Henceforward, as it appears to me, the connection of medicine with the biological sciences is clearly indicated. Pure pathology is that branch of biology which defines the particular perturbation of cell-life, or of the co-ordinating machinery, or of both, on which the phenomena of disease depend.
Those who are conversant with the present state of biology will hardly hesitate to admit that the conception of the life of one of the higher animals as the summation of the lives of a cell aggregate, brought into harmonious action by a co-ordinative machinery formed by some of these cells, constitutes a permanent acquisition of physiological science. But the last form of the battle between the animistic and the physical views of life is seen in the contention whether the physical analysis of vital phenomena can be carried beyond this point or not.
There are some to whom living protoplasm is a substance, even such as Harvey conceived the blood to be, "summâ cum providentiâ et intellectu in finem certum agens, quasi ratiocinio quodam;" and who look with as little favour as Bichat did, upon any attempt to apply the principles and the methods of physics and chemistry to the investigation of the vital processes of growth, metabolism, and contractility. They stand upon the ancient ways; only, in accordance with that progress towards democracy, which a great political writer has declared to be the fatal characteristic of modern times, they substitute a republic formed by a few billion of "animulae" for the monarchy of the all-pervading "anima."
Others, on the contrary, supported by a robust faith in the universal applicability of the principles laid down by Descartes, and seeing that the actions called "vital" are, so far as we have any means of knowing, nothing but changes of place of particles of matter, look to molecular physics to achieve the analysis of the living protoplasm itself into a molecular mechanism. If there is any truth in the received doctrines of physics, that contrast between living and inert matter, on which Bichat lays so much stress, does not exist. In nature, nothing is at rest, nothing is amorphous; the simplest particle of that which men in their blindness are pleased to call "brute matter" is a vast aggregate of molecular mechanisms performing complicated movements of immense rapidity, and sensitively adjusting themselves to every change in the surrounding world. Living matter differs from other matter in degree and not in kind; the microcosm repeats the macrocosm; and one chain of causation connects the nebulous original of suns and planetary systems with the protoplasmic foundation of life and organisation.
From this point of view, pathology is the analogue of the theory of perturbations in astronomy; and therapeutics resolves itself into the discovery of the means by which a system of forces competent to eliminate any given perturbation may be introduced into the economy. And, as pathology bases itself upon normal physiology, so therapeutics rests upon pharmacology; which is, strictly speaking, a part of the great biological topic of the influence of conditions on the living organism, and has no scientific foundation apart from physiology.
It appears to me that there is no more hopeful indication of the progress of medicine towards the ideal of Descartes than is to be derived from a comparison of the state of pharmacology, at the present day, with that which existed forty years ago. If we consider the knowledge positively acquired, in this short time, of the modus operandi of urari, of atropia, of physostigmin, of veratria, of casca, of strychnia, of bromide of potassium, of phosphorus, there can surely be no ground for doubting that, sooner or later, the pharmacologist will supply the physician with the means of affecting, in any desired sense, the functions of any physiological element of the body. It will, in short, become possible to introduce into the economy a molecular mechanism which, like a very cunningly-contrived torpedo, shall find its way to some particular group of living elements, and cause an explosion among them, leaving the rest untouched.
The search for the explanation of diseased states in modified cell-life; the discovery of the important part played by parasitic organisms in the aetiology of disease; the elucidation of the action of medicaments by the methods and the data of experimental physiology; appear to me to be the greatest steps which have ever been made towards the establishment of medicine on a scientific basis. I need hardly say they could not have been made except for the advance of normal biology.
There can be no question, then, as to the nature or the value of the connection between medicine and the biological sciences. There can be no doubt that the future of pathology and of therapeutics, and, therefore, that of practical medicine, depends upon the extent to which those who occupy themselves with these subjects are trained in the methods and impregnated with the fundamental truths of biology.
And, in conclusion, I venture to suggest that the collective sagacity of this congress could occupy itself with no more important question than with this: How is medical education to be arranged, so that, without entangling the student in those details of the systematist which are valueless to him, he may be enabled to obtain a firm grasp of the great truths respecting animal and vegetable life, without which, notwithstanding all the progress of scientific medicine, he will still find himself an empiric?