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WALTER JAR VIS BARLOW

HISTORY OF MEDICINE COLLECTION

BIOMEDICAL LIBRARY.
UNIVERSITY OF CALIFORNIA AT LOS ANGELES

THE BIRTH AND GROWTH OF
SCIENCE IN MEDICINE

BEING

THE HARVEIAN ORATION

DELIVERED BEFORE THE ROYAL COLLEGE OF
PHYSICIANS OF LONDON, OCTOBER i8th, 1920

BY

SIR FREDERICK W. ANDREWES

M.D., F.R.C.P., F.R.S.

PROFESSOR OK PATHOLOGY AT ST. BARTHOLOMEWS
HOSPITAL IN THE UNIVERSITY OF LONDON

il onion :

ADLARD and son and west NEWMAN, LTD.

BARTHOLOMEW CLOSE, E.C.

1920

Printed by

Adlatd & Son & West Nezuman, Ltd.,

London and Darking.

/ / / u

THE BIRTH AND GROWTH OF
SCIENCE IN MEDICINE.

Mr. President and Fellows, —

A Harveian orator, in choosing the subject of his
discourse, hesitates between two paths. He may seek to
elucidate some point in the founder's Hfe or work which
has escaped the notice of previous orators, or he may take
some wider theme and speak of the spirit in which Harvey
carried on his labours. I have not the knowledge to
attempt the first of these alternatives, and when. Sir, you
did me the great honour of nomination as this year's
orator, it was clear to me that I must adopt the second.
Many of my predecessors in the office have been more
distinguished pathologists than I am, but I believe that
this is the first occasion on which the honour has been
conferred upon one who is not engaged in ordinary
medical practice, but is a pathologist by profession. I
have to thank you, Sir, not only on my own behalf, but
even more in the name of the subject which, in all
humilit}', I represent.

The Harveian orator is enjoined to commemorate
the various benefactors of the College, but considerable
latitude is by custom allowed him as to the manner in
which he fulfils this duty. Our College is rich in former
gifts of books, pictures, silver and other valuable and
beautiful possessions ; our endowments in houses and
lands enable the Foundation to carry out its work with
ampler means. To all those who have conferred such
benefactions upon the College our grateful thanks are
due, and if to-day I do not formally recite the long list
I

2 THE I5IRTH AND GROWTH OF SCIENCE IN MEniCINE

of names it is because I believe that the founder of this
Oration would himself have been the first to recognise
that our intellectual heritage is a treasure of greater
worth than material possessions. The great men of the
past, to whose labours we owe the development of medical
science, have been benefactors of this College, and of all
that it represents, in a nobler sense. Harvey was one,
and not the least, among them, and I conceive that I cannot
more fittingly honour his memory than by devoting this
oration to the inward spirit which has animated the
progress of medical science. Many great names stand
along the centuries, marking the toilsome and broken
road by which our science has reached its present position,
and Harvey is worthy of his company.

It is natural that, as a pathologist, I should take the
more purely scientific aspect of medicine as the subject
of my discourse, and it will be proper in the first place
to consider the position which medicine occupies amongst
the sciences. We are accustomed to speak of the " art
and science of medicine," perhaps without reflecting upon
where the art begins and the science leaves off. A body of
facts in any branch of knowledge, however thoroughly their
truth has been established, does not of itself constitute
a science. Science lies in the way the facts are treated.
They need to be classified and viewed in their mutual
relations : then, by appropriate reasoning, it is sought
to formulate the general laws which govern the province
of Nature studied. The aim of science is to discover
the "Laws of Nature," and in its truest though narrowest
sense it is the pursuit of this knowledge for its own sake,
irrespective of any practical use to which it may be put.

The primary aim of medicine is the practical one of
healing the sick or preventing disease, and therefore, in
the narrower sense, medicine is not a science but an art.
Physiology, pathology and pharmacology are sciences in
the strictest sense : medicine is the art of applying the
laws established by these sciences to the prevention and
cure of disease ; more than this, it is the very human art

THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE. 3

of treating the patient as well as his disease. But in a
broader, and surely a more natural, sense we may regard
medicine as a science. Pathology may, it is true, be
pursued as an abstract subject, but in real life it is
inseparable from medicine. Treatment and prevention
are so intimately bound up with a right understanding of
the nature of disease and of the laws which govern its
course, that I refuse to separate pathology and medicine.
It has too long been the fashion to limit the sphere of
pathology to the dead-house and the laboratory ; its field
is also at the bedside, and indeed I would assert that there
is no method of studying the natural history of disease
which pathology may not claim as its proper province.

By Harvey's injunction I am to admonish you to seek
out the truths of Nature by observation and experiment.
These are two different ways of pursuing a subject, and
indeed the concrete sciences have been divided into the
" observational " and the " experimental ": anatomy is an
observational science, physiology an experimental one.
The observational sciences long preceded the experimental,
and in pathology and medicine, which partake of the
nature of both, the experimental method is of late growth.

