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TRADITION IN MEDICINE.THE influence of tradition over social progress

can be illustrated in many fields by the considera-tion of medical history. A small volume by Dr.BERNHARD J. STERN,1 emanating from the Facultyof Political Science in Columbia University, setsout to demonstrate how far this mode of reasoningcan be employed, and although it is intendedthat its pages should be read in the light of previoussociological studies issued in the same series and

dealing with social factors of a more conservativenature than the science of medicine ever can be,the fundamental questions put by Dr. STERN showhow well medicine can be made a chosen field of

inquiry. Premising that the term culture is used

throughout the book as the equivalent of social

heritage-that is of accumulated knowledge-heasks to what extent and why are innovations or

changes in culture resisted, and what are the psycho-logical and sociological factors involved. He proceedsto consider these questions, and others arising directlyout of them, in two ways, using the history of medicinefor the source of his examples, first by an inquiryinto the circumstances which retard the disseminationof new learning, and second by an examination ofthe various steps by which medicine has progressed.These make tremendous subjects for discussion inone slender volume, but by the help of copious and Idetailed references the ground is fairly surveyed ina superficial manner, with excellent indications formore intensive study.The factors involved in retarding social change

are mainly psychological, as Dr. STERN recognises,and in emphasising the influences of persistenthabit reactions, of the desire to avoid unpleasantsituations, and of the fear of the unknown, he furnishesa criticism of common social procedure which is ofdefinitely medical application. Threats to economicvested interests, which he next discusses, can hardlybe said to have played much part in medical develop-ments, but in this section he treats of the powerof tradition, as it is manifested in reverence for

authority, leading to unwillingness to analyse newclaims or to subvert recognised teaching. Here allmust see the pertinence of his arguments to the

development of a science, and here the author makesa brave attempt to interpret the status of medicineas a science. He emphasises the ditficulties exemplifiedby various conflicts in medical theory and medicalpractice, where each side has been taken with equalvehemence by authorities who, he appears to assume,have been of equal competence. The assumption,of course, begs the question, for in most of the

necessary differences of opinion which have beenmanifested in the developments of progressive sciencethe opponents were not actually of equal competence ;they only appeared to be so because they were vestedwith equal academic authority or had been engagedin equally important researches. Individually theywere not equated. The officials of the learned societywho declined to accept clinical cases from THOMASADDISON in illustration of his discoveries were notof equal competence with the discoverer, thoughthey appeared to be, and while temporarily they mayhave impeded the dissemination of his views, thetruth prevailed, as it will. The opposition to HARVEY’Htheory of the circulation of the blood was endorsedby many famous anatomists, but the mere fact thatthe attempts to confute him did not take the shape

1 Social Factors in Medical Progress. By Bernhard J. Stern,Ph.D. London: P. S. King and Sons, Ltd, ; New York :Columbia University Press. 1927. Pp. 136. 9s.

of anatomical dernonstrations proves—unless we areto assume deliberate cowardice and chicanery on thepart of a group of learned men—that HARVEY’S

arguments were not really understood. When theywere grasped opposition ceased. Similarly, LISIER’Smain opponents in London, though stand ittj. in

professional repute and by academic degrees on thesame plane which he occupied, were in no sense hisintellectual equals. The opposition to LISTER isnot accurately described by Dr. STERN, but it form;;an excellent example of the power of tradition in theworking, for the resistance to innovation was basedupon the reasoning of persons who, being themselvesbadly informed, were betrayed into illogicality.The opponents of LISTER seized upon minor errors intechnique, forgetting that no innovation when first

presented is entirely perfect ; but the cavilling erit icismswere not long effective in obscuring and discountingthe importance of the discovery, or in delaying itsacceptance, or in perpetuating the ancient procedure’s.

Dr. STERN concludes with a very just criticism ofmedical history as it at present exists, namely, thatit is too much a study of biographies, so that individualswho have contributed to the development of medicineare removed from their scientific background and givenan exaggerated importance. While all can see thatprogressive changes may start with the activities ofgifted individuals, the measure of their responsibilityis not clear in many of the places where their tiamesremain in association with the reform. We oughtto consider how far these changes might have occurredwithout the work of those who are accredited with thediscoveries, and how far each man builds on theaccumulated knowledge of others. As a commentaryon this possibility he gives a list of multiple discoveriesand inventions in the history of medicine, which isof melancholy interest in recalling many wranglesover priority. The list has been compiled from thewritings of many authorities, and, although not perfect,records ample proof of the frequency with whichgreat minds in medicine have thought alike. And howshould it be otherwise, considering the common

training which their minds have received, and thecommon nature of the problems which life placesbefore them?

PERINEAL PROSTATECTOMY.Ix few branches of surgery has so much advance

been made within recent years as in the treatment ofthe hypertrophied prostate. The removal of adeno-mata of the prostate, from being an operation xassociated with grave risk to the patient, his becomea relatively safe procedure in the hands of the

experienced urologist. The dangers of death fromuraemia, shock, haemorrhage, sepsis, and heart failurehave been reduced to the minimum by diligent pre-operative preparation, scrupulous care on the operatingtable, and thoughtful after-treatment. Long series ofoperations by the suprapubic route with an almostinsignificant mortality are reported by leadingurinary surgeons in this country, and the results havebeen so good that there seems to be little need for thedevelopment of a different technique. It was withgreat interest, therefore, that on May 23rd the HoyalSociety of Medicine welcomed Prof. Hans Wildbolz,of Berne, who read a paper in the ITrological Sectionupon the results of 300 prostatectomies by the perincalroute. He attributed his good results—6.5 percent. of deaths-to careful study of the condition ofthe patient before operation and to the employment.of a particular technique. He does not advocate

operation in the early stages of prostatic hypertrophy,