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MODERN PROGRESS] into his professional studies. The founding of new teaching universities, in which England, and even France, had been at some disadvantage as compared with Scotland and Germany, strengthened the movement in favour of enlarging and liberalizing technical training, and of anticipating technical instruction by some broader scientific discipline; though, as in all times of transition, something was lost temporarily by a departure from the old discipline of the grammar school before a new scheme of training the mind in scientific habits and conceptions was established or fully apprehended. Yet on the whole, even from the beginning, the revolt was useful in that it shook the position of the “learned physician,” who took a literary, fastidious and meditative rather than an experimental interest in his profession, and, as in great part a descendant of the humanists, was never in full sympathy with experimental science. At the risk no doubt of some defects of culture, the newer education cleared the way for a more positive temper, awoke a new sense of accuracy and of verification, and created a sceptical attitude towards all conventions, whether of argument or of practice. Among the drawbacks of this temper, which on the whole made for progress, was the rise of a school of excessive scepticism, which, forgetting the value of the accumulated stores of empiricism, despised those degrees of moral certainty that, in so complex a study and so tentative a practice as medicine, must be our portion for the present, and even for a long future, however great the triumphs of medicine may become. This scepticism took form in the school, most active between 1860 and 1880, known as the school of “Expectant Medicine.” These teachers, genuinely touched with a sense of the scantiness of our knowledge, of our confidence in abstract terms, of the insecurity of our alleged “facts,” case-histories and observations, alienated from traditional dogmatisms and disgusted by meddlesome polypharmacy—enlightened, moreover, by the issue of cases treated by means such as the homoeopathic, which were practically “expectant”—urged that the only course open to the physician, duly conscious of his own ignorance and of the mystery of nature, is to put his patient under diet and nursing, and, relying on the tendency of all equilibriums to recover themselves under perturbation, to await events (Vis medicatrix naturae). Those physicians who had occupied themselves in the study of the exacter sciences, or more closely or more exclusively of the wreckage of the post mortem room, were the strongest men of this school, whether in England or abroad.

But to sit down helpless before human suffering is an unendurable attitude. Moreover, the insight into origins, into initial morbid processes revealed by the pathologists, awoke more and more the hope of dealing with the elements of disease, with its first beginnings; and in the field of therapeutics, chemical and biological experiment, as in

the case of digitalis, mercury and the iodides, was rapidly simplifying remedies and defining their virtues, so that these agents could be used at the bedside with more precision. Furthermore, the aversion from drugging had the advantage of directing men’s minds to remedies taken from the region of the physical forces, of electricity (G. B. Duchenne, 1806–1875), of gymnastics (Ling, 1776–1839), of hydropathy (V. Priessnitz), of massage (Weir Mitchell), of climate (James Clarke), of diet (R. B. Todd, King Chambers, &c.), and even of hypnotism (James Braid 1795?–1860), while with the improvement of the means of locomotion came the renewal of the old faith and the establishment of new methods in the use of mineral springs. These and such means, often in combination, took much of the place formerly given to the use of drugs.

Again, a like spirit dictated the use of the physical or “natural” methods on a larger scale in the field of prevention. From the new regard given by physiologists and pathologists to the study of origins, and in the new hopes of thus dealing with disease at its springs, not in individuals only but in cities and nations, issued the great school

of Preventive Medicine, initiated in England—E. A. Parkes (1819–1876), J. Simon, Sir B. W. Richardson (1828–1896), Sir H. W. Acland (1815–1900), Sir G. Buchanan (1831–1895), and

forwarded in Germany by Max von Pettenkofer (1818–1901). Hygiene became for pathology what “milieu” is for physiology. By the modification of physical conditions on a national scale a prodigious advance was made in the art of preventing disease. The ghastly roll of infantile mortality was quickly purged of its darkest features (Ballard and others); aided by bacteriology, sanitary measures attained some considerable degree of exactness; public medicine gained such an ascendancy that special training and diplomas were offered at universities; and in 1875 a consolidated act was passed for the United Kingdom establishing medical officers of health, and responsible lay sanitary authorities, with no inconsiderable powers of enforcing the means of public health in rural, urban, port and other jurisdictions, with summary methods of procedure. A department of public health was formed within the precincts of the Local Government Board; government laboratories were established, and machinery was devised for the notification of infectious diseases. The enormous growth of towns during the second half of the 19th century was thus attended with comparative safety to these great aggregates of mankind; and the death-rates, so far from being increased, relatively decreased in substantial proportions. In 1878 an act was passed giving like powers in the case of the infectious diseases of animals. The establishment in England of the Register of qualified practitioners and of the General Medical Council (in 1858) did something, however imperfectly, to give unity to the profession, unhappily bisected by “the two colleges”; and did much to organize, to strengthen and to purify medical education and qualification. In 1876 women were admitted to the Register kept by the Council. In 1871 the Anatomical Act of 1832 was amended; and in 1876 the Vivisection Act was passed, a measure which investigators engaged in the medical sciences of physiology and pathology resented as likely to prevent in England the advance of knowledge of living function, both in its normal balance and in its aberrancies, and moreover to slacken that habit of incessant reference of propositions to verification which is as necessary to the clinical observer as to the experimentalist. However the opinion of later generations may stand in respect of the Vivisection Act, it will surely appear to them that the other acts, largely based upon the results of experimental methods, strengthening and consolidating the medical profession, and fortifying the advance of medical education, led directly to a fundamental change in the circumstances of the people in respect of health. The intelligent classes have become far better educated in the laws of health, and less disposed to quackery; the less intelligent are better cared for and protected by municipal and central authority. Thus the housing of the poor has been improved, though this difficult problem is yet far from solution; not the large towns only, but the larger villages also, are cleansed and drained; food has been submitted to inspection by skilled officers; water supplies have been undertaken on a vast scale; personal cleanliness has been encouraged, and with wonderful success efforts have been made to bring civilized Europe back from the effects of a long wave of Oriental asceticism, which in its neglect and contempt of the body led men to regard filth even as a virtue, to its pristine cleanliness under the Greeks and Romans. During the latter half of the 19th century the death-rate of many towns was reduced by something like 50%. Some plagues, such as typhus fever, have been dispelled; others, such as enteric fever, have been almost banished from large areas; and there is much reason to hope that cholera and plague, if introduced, could not get a footing in western Europe, or in any case could be combated on scientific principles, and greatly reduced. Temperance in the use of alcohol has followed the demonstration not only of its unimportance as a food or tonic, but also of its harmfulness, save in very small quantities. In the earlier part of the 19th century, and in remoter districts even in its later years, the use of alcohol was regarded not as a mere indulgence, but as essential to health; the example of teetotallers, as seen in private life and in the returns of the insurance offices, has undermined this prepossession. From the time of Plato medicine has been accused of ministering to the survival of unfit persons, and to