My aim is to trace, so far as I may in the allotted span
of time, the influences which have governed the growth
of our knowledge of disease, and to pursue them to their
beginnings rather than to record their final results. I
cannot, indeed, hope to say anything new ; I can only
endeavour to place before you the facts to be gathered
from literature in the way in which they group themselves
in my own mind.

In the first place let me consider the conditions necessary
to the successful development of a science. The foremost
is liberty of thought. Unless man is free to reason from
his facts unhampered by deference to received opinion or
tradition, real progress in science is impossible. The
history of medicine abounds in evidence of this truth —
indeed Harvey's demonstration of the circulation offers a
striking instance. The second condition is accuracy of

4 THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE.

observation, with patient accumulation of the facts which
form the building-stones of science. The third, widely
different from the preceding, is the gift of imagination
which can frame a tentative explanation of the observed
facts — a rarer faculty in the chastened form demanded
by science, and perhaps a more dangerous one. The two
conditions last named are seen united only in exceptional
men : they were so in Harvey, who has left a clear record
of the mental processes which led him to the truth. In
the fourth place comes the verification of hypothesis by
experiment in which the conditions are so controlled as
to allow of more convincing conclusions than chance
observations permit. And governing the whole chain of
thought from its first inception there must be present
that capacity for severely correct thinking, the rules for
which are embodied in logic. Let us now see how the
history of medical science sheds light on the development
of these fundamental conditions.

History has been said to be the story of the influence
of great men. It is true that we can associate the more
striking advances in medical science with the names of
individual men who stand out as landmarks in its develop-
ment, but the course of history is surely swayed by
influences deeper than this. A great man is the product
of his times. Harvey would not have discovered the
circulation had it not been for the labours of his pre-
decessors and the intellectual atmosphere in which he
lived. The great man is he who has the vision to combine
the scattered facts into a harmonious whole, and who
can carry conviction to others by the force of his reasoning.
I shall have to commemorate such great names standing
along the history of medical science, but I shall also be
obliged to consider the conditions which produced them.

In his suggestive little book, entitled ' The Revolutions
of Civilisation,' Prof. Flinders Petrie has pointed out that
culture is an intermittent phenomenon. No civilisation
in the past has proved permanent, and he estimates the
average duration of any given period of culture at about

THE BIRTH AND GROWTH OK SCIENCE IN MEDICINE. 5

1500 years: in Egypt he traces eight such periods. The
downfall is usually brought about by the invasion of a
people of lower culture but greater virility, and from the
mixture of the old and the new races a new civilisation is
born, but only after an interval of relative barbarism — a
sort of incubation period lasting some hundreds of years.
The first phase of the new culture is hampered by im-
perfect traditions of the past : it is the stage of archaism
in art, and in science it is marked by blind reliance on
received opinion. In time these trammels are shaken off
and the new people enters upon the unfettered exercise
of its inborn genius. It acquires intellectual liberty, and
now comes the phase of maximum fertility in every branch
of human enterprise, lasting, perhaps, but a century or
two, and followed by gradual decadence till the over-ripe
civilisation is ready to fall. That this has been the course
of all the civilisations known to us admits of no dispute,
and Prof. Flinders Petrie adds the important observation
that there is a fairly regular sequence in the development
of the various branches of human activity. Art is the
first to reach its highest point, and notably sculpture and
architecture ; literature follows later, while science is last
of all in its development, and may be delayed for 500 years
or more after sculpture has reached its acme. Our own
civilisation offers confirmation of the truth of these pro-
positions. Science is still advancing rapidly with us, but, as
a race, we are now quite incapable of Salisbury Cathedral,
of Magdalen Tower, or of King Henry VII's Chapel.
Consider the recent work at Cambridge on the structure
of the atom, and then go and look at the statue of Sir
Wilfred Lawson on the Embankment.

But, with all this intcrmittence, there is none the less
an upward movement of civilisation as a whole. Each
new period of culture is coming to found itself more and
more on that which has preceded it. In early times a
civilisation, when it fell, passed more or less utterly
away : its successor had to begin again from the begin-
ning. The invention of writing has profoundly affected

6 THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE.

the degree to which one period can influence that which
comes after it. In spite of all that has been lost, our
debt to classical antiquity is one that never can be
measured, and with the art of printing and the distribu-
tion of books over the world it would seem impossible
that any important element in our own culture should be
lost to our successors when our civilisation perishes in
its turn.

These considerations are of no little significance in
relation to the development of medical science. We are
aware of three great periods of civilisation in Europe
during the past 5000 years — the Mediterranean or Minoan,
with its headquarters in Crete, from 3000 to 1200 B.C.;
the Classical, of which Greece was the fountain head;
and the Modern or Western, in which we are still living.
We know too little of the first of these, at least from the
aspect of science, to enable me to say much about it ;
medical science, so far as we are aware, began with the
ancient Greeks.

