Medicine - The Leaven of Science Part 2
( Originally Published 1905 )
Turning from the men to the subject in which they worked, from the past to the present, let us take a hasty glance at some of the developments of human anatomy and biology. Truth has been well called the daughter of Time, and even in anatomy, which is a science in a state of fact, the point of view changes with successive generations. The following story, told by Sir Robert Christison, of Barclay, one of the leading anatomists of the early part of this century, illustrates the old attitude of mind still met with among "bread and butter" teachers of the subject. Bar-clay spoke to his class as follows: "Gentlemen, while carrying on your work in the dissecting-room, beware of making anatomical discoveries; and above all beware of rushing with them into print. Our precursors have left us little to discover. You may, perhaps, fall in with a supernumerary muscle or tendon, a slight deviation or extra branchlet of an artery, or, perhaps, a minute stray twig of a nerve—that will be all. But beware! Publish the fact, and ten chances to one you will have it shown that you have been forestalled long ago. Anatomy may be likened to a harvest-field. First come the reapers, who, entering upon untrodden ground, cut down great store of corn from all sides of them. These are the early anatomists of modern Europe, such as Vesalius, Fallopius, Malpighi, and Harvey. Then come the gleaners, who gather up ears enough from the bare ridges to make a few loaves of bread. Such were the anatomists of last century—Valsalva, Cotunnius, Haller, Winslow, Vicq d'Azyr, Camper, Hunter, and the two Monros. Last of all come the geese, who still contrive to pick up a few grains scattered here and there among the stubble, and waddle home in the evening, poor things, cackling with joy because of their success. Gentlemen, we are the geese." Yes, geese they were, gleaning amid the stubble of a restricted field, when the broad acres of biology were open before them. Those were the days when anatomy meant a knowledge of the human frame alone; and yet the way had been opened to the larger view by the work of John Hunter, whose comprehensive mind grasped as proper subjects of study for the anatomist all the manifestations of life in order and disorder.
The determination of structure with a view to the discovery of function has been the foundation of progress. The meaning may not always have been for "him who runs to read;" often, indeed, it has been at the time far from clear; and yet a knowledge in full detail of the form and relations must precede a correct physiology. The extraordinary development of all the physical sciences, and the corresponding refinement of means of research, have contributed most largely to the enlightenment of the "geese" of Barclay's witticism. Take the progress in any one department which has a practical aspect, such as, in the anatomy and physiology of the nervous system. Read, for example, in the third edition of Wistar's Anatomy, edited by Horner in 1825, the description of the convolutions of the brain, on which today a whole army of special students are at work, medical, surgical, and anthropological, and the functions of which are the objective point of physiological and psychological research—the whole subject is thus disposed of : "The surface of the brain resembles that of the mass of the small intestine, or of a convoluted, cylindrical tube; it is, therefore, said to be convoluted. The fissures between these convolutions do not extend very deep into the substance of the brain." The knowledge of function correlated with this meagre picture of structure is best expressed, perhaps, in Shakespearian diction, "that when the brains were out, the man would die." The laborious, careful establishment of structure by the first two generations in this century led to those brilliant discoveries in the functions of the nervous system which have not only revolutionized medicine, but have almost enabled psychologists to dispense with metaphysics altogether. It is particularly interesting to note the widespread dependence of many departments on accurate anatomical knowledge. The new cerebral anatomy, particularly the study of the surface of the brain, so summarily dismissed in a few lines by Wistar, made plain the path for Hitzig and Fritsch, the careful dissection of cases of disease of the brain prepared the way for Hughlings Jackson; and gradually a new phrenology on a scientific basis has replaced the crude notions of Gall and Spurzheim; so that with the present generation, little by little, there has been established on a solid structure of anatomy, the localization of many of the functions of the brain. Excite with a rough touch, from within or from without, a small region of that mysterious surface, and my lips may move, but not in the articulate expression of thought, and I may see, but I cannot read the page before me; touch here and sight is gone, and there again and hearing fails. One by one the centres may be touched which preside over the muscles, and they may, singly or together, lose their power. All these functions may go without the loss of consciousness. Touch with the slow finger of Time the nutrition of that thin layer, and backward by slow degrees creep the intellectual faculties, back to childish simplicity, back to infantile silliness, back to the oblivion of the womb.
