakable difficulty 
 which every student of medicine must feel in the present 
 1 Harveian Oration. 
 
PROFESSIONAL LIFE. xxi 
 
 imperfect state of knowledge. To hold the mind in an 
 equal balance as it passes from the contemplation of the 
 lower facts of our existence to those which characterise the 
 highest claims of our humanity, so as neither to degrade the 
 one nor neglect the other, is one of the highest attainments. 
 What eye is single enough to survey the range of life from 
 the material atoms which build our structures, to those 
 ' mighty hopes which make us men,' without faltering in the 
 vision, or without confusion of the objects ? " 
 
 1 " I believe that, as men occupied with the study and 
 treatment of disease, we cannot have too strong a conviction 
 that the problems presented to us are physical problems, 
 which perhaps we may never solve, but still admitting of 
 solution only in one way, namely, by regarding them as part 
 of an unbroken series, running up from the lowest elemen- 
 tary conditions of matter to the highest composition of 
 organic structure." 
 
 At all times he strove to guard those he taught against 
 a narrow specialism ; he would say, " there are no farts in 
 the body, but only different localities," and as is well known 
 he regarded chronic Bright's disease as an affection of the 
 whole arterial system, not one of the kidneys only. Of a 
 specimen of contracted kidneys exhibited by Dr. Bright as 
 a cause of albuminuria he used to say, " Bright observed 
 the heart and kidneys, but he forgot the man between ; the 
 whole man should have been included in the specimen." 
 
 He urged the cultivation of a docile spirit, as essential to 
 scientific study. 
 
 s " If the first lesson be patience, . . . the next lesson is 
 docility, a readiness to learn at any source, . . . wherever 
 
 the facts lie hid Who could have believed that 
 
 the particles of a dew-drop and the masses of a planet 
 are moulded and controlled by the same force ; that the 
 introduction into the human body of a small particle of 
 matter from a cow's udder might be the means of saving 
 thousands of human lives ? We learn from these and in- 
 numerable similar instances that the highest truths lie hid 
 in the simplest facts ; that, unlike human proclamations, 
 
 1 Hunterian Oration. 
 
 2 'Study of Medicine.' 
 
xxii MEMOIR. 
 
 nature's teachings are not by sound of trumpet, but often 
 in the stillest voice, by indirect hints and obscure sugges- 
 tions, but always with the unequalled advantage that they 
 are unequivocal, constant, and uniform. The difficulty, 
 however, is in maintaining the docile spirit of which I 
 speak, in preventing ourselves from assuming a knowledge 
 we have not ; in not hastily coming to a conclusion with- 
 out evidence, and not resting content in our ignorance 
 with a fool's satisfaction that no good would come of more 
 knowledge if we had it." 
 
 He encouraged his students to educate themselves. 
 1 " Medicine," he writes, " is essentially a learned profession. 
 Its literature is ancient, and connects it with the most learned 
 periods of antiquity ; and its terminology continues to be 
 Greek or Latin. You cannot name a part of the body, and 
 scarcely a disease, without the use of a classical term. Every 
 structure bears upon it the impress of learning, and is 
 a silent appeal to the student to cultivate an acquaintance with 
 the sources from which the nomenclature of his profession is 
 derived." 
 
 An old student gives the following interesting reminis- 
 cences. 
 
 " It was a pleasure to work for him ; he would make the 
 less ardent student feel a personal interest in his work, and 
 a responsibility for the welfare of the patients. For though 
 often he would talk freely about a patient, yet he never 
 forgot that it was a human being with human ties that had 
 to be looked after. I well remember his looking sadly at a 
 policeman, moribund of typhoid fever. The man had been 
 keeping at his work long after he ought to have given in ; 
 but he had a sickly wife and family who needed his full 
 earnings. Gull turned round and said to the students, 
 ' More heroism there, in working with a fever on you, than 
 in rushing into the breach.' 
 
 "He was bold in diagnosis, and often astonished men 
 by the minute accuracy of his prophecies. Of course, 
 like all men he made mistakes, but he was able to take 
 care of himself, and I shall not forget one instance of 
 this by which I suffered. While ward clerk for him, a 
 ' Study of Medicine.' 
 
PROFESSIONAL LIFE. xxm 
 
 child was brought into the hospital, and Dr. Gull, after 
 a short examination said, ' Measles ; keep the little one 
 warm.' The next day it was certain that the child had 
 smallpox, and it was sent out of the hospital. I told 
 everyone that I had got Gull beyond escape, and many 
 students came to see how it would end. When he got to 
 the empty bed, Dr. Gull said, ' Where is our little patient ? ' 
 I with wicked pleasure said, ' In the smallpox hospital.' 
 He said nothing but passed on, then at the next bed 
 stopped and quietly began thus : ' Tou know, gentlemen, 
 that I have over and over again pointed out to you that 
 the diagnosis between measles, scarlet fever, and smallpox 
 could be made from a correct history of the development of 
 the symptoms ; in the case of this child I trusted to S — ; I 
 thought I could trust him, but I was mistaken. I am sorry! ' 
 
 " The way in which he treated men, not diseases, was 
 certainly one of his strongest points. ' Never forget that it 
 is not a pneumonia, but a pneumonic man who is your 
 patient. Not a typhoid fever, but a typhoid man.' 
 
 " He left his impress on the students who were under him ; 
 they felt that they could never know enough of all things 
 to be physicians. He encouraged men to study the Arts, 
 to teach themselves German, and not to neglect the 
 courtesies of life. 
 
 " The Sunday morning walks round the wards were full of 
 interests of all sorts, and in the end, on more than one 
 occasion he took me by the arm, and quietly pushing me 
 toward the chapel, said : ' I have taught you all I can this 
 morning, go and learn something there ; if from nothing 
 else, from the statue in the chapel, and tell me what the 
 patient helped by Guy was suffering from.' " 
 
 A favourite piece of advice to his students was, " never 
 disregard what a mother says j" he knew the mother's 
 instinct, and her perception, quickened by love, would make 
 her a keen observer. 
 
 As a guide of conduct in the difficulties of medical 
 practice, he often quoted George Herbert's words : 
 
 " Who when he is to treat, 
 With sick folk, women, those whom passions sway, 
 Allows for that, and keeps his constant way." 
 
XXIV MEMOIR. 
 
 1 " As a lecturer Gull was careful, instructive, and 
 interesting, full of impressive aphorisms and ripe con- 
 clusions, using apt and striking metaphors, and enforcing 
 what he taught by a dignified, slow, and careful reiteration 
 which never wearied, and which it required more than 
 average carelessness to forget." 
 
 It has been said that " he seldom delivered a lecture 
 which was not remarkable for some phrase full of wise 
 teaching, which from its point and conciseness became 
 almost a proverb amongst his pupils." His lectures were 
 well attended, and listened to with marked interest. 
 
 In 1874, when he gave the introductory lecture at Guy's, 
 so numerous an audience assembled to hear him that the 
 theatre could not accommodate them, and it was found 
 necessary to adjourn to a large public room at the London 
 Bridge Hotel. 
 
 Among his public addresses and orations, his Inaugural 
 addresses at Guy's in 1855 and 1874, his address at the 
 meeting of the British Medical Association at Oxford in 
 1 868, the Harveian Oration, delivered in 1870, and his 
 address as President of the Clinical Society in 1872, may 
 be singled out as brilliant examples of his power as an 
 orator, not only for the breadth and depth of their views, 
 but also for the eloquence of the language in which they 
 are clothed. To thoroughly understand his addresses they 
 should be read in full, for neither extracts nor critical 
 summaries alone, reveal the true mind of the man. 
 
 1 " Sir William was generally supposed to be a sceptic 
 as to therapeutics, and his treatment to be what some 
 people call ' expectant/ and others ' do-nothing.' As in 
 most cases of general reputation, the conclusion, so far 
 as it was incorrect, was in great measure due to the 
 very man whom it wronged. If a physician honestly 
 believes that medicine is powerless over disease, he need 
 not relinquish his practice; for it is often well worth a 
 patient's while to ascertain whether he is really ill or 
 not, and what is the nature of his complaint : he may 
 often wisely pay for the knowledge of what is likely to 
 happen, and what cannot be cured may often be prevented. 
 1 ' Guy's Hospital Reports.' 
 
PROFESSIONAL LIFE. XXV 
 
 But although negative practice may still be followed for the 
 sake of diagnosis and prognosis and prophylaxis, yet an 
 honest disbeliever in therapeutics could never prescribe a 
 potion or a pill without losing his self-respect. As a matter 
 of fact, Sir William Gull often prescribed no drugs whatever, 
 and his prescriptions, when he wrote them, were of extreme 
 simplicity. . . . 
 
 " He was never tired of exposing the absurdity of much 
 of the traditional polypharmacy. He would show how 
 much harm may be done by the vigorous treating of half- 
 understood diseases, and he once said that if every drug in 
 the world were abolished a physician would still be a useful 
 member of society. To appi-eciate his position, we must 
 remember something of the unquestioning faith in bleeding 
 and blistering, purging and physicking, which was still held 
 when Gull was a student. . . . 
 
 " He once said to the present writer, after his retirement 
 from practice, ' One thing I am thankful Jenner and I 
 have together succeeded in doing. We have disabused 
 the public of the belief that doctoring consists in drench- 
 ing them with nauseous drugs.' Nevertheless, those who 
 knew Gull's practice, either in the hospital or in private, 
 are well aware that his scepticism was perfectly reasonable, 
 and his therapeutical faith all the stronger because it was 
 discriminating. 
 
 " He often did not do himself justice. His paper on the 
 treatment of rheumatic fever was headed ' Cases of Acute 
 Rheumatism treated by Mint Water/ But really his treat- 
 ment of this disorder was most thorough and efficient. He 
 had the patient's bed screened from the rest of the ward, 
 his friends were not allowed to visit him, he was not suffered 
 to be moved, and no examination of the heart was made 
 beyond what could be carried out without disturbing him. 
 He was put on low diet, with plenty of barley water to 
 drink, the inflamed joints were carefully wrapped in cotton 
 wool and protected with cradles, and he always had enough 
 opium at night to secure sleep and prevent painful startings 
 of the limbs." 
 
 He never hesitated to prescribe the medicines of which 
 the effects had been proved by facts well observed ; but he 
 
XXVi MEMOIR. 
 
 endeavoured, above all things, to study the natural history 
 of disease, uncomplicated by the action of unnecessary 
 drugs, and he resented all useless interference with the 
 course of nature. He would say of meddlesome poly- 
 pharmacy — 
 
 " Pools rush in, where angels fear to tread." 
 
 His treatment of disease on rational principles rather 
 than by drugs did not always meet with grateful recogni- 
 tion. A patient who had passed successfully through a 
 severe attack of typhoid fever without medicine., in Guy's 
 Hospital, was congratulated by Dr. Gull on his recovery. 
 " Yes," replied the man, " and no thanks to you either." 
 
 He sought to teach his students not to think they could 
 cure disease. " The best of all remedies," he would say, 
 "is a warm bed." "I can tell you something of how you 
 get ill, but I cannot tell you how you get well." " Healing 
 is accomplished 
 
 ' By an operation more divine 
 Than tongue or pen can give expression to.' " 
 
 " Remedies act best when there is a tendency to get 
 well." 
 
 Sir William, it has been well said, " has left the mark 
 of his impressive thought on the medicine of our day, and 
 has moulded the shape of our theories, conclusions, and 
 practice, to an extent which can only be measured by a 
 wide survey and a subtle insight into the changes which, 
 during the last forty years, have altered the whole character 
 of our medical faith." 
 
 He held that the highest work of a physician should be 
 rather the prevention than the cure of disease ; and the 
 wide scope of preventive medicine, with all its possibilities 
 for the future, was a subject that profoundly interested him. 
 He writes : — 
 
 ltl As health is our object, or as near an approach to it 
 as circumstances admit, hygiene and therapeutics claim the 
 last and highest place in our thoughts. Happily, at this 
 day, hygiene has gained strength enough to maintain an 
 independent position as a science. To know and counteract 
 1 'Medicine in Modern Times.' 
 
PROFESSIONAL LIFE. xxvn 
 
 the cause of diseases before they become effective is evidently 
 the triumph of our art ; but it will be long before mankind 
 will be wise enough to accept the aid we could give in 
 this direction. Ignorance of the laws of health and 
 intemperance of all kinds are too powerful for us. Still we 
 shall continue to wage an undying crusade, and truly we 
 may congratulate ourselves that no crusade ever called forth 
 more able and devoted warriors than are thus engaged. 
 
 " Nothing can stimulate science more to the investigation 
 of therapeutics than the feeling that the diseases calling for 
 treatment prevail in spite of our best efforts to prevent them. 
 Where hygiene fails, properly commences the work of 
 therapeutics; but it is painful to find ourselves occupied in 
 making feeble and often useless efforts to combat the effects 
 of a poison which might perhaps have been stamped out in 
 its beginnings." 
 
 And again, l " Medicine yet owes it to society to demon- 
 strate more fully those secondary conditions whereby a 
 healthy mental activity may be secured and advanced ; for 
 of nothing can we be more certain than that the laws of life, 
 in their unimpeded operation, culminate in the advancing 
 perfection of man — corporeally, intellectually, and morally. 
 But the operation of these laws depends upon common 
 things. Whilst the ignorant have recourse to the super- 
 natural, science asserts that everything, if not traced, is 
 yet traceable to its antecedents ; and thus, as the handmaid 
 of religion, proves that what a man soweth, that shall he 
 also reap." 
 
 At a meeting of the Charity Organisation Society, for 
 promoting the establishment of Provident Dispensaries, at 
 which he spoke, he emphasised the importance of disabusing 
 the poor of their belief in drugs, and of inculcating upon 
 them cleanly habits and healthy ways. " There is a belief," 
 he said, "amongst the poor that disease comes by Providence 
 and is cured by drugs ; " adding, " whilst you put up a 
 public house at one end of your street and a provident 
 dispensary at the other, how can you expect your people to 
 be healthy ? " 
 
 Notwithstanding the pressure of Sir William's private 
 1 ' Havveian Oration .' 
 
xxvill MEMOIR. 
 
 and public work, he found time to continue his investiga- 
 tions into the causes and nature of disease. His scientific 
 papers, lectures, and addresses, will hold their place in 
 medical literature, for they relate to one of the most im- 
 portant epochs in the whole history of medicine. As these 
 papers were published last year by this Society it is not 
 necessary to enumerate them here. One of his earliest and 
 most important works was his report upon Cholera made 
 conjointly with Dr. Baly for the College of Physicians in 
 1849. Special mention should also be made of his paper 
 on " A Cretinoid Condition in Adult Women," almost the 
 last he wrote. It bears evidence of the keenness of his 
 perception, and the accuracy of his pathological views, 
 expressed about a not uncommon disease which had hitherto 
 escaped notice. 1 " It is remarkable," writes one of his 
 colleagues, " that a disease which no one had recognised 
 before its existence and characters were established by Gull, 
 has since been found to exist not only in this country and 
 on the Continent, but in America and Australia. Moreover, 
 he not only caught its characteristic fades, and recognised 
 its importance, but in the name under which he described it, 
 he indicated its true pathological relations, doubtful and 
 obscure for some time, but by recent investigation 
 established beyond all reasonable doubt." 
 
 It is also interesting to note that 1 " long before Wunderlich 
 had shown the characteristic curves of temperature in fever 
 Gull had learnt the pathological lesson now everywhere 
 recognised, that fever is a process, with a beginning, an 
 ingravescent stage, an acme, and a gradual subsidence. 
 He used to enforce this doctrine in his lectures by drawing 
 curves on the blackboard, — a long, gentle, and irregular 
 one for typhoid fever, a shorter, more abrupt, and more 
 regular curve for typhus and for scarlet fever." 
 
 " On the whole," the same writer adds, " it may be said 
 that scarcely any living physician has made so many, so 
 important, and so varied original observations." 
 
 Sir William fully appreciated the importance of the 
 collective investigation of disease, and did what he could 
 to advance this branch of medical study. He writes : 
 1 ' Guy's Hospital Reports.' 
 
PROFESSIONAL LIFE. xxix 
 
 1 " Man individually is but a unit in a large account, a 
 living atom in the great body of human social life, and 
 so to study him is a subject demanding our thought 
 and work. By looking at large numbers, facts before 
 unnoticeable become proportionably magnified. Causes 
 affecting health and shortening life may be inappreciable in 
 the individual, but sufficiently obvious when their effect is 
 multiplied a thousandfold. If the conditions of society 
 render us liable to many diseases, they in return enable us 
 to establish the general laws of life and health, a knowledge 
 »f which soon becomes a distributive blessing." 
 
 In 1884 he attended the Medical Congress at Copen- 
 hagen as representative of the International Society for 
 the Collective Investigation of Disease. The following 
 quotation, taken from his address on this occasion, shows 
 the gain he anticipated from this method of combined study. 
 
 " In an international collective investigation the ground 
 widens very much, not only from the different intellectual 
 characters of its working members, but also from the greater 
 variety under which disease presents itself. 
 
 " The first gain, no doubt, will be from the intercourse 
 and reaction of different national modes of thought with and 
 upon each other. It need not be said that the ways in 
 which any subject may be viewed do not depend upon the 
 subject itself, but upon the varied capacity of the minds 
 brought into relation to it. Minds evolved during ages 
 under special local and national conditions, and educated 
 in lines of their own, cannot fail to give new direction and 
 shape to the questions proposed for solution. 
 
 " Each national mind will feel a different mental neces- 
 sity. . . . Each nationality produces its own scientific 
 school, and not least in respect of the science of medicine. 
 One nationality is more distinguished by its powers of 
 analysis, another by its power of synthesis ; one is critical, 
 another historical ; one characteristically anatomical, another 
 physiological. Even if this occurred to only a limited degree 
 there must follow an interchange and fertilisation of ideas. 
 And let no one believe that this is a dream. We have 
 reached no more than the threshold of intellectual evolution." 
 ' ' ' Study of Medicine.' 
 
xxx MEMOIR. 
 
 He was one of the chief promoters of the Association for 
 the Advancement of Medicine by Research, and it is -with 
 the view of helping forward this important work, in which 
 he took so great an interest, that his son, Sir Cameron Gull, 
 has founded a scholarship at Guy's Hospital, bearing his name. 
 
 He took an active part in the controversy on vivisection, 
 and his evidence before the House of Lords was important 
 and judicial. In an article on this subject, written for the 
 'Nineteenth Century,' he sums up his convictions. "There 
 is no doubt that physiological experiments are useful, useful 
 for animals as well as for man ; . . . they are therefore 
 justifiable. ... To the accusation of cruelty, physiologists 
 may fairly reply, supported by all past experience, that 
 there is nothing so cruel as ignorance." 
 
 Believing as he did that good nursing was one of the most 
 important factors in recovery from sickness, Sir William took 
 deep interest in every effort to promote the better training 
 and welfare of nurses. He warmly supported the change 
 at Guy's from the old regime of nursing to the new, although 
 he deeply regretted the conflict of opinion with some of his 
 colleagues into which his action in this matter brought him. 
 He fully appreciated the arduous duties of a nurse, and 
 held in honour those who from high motives devoted their 
 lives to this humane work. "Nursing," he said, "has 
 sometimes been made a trade, sometimes a profession ; it 
 will never be what it should be until it is made a religion." 
 
 He never would adopt a course because it was popular, 
 unless at the same time he believed it to be right. His 
 courage was equal to his sense of duty. On the occasion 
 of his receiving the LL.D. degree at Cambridge, when, 
 owing to the evidence which he had recently given upon 
 the trial of a nurse, charged, as he believed unjustly, with 
 manslaughter, he was received with hisses and groans, he 
 refused to allow the Vice-Chancellor to put a stop to the 
 uproar, and stood calmly until it had subsided. He said 
 afterwards he felt it to be the greatest honour that had ever 
 been done him, and however unpopular at the moment, he 
 never doubted that the attitude he had assumed at the 
 trial was right. 
 
 At all times he endeavoured to raise the standard of his 
 
PROFESSIONAL LIFE. xxxi 
 
 profession, — moral, scientific, and social. " There is," he 
 writes, " probably no human work which daily confers 
 greater good upon society than does ours ; and when we 
 consider that from the ranks of our profession the chief 
 cultivators of modern science have sprung, whether we 
 speak of botany, hygiene, or social science, we may feel 
 justifiable pride, and be encouraged, in spite of all failures, 
 to go on, assured that our future must be one of ever- 
 increasing usefulness and honour." 
 
 Sir William Gull took an important part in the public 
 work of his day. Prom 1856 to 1889 he served on the 
 Senate of the University of London. He was the first 
 medical graduate nominated to fill that position. His 
 success in its examinations had added largely to the repu- 
 tation which secured his early advancement at Guy's, and 
 by his later successes he could be counted among the first 
 of those by whose career the value of the M.D. degree 
 would be illustrated. 
 
 From 1 87 1 to 1883 he represented the Crown, and from 
 1886 to 1887 he represented the University of London on 
 the General Medical Council. It has been said that " in 
 administrative questions he did not lend himself to details 
 as he did in all his clinical work;" but his judgment was 
 sound, and his influence always in favour of advance and 
 improvement. He was not a frequent speaker, but when he 
 spoke his words were always to the purpose, " he was 
 listened to with attention and his opinion carried great 
 weight." 
 
 In 1871 and 1872 he was President of the Clinical Society. 
 Among other public works, the part he took in the promo- 
 tion of the scheme for the Brown Institute should not 
 be forgotten. No one foresaw more clearly than he the 
 value of Comparative Pathology, or realised more fully the 
 gain to man of enlarging the confines of the study of 
 medicine from the narrow limits of the sick chamber, or 
 post-mortem room, to the study of all living things. 
 
 Dr. Gull was appointed Assistant Physician to Guy's 
 Hospital in 1851. In 1858 he became full Physician, and 
 having retired from his work at the Hospital in 1868, he 
 was in 1871 made Consulting Physician. He was appointed 
 
xxxil MEMOIR. 
 
 Lecturer on Medicine at Guy's in 1856, together with Dr. 
 Owen Rees, and he held this post until 1867. 
 
 In 1858 he was elected a Fellow of the Eoyal Society, and 
 was for many years a member of the Council. He received 
 the honorary degree of D.C.L. of Oxon. in 1868; of LL.D. 
 of Cambridge in 1880; of LL.D. of Edinburgh in 1884, and 
 in 1872 he was created a baronet, in recognition of his 
 services during the severe illness of H.R.H. the Prince of 
 Wales in 1871. He was at the same time appointed Physician 
 to the Prince of Wales, and subsequently Physician Extra- 
 ordinary, and latterly Physician in Ordinary to Her Majesty, 
 Queen Victoria. 
 
 1 "Few men have practised a lucrative profession with less 
 eagerness to grasp at its pecuniary rewards. He kept up 
 the honourable standard of generosity to poor patients, 
 which has been handed down from Mead and Heberden ; 
 and with a liberality which is less common, he showed no 
 jealousy of younger men sharing in his good fortune. Not 
 one, but five or six of those who were rising in the pro- 
 fession, owed much of their success to his help. J ' 
 
 This short memoir is written, not as a review or 
 criticism of the professional works of their author, but 
 rather as a sketch of the personal character of the man who 
 wrote them, and who occupied for full forty years an 
 important place in the eyes of the Public, of men of Science, 
 and of members of the Medical profession. Few men of 
 eminence have during their lifetime been more freely criti- 
 cised. This arose partly from the novelty of some of his 
 opinions, and partly from a certain prejudice against his 
 somewhat imperious manner, and his seeming dogmatism in 
 regard to his scientific inquiries and his therapeutical con- 
 clusions. 
 
 But here this account of his professional life must cease, 
 adding once more that he seemed in all the varied circum- 
 stances in which he was placed, as a man of science or as a 
 physician, to be endued with a strange power and a strong 
 will ; he strove his best, according to his belief, from his 
 childhood to his grave. 
 
 1 ' Proceedings of the Royal Society,,' Obituary Notice. 
 
CHARACTER AND DAILY LIFE. 
 
 III. CHARACTER AND DAILY LIFE. 
 
 The love of his early days continued with Sir William 
 all through life. He never wearied of recalling their 
 happy memories. His deep affection for his mother, his 
 admiration of her character, and his love for the simple life 
 and pursuits of his childhood's home, remained always 
 unchanged. 
 
 His admiring wonder of the works of Nature, first excited 
 as he studied the lowest forms of life in the water-butt 
 in his mother's garden, in his wanderings by the sea-shore, 
 or, in the various creatures dredged up, on the many 
 expeditions in his father's boats, continued undiminished 
 throughout his long and active career, and was a constant 
 source of relaxation to him from his professional work. 
 Even the marvel of a tadpole was always fresh, teaching 
 new lessons and opening out new avenues of thought. 
 
 In London the sparrows were his teachers and his 
 friends. He would watch their habits and ways with the 
 greatest interest, and would note their respective positions 
 when roosting, deducing from the similai-ity of these night 
 by night, and the quarrelling that took place over the 
 settlement^ the probable fact that each sparrow had its own 
 particular resting place. 
 
 For every subject of interest he had a ready quotation, 
 and he would add after contemplation of his little friends, 
 Shakespeare's words : 
 
 " There's a special providence in the fall of a sparrow." 
 
 His early rambles in the pursuit of botany over the hills 
 at Lewes, under the helpful guidance of Mr. Joseph Woods, 
 were recalled again and again, and in passing by train he 
 would often point out the old favourite haunts. 
 
 His love of nature was intense — it was an entire devotion. 
 On his holidays there was hardly a walk but some insect 
 or plant was brought home for observation, study, and 
 reflection. 
 
xxxiv MEMOIR. 
 
 In the daily rambles, being struck by some beauty of 
 nature, he would return day after day to the same spot. 
 A memorable tuft of heather, a mass of bloom, was thus 
 visited by him for more than a week. " The ' burning 
 bush. ' — burning with, life/' he said, as he stood before it 
 in silent wonder and contemplation. 
 
 A wayside flower, a coloured moss, a tiny insect, would 
 move him to the depth of his being. 
 
 " To me the meanest flower that blows can give 
 Thoughts that do often lie too deep for tears," 
 
 was to him a reality, and not a mere form of words. 
 
 During his last illness he would drive considerable 
 distances to see or gather some favourite flower or plant ; 
 thus the great horned poppy, the " wayfarers' " tree, or a 
 patch of sea-kale growing on the shore near Eastbourne, 
 was the goal of many an afternoon's excursion. 
 
 Nature was truly to him the revelation of God. He 
 was never tired of studying, observing, humbly admir- 
 ing, almost worshipping, any living thing. He writes, 
 " What bright and convincing lessons of theology might 
 man (would he but open his eyes) read in his own 
 person — that microcosm of divine art, where, as in the 
 sentence of a divine epitome he might trace in every 
 lineament or member, the finger and authorship of the 
 Godhead ! " 
 
 He would quote from Newton : " The main business 
 of natural philosophy is to argue from phenomena without 
 feigning hypotheses, and to deduce causes from effects, till 
 we come to the very first cause, which certainly is not 
 mechanical." And again from Milton : 
 
 " Oh, Adam ! One almighty is, from whom 
 All things proceed, and up to Him return, 
 If not depraved from good ; created all 
 Such to perfection, one first matter all." 
 
 The former passage, marked in his copy of the " Treatise 
 on Optics" many years before, seemed to impress itself 
 more and more upon him, and was frequently on his lips 
 during the last year or two of his life. 
 
CHARACTER AND DAILY LIFE. XXXV 
 
 In the contemplation of the perfection of God's work and 
 power in nature the attitude of his mind was the humblest 
 and most reverent ; " I am but a child, I know nothing/' 
 he would say as he turned from some fresh revelation of 
 wonder or beauty ; and he would add, " Except ye become 
 as little children." He often repeated Chaucer's words, 
 
 " For every mortal marines power nys 
 But lyk a bladder ful of wynd, i-wis ; 
 For with a nedeles poynt, whan it is blowe, 
 May al the bost ' of it be layd ful lowe." 
 
 His love of nature extended to all created things. The 
 study of the nervous system of a caterpillar or slug stirred 
 in him the deepest admiration. " all ye works of the 
 Lord, bless ye the Lord," — "but," he added, "your 
 Benedicite is too narrow ; we must put in ' all ye cater- 
 pillars and slugs, — all ye creeping things, — bless ye the 
 Lord.'" 
 
 " He prayeth best who loveth best 
 All things both great and small ; 
 For the dear God who loveth us, 
 He made and loveth all." 
 
 Sir William had an immense capacity for work, and the 
 love of it for its own sake was a remarkable trait in his 
 character. He insisted that work is an essential condition 
 of life ; the advantage of wealth, he would say, was not 
 that it excused a man from the necessity of work, but that 
 it left him free to choose what should be its direction and 
 its aim. 
 
 On one occasion a young lady of high position being 
 brought to him for advice, he said to her, " you must earn 
 your own living and then you will be well ! " 
 
 " True happiness," he would say, " consists in the 
 exercise of the faculties upon their proper objects." 
 
 He had a great dislike to the word pastime ; all amuse- 
 ments, he contended, should be for re-creation. A frequently 
 repeated maxim was that " rest is change of employment 
 and thought, not cessation." 
 
 One of his favourite poems, and one most often quoted, 
 
 1 Boast. 
 
xxxvi MEMOIE. 
 
 was George Herbert's ' Elixir/ " Foe thy sake." This, 
 he held, gave to work its true dignity, its object, and its 
 purpose. 
 
 " This is the famous stone 
 That turneth all to gold 
 
 A servant with this clause 
 
 Makes drudgery divine ; 
 Who sweeps a room as for Thy laws 
 
 Makes that and the action fine." 
 
 Many were the quotations on this favourite subject, 
 gathered from all sources, with which his mind was stored. 
 Of these the following may be instanced : 
 
 " In earthly races 
 To victors only, do the heralds call, 
 But oh ! in yonder high and heavenly places 
 Success is nothing, and the work is all." 
 
 " God gave thy soul brave wings ; put not those feathers 
 Into a bed, to sleep out all ill weathers." 
 
 " Oh that I were an orange tree — 
 
 That busy plant ! 
 Then should I ever laden be, 
 
 And never want 
 Some fruit for him that dresseth me." 
 
 In figure Sir William Gull was of medium height, and 
 squarely built, of great strength and vigour, and endowed 
 with a power of physical endurance such as alone could 
 have enabled him to do the vast amount of work which he 
 successfully carried out during all his professional life. His 
 voice was sympathetic and impressive, his utterance measured 
 and forcible, and at times startlingly abrupt. In face, form, 
 and manner it was frequently said that he resembled the 
 first Napoleon. 
 
 In conversation he was brilliant, and his stories and 
 his aphorisms must dwell in the minds of many. 
 
 His love of argument was great, and he would often play 
 the part of advocatus diaboli for the sake of indulging in it. 
 
 One of his contemporaries writes, " He had not exactly 
 a vein of pure humour, for his humour was generally 
 critical and sometimes sarcastic, but he would speak of the 
 
CHARACTER AND DAILY LIFE. XXXVU 
 
 whims and fancies of men in terms of material pathology, 
 with a cheery satire quite inimitable, and with a depth of 
 sympathy, and a force pathetic and startling. Hence, in 
 part, his power over his fellows ; for these qualities were 
 lavishly poured forth on any subject which seemed to him 
 open to it, and especially on all that he thought to be 
 unreal, or false, or hypocritical, whether it occurred in 
 religion, in politics, or in his profession." 
 
 Those who may have heard him quote Thackeray's 
 withering satire on George the Fourth will never forget it. 
 " Under waistcoats, — more under waistcoats, and then — 
 nothing." He would say, " That which makes the man is 
 the manhood." " A man must be greater than his 
 surroundings." 
 
 Brilliant and epigrammatic as he was in his speech, the 
 work of expressing himself in writing was one of great 
 difficulty to him. He would labour long over the construction 
 of a single sentence, and his lectures and addresses were 
 accomplished by sheer hard work. He sometimes paced the 
 room for hours together seeking to find expression in words 
 for the thoughts of which his mind was full. 
 
 He possessed a remarkable power of concentration, 
 and at the same time a no less remarkable versatility 
 of mind. He could at a moment's notice throw aside all 
 thought of work or anxiety and return to some quotation or 
 argument, dropped it might be some hours, or even the 
 njght before, taking it up exactly where he had left it. In 
 the same way his mind would recur at intervals of cessation 
 of work during the day, to some main thought which was 
 engaging it. 
 
 He was gifted with the power of almost instantaneous 
 repose and sleep. He could sleep anywhere and at any 
 time. During his hard professional work he constantly 
 slept for ten hours at night, and he considered that no one 
 should have less than eight hours' sleep. 
 
 He was never in a hurry, always deliberate, and in the 
 middle of the busiest morning would find leisure to converse 
 with a friend on some topic of general interest. He often 
 made use of Mr. Gladstone's words: "If you want leisure 
 you must make it." 
 
XXXVUl MEMOIR. 
 
 His bodily strength and vigour were associated with an 
 equal power of mind and independence of character. 
 
 Having once formed an opinion, or determined upon a line 
 of action, he carried it out unhesitatingly, uninfluenced by 
 any thought of consequences. He was unswerving in his 
 ideas of right and wrong, uninfluenced by other people's 
 views and opinions. 
 
 He would not express any judgment unless he believed 
 himself certain of his data, and knew his conclusions to 
 be correctly drawn from them. It followed as a conse- 
 quence that he despised, and sometimes showed that he 
 despised, careless conclusions from inadequate data, on 
 professional or any other subjects. 
 
 His insight into truths which lesser minds were blind to 
 see and powerless to grasp, and a lifelong experience that 
 his vast capacities generally placed him in the truest relation 
 to things, developed in him an absolute confidence in the 
 infallibility of his own judgment on certain points. This 
 led him at times to an intensely dogmatic expression of his 
 own views, which not uni'requently provoked antagonism 
 and gave offence, when none was intended, to those who did 
 not know him well. 
 
 From self-assertion, properly so-called, he was entirely 
 free, his whole life being characterised by a remarkable 
 simplicity, and absence of ostentation. 
 
 He had a great intolerance of forms, " etiquettes," and 
 private considerations, when standing in the way of what 
 he considered right and truth. 
 
 The sharp, clever spirit of mere wordly wisdom, all that 
 was mean, paltry, sordid, self-seeking, found no countenance 
 from him. 
 
 Of all evils, he looked upon ignorance as one of the 
 worst. He often said, *' There is nothing so cruel as 
 ignorance." " The devil has been painted in many ways ; 
 I should like to paint an ignorant devil." He desired to 
 portray in so forcible a manner as to command attention, 
 that spirit of ignorance and prejudice, to which so much 
 preventable suffering and disease may be referred, whether 
 by the neglect of God's laws of health and conduct, or by 
 hindering the investigations of science for humane purposes. 
 
CHARACTER AND DAILY LIFE. XXXIX 
 
 " The breaking of God's laws, moral and physical," he 
 would say, " of necessity brings its own punishment ;" 
 " the intellect of man in operation is the providence of God ;" 
 " I would gladly leave off attending disease to teach people 
 how to live." 
 
 Sir William was gifted with a strong power of sympathy 
 with suffering in every form, but more especially was this 
 the case when the sufferer belonged to one of three classes 
 — the young, the aged, or the sick ; these, he said, must 
 always be helped. 
 
 He had many poor people among his patients to the last. 
 Late one night, on returning tired from a long journey, 
 the cabman, on receipt of his fare, still held out his hand 
 with the money in it, hesitated, and said, "But could 
 you give me something for my cough ?" The man was 
 taken into the house, prescribed for, and sent away happy. 
 Another time, on arriving in London in the early hours of 
 the morning, a cabman refused to take him. " I want 
 luggage," said the man, who doubtless had been waiting 
 long for his fare. " All right," said Sir William, " I will 
 be your luggage." 
 
 When absent on his holidays, a little child, a sick mother, 
 a suffering man, would be gladly attended, and receive the 
 best advice he could give ; but if asked to visit some 
 wealthy or fashionable person, the answer was invariably a 
 refusal. "On my holiday," said Sir William, "I cease to 
 be a doctor, but I do not cease to be a man." "I am 
 willing to be a good Samaritan, but only on a like 
 emergency." 
 
 It will appear over and over again, that with all the 
 detailed knowledge and determined grasp of things material 
 with which Sir William had to do, whether anatomical or 
 biological, normal or abnormal, there lay a hidden fire 
 beneath, which broke out unexpectedly in some quaint way, 
 and showed itself as a yearning for a spiritual light which 
 might enlighten all things visible and invisible. 
 
 " Man's life," he would say, " is as a pyramid ; the base 
 material, the middle mental, the top and crown of all 
 spiritual." He loved to dwell on the transformation of 
 material into spiritual ; the grass into the sheep, the sheep 
 
xl MEMOIR. 
 
 into the man, adding, according to his usual habit, a 
 favourite quotation, 
 
 " Tasting concoct, digest, assimilate, 
 And corporeal to incorporeal turn." 
 
 " Till body up to spirit turn." ' 
 In his Scottish home he would (inverting Homer's 
 simile, perhaps unconsciously, otij irep <pv\\a>v ytvsr), toiti 
 <5e txai avSpwv) watch the leaves as they fell, likening 
 them to the generations of men succeeding one another, 
 flourishing, falling, forgotten, whose places are filled by 
 another generation, flourishing and going in their turn, 
 the tree itself remaining as the principle of life, just as 
 God's world lives on, though the units come and go. 
 
 So in the most ordinary human affairs he coupled the 
 warm love of material nature with the inner spirit, which 
 to him was the real life. 
 
 A plant growing in a pond in his garden supplied 
 reflection for weeks — a parable, he said, of man's life, of 
 the Pattern Life. Its shapeless growth beneath the 
 water. — the change of form, — the flower on coming to the 
 surface. He got a friend to draw this, and himself put in 
 the words, " No form nor comeliness — hope, — fulfilment." 
 Afterwards he got the same friend to add to the drawing 
 the grub of a dragon-fly, and the dragon-fly itself, with the 
 words, 
 
 " To-day I saw the dragon-fly 
 
 Come from the wells where he did lie, 
 
 An inner impulse rent the veil, 
 
 Of his old husk, from head to tail 
 
 Came out clear plates of sapphire mail. 
 
 He dried his wings, like gauze they grew; 
 
 Through crops and pastures wet with dew, 
 
 A living flash of light he flew." 
 
 To a friend in trouble he presented a drawing of a winter 
 rose under which was written, " In tenebris lux." 
 
 To a little child who had nearly died of diphtheria he 
 gave a spoon on which was engraved, " Who healeth all 
 thy diseases, who redeemeth thy life from destruction." 
 
 1 Cf. " And from those corporal nutriments perhaps 
 Your bodies may at last turn all to spirit." 
 
 Milton's Paradise Lost, Book x. 
 
CHARACTER AND DAILY LIFE. xli 
 
 The drawing of a spray of holly and holly berries, 
 arranged by him in the form of a cross, bears the words 
 " Spinae efc sanguis." 
 
 Upon his bread platter he had engraved " Man shall not 
 live by bread alone." 
 
 He would quote, 
 
 " But as birds drink, and straight lift up their head, 
 So must he sip and think 
 Of better drink 
 He may attain to after he is dead." 
 
 This habit of regarding the spiritual through the 
 material, was for him beautifully expressed by George 
 Herbert, in words of which he never tired, 
 
 " The man that looks on glass 
 On it may stay his eye ; 
 Or if he pleaseth through it pass 
 And then the heaven espy." 
 
 Books were his life companions and friends ; he was not 
 an " omnivorous " reader, but his range of literature was 
 wide. His favourite poets were George Herbert, Shake- 
 speare, Schiller, Dante, Spenser, Chaucer, and Burns. 
 On his long country journeys one or other of these was 
 constantly his companion, and those who knew him will 
 recollect his pleasure in capping some passing event, some 
 point in the conversation or discussion, with a favourite 
 quotation. 
 
 First and nearest, all through his life, must be placed, 
 as has been said above, George Herbert. He had a ring 
 engraved for himself, bearing the design of one given to 
 George Herbert by Dr. Donne — a crucifix in the form of 
 an anchor, — with the words written on the paper in which 
 this ring was found wrapped, after George Herbert's 
 death, " Crux ancora mihi." This he always wore. 
 
 Shakespeare he read at all times. Though he some- 
 times quoted Goethe, yet his mode of thought and feeling 
 were not congenial to him, and after some years he 
 was rejected. Schiller he studied much. One year in 
 Scotland he beautifully translated his " Sehnsucht," which 
 
xlii MEMOIR. 
 
 fully expressed his own unsatisfied and unsatisfiable mind. 
 He would stand day after day and look up to the Scottish 
 hills, and say the same words : 
 
 " Und die Luft auf jene Hohe 
 O wie lebend muss sie sein." 
 
 He learned Italian from an Italian Bible which was given 
 him when he first came to London, and during his con- 
 valescence from typhoid fever, the only serious illness he 
 had until his final attack, he set himself to study Dante. 
 In him he found the climax of truth and beauty, and he 
 was never without the great Italian's works during the 
 later years of his life. He always read it in the original. 
 He had a true veneration for Dante, — " My Dante/' " my 
 personal friend," he called him, — and fulfilled in his un- 
 tiring zest for his works one of his favourite quotations : 
 
 " E duopo il festa piu fiame 
 Che pria." 
 
 He read Tennyson with attention, but not with full satis- 
 faction, though he often quoted some of his poems. His 
 copies of Spenser and Chaucer were marked in every 
 part. Milton's "Paradise Lost," as also some of his minor 
 poems, were read and admired. Burns appealed to him 
 for his love of nature. 
 
 Amongst prose writers of the day he read Thackeray and 
 Dickens with pleasure. He was not in sympathy with 
 Carlyle. But here I must pause, though not without a word 
 of his study of Hooker, of Jeremy Taylor, and to some extent 
 of St. Augustine and St. Thomas Aquinas. 
 
 The books he cared for were never merely read, they 
 were studied, pondered over, digested, absorbed, until the 
 mind of the author became as it were a part of his own. 
 Passages which impressed him were marked, committed to 
 memory, and once learnt were never forgotten. He would 
 work at one book for a year or more, making it a constant 
 companion, recurring to, and quoting again and again some 
 favourite passage. He would often ponder over one sentence 
 or verse for a whole evening. 
 
 He always rose at 8, but for many years it was his 
 custom not to breakfast till 9.15, and this quiet time he 
 
CHARACTER AND DAILY LIFE. xliii 
 
 would spend in studying one of his favourite authors or in 
 occupying himself with his own thoughts, writing down in 
 a few words the subject or the outcome of these meditations. 
 His mind, was clear to the last, and his love for his books 
 and quotations, so characteristic of himself, remained with 
 him to the end. The following was one of his latest 
 quotations, often repeated during his fatal illness : 
 
 " His words breathe truth, who breathes his words in pain." 
 
 This brief sketch of Sir William's daily life would be 
 incomplete without a word concerning his friends, his 
 manner of taking or making a holiday, and his religious 
 beliefs. 
 
 He did not form numerous friendships, but those he did 
 were deep and lasting. 
 
 His gratitude and affection for Benjamin Harrison, to 
 whose help he owed his career at Guy's, remained unchanged 
 to the end of his life. 
 
 His early associations with Frederick Denison Maurice, 
 the much loved Chaplain of Guy's Hospital, influenced, 
 it may be believed, his whole life. Maurice was, as all 
 acquainted with the history of the "Oxford Movement" 
 know, a spiritual force little congenial to many ; be- 
 loved, almost adored, by some. For the life and history 
 of Maurice this is not the place ; but Gull was from the 
 first attracted by his saintliness, his intellectual grasp, his 
 tenderness for the sick and suffering, and his sympathy 
 with the medical students. By Maurice, or with him, it 
 cannot be doubted that GulFs devotion was turned to Shake- 
 speare, Milton, George Herbert, and to all the greatest 
 English thinkers. 
 
 His intimacy with Michael Faraday, formed when first 
 lecturing at the Royal Institution, continued close and 
 uninterrupted until Faraday's death in 1867. His simple 
 life, his humble, childlike spirit, and his deep scientific 
 insight, found sympathetic response in Gull's own nature. 
 
 Of the friendships of his later life it is not possible to 
 speak, but the names of Sir Henry Acland, Sir William 
 Jenner, Sir James Paget, Dr. Weber, Dr. Matthews 
 Duncan, and Lord Justice Lindley cannot pass unmen- 
 
xliv MEMOIR. 
 
 tioned. 0£ friendship he would say, " To know a person 
 you must believe in him." 
 
 " The friends thou hast and their adoption tried, 
 Grapple them to thy soul with hoops of steel." 
 
 In the earlier part of his life his holidays were mostly 
 spent abroad. Although his greatest delight was ever in 
 nature, he would study with profound interest cathedrals, 
 buildings, pictures, works of art, in all the places he visited. 
 These as setting forth the workings of man's mind filled 
 him with admiration; and long letters to children and 
 friends, full not only of descriptions of these things, but 
 of the many thoughts they suggested to his ever-fruitful 
 mind, bear record of the minuteness with which all were 
 studied. 
 
 He admired the grandeur of Alpine scenery, but the 
 " chaotic " aspect of nature was never wholly congenial to 
 him. A ploughed field, a richly cultivated land, as 
 betokening the operation of man's intellect, always afforded 
 him more pleasure than a waste of uncultivated country, 
 however beautiful. 
 
 In later years his holidays were almost entirely passed 
 amongst the Scotch mountains. Here he would give him- 
 self to the repose and rest which the contemplation and 
 study of nature and his friendly books afforded, surrounded 
 only by his own family and the many young people he 
 gathered about him. One or other was always a welcomed 
 companion of his rambles, and it was his delight to 
 make them share his pursuits and thoughts, opening to 
 them some loved secret of nature, training their eyes to 
 see something not seen before, storing their minds with some 
 noble or beautiful thought, drawn from one of the authors 
 dear to him, or clothed in his own epigrammatic language. 
 His personal influence was great, and many will look back 
 to those days and feel that they owe to them much of truer 
 views and higher aims. As he would say : 
 
 " We live by admiration, hope, and love ; 
 And e'en as these are well and wisely fixed, 
 In dignity of being we ascend." 
 
 He frequently carried a gun, but cared only for sport as 
 
CHARACTER AND DAILY LIFE. xlv 
 
 giving an object for walking over the hills he loved, and 
 keeping him in the fresh air; the size of his "bag" was 
 nothing to him. It gave him more pleasure to watch 
 unobserved the natural habits of an animal than to 
 kill it. 
 
 During these intervals of leisure both his microscope and 
 telescope were a source of interest and instruction to him- 
 self and to those about him. He studied the heavens with 
 no less delight than the earth, and he found pleasure in 
 wandering alone in the dark. 
 
 These later resting times of his busy life, spent among 
 the Scottish mountains, in the contemplation of quiet and 
 lovely country scenes, among a sturdy and independent 
 people, recalled happily the simple joys and associations 
 of his early years, when the growth of a single flower 
 filled him with a yearning desire to know the whence, the 
 whither, and the how, of every plant or animal form that 
 had life. 
 
 It would be out of place in this sketch of Sir William's 
 personal, as distinguished from his professional life, to 
 pass any judgment on the character of his religious opinions 
 in these days of precise criticism. In the notice of his 
 earliest years the teaching and character of his much-loved 
 mother is shortly described. She never questioned the 
 doctrine of that branch of the Church of Christ in which 
 she had been educated. She observed its ordinances from 
 love and duty. She did not discuss its formularies, and 
 what she believed, she taught. Her son lived in the glare 
 of clashing dogmas. He was not the slave of any. He 
 observed the ordinances of the Church wherein he was 
 born ; and his teacher was his Bible. 
 
 " I do not believe less than you," Sir William said one 
 day to a friend, "I believe more;" adding, "In Him we 
 live and move and have our being." But forms, ceremonies, 
 and dogmas were never greatly in harmony with his mind. 
 
 This memoir will have been of little worth if it has not 
 shown the solemnity that filled Sir William's mind on the 
 contemplation of all things visible and invisible, material 
 or spiritual, in all the varying conditions in which man 
 is placed. 
 
xlvi MEMOIR. 
 
 He would often say, " Belief is necessary to the highest 
 knowledge/' and would quote from Spenser : 
 
 " Oh, why should witless man so much misween 
 That nothing is hut that which he hath seen?" 
 
 He recognised the limits of knowledge, and would fre- 
 quently repeat St. Augustine's words : " There are some 
 things we must know in order to believe them, and there 
 are others we must believe in order to know them." 
 
 Sir William's was a deeply reverent mind ; the following 
 touching passage from the " Eeligio Medici " frequently 
 referred to by him, accorded well with his feelings : 
 
 " At the sight of a cross or crucifix I can dispense with 
 my hat, but scarce with the thought or memory of my 
 Saviour. ... I never can hear an Ave Maria bell without 
 an elevation ; or think it a sufficient warrant, because they 
 erred in one circumstance, for me to err in all, — that is, 
 in silence and dumb contempt. Whilst, therefore, they 
 directed their devotions to her, I offered mine to God, and 
 rectified the errors of their prayers by rightly ordering 
 mine own." 
 
 Lastly, the motto engraven on his seal, for long elabo- 
 rated, allowing as it doubtless does of much discussion, 
 and of widely differing interpretations, represented to his 
 own mind what he conceived to be the relation of man to 
 himself, to science, and to God. 
 
 " Conceptio Dei, 
 Ratio rei, 
 Negatio mei." 
 
 It was during his holiday in Scotland amid the scenes 
 so congenial to him, that in October, 1887, he was struck 
 down by paralysis, from which he never wholly recovered. 
 In a few weeks he was moved to London. The end did not 
 come until January, 1890, when a fresh and acute illness 
 brought to a rapid close the strong life here too feebly 
 portrayed. 
 
NOTES AND APHORISMS. xl\ 
 
 IV. NOTES AND APHORISMS. 
 
 The following part of this sketch is taken entirely from 
 notes jotted upon scraps of paper which were found in 
 Sir William's study after his death. 
 
 It is to be regretted that the pregnant and startling 
 remarks habitual to him of which we have record, para- 
 doxical as they are, should not be more numerous. That 
 the habit of writing down his thoughts was not formed 
 early in life is a loss alike for his portraiture, and for the 
 thought of our time. 
 
 Of these fragments it has been possible to print only a 
 few, the greater number being obviously incomplete. They 
 illustrate the fulness of Sir William's active mind in the 
 intervals of his intensely practical life. Some were probably 
 written after chance conversation with other serious thinkers, 
 on the nature of things, on the ignorance and on the know- 
 ledge of man, and on the relation of man to God. Others 
 formed the subject of well-remembered conversations with 
 those around him. Many were evidently the outcome of 
 reading Dante and George Herbert, or some other of these 
 great teachers of man who were his chief delight, out- 
 side and beyond his profession. Would that these notes 
 were more in number and more full in detail ! They 
 tell, however, how he lived in habitual touch with the 
 deepest questions of modern thought. They are given 
 as they stand, without comment, as the thoughts of a deep 
 writer and thinker, during an overworked practical life. 
 
 The world is not my proposition of it (nicht meine Vor- 
 stellung), but my world is my proposition of it (ist meine 
 Vorstellung) . 
 
xlviii MEMOIR. 
 
 My world is that part of it to which my sense ex- 
 tends. My eye reaches to the stars ; my ears to the 
 thunder in the sky, or to the vibrating vocal chords of the 
 lark which sings there. My nose goes into the petals of 
 the rose by continuity of the perfume which exhales from 
 them ; or into the joint which gives out its appetising 
 smell in the roasting. My taste reaches into the textures 
 brought into contact with it as the touch continues on 
 beyond its immediate self in the tension of a cord or the 
 extension of a rod. 
 
 Not only are the senses related to the world, but they 
 recognise themselves as such ; the light seen is in the direc- 
 tion of my seeing it, the hearing is the object producing 
 the sound. It is true one sense may need another for its 
 assurance in all points, but with this mutual criticism they 
 mostly prove right. The sense is limited to its proper lines 
 of operation, but, this admitted, it may truly be said that 
 the eye as much touches the most distant star as that my 
 fingers touch the pen with which I write. 
 
 The world is to me my proposition of it ; and so is the 
 pig's world, the pig's proposition of it ; or, to use a common 
 saying, " the pig sees with pig's eyes ;" but that the world 
 is more than my proposition of it is proved by the fact that 
 the pig's world is not mine, nor is mine that of a more highly 
 instructed man, of one who has a larger mental capacity, and 
 who is more widely and more intimately acquainted with 
 the workings of nature, inorganic and organic. Newton's and 
 Darwin's world were different from the worlds of most men, 
 and yet their worlds were not the world, but more and 
 better than mine, as they had followed out further and 
 better the teachings of the sense. The world is more than 
 anyone's proposition of it, or, if you please, say conception 
 of it, though to repeat, any man's proposition and concep- 
 tion of it, is his world. Not to name the systems of indivi- 
 duals it may, without doubt and with all respect, be said of 
 them, such is Mr. A — 's world; this is Professor B — 's 
 woi-ld, and so on, to the end of the alphabet. All are worthy 
 of consideration ; all exhibit the mental state of the indivi- 
 dual who puts his system forth ; all are (if he be not a mad- 
 man) in some relation to the world. Newton, in a wider 
 
NOTES AND APHORISMS. xlix 
 
 sense than the village agnostic, who denies because he is 
 ignorant, and is satisfied he knows all because he knows 
 so little. 
 
 What is scientific knowledge ? What is demonstrable to 
 the sciences ? How demonstrable ? By repetition at will 
 of the conditions. Gravitation is demonstrable by leaving 
 a body unsupported. Heat is demonstrated by its effect on 
 bodies, dilating them as in a thermometer of air, spirit, 
 mercury, or a bar of metal. Light is demonstrable by 
 lenses and chemical effects, and by the retina of animals. 
 Electricity is demonstrable by the repulsion of light bodies 
 from each other, by its inducing a magnetic state in copper. 
 By these and numerous other modes, physical powers are 
 demonstrated to be quiescent and active about us. But if 
 we go a step further and inquire into higher combinations, 
 as is open to us, in the leaf of a tree or a blade of grass, and 
 pursue the inquiry, another world of powers is gradually 
 revealed. 
 
 I cannot admit that any near approach has been made to 
 an explanation of our moral and intellectual nature, of that 
 which we call and feel to be ourselves. 
 
 It may please and satisfy some students of nature to think 
 they know more than others, and that from analogy and 
 logic they are able to unravel it, to the last thread of our 
 textures, and then to sit down and contemplate the simpli- 
 city of the organism with its fears and aspirations. Such 
 a spectacle but exhibits the simplicity of the student and 
 the shallowness of his inquiry. This will hardly be consi- 
 dered too severe a criticism if it be admitted that we know 
 nothing of the evolution of sense. 
 
 " Ergo vivida vis animi pervieit 
 
 . . . . Religio pedibus subjecta vicissim 
 Opteritur, nos exaequat victoria caelo." — Lucretius. 
 
 " Religio " is here used for the objects of it, not for the 
 aspect of the mind to holy things. The two uses of the 
 word must be carefully dissevered in our language. 
 
1 MEMOIR. 
 
 Man has been a great loser by not bearing in mind this 
 distinction. 
 
 " It is the shrine which thou dost venerate, 
 And not the beast that bears it on his back." 
 
 The right and duty of man to look into the things of 
 which he forms part, and upon which his very existence 
 depends, is now fully admitted. 
 