This statement requires justification, for we know that
the older civilisations of Egypt and Babylonia had some
acquaintance with medicine and attained a certain degree
of surgical and therapeutic skill. I have spoken of
Science as an endeavour to formulate the laws of Nature,
and as the pursuit of knowledge for its own sake. Now
the Egyptians, as Prof. Burnet has pointed out, had
invented certain practical rules of mensuration, amongst
others one which involved the properties of the triangle
with sides of 3, 4 and 5 units respectively, but they used
their rules empirically. The Greeks took this knowledge
and began to study the properties of numbers for their
own sake : Pythagoras proved the abstract proposition
which we know as Euclid I, 47. The Greeks originated
the science of mathematics. Similarly the Babylonians
amassed data concerning the heavenly bodies, and arrived
at a certain periodicity of eclipses, but they made no
attempt, so far as we know, to formulate the laws
governing the movements of the sun, moon and stars.

THE BIRTH AND GROWTH OF SCIE^XE IN MEDICINE. 7

The Greeks absorbed the Babylonian data, and began to
reason about them ; in a few centuries they found out that
the earth was round and floated in space, and surmised that
it was only a member of a larger system of worlds ; they
not merely observed, but succeeded in explaining eclipses.
They thus founded the science of astronomy. In the
same way, as I propose to relate, they laid the foundations
of medical science.

The way in which Greek history is usually taught in
schools is, to my mind, a deplorable thing. If one takes
up a primer on the subject, one finds it a lamentable
record of petty strife and treachery, redeemed, indeed,
here and there by some noble and heroic action, but
conveying little of the marvellous achievements of the
Greeks in the realms of thought and art. What does
the Peloponnesian war matter, in comparison with the
invention of mathematics and logic, with the rise of
democracy, the development of the drama, or the idealism
of Greek sculpture ? By all means teach the school-boy
what Marathon and Salamis meant for the future of
European civilisation, but teach him, too, the significance
of Hellenism in art, literature and science. The political
failures and downfall of the Greeks may well be relegated
to a tragic addendum, to warn him that no intellectual
brilliancy and freedom can make a nation long successful
in the absence of unselfishness and good faith.

I take it that few things have ever happened in the
world so wonderful as the relatively sudden intellectual
development of the ancient Greeks. Ethnologists tell us
that a peculiarly happy accident of racial fusion was
largely accountable for their genius. Right through the
Bronze Age the dominant race in the ^Egean had been
that which developed the so-called " Minoan " culture—
a people small in stature, active and intelligent, and with
a highly developed artistic talent. Their civilisation was
overwhelmed by successive waves of migration from the
north : the invaders were of Aryan origin, and repre-
sented many different tribes. The Achieans, known to

8 THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE.

US from the pages of Homer, were amongst the earher
comers ; the Dorians came last, and partly drove out the
already half-mingled Mediterranean and Achaean races.
The Dorians seem to have contributed little to the intel-
lectual development of future Greece ; they remained
more or less apart— a military people of which the
Spartans were a type. The effective elements were the
Achaean and Mediterranean races, the first contribu-
ting discipline, order and self-control, while intellectual
acuteness and artistic gifts were brought by the southern
race — a fertile combination for the growth of science.
There was a long period of darkness and barbarism, lasting
some four or five hundred years — a dreadful time about
which history is silent. In the wreck of the old culture
even the art of writing seems to have perished, and a
new alphabet had to be brought into use. But by 800
or 700 B.C. the new civilisation began to dawn, and in
the realms of thought the dawn was earliest, not on the
mainland of Greece, but in the more settled countries
round the ^Egean occupied by the Ionian Greeks.

So far as we are aware, the earliest attempts at science
began in Ionia some six centuries before Christ, and the
name which I would first commemorate as a spiritual
benefactor of this College is that of Thales of Miletus.
I might have chosen Empedocles or Pythagoras, but we
may let Thales, as the first of the succession of early
Greek thinkers, stand as the prototype of the group of
men who laid the foundations upon which science was to
be built by future generations. Doubtless these men
had acquired what they might of the lore of older civili-
sations, but they seem to have been the first to pursue
abstract knowledge. Till their day men had been content
to accept any foolish myth about the nature of the world
and of the things they saw around them. The service
which Thales and his successors rendered to mankind
was that they rejected all fabulous tales, and began to
think for themselves how things had become such as
they saw, definitely reaching out after the laws which

THE iilRTH AKD GROWTH 0¥ SCIENCE H\ MEDICINE, y

they felt sure must govern Nature. Their great contri-
bution to science was to establish that atmosphere of
intellectual liberty which rendered science possible. It
says much for the liberal spirit of that age that these
men, who broke with all the cherished traditions of the
past, were not, as a rule, reviled for impiety, but received
universal honour. Thales was accounted one of the
seven wise men of Greece.

It is easy for us to smile at the crudity of some of the
attempts of these early philosophers to explain Nature.
Yet they early recognised the permanence and inde-
structibility of matter, and one of their chief preoccupations
was the search after the primary substance out of which
they conceived everything to arise. Some identified it
with water, some with air, and Empedocles, in the fifth
century B.C. is credited with formulating the doctrine of
the four elements, earth, air, fire and water, which was
to dominate scientific thought for more than a thousand
years. The obvious antagonism between heat and cold,
dryness and moisture, early led to the doctrine of
" opposites," which became one of the chief tenets of
Greek medicine. Even the atomic theory can be traced
back to Leucippus of Miletus in the fifth century B.C.
This conception, elaborated some four centuries later in
the well-known poem of Lucretius, is an interesting
example of a hypothesis reached by sheer thinking, but
remaining sterile for 2000 j-ears, till established by the
experimental method in the hands of Dalton. That
marks the difference between the science of the armchair
and that of the laboratory.

