ESSAYS IN MEDICAL SOCIOLOGY

ESSAYS
IN
MEDICAL SOCIOLOGY

BY
ELIZABETH BLACKWELL, M.D.

VOLUME II.

LONDON
ERNEST BELL, YORK STREET
COVENT GARDEN
1902

CONTENTS OF VOL. II.

THE INFLUENCE OF WOMEN IN THE PROFESSION OF MEDICINE

Address given at the Opening of the Winter Session of the London School of Medicine for Women, October, 1889

THE INFLUENCE OF WOMEN IN THE PROFESSION OF MEDICINE

In the short time that we meet together to-day I will ask you to let me dwell upon the way in which the most beneficial influence of women in the medical profession may be exercised. I wish also to point out certain dangers, as well as advantages, with which medical study is now surrounded.

The avenues by which all may enter into the profession are now so much more widely thrown open that there is little difficulty in the way of any man or woman who may wish to acquire a legal right to practise medicine. In Paris all the public medical institutions, both college and hospital, are thrown open to students without distinction of sex. Not only as ordinary students, but as internes and externes, sex is no longer regarded there as a barrier to opportunity and position. The democratic principle is everywhere steadily gaining ground, and the individual allowed to try his strength in the great battle of life. Large numbers of women are taking advantage of this wider individual liberty to enter the medical profession. In Great Britain our seventy-three registered lady-doctors are few compared with the 3,000 in the United States, yet the nine students who are now connected with our London school, with, in addition, the Edinburgh classes, the Dublin students, and the latest fact that the Glasgow Medical College has just opened its doors to women, clearly indicate that the movement has taken sturdy root in our country, and when our English work has been carried on for forty years, there is every probability that our British lady-doctors will equal numerically our kinsfolk across the ocean.

I think, therefore, that all will see the importance of considering the future of this growing army of medical women, and I particularly desire that our students of medicine should realize the far-reaching character, the social effects, of this medical career which they are entering on. It is quite certain that the wide adoption of the medical profession by women cannot continue to be an insignificant matter; it must exercise an appreciable effect on future society for good or evil.

If we were children entering upon a course of education, it would be premature to take stock of the results of education, and cast a far-seeing glance into the future.

But it is different with adult women—women of education, somewhat impatient of restraint—entering upon a larger liberty, and legitimately jealous of any interference with that liberty. It is therefore imperative upon us to consider very seriously this matter of self-guidance at the outset of medical education, to take in a large view of future responsibility, and ask ourselves that most important question respecting a medical training: What will be its effect?

The flippant or superficial person may at once reply: Our object is to gain money and pursue a remunerative calling by looking after sick people. Women find so much difficulty in honestly supporting themselves, that it is reason enough that they can in this way do so, and the labourer is worthy of his hire. But I say emphatically that anyone who makes pecuniary gain the chief motive for entering upon a medical career is an unworthy student; he is not fit to become a doctor, and he will be a labourer not worthy of his hire. What should be thought of a statesman who aspired to the direction of national affairs on account of the salary of £10,000? The nobleness of motive must enlarge with the nobleness of occupation, or the unworthy occupier sinks to a degradation measured by the height to which his career should have raised him.

Now, there is no career nobler than that of the physician. The progress and welfare of society is more intimately bound up with the prevailing tone and influence of the medical profession than with the status of any other class of men. This exceptional influence is not only due to the great importance of dealing with the issues of life and death in health and disease, but it is still more owing to the fact that the body and the mind are so inseparably blended in the human constitution, that we cannot deal with one portion of this compound nature without in more or less degree affecting the other. Our ministrations to body and soul cannot be separated by a sharply-defined line. The arbitrary distinction between the physician of the body and the physician of the soul—doctor and priest—tends to disappear as science advances. Every branch of medicine involves moral considerations, both as regards the practitioner and the patient. Even the amputation of a limb, the care of a case of fever, the birth of a child, all contain a moral element which is evident to the clear understanding, and which cannot be neglected without injury to the doctor, to the individual, and to society. But probably it will be generally agreed that the hope of gaining money must not be the primary motive for choosing a medical career; but that interest in the line of study and kind of life, with a perception of the wide and beneficent influence which it can exert, should form the determining motive for becoming a physician.

If, then, we recognise that, although just reward for honest labour is fair, we must not enter upon medicine as a trade for getting money, but from a higher motive, this motive, as it influences conduct, becomes on that account a moral motive or an ideal which should guide our future practical life as physicians. Now, this ideal necessitates a distinct conception of what is right or wrong for us, in medicine, both as human beings and as women. Simply sensuous life, without an ideal or without higher principles of action than the limited needs of every day, tends to degrade the individual and all who surround him.

What we need is a clear idea of what is really right or wrong, with the reasons on which the judgment is based, instead of a confused notion or a vague and ever-shifting standard.

No woman student of medicine can safely ignore this subject. It is a vital one for us, and only a true answer to it will make our entrance into the profession a marked advance in social progress.

I do not attempt to disguise the difficulty of laying down the law of right and wrong in medicine; not only because medicine, as every other part of social life, is subject to the growth of evolution, but because in a state of society that has not yet succeeded in moulding itself on the fundamental principles of Christianity, we are involved in faulty social conditions which prevent us from embodying our moral perceptions in every phase of practical life. But, remember, thought and endeavour may live a righteous life, no matter what faulty conditions surround us. When we have a clear view of right and wrong, we can mentally repudiate whatever appears to violate the moral law. We can strenuously resist the deadening force of habitual wrong-doing, and never cease the effort to find some way of shaping our mental protest into practical opposition to all forms of immorality.

You will see in the course of your medical studies—particularly if you study abroad—much to shock your enlightened intellect and revolt your moral sense. In practice also you will be subjected to strong temptations of the most varied character. But just for the reason that as women we ought to see more clearly the broken bridge or approaching danger, in the onward rush of the male intellect, I now dwell on our special responsibility, and shall endeavour to give the reasons for it.

My object is not to limit, but to enlarge our work in medicine, when I seek to define our ideal. It is true that the great object of this human life of ours is essentially one for every human being, man or woman, barbarous or civilized. It is to become a nobler creature, and to help all others to a higher human status during this brief span of earthly life. But as variety in unity is a law of creation, so there are infinite methods of progress, producing harmony instead of monotony, when the individual or classes of individuals are true to the guiding principles of their own nature.

For the ideal of every creature must be found in the relation of its own nature to the universe around it. Right and wrong are based upon the sound understanding of this positive foundation. It is this fact of variety in unity, in the progress of the race, which justifies the hope that the entrance of women into the medical profession will advance that profession.

In order to carry out this noble aspiration, we must understand what the special contribution is, that women may make to medicine, what the aspect of morality which they are called upon to emphasize.

It is not blind imitation of men, nor thoughtless acceptance of whatever may be taught by them that is required, for this would be to endorse the widespread error that the race is men. Our duty is loyalty to right and opposition to wrong, in accordance with the essential principles of our own nature.

Now, the great essential fact of woman’s nature is the spiritual power of maternity.

We should do miserable injustice to this great fact if, looking at it with semiblind eyes, we only see the shallow material aspect of this remarkable speciality. It is the great spiritual life underlying the physical which gives us our true womanly ideal.

What are the spiritual principles necessarily involved in this special creation of one-half the race—principles which lie within the material facts of gestation and the care of infancy and childhood, which constitute the distinctive material domain of women?

They are the subordination of self to the welfare of others; the recognition of the claim which helplessness and ignorance make upon the stronger and more intelligent; the joy of creation and bestowal of life; the pity and sympathy which tend to make every woman the born foe of cruelty and injustice; and hope—i.e., the realization of the unseen—which foresees the adult in the infant, the future in the present.

All these are great moral tendencies, and they are necessarily involved in the mighty potentiality of maternity. They lay upon women the weighty responsibility of becoming more and more the moral guides in life’s journey. Women are called upon very specially to judge all practical action as right or wrong, and to exercise influence for this high morality in whatever direction it can be most powerfully exerted.

We see the indication of this providential inherited impulse to moral action, in the great and increasing devotion of women to the relief of social suffering and their sturdy opposition to wrong-doing, which form a distinguishing characteristic of our age. These spiritual mothers of the race are often more truly incarnations of the grand maternal life, than those who are technically mothers in the lower physical sense.

With sound intellectual growth the range of moral influence increases. But such sound growth can only take place under the guidance of moral principle; for moral perception becomes reason as the intellectual faculties grow, and reason is the true light for all. It is in this high moral life, enlarged by intelligence, that the ideal of womanhood lies. It is through the moral, guiding the intellectual, that the beneficial influence of woman in any new sphere of activity will be felt.

Thus, from their inherited tendencies, as well as from the existent individuality of their nature, women must seek a high moral standard as their ideal, and acknowledge the supremacy of right over every sphere of intellectual activity. The highest type of moral excellence which we can find in the age in which we live, the beneficence which it exerts, the means by which it has been attained, form so many landmarks to guide us in our search for the right.

This very important method of growth has been well stated by Huxley, that brave fighter in the past for freedom of thought. He has laid down this weighty principle, that ‘the past must be explained by the present.’

This principle is of very wide application.

What produces the noblest human creature now in our nineteenth century? What inspires hope? What sustains us most bravely to fight the battle of life? What makes life most worth living?

When we have ascertained these facts in the present, they will explain the past, and give the foundations of right for guidance in the future.

It is a noteworthy feature of the present day that some of our best men, witnessing the failure of so many panaceas for the intolerable evils that afflict society, are longing for that untried force—the action and co-operation of good women. ‘Our only hope is in women!’ is a cry that may sometimes be heard from the enlightened male conscience. But still more significant is the awakening of an increasing number of women themselves. They begin to realize that truth comes to us through imperfect human media, and is thus rendered imperfect; that every human teacher must be accepted for his suggestiveness only, not as absolute authority. Women are thus rising above the errors of the past, above blind acceptance of imperfect authority, and are earnestly striving to learn the will of the Creator, and walk solely according to what they themselves, diligently seeking, can learn of that Divine will.

There is no line of practical work outside domestic life, so eminently suited to these noble aspirations as the legitimate study and practice of medicine. The legitimate study requires the preservation in full force of those beneficent moral qualities—tenderness, sympathy, guardianship—which form an indispensable spiritual element of maternity; whilst, at the same time, the progress of the race demands that the intellectual horizon be enlarged, and the understanding strengthened by the observation and reasoning which will give increased efficiency to those moral qualities.

The true physician must possess the essential qualities of maternity. The sick are as helpless in his hands as the infant. They depend absolutely upon the insight and judgment, the honesty and hopefulness, of the doctor.

The fact also that every human being we are called on to treat, is, like the infant and the child, soul as well as body, must never be forgotten. Successful treatment requires the insight which comes from recognition of these facts and the sympathy that they demand. In the infinite variety of human ailments the physician will find that she must often be the confessor of her patient, and the consulting-room should have the sacredness of the Confessional, and she must always be the counsellor and guide.

In those two departments of medicine which seem to me peculiarly valuable to women physicians, which I shall refer to later—viz., midwifery and preventive medicine—it would be hard to say whether the moral or intellectual qualities of the physician were called most largely into play, so inseparably are they blended. What patience and hopefulness also are demanded in the lingering trial of chronic illness! What discrimination and union of gentleness and firmness these cases require! Then think of the children in our families! To the girls and boys, the young women and men, who grow up under our ministrations, what an inspirer of nobleness and purity, what a guardian from temptation the true physician can be!

Again, in the treatment of the poor, an immense demand is made upon our pity, patience, and courage. These poor victims of our social stupidity are often extremely trying. The faulty arrangements which compel us to see thirty, fifty even, in an hour exhaust the nervous system of the doctor. It requires faith and courage to recognise the real human soul under the terrible mask of squalor and disease in these crowded masses of poverty, and to resist the temptation to regard them as ‘clinical material.’ The attitude of the student and doctor to the sick poor is a real test of the true physician.

