ANNUAL ADDRESS. THE STUDY OF THE PHYSIOLOGICAL ACTION BY H. NEWELL MARTIN, M. A., M. D., Dr. Se., F.R.S. Some years ago I was present when some young officers were being instructed and examined by the adjutant of their regiment. He finally asked "What, in few words, is the object of the education given a soldier?" The answers were varied :-To increase his intelligence, to make him hardy, to render him fearless, to train him in the art of war. But the adjutant still shook his head. At last some one suggested "To enable him to destroy his enemy." "That is correct," replied the instructor. "The aim of the soldier's training, from the goose-step taught the recruit, to the instruction in the higher mathematics given an artillery officer, is-To enable him to destroy his enemy." Suppose the question put to a number of medical students about. to graduate-what is the object of medical education? How should it be answered? Some might reply, "To enable the doctor to earn a living;" some, "To give him a knowledge of life and living things; " some, "To fit him to increase scientific knowledge of disease;" but overwhelming and drowning all such answers would surely come the chorus "To fit him to practice;" "To enable him to destroy his enemy-disease." The practice of medicine, the prevention and cure of disease is the aim of medical education, from learning the bones to the study of the science of disease, as expounded by a Virchow, a Pasteur, a Cohnheim or a Koch. When we consider the simple training of the soldier of olden times, and contrast it with the education which enabled a young officer, by observing the stars, to guide Wolseley's army on a moonless night for seven miles, through the winding depressions of a pathless desert, and bring them, before dawn, straight to the enemy's entrenchments at Tel el Kebir, we realize how complex the art of war has become, and how dependent on many sciences. As modern warfare differs from ancient, so does modern medicine from that of the Egyptians or Greeks. The fundamental qualities necessary to success in overcoming the enemy-energy, courage, quickness of perception, fertility of resource-remain the same as ever, but the amount of scientific knowledge (and consequently the fighting power) at the disposal of those who contend, either in our ranks or those of a great military organization, are far greater. As professors of physics and chemistry, and great laboratories for the scientific study of explosive compounds are maintained by the military nations of Europe, in order that the soldier who goes to the front, rifle in hand, shall be better equipped for the conflict-so dissecting rooms and laboratories of physiology, of pathology, of therapeutics exist, that the physician may be aided in his daily struggle against disease. The main ends sought by those who devote their lives to medical work, I have already described as the prevention and the cure of disease. If I have chosen for this occasion a topic rather connected with cure than prevention, it is not that I think the latter less important; it is surely the goal which our profession must strive to reach— and it is one concerning which the general public is strangely apathetic, unless during periods of panic when an epidemic threatens. Our profession has done its duty in this matter; it remains for the public to perform its share. When I consider the vast amount of unselfish effort made by physicians to prevent disease-that the medical men in every community are the leaders in sanitary work—that nevertheless such charges are brought against them by the ignorant as that they advocate vaccination because they are paid for performing it, and think it will increase disease-when I read of the physicians of Marseilles and Naples assaulted by the mob because they were believed to have introduced cholera-yet going steadfastly on their way to help the sufferers and risking their lives in experiments to discover the cause as wel as the means of preventing this plague-then, indeed, I feel (and who amongst you does not ?) proud of my profession. You have asked me to address you, as one concerned rather with the theory than the practice of the medical arts-as one whose relations to our holy warfare is rather that of him who makes cartridges in the arsenal, than of the soldier who handles the gun at the outposts. A chief object of such annual gatherings as this of the Medical and Chirurgical Faculty, is to consider in what directions the sciences and the arts of medicine and surgery have advanced. What the practical value of such advance may be at present-with what hope it cheers us for the future-what department, if any, is lagging behind and should be fostered. I have selected as my topic Pharmacology-that branch of science which is concerned with the investigation of the action of drugs on the healthy body-because I believe that it is destined in the near future, to acquire an importance in regard to therapeutics, which is not yet properly appreciated. Pharmacology can hardly be said to have existed in ancient medicine, nor indeed until the present century. The first persons to study experimentally the action of drugs appear to have been those who desired to discover a sure poison for their enemies, or a certain antidote for themselves. The etymology for the word shows that, among the Greeks, medicines were regarded as mysterious things; as substances possessing some magical power, either inherent, or imparted by sorcery. papμakos meant to the Greek the use of drugs, potions, or spells. The word papuaketa indicated alike a physician, a sorcerer, or a poisoner. To-day we find, even in civilized nations, something of this old notion remaining. Medicine is, to a large extent, still regarded by the laity as a mystic art. Seventh sons of seventh sons advertise in the newspapers (no doubt with profit to themselves), that they are prepared, in