The Address Delivered in the Section of Surgery
Authors: A. Prichard
Journal: BMJ (1882)

undoing.Yet farther: our comparison cannot be bounded by the study of our own nearer brethren-of the men of our time and country.Clinical phenomena are not as the chemical or physical, which can be reproduced at will, and are calculable for any latitude.We have to learn how diseases vary with the conditions of place and time, of season and soil, and even of race and temperament.For it may turn out that the races which enter even into the composition of our own nation bring each their own tincture of decay.I remember that, when I left Sir William Jenner's class in Great Ormond Street to practice in Leeds, I was struck by the singular fitness of his description of the " tubercular" subject to the slightly built oval-faced dark-eyed prehistoric race which has survived so many subsequent incursions and.defeats, and still makes so large a part of the population of a district, such as West Yorkshire, which lies under the hills of Strathclyde.Till these studies are more complete-and as yet they are scarcely begun-we cannot hope for a system of medicine, but must content ourselves with a mere corf)us prescriptionum; and the skill of the physician must still lie rather in a " kind of felicity" than in a measured and orderly power.Towards this higher phase of our own art let us strive.Our knowledge of the physical conditions of life is increasing daily, and not only so, but within the life of this Association marvellous discoveries have been made in one vast field of inquiry by the labours of Pasteur and Lister, and their brilliant disciples.I refer to the inquiry into those vital influences which disturb the body from without.Until we can eliminate the chief morbid factors which affect us from without we cannot understand our failures from within.In his treatise on Airs, Water-s, an! Places, Hippocrates laid the foundations of the study of the external factors of life: it has been left to our own day and to the great teachers I have named to advance this research from the study of the inorganic factors to that of the organic.Again, the natural history of acute disease has been mapped out with a degree of completeness which enables us in the continued fevers, in acute pneumonia, in local inflammations, in pulmonary and encephalic hbemorrhages, in chorea, delirium tremens, mental diseases, and so on, to approach somewhat nearer to positive prediction, or at any rate to make some distinction between the course of nature and the effects of our own interference.Another great and curious department of knowledge has been opened out to us during the life of this Association, one which affords yet a much wider scope for discovery and application.I refer to the embryo- logical interpretations of the phenomena of disease ; these being traced either in arrested development, as in many defects and de- formities of body and mind, or in retrogressions, such as leucocythaemia.The comparison of embryonic periods in the same and in different animals may be a master-key even to the diatheses themselves, as may be sug.gested, for instance, in the chief functional disorder of lithiasis, wherein the formation of urates in place of urea is the resumption of a state normal to inferior types.The strumous diathesis again is, it would seem, a permanent arrest of development at a stage short of the highest, and may indeed be, and commonly is, artificially attained by exposure to conditions such as deprivation of light, etc., acting in arrest of the completion of growth, as we know that they do in case of lower forms of life.The later work of our histologists is full of suggestions of this kind drawn from the study of heterogenous growths.Finally, I may refer briefly to a very different method of research-to the numerical- which, although by no means a new principle, may be called neverthe- less a product of our own half century, as beforetimes the means of collecting statistics on scales large enough to eliminate minor variations did not exist.