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simple fact can again be made available to lighten our slow steps along the difficult passes of medical knowledge. And such unphilosophising haste in drawing conclusions from insufficient data, how often does it humiliate us in the sight of the public! When the fallacy is demonstrated and swept away, the deluded hopes and promises to which it gave birth still linger and rankle in the memory.
Let medicine take her stand upon her positive works : they are surely something to be proud of; the ardent labours and devoted energies of those who have struggled and are still struggling in her service have not been unrewarded; the tree is vigorous, though its growth be slow ; each fact gained, small and insignificant though it may seem in its isolation, is a fresh evergreen, and persistent leafanother item added to it. By the combination of individual facts (and each, sooner or later, must find its proper adjustment in the scheme), medicine can alone hope to become a consistent whole. A positive fact—that is, a result which extensive experience demonstrates to us as the invariable consequence flowing from certain given conditions—becomes a principle in our institutes of medicine, which will endure as long as disease afflicts the body; or, if its immediate antecedents and its consequences be yet undiscernible, or dimly seen, there it stands, disconnected as it seems, one more aid acquired, one more solid basis to rest upon, awaiting its true interpretation, which will be manifested either through the illustration it may acquire from other like isolated facts already gathered, or from those which, yet undiscovered, remain to reward the searcher's industry; and who can doubt (however far distant the day may be) that the accumulation of these treasures will, at last, in the hand of some comprehensive genius, be made to yield grand and general principles in medicine ?
Much, I believe, of the erroneous method we pursue in the treatment of diseases, as here related, may be traced up to the views we are apt to take of their nature. Such views have, not unnaturally, resulted from the manner in which we have been hitherto compelled to study pathology. The searching spirit with which the physical diagnosis of disease has of late years been prosecuted, may also have to answer, in some degree, for the confined ideas which its cultivation has engendered. Pathological investigations have been necessarily exercised, in the first instance, upon the morbid changes which individual organs and parts present to the anatomist, and this has led us often enough to imagine that the abnormal conditions of this or that diseased organ was, in fact, the disease itself. Our physical diagnosis, too, so carefully applied, has also inclined us to give a locality to disease, and to withdraw our attention from broader ideas of its nature. We must remember, however, that these visible, or, as we call them, organic changes of parts, are, after all, and in almost every case, nothing more than the rude manifestations of some general evil, which has been long working in the system; that what we are pleased to call the disease is, in truth, the last conse
quences of a series of morbid actions, of whose existence we thus obtain the knowledge, but whose intimate nature is hidden from us.
The investigations of the degenerations of the tissues, etc., of the body, which have of late been so acutely carried out, are now beginning to awaken the physician to the necessity of taking wider notions concerning the nature of disease, and must sooner or later work a change in our system of therapeutics. They teach us that we have been wont to take too isolated notions concerning the nature of any one morbid condition, and lead us to see more clearly the mutual relations and dependencies which exist in disease be tween different organs, or parts of the same organ.
The duty of the mere pathological anatomist consists in accurately describing the character of the changes which healthy structures have undergone, but this does not suffice for the physician; he must embrace, in one general coup dæil the whole of the disordered states which the body at any given time presents, and not let his opinion be swayed by any one particular, however prominent, disorder. It may indeed, and very frequently does happen, that the originally faulty organ—perhaps an injured valve of the heart—which has now given rise to a variety of ailments, is just the one which at the moment demands his attention least; he is not now to be speculating about the curability of the diseased valve, but his art is instantly required to relieve some oppressed organfor example, the lungs—whose functions are seriously affected. The disease of the heart is forgotten for the moment amidst the disorders to which it has given birth. And so again must our treatment lose its local tendency in proportion as we begin to understand how many of the abnormal changes, which organs undergo, are but expressions or results, and, for the most part (as far as our agency is concerned) the irremediable results of some diseased action which is at work, not in one organ only, but in many of the organs of the body at the same time.
