Part 15

At the same time the bases of the systems from which these schools started were mostly views on natural science which it would have been quite right to utilise within a narrow circle. What was not right was the delusion that it was more scientific to refer all diseases to one kind of explanation, than to several. What was called the solidar pathology wanted to deduce everything from the altered mechanism of the solid parts, especially from their altered tension; from the strictum and laxum, from tone and want of tone, and afterwards from strained or relaxed nerves and from obstructions in the vessels. Humoral pathology was only acquainted with alterations in mixture. The four cardinal fluids, representatives of the classical four elements, blood, phlegm, black and yellow gall; with others, the acrimonies or dyscrasies, which had to be expelled by sweating and purging; in the beginning of our modern epoch, the acids and alkalies or the alchymistic spirits, and the occult qualities of the substances assimilated--all these were the elements of this chemistry. Along with these were found all kinds of physiological conceptions, some of which contained remarkable foreshadowings, such as the ἔμφυτον θέρμον, the inherent vital force of Hippokrates, which is kept up by nutritive substances, this again boils in the stomach and is the source of all motion; here the thread is begun to be spun which subsequently led a physician to the law of the conservation of force. On the other hand, the =πνεῦμα=, which is half spirit and half air, which can be driven from the lungs into the arteries and fills them, has produced much confusion. The fact that air is generally found in the arteries of dead bodies, which indeed only penetrates in the moment in which the vessels are cut, led the ancients to the belief that air is also present in the arteries during life. The veins only remained then in which blood could circulate. It was believed to be formed in the liver, to move from there to the heart, and through the veins to the organs. Any careful observation of the operation of blood-letting must have taught that, in the veins, it comes from the periphery, and flows towards the heart. But this false theory had become so mixed up with the explanation of fever and of inflammation, that it acquired the authority of a dogma, which it was dangerous to attack.

Yet the essential and fundamental error of this system was, and still continued to be, the false kind of logical conclusion to which it was supposed to lead; the conception that it must be possible to build a complete system which would embrace all forms of disease, and their cure, upon any one such simple explanation. Complete knowledge of the causal connection of one class of phenomena gives finally a logical coherent system. There is no prouder edifice of the most exact thought than modern astronomy, deduced even to the minutest of its small disturbances, from Newton’s law of gravitation. But Newton had been preceded by Kepler, who had by induction collated all the facts; and the astronomers have never believed that Newton’s force excluded the simultaneous action of other forces. They have been continually on the watch to see whether friction, resisting media, and swarms of meteors have not also some influence. The older philosophers and physicians believed they could deduce, before they had settled their general principles by induction. They forgot that a deduction can have no more certainty than the principle from which it is deduced; and that each new induction must in the first place be a new test, by experience, of its own bases. That a conclusion is deduced by the strictest logical method from an uncertain premise does not give it a hair’s breadth of certainty or of value.

One characteristic of the schools which built up their system on such hypotheses, which they assumed as dogmas, is the intolerance of expression which I have already partially mentioned. One who works upon a well-ascertained foundation may readily admit an error; he loses, by so doing, nothing more than that in which he erred. If, however, the starting-point has been placed upon a hypothesis, which either appears guaranteed by authority, or is only chosen because it agrees with that which it is wished to believe true, any crack may then hopelessly destroy the whole fabric of conviction. The convinced disciples must therefore claim for each individual part of such a fabric the same degree of infallibility; for the anatomy of Hippokrates just as much as for fever crises; every opponent must only appear then as stupid or depraved, and the dispute will thus, according to old precedent, be so much the more passionate and personal, the more uncertain is the basis which is defended. We have frequent opportunities of confirming these general rules in the schools of dogmatic deductive medicine. They turned their intolerance partly against each other, and partly against the eclectics who found various explanations for various forms of disease. This method, which in its essence is completely justified, had, in the eyes of systematists, the defect of being illogical. And yet the greatest physicians and observers, Hippokrates at the head, Aretæus, Galen, Sydenham, and Boerhaave, had become eclectics, or at any rate very lax systematists.