Having thus realized the profound adaptation of the nature of woman to the practice of the Art of Healing, let us consider in what way the intellectual faculties may be strengthened, so as to give enlarged efficiency to the maternal qualities. In other words, how shall we become reliable doctors?

What I have hitherto dwelt on is the necessary attitude of mind or the atmosphere and light in which women physicians must breathe and work if they are to attain to their distinctive efficiency; let me now refer more particularly to the method of training for our practical work.

The intellectual training required for the physician is admirably adapted to supply deficiencies in the ordinary experience of women.

The intellectual characteristics which must be especially gained during student life are: the faculty of patient observation, exact statement of what is observed, and cautious deductions from these observations.

These qualities form the foundation of sound judgment and skilful medical practice. It is not a brilliant theorizer that the sick person requires, but the experience gained by careful observation and sound common-sense, united to the kindly feeling and cheerfulness which make the very sight of the doctor a cordial to the sick. If these necessary results of intellectual training can be secured in harmony with the moral structure of womanhood, then a step of real social progress is made by our study of medicine.

This necessity for making the most painstaking observation of facts, the foundation to be laid by the student in every branch of her studies, is well illustrated in the life of Darwin, who writes thus to a friend: ‘I have been hard at work for the last month in dissecting a little animal about the size of a pin’s head, from the Chronos Archipelago, and I could spend another month and daily see more beautiful structure.’ Of the value of this method of persistent labour, his friend gives this noteworthy testimony: ‘Your sagacious father never did a wiser thing than devote himself to these years of patient toil. It is a remarkable instance of his scientific insight and courage that he saw the necessity of proper training and did not shrink from the labour of acquiring it.’

In medicine, anatomy, physiology and chemistry are the primary studies where that foundation of conscientious exactitude must be laid on which the skill of the future physician so largely depends.

The first and indispensable basis of medicine is anatomy, with which physiology is inseparably blended; for human physiology can only be properly studied in connection with the human structure, whose condition in health and disease forms the direct object of our profession. No student should be satisfied until she has most carefully followed out the structure of every region of that human body with whose life we shall have to deal. Careful anatomical study is the sure and indispensable preparation for that next advanced range of clinical observation, where pathology and therapeutics bring us into the direct study of the sick.

The more thoroughly the human organization is investigated, the more wonderful will the unapproachable mechanism for the use of human life be seen to be. We shall never regret any amount of time and care spent in acquiring the most intimate knowledge of human anatomy. For even if we never perform a surgical operation, the thorough knowledge of the human framework with whose aberrations we have to deal, gives a firm foundation for practice that nothing else can supply.

The thoughtless slashing of the delicate and complicated structure of the body, of which untrained students are sometimes guilty, is indicative of a careless, unconscientious future physician. If carelessness similar to what is sometimes observed in the dissecting-room were carried on in the chemical laboratory, life or limb would soon be sacrificed. Yet a thorough grounding in the structure of every vital organ is more indispensable to us than chemistry, important as the study of chemistry is. Let me here note how the moral element on which I have so strongly insisted comes into play in this the first of our medical studies. Reverence for this physical structure of ours should always be shown in the use and arrangements of the anatomical rooms. Carelessness and irreverence in this department of study exercise a really deteriorating influence on students of medicine. Respect for the material used, care in its disposition, and a decent covering for each work-table in the intervals of work, may seem small observances, but they exercise a large influence over the moral training of the student when persistently carried out.

It does not enter into my present purpose to enlarge upon the right method of studying each branch of medicine, for that would require a series of discourses. But I must give an emphatic warning against the strange neglect of human physiology which I observe. This seems to proceed from the mistaken idea that necessary knowledge can be obtained from other organisms which bear a misleading resemblance to the human.

What I would insist upon is, that we should endeavour to make ourselves thoroughly acquainted with the nature and variations of healthy human physiology before we are perplexed with the changes of pathology.

Auscultation and percussion; observations of the healthy variations of the pulse, the tongue, the skin, and the various secretions, in as many healthy individuals, both adult and infant, as can be examined, compared, and recorded; the vital chemistry of the human tissues and secretions in health and disease; the modifying effects of temperament, heredity, idiosyncrasy, etc.—all this forms a department of human physiology, strangely neglected as a practical study, yet certainly of primary importance to the progress of medicine.

But I must pass on to what is my immediate purpose—viz., the relation of women to medicine. Having dwelt on the moral and intellectual advantages of medical study, I must refer to another aspect of the subject—viz., the dangers which meet our earnest students.

Dr. Carpenter has recorded the wide-spread recognition of this dangerous aspect of medical study when he says: ‘There seems to be something in the process of training students for the medical profession which encourages in them a laxity of thought and expression that too frequently ends in a laxity of principle and of action’; and he further condemns the tone of some works issued by the medical press. Now, this judgment of a very cautious teacher so many years ago, is worthy of the most serious consideration in the present day. The freedom of entrance now accorded to women into the medical profession, lays a very heavy responsibility upon us, to prove that this new and increasing movement will be a future blessing to society.

We are happy in drawing into our schools a large number of capable women—women who may not only be a gain as physicians, but who may exert a most beneficial influence on the profession itself, if they bring into it fresh and independent life.

It is much to be regretted that our students are now compelled to go abroad for the completion of their medical education, for methods of study injurious to morality are exaggerated abroad. The abuse of the poor as subjects of experimental investigation, in whose treatment all decent reserves of modesty are so often stripped away; the contempt felt for the mass of women where chastity is not recognised as an obligatory male virtue; the atrocious cruelty of their experiments on animals—all these results of active intellect, unguided by large morality, as seen in full force abroad, make me deplore the necessity which drives so many of our best but inexperienced students away, in search of more efficient training than they can obtain at home.

The two special dangers against which I would warn our students are:

First, the blind acceptance of what is called ‘authority’ in medicine.

Second, the narrow and superficial materialism which prevails so widely amongst scientific men.

In relation to the first point—viz., distrust of authority—although I fully recognise the respect which is always due to the position of the teacher, and the consideration to be shown to all who are called ‘heads of the profession,’—I would very strongly urge you to remember that medicine is necessarily an uncertain science.

Life in its essence we cannot grasp. We understand it only through its effects, and all human judgment is fallible. Careful and wise observation bring us ever nearer to a knowledge of the conditions which are necessary for human well-being; but experience compels us to recognise the constant failure of theory or dogmatism in dealing with any of the infinitely varied phases of life. In medicine, we are forced to recognise the errors in diagnosis committed even by distinguished men, and to suffer grievous disappointment from the failure of remedies supposed to cure the sick. We cannot fail to note the contradictory results of experiments, the same facts differing according to the observer—one fact upsetting another, and one theory driven out by a later one. This uncertainty resulting from experiment, is strikingly exemplified by the battle of experts about the effects of arsenic displayed in a late criminal trial. Or consider the frequent errors of statistics (a branch of knowledge that enters largely into medical science), owing to the imperfect data on which they are often based, important deductions being drawn from them which are logically indisputable, but entirely false, from the unsound premisses on which they rest. Thus, the death-rate of London, though commonly stated at 23 or 24 per 1,000, is really an unknown quantity, on account of the enormous influx of fresh life and the efflux of broken-down lives.

Our women students especially need caution as to the blind acceptance of authority. Young women come into such a new and stimulating intellectual atmosphere when entering upon medical study, that they breathe it with keen delight; they are inclined to accept with enthusiasm the brilliant theory or statement which the active intellect of a clever teacher lays before them. They are accustomed to accept the government and instruction of men as final, and it hardly occurs to them to question it. It is not the custom to realize the positive fact, that methods and conclusions formed by one-half of the race only, must necessarily require revision as the other half of humanity rises into conscious responsibility.

It is a difficult lesson also, fully to recognise the limitations of the human intellect, which recognition, nevertheless, is necessary before we can grasp this important and positive fact in human experience—viz., that the Moral must guide the Intellectual, or there is no halting-place in the rapid incline to error. The brilliant professor will always exercise an undue influence over the inexperienced student, and particularly over the woman student. I therefore strongly urge the necessity of cherishing a mild scepticism respecting the dicta of so-called medical science, during the period of student life—scepticism not in relation to truth—that noble object which we hope to approach even more nearly—but scepticism in relation to the imperfect or erroneous statement of what is often presented as truth.

Of this one guiding fact, as a basis of judgment, we may be quite sure—viz., that whatever revolts our moral sense as earnest women, is not in accordance with steady progress; it cannot be permanently true, and no amount of clever or logical sophistry can make it true. It will be a real service that we, as medical women, may render to the profession if we search out—calmly, patiently, but resolutely—why what revolts our enlightened sense of right and wrong is not true. We shall thus bring to light the profound reason why the moral faculties are antecedent or superior to the intellectual faculties, and why the sense of right and wrong must govern medical research and practice, as well as all other lines of human effort.

As experience enlarges, we observe the immense separation in lines of conduct which gradually results from an initial divergence between right and wrong—a divergence almost imperceptible at first. We are thus compelled to come to the conclusion, in relation to our own profession, that the worship of the intellect, or so-called knowledge, as an end in itself, entirely regardless of the character of the means by which we seek to gain it, is the most dangerous error that science can make. This false principle, if adopted by the medical profession, will degrade it, and inevitably produce distrust and contempt in the popular mind.

The second danger against which the student of medicine must guard is the materialism which seems to arise from undue absorption in the physical aspect of nature, and which spreads like a blight in our profession.

The basis of materialism is the assertion that only sense is real.

Our medical studies necessarily begin with minute and prolonged study of what we term ‘dead matter.’ If this study be carried on without reverence, it appears to blind the student to any reality except the material under his scalpel or in his crucible—i.e., the facts that the senses reveal. Proceeding logically from this false premiss, that only sense is real, mind is looked upon as an outcome of the brain, and life as the result of organization of matter, which is destroyed when the organization of the material body is broken up.

Some persons, successors of the materialistic ecclesiastics who condemned Galileo, cannot rise beyond the gross evidence of their senses. To such persons reason, which transcends sense, is a vague unreality, and the clear teaching of reason may to them seem doubtful, or superstition. But the stout fight which the old Italian nobly began, and which has been so bravely carried on for freedom of thought in our own day, is beginning to tell and reap a rich reward. Our senses, so far from being the boundary of real existence, are proved to be as untrustworthy guides now, as when Galileo’s accusers insisted that the sun moved round the earth in twenty-four hours. The relations of our senses to our consciousness change with biological differences, as one creature can see what is quite invisible to another. The boundary-line which exists between our senses and our consciousness is constantly changing, and realities are shown to exist, of which our ordinary consciousness connected with the senses has no knowledge. Thus, life beyond, and independent of the senses, is being proved as positive and pregnant fact.

The great generalizations of modern science—the Conservation of Energy, the process of Evolution—are the products of Reason. They are metaphysical conceptions. Like the atomic theory or the law of gravitation, they are practical formulæ necessary to the advancement of science from the structure of our minds but they are the results of reason, not of sense.

Love, Hope, Reverence, are realities of a different order from the senses, but they are positive and constant facts, always active, always working out mighty changes in human life.

A thoughtful writer has characterized Materialism as an attempt to explain the Universe in terms of mass and motion rather than in terms of Intelligence, Love, and Will, and it is a true criticism. Let me recall here the serious warning which Huxley gives to the shallow materialist who limits existence by the senses.