 This right and duty requires, however, a profound sense 
 of the unfitness of untrained minds and unarmed hands for 
 the work. 
 
 Reverence, and even a deep reverence for ourselves and 
 our work is needed, or we may easily find ourselves putting 
 ourselves forward and explaining Nature when we should be 
 patiently and diligently investigating her ways. 
 
 It plainly appears that the same questions which we now 
 ask ourselves to-day have been asked over and over again 
 for thousands of years past. 
 
 When we come into the presence of great writers and 
 teachers we should remember that they have more to teach 
 than we have capacity to take in, however docile we may be. 
 
 If this is true of men, of the prophets and teachers of 
 Nature's truths, how much more of Nature herself, whose 
 ministers they are ! 
 
 The laws of things as we know them, their constancy in 
 the midst of continual change, their invariability and so far 
 permanence, do not, however, carry us further than them- 
 selves, not to that of which they are the expression and 
 form. 
 
 " Diese G-esetze nicht unsere Leitfaden sein konnen." 
 (These laws cannot be our guide.) Schopenhauer regards 
 the platonic and vera explanation of eternal laws as dreams. 
 
 We must go deeper into ourselves if we would be 
 acquainted with the reality of our being. 
 
 It is not even what we do or what we think ; these states 
 are proximate, striving, therefore changeable, and good or 
 bad in their relation to the subject, or not at all, but even 
 the true and best are not the subject. 
 
NOTES AND APHORISMS. h 
 
 " Der Welt Ende und Anfang nicht ausser uns, sondern 
 in uns zu suchen sei." (The end and the beginning of the 
 world is not to be looked for outside us, but in us.) 
 
 What we are, such is our world. 
 
 We have no faculties for passing beyond ourselves, yet in 
 ourselves are unfathomed depths, unexplored powers and 
 relations which need fathoming and searching into. As 
 Schopenhauer says, if we would understand nature our 
 course must not only be horizontal, but perpendicular. 
 
 And though, as he says, the brain is the quarry which 
 affords the material for a priori structures and dogmatic 
 teaching of the veritatis atomm, it is also the means, the 
 medium through which we learn all we can know. 
 
 Unfortunately the senses are such masters, and rightly 
 so, that they prejudice us overmuch in leading us to 
 believe their data are comprehended in form and time, and 
 contain no more, though there is a heaven over our heads 
 as well as an earth under our feet. 
 
 Kant perceived that the forms of thought necessitated 
 by our organisation, and which lead man to dogmatism as 
 well as to the truth necessary for time, must themselves 
 become objects of criticism if we would reach a compre- 
 hensive philosophy. 
 
 Pessimism and optimism are both extreme views of 
 things. 
 
 The present conditions are obviously much more good 
 than bad, but still far from what might be idealised as best. 
 The strife and striving for good is largely weak. The good 
 reached is not at high-standard level. 
 
 The remedy is in ourselves, though few know its use, or 
 can use it. Are we what we see and feel ? If we are, 
 pessimism has a strong basis ; but we are not, though con- 
 vinced we are. 
 
 Truth is truth, says our good Professor. We may well 
 ask, what is truth ? A man may prove much that has no 
 other truth but in him, and all be a turnip lantern leading 
 to a precipice over the sea. 
 
 The idealistic views of the world, as Berkeley and Kant 
 
 d 
 
lii MEMOIE. 
 
 and other thinking men have proved, are the true views of 
 the world. Such is the last conclusion. 
 
 Is it not clear that philosophy may be ever changing its 
 point of view, but that for us the proximate is the real ? 
 
 Our striving must be against negations. These negations, 
 however, differ from algebraic quantities, being + in proxi- 
 mate relations, — in the wider sense. 
 
 Can we separate object and subject ? Myself is nothing 
 but a part of my body, my body is nothing but a part of 
 my food, my food is nothing but a part of the earth, the 
 earth is nothing but a part of the solar system. 
 
 My body differs from my food in its living arrangements, 
 which we call organisation. Through our organisation we 
 get sense, emotions, perceptions, knowledge, and the world 
 and God are revealed to us. (See Milton, Book V.) 
 
 In ourselves we rule or may rule = Will. 
 
 Will = choice. Choice varies with object or indifference. 
 
 This determined by many circumstances — health — 
 intellect. 
 
 Therefore the operations of will are different and various, 
 differing and varying with circumstances. 
 
 Knowledge = relation. 
 
 Explanation = classification. 
 
 The outward world a hieroglyph. 
 
 (Schopenhauer, vol. i, p. 115.) 
 
 Purity = oneness. Water is pure when it is water only, 
 and it is considered pure water if it contains atmospheric 
 air + extra oxygen, provided it be wholesome to the blood ; 
 but should it contain deleterious air, though logically as 
 pure as when it had atmospheric air only, it would be 
 thought impure. 
 
 Purity is therefore used to signify absence of what is 
 injurious, absence of everything hurtful. 
 
 Moral purity seems also to imply this. 
 
 The chemist uses it for oneness, for a thing which is 
 itself and without admixture. 
 
 Practice first, philosophy after. 
 
 The forms of organic life are infinite. There is the 
 
NOTES AND APHORISMS. liii 
 
 whole vegetable kingdom, so varied and extensive, that with 
 our present knowledge it defies definition, much less an enume- 
 ration and classification of its members. If we took a unit of 
 any one species of this kingdom, it would exhaust our powers 
 to make plain the history of its life. Yet we know enough 
 to enable us to see that in this kingdom the primary step of 
 organisation was made. 
 
 Whether animal or vegetable first came is open to farther 
 question, but that the animal kingdom has been and is super- 
 imposed upon the vegetable is plain. 
 
 Now Pathology, like her elder sister Physiology, could 
 occupy herself without stint on any part of this wide field of 
 life, and we have to do so for the side-lights to get on our 
 special subject. 
 
 The pathologist follows the steps of the physiologist, and 
 often their work is but one. 
 
 If the self-will interest which man naturally has in hia 
 body, did not prevent as well as quicken the operations of 
 his mind, we should much more clearly see that often what 
 we call and think of as pathology was" but physiology in 
 another form. Decay and death are physiological — that is, 
 natural and part of life ; but we had rather not think so. We 
 would rather that the course of nature was more in our own 
 hands. We have indeed much power in directing and 
 modifying the course of nature, but we mostly begin not 
 only in the wrong way, but at the wrong end. 
 
 The education and correction of the psychic force is 
 worthy of all attention. The so-called disintegration of 
 moral nature, and its re-establishment by reciprocal control 
 of the nerve-centres, is a proper work of science. But here 
 we reach a region in which our anatomical conceptions are 
 sure to be at fault, since they reach but to form and not to 
 composition. 
 
 The solution of the mystery seems so near, and yet is so far 
 off. We have evidence from the history of the earth that 
 incalculable time and incalculable circumstances have been 
 in the problem. All the forces of our planet are in the 
 problem. And not only the forces of the earth in matter 
 and gravitation, but also the celestial forces of light and 
 
liv MEMOIE. 
 
 heat, both primal and present. And further, the eocene 
 germ forces their constant operation and augmental through 
 all time ; and further, our need of education into the study 
 of nature, and the works and workings for a successful 
 inquiry, are all considerations which show how far off we 
 are from knowing what we are, and how we came to be. 
 
 Doubtless for the ends of practice we have knowledge 
 enough at least for our moral guidance, and science con- 
 tinually though gradually adds to our consciousness of life ; 
 but for full knowledge we are ' infants in the dark.' 
 
 If we could see the working of the world's forces without 
 projecting ourselves into them, how educational an effect on 
 us it would have ! 
 
 Instead of this we project ourselves into them, combining 
 and distorting them, and seeing only ourselves in them, and 
 that only partially and falsely. 
 
 Das Ding an sich- does not exist. 
 
 This is a human idea only. Everything is das Ding an 
 sich, or belongs to it. If it did exist we could not know it. 
 It is therefore inane to discuss what we cannot know or 
 conceive. 
 
 " In the beginning." In the beginning of organic things 
 Light was the factor ; but whence light in the ratio rerum ? 
 The advance in our knowledge has shown that light is but 
 related to the other forces. Though all the effects of sun- 
 light have not been produced by electric light, the steps 
 made that way encourage the hope that such results will be 
 obtained. Yet so wonderful is it even to those (and even 
 more to those) who are familiar with the fact, that light 
 which by our structure we feel as a sensation, and light to 
 which we owe our life, should by common sense be identified 
 by us, though under forms entirely different. 
 
 "Hail, heavenly light!" says Milton. This apostrophe is 
 of wider bearing than it is likely the poet thought. Light 
 is the primordium of organic things. Light is the master 
 sensation in us. The light sense, in all its details of trans- 
 parent, refractive, sensitive, motor, and central condition, 
 presents us with the culmination of organic facts. 
 
NOTES AND APHORISMS. lv 
 
 Organic structure, the result of solar light, brings on a 
 new world, The dark world is mechanical. The world, 
 including light, is more than mechanical. 
 
 We, as living things, know this. We have sensations of 
 novel kinds, conscious likes and dislikes, impulses of different 
 orders, or more properly called appetites. 
 
 The mind must be either one with nature or outside of it. 
 
 All evidence and expression show it to be one with nature. 
 If it be so, so-called material must be more powerful and 
 wonderful than we generally believe. There must be not 
 only the three dimensions of space, but that which has no 
 dimension. 
 
 The analysis of nature has not advanced far enough to 
 admit of a theory of it. 
 
 The whole field of sensation, of thought, and of moral and 
 intellectual relations, has to be brought under scientific 
 research before any general statement can be made. 
 
 One thing would seem probable, namely, that mathemati- 
 cal dimension is not the whole measure of nature ; that, in 
 fact, the three dimensions do not measure the material — at 
 least in all cases. 
 
 Moreover we have no complete knowledge of compound 
 atoms. 
 
 It has been said that the combined intelligence of many 
 men is higher than that of any one in the combination. 
 
 It may in some such sense be true that compounds may 
 possess properties intellectually higher than the components. 
 
 One's whole life might exhaust itself in studying the 
 form and nature of a leaf, and yet leave in it an undis- 
 covered world. If this be so of any simpler object in nature, 
 how much more of an organised body such as man's ! 
 
 When we remember with what punctiliousness the students 
 and defenders of religious dogmas insist upon a point, a 
 letter, or a word, we students of nature should take a lesson 
 to our good, and to our study's advancement ; for here no 
 
lvi MEMOIR. 
 
 point is accidental or equivocal, none without eternal autho- 
 rity. So much cannot nearly be said of studies which begin 
 and end in our own ideas. 
 
 Do not explain Nature, but by patient attention to the 
 facts let her explain herself. 
 
 There are no generalities existent in nature, but only 
 particulars. The questions for science are always what is 
 the special fact, and next, what follows this. 
 
 Generalities are human formulas to help our weakness of 
 thought, or often idleness of thought, or rather want of 
 thought. 
 
 If the human mind is to grow, and if its scope of know- 
 ledge is to increase, it must be by the study of things in 
 their widest relations. The old idea that the earth is the 
 centre of the universe and man the centre of the earth is 
 largely exploded ; and all the questions " why " have been 
 dissipated in the explosion, whilst science is patiently and 
 humbly occupied with " how " and " what next." 
 
 The work of medical students is to inquire into the 
 "how " and the "what next/' and not into the "why." 
 
 A study of nature shows that there is continuity through- 
 out. 
 
 " Eeason has short wings in comparison with nature's." 
 
 (Dante, ' Paradise-.') 
 
 The greatest advance that can be made in practical 
 Science is to a full and intimate recognition of our ignorance. 
 
 We may not satisfy ourselves with logical and a priori 
 conclusions demonstrative to our reason, whether in things 
 Natural or Spiritual. In both we have to learn the relations 
 of each. Learn by observation, study, and experience. We 
 know that bread nourishes by eating it, not from the chemist's 
 analysis. 
 
 Science and common sense differ as cultivated fruits 
 differ from wild fruits. 
 
 Science sows its seeds of inquiry, and gathers the fruit. 
 Common sense picks the fruit, such as it, is by the wayside. 
 Common sense has no fields or orchards of knowledge. 
 
NOTES AND APHORISMS. lvii 
 
 The organisation which exhibits itself in living things is 
 a great second page of nature. The human mind can con- 
 ceive of organisation without life. Organisation does not 
 seem to produce life, but it expresses it, and produces it in 
 a new and higher order. A watch or any other piece of 
 machinery may represent organisation, but not living organi- 
 sation. 
 
 There is no psychology but on an organic basis ; living 
 organisms present, and some are the alone basis of mental 
 facts. 
 
 Our senses and our sensations give us knowledge. May 
 we not infer that they are essentially related to the things 
 they inform us of ? 
 
 Spinoza says the mind is known only through the body. 
 In other words, the body reveals the mind. 
 
 The germ of life is independent of the conditions which 
 evolve it. 
 
 Darwin deals with evolution, not with origin. 
 Spencer tries origin, but altogether fails. 
 
 Health. — This is a subject which appeals to all. What is 
 it ? It is maintenance of the body in strength for our use, 
 so that we may think and do without knowing that we have 
 a body. A healthy man lives and acts, wakes and sleeps, 
 without being troubled about his body. The machine — for 
 machine it is — works quietly day and night without troubling 
 its possessor. It has its own rules and laws, which in 
 health it quietly keeps. When hungry it asks for food, 
 and when satisfied would, if the master would let it alone, 
 leave off eating. But master and doctor and friends and 
 ignorance and prejudice are almost always offering the 
 living machine advice, and making it go wrong by excess or 
 some fanciful thing or other. The various parts of this 
 
lviii MEMOIR. 
 
 living machine have emotions of their own which guide it, 
 though we are unconscious of what they are. The heart 
 beats, the breathing proceeds, the food is digested, and the 
 other different works are performed quietly and regularly, 
 and more regularly if the master does not interfere. 
 
 It is often and often the master's interference directly 
 or by way of some suggestion, which disturbs this daily 
 performance which we call health, and which is indeed 
 health. 
 
 The master has his work to do, and if he does that work 
 well and truly, and leaves his servants to carry on the work 
 of the house, good order will mostly be kept. 
 
 There are no byways to health of mind or health of 
 body. The straight road is narrow. 
 
 The law of health is the law of life. This is not a truism, 
 but a law. 
 
 No man must be considered to have been well until he was, 
 as it is commonly expressed, " taken ill." And no one can 
 be pronounced healthy until after examination post mortem. 
 
 Drugs given in disease are, not unfrequently, for the most 
 part hurtful, perhaps universally so. The object of medical 
 treatment is to maintain the life processes. 
 
 I do not say that no drugs are useful ; but there is not 
 enough discrimination in their use. 
 
 There are many good general practitioners, there is only 
 one good universal practitioner — " a warm bed." 
 
 The one fatal blunder of the profession is the belief 
 that we can treat, with advantage to the patient, the acute 
 maladies, and that we ought and have power to treat the 
 tissue changes, though all admit we are ignorant of the 
 nature and living course of the changes. 
 
NOTES AND APHORISMS. lis 
 
 When one undertakes to show the way, he should know 
 something of the path. 
 
 In therapeutics this has often not been so, but the most 
 confident have generally been the most ignorant and dan- 
 gerous guides. Nor is this criticism confined to unlearned 
 men so called, but honoured and acknowledged authorities 
 have often been proved by the course of time to be as 
 dangerous as the more ignorant and unlettered. What 
 shall we do ? Rest and be still. The workman that made 
 the machine can repair it, all hindrances being removed. 
 Study the hindrances, acquaint yourself with the causes 
 which have led up to the disease. Don't guess at them, 
 but know them through and through if you can ; and if you 
 do not know them, know that you do not, and still inquire. 
 " Cannot " is a word for the idle, the indifferent, the self- 
 satisfied, but it is not admissible in science. " I do not 
 know " is manly if it does not stop there, but to say " I 
 cannot " is a judgment both entirely illogical, and in itself 
 bad as favouring rest in ignorance. 
 
 The study of Medicine is an object lesson ; the object, 
 man's body in health and disease. Man's body as a 
 separate thing will be best understood by comparing it 
 with the bodies of animals. This should be a wide and 
 careful study. 
 
 Knowledge of phenomena, sense, knowledge of forces, 
 interpretations, formulations of forces when known so far 
 as to be subject to formulation, tend to forecast and use. 
 The current is running on in a given line ; this we hinder or 
 divert by other forces, kindred or added. Such is Medi- 
 cine and Surgery. 
 
 What we call health, which looks so fixed and stable, is 
 more changeable than the stability of the rainbow. Its 
 maintenance depends upon the moving equilibrium of more 
 forces than the mind of man can realise. 
 
 We still have doctors who believe in themselves. 
 
Ix MEMOIE. 
 
 Give youf intellect without stint to your profession, not 
 your heart. 
 
 That which is healthy works upon its objects, that which 
 is diseased works upon itself. 
 
 " Things are not what they seem." 
 
 The reality and the truth are not to be settled off-hand 
 by our untutored conceptions. 
 
 Brain and mind are still mysteries to our ignorance, and 
 yet we express our opinions about them. I wrote to : 
 
 " I don't know what brain is, I don't know what sleep is, 
 but I know that a well-nourished brain sleeps." 
 
 As we may have double vision, so we may have double 
 consciousness, explained, as it would seem, by our two 
 cerebral hemispheres. 
 
 In cases which I have observed, the two states have not, 
 however, been equal. Thus a patient will say when 
 questioned, " I am quite well, but a gentleman in the house 
 was very ill last night," the condition being one of memory 
 rather than of consciousness. 
 
 The conditions of delirium give but doubtful evidence for 
 or against the oneness of the ego. 
 
 So far as investigation has gone, we seem to see that 
 the oneness is a resultant or the expression of a complex 
 unity. 
 
 The central fact of our existence we cannot reach by 
 anatomy or physiology. These sciences deal only with time, 
 space, and relation. 
 
 Here lies the arena of practice wherein we may strenuously 
 and hopefully toil and strive, admitting the essences upon 
 which they repose, and declining to discuss or deal with 
 what we have no faculties for knowing as science, but only 
 as a sure ground of belief. 
 
 8 
 
 Hydrophobia. — Of all the strange excursions which the 
 intellect has taken in search of truth, none is more strange 
 and curious than that of M. Pasteur for the discovery of a 
 remedy against the bite of a mad dog. 
 
NOTES AND APHORISMS. lxi 
 
 M. Pasteur had not been a student of hydrophobia, nor 
 was he acquainted with the facts of this or any other disease 
 in animals, men, or dogs, so that he started on this inquiry 
 without knowing the character of the country he had to 
 travel through. It is necessary to premise this, or the 
 course he took would seem but little calculated to lead him 
 to any useful result. He knew, as all have known, that the 
 bite of a ma,d dog produces its results not by fright of the 
 person bitten, but by the poison on the tooth. 
 
 He probably reasoned, as many a one has reasoned, on 
 the similarity of the bite of the mad dog and the wound of 
 the poison fang of the rattlesnake. And no doubt he noticed 
 the difference in time which the two poisons take to produce 
 fatal results, that at once in a few seconds the poison of the 
 rattlesnake begins to produce its dreadful effects, and kills 
 within as many minutes as it takes days or weeks or, strange 
 to say, even years, for the tooth of the mad dog or wolf, 
 however venomous, to produce hydrophobia. Whether he 
 thought of this or not, no one can say. One thing is certain, 
 for he has told us, that it was the vaccine point which is 
 used in vaccination which impressed him as most analogous 
 to the dog's tooth and the poison conveyed to that of vaccine. 
 
 It is right to state that only a want of knowledge of the 
 circumstances, natural to one who had no acquaintance with 
 the facts could have favoured this analogy, since, so far as the 
 known facts go, the vaccine poison and the mad dog poison 
 have nothing in common. It may turn out to have been a 
 happy ignorance, which made the way plain to what follows, 
 which enabled the scientific fancy to leap over much which 
 would have arrested the pathologist on the same march. 
 However that may have been, so it was. The vaccine 
 poison works out its results in a very definite and traceable 
 way, both in time and place. 
 
 What is education ? Teaching a man what his powers 
 and relations are, and how he can best extend, strengthen, 
 and employ them. 
 
xlii MEMOIR. 
 
 Education is not learning, but the training of the mind 
 that it may learn. 
 
 What our education most needs is enlargement as to 
 the intellectual and moral nature, as a scientific enquiry. 
 
 What can advance man ? A careful government of his 
 body in respect of its appetites and exercises. A pains- 
 taking education of his mind and moral nature. The source 
 of this advance lies in the man, lies there often hidden 
 and stagnant. Selfish, narrow aims and purposes afford 
 no stimulus. Ignorance and indifference have no quickening 
 forces, or suffocate them. 
 
 The power of forming ideals is peculiar to humanity ; and 
 the higher the ideals, the higher the humanity. Lower 
 animals have no ideals. 
 
 Man works by ideals, the fictions of his intellectual and 
 moral nature built up from experience and transcending it. 
 
 Man cannot perfect his mechanical works without an ideal 
 standard, such as pure mathematics ; so neither can he perfect 
 his moral and intellectual works without the idea and con- 
 ception of God. 
 
 A man's life is not what he reads or what he thinks, but 
 what his inclinations and aspirations are ; in fine, what his 
 inner life is. 
 
 As there is a moral law in man and an intellectual law, 
 the world must substantially be moral and intellectual. 
 
 Why this is not so evident is from the predominance of 
 the lower animal laws ; — and hence our not reaching to the 
 higher organic stage — the manhood as contrasted with the 
 bestiality. 
 
 Then what is our hope ? 
 
 Our hope is even in Thee (Eternal). 
 
 The moral man is higher than the intellectual. That 
 
NOTES AND APHORISMS. lxiii 
 
 reaches to the centre, this to the conditions ; that to what 
 is, this only to the conditions of what is. 
 
 The moral law and the physiological law are one. The 
 physiological law is the law of life. Life in its entirety 
 includes all. 
 
 It is not the aphorisms of morality which transform a 
 man, but the width and depth of his view of the conditions 
 of existence and life. 
 
 Life is a heavenly problem, to be worked out in earthly 
 materials. 
 
 I could often wish there was more faith in physiological 
 laws. 
 
 The nearer I approach to the end of life the more I am 
 impressed with the spiritual nature of things. It is th& 
 sensuality (not sense, but sensuality) of our nature which 
 restricts and hinders our clearer view. 
 
 The sense of personality in man is the source of his errors 
 intellectual and moral. 
 
 Even the most material work should have the spiritual 
 element in it ; intellect and duty. 
 
 If the fear of the Lord is the beginning of wisdom, tha 
 love of Him is its fulfilment. 
 
 This includes and excludes much. Includes pursuit of all 
 truth, and excludes self-love. 
 
 Man is an agent in world development. 
 
 It is obvious that the economic progress of the world is 
 built up on self-help and mutual help, under the rule of 
 necessity. 
 
 In living things there is everywhere relation, adaptation, 
 dependence and interdependence. 
 
 The intellect of man, in operation, is the providence of 
 God. 
 
Ixiv MEMOIR. 
 
 The conscientious conviction that all truth is consistent 
 with itself is necessary for our moral life. 
 
 Life would be unbearable to the thoughtful man but for 
 the conscious conviction that evil should eventuate in good. 
 
 Scientific things, material things, must be known in order 
 to be believed, Divine things must be believed in order to 
 be known. There be, saith St. Augustine, and he repeats 
 it, some things which must be known in order to be 
 believed, and there be others which must be believed in 
 order to be known. 
 
 This separation of things of sense and things of spirit, of 
 things of science and things of faith, of things human and 
 things Divine, in their relation to knowledge and belief, is 
 fundamental. 
 
 The antithesis of faith is inquiry. 
 
 Things may be opposite without being contrary. 
 
 Opposite, though one could not exist without the other. 
 The North Pole is opposite to the South, but there could be 
 no North Pole without a South. 
 
 Reason is a blind guide, and to put out the religious senti- 
 ment would and must mean chaos with a creature like man. 
 
 Belief is necessary to the highest knowledge. 
 
 The ideas of God and Being, Space and Time, do not need 
 proof. If there be anyone who asks for proof, he must be 
 considered mentally blind, and no reasoning will make 
 him see. 
 
 He is the man of highest mental stature who has the 
 fullest conception of God. 
 
 "Whom truly to know is to confess that we know Him 
 not " (Hooker) . The spirit of a man is a storehouse of 
 wonders even more than his body is. Yet, duly considered, 
 all runs in a straight line from nature up to man, from 
 
NOTES AND APHORISMS. lxv 
 
 man to God. An infinite and varied line, ever straight, 
 but often not to be traced for blurs and blots, weakness and 
 feebleness of outline. Tet it runs ever on. 
 
 Life cannot be restored in an aged body, save that life 
 which is eternal — the spirit of righteousness — rightness, — 
 the law of all life when yet there was none. 
 
 Thou canst not make water flow uphill but by expendi- 
 ture of greater force than draws it down. The spirit of 
 fire can do this, — converting it to steam. 
 
 Spiritualise water, and it ascends in spite of itself. 
 
 The earth is not the centre of the universe. Astronomy 
 proves this. 
 
 Self is not the centre of heaven and earth, small reflec- 
 tion will prove this. 
 
 Self is as fallacious a centre of things, as earth is of 
 the universe. 
 
 There are as many worlds as there are persons. 
 The world is each man's conception of it. 
 
 The world is not made by negations. 
 
 Grace, gracioumess. — This human feeling of the mind 
 and its outcome in life is not incompatible with the sternest 
 feeling of truth, but it softens its assertions and the carrying 
 out of its mandates. This spirit of grace decorates the 
 daily events of our life. It is the handmaid of charity, one 
 of the same house, ministering in the guest-chambers to all 
 who come and go, freighting intercourse with pleasant 
 memories, and raising the commonplaces of life to rank and 
 dignity. Some of the lower animals are gracious, raised to 
 this partly by their generous nature, partly by the kindness 
 of man. 
 
 Graciousness, when genuine, is spiritual, and pervades the 
 whole being at all times. . . . Grace gives its colour 
 to every act. . . . Grace is the Fairy of life. But 
 beware of imitations, for there are such, current in society, 
 
lxvi MEMOIR. 
 
 which, have the show but not the truth of grace ; ignes 
 fatui, not of the eternal fire from which all grace and all 
 virtue is. 
 
 How would a mariner fare if at every step he had to con- 
 sider the laws of magnetism ? Enough for us that we have 
 a pole-star : that we have hopes : that we have a world 
 with its sunshine and its storms : that we have eyes that 
 can guide us well enough for our daily life. Let us not 
 then so load ourselves with the riches of science and 
 speculation that all that would be left us would be to lie 
 down and die under the weight. 
 
 Everything must be considered with its context, words or 
 facts. 
 
 Popularity is the admiration of those who are more 
 ignorant than ourselves. 
 
 The proper argument against darkness is a light. 
 
 The best remedy for error is truth. 
 
 By neglect, errors of belief are most surely killed, and not 
 by treatises against them. 
 
 Error is often stimulated into new activity by arguments 
 to prove that it has no life. 
 
 A written truth lasts. 
 
 A spoken truth mostly perishes. 
 
 A written truth can be looked upon, and made a pivot or 
 fulcrum or corner-stone. 
 
 A spoken truth is fluctuating, and soon decays, or soon is 
 metamorphosed into something very unlike its early self. 
 
 The best memory is a record made at the time. 
 
 If any thing is to last, time must be put into it. 
 
 A little learning is a dangerous thing ; — not if you know 
 
 how little it is. 
 
 The world is generous, but not on the lines you would 
 
NOTES AND APHORISMS. lxvii 
 
 expect. Less than this, the generosity comes in by unexpected 
 lines, and by the lines of old obligation but rarely. 
 
 "We make our arrangements for getting through the world 
 instead of lovingly living in it. 
 
 Why does the world look so different to me at sixty-eight 
 from what it did at eighteen ? Then I took nickel plate for 
 silver, and pinchbeck for gold. 
 
 My danger now is lest I make the opposite mistake, 
 thinking gold pinchbeck and silver but nickel. 
 
 For whilst " all golden is not that doth golden seem, 5 ' 
 " gold o'er-dusted " may be misreckoned dust. 
 
 We often see when we do not perceive. 
 
 " The good of others " is a posy worthy of man. 
 
 Never become less by your own fault. 
 
 A man can receive no greater honour than that he bestows 
 on himself. 
 
 Keep the body in great order, for out of the body the 
 spirit grows. 
 
 Sentiment governs things of sentiment, but not things 
 without sentiment. Our wishes can have no effect but on 
 beings that wish. Voluntas non valet nisi supra nientem. 
 
 In childhood we learn to talk ; in age our lesson is to be 
 silent. 
 
 That there is a truth in all things is certain, and yet 
 nothing can be more certain also than that different minds, 
 as it would seem equally well informed, do form most 
 opposite opinions on the same facts. 
 
 An unkind word need never be spoken. Silence becomes 
 us when judgment could not be passed without sinning 
 against charity. 
 
 e 
 
lxviii MEMOIR. 
 
 In life there are some few precious moments of repose, and 
 blessed peace ; . but most of life is a striving with a 
 
 sense of failure against forces too strong for us, — " rowing/' 
 indeed, "hard against the stream." But we must not 
 forget that the mental and moral striving is God's power in 
 us, as is the sunshine His power about us. 
 
 Time does not make us stronger, but it may make us 
 better in many ways. 
 
 To do anything well favours strength, because it leads to 
 perfection. 
 
 Do not let the injustice of man lead to " retaliation." 
 Do not do evil because you have suffered evil. 
 
 Time brings all good things, even when it brings death. 
 
CONCLUSION. lxix 
 
 V. CONCLUSION. 
 
 The facts which have been given in the previous chapters 
 of this brief description or survey of one of the remarkable 
 men of his Profession in this century are of greater value 
 than any comment that can be made upon them or him. 
 
 It is obvious that Sir William's early education rested 
 mainly on his mother's wisdom and love, and on his own 
 innate force. His manly English father, and his mother, 
 trained in the faith of that branch of the Church of Christ 
 which made Wilson, George Herbert, and Ken, laid the 
 foundation, and fixed the bent of the boy's character. 
 Contact with Nature, on land and on water ; watching the 
 fishers at their labour, marvelling at the growth of the 
 plant, and the ways of the birds as they asserted their 
 rights on the tree tops, filled him with a yearning never 
 suppressed to unravel the hidden mystery of all that live or 
 have lived on earth, and the relation of each to man. 
 
 This education, adequate for a capable child gifted by 
 nature with the power of observation, and with a thirst for 
 knowledge of all things seen or unseen, prepared him for 
 the complex studies of his after life — whether in botany, or 
 comparative anatomy ; of man in health, and in disease ; 
 living in virtue, or in vice, in wisdom, or in foolishness ; 
 and developed in him those qualities which make a great 
 physician. 
 
 It would be unjust to pass unnoticed both the wisdom 
 and kindness of his various teachers, who each sought to 
 give opportunity to the latent powers they felt to be in their 
 keeping, culminating in the care of a country rector, Mr. 
 Harrison, and the consequent opportunity for full develop- 
 ment of power, placed at his disposal by the Treasurer of 
 Guy's Hospital. It should be said that such perception 
 and such goodness are indigenous among us everywhere 
 
lxx MEMOIE. 
 
 and at every time, through the freedom of the English 
 people when left to their voluntary efforts for good. 
 
 It would not be well here to discuss the precise turn 
 which Gull's mind took when his professional tutelage was 
 completed, nor of the discussion to which his curt state- 
 ments on Water — and Mint Water ; and Wait — Watch — 
 gave rise at a time when polypharmacy was not extinct, and 
 when hundreds of good medical practitioners were only paid 
 for their services and their knowledge by the cost of the 
 medicines which the sufferers consumed or received. It 
 was a period of transition, now thoroughly understood and 
 happily well-nigh closed. In public Gull rarely spoke of 
 these things, save in his hospital, to his students. 
 
 It is without question that Frederick Denison Maurice 
 was to Gull from the first, at once attraction and light. 
 For at that time — 1840 — before the bitter controversies on 
 theological questions were at their height, Maurice gave 
 to the best youth with whom he associated, an idea of 
 spirituality with power which they never lost. 
 
 The inner depth of his nature was never more touchingly 
 revealed than shortly before the end came. Sir Henry 
 A eland writes : fl I was sitting alone by his side, and, as 
 was his wont, no continuous conversation passed between 
 us. Suddenly, in his deepest and most earnest tone, he 
 slowly said, ' Acland, do you know what I am ? ' Not 
 divining what might be his meaning, I replied, 'Not at 
 all.' ' I am a Christian Agnostic' A better account of 
 my dear friend could not be given. Would there were 
 more like him ! 
 
 " It summed up, it seems to me, the whole of his deepest 
 convictions. ' Not by science — not by knowledge alone — do 
 I live and die. I live by Faith — in Faith I die.' 
 
 "Probably Sir William's deep interest in spiritual questions 
 during half a century, together with the originality and depth 
 of Maurice's religious thought had, unconsciously to himself, 
 framed his concentrated creed — Cheistian Agnostic. It calls 
 to mind the ' Student's Prayer ' which Francis Bacon left 
 to all generations. This prayer is as follows : 
 
 " ' To God the Father, God the Word, God the Spirit, we 
 pour forth most humble and hearty supplications ; that He, 
 
CONCLUSION. lxxi 
 
 •remembering the calamities of mankind, and the pilgrimage 
 of this our life, in which we wear out days few and evil, 
 would please to open to us new refreshments out of the 
 fountains of His goodness, for the alleviating of our 
 miseries. This also we humbly and earnestly beg, that 
 human things may not 'prejudice such as are divine, neither 
 that from the unlocking of the gates of sense, and the 
 kindling of a greater natural light, anything of incredulity 
 or intellectual night may arise in our minds towards divine 
 mysteries. But rather that by our mind thoroughly 
 cleansed and purged from fancy and vanities, and yet 
 subject and perfectly given up to the divine oracles, there 
 may be given unto faith the things that are faith's. — 
 Amen/ 
 
 " It may help some to know what were the convictions of 
 this robust and independent thinker — who through a long 
 life had observed man from birth to death in every condition, 
 of every kind — when in full possession of his reflective facul- 
 ties, and in full consciousness that his death would probably 
 be sudden. He so summed up the mysterious ways to know- 
 ledge that have in the evolution of our little world become 
 open to man." 
 
 This memoir cannot be more fitly closed than by a 
 quotation from a poem written by one of Sir William's old 
 pupils at Guy's — Prank Smith, entitled "The Worker." 
 The passage, marked many years before, was read by him 
 one Sunday shortly before his death, with evident emotion. 
 It refers to the death of a man of science, whose life had 
 been spent in seeking the ' Elixir,' — " the great life giving 
 secret " that should give to men health, strength, and 
 length of days. To those amongst whom he had lived it 
 seemed as though death had but ended a life of visionary 
 Jiopes and aimless toil : 
 
 " Even such the life, even so the end, a search, 
 A life-long weary search, for what ? for nought 
 
 and this was all. 
 
 " This was not all, for God on high Who wrought 
 Himself six days to form the mighty world, - 
 His eyes beheld the long and patient toil 
 . . . . The pure and high design. 
 
 / 
 
lxxii 
 
 MEMOIR. 
 He hath received him and . 
 
 . . . hath given charge to such 
 
 As are the mightiest around His throne 
 
 That he should learn the springs of law and fate, 
 
 The secrets and the mysteries whereof 
 
 The hounds are space, the time eternity." 
 
 Those who heard him read these lines could not doubt 
 that the words expressed his own conviction that death was 
 not the end — that after death would come new light — and 
 that the life-long yearning for fuller knowledge would at 
 last be satisfied. 
 
 In accordance with his own expressed wish Sir William 
 was laid to rest near his father and mother in the church- 
 yard of his childhood's home. On his grave is his favourite 
 text, 
 
 " What doth the Lord require of thee, 
 But to do justly, and to love mercy 
 And to walk humbly with thy God ? " 
 
SECTION VIII. 
 
 ADDRESSES. 
 
SOME GUIDING THOUGHTS 
 
 STUDY OF MEDICINE. 1 
 
 FvufiiqG Si Svo iltjLv ideal' i) fitv yvrjair]' i) 8t GKorir]' ical (TKOTirjQ fiiv rddt 
 (TVfnravra., 6ipi£, dicoy), oSfiT] ytiiffig, ipav&iQ' t) Se yvrj<rii} ajroKEKpyfifjiivri dt 
 ravrtjc. Canons of Democeitus. 
 
 Gentlemen, — Oar intellectual, like our bodily vision, 
 requires us sometimes to place ourselves at a distance 
 from the objects which engage our attention, that we may 
 obtain more correct ideas of them as a whole, and of the 
 relations they bear to collateral subjects. 
 
 The present is an occasion for such a survey, as being 
 especially necessary to those amongst us who to-day begin 
 a new career, and now fairly launch upon the ocean of life ; 
 for how important is it that they should, in nautical phrase, 
 " take a right departure," richly freighted as they are, and 
 with bright hopes and anticipations of a prosperous voyage ! 
 
 The study of Medicine conjoins some of the strongest and 
 highest motives to its earnest cultivation; — its objects are of 
 universal interest to mankind, and appeal to the common 
 principles of our nature, so that we may affirm with the pro- 
 verb, "primus homo primus fuerat medicus ;" — it is so 
 1 A Lecture delivered at Guy's Hospital at the opening of the Session 
 I855-5 6 - 
 
4 ADDRESSES. 
 
 generally esteemed as to obtain respect from the most bar- 
 barous ; — its scope is so wide as to give exercise to all the 
 faculties of the mind, and it borrows from the stores of 
 almost every form of human knowledge ; — it is an epitome 
 of science ; — its operations are so benevolent, that our 
 Divine Master himself assumed its offices as a type of his 
 spiritual ministrations ; — it has in it the very quality of 
 mercy, and 
 
 " is twice bless'd, 
 
 It blesses Km that gives, and him that takes." 
 
 Medicine holds a foremost rank amongst the natural 
 sciences, and can only reach its full development as they 
 advance to perfection. It is the centre to which some of 
 their brightest rays converge, for where beside can we look 
 for such illustrations of the highest expression of natural 
 laws as are found in the structure of the living body. It 
 has been well said, 
 
 " Man is one world, and hath 
 
 Another to attend him." 
 
 The first principle for the student to recognise, and one to 
 which in after life he will often have to recur, is that his 
 work lies not in the fluctuating balance of men's opinion, but 
 with the unchangeable facts of nature. 
 
 The rapid rise and spread of fanciful speculations, the 
 success of theories and confident dogmas, obscuring for a 
 time the more sober realities of experience, may make him 
 doubt if his path lie on so firm a ground, and perhaps tempt 
 him to try others less arduous and more hopeful ; but he must 
 disarm these suggestions with the confident assurance that 
 his object is not opinion, but truth. 
 
 The foundation of the study of Medicine, as of all scientific 
 inquiry, lies in the belief that every natural phenomenon, 
 trifling as it may seem, has a fixed and invariable meaning ; 
 — a flitting pain, or any other scarcely noticeable inconve- 
 nience, being like the form of a summer cloud or the incon- 
 stant currents of the air, the result of laws as durable as 
 those which sustain the more solid and immovable structures 
 of the world. The problem of their solution may be infinitely 
 
THE STUDY OE MEDICINE. 5 
 
 complicated, and often beyond the reach of our present 
 means of knowledge ; but we may surely conclude from 
 analogy, that even in the fluctuating and apparently acci- 
 dental there is the same constancy of action as in that which 
 bears upon it the more obvious stamp of fixity and dura- 
 bility. Unstable as are many of the phenomena we have to 
 inquire into, presenting themselves to us at the bedside in 
 an almost unending variety, like the combinations of a 
 kaleidoscope, we can successfully grapple with them only 
 when we are impressed with the certainty that they result from 
 some simple and unchangeable laws. This conviction sup- 
 plies a constant stimulus to the mind, quickens its energies, 
 and excites its curiosity with the feeling that there is an 
 attainable object, and that truth will reward the toil. 
 
 Scepticism in science is as baneful as in matters of testi- 
 mony and revelation ; it is a dead hinderance to all progress, 
 a upas in the mind. The motto in the pursuit of knowledge, 
 of whatever kind, has always been, " Mope all things ; — Prove 
 all things." Nature is inexhaustible. As yet she has but 
 yielded us a few instalments for our labour ; let us not 
 believe she has no more precious rewards to give. Although 
 it has taken centuries, and the labour of some of the greatest 
 intellects, to build up the science of medicine, as we now 
 have it, and it may be called a " goodly heritage " of know- 
 ledge, yet let us not be content with the mere acquirement 
 of it, but rather cultivate in our minds the feeling of Newton, 
 when he had perfected an eternal structure with his own 
 hands ; " I know not/' said he, "how I may seem to others, 
 but to myself I seem but as one who has gathered a few 
 pebbles on the illimitable ocean of truth. " There are no 
 bounds to nature's wealth, and in her yet hidden stores are 
 doubtless rewards for industry as full of blessings to mankind 
 as any she has already conferred. 
 
 Bewildered and disheartened with the difficulties of our 
 task, we are sometimes ready to accuse nature of obscurity 
 and uncertainty, and, in the childishness of our intellects, 
 attempt to govern when we are too ignorant to obey. The 
 source of those false systems which have disgraced our 
 profession have had their origin in this kind of vanity, turning 
 men from the patient ways of true investigation into the 
 
o ADDRESSES. 
 
 bye-paths of ignorance and superstition. In spite, however, 
 of fashions of opinion, or those false systems of medicine, 
 we return to the truth, that our studies require of us a 
 close acquaintance with nature, where, as Hippocrates 
 himself taught, " Bach thing, both in small and in great, 
 fulfilleth the task which destiny hath set down." 
 
 The clear perception of this truth conferred upon his 
 labours the immortality they enjoy, and supplies us with 
 the highest argument for precision in our observations, for 
 if such material atom courses with undeviating exactness 
 through the mystical cycle of our organisation, it must need 
 all our vigilance and care to track its intricate paths. 
 
 Plato's inscription over the gate of the gardens of 
 Academus — 
 
 " Ovdug ayeofierpijTOQ tia-lru " — 
 
 would be equally appropriate over the portals of Medicine. 
 The study of organisation constitutes a divine mathema, a 
 discipline wherein our mental faculties may find their 
 highest exercise ; and though the student of Medicine may 
 be ignorant of the details of mathematical science, and 
 unable, from the mere want of instruction, to pursue to their 
 elaborated issues the relations of number and space, yet its 
 spirit must be in him ; — the same certainty of truth, though 
 its kind be different ; — the same cautious investigation, 
 though the paths vary; — the same perseverance in pursuit, 
 though the difficulties be as great, and the way be often 
 impenetrably obscure. 
 
 The student of Medicine can no more hope to advance in 
 the mastery of his subject with a loose and careless mind 
 than the student of mathematics. If the laws of abstract 
 truth require such rigid precision from those who study 
 them, we cannot believe the laws of nature require less. 
 On the contrary, they would seem to require more ; for' the 
 facts are obscure ; the means of inquiry imperfect ; and in 
 every exercise of the mind peculiar facilities to err. The 
 truths of mathematics are, moreover, essentially accordant 
 to the mind, whilst those of nature are often contrary to all 
 anticipation. Can it require a higher intellectual capacity, 
 or greater powers of concentration, to demonstrate the 
 
THE STUDY OF MEDICINE. 7 
 
 properties of a circle, than to explain the organisation of the 
 body, or rightly to estimate, at the bedside, the relative 
 importance, in a series of obscure symptoms ? The kinds 
 of mental exercise may be different in these mathemata, but 
 in both there is range for the highest faculty of thought. 
 The modern introduction of chemistry, botany, and physio- 
 logy into the older universities is a public testimony to the 
 truth of the principles I am desirous to maintain, and a 
 further motive for the daily culture and discipline of our 
 minds in the same pursuits. 
 
 The student of Medicine has, however, a twofold induce- 
 ment to approach his subject in the truest spirit. He has 
 not only to discipline his mind and fit it for the acquisition 
 of knowledge, but to furnish it for practice ; his object is 
 both education and acquirement ; mental training and 
 practical knowledge. If he make mere acquisition his only 
 object, he commits an error apt to defeat the very purpose 
 of his industry. He comes here for medical education, 
 which includes the learning how to learn, that when he 
 leaves this hospital he may be able successfully to gather 
 experience for himself, which is the true end of education 
 where knowledge is essentially progressive. 
 
 Plunged, as a student is at the beginning of his studies, 
 into a vortex of many subjects, all is chaos ; — he begins 
 chemistry before he knows the ordinary laws of physics ; 
 the anatomy of the most elaborate piece of organisation, 
 before he has looked at the more simple ; the study of 
 human physiology, before his mind has contemplated the 
 less complex functions of a plant. To tell him, therefore, 
 that he must begin with method, seems like mocking him 
 with an ignis fatuus. It is, however, the only way of 
 escape from the confusion, and begins by the exercise of 
 patient attention. The greatest intellects without it are 
 weak. Newton himself, the prince of men, of whom it 
 stands written, " genus humanum ingenio superavit," said, 
 " I keep a subject constantly before me, and wait until the 
 first dawnings open little by little into a full light." 
 
 Method is an orderly and progressive activity of the 
 mind, leading us to view a subject in every light ; — to 
 exhaust it, as it were, by observation ; — to track its relations ; 
 
8 ADDEESSBS. 
 
 until at length, having gone through it and about it, the 
 mind rises above it, and contemplates it as an element of 
 truth ; a fixed point for the investigation of other truths, 
 until, by gradual addition, the form of science rises in the 
 mind. 
 
 Method is to the intellectual faculty what light is to the 
 eye ; without it we labour to no end, like toiling through a 
 thicket without path or object. As the ancient fire-wor- 
 shippers continually served their altars of flame, so mast we 
 ever refresh the lamp of method, and strive to diffuse its 
 brightness over the mind. To use the words of Bacon, 
 " in this we should imitate the divine foresight and order, 
 for God, on the first day, created only light, and assigned a 
 whole day to that work, without creating any material sub- 
 stance thereon." 
 
 If method be our light and our path, the senses are our 
 pioneers. In Medicine, they are the indispensable servants 
 to truth, though we are often too sluggish and careless to 
 employ them aright, and apt to prefer the suggestions of 
 imagination to the more sober evidence they alone can 
 supply. The errors from mere want of observation are so 
 common, and yet often so easily avoided, as to make one 
 sometimes feel that it requires but a right use of the senses 
 to master the difficulties of our profession. 
 
 We have no longer gravely to discuss whether there be 
 advantages or not in the use of the eye and the ear, as 
 some seem to have doubted who have questioned the value 
 of the aids to these senses in the study of disease. He 
 must have taken a wrong path who asks " Is the micro- 
 scope of use ? Is the stethoscope of use ? " On the con- 
 trary, instead of voluntarily submitting to the dulness of 
 the senses we have, we are almost tempted at times to wish 
 for more means of direct insight into the things before us. 
 But perhaps some will say, many have practised their pro- 
 fession successfully, unaided by the implements of modern 
 science. Without discussing the merits of such an assertion, 
 we may answer that some blind persons have been expert 
 enough to tell colours by the touch, and others less favoured, 
 who have made considerable advances in knowledge ; yet 
 there are few who would prefer such limited acuteness to 
 
THE STUDY OF MEDICINE. 9 
 
 the glimmering of light, however feeble. A lifetime of 
 practice may do much to compensate for the want of more 
 ready and accurate means of knowledge as by mere touch 
 we may become acquainted with most material forms ; yet 
 no one would reject the service of the eye which reveals 
 them in a moment. 
 
 The cultivation of the senses is no unimportant part of 
 the student's task. To him we may say, " apply your senses 
 continually to the work before you/' There will hereafter 
 be many hindrances to the free use of these means of know- 
 ledge, when he will be most anxious to avail himself of 
 them, and when he may be obliged to act upon the experi- 
 ence he has now an opportunity of acquiring. 
 
 But the senses alone cannot inform us of the truths of 
 nature, they must be reached by thought and reflection, 
 without which it is mere groping in the dark. Other 
 animals have senses often more acute than man's, but no 
 intellectual insight into the things they see. No applica- 
 tion of sense, aided by the best means that art can devise, 
 can by itself bring us to the objects of our search; the 
 data that so flow in, require the ever active mind to give 
 them their true place and meaning. Yet I would repeat, 
 there are few things more important to be urged upon a 
 student, than the constant application of his senses to the 
 objects of his pursuit, for the reading of books is so easy, 
 and by them knowledge seems to come as it were by inspi- 
 ration, and we float so pleasantly along on these paper 
 wings, that the harder toil of observing for ourselves is 
 apt to become distasteful. 
 
 Books are but secondary aids to knowledge. They can 
 be read to advantage only after observation, or as helps to 
 it; to trust to them alone, is to spoil the faculty of obser- 
 vation, for we do a violence to our intellectual nature, when 
 we take that on faith which should be admitted only on 
 demonstration. Knowledge so acquired, however full, and 
 round, and beautiful it may seem, is but as the child's 
 bubble, and will collapse on the least contact with the 
 realities of practice. 
 
 All physical knowledge, to be durable and useful, must be 
 built upon the evidence of the senses. In this Hospital, 
 
10 ADDRESSES. 
 
 every care has therefore been taken to lay plainly before the 
 student the phenomena he has to study j and in its wards, 
 through which pass a ceaseless stream of human maladies 
 of every form, he may acquaint himself with the science and 
 practice of his profession. 
 
 It is by observation we begin, and by it we perfect our 
 knowledge. In its exercise we must pass, as it has been 
 said, from the forge of Vulcan to the temple of Minerva; — 
 from the employment of the sense, — to the operations of the 
 mind, if we would penetrate the hidden meaning of things ; 
 — if we would interpret nature rather than content ourselves 
 with looking ignorantly upon the surface of her hiero- 
 glyphical pages, — for this is not education. A man is not 
 educated in a foreign language, who, when a book is pre- 
 sented to him written in it, can only tell the number and 
 names of the letters. He must be able to combine them 
 into words and sentences, and to look through them into 
 the author's meaning, before he has any pretensions to that 
 kind of learning ; and so it is with the student of Nature's 
 book. Phenomena are the letters, and their combinations 
 the words, of that page which we have to study ; and 
 careful must we be to punctuate and accentuate them aright. 
 
 But if facts be nature's words, our words should be true 
 signs of nature's facts. A word rightly imposed is a land- 
 mark indicating so much recovered from the region of ignor- 
 ance ; a step in progress. It recalls the nature of the subject, 
 and becomes a symbol of all our knowledge upon it, a genuine 
 and current coin in the intercourse of mind with mind. 
 
 But in our profession there are words, like quicksands, 
 changeable in their meaning, and full of danger. Compli- 
 cated actions, often but little understood, are expressed in a 
 word, and such words, surrounded by the tinsel of speculation, 
 receive an idol-worship, and, perhaps, victims at their shrines. 
 But notwithstanding this, there is a divinity in words. What 
 are the details of a case, and its history, if we have not the 
 power of completing the equation, by adding the suitable word 
 to express the essential condition of the whole ? The name 
 at once lights up that which was before obscure ; at once 
 reveals the meaning of the facts, and concentrates the expe- 
 rience of the past with the knowledge of the present, and 
 
THE STUDY OF MEDICINE. 11 
 
 throws a kind of prophetic ray upon the course and order of 
 the future. 
 
 A student may often, with recreation and profit, scrutinise 
 the grounds of scientific language. Much is often said, on 
 occasions like the present, of the advantages of a knowledge 
 of languages ; of the position it gives in society and of the 
 honour it reflects on the profession. This you will all admit, 
 for the members of our profession cannot be deficient in 
 those parts of learning, which distinguish the well educated 
 in general, without yielding the position they are entitled to 
 enjoy. But medicine is essentially a learned profession. 
 Its literature is ancient, and connects it with the most learned 
 periods of antiquity ; and its terminology continues to be 
 Greek or Latin. You cannot name a part of the body, and 
 scarcely a disease, without the use of a classical term. Every 
 structure bears upon it the impress of learning, and is a silent 
 appeal to the student to cultivate an acquaintance with the 
 sources from which the nomenclature of his profession is 
 derived. 
 
 But to return ; our object in the study of Medicine is to 
 know the human body, and those external agents which 
 surround and affect it, either as necessaries to its health or 
 as sources of disease. All our knowledge must centre here. 
 However wide our inquiries, they must find their home here 
 or be altogether useless. 
 
 Medicine requires not only the intellectual cultivation of 
 a science, but the patience and practical skill of an art. At 
 the bedside we must be animated by the feeling of faithful 
 artisans, of men whose object and duty is practical work ; 
 for when the art of Medicine is needed by the suffering and 
 the dying it is no question of mere theoretical knowledge 
 and extraneous acquirement. But skill in the commonest 
 art is not to be attained without much practice, far less 
 in the complicated and difficult art of healing, where 
 every case presents some peculiarities. To practise it suc- 
 cessfully, we must have made our home at the bedside, 
 and, if I may say so, have lived with disease, observing it 
 in all its forms and changes. The opportunity of doing so 
 can be obtained only in a large hospital like this. Chemistry, 
 botany, and physiology may be pursued in the study or the 
 
12 ADDRESSES. 
 
 lecture-room, but the practice of our profession only at the 
 bedside. There alone can we acquaint ourselves with the 
 features of disease, the symptoms it exhibits, and the reme- 
 dies which relieve it. If a student is to become a practical 
 and expert workman in his profession, it can only be by a 
 large expenditure of time at the bedside ; — there he must 
 get the facility for practical investigation ; — there he must 
 sit with the objects before him, and note and methodise the 
 facts which lay the foundations of experience. 
 
 But man individually is but a unit in a large account, — a 
 living atom in the great body of human social life, and so to 
 study him is a subject demanding some of our thought and 
 work. By looking at large numbers, facts before unnotice- 
 able become proportionably magnified. Causes affecting 
 health and shortening life may be inappreciable in the indi- 
 vidual, but sufficiently obvious when their effect is multiplied 
 a thousand-fold. If the conditions of society render us liable 
 to many diseases, they in return enable us to establish the 
 general laws of life and health, a knowledge of which soon 
 becomes a distributive blessing. The cure of individual 
 diseases, whilst we leave open the dark fountains from which 
 they spring, is to labour like Sisyphus, and have our work 
 continually returning upon our hands. And, again, there 
 are diseases over which, directly, we have little or no control, 
 as if Providence had set them as signs to direct us to wider 
 fields of inquiry and exertion. Even partial success is often 
 denied, lest we should rest satisfied with it, and forget the 
 truer and better means of prevention. Therefore, although 
 at the bedside, man, with all the peculiarities which distin- 
 guish him as an individual, — his parentage, his birth, his age, 
 his habits, his previous diseases, and his actual condition, — 
 is our daily and more especial work. Tet man, in his social 
 relations, claims some of our attention, since it is only by 
 the collective labours of the profession that the principles of 
 Hygiene can be finally established. 
 
