i 
 
^mmll ^nivmii^ Jihai^g 
 
 THE GIFT OF 
 
 uAl (2fcW.4!-iii-Cai.... tRM^tior.. 
 
 L-^4-lAl - -- ^^k\j^p. 
 
arW9811 '^°"''" """"""v '^'"^'T 
 ^?iiii?i»PiiSi'SS'iIlf.'?J!l '° ' philosophy of medic 
 
 3 1924 031 430 683 
 ■ anx 
 
Cornell University 
 Library 
 
 The original of tiiis book is in 
 the Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/cletails/cu31924031430683 
 
SOME PROLEGOMENA 
 
 TO A 
 
 PHILOSOPHY OF MEDICINE. 
 
SOME PROLEGOMEIS^A 
 
 TO A 
 
 PHILOSOPHY OF MEDICINE 
 
 BY 
 
 GILES F. GOLDSBROUGH, M.D. 
 
 President of the British Homcsopathic Society, 
 Assistant Physician to the London Hommopathic Hospital 
 
 JOHN . BALE & SONS 
 
 OXFOED HOUSE 
 85-89, GREAT TITCHPIELD STREET, OXFORD STREET, W. 
 
 1896 
 Three Shillings and Sixpence, nett 
 
PEEFACE. 
 
 The substance of the chapters constituting the present essay 
 was delivered before the British Homoeopathic Society as the 
 presidential address for the session commencing in October 
 last, and the essay is published in its present form by permission 
 of the Council of the Society. 
 
 The occasion of the commencement of the present session 
 was somewhat unusual, as the meeting of the Society took place, 
 for the first time, in the new London Homceopathie Hospital, 
 in Great Ormond Street ; and hitherto it had been the custom 
 for the President to give his annual address at the end of the 
 session, instead of at the beginning. For these reasons, in 
 addition to the main consideration stated in the introductory 
 chapter, the author deemed the occasion most opportune for 
 introducing the philosophical aspect of medicine given in this 
 essay, which had been occupying his mind, in greater or less 
 degree, for some years. 
 
 The author desires most sincerely to thank Dr. Hughes,. 
 Editor of the Joii/rnal of the British Homceopathie Society, for 
 his kindness in revising the proof sheets, prior to the publica- 
 tion of the address in the Journal. 
 
 March, 1896. 
 
CONTENTS. 
 
 OHAPTEK I. 
 
 PAGE 
 
 Introduction . . . . . . . . . . . . 1 
 
 CHAPTER II. 
 Need and Conditions op Philosophy in Medicine .. .. 6 
 
 § 1. — Three- fold view of success. § 2.— Illustration. § 3. — Success 
 dependent on philosopMcal habit of mind. § 4 Relationship of medi- 
 cal knowledge to other knowledge. § 5. — Wideness of a philosophy 
 of medicine. § 6. — Scientific and philosophical methods compared. 
 § 7. — The physician's mission. § 8. — Individual observation and 
 practice. § 9. — Philosophy of medicine a constructive process. 
 § 10. — Positive science and common sense. § 11. — " States of 
 health." § 12. — Life and not-life. § 13. — Unity of life {conscious- 
 ness and knowledge). § 14. — Test of theory. § 15. — Self-evident 
 conclusions. § 16. — " What is life ? " § 17. — Herbert Spencer's 
 theory. § 18. — Protoplasmic theory. § 19. — Final test question. 
 
 CHAPTER III. 
 
 A Bio-Dynamic Law . . . . . . . . . . . . 24 
 
 § 1. — Requirements of a bio-dynamic law. § 2. — Rest and activity 
 of conscious thought. § 3; — " Rest." § 4.— Definition of the theory of 
 life. § 5.— Explanation of terms used. § 6. — A re-statement of the 
 theory. §7. — niustrations : Movement of Protoplasm. §8. — Physio- 
 logy of the cell. § 9. — Embryology. § 10. — General physiology. 
 § 11.— Psychology. 
 
 CHAPTER IV. 
 Inpebbnces prom the Bio-dynamic Law . . . . . . 45 
 
 § 1. Health defined. § 2. — The law of life and disease. § 3. — 
 
 External and internal conditions. § 4. — Clinical Mstory— morbid 
 anatomy— pathology. § 5.— Diagnosis of disease. § 6.— Natural 
 classification of disease. § 7.— Recovery from disease. § 8.— Prog- 
 nosis of disease. § 9.— Treatment of disease. § 10. — Explanatory 
 value of the law of life. § 11.— Bacteriology and the law of life. 
 
 § 12. Pharmacology (pharmacodynamics and drug pathogenesy). 
 
 s 13. Therapeutics and disease. Inductions of Hahnemann. Other 
 
 inferences. 
 
SOME PROLEGOMENA TO A PHILOSOPHY 
 OF MEDICINE. 
 
 CHAPTEE I. 
 
 Introduction. 
 
 The question often crosses the mind of the con- 
 vinced homoeopathist, why the majority of the profession 
 refuse medical reform in the direction of an avowed and 
 general adoption of the homoeopathic rule or method. The 
 medical mind is open to advances in knowledge in all other 
 branches, which are the foundations of practice — medical or 
 surgical. Even pharmacology, although with little general- 
 ised system, has found a place among the sciences of medi- 
 cine. But, when the schools arrive at therapeutics, there is 
 a steady, point-blank refusal even to inquire into a method, 
 which is really simple when once conceived, practically uni- 
 versal as far as the uses of drugs are concerned, and verified 
 by the experience of a large body of medical men throughout 
 the world. 
 
 What is the fundamental reason of this attitude — apart, 
 I mean, from wilful ignorance or misrepresentation? I 
 cannot believe that men who have open minds to the new 
 facts of other sciences, can simply be blindly led by bigotry 
 or partisanship when they come to consider a branch of 
 knowledge most nearly concerning their success as prac- 
 titioners, and their reputation as honest, open-minded 
 observers and seekers after truth. 
 
 1 
 
2 SOME PHOLBGOMENA TO A PHILOSOPHY OP MEDICINE. 
 
 The reason lies, as it seems to me, in the fact that as far 
 as the current knowledge of physiology and pathology goes 
 (and therapeutics are rationally based on these sciences), the 
 homoeopathic method or rule is ultra-rational, or ultra- 
 scienjiific. What are the facts on both sides ? Take those 
 first of physiology and pathology. The object of physi- 
 ology is stated by Landois and Sterling^ to be the establish- 
 ment of the phenomena of organisms, to determine their 
 regularity and causes, and to refer them to the general 
 fundamental laws of Natural Science, viz., the laws of 
 physics and of chemistry. 
 
 And again, the whole series of phenomena of physiology 
 considered as a sign of life, and termed metabolism, consist 
 in the introduction, assimilation, integration, and excretion 
 of matter. 
 
 With regard to pathology. Sir James Paget says, in 
 Quain's "Dictionary of Medicine": "It is the name gener- 
 ally given to the science of disease, but the subjects which 
 it may include cannot be exactly defined. For ease and dis- 
 ease, well and ill, and all their synonyms, are relative terms 
 of which none can be defined unconditionally," and in a later 
 paragraph, " Pathology finds in physiology its basis, the 
 varying standards of healthy structure and functions with 
 which its subject matters are in contrast, and the models and 
 methods of its study ; but its range is wider than that of physi- 
 ology, inasmuch as the conditions giving rise to disease are 
 much more numerous and more various than those of health." 
 With regard to rational therapeutics. Dr. Lauder Brunton, 
 in the same work, says, "that depending on experimental 
 physiology and pharmacology, the practitioner may hope to 
 recognise, from the symptoms of the patient, the organ 
 affected by disease, the nature of the disturbance in its func- 
 tion, and to apply, with some degree of success, a remedy 
 which will counteract such disturbance." Now it will be 
 readily agreed that neither in physiology nor pathology, 
 have we anything approaching simphcity of aim, or method, 
 or result. In therapeutics, matters are still more confused. 
 
 ' " Text-book of Physiology," vol. i., Introduction. 
 
SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 3 
 
 The conditions on which the single result desired, the cure 
 of disease, depends, are known to be so complicated, that 
 though based on facts from all the natural sciences, unco- 
 ordinated and unarranged, it is deemed rational to apply 
 the bare notion of physical force, to bring about that result. 
 Reason, we may well exclaim, but it requires an adjective to 
 qualify it, the reason of blind force, it is true, but not of 
 science either exact or even natural. 
 
 But turn to a similar line of facts relating to homoeopathy. 
 The ground-work of homoeopathy is unquestionably the 
 science of pharmacology or drug pathogenesy, as our classical 
 work on the subject has it.^ The methods of this science are 
 those of experimental physiology, carried, in theory at least, 
 to the finest degree in the human subject, with side-lights 
 from experiments on animals. 
 
 In the application of the method of homoeopathy, the facts 
 of disease, in their simultaneity and succession and inter- 
 dependence, are the only reliable phenomena which have to 
 be dealt with as disease, and the rule of application between 
 these phenomena and those of drug pathogenesy is the 
 authority of a similar relationship. The authority of a 
 similar relationship ! What is that authority ? Here we 
 have the crux of the question. Two recent writers opposed 
 to each other agree that the method does not " explain itself, 
 and never can." Still, the grounds for the adoption of 
 homoeopathy are good, and by a long way higher than the 
 roughly rational quasi-scientific methods of the predomi- 
 nant school. For the past hundred years, in the hands of 
 observers equally competent to any in any field of science, 
 in the phenomena of drug pathogenesy, and in the results 
 of the treatment of disease by homoeopathy, we have had, in 
 process of collection, the concrete phenomena for the forma- 
 tion of a science of therapeutics, but the law which connects 
 them has not as yet been defined. 
 
 Many analogies in the history of disease and its natural 
 recovery, suggest that there is such a law, some among them 
 having been brought forward by Dr. Madden in his presi- 
 dential address at the recent Homoeopathic Congress at 
 
 ' " Cyclopaedia of Drug Pathogenesy." Edited by E. Hughes and J. P. Dake. 
 
4 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 Leeds.^ A number of explanations have been offered, as you 
 know, which are suggestive, but by no means conclusive, but 
 we have no law to explain the operation of the simillimum, in 
 the sense that gravitation is law, or in the sense of Ohm'& 
 law of electricity, or Bell's law of the sensory and motor 
 functions of the roots of spinal nerves. The advocates of 
 homoeopathy, however, by the parallelism they draw between 
 drug effects and disease, and by the universality of the 
 application of one to the other they endeavour to establish, 
 assert in effect, that the rule of similars must be based on a- 
 law of equal universality, if only such a law could be per- 
 ceived, defined, and established in the mind. 
 
 Now this philosophical position of homoeopathy places it 
 higher in the scale of thought than the current philosophical 
 bases of physiology, pathology, and therapeutics. As far 
 as average science is concerned, homoeopathy is therefore 
 ultra-rational — it is beyond science. In the minds pi those 
 who are convinced of the practical value of the rule of simi- 
 lars in the treatment of disease, its scientific truth remains 
 as a conviction, a belief, a faith, and there remains yet 
 the necessity of formulating the basis of this conviction in 
 philosophical relationship with other departments of medical 
 knowledge. 
 
 What relationship, then, do the supporters of homoeopathy 
 bear to the dominant school ? In view of the responsibility 
 which attaches to the medical community in the treatment 
 of disease, the relationship between the two spheres of 
 thought is plainly ethical. Not the common ethical basis of 
 professional etiquette. Far higher than that. On the one 
 side, physiologists and pathologists, who are, at the same 
 time, practitioners of medicine, ought not to close their eyes 
 to the facts of experience, or the claims of a method which 
 results in those facts, even though no explanation is forth- 
 coming, and the facts run counter to received opinion or 
 reason so far developed. And, on the other hand, men who 
 have become convinced of the practical utility of the homoeo- 
 pathic rule ought to set forth their experience clearly and 
 scientifically, in accordance with received and known con- 
 
 ' Homoeopathic Review, October. 189.'5. 
 
SOME PEOLEGOMBNA TO A PHILOSOPHY OP MEDICINE. O 
 
 elusions in physiology and pathology, and to spare no pains 
 to discover, if possible, the law or laws on which the issue 
 of those facts depends. This philosophical aspect of 
 homoeopathy is the main consideration, why I have 
 chosen to address you on the subject of the philosophy of 
 medicine this evening, and to give you the views which form 
 the chief part of the following address. But before I do give 
 you those views I should like to make a personal explanation 
 respecting them. 
 
 These views did not arise in my mind, while endeavour- 
 ing to find a scientific or rational explanation for the rule of 
 similars, but while giving close consideration to another 
 branch of philosophy. I make this explanation so that with- 
 out " special pleading " I may emphasise^ the fact that I 
 believe homoeopathy may fall naturally into its place in a 
 general philosophy of life and mind. 
 
 In the preparation of this address I have to gratefully 
 acknowledge my indebtedness to a number of authors and 
 works. For the scientific part, I have relied mainly on 
 Quain's " Anatomy," the latest edition, edited by Professors 
 Schafer and G. D. Thane ; Landois and Sterling's " Text- 
 book of Physiology"; Quain's " Dictionary of Medicine"; 
 and a little " Manual of Bacteriology," by Professor Klein. 
 I must add to these the works of Hahnemann as translated 
 by Dudgeon, and the writings of Hughes, Carroll Dunham, 
 Drysdale, Hayward, H. E. Madden, and others. In 
 philosophy, including psychology, I have taken much from 
 the works of Bain and Spencer and William James. " The 
 Protoplasmic Theory of Life," by the late Dr. Drysdale, has 
 been a great help to me, as also, in philosophical purpose and 
 method, a presidential address by Mr. Shadworth Hodg- 
 son, entitled, "Philosophy and Experience";^ and various 
 articles which, from time to time, have appeared in Mind. 
 
 ' Williams and Norgate, 1885. 
 
CHAPTEE II. 
 
 Need and Conditions of Philosophy in Medicine.^ 
 
 § 1. The attainment of success is uppermost in the 
 mind of every medical man. Success is what every man 
 hopes for, and it is the only goal he can be satisfied v^ith as 
 a result of his study, his knowledge, and his practice. But 
 the word must not have given to it a narrow or restricted 
 meaning. Success does not include merely personal success. 
 Such is the place medical men occupy in the social organism^ 
 that it is the welfare of the community they are bound to 
 consider before their own. Although personal success does 
 not fall out of consideration, it occupies distinctly a second 
 place. It is wrapped up in the welfare or success of suffering 
 humanity ; or, we might say, it is on the relief of suffering 
 humanity that medical success depends. 
 
 There is another aspect of success which must not be 
 overlooked. As personal success depends on the welfare of 
 the community, whom it is the duty of the medical man to 
 serve, so does it also depend on the combined success of the 
 whole profession. What is success for one man to-day, will 
 be, by imitation, success for all to-morrow. What is success 
 for the whole profession to-day, may be success for the 
 single man to-morrow. 
 
 § 2. This three-fold view of success may be illustrated 
 by a reference to the possible experience of surgeons in the 
 development of a major operation ; taking ovariotomy for an 
 example. In order to make the operation of ovariotomy a 
 success the whole mind and interest of the surgeon are, for 
 the time, intent upon the preparations, the instruments, and 
 
 ' About half the paragraphs in thia and the next section were omitted in 
 
 delivery. 
 
SOME PBOLEGOMBNA TO A PHILOSOPHY OP MEDICINE. i 
 
 the manipulations required for its performance. On these, 
 all combined, the condition of the patient being considered 
 suitable, the successful result of the operation depends. The 
 operation is performed ; and is successful if the patient sur- 
 vives its actual performance. This is a personal success for 
 the surgeon so far ; and such success is not detracted from 
 by the fact of the death of the patient after the operation, 
 from any cause not directly ensuing from the fact of its per- 
 formance. But if all patients died after the performance of 
 that operation, even though every attention had been paid to 
 ensure its successful performance, and the patients had sur- 
 vived the performance, the surgeon would not consider he 
 had attained success in that operation, and he would seek for 
 an explanation of the reason why. But supposing the ex- 
 perience of the particular surgeon was but the experience of 
 all surgeons (which was, in fact, the case with ovariotomy 
 before the introduction of antiseptics), the success of the one 
 man would not be such a serious consideration to him 
 personally, except in so far that in his own success was 
 implied the success of the whole profession ; and that the 
 success of the whole profession would become one con- 
 dition of the success of the single man. 
 