He says: ‘The great danger which besets the speculative faculty is the temptation to deal with the accepted statement of facts in natural science as if they were not only correct but exhaustive—as if they might be dealt with exhaustively, in the same way as propositions of Euclid may be dealt with. In reality, every such statement, however true it may be, is true only relatively to the means of observation and the point of view of those who have enunciated it. Whether it will bear every speculative conclusion that may be logically deduced from it is quite another question.’ ‘In the complexity of organic nature there are multitudes of phenomena which are not deducible from any generalizations that we have yet reached; this is true of every other class of natural objects (as the moon’s motions, gravitation, etc.). All that should be attempted is a working hypothesis, assuming only such causes as can be proved to be actually at work.’

These are valuable warnings from our great naturalist.

The tendency of unprejudiced science in our day is to show the unsatisfactory character of the terms ‘matter’ and ‘spirit.’ For the exaltation of what we term ‘matter’ tends constantly to lose itself in what we call ‘spirit.’

Reality always transcends sense. As the vibrations of ether are only known as light and colour, and the vibrations of the atmosphere are translated into sound, so in the careful observation of our own mental states, in the experiences of dream-land, in the study of clairvoyants and somnambulists and the revelations of hypnotism, we gain an insight into states of consciousness independent of the senses—states where the old distinctions between matter and spirit seem to become quite inapplicable.

One third of human life is spent in sleep, a condition of which at present we know little, except that it entirely changes the life of conscious sense, and that it possesses a mysterious restorative power of the most precious significance to us as physicians. A study of all these mysterious conditions of human life itself, many of which, although occurring abnormally, have been presented again and again through all the ages, is surely the most important of all subjects for scientific medical investigation. Let us always bear in mind, as has been well said, ‘the fact of illusion is not an illusory fact.’ As an exception to a rule is the most suggestive fact for the investigator to grapple with, so those exceptional facts of human nature, which are nevertheless occurring in every age and in every nation, are the facts of all others the most worthy of investigation by the scientific medical intellect. This new realm of research, when legitimately pursued, promises results of the very highest importance.

I must not now dwell longer on this new and valuable department of medical investigation—psycho-physiology. But it is an inspiring thought that true science supports the noblest intuitions of humanity, and its tendency is to furnish proof suited to our age of these intuitions. I have specially dwelt on this subject now, because the discouragement which results from the false reasoning of materialism, injuring hope, aspiration, and our sense of justice, is especially antagonistic to women, whose distinctive work is joyful creation.

In practical medicine the loss is immense when recognition of the higher facts of consciousness is obscured, and the physician is unable to perceive life more real than the narrow limits of sensation.

The physician is called to stand by the death-bed of the most carefully-tended patient. At that solemn moment the clear glance that sees beyond the boundary of sense, the reverential hand-clasp which conveys hope to the mourner, is the seal of his noble art of healing and the profoundest consolation he can offer to the bereaved. May the time come when every physician can convey this highest gift of healing with his ministrations!

I have now considered the fundamental reason why great advantage will result to society through the intellectual cultivation of the woman physician, unless the study of medicine be pursued in such a way as to do violence to our nature by the destruction of sympathy, reverence, and hope.

I have also dwelt on the method of training especially needful to our students—viz., patient, persistent drill in the fundamental studies of medical education, a training which will form the habit of close and careful observation at the commencement of medical life.

I would now offer a few words of counsel in relation to the work which lies before us when we enter upon the practical career of the physician, for which our medical studies should carefully prepare us.

I believe that the department of medicine in which the great and beneficent influence of women may be especially exerted, is that of the family physician, and that not as specialists, but as the trusted guides and wise counsellors in all that concerns the physical welfare of the family, they will find their most congenial field of labour.

It is to fit ourselves for this most useful and influential position—viz., as the medical advisers of families—that, not limiting our education to any speciality, we have laboured, and must continue to labour, to remove all obstacles in the way of obtaining the fullest medical education. For this reason I have laid so much stress upon the cultivation of habits of careful observation, and I now would give a warning against sensationalism in medical study.

The unreflecting student (not unnaturally) rushes after novelties. There is a certain excitement in witnessing a formidable surgical operation, or seeing a rare case of disease that may never again be presented to our observation. But these exceptional occurrences do not fit us for our future medical life as does the careful study of the commoner forms of disease, for those are the cases that most nearly concern us. But because they are common they cease to interest the unobservant student, who applies a routine treatment. But the physician whose faculties of observation have been thoroughly drilled has learned this lesson—viz., that no two cases of illness are exactly alike, and that it is of the utmost importance to our future success as practitioners to note these individual differences, their results, and why some die whilst others recover. It is far more important to our success as practical physicians to thoroughly master measles and whooping-cough, scarlet fever and porrigo, than to study an isolated case of hydrophobia or leprosy. Moreover, I hold it to be a special duty of our profession to extirpate these common diseases, not to accept them hopelessly as necessary evils. And it is only by a profounder and more comprehensive clinical study of the ordinary diseases of domestic life that we can hope to do this.

There are two great branches of medicine whose importance will, I hope, more and more engage the attention of women physicians. These are midwifery, which introduces us to the precious position of the family physician; and sanitary or preventive medicine, which enables us to educate a healthy generation.

These two departments of the healing art will never cease from amongst us. I consider it a radical defect in our present system of medical education, that these subjects are not brought more prominently forward, and both of them raised into first-class professorial chairs.

Before closing, I must dwell for a few moments on the vital importance of midwifery to the future success of women physicians. This is the more necessary because I observe a singular and growing disposition on the part of our students, whether in America, France, or England, to despise or neglect midwifery. I do not know whether this proceeds from indolence, as midwifery is the most fatiguing and enchaining branch of the profession, or whether the neglect arises from failure to perceive the reason of our refusal to be simply midwives, for our insistence upon a complete education really means our determination to elevate, not repudiate, midwifery.

But the curious fact remains that many women doctors appear to look down upon this most important branch, and often state that they do not intend to undertake it. Yet it is through the confidence felt by the mother during our skilful attendance upon her, that we are called in to attend other ailments of the family, and thus secure the care of the family health. It is therefore of the utmost importance to our future position in medicine to establish our ability as thoroughly trustworthy obstetricians.

It is indispensable to the stability of our movement that very thorough provision be made for the obstetrical education of all our medical graduates. I do not think that any young woman physician is properly equipped for her future difficult career unless she has been to a great extent responsible for at least thirty midwifery patients, of whose cases she has made careful and discriminating records, and has had the opportunity of observing a great many more patients, in addition to the drill in all operative manœuvres that can be given in college. We need a great maternity department, thoroughly organized, which, whilst arranged with kindest consideration for the poor, will put our students through a severe drill, such as is considered necessary at La Maternité in Paris. That institution, which receives annually an average of 2,500 patients, having over 10,000 applications in the year, is not only an invaluable practical school, but it has reduced the mortality amongst its patients to a minimum; and the searching method of instruction there pursued could be studied by us to great advantage as we try to secure a well-organized maternity charity for our students in London. Such a charity, if humanely planned, would be a blessing to poor mothers, and it would to a great extent remove the reproach of being obliged to send our enterprising young doctors abroad because London does not afford them sufficient necessary practical training.

But time warns me to close these remarks, although I would gladly have enlarged upon the primary importance of preventive medicine—the medicine of the future—for it is quite certain that the greater part of disease, even including many surgical operations, is preventable disease. It is now, unfortunately, the case that unavoidable absorption in the treatment of disease makes the practical physician too often ignore the yet larger duty of preventing it.

I have tried to show (1) That women, from their constitutional adaptation to creation and guardianship, are thus fitted for a special and noble part in the advancement of the healing art. (2) That the cultivation of the intellectual faculties necessary to secure their moral influence requires a long and patient training by methods that do not injure morality. (3) That the noblest department of medicine to which we can devote our energies, will be through that guardianship of the rising generation which is the especial privilege of the family physician.

In conclusion, my young friends and fellow-workers, I would ask you all to join with me in the pledge which I gave more than forty years ago to the Chancellor of the Western University, who handed to me our first Diploma of Doctor of Medicine. I then promised ‘that it should be the effort of my life to shed honour on that diploma.’

This is the pledge that we must all prepare for when entering the noble profession of medicine; in receiving honour we must add lustre to it, or we become unworthy of it.

It is a difficult life that we enter upon, in entering upon a medical career; but if our Christianity is worth anything, it must be ‘a battle, not a dream.’ We must be members of the church militant if we wish to enter the church triumphant. Life is a grand preparation for the exercise of ever larger powers, and I heartily welcome you to this winter’s course of study, hoping that it may be a little step forward, but a sure one, towards that grand ideal which must be ever before us.

ERRONEOUS METHOD IN MEDICAL EDUCATION

Addressed originally[1] to the Alumnæ Association of the Woman’s Medical College of the New York Infirmary

ERRONEOUS METHOD IN MEDICAL EDUCATION

Although it is many years since I have been able to assist in the management of the Infirmary and School which I helped to found in 1853, yet I watch its growth with steady sympathy, and rejoice in its success.

The last Report of the School, which has just reached me, contains a very important item—viz., the effort of the Alumnæ Association to ‘Equip a Physiological Laboratory and place it under the superintendence of Professor W. Gilman Thompson,’ a New York Vivisector. In relation to this effort, I desire to bring before you some grave considerations which are the result of my long experience in Medicine.

These considerations refer, first, to the kind of work that should be carried on in a Physiological Laboratory, and, second, to the special influence which women are called on to exercise in medicine.

A Physiological or Pathological Laboratory arranged for the legitimate investigation of the material composition of the tissues and secretions of the human body, is an interesting and important department of medical study. The laboratory, however, is now commonly used as a place for experimenting upon living animals as if they were dead matter, or simple machines. This method of research is proving in several ways extremely injurious to the progress of the Healing Art.

The practice of Vivisection and unlimited experimentations upon our humbler fellow-creatures must be considered by us both under its intellectual and its moral aspects. From both these points of view very careful observation has led me to the conviction that this method of investigation is a grave error.

Let me here state distinctly that I willingly acknowledge the good intentions of all and the ability of some of the clever physiologists of the present day, although their method of experimentation is erroneous and the effects of that method injurious, being founded on a fallacy. What I now say, however, is directed chiefly to the instruction of medical students and to the practice of our young women doctors.

I ask you to consider, first, the intellectual fallacy which underlies this method of research. It is a twofold fallacy, resulting from the differences of organization in different classes of living creatures, and from the fact that when any organ is injured, it is a process of destruction or death—not life—that is exhibited.

There is an ineradicable difference of physical structure between Man and every species of lower animal. Nowhere is there identity of structure or of function. Resemblance or parallelism often exists, but identity never. Take the dog, for instance, whose attachment to Man furnishes us with the widest opportunities of observation. In no single function of its body is the action of the function the same as in Man. All the processes of digestion, including its large group of connected organs, differ from those of the human being. Observe carefully the processes of healthy living animals. You will find that their senses act in a different way to ours—a way which is often quite unknown to us, we possessing no power even comparable with many of their powers. Their relations to nature differ in many ways from our relations. It is true that they eat and sleep and dream; that they possess intellectual and moral powers, and are susceptible of education. They exhibit a rough rudimentary sketch of our higher spiritual powers, and are related to us in many ways. But the differences are so great, their whole attitude towards external life is so different, that they may be truly said to live in a different world from ours. So that in no possible instance can we draw a positive conclusion respecting the lower animal nature, that can be transferred as reliable information to guide us in relation to the action of the human organs and functions, either in health or disease. This misleading difference is true not only in relation to the spontaneous working of functions, but it is also true in respect to the actions of poisons, of drugs, and the artificial production of diseases. Animals can be rendered scrofulous, diabetic, syphilitic, leprous, by forcing the poison of diseases into their bodies. Morbid action, atrophy, slow death, can be produced by removing portions of their organs; but no deductions drawn from these artificial conditions can be transferred to man in order to cure human disease or restore lost function. The scrofula, diabetes, syphilis, or rabies, takes on a different form when the lower animal has been artificially poisoned by these diseases. In not a single instance known to science has the cure of any human disease resulted necessarily from this fallacious method of research.