But let me now consider what the earlier Greeks did
for medical science. Medicine of a sort and rude surgery
must have been transmitted even through the dark ages,
handed down, it is said, by special families — the Askle-
piadae — just as the epic tradition was passed along by the
Homendge. Certain rules of surgery and the practices of
blood-letting and purgation are known to be of immemorial
antiquity, but for the most part the medical practice of

10 fiit BIRTH AND GROWTH OF SCIENCE IN MEDICINE.

those times seems to have been bound up with fetish-
worship and superstition. There is no evidence that
Egypt had any true medical science to impart, and our
knowledge of Minoan medicine is hmited to the single
fact that in the great palace at Cnossus there existed a
system of sanitation so good that it was never equalled
till the reign of Queen Victoria. We may be quite sure
that the inquisitive and receptive Greek mind was quick
to pick up what it could from the older civilisations, and
then, in accordance with its peculiar genius, it proceeded
to develop it out of all recognition. The greatest achieve-
ments of the Greeks were not in medical science : other
sciences had to develop before medicine could rest upon
a proper foundation ; but what they did for medicine was
no small thing.

Their physicians were usually philosophers, and their
philosophers speculated as freely about the functions of
the body as they did about the universe. Their physiology
naturally reflected their views on science in general. The
school of Empedocles identified his four elements with
the hot and the cold, the moist and the dry, and loss of
balance between these opposites was held to produce
disease. Had such crude speculations been all, medicine
might have owed little to the earlier Greeks. But there
was much more. The Greeks were acute observers, and
they began to study and to record the phenomena of
disease, grouping and classifying according to the lights
of the time : thus medicine entered upon its first scientific
stage ; it became an observational science. More than
this, just as in other matters the philosophers had put
away the myths and fairly tales of their ancestors, so, too,
in medicine they rejected the magic and fetish-worship
which had hitherto formed so large a part of practice :
this was one of the greatest services rendered by the
Greeks to medical science. Not that medicine became
altogether dissociated from religion. /Esculapius was
worshipped at num.erous temples, and thither the sick
were brought to receive such benefit as they might from

THE BIRTH ANt> GROWTH OF SCIENCE: IN MEDICINE. I f

the rites of the god. But at such health resorts they
were also subjected to other inlluences — careful diet, pure
water, rest and cheerful associations — and when improve-
ment occurred, the physicians had the acuteness to
perceive that this simple treatment had probably more
to do with the result than the religious rites.

This brings me to the second name which I naturally
commemorate to-day — that of Hippocrates of Cos — the
first great clinician of whom we have any knowledge, and
one whose name will always be associated with the phase
which Greek medicine had now reached. When Hippo-
crates was born, about 460 B.C., observational medicine
had attained a considerable pitch of excellence. He
doubtless imbibed the teachings of other great physicians
who had gone before him, but the veneration in which
Hippocrates was held by the Greeks themselves assures
us that he was a man of outstanding character and attain-
ments. We can, however, judge of him more directly.
It is certain that only a small part of the Hippocratic
treatises which have come down to us are from the pen
of the master himself, but we may reasonably take them,
as a whole, to represent his teaching, and they give us a
fair idea of the stage at which the best Greek medical
science had arrived in the fifth century B.C. It was a
simple and rational medicine based on careful clinical
observation and on a watchful study of the results which
followed hygienic treatment. The healing powers of
Nature formed a leading tenet of the Coan school : we
may almost regard Hippocrates as the founder of sana-
torium treatment. Perusal of those of the Books of
Epidemics which are most certainly by Hippocrates
himself, shows that he was an admirable case-taker ; in
the light of our present knowledge we can readily make
a diagnosis from many of his descriptions. His medicine
shows, of course, the natural limits of a purely observa-
tional science : it knows little of anatomy and less of
physiology ; its crude pathology is based on the doctrine
of " opposites " ; the idea of experiment as a means of

12 tut BIRTH ANt) GROWTH OF SCIENCE IN MEDICINE

investigation has not yet arisen. Yet in spite of this the
school of Cos is a landmark in the history of rational
medicine. Throughout its writings there breathes a certain
lofty and independent spirit, so that we feel that we must
reverence Hippocrates not only as a great physician but
as a great gentleman.