 § 3. The illustration here used serves to point out the 
 place of philosophy in medicine, ancl to suggest that the 
 success of every man depends on his exercising a philo- 
 sophical habit of mind. It was impossible that an operation 
 like ovariotomy, which had aroused the keenest interest 
 among surgeons, and which had in it all the elements of 
 successful performance, could be allowed to drop. What 
 was the process which raised it to its present position as 
 not only a justifiable operation, but as a triumphant, success 
 to the community, to the profession, and to the individual 
 surgeon ? 
 
 This success depended in the first instance on the ex- 
 planations of failure. The philosophy of the subject was 
 brought into view by a re-examination of the facts and 
 principles on which the operation had been based ; these 
 were found to be good in all save one inost important par- 
 ticular. But this particular, the septic condition of wounds, 
 
8 SOME PROLEGOMENA TO A PHIDOSOPHY OF MEDICINE. 
 
 was being investigated in collateral fields ; the method of 
 antiseptics was introduced ; it was tried in this operation 
 with partial success, the inference of asepsis was drawn 
 from partial failure under antisepsis, and now under asepsis 
 and antisepsis the operation has become a success of which 
 the whole profession, as well as the individual surgeon, 
 might well be proud. 
 
 § 4. It is an extension of the method of explanation in 
 view, of failure to attain success in every disease which 
 makes possible a philosophy of medicine. If, in the face of 
 failure and in the absolute necessity of success, and in the 
 interest which a view of both failure and success excites in 
 the mind, we have impelled a philosophical habit of mind 
 which invites investigation of particular points, and by 
 means of explanation, and the application of principles 
 and inferences from different departments of knowledge, 
 there ensues great practical advance in the direction of 
 success — that is to say, that inferences of the mind are as 
 real in themselves as the processes concerning which the 
 inferences are made — it is a legitimate deduction that a 
 proportionately great practical advantage would ensue if the 
 process of explanation were so extended that a final explana- 
 tion of all the explanations becomes possible. It also may 
 be safely inferred that such an explanation may be as real 
 as any of the explanations it seeks to explain (and they 
 have been proved real by serving practical purposes) ; there- 
 fore, if the final explanation is real, it also will be conducive 
 to success, relatively that through it all facts, causes, pro- 
 cesses, and results included in both failure and success can 
 be understood as they become objects of thought and 
 relation by the mind. 
 
 If, on undertaking the consideration and treatment of a 
 case of disease the practitioner of medicine or surgery 
 knows precisely and definitely the relationship of causes, 
 symptoms, and morbid anatomy so that a prognosis can 
 with certainty be made, whether the case were left alone, 
 or what would ensue if all available measures of treatment 
 were adopted, he would look upon the consideration and 
 treatment of such a case with perfect confidence or rest 
 
SOME PROLEGOMENA TO A PHILOSOPHY OP MEDICINE. 9 
 
 of mind, provided always that recovery were the issue he 
 knew would follow. The practitioner would be confident of 
 success. It is confidence, or rest of mind, that is the goal 
 of philosophy and that all understanding aims at, not rest 
 in the sense of inactivity, but rest as preliminary to, and a 
 basis of, increased personal activity. If a practitioner 
 understands a case, he is in a position to treat it. His 
 position is satisfactory philosophically. His knowledge 
 furnishes his understanding with objective thought. Ob- 
 jective thought leads to the subjective act. The subjective 
 act leads to further objective thought; the relation between 
 the two sides of the shield is one of rest ; and, as a final 
 point, the rest of the practitioner of medicine is in philo- 
 sophical relationship to his life and mind as a man among 
 other men. 
 
 Thus we have set out the scope and purpose of philosophy 
 in medicine. It begins with explanations of failure in single 
 instances, and it ends by arriving at an explanation of the 
 relationship of all medical knowledge to other knowledge, 
 and also in what all knowledge consists, apid on what it 
 depends. 
 
 § 5. An immediate practical inference may be drawn 
 from a recognition of the wideness of a philosophy of 
 medicine. The vastness of knowledge and the success 
 which results from it, do not depend upon the knowledge 
 and practice of one man but upon all. " Every man in his 
 place," to the exercise of the highest and all his capacity, is 
 as much a motto for the medical profession as for the 
 ancient Hebrew army man. And every man who does what 
 he can, cannot be done without. Whatever in the opinion 
 of Mr. Herbert Spencer^ may have been the ancestry of 
 " physicians and surgeons," and by what process of evo- 
 lution their descent down the ages has been accomplished, 
 the point in evolution which interests them most is that 
 they are hen^e, they have arrived, and, nolens volens, they 
 find themselves dependent on each other for the work they 
 have to do. 
 
 ' Vide Contemporary Review, June, 1895. 
 
10 BOMB PEOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 § 6. In philosophy as applied to medicine as to any other 
 department of knowledge, a distinction has to be drawn 
 between philosophical method and scientific method. For 
 a complete account of this distinction the reader is referred 
 to Mr. Shadworth Hodgson's Aristotelian address entitled 
 " Philosophy and Experience." ^ 
 
 Experience is the field both of philosophy and science, 
 but in philosophy the question is asked, What is ? as distinct 
 from the question of science. How comes ? and the question, 
 What is ? asked after the question. How comes ? has ex- 
 hausted the possibility of an answer. Science makes her 
 answers first and then hands them on to philosophy for 
 further investigation, and she puts again the question to each 
 of them. What is ? There are, however, two aspects of 
 scientific investigation, and philosophy in reality deals with 
 only one of them, and her results are applicable as explana- 
 tions through one to the other. Philosophy explains 
 through psychology to positive science and common-sense. 
 Take as an illustration the ordinary common-sense idea of 
 the cure of disease. Science asks, How comes it? Philosophy 
 takes up the answers given and asks of each of them. What 
 is it ? Her answer can only be given in terms of science 
 plus the personal experience of science. Even then the 
 question may be re-asked of the answers given. What is it ? 
 And the answer given is the most final one that can be given. 
 However often the question, What is? may be put, the nearest 
 answer that can be given is a psychological or subjectively 
 scientific one ; therefore, if positive science and common- 
 sense are treated philosophically they must be so through 
 psychology or subjective reality. 
 
 § 7. Hahnemann has said that " the physician's high 
 and only mission is to restore the sick to health, to cure, 
 as it is termed."^ Some of the sick, however, cannot be 
 cured, and it is a matter of common experience that they 
 cannot. Where the structure of organs has been destroyed 
 by disease — and such a contingency may arise in a moment 
 of time — neither knowledge nor practice are of any avail to 
 
 ' VS'illiams and Norgate, 1885. 
 
 ■' " Orgauon of Medicine," § 1, translated by Dudgeon, 1893. 
 
SOME PEOLEGOMENA TO A PHILOSOPHr OF MEDICINE. 11 
 
 restore the sick to health, or to cure as it is termed. Thus, 
 as well as asking what is the cure of disease, the mind 
 cannot help asking, What is incurable disease? And so opens 
 up at once one of the widest questions of the medical 
 philosopher. What is disease at all ? An attempted single 
 answer to this question is not a primary one, however, and 
 would not give much aid to a true solution of it. 
 
 But the common experience of disease and of incurable 
 disease, also the discovered power to prevent some of the 
 causes of disease, has led to further inquiry into the cause of 
 all disease, and the aim to prevent it all. Hence is arrived 
 at a further conception of the mission of the physician. He 
 is the curer of disease ; but he is also the preventer of 
 disease. It is not, however, by an attempted answer to the 
 question, What is the cause of all disease? that disease 
 can be prevented : but in the scientific way of all true 
 philosophy, the question is asked in a given instance, What 
 is the cause of this ? Having ascertained the cause of one, 
 it can be correlated with others, and with the power to pre- 
 vent them. So by a widening and deepening of knowledge 
 of proximate causes with the ability to prevent some of them, 
 the modern science of preventive medicine is being built up. 
 It would not be very hazardous to prophesy that, as know-^ 
 ledge of disease and its causation advances, and as higher 
 conceptions of responsibility in general human life emerge, 
 the major consideration in medical practice will become the 
 prevention of disease rather than its cure. The differentia- 
 tion of medical knowledge into curative medicine and pre- 
 ventive medicine had not been made in Hahnemann's time, 
 although he was fully alive to the importance of it when he 
 says : " He (the physician) is likewise a preserver of health 
 if he knows the things that derange health and cause 
 disease, and how to remove them from persons in health." 
 
 § 8. But we must enlarge the mission of the. physician 
 even yet. As we saw that the success of the single man 
 depended so largely on the success of the whole profession, 
 so the continued inevitable progress of the knowledge of the 
 whole profession, and the modification of practice in accord- 
 ance therewith, depends for its advance upon the observation 
 
12 SOME PBOLBGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 and practice of the single man. I need not enlarge on the detail 
 of what such a conception of the mission of the single medical 
 man involves. Broadly, it may be said, the education of the 
 profession depends upon him. Although, in accordance with 
 custom and best method, certain men are told off as teachers, 
 and these find their places in colleges and universities, the 
 facts of knowledge have to be gleaned first from the single 
 case and group of cases ; and the profession depends on 
 every man to furnish some fact or facts to the common fund. 
 How much this is the case may be noticed by a reference to 
 the conditions under which medical education is conducted. 
 The position occupied by hospitals, their relation to the 
 medical schools, and the attitude of the State to both of 
 them, are such that the responsibility for the record of facts 
 is placed almpst entirely upon the single man, or, at the 
 most, on the voluntary association of men together, for 
 the purpose. 
 
 § 9. These three common conceptions ; the cure of 
 disease, the prevention of disease, and the education of the 
 profession, thus indicate the experience which marks off 
 the medical man from other individuals in the social com- 
 munity. We are, therefore, in a position to indicate the 
 scope and limitations of a complete philosophy of medicine. 
 
 A philosophy of medicine will include a personal analysis, 
 with results giving in psychological fact and arrangement 
 all objects and branches of knowledge which can be in- 
 cluded within the conceptions of the prevention of disease, 
 the cure of disease, and of what is special in the acquisition 
 or the imparting of knowledge included in these conceptions. 
 Having made his analysis, the philosopher will be then in a 
 position to bring his results to a psychological arrangement 
 with each other, in the ordered system of his entire mental 
 experience. He may become constructive. It will thus be 
 perceived that philosophy is regarded as a process, a living 
 and growing process, which can go on in the experience of 
 every man, if he gives his attention to it ; and, as we have 
 gathered, the medical man is compelled, by the very nature 
 of that experience, to engage somewhat in the philosophical 
 process. A system of philosophy is the final result if the 
 
SOME PEOLEGOMBNA TO A PHILOSOPHY OF MEDICINE. 13 
 
 philosopliical process is pushed to the utmost Hmits the 
 mind is capable of, which involves a final analysis and con- 
 struction of itself, as the philosophising instrument. 
 
 It may, however, be added that inasmuch as knowledge 
 is for ever growing, any system of philosophy, to be of 
 value, must give an account of. and allow for this growing 
 process, or it will have little explanatory value except for 
 the immediate present. It will soon be relegated to the 
 limbo of forgotten thought. 
 
 And it must also be added, that what one man may do 
 by way of a personal analysis and synthesis of his own 
 knowledge, has a supreme value for himself alone, until he 
 can set forth the process of his thought in language that 
 may be used and understood by other minds, and by the 
 association of this language in their own minds they are 
 able to perceive and co-ordinate their own experience 
 by his. 
 
 § 10. In a series of prolegomena to a philosophy of 
 medicine it must first be noticed, what are the special features 
 in medical knowledge which distinguish it as knowledge 
 from the ordinary every-day knowledge of people at large ? 
 And what are the special conditions of its acquisition ? 
 
 Broadly stated, this distinction consists in the difference 
 carried as far as possible between positive science and 
 common-sense. In the education of students of medicine, 
 it is necessary to attract attention away from the ordinary 
 objects of experience and common-sense, and to fix it on 
 an accurate and orderly presentation of the facts which 
 are to form the content of his medical knowledge. But 
 the difference does not lie here alone. In ordinary 
 common-sense knowledge and experience, the conceptions 
 of objects and relations between them and generalisations 
 from them, of which this knowledge is built up, has 
 a certain ii;idefiniteness about it ; the sensory impres- 
 sions received from without have not had their utmost 
 afferent discharge ; they have been inhibited, partly by 
 their multiplication and confusion together, partly by 
 want of voluntary attention to one element or group of 
 elements at a time, and partly by some other process in 
 
14 SOME PEOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 consciousness, or a feeling of self. Common-sense know- 
 ledge, however, serves the ordinary every-day requirements 
 of man that he has in common with the average of his 
 fellows. But such common-sense knowledge is by no means 
 sufficient when from one branch of thought an accurate 
 co-ordinate practice has to . e^sue. A step in advance of 
 common-sense has then to be made. Such is the case par 
 excellence with medical knowledge. Were it not so, every 
 element of that knowledge would have to be accompanied 
 with a further explanation and life would be all philosophy 
 and no science and no practice. In medicine, as, indeed, in 
 all positive science, the inhibitory process, which is every- 
 where prone to operate on sense impressions, is itself further 
 inhibited by a higher requirement of interest or duty on the 
 part of the mind. Every sense impression which this 
 interest or duty points to as important is allowed to have 
 its full afferent discharge. Attention, which from one point 
 of view may be described as the inhibition of inhibition, has 
 the exercise of its full voluntary activity, discrimination of 
 relations is exercised to the utmost, and generalisations 
 formed are definite, and rounded off only by the impressions 
 and relations which have been received from without and 
 conceived to exist. If to a generalisation is added any 
 contributory element of the mind other than that supplied 
 from without, either past or present through association, 
 the generalisation partakes of the character of unverifiable 
 theory, and can have no place as real and positive medical 
 knowledge. 
 
 From a survey of this distinctive quality of medical 
 knowledge arises at once the reason why personal observa- 
 tion and experiment and practice are so necessary in medical 
 education, and in proportion as the student can see for 
 himself and think for himself and operate himself, so will he, 
 consistently with his relative capacity, be the most suc- 
 cessful medical man. 
 
 § 11. On entering into a philosophical consideration of 
 the remaining distinguishing features of the calling of the 
 medical practitioner, viz., the prevention of disease and the 
 cure of disease, the question may be asked, " What is the 
 
SOME PEOLBGOMBNA TO A PHILOSOPHY OP MEDICINE. 15 
 
 first content which marks off a consideration of knowledge 
 involved in these two conceptions from other knowledge?" 
 A reply might be ready at once — "A state or states of 
 health." This would be the common-sense reply, but from 
 the scientific standpoint, it does not carry very far. The 
 standpoint of health is a common and familiar one, as well 
 as the liability to departures from it, but when we consider 
 the transition from bad health to good health, from illness 
 to wellness, the notion of a state of health is seen to be a 
 very relative and a very general one. It is the feeling of 
 life plus the very important consideration as to whose life. 
 Thus at the very outset of our philosophica analysis we are 
 met by the great problem of individuality. If a patient is 
 asked by the physician or surgeon as to his state of health, 
 his answer, if given at all, is always referred to his own 
 personalit}', such as, "Jam very ill," or "very well," as the 
 case may be. It will be readily allowed, however, that the 
 very consciousness or notion of personal individuality may 
 become an object for the physician or surgeon to consider as 
 to the goodness oi badness of health, more especially when 
 the particular person in question has disordered feeling on 
 the subject, or no feeling whatsoever. 
 
 Accordingly, the notion of the state of health for philo- 
 sophical purposes must be set aside as inadequate for a 
 fundamental distinguishing element in the knowledge of 
 medicine, and the wider notion of life must take its place. 
 Both the feehng of health, and the generalised conception 
 of it, and the consciousness of individuality, are included in 
 the notion of life. 
 
 § 12. What is life ? is the point, then, from which we 
 start. The very utterance of the question suggests that we 
 can conceive of something which is not life, and yet some- 
 thing as real, tangible, and as much an object of sense and 
 thought as life itself. Even if we knew no more about the 
 not-life than that it was a bare set-off or relation to life, 
 should we dare to exclude that relation from philosophical 
 consideration ? But as we do know more about it than that 
 it is a mere relation, and have reason to believe that what is 
 not life is as important to the existence and maintenance of 
 
16 SOME PEOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 life as life itself, two questions then confront us — What is 
 life ? and What is the not-life in relation to life ? 
 