return for a few dollars, to exercise their magical power for the cure of disease; and many otherwise intelligent persons are gulled by the jargon of those who describe the supernatural virtues of an infinitesimal dose of some drug, raised to almost omnipotent power by a seventeenth or a seventieth trituration. The discovery of useful remedies was, in former times, a matter of accident. There was no organized search for them; nor any rational attempt to reach some hypothesis as to the mode of action of drugs, which might give a clue to their usefulness in various pathological conditions. By multiplied experience the list of medicines was slowly increased. According to Strabo, the Egyptians exposed in the streets persons who were dangerously ill, that passers-by, who had seen some similar case recover, might advise treatment. When we consider how, nowadays, everyone has a sure cure for dyspepsia, which he or she recommends as infallible to each sufferer from that multiform disease, we can picture to ourselves the unhappy condition of those Egyptian patients, that is, if they tried to act in accordance with all the advice given them. However, after repeated trial some remedies, no doubt, proved useful in certain diseases; and handed down by tradition or recorded by priests, made the beginning of a materia medica. Somewhat later in the world's story, in Greece and Rome, the votive tablets describing their disease and its treatment, placed by grateful patients in certain temples, added to the list of medicines which had been tested and found valuable. In the centuries of mediaval darkness the Arabs did something to advance pharmacology; the Europeans almost nothing. The Egyptians, the Greeks and the Romans, had been sound in their method, so far as it went. It was empirical. What they had found. to do good before they gave again in a similar disease, as we to-day order quinine in intermittent fever, not because of any knowledge or theory as to its mode of action, but because we have found it more often useful than any other medicine in the treatment of this disease. In the middle ages, this sound, if narrow Hippocratic method was replaced by pseudo-sciences of the most absurd kind. All sorts of fanciful doctrines as to drugs were allowed to determine their administration, quite regardless of observation or experiment as to their effect. Of such doctrine, that of "signatures" may serve as an example. It originated with Paracelsus in the sixteenth century, and had great vogue. According to it, natural objects, especially plants, were given medicinal virtues by the stars; and each bore some mark or signature from which its proper use might be learned. The duty of the physician was to decipher these signatures. Thus the houseleek resembles the gums in the texture of its leaves, hence is a valuable remedy for scurvy; the root of the hedgeturnip is like a swollen foot; a sure sign that it is a cure for dropsy; the eyes on a peacock's tail, resembling the nipple of the female surrounded by its areola, are clearly indicated for diseases of the breast. How wide spread this doctrine was is indicated by the many European plants which owe to it their names, both common and scientific. The lungwort, still known to botanists as Pulmonaria, owes its same to the belief that the grayish mottled appearance of its petals (somewhat resembling a tuberculous lung) indicated it as a specific for phthisis; the liverworts or Hepatica have a peculiarly marked epidermis, which suggests the outlines of the liver lobules, hence were used in liver disease. A species of Aristolochia is still known in England as "birthwort." It has a corolla, whose opening suggests the form of the female pudendum when dilated. Infusions or decoctions of it were given with great faith in their efficacy in all cases of labor. To those who objected that experience had proven these plants and animals not to have the virtues attributed them, the advocates of the doctrine of signatures replied that to deny it was to call God a liar-a mode of argument not yet entirely given up by those who would have us read the book of Nature through the spectacles of some preconception, rather than by patient, unbiased, and reverential observation and experiment. Even at the end of the seventeenth century we find in the London Pharmacopoeia, issued by the Royal College of Physicians, such drugs as crab's eyes, pearls, oyster shell, and coral. All of these are of course nothing but somewhat impure calcium carbonate, such action on the body as they may exert being the same as that of chalk. But each one, on account of fantastic notions concerning the animal it was derived from, and the nature of disease, was imagined to have very different therapeutic properties. The doctor who should prescribe crab's eyes when tradition ordered oyster shell, would surely have been held guilty of malpraxis. Other drugs found in this pharmacopoeia are the excrement of mice, of the dog, and of the goose; calculi; moss which had grown on the human skull-clearly a most precious remedy, for even in the edition of 1721, edited by Sir Hans Sloane, and a great improvement on its predecessors, this moss is retained, as also dog's excrement and earthworms. While physicians believed on mere a priori grounds, apart from all serious study of facts or any attempts at experimental investigation, that such drugs had a special and mysterious efficacy in certain diseases; while the therapeutical value of a vegetable preparation was believed to depend largely on whether the leaves had been gathered during the conjunction of Venus and Jupiter; while tradition, not observation, was the basis of medical practice, pharmacology could not be born. Even after Sydenham, the father of modern English and American medicine, had led the way back to Hippocratic methods, pharmacology had still to wait to wait until chemistry |