Every day's new experience in pathology teaches us this : that in the treatment of disease we have much to unlearn ; no need is there to tell us how much we have to learn. We cannot expect much progress in a right direction, while error still clings to us and clogs our footsteps. The most discordant opinions, which equally honest, and equally skilled men hold respecting the treatment of acute diseases, must have a meaning; and they have one which is often responded to by our consciences at the bedside of the patient. The follies and wickednesses of others may teach us much; and thus from homeopathy we may learn the mischief which the human body has often suffered from want of discrimination in the use of remedies ; to what other cause can be attributed the successes of that cheat? How are we to reconcile, but in one way, the unhesitating opinions which men hold to-day, and the equally unhesitating,
I must specially refer to the labours of my colleague, S. H. Joncs.
but exactly opposite opinions on treatment, which they hold to-morrow? We may say diseases change their type, but what proof have we of this ? And we may explain the discrepancy in half-a-dozen other ways, but we cannot deceive ourselves this way. Are we to believe that the human body has so changed its conditions, or that the nature of diseases is so totally altered, as thereby to give account of the fact of the wholesale blood-lettings which characterised the treatment of disease in the last generation, and the almost total abstinence from them which characterises the present treatment? Impossible. Is it overstating the bare truth to say, that we have yet to learn the effects of remedies on acute diseases? Have we data by which to answer the question? I think not. And the fair and legitimate inference which we have a right to draw from facts like these which we are bound to draw, I beg to assert, is this, that we have deceived ourselves into a belief that our remedies exercise a greater control over disease than they actually do. Why not confess an error, if error it be? If it be no error, why not prove clearly that it is not so ?
(To be continued.)
ARTICLE V.-Confirmation in two Quarters of the Discovery by
Keber, of the Penetration of a Remarkable Body, believed by him to be a Spermatozoon, into the Ovum of the Fresh- Water Mussel. By Martin BARRY, M.D., F.R.S.
On the subject of fecundation, the Cyclopædia of Physiology has the following remark :-" The truth is, that the how' of the fecundation is as far removed from our knowledge to-day as it was thousands of years ago ; this process is still enveloped in what we feel inclined to consider its sacred mystery.” There is much in fecundation that will doubtless ever remain a “secret mystery." But the excellent authors of the remark now quoted, add : “ It would be different if we could prove that the spermatozoa really yielded the material foundation for the body of the embryo; that they pene
trated into the ovum, and were developed into the animal, or else ; that they became metamorphosed into the central parts of the nervous system.”
When the article from which I quote was published, i.e., in 1849, a drawing from nature had been before physiologists for six years, representing spermatozoa, not indeed becoming “ metamorphosed into the central parts of the nervous system,” but within the ovum. That drawing was published in 1843.2 As it has probably been
? Article “ Semen," by R. Wagner and R. Leuckart. Lc. p. 507.
? In the Edin. New Phil. Journal for October of that year, Pl. V. fig. 1, with the statement that in an ovum of the same rabbit I saw more than twenty spermatozoa.
NEW SERIES.-NO, I. JANUARY 1875.
seen by very few, or is by this time quite forgotten, and the subject having at length become one of general interest, I now reproduce it in a woodcut. It represents, in outline, an ovum of the Rabbit of twenty-four hours from the middle of the Fallopian tube; f is the zona pellucida; bs, the germ, consisting of two large cells. (There were present also several smaller cells. Such minute bodies (nuclei or cells) are very frequent. In 1890 I thought them merely the remains of cells of the so-called 4 “yelk," not yet absorbed, but destined for immediate or speedy absorption. Since 1843, when I saw spermatozoa within the ovum added in consider. able number, it has occurred to me that possibly the said minute bodies remain, in order to unite in liquefaction with these additional spermatozoa, after which the resulting compound is taken up by the already fecundated germ, bs). The spermatozoa are seen lying around and between the germ cells. When the ova were first examined, I thought I saw traces of spermatozoa within the germ cells. In the Phil. Trans. for 1843, p. 33, will be found a statement of these facts, as well as the mention of several ova in a somewhat earlier stage from the Fallopian tube of another rabbit, which enabled me to confirm the observation. I at the same time said: “ These ova were submitted to the inspection of Professor Owen. and I afterwards showed one of them to Professors Sharpey and Grainger, all of whom agreed that the spermatozoa were contained within the ovum." 1
Now, as in the passage quoted from the Cyclopædia of Physiology, the admission was made in 1849, that it would be different " if we could prove that the spermatozoa penetrated into the ovum,” it seems that after all “ the how of the fecundation " had been brought a trace nearer to our knowledge rather less than “ thousands of years ago," namely, in the year 1843.
