Medicine – British Medicine in Greater Britain Part 3

Turning now to the second period, we may remark in passing that the nineteenth century did not open very auspiciously for British medicine. Hunter had left no successor, and powerful as had been his influence it was too weak to stem the tide of abstract speculation, with which Cullen, Brown, and others flooded the profession. No more sterile period exists than the early decades of this century. Willan (a great naturalist in skin diseases) with a few others saved it from utter oblivion. The methods of Hippocrates, of Sydenham, and of Hunter had not yet been made available in everyday work.

The awakening came in France, and such an awakening! It can be compared with nothing but the renaissance in the sixteenth and seventeenth centuries, which gave us Vesalius and Harvey. “Citizen” Bichat and Broussais led the way, but Laennec really created clinical medicine as we know it to-day. The discovery of auscultation was only an incident, of vast moment it is true, in a systematic study of the correlation of symptoms with anatomical changes. Louis, Andral, and Chomel, extended the reputation of the French school which was maintained to the full until the sixth decade, when the brilliant Trousseau ended for a time a long line of Paris teachers, whose audience had been world-wide. The revival of medicine in Great Britain was directly due to the French. Bright and Addison, Graves and Stokes, Forbes and Marshall Hall, Latham and Bennett were profoundly affected by the new movement. In the United States Anglican influence did not wane until after 1820. Translations of the works of Bichat appeared as early as 1802, and there were reprints in subsequent years, but it was not until 1823 that the first translation (a reprint of Forbes’ edition) of Laennec was issued. Broussais’ works became very popular in translations after 1830, and in the journals from this time on the change of allegiance became very evident. But men rather than books diverted the trend of professional thought. After 1825, American students no longer went to Edinburgh and London, but to Paris, and we can say that between 1830 and 1860, every teacher and writer of note passed under the Gallic yoke. The translations of Louis’ works and the extraordinary success of his American pupils, a band of the ablest young men the country had ever seen, added force to the movement. And yet this was a period in which American medical literature was made up largely of pirated English books, and the systems, encyclopedias, and libraries, chiefly reprints, testify to the zeal of the publishers. Stokes, Graves, Watson, Todd, Bennett, and Williams, furnished Anglican pap to the sucklings, as well as strong meat to the full grown. In spite of the powerful French influence the text books of the schools were almost exclusively English.

In Canada the period from 1820 to 1860 saw the establishment of the English universities and medical schools. In Montreal the agencies at work were wholly Scotch. The McGill Medical School was organized by Scotchmen, and from its inception has followed closely Edinburgh methods. The Paris influence, less personal, was exerted chiefly through English and Scotch channels. The Upper Canada schools were organized by men with English affiliations, and the traditions of Guy’s, St. Bartholomew’s, St. Thomas’s, St. George’s, and of the London Hospital, rather than those of Edinburgh, have prevailed in Toronto and Kingston.

The local French influence on British medicine in Canada has been very slight. In the early decades of the century, when the cities were smaller, and the intercourse between the French and English somewhat closer, the reciprocal action was more marked. At that period English methods became somewhat the vogue among the French; several very prominent French Canadians were Edinburgh graduates. Attempts were made in the medical journals to have communications in both languages, but the fusion of the two sections of the profession was no more feasible than the fusion of the two nationalities, and the development has progressed along separate lines.

The third period dates from about 1860 when the influence of German medicine began to be felt. The rise of the Vienna school was for a long time the only visible result in Germany of the French renaissance. Skoda, the German Laennec and Rokitansky, the German Morgagni, influenced English and American thought between 1840 and 1860, but it was not until after the last date that Teutonic medicine began to be felt as a vitalizing power, chiefly through the energy of Virchow. After the translation of the Cellular Pathology by Chance (1860) the way lay clear and open to every young student who desired inspiration. There had been great men in Berlin before Virchow, but he made the town on the Spree a Mecca for the faithful of all lands. From this period we can date the rise of German influence on the profession of this continent. It came partly through the study of pathological histology, under the stimulus given by Virchow, and partly through the development of the specialties, particularly diseases of the eye, of the skin and of the larynx. The singularly attractive courses of Hebra, the organization on a large scale in Vienna of a system of graduate teaching designed especially for foreigners and the remarkable expansion of the German laboratories combined to divert the stream of students from France. The change of allegiance was a deserved tribute to the splendid organization of the German universities, to the untiring zeal and energy of their professors and to their single-minded devotion to science for its own sake.

In certain aspects the Australasian Settlements present the most interesting problems of Greater Britain. More homogeneous, thoroughly British, isolated, distant, they must work out their destiny with a less stringent environment, than, for example, surrounds the English in Canada. The traditions are more uniform and of whatever character have filtered through British channels. The professional population of native-trained men is as yet small, and the proportion of graduates and licentiates from the English, Scotch and Irish colleges and boards guarantees a dominance of Old Country ideas. What the maturity will show cannot be predicted, but the vigorous infancy is full of crescent promise. On looking over the files of Australian and New Zealand journals, one is impressed with the monotonous similarity of the diseases in the antipodes to those of Great Britain and of this continent. Except in the matter of parasitic affections and snake-bites, the nosology presents few distinctive qualities. The proceedings of the four Intercolonial Congresses indicate a high level of professional thought. In two points Australia has not progressed as other parts of Greater Britain. The satisfactory regulation of practice, so early settled in Canada, has been beset with many difficulties. Both in the United States and in Australia the absence of the military element, which was so strong in Canada, may in part at least account for the great difference which has prevailed in this matter of the state licence. The other relates to the question of ethics, to which one really does not care to refer, were it not absolutely forced upon the attention in reading the journals. Else-where professional squabbles, always so unseemly and distressing, are happily becoming very rare, and in Great Britain, and on this side of the water, we try at any rate “to wash our dirty linen at home.” In the large Australian cities, differences and dissensions seem lamentably common. Surely they must be fomented by the atrocious system of elections to the hospitals, which plunges the entire profession every third or fourth year into the throes of a contest, in which the candidates have to solicit the suffrages of from 2,000 to 4,000 voters! Well, indeed, might Dr. Batchelor, say, in his address at the fourth Intercolonial Congress: “It is a scandal that in any British community, much less in a community which takes pride in a progressive spirit, such a pernicious system should survive for an hour.”

