Volume V Part 8 (1/2)

Whichever way one turns in science, subjects are always found thus dovetailing into one another and refusing to be sharply outlined.

Nevertheless, here as elsewhere, there are theoretical bounds that suffice for purposes of definition, if not very rigidly lived up to in practice; and we are justified in thinking of the pathologist (perhaps I should say the pathological anatomist) as the investigator of disease who is directly concerned with effects rather than with causes, who aims directly at the diseased tissue itself and reasons only secondarily to the causes. His problem is: given a certain disease (if I may be permitted this personified form of expression), to find what tissues of the body are changed by it from the normal and in what manner changed.

It requires but a moment's reflection to make it clear that a certain crude insight into the solution of this problem, as regards all common diseases, must have been the common knowledge of medical men since the earliest times. Thus not even medical knowledge was needed to demonstrate that the tissues of an in: flamed part become red and swollen; and numerous other changes of diseased tissues are almost equally patent. But this species of knowledge, based on microscopic inspection, was very vague and untrustworthy, and it was only after the advent of the perfected microscope, some three-quarters of a century ago, that pathological anatomy began to have any proper claim to scientific rank. Indeed, it was not until about the year 1865 that the real clew was discovered which gave the same impetus to pathology that the demonstration of the germ theory of disease gave at about the same time to etiology, or the study of causes of disease. This clew consisted of the final demonstration that all organic action is in the last resort a question of cellular activities, and, specifically, that all abnormal changes in any tissues of the body, due to whatever disease, can consist of nothing more than the destruction, or the proliferation, or the alteration of the cells that compose that tissue.

That seems a simple enough proposition nowadays, but it was at once revolutionary and inspiring in the day of its original enunciation some forty years ago. The man who had made the discovery was a young German physician, professor in the University of Freiburg, by name Rudolph Virchow. The discovery made him famous, and from that day to this the name of Virchow has held somewhat the same position in the world of pathology that the name of Pasteur occupied in the realm of bacteriology. Virchow was called presently to a professors.h.i.+p in the University of Berlin. In connection with this chair he established his famous Inst.i.tute of Pathology, which has been the Mecca of all students of pathology ever since. He did a host of other notable things as well, among others, entering the field of politics, and becoming a recognized leader there no less than in science. Indeed, it seemed during the later decades of his life as if one encountered Virchow in whatever direction one turned in Berlin, and one feels that it was not without reason that his compatriots spoke of him as ”the man who knows everything.” To the end he retained all the alertness of intellect and the energy of body that had made him what he was. One found him at an early hour in the morning attending to the routine of his hospital duties, his lectures, and clinical demonstrations. These finished, he rushed off, perhaps to his parliamentary duties; thence to a meeting of the Academy of Sciences, or to preside at the Academy of Medicine or at some other scientific gathering. And in intervals of these diversified pursuits he was besieged ever by a host of private callers, who sought his opinion, his advice, his influence in some matter of practical politics, of statecraft, or of science, or who, perhaps, had merely come the length of the continent that they might grasp the hand of the ”father of pathology.”

In whatever capacity one sought him out, provided the seeking were not too presumptuous, one was sure to find the great savant approachable, courteous, even cordial. A man of multifarious affairs, he impressed one as having abundance of time for them all, and to spare. There is a leisureliness about the seeming habit of existence on the Continent that does not pertain in America, and one felt the flavor of it quite as much in the presence of this great worker as among those people who from our stand-point seem never really to work at all. This is to a certain extent explained if one visited Virchow in his home, and found to his astonishment that the world-renowned physician, statesman, pathologist, anthropologist was domiciled in a little apartment of the most modest equipment, up two flights, in a house of most unpretentious character.

Everything was entirely respectable, altogether comfortable, to be sure; but it was a grade of living which a man of corresponding position in America could not hold to without finding himself quite out of step with his confreres and the subject of endless comment. But in this city of universal apartment-house occupancy and relatively low average of display in living it is quite otherwise. Virchow lived on the same plane, generally speaking, with the other scientists of Europe; it is only from the American standpoint that there is any seeming disparity between his fame and his material station in life; nor do I claim this as a merit of the American stand-point.

Be that as it may, however, our present concern lies not with these matters, but with Virchow the pathologist and teacher. To see the great scientist at his best in this role, it was necessary to visit the Inst.i.tute of Pathology on a Thursday morning at the hour of nine. On the morning of our visit we found the students already a.s.sembled and gathered in cl.u.s.ters all about the room, examining specimens of morbid anatomy, under guidance of various laboratory a.s.sistants. This was to give them a general familiarity with the appearances of the disease-products that would be described to them in the ensuing lecture.

