The Evolution of Modern Medicine: A Series of Lectures Delivered at Yale University on the Silliman Foundation in April, 1913Osler, William, Sir
History
The Evolution of Modern Medicine: A Series of Lectures Delivered at Yale University on the Silliman Foundation in April, 1913
Osler, William, Sir
Medicine -- History
ONE of the greatest contributions of the nineteenth century to
scientific medicine was the discovery of the internal secretions of
organs. The basic work on the subject was done by Claude Bernard, a
pupil of the great Magendie, whose saying it is well to remember--"When
entering a laboratory one should leave theories in the cloakroom." More
than any other man of his generation, Claude Bernard appreciated the
importance of experiment in practical medicine. For him the experimental
physician was the physician of the future--a view well borne out by the
influence his epoch-making work has had on the treatment of disease. His
studies on the glycogenic functions of the liver opened the way for the
modern fruitful researches on the internal secretions of the various
glands. About the same time that Bernard was developing the laboratory
side of the problem, Addison, a physician to Guy's Hospital, in 1855,
pointed out the relation of a remarkable group of symptoms to disease
of the suprarenal glands, small bodies situated above the kidneys, the
importance of which had not been previously recognized. With the loss
of the function of these glands by disease, the body was deprived of
something formed by them which was essential to its proper working.
Then, in the last third of the century, came in rapid succession the
demonstration of the relations of the pancreas to diabetes, of the vital
importance of the thyroid gland and of the pituitary body. Perhaps no
more striking illustration of the value of experimental medicine has
ever been given than that afforded by the studies upon those glands.
The thyroid body, situated in the neck and the enlargement of which is
called goitre, secretes substances which pass into the blood, and
which are necessary for the growth of the body in childhood, for the
development of the mind and for the nutrition of the tissues of the
skin. If, following an infectious disease, a child has wasting of this
gland, or if, living in a certain district, it has a large goitre,
normal development does not take place, and the child does not grow in
mind or body and becomes what is called a cretin. More than this--if in
adult life the gland is completely removed, or if it wastes, a somewhat
similar condition is produced, and the patient in time loses his mental
powers and becomes fat and flabby--myxedematous. It has been shown
experimentally in various ways that the necessary elements of the
secretion can be furnished by feeding with the gland or its extracts,
and that the cretinoid or myxedematous conditions could thus be cured or
prevented.
Experimental work has also demonstrated the functions of the suprarenal
glands and explained the symptoms of Addison's disease, and chemists
have even succeeded in making synthetically the active principle
adrenalin.
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