In 1849-50 I was a student in Paris, and, with the narrow range of thought which marks youth, I was extremely interested in the investigations respecting the liver and gall bladder which Claude Bernard (Majendie’s successor) was then carrying on and lecturing upon at the Collège de France and the Sorbonne. I called upon M. Bernard to ask him where I could find some work on ‘Physiologie Appliquée’ which would show me how the results of these investigations could be applied to the benefit of man. M. Bernard received me with the utmost courtesy, but told me there was no such book written; the time had not come for the deductions I sought; experimenters were simply accumulating facts. We are still, forty years later, vainly accumulating facts! This present summer Dr. Semmola, ‘one of the most brilliant pupils of Claude Bernard,’ lectured in Paris on Bright’s disease, which he has been studying for forty years with unlimited experimentation on the lower animals, for the purpose of producing in them artificial inflammation and disease of the kidneys. What is the result to the human being of all this prolonged and ingenious suffering inflicted on helpless creatures? ‘Dr. Semmola insisted upon temperance in eating as well as drinking, and said that the best way to preserve health was to eat only what was needed for the nourishment of the body.’ No cure for the human malady had resulted from this persistent experimentation.

Is it not intellectual imbecility to waste thought and ingenuity in putting animals to lingering and painful deaths in order to reassert the well-proved fact that intemperance in eating and drinking will produce forms of digestive and excretory disease varying with the idiosyncrasy of the individual?

In late discussions in the French Academy of Medicine relative to chloroform, where Laborde and Franck exhibited experiments on animals, Dr. Le Fort (the distinguished surgeon) says: ‘None of these experiments give us any instruction whatever which is useful in practical surgery. Whatever their scientific interest may be, their deductions are in no way applicable to man. Experimenters relate causes of death, but nothing of the sort is generally found in the deaths of practical surgery. The man faints when operations are begun too soon, or is frightened by preparations. He dies because, being a man, his nervous system reacts in a different way from that of the dog or the rabbit. Do not count in any way upon the teachings of physiologists in practical matters. Don’t let your patient see any preparations, give the chloroform slowly, wait till he is profoundly asleep. That is all you can do.’

Again, at another discussion at the Academy, M. Verneuil says: ‘It is incorrect to say that laboratory experiments give certainty to medicine, and make it scientific instead of empirical. The fact is that experimentation has put forth as many errors as truths. There is not sufficient identity, either physiologic or pathologic, between man and the mammifères such as the dog and the rabbit.’ The different ways of dying under chloroform have been long ago stated by surgeons. The experiments shown by M. Laborde on the rabbit must be absolutely rejected, as contrary to experience (in man). Maurice Perrin showed to Vulpian in 1882 that the nervous reactions in man differ from those in animals, and the effects produced by chloroformization could not be relied on as being the same as on man. Vulpian entirely accepted this. The experiments of physiologists have taught us absolutely nothing in the way of preventing chloroform accidents; surgeons have been beforehand (as was natural) in practising artificial respiration and every other method of recovery. However interesting these experiments on animals may be considered, they do not explain satisfactorily the cause of chloroform accidents in man, and in no way show the way of avoiding them.

I could multiply these facts by indefinite quotations from experienced physicians, of the intellectual uselessness of a method of research which ignores the spiritual essence of Life and hopes to surprise its secrets by ruthless prying into the physical structure of the lower animals. We are learning that vivisection is examination of the beginning of death, not of life. Loss of blood is a loss of nutriment; the result is muscular debility and enfeeblement of the vital organs, and the introduction of a disturbance in the vital processes which ends in their destruction. This method of research is now being discredited by many of the most enlightened members of our Profession.

But what I wish especially to call your attention to, is the educational uselessness of vivisection in training students, and the moral danger of hardening their nature and injuring their future usefulness as good physicians.

It is not true that vivisection is necessary to the medical student in order that she may attain the thorough knowledge of human physiology which is needed for the intelligent exercise of the medical profession. Class demonstrations in opening the bodies of the lower animals to examine their organs and tissues are misleading in respect to the action of human organs. The action of the human salivary glands, the action of the cavities of the human heart, the secretion of the gastric juice, etc., can be more correctly realized by careful anatomical study in connection with clinical observation of the effects of healthy and diseased action in the human being, than by any amount of bloody experiment and mutilation of still living cats and dogs. Such demonstration may gratify that instinct of curiosity which always exists in youthful human nature, or it may pander to that craving for excitement which makes the spectacle of a surgical operation so much more attractive to the undeveloped mind than careful clinical study—a tendency which is also seen in gambling, watching executions, bull-fights, etc.—but these are tendencies to be repressed in serious and responsible study, not encouraged. The precious mental activities of the student need to be specially trained into observation of our human faculties in health and in disease. The establishment of a Physiological Laboratory for experimenting on living animals, in a medical school, is not only giving a wrong direction to intellectual activity, but is wasting the valuable time of the student, and diverting the attention of the young practitioner from that careful and intelligent study of the human organism, which alone can lead to practical beneficial results. This practice must therefore be condemned, as giving a false direction to the intellectual faculties of the young.

Of the moral danger involved in such methods of study there can be but one opinion by thoughtful and observant persons within the ranks of our Profession.

The exercise of our superior cunning in destroying an animal’s natural means of self-defence, that we may (with convenience to ourselves) watch changes that occur in its organs during the slow process of a lingering death, is an exercise of curiosity which inevitably tends to blunt the moral sense and injure that intelligent sympathy with suffering, which is a fundamental quality in the good physician. The practice of recklessly sacrificing animal life for the gratification, either of curiosity, excitement, or cruelty, tends inevitably to create a habit of mind which affects injuriously all our relations with inferior or helpless classes of creatures. It tends to make us less scrupulous in our treatment of the sick and helpless poor. It increases that disposition to regard the poor as ‘clinical material,’ which has become, alas! not without reason, a widespread reproach to many of the young members of our most honourable and merciful profession. The hardening effect of vivisection is distinctly recognised in the Profession, although often excused under the abused term—‘scientific.’ Dr. Loye, who, with another physician, studied the process of guillotining a malefactor at Troyes, thus writes: ‘Both of us believed that our wide experience of bloody vivisection would have hardened us sufficiently to go through the spectacle without very great emotion.’

It is our duty and privilege, as women entering into the medical profession, to strengthen its humane aspirations—to discourage its dangerous tendencies. We must not be misled by clever or brilliant materialists who take the narrow view that physical life can be profitably studied without reverencing the spiritual force on which it depends. A physiological and pathological laboratory, legitimately conducted for the investigation of healthy and diseased human secretions, in connection with clinical observation, may be made a valuable aid to medical advancement, and I would always encourage the organization of such a laboratory. But to use it for cutting up animals dying under anæsthetics is stupidity, and to convert it into a torture chamber of the lower animals, is an intellectual error and a moral crime.

The possible results of slow deterioration in the moral nature when we violate in any degree our religious standard of justice and mercy may be most strongly realized in living examples of diseased inherited tendencies. Such a fearful example is before us in the life history of the criminal, Jesse Pomeroy, now in the State Prison of Charlestown, Mass., who has spent his life in penal servitude, expiating his atrocious mutilations and murders of little children, committed when he was a lad of fifteen. The deteriorating moral influence exercised on offspring by vicious parental tendencies, is directly exhibited in this living object lesson. The father of this lad was a butcher. His mother, during the gestation of this child, took a persistent and morbid delight in watching the death of the animals slaughtered by her husband. We see in the atrocities committed by her young son, a terrible example of the evil effect which the mind can exercise, in deteriorating individual character and in extending its evil influence to others. All experience proves the powerful influence exercised by the parental, and especially the maternal, qualities upon the offspring. Every woman is potentially a mother. The excuse or toleration of cruelty by a woman upon any living creature is a deadly sin against the grandest force in creation—maternal love.

I earnestly ask all women physicians to consider the special responsibility which rests upon them, to take that large religious view of life which alone can check any degrading tendencies in intellectual human activity and elevate our noble Profession. Let us not be misled by sophistical arguments, but look steadily at the actual facts of animal torture, and work persistently for the total abolition of vivisection from our medical schools. In this way we shall justify our entrance into medicine, and prove ourselves strong supporters of that noble humanity which is the especial characteristic and solid foundation of the Medical Profession.

FOOTNOTES:

[1] In 1891.

WHY HYGIENIC CONGRESSES FAIL
LESSONS TAUGHT BY THE INTERNATIONAL CONGRESS OF 1891

INTRODUCTION

The noblest aim of humanity is the application of Truth to the conduct of life. By doing we develop our faculty of knowing.

The difficulty, however, of knowing how to apply Truth in daily life is so great, and yet the need is so urgent, that the most pressing duty of those who have faith in the Divine is to bring forward to the light of sympathetic conference, the facts of life in which one’s most intimate experience lies.

Thus the merchant and manufacturer, the business man and the legislator, the farmer, householder, literary man, and those who, living upon interest, should know how that interest is gained, must ever hold it to be true religious duty to seek, in conference with others, the way of elevating every department of life.

Religious or Unitary truth possesses invaluable guidance for Medicine, not only in its practical application as an art, but in the methods by which it can alone become a science.

Truth recognises this great fundamental fact—viz., that spirit moulds form, that the senses alone are not reliable guides in solving the problems of even physical life.

Research and observation also show that essential elements of Truth have always existed in Humanity; that we cripple our power of advancing in Truth if we do not seek out these indications of the Divine in all past experience and carefully consider the light they throw on present life.

We recognise in these weighty facts a great Providential method of human growth and an infinitely beneficent aid towards the attainment of that moral Ideal wherein Goodness and Truth, Justice and Mercy, Love and Wisdom, become one—inseparably united.

One of the great truths given in past ages, which it is necessary to study and enforce in the present age, is the intimate connection which exists both mentally and physically between human beings and lower forms of animal life.

This is a truth of great moral significance. It was dimly, perhaps grotesquely, seen in some religions of the past, but is so much lost sight of in the present day that our responsibility for the care of the inferior creation we were intended to train with justice and gentleness, becomes too often a cruel and odious tyranny. Even in some branches of knowledge (knowledge which can only justly claim the name of science when it is the most comprehensive study of truth) injustice and cruelty are misleading the intellect, and thus threatening danger to the progress of the human race.

Being profoundly impressed by the fundamental character of these truths as necessary guides in medicine as well as in every department of human life, when I learned that extensive preparations were being made in the greatest city of the world for consideration of perhaps the most important subject that can engage our attention—viz., Health—I arranged to be present as a delegate, and steadily attended the Congress, comparing notes with other friends who were attending its various sections.

In this way we gathered an accurate knowledge of the tone of the discussions, the methods pursued, and the tendencies of modern investigation.

These facts seemed to me of sufficiently serious import to make them worth recording in the following pages.

WHY HYGIENIC CONGRESSES FAIL

The Seventh International Congress of Hygiene was held in London from August 10 to 15 of 1891. It is noteworthy for the number and representative character of its members, and also for the wide range of subjects affecting the physical welfare of the race, which were considered. Representatives from America and from Asia, as well as from the various nations of Europe, assembled in the Great Metropolis to consider the vital subject of Health. These learned men met together daily during the week in nine different sections, from ten to two o’clock. They were occupied with the subjects of Architecture, Engineering, Chemistry, the health of soldiers and sailors, the care of early childhood, the duty of the State in relation to the Health of the Nation, Health Statistics, Bacteriology, and the relations of Animal and Human Disease.