We look back to Athens in the fifth and fourth
centuries B.C. as the golden age of Greece and the fountain-
head of later European thought. It is the more dis-
appointing to find that Athens itself made little direct
contribution to medical science : the Athenians of those
centuries were more concerned with metaphysical specu-
lations than with science until, indeed, we come to
Aristotle. Nevertheless it would be a grave mistake to
suppose that Athens did nothing for medicine, for at this
period were iirmly founded some of those abstract sciences,
and, above all, mathematics and logic, upon which the
future development of the concrete sciences ultimately
rested. I must not dwell on Aristotle, for he has been
the theme of more than one Harveian oration, and rightly
so, for his influence on Harvey was immense : probably
no one man has so profoundly affected the thought of
succeeding generations. Logicwas essentially his creation :
his works remain a monument to the genius of the Greeks,
not only for careful observation and daring speculation
but for correct thinking. I have at times thought it might
be well if this College insisted on a course of logic for
the diploma of membership.

The gradual decay in the glory of ancient Greece is
usually attributed to the known historical facts — to their
petty quarrels and their incapacity for combining amongst
themselves. There was probably also a deeper cause —
the racial fusion to which they owed their origin had
passed its period of maximum fertility, and the Greeks
but fulfilled the doom which ultimately overtakes every
civilisation. But Hellenism did not die : what the Greeks
had achieved remains as a quickening influence for all time.

In medical science the centre of interest now shifts

THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE. I 3

elsewhere, and especially to Alexandria, but it remains
Greek. Alexandrian culture represents a sort of con-
tinuation of that of Athens, though, perhaps, in com-
parison, smacking somewhat of Wardour Street. The great
creative age in art and poetry had gone by ; it was a
period of imitation in art, and in literature largely a time
of scholiasts and commentators on the better work that
had been done before. But here we have an excellent
illustration of Flinders Petrie's dictum that, in each
period of culture, science reaches its prime long after art
and literature have begun to decline. For all the
branches of science, then extant, continued to advance
in Alexandria. I need hardly recall how mathematics
and astronomy flourished under the Ptolemies, while in
medical science the Alexandrian school maintained its
premiership for many hundred years. Anatomy and
physiology form a necessary basis for medical science,
and, much as the earlier Greeks had done for medicine,
they had lacked any adequate knowledge of these subjects.
The later Greeks proceeded to remedy this defect. The
practice of dissection became established, and anatomists
must look back to the Alexandrian school for the founda-
tion of their science. I must pass over Herophilus and
Erasistratus, and commemorate the later Greek school
in the person of its most distinguished alumnus — Galen.

The gifts of Rome to Europe were law, order and
settled government : the Romans left us a stately litera-
ture, but to science, as to art, they made little original
contribution. If we except the elder Pliny's ' Naturalis
Historia,' itself largely a compendium, Rome produced
no great scientific work. Roman medicine, like its art,
was wholly Greek in origin : its great physicians received
their training in Greek schools, and Celsus, the best-
known writer on medical subjects, was not himself a
practitioner of medicine. Thus, though we associate
Galen with Rome, I must commemorate him as a Greek
— the last and in many ways the greatest of the Greek
physicians,

14 THE P.IRTir AND GROWTH OF SCIENCE IN MEDICINE.

Nearly 600 years had passed between Hippocrates and
Galen, and when we compare the two it must be remem-
bered that Galen had the advantage of that 600 years of
medical experience. It gave him a wider outlook and
thus made him the better physician, though I conceive
Hippocrates, considering his times, to have been the
bigger man. I do not propose to dwell on Galen's
eminence as a physician, though he stood far above all
others of his age. His real claim to immortality may be
put into a few words : he was the first to make systematic
use of the experimental method in medicine, and he
founded the science of physiology. He probably owed
more to his studies in Alexandria than to his native
school of Pergamum, for there he had the opportunities
for human dissection which were denied to him later in
Rome, and there, too, he must have gained his first
insight into the possibilities of the experimental method.
To us it seems a marvel that a man of Galen's ability,
an adept in the methods which we know he used, should
have failed to apprehend the circulation of the blood, for
he came very near it. History is full of instances in
which erroneous assumptions, so firmly held that their
truth is never called in question, blind men to a truth
which would otherwise be obvious. It was so with Galen,
and, did we know it, it is probably true of ourselves.
Nevertheless his experimental discoveries in other regions
of physiology, and particularly in the domain of the
nervous system, entitle him to be called the father of
that science. Galen must also be credited with a great
advance in pathology. The earlier Greeks had regarded
internal medicine from a purely humoral aspect : the later
Greeks began to recognise affections of certain definite
organs, but Galen developed this conception beyond any
of his predecessors. His latest treatise, ' De locis affectis,'
deals with the morbid conditions of the different organs
as judged from the symptoms of the patient. Dr. Payne
has justly remarked that, had Galen been able to make
post-mortem examinations, he might have founded morbid

THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE. I 5

anatomy. It so happened that Galen was one of the
most proHfic writers w ho ever Hved, and by devious ways
much of what he wrote has come down to us. It is no
wonder that the works of so eminent a man should have
come to occupy in later ages a position in medicine almost
like that of the Bible.