But what is most striking about the room was the very unique method of arrangement of the desk or table on which the specimens rested. It was virtually a long-drawn-out series of desks winding back and forth throughout the entire room, but all united into one, so that a specimen pa.s.sed along the table from end to end will make a zigzag tour of the room, pa.s.sing finally before each person in the entire audience. To facilitate such transit, there was a little iron railway all along the centre of the table, with miniature turn-tables at the corners, along which microscopes, with adjusted specimens for examination, might be conveyed without danger of maladjustment or injury. This may seem a small detail, but it is really an important auxiliary in the teaching by demonstration with specimens for which this room was peculiarly intended. The ordinary lectures of Professor Virchow were held in a neighboring amphitheatre of conventional type.

Of a sudden there was a hush in the hum of voices, as a little, thin, frail-seeming man entered and stepped briskly to the front of the room and upon the low platform before the blackboard in the corner. A moment's pause for the students to take their places, and the lecturer, who of course was Virchow himself, began, in a clear, conversational voice, to discourse on the topic of the day, which chanced to be the formation of clots in blood-vessels. There was no particular attempt at oratory; rather the lecturer proceeded as if talking man to man, with no thought but to make his meaning perfectly clear. He began at once putting specimens in circulation, as supplied on his demand by his a.s.sistants from a rather grewsome-looking collection before him. Now he paused to chaff the a.s.sistant who was making the labels, poking good-humored jokes at his awkwardness, but with no trace of sting. Again he became animated, his voice raised a little, his speech more vehement, as he advanced his own views on some contested theory or refuted the objections that some opponent had urged against him, always, however, with a smile lurking about his eyes or openly showing on his lips.

Constantly the lecturer turned to the blackboard to ill.u.s.trate with colored, crayons such points of his discourse as the actual specimens in circulation might leave obscure. Everything must be made plain to every hearer or he would not be satisfied. One can but contrast such teaching as this with the lectures of the average German professor, who seems not to concern himself in the least as to whether anything is understood by any one. But Virchow had the spirit of the true teacher. He had the air of loving his task, old story as it was to him. Most of his auditors were mere students, yet he appealed to them as earnestly as if they were a.s.sociates and equals. He seemed to try to put himself on their level--to make his thought near to them. Physically he was near to them as he talked, the platform on which he stood being but a few inches in height, and such physical nearness conduces to a familiarity of discourse that is best fitted for placing lecturer and hearers _en rapport_. All in all, appealing as it does almost equally to ear and eye, it is a type of what a lecturer should be. Not a student there but went away with an added fund of information, which is far more than can be said of most of the lectures in a German university.

Needless to say, there are other departments to the Inst.i.tute of Pathology. There are collections of beautifully preserved specimens for examination; rooms for practical experimentation in all phases of the subject, the chemical side included; but these are not very different from the similar departments of similar inst.i.tutions everywhere. What was unique and characteristic about this inst.i.tution was the personality of the director. Now he is gone, but his influence will not soon be forgotten. The pupils of a great teacher are sure to carry forward the work somewhat in the spirit of the master for at least a generation.

THE BERLIN INSt.i.tUTE OP HYGIENE

I purposely refrain from entering into any details as to the character of the technical work done at the Virchow Inst.i.tute, because the subject of pathology, despite its directly practical bearings, is in itself necessarily somewhat removed from the knowledge of the general reader.

One cannot well understand the details of changes in tissues under abnormal conditions unless one first understands the normal conditions of the tissues themselves, and such knowledge is reserved for the special students of anatomy. For the nonprofessional observer the interest of the Virchow Inst.i.tute must lie in its general scope rather than in the details of the subjects there brought under investigation, which latter have, indeed, of necessity, a somewhat grewsome character despite the beneficent results that spring from them. It is quite otherwise, however, with the work of the allied inst.i.tution of which I now come to speak. The Inst.i.tute of Hygiene deals with topics not very remote from those studied in the Virchow Inst.i.tute, part of its work, indeed, falling clearly within the scope of pathology; but it differs in being clearly comprehensible to the general public and of immediate and tangible interest from the most strictly utilitarian stand-point, hygiene being, in effect, the tangible link between the more abstract medical sciences and the affairs of every-day life.

The Inst.i.tute of Hygiene has also the interest that always attaches to a.s.sociation with a famous name, for it was here that Professor Koch made the greater part of those investigations which made his name the best known, next to that of Pasteur, of any in the field of bacteriology.