To this new cerebral physiology, which has thus gradually developed with increasing knowledge of structure, the study of cases of disease has contributed enormously, and today the diagnosis of affections of the nervous system has reached an astonishing degree of accuracy. The inter-dependence and sequence of knowledge in various branches of science is nowhere better shown than in this very subject. The facts obtained by precise anatomical investigation, from experiments on animals in the laboratory, from the study of nature's experiments upon us in disease, slowly and painfully acquired by many minds in many lands, have brought order out of the chaos of fifty years ago. In a practical age this vast change has wrought a corresponding alteration in our ideas of what may or may not be done in the condition of perverted health which we call disease, and we not only know better what to do, but also what to leave undone. The localization of centres in the surface of the brain has rendered it possible to make, with a considerable degree of certainty, the diagnosis of focal disease, and Macewen and Horsley have supplemented the new cerebral physiology and pathology by a new cerebro-spinal surgery, the achievements of which are scarcely credible.
But this is not all; in addition to the determination of the centres of sight, hearing, speech, and motor activities, we are gradually reaching a knowledge of the physical basis of mental phenomena. The correlation of intelligence and brain weight, of mental endowment and in-creased convolution of the brain surface, was recognized even by the gleaners of Barclay's story; but within the past twenty-five years the minute anatomy of the organ has been subjected to extensive study by methods of ever-increasing delicacy, which have laid bare its complex mechanism. The pyramidal cells of the cerebral grey matter constitute the anatomical basis of thought, and with the development, association, and complex connection of these psychical cells, as they have been termed, the psychical functions are correlated. How far these mechanical conceptions have been carried, may be gathered from the recent Croonian Lecture before the Royal Society, in which Ramon y Cajal based the action and the degree, and the development of intelligence upon the complexity of the cell mechanism and its associations. Even the physical basis of a moody madness has not evaded demonstration. Researches upon the finer structure of the cerebral cortex lead to the conclusion that imbecility, mental derangement, and the various forms of insanity are but symptoms of diseased conditions of the pyramidal cells, and not separate affections of an indefinable entity, the mind. Still further; there is a school of anthropologists which strives to associate moral derangement with physical abnormalities, particularly of the brain, and urges a belief in a criminal psychosis, in which men are "villains by necessity, fools by heavenly compulsion, knaves, thieves, and treachers by spherical predominance." This remarkable revolution in our knowledge of brain functions has resulted directly from the careful and accurate study by Barclay's "geese," of the anatomy of the nervous system. Truly the gleaning of the grapes of Ephraim has been better than the vintage of Abiezer.
The study of structure, however, as the basis of vital phenomena, the strict province of anatomy, forms but a small part of the wide subject of biology, which deals with the multiform manifestations of life, and seeks to know the laws governing the growth, development, and actions of living things. John Hunter, the master of Shippen and Physick, was the first great biologist of the moderns, not alone because of his extraordinary powers of observation and the comprehensive sweep of his intellect, but chiefly because he first looked at life as a whole, and studied all of its manifestations, in order and disorder, in health and in disease. He first, in the words of Buckle, "determined to contemplate nature as a vast and united whole, exhibiting, indeed, at different times, different appearances, but preserving amidst every change, a principle of uniform, and uninterrupted order, admitting of no division, under-going no disturbance, and presenting no real irregularity albeit to the common eye irregularities abound on every side." We of the medical profession may take no little pride in the thought that there have never been wanting men in our ranks who have trodden in the footsteps of this great man; not only such giants as Owen, Huxley, and Leidy, but in a more humble way many of the most diligent students of biology have been physicians. From John Hunter to Charles Darwin enormous progress was made in every department of zoology and botany, and not only in the accumulation of facts relating to structure, but in the knowledge of function, so that the conception of the phenomena of living matter was progressively widened. Then with the Origin of Species came the awakening, and the theory of evolution has not only changed the entire aspect of biology, but has revolutionized every department of human thought.