For, with Galen, we come to the end of the great age
of classical civilisation, and it will be fitting, before leaving
it, to summarise ^\•hat Greek genius had accomplished in
medical science. An atmosphere of intellectual liberty
had been established by the Greeks, essential to the birth
and growth of science : they had developed the love of
knowledge for its own sake. Their shrewd observation
had transformed medicine from a medley of traditional
empiricism and superstition into a natural science : they
freed it from magic, and laid the foundations of a rational
treatment of disease. Towards the close of their epoch
they devised the experimental method and used it to
found the science of physiolog}-. Indirectly medicine,
like the other sciences, owes to them the laws of clear
thinking, and the development of mathematics and
mechanics. Could I have selected four names from
antiquity who more fully deserve our gratitude as bene-
factors of this College than Thales, Hippocrates, Aristotle
and Galen ?

When the Minoan civilisation passed away, the Greeks
had been compelled to begin again, almost from the
beginning. There was no such complete break between
the classical period and our modern civilisation : much
was handed on by direct tradition, and vastly more by
written manuscript. Nevertheless, after the fall of the
Roman Empire, Europe had to be re-made and to pass
through its dark ages before the dawn of a new culture.
The new mixture of races seems to have been incapable
of intellectual achievement till the ordained incubation-
period was over, and that period was at its darkest from
the fifth to the tenth centuries a.d. Art was at a low ebb,
and the culture of classical times was largely forgotten :

1 6 THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE,

the great libraries were neglected, or in some cases
destroyed, and an immense amount of the literature of
Greece and Rome perished beyond recall. Medicine
shared the fate of the other sciences, and what was not
forgotten became debased by admixture with Eastern
magic and superstition. The dominant power in Europe
during this period was the Church, and although its
conservatism had a wholly deadening influence as regards
the advance of science, it did much to preserve the culture
of classical times. The mediaeval monasteries were the
storehouses of learning, and though the study of pagan
writings was not encouraged, there was nothing to prevent
a good monk of literary tastes from making copies of
ancient manuscripts. This was one channel by which
some knowledge of classical medicine was handed down
the dark ages, but there was another of even greater
importance. In the seventh century occurred the last of
the four known Arab migrations which have overwhelmed
neighbouring peoples : it spread not only over Western
Asia, but all round the Mediterranean. Whatever may
have been the primitive culture of these Arab invaders,
they presently acquired a high degree of civilisation.
They were a keen-witted race, quick to assimilate the
culture with which they came in contact, and this was
largely Greek in origin. For some hundreds of years the
Moorish Empire in Spain was far in advance of the rest
of Europe in literature, in science, and in medicine. The
best medical works of classical antiquity were translated
into Arabic, and it is by this strange route that much
has come down to us which would otherwise have been
irretrievably lost. The Arabs were skilled in criticism
and dialectics, but they were not great original thinkers.
They left us descriptions of certain diseases unknown
to the ancients, such as measles and smallpox, but
medical science o\\es them relatively little. Their chief
share in medicine was to absorb and transmit the
knowledge of the Greeks.

An end came at last to the dark ages of Europe, and

THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE. I 7

in one sphere of activity after another the fetters of the
past began to be shaken off. Art was the first to revive ;
sculpture and architecture almost reached the zenith of
their development in the thirteenth century : painting
took some tvi'O centuries longer to free itself from archaism.
Intellectual freedom was still longer delayed : from the
twelfth to the fifteenth century there was learning in
plenty, but it was study devoted to what had been
written in the past, not the free exercise of the mind in
fearless inquiry after the truth. It is easy to blame the
Church for this exclusive devotion to tradition and dogma,
but the Church could not prevent the Renaissance when
the times were ripe : we should rather regard the fact,
with Flinders Petrie, as part of the ordained cycle in the
evolution of a civilisation. Medicine reflects the spirit
of these centuries : the traditions of the past were still
supreme, and Galen was the god of the medical world.
Men felt him to have been a better man than themselves,
as in truth he was, and it was enough that Galen said
this or that, or that his writings could be interpreted in
such and such a sense, and there the matter ended.

And then, in the fulness of time, after more than a
thousand years of intellectual slumber, men again began
to think for themselves, just as the Ionian Greeks had
done twenty centuries before. The Renaissance was at
first literally a Revival of Learning due to the renewed
study of the Greek language, and the discovery of much
of the classical literature which had been hidden away in
the libraries of the East. It is outside my province to
discuss this great movement, which spread from Italy to
England in the fifteenth and sixteenth centuries, except
in so far as it influenced medical science. The first effect
of the revival was to strengthen the position of Galen.
It must be remembered that he was but imperfectly known
in mediaeval times. Much of his work had been lost, and
as for what remained it is unlikely that all the spirit of
the original would be conveyed by Greek writings, trans-
lated into Arabic, and later rendered into corrupt Latin.
2

I 8 THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE.