 All the facts which are included in the word life come 
 under consideration in our analysis, also all the facts of the 
 not-life which can be perceived to have any relationship to 
 life. It is also from the standpoint of life the not-life is 
 to be viewed, and not life from the standpoint of not-life. 
 
 But it is necessary carefully to note that we have not to do 
 with the origin of life, except in so far as, if it can be dis- 
 covered, it affords any explanation of the forms or processes 
 of life. Nor have we anything to do with the cessation of 
 life, except in so far as it affords any explanation of those 
 forms and processes. We have, however, to do with the 
 effects of life on the not-life, because they may afford 
 explanation of the forms and processes of life, the whole 
 realm of organic chemical effects for example ; and also, for 
 a similar though much wider reason, we have to do with the 
 effects of life upon life. Part of the effects of life upon life 
 are perceived in consciousness alone, and knowledge as a 
 part of consciousness has an effect upon life. Accordingly, 
 the whole realm of consciousness and knowledge comes 
 under analysis in a philosophy of medicine. 
 
 § 13. In relation to life, a complete scientific theory, or 
 generalisation of it, has never yet been made which includes 
 all the elements indicated in the last paragraph. The reason 
 of this must be that life, as including consciousness and 
 knowledge, has never yet been conceived by the mind in its 
 entirety. Yet common-sense and positive science from a 
 certain standpoint both consider life as one. Consciousness 
 declares itself as unity, and the objective thought that life is 
 manifested in separate organisations, which, in the case of 
 man at least, include nearly all the separate phenomena of 
 all animal life, witnesses to the correctness of the conclusion 
 that there must be a single law or principle underlying both 
 consciousness or the subjective view of life, and organisation 
 in unity, the objective view. The reasonableness of this 
 conclusion has led scientific men, and medical men in parti- 
 cular, to spare no effort to discover this law or principle. 
 
 Many efforts have been made to generalise upon the 
 
SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 17 
 
 phenomena, or facts of life, but the arrival by consciousness 
 at a perfectly satisfactory and definite conclusion has hitherto 
 been inhibited by some other conclusion which had previously 
 found a stronger hold of reason and judgment. Life, as 
 including consciousness and knowledge, has hitherto been 
 looked at from one of two opposing points of view. First, 
 that it is something in itself, independent of that which does 
 not constitute life. Although it appeared to have a certain 
 relative dependence on the not-life, yet it has been assumed 
 that this dependence was seeming, or appearance only, and 
 that the reality of life was independent of its material 
 conditions. 
 
 The opposite, or negative view, arose out of a critical 
 analysis of the first-named view. It assumes that life is 
 made up only of the phenomena of the not-life, and that the 
 only final interpretation of it possible is by means of the laws 
 and phenomena of the not-life. Present day positive know- 
 ledge places life somewhat between these two extremes. The 
 negative critical element predominates, but it is not supreme. 
 Students of medicine begin their studies with a knowledge 
 of the facts of the not-life, on which life is said to depend ; 
 and, indeed, in theory they end here, for they are taught that 
 the purpose of physiology is to refer all the phenomena of 
 life to the natural laws of physics and chemistry. In fact, 
 however, they do not end here, for writers and teachers on 
 physiology postulate certain phenomena, which they term 
 distinctively vital, and which do not admit of being all included 
 in the phenomena and laws of physics and chemistry taken 
 by themselves. The phenomena distinctively vital form the 
 content of the whole division of science called biology, which 
 includes physiology, embryology, psychology, and sociology. 
 Biology, indeed, would have no locus standi as a science if 
 all its facts and laws could be referred to the laws of physics 
 and chemistry. This point need not be further pressed, 
 however, for, as every one knows, there is a distinct mor- 
 phology both of plants and animals, which cannot thus be 
 explained without destroying it altogether. 
 
 As stated in the first sentence of this paragraph, life has 
 never yet been viewed philosophically entirely as one, includ- 
 2 
 
18 SOME PEOLEGOMBNA TO A PHILOSOPHY OP MEDICINE. 
 
 ing the objective phenomena, subjective consciousness and 
 knowledge all combined. 
 
 § 14. The question thus remains to be considered whether 
 life can be viewed philosophically as one. It cannot be by 
 the objective phenomena of life alone, because they do not 
 include feeling, except as inference from reflective conscious- 
 ness. It cannot be by consciousness observing itself alone, 
 because there would be no proof of anything but the sub- 
 jective consciousness of one individual. But can it be 
 from an observation of knowledge as including both these 
 elements ? That is, can knowledge, understand and explain 
 itself, and the objects which form the content of knowledge ; 
 and can this explanation be stated in one theory, which shall 
 commend itself objectively as positive science and subjectively 
 as psychology in one and the same statement of real fact ? 
 
 An answer to this question can be given in an asser- 
 tion of affirmation ; but the affirmation has philosophical 
 validity only if the theory offered explains all the facts it 
 professes to explain, namely, all the facts of biology, of 
 psychology, and of philosophy. It may be added, too, that 
 this has always been the final goal of all systems of 
 philosophy, although they never yet have reached their 
 aim. It is the purpose of these prolegomena to indicate 
 whether any advance can be made upon the latest theories 
 of life, which have been formulated by minds which have 
 analysed the subject philosophically, and have been able to 
 construct a theory thereupon. 
 
 § 15. We have said that the real and complete theory of 
 life must explain philosophy. This is equivalent to saying 
 that further proof or explanation is unnecessary, the theory, 
 therefore, must be self-evident ; and as it is at the same time 
 to be capable of explaining subjective consciousness, and 
 objective knowledge, it must carry self-evident conclusions 
 or proof with it into every fact of consciousness and objective 
 knowledge. 
 
 § 16. There are two current theories of life which have 
 had much influence over the philosophy of the present day. 
 An examination of each of these theories is necessary, in 
 order that it may be seen how far they cover the ground 
 
SOME PROLEGOMENA TO A PHILOSOPHY OP MEDICINE. 19 
 
 "which is laid down by philosophy as necessary to the answer 
 ■of the question, " What is life ? " 
 
 § 17. The first theory is that, of Mr. Herbert Spencer ; 
 and is predominated by two fundamental ideas — change and 
 ■evolution. Mr. Spencer says that life is " the definite com- 
 bination of heterogeneous changes, both simultaneous and 
 successive, in correspondence with external co-existences 
 and sequences." ^ If a little thought is given to this state- 
 ment it will be seen to be self-evident as far as it goes ; that 
 is to say, that life is made up of change ; but if we ask how 
 those changes are made into definite combination, how they 
 can be said to occur together, or successively ; what is 
 internal and external, and what correspondence is there 
 between them ; and what are external co-existences and 
 sequences ; all these things are not self-explanatory or self- 
 evident ; they postulate something further. Mr. Spencer 
 says this something further is merely the process of change 
 — evolution. But although evolution may be objectively 
 evident when observed externally it certainly is not self- 
 explanatory; it needs a further explanation. Of this ex- 
 planation Mr. Spencer himself feels the need ; for he 
 postulates two other things in addition to both change 
 and evolution, of which he offers no explanation. In 
 order to account for certain peculiarities of form assumed 
 by life, Mr. Spencer introduces the term organic polarity. 
 The word polarity is adopted from the tendency which 
 certain bodies in the external world have to assume a form 
 peculiarly their own, and Mr. Spencer uses it in reference 
 to what he terms the physiological unit, an aggregation of 
 which give unity and form to organised beings. He terms the 
 sum of the force of this aggregation, the sum of organic 
 polarity.'' But this is only putting the question of life further 
 off, for we have no explanation of what the physiological unit 
 is, nor any suggestion as to the meaning of the term, 
 " organisation." The other element Mr. Spencer introduces 
 into his philosophy, is what he terms a " unit of conscious- 
 
 ' "Principlss o£ Biology." London : Williams and Norgate. 
 '" Principlss of Biology," vol. i., ohap. iv., p. 181. 
 
20 SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 
 
 ness," and he assumes that consciousness in the mass is an 
 aggregation of these units. The same remark applies to this 
 assumption as to the former one, it shifts the ground further 
 off, without being an explanation of the existence, either of 
 unity, or of consciousness. 
 
 § 18. The protoplasmic theory of life is of quite a 
 different order from that of Mr. Spencer. It aims at no 
 comprehensive view of life in the abstract but endeavours to 
 arrive at its beginning, and conclude the nature of its essence 
 from that beginning. If I were to characterise it shortly, I 
 might say it is the result of a diagnosis by exclusion. The 
 mind is driven up to the primitive substance of the organism, 
 and its most elementary movement, and the substance itself 
 is recognised as life, and its movements, phenomena belonging 
 to it. 
 
 The result is very important, for not only is the sub- 
 stance protoplasm discovered to be the ultimate known 
 basis of the , life of all organisation, but that itself lives 
 absolutely without organisation, and all organisation is the 
 result of the action of the life-substance, and cannot be 
 maintained apart from it. 
 
 The physical characters of this substance are as follows : 
 " It is a clear, transparent, structureless, colourless, semi- 
 fluid, viscid substance, which possesses weight ; its chemical 
 constitution is unknown ; in contact with other substances 
 it possesses the power of spontaneous movement, or of act- 
 ing against its own gravity." 
 
 This theory was the result of scientific observation of life 
 in its simplest forms, and it has found expression in the 
 work of the late Dr. John Drysdale.^ 
 
 Drysdale's book was written in 1874. As a matter of 
 course, researches have been going on ever since ; but the 
 theory in its essential features maintains its ground. 
 
 As a summing up of the latest researches I may make 
 the following quotation from Quain's "Anatomy," ed. 1893 : 
 " Until comparatively recent years it was universally held 
 
 ' Dr. Drysdale was himself an original observer in tlie field of the micro- 
 scope, and at the same time an honoured member of the Homoeopathic 
 Society. 
 
SOME PEOLEGOMENA TO A PHIEiOSOPHY OF MEDICINE. 21 
 
 that the principal or living substance of the cell to which 
 the narae protoplasm is applied is a completely homo- 
 geneous material . . . entirely devoid of structure. It is 
 possible that this view may hold good for some cells both 
 animal and vegetable, especially in those which are ' fixed ' 
 •or non-amoeboid. It is found that a differentiation of the 
 protoplasm has occurred in such a manner that a part of it 
 appears under high powers of the microscope in the form of 
 a net-work or sponge- work, whilst the rest of the protoplasm 
 occupies the meshes of this net-work." Be this as it rnay, 
 both the spongioplasm and hyaloplasm, as these varieties are 
 termed, are both protoplasm. 
 
 It has also been noted that the younger the cell the 
 greater is the relative amount of hyaloplasm ; it is, therefore, 
 probably safe for the present to infer that the structureless 
 variety is the more primitive. 
 
 The relation of the protoplasmic theory to the structure 
 of the cell may be stated as follows : — The cell wall, if present, 
 and whatever structural element there may be within, or 
 helping to constitute the nucleus, such, for example, as the 
 chromatic filaments, are the result of the vital activity of 
 the protoplasm, which vital activity is considered to be more 
 active in the region of the nucleus than in the outer part of 
 the cell. Under the dominion of the protoplasmic theory, 
 all parts of the body which do not consist entirely of this 
 substance are considered to be dead ; that alone is alive ; 
 that alone is the animating substance of the completely 
 developed individual. Thus (following Drysdale) within the 
 body we have — 
 
 So-called living matter. — White blood corpuscles ; proto- 
 plasm of epithelial cells; bioplasts of different tissues, 
 varying in number according to the different tissues ; 
 nucleus of the cells of grey matter of brain and spinal cord 
 and ganglia; nuclei of nerve fibres. 
 
 So-called non-living matter. — Cell wall ; threads and 
 filaments and vacuoles between cells ; fibrous, connective, 
 bony, elastic, or other tissues ; radiating fibres of caudate 
 nerve cells and outer coats of the cells ; nerve fibres in 
 general ; hard parts of epithelial cells ; all liquid secretions 
 
22 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE, 
 
 and liquid parts of blood, lymph, chyle ; cilia; cuticle, hair, 
 nails, horn. 
 
 Drysdale's summing-up of this theory and conclusions 
 drawn from observations on the phenomena of protoplasm 
 may be stated as follows : — " Life is, therefore, not an 
 entity nor a force, but an action — that action alone which is 
 involved in the consumption and regeneration, from pabulum, 
 of a material compound entirely sui generis, under certain 
 conditions or stimuli." 
 
 The main value of this theory lies in the fact that it 
 brings before the mind two elements that are characteristic 
 of all life, all consciousness, and all knowledge. Neither 
 knowledge nor consciousness nor life are known to exist 
 without them. 
 
 These elements are known as matter and movement. 
 Whatever validity or significance may eventually be attached 
 to those terms, they are at present elemental in their meaning, 
 and may be accepted as the groundwork of a satisfactory 
 explanatory theory of life. But the theory affords another 
 element characteristic of all life, consciousness and know- 
 ledge. Protoplasm is said to possess the power of acting 
 against gravity, and although this power is never exercised 
 except under the influence of a power from without, yet it 
 is not a mere result of that power, for according to known 
 physical laws, the energy resulting from potential energy is 
 kinetic energy, whereas when potential energy acts upon 
 protoplasm in degree relative to its mass, the result is not 
 kinetic but potential. 
 
 In other words, there is a reaction sui generis of the 
 protoplasm, in addition to bare reaction of the mass. Only 
 in this sense can a mass be said to act against gravity. If 
 this activity is imagined in consciousness and knowledge, 
 its truth will become self-evident as a fact of consciousness 
 and of knowledge itself. 
 
 In these three points, then, that hfe consists of both 
 matter and movement, and, dependent on matter and move- 
 ment, acting upon itself, has a movement of its own, the 
 value of this theory ends. It gives no account of the 
 effects of the movement of life which are pecuUar to itself, 
 
SOME PBOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 23 
 
 except to infer that organisation is the result of it. No 
 account is taken of the fact that organisation is made to 
 serve the purpose of this movement, or that this movement 
 is intensified by means of organisation. A further state- 
 ment concerning this movement is necessary ; it requires a 
 further generalisation of the mind — a law to explain it. 
 
 § 19. A final question must be considered, and it resolves 
 itself into a test of the validity of the knowledge which is 
 derived from an observation of itself. The validity must be 
 tested by the results of the inference when arrived at. If it 
 is self-evident, and explanatory of all objective knowledge 
 of life, and of consciousness itself, it will be valid for the 
 purpose for which it is made. With regard to an ultimate 
 test of validity for all knowledge, we accept Mr. Spencer's 
 criterion. The inference must submit to the furthest critical 
 analysis it is susceptible of, and then the contrary must be 
 discovered to be unthinkable. 
 
CHAPTBE III. 
 A Bio-Dynamic Law. 
 
 § 1. The requirements of an adequate bio-dynamic law 
 may now be briefly stated as inferences from the foregoing 
 statements : — (a) The statement of the law must set forth 
 the relationship which obtains between life and the not- 
 life. In other words, the facts and laws of physics and 
 chemistry must have their place assigned as causes of the 
 facts of life ; (&) The statement of the law must consist in 
 a generalisation which shall include all the facts of life itself, 
 and distinctive of all forms of its matter and movement ; and 
 (c) On account of the known fact of life having a matter and 
 movement sui generis, the statement of the law must indi- 
 cate the causative or dependent relationship of this movement 
 to the physical and chemical facts and laws of itself. 
 
 § 2. One of the most obvious facts of conscious thought 
 is that it may be either resting or active. Such a statement 
 applies to consciousness itself, as witnessed by the difference 
 between sleeping and waking, or when we say a person is 
 unconscious. It also applies to the process of thinking in 
 relation to consciousness. Another point in relation to both 
 rest and activity is also obvious — namely, that both the rest 
 and activity of consciousness and thinking alternate with 
 each other throughout the whole of the range of conscious- 
 ness and knowledge, and that the one is in relation of causa- 
 tive dependence upon the other. Consciousness could not 
 continue without rest either as a contained phenomenon of 
 the organism, or as an element of activity. And the same 
 statement applies to thinking in relation to consciousness. 
 