 Gentlemen, amongst all the varied occupations which the 
 necessities of life entail, it is a matter of no trifling con- 
 gratulation to have one that ennobles and expands our 
 nature, and bends our faculties to the common good. 
 Constituted as man is, it is certainly no slight advantage to 
 
THE STUDY OF MEDICINE. 13 
 
 be the members of a profession in which the commonest duties 
 require the highest principles, and are a constant exercise 
 in the pursuit of truth. All true science has an upward 
 tendency. As terrestrial influences point the needle to that 
 
 " stedfast starre 
 
 That was in Ocean waves, yet never wet ;" 
 
 so the mind, unfettered by prejudice and unswayed by 
 passion, should, under the right influence of mere natural 
 science, turn to that Centre which it recognises as the source 
 of all its knowledge. Even heathen antiquity affords us 
 such examples; and gross as was its mythology, it yet 
 embodied thoughts struggling to light and purity. What 
 else were its divinities of the several kingdoms of nature 
 but so many plain acknowledgments of the presence of a 
 divine power in universal operation. Why was it feigned 
 that Minerva sprung from the head of Jove, but to indicate 
 the source of heavenly wisdom ? Why was Vulcan, the god 
 of Physical Science, but a lame divinity, if not to teach that 
 such knowledge by itself is defective and lame, — and why 
 is it said that his principal works were a collar and a sceptre, 
 but to illustrate how natural science may become to us, 
 according as we use it, either an enslaving or an ennobling 
 power. 
 
 It is an unfounded assertion that the study of Medicine 
 necessarily stints the mind, limits it to second causes, and 
 hinders it from reaching to higher realities than those of 
 sense. " There is," truly says Hooker, " no kind of 
 knowledge whereby any part of truth is perceived but we 
 justly account it precious — yea, that principal truth, in 
 comparison whereof all other knowledge is vile, may receive 
 from it some kind of light ; — to detract, therefore, from the 
 (true use and) dignity thereof, were to injure even God 
 himself, who, being that light which none can approach 
 unto, hath sent out these lights whereof we are capable, 
 even as so many sparHes resembling the bright fountain 
 from which they rise." 
 
 There is not a step in the path of our studies but is strewn 
 with such sparkles of the divine wisdom, power, and goodness. 
 The truly philosophic eye has always seen them and rejoiced 
 
14 
 
 AJDDEBSSES. 
 
 in their light. The lessons they teach are no mere hypo- 
 thesis or fanciful speculation, hut a direct induction from 
 the facts themselves. Of the structure and relations of the 
 parts of our bodies, we may assert that they show no traces 
 of a law of necessity, but many of the highest wisdom and 
 choice — " multa sane sapientissimi consilii nulla necessitatis 
 vestigia," — evidences of design which, opening out into 
 wider and wider fields of beauty as the intellect of man 
 explores them, are an unimpeachable proof of Divine Wisdom. 
 As to Infinite Power ; — if we stand in wonder before the 
 truths astronomy reveals, and contemplate its mighty orbs 
 balanced in space, and gathering from the scene fresh 
 thoughts of God's power and presence, exclaim with the poet, 
 
 " An undevout astronomer is mad," 
 
 can we overlook the infinity of power in another direction, 
 and refuse to turn our eye inward upon the atoms of the 
 living structures ? They are balanced with a finer adjust- 
 ment than instruments can measure, they move through their 
 intricate courses with scarce a shadow of irregularity, now 
 entering in to play their part, or now dismissed to be 
 succeeded in their turn by others with such observance of 
 law and order, that we are insensible of the change. If 
 astronomy shows us power infinitely great, anatomy and 
 physiology show us power infinitely delicate. There is an 
 infinity in the division of force as there is an infinity in its 
 multiplication. 
 
 As to Goodness ; — all is framed for healthful exercise and 
 pleasure. " There is no nerve," significantly says Paley, 
 " whose proper function is pain ;" and on pain itself what 
 a volume could be written to show the benevolent design 
 which renders us the occasional subjects of it. Every part 
 of our structure is replete with goodness. It is the theme 
 of every pen. " There are two books," says that ornament 
 of our profession, Sir Thomas Brown, " from which I collect 
 my divinity. Besides that written one of God, another of 
 his servant Nature, that universal and public manuscript 
 which lies expanded to the eyes of all ;" and of which, I 
 may add, our profession opens the page most full of mean- 
 ing. 
 
THE STUDY OP MEDICINE. 15 
 
 I claim for science only a second place. It is applicable 
 only to matters of experience. This is its horizon ; and, 
 however it may be enlarged, " it is an horizon still, a circle 
 beyond which, however wide it may be, there shine like fixed 
 stars without a parallax, eternal problems, in which the 
 march of intellect never shows any change of place." x These 
 problems, gentlemen, will, I trust, commend themselves to 
 you by their intrinsic importance. I may not in this place 
 urge them further upon your attention, than by showing 
 that your studies, if rightly viewed, may fit your minds for 
 receiving the testimony upon which their solution rests, and 
 that the employment of the mind in one department of truth 
 ought to open it, and prepare it for a readier entrance into 
 others. We have the authority of the great master of the 
 Inductive Philosophy for saying, " that any one who rightly 
 considers the subject will find natural science to be, after the 
 Word of God, the surest remedy against superstition, and 
 the most approved support of Faith. She has therefore been 
 wisely bestowed upon Religion as her most faithful attendant, 
 for the one exhibits the will, and the other the power, of 
 God." "Nor," he adds, "was He wrong who observed, 
 ' Ye err, not knowing the Scriptures nor the power of God,' 
 thus uniting in one bond the revelation of His will and the 
 contemplation of His power." The perfecting of this bond 
 — the uniting true religion with the study of his profession 
 — is a subject to which my colleagues and myself would 
 earnestly direct the attention of the student ; for, however 
 great hereafter his attainments may be, or however distin- 
 guished his future success, these can supply but a part of his 
 daily wants, and will leave a void which can only be filled by 
 the exercise of that hope which is set before us in the Gospel 
 of Christ. 
 
 But I may detain you no longer. I have said but little 
 on your individual studies, because I have thought that best 
 left to the Professors in their several departments. I have 
 said nothing of the rewards presented in this Hospital to the 
 industrious student, because I feel that, in every medical 
 school of this metropolis, the object is to encourage industry, 
 
 1 Newspaper Report of the Duke of Argyle's speech at the Meeting of the 
 British Association at Glasgow. 
 
16 ADDRESSES. 
 
 and to reward it. In this, therefore, we strive with others. 
 It is true neither medals nor books are awarded by us, 
 because they are thought to correspond but little to your 
 age, or to the spirit which should animate you. In this 
 school the industrious is rewarded by giving him the best 
 scope for his industry. He is promoted to offices whose 
 duties, well performed, will go far in ensuring him pre- 
 eminence in the future practice of his profession. He has 
 in fact, more given him to do, and he may find in that a 
 higher reward than in any merely tangible object he could 
 exhibit to his friends. 
 
 Gentlemen, there never was a time more propitious to the 
 student entering the profession of Medicine. Its ranks are 
 far from overcrowded, and fields of reward, before closed by 
 private patronage, are now thrown open to public competition. 
 The students of this Hospital have always maintained a dis- 
 tinguished position in such contests, and in the ranks of the 
 profession are well known for their practical knowledge and 
 high character. I have to ask you not to let these honours 
 fade in your hands, but to transmit them with increase to 
 those who shall in future years follow you on these benches. 
 I will assure you, in the name of my colleagues and myself, 
 that no pains will be spared by us to facilitate your work. 
 
 [To the Treasurer.] 
 
 And now, sir, I have only to thank you for your presence 
 here to-day ; and, through you, the Governors, for the favour 
 with which they have always regarded our efforts in the 
 cause of Medical Education. 
 
 "When Guy founded this Hospital, he probably but little 
 contemplated occasions like the present ; but, sir, I think 
 you will admit that his benevolent intentions have been 
 greatly promoted by the establishment of this Medical School. 
 The stimulus it affords results in increased advantages to 
 every unfortunate inmate of this house, and has obtained for 
 it a world-wide reputation. To maintain this is the earnest 
 desire of my colleagues and myself, and we shall, I trust, 
 be seconded by your further support. 
 
AN ORATION 
 
 DELIVERED BEFORE 
 
 THE HTJNTERIAN SOCIETY, 
 
 February 13TH, 1 86 1. 
 
 The institution of an annual meeting for the delivery of 
 an address bearing the name of Hunter, must have been for 
 the cultivation of that spirit of scientific inquiry which ren- 
 dered him so distinguished and so worthy of our honour. 
 
 Had its purpose been to afford an opportunity for pouring 
 forth laudations to his memory, or for detailing the facts of 
 his personal history, it could scarcely have been thought 
 necessary to repeat so useless a ceremony year by year ; but 
 if, as I have assumed, the intention was to stir up in us the 
 same animus that urged forward the great man whose name 
 this Society bears, then, for such a purpose, an annual meet- 
 ing is not a too frequent occasion, nor will it, though repeated 
 long after we have passed from these scenes, find our suc- 
 cessors with an exhausted theme. 
 
 Of all the gifts bestowed upon humanity, none is more 
 precious than the example of a great man, in whatever pro- 
 fession he may arise. He stands before us a revelation of 
 high motives, right methods, and untiring energies, and he 
 carries with him to a higher level all those whose objects 
 are one with his. 
 
 Hunter was such to our profession. He was a true believer 
 
 2 
 
18 ADDRESSES. 
 
 in the inexhaustible riches of knowledge which lie as yet 
 undiscovered around us and within us. His thoughts busied 
 themselves upon every living object. " My mind," he said 
 to Abernethy, " is like a bee-hive ;" and the remark reveals 
 to us the incessant activity and yet the order of his thoughts. 
 Unwittingly his simile testified that he was in a true position 
 to his work, for, according to Bacon, the true philosopher is 
 like the bee. "Empirics are," he says, "like ants, which 
 collect only for present use, and rationalists, like spiders, 
 weave but flimsy textures out of their own bowels, but the 
 bee gathers material from every flower of the garden and 
 of the field, and converts and digests it by an operation of 
 its own." Hunter might well say, therefore, his mind was 
 like a bee-hive, since into it came observations from every 
 quarter laden with treasures which he was ever occupied in ar- 
 ranging and building up into the structure of science. " Come 
 early to me to-morrow morning, young gentleman," he said 
 to a medical student who had been introduced to him, " and I 
 will put you in the way of things. Come early in the morn- 
 ing, as soon as four, if you can." The appointment was 
 kept, and at that early hour Hunter was found dissecting a 
 beetle ! 
 
 Medicine and surgery in their practical application refer 
 to man only, but their study embraces a knowledge of almost 
 all physical objects. There are, and perhaps always must be, 
 two views under which the student of medicine will regard 
 man — the empirical and the scientific. It can only be as 
 science reaches perfection that these two views will coincide. 
 At present we are far from such a desirable position, and 
 yet both demand our fullest consideration. To limit our- 
 selves to the one or the other is to act over again the fable 
 of the shield with its gold and silver sides. The practical 
 man, whose life is spent at the bedside, and whose mind is 
 intent upon the diagnosis and treatment of the secondary 
 conditions of disease, and to whom the death or recovery of 
 his patient seems to depend upon a strict limitation of his 
 thoughts to the case before him, feels, as we have all felt 
 under such circumstances, a distaste amounting almost to 
 disgust at any attempt to occupy himself with the purely 
 scientific questions of physiology or pathology. He cannot 
 
HUNTBRIAN ORATION. 19 
 
 but feel that what he wants is not to be gained by a trans- 
 cendental knowledge of archetypal forms, nor can he readily 
 see that his usefulness is much promoted by devoting himself 
 to tracing up from remote ages or from inorganic atoms the 
 conditions of life, or by occupying himself with whatever sub- 
 jects if they lie out of his immediate path. Yet it will be 
 generally admitted — and the name of this Society is a suffi- 
 cient guarantee — that its members especially are convinced 
 that the growth and strength and dignity of our profession 
 depend upon our successfully combating this tendency to an 
 empirical bias, and that whilst the practice of medicine 
 depends upon experience in the strictest sense, it requires 
 the illumination which every light of science can throw upon 
 it. 
 
 The one great question which occupied Hunter's mind, is 
 that which will ever recur to us and demand fresh inquiry 
 until its solution is reached, I mean the law or principle of 
 the vital force. It is the chiefest in physiology, and com- 
 parable to the law or principal of gravitation in natural philo- 
 sophy. What is life ? Is it something superadded to a 
 peculiar modification of matter, or is this modification of 
 matter so ai'ranged that the principle of life arises out of the 
 arrangement. Between these two ideas fluctuated the mind 
 of Hunter, and we to the present day continue to vacillate 
 between them. Daily advances in science make it more 
 and more probable that organised beings are the necessary 
 development of the physical conditions of our globe. The 
 elements of which they are composed are remarkable for 
 their ordinary physical and chemical properties. They are 
 such, indeed, as a knowledge of these properties alone wonld 
 have led us to select had we proposed to ourselves the con- 
 struction of a being endowed with ordinary animal capa- 
 bilities. I do not say that we have any such knowledge of 
 oxygen, hydrogen, nitrogen, carbon, phosphorus and sulphur 
 as would enable us to predict of these substances any relation 
 to the higher animal functions, but only that so far as we 
 do know them, they alone of all the fifty-four elements with 
 which we are acquainted, seem fitted to the organic task 
 assigned them. Surely it is a fact of no small significance 
 that our tissues are so composed. And if we may safely 
 
20 ADDEESSES. 
 
 argue that lime is in our bones to give them resistance, and 
 alkalies in our blood to make it fluid, may we not conclude, 
 though as yet we are not able to penetrate the mystery, that 
 the forces of the nervous system are also the product of its 
 composition. No doubt it must be admitted that we cannot 
 range under the known chemical and physical forces all the 
 phenomena of living beings, nor indeed any of such as are 
 especially distinctive of animal life — as sensibility, and the 
 like ; but we know that although the ultimate changes in 
 our nervous system connected with sensation are altogether 
 obscure, yet that the first steps of the process are according 
 to the exactest rules of physics. That we need an optical 
 apparatus of absolute perfection for the concentration and 
 arrangement of the rays of light at the peripheral termination 
 of the optic nerve, suggests that an equally exact though 
 different arrangement of structure exists at its centre. If 
 " physics " prevail at the periphery, then we must infer that 
 " physics " prevail at the centre also, and this may be true 
 to the fullest extent, though the living principle be, as Hunter 
 says, in itself not the least mechanical, neither does it arise 
 from, nor is it in the least connected with, any mechanical 
 principle. For it would be too much to suppose that all the 
 ultimate actions of matter are according to what we now 
 include under mechanical or chemical principles. I think it 
 is a necessary conviction that our knowledge of material 
 actions is in its infancy, and that though we may safely say 
 of any particular series of them that it stands by itself and 
 is not reducible to more common terms, it would be assuming 
 too much to deny such a possiblity, and would have the evil 
 effect of making us content with our ignorance. 
 
 Suppose it probable that we are not able from the nature 
 of the case to comprehend the ultimate conditions of sensi- 
 bility or of voluntary action, we are not on this account pre- 
 cluded from inquiring how far these faculties correlate with 
 certain changes in the nervous substance — how far, in fact, 
 an equivalent of material change corresponds with an equi- 
 valent of sensorial or volitional change. For example, 
 without knowing anything of an electro-magnet, I mean as 
 to the arrangement of the insulated wire around the soft 
 iron, or of the magnetical properties of the current, I might 
 
HUNTERIAN ORATION. 21 
 
 yet be able, were all the arrangements totally hidden from 
 me, to make out in all its details the correlation of the chemi- 
 cal change in the battery with the force exhibited in the 
 magnet. And it may be so in the working of our bodies. 
 We may not be able to unravel all the steps, yet we may 
 succeed in showing the essential relation between the extreme 
 terms of the process. 
 
 It is but a few years ago that chemists discovered in the 
 vegetable kingdom organic products having a composition 
 identical with the highest that are found in animals. This 
 discovery overturned all the dogmatical assumptions which 
 had previously found favour with physiologists respecting 
 the vital force. It had been maintained that animals alone 
 could form these products, and that they resulted from the 
 operation of some special animal principle. When, therefore, 
 it was shown that vegetables were the great laboratory for 
 their formation, and that animals only assimilated what was 
 so prepared, the suggestion was obvious that we must look 
 for the origin of the vital force, as it regarded animals, in 
 the lower kingdoms of nature. When animals were proved 
 to be so dependent, not only for the materials of their 
 structures, but also for their special arrangement, it was at 
 least probable that this dependence might extend further, 
 and that what still seemed a specific vital principle in them 
 might be but a form of operation of more common forces. 
 Collateral advances in natural philosophy, and especially the 
 views of Professor Grove as to the correlation of the physical 
 forces, which led him to the law that if any kind of force 
 disappears it is only to re-appear in an equivalent of some 
 other force, greatly favoured this probability, and brought 
 new labourers into the field for its support. First of all 
 Dr. Carpenter, in his paper on the mutual relations of the 
 vital and physical forces, directed attention to the 'precise 
 relation which obtains in the lower tribes of animals and in 
 the entire vegetable kingdom, between the vital activity of each 
 individual and the amount of heat which it receives from ex- 
 ternal sources. " Every species," he says, " is adapted to 
 flourish within a certain range of temperature, and that 
 amount of heat which is most effective in sustaining the life 
 of one species, may be injurious, or even fatal, to another. 
 
22 ADDRESSES. 
 
 But within the range which is compatible with the manifes- 
 tation of its vital powers, we find that the relation is most 
 constant between the temperature and the organising force 
 exhibited by each species." And according to the same 
 author, on the authority of Boussingault, an annual plant, in 
 arriving at its full development and going through all the 
 processes of flowering and maturation of its seed, every- 
 where receives the same amount of solar light and heat, whether 
 it be grown at the equator or in the temperate zone, its rate 
 of growth being in a precisely direct ratio to the amount it 
 receives in any given time. The plant, therefore, according 
 to such a theory, is a correlative of a certain amount of light 
 and heat — or, in other words, the plant is light and heat 
 exhibited to us as organic vegetable force. 
 
 This theory of Dr. Carpenter's, which exhibits to us animal 
 and vegetable life as light and heat acting through certain 
 material substrata and so suppressed in them as to appear in 
 a new form, important as it is as a step in the progress of 
 dynamical physiology, seems to be deficient in not sufficiently 
 recognising the participating activity of the forces of the 
 material substrata themselves, through and upon which the 
 light and heat operate ; nor does it account for the formation 
 of organic substances, either as to their origin or their increase. 
 It is to me a matter of regret that I should not be able to 
 name, as the next labourer at this important question, my 
 excellent friend to whom we owe the Physiological Riddles. 
 His paper, entitled " An attempt towards a more extended 
 Induction of the Laws of Light," though written long since, 
 exists only in manuscript. The views it contains have lately 
 been brought before us by an entirely independent thinker, 
 Professor Le Conte, of South Carolina. Starting from the 
 admitted and almost axiomatic truth that no force in nature 
 is destructible, nor any capable of latency, and that if there 
 seems to be such destruction or latency we arebound to believe 
 it so only in appearance, and to follow up the inquiry until 
 we have found our Proteus under the equivalent of some 
 other force, Le Conte proceeds to place before us, in their 
 relative order, the four planes of material existence, — the 
 elementary ; the chemical ; the vegetable ; and the animal — 
 as in an ascending series, and endeavours to trace the steps 
 
HUNTBEIAN ORATION. 23 
 
 of the process by which the force in one plane may raise the 
 material in it to the plane next above. Though it must be 
 admitted that the proof is often defective, and at the mosb 
 rises no higher than a reasonable degree of probability, yet 
 the subject is one that must interest the mind of every phy- 
 sical inquirer, and especially of the physiologist. 
 
 Matter, it is obvious, may be so arranged in four such 
 ascending planes. On the lower we may place the elemen- 
 tary substances, next above them chemical compounds, on 
 the third vegetables, and on the fourth animals. The extent 
 of these planes diminishes upwards, so far as the amount of 
 the material contained in each is concerned, the vegetable 
 and animal planes containing in them but a comparatively 
 small amount of matter. But as respects the quantity of 
 force contained in each plane, the conditions are reversed. 
 It is this inverse relation of force to the quantity of matter 
 which seems to promise a solution of the hitherto impene- 
 trable mystery of organisation. Matter and force constitute 
 the world, and forces, under certain combinations with 
 matter, appear to be convertible in kind. Chemical action 
 may produce its equivalent of heat, heat its equivalent of 
 electricity, electricity its equivalent of magnetism, and mag- 
 netism, in its turn, an equivalent of one of these. The great 
 question therefore arises whether either, or all, or any 
 combination of these forces can change into an equivalent 
 of vegetable organic force, and if this should be proved, 
 whether vegetable organic force can, in its turn, be repre- 
 sented by an equivalent of animal organic force. The whole 
 subject is of the deepest importance to us as medical men. 
 It at least raises the hope that the time may come when this 
 inquiry, reduced to rigid experiment, may elevate physiology 
 to the rank of a demonstrative science. As yet that day 
 must be far distant, but one cannot but rejoice at the pros- 
 pect of seeing a way of escape from the unsatisfying condition 
 of physiology as it now exists. The last decenniad has seen 
 rapid and almost exhaustive advances in our knowledge of 
 general and minute anatomy, yet it has given us a stone 
 when we asked for bread. Have we not all felt it was 
 but a mockery to tell us the microscopic elements of a tissue 
 or of a fluid, when we sought its nature and purpose ? and 
 
24 ADDRESSES. 
 
 to seek to palm upon us a chemical formula, when we 
 wanted the dynamics of the thing ? Doubtless such know- 
 ledge must have been acquired in order to say to us ' it is 
 not in me.' 
 
 The quantity of force which combines the elements of the 
 simplest compound almost exceeds belief. Mr. Faraday so 
 far experimentally determined it for water, as to enable him 
 to assert that the elements of a single grain are held together 
 by an amount of electricity, which, if suddenly set free, would 
 produce the effect of a powerful flash of lightning. Chemistry 
 informs us that the nascent energy of such force is irresistible, 
 and the chemist in his laboratory, taking advantage of it, is 
 able to imitate the operations of nature in the production of 
 organic compounds, and so affords us a further proof that it 
 is not by any new force that nature works in animals and 
 vegetables, but only by a limitation or direction of such as 
 are common to inorganic substances. But it may be asked, 
 How can organic matter be due to chemical affinity, if chemical 
 affinity is, as it notoriously is, its destruction ? And has it 
 not always been considered as proved that the conditions of 
 life are in themselves opposed to chemical action, and that 
 the body is unable to resist those chemical actions which 
 come into play as soon as life is extinct ? It is on this very 
 ground that the authors I have named take their stand, and 
 seem to prove that whilst chemical action is consuming our 
 textures, it is equally, at the same time, serving to build them 
 up and maintain them. 
 
 In the germination of the seed, the oxygen of the air, 
 favoured by the presence of moisture and heat, decomposes 
 the organic material which is laid up around the embryo as 
 food, in the form of starch, and by this decomposition appears 
 to afford a necessary organising force to the germ itself. It 
 is obvious that in germination there are two equal and opposite 
 actions going on at the same time, there is a falling down of 
 carbon from the vegetable plane above to the chemical plane 
 below, and by this fall there is thought to be generated an 
 opposite force, which, acting upon the elements of the 
 embryo, determines its growth. In the after-life of the plant 
 the same processes are in operation, though with opposite 
 results as regards the production of carbonic acid, the agency 
 
HUNTERIAN ORATION. 25 
 
 of sunlight on the green parts decomposes the carbonic acid, 
 the oxygen falls to the mineral plane, by escaping uncombined 
 into the air, whilst the carbon, becoming fixed in the plant, 
 rises to the organic vegetable plane. If we turn from the 
 vegetable to the animal, we meet with the same operation. 
 Whilst the embryo of the egg develops upwards, a portion 
 of the egg is oxidised, and goes downwards. But here, as 
 in the case of the germinating seed, the amount of force 
 required is comparatively small, since the rise is only from 
 that which is organic to that which is organised. If this 
 view of chemical affinity, as a source of the organising force, 
 be true, it enables us to estimate many, if not all, the com- 
 mon conditions of life very differently from what we have 
 hitherto been able to do. The decarbonisation of the blood 
 by the action of oxygen upon it, though serving for the re- 
 moval of the production of animal heat and effete materials, 
 may have the higher purpose of yielding force to the blood 
 itself, for the maintenance of its vital state. Our food, 
 which Liebig distributed into two uses, namely, for the nutri- 
 tion of the body and for the keeping it warm, may have a 
 third upon which the first immediately depends, and indeed 
 the second may, in all probability, minister to the first. 
 This third use is the production of an upward force, as 
 the food, by oxidation, falls into a lower plane. There is 
 something highly suggestive of this in the remarkable fact, 
 that there must be normally within us such an amount of 
 downward chemical action, as may be represented by 32 
 Fan., for it is worthy of remark that, though our blood is at 
 ioo° Pah., 6o° Fah. for the surrounding air is temperate, 
 and we feel it neither hot nor cold. This fact, which we 
 bear about us at all times, has hitherto received no attention 
 or explanation, though it seems to suggest the dynamical 
 one I am now speaking of. Nor has it escaped observation 
 that much more food is consumed in tropical climates than 
 would seem to be required, if the only use of it were for the 
 purposes indicated by Liebig ; but if, as here suggested, in 
 the consumption of food we have a supply of force for our 
 maintenance, to keep the living tissues in their vital state, 
 then we can understand why, both in temperate and in tro- 
 pical regions, there are necessities for nutriment not to be 
 
26 ADDRESSES. 
 
 measured by the mere waste of the tissue, nor by external 
 temperature. To carry on the illustration, I may allude to 
 the well-known fact that the exercise of the organs of our 
 body, if within certain limits, leads to their increased growth 
 and strength, whilst on the contrary, disease leads to debility 
 and atrophy. There are obviously several secondary reasons 
 for this, amongst others increased activity produces a larger 
 supply of blood to a part, but probably the chief cause, and 
 that upon which the others are dependent, is the resultant 
 force which, opposed to chemical affinity though produced by 
 it, supplies fresh organising force to the tissue in proportion 
 as its waste is increased. This dynamical view of the vital 
 processes, and of the origin or at least reproduction of 
 organic force, if confirmed by the progress of science, cannot 
 but greatly aid our mere empirical labours, for surely the 
 conviction that all vital phenomena are the expression of 
 common physical force, must quicken our observation of them, 
 and more practically direct our attention to their relation, 
 than could follow from the tacit assumption that they spring 
 from a cause which is in its nature incomprehensible. To 
 us, as practical men, this is of the greatest importance, for 
 the mind soon ceases to be interested in the study of facts 
 to which we have no clue. The inquiries to which I have 
 here alluded, bear only upon the lowest conditions of life, 
 upon the vital arrangement of the elements only, and not 
 upon the organisation of the body into its several tissues and 
 organs. I know of no observations which inform us how it 
 is that out of the homogeneous or apparently homogeneous 
 embryonic substance, there is evolved such a complex 
 arrangement of parts as is presented by the perfect animal. 
 There are, it is true, some faint traces of such polar or oppo- 
 site effects, such upward and downward tendencies in the 
 processes of organisation, as we have seen to occur in the 
 vitalisation of matter. For instance, atrophy everywhere 
 attends the process of growth in the formation of the body, 
 and gives us the appearance of a special modelling process. 
 Again, as nervous and muscular tissue develop in one direc- 
 tion, so bone and tendon are formed in the other, but 
 beyond these vague indications little is known. To think 
 that we explain the difficulty by saying that these results 
 
HTJNTEBIAN ORATION. 27 
 
 are due to a process of differentiation would be to hoodwink 
 ourselves with a word which enables us only to re-state the 
 case in a new form. Differentiation is a learned term applied, 
 and perhaps not very appropriately, only to a series of 
 effects. We might, I think, as well say that the products 
 of decomposition of the dead body are due to a differentiation 
 of it, as that its various textures and organs are the result 
 of a differentiation of the germinal mass. It will therefore 
 be obvious that we gain nothing by the use of the term, at 
 least in the way of explanation of the difficulties of organi- 
 sation. 
 
 However useful and even necessary it may be in the 
 present state of our knowledge to adopt an empirical 
 formula for the phenomena of life, such as that " life is the 
 principal of self-preservation/' " the principal of action/' 
 that " life is a principle that prevents matter from falling 
 into dissolution," expressions used by Hunter, I think it is 
 certain that it is not through them we shall explain its great 
 problem. It is not by separating organised beings from the 
 conditions which surround them that we can hope to explain 
 the mysteries they present, but by striving so to increase 
 our knowledge, as that they may present themselves to us 
 as necessary correlatives of the conditions out of which they 
 spring, and to which they are in all respects so strictly and 
 wonderfully related. And here I ought perhaps to guard 
 against misapprehension, by remarking that I limit all I 
 have said to the bodily structure and functions, and that I 
 leave out of consideration the conditions of the mind, as 
 being at present no part of our subject. I believe that as 
 men occupied with the study and treatment of disease, we 
 cannot have too strong a conviction that the problems pre- 
 sented to us are physical problems, which perhaps we may 
 never solve, but still admitting of solution only in one way, 
 namely, by regarding them as part of an unbroken series, 
 running up from the lowest elementary conditions of matter 
 to the highest composition of organic structure. 
 
 To any one who will take a survey of the progress of 
 medicine, it will be apparent that every step has been gained 
 by clearing away abstract theories of the vital force, and by 
 bringing the vital phenomena into connection with the more 
 
28 ADDRESSES. 
 
 simple forces of nature. There are still, however, in the 
 practical parts of our profession, many remnants of that ten- 
 dency of the human mind to create independent and self- 
 existent entities out of contingent and variable conditions, 
 which so long obstructed physiology. We hear still of de- 
 bility as a cause of disease, as if debility were an agent rather 
 than an effect. We still hear diseases spoken of as if they 
 were independent processes ingrafted upon or invading the 
 system. We hear of good and bad constitutions, as if such 
 could be estimated apart from the activities of the several 
 organs of the body. The opprobrium has long been cast 
 upon us, that though we boast ourselves to be practical men, 
 we are yet the most irrational of theorists, that we are ex- 
 travagant ontologists, separating disease as an independent 
 entity from the person who has it, and assuming as active 
 causes what are but passive effects. It can hardly be main- 
 tained that such criticisms are undeserved, and that no evil 
 follows from such language as I have referred to. It must 
 be admitted that debility is now a great " idol of the market," 
 and some not mean authorities have gone so far to support 
 it, as to assert that the human constitution has undergone 
 during the last few years such a change, as that all diseases 
 partake of this mysterious influence. Without suggesting 
 that if this supposed change of constitution were real, we 
 ought to see traces of it in the ordinary growth and strength 
 of the body, in which it is certain there is no falling off, I 
 would observe that in the nature of the case there cannot 
 be strictly speaking a sthenic disease. Life presents essen- 
 tially two phases, one of nutrition and one of function. 
 Nutrition is a source of strength, function causes its expen- 
 diture. The phenomena of acute disease are all those of 
 perverted or exaggerated function ; they are all, therefore, 
 due to waste, without the control of that regulating influ- 
 ence, whether in the nervous system or not, which obtains in 
 health. There is no increase, but, on the contrary, a 
 decrease of normal nutrition in acute diseases. We might 
 as well, like children, regard the whirling movements of the 
 hands of a watch whose balance- spring is broken, as evidence 
 of new strength in it, as believe that excessive heat, exces- 
 sive activity of the heart, rapid breathing, delirium, and 
 
HUNTERIAN ORATION. 29 
 
 convulsions are proofs of strength. Comparatively they 
 may indeed be so, and by such phenomena we may be able 
 to estimate the previous condition of the patient, but in 
 themselves, so far as his condition is then concerned, they 
 are proofs of rapid disorganising changes. Yet how many 
 victims have there been to the false assumption that they were 
 signs of an excess of strength to be combated by weakening 
 the body. 
 
 So far, therefore, as in the treatment of disease we attribute 
 these symptoms to changes which of necessity lead to exhaus- 
 tion, and so far as we strive to meet them by such conservative 
 means as we possess, I cannot call the observance of debility 
 an idol worship, but, on the contrary, regard it as one of the 
 truest and most important services we can render to our 
 patient. My objections lie rather against the indiscriminate 
 assumption of debility as a condition to be combated without 
 a due estimate of the causes out of which it springs. If vital 
 strength be a resultant of many complex correlated conditions, 
 the variations in it may be traceable to any link in the chain. 
 To put the effect for the cause is a common and dangerous 
 error which perverts our practice. To go no further for an 
 illustration than our too common and sad experience of 
 diphtheria, how often do we blindly prescribe our remedies 
 as against a hypothetical debility, without any regard to the 
 actual condition of the organs involved ; and when the results 
 are unfavourable, it seems rarely to occur to us that we can 
 have failed in any part of the treatment if we have continu- 
 ally striven to counteract the debility. Yet the least clinical 
 observation would inform us that our task is by no means 
 so simple as this, that whatever weakening influence may be 
 operating in diphtheria, the causes of a fatal issue may lie in 
 another direction. The function of the kidneys may be so 
 suppressed as to need the vicarious action of the intestine, and 
 purgation may be as necessary on the one hand, as wine or 
 brandy may be on the other. Or, if the exudation extends 
 from the fauces to the larynx, we may be as much called 
 upon to deteriorate it by the use of mercury, as we are to 
 support the action of the heart by stimulants. Debility may 
 plainly arise from causes which are in their nature opposite. 
 The flame of a candle may be dim as well from an accumu- 
 
30 ADDRESSES. 
 
 lation of the unconsumed wick, as from a deficiency of air or 
 oil, which are its stimulus and pabulum. So the body may 
 be weakened by defective excretion as well as by defective 
 nourishment. 
 
 If this were a fitting occasion we might pursue the analysis 
 of the causes of debility much further. We might perhaps 
 with some advantage show how many diseases are overlooked 
 by assuming this effect of them, as a cause requiring no in- 
 vestigation. It so easily commends itself to the prejudices 
 of the sick, that they are quite ready to believe the statement 
 that their symptoms, whatever they are, arise from debility. 
 It is a ready explanation of all difficulties, and seems at once 
 to obviate the necessity of any further inquiry. Yet I 
 suppose, as I have just said, that it would be difficult to find 
 a more strange instance of inconsistency than that of a 
 student of nature putting a mere negation in the place of an 
 active efficient cause. But this, I repeat, is an inconsistency 
 justly attributable to us whenever, without inquiry into the 
 conditions which give rise to it, we set up debility as a cause 
 in itself. 
 
 I have said that we still hear diseases spoken of as if they 
 were something ingrafted upon the body. In the case of 
 parasites this may be partially true. Worms and epiphytes 
 may repi'esent to us such invading causes. But when a man 
 sickens of a fever, or falls ill of a pneumonia, the matter is by 
 no means so simple. Though we may give the disease a sub- 
 stantive name, it is in reality an adjective disturbance, which 
 can only be rightly understood when viewed in relation to 
 the whole system. This is most obvious in the case of a fever. 
 We may indeed say that a man has a fever, but in reality he 
 is the fever. For the time being he presents us with a new 
 though abnormal phase of life. It is this fever-life that we 
 have to study, and not any substantive disease to be eradicated 
 and cast out. And it is this fever-life in an individual, whose 
 constitution may have been previously healthy or diseased, 
 who may be young or old, who may be living in the town or 
 country, in- a temperate or in a tropical region. Can any one 
 with so many variable circumstances before him speak of 
 fever as if, to use a mathematical expression, it were a con- 
 stant quantity ? And can we, by medicating this or that 
 
HUNTERJAN ORATION. 31 
 
 particular organ, hope to cure a perversion -which is 
 universal ? 
 
 With such thoughts as these in one's mind, how inappro- 
 priate seems a large part of the routine treatment to which 
 patients were formerly submitted for correcting the secre- 
 tions, for subduing local inflammations, and for repressing 
 febrile symptoms, by mercurials, by blisters, and by so-called 
 antiphlogistics. And how much more safely do we conduct 
 our patient through the dangers which beset him, by regard- 
 ing his whole vital condition, and favouring it by pure air, 
 mean temperature, light nourishment, and moderate stimuli, 
 administering medicines only as occasional aids. This I say 
 of the therapeutics of fever merely by the way, for I am by 
 no means prepared to assert that medicinal measures have 
 always so subordinate a position. On the contrary, they 
 may occupy the first place. What, therefore, I wish by this 
 illustration to maintain is, that it is the object of a sound 
 pathology to associate itself with physiology, since disease 
 can never be anything else than a disturbance of the natural 
 actions of the body. 
 
 It has long been established by experience, even when 
 experience was perplexed by such difficult terms as ' sthenic ' 
 and ' asthenic,' ' antiphlogistic ' and ' tonic,' and when the 
 attention was almost exclusively confined to the local changes 
 produced by disease, that there were cas.es where these local 
 changes had for the safety of the patient to be overlooked, 
 and his general powers to be maintained. The extension of 
 this principle of treatment is one of the chief steps of ad- 
 vancement made in our day. I say this principle of treat- 
 ment, for no doubt prior to the cultivation of a more perfect 
 physical diagnosis, and in the hands of those who still neglect 
 physical diagnosis, the same treatment was and is used ; yet 
 we can hardly say that there was any principle in it, beyond 
 that of an instinctive feeling of the necessity to keep the 
 patient alive. But the principle of which I speak is, that 
 with our eyes fully open to the presence of acute inflamma- 
 tory changes in a part, as for example in the lungs or in the 
 heart, we should be prepared, if the nervous system shows 
 any symptoms of excessive disturbance, either in the excited 
 function of the diseased organ, or generally, to abandon all 
 
32 ADDBESSES. 
 
 local indications, and simply support the patient by suitable 
 food and stimuli. 
 
 I am not prepared to second to their full extent all the 
 propositions of a late distinguished physician on this impor- 
 tant question, nor to defend his treatment to the extent it 
 was sometimes carried ; but I cannot too emphatically assert 
 my conviction that no more dangerous course can be pur- 
 sued in many acute diseases, than that which is usually called 
 antiphlogistic. 
 
 This mischievous tendency to isolate diseases from the 
 conditions of the individual in whom they occur, has been 
 somewhat fostered in modern times by the attempt to apply 
 statistics generally to practical medicine. No doubt if the 
 name of a disease were always of the same value, statistics 
 might be relied on, but since such an assumption is un- 
 founded, they often serve to propagate only error and con- 
 tradiction. 
 
 I might appeal to the experience of anyone, whether it 
 must not be fallacious to take, for instance, a number of 
 cases having such symptoms as, collectively, we term deli- 
 rium tremens, and put them, without any further analysis, 
 into a statistical table, for the purpose of proving or disprov- 
 ing the value of any particular method of treatment. In one 
 case we may have these symptoms with highly albuminous 
 urine, in another there may be pneumonia ; one may be 
 saturated with spirit from continued drunkenness, and ano- 
 ther exhausted from being deprived of his usual stimulus ; 
 one may be in the early stage of his career of intemperance, 
 and still young and strong, whilst another may be so debili- 
 tated from advanced degeneration of all his organs as that no 
 possible treatment can avail him. It cannot therefore sur- 
 prise us, and certainly should not shake our faith in treat- 
 ment, when we meet with the most contradictory statements 
 respecting this or similar affections. For it must always be 
 so if tables are constructed of cases which are in their 
 nature dissimilar. We have most of us seen cases of delirium 
 tremens which required no other treatment than by purga- 
 tives, others where little or nothing was needed beyond an 
 effervescing draught, some where we had more to regard the 
 affection of the kidneys than of the brain, some where opium 
 
HUNTEEIAN OEATION. 33 
 
 was admissible, others in which its administration would 
 have been dangerous ; and yet these differences depend not 
 upon the mere delirium tremens, but upon concomitant cir- 
 cumstances. 
 
 This limited view of disease, against which, in the name 
 of this Socieby, I would raise my voice, is still further favoured 
 by the popular prejudice for specialities, unfortunately too 
 readily responded to by our profession. That a certain divi- 
 sion of labour, as well in science as in art, is desirable, needs 
 no proof. But in medicine such division must of necessity 
 be far less strict than that which they who are ignorant of 
 the conditions of life would force upon us. The body is not 
 like a mechanism of human construction, where the parts, 
 though acting in concert, are separable and independent ; for 
 in strictness the body does not consist of parts. The ana- 
 tomist for the sake of description may call them such, but 
 we might challenge him to give us a line of demarcation 
 between one part and another. Who can treat as a speciality 
 the derangements and diseases of the stomach, whilst its 
 relations and sympathies are so universal ? How can there 
 be a special ' brain doctor/ whilst the functions of the brain 
 are so dependent upon parts the most distant, and influences 
 the most various ? A tumour in the brain may tell of its 
 presence only through disturbance in the stomach, and a dis- 
 order of the stomach and its appendages may have for its 
 most prominent symptoms only various disturbances of the 
 brain. Man's body is a system of correlated activities, in 
 which a disturbance at any part may be felt through the 
 whole, and alter the whole. As the poet says, 
 
 Each part may call the farthest brother, 
 And hand with foot hath secret amity. 
 
 Hunter was certainly no specialist. As I have before said, 
 he strove earnestly to get an insight into that principle of 
 unity which is the great characteristic of human organisa- 
 tion ; that principle stood before Hunter as a principle of 
 self-preservation, in which he seems to have recognised the 
 essential dependence of the different parts upon each other ; 
 that condition which we express when, as in common lan- 
 guage, we call man an ' individual.' To proceed, therefore, 
 
 3 
 
34 ADDBBSSES. 
 
 relentlessly to divide him up into systems, organs, and tissues, 
 and to believe that, in so doing, we reach the end of our re- 
 search, is to stop midway. Here, as in all human inquiries, 
 two processes are necessary, one of analysis, and one of syn- 
 thesis. We must, of necessity, begin with analysis, and 
 follow it to its utmost limits, but only that we may be en- 
 abled to obtain a more complete organic synthesis of our 
 subject. We must separate the components, but only that 
 we may re-combine them into a living unity. Anatomy, his- 
 tology, and chemistry may enumerate the several dramatis 
 personse, but they can tell us nothing of the characters each 
 may afterwards exhibit in the play of life. The spirit of 
 Hunter would urge us to look at man in every aspect, not 
 only in his individual and perfected relations, but also as a unit 
 in the whole scheme of nature. Led by it, we descend into 
 bygone ages, and trace how gradually organic forms have 
 been evolved, until they have culminated in man. Animated 
 by it, we cannot carelessly regard any effort to explain by 
 what steps the present state of things has been achieved. Nay 
 rather, imperfect as such efforts must be, they all tend to true 
 progress, if they serve to connect man with the conditions 
 which have preceded him, and with those in which he now 
 exists. Not that any inquiry can, in the nature of the case, 
 degrade man into a lower creature, and make him less than 
 he is, for, through whatever process he may have been created 
 — whether, to use the expression of a late writer, he was 
 flashed into being at once from the dust of the earth, or 
 developed more gradually through intermediate forms to be 
 what he is, of necessity presupposes in either case essentially 
 the same operation. 
 
 Let us not, therefore, whilst repudiating specialism in 
 medicine as contrary to the true Hunterian spirit, adopt it in 
 our physiology, and separate man from those conditions 
 upon which he is dependent, and from those lower creatures 
 which, if rightly comprehended, may serve to illustrate his 
 being, and exhibit the steps through which it has been per- 
 fected. On every side our subject divides itself in two, and 
 demands of us a corresponding extension and limitation of 
 our thoughts. Now we must think of man as part of the 
 common forces of nature, and again as a special individual. 
 
HUNTBEIAN ORATION. 35 
 
 Now we must unravel his textures and separate his different 
 organs, and now we must study them in their combined ope- 
 ration. Now we must consider the inherent force of the 
 germ, and the directive tendencies which are due to it, and 
 then we must turn to a contemplation of the external forces 
 which it assimilates for its extension, its support, and its 
 activity. In disease we must, on the one hand, look at the 
 morbid processes in their relation to healthy nutrition ; and, 
 on the other, concentrate our attention on that which gives 
 them their peculiar morbid character. In therapeutics we 
 must consider both what the local lesion requires, and what 
 is necessary for the constitution as a whole. In aiming at a 
 given result, we must consider that what may seem best 
 absolutely may in any case be relatively worst for the indi- 
 vidual, or for the function of any given organ ; that it may 
 be our practical aim to deteriorate the vital processes at one 
 part, in order to favour them at another ; and generally, we 
 must correct our scientific conceptions by the more homely 
 teachings of experience, and counteract the narrowness of 
 these by the wider views of science. On all sides these dual 
 relations claim our attention. Their recognition is the basis 
 of medicine as a scientific art, and this was the character 
 which Hunter strove to give it. But to limit our attention 
 to vital phenomena only, and, especially, further to limit it 
 to the vital phenomena of our own bodies, cannot fail to en- 
 gender in us all kinds of vicious theories. For how can the 
 mind look with an equal eye upon results in which there is 
 so great a personal interest, and towards which our sym- 
 pathies are so strongly biassed ? The Hunterian Society is 
 called upon to counteract this weakness, to give medicine its 
 widest scope, and to cultivate it in the most liberal spirit. 
 To use again Hunter's own simile, its members, like so many 
 bees, should be animated by one common instinct of research 
 in every quarter, to gather knowledge for the common good. 
 And beyond all professional aims, our duties bestow upon us 
 unusual privileges ; for, to quote the words of Akenside, 
 Physician to St. Thomas's Hospital, and who lived before 
 Hunter, to us — 
 
 The Sire Omnipotent unfolds 
 
 The world's harmonious volume, there to read 
 
 The transcript of Himself. 
 
CLINICAL OBSERVATION 
 
 IN BEIATION TO 
 
 MEDICINE IN MODEEN TIMES. 
 
 I deeply feel the honour and responsibility which you have 
 put upon me, by placing me here to-day as your exponent 
 of the present position of Clinical Medicine. My task is 
 difficult from the distinguished character of my audience, and 
 from the imperfections of our knowledge in the subject of 
 which I have to speak. I feel, indeed, as one about to 
 undergo the ordeal by fire, the difficulty and delicacy of my 
 task being so great that I dare not hope to escape adverse 
 criticism. 
 
 You have been listening to learned discourses on the 
 physics and physiology of living things, wherein the lec- 
 turers have been able to instruct and satisfy the mind with 
 details more or less capable of demonstration ; whilst I have 
 to admit that my subject lies on the confines of human know- 
 ledge, and that too often the highest effort of the clinical 
 student is to arrive at some feeble probability, in the pre- 
 sence of uncertain, or even delusive, evidence. 
 
 Clinical medicine, though a special department of know- 
 ledge, is so intimately connected with other sciences that 
 when the claims of these are satisfied, it might seem that 
 nothing would remain to it. This appears to me the present 
 error of our schools. It would not, however, be too much 
 
 1 Address delivered at a meeting of the British Medical Association at 
 Oxford, August 7th, 1868. 
 
MEDICINE IN MODERN TIMES. 37 
 
 to assert that, were it possible to conjoin in one human intel- 
 ligence all that is now known of other sciences, such know- 
 ledge would be compatible with entire ignorance of the 
 department of clinical medicine. As the physiologist must 
 yet assert that the phenomena of living tissues are not ex- 
 plained by their chemical composition, or, as the chemist 
 himself has equally to admit, that mere isomerism may be no 
 clue to chemical qualities, so the clinical physician knows 
 that the phenomena of disease are not explained by the 
 knowledge of healthy textures, nor by the action of healthy 
 organs. Clinical work is a work by itself ; and yet, if I may 
 use the comparison, only so far by itself as one form of 
 organic life may be considered separate from another. It 
 stands apart, but has the most intimate relations to all that 
 surrounds it. It is elucidated by the light of physics, 
 chemistry, and physiology, yet is not comprehended by 
 them as they now stand. In ages gone by, Hippocrates had 
 to vindicate the study of disease from the inroads of super- 
 stition ; at the present day we have to guard it against 
 assaults on the side of science, and need to watch lest we 
 betray it by accepting a too chemical or physical limit to 
 our thoughts. 
 
 We should all contemplate with great satisfaction such 
 inroads of the collateral sciences upon medicine as that at 
 length medicine might have no separate existence ; but this 
 consummation appears to be, as yet, far distant, and must be 
 so acknowledged. Happily, such is the extension of the 
 human mind into nature that almost daily new regions are 
 discovered; and the boundaries of the old are so extended 
 as to require fresh subdivisions in order to bring them within 
 the domain of thought. Formerly, the physician might have 
 been able to comprehend all that then constituted the allied 
 sciences of medicine ; but that can never again be possible. 
 His duty lies, therefore, in giving an exact and scientific 
 character to the department which remains to him, — to in- 
 vestigate its phenomena with that concentration which is 
 necessary in every physical inquiry, and with all those aids 
 which are afforded in increasing perfection by modern 
 science. 
 
 It is not, however, to be overlooked that even Science 
 
38 ADDRESSES. 
 
 herself is apt to have her moments of dogmatism, and, by- 
 throwing the light of some particular inquiry full in our 
 eyes, to blind us for the time to that which lies beyond. 
 How often has Medicine been thus diverted from her difficult 
 path ! A discovery in physics has made us for the moment 
 no more than galvanic batteries, or a discovery in chemistry 
 mere oxidising machines. To-day, however, we go to bed- 
 side work untrammelled by any exclusive theories of this 
 kind, ready to investigate diseases in every way that inves- 
 tigation is yet possible, and forming our judgment in no 
 narrow spirit of a foregone conclusion. We have no system 
 to satisfy ; no dogmatic opinions to enforce. We have no 
 ignorance to cloak, for we confess it ; but we have to bring 
 into the court of inquiry all possible evidence, and to decide 
 upon it by the light of science and experience. They 
 whose work lies more open to experiment and demonstration 
 are apt to forget the difficulties we have to encounter, and 
 the mental labour required for dealing with them with any 
 measure of success. They would have us postpone these 
 difficulties to a more convenient season, until, by the advance- 
 ment of other branches of science, their investigation could 
 be undertaken with less risk of failure. 
 
 However gratifying and proper this delay might be, were 
 the end of our knowledge contemplation only, and were there 
 no motives to present action, yet, as we are in the midst of 
 human suffering, and have some knowledge for its relief, it 
 is plainly the duty of some, and worthy of the highest intel- 
 lects, to apply themselves to this work, even though by so 
 doing they may forego the immediate rewards which pure 
 science so liberally affords. 
 
 Whilst thus asking for the unstinted recognition of clinical 
 medicine as a scientific department, I am not forgetful of the 
 obligations imposed upon us, nor that in it there lie pro- 
 blems, as yet, far beyond a scientific solution. No one can 
 hope, even as the sciences now stand, and much less as they 
 shall further advance, to obtain a foremost knowledge of them 
 and of medicine at the same time. Yet such knowledge is 
 to us of daily necessity. We must, therefore, refer our phy- 
 siological difficulties to the physiologist, and our chemical 
 questions to the chemist, and still admit that there remains 
 
MEDICINE IN MODERN TIMES. 39 
 
 an unlimited area of study for us, in tracing the causes and 
 relations, and in recognising the presence, of disease. I 
 would not be understood to say that the physician should 
 neglect the sciences of chemistry and biology, and devote 
 himself to the limited study of morbid phenomena. If any 
 should desire to do so, the attempt would prove its impos- 
 sibility. The interchangeable relations of things are such 
 as to make necessary the most discursive operations of the 
 mind, if it would successfully enquire into that which is most 
 special. I desire only that that which is our proper work 
 should have our entire energies, strengthened and directed by 
 every collateral aid. 
 
 Whilst the biologist traces downwards the relations of the 
 various forms of living things, and, breaking away one by 
 one the barriers of separation between them, at length views 
 them all as springing from a common germ, the student of 
 clinical medicine, working in another direction, seeks oppo- 
 site results. To him one form of life absorbs and centralises 
 all other forms. His object is to see the facts of human or- 
 ganisation in their most special relations. The very perfec- 
 tion of his work lies in this. It is not even man in general ; 
 it is the individual man upon whom his attention has to con- 
 centrate. The stock whence he may have sprung, the cir- 
 cumstances of his birth, the time he may have lived, the dis- 
 eases he may have undergone, the habits he may have 
 acquired, are all subjects to be brought into the focus of 
 thought at the bedside, and made to clear up the problem of 
 disease. 
 
 Medicine is a specialism, but of no narrow kind. We 
 have to dissect nature, which for practice is better than to 
 abstract it. 1 Every form of life has to us a value, but in an 
 order the reverse of the generalisations of natural history. 
 We desire to know what limits, specialises, and perverts. 
 We study in order to distinguish, and not to classify. 
 
 Yet it is not only the individual that as a whole we have 
 to isolate for the purposes of clinical study ; we have further 
 to inquire into the life of his several organs and tissues. 
 These have each their own life, and correlative with it their 
 own tendency to disease and their specific power and mode 
 1 ' Nov. Org.' 
 
40 ADDRESSES. 
 
 of repair. To clinical medicine, therefore, the body becomes 
 a pathological museum. In every part we recognise certain 
 proclivities to morbid action; and the purpose of our study 
 is to trace these tendencies to their source on the one hand, 
 and to their effects on the other. Histology and anatomy 
 are daily widening this fundamental department of medicine, 
 and we may be sanguine that an acquaintance with the 
 morbid changes to which the same parts are liable, where 
 present in the lower animals (comparative pathology), will 
 afford further valuable aid, as by it we shall have in some 
 degree a dynamic test of the general tendency to these 
 morbid states, in addition to that furnished by human 
 pathology. A knowledge of these intrinsic tendencies to 
 pathological change in the several organs prepares us before- 
 hand to recognise their occurrence where, without such know- 
 ledge, the signs and symptoms which are present would 
 convey no information. To know, for instance, that the brain, 
 from the early period of adult age, in persons otherwise 
 healthy, is prone, without obvious exciting cause, to the forma- 
 tion of tumour in its substance — to be aware of the proba- 
 bility of insidious ramollisement of the central commissures 
 in younger subjects — often enables us to suspect these con- 
 ditions, and to give weight to what might otherwise seem some 
 unimportant ailment. As I name these two instances, I feel 
 sure your clinical reminiscences will supply the proof of what 
 I state, and afford a sad page of suffering, death, and error. 
 
 There would appear to be some textures of the body en- 
 dowed with an almost complete immunity from disease, whilst 
 others are equally liable to it — a difference of which at pre- 
 sent we cannot give a sufficient account. Both stand as 
 glaring instances to warn us against the adoption of some of 
 our current theories. For instance, there is, perhaps, no part 
 of the body organised for more rapid cell- life, or that is more 
 extensive or more vascular, than the mucous membrane of 
 the jejunum ; yet, with the exception of the choleraic and 
 diphtheritic processes, it is almost exempt from primary 
 organic changes — so much so that at the bedside, in consider- 
 ing the probabilities of disease in the abdomen, we have, 
 on the one hand, to exclude this part from our considera- 
 tion (except in mechanical obstruction), and on the other to 
 
MEDICINE IN MODERN TIMES. 41 
 
 direct special attention to certain seats of lesion whence the 
 trouble is likely to have sprung. Contrast the limited area 
 presented by the lesser curvature and pyloric region of the 
 stomach, the duodenum, cascum, and rectum, with the enor- 
 mous extent of the valvulse conniventes, and compare the 
 frequency and character of the lesions in the one with those 
 of the others, taken together, and it is obvious how much our 
 diagnosis of abdominal disease depends upon our acquaint- 
 ance with the tendency of certain textures in the abdomen to 
 morbid changes. 
 