But with the revival of Greek in the fifteenth century
his original writings became accessible, and manuscripts
hitherto unknown came to light. It became the aim of
the scholars of the time to translate these works into
polished Latin for the benefit of those unacquainted with
Greek. Amongst the " Medical Humanists," as they are
termed, was the Founder and first President of this
College. There is no more honoured name in scholarship
than that of Linacre, but it is instructive to note the
difference between his mental attitude and that of Harvey
little more than a hundred years later. Linacre stands
for the revival of learning, Harvey for the intellectual
quickening that revival was to engender. The avowed
aim of the medical humanists was not the advance of
medical science but a return to the uncorrupted knowledge
of the Greeks : the thought and science of antiquity were
still held so immeasurably superior to anything that
modern times could produce that no advance was con-
templated. But the seed was sown. Greek literature
was the product of an original creative activity and a
mental freedom to which Europe had long been vm-
accustomed. Men could not study it without at the same
time drinking in something of the spirit in which it had
been conceived and which animates it for all time. This
was our true heritage in the Renaissance, and, once again
imbued with this spirit, men felt at liberty to ask whether
the ancients were always right, and to criticise and test
their statements. The reign of mere authority came to
an end and science recommenced that advance which has
continued to the present day.

The first science to bear new fruit was anatomy. It
was in Italy that the resurrection began, and the book
written by Vesalius on ' The Structure of the Human
Body,' published in 1543, set the seal upon the new-
method — the appeal to fact instead of to dogma. But
the story of the rise of anatomy has been told so often
and so well in Harveian orations, especially in relation
to the organs of circulation, that I need not dwell on it.

THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE. I 9

We all know that the truth as to the pulmonary circulation
was first ascertained, while it was reserved for Harvey
to demonstrate the systemic circuit. The method of
experiment as an adjunct to observation, instead of being
delayed for hundreds of years as it had been amongst the
Greeks, was now, thanks to Galen, an instrument ready
to hand. And thus it came about that, when a man
arose, deeply imbued with the true spirit of science, and
capable of using this instrument with intelligence and an
open mind, his study of the circulation was at once
rewarded by a discovery of capital importance.

One does not commemorate the name of William
Harvey in this oration merely from a sense of duty : he
truly stands as one of the landmarks in the history of
medical science. His was the first scientific discovery
of absolutely first-rate importance to be made by the
application of the methods and spirit now revived from
ancient times : he possessed the vision, the power of
imagination, as well as the needful industry and patience
in gathering his facts and devising his experiments.

Harvey has left us two treatises of unequal greatness.
The ' De Motu Cordis ' has no need of any introductory
disquisition on scientific method, for it, itself, is the
method incarnate. It is the mature work of a master
who is sure of his ground : it sweeps us along from
one short chapter to another, each filled with accurate
observation and close reasoning so that no hesitation or
doubt is possible to the reader. And we feel that this is
because the methods open to Harvey had been adequate
to solve the problem at issue ; the times were ripe for his
discovery. But he also essayed to solve other biological
problems for which his means were not adequate, and the
' De Generatione,' which he was reluctant to publish, is
reading of a different kind. The most instructive part
of this treatise is perhaps the introduction on scientific
method — " Of the Manner and Order of acquiring Know-
ledge." Here Harvey, in his later age, sets forth the
principles which had guided him, with Aristotle as his

20 THE P.IRTH AND GROWTH OF SCIENCE IN MEDICINE.

leader, in his life's work, and we realise how truly
scientific were his methods. But though these methods
enabled him to correct many of the errors of his pre-
decessors, and though the ' De Generatione ' is full of
accurate and curious observations and good reasoning, in
comparison with the ' De Motu Cordis ' it leaves us
cold. No great conclusion emerges ; the real problems of
generation remain unsolved. And no wonder. Harvey
had no microscope.* But the methods and reasoning
he employed, his freedom from prejudice, his modesty —
these remain a guiding light to future generations to point
out the path by which science should be pursued.

With Harvey we feel that medical science has fairly
entered that path. The conditions which I ventured to
lay down at the beginning of this discourse as essential
to scientific progress — freedom of thought, accurac}' of
observation, imagination, experimental verification, logical
reasoning — all are exemplified in Harvey's work. I have
endeavoured to trace the birth and growth of medical
science up to this point, and I fear that, in the attempt to
cover so wide a field in the brief hour allotted me I may
have incurred the charge of superficiality. I must be
content if the sketch, though superficial, is not wholly
wanting in perspective. I have intentionally dwelt upon
the earlier phases of scientific medicine, for my theme
has been the spirit which brought it to birth rather than
the triumphs of its maturity.

If you are not weary of somewhat trite observations, I
will conclude by passing in brief review some of the
influences which, since Harvey's day, have been most
fruitful in furthering the growth of medical science.
However admirable the spirit of inquiry, medicine can
only employ the means at its command, and of all

* This statement is not strictly correct. It has been pointed out to me
that one of the portraits of Harvey shows an instrument of the compound
type. It is, however, clear from negative evidence that this imperfect
microscope was of no great service to him in his researches ; otherwise he
would have mentioned the fact.

THE BIRTH AND GROWTH OF SCIENCE IN MEDICINE. 2 1

sciences medicine is perhaps the most complex, the most
dependent upon other sciences for its development.
Hence it is from outside medicine that the chief stimuli
to progress in medical science have come. In saying this
I would not be thought to undervalue the vast internal
progress which has been brought about by clinical study.
One has but to recall the mighty name of Sydenham to
realise what a pure clinician can accomplish. Sydenham
would have none of physiology or pathology, and we may
almost wonder whether one so disdainful of science would
have been pleased to know that he was the founder of
Epidemiology.

