Medical Essays, 1842-1882 by Oliver Wendell Holmes, Sr.
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| Table of Contents | |
| Section | Page |
| Start of eBook | 1 |
| PREFACE. | 1 |
| A SECOND PREFACE. | 4 |
| PREFACE TO THE NEW EDITION. | 4 |
| hom*oEOPATHY AND ITS KINDRED DELUSIONS | 7 |
| I | 8 |
| II. | 28 |
| THE CONTAGIOUSNESS OF PUERPERAL FEVER | 64 |
| THE AFFIRMATIVE. | 64 |
| THE NEGATIVE. | 64 |
| III | 103 |
| BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. | 123 |
| SCHOLASTIC AND BEDSIDE TEACHING. | 160 |
| THE MEDICAL PROFESSION IN MASSACHUSETTS. | 182 |
| THE YOUNG PRACTITIONER | 212 |
| MEDICAL LIBRARIES. | 227 |
| SOME OF MY EARLY TEACHERS | 241 |
| APPENDUM | 252 |
| NOTE A.— | 252 |
| NOTE B.— | 253 |
| NOTE C.— | 254 |
PREFACE.
The character of the opposition which some of thesepapers have met with suggests the inference that theycontain really important, but unwelcome truths.Negatives multiplied into each other change their signand become positives. Hostile criticisms meetingtogether are often equivalent to praise, and the squareof fault-finding turns out to be the same thing aseulogy.
But a writer has rarely so many enemies as it pleaseshim to believe. Self-love leads us to overratethe numbers of our negative constituency. Thelarger portion of my limited circle of readers mustbe quite indifferent to, if not ignorant of, the adverseopinions which have been expressed or recorded concerningany of these Addresses or Essays now submitted totheir own judgment. It is proper, however, toinform them, that some of the positions maintainedin these pages have been unsparingly attacked, withvarious degrees of ability, scholarship, and good-breeding.The tone of criticism naturally changes with localconditions in different parts of a country extendedlike our own, so that it is one of the most convenientgauges of the partial movements in the direction ofcivilization. It is satisfactory to add, thatthe views assailed have also been unflinchingly defendedby unsought champions, among the ablest of whom itis pleasant to mention, at this moment of politicalalienation, the Editor of the Charleston Medical Journal.
“Currents and Counter-Currents” was writtenand delivered as an Oration, a florid rhetorical composition,expressly intended to secure the attention of an audiencenot easy to hold as listeners. It succeeded indoing this, and also in being as curiously misunderstoodand misrepresented as if it had been a political harangue.This gave it more local notoriety than it might otherwisehave attained, so that, as I learn, one ingeniousperson made use of its title as an advertisem*nt toa production of his own.
The commonest mode of misrepresentation was this:qualified propositions, the whole meaning of whichdepended on the qualifications, were stripped of theseand taken as absolute. Thus, the attempt to establisha presumption against giving poisons to sick personswas considered as equivalent to condemning the useof these substances. The only important inferencethe writer has been able to draw from the greater numberof the refutations of his opinions which have beenkindly sent him, is that the preliminary educationof the Medical Profession is not always what it oughtto be.
One concession he is willing to make, whatever sacrificeof pride it may involve. The story of Massasoit,which has furnished a coral, as it were, for someteething critics, when subjected to a powerful logicalanalysis, though correct in its essentials, provesto have been told with exceptionable breadth of statement,and therefore (to resume the metaphor) has been slightlyrounded off at its edges, so as to be smoother forany who may wish to bite upon it hereafter. Inother respects the Discourse has hardly been touched.It is only an individual’s expression, in hisown way, of opinions entertained by hundreds of theMedical Profession in every civilized country, andhas nothing in it which on revision the writer seescause to retract or modify. The superstitionsit attacks lie at the very foundation of hom*oeopathy,and of almost every form of medical charlatanism.Still the mere routinists and unthinking artisansin most callings dislike whatever shakes the dustout of their traditions, and it may be unreasonableto expect that Medicine will always prove an exceptionto the rule. One half the opposition which thenumerical system of Louis has met with, as appliedto the results of treatment, has been owing to thefact that it showed the movements of disease to befar more independent of the kind of practice pursuedthan was agreeable to the pride of those whose self-confidenceit abated.
The statement, that medicines are more sparingly usedin physicians’ families than in most others,admits of a very natural explanation, without puttinga harsh construction upon it, which it was not intendedto admit. Outside pressure is less felt in thephysician’s own household; that is all.If this does not sometimes influence him to give medicine,or what seems to be medicine, when among those whohave more confidence in drugging than his own familycommonly has, the learned Professor Dunglison is herebyrequested to apologize for his definition of the wordPlacebo, or to expunge it from his Medical Dictionary.