About the time when we seniors commenced the study of medicine, it was still under the influence of the important discoveries which Albrecht von Haller had made on the excitability of nerves; and which he had placed in connection with the vitalistic theory of the nature of life. Haller had observed the excitability in the nerves and muscles of amputated members. The most surprising thing to him was, that the most varied external actions, mechanical, chemical, thermal, to which electrical ones were subsequently added, had always the same result; namely, that they produced muscular contraction. They were only quantitatively distinguished as regards their action on the organism, that is, only by the strength of the excitation; he designated them by the common name of stimulus; he called the altered condition of the nerve the excitation, and its capacity of responding to a stimulus the excitability, which was lost at death. This entire condition of things, which physically speaking asserts no more than that the nerves, as concerns the changes which take place in them after excitation, are in an exceedingly unstable state of equilibrium; this was looked upon as the fundamental property of animal life, and was unhesitatingly transferred to the other organs and tissues of the body, for which there was no similar justification. It was believed that none of them were active of themselves, but must receive an impulse by a stimulus from without; air and nourishment were considered to be the normal stimuli. The kind of activity seemed, on the contrary, to be conditioned by the specific energy of the organ, under the influence of the vital force. Increase or diminution of the excitability was the category under which the whole of the acute diseases were referred, and from which indications were taken as to whether the treatment should be lowering or stimulating. The rigid one-sidedness and the unrelenting logic with which Robert Brown had once worked out this system was broken, but it always furnished the leading points of view.

The vital force had formerly lodged as ethereal spirit, as a Pneuma in the arteries; it had then with Paracelsus acquired the form of an Archeus, a kind of useful Kobold, or indwelling alchymist, and had acquired its clearest scientific position as ‘soul of life’, anima inscia, in Georg Ernst Stahl, who, in the first half of the last century, was professor of chemistry and pathology in Halle. Stahl had a clear and acute mind, which is informing and stimulating, from the way in which he states the proper question, even in those cases in which he decides against our present views. He it is who established the first comprehensive system of chemistry, that of phlogiston. If we translate his phlogiston into latent heat, the theoretical bases of his system passed essentially into the system of Lavoisier; Stahl did not then know oxygen, which occasioned some false hypotheses; for instance, on the negative gravity of phlogiston. Stahl’s ‘soul of life’ is, on the whole, constructed on the pattern on which the pietistic communities of that period represented to themselves the sinful human soul; it is subject to errors and passions, to sloth, fear, impatience, sorrow, indiscretion, despair. The physician must first appease it, or then incite it, or punish it, and compel it to repent. And the way in which, at the same time, he established the necessity of the physical and vital actions was well thought out. The soul of life governs the body, and only acts by means of the physico-chemical forces of the substances assimilated. But it has the power to bind and to loose these forces, to allow them full play or to restrain them. After death the restrained forces become free, and evoke putrefaction and decomposition. For the refutation of this hypothesis of binding and loosing, it was necessary to discover the law of the conservation of force.

The second half of the previous century was too much possessed by the principles of rationalism to recognise openly Stahl’s ‘soul of life.’ It was presented more scientifically as vital force, Vis vitalis, while in the main it retained its functions, and under the name of ‘Nature’s healing power’ it played a prominent part in the treatment of diseases.

The doctrine of vital force entered into the pathological system of changes in irritability. The attempt was made to separate the direct actions of the virus which produce disease, in so far as they depended on the play of blind natural forces, the symptomata morbi, from those which brought on the reaction of vital force, the symptomata reactionis. The latter were principally seen in inflammation and in fever. It was the function of the physician to observe the strength of this reaction, and to stimulate or moderate it according to circumstances.

The treatment of fever seemed at that time to be the chief point; to be that part of medicine which had a real scientific foundation, and in which the local treatment fell comparatively into the background. The therapeutics of febrile diseases had thereby become very monotonous, although the means indicated by theory were still abundantly used, and especially blood-letting, which since that time has almost been entirely abandoned. Therapeutics became still more impoverished as the younger and more critical generation grew up, and tested the assumptions of that which was considered to be scientific. Among the younger generation were many who, in despair as to their science, had almost entirely given up therapeutics, or on principle had grasped at an empiricism such as Rademacher then taught, which regarded any expectation of a scientific explanation as a vain hope.

What we learned at that time were only the ruins of the older dogmatism, but their doubtful features soon manifested themselves.

The vitalistic physician considered that the essential part of the vital processes did not depend upon natural forces, which, doing their work with blind necessity and according to a fixed law, determined the result. What these forces could do appeared quite subordinate, and scarcely worthy of a minute study. He thought that he had to deal with a soul-like being, to which a thinker, a philosopher, and an intelligent man must be opposed. May I elucidate this by a few outlines?