There is room for difference of opinion as to the impulses
from external sources which have had the most far-
reaching effects upon medicine, but I would name four
as of exceptional importance. They are : the invention of
the compound microscope, the development of chemistry,
the acceptance of the doctrine of evolution, and the dis-
covery of the relation of micro-organisms to disease.

The microscope was invented in Holland early in the
seventeenth century, but its possibilities as an aid to
anatomy were not at first grasped, and it was not till after
Harvey's death that Malpighi actually saw the capillaries,
and the contrary direction of the blood-flow in arteries
and veins. The rise of histology from that time forward
has transformed our ideas of the structure of the body,
and with each improvement in the microscope our hori;?on
has widened. We have passed from the organ to the
units of which it is built up, and Virchow's ' Cellular
Pathology ' marks an epoch in the history of medicine.
To-day we are a stage further, for the inquiry is being
pushed into the more intimate structure of the cell itself,
in the hope of revealing the nature of the processes by
which it carries on its work.

The rise of physics and chemistry has been even more
fruitful for medicine. We cannot nowadays consider them
separately, so closely merged have they become. We
recognise the fundamental importance of these sciences

2 2 THE lURTH AND GROWTH OF SCIENCE IN MEDICINE.

for the right understanding of physiology and pathology,
bv placing them at the root of medical education.
Chemistry has influenced medicine from the days of
alchemy onwards ; Paracelsus and Van Helmont stand
out as picturesque figures in its history. In England the
rise of physics and chemistry began in Harvey's lifetime
with those meetings of scientific men which later gave
birth to the Royal Society. It must not be forgotten
that the work of such men as Boyle, Hooke, Lower and
Mayow practically solved the problem of respiration not
long after Harvey's death — a problem second only in
importance to that of the circulation — though a century
was to elapse for its full meaning to become clear with
the discovery of oxygen. Every advance in physics and
chemistry has borne fruit for us in its turn ; to-day we
can almost affirm that the chief issues in physiology and
pathology are to be sought in the chemical activities of
the human body. These, again, are bound up with
physical conditions, and there is one modern branch of
chemistry, the possibilities of which are only beginning
to be appreciated in medicine. If we reflect that the
body, from a chemical point of view, consists almost
entirely of colloidal compounds, the behaviour of which
is still imperfectly understood, it will be realised that
advances in colloidal chemistry are destined to throw a
flood of light upon the processes of vital activity.

The doctrine of evolution has scarcely received the
attention it merits as a factor in modifying the opinions
of medical science. So long as it was believed that the
body, with all its natural functions, had been created
from the first in its present condition, there was little
room for inquiry into the origin of those functions, and
still less into that of morbid processes. Darwin has
changed all this, as a single instance will suffice to show.
Metchnikoff's studies on the comparative pathology of
inflammation have taught us that this is not a diseased
state, but a purposeful reaction against injury, gradually
perfected in passing up from the lower to the higher

THE i3lRTM AND GROWTH OF SCIENCE IN MEDICINE. 2 J

animals. Almost without our being conscious of it the
idea of evolution has gradually effected a great change
in the standpoint from which we view a large number
of diseases, the symptoms and morbid changes in which
we now understand as efforts of the body to maintain its
integrity in face of the injurious agencies which threaten
it. One might almost re-write pathology from the
evolutionary point of view.

Last, but not least, of the great changes which have
swept over medical science is that which was due in the
first place to Pasteur, was carried on by Koch, and
brought to triumphant practical application by Lister.
The discovery of the true nature of infection has of
necessity transformed the outlook of medicine and surgerj-,
but bacteriology and its daughter science, immunology,
would demand a Harveian oration to themselves.

We loosely speak of such fundamental discoveries as
those I have just mentioned, as producing a revolution
in medical science. It is not revolution but upward
growth. With the establishment of each great principle
we gain a fresh height, from which the field of science
takes on a new and wider aspect, and we may be confident
that we shall reach yet greater heights, to reward us with
an even ampler range of vision. There is no sign that
the vitality of science in our civilisation is in any w-ay
spent : on the contrary its fertility is unchecked. During
the late war we saw for the first time the scientific forces
of this country fully mobilised, and no previous five years
have seen so many scientific problems brought to a
successful issue. So forcible has been the lesson that
science has gained mightily in public estimation, and
research is on the lips of everyone. New facts are being
gathered in, old facts are coming to be seen in a new
light ; we are almost bewildered by our own progress.
The workers in the field of medical science are many,
and it may not be given to any one of us to make an
immortal discovery such as that of the circulation of the
blcod. But the humblest of us can work in Harvey's

24 THE BIRTH AND GROWTH Of SCIENCE IN MEDICINE.

spirit and bring his contribution to the building up of
knowledge in the full assurance that even a single stone,
if honestly and truly squared, will in due time find its
proper place in the fabric.

ADLARD AND SON AND WEST NEWMAN, LTD., iMPK., LONDON AND DORKING'.

UNIVERSITY OF CALIFORNIA LIBRARY

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