 The investigations of morbid anatomy have thrown a flood 
 of light upon the so-called acute idiopathic diseases. For- 
 merly such affections were supposed to be of common occur- 
 rence ; and the treatment of the day was adapted to their 
 apparent violence. But how rarely now do we meet with a 
 case of acute inflammation of the membranes of the brain, or 
 of the peritoneum, or, indeed, of any other texture, which we 
 cannot refer to some chronic lesion, or to some distinct 
 cachexia! the only idiopathic part of the case being that which 
 was formerly overlooked or unrecognised — some chronic tissu e- 
 change, unnoticed in the storm of acute disease to which it 
 had given rise. 
 
 Oken has said that all the tissues are nervous, and bone is 
 hardened nerve. I need not discuss this assertion on the 
 present occasion ; no doubt modern physiology and pathology 
 are advancing the evidence that whatever is living has 
 nerve-quality in it. The highest expression of this quality is 
 conscious intelligence ; the lowest it is, from the nature of 
 the case, at present impossible to mark. This much, how- 
 ever, it appears important to recognise clinically — that 
 morbid brain-force may give rise to a variety of disorders, 
 apparently distinct from their original cause. There is a 
 neuropathology from the brain to the tissues, as there is a 
 reverse order of disturbance from the tissues to the brain. 
 If we trace the history of morbid brain-force through the 
 various members of a family, we shall often recognise a great 
 variety of related phenomena, which in nosological classifica- 
 tion are separated and considered as distinct. The intellectual 
 disturbance in one may appear as epilepsy in a second ; as 
 mere dyspepsia and so-called acidity in a third ; in a fourth as 
 
42 ADDRESSES. 
 
 some peculiar neuralgia; in a fifth, if a female, in many 
 varieties of capillary disturbance, such as amenorrhcea, 
 vicarious menstruation, hEematemesis, or even basmoptysis ; 
 in a sixth, some part of the intestinal tract, tbe colon chiefly 
 may appear to be the recipient of the morbid nerve-process, 
 and the patient be tortured with fears of a tumour, which, 
 though a mere phantom, is yet calculated to mislead the 
 unwary. Nor does this list exhaust the catalogue of these 
 strange vagaries. It would seem as if sometimes this 
 morbid brain-action expended itself upon the voluntary 
 muscles, which, if of the abdomen, may be shaped into forms 
 that defy diagnosis and bewilder the most cautious. 
 
 It might be thought unnecessary for me to point to this 
 strange field of pathology, which has long been recognised 
 as in part connected with hysteria, but I have reason to 
 think our views on the subject are still wanting in distinct- 
 ness, and that the term ' hysteria,' as now understood, does 
 not include all I here intend. These morbid conditions 
 occur as essentially, if not so frequently, in the male as in 
 the female, though the form of them may be determined by 
 the sex. It would seem that, in different individuals, 
 different portions of grey matter became the seat of the same 
 kind of morbid action ; the equivalent of mental disorder in 
 one occurring as some visceral disorder in another, and so 
 on. And, besides these mere functional disturbances, the 
 history of medicine and my own individual experience supply 
 instances of actual tissue-changes which admit of no explana- 
 tion until thus looked at ; and, I need not add, such cases 
 are entirely distinct from feigned and fictitious disorders. 
 
 The flatulent dyspepsia of the student, the tears of the 
 distressed, the dry mouth of the anxious, and the jaundice 
 of fright, daily remind us how far the cerebral influence 
 extends, and physiology will hereafter teach us to trace the 
 steps whereby these effects are produced. As there is no 
 explanation of laughter when the axillary nerves are tickled, 
 so there seems to be none of the morbid fears which oppress 
 those who are the subjects of some affections of the colon, 
 and who weary our patience with their doleful complaints. 
 Yet surely we have no more ground to deny the reality of 
 the one than of the other, though we must at present refer 
 
MEDICINE IN MODERN TIMES. 43 
 
 both to some ultimate fact of our natural history. 'As face 
 answereth to face ' by mysterious sympathy, so do these and 
 other peripheral impressions excite or depress, in an equally 
 mysterious way, the subjects of them. 
 
 I cannot turn from this hasty glance at the idiopathic 
 pathology of the tissues without mentioning how much 
 clinical medicine has gained by recognising the relations of 
 the tissues to time. The wise man says, ' There is a time 
 to be born, and a time to die.' What the physiological limit 
 of the latter may be has not been determined, but at the 
 bedside it has to be recognised and its concomitants distin- 
 guished from the phenomena of disease. 
 
 Abercrombie was amongst the first to point out that the 
 paralytic affections of age were due to senile changes in the 
 tissues ; and more recently the convulsive affections of 
 otherwise healthy but aged people, have been included in the 
 same category. The epileptic attack of the old man is an 
 evidence of failing power, as his paralytic seizure is an evi- 
 dence of failing tissue. Though the actively growing organs 
 of the child contrast in a striking manner with the same 
 in decay in the old, there is yet, in some respects, a similar- 
 ity between the diseases of the two periods of life, like the 
 tints of the rising and the setting sun. In the first period 
 the organism has not acquired its forces ; in the latter 
 period it is losing them. Infantile convulsions and senile 
 convulsions; infantile diarrhoea and senile diarrhoea; infan- 
 tile eczema and senile eczema ; uric acid deposits in child- 
 hood and uric acid deposits in age, may afford illustration 
 of the truth of my statement. 
 
 Time, moreover, acting differently upon different parts of 
 our organism, often performs a kind of pathological dissec- 
 tion, exposing the inherent weakness of entire organs, or 
 parts of them, and giving rise to diseases for which at 
 present we have often no name but that which designates 
 some prominent symptom. This process of decay, due to 
 time only, occurs at almost every period of life, according to 
 the constitution of the individual. The fatty degeneration 
 of muscular fibre, occurring in the children of certain 
 families, affords an illustration of this, and we have yet 
 more striking ones in the progressive muscular atrophy, 
 
44 ADDKESSBB. 
 
 which occasionally exhibits itself from primary changes in 
 the nervous system, in equally young subjects. Senile 
 changes may thus occur in childhood, as in the ephemera 
 old age comes on in a day. My thoughts have been spe- 
 cially directed to this subject of late, whilst passing in review 
 the facts of locomotor ataxy. The condition of the nervous 
 system which most commonly gives rise to this form of un- 
 steadiness of gait is plainly one of decay, like baldness, or 
 greyness, or the occurrence of the arcus senilis. It occurs 
 to individuals of particular families, in which other forms of 
 nerve-degeneration are prevalent. It is limited almost 
 entirely to males, at the middle or after the middle period 
 of life ; and, if we may venture to draw general conclusions 
 from the few observations that have been made post mortem, 
 is connected with fatty degeneration of the posterior columns 
 of the cord ; not, however, limited to these, but associated 
 with changes of the like kind in other parts of the cord, 
 and in the brain itself. 
 
 My friends Mr. Lockhart Clarke and Dr. Hughlings 
 Jackson 1 endorse the opinion first put forward by Duchenne, 
 
 1 Mr. Lockhart Clarke writes to me that he has long objected to the 
 theory which limits ataxia to lesions of the cord only, and that he has fully 
 stated this in the ' Lancet ' of December, 1865, p. 729. 
 
 The following letter was written to the ' Lancet ' and ' British Medical 
 Journal' on this point, April 22nd, 1868 : 
 
 Locomotor Ataxy. 
 Sib, — In my Address in Medicine, delivered at Oxford last week, I 
 there stated that Mr. Lockhart Clarke endorsed the opinion that locomotor 
 ataxy depended upon disease of the spinal cord only. This is not so. 
 Mr. Lockhart Clarke, in the 'Lancet' of December 30th, 1865, p. 729, 
 writes thus : — " I object to the practice of speaking of this disease under 
 the term ' degeneration of the posterior columns of the cord,' first because I 
 have found the grey substance more or less affected ; and secondly, because 
 the lesions, as we have seen, are not confined to the cord." Mr. Lockhart 
 Clarke adds, in a note to me on this subject, which I have just received, that 
 " Dr. Hughlings Jackson holds the same opinion in this matter as himself ; 
 nor," he further adds, " does Dr. Duchenne disent from it now, whatever 
 may have been the opinion he formerly entertained." 
 
 I shall be much obliged by your giving insertion to this note, not only in 
 justice to my friends whose views are here stated, but also as supporting 
 opinions long eld in this country, that ataxia is a cerebro-spinal lesion. 
 
 I am, Sir, your obedient servant, 
 
 William W. Gull. 
 
MEDICINE IN MODERN TIMES. 45 
 
 and subsequently maintained by Trousseau, that this loco- 
 motor ataxy is due to disease of the spinal marrow only ; 
 but I am disposed to think that they arrived at this opinion 
 against clinical evidence, and perhaps biased unconscionsly 
 by prevailing theories of the relation of the nervous centres 
 to each other. 
 
 It is only fair to English pathologists here to state that 
 this form of disease has long been known to them. 
 Matthew Baillie regarded it as the most common form of 
 paraplegia, and had an anatomical explanation of its pecu- 
 liarities which, imperfect as it is, proves that he had in- 
 vestigated its post-mortem anatomy. His theory was that 
 the malady arose from a morbid effusion of cerebro-spinal 
 fluid, which, when the patient was erect, gravitated into the 
 lower part of the theca vertebralis, and, by pressing upon 
 the cord, rendered the patient unable to steady his move- 
 ments ; whilst, from the same cause, these became free again 
 when he was placed in a recumbent position. I quoted 
 these observations of Baillie in the year 1849/ and took 
 occasion then to call the malady encephalic paraplegia. It 
 is probable that this was too restricted a term, as is also 
 that of locomotor ataxy ; and that in our further considera- 
 tion of the disease we must recognise a diminution of 
 nervous power from failing nutrition of a more general kind 
 as well as special lines of more unequivocal decay, chiefly 
 marked in the posterior columns of the cord. In support of 
 this opinion I may state that ataxy alone occurred but three 
 times in fifty cases referred to by Trousseau. And yet, not- 
 withstanding this, Trousseau drew the characters of the 
 disease which he wished to typify from these three cases, 
 and not from the forty-seven others in which there was 
 evidently disease of parts of the brain, as well as of the cord. 
 If, however, all that has yet been done still leaves the 
 question of the lesion occasioning this form of paralysis in 
 dispute, one suggestive fact remains — namely, the singular 
 isolation of the posterior columns of the cord by the 
 degenerative process. This fact appears to indicate that the 
 affected structures have their own vitality, and probably, 
 therefore, a separate function from that of adjacent parts. 
 1 Gulstonian Lect., 1849. 
 
46 ADDRESSES. 
 
 Todd maintained the existence, of this separate function on 
 other grounds, and concluded that the posterior columns 
 were mere commissures. This theory seems the more 
 probable from the facts now alluded to, inasmuch as textures 
 fulfilling only such a function may be expected to have a 
 lower vitality than others which are more essential. This 
 supposition is strengthened by what is observed under 
 extreme inanition, it having been proved by the well-known 
 experiments of Chossat that the nervous centres resist 
 atrophy more than other tissues. Eelated to these intrinsic 
 morbid changes, whether local or general, are the cancerous 
 and tubercular affections, and the universal liability of the 
 tissues to that perverted process of nutrition which we call 
 inflammation. Although, for practical purposes, it is con- 
 venient to intensify the differences between cancer, tubercle, 
 and the inflammatory process, we have abundant evidence of 
 intimate relations between them. Thus the children of 
 parents dying of cancer are not rarely tubercular, and those 
 of the third generation are liable to various forms of chronic 
 inflammation ; whilst in the same families are healthy indi- 
 viduals, in whom we can discover no evidence of any special 
 morbid tendency. It is not improbable that that which 
 seems most special to us in cancer and tubercle may depend 
 more upon gradation than change of diathesis, and that both 
 are allied to more common degenerations. 
 
 In tubercular phthisis this has long been felt and acknow- 
 ledged. Those who have given most attention to the sub- 
 ject (and I could name no one whose experience would have 
 more weight than that of the late Dr. Addison) have had to 
 confess that the larger their observation, the greater their 
 difficulty in drawing a line of demarcation, limiting tuber- 
 culous from simply inflammatory productions. No doubt 
 many of the errors of prognosis in phthisis, some wilful, some 
 unwitting, arise from assuming a distinction which does not 
 exist, except in extreme cases where, as the logicians would 
 say, the quantum passes into the quale. Although it has 
 been observed that the scrofulous diathesis of early life may 
 show its special characters in age, still we have, on the other 
 side, frequent proof of a change to that which is malignant ; 
 and experience will, I am sure, confirm my statement that 
 
MEDICINE IN MODERN TIMES. 47 
 
 the tubercular peritonitis of childhood corresponds with great 
 strictness to the cancerous peritonitis of age. It is probable 
 that cancer is nearer to the simple degradation of tissues than 
 tubercle. It appears to be more independent of an external 
 exciting cause ; and although in its structure there is an 
 appearance of vital activity, such activity has no correlation 
 with the healthy organic processes, and is a mere eddying off 
 and separation from the organic cycle. A closer inquiry 
 into the local origin of cancer, and of the mode whereby the 
 system becomes infected by it, are yet desiderata. The ten- 
 dency to infect the body generally may, after all, not be 
 dependent upon a more marked cancerous diathesis, but upon 
 local circumstances. Something analogous appears to exist 
 in the infecting and non-infecting chancre ; for though, 
 according to some authorities, one is essentially local, and 
 the other as essentially infecting, yet it appears certain that 
 even the infecting kind has not always the same infecting 
 power. 
 
 In passing from these idiopathic or intrinsic morbid con- 
 ditions to such as arise from accident or ab extra, the fevers 
 chiefly claim our notice. In the consideration of these, 
 smallpox stands first ; since through vaccination we have it 
 clearly demonstrated, at least for this one form of fever, and 
 it seems but fair to infer the same of others, that recovery 
 and subsequent immunity are produced by a process of im- 
 pregnation and assimilation, and not, as is still by some main- 
 tained, of elimination. The old theory of depuration, though 
 true of gross chemical poisons, as lead, or mercury, or 
 arsenic, appears to have no application to those operations 
 which take place in the body, in contagious diseases, as the 
 effect of organic poisons. After any one of these the organism 
 is not restored to its former condition, as if any poison had 
 simply been cast out ; but there is notoriously a residual and 
 permanent effect, which has been induced under the super- 
 ficial disorder : this effect being shown by permanent indis- 
 position to a repetition of the same morbid process. Unfor- 
 tunately for science, the phenomena of fermentation have 
 been assumed in explanation of what takes place under these 
 circumstances ; and by the theory of zymosis we are carried 
 back to the days of ignorance, when concoction and matura- 
 
48 ADDRESSES. 
 
 tion were made to explain whatever was obscure. We dis- 
 cover, however, at the bedside nothing in the phenomena of 
 febrile disease proper to zymosis. As well might we call 
 the evolution of the germ after impregnation by that name. 
 The physiological disturbances induced by any one of the 
 fever-poisons — namely, the excess of heat, the rapid waste, 
 the quick action of the heart, the altered functions of secre- 
 tion and excretion, &c, the so-called symptoms of the disease 
 — are but the outward effects common to the class, and only so 
 far peculiar to each as they may vary in time and intensity. 
 That which really constitutes the specific character of each 
 fever is the attendant tissue-change which, when completed 
 according to the special poison, is followed by convalescence. 
 
 It this be in any degree an approach to a true conception 
 of these diseases, it follows that the object of medicine must 
 be rather to limit the violence of attendant symptoms, than, 
 with our present knowledge of therapeutics, to aim at 
 arresting or neutralising their specific processes. Had any 
 one formerly been asked the remedy for smallpox he would 
 hardly have seriously supposed the answer to be the poison 
 of smallpox itself. Yet so it has proved ; and from this 
 experience we have learned that help may come precisely in 
 the opposite direction to that looked for in our theories, and 
 we obtain a striking proof of the truth of Bacon's aphorism, 
 " Natura non nisi parendo vincitur." 
 
 Yet, notwithstanding this teaching, pathology still per- 
 sists in looking in another direction ; and therapeutics are 
 governed by the idea that disease is an entity which must 
 be combated and cast out. I fancy that the habit of 
 calling these and similar affections blood diseases insensibly 
 fosters the idea of depuration. Now, though I am not 
 disposed to stir up a discussion between Solidists and 
 Humor alists, I cannot but express my conviction that the 
 susceptibility to the various contagious fevers does not lie 
 in the blood, except so far as it may be a channel through 
 which the poisons reach the tissues ; and that it is in these, 
 and especially in the nervous tissues, that the true fever 
 processes begin and end. The facts of habit, such as those 
 of taking opium or using tobacco, the facts of acclimatisa- 
 tion, and of the commoner experience of our life, whereby 
 
MEDICINE IN MODERN TIMES. 49 
 
 the nervous system becomes accustomed and indifferent to 
 continued sources of irritation, render such an opinion the 
 more probable ; and a confirmation of it is gained by that 
 enduring effect which ensures against a repetition of morbid 
 actions. 
 
 Were I to give liberty to my imagination I might perhaps 
 trace here a much more extensive law of our nervous organ- 
 isation, whereby that which is new excites, and that which 
 is old becomes indifferent. For my own part, the views 
 which have been put forth as to syphilisation have, on these 
 grounds, seemed to deserve the fullest consideration ; and, 
 though I have not original observations to set against the 
 adverse conclusions of some who have made the subject a 
 matter of experimental inquiry, I feel that we cannot easily 
 set aside the experience of those who have asserted its 
 success. Analogy is in its favour. 
 
 I cannot conclude these general remarks on some diffi- 
 culties which now occupy our minds in respect to pathology 
 without alluding to the vexed question of rheumatic fever. 
 Is this state due, or is it not, to a materies morbi ? Farther, 
 have we any grounds for assuming that such materies morbi 
 is lactic or acetic acid ? I put these questions thus ex- 
 plicitly, because it seems to have been settled upon mere 
 authority that they may both be answered in the affirmative. 
 I say authority alone, not forgetting the experiments which 
 have been made on animals in proof of this theory, since 
 such experiments appear to me to prove only this, that the 
 acids named, entering the blood, may cause endocarditis 
 and some other pathological changes simulating those of 
 rheumatism ; but I cannot therein recognise the rheumatic 
 state as I am acquainted with it at the bedside. There 
 are, so far as I know, no analyses of the blood in rheuma- 
 tism which show that it differs from normal blood in respect 
 of its acidity. The theory of an acid materies morbi appears 
 to be supported chiefly upon the excessively acid secretion 
 of the skin in this disease, and the increased acidity of the 
 urine. But neither of these can be considered in any 
 degree characteristic ; for not only in the worst forms of 
 the rheumatic process is the secretion of the skin not acid 
 but alkaline, but in conditions of the system totally dissimilar 
 
 4 
 
50 ADDRESSES. 
 
 from rheumatism — as, for instance, in phlebitis, and especially 
 in that form following injuries to the head, as well as in 
 arterial embolism — we often meet with excessive acid sweat- 
 ing, misleading to a false diagnosis those who believe this 
 to be characteristic of rheumatism. Notoriously, a proper 
 function of the skin is to secrete, and probably to form in 
 itself, lactic and acetic acid. Under different kinds of 
 irritation this formation becomes excessive ; but I know of 
 no facts to show that this excess indicates a special patho- 
 logy, or may be regarded as a salutary process, whereby 
 the system is relieved of a materies morbi. In so supposing 
 it, we seem to be misled by the same fallacies as, before the 
 time of Sydenham, misled practitioners in the treatment of 
 eruptive diseases. I confess to a strong sympathy with 
 those errors, and though my reason is convinced that they 
 were errors of the most dangerous kind, I cannot but 
 excuse them, and admire the genius and courage of Syden- 
 ham, which enabled him to detect and correct them. 
 
 If, failing the evidence of the cutaneous secretion, the 
 rheumatologist adduces proof of an acid diathesis from the 
 character of the urine, must not the force of his argument 
 be abated by the admission that urates replace urea in a 
 large number of other morbid conditions, so that we cannot 
 attach any specific value to this fact, the general significance 
 of which will be better appreciated by the physiologist, who 
 will see in the presence of uric acid and the urates a 
 debased condition of organic waste, common to the life of 
 inferior organisms ? 
 
 To pass, however, from these desultory observations, 
 which the present position of pathology has suggested, the 
 subject of diagnosis claims a few words. We must all 
 admit that diagnosis ultimately rests upon an exhaustive 
 pathology. Without a knowledge of what is possible in 
 disease, diagnosis must be defective, and is, therefore, in 
 that degree defective at the present day, since it is plain 
 that we are unacquainted with many pathological states, if, 
 indeed, we be fully acquainted with any. Moreover a 
 knowledge which seems exhaustive to-day may, in the 
 changing circumstances of the world, be defective to-morrow. 
 Without raising the question whether disease has within 
 
MEDICINE IN MODERN TIMES. 51 
 
 historical periods changed its type, it maybe maintained, as 
 was long ago pointed out, that the pathological tendencies 
 of the body do vary with the genius anni, as witness the 
 changes in epidemic disease. "Within our present experience 
 cholera has afforded us new pathological questions, which 
 are not yet solved ; and, strangely, side by side with it — to 
 make the contrast more impressive — diphtheria has revived ; 
 laying before us, as if to teach us how feeble our pathological 
 science is, two opposite conditions, two diseased mucous 
 surfaces — one digestive, one respiratory : from the former of 
 which, by mysterious inversion of its normal forces, the 
 salines and water of the blood may be fatally diffused ; and 
 from the latter, as by a kind of morbid polarity, the fibrin 
 only poured out. 
 
 Albhough the perfection of diagnosis cannot be reached 
 till we have a perfect pathology, we have to confess that it 
 falls behind the pathological knowledge we at present 
 possess, as the revelations of the post-mortem tables abun- 
 dantly confirm. 
 
 And this brings me to the second principle of diagnosis, 
 a knowledge of the probable in disease. Of this, experience 
 alone can inform us, and experience of the most varied kind. 
 But when so varied, and supported by a large knowledge of 
 pathology, it often enables us, as by prophetic insight, tq 
 diagnosticate conditions, which neither direct physical 
 examination nor the most systematic arrangement of sym- 
 ptoms could explain. These suggestions are amongst the 
 best fruits of experience — of that experience which is able 
 to arrive at causes, and from causes anticipate effects. The 
 advancement of* diagnosis depends upon the capacity of 
 medicine to make these anticipations with increasing cer- 
 tainty, which, though in a sense anticipationes mentis, are 
 truly interpretations naturae. To illustrate these remarks, 
 what could I better quote than the clinical history of throm- 
 bosis and embolism ? What mysterious obscurity, until 
 recently, involved the phenomena of which embolism was 
 the cause ! but, thanks to Virchow and Kirkes, when once 
 the pregnant fact of embolism in vein or artery is recognised, 
 not only present phenomena arrange themselves in order, 
 but we are able to anticipate the possible occurrence of 
 
52 ADDRESSES. 
 
 others, and by anticipation often to prevent them. Sym- 
 ptoms and physical signs may supply us with abundance of 
 clinical facts ; but, until the one great fact be recognised in 
 such cases, we can make no step in diagnosis. 
 
 This instance by no means stands alone ; for wherever, 
 from the nature of the case, we are unable to make a com- 
 plete physical examination, as must always occur in diseases 
 of the brain, and as too often occurs in diseases of the 
 abdomen, pathological inference, or pathological antici- 
 pation, has to supply a meaning to other portions of the 
 evidence. In brain diseases this method of interpreta- 
 tion comes largely into play ; and the neglect of it has much 
 to do with the obscurity in which these diseases are still 
 involved. It is often impossible to form any opinion what- 
 ever of the lesion under which a patient with brain disturb- 
 ance may be labouring from an inquiry, however acute, 
 and however complete, into the mere statical facts, as they 
 at the moment present themselves. The attempt to do so is 
 perhaps more likely to lead to error than to truth ; a fact 
 which, if I be right in the statement of it, shows of how 
 little value mere symptoms are in the diagnosis of such 
 cases. 
 
 Abercrombie felt this to its full extent, and one of the 
 objects of his treatise on cerebral disease was to make it 
 clear, and to warn us against future attempts in that direc- 
 tion. A perusal of his writings leaves upon the mind the 
 impression that the most diverse affections of the brain may, 
 at the bedside, present the same symptoms ; that in the 
 most extensive lesions there may be no symptoms at all; or 
 that the whole catalogue may appear without any lesion. 
 But the feeling of despair which such a perusal formerly 
 produced is now in great part dissipated by the success with 
 which the inquiry can be made in the direction pointed out. 
 Admitting that we shall never diagnosticate cerebral lesions 
 by their symptoms — partly because different lesions produce 
 the same symptoms if the seat be the same ; partly because 
 there appear to be surplusage portions of brain-tissue, as, for 
 instance, in the hemispheres, where lesions cannot make their 
 presence known ; and partly because in that monster disturb- 
 ance, epilepsy, we have a variety of states simulating organic 
 
MEDICINE IN MODERN TIMES. 53 
 
 lesion, — we betake ourselves again with renewed energy to 
 the study of morbid anatomy and pathology, which first 
 caused the confusion by disturbing our ignorance, feeling 
 assured they will at last afford us a full clue to the difficulty. 
 To a large extent they have already afforded this clue. To 
 begin with the last fallacy I have named, I may remark that 
 we are better acquainted than formerly with the various forms 
 of the epileptic state. A better pathology has prepared us 
 to recognise in this condition a great variety of effects. 
 Todd drew attention to epileptic hemiplegia ; and in the same 
 subjects there occurs also a remarkable form of coma, which 
 has often led to the supposition of effused blood, or tumour, or 
 abscess — suppositions which have been falsified by the reco- 
 very of the patient. Whilst our notion of epilepsy included 
 nothing more than a convulsive state with unconsciousness, 
 numerous errors in diagnosis must have occurred from this 
 source alone. It now represents to us a condition of dis- 
 turbed nerve-force, in which may occur not only the common 
 phenomena of epilepsy, but coma without convulsion, para- 
 lysis following convulsion, sudden and transient mania, or an 
 approach to it, as well as, according to Trousseau, some strange 
 forms of neuralgia. A knowledge, therefore, that a 
 patient is liable to epilepsy, or comes of a family in which 
 such a state has occurred, must make us pause in our dia- 
 gnosis, and thus save us from a precipitate or erroneous con- 
 clusion. The proneness of the aged to epilepsy is a fact 
 probably not sufficiently borne in mind in the diagnosis 
 of cerebral disorders. As to the second fallacy, when dis- 
 ease is situated in what may perhaps be called without 
 misuse of the term, the surplusage of the cerebrum or 
 cerebellum, we are often led to suspect its presence, and as 
 often correctly to infer its nature and avoid the third fallacy 
 from a knowledge of the fact of surplusage, and of what is 
 probable under collateral circumstances, though the symptoms 
 of organic disease may be apparently of an insignificant 
 kind. For instance, headache with occasional bilious vomit- 
 ing in a young and healthy adult — tumour (?) ; the same 
 symptoms, with chronic suppuration about the ear, or in 
 some distant part — abscess (?) ; nearly the same symptoms 
 ■with syphilitic cachexia — syphilitic affection of the brain (?). 
 
54 ADDRESSES. 
 
 This is the merest outline, but is true to nature. May I 
 say, once for all, that any peculiar shape of head, large or 
 small, has, like the epileptic brain, long been known to increase 
 the difficulties of cerebral diagnosis ? Further, how much 
 have we gained in the diagnosis of cerebral disease by 
 the known tendency of renal cachexia to induce chronic 
 or subacute cerebritis, and of embolism to plug the 
 vessels ! 
 
 In turning from the diseases of the brain to affections of 
 the chest, we find that we are able to combine our know- 
 ledge of the possible and the probable with direct physical 
 signs ; and consequently the diagnosis of chest affections has 
 very steadily advanced. Old errors, however, still linger 
 even here, and a true dynamic estimate of lung lesions is 
 yet a desideratum. This must be supplied by improved in- 
 terpretation of physical signs through attendant physiolo- 
 gical conditions. The word " phthisis," which has now too 
 often a specific value, will dilate so as to include a whole 
 genus of chronic affections, which, when duly recognised 
 and classified, will afford more secure grounds of prognosis, 
 and spare us the perusal of worthless records of so-called 
 consumption cured. 
 
 In the diagnosis of abdominal diseases we want an 
 increase in the number of cardinal facts ; such, for instance, 
 as that the enlarged gall-bladder changes its shape by con- 
 traction of its muscular coat ; or of the two characteristic 
 notches in an enlarged spleen, or of the peculiar position of 
 the colon in enlarged kidney, &c. At present our diagnosis 
 is mostly one of inference, from our knowledge of the 
 liability of the several organs to particular lesions : thus we 
 avoid the error of supposing the presence of mesenteric 
 disease in young women emaciated to the last degree through 
 hysteric apepsia, 1 by our knowledge of the latter affection, 
 and by the absence of tubercular disease elsewhere. We 
 infer alcoholic changes in the liver from the aspect of the 
 face, yellowish and mottled by venous stigmata, even with- 
 out any direct knowledge of the state of the liver or the 
 habits of the patient. We suspect a cancerous disease of 
 
 1 I have ventured to apply this term to the state indicated, in the hope 
 of directing more attention to it. — W. W. (jr. 
 
MEDICINE IN MODEEN TIMES. 55 
 
 the peritoneum in the aged from the pain with ascitic effu- 
 sion. 
 
 It is obviously to an increased perfection of physical 
 diagnosis, aided by pathology, that we must look for the 
 advancement of medicine. The feelings of the patient, 
 the so-called symptoms, are of little value taken by them- 
 selves ; often, in fact, their mere number and variety are a 
 proof of the absence of disease, and it is admitted on all 
 hands that they need the interpretation of physical inquiry. 
 
 The eye, the ear, the touch — and chemistry supplement- 
 ing the other two senses,— are impressed into our daily 
 service, and we may hope that what the ophthalmoscope has 
 effected for the eye, these other means may do for other 
 parts. To chemistry we owe much j but there are two yet 
 unsatisfied claims clinical medicine has to make upon it. 
 We want analyses of the residuum of the urine, in which 
 we may hope to discover new elements for diagnosis ; and 
 we further want ready clinical means for recognising what 
 has been discovered by more elaborate processes. Our hope 
 in the direction of chemistry is unlimited, seeing that there 
 must be changes in the urine largely corresponding to the 
 changes in the organs and textures, whether healthy or 
 morbid. 
 
 To return, however, to physical diagnosis ; the fidelity 
 with which the characters of a disease are often marked 
 in its tissue-changes must excite equally our wonder 
 and attention. It may be no more than the tint of the mor- 
 bidly vascular part — a condition apparently the most trivial 
 and accidental ; and yet it returns with unerring certainty 
 under the like conditions, as our guide to diagnosis. The 
 multiplied generations of the vaccine vesicle from one lymph 
 maintaining to this day, in all respects, the characteristics 
 of that which first arose under the hand of its immortal dis- 
 coverer, is one of the strongest evidences that I could 
 adduce of such fidelity, and may well encourage us to the 
 investigation of physical signs as an evidence of the patho- 
 logical causes to which they are due. 
 
 But our diagnosis is not always of a single morbid state. 
 There may be grafted upon some special diathesis, as of 
 tubercle or of gout, the effects of alcohol, syphilis, mercury, 
 
56 ADDRESSES. 
 
 or miasm. No doubt even more complicated instances could 
 be given, but this will suffice to show what diagnosis must 
 embrace before we proceed to treatment. 
 
 As health is our object, or as near an approach to it as 
 circumstances admit, hygiene and therapeutics claim the last 
 and highest place in our thoughts. Happily, at this day, 
 hygiene has gained strength enough to maintain an inde- 
 pendent position as a science. To know and counteract the 
 causes of disease before they become effective is evidently the 
 triumph of our art ; but it will be long before mankind will 
 be wise enough to accept the aid we could give them in this 
 direction. Ignorance of the laws of health and intemperance 
 of all kinds are too powerful for us. Still we shall continue 
 to wage an undying crusade ; and truly we may congratulate 
 ourselves that no crusade ever called forth more able and 
 devoted warriors than are thus engaged. 
 
 The diseases of the young are in large part preventable 
 diseases. 
 
 Epidemics carry off in great proportion the healthy 
 members of a community. 
 
 It is futile, if not worse, to speak as some do of leaving 
 diseases to work out their own ends, as agents of a moral 
 police. Medicine allows no such prerogative to our judg- 
 ment. It is enough for us that diseases prevail, to stimulate 
 our best efforts for their prevention, without our asking a 
 question beyond. 
 
 Nothing can stimulate science more to the investigation 
 of therapeutics than the feeling that the diseases calling for 
 treatment prevail in spite of our best efforts to prevent them. 
 Where hygiene fails, properly commences the work of thera- 
 peutics ; but it is painful to find ourselves occupied in 
 making feeble and often useless efforts to combat the effects 
 of a poison which might perhaps have been stamped out in 
 its beginnings. 
 
 The strength of modern therapeutics lies in the clearer 
 perception than formerly of the great truth that diseases are 
 but perverted life-processes, and have for their natural 
 history not only a beginning, but equally a period of cul- 
 mination and decline. 
 
 In common inflammatory affections this is now admitted 
 
MEDICINE IN MODERN TIMES. 57 
 
 to be an all but universal law. By time and rest, that 
 innate vis medicatrix — 
 
 " Which hath an operation more divine 
 Than breath or pen can give expressure to,'' 
 
 reduces the perversions back again to the physiological 
 limits, and health is restored. To this beneficent law we 
 owe the maintenance of the form and beauty of our race in 
 the presence of so much that tends to spoil and degrade it. 
 We cannot pass through the crowded streets and alleys of 
 our cities without recognising proofs of this in the children's 
 faces, in spite of all their squalor and misery ; and when we 
 remember what this illustration in all its details reveals we 
 may well take heart, even where our work seems most 
 hopeless. The effects of disease may be for a third or 
 fourth generation, but the laws of health are for a thousand. 
 Bearing this in mind, I have often had occasion to remark 
 in practice how little we can estimate the reparative powers, 
 however able we may be to discover disease. This is, 
 perhaps, never more striking than in some chronic affec- 
 tions, which, having resisted all our efforts to cure, may 
 have been abandoned in despair, or at length placed under 
 some indifferent treatment. Under these circumstances, 
 with what interest have most of us day by day watched the 
 lessening deviations of disease until the balance of health 
 has been again all but restored, unstable though the equi- 
 librium thus gained may, from the nature of the case, 
 eventually prove ! 
 
 Therapeutics were at one time directed only by two ideas 
 — of strength and of weakness. Sthenic and Asthenic ex- 
 pressed in general terms the morbid conditions requiring 
 treatment. Of the same import, but of older date, were 
 the thoughts derived from the then current theory of 
 Phlogiston ; and the terms Phlogistic and Antiphlogistic 
 still linger in medical treatises. Prom a better physiology, 
 however, we have learnt that perverted functions in disease, 
 however exaggerated, are due to failure and not to excess 
 of the vital powers. 
 
 Organic strength lies nowhere but in the living circle of 
 nutrition and function. 
 
58 ADDRESSES. 
 
 A rapid pulse and active delirium, like the increase of 
 the animal heat, are signs of deficient balance power — a 
 power which we have been so slow to recognise in living 
 organisms that we have not yet an accepted expression for 
 it. How different seems to us at the present day the value- 
 of the symptoms which were formerly considered indicative- 
 of strength ! 
 
 In an increase of temperature we see but increased 
 waste. Every degree of rise in the thermometer indicates 
 to us a corresponding decline in that nervous control which 
 regulates the functions in health ; and this decline is the- 
 more important, if it be true in complex organisms as it is 
 in simple machines, that this combination which limits the 
 mere working forces is the highest and most characteristic. 
 The terms " strength " and " weakness " are valueless as 
 expressive of conditions so complicated as those of disease. 
 They are deduced for the most part from the feelings of the 
 patient and a few superficial phenomena. They are empty 
 idols, impressive only by the extent of their emptiness. 
 Surgical treatment was greatly advanced by the imaginary 
 discovery of the sympathetic powder, which being placed 
 upon the instrument inflicting the wound, the injured part, 
 by time and rest, was allowed to recover under the simplest 
 means. We need now to import into medicine a large part 
 of the best surgical principles so deduced. The surgeon 
 is contented to place a wounded part under the conditions 
 of physical and physiological rest, and after attention to 
 hygienic conditions, the res non naturales of our forefathers, 
 to abide the result. This, no doubt, expresses the largest 
 part of our treatment of common acute disease. We now 
 know that we cannot directly control the morbid processes 
 in pneumonia, pleurisy, or pericarditis ; we know, further, 
 that the means formerly considered essential to the cure of 
 these diseases, tested by better clinical observations, were 
 either useless or pernicious ; that instead of favouring the 
 plastic processes in inflammation, whereby the normal 
 decline of the disease was promoted, the effused material 
 was often more or less degraded and spoilt by the treatment 
 employed, and remained in the affected parts, either as a 
 foreign body, or in different degrees approaching thereto. 
 
MEDICINE IN MODEBN TIMES. 59 
 
 And this must always have been so, had we continued to 
 regard these effusions as simply foreign products ; but as 
 soon as we perceived their physiological relations, and that 
 they had a course of life like the tissues from which they 
 sprung, they took a different aspect, and it became our 
 duty, often without much interference, to stand by and 
 watch this course to the end. With an audience like the 
 present, so capable of supplying the proper safeguards to 
 these expressions, I am not likely to be misunderstood, as if 
 the duties of the physician were of a negative kind. There 
 is a sufficient sphere for our activity in ways too numerous 
 for me to mention : in the relief of symptoms where the 
 lesion may be left to its natural course — in the treatment of 
 the lesion itself, where we have means adapted to it, and of 
 these we may have many — in maintaining the health when 
 the degeneration or lesion is incurable. Time would fail 
 me, if it were otherwise proper in this place, to enumerate 
 and enlarge upon the valuable applications of medicine. 
 The discovery of disease — the alleviation of its symptoms — 
 the obviating its inroads — the placing our patient under 
 favorable conditions to bear it — the guarding him against 
 what would be injurious — and the administration of reme- 
 dies often in themselves effectual for its removal, are surely 
 services of no unimportant kind. 
 
 There is probably no human work which daily confers 
 greater good upon society than does ours ; and when we 
 consider that from the ranks of our profession the chief 
 cultivators of modern sciences have sprung, whether we 
 speak of botany, comparative anatomy, chemistry, physio- 
 logy, biology, hygiene, or social science, we may feel some 
 justifiable pride and be encouraged in spite of all failures 
 to go on, assured that our future must be one of ever- 
 increasing usefulness and honour. 
 
THE HAEVEIAN OBATION. 1 
 
 Me. President and Fellows, — " Once in a year there shall 
 be given a solemn oration to commemorate the benefactors 
 of the College, and to encourage its members to search out 
 the secrets of nature by way of experiment." 
 
 This was the express wish of Harvey, and for the annual 
 fulfilment of it he duly provided. It is this occasion which, 
 after more than two centuries, calls us together to-day. 
 Had I not felt it a duty to comply with the request of our 
 President to deliver this oration, I should gladly have put 
 aside the task thus devolving upon me, feeling as I do very 
 deeply the responsibility of undertaking it. But by doing so 
 I felt I should incur greater blame than by failing in a faithful 
 attempt, however feeble, to perform it. To have shrunk 
 from this duty would have involved a seeming unreadiness to 
 do my best, and an apparent neglect of the command of 
 Harvey, whose immortal name confers not only the highest 
 honour upon our country, but an undying distinction upon 
 this College. 
 
 We have not met to-day to do honour to Harvey by laud- 
 ing again the splendour of his discoveries, or to justify the 
 scientific method he employed in making them. This has 
 been done so repeatedly and so well* in this place that it 
 would be both superfluous and presumptuous to go over the 
 ground again. My duty is rather to fulfil, as far as lies in 
 my power, Harvey's intention in instituting this oration by 
 moving your minds to a consideration of our position as 
 students of medicine, and to encourage a further search into 
 nature's mysteries. 
 
 1 Delivered at the Koyal College of Physicians, London, June 24th, 1870. 
 
HABVEIAN ORATION. 61 
 
 The science of medicine, being the science of man (in 
 health and disease), must occupy the central place in human 
 knowledge — physics and metaphysics being the poles of his 
 existence, and the social sciences comprising his history. But 
 it may be asked if our minds are made up as to whether man 
 is altogether an object of scientific study or not ; whether 
 the mysteries of his organisation are fairly subjects admitting 
 of investigation ; and therefore whether it is becoming in 
 the Harveian orator to stir up your minds to search these 
 mysteries out to their fullest extent. The doubt implied is 
 not one of my own suggesting, for I confess it seems strange 
 to me that any one at this day should assert that " life is a 
 power entirely different from and in no way correlated with 
 matter and its ordinary forces," and consequently, I may add, 
 no proper object of science. Yet this assertion, though not 
 the inference, comes from one amongst ourselves who is 
 well entitled to respect, and therefore it obliges me to a survey 
 of our present position. 
 
 It is not thirty years since it was gravely questioned 
 whether a living body could not generate, by its vital force, 
 some of the elements of which it is composed. An organism 
 was considered to be a creative agent, forming and trans- 
 muting the materials of its higher structures. How far the 
 investigations of chemistry have separated us from such 
 fictions I need not remind you ; for whatever may be thought 
 of the forces exhibited by living beings, no one would now 
 question the origin and nature of their materials. No one at 
 this day would even dare to hint at any transmutation of the 
 organic elements. It appears, however, that we are not yet 
 entirely emancipated from such conceptions ; and that there 
 is still wanting a full and implicit belief that the as yet mys- 
 terious phenomena of life are correlative with the lower 
 forces in nature. Whilst the advances of chemistry were 
 settling the question of material elements, physics was 
 deeply occupied with the relations of forces. These relations, 
 which had so long engaged and perplexed logical ingenuity, 
 still remained comparatively barren. Cause and effect were 
 to the logician but invariable sequences, of which he could 
 give no account. To the physicist they now became essential 
 continuities : effect was cause in a new form ; suppression 
 
62 ADDKESSES. 
 
 and reappearance took the place of mere physical sequence. 
 The stone which logic offered became bread in the hand of 
 science. A boundless vista at once opened before the mind ; 
 and, instead of isolated and independent phenomena, the 
 essential relations of all the physical forces became more or 
 less clearly discernible, rendering it probable that as a me- 
 chanical cause in its simplest form is evolved into its effect 
 by suppression, or as the higher forms of force, heat, light, 
 electricity, and magnetism, could be equally evolved under 
 suitable material conditions from a merely mechanical cause 
 by a similar suppression, so might the organic processes in 
 their entirety be equally correlative of the lower forces. 
 That as the living body neither formed nor transmuted its 
 material elements, neither was it the creative centre of an 
 immaterial and independent organic law working within. 
 
 If, in fine, it is ascertained beyond all doubt that, in respect 
 of its materials, a living body contains no more than it has 
 received ; that, however strange and mysterious its organs 
 and their functions, the warp and woof are of substances 
 with which we are acquainted under simpler conditions, 
 cannot the same be maintained of the form and forces it ex- 
 hibits ? 
 
 To begin with the lowest series of living things. There 
 will probably be no hesitation in admitting that the vegetable 
 kingdom is no more than an expression in a higher form of 
 the terrestrial conditions which even common experience 
 proves to be in a general way necessary to vegetable life. 
 And this admission will be freely made, though the infinite 
 details it includes have yet to be made known. Thus the 
 fulfilment of the Almighty fiat — " Let the earth bring forth 
 grass, the herb yielding seed, and the fruit tree yielding fruit 
 after his kind " — will be regarded not as the unconditioned 
 effect of an absolute will, but as the working out of that will 
 through means laid open to the investigation of science. 
 
 To pass from a lower series to a higher, it will be equally 
 admitted that the animal kingdom is sustained at all points 
 by the vegetable kingdom. 
 
 That the forces exhibited in animal functions are those 
 previously stored tip in plants by assimilation is a fixed 
 position in physiology, and so far the operation of the law 
 
HAEVEIAN ORATION. 63 
 
 ■of life is plain ; bat as we pass to a consideration of the 
 more intimate modes of it, the difficulties increase, and yet 
 probably they are not essentially greater difficulties than 
 such as have been overcome by the patience and docility of 
 those investigators whom it is my duty to commemorate on 
 this occasion. 
 
 It may be objected that there is lurking a kind of petitio 
 principii in the supposed relations of simpler forces to their 
 higher forms ; that, for the conversion of the former into 
 the latter, it is necessary to postulate material conditions of 
 a certain kind, and that for the organic conversion we must 
 begin with a living body or its germ. That the boast of 
 the physiologist is like the boast of Archimedes. If he 
 wanted a 7roiJ orw, they require germs or ova and a living 
 body. But it is clear that such an objection has no weight 
 as in favour of a vital force which is not material, since it 
 is abundantly proved that, whatever be the conditions 
 required, they do not generate any power, but only vary the 
 form of it. 
 
 They who maintain the hypothesis of a separate vital 
 force independent of the ordinary forces of nature, and 
 which has no essential relation to them, do, by the very 
 terms of the hypothesis, assume that the phenomena in 
 living things are out of the proper range of science, and 
 they consign us to a perpetual mental inactivity and ignor- 
 ance in that region of knowledge in which above all others 
 man is interested. They seem to abjure that birthright 
 which a learned physiologist has spoken of as our highest 
 inheritance when he says, " Man is not only the most 
 wonderful creature God hath created, in the perfection of 
 his organisation ; but most in this, that He hath endowed 
 him with an intellect to understand Himself." " When this 
 height is reached," this same writer adds, " then, and not 
 till then, will man be a perfect monument of the wisdom 
 and power of his Maker, a created being knowing his own 
 existence, and capable of explaining it." ] An hypothesis 
 like that of a separate vital principle, which demands so 
 much, which stops inquiry at once, making progress im- 
 possible by removing the steps by which it could ascend, 
 1 Draper's ' Human Physiology,' 1856, p. 25. 
 
64 ADDRESSES. 
 
 should at least have the highest sanctions of our intellect. 
 This, however, seems not to be so ; for, says one of the 
 acutest thinkers, 1 " To a reflecting mind the very fact that 
 the powers peculiar to life include cohesion, elasticity, &c, 
 that living matter exhibits these physical properties, would 
 demonstrate that, in the truth of things, they are homo- 
 geneous, and that both the classes are but degrees and 
 different dignities of one and the same tendency. For the 
 latter are not subjected to the former as a lever or walking- 
 stick to the muscles ; the more intense life is, the less does 
 elasticity, for instance, appear as elasticity. It sinks down 
 into the nearest approach to its physical form by a series of 
 degrees, from the contraction and elongation of the irritable 
 muscle to the physical hardness of the insensitive nail. The 
 lower powers are assimilated, not merely employed, and 
 assimilation presupposes the homogeneous nature of the 
 thing assimilated ; else it is a miracle, because it would 
 imply that additional and equal miracle of annihilation. In 
 short, all the impossibilities which the acutest divines have 
 detected in transubstantiation would apply totidem verbis et 
 syllabis to that of assimilation, if the objects and the agents 
 were really heterogeneous. Unless, therefore, a thing can 
 exhibit properties which do not belong to it, the very 
 admission that living matter exhibits physical properties 
 includes the further admission that those physical or dead 
 properties are in themselves vital in essence, really distinct, 
 but in appearance only different." The impassable chasm 
 between the living and the dead which this hypothesis of a 
 vital force assumes, and then attempts to bridge over, 
 appears to be a human figment, arising out of the mechan- 
 ical mode by which alone man can work upon material ; 
 but, says Newton, 2 " the main business of natural philo- 
 sophy is to ague from phenomena without feigning hypo- 
 theses, and to deduce causes from effects until we come to 
 the first cause, which certainly is not mechanical.-" Science 
 may probably never be able to give an account of the 
 primitive germs of living things, if only because the pri- 
 
 1 Coleridge, 'Hints towards the Formation of a more Comprehensive 
 Theory of Life,' 1848. 
 
 2 ' Optics,' p. 344, 1 7 18. 
 
HARVEIAN ORATION. 65 
 
 meval conditions of the world cannot repeat themselves for 
 our investigation ; but it is not improbable that the concep- 
 tion we form of germs and ova is as faulty as was that of 
 early physiologists respecting the generation of elementary 
 substances by organic bodies, or of that till lately generally 
 entertained, and still entertained by some, respecting the 
 vital forces, as if they were not terrestrial. That living 
 things throw off at times portions of their mass, which 
 become through a definite set of physical relations like the 
 parent from which they sprang, is of common experience ; 
 but whether these masses, germs, or ova, as they may happen 
 to be called, are as limited and specific as we have hitherto 
 regarded them, is the questio vexata of the day. 
 
 That like should beget like, might a priori be inferred 
 from the equality of the conditions. But observation also 
 shows that, the conditions varying, like does not necessarily 
 beget likeness ; and this variation occurs both upwards 
 towards a higher organisation, downwards towards an ex- 
 tinction of it, and divergently towards variety of organic 
 form. 
 
 The dogma " omne vivum ex ovo," for the truth of which 
 Harvey so justly contended against the fanciful notions of 
 his age, cannot, perhaps, be now maintained in its integrity. 
 Whether, to use an expression of that day, living things are 
 ever produced automatically — that is, de novo — through 
 putrefaction or otherwise, is, like the question of the limi- 
 tation or universality of the germ power, still a matter upon 
 which opinion is divided ; and if it is my duty on this occa- 
 sion to exhort you to investigate nature by way of experi- 
 ment, I must ask you not readily to accept negative conclusions 
 which impose limits where none may really exist. 
 
 Still, it must be admitted that it is under the strictest 
 and severest limits that nature does operate. If organisation 
 be automatic, it is so in a deeper and higher, in a wider and 
 stricter sense than the mind of man hath as yet conceived. 
 It is a process of whose beginning we have no knowledge 
 or conception, and the present facts of which must ever 
 make greater and greater demands upon the intellect to 
 fathom them. It is an operation which reaches so far as to 
 include in its last developments an intellectual and a moral 
 
 vol. n. 5 
 
66 ADDRESSES. 
 
 law, — all the infinite organic variety we see around us, and 
 that subtle world we feel within. 
 
 The time is passing in which the human mind can remain 
 satisfied to rest under the fetters it has imposed upon itself, 
 or to cherish its own phantasms as if its very existence de- 
 pended upon them. " Man knows only what he has observed 
 of the course of nature " is the notorious dictum of science, 
 showing the limit and the mode of the acquirement of our 
 knowledge ; the limit as wide as nature itself, and the 
 mode but readiness to be taught. Notwithstanding, there- 
 fore, the adverse decision of schools and dogmas, science 
 still occupies itself with the possibilities of occasional 
 automatic generation. And that it should be so, let it not 
 raise antagonism in the minds of those whose inquiries lie 
 in another direction, since the infinity of nature may well 
 include facts which at first seem to be antagonistic. 
 
 But here, as in all search after truth, we pass between 
 Scylla and Charybdis. On the one hand, we may not incline 
 to those easy systems which satisfy the intellect by explana- 
 tions which the imagination supposes ; neither may we, on 
 the other, give ourselves over to systems of immature science, 
 which, whilst they seem to be carrying us forward, are but 
 revolving us in the narrowest circles of knowledge, — for mind 
 is not mechanical, life is not chemistry, anatomy is not phy- 
 siology ; and I think, as the poet says, that we are not alto- 
 gether magnetic mockeries. Still, as it has been stated 
 elsewhere, the student of medicine would gladly yield up the 
 department of knowledge in which he labours, to be parti- 
 tioned amongst the claimants of the collateral sciences of 
 physics and chemistry, if their claim was fairly made out ; 
 but, however much we may congratulate our fellow-labourers 
 on the work they have accomplished, we cannot admit that 
 their investigations have as yet approached even the confines 
 of the organic kingdom. 
 
 Physiology in the range of animal and vegetable morpho- 
 logy has done much to give us the assurance that the 
 infinite variety of organic forms will be traced to their 
 secondary causes. It may seem but trifling to note how 
 vegetable symmetry is dependent upon the relations of light 
 and moisture, and the circumambient fluids, air or water ; 
 
HARVEIAN ORATION. 67 
 
 or that leaves and flowers will be regular or not, according 
 to the varying firmness of the stem on which they are sup- 
 ported. But if from these observations we can be carried on 
 to those elaborate arrangements which have been described 
 as so admirable in their intentions as to surpass the utmost 
 ingenuity of man to conceive, we cannot believe that there is 
 a limit to our progress but that which our supineness or 
 pride of intellect imposes upon us. Whilst we accept this 
 encouragement, it is to be remarked that the explanations 
 afforded are chiefly statical or mechanical — that they do not 
 approach the conditions which we are accustomed to regard 
 as in a higher sense vital. Yet, even with respect to 
 these, as was brought before you on a former occasion, 
 science does not shrink from the task of ultimately unveiling 
 their mystery. "To suppose/' says Darwin, 1 "that the 
 eye, with all its inimitable contrivances for adjusting the 
 focus to different distances, for admitting different amounts 
 of light, and for the correction of spherical and chromatic 
 aberration, could have been formed by natural selection, 
 seems, I freely confess, absurd in the highest possible degree. 
 Yet reason tells me that if numerous gradations, from a 
 perfect and complex eye to one very imperfect and simple, 
 each grade being useful to its possessor, can be shown to 
 exist ; if, further, the eye does vary ever so slightly, and the 
 variation be inherited, which is certainly the case ; and if 
 any variation or modification in the organ be ever useful to 
 an animal under changing conditions of life, then the diffi- 
 culty of believing that a perfect and complex eye could be 
 formed by natural selection, though insuperable by our imagi- 
 nation, can hardly be considered real." 
 
 Admitting the full force of this reasoning, and though 
 anatomy shows that the elementary eye arises by a simple 
 involution of the integument, the difficulty is that the same, 
 or nearly the same, occurs for the ear ; and we have no 
 knowledge which would enable us to predict from such be- 
 ginning the formation of organs so elaborate as these ulti- 
 mately become, for that can hardly be called knowledge which 
 but deals with facts by contemplation alone. "We cannot be 
 said to have acquired a clue to the idea of organic operations 
 1 Darwin ' On the Origin of Species,' p. 186. 
 
68 ADDRESSES. 
 
 until we are able to try our knowledge by prediction, and to 
 foretell what must arise under given conditions. Although, 
 however, physiology is obliged to assume the unit of each 
 organ, we cannot survey the relations of organic beings 
 throughout their whole extent without the conviction that we 
 have before us the varied illustrations of one pervading law, 
 reaching from the simple elements to the highest tissues and 
 organs. 
 
 Not to occupy time by recapitulating the arguments of the 
 Bridgewater Treatises, which, although written from another 
 point of view, would equally prove this unity, I cannot for- 
 bear asking you for one moment to consider again this 
 organisation of our own bodies in relation to the earth we 
 inhabit, and then say if it be otherwise conceivable but as 
 the expression of the highest correlation of these external 
 conditions. But some will reply, " This is admitted, and 
 explained by the direct operation of a Divine Power upon 
 the material, fitting one thing to another — the organ to its 
 function, the sense to its object." Accepting to the full 
 all that could properly be contained in this assertion, it 
 is still to be asked, in the interests of science, that, 
 instead of closing the inquiry, it should, on the contrary, 
 but open it, and quicken and make patient the under- 
 standing in our search after the facts by which such results 
 are obtained ; for the operation of an infinite wisdom 
 and power in nature does not obviate secondary causes or 
 explain the processes which lie between the extremes of 
 existence. I admit that, as Darwin says, the imagination 
 fails to conceive the means in their operation, and that it 
 would rather avoid the labour of inquiry. But if, in the 
 study of natural phenomena, our choice lies between the 
 inconceivable and the miraculous, there can be no doubt 
 where it must be made. That which is only inconceivable 
 may be made clear by advancement of knowledge ; but that 
 which is miraculous supposes agencies above and beyond 
 human knowledge, and therefore makes all labour to 
 investigate it useless and vain. 
 
