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l’J.U’;:’OU1.JvU a...1.a<LLU.1.J maumy L 1-0a"LVy V.1. crriacNay VY’V auvuau uu

have some weighty evidence. ar

To leave general paralysis of the insane out of the ticonsideration of the relation of insanity to life assurance femay seem strange-the more so when I say that it appa- th

rently causes ten times as many premature deaths as all wthe other forms of insanity put together. In the record of k]the Scottish Widows Fund Muirhead recognises that this sc

cause of death seems to have been recognised and designated dE

adequately only in the last of his three septennial periods. ui

In this it caused 52 deaths. If we ascribe to the two pre- ei

ceding septennial periods a proportionate number of deaths c(

corresponding to the total number of cases in each we have ela total of 120. This is ten times the number of claims from pother forms of insanity. Further, it almost always causes a el

loss, often serious. This is shown by the cases that have e:

come under my own observation and very clearly by " I

Muirhead’s facts. Of the 52 cases only one exceeded his a

expectation. The average age at death was 44 years. Youall know what this means to the assuring office. Hence s

the question is very important-Can anything be done n

to lessen this loss 1 I regret that I think it would a

be alike futile and unwise to consider this subject v

to night. The essential problem depends on the fact that v

the place of general paralysis is beside tabes and not among tthe forms of insanity. The only possible means that could r

Me adopted, at least so it seems to me, are the following: r

(1) to ascertain systematically whether or not there has been 2

preceding specific disease ; and (2) to ascertain the presence c

or absence (a) of the knee-jerks and (b) of the pupil-light 1action. The recognition of the early symptoms of general 1paralysis and the difficulties of its diagnosis are outside the (

scope of this association. No proposer who presents any ssuggestive symptoms, however uncertain, could be con- isidered for a moment. The subject is thus a wide one, (

needing very careful consideration and discussion, and it is (

not within the limits of that which we are met to consider.Perhaps my feeling is the stronger because I despair of anyresult from the measures I have suggested, or rather Ibelieve the evil of the attempt would more than balance thegood. This opinion illustrates how difficult the subject is.I would therefore venture strongly to deprecate any attemptto discuss it this evening.

I have applied the term " impressions " to the ideas I haveput before you. They are, indeed, but an attempt to givehome shape and design to the subject, which as liasticclay I pa-s into your hands, and I shall look forward withinterest to the form it ultimately receives from your dis-cussion, should any form survive.

[The discussion on Sir William Gowers’s paper was

adjourned to Nov. 2nd and we hope to give a report ofthe same after that date.-ED. L.]

An Introductory AddressON

KNOWLEDGE AND THE METHODSOF REACHING IT.

Delivered at the opening of the Medical Faculty of theUniversity of Birmingham on Oct. 3rd, 1904,

BY P. H. PYE-SMITH, M.D. LOND., F.R.S.,CONSULTING PHYSICIAN TO GUY’S HOSPITAL, ETC.

GENTLEMEN, - Let me first congratulate you upon theprogress which this great University has already made sinceit received its charter. Like Manchester and Liverpool ithas left a connexion with the University of London whichfor so m my years existed, and, as representing the parentbody, I may say that we are convinced it was for our benefitas well as for yours. May Birmingham become as noted forlearning and national progress as the greatest universities ofour own oriny other country.

If we look over the history of the connexion between theUniversity of London and its colleges, we see the constantrivalry for importance between teaching and examining.In 1827, when a new institution was founded without

: recommendation of age or wealth, with no traditions,1 with sadly inadequate resources, there were two diree-os in which it developed-the one was that of con-

ring degrees and other academic distinctions only as

: result of impartial and external examination ; the others to offer to intelligent youths opportunities for acquiringawledge independently of wealth or of the trammels ofiolastic discipline. At first there was no power to grantrees, and when it was granted by the foundation of a newiversity in 1836 it was deemed necessary to separateGirely the teaching from the examining bodies. The wholearse of public opinion in the 70 years which have sinceLpsed has greatly diminished the value attached to com-tition and greatly increased the value attributed toucation as distinct from instruction. One criticism was

pressed in the term applied to the University of a

graduating machine" and the other in the nicknameplied to the University College of a "knowledge shop."I think, and you here think, that competition is a valuablemulus to work, and that many of us owe very much to the:cessities of a curriculum ; we also believe in the merecumulation of knowledge, as we see it in clever childrenhose memory is always superior to their judgment andhose aptitude for imbibing information is as remarkable as,eir imperfect power of using it. We agree, therefore, that;ither competitive examinations nor acquiring facts, even ificonnected, are to be discarded because they have been)used. But if we participate in the public opinion, whichi the whole is educated opinion, we shall put before