 Another very obvious fact is that granting the successive 
 cessations of activity in rest, the activity of the process of 
 thinking increases itself by exercise, or thinking increases by 
 
SOME PBOLBGOMENA TO A PHILOSOPHY OF MEDICINE. 25 
 
 spending itself. Consciousness also increases itself by spend- 
 ing itself in the thought of itself, not in the sense of exten- 
 sion, however, for consciousness is thus bounded by the 
 extended object in which it rests, but in the sense of inten- 
 sion or intensity. "When it is said that thought widens, it 
 is not meant that it extends, but that it intends — that is, 
 every increase of thought becomes potential for further 
 increase. The same applies when it is said thought deepens 
 when it comes to think more and more upon itself. 
 
 § 3. These are obvious elements in the process of 
 knowledge, and if an attempt is made to believe their con- 
 trary, it will be found impossible. It is proposed, then, 
 that these elements shall be gathered into a formal state- 
 ment, and applied to what is known of life in protoplasm 
 a,nd organisation. It will then be seen if they afford any 
 further explanation of protoplasm and organisation than 
 has already been given. One word, however, as to the 
 meaning of the term rest. It is relative rest that is to be 
 understood. For instance, thought rests in personal con- 
 sciousness ; consciousness rests in the organism which 
 contains.it; the organism rests by gravity on the earth; the 
 activity of the organism rests in its own gravity resting in 
 the gravity of the earth. Thus the law of gravity is an 
 absolutely essential condition to a knowledge of life and to 
 the existence of life. It may be most fittingly termed the 
 physical basis of life, and the law of gravity is part of the 
 law of life. 
 
 § 4. The theory of life may accordingly be stated as 
 follows : — 
 
 In absolute dependence on the phenomena and la/ws of 
 physics and chemistry, life is a mode of energy, sui generis, 
 occurring simultaneously in the resting and active conditions. 
 The law of its resting condition is the purpose of the active. 
 The law of the active condition is that it increases itself by 
 spending itself. 
 
 § 5. Before proceeding to give illustrations of the theory, 
 it will be necessary to make some general observations ex- 
 planatory of the phraseology used in the statement. 
 
 (a) No further attempt is made to explain the relation- 
 
26 SOME PBOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 ship of the laws of physics and chemistry to the universe at 
 large or their special causative relationship to life. Their 
 special causative relationship to life is not yet known, except 
 the fact of an absolute dependence on their constancy and 
 operation. Their relationship to the universe at large is 
 outside the immediate scope of a philosophy of medicine. 
 
 (h) On the use of the word Energy. — This word is used 
 advisedly because of its ultimate conceptual character. 
 Potential energy must be understood, and it must be care- 
 fully distinguished from the isolated conception of force. 
 Force may be the result of potential energy, but it cannot 
 exist without matter, whereas potential energy or power is 
 behind both matter and force. Life is thus a mode of 
 energy — that is, it exists as matter and displays force in 
 certain ways or modes, but it is not a force distinct and by 
 itself. To term it so is recognised at the present day as a 
 mere convenience of phrase which may belong to common- 
 sense but not to positive science. 
 
 (c) The statement of this theory will be discovered to be 
 self-contradictory if, as far as the objective phenomena of 
 life are concerned, any attempt be made to imagine it in its 
 entirety in the mind. Why so? Because in whatever state 
 of life these phenomena are observed, only a part of the 
 process is seen to be in operation at once. The total pro- 
 cess includes the opposite or contrasted and inter-dependent 
 part, which may come under observation the next minute, 
 and be perceived to be a part of the whole by an effort of the 
 mind. Take a simple example : — The phenomenon of the 
 action of the biceps muscle is observed and known to be the 
 result of the contraction of the fibres of that muscle, which 
 again results from an impulse received from its related 
 nerve. But if we turn from watching the action of the 
 muscle, say in lifting a weight, to examine the muscle itself 
 or its nerve, or the connection between the two, the action 
 of the muscle for the time being drops out of mind, although 
 there is an association by the mind of the one being depen- 
 dent on the other. They are both referred to a vital process, 
 although this vital process cannot be witnessed in its entirety 
 at once. 
 
SOME PEOLBGOMENA TO A PHILOSOPHY OF MEDICINE. 27 
 
 (d) The bio-dynamic law illustrates what I have been 
 noting in its most extreme form. It will be recollected that 
 an element in the protoplasmic theory was that protoplasm 
 could act against gravity. If an effort is made to conceive 
 this, it is impossible, yet there is no doubt that if a man or 
 an animal tumbles down, and has conscious intelligence or 
 vitality enough, he will get up again and assume a position 
 of equilibrium, that is, he will set his vitality against his 
 gravity, depending, of course, on the gravity of the earth. 
 But the bio-dynamic law means more than this, and some- 
 thing which makes it more dif&cult still to image in the 
 mind. Not only does vitality act against gravity, but, 
 depending on it, it increases itself by spending itself. This 
 is the central fact of life. What is lacking in previous 
 explanations of life receives interpretation from this fact 
 observed in the relations on which it depends. 
 
 § 6. The statement of the law is now given ; and, of 
 course, its value depends on its applicability to the pheno- 
 mena of life as they are known in the sciences included 
 under the class biological. 
 
 The theory here given may be stated shortly again in the 
 sentence, that it is the protoplasmic theory plus the fact that 
 life increases itself by its own activity. It will now be 
 necessary to illustrate its explanatory value by a reference ta 
 facts relating to the movement of protoplasm itself, to the 
 physiology of the cell, embryology, general physiology, and 
 psychology. 
 
 § 7. The Movement of Protoplasm. — In considering th& 
 phenomena of the movement of protoplasm, it is necessary tO' 
 assume that these phenomena will not be exhibited at all 
 except under the stimulus of energy from without. But 
 note this : — That wherever protoplasm exists at all there 
 always is energy without, which in popular language is 
 called the environment. The protoplasm is dependent on 
 some influence from its environment as an incentive to the 
 manifestation of any of its activity. There are the simple 
 mechanical action of currents of air, different degrees of heat 
 and electrical tension, and a relative intensity of light. 
 Other gases besides those included in air exert an effect. 
 
28 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 upon it, as well as liquids and solids of the greatest variety 
 and difference of density. The wonder is, that considering 
 the physical qualities of protoplasm it does not on the 
 slightest stimulus become dissolved ; but wonder ceases if 
 we recognise a law for itself in addition to the laws of the 
 environment. Protoplasm reacts upon the varying stimuli 
 which are operating upon it. Can we doubt the significance 
 of the "amoeboid" movements, that they are a direct 
 response to different movements in relation to it ? In these 
 amoeboid movements we have an expenditure of force, 
 a reaction against other force. But what is the result? 
 A dissipation, of the particular substance which is the 
 potential source of it ? Not at all, but the very reverse. In 
 the course of these movements, oxygen is being absorbed, 
 heat is generated, some particles of other substances are 
 caught and invaginated into the protoplasmic substance, 
 movement is possible, some so-called organic material ex- 
 creted ; all being, in common language, a dissipation of 
 energy. But does the protoplasm body dissipate ? Not at 
 all, but the reverse. It gets larger, its activity intensifies. 
 Now allow a sufficiently strong mechanical stimulus to 
 divide the protoplasm gently into two. What is the result ? 
 A dissipation of the energy of the whole ? Not at all, but 
 the reverse. Each division in itself becomes a centre, a focus 
 for a reaction against the environment equal to the original 
 reaction of the parent multiplied by two. 
 
 I am arguing for an absolutely self-contained reaction of 
 the protoplasm on the environment ; but, as a matter oifact, 
 that is never observed to take place. What is seen is only 
 part, which is the result of the operation of a law of the 
 whole. Part is at rest and part in movement : at least so it 
 appears ; and the resting part is a basis for the acting part, 
 as witness the support which the main part of a corpuscle 
 must give to the pseudopodium as it is projected out from 
 the body in response to a stimulus. This latter point wiU be 
 illustrated better when we consider ;the subject of organisa- 
 tion. 
 
 § 8. The Physiology of the Cell— The cell is the first 
 step in the process of organisation. The cell wall and re- 
 
SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 29" 
 
 ticulum, when present, serves a double purpose. If any 
 portion of protoplasm can display degrees of energy in its 
 reaction on the environment, and can, by means of energy 
 received from without, convert itself nto a substance of 
 greater density than itself and of different relative density to 
 substances which constitute the environment, this substance 
 will become a substance on which the protoplasm may 
 depend, and against which it may react. This is an obvious 
 truth, but it is the root-fact of all organisation. In the- 
 formation of the cell wall or reticulum, even though it may 
 result from some special influence of the environment, and 
 death of some protoplasm substance, as long as it remains 
 round or in contact with the cell, and is renewed by its 
 activity, it becomes a means to the increase of its vitality. 
 The formation of such a structure is an illustration of the 
 law that life increases itself by spending itself. 
 
 A careful note must be made of the fact, that the cell 
 wall or reticulum, or spongioplasm as it is termed, possesses. 
 in its inherent quality the merest shade of difference from 
 the original protoplasm. Too much importance cannot be 
 laid on this difference. Its significance is more than can be 
 sufficiently emphasised. In that shade of difference may be 
 perceived not only the beginning of organisation, but also 
 the foundation of all pathological conditions, and likewise 
 the possibility of scientific therapeutics. As structure be- 
 comes more differentiated in form, and life more intensified ; 
 as the body of formed material and protoplasm becomes 
 more and more an organised unity, the finer differences 
 disappear from view, but their significance remains. 
 
 In the phenomena of karyokinesis' or reproduction of the 
 cell by means of changes which take place within the nu- 
 cleus, the significance of this difference maybe more fully 
 illustrated. An acquaintance with the phenomena of karyo- 
 kinesis is assumed ; it would take too much space to describe 
 the process in full detail. The first point to which attention 
 should be given is that the process starts when the nucleus- 
 is in a state of rest. Eest is the basis or condition of the 
 
 ' Quain's " Anatomy," vol. i., part ii. ; Waldeyer, Quarterly Journal- 
 Micros, Science, vol. xxx., 1889. 
 
30 SOME PKOLBGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 activity of life. The contents of the nucleus, the chromo- 
 plasmic network (so termed, because of its highly refractive 
 character) consists of material formed out of the protoplasm 
 of the nucleus or cell ; this becomes converted into a closely 
 constricted skein of filaments — shall we say as a result of 
 the protoplasm entering into a highly complicated chemical 
 union with substances which have been absorbed from 
 without? By a star-like arrangement the skein becomes 
 gradually divided, not, however, without the -intervention of a 
 structure more proximate to the protoplasm. This consists 
 of a thread-work in the shape of a spindle consisting of 
 achromatic fibres, which finds its way to the polar area of 
 the nucleus and seems to have an important function in 
 assisting the disposition of the chromatic skein, which 
 eventually results in the division of the nucleus and thereby 
 of the reproduction of the cell. Our bio-dynamic law here 
 suggests that the cell generates the achromatic spindle, and 
 the network of chromatic fibres, by union with some sub- 
 stances in its environment, and then depends upon the 
 presence of this formed material to effect its own division 
 and consequent reproduction. That is, the progressively non- 
 vital achromatic and chromatic filaments effect the division 
 in the nucleus, but the separated protoplasm lives on and 
 increases by its inherent vitality. 
 
 § 9. Embryology. — In a consideration of the subject of 
 embryology in the light of our proposed theory of life, it is 
 necessary to allude first to the structure and contents of the 
 ovum in their relations to each other. Taking them in order, 
 as the ovum leaves the Graafian follicle, there is the invest- 
 ing membrane, the zona pellucida, the mass of protoplasm, a 
 number of small, highly-refracting granules, and globules of 
 various sizes, and, lastly, the germinal vesicle. The latter 
 is, perhaps, undergoing the process of karyokinesis, the result 
 being the polar globules, which are extruded, leaving the 
 female pronucleus which becomes the subject of fertihsation 
 by the male pronucleus. 
 
 Has the zona pellucida any function ? Looked at physi- 
 cally, its occurrence is a mere accident, but vitally, it cannot 
 be so regarded. Consisting of formed material, contributed 
 
SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 31 
 
 by the maternal protoplasm, it forms a protective covering 
 for the ovum. But its function is much more important 
 than this. It also forms a preliminary mechanical environ- 
 ment for the protoplasm of the ovum, acting as a stimulus 
 to the activity of the cells after fertilisation and segmenta- 
 tion has taken place, and potent in the production of the 
 outer layer of the blastodermic vesicle. What has been 
 said as to the function of the cell wall applies, under the 
 altered conditions, to the zona pellucida until it disappears, 
 after the formation of the blastodermic vesicle. 
 
 The variety and composition of the granules and globules 
 vyithin the yolk cannot fail to have important physical 
 relationship to the cells of the protoplasm, as they become 
 more and more divided. 
 
 Primarily these substances afford nourishment to the 
 protoplasm, but they must have a distributing influence 
 upon the cells as well, if the intimate movement of the 
 cells is capable of being influenced by surrounding con- 
 ditions. It is not very hazardous to say that varieties in 
 the individuality of different offspring might arise from the 
 influence of varieties in the contents of the ovum at the 
 time of fertilisation. It would be difficult to say where 
 this influence begins or how far it may be extended into 
 subsequent organisation, but the movement of the proto- 
 plasm, in its reaction upon this limited environment, is 
 always in the mode of self-increase by self-expenditure. 
 
 Before referring to the process of fertilisation, the signifi- 
 cance of sex must be alluded to. The most elementary fact 
 of sex is the possibility of fusion of masses of protoplasm, 
 and a continuation thereby of its normal movement. No 
 advantage results from simple fusion, however, until some 
 difference exists in the relative intensity of the normal move- 
 ment of the different masses, and in viewing sex, philo- 
 sophically, it may be said to be the extreme advantage of 
 the effect of difference taken by life. The difference would 
 generally consist in intensity of energy or movement, com- 
 bining in reaction on external stimuli, the result being more 
 highly differentiated organisation. But while sex is the 
 extreme advantage of difference taken by life, it is also the 
 
32 SOME PEOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 most evenly balanced effect of life upon life. There are 
 homologous parts contributed by both sexes to the re- 
 production of the new offspring. The male pronucleus has 
 little difference in appearance of structure from the female 
 pronucleus, but the organisation of the spermatozoon is as 
 different as possible from the protoplasm mass of the yolk. 
 These are homologous, but they are relatively almost op- 
 posite modes of energy, the one representing the active and 
 the other the passive conditions of energy, but both are sub- 
 servient to the reproduction, development, and increase of 
 life. 
 
 How far these principles are applicable to the likeness 
 and difference of sex will be readily seen ; one statement only 
 is sufficient to indicate sex as the most conspicuous illustra- 
 tion of the theory of life here given. What is common to 
 both sexes is the uniform mode of movement of life, it 
 increases itself by spending itself. "What is distinctive of 
 either (in relative degrees, of course) is the resting or active 
 conditions, and the one is for the purpose of the other, which 
 is common to both — the increase of life. A recognition of 
 these principles will afford an explanation of all problems of 
 the effects of sex, and will be a key to the process of natural 
 or sexual selection, always remembering that the principles 
 are relative in their operation as regards the distinctive, 
 but absolute as regards their essential qualities. And a 
 self-evident inference may be added in the statement that 
 the most highly developed offspring will result when the 
 essential qualities of the sexes are exhibited with the 
 greatest intensity, combined with the most refined and 
 delicate adjustment of their distinctive qualities. 
 
 The most conspicuous effect wrought by the process of 
 fertilisation is the determining character which is given to 
 the nucleus formed out of the conjugation of the male and 
 female pronuclei. In the most highly-developed form of life, 
 the determination wrought by the nucleus results in the 
 transmission to the offspring of the most exquisite differences 
 in structure and function found in the parents, and which 
 mark them off from each other as individuals, also with some 
 new qualities produced peculiar to the new offspring, so that 
 
SOME PBOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 33 
 
 a new individuality is the result. The offspring is also 
 marked off hy differences which occur in the same family 
 as distinct from other families, as well as by more marked 
 differences in the same race, species, genus, class, or division 
 of the animal kingdom. The one central fact common to 
 all likeness in difference here exhibited, is the intense ex- 
 penditure of intense energy by the original nucleus, in order 
 that the same energy may be reproduced, and still further 
 intensified. 
 