In the consideration of this wide range of subjects, valuable experience and much useful information were presented in the papers read and in the discussions that followed. But in a Congress not held together by any great guiding principle, where persons of various nationalities, moulded by different laws, methods of education, and social customs were represented, a great variety of opinion, of contradictory facts, of imperfect statistics and superficial theories, would necessarily be brought forward. Nevertheless, a remarkable concensus of opinion established one great result of experience—a result which may be considered the striking practical lesson of the Congress—viz., that it is to sanitation that we must look, not only for the prevention of disease, but largely also for its cure.

Supremacy of Hygiene.—Taking the results of sectional discussions as a whole, it was very generally shown that, by our increasing knowledge of hygienic law, its wide diffusion amongst the people, and its intelligent application to daily life, we can counteract the evil influence of heredity, get rid of epidemics, improve the stamina of the race, advance in longevity and in the natural enjoyment of our earthly span of life. Thus it is by the advance of sanitation that the Art of Healing can alone become a science of Medicine.

A few illustrations will show how this growing result of modern thought was both directly and indirectly supported by the papers and discussions of the various sections.

Thus Sir Charles Cameron, of Dublin, showed the beneficial change wrought by ten years’ sanitary effort in the Dublin slums through rebuilding, draining, cleaning, and free disinfecting. Those wretched quarters were a breeding-ground of human misery in 1871, where small-pox, typhoid fever, and all contagious diseases seemed to be endemic. The annual mortality was reduced in ten years by sanitary measures from 34·11 to 28·80 in the most crowded portions of this wretched quarter; in its less crowded part the mortality had fallen to a much lower figure, notwithstanding the intemperance and destitution which still continued to afflict the inhabitants. In this example it should be especially noted that the goodwill of the people was enlisted, for the municipality laid aside the idea of pecuniary gain on the sum expended in rebuilding, etc., and offered a better lodging at a rent that could be paid, and provided all sanitary appliances free, thus losing, in the sense of money profit, to gain in the far higher value—health.

Another remarkable illustration from very large experience was that given by Professor Smith, of Aldershot, who is at the head of the cavalry department of our army. He showed, by most interesting tables, that diseases formally rife amongst horses—glanders, farcy, canker of the foot, etc.—were now practically unknown in the army. This triumphant result was entirely due to careful hygiene, the utmost attention being paid to food, ventilation, drainage of stables, the care of the feet and shoeing, of saddles and harness, and reduction of the burden which the horses were required to carry, to fifteen stone as a fair average. As was justly remarked, there is a limit to the weight that a horse can carry or draw, beyond which is cruelty and injury.

Drs. Schrevens and Gibert, from France; Dr. Abbott, of Mass.; Dr. Pagett, of Salford; in discussing diphtheria and typhoid diseases from defective drainage, laid stress upon purity of air and cleanliness of the soil as the chief points for consideration. The same indispensable principle of sanitation was shown in respect to meat and milk used for food. In France 5 per 1,000 of animals used as food are tuberculous, such disease resulting from wrong methods of breeding, feeding, and managing these useful animals.

Professor Ralli showed how parasites could be conveyed from animals to men, and dwelt on clean bedding, coverings, suitable food, water, free exercise, as the necessary prophylaxis.

Dr. Hime, of Bradford, and Chauveau, of France, dwelt upon terrible diseases, such as the woolsorters’ disease, to which men are exposed who handle the skin, horns, etc., of animals—diseases which are entirely preventable if the manufacturers engaged in such trades would place the health of men above the profit to be gained by trade; thorough ventilation, disinfection, and other sanitary measures would entirely prevent the present reckless destruction of health. The same was true in the large industry of sorting rags imported from abroad, of match-making, etc.

It is a noteworthy fact that in the section of the Congress devoted to the relation of diseases of men and animals, which I especially attended, sanitary prophylaxis alone was dwelt upon as the condition of supreme importance. Inoculation was not advocated by any speaker, except the official representative of the French Pasteur Institute.[2]

Compliments were duly paid to M. Pasteur, whose skill and zeal in a false method of research may justly command intellectual recognition. But no one in any case advocated the theory of diffusing mild forms of disease for the purpose of preventing the severe type in the important and practical discussions which took place daily in relation to diseases common to man and the lower animals.

Thus a great principle of progress in the prevention of disease and in the attainment of a higher standard of health was directly or indirectly acknowledged by this varied body of men of trained intelligence and large experience—viz., the paramount importance of sanitary knowledge and practice.

Obedience to the conditions of healthy growth is the law of progress, from which there is no escape. It is the only way by which disease can be gradually eradicated. Every attempt at evasion inevitably brings its own retribution in various ways, swiftly or slowly, but surely.

All medical by-paths leading in a different direction from the conditions of healthy life, however tempting they may appear to active intellectual curiosity, or however desirable it may seem to find a short cut to health, necessarily lead to error if the supreme importance of sanitation be ignored.

Now, notwithstanding the large amount of valuable experience brought together in this International Congress, there was one serious omission in the otherwise wide and interesting plan of the Congress—an omission which had a direct practical bearing on the discussions carried on in the various sections. This vitiating lack was the failure to recognise the fundamental connection of mind and body in the phenomena of Life. There was no appointment of any special section which should give prominence to this subject, and thus strike the keynote capable of bringing all the sections into harmony.

This omission was the more noteworthy because a section was devoted to the theories of bacteriology, which, as will be seen, are directly opposed to the true science of Health.

Practical success in sanitation is impossible without the recognition of mind, both in the actual working of the organs of the living body and in the knowledge and acceptance by mankind of the conditions which are essential to health.

If the human constitution be governed by laws in obedience to which healthy growth is alone possible, then those laws must be carefully sought for before we can build up a science of hygiene. To regard living beings as simply material bodies, without the constant and varying influences of mental action upon the working of those bodies, is an intellectual error which disregards the essential condition of mental harmony in relation to health.

It must also be recognised that whatever may be the discoveries of physiological science, they will remain barren unless applied by individuals. In all the concerns of life, whether in the application of principles or in the unconscious formation of habits, we are compelled to deal with the ceaseless power or effect of Will. To treat even the most ignorant adults by arbitrary, unreasoning compulsion is a scientific blunder.[3]

The Two Problems of Hygiene.—The two fundamental questions for hygiene to solve are therefore: 1st. What are the conditions of healthy growth? 2nd. How can those conditions be secured?

In answering these two fundamental questions the problem of mental action enters into every hygienic section of a Congress, and is the keynote which must be struck if harmony of theory and practice is to be attained.

But in consequence of too narrow a view of hygiene these questions were not solved, and this remarkable assembly of learned men, brought together with such careful preparation and hospitable welcome, produced no practical results of the commanding value that the public had a right to expect from it.

Sanitary legislation was shown to be largely evaded, but the reasons for this unsatisfactory evasion were not examined; the results of experimental research were proved to be strangely contradictory, but the conditions which would harmonize them were not discovered; unproved theories abounded, but the fallacies that vitiated them were not made clear.

Disappointment as to the practical utility of the Congress was widely felt both at home and abroad.

This disappointment with the results of the Congress has been publicly expressed by our foreign guests. A clever abstract of the work done at this Seventh International Hygienic Congress has been published in Paris by the well-known editors of The Review of Hygienic and Sanitary Police. Some noteworthy statements are made in the introduction to this volume which should be seriously considered by all who reverence righteous sanitary science as the foundation of human welfare, but who also know that sanitary science must approve itself to the good sense of a people, or it will be of little practical utility.

Failure of English as well as Foreign Sanitation.—This high French authority declares that notwithstanding the efforts for sanitary improvement in which England has set an example for fifty years, the relative mortality of England has not diminished. It is stated: ‘The subject of the mortality of England, although not touched upon in the Congress, was the subject of most private conversation. The real figures of English mortality show a singular coincidence with the mortality of other European countries. It is shown that in none of these countries has the mortality diminished during the last fourteen or fifteen years, except when the birth-rate has diminished, and only in an exact proportion to this birth-rate.’ England has no better record to show in this respect than her Continental neighbours, notwithstanding the increasing demands of her specialists for extended legislative powers. Our French critics remark that ‘English hygienists of to-day are demanding great administrative centralization; their sanitary laws are rigorous to a degree that other countries would consider excessive; local self-government as well as individual liberty is less and less respected, and, from the statements of specialists interested in the subject, there is reason to believe that at no distant date every branch of public hygiene will be entirely administered by the Central Government.’

‘It is to be hoped’ (they remark) ‘that English good sense will learn how to avoid the abuse of centralization, for it is just as illogical to wait for the intervention of the Central Government in the sanitation of a parish or the prevention of a local epidemic as to refuse such intervention when public danger arises from negligence or stupidity.’

These observations of hygienists, coming from France, a country which we are accustomed to consider (and which in some respects really is) much more over-ridden by officialism than England, are extremely valuable. They serve to warn us of the grave danger of depending upon centralized legislation or arbitrary authority withdrawn from popular influence, and from that growth of individual enlightenment which arises through the sense of responsibility.

Our friendly foreign critics justly ask: How is it that England, first in the field of sanitary science, with a rigorous system of compulsory legislation, with administration, laws, regulations, agents, and also a gradual development of private hygiene, has still to deplore the unhealthiness of such a large number of towns, quarters, and habitations, and sees no diminution in her annual rate of mortality?

They advance towards the root of the matter when they observe in this same report that laws are one thing, their application quite another thing! ‘So true it is that public hygiene depends upon general education as well as on the education of specialists, that no laws or regulations will suffice when the habits of the people generally do not promote their application.’

In other words, mind as well as matter must be considered in the subject of sanitation.

The student of science who has learned the great principle of creative Unity knows that no manifestation of existence can be absolutely separated from the rest of creation. As we investigate phenomena it is seen that the laws governing separate phenomena become more comprehensive as knowledge increases, because more widely embracing separate facts; varieties are seen to be linked together by relationships, and apparently different phenomena can be transmuted into one greater force.

In the plan of an International Congress, designed to gather together the advanced knowledge of many nations on the whole science of health, the omission of any section which should bring into prominence this powerful fact in life—the influence of mind on body—is a very grave defect. It is an error which affects both the investigation of facts and the application of results, the two indispensable factors to the progress of sanitation. Their neglect in an International Congress on Health was the more unfortunate because mental influence is a fact which is forcing itself upon the attention of investigators with increasing urgency.

Increasing Importance of the Mental Problem.—Under the modern title of hypnotism facts of the most remarkable character are now acknowledged and studied. The cure of disease by suggestion, carefully and humanely applied, has been proved beyond the possibility of rational denial. The reality and practical effects of mental epidemics is a positive fact. The effect of fear in predisposing to cholera, hydrophobia, and other diseases cannot be denied.[4]

The contagion of religious enthusiasm or religious fanaticism are facts; whether the effects are seen in the devotion of the Salvation Army, or in pilgrimages to Lourdes or Trèves with their so-called miracles of faith-healing, they are equally facts requiring consideration. Wild business speculations in the craze for riches become contagious, and lure multitudes to ruin.

The history of past and present medical delusions is also most instructive. We need not go to the Sangrados of a past generation, who treated every disease by blood-letting, or the search for the elixir of life in illustration; the contagion of false hopes in relation to consumption, which upset the judgment of two hemispheres, cannot yet be forgotten. Thoughtful physicians possess abundant warning against being carried away by new theories which violate the moral sense or the Law of Unity, even when such theories are supported by distinguished names.

Experience proves the potent character of mental stimuli in moulding practical action. Fear or hope, curiosity, vanity, cupidity, when regardless of the Law of Unity, seize upon isolated phenomena removed from their natural connection, and distort them by creating morbid conditions, thus viewing facts out of proportion. Statistics thus formed become fallacious, and serve as the bases of dangerous theories—theories which, unless checked by popular common-sense from being put into practice, would cause the moral and physical degradation of the race. I need only refer to the folly of injustice embodied in certain medical acts lately abolished and to the present theory of inoculation, as noteworthy instances of dangerous mental delusion desiring to shape itself into action.

