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PREFACE

FIRST EDITION.

The lectures which I herewith lay before the medical public at large were delivered in the early part of this year, in the new Pathological Institute of the University of Berlin, in the presence of a somewhat numerous assembly of medical men, for the most part physicians practising in the town. The object chiefly aimed at in them, illustrated as they were by as extensive a series of microscopical preparations as it was in my power to supply, was to furnish a clear and connected explanation of those facts upon which, according to my ideas, the theory of life must now be based, and out of which also the science of pathology has now to be constructed. They were more particularly intended as an attempt to offer in a better arranged form than had hitherto been done, a view of the cellular nature of all vital processes, both physiological and pathological, animal and vegetable, so as distinctly to set forth what even the people have long been dimly conscious of, namely, the unity of life1 in all organized beings, in opposition to the one-sided humoral and neuristical (solidistic) tendencies which have been transmitted from the mythical days of antiquity to our own times, and at the same time to contrast with the equally one-sided interpretations of a grossly mechanical and chemical bias —the more delicate mechanism and chemistry of the cell.

1 See Lcct. I, pp. 13—14, and Led. XIV, pp. 284—286.—Trans.

In consequence of the great advances that have been made in the details of science, it has been becoming continually more and more difficult to the majority of those who are engaged in practice, to obtain in the subjects treated on in these lectures that amount of personal experience which alone can guarantee a certain degree of accuracy of judgment. Day by day do those who are obliged to consume their best energies in the frequently so toilsome and so exhausting routine of practice find it becoming less and less possible for them, not only to closely examine, but even to understand the more recent medical works. For even the language of medicine is gradually assuming another appearance; well-known processes to which the prevailing system had assigned a certain place and name in the circle of our thoughts, change with the dissolution of the system their position and their denomination. When a certain action is transferred from the nerves, blood, or vessels to the tissues, when a passive process is recognized to be an active one, an exudation to be a proliferation, then it becomes absolutely necessary to choose other expressions whereby these actions, processes, and products shall be designated; and in proportion as our knowledge of the more delicate modes, in which the processes of life are carried on, becomes more perfect, just in that proportion must the new denominations also be adapted to this more delicate ground-work of our knowledge.

It would not be easy for any one to attempt to carry out the necessary reform in medical opinion with more respect for tradition than I have made it my endeavour to observe. Still my own experience has taught me that even in this there is a certain limit. Too great respect is a real fault, for it favours confusion; a well-selected expression renders at once accessible PREFACE TO THE FIRST EDITION. ix

to the understanding of all, what, without it, efforts prolonged for years would be able to render intelligible at most only to a few. As examples I will cite the terms, parenchymatous inflammation, thrombosis and embolia, leukaemia and ichorrhaemia, osteoid and mucous tissue, cheesy and amyloid metamorphosis, and substitution of tissues. New names cannot be avoided, where actual additions to experimental (empirical) knowledge are being treated of.

On the other hand, I have already often been reproached with endeavouring to rehabilitate antiquated views in modern science. In respect to this I can, I think, say with a safe conscience that I am just as little inclined to restore Galen and Paracelsus to the position they formerly held, as I am afraid openly to acknowledge whatever truth there is in their views and observations. In fact, I find not only that the physicians of antiquity and the middle ages had not in all cases their senses shackled by traditional prejudices, but more than this, that among the people common sense has clung to certain truths, notwithstanding the criticism of the learned had pronounced them overthrown. What should hinder me from avowing that the criticism of the learned has not always proved correct, that system has not always been nature, and that a false interpretation does not impair the correctness of the fact? Why should I not retain good expressions, or restore them, even though false ideas have been attached to them? My experience constrains me to regard the term fluxion (active congestion—Wallung)J as preferable to that of congestion; I cannot help allowing inflammation to be a definite form in which pathological processes display themselves, although I am unable to admit its claims to be regarded as an entity; and I must needs, in spite of the decided counter-statements of many investigators, maintain tubercle to be a miliary granule, and epithelioma a heteroplastic, malignant new-formation (cancroid).

1 See the Author's 'Handbuch dcr speciellcn Path, und Therapic,' Vol. I, p. HI.

Perhaps it is now-a-days a merit to recognise historic rights, for it is indeed astonishing with what levity those very men, who herald forth every trifle, which they have stumbled upon, as a discovery, pass their judgment upon their predecessors. I uphold my own rights, and therefore I also recognize the rights of others. This is the principle I act upon in life, in politics and in science. We owe it to ourselves to defend our rights, for it is the only guarantee for our individual development, and for our influence upon the community at large. Such a defence is no act of vain ambition, and it involves no renunciation of purely scientific aims. For, if we would serve science, we must extend her limits, not only as far as our own knowledge is concerned, but in the estimation of others. Now this estimation depends in a great measure upon the acknowledgment accorded to our rights, upon the confidence placed in our investigations, by others; and this is the reason why I uphold my rights.

In a science so directly practical as that of medicine, and at a time when such a rapid accumulation of facts is taking place, as there is in ours, we are doubly bound to render our knowledge accessible to the whole body of our professional brethren. We would have reform, and not revolution: we would preserve the old, and add the new. But our contemporaries have a confused idea of the results of our activity. For only too much it is apt to appear as though nought but a confused and motley mass of old and new would thereby be obtained; and the necessity of combating rather the false or exclusive doctrines of the more modern, than those of the older writers, produces the impression that our endeavours savour more of revolution than reformation. It is, no doubt, much more agreeable to confine oneself to the investigation and simple publication of what one discovers, and to leave to others to "take it to market" (verPREFACE TO THE FIRST EDITION. xi

werthen—exploiter), but experience teaches us that this is extremely dangerous, and in the end only turns out to the advantage of those who have the least tenderness of conscience. Let us undertake, therefore, every one of us to fulfil the duties both of an observer and of an instructor.

The lectures, which I here publish with the view of accomplishing this double purpose, have found such very patient auditors, that they may perhaps venture to hope for indulgent readers likewise. How greatly they stand in need of indulgence, I myself feel very strongly. Every kind of lecture can only satisfy the actual hearers; and especially when it is chiefly intended to serve as an explanation of drawings on a board, and microscopical preparations, it must necessarily appear heterogeneous and defective to the reader. When the intention is to give a concise view of a comprehensive subject, it necessarily becomes impossible to bring forward all the arguments that could be advanced, and to support them by the requisite quotations. In lectures such as these too the personal views of the lecturer may seem to be brought forward with undue ex clusiveness, but, as it is his business to give a clear exposition of the actual state of the science of which he treats, he is obliged to define with precision the principles, the correctness of which he has proved by his own experience.

I trust therefore that what I offer may not be taken for more than it is intended to be. Those, who have found leisure enough to keep up their knowledge by reading the current medical literature, will find but little that is new in these lectures. The rest will not, by reading them, be spared the trouble of being obliged to study the subjects, which are here only briefly touched upon, more closely in the special histological, physiological and pathological works. But they will at least be in possession of a summary of the discoveries which are the most important as far as the cellular theory is concerned, and they will easily be able to add their more accurate study

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