:lOwledge and before competition in the first place what isroperly called education-the drawing out of the powersE the mind, the discipline which strengthens the mentalnews and prepares the intellect by a kind of gymnastics)r the duties of which it is capable. Side by side, more-ver, with the justly increased importance now attached toiscipline and healthy development of mind and body weave also learnt to regard a college or university as a verynperfect instrument for good if it only educates its studentsnd does not at the same time teach them to add tohe sum of human knowledge. But these different aimslike other aims which are just and practical) are farrom being opposed one to another. It is an admirable

hing for the memory to be strong and tenacious. It is anxcellent thing for a boy or girl to delight in omnivorouseading, to acquire the art of learning quickly, of discerninghe main and important points to be understood, and to formresh and tenacious receptacles for every new branch ofknowledge which they encounter. It is well that by anionourable ambition young men and maidens should be

villing to scorn delights and to live laborious days in the.iope of attaining the fair garland which adorns the learnedjrow, and the very power which has been gained by suchliscipline is that which can be applied to investigation andexpansion of knowledge.

I. First, then, of knowledge. A child learns to name

objects, then he connects objects with qualities, and intime forms chains of connexion between related events.He learns that sugar is sweet and that fire burns. Helearns to trust to the evidence of his senses and tomeasure distances not only by the eyes and the ears but bythe muscular sense of the eye and of locomotion. Before

long an intelligent boy is not satisfied with knowing thatthis or that is a thing with certain colours, shape, and move-ments. He asks himself how he knows it; and he soon

learns that the perceptions of the senses are insufficient.He finds that the combination of two senses corrects mistakesand strengthens his assurance of fact. He learns to makeallowance for atmospheric perspective, for the duration ofmovements and of visual impressions. He begins to detectvarious delusions into which observation by the senses willlead him. Before long he will have gained the importantconviction that all knowledge derived from the senses is butmediate, that it is not the eye that sees or the ear thathears or the finger that feels, that touch and vision andperception of sound and pleasure and pain are processes ofthe brain, not of the sense-organs. They are states of con-sciousness and their continuity makes up the course of life.Even in sleep there are dreams and on awaking from sleepself-consciousness recognises the continuity of the timebefore and the time after unconsciousness.

So much for the development of knowledge by the senses.A further step is taken when a boy begins to reason. In

following the propositions of Euclid, in learning the

elements of logic, he sees how one fact inevitably depends

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upon another. But an intelligent boy will soon observethat the beautiful sequence of argument in mathematicsdepends for its perfection on the absence of reality. A linewithout breadth, a point without magnitude, a perfect circle-these are not objects of the senses : they are figments ofthe imagination. Moreover, the student finds in the domainof deductive logic that a syllogism is open to the defect ofpretending to prove what is really stated in the first premiss.The apparently inevitable process of reasoning which endedin contradiction, the logical fallacies like sorites, and theconflicting results of the arguments of nominalist andrealist schoolmen led to the conclusion that, howeverexcellent as a method of sharpening the wits, mere

argumentation serves only as a sign of warning Nothoroughfare " by this path.There is, however, as men at last learnt, another method of

arriving at true results than that of tracing the intellectualsequence of ideas and stripping natural objects of some oftheir properties in order to deal with them as flawless

imaginations. This course of investigation we call expe-rience or, if we determine the experience for ourselves,experiment, and when experiment is repeated again andagain and results are constant then we have on what seemssure ground the proof of the connexion between cause andeffect. Moreover, there is a satisfactory test of the justnessof our conclusions in the result of fresh experiment. Whenastronomers were able to predict eclipses they showed thattheir science was a real and trustworthy one, and so in theart of medicine the all-sufficient proof of diagnosis is theverification of prognosis.Very soon in the education of the child it is desirable that

he should, according to his powers, investigate, that heshould try, as one clever child who was afterwards ClerkMaxwell tried, to find out the "go" of every plaything ormachine that he observes. It is most important that heshould be encouraged to search out for himself, and when hehas succeeded in his quest he should be encouraged to remakethe object which he has reduced to its elements. He shouldnever be put off by explanations which are delusive ; forinstance, explaining the fact that one cannot see through astone wall by the assurance that it depends on the opacity ofstone or the fact that we can set paper burning with a lens andsunlight by calling the paper inflammable. In all cases weshould try to answer the question ’’ why " by substitutingthe question how" ; for, as intelligent women often remindscientific men, the explanations of science always leavesomething else to be explained and carry us but a littleway.

