SIR W. GULL ON PHYSIOLOGICAL INTERVENTION.
4.; SIR WILLIAM GULL, in a remarkable address read on the 26th January before the Clinical Society,* threw out a suggestion of which any layman is competent to appre- ciate the very wide possible bearings. He began by avowing for himself, and claiming (we know not on what grounds) for the whole Clinical Society, an optimist view of Nature, a belief in the steady progress of Creation from better to better in the past, and a profound faith that that progress would never be termin- ated in the future,—(a faith which, of course, rejects the physical possibility of an astronomical catastrophe), —but he maintained that from the point at which the human mind comes into active being, that law of progress can be secured only by the active co-opera- tion of that mind,—and that that co-operation implies not merely a careful study and use of Nature, but perfect readiness, wherever we have the adequate means and knowledge, to override Nature, to make her something different from what she would be without our interference, something better than she would be if we did not meddle with her. In fact his doctrine is that we may,—if we will act soberly and on sufficient knowledge,—adopt a policy of physiological intervention even in regard to some of those natural organic growths of our own bodies which are usually assumed to be amongst the absolute data of our life. Sir William Gull rejects with some scorn what we may call the physiological quietism of those who simply watch and wait upon Nature, and proclaim themselves non-interventionists with regard to her processes. And indeed all except the very small school who regard vaccination as a culpable intervention in the physiology of the body—nay, all who would not condemn an operation for cataract, or the extrac- tion of a diseased tooth, or the amputation of a mortifying limb as an audacious "flying in the face of Nature,"—must admit that there is a just limit to the quietist policy somewhere. But Sir William Gull goes further ; he quotes with approbation a saying of Professor Haughton's with regard to the theory that the most painful of the effects of cholera are "an effort of Nature to cure the disease," "I will tell you what Nature wants ; she wants to put the man in his coffin ; and that is what she succeeds in doing, for the most part ;" and he maintains that medical and surgical science is bound to assume that Nature wants to do some things which we must check her in doing, if we are to make the best of the world, and wants not to do other things which we may compel her to do. Even this doctrine, however, in the abstract would hardly be questioned by ordinary physiologists; but Sir William Gull gives it a rather unexpected application,—namely, in relation to positive organs which may, on adequate investigation, appear to be the superfluous monuments or relicts of a lower state of being. He remarks that organs which exist in the embryo, and which usually fade away as the body grows into its perfect human form, do sometimes, from some physiological eccentricity of the individual, develop them- selves as fully as they are developed in other animal species, and that where this is the case, disease, if it comes at all, is especially likely to concentrate itself on this deformity, as we should call it,—that is, on the eccentrically developed organ which in most other men is rudimentary only, if traceable in them at all. "Those parts whose functions are indefinite," he says, are apt to be "the foci of patho- logy," that is, we suppose, the seats of disease. He instances the case of a particular duct which is usually undeveloped in man, and can be of very little if any use to the human economy,—one which Sir William Gull supposes to be a vestige of the oviparous tribes,— and which, when eccentrically developed, led to the death of a man, otherwise healthy, in whom this superfluity had matured. Such superfluous and eccentrically developed organs he thinks the surgery of the future may very likely make a practice of removing at once in the young,—when they can be got at with- out danger to the patient,—and he is inclined to augur great advantages from this decisive surgical intervention to remove dangerous superfluities. Nay, if we understand Sir William Gull rightly, he would go further, and be at least disposed to expect that if there be, as he apparently thinks there are, in the body of men, not only eccentrically, but uniformly deve-
* And published In the Lancet of 3rd and 10th February.
loped organs for which men in their present state have no use, and which Sir William Gull would regard as "relicts of our ancestral relations," "which may be superfluous and even injurious to us," these organs might be removed in infancy with very great prospects of advantage to the body from their loss. We sappose,—for here we are left to conjec- ture,—that Sir William Gull may refer to such organs, should further investigation find no use for them, as the uvula, which so often causes relaxed sore-throat by its inflam- mation,—the spleen, we suppose, even if it were discovered to be useless to the human body, would be far too closely wrapped up in the body to be thus easily got rid of,—but it is clear that he contemplates the possibility of such real pruning of the body by the surgery of the future as would relieve it of some of the more accessible of those cumbrous physiological heirlooms which he believes to be derived from ancestors with different wants from ours. "For the surgeons," he says, "as I have hinted, a new prospect is opening. Should advancing knowledge show that we have parts, or organs, of doubtful use, and especially if these equivocal parts are liable to disease, —what a land of promise for operations I" That is, Sir William Gull thinks it very likely that even of our normal organs some are mere excrescences on the human body under its present conditions, and if so, are specially liable to disease, and that surgical interven- tion may prove to be of the greatest use in ridding us of them in infancy. As almost all physicians support the system of vaccination, which undoubtedly replaces the natural state of the organization by one that is artificially proof against a particular disease ; so Sir William Gull would not hesitate to interfere even in the moulding of the external organization, if he could thereby relieve the body of what is in excess of its wants, and, therefore, probably at least, a superfluous drain upon its strength. Of course, Sir William Gull would be the first to in- sist on the greatest scientific caution in inaugurating such a policy ; but suppose that such caution had been observed, and that a study of the lower animals had triumphantly shown that particular organs are as needless to men as long hair, and a much more common cause of disease, and that they could be easily re- moved without danger or any known bad consequences,—would there be any sort of consideration not derivable from physio- logical grounds forbidding such a policy of surgical "inter- vention"? Would it be possible to argue with any plausibility, for instance, that reverence for the body, as a divine work, should for- bid us from this pruning away anything that Nature, and of course God through Nature, insists on giving ?
