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Rh that of hormones (Starling), juices prepared, not for excretion, not even for partial excretion, but for the fulfilment of physiological equilibrium. Thus the reciprocity of the various organs, maintained throughout the divisions of physiological labour, is not merely a mechanical stability; it is also a mutual equilibration in functions incessantly at work on chemical levels, and on those levels of still higher complexity which seem to rise as far beyond chemistry as chemistry beyond physics. Not only are the secreted juices of specialized cells thus set one against another in the body, whereby the various organs of the body maintain a mutual play, but the blood itself also in its cellular and fluid parts contains elements potent in the destruction of bacteria and of their secretions. Thus endowed, the blood, unless overwhelmed by extraordinary invasions, does not fail in stability and self-purification. So various are the conditions of self-regulation in various animals, both in respect of their peculiar and several modes of assimilating different foods, and of protecting themselves against particular dangers from without, that, as we might have expected, the bloods taken from different species, or even perhaps from different individuals, are found to be so divergent that the healthy serum of one species may be, and often is, poisonous to another; not so much in respect of adventitious substances, as because the phases of physiological change in different species do not harmonize; each by its peculiar needs has been modified until, in their several conditions of life, they vary so much about the mean as to have become almost if not quite alien one to another.

In the preservation of immunity then, in its various degrees and kinds, not only is the chemistry of the blood to be studied, but also its histology. By his eminent labours in cellular pathology, Virchow, and Metchnikoff later, gave the last blow to the mere humoral pathology which, after an almost unchallenged prevalence for some two thousand years, now finds a resting-place only in our nurseries. Now the cellular pathology of the blood, investigated by the aid of modern staining methods, is as important as that of the solid organs; no clinical investigator—indeed, apart from research, no practitioner at this day—can dispense with examination of the blood for purposes of diagnosis; its coagulability and the kinds and the variations of the cells it contains being evidence of many definitely morbid states of the body. Again, not only in certain diseases may strange cells be found in the blood (e.g. in myelogenic leucaemia), but parasites also, both in man, as those of malaria, of sleeping sickness, of kala-azar, and in animals, as redwater, yellow fever, n’gana have been discovered, to the great advantage of preventive medicine. For some of these, as redwater (pyrosoma), antidotes are already found; for others, as for yellow fever—of which the parasite is unknown, but the mode of its transmission, by the mosquito, discovered (Finlay-Reed)—preventive measures are reducing the prevalence.

It is obvious that the results of such advances prescribe for the clinical physician methods which cannot be pursued without expert assistance; a physician engaged in busy practice cannot himself undertake even the verifications required in the conduct of individual cases. Skill in modern laboratory work is as far out of the reach of the untaught as

performance on a musical instrument. In spite, therefore, of the encyclopaedic tradition which has persisted from Aristotle through the Arab and medieval schools down to Herbert Spencer, it is forced upon us in our own day that in a pursuit so many-sided as medicine, whether in its scientific or in its practical aspect, we have to submit more and more to that division of labour which has been a condition of advance in all other walks of life. It is now fully recognized that diseases of infants and children, of the insane, of the generative organs of women, of the larynx, of the eye, have been brought successively into the light of modern knowledge by “specialists,” and by them distributed to the profession; and that in no other way could this end have been attained. That the division of labour, which may seem to disintegrate the calling of the physician, really unites it, is well seen in the clinical laboratories which were initiated in the later 19th century, and which are destined to a great

future. By the approach of skilled pathologists to the clinical wards, a link is forged between practitioners and the men of science who pursue pathology disinterestedly. The first clinical laboratory seems to have been that of Von Ziemssen (1829–1902) at Munich, founded in 1885; and, although his example has not yet been followed as it ought to have been, enough has been done in this way, at Johns Hopkins University and elsewhere, to prove the vital importance of the system to the progress of modern medicine. At the same time provision must be made for the integration of knowledge as well as for the winning of it by several adits. A conspicuous example of the incalculable evil wrought by lack of integration is well seen in the radical divorce of surgery from medicine, which is one of the most mischievous legacies of the middle ages—one whose mischief is scarcely yet fully recognized, and yet which is so deeply rooted in our institutions, in the United Kingdom at any rate, as to be hard to obliterate. That the methods and the subject-matter of surgery and of medicine are substantially the same, and that the advance of one is the advance of the other, the division being purely artificial and founded merely on accidents of personal bent and skill, must be insisted upon at this time of our history. The distinction was never a scientific one, even in the sense in which the word science can be used of the middle ages; it originated in social conceits and in the contempt for mechanical arts which came of the cultivation of “ideas” as opposed to converse with “matter,” and which, in the dawn of modern methods, led to the derision of Boyle by Oxford humanists as one given up to “base and mechanical pursuits.” Had physicians been brought into contact with facts as hard as those faced by the surgeons of the 16th century (cf. Ambrose Paré), their art would not have lain so long in degradation. It is under this closer occupation with mechanical conditions that surgery to-day is said—not without excuse, but with no more than superficial truth—to have made more progress than medicine. Medicine and surgery are but two aspects of one art; Pasteur shed light on both surgery and medicine, and when Lister, his disciple, penetrated into the secrets of wound fevers and septicaemia, he illuminated surgery and medicine alike, and, in the one sphere as in the other, co-operated in the destruction of the idea of “essential fevers” and of inflammation as an “entity.” Together, then, with the necessary multiplication of specialism, one of the chief lessons of the latter moiety of the 19th century was the unity of medicine in all its branches—a unity strengthened rather than weakened by special researches, such as those into “medical” and “surgical” pathology, which are daily making more manifest the absurdity of the distinction. Surgeons, physicians, oculists, laryngologists, gynaecologists, neurologists and the rest, all are working in allotments of the same field, and combining to a common harvest.

While pathology then, which is especially the “science of medicine,” was winning territory on one side from physiology, of which in a sense it is but an aspect, and on another by making ground of its own in the post mortem room and museum of morbid anatomy, and was fusing these gains in the laboratory so as to claim for itself, as a special

branch of science by virtue of peculiar concepts, its due place and provision—provision in the establishment of chairs and of special laboratories for its chemical and biological subdivisions—clinical medicine, by the formal provision of disciplinary classes, was illustrating the truth of the experience that teaching and research must go hand-in-hand, the one reinforcing the other: that no teacher can be efficient unless he be engaged in research also; nay, that for the most part even the investigator needs the encouragement of disciples. Yet it was scarcely until the last quarter of the 19th century that the apprenticeship system, which was a mere initiation into the art and mystery of a craft, was recognized as antiquated and, in its virtual exclusion of academic study, even mischievous. In place of it, systematic clinical classes have become part of the scheme of every efficient school of medicine. A condition of this reform was the need of a preliminary training of the mind of the pupil in pure science, even in physics and chemistry; that is to say, before introduction