the evolution of modern medicine(现代医药的演变)-第40章
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small bodies situated above the kidneys； the importance of which had not
been previously recognized。 With the loss of the function of these glands
by disease； the body was deprived of something formed by them which
was essential to its proper working。 Then； in the last third of the century；
came in rapid succession the demonstration of the relations of the pancreas
to diabetes； of the vital importance of the thyroid gland and of the pituitary
body。 Perhaps no more striking illustration of the value of experimental
medicine has ever been given than that afforded by the studies upon those
glands。
The thyroid body； situated in the neck and the enlargement of which is
called goitre； secretes substances which pass into the blood； and which are
necessary for the growth of the body in childhood； for the development of
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the mind and for the nutrition of the tissues of the skin。 If； following an
infectious disease； a child has wasting of this gland； or if； living in a
certain district； it has a large goitre； normal development does not take
place； and the child does not grow in mind or body and becomes what is
called a cretin。 More than thisif in adult life the gland is completely
removed； or if it wastes； a somewhat similar condition is produced； and
the patient in time loses his mental powers and becomes fat and flabby
myxedematous。 It has been shown experimentally in various ways that the
necessary elements of the secretion can be furnished by feeding with the
gland or its extracts； and that the cretinoid or myxedematous conditions
could thus be cured or prevented。
Experimental work has also demonstrated the functions of the
suprarenal glands and explained the symptoms of Addison's disease； and
chemists have even succeeded in making synthetically the active principle
adrenalin。
There is perhaps no more fascinating story in the history of science
than that of the discovery of these so…called ductless glands。 Part of its
special interest is due to the fact that clinicians； surgeons； experimental
physiologists； pathologists and chemists have all combined in splendid
teamwork to win the victory。 No such miracles have ever before been
wrought by physicians as those which we see in connection with the
internal secretion of the thyroid gland。 The myth of bringing the dead back
to life has been associated with the names of many great healers since the
incident of Empedocles and Pantheia； but nowadays the dead in mind and
the deformed in body may be restored by the touch of the magic wand of
science。 The study of the interaction of these internal secretions； their
influence upon development； upon mental process and upon disorders of
metabolism is likely to prove in the future of a benefit scarcely less
remarkable than that which we have traced in the infectious diseases。
CHEMISTRY
IT is not making too strong a statement to say that the chemistry and
chemical physics of the nineteenth century have revolutionized the world。
It is difficult to realize that Liebig's famous Giessen laboratory； the first to
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be opened to students for practical study； was founded in the year 1825。
Boyle； Cavendish； Priestley； Lavoisier； Black； Dalton and others had laid a
broad foundation； and Young； Frauenhofer； Rumford； Davy； Joule；
Faraday； Clerk…Maxwell； Helmholtz and others built upon that and gave us
the new physics and made possible our age of electricity。 New technique
and new methods have given a powerful stimulus to the study of the
chemical changes that take place in the body； which； only a few years ago；
were matters largely of speculation。 〃Now；〃 in the words of Professor Lee；
〃we recognize that； with its living and its non…living substances
inextricably intermingled； the body constitutes an intensive chemical
laboratory in which there is ever occurring a vast congeries of chemical
reactions； both constructive and destructive processes go on； new
protoplasm takes the place of old。 We can analyze the income of the body
and we can analyze its output； and from these data we can learn much
concerning the body's chemistry。 A great improvement in the method of
such work has recently been secured by the device of inclosing the person
who is the subject of the experiment in a respiration calorimeter。 This is an
air…tight chamber； artificially supplied with a constant stream of pure air；
and from which the expired air； laden with the products of respiration； is
withdrawn for purposes of analysis。 The subject may remain in the
chamber for days； the composition of all food and all excrete being
determined； and all heat that is given off being measured。 Favorable
conditions are thus established for an exact study of many problems of
nutrition。 The difficulties increase when we attempt to trace the successive
steps in the corporeal pathway of molecule and atom。 Yet these secrets of
the vital process are also gradually being revealed。 When we remember
that it is in this very field of nutrition that there exist great popular
ignorance and a special proneness to fad and prejudice； we realize how
practically helpful are such exact studies of metabolism。〃＇13＇
＇13＇ Frederick S。 Lee； Ph。D。： Scientific Features of Modern Medicine；
New York； 1911。 I would like to call attention to this work of Professor
Lee's as presenting all the scientific features of modern medicine in a way
admirably adapted for anyone； lay or medical； who wishes to get a clear
sketch of them。
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CHAPTER VI
THE RISE OF PREVENTIVE MEDICINE
THE story so far has been of men and of movementsof men who
have； consciously or unconsciously； initiated great movements； and of
movements by which； nolens volens； the men of the time were moulded
and controlled。 Hippocrates； in the tractate on 〃Ancient Medicine；〃 has a
splendid paragraph on the attitude of mind towards the men of the past。
My attention was called to it one day in the Roman Forum by
Commendatore Boni； who quoted it as one of the great sayings of
antiquity。 Here it is： 〃But on that account； I say； we ought not to reject the
ancient Art； as if it were not； and had not been properly founded； because
it did not attain accuracy in all things； but rather； since it is capable of
reaching to the greatest exactitude by reasoning； to receive it and admire
its discoveries； made from a state of great ignorance； and as having been
well and properly made； and not from chance。〃＇1＇
＇1＇ The Works of Hippocrates； Adams； Vol。 I； p。 168； London； 1849
（Sydenham Society）。
I have tried to tell you what the best of these men in successive ages
knew； to show you their point of outlook on the things that interest us。 To
understand the old writers one must see as they saw； feel as they felt；
believe as they believedand this is hard； indeed impossible！ We may get
near them by asking the Spirit of the Age in which they lived to enter in
and dwell with us； but it does not always come。 Literary criticism is not
literary historywe have no use here for the former； but to analyze his
writings is to get as far as we can behind the doors of a man's mind； to
know and appraise his knowledge； not from our standpoint； but from that
of his contemporaries； his predecessors and his immediate successors。
Each generation has its own problems to face； looks at truth from a special
focus and does not see quite the same outlines as any other。 For example；
men of the present generation grow up under influences very different
from those which surrounded my generation in the seventies of the last
century； when Virchow and his great contemporaries laid the sure and
deep foundations of modern pathology。 Which of you now knows the
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〃Cellular Pathology〃 as we did？ To many of you it is a closed book；to
many more Virchow may be thought a spent force。 But no； he has only
taken his place in a great galaxy。 We do not forget the magnitude of his
labors； but a new generation has new problemshis message was not for
youbut that medicine today runs in larger moulds and turns out finer
castings is due to his life and work。 It is one of the values of lectures on
the history of medicine to keep alive the good influences of great men
even after their positive teaching is antiquated。 Let no man be so foolish as
to think that he has exhausted any subject for his generation。 Virchow was
not happy when he saw the young men pour into the old bottle of cellular
pathology the new wine of bacteriology。 Lister could never understand
how aseptic surgery arose out of his work。 Ehrlich would not recognize his
epoch…making views on immunity when this generation has finished with
them。 I believe it was Hegel who said that progress is a series of
negationsthe denial today of what was accepted yesterday； the
contradiction by each generation of some part at least of the philosophy of
the last； but all is not lost； the germ plasm remains； a nucleus of truth to be
fertilized by men often ignorant even of the body from which it has come。