Of India, of “Vishnu-land,” what can one say in a few minutes? Three thoughts at once claim recognition. Here in the dim dawn of history, with the great Aryan people, was the intellectual cradle of the world. To the Hindoos we owe a debt which we can at any rate acknowledge; and even in medicine, many of our traditions and practices may be traced to them, as may be gathered from that most interesting History of Aryan Medical Science, by the Thakore Saheb of Gondal.

Quickly there arises the memory of the men who have done so much for British medicine in that great empire. Far from their homes, far from congenial surroundings, and far from the stimulus of scientific influences, Annesley, Ballingall, Twining, Morehead, Waring, Parkes, Cunning-ham, Lewis, Vandyke Carter, and many others, have upheld the traditions of Harvey and of Sydenham. On the great epidemic diseases how impoverished would our literature be in the absence of their contributions! But then there comes the thought of “the petty done, the undone vast,” when one considers the remarkable opportunities for study which India has presented. Where else in the world is there such a field for observation in cholera, leprosy, dysentery, the plague, typhoid fever, malaria, and in a host of other less important maladies. And what has the British Government done towards the scientific investigation of the diseases of India? Until recently little or nothing, and the proposal to found an institute for the scientific study of disease has actually come from the native chiefs! The work of Dr. Hankin and of Professor Haffkine, and the not unmixed evil of the brisk epidemic of plague in Bombay, may arouse the officials to a consciousness of their short-comings. While sanitary progress has been great as shown in a reduction of the mortality from sixty-nine per mille before 18,57 to fifteen per mille at present, many problems are still urgent, as may be gathered from reading Dr. Harvey’s Presidental address and the proceedings of the Indian Medical congress. That typhoid fever can be called the “scourge of India,” and that the incidence of the disease should remain so high among the troops point to serious sanitary defects as yet unremedied. As to the prevalence of veneral disease among the soldiers—an admission of nearly 500 per mille tells its own tale.

On reading the journals and discussions one gets the impression that matters are not as they should be in India. There seems to be an absence of proper standards of authority. Had there been in each presidency during the past twenty years thoroughly equipped government laboratories in charge of able men, well trained in modern methods,the contributions to our knowledge of epidemic diseases might have been epoch-making, and at any rate we should have been spared the crudeness which is evident in the work (particularly in that upon malaria) of some zealous but badly trained men.

In estimating the progress of medicine in the countries comprising Greater Britain, the future rather than the present should be in our minds. The strides which have been taken during the past twenty years are a strong warrant that we have entered upon a period of exceptional development. When I see what has been accomplished in this city in the short space of time since I left, I can scarcely credit my eyes: the reality exceeds the utmost desire of my dreams. The awakening of the profession in the United States to a consciousness of its responsibilities and opportunities has caused unparalleled changes, which have given an impetus to medical education and to higher lines of medical work which has already borne a rich harvest. Within two hundred years who can say where the intellectual centre of the Anglo-Saxon race will be? The Mother Country herself has only become an intellectual nation of the first rank within a period altogether too short to justify a prediction that she has reached the zenith. She will probably reverse the history of Hellas, in which the mental superiority was at first with the colonies. At the end of the twentieth century, ardent old-world students may come to this side “as o’er a brook,” seeking inspiration from great masters, perhaps in this very city; or the current may turn towards the schools of the great nations of the south. Under new and previously unknown conditions, the Africander, the Australian, or the New Zealander may reach a development before which even “the glory that was Greece” may pale. Visionary as this may appear, it is not one whit more improbable today than would have been a prophecy made in 1797 that such a gathering as the present would be possible within a century on the banks of the St. Lawrence.

Meanwhile, to the throbbing vitality of modern medicine the two great meetings held this month, in lands so widely distant, bear eloquent testimony. Free, cosmopolitan, no longer hampered by the dogmas of schools, we may feel a just pride in a profession almost totally emancipated from the bondage of error and prejudice. Distinctions of race, nationality, colour, and creed are unknown within the portals of the temple of Esculapius. Dare we dream that this harmony and cohesion so rapidly developing in medicine, obliterating the strongest lines of division, knowing no tie of loyalty, but loyalty to truth—dare we hope, I say, that in the wider range of human affairs a similar solidarity may ultimately be reached? Who can say that the forges of Time will weld no links between man and man stronger than those of religion or of country? Some Son of Beor, touched with prophetic vision, piercing the clouds which now veil the eternal sunshine of the mountain top—some spectator of all time and all existence (to use Plato’s expression)—might see in this gathering of men of one blood and one tongue a gleam of hope for the future, of hope at least that the great race so dominant on the earth to-day may progress in the bonds of peace—a faint glimmer perhaps of the larger hope of humanity, of that day when “the common sense of most shall hold a fretful ‘world’ in awe.” There remains for us, Greater Britons of whatsoever land, the bounden duty to cherish the best traditions of our fathers, and particularly of the men who gave to British medicine its most distinctive features, of the men, too, who found for us the light and liberty of Greek thought Linacre, Harvey and Sydenham, those ancient founts of inspiration and models for all time in Literature, Science and Practice.