Materialism, which is blind to other than sensuous life, which insists upon reducing every phenomenon to the limits of the senses, which refuses to be enlightened by any higher reality, or sneers at the term ‘vitality,’ neglects a great range of positive facts, and has no right to the noble name of science. Reflection, therefore, shows that the moulding and guiding power of mental action in shaping physical results being a fact of the most far-reaching character and of permanent operation in sentient creation, its omission in a Congress of Health was a serious injury to the results of the Congress. It was a sufficient reason for that sterility of result which has been publicly and privately expressed.

The error of not recognising mental as well as physical forces, or the Law of Unity, in relation to health, and the tyranny that may result from such imperfect method in the study and application of sanitation and medicine, may be illustrated by an interesting incident of the Congress.

An important joint meeting of two sections took place in order to listen to the discourse of one of our ablest investigators—a man in high position, and one who wields a powerful influence on the rising generation of medical students. This gentleman early in his discourse made the following noteworthy announcement: ‘I claim the right of science to dictate’—and as if to strengthen this claim by the authority of our French brethren he added ‘conformément à la logique’—‘I claim the right of science to dictate in accordance with logic.’

The bold demand for absolute obedience thus authoritatively made by a professor at the head of biological research demands careful consideration. It is the announcement of a new priesthood or esoteric sect of physical science. In the mind of the speaker it means that his science is identical with truth. If that be admitted, it is the highest wisdom of the human being to obey gladly and unhesitatingly, and the teacher thus inspired with truth rightfully commands our grateful and profound reverence. But this claim may also mean the unconscious arrogance of a mind taking too narrow a view of science—a mind which, whilst earnest and laborious in investigating partial phenomena, is intoxicated by the discovery of new facts with the theories which can be built upon them, and at once announces himself as one of the priests of a new religion demanding absolute obedience; for the temptation of all priesthoods is to form an esoteric sect.

In this second case it is the bounden duty of every truthful mind to refuse obedience. For until the claim is fully examined in all its aspects, in both its physical and mental relations, and sustained by the deliberate and hearty assent of all intelligent minds and the instinctive accord of the people generally, this demand for absolute obedience to the theories of so-called science must be resolutely withstood as a reintroduction of mischievous and degrading superstition.

The special occasion which led to this unfortunate claim for dictation, or the compulsory regulation of disease by specialists, was the subject of tuberculosis and the exaggerated claim of the modern bacteriologist that the tubercle bacillus is the sole primary cause of consumption, with the logical claim that, as only the thoroughly-trained specialist can detect this bacillus, consumption should be scheduled as a contagious disease, and subjected to the rigorous regulations of the specialist and his board of advisers.

As our largest item in annual mortality is death from tuberculosis—about 14 per cent. with us—and as food and air may introduce a bacillus into the system, we can dimly imagine the extent to which the claim for dictation may grow in ‘accordance with logic.’

Many striking instances of crude official tyranny were revealed by our Canadian and other foreign delegates. Thus, railway passengers from Montreal to Ontario were compulsorily revaccinated on the train before being allowed to enter Ontario.[5] The foolish and fallacious system of attempting to regulate special vice was seen to prevail largely in the inexperienced civilizations of Canada and Western United States.

Scientific Inquisitors.—I will here quote a late statement of Professor Huxley’s, which might well be emblazoned in all our medical schools. He says: ‘We are at the beginning of our knowledge instead of at the end of it; the limitation of our faculties is such that we never can set bounds to the possibilities of nature. The verdict may be always more or less wrong, the best information being never complete, and the best reasoning liable to fallacy.

‘The greatest mistake those who are interested in free thought can make is to overlook these limitations and deck themselves with the dogmatic feathers which are the traditional adornments of opponents.’

This vigorous protest of our English naturalist against the dictation of so-called science is in striking accord with the observations of our French visitors in relation to the futility of compulsory legislation now urged by scientific specialists.

What is Science?—When the investigators in any limited branch of knowledge glibly use the term ‘science’ to compel assent or to enforce legislation, we are forced to ask, What is true science or certain knowledge grounded on demonstration, as distinguished from false science, which is uncertain knowledge, based upon varying and imperfectly observed phenomena or upon theory? Knowledge is of various kinds: Mental, Physical, Mathematical. These separate departments of knowledge rest equally on bases of fact. Love is as much a fact as bread-and-butter; justice is as potent in its effects as microbes; and from their wider range of action and more permanent duration these mental facts are far more real than the physical phenomena.

In determining the claim of science to obedience the great Law of Unity gives the guiding principle, which, however humbling to human arrogance, or however affirmative of the limitations of our intellect, the truly scientific mind is bound to accept.

The Law of Unity the Foundation of Science.—The Law of Unity teaches us that no explanation of any fact is final or ‘true’ if it contradicts other facts. It announces that no method of examining facts is reliable that destroys other facts equally patent, and that any results deducible from partial phenomena, however interesting or even apparently useful, can only be regarded from the point of view of true science as temporary expedients. They may possibly be recommendations for useful trial, but they can never be justified as subjects for dictation.

The confusion of thought which has brought the unnatural practices of inoculation into fashion may be usefully illustrated by dwelling on the mingling of truth and error which exists in relation to vaccination. Vaccination must not be confounded with inoculation, although the word ‘vaccination’ is now incorrectly used by bacteriologists to cover up the alarming practice of injecting the diluted virus of any particular disease, which is inoculation. Vaccination, on the other hand, is solely the injection of matter derived from a disease in the vacca, which disease is neither small-pox nor derived from small-pox, and vaccinia in a healthy cow is a mild disease.

During a lifetime of medical practice I have vaccinated children (sharing the widespread belief that it was preventive of small-pox). The practice, however, has always seemed to be an unsatisfactory method, which I hoped increased knowledge of sanitation would enable us to improve.

I also recognised the powerful influence of fear in predisposing to disease, and I regarded vaccination as a sedative for the family or community. My faith in the innocence of this practice was, however, rudely shaken by the lamentable death, in my own practice, of a scrofulous infant—a death clearly caused by the phagedenic ulceration produced by the vaccination. I also noted the accumulating evidence of very serious diseases communicated by so-called vaccine lymph.

Vaccination not Scientific.—But Professor Crookshank, in his exhaustive work lately published on vaccination, has conclusively proved the unscientific character of the evidence on which this practice is based, our ignorance of the sources of the virus commonly used and its mode of action, and also the uncertainty of its prophylactic power.[6] That the generally mild disorder of vaccination, although arbitrarily and even tyrannically enforced on every child born in our country, does not prove the prevention of small-pox which it is claimed to be, is shown by the recurrence of epidemics of small-pox amongst us, by the occurrence of the disease in vaccinated persons, and also by the demand now made by the French Academy of Medicine (which recognises the failure of our system of vaccination) for legislative powers to compel repeated revaccination. This demand for power of indefinite revaccination is a logical demand. For, proceeding on the assumed premiss that vaccination prevents small-pox, but being met by the inexorable fact that epidemics of small-pox do occur and spread amongst vaccinated people, the cause of this contradiction is assumed to be that the supposed preventive power of vaccination has been thrown out of the system, and must therefore be again renewed. Logically, therefore, not only the infant must be subjected, but the child, the adolescent, and the adult. All must be compulsorily revaccinated, as the human system undergoes a change at each of those periods of growth.

The history of the struggle against compulsion in vaccination is very interesting, as a strong condemnation of that arrogance of false science which presumes to trample on human rights whilst neglecting hygienic conditions. As all intelligent persons should be able to form a practical judgment on the important question at issue, I should like to dwell a moment on the subject of immunity, a fact (though now misapplied) on which compulsory vaccination is based.

Immunity.—Observation has long shown us that when the human system is gradually exposed to injurious influences, a certain tolerance of those influences may be acquired, which often enables those exposed to them to escape immediate death, although with impaired health, whilst healthy persons suddenly exposed to the same injurious influences die. This is a well-known fact, capable of abundant verification. Thus, persons long resident in a badly-drained house, although frequently ailing in various ways, may never be laid up with typhoid fever; a certain immunity has been obtained by the slow adaptation of the system to bad air, but at the sacrifice of vigorous health. But if a new and healthy family move into the same house a deadly outbreak of typhoid or diphtheria may at once result.

In the malarious districts of the United States a large scattered population of what are called by the negroes ‘mean whites’ continue to live, with clay-coloured faces, enlarged spleens, and impaired vitality, yet for a stranger to sleep in those regions is deadly. The strong tendency to live, which we call vitality, though it has enabled those born and brought up under injurious influences to struggle on through life, does not prove equal to resistance in many constitutions suddenly exposed to the injurious influences. The medical statistics of our army in India show that the newly-arrived is far more apt to suffer from enteric fever than one who has been long in the country.

‘The percentage of deaths from this cause is nearly fivefold greater in the first or second year of service than from the sixth to the tenth year. Medical officers are unable to trace out in any given instance a definite insanitary condition to which with certainty the outbreak can be attributed.’

There is, therefore, fact for theory to be built on—viz., the possible adaptation of the human constitution to injurious influences, an adaptation which, whilst impairing general vigour, often produces immunity from rapid death.

This fact, confirmed in the mind of the bacteriologist by the fallacious system of diseasing animals as ‘témoins’ or ‘controls,’ has given rise to the dangerous theory that all contagious diseases may be forestalled in their most deadly form by the inoculation of human beings with diluted virus produced by those diseases. This dangerous belief has been widely fostered by the unfortunate educational influence of the law of compulsory vaccination. But it must be observed that vaccination, unlike inoculation, does not introduce any products of the special disease—small-pox—into the system. The vaccine disease in the cow is not small-pox, nor can it ever be made to produce small-pox. The preservative power which is claimed for it, therefore, has not the dangers which are attached to inoculation, but neither can it claim the occasional immunity which may attend that dangerous practice of introducing small-pox virus into the blood. Pure air, cleanliness, and decent house-room secured to all our people, form the true prophylaxis of small-pox.

Exaggeration of Bacteriology.—We observe how neglect of the Law of Unity is misleading the intellect in relation to bacteriology. This subject, useful if pursued without cruelty and in subordination to higher facts, has become a mischievous exaggeration[7] both as to what it signifies and as to what it may lead to.

The majority of our active and intelligent medical investigators are now intensely engaged in the search for a microbe as the primary cause of every disease known to humanity. Cancer, leprosy, fevers, hydrophobia, diphtheria, tetanus, insanity, etc., are being largely studied by this imperfect method, in hope of finding a characteristic microbe which can be pronounced the essential cause of the disease. The great mental energy of biological investigators is diverted from sanitary investigation to the search for fresh bacilli. Admirable perseverance, acute ingenuity, unwearied energy are devoted to this search.

Advantage has been taken of the helplessness of the lower animals to carry on a system of experimentation upon them, the extent and ruthlessness of which has never before been attempted. Disease is studiously propagated. Myriads of healthy living creatures are filled with loathsome disease in order to furnish ‘material’ for experimentation. So many kilos of dog or rabbit (used for injecting disease, or noted as more or less slowly resisting the death thus gradually inflicted) is a common expression now used in experimentation, and supposed to give ‘scientific accuracy’ to experiments. It is a pitiful intellectual fallacy of short-sighted materialism that supposes it possible to obtain ‘scientific accuracy’ by regarding so many kilos of living dog as if they could be experimented on as so many kilos of dead matter, or as if they were the materials of a steam-engine, which can be taken apart, examined, cleaned, tested, and put together again in complete working order.