 With truth it may be said that energy, acting from with- 
 out, is infinite in the variety of promptings to protoplasm 
 to exert its peculiar mode of activity ; and that such energy 
 was operating before and has been operating ever since the 
 conditions were fulfilled necessary to the appearance of life 
 upon the globe. Grant then, that protoplasm has been exert- 
 ing its own peculiar mode of activity — that of increase of 
 itself by spending itself — with dependence on gravity and 
 difference of stimuli, have we not an intelligible explanation 
 presented to the mind of the factors which have worked out 
 the almost infinite variety of form which organisms have 
 assumed on the face of the globe ? 
 
 In the segmentation of the protoplasm of the yolk which 
 has been determined by the fertilised nucleus, combined 
 witld the distributing physical qualities of the refracting 
 granules and globules, we have the factors necessary to the 
 formation of the blastodermic vesicle and its further separa- 
 tion into the layers epiblastic, hypoblastic, and mesoblastic. 
 
 The next process is that of specialisation in the character 
 of some of the newly-formed cells, which are the basis of 
 the first essentially organised tissue to receive indications of 
 differentiation — the nervous tissue. This specialisation con- 
 sists in one layer possessing the darkest cells vdth the largest 
 nuclei — the epiblast. In these cells there is a concentration 
 of the energy of the protoplasm which through generations 
 has resulted from a variety of pressure or stimulus from the 
 environment, but in each individual is determined by the 
 intensity of energy in the protoplasm of the ovum, combined 
 with, and more finely determined by, the nuclear elements 
 of the germinal vesicles, both male and female. In propor- 
 
 3 
 
34 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 tion as the energy of the protoplasm thus becomes differen- 
 tiated and concentrated, so, in proportion, according to 
 the inevitable result of the operation of the law of life, 
 does it assume a controlling and determining energy in 
 relation to all other protoplasm and formed material within 
 the organism. The stages of development of the different 
 structures of the embryo in which the young life takes on an 
 activity in relation to its own organism, constitute the real 
 dividing line between embryology and general physiology. 
 Por the purposes of illustration, further references to the 
 processes of development will be made under the head of 
 general physiology. 
 
 § 10. General Physiology. — As structure becomes more 
 developed and more complex, the protoplasm in intimate 
 association with it, on account of the extra resistance of 
 structure, loses its energy in proportion. But the very 
 occurrence of structure or formed material, has been a 
 stimulus to other cells to a more intense activity, and as 
 these latter depend or rest on the other structures formed, 
 which are still animated by their own protoplasm, though 
 but feebly, the higher experience a concentration of their 
 energy. On account of this, in accordance with the law of 
 life, these concentrated cells assume more and more a 
 controlling, determining power over other parts. Such a 
 statement in a few words may be called the theory of the 
 nervous system, and in the animal kingdom, as is well 
 known, a germ of a nervous system appears as soon as there 
 is a collection of cells united by structure to form a single 
 organism, for example, in the Coelenterata. Little or no 
 difference can be noted in the appearance of the protoplasm 
 of the nerve cells from that of ordinary cells, except that the 
 nucleus is larger and perhaps darker than usual. But there 
 is the widest difference in the functional activity of these cells 
 from those of other tissues of the body, for example, those 
 of the epithelium of different serous and mucous cavities, the 
 gland cells, &c., &c., and also between different cells of 
 different parts of the nervous system. The process of differ- 
 entiation and consequent control is carried so far that even 
 the structure which supports the nerve cells is supplied with 
 
SOME PKOLEGOMBNA TO A PHILOSOPHY OP MEDICINE. 3& 
 
 nerves in the shape of the nervi nervorum. We must not 
 assume, however, that the cells of other organs, or the bio- 
 plasts of the formed material, have no independent activity 
 of their own ; if they had not, they would cease to be pro- 
 toplasm. They have an activity of their own and an es- 
 sential one, only, if left without the guidance of nerve 
 impulse, they would be over-shadowed by the structures to 
 which they are related, and would so act out of harmony 
 with cells of other organs with which they are intimately 
 connected. I may cite two disorders familiarly illustrative 
 of this — the production of glycosuria as a result of injury 
 to the floor of the fourth ventricle, and functional albu- 
 minuria on account of some eni,ptional nervous disturbance. 
 
 A modification of nerve cells is exhibited in the nerve 
 fibres. The axis cylinder is developed out of rudimentary 
 ganglia cells, each cell being bi-polar and stretching out its 
 projections to join with other cells, and so constitute a vital or 
 protoplasmic connection through the centres with every part 
 of the body. Thus, what is termed conduction of impression 
 or impulse is as much a vital process as sensation or move- 
 ment. That the sensory nerves are seen to begin their 
 process of development before the motor, is a fact in keeping 
 with increase of life generally, and with the dynamic law 
 which waits for a stimulus from without for the excitement 
 of its activity. 
 
 Another important point is in relation to the connection 
 of the afferent nerves with^ the nerve centres.^ " Having 
 entered the nerve centre, the bundle of fibres divides into 
 two branches which' appear to break up into fine rami- 
 fications without being continuous with the grey substance." 
 We may gather from this that sensation is a separate and 
 distinct function of life, and is not necessarily connected 
 with movement. The stimulus from without finds the 
 sensory nerve, both organ and fibres, at rest, it awakens 
 their activity, the sensation remains with the end organ or 
 is conveyed to the centre, and the stimulus ceases, the end 
 organ and nerve return to rest ; but the centre may have 
 been awakened to activity, that activity may be manifested 
 ' Quain's " Anatomy," vol. i., part ii., p. 328. 
 
36 SOME PEOLEGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 in discrimination of the sensation, and, associated with 
 others, it may be received and a flush of pleasurable sensa- 
 tion pass over the vs^hole body. But if the sensation be of 
 a different order, other nerve activity may be excited, that 
 which impels a single rhovement or co-ordinates a number 
 of movements in certain muscles. As soon as the sensa^ 
 tion is discriminated the sensory centre returns to rest ; as 
 soon as the movement is accomplished, the motor or co- 
 ordinating centre and nerve return to rest. What is the 
 significance of all this ? Simply that sensation, discrimina- 
 tion, motor impulse, co-ordination and the resulting muscular 
 movement are all separate functions, and have as their one 
 common associated law the increase or interest of the life of 
 the organism, and that they intimately and separately work 
 from the resting state to the active state, and from the 
 active to the resting, the one being for the purpose of the 
 other, and in so far as rest and activity are properties of one 
 set of structure and function, so do they combined contri- 
 bute to the activity and rest of the whole organism. Let it 
 also be noted that as sensation and movement are separate 
 functions, they are transitions to and from a more or less 
 full intensity of life. Especially if they are pleasurable, 
 they are transitions to and from &more intense life. If they 
 are painful they are transitions from a greater degree of 
 intensity of life to a less. 
 
 Neither pleasure nor pain as sensation could result if 
 there were no special law of life. The one results from 
 increase in itself, and the sensation of pleasure is part of 
 the increase, the other results from decrease of itself and is 
 part of the decrease. And so pleasure and pain themselves 
 become confirmatory of the l^w of life. 
 
 Some mention should be here made that symmetry of 
 form and combination of form in symmetrical or multiplied 
 organs can be explained by the operation of the bio-dynamic 
 law in the face of gravity, and influence from the environ- 
 ment, but the proof followed out in detail would occupy too 
 much space for the present address. 
 
 Having considered the nervous system in relation to the 
 body generally as possessing the controlling function over all 
 
SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 37 
 
 parts of the organism, detailed reference to the separate 
 functions is unnecessary except to indicate their relative 
 importance as contributory to the vitality of the whole. 
 Foremost and most general of these functions is the re- 
 generation of formed material through the circulation of 
 the blood and by means of the subsidiary functions which 
 maintain the blood in its required condition. Mention 
 might be made of the action of the heart, the combination 
 of its innervation, muscular movement, own blood supply, 
 and rythmical action and reaction to the stimuli wrought by 
 blood pressure as well as blood condition. This compli- 
 cated mechanism is sustained in its operation by a relative 
 intensity of life in the balance of its innervation and motor 
 function, both being related to the exercise and self-increase 
 of the whole organism. 
 
 The same may be said, although in altered relation, of 
 respiration, digestion, absorption, assimilation, secretion 
 (internal and external), and excretion. They all exhibit, to 
 some extent, in their individual operation, the law of self- 
 increase by exercise, but only in relation to the balanced 
 operation of each other, and the integrity of the nervous 
 system which controls them. 
 
 Reproduction is so much a manifestation of the law of 
 life in itself, that although the mechanism of it is relegated 
 . to certain organs, these cannot act of themselves without the 
 co-operation of all nerve centres, which have a controlling 
 function over the whole organism, and unless any centres 
 which have a higher function than that of reproduction, such 
 as the reflective consciousness in man, are themselves at 
 rest. 
 
 All the organs and functions of the body find their unity 
 through the nervous system by means of its operation upon 
 the gravity of the mass. It must, however, be remembered 
 that the nervous system could not exist, and, indeed, could 
 be of no use apart from the whole body, or the integrity of 
 all the parts, and that the function, or purpose, of the whole 
 is that of self -increase, which is accomplished by the expendi- 
 ture of force on the part of the whole in the balanced opera- 
 tion and alternation of activity and rest. 
 
38 SOME PEOLEGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 § 11. Psychology. — (i.) In his " Protoplasmic Theory of 
 Life,"' Drysdale refers to consciousness as an incidental 
 phenomenon in relation to protoplasm, and that it is not 
 a link in the chain of material transformations, which are 
 accounted for by other causes and results. " Consciousness 
 (it is said) thus belongs to the properties, not the forces, of 
 matter, if to matter at all, and is equally out of the province 
 of a priori investigation v^ith the qualities of the ether, and 
 the atoms, which must be postulated as the necessary founda- 
 tions of all scientific inquiry." Such a begging of the ques- 
 tion is eminently unsatisfactory ; it arises from accepting as 
 a complete theory of life what is only a basis for a theory. 
 
 (ii.) Consciousness is the basis of psychological inquiry, 
 and the link which joins psychology to physiology is the 
 conception we have arrived at in the last paragraph — the 
 organic unity of the nervous system. All parts of the nervous 
 system are capable of acting in relation with all other parts. 
 This is an obvious truth from experience and physiological 
 knowledge. But it implies a great deal more than the mere 
 conception of the reception and conduction of sensory 
 impressions, the discrimination of them, the co-ordination 
 of impulses to movement, and the impulses to movement 
 themselves. If all these elements are to act in relation to 
 each other from any part of the body, or in relation to a 
 possible activity of the whole, there is implied a much 
 greater intensity of activity in the centres of the nervous 
 system than in any of its parts, and if one of these elements 
 can act in relation to the whole, there must be a centre for 
 that whole, which must exhibit the greatest degree of in- 
 tensity of activity of any part of the nervous system. The 
 arrival at such an actual synthesis of all nervous structure 
 and activity may be taken as the organic basis of conscious- 
 ness. 
 
 (iii.) We should like to localise this synthesis in the brain, 
 but as this can only be done theoretically its value is 
 psychological only. Some elements in such a synthesis may, 
 however, be pointed out. 
 
 It would include in the lowest animals possessing a de- 
 
 ' " Protoplasmic Theory of Lite," pp. 233-235. 
 
SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 39 
 
 veloped nervous system, a massive connection and contribu- 
 tion from the spinal cord, both from the posterior and an- 
 terior columns, and their commissural fibres in both cord 
 and brain, less massive connections from the centres in the 
 medulla oblongata, these again being associated in some 
 degree with the spinal cord. A most massive connection 
 and contribution from the cerebellum would be included, as 
 well as the great cerebral ganglia and their connections. 
 The association of all these with the optic and olfactory 
 tracts and the auditory and gustatory centres would make 
 up the group. The cerebral cortex, for this purpose, may be 
 regarded as an after product. 
 
 It is impossible to go into detail as to the multiplication 
 of effects both in structure and function, in sensation and 
 movement, in brain states and consciousness, which such a 
 synthesis involves ; they form the whole content of brain 
 physiology. A few features may be noted illustrative of the 
 operation of the law of life. 
 
 (iv.) What is involved in our conception of the organic 
 unity of the nervous system plus the beginning of conscious- 
 ness ? Let there be carried in the mind the separate func- 
 tions in the massiveness in which their operation is 
 experienced, and let it be remembered that if one is called 
 into play, there is a certain activity implied of that one, and 
 then rest of that one results. But because a nerve centre 
 is resting, is there no life in it, or is the dynamic law not 
 in operation? Does it not simply wait in a condition of 
 unstable equilibrium, until a fresh stimulus, either from 
 without or within, rouses it into activity again ? Apply 
 this principle all round. Suppose there is no activity of 
 any part of the brain going on, the animal is asleep, in a 
 resting state, a relatively passive condition of unstable equi- 
 librium of the whole central nervous system, which may be 
 roused in some part to activity as soon as a sufficient stimulus 
 be applied. 
 
 Let that stimulus be applied to some part of the body 
 sufficient to rouse the whole. Bare consciousness is the first 
 experience, plus the sensation of the stimulus, the emerging 
 of an overtone of the organic unity of the nervous system. 
 
40 SOME PEOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 containing a contribution from all parts, as suggested in the 
 previous paragraph. The inference is that consciousness 
 begins in the experience of an individual, as soon as that 
 unity is organised in the brain, and afterwards it always 
 emerges as a result of that organised unity being in a resting 
 state. 
 
 It will have been implied that the conception of the unity 
 of the nervous system involves the conception of a relative 
 degree of intensity of energy, an intensity which not only 
 allows of each part acting in response to a stimulus but 
 what is common to all, being roused at the same time. 
 This common element is the energy to increase itself by 
 exercise. 
 
 (v.) The scheme involved in this conception may be set 
 out in detail as follows : Sensation is increased by the 
 exercise of itself, and it is associated with discrimination and 
 co-ordination and with movement. 
 
 Discrimination is increased by the exercise of itself, and 
 it is associated with sensation, with co-ordination and with 
 movement. 
 
 Co-ordination is increased by the exercise of itself, and 
 it is associated with sensation, discrimination and the im- 
 pulse to movement. 
 
 The impulse to movement is increased by exercise, and 
 is in association with co-ordination and discrimination and 
 sensation. Now, if this is so, it is not possible for all these 
 processes to be aroused in part, without in some sense the 
 whole to be aroused. But in their mechanical effects, two 
 of them, co-ordination and movement, act against the other 
 two, discrimination and sensation. The physical force 
 between them must therefore be neutralised, but what 
 remains is its combined intensity, which, as a whole, 
 manifests itself as consciousness. 
 
 If the bio-dynamic law here given is true, in conscious- 
 ness it will be observed to be acting as a whole and not in 
 part. Is this so? 
 
 (vi.) In what does the consciousness of self consist? It 
 may be repHed, in an intensification of bare consciousness 
 brought about by the law of increase by exercise, operating 
 
SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 41 
 
 through bare consciousness in relation to one part of the 
 brain and in connection with another. 
 
 Examine the consciousness of self and see if anything 
 more can be found in it than the uninterrupted and continued 
 operation of the law of increase by exercise, always provided 
 however, that periods of relative rest are understood, for both 
 whole and part, these again being preliminary and prepara- 
 tory to a further increase of the whole or part by exercise. 
 
 A stimulus can be applied to one part of the body only 
 while every other part is at rest. Or, an incitement to 
 movement from sensation without or within may occur 
 within any part of the central nervous system while every 
 other part is at rest. "What is the significance of these facts 
 in relation to consciousness ? They are the primary funda- 
 mental elements of thought, a feeling of difference, a relation, 
 the first stage of stimulus to the thought of self as distinct 
 iiova. parts of the conscious self. 
 
 In this elementary feeling of difference there are two 
 c[ualities. These qualities we saw in effect to exist in the 
 most elementary stages of life, only in consciousness they 
 arise as part of self-feeling. The first quality is the 'feeling 
 of. reaction of the body to the external stimulus. The 
 second is the feeling of rest which results from it, the feel- 
 ing of rest resulting from the stimulus to reaction of the 
 body against its own gravity. 
 