Even the theory itself has come within the law; and to those of us whose biology is ten years old, the new conceptions are, perhaps, a little bewildering. The recent literature shows, however, a remarkable fertility and strength. Around the nature of cell-organization the battle wages most fiercely, and here again the knowledge of structure is sought eagerly as the basis of explanation of the vital phenomena,. So radical have been the changes in this direction that a new and complicated terminology has sprung up, and the simple, undifferentiated bit of protoplasm has now its cytosome, cytolymph, caryosome, chromosome, with their somacules and biophores. These accurate studies in the vital units have led to material modifications in the theory of descent. Weismann's views, particularly on the immortality of the unicellular organisms, and of the reproductive cells of the higher forms, and on the transmission or non-transmission of acquired characters, have been based directly upon studies of cell-structure and cell-fission.
In no way has biological science so widened the thoughts of men as in its application to social problems. That throughout the ages, in the gradual evolution of life, one unceasing purpose runs; that progress comes through unceasing competition, through unceasing selection and rejection; in a word, that evolution is the one great law controlling all living things, "the one divine event to which the whole creation moves," this conception has been the great gift of biology to the nineteenth century. In his work on Social Evolution, Kidd thus states the problem in clear terms: "Nothing tends to exhibit more strikingly the extent to which the study of our social phenomena must in future be based on the biological sciences, than the fact that the technical controversy now being waged by biologists as to the transmission or non-transmission to offspring of qualities acquired during the lifetime of the parent, is one which, if decided in the latter sense, must produce the most revolutionary effect throughout the whole domain of social and political philosophy. If the old view is correct, and the effects of use and education are transmitted by inheritance, then the Utopian dreams of philosophy in the past are undoubtedly possible of realization. If we tend to inherit in our own persons the result of the education and mental and moral culture of past generations, then we may venture to anticipate a future society which will not deteriorate, but which may continue to make progress, even though the struggle for existence be suspended, the population regulated exactly to the means of subsistence, and the antagonism between the individual and the social organism extinguished. But if the views of the Weismann party are in the main correct; if there can be no progress except by the accumulation of congenital variations above the average to the exclusion of others below; if, without the constant stress of selection which this involves, the tendency of every higher form of life is actually retrograde; then is the whole human race caught in the toils of that struggle and rivalry of life which has been in progress from the beginning. Then must the rivalry of existence continue, humanized as to conditions it may be, but immutable and inevitable to the end. Then also must all the phenomena of human life, individual, political, social, and religious, be considered as aspects of this cosmic process, capable of being studied and under-stood by science only in their relations thereto."
Biology touches the problems of life at every point, and may claim, as no other science, completeness of view and a comprehensiveness which pertains to it alone. To all whose daily work lies in her manifestations the value of a deep insight into her relations cannot be overestimated. The study of biology trains the mind in accurate methods of observation and correct methods of reasoning, and gives to a man clearer points of view, and an attitude of mind more serviceable in the working-day-world than that given by other sciences,, or even by the humanities. Year by year it is to be hoped that young men will obtain in this Institute a fundamental knowledge of the laws of life.
To the physician particularly a scientific discipline is an incalculable gift, which leavens his whole life, giving exactness to habits of thought and tempering the mind with that judicious faculty of distrust which can alone, amid the uncertainties of practice, make him wise unto salvation. For perdition inevitably awaits the mind of the practitioner who has never had the full inoculation with the leaven, who has never grasped clearly the relations of science to his art, and who knows nothing, and perhaps cares less, for the limitations of either.
And I may be permitted on higher grounds to congratulate the University of Pennsylvania on the acquisition of this Institute. There is great need in the colleges of this country of men who are thinkers as well as workers—men with ideas, men who have drunk deep of the Astral wine, and whose energies are not sapped in the tread-mill of the class-room. In these laboratories will be given opportunities for this higher sort of university work. The conditions about us are changing rapidly: in the older states utility is no longer regarded as the test of fitness, and the value of the intellectual life has risen enormously in every department. Germany must be our model in this respect. She is great because she has a large group of men pursuing pure science with unflagging industry, with self-denying zeal, and with high ideals. No secondary motives sway their minds, no cry reaches them in the recesses of their laboratories, "of what practical utility is your work?" but, unhampered by social or theological prejudices, they have been enabled to cherish "the truth which has never been deceived—that complete truth which carries with it the antidote against the bane and danger which follow in the train of half-knowledge." (Helmholtz.)