At this time auscultation and percussion of the organs of the chest were being regularly practised in the clinical wards. But I have often heard it maintained that they were a coarse mechanical means of investigation which a physician with a clear mental vision did not need; and it indeed lowered and debased the patient, who was anyhow a human being, by treating him as a machine. To feel the pulse seemed the most direct method of learning the mode of action of the vital force, and it was practised, therefore, as by far the most important means of investigation. To count with a repeater was quite usual, but seemed to the old gentlemen as a method not quite in good taste. There was, as yet, no idea of measuring temperature in cases of disease. In reference to the ophthalmoscope, a celebrated surgical colleague said to me that he would never use the instrument, it was too dangerous to admit crude light into diseased eyes; another said the mirror might be useful for physicians with bad eyes, his, however, were good, and he did not need it.

A professor of physiology of that time, celebrated for his literary activity, and noted as an orator and intelligent man, had a dispute on the images in the eye with his colleague the physicist. The latter challenged the physiologist to visit him and witness the experiment. The physiologist, however, refused his request with indignation; alleging that a physiologist had nothing to do with experiments; they were of no good but for the physicist. Another aged and learned professor of therapeutics, who occupied himself much with the reorganisation of the Universities, was urgent with me to divide physiology, in order to restore the good old time; that I myself should lecture on the really intellectual part, and should hand over the lower experimental part to a colleague whom he regarded as good enough for the purpose. He quite gave me up when I said that I myself considered experiments to be the true basis of science.

I mention these points, which I myself have experienced, to elucidate the feeling of the older schools, and indeed of the most illustrious representatives of medical science, in reference to the progressive set of ideas of the natural sciences; in literature these ideas naturally found feebler expression, for the old gentlemen were cautious and worldly wise.

You will understand how great a hindrance to progress such a feeling on the part of influential and respected men must have been. The medical education of that time was based mainly on the study of books; there were still lectures, which were restricted to mere dictation; for experiments and demonstrations in the laboratory the provision made was sometimes good and sometimes the reverse; there were no physiological and physical laboratories in which the student himself might go to work. Liebig’s great deed, the foundation of the chemical laboratory, was complete, as far as chemistry was concerned, but his example had not been imitated elsewhere. Yet medicine possessed in anatomical dissections a great means of education for independent observation, which is wanting in the other faculties, and to which I am disposed to attach great weight. Microscopic demonstrations were isolated and infrequent in the lectures. Microscopic instruments were costly and scarce. I came into possession of one by having spent my autumn vacation in 1841 in the Charité, prostrated by typhoid fever; as pupil, I was nursed without expense, and on my recovery I found myself in possession of the savings of my small resources. The instrument was not beautiful, yet I was able to recognise by its means the prolongations of the ganglionic cells in the invertebrata, which I described in my dissertation, and to investigate the vibrions in my research on putrefaction and fermentation.

Any of my fellow-students who wished to make experiments had to do so at the cost of his pocket-money. One thing we learned thereby, which the younger generation does not, perhaps, learn so well in the laboratories--that is, to consider in all directions the ways and means of attaining the end, and to exhaust all possibilities, in the consideration, until a practicable path was found. We had, it is true, an almost uncultivated field before us, in which almost every stroke of the spade might produce remunerative results.

It was one man more especially who aroused our enthusiasm for work in the right direction--that is, Johannes Müller, the physiologist. In his theoretical views he favoured the vitalistic hypothesis, but in the most essential points he was a natural philosopher, firm and immovable; for him, all theories were but hypotheses, which had to be tested by facts, and about which facts could alone decide. Even the views upon those points which most easily crystallise into dogmas, on the mode of activity of the vital force and the activity of the conscious soul, he tried continually to define more precisely, to prove or to refute by means of facts.

And, although the art of anatomical investigation was most familiar to him, and he therefore recurred most willingly to this, yet he worked himself into the chemical and physical methods which were more foreign to him. He furnished the proof that fibrine is dissolved in blood; he experimented on the propagation of sound in such mechanisms as are found in the drum of the ear; he treated the action of the eye as an optician. His most important performance for the physiology of the nervous system, as well as for the theory of cognition, was the actual definite establishment of the doctrine of the specific energies of the nerves. In reference to the separation of the nerves of motor and sensible energy, he showed how to make the experimental proof of Bell’s law of the roots of the spinal cord so as to be free from errors; and in regard to the sensible energies he not only established the general law, but carried out a great number of separate investigations, to eliminate objections, and to refute false indications and evasions. That which hitherto had been imagined from the data of everyday experience, and which had been sought to be expressed in a vague manner, in which the true was mixed up with the false; or which had just been established for individual branches, such as by Dr. Young for the theory of colours, or by Sir Charles Bell for the motor nerves, that emerged from Müller’s hands in a state of classical perfection--a scientific achievement whose value I am inclined to consider as equal to that of the discovery of the law of gravitation.

