PRINCIPIA THERAPEUTICA.* SOME five-and-twenty years ago it was said, probably
with truth, that a skilled pathologist made a poor physician. Frequent study of the ravages of chronic disease in vital tissues seemed to breed a sense of helplessness and pessimism, an attitude of mind the reverse of the cheerful optimism of Paracelsus, and not conducive to success in the practice of clinical medicine. Since that time, however, not only has the therapeutic armoury been strengthened by certain valuable additions, some of which owe their primary origin to the pathologist, but physiology has stepped in to point the way, and the physician calls upon other organs to compensate for the loss of function in those which are diseased, and so post- pones the evil day when the body as a whole succumbs to the disease of a part. Further, a revolution has taken place in the relation of medicine to surgery, and whereas formerly an organ doomed by pathology defied medicine, there is now always the possibility that the physician by a timely resort to surgery may snatch a victory at the last moment, and falsify the gloomy prophecies of the pathologist. The surgeon nowadays is the physician's most valuable asset, and not only does the latter view a case with an eye to surgical possibilities, but the former has perforce become learned in scientific medicine, the old gulf between the two has been bridged over, and there is scarcely a single organ in the body which can still fly the signal " Noli me tangere " of former days.
Dr. Sainsbuty's book opens with a quasi-Platonic dialogue in which the old duel between the pathologist and the physician is fought over again, and the position of the latter firmly established. This is followed by the more technical chapters in which the principles of modern therapeutics are discussed with much ability, eloquence, and aptness of illus- tration; indeed, it is rare to find a medical treatise, appealing primarily to medical readers, laying claim, as does Dr. Sains- bury's work, to some distinction of style. There are, how- ever, several chapters, notably those entitled " Diaeteticae," " Habit," " Imponderabilia," which provide the lay reader with much material for reflection.
A consideration which will at once present itself is the extreme desirability of teaching some elemental knowledge of the laws of health during the educative and receptive period of life. Just as the physician of the soul rightly demands that a child should be instructed in the rudiments of his faith, so may the physician of the body claim that some kind of catechism of health should be learned, understood, and practised during youth. To take an instance, what more valuable knowledge et priori could there be than that alcohol as a food is negligible, that its main action is to set free potential energies, that its use should be limited to the rare occasions when energies are required which are not otherwise to be obtained, that the habitual use of it is to spend capital as well as interest and to court a premature bankruptcy of vital force ? Or, again, take the question of the formation of habits. Should we not know that habits not essential to life and frequently harmful are easily acquired, easily persisted in, and with difficulty shaken off, the difficulty increasing in pro- portion with the persistence, until a time comes when external aid must be sought to get rid of them ? "Why," says Dr. Sainsbury, "we should have the power to enjoy to our own hurt is a mystery, why self-restraint should be essential to the higher life is equally obscure, but that it is as fundamental to the higher life as air and water and the aliments are to the organic life, is quite certain." That is very well said. It points the moral of self-restraint and of the need for in- struction. We err primarily against the laws of health often from sheer ignorance, we may inherit a particular tendency to a particular habit, and we need to be forewarned lest we drift into it ; that which maketh glad the heart of man is to be used, not abused, and the lesson of self-restraint has got to be learned whether the motive with which we learn it be physical
• Principia Therapeutica. By Harrington Sainsbury, M.D., F.R.C.P. London : Methuen and Co. C73. 8d. net.)
or moral. Preventive medicine cannot directly teach self- restraint, but it can and does teach what is and what is not harmful to life and health. Curiously enough, however, it at
present deals solely with communities, and takes no thought for the individual. It protects the community against the
individual, but does not protect the individual against him- self. This task is left to the family doctor, and too often he finds reason to deplore that be has had no chance of giving a timely warning, that the golden opportunity, when it would have been of real service, has long passed by. He is listened to only when curative measures are urgently needed; be is expected to act, not to teach ; and his influence is rarely felt beyond the immediate needs of the moment. No one, in fact, _practises preventive medicine as regards the individual,—it is perhaps because we are in doubt as to whether this task belongs to the teacher or to the doctor that it is undertaken by neither the one nor the other.
How wide is Dr. Sainsbury's view of the scope of thera- peutics may be learned from the chapter quaintly termed " Imponderabilia," dealing with the influence of the arts, emotions, aspirations, beliefs, and enthusiasms on life and health. His illustration of this question towards the end of the chapter is as follows:—
" Who has not seen the life of the body, in all its departments, languish for lack of an ideal, for want of an object upon which to fix the mind or heart ? To meet this state of things it will not profit to order a change of diet, a regulated scheme of repose and exercise, a modification of the clothing. Then, too, 'will hygiene fail us, as also will medicine, though we turn to the materia medica and invoke its aid. In despair, we shall perhaps counsel travel; in vain,—we may change the sky, we shall not change the spirit. The rules of bodily health, the virtues of herbs, the stimulus of altered surroundings, will alike prove ineffectual ; the thing which is lacking is an interest, not a rule of health ; a desire, not a drug ; a purpose, not a distraction ; and it is in default of these that the faculties lie dormant, and the tide of life runs
low The touch which shall give life, when it does come, will come not by way of the laws of matter and of motion, but by way of the laws of the spirit, so true is it that man shall not live by bread alone."
How nearly, then, do the provinces of the priest and the physician encroach upon one another ; nay, do they not overlap ? Of how much sympathy and insight into the needs of others does a cold materialism deprive the physician of the body ! Not the least merit of the volume before us is that throughout its pages there shines a firm belief in the things unseen and eternal, and that the author does not, with Mr. Matthew Arnold, look upon man as living "alone" in the universe, "misled" by an "unplumbed, salt, estranging sea."
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