 The feebleness and impatience of the intellect will ever 
 incline us to believe that each advance of knowledge is 
 bringing us near to the point of its consummation. It is so 
 
HAEVEIAN OBATION. 69 
 
 i 
 with every discovery ; and it is well it should be so, other- 
 wise the ardent inquirer might sit down hopeless at the 
 extent and difficulties of the route to be traversed, and of 
 the ascent to be made : still we must beware of accepting 
 any conclusions as final. As I had to remark upon chemis- 
 try, that when it reaches the confines of organisation it 
 probably ceases in our living tissues under that form, to 
 appear under some higher correlative — so, no doubt, the 
 same may be said of those molecular conditions with which 
 we are now becoming acquainted. The investigation of the 
 reactions of colloids is doing for organic tissues and functions 
 what chemistry has done for elements and elementary com- 
 position ; but how far the explanations thus afforded extend 
 can be determined only by the further progress of know- 
 ledge. Whether we are justified in speaking of muscle and 
 nerve as if they had any relation to mere colloid substances, 
 or whether by a knowledge of these we approach nearer to 
 an explanation of nerve-force and its transmission, or to the 
 contraction of muscle, is at least doubtful ; for, notwith- 
 standing the admitted instability of homogeneous substances 
 of complex composition, and the tendency to differentiate in 
 various ways, our knowledge of the evolution of the various 
 tissues and organs of the body from the apparently homogene- 
 ous ovum is almost as much beyond scientific comprehension 
 as it was when this oration was instituted. It is still, as 
 Harvey remarked, " as if the whole body (chick) was created 
 by a command to this effect of the Divine Architect : ' Let 
 there be a similar colourless mass, and let it be divided 
 into parts and made to increase ; and in the meantime, while 
 it is growing, let there be a separation and delineation of 
 parts, and let this be harder and denser and more 
 glistening — that be softer and more coloured : and it was 
 so.' " Yet let it be remembered that Harvey felt the same 
 difficulty when he began the study of the motion of the 
 heart. " I found the task," he says, " so truly arduous, 
 so full of difficulties, that I was almost tempted to think 
 that the motion of the heart was only to be 
 comprehended by God. For I could neither rightly perceive 
 at first when the systole and when the diastole took place, 
 nor when and where dilatation and contraction occurred, by 
 
70 ADDRESSES. 
 
 reason of the rapidity of the motion, which in many animals 
 is accomplished in the twinkling of an eye, coming and going 
 like a flash of lightning : so that the systole presented 
 itself to me now from this point, now from that ; the diastole 
 the same : and then everything was reversed, the motions 
 occurring, as it seemed, variously and confusedly together. 
 My mind was, therefore, greatly unsettled ; nor did I know 
 what I should myself conclude, nor what believe from others." 
 Tet if Harvey's immortal labours overcame the apparently 
 superhuman difficulties of the circulation, who can doubt 
 that some kindred genius shall herafter lay open before us 
 the springs of development (evolution) ? That this will be 
 done cannot be doubted ; for who can draw a limit either in 
 nature or in the understanding, after contemplating the 
 greatness of results, and the simplicity of the factors pre- 
 sented to us in the history of generation ? Prior to experi- 
 ence, what could have made such demands upon our belief 
 as that which is daily presented to us in the development 
 of the ovum ? Prom a cell so simple that our minds are 
 baffled by its simplicity in attaching any significance to it 
 whatever, the whole complex organism grows into form and 
 activity. Is it not therefore conceivable, is it not rather 
 by this example suggested, that the higher organic 
 forms which inhabit the world to-day may, by the keen 
 eye of science, be tracked through the dim vista of 
 past time to their equally simple beginnings, varied and 
 modified by the changing circumstances in and around 
 them ? Simplicity, as we have proof in these early conditions 
 of the ovum, raises of itself no objections. It is imposed 
 upon the highest as well as on the lowest organisms to have 
 the same homogeneous beginnings ; and if, as a modern 
 physiologist 1 says, " a single cell, under appropriate condi- 
 tions, becomes a man in the space of a few years, there can 
 surely be no difficulty in understanding how, under appro- 
 priateconditions,a cell may in the course of untold years, from 
 the same simple beginning, give origin to the human race." 
 Biology teaches us that apparently insignificant forces may 
 work large increments of change when the time of their 
 operation is unlimited. It teaches us that there is a sim- 
 ' Herbert Spencer, ' Principles of Biology,' vol. i, p. 350. 
 
HARVEIAN ORATION. 71 
 
 plicity in nature greater than the untutored mind could 
 suggest j that the agents are so apparently simple and 
 insignificant that the common sense — or, as remarked, the 
 " common ignorance " — of mankind passes by them without 
 thinking them worthy of attention. But, says Coleridge, to 
 whom I have already referred, " the positions of science must 
 be tried in the jeweller's scales, not like the mixed commo- 
 dities of the market on the weigh-bridge of common opinion 
 and vulgar usage." 
 
 Every advancement of science exhibits to us new illustra- 
 tions of great results from causes apparently the most 
 inefficient. Tyndall has lately shown the probability that 
 the green parts of plants may be formed by the decom- 
 position of carbonic acid, through the mechanical action of 
 light, under favorable conditions ; yet what imagination 
 can picture to itself the force of a single vibration of such 
 light, millions of millions of which strike in a second upon 
 the retina, without causing even a sensation, or only the 
 feeblest ? But if Tyndall be right, such force repeated, 
 inconceivably small as it is, is sufficient to clothe our forests 
 from spring to spring, and to fill our fields and vineyards 
 with ample store of food. If we cannot as yet dogmatically 
 assert " ubi vero lumen, ibi quoque vita," we do thus by every 
 advance of knowledge more clearly perceive that the physical 
 existence, as well as the intellectual development of living 
 things, was involved in the first fiat, " Let there be light." 
 
 To turn from these considerations to such as more imme- 
 diately concern us, let me speak now of the progress which 
 has been made in our knowledge of the nervous system. 
 
 Since the discovery of the circulation no greater work 
 has probably been done in physiology than that by Marshall 
 Hall when he established the conditions of a reflex nervous 
 action. This unit appears to be the key of the most com- 
 plex nervous phenomena, if it be not, indeed, an expression 
 of the law which determines the form of the whole. Prom 
 it physiologists have obtained a clue whereby to track the 
 labyrinths of instinct and habit ; for assuming as we must 
 that the mechanical arrangements in the nervous system at 
 periphery and centre are, in their way, as artificial as the 
 optical arrangements of the eye, or the acoustic arrange- 
 
72 ADDBESSES. 
 
 merits in the ear, we can recognise how the instinctive and 
 volitional acts are performed independently of the conscious 
 determination of the individual. 
 
 Physiologists have long pointed out that the basis of our 
 volitional acts is instinctive. That, the most instructed 
 anatomist has no advantage over the ignorant in directing 
 his voluntary movements, each being guided by the objec- 
 tive intention, and both equally intellectually unconcerned 
 in the steps whereby that intention is fulfilled. Together 
 with these innate arrangements it would appear that habit 
 and education can induce new capacities of a similar kind 
 upon us. From anatomical proof, as well as from actual 
 experience, it would seem that the nervous tissue is highly 
 plastic. Not only is it capable of receiving and registering 
 the impressions made upon it, but of acquiring an instinct 
 for complicated acts. 
 
 This, the physical basis of education, and even of morals, 
 though not overlooked, is too little regarded in daily prac- 
 tice. We may therefore congratulate the College that the 
 Gulstonian lecturer of this year has taken up this difficult 
 and important subject, and treated it so ably. 
 
 By quitting all abstract considerations, and limiting the 
 inquiry to the secondary conditions upon which depend the 
 mental operations, we open a mine rich in practical wealth. 
 Medicine yet owes it to society to demonstrate more fully 
 those secondary conditions whereby a healthy mental 
 activity may be secured and advanced ; for of nothing can 
 we be more certain than that the laws of life, in their 
 unimpeded operation, culminate in the advancing perfection 
 of man — corporeally, intellectually, and morally. But the 
 operation of these laws depends upon common things. 
 Whilst the ignorant have recourse to the supernatural, 
 science asserts that everything, if not traced, is yet traceable 
 to its antecedents ; and thus, as the handmaid of religion, 
 proves that what a man soweth, that shall he also reap. 
 
 But to return. Whilst lower natures in the organic 
 scale are the immediate subjects of external influences, 
 which act upon and mould them with but little resistance, 
 the reflex nervous actions institute a new order of pheno- 
 mena, culminating in the intellect and the use of means. 
 
HAEVEIAN ORATION. 73 
 
 As feeling dawns into sensation the sentient being directs 
 its movements so as to avoid what is injurious, and to attain 
 what is useful, and in that degree resists those disturbances 
 which would modify the equilibrium of non-sentient natures. 
 As sensation grows into perception wider relations for good 
 and for evil disclose themselves, and these higher creatures, 
 in the same proportion, avoid what is unfavorable, or seek, 
 on the contrary, by wider movements, the necessary condi- 
 tions for their existence. As perception leads to knowledge, 
 and mind develops, means of a higher kind are used, and 
 the intellect obviates or regulates the disturbing conditions, 
 until man becomes cosmopolitan, and greatly independent 
 of the varying forces around him. 
 
 He stands, as it has been remarked, at the beginning of 
 a new epoch of existence. His body, moulded by those 
 conditions which have equally acted upon other forms, 
 retains a natural alliance to them, so that the comparative 
 anatomist finds it difficult to place him in a group distinct 
 from Quadrumana ; but the inner developments of his 
 nature have fixed a gulf between him and the creatures 
 outwardly allied to him, which is immeasurable and impass- 
 able. By what steps or processes the perception of sense 
 graduated towards the higher forms of intelligence cannot 
 now be discerned ; but when mind began to exercise its 
 prerogative of subduing the earth, it obviously brought the 
 subject of it under a new law of existence. The outward 
 agencies which in the beginning had co-operated to produce 
 mechanical results upon our frame, were now opposed and 
 hindered by the operations of mind, and the equilibrium of 
 our physical condition was maintained in spite of circum- 
 stances the most variable. Art controlling nature is but a 
 partial expression of the law of man's existence ; but even 
 this separates him from creatures next to him by what I 
 have said is an immeasurable and impassable gulf — im- 
 measurable, because there is no known increment which 
 could multiply knowledge according to sense into knowledge 
 according to reason ; impassable, because in the onward 
 course of nature those primeval conditions which have 
 culminated in man cannot be supposed ever to recur. 
 Though, therefore, our outward forms remain, like geologic 
 
74 ADDRESSES. 
 
 strata in the earth, to indicate the forces by which they 
 were originally moulded, they can be considered no measure 
 of the relation we at present stand in to the lower animals. 
 " Man is," to use the words of the writer 1 to whom I am 
 indebted for these suggestions, " a being apart, since he is 
 not influenced by the great laws which irresistibly modify 
 all other organic beings." He is a being who is, in some 
 degree, superior to Nature, inasmuch as he knows how to 
 control and regulate her actions, and to keep himself in 
 harmony with her, not by a change in his body, but by an 
 advance in his mind. 
 
 The lower law of nature advances in man to a higher 
 form. It ceases to be mechanical, and becomes intellectual 
 and moral. Force does not now properly balance force, as 
 of individual against individual, and kind against kind, as in 
 the lower natures ; but force is properly balanced by right, 
 and right modified by duty. Man is social, as distinct from 
 gregarious ; and, in the highest conceptions of that state, 
 would be governed by love rather than by law ; for, as we 
 are taught, " love is the fulfilling of the law ;" which latter, 
 to use the expression of a friend, 2 " is as it were latent in 
 love, like an inscription in a fountain, becoming visible only 
 when the stream is dry." 
 
 And this brings me to speak of a subject now much 
 under discussion, and which touches our duty to society. 
 
 We cannot, I think, agree to neglect any means which lie 
 within our power of preventing disease. If a rigid scientific 
 method excludes the consideration of final causes where 
 they are so patent, and I may say prominently set forward, 
 as they seem to us, in organic structures ; and if it teaches 
 us that this appearance may be more to human eyes than in 
 the sight of Him who ordereth all things by a wisdom 
 transcending our comprehension; if we may not, in fine, 
 without the charge of temerity, venture to assign the why 
 in physical causes, how much more open are we to the 
 charge when we set up ourselves as judges of the moral 
 purposes of disease ? 
 
 1 Alfred R. Wallace "On the Origin of Human Races," 'Anthropo- 
 logical Review,' May, 1864. 
 
 2 ' Man and his Dwelling-place,' chap. vii. 
 
HAEVEIAN ORATION. 75 
 
 I cannot doubt it is on all sides imperative upon us to 
 limit, and if possible to blot out, all diseases of whatever 
 kind. Who would assume the responsibility of letting a 
 preventable evil fester in society, on a pretence of a know- 
 ledge of the divine purposes, or under the pretext that 
 public morality would be thereby promoted ? The duty 
 which lies nearest to us must ever have the first claim ; and 
 it cannot but be admitted that the nearest duty each man 
 has to his fellow is to save him as far as possible from all 
 injury, even though that injury may arise as the consequence 
 of his own fault. Nor will it be questioned that the cause 
 of morality is more advanced by beneficent interference 
 than by permitting ourselves to stand passively by whilst 
 intemperance and vice work ruin and infect the very foun- 
 tains of life. 
 
 In what way society should work thus to protect itself 
 may involve considerations of the most delicate and difficult 
 kind ; but the object no less remains, and the duty of 
 striving to attain it becomes daily more and more impera- 
 tive. These remarks apply to all diseases which are common 
 to the social state. 
 
 It is now universally acknowledged that the art of 
 medicine is all but powerless in controlling the morbid 
 actions set up in the large class of diseases called zymotic. 
 Specifics will no doubt continue to be sought after, but 
 preventive medicine will more largely obtain the suffrages of 
 the best informed members of our profession. 
 
 There can be no more saddening task allotted to the 
 physician than that of having to prescribe drugs against 
 agents which he knows will work out their destructive 
 effects to the end, in spite of such means. It may be that 
 there do not exist, nor may ever be formed by art, antidotes 
 to these poisons. But should it be otherwise, my duty at 
 this moment still seems to be clear, that I ought not to stir 
 up your minds to search out sioch secrets of nature. Upon 
 this search already too much time has been wasted, and an 
 incalculable amount of life has been lost. On the contrary, 
 I ought to urge upon the profession the most strenuous and 
 united exertions for limiting the spread of these diseases, if 
 it be not possible to altogether stamp them out ; and then, 
 
76 ADDRESSES. 
 
 if hereafter antidotes should be discovered, we may hope the 
 cases will be rare upon which their, operation could be tried. 
 I cannot pass from this subject without congratulating 
 the College that we number amongst ourselves many dis- 
 tinguished labourers in this department of medicine, or 
 without acknowledging the debt we owe to the late Sir James 
 Simpson. No one more earnestly drew attention to the 
 demands of preventive medicine than he did ; and amongst 
 the many claims his memory has upon posterity, there is 
 perhaps none higher than this, that his mind was intent 
 upon the means which might be best calculated to extin- 
 guish contagious diseases. It might seem Utopian were I 
 to attempt to foreshadow the results of a perfect preven- 
 tive medicine and hygiene ; but I may at least say that, 
 followed to their conclusions, they would leave us with 
 a greatly reduced nomenclature of disease. 
 
 By drainage of the soil alone, the mortality from pul- 
 monary consumption has been in several places largely 
 reduced. By drainage, as it affects the purity of water- 
 supply, the prevalence of enteric fever has also been greatly 
 limited. And whatever may be the ultimate value of the 
 germ theory of disease, had it done no more than promote 
 the purity of the water-supply to large towns, its good 
 results would have been incalculable. We already owe to 
 it the Metropolitan Drainage Works, the Thames Embank- 
 ment, the Royal Commission on the Water-supply of Large 
 Towns, the purification of the Thames, and such partial 
 filtration of our drinking-water as the public waterworks- 
 companies cannot avoid. 
 
 We have lately been rather blamed for not gratefully and 
 more fully accepting the germ theory of disease ; but to 
 this College the theory is not new, and, I think I may add, 
 has not been proved to be true to the extent its more 
 zealous supporters believe. It will be in the remembrance 
 of many present that in the year 1849 a theory was put 
 forth that epidemic cholera was due to fungi and their 
 germs. Peculiar bodies, it was said, had been found in the 
 rice-water evacuations, and also in the air and drinking 
 waters of the infected localities. 
 
 It was confidently asserted that we had substantial facts 
 
.* HABVBIAN ORATION. 77 
 
 in support of the theory, and that it fulfilled the conditions 
 required of being both true and sufficient. This College 
 thought the subject of such moment that a sub-committee 
 was formed from the Cholera Committee of that day for its 
 investigation. The drinking-water of infected places . was 
 examined, the air of rooms in which cholera patients were 
 dying was condensed, that it might afford whatever floated 
 in it for examination ; dust was collected from cobwebs, 
 window-frames, books, surfaces of exposed food, and every 
 imaginable place, to try it for cholera germs. The rice- 
 water stools and the intestinal evacuations passed in 
 different diseases were scrutinised without stint of labour ; 
 but the value of the facts put forth by the promoters of the 
 theory gradually faded under the inquiry. The supposed 
 germs, when really germs (for many shapes had been in- 
 cluded in the supposed direful growth), were found to be 
 spores of known harmless fungi and confervas, of which, if 
 even the startling number of thirty- seven and a half millions 
 should be contained in about two drachms of water, as 
 quoted by Tyndall, from Mr. Dancer's examination, it is 
 probable that the whole or repeated units of such millions 
 might be harmlessly swallowed. 
 
 But for the most part the supposed germs were not germs 
 of any kind, but broken scraps of vegetable and animal 
 tissues, spiral vessels from dried horse-dung, hairs, wings, 
 and legs of insects, detrita of dress, and the like. The 
 results were, in fact, entirely negative of any peculiar 
 bodies to which the epidemic disease could be referred. 
 
 One general result arrived at at that time, however, agrees 
 with the observation of Tyndall in his recent investigation 
 of dust by a beam of light — viz. that the floating particles 
 in the air are chiefly of an organic nature. This we might 
 have been prepared for, from the specific weight of dried 
 organic material enabling such dust to float, when the 
 heavier inorganic substances would be deposited. 
 
 That infectious diseases, as the name imports, spread by 
 emanations from the sick, must have been long known, and 
 that such emanations are of a solid nature we may infer 
 from the fact that they may be dried and conveyed from 
 place to place ; but in what state, whether as amorphous 
 
78 ADDRESSES. 
 
 material or as germs, we know no more to-day than was 
 known a thousand years past. 
 
 No new fact bearing upon the propagation of contagious 
 diseases has been reached by the recent investigations on 
 dust. We cannot infer that summer catarrh is due to 
 infusoria, because the nasal mucus formed in the disease, 
 and at no other time (?), was found peopled by vibriones, 
 since decomposing mucus is generally populous with these 
 infusorial creatures. 
 
 The phenomena of fermentation and putrefaction in dead 
 and decomposing substances afford no explanation of the 
 changes observed in a living body in a fever process. The 
 purulent matter produced in smallpox is not in any way 
 comparable to the yeast plant, growing in fermenting fluids. 
 The microscope shows no forms in variolous pus, which are 
 not contained in other purulent innocuous exudations. It 
 is to be regretted that a confusion in terms has been made. 
 Instead of dust and disease it should rather have been dust 
 and putrefaction, or dust and fermentation, since the rela- 
 tion of dust to disease has not been revealed anywhere in 
 the inquiry. That the air conveys the material causes of 
 infectious diseases from the sick to the healthy is a notorious 
 fact, which had equal force before these inquiries were 
 instituted, though, owing to the exigencies of social inter- 
 course, it is a fact now more neglected than in times of 
 comparative ignorance. 
 
 It is difficult to vindicate exactness in progress without 
 seeming to be at the same time a hinderer of it. The 
 onward and the regulating forces of a machine, though not 
 incompatible, but necessary, require the nicest balance. 
 This reflection suggests itself by the way the spread of 
 infectious diseases has been handled. The theories it has 
 given rise to have been so easily put forward as to thereby 
 create distrust. But the spirit of science is no favourer of 
 negations. " Der Geist der stets verneint " finds no greater 
 friend in medicine than in theology. But it will be admitted 
 that no progress can be made by the ready acceptance of 
 every proposition, however distinguished the source from 
 which it emanates. The parasitic origin and nature of 
 epidemics may be true, but it has yet to be proved. As an 
 
HABVEIAN OEATION. 79 
 
 hypothesis it admits of proof or disproof, and so has further 
 claim upon the industry of those who have put it forward 
 as a suggestion. Without going to the length which this 
 hypothesis demands, we must admit, however, that we know 
 enough to guide us much further than we have yet gone in 
 the practice of prevention. 
 
 To leave these discursions, and in a few words to conclude 
 my task, I would repeat that the distinction of medicine, as 
 a study, lies in its comprehensiveness. The student of 
 physical science admits that he has to deal with but one half 
 of that truth which is expressed in man. The student of 
 medicine cannot so limit himself. The facts of sensation, 
 whether pleasurable or painful ; the influence of the mental 
 emotions, whether exciting or depressing ; the dominion of 
 the conscience, approving or disapproving, are for him facts 
 due to the operation of laws into which he must inquire. 
 Looked at from the point of view which the student of 
 medicine occupies, these higher facts of man's nature are as 
 essentially parts of one law, and control and modify human 
 existence equally with those lower conditions with which 
 physics alone is concerned. This constitutes the unspeak- 
 able difficulty which every student of medicine must feel in 
 the present imperfect state of knowledge. To hold the 
 mind in an equal balance as it passes from the contempla- 
 tion of the lower facts of our existence to those which 
 characterise the highest claims of our humanity, so as 
 neither to degrade the one nor neglect the other, is one of 
 the highest attainments. What eye is single enough to 
 survey the range of life from the material atoms which 
 build our structures, to those " mighty hopes which make- 
 us men," without faltering in the vision, or without confu- 
 sion of the objects ? 
 
 Every student exalts and distorts the work upon which 
 he is chiefly occupied. The anatomist with his microscope 
 hopes thereby to fathom the depths of nature, and the 
 student of the pure intellect despises his labours, each 
 arriving at impotent conclusions by not mutually aiding and 
 supporting his fellow-labourer. Yet perhaps the chasm 
 between the two orders of human facts is other than it 
 seems. It may be due to our not seeing that we are not 
 
80 ADDEBSSES. 
 
 dealing with contraries, but with opposites : opposites in the 
 highest sense ; not as if the terms of the one contradicted 
 the terms of the other, but with the assurance that each 
 will be understood by admitting its antithesis. Here, says 
 Herbert Spencer, " we arrive at the barrier which needs to 
 be perpetually pointed out, alike to those who seek material- 
 istic explanations of mental phenomena, and to those who 
 are alarmed lest such explanations should be found. The 
 last class prove by their fear almost as much as the first 
 prove by their hope, that they believe mind may possibly 
 be interpreted in terms of matter, whereas there is not the 
 remotest possibility of so interpreting them." 1 
 
 What the student of nature's mysteries always needs to 
 remember is his position as viewing things from his own 
 centre, rather than from the centre. What he has chiefly 
 to avoid is that discouragement should not pass into denial. 
 If our difficulties are great, our hope is assured that the 
 organic laws, in their highest conception, correlate with laws 
 of truth, and culminate in that moral nature expressed by 
 the term holiness. Thus, only to those unconversant with 
 the practice of medicine can it seem strange that, ever 
 occupied as we are with the failures of humanity, the mists 
 of physical and moral disease cannot obscure the brightness 
 of that ideal perfection which the " law of life " casts upon 
 our path. 
 
 1 ' Principles of Psychology,' p. 158. 
 
ADDRESS AS PRESIDENT OE THE 
 CLINICAL SOCIETY, 1871. 
 
 Gentlemen, — The trust you place in my hands by making 
 me your President awakens in my mind a deep sense of the 
 responsibility I incur in accepting it. If a life devoted to 
 those objects at which this Society aims could give me con- 
 fidence in the future, I should receive the honour you confer 
 upon me more cheerfully and hopefully than I can now 
 venture to do ; but whoever shall strive to set before him- 
 self what has been done in clinical medicine, and foreshadow 
 in his mind what remains to be done and the difficulty of 
 doing it, will be apt to be discouraged rather than elated at 
 the prospect. I fancy the Father of Clinical Medicine must 
 have had somewhat similar thoughts when he selected for 
 his first aphorismal utterances, " Life is short : experience is 
 fallacious." I confess, however, that I think these expressions 
 of Hippocrates give more help than could have been given 
 by any protestations of confidence which he might have made 
 respecting himself or his art. If Hippocrates were with us 
 this evening, he might congratulate himself that, however 
 short is the individual life of man, by associations like these 
 it becomes perpetual, and ever young and hopeful; that, 
 instead of the occasional activity of one mind, we can by a 
 society ensure the increasing and varied co-operation of 
 many minds. 
 
 It is one of the most striking characteristics of our time 
 that the individual is less and less, and associated activity 
 more and more. But if the vita brevis of the isolated 
 labourer is thus obviated, there arises in place of it the 
 
 6 
 
82 ADDRESSES. 
 
 danger of desultory and undirected exertions, which may 
 be fruitful only of the thorns and thistles of contradictory 
 statements, and as barren of true results as are the limited 
 and often prejudiced observations of a single individual. 
 To counteract this, it will be my duty to ask your earnest 
 co-operation for extending and perfecting the labours of 
 the committees of this Society for the investigation of 
 clinical and therapeutical questions. By our present rules, 
 the president has a right to nominate such committees ; but 
 it seems to me that it is his duty to invite any member, 
 according to the bent of his inclination, either to initiate 
 some kind of active inquiry or to co-operate with others 
 in it. 
 
 By putting positive questions to Nature we are more 
 likely to find out her secrets than by waiting, however 
 patiently, for her own revelation of them. The more 
 narrowly and positively such questions are framed, the 
 less equivocal will be the reply ; however feeble and dubious 
 the response, inaudible perhaps to any single ear, or in 
 characters invisible to any single eye, it may be plain and 
 distinct when repeated over and over again. The aid 
 afforded by such questions and cross-questions, putting 
 Nature, as it were, upon her trial, and winnowing her replies 
 by the exacted methods of research, mental or mechanical, 
 is, as Bacon says, comparable to the lever and the screw in 
 mechanical operations. " If,'' says he, " men should enter 
 upon mechanical works with naked hands, without the 
 force and assistance of instruments, as they have not hesi- 
 tated to enter upon the works of the intellect with the 
 naked forces of the mind, small indeed would have been the 
 things they would have been able to accomplish, however 
 earnest and conjoined their efforts. And if," he continues, 
 " to dwell a little longer on this instance, and to look into it 
 as into a glass, we should ask if by chance any sober spec- 
 tator should see men striving to raise a mighty obelisk 
 without mechanical appliances, would he not say they were 
 demented ? But if, so failing, they should be confident of 
 success by increasing their numbers, would he not think they 
 were still more mad ? But if they should consult together 
 ±o make a selection, and to dismiss the weak, and only by 
 
president's address, clinical society, 1871. 83 
 
 tie help of the vigorous should expect to accomplish their 
 object, would he not think they were hopelessly insane ? 
 But if further, not content with this, they should establish 
 athletic exercises, and summon all thus prepared for the 
 work, would he not cry out, " These people have gone mad, 
 •even with reason and prudence''?' And should not we 
 be open to have a similar opprobrium cast upon us if, unit- 
 ing ourselves into a Clinical Society, we were contented to 
 strive to accomplish the work before us without the assist- 
 ance of the highest intellectual combinations and methods ? 
 
 If the existence of this Society, ever recruiting itself, as 
 I trust it will do, with young and devoted labourers, anni- 
 hilates, as I have said, the first lament of Hippocrates that 
 " life is short," I trust that oar work will be so prosecuted 
 that his subsequent statement, " experience is fallacious," 
 may no longer obtain. It is perhaps too much to hope that 
 a growth which is indigenous to our minds, and which has 
 shown so much vitality, should easily be rooted out. 
 Hitherto, from the favouring influence of prejudice and 
 self-love, nothing has equalled the exuberance of this sort 
 of experience ; no pernicious practice, no fanciful hypo- 
 thesis, no unfounded dogma but has been and is fed and 
 maintained by it. 
 
 Experience in medicine is fallacious because it is limited 
 and imperfect — limited to the few observations gleaned in 
 some narrow area, limited to some season or short period of 
 time, limited by the prejudice, or interest, or incapacity of 
 the observer, or by defects in his methods of examination ; 
 and imperfect through our ignorance of the natural course 
 of events, which leads us to attribute results to some acci- 
 dental interference on our part rather than to the essential 
 course of things ; imperfect also because we are satisfied 
 with that sort of experience which affords satisfaction to 
 ourselves, and supplies some ready explanation to those who 
 are dependent upon us. 
 
 It is in the nature of inquiries so complicated as those 
 are with which medicine has to deal that fallacies should at 
 all points beset our path. Perhaps also the sense of doubt 
 arising from the fallacies of experience, which weighed upon 
 the mind of Hippocrates, should, like the whisperings of the 
 
84 ADDRESSES. 
 
 slave in the conqueror's ear at his triumph, be ever present 
 to us, even when our knowledge seems most assured. 
 
 In clinical medicine the greatest correction of fallacious 
 experience is a true diagnosis — a diagnosis not only of the 
 anatomical conditions, but such a diagnosis of the forces 
 concerned as shall lay open before us a knowledge of the 
 course events will take. If the momentum and direction 
 of a moving body be known, its course and the results of 
 impediments upon it can be calculated. So if we would 
 obtain any true experience of therapeutical measures, we 
 must of necessity acquaint ourselves with the exact strength 
 and tendency of the forces against which we operate. 
 
 What voluminous records are there of cures and means 
 of cure which are as valueless as the rags upon which they 
 are printed ! " What pains and expense," says Herschel, 
 " would not the alchemists have been spared by a know- 
 ledge of those simple laws of composition and decomposition 
 which now preclude all idea of the attainment of their 
 declared object ! What an amount of ingenuity thrown 
 away on the pursuit of the perpetual motion might have 
 been turned to better use if the simplest laws of mechanics 
 had been known and attended to by the inventors of 
 innumerable contrivances destined to that end ! What 
 tortures inflicted on patients by imaginary cures of incur- 
 able diseases might have been dispensed with had a few 
 simple principles of physiology been earlier recognised ! 
 But," he continues, "if the laws of nature, on the one 
 hand, are invincible opponents, on the other they are irre- 
 sistible auxiliaries : (i) in showing us how to avoid attempt- 
 ing impossibilities; (2) in securing us from important 
 mistakes in attempting what is, in itself, possible, by 
 means either inadequate or actually opposed to the end in 
 view ; (3) in enabling us to accomplish our ends in the 
 easiest, shortest, most economical, and most effectual man- 
 ner ; (4) in inducing us to attempt, and enabling us to 
 accomplish, objects which but for such knowledge we should 
 never have thought of undertaking." 
 
 It is only through a perfect diagnosis that we can see 
 in what direction therapeutical interference should be at- 
 tempted. It is true that accident has sometimes aided us 
 
president's address, clinical society, 1871. 85 
 
 -where knowledge has failed ; but it is obviously unbecoming 
 in intellectual creatures to satisfy themselves with such 
 scant and precarious fruits, when by due culture large 
 harvests might be reaped. If, as Herschel says, know- 
 ledge saves us from futile and inglorious effort, it widely 
 opens to us ways of success which are closed to ignorance. 
 In the present imperfect state of medicine that success may 
 often be but partial ; but even to that degree the amount of 
 human suffering that may be avoided, and the amount of 
 good that may be obtained, is in the total incalculable. 
 
 It would be impertinent if I should attempt to exhibit 
 before you the successes, partial or otherwise, of thera- 
 peutics. But I cannot forbear expressing our obligations 
 to the sister science of surgery in all its departments. I 
 assert that I have received as lively intellectual satisfaction, 
 and have been as deeply impressed with the feeling that 
 knowledge is power, whilst witnessing the effects of some 
 surgical operation, as I have in contemplating the highest 
 triumphs of physical or chemical science. It is, perhaps, 
 to be regretted that medicine and surgery have been in any 
 way dissociated. Happily in this Society they are united. 
 What detriment surgery has received from the separation 
 others must say ; but medicine requires constantly quicken- 
 ing by the necessity of that exact anatomical observation 
 which the problems of surgery amply supply. 
 
 The tendency in modern medicine to increasing perfec- 
 tion in diagnosis is daily lessening the hiatus which has 
 existed between the two branches of study ; and patho- 
 logical anatomy is largely confirming their identity. Clinical 
 medicine requires ever-increasing exactness in these re- 
 searches. In the reports with which we shall be favoured 
 from the different members in this session, I feel sure that 
 every effort will be made to give the observations contained 
 in them the highest possible exactness of expression. 
 
 This Society has two functions to fulfil : to exhibit the 
 working of the most critical methods of research — to show, 
 in fact, what clinical medicine should be ; and to improve 
 those methods. For myself I am far from believing that 
 he is the best observer who records the greatest number of 
 facts ; but he who has the perception which enables him to 
 
86 ADDRESSES. 
 
 separate the chaff from the wheat — what is essential from 
 what is accidental. In the nature of the case such discri- 
 mination must begin somewhere, but where must be left to 
 the intellect of the observer, or to the circumstances of his 
 work. Treatises have been written on the laws for the 
 guidance of physical research, but there seems to be but 
 one rule that is universal — namely, that the student should 
 be honest and skilful in the pursuit of truth. Honesty 
 before skill. Then we may hope to go on towards com- 
 pleting the perfection sketched by Shakespeare, who, speak- 
 ing of the physician, says, " His skill was almost as great as 
 his honesty ; had it stretched so far, would have made 
 nature immortal, and death should have play for lack of 
 work." This law of skill in research, guided by honesty of 
 purpose, we must work out with the best means at our 
 command, ever striving, for better. Where the scalpel will 
 not reach, the microscope may reach ; where the microscope 
 will not help us, chemistry may help us ; where chemistry 
 fails, the refinements of physics may come in ; and where 
 these fail, that finer power of the mind which enables us to 
 deduce truth from history may lay open before us the work- 
 ings of forces too fine even for that scientific exercise of the 
 imagination which has lately been so eloquently commended 
 to us ; as we see in those hereditary tendencies to disease 
 which as certainly take effect, and produce results as 
 sharply defined and often as coarsely anatomical, as if their 
 physical causes could be labelled and placed upon the 
 shelves of a museum. 
 
 But whilst for the purposes of immediate practice we 
 must occupy ourselves with, and so far be satisfied in com- 
 pleting and perfecting, what we have already gained, a 
 little, and but a little, reflection will be required to convince 
 us how much more than this suffering humanity requires at 
 our hands. What unexplored regions are inviting our 
 attention will be obvious to anyone who will look over the 
 pages of any year-book of facts recording the labours in the 
 different departments of medical knowledge. The perusal 
 wilt leave upon the mind the sense how little has anywhere 
 been accomplished, and how far the lines of inquiry extend. 
 
 To take that commonest of all maladies, phthisis, it may 
 
president's address, clinical society, 1871. 87 
 
 be said to present a great chaotic field, distinct in nothing 
 but in its mortality, and all but unexplored by science in 
 respect of those steps and processes whereby the fatal issue 
 is reached. The ' Transactions ' of this Society already con- 
 tain some contributions towards a better clinical history of 
 some forms of this disease, and I trust that in each session 
 more may be done towards tracking the earlier history of its 
 different varieties ; for if anywhere in physic the principle 
 principiis obsta is valuable, it is probably here. I trust, how- 
 ever, I may not be understood as if our records of the coarser 
 phenomena of phthisis were not more than enough. Under 
 the generic term phthisis are included many different mala- 
 dies ; and, if the whole object of medicine were satisfied 
 when these forms had been distinguished, and the popular 
 remedies prescribed, there would be no more to say. But 
 clinical science revolts against this conclusion, and requires 
 a still finer discrimination of the morbid processes in ques- 
 tion, with information as to how they begin, and by what 
 means they may be obviated or hindered. There is some- 
 thing very suggestive in seeing one member of a family left 
 in health and strength to old age, whilst all the members of 
 the same family, coming either before or after, fall victims to 
 this disease or its alliances ; or in seeing exceptions made to 
 its ravages through the intervention of some diverse patho- 
 logical state — insanity, epilepsy, or rheumatism. Our clinical 
 knowledge ought to show how this is determined, as from 
 such knowledge prevention might be hoped for. 
 
 Or, to turn to another and equally extensive field of re- 
 search, the large class of vascular degenerations occurring 
 mainly between the ages of forty and sixty. If the pro- 
 cesses, near or remote, which bring about these morbid states 
 of the heart and vessels, were more fully elucidated, some 
 part of the chapters which now treat of the diseases of the 
 brain, of the chronic diseases of the lungs, of the liver, and 
 especially of the kidneys, would have to be rewritten. 
 
 It seems probable that in a good deal of our clinical 
 pathology we have mistaken the end for the beginning ; 
 and, being impressed chiefly by the more prominent, or 
 more easily demonstrable lesion, have regarded it as a cause, 
 when it was but part of another and antecedent state. It 
 
88 ADDRESSES. 
 
 is from clinical study alone that we can learn the begin- 
 nings of disease. Often when the gathered clouds of the 
 final storm have filled the atmosphere, it is in vain that we 
 look round to see from what point of the heavens it began. 
 The apparently trifling ailments of to-day may, when we are 
 able rightly to interpret them, foreshadow the coming of 
 much graver events. 
 
 For these inquiries private practice affords the only 
 opportunities. The record of individual cases, illustrative 
 of the early traces of pathological change, would be of great 
 value. Perhaps, as a rule, we have looked too exclusively 
 to the wards of our hospitals, and to the records of post- 
 mortem examinations, to teach us our clinical lessons. This 
 Society seems to afford special means for correcting these 
 defects. The opportunities of private practice, if carefully 
 utilised, might soon solve for us many obscure problems. 
 Take, for instance, the onset of infectious diseases. By a 
 more accurate study of this stage, which can rarely occur in 
 hospitals, we might learn through what ways the infection 
 invades the organism, and thus might be enabled, if not to 
 obviate its progress, at least to learn something more of the 
 means for controlling it. But I may not longer detain you 
 with these details. Suffice it to say that any new fact, 
 however apparently useless and disconnected, is worthy of a 
 record. It may be, to use the language of embryology, the 
 primitive trace in the development of a new form of thought 
 and knowledge ; or, to alter the simile, its meaning may not 
 appear until the context is discovered. The superstitious 
 worshipper of Islam preserves every scrap of writing, lest by 
 destroying it he might mar a portion of the sacred text. 
 Let each one of us, engaged as we are in amassing materials 
 of knowledge, treasure up every stray fact, convinced that it 
 forms part of a precious record, which if not deciphered now 
 will become legible by some subsequent addition. 
 
 As the whole purpose of clinical medicine is the cure or 
 alleviation of disease, the efforts of a Clinical Society can 
 never with success deviate from the prosecution of those 
 practical and primary objects. The advancement of thera- 
 peutics in their entirety is the end we aim at. Happily 
 it is no longer necessary to prove that therapeutics and the 
 
president's address, clinical society, 1871. 89 
 
 administration of drugs are not synonymous. It is an 
 ancient saying in medicine that " nature cures diseases," 
 and we have learned in modern times that both in medicine 
 and surgery it may often be our truest aim to secure our 
 patients from interference until a healthy equilibrium is 
 restored. The doctrine of physiological and mechanical 
 rest in the cure of diseases has vindicated and obtained for 
 itself a permanent position in therapeutics. Every contri- 
 bution to our ' Transactions ' in illustration and maintenance 
 of the doctrine will be valuable. If it often taxes the 
 ingenuity of the surgeon to insure mechanical rest for an 
 injured part, how much higher are the demands made 
 upon our therapeutics to obtain physiological rest, or any 
 degree of it, amidst the perturbations of disease. It seems 
 probable that a large number of acute diseases may be 
 sufficiently treated by following these indications of rest 
 only. Tet the greatest misunderstanding prevails, in our 
 profession as well as with the public, respecting the objects 
 pointed out, as if they were of so trivial a nature as to 
 require no skill or attention ; but I might venture to assert 
 that they challenge the exercise of the highest faculties, 
 and still often leave us far from their perfect attainment. 
 I would say that the expression, " Nature cures disease," is 
 both a good and a bad expression. It is a good expression 
 if it represent to our minds, however imperfectly, the 
 principle of compensation which prevails throughout a 
 living body, causing the disturbance of the physiological 
 balance in an organ to be corrected by a correlated change 
 in it, or in some other part ; as, for instance, when the 
 fainting heart feebly supplies the brain and the centre of 
 voluntary action failing, the patient falls down, and the 
 circulation is restored. To say that " nature cures disease " 
 is a bad expression if it create in our minds a metaphysical 
 conception, as if there w re in us some personal anima con- 
 trolling the operations. The former use of the term is that 
 which we, as a Clinical Society, must ever contend for ; and 
 our chief object is to encourage amongst ourselves those 
 researches which show how nature in this sense cures 
 disease, and so have plainly before us the circumstances 
 which should direct and control our interference. 
 
90 ADDKESSES. 
 
 Of equal antiquity with the expression I have just quoted 
 is that more famous one, which must ever be remembered in 
 a Clinical Society, that the two special objects of medicine 
 are to do good or to do no harm. The latter alternative has, 
 from Galen downwards, been thought a matter of too easy 
 attainment ; but doing no harm is not always an easy virtue 
 in medicine. I desire on this point to call the attention of 
 the members of the Society to the present state of our prac- 
 tice in regard to many chronic and acute diseases, that we 
 may by improved records learn what is the value of positive 
 treatment in many of these maladies. As to the doing good 
 by the exhibition of remedies, which is the more popular 
 view of therapeutics, I need not say a word to stimulate 
 exertion in this direction. We are all impressed with the 
 importance of the subject ; but it is to be urged that the 
 cases which shall be brought forward to illustrate any treat- 
 ment, or the effects of any particular drug, shall be so se- 
 lected as to lead, as far as possible, to positive conclusions. 
 
 Gentlemen, I fear I have detained you too long; yet I 
 cannot forbear expressing a feeling which I am sure is in 
 every mind at this moment, that we ought to be thankful we 
 are enjoying the blessings of peace, which enable us to meet 
 on these occasions to encourage each other in the pursuit of 
 knowledge which we hope may contribute to the welfare and 
 happiness of mankind. I earnestly trust these blessings 
 may long be continued to us. The sure foundation of such 
 a hope must ever lie in the fulfilment of that sentiment of 
 one of our greatest heroes — " England expects every man to 
 do his duty," — to which I add, in the arts of peace as well as 
 in the circumstance of war. 
 
 January 27th, 1871. 
 
ADDRESS AS PRESIDENT OF THE 
 CLINICAL SOCIETY, 1872. 
 
 Gentlemen, — I shall have to-night to throw myself very 
 much upon the indulgence of the Society in any remarks I 
 may have to make, because I have not had time to dress 
 them in such words as I should desire in order to place them 
 properly before you. Many circumstances, which I need not 
 dwell upon, have prevented my better intention ; but I could 
 not be satisfied to take the chair and assume the honour 
 which you have conferred upon me a second time without 
 some observations. It would not be becoming that I 
 should do so either in respect of the honour you have be- 
 stowed upon me or of the work in which we have to engage, 
 since, as president of this Society, I am in some sense your 
 spokesman to the world, concerning the objects we set 
 before us. 
 
 Our position is a somewhat peculiar one. We are partially 
 antagonistic to the theologic and the scientific aspects of 
 the world as generally presented to us. We differ in opinion 
 in one sense and, I think, in a very serious sense, from that 
 section of theologians who regard the world as a decaying 
 world — as a world that was once better than it now is ; who 
 believe there was a past, however limited, without disease or 
 death; who regard the troubles and perils which now exist 
 as the result of antecedents which I shall not now discuss, 
 and which evils we must bear as best we can, with but little 
 hope they will be better, and with the fear that they may be 
 
92 ADDRESSES. 
 
 worse. This is, I think, entirely opposed to the views which, 
 as students of nature, we are obliged to entertain. Whoever 
 will take the least pains to look over the facts of creation 
 may see that this world has always been evolving into that 
 which is higher and better — that it has always had a coming 
 future of good, not having reached perfection, and not, in the 
 present condition of things, approaching it, but ever advanc- 
 ing towards that " far-off divine event." 
 
 Whilst the one set of thinkers regard the world as decaying, 
 we look on it as improving, — improving in all respects in its 
 physical conditions as well as in its moral and intellectual 
 conditions ; and as a society we meet here year by year for 
 working together towards the end which this idea sets before 
 us. We are optimists of nature. We believe — though we 
 rarely see signs of it, and work more by faith than by sight 
 — that this world has, amidst all its diseases and its failures, 
 a law of perfection with its inexhaustible fruits in store for 
 it ; and when we see individual suffering, disease, deformity, 
 or premature death, we regard them as the failures of a law 
 which in our minds we strive to recognise, though its opera- 
 tions are so often frustrated. 
 
 Again, believing as I do, that this is the view which we all 
 must entertain — that to-morrow will be better than to-day, 
 and the day after better than that — as in the days of con- 
 valescence, when the last are always the best, — still I think 
 we cannot but feel that we are hindered by considerations 
 coming from the side of physical science, and which we owe 
 it to ourselves not to receive as final, considerations which 
 would make us forego that hope which the student of the 
 lower forms in nature is very apt to deny himself. We are 
 prone to think we have now before us all the conditions that 
 are possible in respect of the intellect, and that science has 
 its proper sphere finally marked out for it which cannot be en- 
 larged ; a line beyond which it cannot pass. The student 
 of physiology, however, occupied with facts which cannot be 
 included in our present scientific conceptions, is perhaps better 
 placed than his colleague in the lower physics for the expan- 
 sion of his ideas, if only in this — that he must believe that 
 the intellect will open for us a wider world beyond, and in- 
 commensurable with that which we now consider the scientific, 
 
president's address, olinioal society, 1872. 93 
 
 the limit of which at this moment is the limit of the ponder- 
 able and the measurable. 
 
 If the early animal inhabitants of this planet could have 
 met in conclave they might well have concluded that there 
 was nothing conceivable beyond their own degree of mental 
 organisation ; and could anyone have foreshadowed to such 
 dull intelligences the future mental activity of man, he must 
 have met with an obstinate and sceptical denial. The student 
 of medicine can as little deny the subjective as he can the 
 objective. If he resists the inroads of superstition on the 
 one hand, neither can he admit on the other the limit which 
 scepticism would impose. We are often taunted with being 
 servile worshippers of nature, and yet we are so only in a 
 limited degree. We cannot believe that nature, as thus 
 vaguely expressed, is in the highest sense perfect. Though 
 we are admirers, we are not blind devotees of nature. 
 Nature, as expressed to us in living forms, shows the ten- 
 dency to perfection, though in many parts the results are 
 imperfect. We are met here to-night in view of such im- 
 perfection, and with that as an object for the operations of 
 our intellect. 
 
 To turn more especially to the object of our work, the 
 living body, there is no doubt but that it is of the first im- 
 portance for practice to obtain the largest and truest view of 
 all the bearings of the subject. One of the greatest advances 
 in clinical medicine, and which is daily growing, is the more 
 thorough physiological view of disease. Disease is not now 
 regarded as some independent entity in the body, but as a 
 perversion of those essential life conditions which, when 
 normal, constitute the state of health. We can no longer 
 regard all diseases as grafts on healthy parts. The time is 
 gone by when text-books could teach what I and probably 
 many others here had to learn, — that acute disease may be 
 idiopathic in healthy subjects. 
 
 In one sense it might be maintained that there is no such 
 thing as disease. Abstracted from personal care and pain, 
 disease sinks at once into the ordinary course of physical 
 phenomena, and would rank in a far different category from 
 that in which we usually contemplate it. It is well some- 
 times to look at our facts in such light, to accustom the mind 
 
94 ADDRESSES. 
 
 to other conceptions, although I fear that if we maintained 
 such a position we should hardly be welcome to the sick, and 
 certainly the science of medicine or of cure could not exist. 
 " Skin for skin, what will not a man give for his life ? " and 
 every man has to consider, and well to consider, his own 
 personal existence and comfort — a practical view of disease 
 which we medical men cannot too earnestly entertain. Still, 
 as I say, it is well sometimes, for the due enlargement of the 
 conceptions of the mind, to get views beyond that which 
 is merely personal, and to consider that those conditions 
 which we call disease belong to a still larger class of pheno- 
 mena. 
 
 At our present stage of knowledge we have, I am happy 
 to say, travelled a long way beyond the necessity for defini- 
 tions, or you might perhaps expect from me a definition of 
 disease. I do not, however, think that there is any member 
 of this Society, or of the Pathological Society, or of the 
 Royal Medical Chirurgical Society, that would venture to 
 give such a definition. Disease is not a status, nor a defin- 
 able condition, but that course of nature in a living thing 
 which is not according to its health. It is, whatever else it 
 may be, such a course of nature for the individual. 
 
 This view of disease takes in a beginning, a middle, and 
 an end. We have often to consider conditions afar off in the 
 past to come to a beginning. It is to be remembered that, 
 in present disease, we are sometimes dealing with physiolo- 
 gical conditions in a course of nature which may have had 
 distant beginnings. Disease to the ignorant is some present 
 definable entity ; something to be searched out and contem- 
 plated by itself, and, if need be, attacked and exorcised as 
 might be an evil spirit. This idea has given us a word still 
 extant in medicine, "seizure." But what is a sick man seized 
 by '! The old theological notion that an evil spirit entered, 
 the sick is gone, though its mark remains, and still imposes 
 upon the mind some part of the popular notion. Seizures, 
 however, there are none, though we still use the word to ex- 
 press the beginnings of disease, and although to the ignorant 
 it still implies something ah extra that must be rooted out of 
 the individual as soon as possible. 
 
 To the superficial observer, disease is a chaotic concep- 
 
president's addeess, clinical society, 1872. 95 
 
 tion ; a chaos of symptoms, to be met at all points with 
 drugs and similar means, to every symptom its remedy. 
 And thereon is even founded a system of medicine. To its 
 disciples disease can, therefore, be only a set of symptoms ; but 
 to the students of a truer medical science the causes of the 
 symptoms are the objects of contemplation. We require a 
 history, and not a definition of disease. 
 
 I said just now that by anyone whose notions of disease 
 were duly corrected, many states of the body formerly re- 
 garded as disease could not now be so considered. But 
 such errors do still obtain in the practice of our profession. 
 
 It may be fairly said that there are some people who, 
 without having any disease, are born to suffer. Under the 
 present conditions of sublunary things they cannot main- 
 tain a healthy equilibrium. They are always ailing. Medi- 
 cine fails on such. Unstable health is their law, in spite of 
 the contents of the Pharmacopoeia. In practical medicine 
 it is important to recognise these sufferers. The same 
 remarks apply equally to the conditions of age, and this at 
 various periods of life. 
 
 Of tissues, as of the whole man, it may be said there is 
 a time to be born and a time to die, but for different indi- 
 viduals this cannot well be determined, and at least the 
 diagnosis is difficult. Yet I may appeal to my hearers if they 
 cannot recall cases where they have prescribed all the farrago 
 of tonics, with as good a purpose and result as if they would 
 thereby strive to prevent the setting of the sun. I repeat, 
 there are states too hastily regarded as disease, which are to 
 the individual his normal existence. Such are the peculi- 
 arities of some persons when measured by the cases of 
 others. Such are the normal senile changes of the body. 
 Such, too, are the abnormal senile changes produced by 
 •disease. For in many diseases there comes a time when the 
 conditions undergo change, and we get a new order, not 
 strictly dependent upon that which preceded ; as, for 
 instance, syphilis may cease to exhibit its proper effects, 
 and may have produced such a general influence on the 
 nutrition as to lead to early decay, — syphilis ceasing as 
 syphilis, but leaving decay in its stead. Thus the problems 
 with which we have to deal may change, even as we are 
 
96 ADDKESSES. 
 
 occupied in their solution, and that which we have to deal 
 with in the end may be entirely different from that with 
 which we began. Iodide of potassium, for instance, may 
 cure a syphilis, but the cachexia of the organism caused by 
 the syphilis and its remedies may never be cured, but may 
 advance in spite of all specifics, being no more a disease 
 than the decay of advanced age is disease. 
 
 Now let us consider the extent of our work, — all the 
 disturbing influences and the various morbific agencies that 
 act upon our organism. I sometimes think that if, instead 
 of covering these walls with books which are but little 
 read, we were to emblazon them with a catalogue of all the 
 morbific agents and agencies which may disturb our health, 
 from the itch insect to the typhoid poison, the gain would, 
 be great. I am old enough to know — I am not sure that- 
 there may not be others here who may remember also — that 
 itch was once considered to be a constitutional disease ! I 
 know those who believe now that pityriasis versicolor may 
 depend upon hepatic or uterine disorder ! Our supposed 
 knowledge of other diseases may, though unsuspected, be 
 equally at fault. 
 
 To know in exact detail the lines of morbid action and 
 seats of the primary operation of morbific causes would be 
 of incalculable worth to us. Upon what tissue, for instance, 
 does the scarlet fever poison first operate ? " Oh," it will be 
 said, " upon the blood." But this may be verymuch doubted. 
 It is more than doubtful if the blood be affected directly 
 by the poison of this and other fevers. Many organs with 
 which the blood has most to do show no change. Look at 
 the voluntary muscles : they receive much blood, but do not 
 primarily go wrong. Look at the choroid and other deep 
 vascular tissues of the eye, which, however richly supplied 
 with blood, do not get particularly involved in the early phe- 
 nomena of scarlet fever. It may be much doubted whether 
 our notions about the blood are not very vague, and I must 
 appeal to the members of this Society to help to improve 
 our knowledge on these points ; to help us, in respect of 
 the primary operation of morbid poisons, to determine upon 
 what tissues they first act, and what is the first effect of their 
 operation. Their entry and exit from the blood may be but 
 
president's address, clinical society, 1872. 97 
 
 indifferent facts. Probably, and almost certainly, they do 
 pass through persons indifferent to their operation. What 
 we want to know in clinical medicine is where, according to 
 their kind, they act. We may know where pityriasis ver- 
 sicolor begins, and how it limits its operations ; but we do not 
 know when and where the poison of scarlet fever first begins 
 to rankle, or when or how the poison of smallpox first 
 begins its fatal work. 
 