In particular, the researches on the cholera germ, and those even more widely heralded researches that led to the discovery of the bacillus of tuberculosis, and the development of the remedy tuberculin, of which so much was at first expected, were made by Professor Koch in the laboratories of the antiquated building which was then and is still the seat of the Inst.i.tute of Hygiene. More recently Professor Koch has severed his connection with the inst.i.tution after presiding over it for many years, having now a semi-private laboratory just across from the Virchow Inst.i.tute, in connection with the Charite Hospital; but one still thinks of the Inst.i.tute of Hygiene as peculiarly the ”Koch Inst.i.tute” without injustice, so fully does its work follow the lines laid out for it by the great leader.

But however much the stamp of any individual personality may rest upon the inst.i.tute, it is officially a department of the university, just as is the Virchow Inst.i.tute. Like the latter, also, its local habitation is an antiquated building, strangely at variance, according to American ideas, with its reputation, though by no means noteworthy in this regard in the case of a German inst.i.tution. It is situated in a part of the city distant from any other department of the university, and there is nothing about it exteriorly to distinguish it from other houses of the solid block in which it stands. Interiorly, it reminds one rather of a converted dwelling than a laboratory proper. Its rooms are well enough adapted to their purpose, but they give one the impression of a makes.h.i.+ft. The smallest American college would be ill-satisfied with such an equipment for any department of its work. Yet in these dingy quarters has been accomplished some of the best work in the new science of bacteriology that our century will have to boast.

The actual equipment of the bacteriological laboratory here is not, indeed, quite as meagre as it seems at first, there being numerous rooms, scattered here and there, which in the aggregate give opportunity for work to a large number of investigators, though no single room makes an impressive appearance. There is one room, however, large enough to give audience to a considerable cla.s.s, and here lectures were given by Professor Koch and continue to be given by his successors to the special students of bacteriology who come from all over the world, as well as to the university students who take the course as a part of their regular medical curriculum. In regard to this feature of its work, the Inst.i.tute of Hygiene differs in no essential respect from the Pasteur Inst.i.tute and other laboratories of bacteriology. The same general routine of work pertains: the patient cultivation of the minute organisms in various mediums, their careful staining by special processes, and their investigation under the microscope mark the work of the bacteriologist everywhere. Many details of the special methods of culture or treatment originated here with Professor Koch, but such matters are never kept secret in science, so one may see them practised quite as generally and as efficiently in other laboratories as in this one. Indeed, it may frankly be admitted that, aside from its historical a.s.sociations with the pioneer work in bacteriology, which will always make it memorable, there is nothing about the bacteriological laboratory here to give it distinction over hundreds of similar ones elsewhere; while in point of technical equipment, as already noted, it is remarkable rather for what it lacks than for what it presents.

The department of bacteriology, however, is only one of several important features of the inst.i.tute. One has but to ascend another flight of stairs to pa.s.s out of the sphere of the microbe and enter a department where attention is directed to quite another field. We have now come to what may be considered the laboratory of hygiene proper, since here the investigations have to do directly with the functionings of the human body in their relations to the every-day environment.

Here again one is struck with the meagre equipment with which important results may be attained by patient and skilled investigators. In only one room does one find a really elaborate piece of apparatus. This exceptional mechanism consists essentially of a cabinet large enough to give comfortable lodgment to a human subject--a cabinet with walls of peculiar structure, partly of gla.s.s, and connected by various pipes with sundry mysterious-seeming retorts. This single apparatus, however, is susceptible of being employed for the investigation of an almost endless variety of questions pertaining to the functionings of the human body considered as a working mechanism.

Thus, for example, a human subject to be experimented upon may remain for an indefinite period within this cabinet, occupied in various ways, taking physical exercise, reading, engaged in creative mental labor, or sleeping. Meantime, air is supplied for respiration in measured quant.i.ties, and of a precisely determined composition, as regards chemical impurities, moisture, and temperature. The air after pa.s.sing through the chamber being again a.n.a.lyzed, the exact const.i.tuents added to it as waste products of the human machine in action under varying conditions are determined. It will readily be seen that by indefinitely varying the conditions of such experiments a great variety of data may be secured as to the exact physiological accompaniments of various bodily and mental activities. Such data are of manifest importance to the physiologist and pathologist on the one hand, while at the same time having a direct bearing on such eminently practical topics as the construction of shops, auditoriums, and dwellings in reference to light, heat, and ventilation. It remains only for practical architecture to take advantage of the unequivocal data thus placed at its disposal--an opportunity of which practical architecture, in Germany as elsewhere on the Continent, has. .h.i.therto been very slow to avail itself.