 The whole knowledge of the external world, the whole 
 process of thought, the differentiation by thought of sense- 
 impressions, associated with self and the thought of self, 
 into perceptions, perceptions into conceptions, feeling, and 
 the perception of relations between things and thoughts, 
 and between things and thoughts and self, are one and all 
 built up by the original feeling of difference in response to 
 the stimulus from without, and the reaction of the dynamic 
 law ; always remembering the relative . capacity of this 
 reaction to rest, that the reaction is always in the nature of 
 increase by exercise, and that the increase takes place in 
 consciousness intensively and not extensively. If this is so, 
 the law affords an explanation of the increase by experience 
 ^nd knowledge, not by mere mechanical exercise of the 
 
42 SOME PEOIiBGOMENA TO A PHILOSOPHY OP MEDICINE. 
 
 body, but by an increase in the power to perceive shades 
 of difference in proportion to the intensive activity of the 
 nervous system and thought. 
 
 (vii.) A few words must here be said on the subject of 
 attention. The fundamental element in attention is the 
 co-ordination of the activity of consciousness upon some 
 element or elements which arise in thought ; these elements 
 consisting of sensations, perceptions, conceptions and the 
 relations between them, or the relations from them ab- 
 stracted by thought into a relation to itself. Attention may 
 be involuntary or voluntary. An " arrest of attention " 
 may arise from some stimulus from without or within the 
 organism ; the concentrated reaction of the mind arising 
 from an interest in the effect of that stimulus affecting the 
 whole. 
 
 This interest partakes either of pleasure or of pain, 
 either of the increase or decrease of life. " Voluntary 
 attention " consists of an intensification of the simply 
 arrested attention, where all the energy of the mind is 
 concentrated upon the stimulus to thought in consciousness. 
 
 (viii.) A reference to the known laws of association must 
 conclude our illustrations under the head of psychology. 
 Here I draw largely from the most modern work on 
 physiological psychology, that of Professor William James,, 
 of Harvard University.^ 
 
 Professor James attributes association primarily to the 
 mechanical arrangement of the brain structure. Under the 
 influence of what law this has been developed, has been sug- 
 gested in previous .paragraphs. 
 
 But we cannot consider that the mere mechanical 
 arrangement of the brain structure is sufficient to account 
 for association. The whole multitude of sensations, percepts, 
 concepts, and their relations depend, no doubt, upon the 
 organic activity of the nervous tissue ; but it is to be doubted 
 that by the laws of nervous action, as hitherto formulated, 
 these can be summoned before the mind in a certain order,, 
 some of them selected, and some of them rejected — a new 
 thought compounded by the process, and this thought 
 
 1 " Principles of Psychology," Maomillan and Co., 1891, vol. i. 
 
SOME PBOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 43^ 
 
 perceived and concei'ved in relation to all the others, to 
 personal consciousness, and to all the new sensations of the: 
 external world. 
 
 The most elemental conception of association is the 
 occurrence of two thoughts of objects, together with some- 
 thing as a common bond between them, namely, Conscious- 
 ness understood. But the thought which binds the two 
 thoughts together and makes a new one of them, is by no 
 means a mere conductor of sensation or impulse to move- 
 ment, as might be supposed to take place through a nerve 
 fibre. 
 
 This so-called combining thought is itself an activity, a 
 synthesis, or what appears as a new thought never could 
 arise. And what I contend for is that this very process of 
 association itself is an illustration of the operation of our 
 dynamic law. The essential element in it is thai thought is 
 increasing itself while it is spending itself; and that both 
 the first object or relation thought of and all the elemeiits it 
 is associated with are part of the activity of personal con- 
 sciousness which in its turn is brain activity. 
 
 Let this essential element of association be kept in mind 
 while the laws of association are considered alongside of it, 
 and they will be observed not only to corroborate the view 
 here given, but to be themselves illustrations of the same 
 fundamental law. Take the law of contiguity, for example.^ 
 " Objects once experienced together tend to become associated. 
 in the imagination, so that when any one of them is thought 
 of, the others are likely to be thought of also in the same, 
 order of sequence or co-existence as before." 
 
 What have we at the foundation of the following concep- 
 tions : " Objects occurring together," " associated in the 
 imagination," "likely to be thought of," "same order," 
 "sequence," "co-existence," "before"? Every thought 
 in this sentence implies the operation of the law here 
 given in its entirety, and observed in different degrees of 
 operation, with different resting states. 
 
 In the ordinary process of association the law does not 
 have free play to act of itself. " In no revival of past. 
 
 ' " Principles of Psychology," W. James, vol. i., p. 561. 
 
44 SOME PBOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 experience are all the items of thought equally . operative 
 in determining what the next thought shall be ; some 
 ingredient is prepotent over the rest, and the prepotent 
 items are received from some element of interest to the 
 personal consciousness or organism." And all elements of 
 interest, as I have tried to show, can be reduced in their 
 lowest physiological terms to an increase of self by spending 
 self, or to a spending of self for the increase of self, and 
 through rest to a perpetual increase of the operations of the 
 law. 
 
 (ix.) The operation of association depends entirely upon 
 one, and very much upon other, certain conditions of mind 
 and brain, which, in their related order, could be shown to 
 be dependent in themselves and their effects upon the same 
 law. They must be simply named, however, and the infer- 
 ence drawn from what has already been said. These con- 
 ditions are as follows : — 
 
 (1) The principle of constancy in the mind's meanings, 
 whereby " the same matters maybe thought of in successive 
 portions of the mental stream, and some of these portions 
 can know that they mean the same matters which the other 
 portions meant." This is the absolute condition. 
 
 (2) Automatism and habit, recency and vividness, con- 
 gruity of both emotional and physiological tone. These are 
 the modifying conditions. 
 
 At the present day it is agreed by all psychologists that 
 all the higher operations of the mind are carried on by means 
 of association with attention operating according to its laws. 
 Such, for example, as memory, expectation, constructive 
 imagination, judgment, reasoning , and generalisation. 
 
 To these must be added transferred feelings of pleasure 
 and pain, benevolence, conscientiousness, and, finally, all the 
 generalisations of science, of ethics, and of religion. 
 
 In these prolegomena to a philosophy of medicine there 
 is no opportunity to point out how all these higher expe- 
 riences are related to the law of life. The illustrations 
 given, however, may be sufficient to enforce a preliminary 
 recognition of such a law. 
 
 In a full treatment of the subject an adequate exposition 
 of the law in all its bearings worlf ':' -.;':: "■ 
 
CHAPTER IV. 
 
 Inferences from the Bio-dynamic Law. 
 
 § 1. If I have adduced sufficient evidence to enforce the 
 recognition of a bio-dynamic law, we are in a position now 
 to consider its relationship to the ordinary conceptions of 
 health and disease. 
 
 A person may be said t o be in full health when the law 
 of life has the fullest operation consistent with the structure 
 of the body — that is to say, when the resting and active states 
 relatively balance each other. In the resting state the body 
 will be in a condition of unstable equilibrium, ready for the 
 capacity for increase by exercise to be manifested in any 
 direction. The individual will be refreshed by rest of any 
 description. Waking from sleep will be attended with mani- 
 fest pleasure in anticipation of a possible increase of life, and, 
 in fact, of that increase already begun. Exercise and increase 
 will ensue, with pleasure in their results, rest will follow, 
 and the round be commenced again. This is ideal health, 
 and pre-supposes external and internal conditions to favour 
 it entirely. 
 
 § 2. If these external and internal conditions do not ] 
 favour it entirely there will be a departure from health. In 
 some degree, however slight, the equilibrium of the resting 
 state will be disturbed, and the increase by exercise will 
 become out of due proportion in different parts, and be un- 
 attended with pleasure if not attended with pain. There j 
 cannot, however, be a departure from the law of life as long j 
 as life is not destroyed. If this law could be abrogated it 
 would not be a law. The external and internal conditions \ 
 which do not favour the well-balanced operation of the law j 
 are the causes of disease. They are legion, as is well known, i 
 and a study of them is a science in itself. Disease is con-. 
 
46 SOME PROLEGOMENA TO A PHILOSOPHY OE MEDICINE. 
 
 stituted by the reaction of the law of life against these 
 •causes, it is the effort of the law of life in the face of con- 
 ditions which tend to the destruction of life instead of its 
 maintenance and increase. 
 
 § 3. A distinction has been made between these con- 
 ditions as external and internal. If a group of external 
 conditions has induced an ill-balanced operation of the law 
 of life, some structural alteration may be the result, and 
 this in its turn may be an internal cause of some further 
 disease. Such internal cause m'ay lead to mechanical or 
 •chemical defects, which in their turn may lead to further 
 structural and functional defect. 
 
 § 4. The phenomena observed as the result of the re- 
 action of the law of life against the causes of disease, in 
 their co-existence and sequence, truly vital, m.echanical and 
 •chemical, are termed the clinical history of disease : the 
 structural alterations which are characteristic of it, the 
 morbid anatomy, and the interaction of the law of life with 
 the internal causes as far as it can be observed and generalised 
 upon, pathology. 
 
 § 5. It is obvious that the causes of disease are im- 
 mensely more numerous than the conditions of health. 
 Every phase of disease which can be observed is observed as 
 & departure from health of the particular individual who is 
 manifesting these phases. 
 
 The recognition of the disease, in its clinical history, 
 morbid anatomy, and pathology, as related to the degree of 
 health it displaces, and as related to all other phases of 
 ■disease that are known to have occurred, is termed the 
 ■diagnosis of the disease. 
 
 § 6. A classification of disease to be natural follows the 
 anatomical and physiological order (primarily the resting 
 «.nd active normal states of the organism), beginning with 
 the most general of all, caused by some morbid poison, and 
 -ending with new growths. 
 
 Sub-groups are formed following more special anatomical 
 and physiological divisions, naming the disease, first, accord- 
 ing to the manifest pathological state, and, secondly, as to 
 the supposed, pathological or external cause. 
 
SOME PROLEGOMENA TO A PHILOSOPHY OP MEDICINE. 47 
 
 § 7. Eecovery from disease takes place when by its 
 own effort under the ordinary conditions which maintain 
 health, the law of hfe is able to resume its balanced capacity 
 to the full. 
 
 The tendency to recovery was formerly called the vis 
 medicatrix naturce, but it may be observed to be part of the 
 action of the law of life against the causes of disease. 
 
 § 8. An estimation of probability of recovery arrived at 
 by a comparison of the full diagnosis of the disease with 
 what remains of health in the organism is termed the 
 prognosis of disease. 
 
 § 9. If the causes, external and internal, of disease can 
 be voluntarily removed or altered in their effects from with- 
 out, either by a modification of the ordinary conditions of 
 health (hygiene), or by the application of a substance ex- 
 ternally, or the introduction of any substance internally 
 capable of altering the balance of the law of life in its full 
 capacity (therapeutics), or if mechanical operative measures 
 are brought to bear on the structure of the body (surgery), 
 these processes, one or all of them, are comprised under the 
 treatment of disease. 
 
 § 10. A recognition by the mind of the universal opera- 
 tion of the law of life will serve the widest philosophical or 
 explanatory purpose in the knowledge of disease, in its causa- 
 tion, clinical history, morbid anatomy, pathology, diagnosis, 
 prognosis, and treatment. 
 
 This statement might be illustrated by reference to a 
 single disease such as pneumonia, or a malignant new growth. 
 Let it be suggested to anyone who will undertake the task 
 to read the notes of a concrete case of either of these diseases, 
 or a text-book description of them, in the light of this law, 
 and it will be noticed how explanatory a knowledge of it will 
 be all along the line. 
 
 Take the instance of a new growth. Why is it malig- 
 nant ? The law will explain that the structural elements 
 are so much like the normal structural elements of the 
 organism, and the processes of growth so nearly allied to 
 normal processes of growth, that given the cause of heredity 
 in a certain individual, which is itself an illustration of the 
 
48 SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 
 
 law, the reaction of the law against the spread of the disease 
 is reduced to a minimum. It is almost like the law of life 
 operating against itself for recovery to,take place from a fully- 
 developed cancer. The law of life operating against itself 
 could only be death. 
 
 Another point, however, should be noticed. Malignant 
 disease occurs in the tissues which are next less highly 
 organised than the tissue of the nervous system, hence it 
 might be presumed that there would be some reaction against 
 the progress of the disease, which is, indeed, the case. And 
 this reaction is in proportion to the vigour and tone in which 
 the nervous system is able to continue. Note, too, the infer- 
 ences which our law gives to the general principles of the treat- 
 ment of malignant disease. Early and complete removal of 
 every vestige of the growth, and of any infected foci of con- 
 tagion, a maintenance of the health of the patient, as far as 
 this can be made vigorous under the circumstances, and a 
 placing him under the most favourable external conditions, 
 mental and bodily, for the continuance of health. 
 
 § 11. (i.) The wide, new, and fascinating science of bac- 
 teriology as a branch of biology might afford many illustra- 
 tions of the operation of the law of life, but they would be 
 out of place in this connection. 
 
 Two or three points may be referred to : The relative 
 simplicity of organisation, weakness of natural activity of 
 the single organism of bacteria, makes their propagation by 
 self-division so much the more easy if a suitable nourishing 
 material is provided for them. On the other hand, if this 
 nourishing material is denied them, their propagation is 
 reduced to a minimum, and known substances are capable of 
 destroying nearly all of them. Thus they occupy the lowest 
 standard in the scale of living beings, and in view of the 
 multitude of their forms and habitat, they would occupy a 
 relatively balanced position in relation to the causes or 
 recovery from disease and so, indeed, they do, as witness 
 the phenomena of phagocytosis. 
 
 (ii.) It is, however, as causes of disease that bacteria 
 offer the widest field for investigation and speculation in 
 relation to medicine. The whole theory of infection is based 
 
SOME PBOLBGOMENA TO A PHILOSOPHY OF MEDICINE. 49 
 
 upon bacteria, and as this covers the ground of more than 
 one generation, the process of infection is by no means an 
 easy one to understand. Our law will aid us, however, by 
 discriminating in a given disease or case as to what belongs 
 to the life of the bacteria and what to the life of the infected 
 individual. This point is a most important one in the 
 history of all infectious diseases, but more especially in the 
 history of tuberculosis. Perhaps less than in any other 
 disease, the pathology and morbid anatomy of tuberculous 
 disease does not belong to the life of the tubercle bacillus, but 
 is an organic result of that bacillus acting as an incentive to 
 the life of the organism which it infects. 
 
 (iii.) A knowledge of the law of life, too, will aid in the 
 treatment of infectious disease by effecting a discrimination 
 between the measures to be employed for destroying the 
 micro-organisms, or staying the process of infection, and the 
 measures to be adopted for aiding directly a recovery from 
 the effects of the infective cause. 
 
 § 12. (i.) The Science of Fharmacology., which may be 
 held to include both pharmacodynamics ,and drug patho- 
 genesy, occupies a most important position in the philosophy 
 of medicine. 
 
 A distinction must be drawn as to the use of the two terms 
 pharmacodynamics and drug pathogenesy. Pharmacody- 
 namics is not a branch of biology, except in so far as some 
 drugs have their orderly place in botany, and a certain 
 behaviour when subjected to preparation before being ad- 
 ministered to healthy life. These points, along with their 
 chemistry and the chemistry and physical qualities of non- 
 organic substances, constitute the true science of pharmaco- 
 dynamics. On the other hand, drug jpathogenesy is a true 
 branch of biology, or physiology, more strictly speaking. In 
 its origin scientifically, drug pathogenesy is an off-shoot from 
 the science of symptomatology and pathology, although 
 experimentally it has been derived from the common-sense 
 employment of drugs in the treatment of disease. 
 
 (ii.) Hahnemann was the founder of the science of drug 
 pathogenesy. It arose from a discontent with the prevalent 
 common-sense medicine of his day, and a perception that 
 
 4 
 
50 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 unless the effects of drugs were known in themselves from 
 having been administered experimentally in the healthy 
 individual, no accurate, or definite, or reliable inference could 
 be formed for their use in disease. 
 