 There is much hope that comparative pathology will teach 
 ns something on this and kindred subjects. We are learning 
 that there are parts in us more and other than we indivi- 
 dually want, and without which we should be no losers — the 
 relicta of our ancestral relations. Other organisms may have 
 needed parts which may be superfluous and even injurious 
 to us. A perfected comparative anatomy and pathology may 
 teach us more on this. Probably coming, as it seems we 
 have, through a long line of dissimilar ancestry, there may 
 have been entailed upon us elements not especially needful 
 or useful. This opens an inquiry whether, if there be such 
 parts or organs, they may not be, from their very nature, the 
 more liable to disease, since those parts whose functions are 
 least definite are apt to be the foci of pathological changes. 
 Every pathologist will bear me out in the assertion that 
 malformed parts are common seats of disease. Instance the 
 cancer of undescended testicle. Again, the vitelline duct in 
 the ovum of man, considering the size of the ovum, must 
 have but a microscopic function, and it may be that the 
 vitellus is but the relictum of the ovipara. But however it be, 
 I do not suppose its function in man is great, either in 
 respect of time or space ; and certainly for the most part 
 the vitello-intestinal duct is as transient as we may suppose 
 its importance to be slight. Still it sometimes persists and 
 grows with the intestine, giving rise to a large and by no 
 means unimportant diverticulum of the ileum. Our museums 
 contain frequent instances of this, and there happens to be 
 in the museum at Guy's a diverticulum in a full-grown 
 state, retaining its connection with the umbilicus. This was 
 taken from the body of a young man aged thirty-six, who 
 had enjoyed perfect health until his fatal illness, which was 
 
 due to this superfluity. Owing to cold, or some such cir- 
 
 7 
 
98 ADDRESSES. 
 
 cumstance, an irregular peristalsis of the intestines twisted 
 them round this useless part and set up fatal obstruction, so 
 that to him was applicable, with a change of a word, the 
 epitaph on Burton, the author of ' The Anatomy of Melan- 
 choly,' and I requested it might be thus recorded : — " Oui 
 vitam et mortem dedit diverticulum." How much longer 
 and happier perhaps would have been this man's life had his 
 oviparous ancestry not entailed this vitellus and its duct 
 upon him! Perhaps my illustration may admit of critical 
 objections, but there still remains the suggestion that an 
 advanced comparative anatomy and pathology may show 
 that there are some organs in us without which, as indi- 
 viduals, we might be much better off. These sciences may 
 tell us more of the vital history of different organs and 
 tissues, for, like bees, we must go far afield in these regions 
 for our honey, and gather from every source of knowledge, 
 returning home to study the special life and function of 
 every fibre and organ. 
 
 A great nature philosopher (Oken) has said that every 
 part of the body is nerve — that bone is hardened nerve. 
 Whether this view be extravagant or not I will not stop 
 to discuss, since we must believe that the elements of the 
 groups of the different textures are living — that each has its 
 own biology and pathology. The history of the process of 
 life, from the primitive trace in the ovum to the last breath 
 of age, is a series of illustrations of textural growth and 
 decay ; impressing upon us the truth that, however neces- 
 sary it may be to obtain general conceptions of the organic 
 law as a whole, it is only by the most special study that we 
 can pursue the objects which medicine proposes. The 
 history of whole organs in us confirms this truth. Could 
 the early fcetus feel and reason upon its existence, what 
 would be its disquiet at the apparently revolutionary changes 
 at work in its structures — atrophy everywhere side by side 
 with growth, — until, in ignorance, it might desire to fore- 
 stall and hinder the organic laws. These are fanciful 
 speculations, but may bear upon our ignorance at a more 
 advanced stage. It is to be hoped that the new hospital 
 now established in London for comparative pathology will 
 afford us a larger knowledge of the diseases of the different 
 
president's address, olinioal society, 1872. 99 
 
 tissues and organs in the animal series, and will show us 
 the natural history of disease, not only on a larger scale, 
 but with a truer appreciation than we could gain if our 
 observations were limited to the human body alone. For if 
 we are to operate successfully on living things, we must be 
 largely informed as to the full meaning, not alone of the 
 whole individual, but of his minutest parts. 
 
 So far for the general scope of clinical work, a due 
 estimate of which bears directly on diagnosis, since the eye 
 sees no more than it brings with it the power of seeing ; and 
 as diagnosis is the basis of practice, it must be laid four- 
 square to every aspect of knowledge. 
 
 Improvement in physical diagnosis must always be an 
 object immediately dear to a Clinical Society, and yet it is 
 often, and for the most part, however it may be perfected, 
 only the preliminary process to sound practice. Upon the 
 exactest mechanical diagnosis must follow the intellectual 
 determination of the vital conditions, and of the possible 
 and the impossible. It may be granted that the practically 
 possible and impossible are changing, and that our efforts 
 are to destroy the latter. Still there is always a practical 
 impossible, and in relation to disease we have always to 
 make such a diagnosis as shall show what we can and what 
 we cannot effect. Perhaps it would be well if members of 
 this Society would bring before it some illustrations of the 
 impossible as well as of the possible. It would tend to 
 prevent us from making foolish, because ignorant, attempts 
 to do that which cannot be accomplished ; attempts which 
 only result in loss and hurt to the individual. As a prac- 
 tical profession this is not an unimportant consideration. I 
 remember my friend Dr. Acland, the present Eegius Pro- 
 fessor of Medicine at the University of Oxford, saying to 
 me that he would have engraved round the Radcliffe 
 Infirmary the saying of Trophilus the Bphesian, " He is the 
 best physician who knows what is possible and impossible." 
 The negative results of such a mental exercise are by no 
 means indifferent if one may judge by the results which are 
 often seen in the treatment of chronic incurable disease, 
 where the small remnant of life is wasted in futile and 
 painful efforts at cure. And in the same category are the 
 
100 ADDRESSES. 
 
 attempts at the impossible upon those unfortunate members 
 of the human family who are born with a feeble vital 
 capacity ; delicate women, for instance, who, if I may say 
 so, have no more stature of strength than falls to the lot of 
 a canary, and yet upon whom we try, how vainly ! all the 
 chemistry of tonics. A friend of mine once consulting me 
 on such an instance, I could not refrain saying to him, " Do 
 you know what you are trying to do ? You are trying to 
 put a quart measure into a pint." He replied, " I have been 
 giving strengthening medicines to this patient for years. I 
 have exhausted every means, and yet she is ailing — always 
 ailing." I saw the other day an advertisement inviting 
 persons of short stature to come and be made tall, and with 
 the promise that any defects of height could be duly recti- 
 fied — a proposition not much more absurd than that we are 
 expected to meet promptly, by a prescription of iron or 
 quinine, for every sort of debility that may come before us. 
 As our business is not knavery, but knowledge, it is clear 
 that the diagnosis of the possible and the impossible is of 
 the first importance, that we may not waste words and 
 efforts on useless pursuits. 
 
 On physical diagnosis I shall not detain you. All are 
 fully alive to the importance of advancing physical diagnosis 
 to the fullest perfection. Therefore, when any new means 
 or increased exactness of the old means of physical diagnosis 
 is discovered, this Society cannot but hail it with delight, 
 even though it may throw us for a time into doubt and 
 confusion. Such is the state of thermometric knowledge at 
 the present moment. I have more than once been tempted 
 to lay aside my thermometer because it has contradicted my 
 clinical knowledge. But it must be so at first with all new 
 evidence ; it takes time to bring it fairly into court. 
 
 But that vital diagnosis to which I have alluded, and 
 which weights and measures, however refined, cannot give 
 us, comes from experience. Take, for instance, such an 
 eruptive fever as smallpox. From its outset its future can 
 be predicted, if not as to intensity, at least as to character 
 and duration. Well might the poet insist, and chiefly it is 
 true in clinical medicine, that "per causas scire est vere scire." 
 That which, in contrast with mechanical diagnosis, may be 
 
president's address, clinical society, 1872. 101 
 
 called vital diagnosis, is the last important object at which 
 this Society aims. What our actual knowledge on this is 
 may be illustrated by reference to the diagnosis of pneu- 
 monia. The mechanical diagnosis of pneumonia is familiar 
 through physical signs, but how far from exact practice 
 does this land us ! For prognosis and treatment we need a 
 deeper insight. Some forms of pneumonia will, we know 
 with certainty, clear up in seven days, whilst others will 
 never clear up at all, although both may begin much alike. 
 One has, to use a former expression, a beginning, a middle, 
 and an end j the other has but a beginning. What are the 
 grounds for a . true discrimination of each and of all the 
 intermediate gradations, and of that form which, as I have 
 said, has but a beginning with no other ending but death ? 
 What are the invariable facts which shall tell us why this 
 case degenerates into a form of phthisis, going on in a vari- 
 able degree for years, whilst that shall run its course more 
 quickly, killing the patient in a few weeks or months ? We 
 know, as the logicians say, the differentiee of common in- 
 flammation and the various forms of specific inflammation — 
 rheumatic, syphilitic, gouty, — all of which are modes of 
 vital diagnosis. If we put the word aright upon them we 
 adapt the treatment accordingly ; but of pneumonia we have 
 no such exact diagnosis, and I speak of pneumonia since the 
 pulmonary system equals in a sense the systemic. It cannot 
 be doubted that the tissues of the lung undergo a great 
 variety of changes, having different vital qualities. The 
 dynamics from the beginning are different, though difficult 
 or impossible to distinguish. On the skin we can better 
 distinguish, but not yet so accurately as we ought. It is 
 too often but a general distinction, as of eczematous affec- 
 tions from leprous affections, and of papular from both ; 
 but in pneumonia and pleurisy, renal diseases, and other 
 internal affections we have often not even this accuracy of 
 vital diagnosis, and therefore I call upon this Society to 
 perfect it. The conditions of physical diagnosis are imper- 
 fect, but those of vital diagnosis are much more so. 
 
 Lately you are aware I have been called upon to make a 
 diagnosis of the finest kind — of the working of the function 
 of the brain as expressed in the mind ; — not to diagnosticate 
 
102 ADDRESSES. 
 
 a tumour, a ramollissement, a degeneration of the brain, but 
 to test its moral and intellectual dynamics. There is often 
 encountered a prejudice at the outset of such an inquiry 
 from the taunt that the doctors assert that such and such a 
 person is insane because he has committed a crime. But 
 permit me for a moment to point out that we judge of the 
 previous strength of any material by the strain it will bear. 
 Should it break under the test it would be absurd to main- 
 tain it could not have been weak or imperfect beforehand ; 
 and may not the first evidence of mental and moral defect 
 be due to some stress of circumstances, often exaggerated 
 and distorted, which is put upon the brain, and that break- 
 down which in one would be crime becomes in another the 
 first sign of insanity ? In the defects and diseases of other 
 organs this is a matter of the tritest experience. How 
 often does aortic or mitral imperfection first become known 
 by some sudden exertion ! yet who would on that account, 
 deny the previous weakness ? The beginnings of disease 
 are, as a rule, latent and obscure, and discover themselves 
 only when some strain is put upon the weak part. Illustra- 
 tions of this are at hand on all sides, whether in the heart, 
 the lungs, the abdomen, or the brain. It was only our 
 ignorance which led us formerly to believe in acute idio- 
 pathic disease in healthy subjects, and it is probably equally 
 so with nervous conditions, and with the mind. There are, 
 doubtless, many persons living uneventful lives who main- 
 tain a sane equilibrium until influenced by some circum- 
 stance, real or imaginary, and who then at once show their 
 weakness ; and yet from the high seat of justice we often 
 hear the objection put forth as an argument that therefore 
 the patient was sound because there was no sign of insanity 
 beforehand. But the sign of unsoundness may be what has 
 occurred. I am sure we, as clinical students, have our 
 minds perfectly alive to this j and although some of the most 
 learned and practical men in our profession maintain that 
 the diagnosis of the intellectual and moral status is an 
 inquiry we ought not to take up, and that the common 
 sense of man fits every one equally to make this diagnosis 
 with the most accomplished physician, I cannot think so : 
 and if it be a fact it must not remain so, for it would be 
 
president's address, clinical society, 1872. 103 
 
 unworthy of us to leave uncultivated a field of inquiry so 
 important to us all. Medici sumus, humani nihil nobis 
 alienum esse putamus. As medical men we know of ten- 
 dencies to latent insanity without the least overt evidence 
 of their existence ; minds which on a strain will certainly 
 give way. We know this as well as we know of weak and 
 imperfect hearts or other viscera, which perform their func- 
 tions fairly until called upon to meet some extra demand, 
 and then they fail altogether. The onset of acute disorders 
 of mind or body, to use a common expression, by no means 
 coincides with the date of their causes. This is so well 
 established in medicine that we go back upon a latent cause 
 from the occurrence of acute effects, feeling assured we 
 shall find it, however previously hidden. It is only the 
 ignorant who can overlook these connections, and yet in 
 matters of the mind this oversight is esteemed the safeguard 
 of truth ! 
 
 I come now to the last division of my subject, Thera- 
 peutics. The other aspects of medicine might afford suffi- 
 ciently pleasant contemplations, but finis coronat opus — care, 
 and where possible medication, in order to cure. We are 
 often twitted with being, as I have before said, merely passive 
 attendants upon and worshippers of nature. As Goethe 
 satirically says, " Man durchstudirt die gross und kleine 
 Welt, um es am Bnde gehen zulassen, wie's Gott gefallt." 
 This, however, I repudiate. We believe that God's will is 
 that we should be wise and active and when we say, and I 
 am sure our profession is not behind any in saying devoutly, 
 " Thy will be done," it is not that we may sit down, like 
 fatalist Moslems, and let the supposed inevitable pass over 
 us ; but ours is an active interpretation of the prayer, that 
 we may learn the Divine will in order to obey it, convinced 
 that the Divine will is the exact contrary of ignorance. 
 There is, no doubt, a time to each when he must bear his 
 lot in patience and submission, but, as students and prac- 
 titioners of medicine, our interpretation of the Divine prayer 
 is in an active sense, and should incite us to every exertion. 
 The will of God, as expressed in the purposes of the human 
 intellect, is apt to be too lightly passed over, but he who has 
 but a faint conception of that purpose will not be open to 
 
104 ADDRESSES. 
 
 Goethe's remark of letting events pass on without any effort 
 to control them. It is only they who are weak in faith and 
 intellect who exclaim, " The world (time) is out of joint. 
 Oh, wretched spite, that ever I was born to set it right ! " — 
 for this is our true sphere of work. Whilst we more clearly 
 discern the operation of those forces which bring health out 
 of disease, we are not contented to be spectators only. 
 Efforts of nature are regarded with watchfulness and doubt, 
 and often must we agree with Professor Haughton, who, 
 when told that the evacuations of cholera were due to an 
 effort of nature to cure the disease, said, " I will tell you 
 what Nature wants ; she wants to put the man in his coffin. 
 And that is what she succeeds in doing for the most part." 
 In fact, the expression " effort of nature " is little else than 
 a vague metaphysical conception, a mere imago of the true 
 and practical idea of the recuperative forces which are at 
 work in the organism, and which collectively we name the 
 vis medicatrix naturse — that centripetal tendency which 
 restores the disturbed relations. Were we able to make a 
 due analysis of this tendency in us, it would indicate a true 
 science of therapeutics. It would show that in the subject 
 of typhus or typhoid, or other fever, there were, together 
 with the more obvious fever facts, others correlated to them, 
 by which health is for the most part restored. In other 
 words, that under the conditions of disease there lie physio- 
 logical processes, which not only restore the normal equi- 
 librium, but which leave a permanent resistance to any 
 similar disturbance. The causes of this immunity are as 
 much facts for our study as are those which we more 
 commonly call the disease. For example, in smallpox, to 
 the indifferent observer the whole disease is embraced in the 
 description of its symptoms and the eruption ; but there is 
 a most important obverse to these in those prominent physio- 
 logical changes by which the subject of them is likely to 
 obtain a permanent indifference to the variolous process. I 
 desire more expressly to say that, in the class of fevers, what 
 we term the disease is but the attendant disturbance of an 
 underlying process, which being completed, its accidents 
 subside. We owe a very practical application of these views 
 to Dr. Stokes, of Dublin. In some excellent papers on fever 
 
president's address, clinical society, 1872. 105 
 
 lie long ago pointed out that the various local affections in 
 fever must be looked upon as part of the fever itself, and 
 not as separated or separable conditions. I well remember 
 the time when the irritation of the brain in fever was 
 regarded as inflammation of the meninges, to be treated 
 with mercurial inunction ; — when irritation of the bowels 
 and the foetid evacuations were to be corrected by giving 
 the grey powder ; — the obstruction of the air-passages to be 
 medicated by blisters and expectorants. When I had to 
 teach medicine, I impressed as far as I could upon the 
 students of my class the importance in fever therapeutics of 
 minding these local affections as our Nelson minded the 
 signals given him to retire from action ; whilst at the same 
 time we maintain to the best of our power the strength of 
 the patient. 
 
 In therapeutics as in pathology we have no kinship with 
 those who believe that diseases are only sets of symptoms 
 to be combated by drugs. The symptoms of a disease may, 
 in fact, give doubtful and dangerous indications for treat- 
 ment. The worst diseases have but few and not prominent 
 symptoms, and even when the symptoms are characteristic 
 they are not the disease. Frequently the most numerous 
 symptoms occur without any disease at all. It may be all 
 very well for the popular charlatan to make symptoms the 
 whole object of his efforts, but to tbe better informed the 
 chief fact is, as I have said, the condition which underlies 
 and produces them. 
 
 In therapeutics the greater often depends upon the less. 
 It has been said that Wellington overcame his great antago- 
 nist by attending to the shoes of his soldiers. This may have 
 been so, for often we see great purposes frustrated by neglect 
 of trifles : a man brought through his fever and dying of 
 bedsore ; a broken spine in process of repair, whilst death 
 comes on from the careless passing of a catheter. 
 
 With the gold-headed cane and the horsehair wig passed 
 away, we may hope, the days of pompous inanity ; and we 
 may further hope that nothing will hereafter be thought 
 unworthy the attention of the physician which can contri- 
 bute to the saving of a life. 
 
 For the surgeons, as I have hinted, a new prospect is 
 
106 ADDEESSBS. 
 
 opening. Should advancing knowledge show that we have- 
 parts or organs of doubtful use, and especially if these 
 equivocal parts are liable to disease, what a land of promise 
 for operations ! 
 
 But I must forbear. I am sure we have a hopeful future 
 before us, whatever may be the direction of our efforts, and 
 it is my duty and my privilege to invite you to enter upon 
 it with industrious hands and true hearts. 
 
ON THE STUDY OF MEDICINE. 1 
 
 Me. Tbeasueeb and Gentlemen, — I feel it a great privi- 
 lege and honour to be in this place to-day. The occasion 
 which brings us together recalls vividly to my mind the 
 time when I first entered this theatre. Though many years 
 have passed, I feel again, in sympathy with those whom I 
 have now to address, the dread and doubt and fear as to the 
 future which I felt so keenly then. Everything then seemed 
 to combine to depress and bewilder me. Such a burden 
 doubtless weighs upon the minds of many of you now here 
 for the first time. It is natural that it should ; for, how- 
 ever full of hope and ardour you may be, the uncertainty 
 and extent of the future cannot but cast some gloom upon 
 the present. If it be so, it is my duty to bid you an encou- 
 raging and kindly welcome, and to give you, if I can, such 
 directions as may aid you in making the journey of your 
 life successful, whether cheered by prosperity, or chilled by 
 disappointment and apparent failure. Happily, true success 
 is not so much dependent upon accident as it seems. This 
 truth you will confidently set before you foremost, not 
 letting any circumstances deprive you of the assurance that 
 what is most worthy the name of success is attainable under 
 all conditions, and often the more certainly under those 
 which seem the most adverse. That this is true, you must 
 have already abundantly learned by the common testimony 
 of history, and, what is better still, may learn it by the 
 testimony of your own conscience. Tou will bear in mind 
 that the claims of your manhood are supreme ; that, if you 
 become successful doctors in the world's esteem, and fail of 
 
 1 An address delivered at Gruy's Hospital, October, 1874. Eeprinted 
 from the ' British Medical Journal,' vol. ii, 1874, p. 425. 
 
108 ADDRESSES. 
 
 becoming true men, your success will be but a cheat upon 
 yourselves, and a stumbling-stone to others. 
 
 Though it would not become me on this occasion to 
 touch too nearly upon personal and sacred subjects, still I 
 would ask you to believe that honest work is a high and 
 true service ; that availing yourselves of every means of 
 moral and intellectual enlightenment is an imperious duty, and 
 especially imperious upon you, who look forward to claim the 
 confidence of society in its highest interests. 
 
 The study of medicine is liberal and unfettered. It 
 ranges through human nature and into nature in general. 
 It looks at man in every aspect, and has this great collateral 
 advantage for its followers, that, in pursuing it, they are 
 learning something of themselves. What this advantage 
 may be to you as medical students is not to be calculated 
 if it duly impress you with the fact that the laws of human 
 health in its widest significance are part of the laws of 
 moral and intellectual life ; that indulgence, sloth, and vice 
 are as contrary to our lower nature as they are to the higher 
 laws within us. It was, therefore, well said by Sir Thomas 
 Browne, that " there are two books from which we may 
 gather our divinity ; beside that written one of God, another 
 by His servant Nature, that broad and universal manuscript 
 which lies expansed to the eyes of all." I assert, therefore, 
 that the medical student has peculiar advantages ; and that 
 there is nothing in his studies to limit and contract his feel- 
 ings or his sympathies, nothing to make him take a low and 
 unworthy view of man or of his destiny ; but, on the con- 
 trary, as a learned divine whose name is dear to this hos- 
 pital used to remark, he who is most occupied with disease 
 and death will have the truest idea of life and of all that 
 contributes to it. 
 
 Your studies require constant mental direction. As, in 
 order to get a correct image from a mirror, it must be 
 placed evenly before its object, so you must be careful that 
 your minds are not obliquely set to your work, but freely 
 and openly directed to it. It is a common error with young 
 students to think that it is only by some strong intellectual 
 effort that good work can be done ; whereas, in truth, it is 
 more through patient and well-directed labour. You may, 
 
ON THE STODY OF MEDICINE. 109 
 
 in fact, often advantageously recall the fable of the hare 
 and the tortoise ; for, in the study of medicine, you will 
 soon be convinced that the race is not to the swift. If the 
 first lesson be patience — a patience which knows how to 
 work and wait, undismayed by what seems to be insuperable, 
 such a patience as even Newton required and practised when 
 he tells us that he learned to keep a» subject before him, and 
 to wait until by slow degrees light dawned upon it — the 
 next lesson is docility, a readiness to learn at any source, 
 not fastidiously or delicately, not where it may please us, 
 but wherever the facts lie hid ; remembering that to the 
 pure all things are pure ; and that, in the investigation of 
 truth, there is no high nor low, no great nor small j that, to 
 use a common simile, like the rays of the sun, the rays of science 
 enter alike every place. Who could have believed that the 
 particles of a dewdrop and the masses of the planet are 
 moulded and controlled by the same force ; that the intro- 
 duction into the human body of a small particle of matter 
 from a cow's udder might be the means of saving thousands 
 of human lives ? We learn from these and innumerable 
 similar instances that the highest truths lie hid in the 
 simplest facts ; that, unlike . human proclamations, nature's 
 teachings are not by sound of trumpet, but often in the 
 stillest voice, by indirect hints and obscure suggestions, but 
 always with the unequalled advantage that they are unequi- 
 vocal, constant, and uniform. The difficulty, however, is in 
 maintaining the docile spirit of which I speak ; in prevent- 
 ing ourselves from assuming a knowlege we have not ; in 
 not hastily coming to a conclusion without evidence ; and 
 not resting content in our ignorance with the fool's satisfac- 
 tion that no good would come of more knowledge if we had 
 it. The student will consider what has already been accom- 
 plished by the industry of man ; what truths have been 
 gathered on all sides ; how much has been done to make the 
 world more habitable ; the victories over ignorance, disease, 
 and pain ; and he will be stimulated to enter upon his work 
 with enthusiastic earnestness, knowing that, great as these 
 results are, they are but the firstfruits of a fuller harvest 
 in which he may hope to take an active part. 
 
 The student's training of to-day must at every step be 
 
110 ADDRESSES. 
 
 directed by the light and checks of science, and his ac- 
 quirements must go hand in hand with that high mental 
 culture which can alone enable him to apply his knowlege 
 successfully. If, in what has to be done mechanically, 
 technical rules for action can be given, it is not so when 
 living processes have to be dealt with ; for then there has 
 to be exercised the power of judging of the value of the 
 known against the unknown, and of deciding for or against 
 many obscure probabilities. These are difficulties we cannot 
 avoid, and these are the difficulties you have to fit yourselves 
 to meet. The voice of pure science would be for waiting 
 for certain light; but suffering humanity has stronger 
 claims, and cannot wait. Let me, therefore, insist upon the 
 careful mental discipline to which you must accustom your- 
 selves, if you are to use the knowledge you acquire with 
 safety and advantage where failure is so easy. 
 
 The medical profession stands almost alone in having to 
 make the investigation of nature its prime duty. Others 
 may labour in the same direction from a pure love of truth, 
 or to relieve the tedium of life ; but the medical student, 
 having once selected his part, cannot avoid the calls of duty 
 to urge him to his work. He has to study always with the 
 feeling that he must as far as possible fit himself for the 
 position of trust to which he aspires. He has to acquaint 
 himself with the course of nature, to the practical end of 
 instituting a course of action under given circumstances. 
 I admit that the study of medicine is throughout full of 
 inducements to its earnest pursuit ; but there is besides the 
 further consideration that we voluntarily undertake the task 
 of rendering material service to society, and are, therefore, 
 bound in honour to do that service well. Were man's 
 physical condition immoveably stable, were the equilibrium 
 of his health constant from childhood to age, were there 
 no accidents to cross his path, the proper study of mankind 
 might still be man, but it would have no relation to the 
 study of medicine. Whatever knowledge there would be 
 of man so conditioned, it would have no object in practice. 
 It might excite our wonder and admiration, but not our 
 sympathy ; for there would be no suffering, and no need of 
 interference. 
 
ON THE STUDY OF MEDICINE. Ill 
 
 In the high, object of medicine lies its greatest danger. 
 The stimulus and the natural desire to act are mostly out of 
 proportion to our knowledge and means for action. So 
 ■often is it, as Goethe says, that — 
 
 " Was man nioht weiss, das eben brauchte man ; 
 Und was man weiss, kann man nicht brauchen." 
 
 The motive to do something is but too apt to tempt to 
 pretence of knowledge, which necessarily perverts the science 
 and practice of medicine. How can I, therefore, so happily 
 impress your minds with the dangers of charlatanism as 
 still to leave your energies fresh to actively pursue the 
 truth j so urge upon you to neglect no means, to despise no 
 service, which may be necessary to promote the successful 
 •operation of your knowledge, and yet guard you against 
 ignorant and trifling interference, of which the least that 
 can be said is that, if not injurious to the patient, it spoils 
 the practitioner ? 
 
 The study of medicine, I have said, it is difficult to limit. 
 The ancients called the human body the microcosm, and the 
 outer world the macrocosm ; in fact, one world within 
 another ; or, as the poet puts it, " Man is one world, and 
 hath another to attend him." There are infinite and 
 intimate relations between the two, more and more intimate, 
 perhaps, than we in our philosophy have yet dreamt of, 
 though in our day we have gone far. You will, in the 
 more discursive teachings of your subjects, probably be told 
 that a continuous line of relations connects the macrocosm 
 and the microcosm ; and you will at least learn that, if not 
 continuous, the points of contact are too intimate and essen- 
 tial to admit of any distinct line of separation. The whole 
 art of medicine is to know and to act upon these relations 
 so as to favour what is favorable and exclude the contrary. 
 The air we breathe, the water we drink, the food we eat, 
 the mechanical accidents to which we are subject, and the 
 varied operations on the senses, show how close these condi- 
 tions are, and how immediately dependent life is in every 
 way upon them — more dependent even than is commonly 
 perceived, for it would seem that not only is our bodily 
 structure formed and maintained by the surrounding con- 
 
112 ADDEESSES. 
 
 ditions, but even our mental state is thereby developed and 
 its training advances. 
 
 The dogma that man's power and knowledge are limited 
 by his observation of the course of nature cannot be too 
 plainly impressed upon the mind of the student of medicine. 
 It might well be written in letters of gold in every medical 
 theatre. It is true, we may and must believe and hope far 
 beyond the boundaries thus prescribed, but belief and hope 
 are but pioneers and substitutes for knowledge, and where 
 observation can lead the way there must be no halting in 
 our steps to follow it. The first aphorism of the ' Novum 
 Organon ' sounds clearly the note in harmony with which our 
 medical studies must be conducted, though I repeat that 
 the limits of scientific knowledge are not the limits of hope 
 and belief, even in the driest minds. They supplement and 
 aid the powers of observation everywhere. The purest 
 physicist works his way into the unknown by hope, and 
 entertains a belief much more comprehensive than his 
 knowledge. 
 
 The expression " order of nature " indicates a rule which, 
 in one aspect, is the most hard and inflexible. Amongst all 
 the ever-changing phenomena of Nature, in all her forms 
 and moods, it asserts that there is an unvarying oneness 
 beneath. The harmonies may be infinitely varied, but the 
 vibrating chord is unchangeable. Eealise, if you can, what 
 a paralysing influence on all scientific inquiry the ancient 
 belief must have had which attributed the operations of 
 nature to the caprice not of one divinity only, but of many. 
 There still remain vestiges of this in most of our minds, 
 and the more distinct in proportion to our weakness and 
 ignorance. It still opposes a hindrance to knowledge, and 
 resists the conclusions of experience. In fact, few really 
 believe in a fixed course of nature ; none, indeed, but they 
 who have undergone mnch mental discipline. 
 
 I say that, in one aspect, the course of nature is un- 
 varied. The materials, the material atoms, as we now think 
 of them, the physical elements, as they are called, are be- 
 lieved to have constant qualities. What these qualities are 
 we only know very imperfectly, but, as far as our acquaint- 
 ance with them goes, they are not subject to any variation. 
 
ON THE STUDY OF MEDICINE. 113 
 
 The variations in phenomena are the variations in their 
 combinations or the variations of their relations ; but in the 
 substratum itself there is no variation, nor any in the 
 resultant where the conditions are the same. That is the 
 law of nature, but obviously its course admits of infinite 
 variations. What are the changes that can be rung on 
 twelve bells, used to tax our boyish calculations ; but what 
 are the resultants when twelve elements combine in infinitely 
 changing proportions, who can express ? Yet still this is 
 but a part of the problem of the play of the physical atoms, 
 which, far from being dead things, are centres of active 
 powers expressing themselves in various ways, of which we 
 know at present only some, under the forms of motion, heat, 
 electricity, and magnetism. 
 
 That the course of nature may be varied we have assumed 
 by our meeting here to-day. The whole object of the science 
 of medicine is based on this assumption. It is the whole 
 purpose of our knowledge to find out and obviate what is 
 inimical to our systems, and to discover and promote what 
 is favorable to us. It is difficult to form even an imper- 
 fect image of the course of nature in a living thing. What 
 we call health, which looks so fixed and stable, is more 
 changeable than the stability of the rainbow. Its mainte- 
 nance depends upon the moving equilibrium of more forces 
 than the mind of man can realise. The inorganic elements 
 make a constant war upon us, and yet maintain us by the 
 strife. Everywhere this struggle for existence has to be 
 maintained ; but in man, for the first time, intellect comes 
 to take part in the struggle. It is the curious work of 
 physiology to trace from the first shrinking of the lowest 
 organisms, through all the gradations of instinct, this power 
 which becomes intelligence in man, with the prerogative of 
 knowing the course of nature, and of changing it for his 
 good. When we hear the complaints of the weak and 
 ignorant against the hardness of their lot, when we are 
 moved in sympathy with the sufferings of the sick, let such 
 complaints and our sympathy remind us that in the provi- 
 dence of God the intellect of man comes in as a corrective 
 agent. 
 
 It is both impious and foolish to stand with our backs to 
 
 8 
 
114 ADDRESSES. 
 
 the storm bewailing our miserable plight, or to remain 
 patient under it through the deadening influence of super- 
 stition, like brute creatures on a waste moorland. Even at 
 present, feebly instructed as we are, so much has been done 
 as to give us good assurance that the time will come when 
 the triumph of the intellect will fully " justify the ways of 
 Grod to man," not only by obviating or controlling human 
 suffering, but by so combating the faults of ignorance, and 
 enlarging knowledge, that humanity may recognise its high 
 destiny, and walk in the light of it. Bacon justly says, 
 " Vere rem reputanti philosophia naturalis post verbum Dei 
 certissima superstitionis medicina est eademque probatis- 
 simum fidei alimentum." We have disarmed the lightning 
 of its destructive force, and tamed it to carry our thoughts 
 across the world, affording an instance of what was once 
 regarded as evil turned to good in relation to that order 
 which man's life requires. Again, let me instance the 
 pestilence (typhus fever), whose ravages were so mysterious 
 that the inspired writers speak of it as one of God's sore 
 judgments walking in darkness, and humbly consider what 
 power the intelligence of man has gained over it. We have 
 tracked it to its lair, have discovered its cause and their 
 preventives. Dreadful as have been its visitations, we have 
 learned so much of it as to see that its teachings are friendly. 
 I am not speaking the language of metaphor. The pesti- 
 lence which formerly swept over the world like a scorching 
 wind, withering and, destroying the human race in uncounted 
 numbers, had no mysterious or supernatural origin, but was 
 the natural product of want and squalor — a protest against 
 the violence, selfishness, and ignorance of man. The friendly 
 relations of commerce and the common uses of cleanliness 
 have as entirely disarmed the pestilence of its terror as the 
 lightning conductor has diverted the bolt from its threatened 
 victim. Happily, these are not solitary illustrations of 
 man's power to modify the course of nature for his own 
 good. Civilised life is but a varied expression of such 
 illustrations. There still remains an unlimited arena for 
 future work, and for that crusade against the powers of evil 
 which is inaugurated in this and in other hospitals year 
 after year. 
 
ON THE STUDY OF MEDICINE. 115 
 
 As respects nature's unswerving order under like condi- 
 tions, you have not only to realise it for yourselves, but at 
 times you will have to impress it on your patients and on 
 the public. I said just now that few persons had a uniform 
 belief in this stern course of things. All would perhaps 
 assert that they have, but we see too plainly both the indi- 
 vidual and the public health suffer in many ways through 
 the operation of the contrary feeling. The laws of health 
 are broken on all sides with the lurking confidence that 
 there is no attendent Nemesis to vindicate their observance ; 
 whilst at the same time the worst things are submitted to 
 because they are regarded as natural and therefore inevitable. 
 Nature, to the student of medicine, is not a name of terror 
 or superstition. With all its stupendous forces, it still 
 conveys to his mind the idea of Tightness and beneficence. 
 As he traces the progress of living things from the dawn of 
 time to the present, he cannot but recognise an evolution 
 to an ever higher perfection. Fixed as is the course of 
 nature, it does not seem to him fixed by blind necessity, but 
 ordered so that the intellect of man may learn it and 
 dispose it for his good. As yet we live but in the infancy 
 of science, and who can say how much our present state is 
 limited by our ignorance ? That cannot be known until 
 Science shall reach her own limit, and has to confess that 
 nature will reveal no more. 
 
 To come to that which will most have to occupy your time 
 here, the course of nature in disease. You will soon learn 
 that diseases, like other natural facts, require no peculiar 
 mode of study. Without doubt, the personal interest we have 
 in them does much to hinder their due investigation, and 
 surround them with a mysteriousness which is not essen- 
 tially belonging to them. Man is naturally unwilling to 
 feel himself but a part, though the highest part as yet, 
 of the course of nature, however deeply he may be con- 
 vinced that all is ruled by the wisest providence. He 
 desires to feel himself an exception from the common laws 
 of nature. There is essentially the principle of fear in all 
 living things. Its physical expression is that shrinking of 
 of a piece of living jelly when it is touched, of which I 
 have spoken, or the closing of the eye to a particle of dust, 
 
116 ADDRESSES. 
 
 and all the like phenomena. The fear of change is essen- 
 tial to the safety and growth of a living thing, surrounded 
 as it is by causes which are calculated to invade and destroy 
 it. It is the groundwork of that struggle for existence 
 through which all living things have advanced, and is in 
 another form the chief spur to the human intellect. We 
 cannot, therefore, be surprised to find this feeling, in one 
 way or another too intrusive, thrusting itself between the 
 facts and their due observation, and surrounding them with 
 a sort of personal and exceptional mystery. It was the 
 great merit of Hippocrates to have striven to break down this 
 barrier of mysteriousness which prevented medical progress. 
 But though so many ages have passed, all traces of it are 
 not gone. The sense of mystery is so indigenous, and so 
 constantly attaches itself to the unknown, that, although I 
 do not for a moment suppose any well-educated medical man 
 could think that disease ever comes but through discoverable 
 natural courses, we assume almost as much when we are 
 satisfied not to have traced them to their beginnings. It is 
 curious also to notice how our language still retains the terms 
 expressive of the mysterious origin and nature of disease. 
 The epileptic is still said to have " his seizure," though we 
 have long known that the cause of the convulsion is but an 
 irregular oscillation of nerve-particles transmitted to a given 
 point. The apoplectic state is still commonly called " a 
 stroke," though anatomy has shown it to be traceable to any- 
 thing but mysterious changes in the blood-vessels. Diseases 
 are but parts of a course of natural history, some as simple 
 as the growth of a lichen on the surface of a rock ; others 
 dependent upon the development of some lower creature in 
 us, "fellow-lodgers," as they have been called; some no 
 more than irregular oscillations of nerve-tissue, as I have 
 just said ; others, the so-called inflammations, are but deeper 
 lesions of the nutritive functions ; and so forth, in every 
 variety, according to the course of health in us, and the course 
 of nature surrounding us, but always, as you will perceive, as 
 parts of a natural history. Medicine has much advanced 
 since she has freed herself from the old conception of diseases 
 being independent entities, admitting of classification and 
 of being labelled in orders and sub-orders. We are, how- 
 
ON THE STUDY OF MEDICINE. 117 
 
 ever, not yet quite free of this, nor can we, in the nature of 
 the case, altogether avoid definitions, though the aim of a 
 good medical education is to teach you to use words and defini- 
 tions but as a medium for arranging knowledge, not for re- 
 stricting it within artificial limits, and crystallising it as it 
 were into uniformity. 
 
 Plain as is the course of study before you ; simple as are 
 the means for its proper pursuit in a due training of the 
 senses and the intellect ; unembarrassed as you may feel 
 yourselves with any supposed necessary prejudices or weight 
 of authorities ; encouraged with the assurance that the 
 prerogative of genius, where it exists, is only more exact 
 and continuous labour ; and certain that success in the 
 prosecution of medicine as of other natural sciences must 
 really be dependent upon the knowledge acquired, I should 
 mislead you did you suppose that your task was an easy one. 
 
 If it required the genius of Bunyan to outline the way of 
 the "Pilgrim's Progress" for his moral journey, and to 
 describe all the hindrances which would beset him from men 
 and things through the Slough of Despond and through 
 Vanity Fair, it will require all the genius of your teachers 
 to direct you in the intellectual journey which you commence 
 to-day. But I may say this much, that the course of the 
 two journeys is parallel, and, if well pursued, they end in 
 one goal, your temporal and eternal happiness. 
 
 I have spoken much of intellectual culture as if it were 
 the main purpose of your medical studies, and though it is 
 certain they cannot be rightly pursued on any lower ground, 
 still I should remind you that there are other calls for your 
 energies. Whatever duty you owe yourselves, there is 
 further that also which arises, as I have before said, from 
 the claims to be hereafter made on your knowledge. The 
 public have a right to expect that you shall lose no oppor- 
 tunity of preparing yourselves for that trust which must be 
 confided to you in practice. If, therefore, there be any 
 among you to whom the love of knowledge, the pleasures of 
 its attainment, and the incalculable personal advantages it 
 bestows upon its possessors, are not motives sufficiently 
 strong, or operate but feebly, let them remember that they 
 are at least bound by the obligation of service and reward. 
 
118 ADDBESSES. 
 
 Most of you, and probably all of you, look for success in 
 future practice. There should be a double success j your 
 practice should be as successful to your patients as to your- 
 selves. This is what may be fairly looked for. I do not 
 mean that your patients can measure successful practice by 
 recovery from disease, or should expect you to do impossi- 
 bilities, but I mean that the sick man has a fair right to 
 expect and to receive all the aid that is possible under the 
 circumstances, if you, on your part, look for substantial 
 reward. Whilst I speak thus I feel I owe it to the 
 members of my profession to assert that mercenary con- 
 siderations have had but little influence with them. No 
 set of men are more unsparing of themselves or more open- 
 handed in their services for public or private good. I 
 could, did it not seem invidious, say they are unrivalled in 
 this respect. You will therefore, gentlemen, for the sake 
 of your profession as well as for yourselves, maintain the 
 position I now assert. Accumulate all the high and honest 
 motives you can for your intellectual advancement. They 
 will severally be wanted on different occasions, whether 
 they be such as arise from duty to your friends who send 
 you here, and the arguments of love and honour they 
 include, whether from what is due to yourselves as having 
 intellects to instruct and knowledge to acquire, whether 
 from the high reputation of this school, which, as students 
 of Guy's, you are bound to maintain, from the demands of 
 your profession, which justly expects that you will fit your- 
 selves to ornament its ranks and advance its influence, or 
 from society, which will reward and honour you if you do it 
 service. Supplement these reasons by the highest, your 
 duty to the Highest, Who alone can satisfy the wants of 
 your nature, and with Whom a faithful study of your 
 profession cannot but make you better acquainted. 
 
 In the strongest of your doubts and mistrust of things 
 you must faithfully look beyond the clouds that oppress 
 you, and fix your minds upon the certain truth that, however 
 halting and tortuous, the course of nature in man tends to 
 physical, moral, and intellectual perfection. No disappoint- 
 ments, no failures, how often so ever repeated, should make 
 us turn our backs on the final purposes of our life. It has 
 
ON THE STUDY OF MEDICINE. 119 
 
 been thought that the study of medicine has been apt to 
 divert the mind from these higher considerations. I believe 
 such an opinion to be as unfounded as that our familiarity 
 with suffering makes us indifferent to it. Such opinions are 
 held only by those who are either ignorant of the large 
 extent of our studies, or who do not sufficiently bear in mind 
 that its range is from the " atoms that make the textures, 
 to the hopes that make the man." As students of man, we 
 can no more ignore the immeasurable relations of the one 
 than we can deny the ponderable relations of the other, for 
 man's hopes as rightly tend to the highest and the best, as 
 his material atoms to the centre of gravitation. 
 
 There is a necessary caution arising out of an expression 
 I have made use of. Medicine, I assert, is unfettered in its 
 lines of study, and, as man is its subject, this implies that 
 whatever concerns his bodily or mental existence is open to 
 our research freely and without prejudice. This is a posi- 
 tion which medical science, as one of the natural sciences, 
 must occupy. But we may not jump to the conclusion that 
 scientific progress is so far advanced that a complete and 
 satisfactory theory of man can at present be given. It is 
 said that the medical profession is especially open to such 
 hasty conclusions ; that, being so largely occupied as we are 
 with the more fleeting phenomena of existence, and seeing 
 more of the weakness than of the strength of man, we are 
 naturally led to ignore his higher nature and to regard him 
 but as a very exquisite piece of material mechanism and no 
 more. No doubt there is this danger — whatever part of a 
 subject most presses upon the attention is likely to occupy 
 it too much, and to exclude that larger part which must be 
 taken into consideration for a proper conception of the 
 whole. But this may be corrected by reflection. The 
 medical student, when he has learned all that is known of 
 oxygen, hydrogen, nitrogen, and carbon, and the other 
 chief organic elements which play so great a part in our 
 existence, will ask himself how much still remains to be 
 known about them. When he enjoys the fragrance of a 
 rose, he will, perhaps, reflect on all the conditions of it, and 
 he will find he comes to a chasm he cannot leap. At 
 present we know only in part. The mind is not advanced 
 
120 ADDRESSES. 
 
 as yet so far as to know either all its weakness or all its 
 strength. 
 
 The teachings of science are, doubtless, full of hope and 
 belief. It is only when we think its work is so far done 
 that we can see the end of it that disappointment comes in, 
 and with it a conflict between our instincts and the supposed 
 reality. Hope and belief are the necessary supplements of 
 imperfect knowledge. Without them, we should deprive 
 ourselves of the best motives and surest grounds of action. 
 
 I have thus far tried to indicate, though very imperfectly, 
 the character and scope of your work and the temper of the 
 intellect in which it must be conducted, and now I must add 
 a few words on the method of it. The order is, more or 
 less, fixed by the. several examining bodies to which you 
 have hereafter to present yourselves, but understand that 
 the method must be your own. 
 
 First of all, resolutely determine that you will never be 
 satisfied with second-hand knowledge from lectures or books, 
 where it is within your power to get impressions directly 
 from the objects themselves. The necessity of this is the 
 ground of your having to come to a medical school. 
 Anatomy, chemistry, practical physiology, morbid anatomy, 
 and clinical medicine are not studies of which you can 
 acquire any proper knowledge through books or descriptive 
 lectures. The things must be seen, handled, analysed, and 
 dissected by yourselves. They require of you a personal 
 and intimate acquaintance to be of any practical good. 
 Words and descriptions, good as they are, after you have 
 acquainted yourselves with the things themselves, are 
 always ready to come between you and the objects and to 
 dim your impressions of them. Many a man, most of us 
 indeed, goes through the world without ever coming into 
 scientific contact with the things in it. We look through 
 the eyes of others. Our impressions and thoughts are 
 mostly but shadows of shadows ; no wonder, therefore, 
 they are so inconstant and confused. Why, I might ask in 
 all simplicity, have you eyes, if they are not to be trained 
 for the purposes of your profession ? Why touch, if not to 
 be used in detecting injury or disease ? The senses and 
 the mind are active powers which call for due objective 
 
ON THE STUDY OF MEDICINE. 121 
 
 exercise. Medical study is a mere pretence without it. 
 Tou do not come here as passive receptacles to be filled 
 through books and lectures with a complement of so-called 
 knowledge which shall fit you to answer questions. Hap- 
 pily the times for this are changed. Examinations them- 
 selves are passing from the verbal to the objective stage, 
 and nothing can supply the student with so practical a 
 stimulus in the right direction as this change. I will not 
 say anything to lessen the value of lectures. In some 
 points, lectures are indispensable. Many of them are 
 demonstrations of facts, where you are shown at the same 
 time the method of inquiry and the results of it. In a 
 lecture you have also the teaching by personal influence, 
 which is invaluable. Example is contagious, and descends 
 from teacher to pupil. This accounts for those fertile spots 
 in literature and science which spring up from time to time. 
 This it is which gives a character to a school. 
 
 As to books, for the most part read the most recent on 
 the subjects you have to study. Knowledge in every de- 
 partment is growing fast. A book on physiology or prac- 
 tice of medicine soon becomes obsolete, or ought to be so. 
 Hospital reports, journals, and year-books are, for a profes- 
 sion like medicine, invaluable. Their flourishing existence 
 is a sign of activity and progress ; they store up our gains 
 and afford the soundest materials in the literature of our 
 profession — a source from which the best treatises on a 
 subject are produced. Nor must I forget your weekly 
 ' Hospital Gazette.' It is very useful auxiliary in your work, 
 as well as a means of friendly interchange of ideas between 
 you. I hope it will be kept up with vigour. 
 
 Though most of you must hereafter be chiefly occupied 
 in practice, all will have opportunities of adding something 
 to the stock of professional knowledge ; whilst some, we 
 may hope, may make such larger contributions as shall add 
 fresh honour to our school. It was in bur medical theatre 
 that Jenner read his first papers on vaccination. It was in 
 our wards that Bright pursued his investigations, which have 
 made his name so famous. It was in this theatre that 
 Addison instructed many generations of Guy's students, and, 
 through his clinical and pathological researches, left an 
 
122 ADDRESSES. 
 
 immortal name. Nor must I forget Sir Astley Cooper, who 
 laboured so much in the foundation of our school. May 
 the example of such men, whose memories are so dear to us 
 Guy's men, beget in you a lasting enthusiasm for your pro- 
 fession. 
 
 As the method of your studies is objective, it requires no 
 arguments to prove what advantages may be gained by the 
 use of those instruments which aid the sense ; the micro- 
 scope, the thermometer, and the sphygmograph. You will 
 naturally avail yourselves of these and of all such other 
 means as may further exact observation ; at the same time, 
 do not fail to educate the unaided senses. Their educational 
 susceptibility it would be difficult to limit. See all you can 
 by the unassisted eye or the common lens, and educate the 
 touch to its finest development. Where exact means are 
 available and applicable, you will obviously have recourse to 
 them. In the study of your profession they are indispen- 
 sable, but in practice we are often prevented from their use, 
 and have to reply upon mere technical skill. 
 
 You will not study your profession in a narrow or niggard 
 spirit. Though the centre of all your work lies in man, 
 you must gather up your knowledge from a very wide 
 radius if you are to understand the problems he presents. 
 At first view, there is an apparent independence and unity 
 in a living thing which sharply separates it from its sur- 
 roundings ; and of all living things, this appears most in 
 man. Our idea of an individual commonly limits itself to 
 the anatomical outline ; but physiology teaches that no 
 proper outline can be drawn. What meaning would muscles 
 have without gravitation, which itself is dependent upon the 
 size of the earth we inhabit ? Draw a close line of separa- 
 tion between man and the surrounding air, and where is his 
 life ? What would be the scope of our knowledge without 
 light ? What constitutes the body itself but a constant 
 relation to freshly added materials ? The human body does 
 indeed especially express the idea of unity, and its oneness 
 is such that we may say of it as Newton said of the phy- 
 sical universe, " Centrum ubique, circumferentia nusquam ; " 
 but physiological studies soon show the human unit in far 
 wider relations than those which are simply corporeal. Man 
 
ON THE STUDY OF MEDICINE. 123 
 
 is both more and less individual than he seems at first glance ; 
 more in the direction of that close relation and dependence 
 of our organs one on another which forbids a partitioning 
 them into separate sections for the special purposes of 
 medical practice, and less in the direction of our surround- 
 ings and antecedents. This conviction it was which led 
 Hunter into the field of comparative anatomy, with what 
 honour to our profession you all know; and the same con- 
 viction must actuate you to obtain a fair knowledge of 
 biological science, which, if it do not confer power on you 
 as medical practitioners, will at least throw such a light on 
 your work as will enable you to do it better. 
 
 You and your friends will perhaps say that the time 
 here for acquiring a comprehensive, together with an 
 exact acquaintance with your subjects, is too limited ; that 
 you do not come to the hospitals to be chemists and biolo- 
 gists, but practitioners. This I admit to the full ; but at 
 the same time, from the nature of the subjects themselves, 
 and in the presence of that wider individuality of which I 
 have spoken, and which often connects the farthest fact 
 with the nearest detail, it must be maintained that to know 
 one thing well you must know its relations to many others. 
 This truth in respect to the study of man is the chiefest. 
 Most of our errors respecting him, whether in regard to his 
 bodily or his mental organisation, have arisen from experi- 
 ence gathered in too narrow a circle and therefore fallacious. 
 As to time, the shorter it is, the more important that the 
 method of study should be intelligently arranged. Ac- 
 quaintance with known facts, if undertaken practically and 
 under good direction, though slow at the outset, is in the 
 end a saving of time, because the results on the mind are 
 more lasting and fruitful. If medical education had for its 
 end only mechanical operations, I grant it would not require 
 more than a technical acquaintance with details ; but neither 
 medicine nor surgery is a mechanical art, though the unini- 
 tiated public regard them so. So they regard the body as 
 a piece of very good carpentry and joinery, and think any 
 one of its organs, like the wheel or piston of an engine, 
 can be mended by medicine duly prescribed. Such ignor- 
 ance is easily satisfied. It is not for its satisfaction that 
 
124 ADDRESSES. 
 
 medical studies are required at all. It very rarely occurs 
 in the practice of medicine and surgery that merely mecha- 
 nical performance can fully meet the conditions of a case. 
 When it can, the man who does the mere mechanical opera- 
 tion most often will be likely to do it the best. Nor should 
 this excellence be depreciated ; but when the treatment of 
 disease ceases to be mechanical, we require for its proper 
 direction a very different mental cultivation. It is the 
 admission of this which is advancing the study of medicine, 
 and from which we may with full assurance augur a greater 
 future. 
 
 With all the extension of knowledge, the student of 
 modern medicine has a far more advantageous position than 
 his predecessors; the facts you have to learn are better known; 
 the relations of your subjects have become more fully illus- 
 trated by collateral knowledge ; the limit of our ignorance is 
 more defined ; the general public are better instructed, and 
 therefore more able to appreciate sound knowledge ; autho- 
 rity and so-called experience, the " wig and cane," are less 
 imposing, and the well informed, though young student, 
 begins his career of practice under favorable auspices. 
 There is something of the spirit abroad which one of our 
 American cousins expressed when walking through St. Paul's 
 Churchyard he read over a shop ' Established 1726;' "That 
 would not do in my country ; it would be better if it started 
 yesterday." In proof of the vitality of our profession, and 
 how little it is dependent upon the supposed prescriptive 
 rights of age, I might point to the clinical labours of many 
 of our younger members, who are daily making most im- 
 portant additions to practical knowledge. 
 
 To repeat, the end of medical studies is not to satisfy the 
 ignorant, but to satisfy the requirements of science. I am 
 conscious how unequal we are to this, but we need not be 
 unequal to the duty it imposes. With all care you will find 
 it difficult to keep the mind even to its duties under the 
 disturbing influences which are necessarily associated with 
 human suffering. He does well 
 
 " Who, when he is to treat 
 With sick folk, women, those whom passions sway, 
 Allows for that, and keeps his constant way." 
 
ON THE STUDY OF MEDICINE. 125 
 
 If I am oppressed with the feeling of having but too im- 
 perfectly indicated the spirit in which you should enter upon 
 your medical studies, I satisfy myself with the reflection that 
 you will be more effectually aided and directed by your 
 teachers in the several departments. I know, from long and 
 intimate acquaintance with most of them, that they will not 
 fail to impress upon you the importance of applying your- 
 selves to your work in a scientific spirit. They will insist 
 upon the fact, that you can fit yourselves for the practice of 
 your profession only by sound intellectual training, as well 
 as by an accurate knowledge of details ; they will caution you 
 against substituting words for things ; they will tell you that 
 the most important part of your work is of a humble kind, 
 consisting of an acquaintance with the proximate conditions 
 of life, and not with the unfathomed and perhaps unfathom- 
 able metaphysics of it. Their object will be so to instruct 
 you that, whilst you are not deficient in any part of that 
 knowledge which is open to you as medical practitioners, you 
 will still be aware of your ignorance, or what should restrain 
 you from futile attempts, and from becoming believers in 
 some fanciful theory or other springing out of too limited 
 observation. The chemist will descant on the nature of atoms, 
 and exhibit to you many of their properties ; but he will 
 have to point out, as I have already said, how much we have 
 to assume respecting them, and that they are still very mys- 
 terious essences. The anatomist's task will be the most 
 satisfactory because our knowledge on that subject is the most 
 complete, and, as our colleague Mr. Hilton has abundantly 
 proved, admits of some rationale. The physiologist has a 
 harder and drier duty in pointing the development of the 
 organs and the combination of their functions into an organic 
 whole, since if he lapse — as who can at all times help it ? — 
 into theories of the " Why," he weakens the directness of 
 observation upon which you must build, if you build securely. 
 Then comes the pathologist on the nature and course of dis- 
 ease, proving it to be mostly but a part of physiology. 
 After these, therapeutics, happily much less encumbered than 
 formerly with a farrago of nostrums, since pathology has 
 taught us that the processes of disease have often a conser- 
 vative tendency, and that frequently our duty is to do no 
 
126 ADDRESSES. 
 
 more than prevent violent interference. When and how we 
 can do more, it is the great objects of therapeutics to point 
 out. Of the study of the practice of medicine and surgery, 
 everything around you here speaks at all times and invites 
 your attention. The several departments of the hospital 
 afford the rarest opportunities for acquaintance with acci- 
 dents and disease in all forms ; and if a knowledge of the 
 practical parts of your profession cannot be gained here, it 
 may be certainly said it cannot be gained elsewhere. 
 