His scientific tendency, and more especially his example, were continued in his pupils. We had been preceded by Schwann, Henle, Reichert, Peters, Remak; I met as fellow-students E. Du Bois-Reymond, Virchow, Brücke, Ludwig, Traube, J. Meyer, Lieberkühn, Hallmann; we were succeeded by A. von Graefe, W. Busch, Max Schultze, A. Schneider.

Microscopic and pathological anatomy, the study of organic types, physiology, experimental pathology and therapeutics, ophthalmology, developed themselves in Germany under the influence of this powerful impulse far beyond the standard of rival adjacent countries. This was helped by the labours of those of similar tendencies among Müller’s contemporaries, among whom the three brothers Weber of Leipzig must first of all be mentioned, who have built solid foundations in the mechanism of the circulation, of the muscles, of the joints, and of the ear.

The attack was made wherever a way could be perceived of understanding one of the vital processes; it was assumed that they could be understood, and success justified this assumption. A delicate and copious technical apparatus has been developed in the methods of microscopy, of physiological chemistry, and of vivisection; the latter greatly facilitated more particularly by the use of anæsthetic ether and of the paralysing curara, by which a number of deep problems became open to attack, which to our generation seemed hopeless. The thermometer, the ophthalmoscope, the auricular speculum, the laryngoscope, nervous irritation on the living body, opened out to the physician possibilities of delicate and yet certain diagnosis where there seemed to be absolute darkness. The continually increasing number of proved parasitical organisms substitute tangible objects for mystical entities, and teach the surgeon to forestall the fearfully subtle diseases of decomposition.

But do not think, gentlemen, that the struggle is at an end. As long as there are people of such astounding conceit as to imagine that they can effect, by a few clever strokes, that which man can otherwise only hope to achieve by toilsome labour, hypotheses will be started which, propounded as dogmas, at once promise to solve all riddles. And as long as there are people who believe implicitly in that which they wish to be true, so long will the hypotheses of the former find credence. Both classes will certainly not die out, and to the latter the majority will always belong.

There are two characteristics more particularly which metaphysical systems have always possessed. In the first place man is always desirous of feeling himself to be a being of a higher order, far beyond the standard of the rest of nature; this wish is satisfied by the spiritualists. On the other hand, he would like to believe that by his thought he was unrestrained lord of the world, and of course by his thinking with those conceptions, to the development of which he has attained; this is attempted to be satisfied by the materialists.

But one who, like the physician, has actively to face natural forces which bring about weal or woe, is also under the obligation of seeking for a knowledge of the truth, and of the truth only; without considering whether, what he finds, is pleasant in one way or the other. His aim is one which is firmly settled; for him the success of facts is alone finally decisive. He must endeavour to ascertain beforehand, what will be the result of his attack if he pursues this or that course. In order to acquire this foreknowledge of what is coming, but of what has not been settled by observations, no other method is possible than that of endeavouring to arrive at the laws of facts by observations; and we can only learn them by induction, by the careful selection, collation, and observation of those cases which fall under the law. When we fancy that we have arrived at a law, the business of deduction commences. It is then our duty to develop the consequences of our law as completely as may be, but in the first place only to apply to them the test of experience, so far as they can be tested, and then to decide by this test whether the law holds, and to what extent. This is a test which really never ceases. The true natural philosopher reflects at each new phenomenon, whether the best established laws of the best known forces may not experience a change; it can of course only be a question of a change which does not contradict the whole store of our previously collected experiences. It never thus attains unconditional truth, but such a high degree of probability that it is practically equal to certainty. The metaphysicians may amuse themselves at this; we will take their mocking to heart when they are in a position to do better, or even as well. The old words of Socrates, the prime master of inductive definitions, in reference to them are just as fresh as they were 2,000 years ago: ‘They imagined they knew what they did not know, and he at any rate had the advantage of not pretending to know what he did not know.’ And again, he was surprised at its not being clear to them that it is not possible for men to discover such things; since even those who most prided themselves on the speeches made on the matter, did not agree among themselves, but behaved to each other like madmen (τοῖς μαινομένοις ὁμοίως). Socrates calls them τοὺς μέγιστον φρονοῦντας. Schopenhauer calls himself a Mont Blanc, by the side of a mole-heap, when he compares himself with a natural philosopher. The pupils admire these big words and try to imitate the master.