The leaven of science gives to men habits of mental accuracy, modes of thought which enlarge the mental vision, and strengthens—to use an expression of Epicharmus—"the sinews of the understanding." But is there nothing further? Has science, the last gift of the gods, no message of hope for the race as a whole; can it do no more than impart to the individual imperturbability amid the storms of life, judgment in times of perplexity? Where are the bright promises of the days when "the kindly earth should slumber rapt in universal law"? Are these, then, futile hopes, vain imaginings of the dreamers, who from Plato to Comte have sought for law, for order, for the civitas Dei in the regnum hominis?
Science has done much, and will do more, to alleviate the unhappy condition in which so many millions of our fellow-creatures live, and in no way more than in mitigating some of the horrors of disease; but we are too apt to forget that apart from and beyond her domain lie those irresistible forces which alone sway the hearts of men. With reason science never parts company, but with feeling, emotion, passion, what has she to do? They are not of her; they owe her no allegiance. She may study, analyze, and define, she can never control them, and by no possibility can their ways be justified to her. The great philosopher who took such a deep interest in the foundation of this University, chained the lightnings, but who has chained the wayward spirit of man? Strange compound, now wrapt in the ecstasy of the beatific vision, now wallowing in the sloughs of iniquity, no leaven, earthly or divine, has worked any permanent change in him. Listen to the words of a student of the heart of man, a depictor of his emotions: "In all ages the reason of the world has been at the mercy of brute force. The reign of law has never had more than a passing reality, and never can have more than that so long as man is human. The individual intellect, and the aggregate intelligence of nations and races, have alike perished in the struggle of mankind, to revive again, indeed, but as surely to be again put to the edge of the sword. Look where you will throughout the length and breadth of all that was the world, 5000 or 500 years ago; everywhere passion has swept thought before it, and belief, reason. Passion rules the world, and rules alone. And passion is neither of the head nor of the hand, but of the heart. Love, hate, ambition, anger, avarice, either make a slave of intelligence to serve their impulses, or break down its impotent opposition with the unanswerable argument of brute force, and tear it to pieces with iron hands." (Marion Crawford.)
Who runs may read the scroll which reason has placed as a warning over the human menageries: "chained, not tamed." And yet who can doubt that the leaven of science, working in the individual, leavens in some slight degree the whole social fabric. Reason is at least free, or nearly so; the shackles of dogma have been removed, and faith herself, freed from a morganatic alliance, finds in the release great gain.
One of the many fertile fancies of the "laughing philosopher," a happy anticipation again of an idea peculiarly modern, was that of the influence upon us for weal or woe of Externals, of the idola, images, and effluences which encompass us—of Externals upon which so much of our happiness, yes, so much of our every character depends.
The trend of scientific thought in this, as in the atomic theory, has reverted to the Sage of Abdera; and if environment really means so much, how all-important a feature in education must be the nature of these encompassing effluences. This magnificent structure, so admirably adapted to the prosecution of that science from which modern thought has drawn its most fruitful inspirations, gives completeness to the already exhilarating milieu of this University. Here at last, and largely owing to your indomitable energy, Mr. Provost, are gathered all the externals which make up a Schola major worthy of this great Commonwealth. What, after all, is education but a subtle, slowly-affected change, due to the action upon us of the Externals; of the written record of the great minds of all ages, of the beautiful and harmonious surroundings of nature and of art, and of the lives, good or ill, of our fellows—these alone educate us, these alone mould the developing minds. Within the bounds of this campus these influences will lead successive generations of youth from matriculation in the college to graduation in the special school, the complex, varied influences of Art, of Science, and of Charity; of Art, the highest development of which can only come with that sustaining love for ideals which, "burns bright or dim as each are mirrors of the fire for which all thirst;" of Science, the cold logic of which keeps the mind independent and free from toils of self-deception and half-knowledge; of Charity, in which we of the medical profession, to walk worthily, must live and move and have our being.