 I look back with pleasure to the time when I had no 
 world but the wards of this hospital, and often regret I am 
 now so separated from them. All the success I have had 
 springs from Guy's, and here are my early and best associa- 
 tions. I cannot, therefore, but feel as one of yourselves. 
 I could wish it were again my lot to work with you, but 
 the time is passed, and younger and stronger hands will 
 direct you, whilst it only remains for me to cordially wish 
 you success. 
 
 Mr. Treasurer, I cannot close this address without publicly 
 acknowledging the great debt which our hospital and school 
 owe to your able and devoted services. I know that you and 
 the governors are deeply convinced that the prosperity of 
 the two are intimately connected. My colleagues equally feel 
 this to be so, and speaking for them, I may confidently 
 assure you that their best energies will be devoted to both. 
 
ADDEESS AS PEESIDENT OF THE 
 SECTION OF MEDICINE 
 
 INTERNATIONAL MEDICAL CONGRESS, LONDON, 
 August 3RD, 1881. 
 
 Gentlemen, Feiends, and Colleagues, — I am deeply sen- 
 sible of the honour conferred upon me in being called upon 
 to preside over this Section, and I offer you my cordial 
 thanks. 
 
 Happily the duties will not be arduous, since the general 
 addresses which have been arranged and admirably allotted, 
 relieve me of the responsibility of attempting to develop 
 before you the actual position of medicine, or the probable 
 lines of its future progress. 
 
 As the International Medical Congress assembles in 
 England for the first time under the auspices of Queen 
 Victoria, so I am reminded that 300 years ago, under Queen 
 Elizabeth, Bacon enunciated for the first time, in the simplest 
 terms, the position of the student of nature in relation to the 
 work before him. 
 
 Prone as we mostly are to easy satisfaction on imperfect 
 evidence, and to rest in the experientia fallax, it is something 
 that we are all agreed, in aim and means, and admit that 
 there is but one source and test of knowledge, " the obser- 
 
128 ADDRESSES. 
 
 vation of the order of nature." We have no principles, but 
 facts ; no eclecticism, but of these ; and nothing touching the 
 conditions of humanity is foreign to our consideration. 
 
 Anatomy, physiology, and pathology have an impersonal 
 and scientific object. Their aim is wide and general. The 
 facts with which they deal are subject to no deflection from 
 affection. Great or small, they have all an equal value. Patho- 
 logy even denies its name in the presence of that which is 
 universal, merges into physiology, and sees that " whatever 
 is, is right." But far otherwise is it with clinical medicine, 
 where the welfare of the individual alone has to be considered. 
 We call ourselves physicians, and cannot be too jealous of 
 the title and of all that it includes ; but we are Medici or 
 curers of disease. Hence, together with the highest duties 
 which science imposes, there are the various personal claims 
 of humanity, augmented by suffering and charged with every 
 disturbing element that weighs upon the heart of man ; but 
 at the same time for us with every high and quickening 
 motive. These are warping influences, and to correct them 
 we have often with effort to bring our clinical questions into 
 relation with that which is impersonal and above passion. 
 
 It is an agreeable fancy on these occasions to suppose that 
 civilisation may have been differentiated into its various 
 nationalities, less for the strife of war than that each nation 
 might contribute, according to its genius, to the progress of 
 the sciences. It may be Utopian to see it thus. Yet a re* 
 view of the past two or three centuries would suggest as much. 
 That scientific congresses have met, and they continue to meet, 
 promise better things to come out of the social chaos — as the 
 imagination realises organisation springing up amidst the 
 strife of the elements in an early world. 
 
 To Italy and the South we owe the early development of 
 anatomy. The illustrious names of Morgagni, Galvani, 
 Scarpa and others, many of whom have left their names for 
 ever inscribed on our textures, bear early and continued 
 witness of this. And although we Englishmen will ever be 
 tenacious of vindicating for our Harvey the immortal honour 
 of having first demonstrated the circulation of the blood, we 
 equally admit that Italy was his teacher of anatomy. And 
 no less did Italy lead the way in morbid anatomy, as testify 
 
ADDRESS AT MEDICAL CONGRESS. 129 
 
 the pages of Morgagni in his treatise ' De Oausis et Sedibus 
 Morborum.' 
 
 To Germany and the North we are largely indebted for 
 analytical progress. Their profound investigations in 
 chemistry, and their exhaustive researches into minute ana- 
 tomy and histology, have gone far to solve the problems of 
 organic composition and organic structure. I will not support 
 my position by citing illustrious names. Happily, many 
 whom I should have to mention are still amongst us ; but 
 biological science will never forget Leauwenhoek and Ehren- 
 berg, or Berzelius and Liebig, nor the labours of the modern 
 schools. 
 
 France, with her rare synthetic faculty, seems specially 
 gifted for promoting the science of physiology. I have but 
 to recall the name of Bichat, and to point to the refined 
 investigations of Bernard and to those of his successors of 
 to-day. And with France I may join Switzerland, whose 
 Haller gave the earliest and strongest impulse to the study 
 ■of the laws of living things as a separate science ; though, 
 as in the case of Harvey, his lamp was lighted abroad, — in 
 the famous school of Leyden. 
 
 The English genius is perhaps more fitted for the 
 Historical method, and its obvious lessons. But perhaps 
 I ought not to say obvious, for not rarely the English 
 have been satisfied with records without inferences. There 
 are, however, splendid instances of both ; of the one in the 
 museum of Hunter, and of the other in the works of Darwin. 
 
 But here you will be ready to exclaim " Siste !" for who 
 in the least acquainted with the progress of the biological 
 sciences in different schools at the present time, would 
 venture to claim for either some special fitness over the rest 
 for any line of pursuit, and when the spirit of each can say 
 like Goethe's Natur-geist — 
 
 " In Lebensfluthen, im Thatensturm 
 Wall ich auf und ab 
 Wehe bin und her ! " 
 
 Some have prophesied that the advancement of the 
 biological sciences will leave medicine a barren waste in 
 their midst; but such a result, in the natural course of 
 
 9 
 
130 ADDRESSES. 
 
 ttings, cannot happen. There is an indissoluble union 
 between all the sciences which, for medicine especially, 
 human interest will ever strengthen. The past history, 
 and the present state of our profession, give us abundant 
 assurance of this. It is not too much to assert that the 
 study of medicine will for all time attract a large proportion 
 of the best thinkers and workers of the world. It has ever 
 been so ; and what has been, doubtless shall be in the time 
 to come. Besides, almost every germ of scientific thought 
 has sprung in some way from medicine ; and I have only to 
 remind you that some of the most illustrious physiologists 
 and pathologists of to-day are members of our own profession. 
 And if from the delicacy, intricacy, and the demands made 
 upon all the powers of the intellect by the extent and 
 character of their investigations, they have as it were turned 
 aside from immediate clinical work, they are still so much 
 in union with us that we daily at the bedside avail ourselves 
 of the results of their labours, and gratefully acknowledge 
 that they are our ministering angels, ascending and descend- 
 ing upon the ladder of science in the furtherance of all good 
 practice. 
 
 Clinical medicine, however, of itself, affords opportunities 
 for the study of pathology which are, in some respects at 
 least, unique. Through it, and through it alone, we become 
 acquainted with the first deviations from normal function. 
 From such early beginnings we may trace the development 
 of pathological processes, until the organism is finally, and 
 in different ways, overwhelmed by them. I need only 
 suggest those chronic lesions which spring up from condi- 
 tions ab intra. In the later stages of these degenerative 
 processes, we are apt, without their history, to be so im- 
 pressed with the more prominent mechanical results, that 
 these would seem to us the original and essential conditions ; 
 as, to the Nile- worshipper, the Eiver is a power in itself. 
 
 It is well for the progress of clinical medicine that its 
 lines of investigation are thus intimately interwoven with 
 the more scientific departments. It saves us from the 
 dangers of Separatism, and our colleagues from those of 
 Pharisaism; and it quickens our observations where they 
 might otherwise be thought insignificant. If we cannot 
 
ADDRESS AT MBDIOAL CONGRESS. 131 
 
 weigh and measure the data before us, we may still advance 
 the solution of some of the more difficult problems of our 
 condition by critical and exact records. How much has 
 been done in this field of late, especially in cerebral physi- 
 ology, need not now be told. Every fact to the clinical 
 physician has its value, though it may be of a different 
 order to the phenomena of gravitation. A tone of the 
 voice, the play of the features, the outline and carriage of 
 the body, are to him as invariably related to the central 
 conditions which they reveal, as are the grosser facts of 
 nature. 
 
 The work of the next few days, so far as it is fore- 
 shadowed by the list of promised papers, will raise some 
 important pathological questions. Tou will be asked to 
 consider peripheral lesions, having their origin in nerve- 
 centres — lesions which have for the most part been hitherto 
 chiefly considered primarily humoral and chemical, but 
 now referred to " trophic changes of nerve-origin." On 
 this point it may be not uninteresting to notice how " Solid- 
 ism " is widely re-asserting itself in the science of living 
 things ; not as an a priori system, but through the pro- 
 gress of knowledge. The proximate conditions of pyrexia 
 are no longer vaguely referred to nerve, but to definite 
 nerve-centres ; hyperemia and inflammatory changes to sym- 
 pathetic lesions ; abnormal chemistry to the great respira- 
 tory centres ; the strange conditions of Addison's disease, 
 with its characteristic pigment, to the supra-renal bodies, 
 themselves probably but nerve-centres, and related, at least 
 by structure, to the system of the pituitary gland ; epilepsy, 
 supposed in Hippocratic times to be due to extraneous male- 
 ficent spiritual influences, is traceable to apparently trifling 
 changes in a few grey nerve-cells. The specific fever pro- 
 cesses notoriously owe much of their character and inten- 
 sity to the nervous system. Their relation to time, their 
 occurrence only in warm-blooded animals, the great mor- 
 tality they cause through nerve-exhaustion, and the immunity 
 they leave behind them, indicate that whatever may be the 
 nature or mode of operation of their several poisons, it is by 
 implication of nerve-elements that fever obtains its chief 
 clinical characteristics. 
 
132 ADDRESSES. 
 
 Further, in the advance of " Solidism," what can interest 
 us more than the recent investigations on Contagia ? Per- 
 haps no more important step has been made in practical patho- 
 logy than the proof that some 1 at least of these contagia are 
 organised solids. This discovery, which it has tried the 
 patience, experimental skill, and scientific criticism of the best 
 observers to establish, has brought us at length within view 
 of that which has hitherto been so mysterious. To have been 
 able to separate, though imperfectly, the contagious particles ; 
 to have come to the conclusion that no fever-poisons are soluble 
 — is a hopeful preliminary towards forcing them to yield up 
 the secret of their nature. 
 
 If " Solidism" as a theory of organic processes wanted con- 
 firmation, we could point to nothing more striking than the 
 present established views on putrefactive changes ; and to the 
 amazing fact that the normal textures and fluids of the 
 body resist decomposition unless invaded by microscopic 
 organisms. 
 
 May we not hereafter find that all organic chemistry is 
 the resultant of mechanical changes in organic solids ? — all 
 nature, in fact, as Newton asserted mechanical, but the Great 
 First Cause ? Of this we are admonished on all sides. His- 
 tology, physiology, pathology, clinical medicine, teach us 
 more and more the supreme importance oiform and relation. 
 
 Lesions extending from alteration of the blood-vessels 
 will also come under consideration. Of course the more 
 common facts relating to aneurism and valvular disease, or 
 such as are thrombolic or embolic, need not be discussed j 
 but there is a contribution which raises the question how 
 far primary general arterial tension may be a starting-point 
 at least in renal pathology. 
 
 The aetiology of typhoid fever will be raised at one of 
 our meetings. This cannot but enforce a rigid criticism of 
 the infective processes, and of the differences between the 
 states of simple pyrexia, septiceemia, and the specific fevers. 
 
 The pathology and treatment of gout, rheumatoid 
 arthritis, and rheumatism, to which, in one form or 
 another, the English seem rather especially prone, will also 
 come up for discussion. Whether they have humoral 
 sources has of late become more and more doubtful. 
 
ADDBESS AT MEDICAL CONGRESS. 133 
 
 Of the pathology of acute rheumatism we may be said 
 to know but little beyond its clinical records and its sym- 
 ptoms ; but unhappily this has not always been sufficiently 
 recognised, and too often a dangerous poly-pharmacy has 
 rushed in to the cure where science has not yet advanced 
 her foot. 
 
 The forms of renal diseases, for a long time included, 
 with little exception, under the term " Bright's disease," 
 will undergo a further degree of analysis. It was a happy 
 omen of this when they moved from the singular into the 
 plural form, " Bright's diseases ; " and we may hope now 
 for a more methodical subdivision of them, making their 
 clinical recognition more easy, and their therapeutics more 
 precise. 
 
 In the matter of diagnosis we have invited contributions 
 on the pathognomonic and diagnostic value of the localisation 
 of disease in the brain and spinal cord, which will be an 
 occasion for a review of our knowledge of cerebral and 
 spinal mechanism, and for further elucidating the pathology 
 of the different conditions of blood, blood-vessels, and con- 
 nective tissue concerned in the nutrition and diseases of 
 these great nerve-centres. Brain-texture proper seems but 
 little liable to primary disease. As the nervous lamina 
 takes the lead in embryonic evolution, so it would seem that 
 its equivalent in the adult maintains a degree of resistance 
 to morbid change throughout life. 
 
 Time fails me to speak of all that we hope to undertake. 
 Any one paragraph of our programme would more than 
 consume the time at our disposal. It must not therefore 
 be inferred that the importance attached to any one of the 
 subjects is in proportion to the prominence given to it in 
 this hasty review. The treatment of disease, for instance, 
 is a subject too large and weighty to speak of in general 
 terms. In some minor points it will come before us, as in 
 a paper on the advantage of high altitudes in the treatment 
 of pulmonary phthisis. 
 
 An organisation such as our own, which it has taken 
 countless ages to evolve, must reasonably require incalcul- 
 able time for its scientific analysis ; and the same may be 
 said of the infinite and varying conditions by which it is 
 
134 ADDEESSES. 
 
 maintained, and upon which its existence constantly and 
 immediately depends. At best we know but a few proxi- 
 mate facts, yet these in judicious hands have afforded a 
 good harvest of practical results : what better fruit we may 
 gather when science has penetrated deeper into the laws of 
 our being, and all that affects it, it is impossible to forecast. 
 In the spirit of the exhortation given by the President in 
 his address to-day, and in the slightly altered words of 
 Bacon, with whom I began, let me conclude by saying, 
 " It were a heaven upon earth to have the mind illumined 
 by Knowledge, to move in Charity, and turn upon the poles 
 of Truth." 
 
THE 
 
 COLLECTIVE INVESTIGATION OF DISEASE. 1 
 
 Me. Pbesident and Gentlemen, — When invited by your 
 President and the Council of the Metropolitan Branch of 
 the British Medical Association to address this meeting on 
 the Collective Investigation of Disease, I gladly accepted 
 the honour of the invitation, since the whole sympathies of 
 my life are in the direction of this movement. 
 
 After the admirable addresses made in different parts of 
 the country on this subject, first at Chester by the late 
 Dr. Hughes Bennett, Dr. Waters, and Dr. Ransome, then 
 at. Cambridge by Professor Humphry and Dr. Mahomed, 
 and lately at Birmingham by Dr. Foster, Mr. Macnamara, 
 Professor Haycraft and others, though I cannot hope to 
 present this matter in any new aspect, or to add anything 
 to the arguments in favour of it, still I am glad of an 
 opportunity, in conjunction with Sir James Paget and others 
 on this occasion, to take part in promoting what promises 
 to be of so much advantage both to the public and the 
 profession. 
 
 This meeting may be considered as a supplement, though 
 it is but accidentally so, to the Bradshawe Lecture, given a 
 month ago at the Boyal College of Surgeons by Sir James 
 Paget, in which he endeavoured to draw the mind of the 
 profession into new lines of pathological inquiry, and to 
 
 1 An Address delivered before the Metropolitan Counties Branch of the 
 British Medical Association. 
 
136 ADDRESSES. 
 
 consolidate the results by the formation and extension of 
 museums of morbid anatomy. 
 
 Now, although morbid anatomy is at an immeasurable 
 distance from a great part of medical pathology, as physio- 
 logy is a distinct science from anatomy, still both are built 
 on anatomy. Without morbid anatomy our work would be 
 foundationless and in the air. Nevertheless, my object 
 to-night is to direct your attention to, and to enlist your 
 services in the investigation of a region of facts, which in 
 large part at least lies at a far distance from the gross 
 mechanical terminations of disease as they come before us 
 in the post-mortem room. And although the hoped-for 
 gains of this collective investigation movement may not be 
 such as to admit of being labelled and placed on the shelves 
 of a museum, they will serve to throw a new light on what 
 is already placed there, and will at least help us to a better 
 knowledge and practice of our profession. 
 
 You will admit that a migraine headache ; an attack of 
 asthma from the smell or sight of some particular object > 
 the troubles of digestion from mental work and anxiety ; 
 the special liabilities to disease of certain families, and the 
 cloud of small ailments which often make life intolerable, 
 though having no morbid anatomy, deserve a more exact 
 study than they have yet obtained, whether for the satis- 
 faction of the intellect, or for the latent pathological mean- 
 ing they may convey to us ; and especially, further, that 
 when we have learned to question nature we find she has 
 much more to tell us, even on trifles, than we had expected. 
 
 The idea of a collective investigation of diseases, in 
 which every member of the medical body shall have his 
 effective part, though obviously not to be realised at once, 
 not indeed until the sun of science, which is the true Apollo 
 of Medicine, has risen far higher in our sky than now, is 
 yet one that at once challenges our ready and best efforts 
 for its realisation. 
 
 Whilst the morbid anatomist is engaged in our hospitals 
 and medical schools in demonstrating the effects of disease 
 on the several organs and tissues of the body, we desire 
 that all the practising members of the profession over the 
 country, in the colonies and in other parts of the world, 
 
THE COLLECTIVE INVESTIGATION OF DISEASE. 137 
 
 should assist in the inquiry as to the origin of diseases : — 
 their early symptoms ; their mode of spreading in families ; 
 their combinations ; the causes of their intensity ; their 
 modifications in individuals, in families ; their occurrence 
 according to time of year, locality, sanitary conditions, 
 occupations, and many other circumstances, some as yet but 
 dimly discerned, and others not yet suspected. The value 
 of this movement will, I believe, be obvious to all after but 
 little consideration, for it will be admitted that had we 
 leisure, proper means at our disposal, and, from previous 
 training, a fitness for exact observation, we should find in 
 general practice one of the most valuable fields of pathology, 
 as here and here only we have before us the earliest signs 
 of departure from health, and the only opportunities for 
 tracing the course of a disease from its beginning to its end. 
 Having passed many years in hospital and private practice, 
 I have come to see that experience gained in the latter is 
 necessary for the correction of that acquired in the former, 
 and especially as helping towards a truer pathology of cases. 
 In hospitals we have more largely to do with organic 
 lesions, with isolated cases of acute inflammations or developed 
 fevers, and in all with an incomplete personal history and 
 without any family record. We cannot thus learn with any 
 exactness either the beginnings or endings of disease. 
 Patients come under observation with their maladies far 
 advanced, and they often pass from observation but im- 
 perfectly cured, thus leaving fallacious histories both in 
 pathology and therapeutics : and if they die, morbid anatomy 
 can often give but a confused and inextricable mass of facts, 
 which it may be difficult or impossible to put into their 
 true relations. One might as well hope to determine the 
 physical geography of a country, by measuring and analysing 
 the contents of its rivers as they fall into the sea, as to 
 reach a true pathology from studying alone the results of 
 disease on the post-mortem table. Let it, however, be 
 remembered that we still insist upon the fundamental 
 necessity of morbid anatomy as the only basis of true ad- 
 vancement. I am glad, therefore, to be informed by Dr. 
 Mahomed that it is in contemplation to associate paid patho- 
 logical experts and morbid anatomists with this movement. 
 
138 ADDRESSES. 
 
 By such means alone can we make our results permanent 
 stepping-stones for those who follow us. 
 
 As a passing illustration of what is here insisted upon 
 respecting the relation of pathology to morbid anatomy, 
 and as indicating what we may expect from wider research, 
 pardon me if for a moment I refer to renal diseases. One 
 of our recent and best writers on the subject concludes by 
 expressing his conviction that " there is but one Bright' s 
 disease ;" this honoured name of Bright defining a state 
 found after death, and fixed upon as the battle-ground of 
 renal pathology — and I see that the latest statement of to- 
 day, drawn from experiments on animals, is to the effect that 
 destructive changes in the kidneys have but one form and 
 lead to but one result in the tissues of these organs. 
 
 I appeal, however, with some confidence to our present 
 limited experience in general practice, and with more to 
 that wider experience which will be gained by collective 
 investigation, whether there are not to be found quite 
 different beginnings, quite different courses, and conditions 
 requiring quite different therapeutics for that which in the 
 ^post-mortem room is regarded but as one pathological state. 
 
 In disease one stream of morbid action naturally falls 
 into another, and whilst morbid anatomy gives us the final 
 synthesis of results, there is but one possible means of 
 analysis, and that through noting beginning, order, and 
 progress. Diseases are apt to so far assimilate as to become 
 much alike towards death. 
 
 Believing as I do that more than we dare now expect 
 will grow out of collective investigation, we must not be 
 over-sanguine as to its immediate fruits. The essentials 
 for success are not only the numbers but the intellectual 
 organisation of the movement. If we aspire to have the 
 arms of Briareus, we shall need the eyes of Argus ; for 
 Nature is very much a Sphinx, answering no question 
 put to her if it be open to evasion, — yet truth lies on the 
 surface if we had minds free from prejudice to see it. 
 
 The plan of this movement at present is to draw up 
 memoranda on the several subjects for inquiry, and to issue 
 with these cards of questions to be answered. Already 
 such and important memoranda have been issued on acute 
 
THE COLLECTIVE INVESTIGATION OP DISEASE. 139 
 
 rheumatism by Drs. Goodharfc and Barlow ; on acute 
 pneumonia by Drs. Sturges and Coupland ; on inherited 
 and acquired syphilis by Mr. Macnamara and Dr. Barlow ; 
 on diphtheria by Mr. Shirley Murphy ; and questions on the 
 evidence of the contagion of phthisis by Dr. Burney Teo. 
 This plan leaves nothing to be desired. 
 
 Nothing can be more useful and instructive than such 
 memoranda. When extended over the whole range of medi- 
 cine, they will place before the practising members of the 
 profession in every locality, more or less succinctly, the 
 state of our knowledge on the different subjects proposed 
 for inquiry, and they will, whilst they indicate what we 
 want to know, inform us of our ignorance on the various 
 subjects. 
 
 The main difficulty lies in properly formulating the ques- 
 tions to accompany the memoranda. They must of necessity 
 be so simple, pointed, and incisive as to admit of no vague 
 answers. This, without saying it, calls for a great amount 
 of knowledge and intellectual combination, and no slight 
 mental perception ; for rightly to ask questions of nature is 
 the highest science of the intellect. 
 
 This is, indeed, the vital centre of the whole movement. 
 If the committees issue for any inquiry a definite question, 
 and that being settled, follow it up by another, and so on in 
 series, nature must at last be driven into a corner, and be 
 obliged to say " Yes " or " No." 
 
 If it be that truth is hidden in nature as a stimulus to 
 the intellect in the general pursuit of knowledge, to us this 
 obscurity of things has a double meaning where duty and 
 interest come in to urge forward the pursuit. 
 
 And here we ought to remind ourselves that if there is an 
 experience which teaches, there is a much larger experience 
 which is fallacious. Hippocrates rightly begins his aphor- 
 isms with this reminder. 
 
 Numbers without perfect organisation can effect but little 
 or nothing. We require not only the fulcra of ascertained 
 facts upon which to base our movement, but such intellectual 
 combinations and direction of effort as is in a manner required 
 in mechanics. If, says Bacon, men had attempted mechani- 
 cal labours with their hands alone, and without the power 
 
140 ADDRESSES. 
 
 and aid of instruments, as they have not hesitated to carry on 
 the labours of their understanding with the unaided efforts 
 of their minds, they would have been able to move and over- 
 come but little, though they had exerted their utmost and 
 united powers. Tet men, he adds, are hurried on by senseless 
 energy and useless combinations in intellectual matters, 
 as long as they expect great results either from the number 
 and agreement or the excellence and acuteness of their wits. 
 
 And we may add, that as great mechanical results can- 
 not be obtained without engines framed by the wit and 
 hands of many men, neither can a knowledge of such facts 
 as we have to deal with be attained without an exact men- 
 tal and numerical combination of the members of our pro- 
 fession. 
 
 It will perhaps be objected, and naturally, that it is 
 almost impossible to organise for any useful purpose the 
 labours of men already overburdened by the cares and 
 fatigue of practice, and that there is neither time nor fitness 
 for delicate inquiries on their part. Admitting that this 
 objection is valid, it may be urged in reply that it need not 
 be insuperable ; that if this movement makes some demand 
 upon the busy practitioner, he will (as remarked by Mr. 
 Macnamara in his speech on this subject at Birmingham) 
 in proportion to the help he affords in carrying on this work 
 successfully, receive back quite as much as he gives ; that 
 further, it cannot be denied that when we see the meaning 
 of the apparent trifles which in practice would otherwise 
 oppress and worry us, our burden is thereby much light- 
 ened, and that nothing could encourage us more than to 
 feel that even one daily observation recorded was adding to 
 our general store of knowledge and making the path of 
 practice more easy. There is no tonic to the mind greater 
 than the sense of work done ; and our journey is likely to 
 be made shorter, as it certainly will be easier, if the way is 
 illuminated. 
 
 We, indeed, owe it to those members of our profession 
 who are admittedly overwhelmed by the apparently sense- 
 less details of their work, to promote a movement like this, 
 the object of which is to bring order into their chaos, and 
 to help them to stamp a scientific value upon facts hitherto 
 
THE COLLECTIVE INVESTIGATION OF DISEASE. 141 
 
 only burdensome. If we compare the unflagging interest 
 of any pursuit where the aim is high and clear, with the 
 tediousness and wearisomeness felt when working in the 
 dark, we shall readily admit that we are actually lightening 
 the burdens of practice by thus adding to them, and by 
 giving some portion of them a sense and meaning. 
 
 It is the spirit of a man which enables him to do his 
 work lightly and cheerfully, and he will certainly be helped 
 in this by a combination with fellow-workers on the same 
 subject. 
 
 There is, however, a further consideration which should 
 weigh with the practising members of our profession ; this 
 combination for the purpose of extending medical knowledge 
 is an important duty in itself to all concerned. For, how- 
 ever slowly and at first imperfectly such a combination may 
 operate, the smallest progress is a great gain to society and 
 to our profession, and if favoured as it plainly claims to be 
 by all the members of it, and helped by the efforts of our 
 best minds, it cannot but in the course of time lead on from 
 what is now but dawn to daylight. 
 
 As to the objection on the score of fitness, if this were 
 urged as an argument against this movement, it would 
 stand self-condemned on every ground ; for if the members 
 of our profession are unfit to observe, they are largely unfit 
 to practise. Probably not so much as this is meant when it 
 is said that the working members of the profession cannot 
 help us, but rather that until the special workers in the 
 sciences of physiology and pathology have made more 
 advance, it would be useless for untrained practitioners to 
 attempt anything novel. 
 
 But we believe this to be one of the fallacies of the day, 
 and one of the causes which retard the progress of practical 
 medicine. 
 
 Without in any degree depreciating the more recondite 
 study of physiology and pathology, whilst indeed hailing 
 with thankfulness the light such studies give us, and 
 honouring those who in that behalf work for us, we may 
 fairly maintain that we have been too indifferent to the 
 value of the facts which lie nearest to us in our daily work. 
 The feeling that only experts in science can do anything, 
 
142 ADDRESSES. 
 
 and that we must wait until they, from their centre, move 
 us, or we shall not move successfully, is only partially 
 true. 
 
 To say that this Association is beginning at the wrong 
 end, is to misapprehend how knowledge is gained. The 
 history of medicine is in our favour. We do not wait to 
 discuss the nature of sensation, and how it is that the 
 peritoneum is painful in inflammation, before we give 
 opium for its relief. Currie proved the use of cold affusion 
 in fever, more than half a century before physiologists 
 began to suspect that there was a nerve-centre in the cord 
 for controlling animal heat, and as yet they have not 
 taught us specially how to utilise their discovery. We 
 have long known the curative effects of quinine in ague, 
 though physiologists have not yet determined the operation 
 of the miasm-organisms which are present, and may give 
 rise to this disease. Laennec developed his method of 
 physical examination of the chest, on the commonest and 
 nearest principles. All practice obviously lies in a know- 
 ledge of proximate facts, and it is equally obvious that that 
 practice will be the most guarded and exact, which is guided 
 by a knowledge of all the facts, both near and remote ; 
 still we are not to esteem lightly that which is near because 
 we are ignorant of that which is remote. It is good know- 
 ledge to have learned that fire burns and water wets ; 
 though obviously it is much better knowledge to know all 
 the facts of combustion and wetting ; the combinations ; 
 the oxidations ; the adhesions ; the capillary attractions ; 
 the amalgamations ; the endosmoses ; the exosmoses ; and 
 the many other molecular changes which attend these pro- 
 cesses. 
 
 It would appear to be one of the faults of the medical 
 education of to-day, which this movement may in some 
 degree correct, to lay undue weight upon ultimate facts, 
 whilst we neglect those which are near ; to indoctrinate the 
 student with the belief that if he can run off upon his 
 fingers the supposed ultimate constitution of the gastric 
 juice (about which we are still very ignorant), that he has 
 learned something respecting the digestive process, or that 
 by reciting the atomic composition of an organic substance 
 
THE COLLECTIVE INVESTIGATION OP DISEASE. 143 
 
 as muscle, lie has learned something about it, though, 
 indeed, nothing but what appertains equally to mere dead 
 substance. 
 
 It will not be the least valuable result of this movement, 
 if it correct our prejudices in these matters ; and hence it 
 has already been well observed that one of the effects will 
 be educational on the whole profession, from the youngest 
 student to the oldest practitioner, and, further, will quicken 
 and keep alive a sense of docility, the want of which is 
 the cause of that confirmed prejudice which we often call 
 experience, and which blocks the way of progress. 
 
 If the eye sees no more than it brings with it the power 
 to see, then any objection against fitness must be met 
 by the several committees of the Association, when they 
 issue their questions, by accompanying them with such 
 memoranda as may instruct the working members in the 
 way of observation in any particular direction. 
 
 We, of all men, ought to be the last to be discouraged 
 by the small promise of beginnings. Had we been present 
 at the dawn of organic life, we should hardly have predicted 
 its wonderful processes as seen in past and present times. 
 
 This collective investigation has been started on the 
 principle of giving significance to what has hitherto been 
 neglected ; it would therefore be directly contrary to the 
 animus of the movement if we underrated the power and 
 probable success of efforts which may at first produce but 
 little fruit. 
 
 The first intention of the Association respecting this 
 movement was to obtain a better notification and more 
 complete statistics of disease ; and this was carried out to 
 some extent by Dr. Kansome in Lancashire and Cheshire, 
 but apparently not much came of it. The present form of 
 the movement is chiefly due to Dr. Mahomed and to the 
 advocacy of Professor Humphry at Cambridge in 1880, and 
 subsequently to the meeting lately held at Birmingham. 
 
 Fifty-four committees have been already organised, one of 
 the branches having six committees, and another four. These 
 committees include from eight hundred to one thousand of 
 the chief practitioners in England, Scotland, and Ireland, 
 already pledged to the work, Dr. Mahomed acting as 
 
144 ADDRESSES. 
 
 honorary secretary to the whole, and who may be called its 
 moving spirit. 
 
 It is not my province on this occasion to indicate 
 specially what should be the subjects for inquiry, or to 
 discuss the memoranda which should be issued upon them, 
 but I may perhaps be permitted to refer to the subject 
 generally. 
 
 For instance, on the contagiousness of phthisis a pre- 
 liminary difficulty occurs as to what is meant by phthisis. 
 Does the term include all the cases of destructive pneumonic 
 changes beginning from the apex, or only those of a dis- 
 tinctly tubercular type, cases beginning acutely with fever 
 and haemoptysis, and ending fatally in a few weeks, and 
 others with pleurisy or bronchitis, and lasting perhaps 
 twenty years, or only those springing up without much 
 observation until the infiltration of the lung is far advanced ? 
 To properly distinguish the cases will be an affair of much 
 difficulty, since they approach from various points and 
 intermingle inextricably. If the evidence of the com- 
 municability of phthisis should appear to gain force by 
 extended inquiry, it will then obviously be necessary to 
 determine with more than common accuracy in which form 
 of phthisis this communicability occurs. If only in the 
 more chronic forms, then whether the phthisis of old age 
 is to be classified in this respect with the phthisis of the 
 young. 
 
 It is plain that if in this movement of collective research 
 we see a land of promise lies before us, we must at the same 
 time recognise that the way to it is by a narrow and danger- 
 ous path. For whilst truth must be accepted when it is 
 proved to be such, nothing will be more pernicious than 
 false conclusions and partial truth sanctioned by so large a 
 body as this. The opinions of a single individual would 
 have less weight, and would take longer to permeate a pro- 
 fession, than conclusions having the colour of authority. 
 Error would be perpetuated by numbers interested in the 
 fallacy. 
 
 Assuming, again, respecting this question of the com- 
 municability of phthisis, that the presence of bacteria in 
 the expectoration is characteristic of the disease at a given 
 
THE COLLECTIVE INVESTIGATION OP DISEASE. 145 
 
 stage, we should then have to determine whether they were 
 present at all stages, and whether the phthisis bacterium 
 received its specific form from the exudation in which it 
 was found, or whether its presence determined the specific 
 form of the exudation. The fallacy of putting effect for 
 cause is here imminent, and families might be broken up 
 and society much alarmed by conclusions having but little 
 foundation. 
 
 As genealogical trees, showing the rise and extension of 
 families, with their many collateral branches and inter- 
 marriages, are found in great houses, and are regarded with 
 pride and veneration ; so we could wish that in a like 
 manner life-histories were found in every family, showing 
 the health and diseases of its different members. We 
 might thus in time find evidence of pathological connec- 
 tions and morbid liabilities not now suspected : and we 
 might discover means of prevention by a better knowledge 
 of the origin and extension of maladies through blood- 
 relation. The proposal of constructing such family life- 
 histories is an important part of this scheme of collective 
 research, and more would certainly be gained socially by 
 the genealogies of health and disease, their connections and 
 causes, and by tracing the strength of the strong as well as 
 the ailments of the weak in a family, than from such barren 
 histories as I have referred to, which tell only of inherited 
 fame, but do not indicate the way to perpetuate and aug- 
 ment the inhei'itance. Unfortunately there is a feeling of 
 safety in ignorance, and there prevails in us a sort of blind 
 superstition, a survival of the darkest ages of man, which 
 makes us think that there is a kind of religious trust in not 
 seeking too minutely into the ways of life, as if the intellect 
 of man were the servant of impiety rather than as it is — the 
 handmaid of all that is good to us. Again, there is another 
 hindrance to our obtaining all we want in this matter of 
 family history : " all men think all men mortal but them- 
 selves," and there is a half-conscious sense of shame in 
 admitting any liability to human frailties. This weakness 
 makes it very difficult to obtain the truth we want, though 
 we may well excuse it and believe it to be an instinctive 
 tribute to the righteousness of Nature's laws, and an 
 
 10 
 
146 ADDEESSES. 
 
 unconfessed confession that many of our diseases are due to 
 our own fault, and ought to have been prevented, as we 
 trust they will be, through this movement, in the course of 
 time. 
 
 This matter of life-histories is no new subject, though it 
 is one to which this Association especially wishes to give a 
 new impetus. All practitioners of large experience would 
 be able to tell us something concerning the associated 
 occurrence of diseases in families which are not generally 
 supposed to have any connection between them. Dr. 
 Cheyne, in his article on " Epilepsy " in the ' Cyclopaedia 
 of Practical Medicine,' says we conceive that epilepsy is as 
 certain a manifestation of the strumous diathesis, as tuber- 
 cular consumption, psoas abscess, &c. Now it is of course 
 not to be maintained that tubercular disease and epilepsy 
 are one state ; but it does not seem improbable that 
 diseases from hereditary defects of organisation may evince 
 themselves in most different ways, and that there may be a 
 common underlying bond of pathology between them. No 
 advance of our knowledge on these and many similar points 
 can be made through morbid anatomy. It is only through 
 family life-histories that the subject can be studied. Such 
 histories, incomplete as they now are, are often of great use 
 in practice. Take, for instance, the anaemia and languor so 
 much complained of in the girls of a family. Though, of 
 course, such ailments are often due to the want of physical 
 and intellectual training, they are by no means altogether 
 so ; and certainly the most difficult and intractable of them 
 are not to be so explained. 
 
 We must in many instances have the life-histories of 
 the parents or more remote ancestors, before we can fully 
 unravel the causes of irregular menstruation, hysteria, 
 anorexia, uterine flexions, and the like. And the same line 
 of inquiry applies to the headache, pallor, dyspepsia, and 
 seminal hypochondriasis of the males of such families. 
 Further, take another example in acute rheumatism, upon 
 which a memorandum and questions are already before the 
 Association. The hereditary transmission of the rheumatic 
 diathesis, its occurrence in intra-uterine life (as appears to 
 be shown by some of the congenital cardiac malformations), 
 
THE COLLECTIVE INVESTIGATION OF DISEASE. 147 
 
 and its association with other diseases prevailing in the same 
 family, throw a light on its pathology not be gained at the 
 bedside or in the post-mortem room. 
 
 Life-histories, as Sir James Paget pointed out in his 
 Bradshawe Lecture, would give us the genesis of new and 
 rare forms of lesion ; I hope I may add they would also 
 show how the organic laws, favoured through generations, 
 prevail over and wear out disease from the stock. 
 
 Again, if I may be allowed to refer once more to the 
 still vexed question of the pathology of the contracted 
 kidney and its relation to cardio-vascular changes, my friend 
 Dr. Sutton and myself believe that it is only by a careful 
 record of the life-histories of such cases that the matter can 
 be settled. We believe it will then appear that the same 
 pathological tendency in the arterioles may give rise to 
 lesions in various parts and not in the kidneys only — to a 
 retinal apoplexy in one, a cerebral apoplexy in another, to 
 chronic changes in the cord or brain and cord in a third, to 
 contraction of the kidneys in a fourth, and in all to muscu- 
 lar changes in the heart. 
 
 Family life-histories would show whether it be true or not 
 that the ailments of childhood and age — eczema, bronchitis, 
 diarrhoea, &c. — have a parallelism in their pathology. Cer- 
 tain it is, they have much in common as to their occurrence. 
 In old age these ailments are called gouty, and in infancy 
 and childhood catarrhal. It would be a point gained, if it 
 were cleared up, whether in fact childhood is as gouty as 
 age ; or whether the word gouty, as applied to the diseases 
 of the latter period, has any actual pathological value or not. 
 If an old man's urine deposits largely crystals of uric acid, 
 whether he be distinctly gouty or not, we refer it to that 
 state j though such deposits are as frequent in infancy and 
 childhood ; the uric acid is the chief component in the urine 
 of many creatures lower than man. Varied and numerous 
 family life-histories might place on a surer basis our know- 
 ledge in this and a thousand matters. 
 
 Take the inquiries of to-day respecting infectious diseases 
 and the increasing evidence that such states are due to agents 
 which we may hope to fix and analyse. These, if ever com- 
 pleted, will still leave untouched a vital question in the 
 
148 ADDEESSES. 
 
 solution of which this collective research will have to take an 
 important or if not isolated part ; — I mean how it is that 
 the same poison acts with such varying intensity in different 
 families ; in some the organism breaking down at almost the 
 first touching of a poison ; others suffering but little, and 
 others having almost or altogether immunity. Does this 
 depend upon certain family peculiarities, and if so, what ? 
 Does the immunity come from ancestors having passed 
 through the ordeal, as occurs to the individual in vaccination 
 and syphilisation ? Family histories will show us how far 
 these immunities and susceptibilities extend ; and with what 
 peculiarities of the nervous system they are associated, and 
 how acquired. Allied to this inquiry is also that of the 
 action of endemic poisons upon the new-comers into a dis- 
 trict ; at which I can only glance. 
 
 In the early part of this address I asserted that collective 
 research would give a new colour and meaning to many 
 ailments, and show their relations to later organic changes ; 
 and I will conclude what I have to say by referring to a set 
 of ailments which very largely claims the attention of the 
 practitioner, and a fuller investigation — I mean a set of 
 cases whose life is nothing but ailment. Their physiology, 
 if I may so express it, is a state of pathology. Their nervous 
 systems are so sensitive, and their digestions so feeble, 
 that they know nothing of that satisfactory resistance to 
 disturbing causes from without which we call health ; and 
 who often suffer as much from futile attempts to cure 
 them, as from their congenital defects. 
 
 These cases supply a constant " clientelle," and I can 
 hardly say how much we should add to the happiness of 
 mankind by a better understanding of them. Of course I 
 exclude those dilettanti malades imaginaires who may be 
 said to enjoy bad health, whilst the class of cases to which 
 I refer of right claim our greatest sympathy. 
 
 But I feel that I must not longer tax your patience. 
 From the nature of the case it would be impossible to 
 indicate, even in a cursory way, the many bearings which 
 this collective research may take. One thing is certain : 
 every question settled will but open another, and give 
 renewed encouragement for fresh exertions. In all its 
 
THE COLLECTIVE INVESTIGATION OF DISEASE. 149 
 
 aspects this project set on foot by the British Medical 
 Association cannot but advance the highest interests of our 
 profession, and the more surely in proportion as it extends 
 our knowledge of the prevention and cure of disease. 
 
 This is the age of combinations, but I know of none 
 which has a purer object than this of collective research, 
 whose purpose is the investigation of truth for the good 
 of man. 
 
THE INTERNATIONAL COLLECTIVE 
 INVESTIGATION OE DISEASE. 1 
 
 Gentlemen, Fkiends, and Colleagues, — I esteem it a 
 great honour to be deputed to address you on this occasion, 
 and on a matter which promises to contribute to the ad- 
 vancement of medical knowledge by a wider and fuller 
 method than has yet been sufficiently attempted. 
 
 The subject of my address is the institution of an Inter- 
 national Collective Investigation of Disease. This object, 
 I need not say, is intimately connected with the main pur- 
 pose of these Congresses, if not indeed in the natural course 
 of things an integral part of them. At present we come 
 together as individual cultivators and practitioners of 
 medical science, each contributing his quota to our know- 
 ledge on this or that subject which may or may not have 
 been selected for thesis and discussion beforehand. Nor 
 are our labours, even under these conditions, without excel- 
 lent results. But a feeling is growing and already wide- 
 spread, that by a more organised combination, a more 
 intimate and better co-operation, not only the members of 
 these Congresses, but all the working members of our 
 profession throughout the civilised world, might sooner or 
 later be organised into a body of fellow-workers, associated 
 for collecting information on medical questions over the 
 widest area. 
 
 1 An Address on the formation of a Committee for the International 
 Collective Investigation of Disease, delivered at the Medical Congress, 
 Copenhagen, August, 1884. 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OP DISEASE. 151 
 
 There is perhaps no profession which enforces npon its 
 individual members so strongly as does medicine the 
 necessity of continued observation and intellectual cultiva- 
 tion ; and there is no means by which this cultivation can 
 be so well promoted as by meetings like the present, and 
 by the active organisations in the form of committees or 
 sub-committees which we hope and anticipate may spring 
 from them. 
 
 The human intellect in its single and separate operation 
 may produce wonderful results. Yet isolated as a man 
 may seem to be in the intellectual labour which occupies 
 him, he makes but little progress apart from the aid and 
 co-operation of other minds which have worked and are 
 working in the same direction. And though doubtless it 
 will always be the privilege of the highest intelligences to 
 clear the boundaries of knowledge, and to throw the rays 
 of their genius into the surrounding darkness, yet all must 
 be agreed on the great and almost supreme value of the 
 intellectual co-operation of less gifted minds in the simple 
 observation of facts, and especially when the needed facts 
 are scattered over a wide field. 
 
 However much apart, as I say, a man may seem in the 
 work of his intellect, he is really much less so than he 
 seems to be ; for as we cannot refer the strength of our bodies 
 to any particular food that we have taken, so neither can we 
 track the thoughts of our minds to the sources whence they 
 may have been fed ; and if our social nature has been 
 raised from savagery to civilisation by social combinations, 
 it is even more necessary that our intellectual nature should 
 be helped in its growth and nurture by such intercourse 
 and association as are here presented, and which we now 
 propose further to advance. 
 
 Our great countryman, Bacon, has not generally been 
 well received in the school of German philosophy, so that I 
 must use some caution in citing him in favour of intellectual 
 combinations in pursuit of the sciences. Still, on thinking 
 over the bearings of Collective Investigation of Disease, I 
 could not but feel that although three centuries have elapsed 
 since he broached this question, and little has been done in 
 it since, we might be about to realise his idea of a Novum 
 
152 . ADDRESSES. 
 
 Organon, the formation of a New Intellectual Machine for 
 removing and overcoming the obstacles to our medical 
 progress. 
 
 The purpose we have before us is no less than this, to 
 enlarge and methodise intellectual co-operation, whereby 
 not only the active, but the at present inactive, faculties of 
 observation of the wide-spread members of our profession 
 may be combined into one or more lines of energy. I am 
 not unmindful how much this pre-supposes ; how it assumes 
 the combination of exact observation and record, with 
 refined criticism and analysis ; how it demands the highest 
 scientific perception, with the humble collection of the 
 meanest facts ; — how, in fine, it means the development of 
 intellectual combination into many forms of organisation 
 which should be not one but many instruments of research. 
 Such a forecast may perhaps lead us to exclaim : " Who is 
 sufficient for these things ? " Yet happily the answer is 
 near : Time, though short for the individual, is inexhaust- 
 ible in the race ; the intellect is in its infancy ; its powers 
 of growth unexhausted, and to these in their evolution 
 there appears to be no limit. The work to be done is 
 unchangeable ; and there are eager and willing workers in 
 all lands, who only need encouragement and direction of 
 the master-minds of medical science to set them to work. 
 
 Happily the phenomena which demand our investigation, 
 though complicated and transient, are, it need not be said, 
 the result of unchangeable laws. The capriciousness of 
 Nature, as we speak of it, is but the weakness of our own 
 sense and understanding ; and its so-called mystery and 
 obscurity, but the darkness in ourselves. 
 
 The physiologist and the pathologist have to admit that 
 not even in the caprices of man is there capriciousness; 
 that mental caprices have their organic basis ; that the 
 whims, the fancies, and the prejudices of the human mind, 
 not less than the changing activities of the functions of his 
 body, or the revolution of the earth on which he lives, are 
 but the resultants of unvarying laws, unchangeable as the 
 fixity of the stars on which he gazes with wonder and 
 admiration. 
 
 We may therefore have this encouragement, that when 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OE DISEASE. 153 
 
 any of our work is done, however small and trifling it may 
 seem, it is done and settled for all time, or at least so long 
 as the laws of organisation remain what they are ; that the 
 clearing of a fact in respect of disease will remain an im- 
 perishable inheritance of knowledge to those who follow us, 
 so long as there is disease in the world. We may support 
 our labours, therefore, with a feeling of surety that the 
 problem before us is a settled problem, however difficult its 
 solution. Nature will not delude us, however much we may 
 delude ourselves. 
 
 A superficial survey of the sections of this Congress 
 shows that the student of medicine occupies an unique 
 position in the pursuit of knowledge. For instance, if I 
 turn the leaves of the programme, I find that the Section of 
 Anatomy invites attention to cell-nucleus and cell-division, 
 the lowest unit of organisation ; and the Section of 
 Psychiatria to the psychic-epileptic equivalent, which, as 
 no one will deny, stretches to the other pole of knowledge ; 
 hence, surely no man more needs to lay hold of the unchang- 
 ing idea of law than the student of medicine, as he ranges 
 from one extreme of observation to another. 
 
 In the International Investigation of Disease, the pre- 
 valence of mental disorders in different nations will be a 
 subject of inquiry. Also the forms which these maladies 
 take, according to nationality, occupation, stratum of society 
 in which they occur, &c. ; the use of stimulants — alcohol, 
 opium, hemp, tobacco, &c. This work obviously lies not 
 only in the physical and physiological conditions of life, but 
 in their intimate correlatives, the facts of psychology. The 
 thoughts of the student of medicine must range from the 
 atoms that build up the textures to the hopes that make the 
 man. And even perhaps further than this, for in most of 
 us the unsatisfied mind cannot answer itself with the 
 measurables and ponderables of physical science, however 
 much it may admit that all else' is dependent upon them, 
 but will strive to go behind appearances and feelings to the 
 substratum of their existence, and cannot find rest for its 
 foot until it traces their relation to an unchangeable First 
 Cause. 
 
 Du Bois Eaymond might well remark that the problem 
 
154 ADDRESSES. 
 
 of organisation would be comparatively easy if it were un- 
 attended with, feeling and thought. That it would then, as 
 it were, present us only with an astronomical problem, in 
 which the atoms of things would, after the manner of the 
 heavenly bodies, move on in their several orbits in lines 
 which science might hope to deal with. For it is within 
 the scope of science, even as we now understand it, to 
 track an atom of oxygen, nitrogen, hydrogen, or carbon 
 through its synthesis in a plant to its combination in the 
 elements of brain or muscle, and still on to its resolution and 
 return into its original form, with corresponding evolution 
 of force. But when this shall have been done, we have 
 learnt nothing of pain, nothing of emotion, nothing, indeed, 
 of the science of many of the common facts with which 
 medicine has to deal every day. How different would be 
 the problem for the physician if disease were unattended by 
 pain or emotion, if the patient were indeed patient as un- 
 organised materials are ; if there were no hopes or fears on 
 the part of the object to be dealt with, and no embarrass- 
 ment on the part of the practitioner from desire to please 
 as well as to heal ! Quacks would then be banished to 
 limbo. The course of nature could be watched until the 
 equilibrium of health was attained, and the temptations of 
 polypharmacy would be no more. But then, on the other 
 hand, we should have nothing to do with life in its higher 
 form, which is our ever-abiding problem, and we should 
 miss the stimulus of affection, which, like a constant trade 
 wind, carries us forward — at least the majority of us. 
 
 If for these preliminary remarks I need any apology, 
 might I not say that I have come from, the country of 
 Newton and Harvey, that I have travelled by the home of 
 Spinoza, and that I am speaking in the presence of the 
 countrymen of Descartes and Leibnitz. 
 
 Gentlemen, I do not appear here to-day on my own 
 behalf, but on behalf of the Collective Investigation Com- 
 mittee of the British Medical Association. 
 
 The British Medical Association is an Association of 
 most of the Medical practitioners in the Kingdom of Great 
 Britain and Ireland ; and it has, I believe, affiliated Asso- 
 ciations in our Colonies. 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OP DISEASE. 155 
 
 It numbers from ten to twelve thousand members, all, or 
 almost all of them, actively engaged in the practice of 
 medicine. 
 
 It is organised into over fifty branches, with their 
 presidents and committees. 
 
 These branches have weekly or monthly meetings for 
 the purposes of professional intercourse, and for reading 
 and discussing papers on medical subjects. It has, more- 
 over, a weekly journal of very extensive circulation, which 
 records the transactions of the different branches, and 
 supplies to its members lectures and communications on 
 the most important current subjects in medical science. 
 
 This Association has been founded over fifty years. 
 
 For some years past, and especially during the last four 
 years, it has been felt that the aims of this great Associa- 
 tion might be advanced to a higher point by establishing 
 an organised plan of medical observation amongst its mem- 
 bers, and, already, sub-committees to the number of fifty, 
 comprising as many as a thousand members, have been 
 established to carry forward this proposition. I am de- 
 puted by the Central Committee of this Association to ask 
 you to-day to extend this combination by establishing an 
 International Committee for the Collective Investigation of 
 Disease, and I trust this may commend itself to the 
 Congress. 
 
 Such an International Committee would have objects 
 entirely germane to the recognised purposes of the Con- 
 gress itself. Probably one might go even further, and say 
 that such an International Committee should form an inte- 
 gral part of these International Medical Congresses, and 
 that their operation would in time become one of the most 
 fertile sources of international medical advancement. I 
 am happy to think that but little argument will be required 
 in this assembly to commend this proposition to your 
 favour. Already in Berlin the " Verein fur innere Medicin " 
 has adopted the principle, and has. established a committee, 
 after the pattern of the British committee, to carry forward 
 the work. The President of the Society, Professor Frerichs, 
 has given his entire adhesion to the movement, and Professor 
 Leyden has accepted the Presidentship of the Committee 
 
156 ADDRESSES. 
 
 itself, which includes also very distinguished names ; and I 
 hope that one or more of our colleagues from Berlin will 
 to-day add a few words in favour of the proposition I am 
 called upon to make. 
 
 In putting arguments forward for the establishment of a 
 National Collective Investigation in its more limited form, 
 it was permissible to insist upon minor advantages to be 
 expected from such association — I refer to its educational 
 value, since it could not but happen that every co-operating 
 member would learn much from the investigations proposed ; 
 and that whilst he promoted science, he would no less 
 promote his own intellectual status. 
 
 Again, I pointed out in my Address in London, that the 
 family physician or practitioner has a sphere of observation 
 specially favorable to the study of etiology, and modes of 
 extension of communicable diseases. He has also special 
 advantages for pathological study, which are not so much 
 afforded to the professor in a university or hospital. It is 
 his privilege to see the earliest beginnings of disease, and 
 to have the opportunity of tracing its evolution and decline, 
 or when so favorable a course does not happen, the steps of 
 pathological progress are before him, whereas at the end of 
 life when the whole organism crushes downwards into a 
 chaos of pathological forms by the advance of disease it is 
 often impossible on the post-mortem table to say where the 
 failure began, and how it has advanced. The family 
 physician's observations should thus supply a corrective to 
 a too exclusive mechanical pathology. 
 
 Amongst the subjects suggesting themselves to us in 
 England in near relation to this matter, was the formation 
 of life-histories and family-histories in respect of disease, 
 and these could only be obtained through the family 
 physician. If such histories could be widely and accurately 
 recorded, the natural associations of different forms of 
 disease in individuals and families would be made evident, 
 and might afford suggestions as to pathological relations 
 not now suspected — relations between diseases which are 
 separated in nosological treatises, but associated in Nature. 
 This mode of inquiry, through family history, would open a 
 wide page for the record of the pathology of ailments; a 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OP DISEASE. 157 
 
 page than which there is none more interesting to the prac- 
 titioner of medicine, since seven-tenths of his work, and 
 perhaps more than this, lie in efforts to correct physiolo- 
 gical deficiencies, and to maintain some near approach to the 
 equilibrium of health, which a feeble organism unaided can- 
 not reach. On this part of the field it is that we can study 
 the relations between functional and organic diseases, 
 especially in the range of nervous affections, where the 
 degenerative tissue-changes in one individual of a family 
 may be compared with the physiological disturbances in 
 another. It is also in these family-histories that we might 
 hope to have elucidated the difficulties of correlated patho- 
 logies. Why, for instance, in a numerous family, whose 
 members are living under the same conditions, one or two 
 should become the subjects of pulmonary phthisis, one or 
 two the victims of rheumatism, another of epilepsy, whilst 
 the others maintain a healthy equilibrium. If such a history 
 should be repeated in ten thousand or in a hundred thousand 
 families, we surely might hope by careful collation of the 
 facts, to come to the groundwork of these differences, and to 
 determine the rule which separates the epileptic and the 
 rheumatic from the inroads of phthisis. 
 