 The paragraph in the " Organon of Medicine" ^ enforcing 
 this truth, deserves to be quoted in full. It is as 
 follows : " There is, therefore, no other possible way in 
 which the peculiar effects of medicines on the health of 
 ■ individuals can be accurately ascertained — there is no sure, 
 no more natural way of accomplishing this object, than to 
 administer the several medicines experimentally, in moderate 
 doses, to healthy persons, in order to ascertain what changes, 
 symptoms, and signs of their influence, each individual pro- 
 duces on the health of the body and of the mind ; that is to 
 say, what disease elements they are able and tend to produce, 
 since, as has been demonstrated,^ all the curative power of 
 medicines lies in the power they possess of changing the 
 state of man's health, and is revealed by observation of the 
 latter." In a note to this paragraph Hahnemann named one 
 other physician — Albrecht von Haller — who had thought of 
 this plan ; but in the next paragraph he says that he himself 
 was the only one who had pursued it with perseverance. In 
 § 110, Hahnemann affirms that known cases of poisoning 
 by drugs afford additional information in the realm of drug 
 pathogenesy ; and in the present day, experiments on animals 
 have been extensively made with poisonous doses, with a 
 view, if possible, to ascertain the deeper action of the drugs 
 in question. As to how far the results of experiments on 
 animals can be taken as equivalent to similar results being 
 expected on the human subject is an open question as yet ; 
 but the well-proved position of practitioners of homoeopathy, 
 that they can be corroborative merely of ascertained results 
 in the human subject, is the only safe one. And the safety 
 of this position is affirmed by the^most various effects from 
 bacterial infection observed in different animals by inocula- 
 tion with the same micro-organism. 
 
 (iii.) What is the relationship of the law of life to the 
 
 ' " Organon of Medicine," translated by Dudgeon, 1893, § § 108, 109. 
 'I6ii^., §§24-27. 
 
SOME PEOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 51 
 
 effects of drugs ? First of all, it teaches that the action of 
 the drug cannot be discovered from any inherent dynamic 
 effect that it has. This action may be either chemical or 
 physical, but whatever the effects may be, they are the effects 
 of a reaction of life upon the action of the drug. And in no 
 sense of the word are action and reaction in this case equal, 
 any more than the reaction of protoplasm, or of organised 
 life, is equal or opposite to the stimuli which are a condition 
 of its life. The conditions of life as stimuli, all the mijlti- 
 farious drugs which might be proved on the healthy, or 
 observed as poisons, or used in experiments on animals, can 
 separately be compared in themselves, classified in their 
 quantitative, mechanical, molecular, physical, and chemical 
 relations ; and so, indeed, can all the observed effects of the 
 operation of these natural or artificial stimuli on the organism 
 be compp,red and classified ; and the two groups of causes 
 and effects may be compared, but, in no sense of the word, can 
 the effects be said to be the result of these causes unless an 
 account be taken of the reaction of the organism upon these 
 stimuli, by means of the operation of the law of life. 
 
 (iv.) An assumption of this position through the recogni- 
 tion of a separate law of life, disposes of the notion of the 
 opposite action of small and large doses of drugs. 
 
 That they may have primary and secondary effects is 
 another matter, and it is to be expected that they would 
 have primary and secondary effects. 
 
 A drug is not a drug, if in a moderate dose it does not cause 
 some symptoms or signs in the organism suggesting disease. 
 These may be slight and quickly pass away, but if the stimu- 
 lant in the nature of the drug has a more violent action, 
 although this cannot be known, the action of the organism 
 is perceived as both action and reaction, which in pure 
 physics are equal and opposite, but in physiology partake of 
 contrasted effects, which in their successive groups appear 
 as one group opposed to the other. The terms primary and 
 secondary in pure strictness can only be applied to groups 
 which seem directly dependent on each other in their order 
 of appearance. Thus they may be associated with one organ 
 or function, or with one part of that organ or one phase of its 
 
52 SOME PEOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 function. These terms, however, may be used in a very 
 much broader sense. They are appHcable to groups of effects 
 vs^hich may form the whole content of a science of drug 
 pathology. Suppose, for example, a haemorrhage results 
 from an ulcer in the duodenum caused by poisoning by 
 the bichromate of potash or nitrate of uranium, and the 
 patient suffers severely from the mechanical effect of blood in 
 the intestine, and from the dynamic effect of being deprived 
 of blood-pressure, pabulum supplied to the tissues, or oxy- 
 genated hsemoglobin. It would be incorrect -to say the 
 symptoms due to the hsemorrhage were symptoms due to 
 the drug, yet they might be most important in the history 
 of the patient's state. This is an extreme case and might 
 not lead to much confusion in the orderly conception of the 
 effects of the drug in the mind of the observer. But what 
 are we to say of the effects of antimony, arsenic, iron, mer- 
 cury, lead, silver or phosphorus on the animal economy ? 
 Their pathogenesy is mixed up with primary and secondary, 
 functional and structural, direct and indirect effects, which 
 in their co-existence and sequence, dependence and inter- 
 dependence, is a science in itself. 
 
 (v.) Why certain drugs should have an af&nity for certain 
 organs or tissues or functions of the body is by no means 
 yet explained. That they have this af&nity is undoubted, 
 and it is acknowledged by many modern observers in phar- 
 macology, although they do not recognise its full significance 
 for therapeutics. Efforts are continually being made to 
 explain this af&nity by chemical analogy and theory, but as 
 the chemical equations of protoplasm and all the formed 
 material of the organism are not yet discovered, any ex- 
 planations of pure pathogenetic effects, from the chemical 
 point of view, at present lack the major premise to a satis- 
 factory conclusion. 
 
 It is in the sphere of chemistry, however, that we may 
 anticipate eventually a solution of this problem, but what a 
 portentous knowledge the explanation will involve ! And 
 when we have it, how many principles and considerations 
 will have to be taken into account in the application of a 
 chemical theory in the «sms mi niorbis. And suppose, too. 
 
SOME PBOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 53 
 
 a chemical theory is forthcoming, will the pathogenetic 
 theory be set aside ? Not at all. The chemical theory will 
 be simply brought into relationship with it, and it is safe to 
 prophesy, I think, that a theory based on pathogenesy will 
 continue to. be the more reliable guide in therapeutics. 
 
 (vi.) Granting the principle of drug aflSnity for certain 
 organs, tissues and functions of the body, in view of the 
 universality of the one law of life, amid the diversity of 
 form and result in which it is manifested, it is not difficult 
 to anticipate that different individuals with different tempera- 
 ments, idiosyncrasies and susceptibilities, would exhibit 
 different shades of reaction to the influence of the same 
 drug. These different shades of reaction have been termed 
 contingent effects as distinguished from the invariable effects 
 which are called absolute. 
 
 It may be added that this distinction between the two 
 classes of effects has been carefully worked out by two pro- 
 minent writers among homoeopathic practitioners — viz., 
 Drs. Drysdale and Hayward. A good account of the sub- 
 ject will be found in " Materia Medica, Physiological and 
 Applied." What I wish to remark upon more especially is 
 the scientific value placed upon contingent effects. It is 
 argued that as indications for the use of a drug in disease, 
 these contingent effects, though of corroborative value, are 
 of higher value than the absolute effects. And for this 
 reason, — that what occurs as a real effect in one individual, 
 presupposes the power of the drug to produce the same 
 effect in all. 
 
 On what but a universal law of life this conclusion could 
 be based it is impossible to conceive. The contingent effects 
 of drugs, however, could scarcely become admitted facts of 
 drug pathogenesy unless they had occurred in two or more 
 persons. Otherwise, as no two persons are absolutely alike, 
 some peculiarities of the idiosyncrasy might be put down 
 as drug effects which had nothing whatever to do with 
 them. 
 
 Every fact set down as a drug effect must be capable of 
 being proved to be a drug effect, or reliance placed upon it 
 may prove to be delusive in the highest degree. 
 
54 SOME PEOLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 § 13. (i.) The broad subject of the Treatment of Disease 
 has been, by a brilliant writer, Dr. Carroll Dunham,^ clearly 
 marked out into two sections — therapeutics and hygiene. 
 Therapeutics consists in the treatment of disease by drugs, 
 and measures adopted other than this partake of the char- 
 acter of hygienic measures, as they consist of a modification 
 of the ordinary conditions of the patient's health. It is only 
 within the last few years that the British Medical Association 
 has devoted a special section of its work to pharmacology 
 and therapeutics. At the first annual meeting of this section 
 in 1884,^ Dr. T. J. Maclagan, the president of the section, 
 laid down the following principles for the guidance of the 
 section. He grouped his remarks under two heads, viz. : 
 1, Methods of therapeutic research ; and 2, Points necessary 
 to scientific inquiry as to results of treatment. Under the 
 first head we have given: (1) Experiments on the lower 
 animals, (2) Statistics, and (3) Individual observation at the 
 bed side. Under the second heading he gives : (1) Accurate 
 noting of all symptoms throughout the course of disease, 
 (2) A statement of the constitutional peculiarities of the 
 patient, (3) Details of the mode of application of methods of 
 treatment, (4) Details of comparisons of different methods. 
 To men who, for a considerable part of their lives, have 
 been familiar with the method of Hahnemann, these points 
 seem poor and meagre in the extreme. But really, in view 
 of the chaotic state of drug treatment at the time of the 
 inauguration of the therapeutic section of the British 
 Medical Association, they contain some excellent principles, 
 which might serve as a foundation for a science of thera- 
 peutics. Of course we shall not forget that Dr. Maclagan, 
 as the custom was and is, simply ignored Hahnemann and 
 his work, and the history of homoeopathy since his time. 
 
 (ii.) When, in many generations to come, a historian 
 writes an account of medical progress through the ages, the 
 pages recording the theory and practice of the nineteenth 
 century will be branded with shame. The leaders of 
 medicine in this century have seen only the mistakes of the 
 
 ' "Lectures on Materia Medioa," vol. ii., Philadelphia, 1886. 
 ^ British Medical Journal, vol. ii. , 1884. 
 
SOME PHOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 55 
 
 man of surprising genius and unhesitating speculative 
 daring, who, a hundred years ago, founded scientific thera- 
 peutics. Had it not been for his capacity for, or even the 
 certainty of his making mistakes, Hahnemann never could 
 have given to the world the suggestion that drugs should be 
 used in diseased conditions similar to what they were capable 
 of causing in health. Even now it seems that this sug- 
 gestion has been given to the world almost a hundred years 
 before its time. That Hahnemann, in the absence of any 
 defined law of the phenomena of life, should have been able 
 to arrive at the generalisation of the rule of similars, speaks 
 volumes for the range of his observation, his critical acumen, 
 the broad basis of his discriminative power, and yet for the 
 patient pursuance of the smallest detail of scienfific research. 
 He has set a grand example to his disciples and indeed to all 
 leaders of medicine to follow in his train. 
 
 (iii.) Hahnemann gave some explanations of the rationality 
 of the employment of the rule of similars. These have been 
 very ably summarised by Dr. Madden,^ in his Congress 
 address, so that I need not repeat them ; ■ and, as Dr. 
 Madden suggested, in the light of present day knowledge 
 they cannot be accepted. Notwithstanding, however, that 
 Hahnemann's explanation of the rationale of the rule of 
 similars fails to be correct, in response to his example, the 
 rule has been tested by the experience of thousands of men 
 of unquestioned capacity ; and in the estimation of those 
 who have faithfully tried it, it stands higher far than any 
 other principle that could be adopted for the administration 
 of drugs in disease. 
 
 (iv.) Does the law of life that I have been illustrating 
 afford a clue as to the rationale of the application of this 
 rule ? I think it does. It will be remembered that I tried to 
 enforce this truth : That life takes advantage of fine shades of 
 difference for the increase of itself. This is observable from the 
 very beginnings of life upwards to the highest scale of thought.. 
 We saw it in the phenomena of reproduction by cell division, 
 in the process of fertilisation, the whole phenomena of sex 
 being an illustration of it, and in the early changes which 
 ' Monthly Homceopathic Review, October, 1895. 
 
56 SOME PEOLEGOMBNA TO A PHILOSOPHY OP MEDICINE. 
 
 take place in the ovum. Its influence could be traced all 
 through the process of development, in the variety of histo- 
 logical element, as well as in naked-eye morphology. To it 
 we owe multiplication and symmetry of form, and diversity of 
 function in all directions. A large number of experiences of 
 daily occurrence might be brought before you as illustrating 
 this truth. I will only mention two or three. Supposing 
 you have been listening intently to an address, and fixing the 
 eyes for some time on illustrations, a state of fatigue ensues, 
 which eventually, in spite of an absorbing interest in what 
 is going on, makes itself felt in consciousness. The slightest 
 movement in the chair, or a rubbing of the eyes with the - 
 hand, or even closing them tightly for a few seconds, will 
 bring about a change and relief to the sense of fatigue, so 
 that attention may still go on for a further length of time. 
 Or, suppose one is reading a story, and the author leads the 
 reader along well-worn channels for most of the way, until in 
 the course of the plot, he introduces a slight new feature, 
 which influences the subsequent course of events in a way 
 that was not anticipated. Directly this new feature is 
 observed, a thrill of fresh interest arises in the mind of the 
 reader, which casts its glow over the whole picture. Or 
 again, if in the course of a series of scientific experiments, 
 some slight new result is attained, not significant in itself, 
 but correlated with other results, the interest supplied 
 by this new feature is extended all along the line, I need 
 not multiply instances, but proceed to apply this truth to the 
 subject in hand. 
 
 We must remember the law of life never ceases its opera- 
 tion until extinguished into silence by actual death. While 
 life lasts, notwithstanding the virulence of the disease, there 
 is still some vestige left of th^ operation of the law of life. 
 By the use of drugs, a set of stimuli of a different order 
 from the normal stimuli of healthy life, and different from 
 the causes of disease, are brought to bear on the organism, 
 to which it is bound to make a response. If a stimulus of 
 this kind is applied in the course of disease, which, given in 
 a sufficiently large dose in health, would cause a condition 
 similar to the picture and course of the disease — what is 
 
SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 57 
 
 likely to happen ? Simply, that the law of life, or the vis 
 medicatrix naturm, or the organism, if you like, will take 
 advantage of the shades of difference in stimuli, and make 
 a larger effort to increase itself; or, in other words, to 
 return to health. It is the shade of difference in the 
 stimuli between the cause of the disease on the one hand, 
 and the dose of the drug exercising its affinity and causal 
 relationship on the other, which is the essential point to keep 
 in mind as an explanation, while the similar relationship is 
 the guiding principle for the selection of the medicine. 
 
 (v.) Let me point out under a few heads how many 
 features which, by experience, are regarded as essential to 
 the success of homoeopathic treatment, are explained by a 
 recognition of this truth : — 
 
 (a) The removal of the external cause or causes of the 
 disease. If these remain, the appropriate drug will be sure 
 to fail in its effect ; it will be neutralised as a stimulus to 
 healthy action. 
 
 (b) Rest or exercise of the particular organ, or organs, as 
 may be called for according to the nature of the disease pro- 
 cess. These are emphatically hygienic measures, which 
 would favour the organism taking advantage of a drug 
 stimulus of the kind referred to. 
 
 (c) Limitation of the dose of the drug to one below that 
 required to produce its physiological effect, or else two 
 similar diseased states might be produced ; one could not be 
 an aggravation of the other, however, only an aggravation 
 of the sufferings of the patient. 
 
 The limitation of the dose, however, must not be pursued 
 so far that there is danger of the patient not having any 
 medicine at all. This question can only be decided by two 
 lines of inquiry : (1) By experiment as to how far drugs can 
 be divided by mechanical means, and yet have some of the 
 substance remaining in the vehicle of division and adminis- 
 tration. (2) By a collection of authenticated cases where 
 drugs have been administered in a very high state of dilution, 
 and the effects noted and compared with those which have 
 had other doses administered, and with those which have 
 had none at all. 
 
58 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 {d) A frequency of repetition of the dose, corresponding to 
 the length of time each dose takes to exhaust its effect. If 
 the dose be too frequent the organism becomes tolerant of 
 its effect, and the drug ceases to be of use. Generalisations 
 on this question can only be made from clinical observation, 
 and by the careful record of facts over a large number of 
 cases. A required frequency of repetition, too, will vary 
 much with the disease in its character, course, progress, 
 intensity, and prognosis, and with the same disease in dif- 
 ferent varieties of temperament and degrees of susceptibility 
 to external influences. 
 
 (vi.) The explanation which I have suggested will throw 
 light also on some inductions of Plahnemann relating to the 
 observation of disease as a guide in the selection of the 
 remedy. 
 
