the evolution of modern medicine(现代医药的演变)-第41章
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fertilized by men often ignorant even of the body from which it has come。
Knowledge evolves； but in such a way that its possessors are never in sure
possession。 〃It is because science is sure of nothing that it is always
advancing〃 （Duclaux）。
History is the biography of the mind of man； and its educational value
is in direct proportion to the completeness of our study of the individuals
through whom this mind has been manifested。 I have tried to take you
back to the beginnings of science； and to trace its gradual development；
which is conditioned by three laws。 In the first place； like a living
organism； truth grows； and its gradual evolution may be traced from the
tiny germ to the mature product。 Never springing； Minerva…like； to full
stature at once； truth may suffer all the hazards incident to generation and
gestation。 Much of history is a record of the mishaps of truths which have
struggled to the birth； only to die or else to wither in premature decay。 Or
the germ may be dormant for centuries； awaiting the fullness of time。
Secondly； all scientific truth is conditioned by the state of knowledge
at the time of its announcement。 Thus； at the beginning of the seventeenth
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century； the science of optics and mechanical appliances had not made
possible （so far as the human mind was concerned） the existence of blood
capillaries and blood corpuscles。 Jenner could not have added to his
〃Inquiry〃 a study on immunity； Sir William Perkin and the chemists made
Koch technique possible； Pasteur gave the conditions that produced Lister；
Davy and others furnished the preliminaries necessary for anaesthesia。
Everywhere we find this filiation； one event following the other in orderly
sequence〃Mind begets mind；〃 as Harvey （De Generatione） says；
〃opinion is the source of opinion。 Democritus with his atoms； and
Eudoxus with his chief good which he placed in pleasure； impregnated
Epicurus； the four elements of Empedocles； Aristotle； the doctrines of the
ancient Thebans； Pythagoras and Plato； geometry； Euclid。〃＇2＇
＇2＇ Works of William Harvey； translated by Robert Willis； London；
1847； p。 532。
And； thirdly； to scientific truth alone may the homo mensura principle
be applied； since of all mental treasures of the race it alone compels
general acquiescence。 That this general acquiescence； this aspect of
certainty； is not reached per saltum； but is of slow； often of difficult
growth；marked by failures and frailties； but crowned at last with an
acceptance accorded to no other product of mental activity；is illustrated
by every important discovery from Copernicus to Darwin。
The difficulty is to get men to the thinking level which compels the
application of scientific truths。 Protagoras； that 〃mighty…wise man；〃 as
Socrates called him； who was responsible for the aphorism that man is the
measure of all things； would have been the first to recognize the folly of
this standard for the people at large。 But we have gradually reached a stage
in which knowledge is translated into action； made helpful for suffering
humanity； just as the great discoveries in physics and chemistry have been
made useful in the advance of civilization。 We have traced medicine
through a series of upward steps a primitive stage； in which it emerged
from magic and religion into an empirical art； as seen among the
Egyptians and Babylonians； a stage in which the natural character of
disease was recognized and the importance of its study as a phenomenon
of nature was announced； a stage in which the structure and functions of
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the human body were worked out； a stage in which the clinical and
anatomical features of disease were determined； a stage in which the
causes of disorders were profitably studied； and a final stage； into which
we have just entered； the application of the knowledge for their prevention。
Science has completely changed man's attitude towards disease。
Take a recent concrete illustration。 A couple of years ago in
Philadelphia and in some other parts of the United States； a very peculiar
disease appeared； characterized by a rash upon the skin and moderate
fever； and a constitutional disturbance proportionate to the extent and
severity of the eruption。 The malady first broke out in the members of a
crew of a private yacht； then in the crews of other boats； and among
persons living in the boarding…houses along the docks。 It was the cause of
a great deal of suffering and disability。
There were three courses open： to accept the disease as a visitation of
God； a chastening affliction sent from above； and to call to aid the spiritual
arm of the church。 Except the 〃Peculiar People〃 few now take this view or
adopt this practice。 The Christian Scientist would probably deny the
existence of the rash and of the fever； refuse to recognize the itching and
get himself into harmony with the Infinite。 Thirdly； the method of
experimental medicine。
First； the conditions were studied under which the individual cases
occurred。 The only common factor seemed to be certain straw mattresses
manufactured by four different firms； all of which obtained the straw from
the same source。
The second point was to determine the relation of the straw to the rash。
One of the investigators exposed a bare arm and shoulder for an hour
between two mattresses。 Three people voluntarily slept on the mattresses
for one night。 Siftings from the straw were applied to the arm； under all of
which circumstances the rash quickly developed； showing conclusively
the relation of the straw to the disease。
Thirdly； siftings from the straw and mattresses which had been
thoroughly disinfected failed to produce the rash。
And fourthly； careful inspection of the siftings of the straw disclosed
living parasites； small mites； which when applied to the skin quickly
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produced the characteristic eruption。
SANITATION
WHEN the thoughtful historian gets far enough away from the
nineteenth century to see it as a whole； no single feature will stand out
with greater distinctness than the fulfilment of the prophecy of Descartes
that we could be freed from an infinity of maladies both of body and mind
if we had sufficient knowledge of their causes and of all the remedies with
which nature has provided us。 Sanitation takes its place among the great
modern revolutions political； social and intellectual。 Great Britain
deserves the credit for the first practical recognition of the maxim salus
populi suprema lex。 In the middle and latter part of the century a
remarkable group of men； Southwood Smith； Chadwick； Budd； Murchison；
Simon； Acland； Buchanan； J。W。 Russell and Benjamin Ward Richardson；
put practical sanitation on a scientific basis。 Even before the full
demonstration of the germ theory； they had grasped the conception that the
battle had to be fought against a living contagion which found in poverty；
filth and wretched homes the conditions for its existence。 One terrible
disease was practically wiped out in twenty…five years of hard work。 It is
difficult to realize that within the memory of men now living； typhus fever
was one of the great scourges of our large cities； and broke out in terrible
epidemicsthe most fatal of all to the medical profession。 In the severe
epidemic in Ireland in the forties of the last century； one fifth of all the
doctors in the island died of typhus。 A better idea of the new crusade；
made possible by new knowledge； is to be had from a consideration of
certain diseases against which the fight is in active progress。
Nothing illustrates more clearly the interdependence of the sciences
than the reciprocal impulse given to new researches in pathology and
entomology by the discovery of the part played by insects in the
transmission of disease。 The flea； the louse； the bedbug； the house fly； the
mosquito； the tick； have all within a few years taken their places as
important transmitters of disease。 The fly population may be taken as the
sanitary index of a place。 The discovery； too； that insects are porters of
disease has led to a great extension of our knowledge of their life history。
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Early in the nineties； when Dr。 Thayer and I were busy with the study of
malaria in Baltimore； we began experiments on the possible transmission
of the parasites； and a tramp； who had been a medical student； offered
himself as a subject。 Before we began； Dr。 Thayer sought information as to
the varieties of mosquitoes known in America； but sought in vain： there
had at that time been no systematic study。 The fundamental study which
set us on the track was a demonstration by Patrick Manson；＇3＇ in 1879； of
the association of filarian disease with the mosquito。 Many observations
had already been made； and were made subsequently； on the importance of
insects as intermediary hosts in the animal parasites； but the first really
great scientific demonstration of a widespread infection through insects
was by Theobald Smith； now of Harvard Un