 So much for the more limited though not less important 
 advantages of National Collective Investigation, but in an 
 International Collective Investigation, the ground widens 
 very much, not only from the different intellectual characters 
 of its working members, but also from the greater variety 
 under which disease presents itself. 
 
 The first gain, no doubt, will be from the intercourse and 
 reaction of different national modes of thought, with and 
 upon each other. It need not be said that the ways in 
 which any subject may be viewed do not depend upon the 
 subject itself, but upon the varied capacity of the minds 
 brought into relation to it. Minds evolved during ages 
 under special local and national conditions, and educated in 
 lines of their own, cannot fail to give new direction and 
 shape to the questions proposed for solution. 
 
 Each national mind will feel a different mental necessity. 
 This view might be much further enlarged, if this were the 
 occasion for it. At the Congress in London I endeavoured 
 
158 ADDEBSSES. 
 
 to show that each nationality produces its own scientific 
 school, and not least in respect of the science of medicine. 
 One nationality is more distinguished by its powers of 
 analysis ; another by its powers of synthesis ; one is critical, 
 another historical ; one characteristically anatomical, another 
 physiological. Even if this occurred to only a limited 
 degree, there must follow an interchange and fertilisation 
 of ideas. And let no one believe that this is a dream. We 
 have reached no more than the threshold of intellectual 
 evolution. 
 
 International Associations like this will serve to nurse 
 and nourish these powers in the future. But, however this 
 may be, these movements and combinations are in accordance 
 with the spirit of the age. It is on all hands felt and 
 acknowledged that the individual worker, apart from his 
 colleagues, cannot hope to do much in any department of 
 science, and that it is only by combination of members and 
 subdivision of labour that scientific observation can be carried 
 on successfully. The establishment of an International 
 Collective Investigation of Disease appeals to us from every 
 side ; personally, as through its influence our energies are 
 stimulated, and our intellectual activity varied; socially, 
 since observations made in one countiy cannot but correct 
 or support those made in another ; collectively, since science 
 is cosmopolitan, and can only grow well when fed from all 
 sources. It has been objected that the results of Collective 
 Investigation must, from the nature of the case, be inaccurate, 
 superficial, and so far useless ; that they are more likely to 
 confirm prejudice than to extend knowledge, and as regards 
 their scientific value, science is made up of quite other stuff. 
 Now to this it may be answered that knowledge advances 
 in many ways ; not only by the investigations of the gifted 
 workers of science, but by the casual observation of an 
 isolated fact. Indeed it has hitherto been objected, at least 
 against the science of therapeutics, that more has been 
 gained by accident than by methodical pursuit. The truth 
 is, one step of knowledge, however gained, leads to another. 
 The accidental infection of a milkmaid's hand, casually 
 brought to the notice of Jenner in a country surgery, has 
 not only contributed more than any other discovery to the 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OF DISEASE. 159 
 
 limitation or suppression of a loathsome disease, but it has 
 opened up pathological speculations of a far-reaching cha- 
 racter, and which to-day, in the hands of Pasteur and his 
 colleagues, reveals the hope that we have the key to many 
 if not all infective diseases. 
 
 All will admit that in the daily routine of practice, facts 
 are occurring that are worthy of record, and that medical 
 science loses much by the want of such record. By the 
 combinations proposed, what are now casual and wasted 
 observations would be methodised and stored for arrange- 
 ment, comparison, and deduction. 
 
 The English Committee has proceeded as follows : — 
 having first determined certain subjects for Collective Inves- 
 tigation, cards of queries have been framed and distributed 
 through the different sections, leaving each member to select 
 such subject or subjects as he might prefer. 
 
 As regards those life-histories of which I have spoken, 
 patients and practitioners are advised to apply to the 
 Association for blank books for these records. The head 
 of the family or other person is directed to request the 
 medical attendant, after each illness, to write a brief account 
 of it, with any note he may be pleased to add ; so that, after 
 the manner of genealogical trees — which show the distinc- 
 tions of a family through the heroic deeds of its ancestors — 
 there should be a genealogical history in time to come of all 
 the diseases to which its members have been subject from 
 generation to generation. Such books might also become 
 a record of health as well as of disease, and so show not 
 only how families, and from them nations, decay, but how 
 they grow. No doubt such records even of a thousand 
 families would contain singular revelations, and place many 
 of our pathological ideas in quite a new light. We might 
 learn that with tendencies to organic disease there was less 
 tendency to epidemic influences ; that if diseases were 
 prone to change their form and multiply, they were equally, 
 if not more, prone to lose their forms in a reversion to health ; 
 that the occurrence of one disease might confer an immunity 
 from another. 
 
 These life-histories might perhaps seem to have a more 
 national than international value, but if they could be 
 
160 ADDRESSES. 
 
 obtained, they would supply material for probably the 
 widest inductions. But there is this difficulty about them.. 
 Fear, as the wise man said, is a bad counsellor, and, unfor- 
 tunately, the construction of these life-histories is beset, 
 with fear. There is a lurking dread in every man, and in 
 every family, of exposing their frailties. This presents an 
 almost impenetrable barrier to gaining the facts upon which 
 life-histories are built. There is a fear also in the minds of 
 the inquirers themselves, since there is a natural disincli- 
 nation to intrude into secrets which are so anxiously guarded. 
 But whilst we bear in mind the wise man's dogma, and 
 remember that fear is a bad counsellor, we may resist its 
 counsels as far as we can, where so much is at stake. 
 
 The clinical subjects which at present have been selected 
 are acute pneumonia, chorea, acute rheumatism, diph- 
 theria, and inherited syphilis. Cards of queries have been 
 issued on each of these subjects, and each card is accom- 
 panied by a memorandum stating the object of the particu- 
 lar inquiry, and directing the attention of the observer to 
 the queries proposed. These memoranda are of the first 
 importance in this movement. It is on them that our hopes 
 of success must be grounded. It is intended that they 
 should indicate the defective state of our knowledge in the 
 subjects brought forward for investigation. In doing this 
 their value to the profession, and to the progress of our 
 knowledge, is almost incalculable. It is no small matter to 
 have set before us in a simple manner what the present 
 state of our knowledge is, the defects which have to be 
 made good, and the inquiries likely to lead to such a 
 result. Text-books on medicine will hereafter have to 
 follow something of this leading. Hitherto, and for the 
 most part, they have aimed too much at satisfying the 
 reader, and, in order to make the treatises complete, have 
 assumed a knowledge both in pathology and therapeutics 
 too little justified by fact, and so have hindered, rather than 
 promoted our progress. 
 
 These memoranda are intended to be critical suggestions 
 and suggestive criticisms on the state of knowledge respecting 
 the subjects brought forward. They are the centre of the 
 proposed system. It may fairly be expected that each 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OP DISEASE. 161 
 
 issue of them will be more exact and incisive. The success- 
 ful framing of them is the one important object to be at- 
 tained. Through them the influence of the more advanced 
 intellects in the profession will extend through the whole of 
 it, and will reach its most scattered and distant members. 
 Nor can we doubt but that there will be a reaction from 
 the periphery to the centre, maintaining a living cycle of 
 active mental co-operation. Who can limit the effect of 
 such action and reaction, or deny that there will thus 
 arise new energy and new genius ? for, happily, the cul- 
 tivation of science need not remain the privilege of professors 
 and teachers, but may become the common inheritance of all. 
 
 The volumes I hold in my hand are the first published 
 records of the Collective Investigation in England. They 
 contain reports and memoranda on the communicability of 
 phthisis, acute pneumonia, chorea, acute rheumatism, and 
 diphtheria. 
 
 I would refer, by way of illustration of my remarks on 
 memoranda, to the memorandum on acute rheumatism. This 
 recites our deficiencies on the etiology of this disease, and 
 might also include its pathology ; the exceptional ways in 
 which rheumatism occasionally develops ; its probable 
 relation to the state of the nervous system ; the new aspect 
 of the pathology of joint-affections in relation to the spinal 
 cord ; the relation of the intensity of the rheumatic affection 
 to anaemia ; its clinical relation to tonsillitis ; the inter- 
 current affections of the skin ; and last, but unhappily not 
 least, the treatment. I might add, however — not as a cri- 
 ticism, but as a suggestion — that an exhaustive memorandum 
 on acute rheumatism, showing the real state of our know- 
 ledge respecting this disease in all its relations, and the 
 more than vagueness of our treatment of it, would have a 
 value which I should find it difficult to express. Long- 
 standing prejudices, which for the most part are entertained, 
 and fostered as if they were established and confirmed 
 experience, would go down before the exposition of such a 
 memorandum, and its results in International Collective 
 Investigation, as dry leaves before an autumn wind. 
 
 When inquirers on a given subject agree at the outset 
 what are the imperfections of their knowledge respecting 
 
 11 
 
162 ADDRESSES. 
 
 it, they naturally combine the more heartily in its further 
 investigation. 
 
 The aspect of an inquiry from a personal standpoint, and 
 that from a collective investigation standpoint, present the 
 most important contrasts. In the one, the Ego, however 
 subordinated, is not lost. It lurks at the centre of the 
 operations, and the results or supposed results of personal 
 inquiry are too apt to be regarded as property, to be 
 defended against all inroads, whether this property be worth 
 defending or not. The observations and experience of any 
 one man, however gifted, cannot be considered more than 
 suggestive, and cannot have any authoritative value until 
 confirmed by the repeated observations of others. 
 
 In a Collective Investigation, whether National or Inter- 
 national, the individual and the results of his inquiry are 
 obviously less open to distortion from personal favour or 
 prejudice. This freedom from undue influence gives a 
 greatly preponderating advantage to such associations as we 
 are here met to establish. 
 
 Here the observer has no selfish interest in the result of 
 the inquiry. His work will be equally good, whether 
 immediately fruitful in positive results or not. The isolated 
 observer, on the other hand, is apt to have interest in little 
 else than positive results. In therapeutics the truth of 
 this is too abundantly evident, to the confusion of medical 
 practice, and to the vaunting of remedies and methods 
 which are mostly of no value, or may be even worse than 
 useless. It has not escaped the remark of the master of 
 the logic of facts, that " Habet enim unusquisque prseter 
 aberrationes naturae humanae in genere, specum sive cavernam 
 quandam individuam, quee lumen naturae frangit et corrumpit 
 — ut plane spiritus humanus (pro ut disponitur in hominibus 
 singulis) sit res varia et omnino perturbataet quasi fortuita. 
 TTnde bene Heraclitus homines scientias quaerere in minoribus 
 mundis, et non in majore sive communi ;" — not in the 
 common world, but in the world of themselves. 
 
 One can hardly forecast the amount of good influence on 
 therapeutics if, instead of individual assertions respecting 
 the value and success of this or that drug or method, we 
 had the teaching of calm and impersonal results deduced 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OE DISEASE. 163 
 
 from an international area of inquiry, so large that the 
 individual observer would be lost in the result. 
 
 Whilst our English association has, as I have described, 
 put forward several subjects for collective inquiry with the 
 memoranda and questions I have named, our German collea- 
 gues have determined upon a somewhat different method. 
 They have selected but one subject for investigation, 
 thinking it better to exhaust that before taking up a second 
 or third ; and they have naturally selected a subject which 
 at the moment prominently occupies the attention of the 
 profession in all lands, I mean pulmonary phthisis. Upon 
 this they have proposed four points for solution: — (i) the 
 heredity of the disease ; (2) the communicability of the 
 disease ; (3) the cure of the disease ; (4) the transition of 
 pneumonia into phthisis. 
 
 These propositions are accompanied with many questions of 
 detail which I will mention presently. The English Com- 
 mittee at the beginning of last year also proposed as a 
 question for Collective Investigation the communicability 
 of phthisis, and have reported upon it. The German 
 inquiry is not yet reported upon. The important discovery 
 of Koch that there is a specific organism associated with 
 pulmonary tubercle, and his infection-experiments, have 
 naturally excited the greatest interest respecting the com- 
 municability of the disease. It is well known that at dif- 
 ferent times and in different countries the contagiousness of 
 phthisis has been confidently believed in ; and as Professor 
 Ewald remarked at a meeting of the Verein fur innere 
 Medicin, observers in America, in England, and in Germany 
 have supported the belief in the contagiousness of phthisis 
 by important records respecting it. Still, until Koch's 
 discovery, the professional mind was very much asleep about 
 it, or with only now and then a half-waking dream. 
 
 The English Collective Investigation Committee have put 
 forward the question of communicability in the simplest form 
 — "yes" or "no" — as follows: "Have you observed any 
 case or cases in which pulmonary phthisis appeared to be 
 communicated from one to another ? Please answer, Yes or 
 No." It will be observed that this is not a mere voting 
 question as to a man's belief, but whether he has observed 
 
164 ADDEBSSES. 
 
 any case or cases of the apparent communicability of the 
 disease. " Out of the 1078 members of the Association who 
 returned answers to the questions issued on this subject, at 
 least 261 believe they have seen cases of phthisis which have 
 originated in communication from one person to another ; 
 about 39 more have seen cases which have made them 
 doubtful whether phthisis may not be so communicated ; 
 while 105 have offered facts and arguments which seem to 
 them to negative such a view. One hundred and fifty-eight 
 of the affirmative returns refer exclusively to cases observed 
 between husband and wife. Communication between hus- 
 band and wife is mentioned, together with other cases, in 34 
 of the remaining returns. So that 192 observers report 
 cases of supposed communication of phthisis occurring be- 
 tween husband and wife." 
 
 There are also a number of special returns where the 
 disease seems to have spread from patient to nurse, and 
 from friend to friend. I am not here of course to discuss 
 the pathology of phthisis or of its communicability from 
 person to person, but to argue for the advantages of col- 
 lective research. And, perhaps, no subject could be selected 
 better to demonstrate these advantages than the supposed 
 contagiousness of phthisis. By extending the inquiry over 
 a wide area, the recurrence of striking cases of apparent 
 communicability are repeated over and over again, and 
 must naturally impress the mind more than a case or two 
 occurring in individual experience. The Committee, there- 
 fore, justly remark in their report, that they hope that this 
 first step in Collective Investigation into one of the most 
 important questions connected with the etiology of phthisis, 
 will be of value in leading to more open-mindedness in the 
 discussion of disputed questions of experience and ob- 
 servation. 
 
 We shall await with interest the report of the Berlin 
 Committee, for its Card of Queries is much beyond that of 
 "Yes" or "No." It presents seven sections : (1) General 
 questions as to the history of the family of the patient, the 
 subject of phthisis. (2) Antecedents of the family. (3) 
 Previous diseases of the patient ; as, for instance, whether 
 of phthisical habit or not; what diseases preceded the 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OE DISEASE. 165 
 
 development of phthisis, as scrofula, measles, whooping- 
 cough, chlorosis, &c. (4) On the question of heredity follow 
 queries on health of parents ? either dead of phthisis ? and 
 when ? have they suffered from scrofula ? disease of the 
 bones ? lung diseases not phthisical ? as pneumonia ? pleu- 
 risy ? gangrene ? bronchitis ? &c. ; were the grandparents 
 or parents related in blood ? age of father or mother at the 
 birth of the patient ? were they sober or not ? &c. (5) On 
 contagiousness or communicability — was the disease taken 
 from husband by wife ? or from wife by husband ? when the 
 malady began ? was the communicability between brothers 
 and sisters or relatives or servants ? was the contagion from 
 residence in prisons, establishments for the insane, barracks, 
 or infirmaries, &c. ? was the infection by residence, clothing, 
 or beds ? by nourishment, as through the milk of scrofulous 
 animals or consumptive nurses, &c. ? (6) On the curability, 
 including only such cases where at least two years had 
 elapsed from the beginning of the disease — where did the 
 arrest or cure seem to begin ? did this come from the im- 
 provement of the general condition ? are cough and expecto- 
 ration gone ? have the physical conditions altered, and in 
 what way ? &c. (7) On the Transition of Pneumonia into 
 Phthisis — the day of the beginning of the pneumonia ? its 
 seat, as at base, apex, or middle of lung, &c. ? right or left 
 lung ? expectoration — sanguineous ? rusty ? grass-green, &c? 
 signs of re-convalescence ? when the first signs of tubercle 
 occurred ? &c. 
 
 I have stated just now that I appear here on behalf of 
 the British Medical Association for Collective Investigation ; 
 but I have to add that it is my duty to lay before you fur- 
 ther what has been done by the Collective Investigation in 
 Berlin. Within the short time that the Berlin Association 
 has been in operation (spring, 1883) its activity and success 
 have been remarkable. The Berlin Association had already, 
 in February, 1884, nine months after its establishment, fifty- 
 five branches ; and Herr Leyden reported to the February 
 meeting of the "Verein fur innere Medicin" a communication 
 he had received from Professor Rauchfuss in St. Petersburg, 
 informing him that they would establish there a separate 
 Association for Collective Research, after the plan of that of 
 
166 ADDRESSES. 
 
 the " Verein fur innere Medicin/' and in relation with it. In 
 Paris also, in the Societe des Hdpitaux, there had been nego- 
 tiations respecting the Collective Investigation of the " Ve- 
 rein fiir innere Medicin/' and a similar one would be there 
 arranged. 
 
 In the June sitting of the Committee, under the presi- 
 dency of Herr Fraentzel and Herr Leyden, Herr S. G-uttman, 
 the secretary, reports that the German Association is daily 
 making progress and exciting great interest ; that on all 
 sides, from Denmark, Sweden, Switzerland, Italy, Spain, and 
 America, there were communications asking for information 
 respecting this Collective Investigation, .and with a request 
 for the cards which had been issued. 
 
 With the " Verein fiir innere Medicin " there are asso- 
 ciated of the Berlin Institutions the " Konigstadt- Verein," 
 the " West-Verein/' the " Siidwest-Verein ;" and for the 
 Associated Societies out of Berlin, there are correspondents 
 for the Medical Societies in Rostock, Schwerin, Giistrow, 
 Miinster, Minden, Arnsberg, Regensburg, Paderborn, Aurich, 
 Thiiringen, Holland, Meran, Hagenau, Salzbrunn, Frankfurt 
 (am Maine), Koslin, Freiburg, Prag, Blbing, Mainz, Hannover, 
 Graetz, Bochum, Frankfurt (am Oder), Hessen, Wiesbaden, 
 Dantzig, Memel, Marienwerder, Friedeberg, Liibeck, Chem- 
 nitz, Niirnberg, Bremen, Pommern, Breslau, Giessen, Dresden, 
 Posen, Essen, Halle, Kiel, Basle, Gottingen, Liegnitz, Riga, 
 Davos, and Marburg. 
 
 Further, there is an Association for Collective Research of 
 the Institutions for the Insane, and already Herr -Jastrowitz 
 reports a combination of twelve of these institutions in dif- 
 ferent parts of the country. There is also a similar move- 
 ment for inquiry into the health and the diseases of the in- 
 mates of prisons and infirmaries. In fact, our German 
 friends have in many lines outrun us. Their exertions and 
 their success in promoting this organisation make it super- 
 fluous for me to add arguments in favour of the proposition 
 before this meeting. 
 
 I hope I may congratulate this sitting of the International 
 Medical Congress in Copenhagen, upon the happy incident 
 that we are to-day called upon to centralise these operations 
 which have begun in England and Germany, into an Inter- 
 
INTERNATIONAL COLLECTIVE INVESTIGATION OF DISEASE. 167 
 
 national Committee of this Congress, whose function will be 
 to promote them in all lands ; and, by the continued co-ope- 
 ration of these Congresses, carry forward a movement, the 
 fruits of which, as I have already said, it will be impossible 
 to over-estimate, whether we limit our view to the results 
 on our members, on the Profession as a whole, on the public 
 good, or on the brotherhood of nations. 
 
 There is but one caution, and that lies against Our attempt- 
 ing too much at first. In our scientific ambition it would 
 not be difficult to o'erleap ourselves. It is by a little well 
 done that we shall do much ; whereas, if our deductions are 
 hasty, incomplete, and unfounded, the authority which will 
 naturally attach to these researches will be much more ob- 
 structive to the cause of science than the fallacious dogmas 
 of separate individuals. If our hopes and prospects are en- 
 couraging, the steps we take cannot be too wary. The pur- 
 pose of our association could only lead to failure, and perhaps 
 even a gigantic failure, if the movement were not waited 
 upon by strict caution and exact criticism. If the work 
 proceeds at the present rate, a few years will witness one of 
 the greatest and most useful movements in modern times. 
 The founding of an International Collective Investigation of 
 Disease will promote the national movements of the same 
 kind in all countries, and will give a stimulus to interna- 
 tional emulation under the happiest form. 
 
 In the time at my disposal it is impossible to sketch even 
 in outline the number of subjects which claim attention. 
 The committees of the different Sections, as the work pro- 
 gresses, will select their subjects from their own point of 
 view j some with a broader purpose will take the more common 
 maladies, and the more curious the rarer ones. One of our 
 English colleagues would have concise descriptions of rare 
 maladies, prepared as an entomologist would have them 
 prepared of newly discovered insects, printing distinguish- 
 ing features in italics. He instances Khinoscleroma, Hebra's 
 Prurigo, Morphse, Alibert's Keloid, Keloid of Scars, Addison's 
 Disease, Hodgkin's Disease. 
 
 Cretinoid State in the Adult (Myx oedema). 
 
 Congenital absence of special bones (such as radius and 
 tibia, with associated portions of carpus or tarsus). 
 
168 ADDRESSES. 
 
 Cases of Spina Bifida, illustrating either results of treat- 
 ment or survival without it. 
 
 Cases of Sacral Tumour. 
 
 Cases of Recurring Iritis in young persons. 
 
 Aneurisms in the orbit. 
 
 The Osteitis Deformans of Paget. 
 
 Disease of joints in Ataxy (Charcot's joint-disease). 
 
 Non-malignant growths in the tongue. 
 
 Hemiglossitis. 
 
 Kaposi's Disease. 
 
 The arguments for these more curious inquiries are not far 
 to seek, since diseases which are rare in some countries may 
 be frequent in others, and by their frequency afford the re- 
 quired ground for the study of their pathology. I might 
 instance the glandular and elephantoid diseases of China, 
 and the successful labours of Manson and Mayers, which 
 have traced them to the presence of the Filaria sanguinis- 
 hominis, producing lymphatic obstructions and filarial throm- 
 boses. The elucidation of such a piece of pathology, though 
 the disease be limited to China, must have a good influence 
 on the whole medical mind in breaking down preconceived 
 opinions, and in showing that we cannot go too far afield 
 for our knowledge. It supplies, moreover, a further argu- 
 ment for the International Collective Investigation of Disease. 
 
 Gentlemen, whilst I thank you for the favour with which 
 you have received this Address, I cannot but express my 
 deep sense of the imperfect way in which I have set forth 
 the greatness and importance of my subject. I can now but 
 commend the matter to your good efforts, assured that, 
 through them, success will not be wanting. 
 
THE ETHICS OE VIVISECTION. 1 
 
 It is to be regretted that the question of " Vivisection " z 
 should still call for further discussion. It was reasonably 
 hoped that after the result of the inquiry by a Royal Com- 
 mission, and the subsequent legislation, physiologists might 
 have been permitted to pursue their investigations, hindered 
 only by the law as it now stands. This expectation was the 
 more reasonable inasmuch as physiologists have loyally ac- 
 cepted the restrictions of the Act in question. But the anti- 
 scientific agitation continues. Some opponents of physio- 
 logical inquiry maintain that experiments on living creatures 
 are altogether cruel, immoral, and disgraceful, and should 
 therefore be entirely suppressed; others, yielding to the 
 evidence of the importance and usefulness of these inquiries, 
 but misled by a laudable dislike to the infliction of pain, 
 would limit much more the sanctions of the law, and reduce 
 these studies almost to a nullity ; others, uninfluenced by 
 either of these considerations, are opponents of vivisection 
 as they would be of all other scientific progress. 
 
 Mr. Hutton, who tells us that a fair number of the articles 
 in favour of a restriction more effective than that of the 
 present law have proceeded from his pen, speaks of practical 
 physiologists as " a new scientific class ;" and of the encou- 
 ragement of the practical physiological method as " a new de- 
 parture," " a most significant and important new departure/' 
 
 1 Reprinted from the 'Nineteenth Century,' No. 61, March, 1882. 
 Note. — Sir William Gull's evidence before the Royal Commission on 
 
 Vivisection was given on Nov. 6th, 1875, and appears in the Blue-hook, 
 p. 265. — Ed. 
 
 2 This term is inaccurate and misleading ; but the question to the dis- 
 cussion of which I contribute is whether it is justifiable to perform experi- 
 ments upon the lower animals, with every precaution against preventable 
 pain in order to increase human knowledge and relieve human suffering. 
 
170 ADDRESSES. 
 
 Other expressions of a similar kind occur in his article, as of 
 practical physiology being "a new profession," "a, new move- 
 ment." We should hardly have expectedfrom so liberal a writer 
 objections against any course of study because it was new. 
 But happily on this score we can easily satisfy any prejudice 
 against novelty. Practical physiology has the prestige and 
 sanction of ages. Whilst Bacon speaks but lightly of the 
 disputatious wisdom of the Greeks of the time of Plato and 
 Aristotle, he warmly commends the physiological studies of 
 Democritus and his colleagues. Galen's experiments are 
 notorious ; and the most learned author of tbe ' Anatomy of 
 Melancholy ' sets forth in his frontispiece Democritus search- 
 ing for the seat of black choler : 
 
 " Old Democritus under a tree, 
 Sits on a stone with book on knee : 
 About him hang there many features 
 Of cats and dogs and such like creatures, 
 Of which he makes anatomy, 
 The seat of black choler to see." 
 
 It is, however, true that for many centuries physiological 
 inquiry, and indeed the study of natural science in general, 
 was almost stifled by the logic of the schoolmen, which better 
 commended itself to the prejudices of men than did the 
 harder task of observing and questioning nature. The 
 commencement of a more prosperous era for physiology dates 
 from the renaissance of science in the sixteenth century. 
 
 One of the earliest fruits of this revival was the discovery 
 of the circulation of the blood, due, as Harvey himself informs 
 us (though certain modern writers may wish to deny it), to 
 " having frequent recourse to vivisections, employing a va- 
 riety of animals for the purpose, and collecting numerous 
 observations." 
 
 The contemporary discovery of the lymphatic system by 
 Aselli, Bartholinus, and Pequet, the subsequent discovery of 
 the capillary circulation by Malpighi, the great advances 
 made by Boyle, and Mayow, and Lower, in the same century, 
 were all the fruits of experiments upon animals ; and ever 
 since, physiology, no less than chemistry and physics, has 
 depended on experiments. 
 
 The supposed novelty of physiological experiments does 
 
THE ETHICS OF VIVISECTION. 171 
 
 not therefore afford an argument against them either in fact 
 or principle. 
 
 That during the last few years physiology has received a 
 new impetus from the great progress of experimental physics 
 in other lines is perfectly true. 
 
 Until to-day the theory that the living quality in us was 
 due to a mysterious vital force, out of the reach of science, 
 preoccupied the mind, and stood in the way of observation 
 and experiment. But now it has become the immoveable 
 standpoint of physiology that a living creature is dependent 
 for all its bodily functions upon the forces of inorganic 
 matter ; in other words, that our corporeal life is but the 
 operation of material atoms and material forces within the 
 reach of experimental inquiry. The clearing away of old 
 hypotheses and suppositions, and the admission of Physiology 
 among the physical sciences, of course imposes upon her the 
 same obligations of exact observation and experiment. She 
 can no longer remain satisfied with specious explanations and 
 fanciful hypotheses, any more than astronomy could accept 
 the offices of the imagination for explaining the nature of 
 eclipses or the causes of comets. 
 
 Physiology having thus set herself free from mental 
 hindrances, and comprehending the extent and intricacy of 
 the problems before her, must, from the nature of the case, 
 claim as much liberty as astronomers and other inquirers 
 enjoy in their several researches. But to prevent misunder- 
 standing, it may be added that while firmly maintaining that 
 the actions in living things are objects for scientific inquiry, 
 and reducible to law — have, in fact, an order as fixed and 
 certain as the stars in their courses — we are not so pre- 
 sumptuous as to suppose that when all these actions in a 
 living body are made plain, we shall have penetrated the 
 mystery of life. The living spirit which manifests itself in 
 these operations can only be known from the consciousness 
 and from the conscience. The eye does not see, neither does 
 the ear hear. The odour of the rose and of the violet are 
 not chemical, although they are chemically caused. If, 
 therefore, physiology has a wide range, it has also its proper 
 limit. 
 
 Physiological experiments, then, are no novelties ; they 
 
172 ADDRESSES. 
 
 are as old as physiology. They correct erroneous doctrines, 
 and are compatible with — nay, they lead to, a reverent con- 
 viction of the limits of human knowledge. 
 
 The more reasonable and respectable opposition to the 
 method of experiment in physiology rests partly on imperfect 
 knowledge of its necessity and use, partly on exaggerated 
 estimate of the sufferings involved. 
 
 If physiology were a cruel and immoral occupation, in which 
 what is gained is out of all proportion to the penalties paid 
 for it, there would be no more to say but to blot it out at 
 once. But if it appear, as it undoubtedly does, that phy- 
 siology investigates problems of the highest importance to 
 mankind, and that the solution of these problems is within 
 the scope of the human intellect, then the matter assumes a 
 very different aspect. It becomes in a high sense a moral 
 duty to press on the acquisition of knowledge, both for its 
 own sake, and for the fruits which it will surely yield. 
 What casuist can doubt the moral duty, with the parable of 
 the talents before him ? Is it not at once the prerogative 
 and the duty of the intellect, essential to its very maintenance 
 and development, that it should have free course for in- 
 quiry ? 
 
 Instead, therefore, of counselling prohibition, it would 
 seem to be the part of lovers of knowledge to foster physio- 
 logical inquiries, subject only to such restrictions as I shall 
 presently show our men of science had already imposed upon 
 themselves before they were recommended by the Royal 
 Commission. But it ought to be noted that there are two 
 sorts of inquiry, which may be confounded together; and 
 Lord Coleridge, in his attack on physiological experiments, 
 does not avoid this confusion. There is the inquiry of idle, 
 vulgar, and impertinent curiosity, which is at best selfish, 
 and may be immoral and even criminal. But this has 
 nothing whatever to do with the inquiries of science, nor are 
 its ways the same. Therefore when Lord Coleridge says 
 that " liberty is claimed for experiment in vacuo, experiment 
 on the chance, experiment in pursuit of nothing in particular, 
 but of anything that may turn up in the course of a hundred 
 thousand vivisections," he misplaces the claims of science, and 
 puts them in the mouth of a monster of his own imagining. 
 
THE ETHICS OF VIVISECTION. 173 
 
 There is in the language and statements of the opponents 
 of vivisection an almost unbroken harmony of exaggeration. 
 A lady, writing of the title of Claude Bernard, to be honoured 
 by physiologists, says that such title is, at least partly, based 
 on the invention of a stove which should enable him to 
 watch the process of "baking dogs alive." Such a statement, 
 without due context and explanation, and couched in such 
 language, is calculated, if not intended, to convey a totally 
 false impression both of the purpose and the details of the 
 memorable experiments of Claude Bernard upon Animal 
 Heat. 
 
 Baking dogs alive ! How horrible and disgusting ! would 
 be a natural exclamation. What purpose could there be in 
 anything so cruel ? This we shall see directly. 
 
 Again, Lord Coleridge, apparently referring to these expe- 
 riments on fever, says : 
 
 " I deny altogether that it concludes the question to admit that vivisection 
 enlarges knowledge. I do not doubt that it does, hut I deny that the pur- 
 suit of knowledge is in itself always lawful ; still more, I deny that the 
 gaining knowledge justifies all means of gaining it. To begin with, pro- 
 portion is forgotten. Supposing it capable of proof that by putting to death 
 with hideous torment three thousand horses, you could find out the real 
 nature of some feverish symptom, I should say without the least hesitation, 
 that it would be unlawful to torture the three thousand horses." 
 
 Now why, it may be asked, does Lord Coleridge, for the 
 purpose of his argument, select horses, and why so large a 
 number as three thousand ? He must know that the horse 
 has been but little experimented upon in the investigations 
 respecting animal heat and fever, and then under the in- 
 fluence of ether, and therefore without suffering ; the ope- 
 ration consisting in a division of the branches of the sym- 
 pathetic nerve in the neck whilst the animal is insensible ; 
 so that the supposition of three thousand horses and hideous 
 torment is an exaggerated supposition, out of proportion to 
 facts — misleading, and in no way conducive to a fair judg- 
 ment on the question at issue. 
 
 From the expression " baking dogs alive " anyone unac- 
 quainted with the subject would suppose that experiments 
 upon animal heat and fever involve hideous torment, and 
 from Lord Coleridge's expression, "to find out the real 
 
174 ADDEESSES. 
 
 nature of some feverish symptom," that these dreadful doings 
 were for a trifling object. But a few words of explanation 
 will put this matter in a different light. 
 
 In the whole range of nature there is no more wonderful 
 fact than the uninformity of the temperature of the blood in 
 health in the different warm-blooded animals. In man, dogs, 
 cats, foxes, seals, &c, this temperature is uniform, whether 
 they be living at the equator or the poles, whether in 
 summer or winter, whether in activity or repose, whether 
 fasting or recently fed, provided they are in health. In 
 birds the natural temperature is higher by several degrees 
 Fahrenheit than in warm-blooded quadrupeds ; and it is a 
 curious fact that if the blood of the latter be raised to the 
 temperature of the blood of birds, the result is fatal. For 
 instance, if a dog be put into a heated chamber, and his 
 blood be raised to ten degrees higher than in health (the 
 natural temperature of, e. g., a swallow's blood), the animal 
 quickly dies ; and the same happens to man, whether this 
 increase of temperature arise through injury or disease. The 
 animal or man is, under such circumstances, " baked alive." 
 Now, yearly in this country more than twenty thousand 
 persons, children and others — mostly children — die of scarlet 
 fever ; and nearly twenty thousand more of typhoid fever ; 
 and one of the chief causes of this mortality is the high 
 temperature of the blood, which results from the disturbance 
 due to the fever process. To use Bernard's expression, " le 
 fait le plus important de tous, celui qui domine tous les 
 autres, celui qui constitue le veritable danger, c'est la chaleur." 
 No wonder, therefore, that physiologists and physicians have 
 anxiously and laboriously occupied themselves in investigating 
 that mechanism of the living body which in health maintains 
 so constant a temperature under varying circumstances, both 
 internal and external, and which becomes so easily and 
 fatally deranged in disease. Thanks to the very intelligent 
 and exact experiments of Bernard, part of this complicated 
 machinery has been traced out ; but the whole matter is so 
 beset with difficulties that the wonder is, not that physio- 
 logists have done no more, but that they have explained so 
 much. Those who carp and cavil may perhaps ask why, if 
 these experiments are so useful, have we not been able more 
 
THE ETHICS OP VIVISECTION. 175 
 
 certainly to control this fever state ? The answer at present 
 must be that the end is not the beginning ; and that the 
 complexity of one of the most wonderful of the many 
 wonders of our bodily frame is not to be fully unravelled in 
 twenty years. The subtlety of nature in a living organism 
 demands the labours of many and various intellects before 
 we can hope to obtain even a small instalment of the reward 
 of their labours. 1 A living body is not a common piece of 
 machinery, framed and fashioned from without; it is evolved 
 from within, and every portion, even to the smallest, is a 
 system in itself. 
 
 Bernard, in these experiments on fever, sacrificed two 
 pigeons, two guinea-pigs, less than twenty rabbits, and six 
 dogs. One might think that the slaughter of even three 
 thousand horses (if they were suitable for the purpose) by a 
 process far less painful than that by which thousands are 
 sacrificed in war, would not be unjustifiable if thereby the 
 machinery for regulating animal heat could be fully dis- 
 covered, and the power of controlling fever put into our 
 hands. Granted that such a sacrifice of life would only be 
 becoming under the sanction and direction of very high 
 intelligence; that provided, it would not be an extravagant 
 price to pay for the redemption of even a part of those who 
 die annually of fever, as Miss Cobbe says, " baked alive." 
 
 The twenty thousand deaths from scarlet fever, and the 
 twenty thousand from typhoid fever, constitute but a small 
 part of the annual deaths in this country in which the high 
 temperature of the blood is a fatal factor. 
 
 The febrile state must have arrested attention from the 
 infancy of man. The mothers of a palaeolithic age must 
 have watched their children consumed to death in it, as do 
 the mothers of to-day. The name of this fiery state is as old 
 as literature. Physicians have never been weary of writing 
 on the symptoms of it. The thermometer we now use at the 
 
 1 This is the meaning of Bernard's modest estimate of his own labours 
 which has been so often quoted. The " legitimate promises " he made have 
 been already in part fulfilled. No one can question the actual " perform- 
 ances " of experiments on animals for medicine after reading the evidence 
 taken by the Royal Commission, or the papers by Professor Humphry, 
 Professor McDonnell, Professor Praser, or those which appear in company 
 with mine in this review. 
 
176 ADDKESSES. 
 
 bedside bears the name of Fahrenheit, who, a century and a 
 half ago, in concert with the famous physician Boerhaave, 
 made exact investigations upon the subject. But it is only 
 during this century, through the labours of many observers 
 both in this country and abroad, and prominently of Sir 
 Benjamin Brodie, that the actual conditions producing and 
 controlling animal heat are becoming known. This fiery 
 furnace, with its uncounted millions of victims, science hopes 
 to close. And it is quite reasonable to believe that the time 
 will come when fever will be as much under our control as 
 are the movements of a chronometer. 
 
 If sufficient cause could be shown for giving pain to 
 animals for the purposes of medical science, there would be 
 little opposition to experiment. The sufficient cause would 
 largely, if not entirely meet the moral difficulty. Mr. Hutton 
 and Lord Coleridge object that such practices, for whatever 
 purpose, are essentially demoralising, and tend to demoralise 
 the community at large. These are strong statements, and 
 would naturally require corresponding evidence to give them 
 validity, especially as ordinary experience does not confirm 
 them. If they were true, surgical operations would be de- 
 moralising, and a calling which is beneficent would rest 
 upon moral degradation. The mother holds back the arm of 
 the surgeon, and for the moment thinks him cruel, for the 
 pain he is obliged to inflict on her child ; but her calmer 
 judgment acquiesces in the infliction of present pain for 
 future good. Mr. Hutton thinks that the moral difficulty 
 would be solved if we spared the lower animals, as we 
 should expect to be spared ourselves were we in the power 
 of a higher race. But it is impossible to conceive an order 
 of nature in which intellectual creatures, having our moral 
 relations, could stand to superior beings as the lower 
 animals stand to us, and hence the moral rule proposed 
 for the solution of the difficulty is inapplicable. Our obli- 
 gations to the lower creatures arise out of ourselves. It is 
 due to ourselves that we should treat them with tenderness 
 and kind regard. Dominion over them has been put into 
 our hands, and that dominion, from the demands of our 
 intellectual and moral nature, must be intelligent. In 
 killing and eating an animal, we are on the same level as 
 
THE ETHICS OP VIVISECTION. 177 
 
 the carnivora ; in using them for our sports, we are on the 
 ordinary level of man ; but in using them intelligently for 
 the advancement of beneficent knowledge, provided that this 
 be with a due sense of proportion between the benefit and 
 the pain, we are justifying the highest purposes of our 
 intelligence. 
 
 To ask why man should have to take such a course to 
 acquire knowledge, is no more to the purpose than to ask 
 why he is ignorant, or why he is placed here to subdue the 
 world to his purposes. 
 
 That physiologists are not and have not been indifferent 
 to or careless of inflicting pain is shown by the following 
 resolutions, which have been already quoted by others, but 
 will bear repetition. They were drawn up and accepted by 
 the British Association in 1871 : — 
 
 " (1) No experiment which can be performed under the influence of an 
 anaesthetic 'ought to be done without it. 
 
 " (2) No painful experiment is justifiable for the mere purpose of illus- 
 trating a law or fact already demonstrated. 
 
 " (3) Whenever, for the purpose of new truth, it is necessary to make a 
 painful experiment, every effort should be made to ensure success, in order 
 that the sufferings inflicted may not be wasted ;" &c. 
 
 These resolutions were signed by the President of the 
 College of Physicians, the President of the College of 
 Surgeons, and others interested in physiological inquiry. 
 They make it sufficiently plain that the moral relations of 
 science to animal suffering are not overlooked. And it is 
 only in the case of •painful experiments — a minority of the 
 whole — that the moral question comes in. 
 
 It is no doubt a weak and unworthy argument, that the 
 good we may obtain to ourselves by physiological experiment 
 should outweigh the immorality of the process ; that our 
 moral susceptibilities ought to be bribed and silenced by 
 our selfish gains. If it were an immoral thing to eat an 
 animal we ought not to eat it, even though our life were at 
 stake ; nor ought we to touch an animal for physiological 
 experiment if it were immoral to do so. It is therefore not 
 true, as a prominent writer against vivisection asserts, that 
 ' the sentiments of compassion and sympathy must retreat 
 and disappear/ and be accounted of no consequence, in the 
 
 12 
 
178 ADDRESSES. 
 
 presence of the requirements of physiology. Nor is ' the 
 deliberate torture of God's harmless creatures ' in any sense 
 a true description of the work of the physiologist. 
 
 The limits of our rights over the lower animals, and even 
 over the lives of our fellow-men, can only he clearly discerned 
 by the light of the purposes for which those rights are 
 exercised — as in war and capital punishment, for the welfare 
 of the State ; in sport, for amusement and health ; and in 
 eating animal food, to give us energy. They are each defen- 
 sible on their own grounds, and to deny them a reasonable 
 sanction is to raise a cry against defensive war, field sports, 
 and animal diet. There are delicate and sensitive natures 
 whose prejudices in these matters ought to be respected 
 as regards themselves ; but it would be a woeful time for a 
 country if their rule were to be made the rule of the State. 
 
 The far smaller sufferings inflicted by science are morally 
 justified by similar considerations. That they are beneficent 
 we have many proofs in daily life, and none perhaps more 
 curious than the ground from which has sprung the very 
 opposition itself to physiological experiment. This opposition 
 is fostered by the larger and truer views of living things 
 which physiology itself has taught. The improved feeling 
 of even careless persons towards the lower animals, and 
 the more enlightened sympathy which is felt towards them, 
 is largely due to a better knowledge of their nature, and of 
 the common tie of life which binds us to them. 
 
 It will appear to anyone who will be at the trouble to 
 inquire even cursorily into the order of nature, that this 
 order does not always accord with human views of bene- 
 volence ; often it seems contrary to them. Our scope is 
 necessarily limited, and the limit depends not only upon 
 the benevolent feelings of the person, but upon his capacity 
 for a comprehensive knowledge of the divinely-ordered 
 system of nature. 
 
 It has been urged that it would be better to leave the 
 progress of physiological knowledge to passive observation, 
 and to give up experiments altogether. But it would be 
 more reasonable to hope to make out the machinery of a 
 watch by looking at it, than to hope to understand the 
 mechanism of a living animal by mere contemplation. The 
 
THE ETHICS OF VIVISECTION. 179 
 
 movements and the value of the levers in the limbs and 
 joints might no doubt be largely made out by inspectipn ; 
 but the deeper and more complicated machinary, part of 
 which has been hinted at in the remarks on animal heat, 
 could not be learned without the most elaborate inquiry into, 
 and analysis of, combined living actions. This has always 
 been strongly felt by those capable of forming a true judg- 
 ment. Hence Harvey instituted an oration, to be delivered 
 annually before the Eoyal College of Physicians in London, 
 one of the conditions of which was that it should contain an 
 exhortation to the members to study and search out, the 
 secrets of nature by way of experiment.'' These orations 
 have been continued from the middle of the seventeenth 
 century to the present time. An unbroken testimony by 
 those most capable of judging has been borne ever since 
 to the value and necessity of physiological experiments. I 
 will only quote the latest, and perhaps the most striking 
 testimony ; which also refutes the slander that physiologists 
 are reckless of inflicting pain. When the International 
 Medical Congress met in London last year the following 
 resolution was adopted at one of its general meetings : 
 
 " That this Congress records its conviction that experiments on living 
 animals have proved of the utmost service to medicine in the past, and are 
 indispensable to its future progress. That accordingly, while strongly 
 deprecating the infliction of unnecessary pain, it is of opinion that it is not 
 desirable, in the interests of man and animals, to restrict competent persons 
 in the performance of such experiments." 
 
 While the course of scientific medicine lies only in the track 
 of discovered facts, those systems of cure which largely rest 
 on theory are more independent of experiment ; and this 
 may in some degree account for the indifference, and even 
 opposition, which some medical writers have felt to experi- 
 mental inquiry. 
 
 Let me offer two or three of the many instances which 
 justify Harvey and the Medical Congress. 
 
 At Oxford, in February, 1665, there being present Dr. 
 John Wallis, Savillian Professor of Mathematics, Dr. 
 Thomas Millington, Doctor of Medicine, and other members 
 of the University, Dr. Richard Lower made the following 
 experiment. Having by him a small dog and a mastiff, he 
 
180 ADDRESSES. 
 
 opened the jugular vein of the smaller dog, and allowed the 
 blood to flow until the animal was faint, and at the point of 
 death. Then, to supply this loss of blood, he connected the 
 carotid artery of the mastiff with the vein, and allowed the 
 blood to flow into it until the fainting animal was restored. 
 At the end of the experiment the vein was closed, the 
 dog leaped from the table, forgetful of what had happened, 
 rolled itself in the grass, and showed no sign of incon- 
 venience. This experiment was a natural corollary to 
 Harvey's discovery of the circulation, and has been the 
 means of saving many lives. If it stood alone, it would be 
 sufficient proof of the value of experiments on animals. The 
 knowledge it afforded could not possibly have been obtained 
 by passive observation or by fancy, and it rested upon the 
 plainest demonstration. Moreover, the pain inflicted on the 
 dogs by bleeding is a fair sample of a large number of the 
 " hideous torments " of vivisection. 
 
 Magendie discovered by his experiments a way of medi- 
 cating the body, which will be practised till the time 
 arrives when " there shall be no more pain." He demon- 
 strated that foreign substances in solution, put into the 
 tissues, as, for instance, under the skin, were immediately 
 absorbed, and so at once passed into the general circulation. 
 This means of introducing remedies into the system is daily 
 practised ; sometimes, indeed, we have no other means, and 
 when we have, this often affords the readiest and the quickest 
 method of giving relief. No mere passive observation could 
 have taught us this. 
 
 There are probably few symptoms more distressing and 
 alarming in the course of common life than severe attacks 
 of giddiness. By experiments on animals and birds it has 
 been proved that these " vertiginous " affections are depend- 
 ent upon irritation at the roots of certain nerves ; and by 
 the light of these experiments, and by observations on man, 
 we have not only been able more exactly to appreciate the 
 value of such symptoms, but to direct the use of our reme- 
 dies. 
 
 Man is liable to convulsions from childhood to old age. 
 Until Dr. Marshall Hall's vivisections, at the beginning of 
 this reign, nothing was really known of the convulsive state, 
 
THE ETHICS OP VIVISECTION. 181 
 
 but his experiments made it clear that a convulsion is a 
 mechanical nerve-process, the beginning of which may be 
 some trifling and removable irritation which propagates 
 itself along nervous lines to their centres, to issue again in 
 various directions to the muscles and other parts, much 
 after the manner of the electrical force telegraphed to a 
 central office, and thence outward in different lines. And 
 all this may go on in our nerves without our being in the 
 least conscious of it until the convulsion begins. Now, 
 prior to Marshall Hall's vivisections, or to speak more 
 exactly the vivisections of De Witt, who preceded him in 
 1 75 1, it was more or less generally supposed that convul- 
 sions were due to the disturbance of some spiritual force 
 within us ; and, indeed, all the bodily movements in health 
 were referred to this spiritual source. The very language 
 we use conveys the thoughts of ancient times in respect of 
 these matters — a " seizure," an " attack," a " stroke," point 
 to some agency external to the body. It is true that 
 philosophers, like Descartes and Willis, contemplating the 
 bodily movements and studying their own consciousness, 
 had arrived at the conclusion that a large number of our 
 actions were as mathematically performed as those of an 
 automaton, but they had no idea to what extent and in 
 what way this occurred in us until the discoveries made by 
 experiment. 
 
 The subject is far from exhausted as yet. When the 
 automatic laws of nervous action are fully explored, not 
 only (as hinted above) may we control fever, but, more 
 fully than at present, those convulsive affections, for which 
 much has already been done. 
 
 Even if no practical results had followed experiments on 
 the nervous system, they might have been defended upon 
 the ground of the lessons they have taught us of our own 
 constitution. Even superficially considered they increase 
 the wonder of our being. Those who have studied the 
 structure of the eye with its various media nicely adapted 
 for the refraction of light, have justly marvelled and ad- 
 mired. But what if they could view before them the 
 mechanical arrangements of the nervous system, whereby 
 day and night, waking and sleeping, the work of life is 
 
182 ADDRESSES. 
 
 done for us ? — here maintaining an equable temperature of 
 the body, there governing the chemical actions in digestion ; 
 from one centre controlling the action of the heart, from 
 another the frequency of the, breathing — and these actions 
 carried on quite unconsciously to ourselves, and all the 
 better without our attention. 
 
 Happily, experiments on the nervous system are far from 
 being usually painful. The great majority are performed 
 on decapitated frogs, or on other animals under the influ- 
 ence of anaesthetics. 
 
 As if this controversy on the rights of vivisection had 
 not already had enough of feeling imported into it, Mrs. 
 Kingsford would raise the cry of Atheism. She sees in the 
 pursuit of physiological science a concealed attack upon all 
 religious and sympathetic sentiment, and a repudiation of 
 man's moral responsibility. 
 
 This accusation needs little reply. We need not here, in 
 the cause of science, discuss the grounds of religious beliefs, 
 nor the relation of scientific knowledge to religious convic- 
 tion. We have it on the highest authority that " the 
 kingdom of God is within us/' and from the earliest time 
 it stands recorded that we cannot " by searching find out 
 God." Science has to do with that which is external to us, 
 with our material nature, its forces and their relations ; 
 with what is ponderable and measurable. What lies beyond 
 or beneath is relegated to other evidence and other tests, of 
 which it may be said that they afford more certainty than 
 even science can give us. There cannot be anything 
 atheistic in knowledge, and science is nothing but exact 
 knowledge. It would be as reasonable to assert that the 
 south pole contradicts the north, as that science affords in 
 any of her regions a negation to religion : on the contrary, 
 as our views of nature expand, our conceptions of the First 
 Cause become more and more reverent. This may, of course, 
 not be true in every case ; but on the whole, and taking 
 humanity throughout, it is a certain and unquestionable 
 result. But science cannot be too watchful against the 
 intrusion of theory into her operations. The imagination, 
 which in some minds is stronger than in others, is a danger- 
 ous ally in the investigation of facts. The exclusion of 
 
THE ETHICS OF VIVISECTION. 183 
 
 this airy spirit from the laboratory is a different thing 
 from a denial of the religious and sympathetic sentiments, 
 or a repudation of man's moral responsibility. Of natural 
 philosophy in general Bacon asserts that ' it is, after the 
 Word of God, the most approved support of Faith.' If he 
 had known what experimental physiology has taught us of 
 our internal mechanism and the deeper conditions of life, he 
 would have had additional reason for his assertion. 
 
 It seems to have been supposed by some persons that 
 medical students, from mere wantonness and for the practice 
 of the hand, are in the habit of cutting up living animals. 
 Those who are informed, on the matter know that such a 
 supposition is utterly groundless ; and this was fully proved 
 by the inquiry of the Royal Commission. One witness, 
 indeed, hinted at such a fact ; but when pressed for evidence 
 declined to give it. No operations on living animals for 
 the purpose of obtaining surgical dexterity have been or are 
 performed at any medical school in the kingdom. No vivi- 
 sectional experiments can be performed anywhere but in a 
 licensed laboratory. In their Report the commissioners 
 state, after a full inquiry : ' We have great satisfaction in 
 assuring your Majesty that at the present time a general 
 sentiment of humanity on this subject appears to pervade 
 all classes in this country. 1 They quote the words of several 
 witnesses, which are to the effect that, " in a'medical school, 
 anything like cruelty or indifference to suffering would be 
 scouted by the public opinion of the students/' To fix the 
 charge of cruelty upon physiologists, the evidence had to be 
 drawn from what is reported to have occurred in foreign 
 countries or in distant times. In matters of daily life this 
 would not be considered admissible. Not that English 
 physiologists would wish it to be understood that they 
 surpass their foreign colleagues in benevolence and com- 
 passion ; but they would maintain that to draw a trustworthy 
 conclusion from what happens in other countries, an exact; 
 and full inquiry ought to be made. 
 
 The sum of the matter seems to be that human life and 
 the relief of human misery are objects which justify the 
 infliction of pain upon animals, provided always that the 
 suffering be no more than is necessary for the ends in view. 
 
184 ADDRESSES. 
 
 There is no doubt (and our more reasonable opponents, 
 Lord Coleridge and Mr. Hutton, admit it) that physiological 
 experiments are useful, useful for animals as well as for man. 
 They are therefore justifiable, within the limits which were 
 laid down / by physiologists for themselves, and have been 
 since enforced by legislation. Physiologists would unre- 
 servedly subscribe the principle, nihil utile quod non ho- 
 nestum. To the accusation of cruelty they may fairly reply, 
 supported by all past experience, that nothing is so cruel as 
 ignorance. For how many centuries had human sufferers to 
 bear pain which is now preventible by better knowledge ? 
 How many thousands festered to death in small-pox before 
 the discovery of vaccination ? How many are now dying of 
 tubercle and scrofula whom a better knowledge of these 
 conditions might rescue ? Yet the pursuit of this knowledge 
 is hindered in England by the outcry of cruelty — the cruelty 
 being no more than the inoculation of some of the lower 
 animals with tubercular and scrofulous matter, in order 
 to study the course of the disease and the modes of pre- 
 vention. The cruelty obviously lies, not in performing these 
 experiments, but in the hindering of progressive knowledge. 
 Genuine scientific investigation should, in the interest of the 
 nation, be fostered, not repressed by penal statutes. The 
 welfare of all, from the highest to the lowest, is dependent 
 at some time or another upon the knowledge which it brings. 
 If to-day it inflict temporary pains, it annihilates their causes 
 and their necessity in the future. It works to no selfish 
 end, and for the most part its only reward is the fulfilment 
 of its own high instincts. " The spirit of man," says 
 Solomon, " is the lamp of God, wherewith He searcheth the 
 inwardness of all secrets." 
 
 PRINTED BY ADLARD AND SON, 
 BARTHOLOMEW CLOSE, E.C., AND 20, HANOVER SQTJARE, W. 
 

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