This diversion of intellectual ability from the true path of sanitation by an exaggerated search for bacilli leads directly to the dangerous practice of inoculation, which threatens the future deterioration of the human race. As one of the most distinguished of our hygienists, the late Dr. Benjamin Ward Richardson, has pronounced, ‘inoculation is bad sanitation.’[8]

Sanitary law teaches us that disease is produced by many causes, not solely by a specific microbe.

These causes are insanitary conditions, which impair or destroy the agents required by our human constitution for its healthy growth, and which act with varying force according to individual tendency. These insanitary conditions, in the course of their operation upon varying individual constitutions, produce various forms of disease, as chill may produce rheumatism, bronchitis, or diarrhœa, according to idiosyncrasy. These varying idiosyncrasies of individuals, both in their physical and mental aspects, as well as the varying action of vital force in different classes of animals, will always vitiate the theories of materialistic investigators. Thus the same poison will not destroy all classes of living creatures. A healthy young dog has been known to resist for months strenuous efforts made to disease him in a particular way. The same disease germs produce quite different forms of disturbance in men and in rabbits.

‘We possess no clue to the immunity of certain animals from poison. Rabbits fed on belladonna show no signs of injury, although their flesh becomes poisonous to those who eat it. Pigeons and other herbivora may be safe from what will cause paralysis and asphyxia in other animals. The meat of goats may similarly become poisonous.

‘Chickens, cats, birds, rodents, are variously affected by poisons, some thriving on what will kill other animals. The whole cat tribe is said to be always proof against morphia.’

Drs. Hahn and von Bergmann, in attempting to justify their cancer-grafting experiments on hospital patients, affirm that ‘it was necessary to select human beings for experiment, inasmuch as none of the lower animals would have been suitable for their purpose.’

Sanitary law teaches us that unhealthy conditions vitiate the living micro-organisms with which we are surrounded, and which, naturally beneficial, may become, through violation of natural law, morbid germs, capable of spreading their various forms of disease amongst persons predisposed to such disease. Thus, according to sanitary law, the violated health conditions (vitiating naturally innocuous particles) are the primary cause of disease; the morbid germ or bacillus is only the secondary cause.

The new bacteriological theory directly contradicts this important law of sanitary experience, and in opposition to it authoritatively announces that contagious or infectious disease can never be produced without the antecedent microbe. It was in defence of this untenable theory that the distinguished professor claimed the ‘right of science to dictate.’

The great mistake, therefore, made by the Hygienic Congress was the neglect of mind as an indispensable and prominent factor in Health, and the exaltation of bacteriology, with the theories based upon it, into the chief point of interest and importance.

The modern exaggeration of bacteriology, with its theory of inoculation, must be steadily opposed by all who realize the power and growing influence of spiritual life. The injurious results of this exaggeration may be summarized as follows:

The Practical Dangers arising from erroneous Scientific Method.—1. It diverts invaluable intellectual activity into methods of comparatively futile investigation. These investigations lead very widely to the exercise of fraud and cruelty upon the lower animals, and tend to reckless experiment on the poor. They waste much time and spread the contagion of intellectual error amongst the students of all our medical schools, where the false practices of experimentation are increasingly carried on. They also pervert the moral sense of the great army of assistants, caretakers, porters, nurses, and others connected with our medical institutions, who become aware of the cruel practices which so largely accompany this method of research.

2. This perversion of medical activity misleads our Parliamentary representatives, who are bewildered by pseudo-science authoritatively announcing itself as Truth, and permits a rapid increase of officialism to crush opposition and force the dicta of superficial ‘science’ upon the protesting conscience of intelligent people. It also misleads the community by fallacious articles in popular magazines, in which facts, theories, statistics, and assertions, often incorrect, are given with an imposing air of science, in relation to which the ordinary reader is quite unable to discriminate the true from the false.

3. The diversion of medical activity from the true path of Preventive Medicine not only hinders the progress of sanitation, but is producing an increasing revolt of common-sense and popular feeling against what are erroneously supposed to be the necessary methods of medicine and the practice of dispensary and hospital. This growing feeling in the community increases the dread with which the poor generally regard the hospital, and it also seriously diminishes the pecuniary support which the well-to-do would otherwise gladly extend to their sick and suffering fellow-creatures.

Conclusion.—In considering the foregoing record of facts it is seen to be a fundamental error, not only in a Hygienic Congress, but in all medical thought and practice, to look only at the body, and not consider those spiritual facts which precede, animate, and succeed the flesh. It is also certain that in the application of hygiene to daily life we may as well pour water into a sieve as hope to enforce permanently practical hygienic measures without enlisting the goodwill of the people in their observance.

As the solution of the two great problems of hygiene—viz., ‘What are the laws and conditions of healthy growth?’ and ‘How can these conditions be secured?’ rests upon principles of spiritual truth, those principles are of fundamental importance in directing human intelligence into right lines of investigation. Being compelled to use the imperfect symbolism of language, we speak of mind and matter, of spiritualism and materialism, as if they were separate or contradictory entities. But this is a limitation in the expression of thought to be recognised and carefully guarded against in thought itself. There can be no real contradiction between Religion and Science; they are only varying manifestations in human thought of Truth, which is essentially one. Our effort must be to unite these manifestations in thought, and thus gain the only safe guidance possible to us for practical action.

The great fundamental principle of our human constitution is incarnation—i.e., spirit shaping form—the Universal manifesting itself in the phenomenal. This principle is the foundation of sanitary science. It forms the basis of the Moral Law which must be the guide of science.

When this principle is understood and applied, it enlarges the intellect and enlightens the conscience. It transforms the narrow, self-centred or arrogant individual into the humble inquirer and sharer of the larger Diviner life.

This universalization of the individual resides essentially in the Will of man, and is the foundation of conscience—conscience which, gradually enlarged by the growing intellect, is the great guide of the human race in its struggle upwards.

This universalization of the primitive self-centred life leads to the realization of Sin. When we enter that Garden of Gethsemane where the woes of the world, the murders and seductions, the cruelties and hypocrisies, are revealed in all their hideousness, we realize that we are partakers in this Sin; for it is the result of that self-centred arrogance, that selfishness with which each one has to fight, and which is the essence of Sin. It is through this tremendous conviction that all must enter into that life of the Universal, where alone is true freedom, and where alone the fulness of individual life is to be found. Only by this saturation with the Universal does that hatred of Sin arise which makes sins henceforth impossible.

Then the recognition of Right and Wrong in human action becomes clear, and the supremacy of the Moral Law inevitable.

It is indispensable to refer to these deeper principles of existence in considering their varied application. They give force to those condensed maxims of practical wisdom which, transmitted to us from the experience of our forefathers, are guides for our present daily life.

‘Never do evil that good may come’ is a proverb so familiar to us in various forms that we fail to see the profound wisdom which it expresses.

It is a confession of that intellectual limitation which cannot foresee complicated results; it is an acceptance of that inflowing light of conscience (however dim) by which everyone must honestly walk; it is the subjection of the narrow, self-centred Will to the Universal Life by which the individual becomes a free co-worker with the Divine.

Physiology rightly studied in the light of this fundamental principle—incarnation—vindicates the supremacy of the Moral Law, which is the Law of Unity, or transfiguration of the Self. It gives the perception of Right and Wrong. The Law of the Universal, reverently and intelligently studied, will guide all practical action; it will show us how to build a hospital, plan a medical school, organize an institute of preventive medicine, legislate for a community, or guide the individual life.

The Law of Unity relegates bacteriology to its proper place as a branch of pathology, and proves that truth cannot be gained by searching into the quivering organs of tortured animals. It shows us also that individual health cannot be secured by building a Chinese wall around one’s self. We cannot stop the revolution of the earth in an atmosphere which may bring bacilli from inundated China, from starved Russia, from leprous India, or from the slums of the West.

We must work gradually towards the realization of our ideal—Health—and work in many directions and on many lines. Advancing sanitation will place our future hospitals in country neighbourhoods, with only temporary receiving houses and dispensaries in large towns.

‘The oldest hospitals were the temples of Esculapius, where Divine assistance was sought.’ To these Asclepeia, always erected on healthy sites, hard-by fresh springs and surrounded by shady groves, the sick and maimed resorted to seek the aid of the ‘god of Health.’ To this wisdom of the ancients we must certainly return when the present tendency to subordinate the welfare of the sick to the convenience of students be checked.

The most urgent need which now exists in our profession is the establishment of an Institute of Preventive Medicine guided by the Moral Law. Such an Institute will recognise that mind and matter meet in the fact called Life, will reverently study all the conditions and laws of healthy life, and not be diverted from this great aim by curious investigations into artificially propagated disease.

The study of the biological sciences, comparative and human physiology, morphology, histology, electro-chemical action, etc., is most important and necessary for the advancement of medical science; but these can be studied without any violation of the moral Law of Unity. It is necessary to study the forms and functions of life which are manifested in organisms lower than man. The laws which govern animal and vegetable growth form important steps towards our increasing knowledge of human physiology and sanitary law; but these can only yield true and available facts when studied through the natural and healthy working of the objects of study. The artificial production of mental or physical disease by fear and suffering vitiates the natural order of life, and leads to error in observation and induction from such observation. Torture is not only unsuited to laboratory work, but is an inevitable source of error in results. A laboratory or workroom should never be degraded into a torture-chamber. Experiment should never degenerate into curiosity or inhumanity.[9]

In the future a wise Institute of Preventive Medicine may possibly be placed in the healthy country. Around such an Institute for wise research a well-planned health colony could grow up, which would be of enormous utility to the overworked brains of our most valuable people. It would be a health centre where the weary brain could be refreshed and its vigour renewed by the restorative effects of manual labour. Guided by true science, it would teach our teachers and our legislators. Here they might learn to reverence those laws of health which are equally violated by overworked brains and overworked muscles. An Institute of Preventive Medicine genuinely ‘scientific’ would be the soul of such a health centre.

But such a colony can only be created when narrow selfhood has been transfigured by the universal life; for, as has been finely said: ‘True social integration will follow upon spiritual integration, and upon nothing else.’

Whilst working towards a fuller realization of our ideal we must respect and aid, as far as we can, those isolated efforts to deal with special transgressions of the Moral Law which are really steps onward in the growth of humanity. Separate efforts to advance temperance and purity, justice to women and children, to the poor and weak, to the humbler animals, our fellow-creatures, are all efforts to be heartily encouraged. Each effort forms a little step out of selfishness into large religious life. Although those who realize the Law of Unity cannot rest in any isolated work, yet it is by the honest fighting of sins that we grow into that hatred of Sin which will lead to its destruction; and by the slow perception of truths we gradually approach that ineffable Light of Truth which will melt away the chains of selfhood, and set us free in the larger liberty of the Universal Life.

FOOTNOTES:

[2] See Appendix, [p. 85].

[3] Dr. Hambleton calculates the pecuniary loss from waste of life in the army from preventable disease, chiefly of the lungs, as at least half a million a year—a waste of life which adds materially to the number of recruits required. Whilst stating the hygienic measures in relation to clothing, special exercises, air, and bathing, which have been shown to restore the inferior physique of recruits, he places as the crowning necessity ‘explaining to the men the effects of good and bad habits upon their health, so as to insure their co-operation.’

[4] Sir Walter Scott, a connoisseur in dogs, writing about popular belief in 1832, remarks: ‘The powers of this talisman have of late been chiefly restricted to the cure of persons bitten by mad dogs, and as the disease in such cases frequently arises from imagination, there can be no reason to doubt that water which has been poured on the Lee penny furnishes a congenial cure.’

[5] An English gentleman, Captain Frank Fairbanks, was detained for a fortnight in quarantine (says a Boston telegram) because he refused to be vaccinated. A younger brother of his had lost his life through vaccination.