We cannot think so. For in the first place, if there were any such moral veto on the dealings of cautious human reason with the body, it would be wrong to cut and shave the hair,—nor is it easy to see any real distinction, except a physiological distinction, between the one intervention and the other. If the protection of the whole is secured by the sacrifice of a part, we always and rightly consider the whole, and not the part ; and all we really want is convincing evidence that we are pruning away nothing serviceable to man, — that its loss is ser- viceable to him. But then it may be said that the best moralists,—Bishop Butler at the " head of thern,—have always started from the assumption that, in the intellectual and moral nature of man at least, nothing is superfluous, nothing radically injurious,—but that evil consists only in the ill-regula- tion of appetites, passions, affections, and capacities, all of which have their appropriate purpose in the mental economy of man, though all are capable of being exaggerated into dangerous excess or repressed into dangerous deficiency. Yet if now we are to assume that specific organs, uniformly developed in the human body, are absolutely superfluous and even injurious, will not the inference be almost inevitable that there is no longer any ground to assume that, even in the human mind, each specific principle must have, for us at least, a divine purpose, the complete suppression of which would be a moral mutilation ? "Revenge," says Lord Bacon, "is a kind of wild justice," and Butler has attempted in one of his very ablest ser- mons to show the enormous moral value of the principle of resent- ment, if kept within the right limits. Such positive proof of course would be as admissible if the new notion of organic superfluities in the body be granted, as before. But would not there be a very much weaker analogical case for the real worth of each of the elementary desires, emotions, and other practical tendencies, as we now have them? Would it not be argned very gravely that if we all really inherit from our ancestors superfluous bodily encumbrances of which it is our duty to rid ourselves, we are exceedingly likely to have also
inherited mental and moral superfluities of the same kind, where again there would be a new field opening not merely for restraint and culture,—but, so far as that is possible, for the intervention of moral surgery, for radical excisions of natural impulses and tendencies? If the human reason applied to physiology has discovered that it has pruning duties in relation to some of the normal organs of the human body, will not the human reason as applied to psychology be strongly biassed in favour of the belief that it may have pruning duties in relation to some of the normal organs of the human mind?
We should reply that it is of course far more difficult to determine what is a distinct organ of the mind than
it is to determine what is a distinct organ of the body ; and further, that as the mind is the highest part of man, you might fairly expect normal organs of the body to have be-
come for all purposes of advantage obsolete, although still inherited from our ancestors, without expecting normal organs of the mind to have already lost all their primitive func- tional uses ; and that, considering the extremely small number, even if there be any, normal bodily organs which medical science can venture to pronounce really useless to man and mere monuments of a primeval body to which they were useful, there is no good analogical reason to expect that anything equivalent would be discernible in the mind. But it would, we think, be perfectly true to say that there are, in the mind itself, traces not perhaps of completely useless habits, or appetites, or impulses which are inherited from our forefathers, but, certainly and frequently, of great excess of activity in such habits, or appetites, or impulses ; nor would it be at all unreason- able to expect that a distant future might yet come in which,—if moral surgery were possible,—if there were such a thing as a moral excision capable of being performed, —it might be of the first bene- fit to man even to eradicate some of the persistent moral tendencies which we have received as heirlooms from our ancestors. Take some of the cases of kleptomania, as it is called, or even of the worse forms of avarice,—i. e., of deeply persistent tendencies, pro- bably in some degree inherited, which have become to their present possessors what Sir William Gull asserts that the eccentrically de- veloped duct he tells us of was to its victim, not only not useful, but centres of local disease,—and can we doubt for a moment that here we have the trace of a greed for accumulation, which in the hard Stone Ages, for instance, may have been almost a condition of existence, developed into a thorougly unsocial and destructive passion in an age of comparative ease and wealth ? And if it be morally certain, as it seems to us to be, that in a higher state of existence the competitive instinct so deep in us, and, within limits, so useful to us now, will disappear, why should it be in- credible that even on this earth in some distant future the moral uses of such a passion might vanish, and it might linger, if it lingered at all, as a mere centre of disease ?
We do not see anything really to startle us in Sir William Gull's striking suggestion that science may in the future show us how even to prune away superfluous organs of our body with a purely beneficial result to man ; nor why something parallel might not happen, in some still more distant future, in relation even to the mental tendencies of men. All such a suggestion would imply is that God educates us to educate ourselves ; and that in the course of that education, as the higher functions of both body and mind become developed, some of the lower will gradually be of less and less use, and finally may become really superfluous, without, how- ever, disappearing until our own reason and conscience are trained to help in extinguishing them. It is hardly possible to doubt that in the only perfect human nature which .ever lived upon this earth, in the divine humanity, some of the lower principles even of the mind,—notably the competitive impulse,—was kept alto- gether inactive.
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