It is remarkable how slowly natural science or the

investigation of the sequence of events has developed.Logic was familiar to Aristotle and the same great mindthat produced the Ethics also produced a wonderfully fulland, on the whole, accurate account of the animal kingdom.Aristotle had worthy successors in Archimedes, in Euclid, inErasistratus, and in Ptolemy, but physics and geometry,anatomy and astronomy, died away with the generaldestruction of ancient civilisation. The ’’ Physiologus " ofthe Middle Ages was a successor of Pliny, not of Aristotle.Natural history was not contrasted with natural science butwith civil history. The first steps in what we now callscience, the theory of the universe, the sequence and

dependence of events, were made by the astronomers of theRenascence, by Tycho Brahe and Kepler and Copernicus, byGilbert the father of magnetism, by Harvey and Mayow thephysiologists, by Boyle the chemist. But the work of Newtonand the early natural philosophers impeded rather thanadvanced the progress of medical science by leading to theIatro-chemical and Iatro-mechanical schools. The pioneers ofmodern natural history were the collectors, the founders ofmuseums of animals and plants in the sixteenth and seven-teenth centuries. Their labours were scorned by philosophersand were treated by intelligent men like Addison andJohnson as laborious trifling. ’’ The proper study of man-kind was man," not as an animal or a machine, but in hismental and moral aspect. Even in the nineteenth century"scientific" was an adjective applied to what we now- call learned. For three centuries natural history was

valued only for its direct use in medicine or agricultureand even in our own day some ancient physicians spoke ofmorbid anatomy as useless in practical medicine and somescientific men lectured on the I Philosophy of a Candle."Physiology began with the use" " attributed"to each severalmuscle or viscus and was more cultivated in the eighteenth’century by surgeons than by physicians.What kinds of knowledge are most essential for education,

considered apart from their practical use ? Technical educa-tion is an admirable thing, but whenever a boy at schoolis put on the modern side because he is intended to be amerchant or a druggist, his education for its own sake,his liberal education, has ended. He may go on if well

grounded to an indefinite degree of excellence, but he hasalready begun the important task of providing for himselfand those dependent on him. His science is Butterbrod-Wissensckccft and he feeds no more on ambrosia. A liberaleducation is that which brings no immediate profit, which isone from one point of view, useless ; and whether a boy istaken from a board school to learn shoemaking, or whetherhe is taken from the broad curriculum of a public school tolearn to be a medical man or a sailor, alike he has finishedhis liberal education and has begun that which is calledtechnical. Of all kinds of scientific knowledge there are twowhich seem to me to be almost universally desirable as ameans of liberal education. The first is botany, commendedby the beauty of the objects with which it is concerned andtheir abundance in every country, by the need of careful andpatient discrimination, by the opportunitv and almostcompulsion to carry on the interest of the study intomature life. A botanist never need be dull, whateverhis trade and in whatever part of the world he lives. More-over, it is the cleanest, the gentlest, and the least costly ofall branches of science. On one ground or other it seems tome to be better adapted for most schools than zoology,anatomy, or geology. If botany is the most convenient anduseful science to teach observation, may we not say that thestudy of physics in its elementary mechanical stages is themost valuable and convenient introduction to scientific

reasoning ? The actions of the levers of machinery and ofthose of our own bodies, the expansion and contraction ofliquids and solids, the lifting and traction of weights, theseare instructive and constantly applicable in daily life. Theyenable a boy to take an interest in machines of all kinds, tounderstand the construction and use of candles, of gas-jets,of electric lighting, of bicycles, and of motor-cars. Such

knowledge is practical and useful but it also enlarges themind and adds greatly to the intellectual pleasures of life.

II. There is, however, another method of arriving at

knowledge at true results-which is distinct in methodfrom those of either deductive or experimental science-Imean the knowledge of literature and of art. In what waycan it be said that we know that the Iliad is a great poem,that the " Bacchus and Ariadne " is a great picture ? ‘!