[6] See Crookshank’s History and Pathology of Vaccination.

[7] Dr. Adametz states that ‘one gramme of Gruyère cheese contains 90,000 microbes; after seventy days they had increased to 800,000. A gramme of another kind of cheese contained about two million microbes, whilst a piece of the rind contained about five million!’

[8] This is virtually accepted by one of the foremost advocates of inoculation, who, acknowledging that preventive inoculation ought to be strictly limited, adds: ‘Inoculation is only a palliative measure, for the first object to be aimed at is the stamping out of infectious disease, and I cannot help thinking that the day will come when preventive inoculation will be a thing of the past.’

[9] The greatest injury which is now being done to medicine and the advancement of hygiene is the abuse of the word ‘research’ and the degradation of this noble exercise of human intellect by methods of application not suited to the subject of investigation.

APPENDIX (Page 56)
On the Humane Prevention of Rabies

In the course of a discussion on the subject of rabies, a suggestion was made that a resolution should be passed by the Section and sent to Government, recommending measures for the prevention of hydrophobia.

As two opposite methods of dealing with rabies had been ably supported by Professors Roux and Fleming, I called attention to the fact that nothing had been said in the discussion of the sufferings necessarily inflicted upon animals where the Pasteur method advocated by Professor Roux was adopted, and I stated that in a Pasteur Institute dogs were kept in a state of madness. I therefore recommended that Municipal and County Regulations, with their excellent results, as shown by Professor Fleming of London, and Professor Ostertag of Berlin, should be adopted rather than Pasteurian methods.

In illustration of the sufferings of dogs when made mad, I referred to my visit to the Rue Dutôt on June 2, 1889, where, after inspecting the Hall of rabbits, guinea-pigs, and pigeons used in experiments for rabies, anthrax, etc., I went to the cages of three dogs also used for experiments in rabies, who were in various stages of madness, one dying after its ten days’ agony; a second in the full fury of madness; a third in frantic terror clinging to the bars of his cage, imploring to be let out.

Professor Roux’s statement in opposition to my recommendation of the humaner methods of dealing with rabies seemed to infer that dogs were not rendered mad in a Pasteur Institute or in dealing with rabies. But when I stated to the Professor that I had myself seen this series of three dogs being made mad, he replied: ‘Oh, you might have seen a great many more, but they are not to inoculate people.’

Now, it is well known from experience that it is too dangerous to inoculate direct from the dog to the human being. But the fact that dogs are constantly made mad for experiment in the Pasteur Institute, or in any institute that adopts Pasteurian methods, should be honestly acknowledged, not evaded. The fact that this frightful disease of rabies is kept up for purposes of experiment, although the virus be transmitted in changed form through other animals for the inoculation of human beings, is in itself a grave fact, and it bears directly on the point which I dwelt on at the Congress—viz., that in choosing the method of protecting humanity from a rare but frightful disease, the method that does not involve sufferings to animals should be adopted by a Christian nation.

SCIENTIFIC METHOD IN BIOLOGY

CONTENTS

INTRODUCTION

A controversy is persistently carried on between an increasing body of the non-professional laity and an important section of the medical profession, in relation to the methods pursued in investigating biological phenomena.

The criticism of medical research by non-medical people is naturally resented by some who are engaged in experimentation, and it is stated seriously that non-scientific persons will impede progress if they interfere with or succeed in restricting the efforts of those who specially devote themselves to this branch of research.

This controversy is still going on in ever-widening circles, and it is bound to do so until the present confusion of thought which exists on this subject is removed, and the broad distinction between right and wrong experimentation is more fully acknowledged and more clearly defined. Our relation to the lower animals has never yet been brought fully into the clear light of reason and conscience. Yet in the order of Providential development it must so come forward.

As advancing humanity has gradually recognised natural rights as existing in the various races of mankind, and is carrying on a persistent warfare against human slavery, and slowly awakening to the moral crime of introducing disease and vice amongst native races, and the rights as well as duties of women and of children are being gradually recognised, so the time has come when the natural rights of inferior living creatures must be seriously studied.

This study has become obligatory, not only in regard to the welfare of the brute creation, but for the sake of our own human growth as rational and moral beings.

The common-sense of mankind recognises our right to use the lower animals for human benefit, whilst our superior intelligence gives us the power to so use them. But ‘can’ and ‘ought’ are different aspects of our mental constitution, which require to be harmonized. What we can do is not the true measure of what we ought to do in any department of life.

We can starve a child or lash a horse to death, but we have no right to do so.

The laws of our human constitution compel us to recognise that intellect and conscience, although essential parts, are not identical parts of our nature. Long experience shows us that social progress can only become permanent when conscience guides intelligence.

How far the guidance of conscience can extend, with the practical results to medical research involved in the recognition of such guidance, forms the subject of present consideration.

CHAPTER I
The Growth of Conscience

It is through the gradual and harmonious development of intelligence with that element in our nature that we name conscience that the human race passes from lower to higher states of civilization. In pursuing our ideals, conscience is our instinctive monitor of right and wrong.

Our great naturalist, Darwin, laid down as a law of evolution that ‘the moral sense, or conscience, is by far the most important of the differences between man and the lower animals. Duty—“ought”—is the most noble of all the attributes of man.’

Victor Hugo, with the prophetic insight of genius, calls conscience ‘that modicum of innate science with which each one is born.’

The growth of human conscience in its perception of justice and in its sympathetic relation to creation is the surest measure of individual and national progress. Various intellectual theories may be formed as to the origin and growth of conscience. It may be held to be intuitive, springing up as inevitably as the instinctive feelings born with the natural relations of life; or it may be looked upon as gradually evolved, the ‘result of countless experiences of fear, love, utility, transmitted through generations.’

But however originating, conscience is a positive and potent fact. It is, indeed, the mightiest factor in social life. It is the great controller of selfhood. It enlarges human character and guides human conduct. The deepening of this principle through the growth of justice and sympathy marks an advancement in the type of humanity. Increasing respect for life is one of the clearest signs of growing conscience. Our reverence for the principle of life grows with our enlarging intellectual perception of its universality and its unlimited power of development.

As life is marked by activity, and cannot remain stationary, so conscience shares this law of life. It must inevitably advance or retrograde.

The degradation as well as the development of conscience may be seen amongst us in the midst of our present civilization. It is contrary to the most rudimentary element of conscience to feed upon one’s kind, and cannibal tribes who devour their captives represent the lowest type of humanity; even the dogs of the Arctic voyager will endure the slow agony of starvation for days before their human taskmasters can compel them to eat the flesh of their companions. The well-known naturalist, Mr. W. H. Hudson, states that wolves, when pressed with hunger, will sometimes devour a fellow-wolf; as a rule, however, rapacious animals will starve to death rather than prey upon one of their own kind.

Yet shipwrecked sailors, even of our own English race, have been known to drink the blood and eat the flesh of their own comrades when confronted by starvation.

We find that intelligence may exist without conscience, but the human type changes to a destructive force when this separation takes place. A lamentable example of the social danger created by the destruction or absence of rudimentary conscience amongst us is shown by the betrayal and murder of the little boy Eccles in Liverpool, for the sake of his clothes, by his two companions of eight and nine years old. There was the deliberate plot to entice him to a pond; the throwing him three times into the water as he scrambled out; the final holding him under water until all struggle had ceased. These facts make a striking, but not unique, object-lesson, showing how intelligence may exist without conscience amongst all our appliances of civilization, and the danger of such separation.

Examples of the social devastation produced by official corruption and business dishonesty are too numerous to be detailed; they are seen in what are called civilized countries—in London, Paris, Rome, and across the ocean. The lack of conscience in public and private transactions creates social misery proportioned to its extent.

Recognising, therefore, that this distinctive principle of conscience is a fact of gradual development, that it grows by the union of the moral with the intellectual elements in our nature, and that the far-reaching consequences for good or evil of vivid or dulled conscience in the individual and the nation are far beyond our power of foresight, a grave responsibility rests upon us in this matter. We are bound to realize that any custom, or method of education, or proposed course of action, that seems to violate the natural instincts of humanity, or is contrary to the present enlightened conscience of any section of our Anglo-American race, demands imperatively the most careful consideration on our part.

CHAPTER II
Conscience in Medicine

Every intelligent member of the medical profession will certainly recognise the special value of human conscience in the profession.

The problems which are involved in the practice of the beneficent art, the absolute reliance which the anxious patient is compelled to place in his physician, the helplessness of the poor, who form so large a majority of those who need medical aid, and who are without the defences of wealth and station, show the need of keen moral sense, as well as intelligence, in those who practise the art of medicine.

The very discoveries of medical science enforce this necessity; for the possibility of abuse in the employment of such beneficent agents as anæsthetics and hypnotism, by incompetent or conscienceless operators, is a very serious fact.

This special responsibility of the medical profession to society is greatly increased by the fact that the training of a very large section of our intelligent youth during the important years of early manhood rests upon them. The moral as well as intellectual influence exerted by those who guide the college, the hospital, the dispensary, and post-graduate classes, will mould the future action of one of the most influential portions of the community—those, viz., on whom the health of the nation chiefly rests.

Now, whilst all recognise the need of the trained and skilful care of a nation’s health, and perceive also that rightly organized medical schools and hospitals are of great value in educating our health-guardians, how is it that a profound distrust of these institutions has grown up in our midst, that the support of hospitals becomes increasingly difficult, whilst at the same time the sentiment of benevolence and desire to help the poor is constantly extended?

How is it that the beneficent and necessary art of medicine no longer commands that respect and confidence which its essential character as part of our social institutions would seem to demand?

The answer to these serious questions involves both moral and intellectual considerations. These problems have arisen from failure to perceive that in education moral and intellectual activity cannot be advantageously divorced, or that one portion of our complex nature cannot be beneficially developed whilst other portions are entirely ignored or injured.

Our medical schools, whilst sharpening the intellectual faculties of their students, must be careful that their modes of teaching bring with them no deterioration of that important faculty of their students—the moral sense. As conscience or the moral sense is unequally developed in human beings, but is indispensable to the physician in his relations with patients, any apathy or negligence in this respect by the trainers of youth may become a national danger.

CHAPTER III
The Moral Element in Research

Morality as a guide in biological science is based upon the practical distinction between organic and inorganic Nature.

If medical progress simply involved the investigation of inorganic Nature, the general public would be only learners, gladly receiving such information in geology, chemistry, astronomy, or physics, as specialists in those branches of physical science were good enough to impart to the unlearned.

But directly scientific research passes beyond the distinctive realm of matter, moulded and transformed by general energy, but not affected by individual will, it has to deal with a very different principle—viz., life. This vital distinction has been well laid down by one of our eminent medical authorities as follows: ‘During the slow growth of medical knowledge it has become more and more plain that physics, chemistry, and biology are distinct sciences, with methods of their own and inductions of their own, each of the latter terms in the series using the results of its predecessors, and adding new results of its own. Although life is a structure built up of physical and chemical facts, yet to the building, to the arrangement, to the ordering of those facts, there goes something that neither physics nor chemistry can explain, any more than algebra can explain the behaviour of a magnet. To strive to interpret the series of events which make up the life of an animal in terms of chemical change (metabolism), or of conservation or expenditure of energy, is an endeavour which will fail.’

As the brute creation as well as human beings share in a physical organization which expresses each variety of life, there is not the same sharply-dividing line between the various categories of animal life as there is between organic and inorganic Nature. Biogenesis, or life generated by life, is the distinctive feature of organic Nature. We are linked to living creatures of higher or lower nature by the power of educating or subduing them, and by all those varying relations involved in the mystery of life.

The distinctive position of man, as an animal placed at the head of the animal world, necessarily creates serious responsibility on the part of the higher towards the lower creature.