 (a) The totality of the symptoms constitutes the disease 
 for the purpose of a cure. Symptoms in preference to the 
 effects of the disease, such as the morbid anatomy, I take 
 it to be meant here. As it is the condition of the patient, 
 rather than the condition of the disease (which is an ab- 
 straction of the mind) , it is desired to influence by the drug, 
 the symptoms offer a far truer guide to the quality and 
 degree of the reaction of the law of life against both the 
 causes and effects of morbid processes, than the causes and 
 effects themselves. Let me illustrate this point by an 
 example. Take a case of empyema coming for the first 
 time under observation, and diagnosed as such. If any 
 benefit is to be derived from drugs in such a case, it will 
 not be by treating the collection of pus in the pleural cavity 
 as such, which would be absurd, but by giving a drug which 
 shall have a similar relationship in its pathogenesy to the 
 symptoms presented by the patient under treatment. If a 
 drug should have caused such a thing as empyema this fact 
 would, cceteris paribus, be an additional indication for the 
 use of such a drug. Of course, the primary and immediate 
 indication in the treatment of such a case would be not by 
 drugs at all, but by the evacuation of the pus and the 
 cleansing of the pleural cavity ; but if there is any truth in 
 the law I have been trying to enforce, in addition to the 
 
SOME PEOLBGOMBNA TO A PHILOSOPHY OF MEDICINE. 59 
 
 surgical procedure required in this case, the patient will be 
 helped by the administration of drugs according to the rule 
 of similars. That is, if the symptoms depending on the 
 original cause of the empyema are taken into account, the 
 presence of the pus as a symptom, the symptoms of dyspnoea, 
 hectic, &c., depending on the presence of the pus, and a 
 prescription made on these. And a fresh prescription will 
 be required after the pus has been evacuated and the cavity 
 cleansed, because the condition of the patient will be 
 altogether different. 
 
 (6) The second induction of Hahnemann I wish to 
 allude to is that the most peculiar and most characteristic 
 of the symptoms out of the totality, particularly those ap- 
 pertaining to the mind, are the more important for the 
 guidance of the physician in the choice of a drug. Let me 
 still illustrate my argument by the pursuit of the illustration 
 of an empyema case. A case was sent into the London 
 Homoeopathic Hospital last year ; it was the result of a 
 very severe attack of influenza, and had been under my care 
 for three weeks, the empyema having been diagnosed a few 
 days before the patient was admitted into the hospital. The 
 patient was a lad of 18. Immediately on admission about 
 fifty ounces of pus were evacuated from the pleural cavity 
 by Mr. Knox Shaw, and the patient was put back to bed. 
 I do not know what medicine was given, but I know that in 
 a day or two afterwards the patient developed hsematuria, 
 and albumen was noted in the urine for some days or weeks 
 afterwards. The patient also was very quiet, depressed, 
 and irritable. These symptoms were doubtless due to the 
 poison of influenza, but the point I want to emphasise is 
 that in this particular case the occurrence of hsematuria 
 became a most important indication for an entire review of 
 the patient's condition as far as the drug treatment was 
 concerned, not because it was necessary to treat the patho- 
 logical state of the patient's kidney, but because the occur- 
 rence of the hsematuria afforded an extremely suggestive 
 and important indication as to the influence of the influenza 
 poison, and by contrast to the behaviour of the organism 
 under it, and by contrast still, it was an important indica- 
 
60 SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 
 
 tion for a drug, whicli should have this as one of the 
 characteristic symptoms in its pathogenesis. I do not know 
 what treatment was adopted in this case, but under the 
 skill of Mr. Knox Shaw and Dr. Moir, the young man com- 
 pletely recovered. 
 
 Why mental states should have an important relation to 
 the symptoms of disease can only be understood by the 
 recognition of a law relating both mind and body conditions. 
 As we saw that in mind the law of life operates in its entirety, 
 the induction of Hahnemann, that mental states are ex- 
 ceptionally important indications as to the whole bodily 
 state, becomes verified by deduction. 
 
 (vii.) The explanation I have been offering of the opera- 
 tion of the rule of similars, also throws much light on the 
 scope and limits of its value in the treatment of disease as 
 at present understood. It is in the large class of functional 
 disorders, which arise from an impingement upon the 
 organism of unfavourable conditions from without, and yet 
 do not give rise to any actual change of structure, and tend 
 to regular and complete recovery, that the method will be 
 most easy to apply, and the organism be most quick to re- 
 spond to its influence. 
 
 The dividing line between functional and structural dis- 
 ease is difficult to mark, but if the knowledge of a single law 
 of life has much influence over the knowledge of diseases, 
 it will determine a much larger number to be regarded as 
 functional than has hitherto been the case. I offer the 
 instance of pneumonia as an illustration for speculation upon 
 the subject. Where, under the influence of heredity, the 
 specific poison of syphilis, or some other long-continued un- 
 healthy condition of mind or body, actual degenerative 
 changes have taken place, or new growths have ensued, 
 there can be little expectation of cure by the operation of 
 the rule of similars. Much, however, may be accomplished 
 by way of relief to conditions which result from the de- 
 generation or the new growth, the principle of treatment 
 being to enable the organism to take advantage of any ex- 
 ternal stimulus to its normal activity and resistance to the 
 process of disease. Here, again, the symptoms are the 
 
SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 61 
 
 guide, provided a careful and accurate discrimination is made 
 between them, past and present, dependent and inter- 
 dependent. 
 
 (viii.) The explanation I have been offering opens up, how- 
 ever, the prospect of new fields of conquest far beyond those 
 at present reached. If the organism invariably takes ad- 
 vantage of shades of difference for the increase of itself, the 
 method of similars in the treatment of disease becomes 
 capable of almost unlimited development, and we may an- 
 ticipate that eventually no process of disease actually in 
 progress and where death of parts or the whole of organs 
 has not taken place, will fail to be brought under its influence. 
 Under this head the whole question of treatment by 
 nosodes and inoculation by cultivations of micro-organisms, 
 which is still in a nebulous state, will come under considera- 
 tion. 
 
 (ix.) And if this law holds good for the recovery from 
 disease, will it not also hold good for its prevention? In 
 his address at the Congress, Dr. Madden instanced many 
 current views under this head, and which seemed to be 
 analogous to the operation of the rule of similars. My 
 argument, I believe, throws light upon them all. When 
 the organism has once passed through the ordeal of an 
 acute specific^disease, it is usually immuned from a second 
 attack. Why ? Because of the law of self-increase by 
 exercise. The distinctive peculiar poison in question offers 
 such a different stimulus to the organism from its ordinary 
 conditions, such is the degree of reaction by the law of life, 
 that if the same stimulus is offered again, the organism is 
 proof against it ; and that the reaction once offered to this 
 peculiar poison is so universal and intense that it covers the 
 whole life of the organism now and for the remainder of its 
 existence. 
 
 Not everyone, however, is immuned from a second at- 
 tack of any disease, and this arises, as is well known, from 
 a difference in the susceptibility of single individuals as dis- 
 tinguished from the majority. In order to illustrate this 
 point, take an example of contrast which, by way of cause, 
 comes perhaps midway between an exaggeration of some 
 
62 SOME PROLEGOMENA TO A PHILOSOPHY OF MEDICINE. 
 
 natural conditions of health and an acute specific poison — 
 I mean, croupous pneumonia. If a patient had just 
 thoroughly recovered from acute croupous pneumonia, it 
 would not be anticipated he would have a second attack of 
 that disease immediately following the first, even if exposed 
 to the cause again. True, it would be dangerous to expose 
 him to the cause, but we can imagine a small relative im- 
 munity against a recurrence of that form of pneumonia, 
 because its cause has a shade of difference about it from 
 that of simple inflammations of the air cells of the lungs, or 
 of the bronchial tubes. But the poisons of small-pox, scarlet 
 fever, or measles are so specific, so peculiar, and affect the 
 whole organism so thoroughly, that (to strain a point) we 
 should require it to renew its youth before it would be 
 affected by an onslaught of these poisons a second time. 
 
 These speculations open up so many channels of thought 
 that one would fain pursue, did space permit. They must, 
 however, be reserved. Vaccination may be named as an 
 established procedure for the prevention of disease, as an 
 illustration of the same principle, and, from a slightly 
 different standpoint, the injection of antitoxin serum for 
 the prevention and cure of diphtheria. 
 
 What is needed for the development of these methods, 
 and an estimation of their relative value, is time and accu- 
 rate observation and collection of facts. A principle' can 
 only be of value in practice when its limits, as well as its 
 scope, are thoroughly understood. 
 
 (x.) Two more points only under the guidance of the 
 law of life I propose to briefly allude to. As the rule of 
 similars is the response of the physician to the natural law 
 of health and disease in its widest sense, so it becomes the 
 most scientific basis for the practice of medicine, and we 
 may truly say that, if faithfully pursued, medicine is raised 
 by it to the position of the finest of the arts. Medicine here, 
 as indeed all curative medicine should, not only touches 
 humanity at its foundation, at its spring, but it also depends 
 for its motive upon the inspiration of that spring. 
 
 As yet, however, knowledge is imperfect, and the science 
 of the causation of disease is but in its infancy. It is, there- 
 
SOME PEOLEGOMENA TO A PHILOSOPHY OP MEDICINE. 63 
 
 fore, impossible to secure the highest results to humanity 
 from the healing art, because the causes of many diseases 
 are still operative and cannot be removed. Accordingly, a 
 pursuance of the science of aetiology, and depending on that 
 preventive medicine, which will progress with far greater 
 strides than hitherto if a knowledge of the law of life is fully 
 grasped, become of primary consideration in the mind of the 
 practitioner. They occupy a major place to' that of the 
 intention to cure. Such advances all take time, however, 
 and there are thousands of patients in bed, suffering in- 
 tolerable pain and dying of incurable disease. What should 
 be done ? First and foremost, they should be given every 
 advantage of treatment by the rule of similars carried to its 
 furthest scientific development. But if, on account of in- 
 eradicable organic change which acts as an incubus to the 
 organism in its endeavour to maintain and increase itself, 
 and causes untold pain and loss of rest, any or every means 
 that can be known should be adopted for relief, here it is 
 that surgery in all her branches finds her place, and in sur- 
 gery the great sphere of anaesthetics. But as long as the 
 patient understands their effect and is willing to place 
 confidence in the wisdom and judgment of the physician, 
 anaesthetics are justifiable in medicine as well as in surgery, 
 I fully believe, and so, less measures than those required to 
 produce anaesthesia — anodynes, sedatives, stimulants, coun- 
 ter irritants and anything which allopathy or antipathy may 
 suggest to the mind of the physician, provided he knows 
 what the effects of the means he uses would be if the 
 patient were in health, and if in the full light of a knowledge 
 of the law of life, he allows the halo of the ideal scien- 
 tific method to cast its glory down his path. And so, too, 
 with the adoption of all measures which in the treatment 
 of disease might be termed hygienic, such as careful dieting, 
 including the use of animal extracts, the use of hydropathic 
 or electropathic measures or the employment of massage. 
 A place for all these will perhaps be found pending' the 
 time when knowledge shall have advanced to the point 
 that the cause of all disease is known to its final degree, 
 and when the primary duty of the physician shall be to 
 
64 SOME PBOLEGOMBNA TO A PHILOSOPHY OF MEDICINE. 
 
 prevent these causes operating, and if he cannot prevent 
 them, it shall be his privilege to cure them, cito, tuto, et 
 jucunde. 
 
 (xi.) One word must be added as to treatment by sug- 
 gestion. There can be no doubt as to its validity, and that 
 it has its basis in the law of life, and in the predominating 
 influence of the mind over the body in health. As I have 
 stated before, in mind we have the law of life operating 
 on itself, or on its essence, if such a thing can be conceived. 
 And in certain classes of disease, which depend on disordered 
 innervation, either central or peripheral, I see no reason 
 why not, but quite the contrary, that treatment by suggestion 
 should be of great practical service. But theoretically, at 
 least, I fail to see the necessity of inducing the hypnotic 
 state, unless indeed the mind of the patient were excessively 
 morbid. In all cases of treatment by suggestion the mind of 
 the physician must be strong, firm, confident, perspicuous, 
 and broadly benevolent, illustrating the law of life in its 
 highest degree. To pursue this subject further would be out 
 of place, it belongs to the psychology of the future rather 
 than the physiology of the present. 
 
 (xii.) Froha the philosophical position indicated in these 
 prolegomena, I must pass rapidly to a few practical con- 
 clusions relating to the work of the Homoeopathic Society in 
 the immediate present. 
 
 As regards the views put forward in this address, I trust 
 they will be seen to have sufficient cogency and practical 
 bearing to merit attention and criticism ; and finally, in 
 whatever form seems most reasonable, acceptance. In the 
 discussions of the sessions later on, there will be abundant 
 opportunity of putting them to the test. I can only say for 
 myself, that ever since I perceived that there was a single 
 fundamental law, operating in the single basis of life, it has 
 given me an insight into the processes of life in health and 
 disease, and has been a guide in treatment, such as I could 
 never have anticipated a possession of. "What is the honest 
 thought of one is not his own, for he never could have 
 attained to it had it not been for his fellows. 
 
 As a direct result of this thinking, it seems to me that 
 
SOME PEOLEGOMBNA TO A PHIJjOSOPHY OF MEDICINE. 65 
 
 certain points are immediately necessary to the progress of 
 scientific medicine. The first of these is the improvement 
 of our knowledge of drug pathogenesy. The facts of the 
 materia medico, still require sifting out from a mass of 
 unverified assertion,, which, until verified by competent ob- 
 servers, can never be accepted as fact. I say this in 
 ignorance of what the Index to the " Cyclopaedia of Drug 
 Pathogenesy " is yet to be. 
 
 Then we need a new presentation of the verified materia, 
 in an orderly anatomical and physiological sequence of ar- 
 rangement. And, finally, the gaps of unknown regions, of 
 suspected pathogenetic effects, require to be filled lip by the 
 systematic re-proving of many drugs ; and this to be under- 
 taken in all the light of modern physiological inquiry and 
 method. In therapeutics, cases, cases, cases are required, 
 with the remedies used, recorded, and made the most of in 
 the detail of the record. In a society primarily devoted to 
 that subject, the record of therapeutics does not belong to 
 the materia medica section alone; it should occupy its 
 adequate portion of the time of the section of medicine, 
 and dovetail into that of surgery and gynaecology. As re- 
 gards the special duties of the medicine section, I need 
 scarcely remind you they are common to all societies of 
 medicine. Even though we may possess a method of drug 
 administration which, to a certain extent, is independent 
 of pathology and morbid anatomy, a knowledge of these is 
 absolutely essential to an understanding of the clinical 
 history, than which there is no more important branch of 
 medical knowledge as to what and when and how to apply 
 a remedy. 
 
 Accordingly, the more the section of medicine can bring 
 forward cases illustrating unusual points in pathology and 
 morbid anatomy, or unusual occurrences in clinical history, 
 the more useful that section is likely to be. 
 
 As to the section of surgery, I scarcely feel myself com- 
 petent to speak, except that as physiologists, pathologists 
 and therapeutists, we may look to surgeons for side-lights 
 on all these spheres. And so also with gynaecology. 
 
 In a great constructive work of engineering skill, in his 
 
66 SOME PEOLBGOMBNA TO A PHILOSOPHY OP MEDICINE. 
 
 drawing of plans and estimation of quantities, the engineer 
 is always bound to reckon on a certain unknown quantity 
 for which the most exact of calculations will fail to account. 
 If this is the case with a science and an art which possess 
 the exactness of the mathematician and physicist, to how 
 much greater an extent is it the case with principles and 
 practice based on the biological sciences, the knowledge of 
 which is based on phenomena which are ever undergoing 
 change. Yet the biologist has one immense advantage over 
 the physicist and mathematician. Although the Unknown 
 element in the reckoning of the medical practitioner is 
 almost infinitely greater than that of the engineer, the 
 unknown is invariably offering itself to the effort of his 
 observation, of his interest, and of his understanding. 
 
 It is in the transition from the known to the unknown 
 that our Society- stands midway. In the present session, as 
 indeed in all future sessions of its existence, may she step 
 still further into the unknown and bring far greater con- 
 quests into the known than ever she has done before.