Certainly no process of logical reasoning, no scientific

investigation, can demonstrate the fact; and yet it is

abundantly certain. The Iliad, as soon as we find itmentioned, was mentioned with admiration ; it was admiredby the earliest listeners, it was admired still more by thebright consummate flower of Athenian intellect in the timeof Pericles. It was regarded with veneration by Virgil, byHorace, and by all great writers since. It only ceased to beadmired when its language ceased to be understood ; andwith the revival of letters its glory has continued increasingrather than diminishing over the whole civilised world.Surely we may say with sober certainty that the Iliad is agreat poem.

Again, Titian’s paintings were reputed as of the highestexcellence while he was living by all the painters of the

greatest period. Successive generations have equally admiredthem and we may now say that ever since his paintingswere produced, in all parts of the world and wherever art iscultivated, they are regarded as amongst the noblest andthe best. Allowance must here and there be made forprejudice of various kinds, and there is always room forindividual preference for this or the other among the greatestand most beautiful works of literature or of art. But thefinal verdict rests with time, that is to say, with the un-

changing conviction of those who are best qualified to judge.Here, again, we have the final test which gives its

sanction to the conclusions of science-the power of pre-diction ; for we would say to anyone who refuses to bowthe knee to the masterpieces of classical literature or Italianart, study the subject, make yourself familiar with the

writings of Greece or the paintings of Venice or the musicof Germany ; learn to write yourself or learn to draw. As

you gain knowledge and gain skill you will, we can

prophesy, feel more and more admiration for the master-pieces of literature or art ; and this prophecy has never yetbeen found to fail.

III. May we not say that in another region of humanthought the same certainty of conviction may be gained bypractice and by action ? May ’we not say that though it

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cannot be proved that truth is better than falsehood, orvirtue than vice, yet these conclusions are held more andmore firmly by those who daily become better qualified tojudge ; and that if anyone denies them we may appeal to hisconscience-that is, to himself-to bear witness against him.No argument, however subtile, can prove the truth of suchbeliefs, no experiment can demonstrate their reality ; but

they are held by all who act in accordance with them, andthe longer and more perfectly they are acted on the strongerand more absolutely are they believed. Some ears cannotappreciate the music of Beethoven, some minds have nopleasure in the poetry of Milton, but all can understand thegoodness of the great soldier who died at his post in

Khartoum, who, unlike most men, "did not wish for moneyand did not fear death," or the self-sacrifice of the humblepriest who deliberately undertook a fatal duty and gave uphis life for the lepers of the Pacific.

IV. May I, in conclusion, offer some adages (ad agendumapta) which may possibly be of service to those who arestudents ? Learn to use your senses, be quick to notice anychanges in the house you live in, or in the clouds and sky,open your eyes to sights of birds and insects as you walk,your ears to their songs, and your heart and intellect to theimpressions of nature. Look as well as see, listen as wellas hear, touch as well as feel. Practise judging distancesand making allowance for different kinds of illumination,learn to detect the optical and sensory fallacies of which youread in books on mental physiology. Exercise not onlyyour muscles but your power of discriminating weights.Cultivate walking and make it a pleasure as well as a

convenience. Take every opportunity of learning anybodily exercise, whether riding or swimming, rowing or

sailing, and whatever you do do it, as Fox said he did,"with all your resources at the time." Learn, as you mayvery well without being artists, to draw sufficiently to

explain your meaning. Cultivate your memory, form thehabit of recalling things at the proper time, and make pro-vision for spare minutes in the day or sleepless hours atnight by fixing poems in your memory, or by repeating thegeological strata of England, the atomic weights of the

elements, the heights of mountains, or the dates of thedecisive battles of the world. Never fear filling your mind ptoo full of fresh knowledge or suppose that one fact will dis- a’

place the other, as water poured into a full vessel adds nothing dto its contents; for the more the mind receives the more it pwill contain, and there is no limit (or none that we ordinary t’

people can see) to the growth of knowledge so long as life pendures. Never be satisfied with a sham explanation or with o

conventional reasons or with argument that will not stand s

criticism. Beware of the commonplaces of argument, of a

declamation, and of assertion. Never waste time over a

worthless literature and in order to be sure of what is good %read chiefly that which has withstood devouring time tand remains to us as the carefully winnowed and approved (