In speaking against the empty manufacture of hypotheses, do not by any means suppose that I wish to diminish the real value of original thoughts. The first discovery of a new law, is the discovery of a similarity which has hitherto been concealed in the course of natural processes. It is a manifestation of that which our forefathers in a serious sense described as ‘wit’; it is of the same quality as the highest performances of artistic perception in the discovery of new types of expression. It is something which cannot be forced, and which cannot be acquired by any known method. Hence all those aspire after it who wish to pass as the favoured children of genius. It seems, too, so easy, so free from trouble, to get by sudden mental flashes an unattainable advantage over our contemporaries. The true artist and the true inquirer knows that great works can only be produced by hard work. The proof that the ideas formed do not merely scrape together superficial resemblances, but are produced by a quick glance into the connection of the whole, can only be acquired when these ideas are completely developed--that is, for a newly discovered natural law, only by its agreement with facts. This estimate must by no means be regarded as depending on external success, but the success is here closely connected with the depth and completeness of the preliminary perceptions.

To find superficial resemblances is easy; it is amusing in society, and witty thoughts soon procure for their author the name of a clever man. Among the great number of such ideas, there must be some which are ultimately found to be partially or wholly correct; it would be a stroke of skill always to guess falsely. In such a happy chance a man can loudly claim his priority for the discovery; if otherwise, a lucky oblivion conceals the false conclusions. The adherents of such a process are glad to certify the value of a first thought. Conscientious workers who are shy at bringing their thoughts before the public before they have tested them in all directions, solved all doubts, and have firmly established the proof, these are at a decided disadvantage. To settle the present kind of questions of priority, only by the date of their first publication, and without considering the ripeness of the research, has seriously favoured this mischief.

In the ‘type case’ of the printer all the wisdom of the world is contained which has been or can be discovered; it is only requisite to know how the letters are to be arranged. So also, in the hundreds of books and pamphlets which are every year published about ether, the structure of atoms, the theory of perception, as well as on the nature of the asthenic fever and carcinoma, all the most refined shades of possible hypotheses are exhausted, and among these there must necessarily be many fragments of the correct theory. But who knows how to find them?

I insist upon this in order to make clear to you that all this literature, of untried and unconfirmed hypotheses, has no value in the progress of science. On the contrary, the few sound ideas which they may contain are concealed by the rubbish of the rest; and one who wants to publish something really new--facts--sees himself open to the danger of countless claims of priority, unless he is prepared to waste time and power in reading beforehand a quantity of absolutely useless books, and to destroy his readers’ patience by a multitude of useless quotations.

Our generation has had to suffer under the tyranny of spiritualistic metaphysics; the newer generation will probably have to guard against that of the materialistic hypotheses. Kant’s rejection of the claims of pure thought has gradually made some impression, but Kant allowed one way of escape. It was as clear to him as to Socrates that all metaphysical systems which up to that time had been propounded were tissues of false conclusions. His Kritik der reinen Vernunft is a continual sermon against the use of the category of thought beyond the limits of possible experience. But geometry seemed to him to do something which metaphysics was striving after; and hence geometrical axioms, which he looked upon as à priori principles antecedent to all experience, he held to be given by transcendental intuition, or as the inherent form of all external intuition. Since that time, pure à priori intuition has been the anchoring-ground of metaphysicians. It is even more convenient than pure thought, because everything can be heaped on it without going into chains of reasoning, which might be capable of proof or of refutation. The nativistic theory of perception of the senses is the expression of this theory in physiology. All mathematicians united to fight against any attempt to resolve the intuitions into their natural elements; whether the so-called pure or the empirical, the axioms of geometry, the principles of mechanics, or the perceptions of vision. For this reason, therefore, the mathematical investigations of Lobatschewsky, Gauss, and Riemann on the alterations which are logically possible in the axioms of geometry; and the proof that the axioms are principles which are to be confirmed or perhaps even refuted by experience, and can accordingly be acquired from experience--these I consider to be very important steps. That all metaphysical sects get into a rage about this must not lead you astray, for these investigations lay the axe at the bases of apparently the firmest supports which their claims still possess. Against those investigators who endeavour to eliminate from among the perceptions of the senses, whatever there may be of the actions of memory, and of the repetition of similar impressions, which occur in memory; whatever, in short, is a matter of experience, against them it is attempted to raise a party cry that they are spiritualists. As if memory, experience, and custom were not also facts, whose laws are to be sought, and which are not to be explained away because they cannot be glibly referred to reflex actions, and to the complex of the prolongation of ganglionic cells, and of the connection of nerve-fibres in the brain.