Further evidence of this is furnished in a second postscript added by R. Wagner (one of the authors referred to in the Cyclopædia of 1849) to the article “ Generation” (Zeugung) in his Dictionary Physiology. In this second postscript he remarks, that although up to almost the latest period there seemed sufficient ground for the belief that the spermatozoon has performed its part by simple contact with the surface of the ovum, yet that the still more recent observations of Keber in Germany, and Newport in England on the spermatozoon, with those of Johannes Müller on a funnel-shaped canal in ova of every species of Holothuria comparable to the micropyle of the vegetable oyum, open a field for renewed research, a field wide
i Phil. Trans. 1843, p. 33.
as the animal kingdom itself, one that will forthwith draw numbers to explore it, and is sure to be productive of a rich return.
He adds: “It is clear that many observations hitherto rejected as incredible, such as those of Barry on the penetration of the spermatozoon into the ovum, deserve renewed consideration, though they may not be confirmed in their whole extent.” 1
From what I have stated to be contained in R. Wagner's second postscript, it will be seen that one of the main movers to a renewal of research in this field was Keber, by his discovery of the penetration of what he believed to be a spermatozoon into the ovum of the fresh-water Mussel.
The discovery of Keber, however, has in its turn been denied by Bischoff. (Bischoff is the man who more determinately than any other combated, as “ born of the imagination,” my fact that the spermatozoon penetrates into the interior of the ovum of the Rabbit. This he did until at the end of about the eighth of a century, i.e. in March of the present year, Meissner's confirmation induced him to renew his en quiries, which led to the confession by Bischoff that the mistake had not been Barry's, but his own.) On hearing of Bischoff's denial of Keber's discovery, I should have investigated the thing myself without delay, but had not health for the labour. I therefore asked a friend to undertake it, one whose acuteness as a microscopical observer I well knew was equalled only by his care to record actual facts or none at all. It was Dr W. W. Webb of Lowestoft. I handel him Keber's work, along with many scores of the river Mussel. In due time Dr Webb sent me a report, stating that he must have laid some hundreds of ova under the microscope, and that they had given him “the means of verifying many of Keber's statements, and of witnessing the conditions, or nearly similar ones, represented in his drawings, numbered 38, 40, 42, 44, 48, 50, 56, 58, 64, 65, and 73.” “ The body believed by Keber to be a spermatozoon,” says Dr Webb, “was thus seen repeatedly within the ovum, in various situations relatively to the micropyle and the yelk; and at last was found arrested in the very act of penetration.” Particular attention was given by Dr Webb to stages in the existence of the micropyle, without entering into the question whether it was once the pedicle of the ovum.“ In the first place," says he, “it is a tube, projecting, like a lipped chimney-pot from, and being a process of, the outer membrane. In a later stage, the chimney-pot has disappeared with the exception of its lip, which now no longer surrounds an aperture—the aperture having been closed up, and obliquely radiating from the lip are corrugations, invariably proceeding from left to right, and stretching out on the surface in undulating lines. Lastly, the corrugations have entirely disappeared, all that remains being the circular lip surrounding a clear closed up
R. Wagner, second postscript above-mentioned, P. 1018°.