result of the imagination, the wisdom and the wit of i

past centuries. Beware of prejudices, prejudices of your profession, prejudices of your education, prejudices of yourcountry. Remember that all that you think of England, and which you rightly ought to think, is also thought by French and Germans and Americans and Hungarians andChinese concerning their own country ; the strength of itsinhabitants, the beauty of its women, the courage of itssoldiers, and its excellence in all the arts and refinementsof life. It is not without reason that Frenchmen speak ofLa grande nation and Germans of Deutschland iiber alles,but such phrases do not lend themselves to translation.Remember that in the important department of populareducation little countries like Saxony and Scotland were formany years far ahead of larger and wealthier nations. Andof all nations since the Reformation the most remarkableachievements in war and in navigation, in exploring andcolonising, in art, in learning, and in science, have beengained, not by the great nations, but by the little people ofthe Netherlands.Here in Birmingham you are rightly proud of your

municipal record. Just as this civic emulation does notdiminish but strengthens your national patriotism, so believethat the glorious history of these little islands does not needdisparagement of our neighbours. By knowledge of theirhistory, their science, and their literature, by sympathy withtheir great qualities, we become more fair-minded, moreliberal, and more humane. In literature, in science, in

manufactures, in pathology, in preventive, medicine, our

fathers have left us a noble heritage ; let it be ours to hand ona still nobler one to our children.

An AddressON

THE RELATION OF THERAPEUTICS TO OTHERSCIENCES IN THE NINETEENTH

CENTURY.Delivered at the International Congress of Arts and Sciences

at St. Louis, U.S.A., on Sept. 24th, 1904,BY OSCAR LIEBREICH, D.C.L. OXON.,

M.D. BERLIN,PROFESSOR OF PHARMACOLOGY IN THE UNIVERSITY OF BERLIN.

L

GENTLEMEN,-Every political historian will prefer to

trace the development of a period of history from one-’ distinct event. A chronological introduction cannot be of’ such importance to him as historical survey, in which

1 events of great moment form the basis of a new develop-s ment. What is true of political evolution applies also to9the growth of every branch of natural science and medicine.11 The first year of the century, though filling men with

yjoyful confidence and new hopes, has not the same attractiona for the investigator ; and yet, in order to obtain a generaly view of the growth of the different branches it is desirable

not to lose sight of this idea but to consider all the stages’ of progress in common from a certain point of time and

thus the study of the history of therapeutics must also bete subordinated to this aim.o- Although the evolution of the nineteenth century has.

frequently been threatened by heavy political clouds weae have seen them often pierced by the sun of progressive scienceae which, especially in that century, has called forth a fertilitytie of culture such as has scarcely been witnessed in anyad previous period of 100 years. The past century more thanis- any other has been distinguished by the multitude of newlyng discovered facts in natural science, as well as by theit perfection and extension of the ideas of great discoverers of,ry the previous century. It is the age in which the greatestife progress in natural science has been made. The vast numbersith of new discoveries in medicine have lessened, or even almost.,nd suppressed, on the part of many persons, the feelings ofof admiration for each new acquisition. The new phenomenaver and experiences which confront us on all sides surpass the

wildest dreams described in former centuries as the eccen-me tricities of fanciful minds. The abundance of materialed compels our admiration and allows the astonished eye no timeof to gaze long at one occurrence, for new impressions already

our crowd it out.our The nineteenth century has spoiled us ; our demands fornd, new acquisitions increase and we grow impatient to know

by more. In this unsettled state the laborious work of theMid individual often seems lost but the true scholar is buoyedits up by the gratifying knowledge that mighty buildings canits only be constructed of a mosaic made up of single stones.mts Yet, truly, humanity often settles down in a new buildingof without admiring either the work of the architect or hislies, material. Moreover, the capability of enjoying nature andion. whatever we have added to our knowledge of the universeular by laborious experiments does not appear to be a naturalfor gift of man. Only education and culture can awaken theAnd enjoyment of what is and of what is about to be. Mightyable natural phenomena, indeed, fill the casual onlooker withand admiration but the observation of what is harmonious inoeen nature and the capacity of assimilating it for our own culturele of can be gained only through education. This also holds good

of art and it is even more difficult in science. Since theyour uneducated majority is often inclined to pass by the greatestnot events with indifference the nineteenth century has spared

lieve no pains to inform humanity of all the great innovations.need to educate them, and thus to gain friends for the progress oftheir civilisation. This, indeed, is the object of your congress.with There are various ways in which therapeutics (and it ismore here chiefly a question of pharmacodynamic therapeutics-in that is, such as concerns itself not with mechanicalour means but with, chemico-physical processes) may develop.

id on New knowledge of the conditions of life of the organismoften leads to remarkable discoveries in therapeutics. Thus