THE MUSEUM OF HYGIENE

The practical lessons thus given in the laboratory are supplemented in an even more tangible manner, because in a way more accessible to the public, in another department of the inst.i.tution which occupies a contiguous building, and is known as the Museum of Hygiene. This, unlike the other departments of the inst.i.tute, is open to the general public on certain days of each week, and it offers a variety of exhibits of distinctly novel character and of high educational value. The general character of the exhibits may be inferred from the name, but perhaps the scope is even wider than might be expected. In a word, it may be said that scarcely anything having to do with practical hygiene has been overlooked. Thus one finds here numberless models of dwelling-houses, showing details of lighting, heating, and ventilation; models not merely of individual dwellings, but also of school-buildings, hospitals, asylums, and even prisons. Sometimes the models represent merely ideal buildings, but more generally they reproduce in miniature actual habitations. In the case of the public buildings, the model usually includes not merely the structures themselves but the surroundings--lawns, drives, trees, out-buildings--so that one can get a very good idea of the more important hospitals, asylums, and prisons of Germany by making a tour of the Museum of Hygiene. Regarding the details of structure, one can actually gain a fuller knowledge in many cases than he could obtain by actual visits to the original inst.i.tutions themselves.

The same thing is true of various other features of the subjects represented. Thus there is a very elaborate model here exhibited of the famous Berlin system of sewage-disposal. As is well known, the essential features of this system consist of the drainage of sewage into local reservoirs, from which it is forced by pumps, natural drainage not sufficing, to distant fields, where it is distributed through tile pipes laid in a network about a yard beneath the surface of the soil. The fields themselves, thus rendered fertile by the waste products of the city, are cultivated, and yield a rich harvest of vegetables and grains of every variety suitable to the climate. The visitor to this field sees only rich farms and market-gardens under ordinary process of cultivation. The system of pipes by which the land is fertilized is as fully hidden from his view as are, for example, the tributary sewage-pipes beneath the city pavements. The average visitor to Berlin knows nothing, of course, about one or the other, and goes away, as he came, ignorant of the important fact that Berlin has reached a better solution of the great sewage problem than has been attained by any other large city. Such, at least, is likely to be the case unless the sight-seer chance to pay a visit to the Museum of Hygiene, in which case a few minutes' inspection of the model there will make the matter entirely clear to him. It is to be regretted that the authorities of other large cities do not make special visits to Berlin for this purpose; though it should be added that some of them have done so, and that the Berlin system of ”ca.n.a.lization” has been adopted in various places in America. But many others might wisely follow their example, notably the Parisians, whose sewerage system, despite the boasted exhibition ca.n.a.l-sewer, is, like so many other things Parisian, of the most primitive character and a reproach to present-day civilization.

It may be added that there are plenty of things exhibited in this museum which the Germans themselves might study to advantage, for it must be understood that the other hygienic conditions pertaining to Berlin are by no means all on a par with the high modern standard of the sewerage system. In the matter of ventilation, for example, one may find admirable models in the museum, showing just how the dwelling and shop and school-room should make provision for a proper supply of pure air for their occupants. But if one goes out from the museum and searches in the actual dwelling or shop or school-room for the counterparts of these models, one will be sorely puzzled where to find them. The general impression which a casual inspection will leave in his mind is that the word ventilation must be as meaningless to the German mind as it is, for example, to the mind of a Frenchman or an Italian. This probably is not quite just, since the German has at least reached the stage of having museum models of ventilated houses, thus proving that the idea does exist, even though latent, in his mental equipment, whereas the other continental nationalities seem not to have reached even this incipient stage of progress. All over Europe the people fear a current of air as if veritable miasm must lurk in it. They seem quite oblivious to any systematic necessity for replenis.h.i.+ng the oxygen supply among large a.s.semblies, as any one can testify who has, for example, visited their theatres or schools. And as to the private dwellings, after making them as nearly air-tight as practicable, they endeavor to preserve the _status quo_ as regards air supply seemingly from season to season. They even seem to have pa.s.sed beyond a mere negative regard for the subject of fresh air, inasmuch as they will bravely a.s.sure you that to sleep in a room with an open window will surely subject you to the penalty of inflamed eyes.

In a country like France, where the open fireplace is the usual means employed to modify the temperature (I will not say warm the room), the dwellings do of necessity get a certain amount of ventilation, particularly since the windows are not usually of the best construction.

But the German, with his nearly air-tight double windows and his even more nearly sealed tile stove, spends the winter in an atmosphere suggestive of the descriptions that arctic travellers give us of the air in the hut of an Eskimo. It is clear, then, that the models in the Museum of Hygiene have thus far failed of the proselyting purpose for which they were presumably intended. How it has chanced that the inhabitants of the country maintain so high an average of robust health after this open defiance is a subject which the physiological department of the Inst.i.tute of Hygiene might well investigate.