One thing is certain. A loud outcry on a slighttouch reveals the weak spot in a profession, as wellas in a patient. It is a doubtful policy to opposethe freest speech in those of our own number who aretrying to show us where they honestly believe ourweakness lies. Vast as are the advances of ourScience and Art, may it not possibly prove on examinationthat we retain other old barbarisms beside the useof the astrological sign of Jupiter, with which weendeavor to insure good luck to our prescriptions?Is it the act of a friend or a foe to try to pointthem out to our brethren when asked to address them,and is the speaker to subdue the constitutional habitof his style to a given standard, under penalty ofgiving offence to a grave assembly?
“hom*oeopathy and its Kindred Delusions”was published nearly twenty years ago, and has beenlong out of print, so that the author tried in vainto procure a copy until the kindness of a friend suppliedhim with the only one he has had for years. Afoolish story reached his ears that he was attemptingto buy up stray copies for the sake of suppressingit. This edition was in the press at that verytime.
Many of the arguments contained in the Lectures havelost whatever novelty they may have possessed.All its predictions have been submitted to the formidabletest of time. They appear to have stood it, sofar, about as well as most uninspired prophecies;indeed, some of them require much less accommodationthan certain grave commentators employ in their readingsof the ancient Prophets.
If some statistics recently published are correct,hom*oeopathy has made very slow progress in Europe.
In all England, as it appears, there are hardly afifth more hom*oeopathic practitioners than there arestudents attending Lectures at the Massachusetts MedicalCollege at the present time. In America it hasundoubtedly proved more popular and lucrative, yethow loose a hold it has on the public confidence isshown by the fact that, when a specially valued life,which has been played with by one of its agents, isseriously threatened, the first thing we expect tohear is that a regular practitioner is by the patient’sbed, and the hom*oeopathic counsellor overruled ordiscarded. Again, how many of the ardent and capriciouspersons who embraced hom*oeopathy have run the wholeround of pretentious novelties;—have beenboarded at water-cure establishments, closeted withuterine and other specialists, and finally wanderedover seas to put themselves in charge of foreign celebrities,who dosed them as lustily as they were ever dosedbefore they took to globules! It will surprisemany to learn to what a shadow of a shade hom*oeopathyhas dwindled in the hands of many of its noted practitioners.The itch-doctrine is treated with contempt. Infinitesimaldoses are replaced by full ones whenever the fancy-practitionerchooses. Good hom*oeopathic reasons can be foundfor employing anything that anybody wants to employ.hom*oeopathy is now merely a name, an unproved theory,and a box of pellets pretending to be specifics, which,as all of us know, fail ignominiously in those caseswhere we would thankfully sacrifice all our prejudicesand give the world to have them true to their promises.
hom*oeopathy has not died out so rapidly as Tractoration.Perhaps it was well that it should not, for it hastaught us a lesson of the healing faculty of Naturewhich was needed, and for which many of us have madeproper acknowledgments. But it probably does moreharm than good to medical science at the present time,by keeping up the delusion of treating everythingby specifics,—the old barbarous notion thatsick people should feed on poisons [Lachesis, arrow-poison,obtained from a serpent (Pulte). Crotalus horridus,rattlesnake’s venom (Neidhard). The lessdangerous Pediculus capitis is the favorite remedyof Dr. Mure, the English “Apostle of hom*oeopathy.”These are examples of the retrograde current settingtowards barbarism] against which a part of the Discourseat the beginning of this volume is directed.
The infinitesimal globules have not become a curiosityas yet, like Perkins’s Tractors. But timeis a very elastic element in Geology and Prophecy.If Daniel’s seventy weeks mean four hundred andninety years, as the learned Prideaux and others havesettled it that they do, the “not many years”of my prediction may be stretched out a generationor two beyond our time, if necessary, when the prophecywill no doubt prove true.
It might be fitting to add a few words with regardto the Essay on the Contagiousness of Puerperal Fever.But the whole question I consider to be now transferredfrom the domain of medical inquiry to the considerationof Life Insurance agencies and Grand Juries. Forthe justification of this somewhat sharply accentedlanguage I must refer the reader to the paper itselffor details which I regret to have been forced toplace on permanent record.
Boston, January, 1861.
A SECOND PREFACE.
These Lectures and Essays are arranged in the ordercorresponding to the date of their delivery or publication.They must, of course, be read with a constant referenceto these dates, by such as care to read them.I have not attempted to modernize their aspect or characterin presenting them, in this somewhat altered connection,to the public. Several of them were containedin a former volume which received its name from theAddress called “Currents and Counter-Currents.”Some of those contained in the former volume havebeen replaced by others. The Essay called “Mechanismof Vital Actions” has been transferred to a distinctcollection of Miscellaneous essays, forming a separatevolume.
I had some intention of including with these papersan Essay on Intermittent Fever in New England, whichreceived one of the Boylston prizes in 1837, and waspublished in the following year. But as this wasupon a subject of local interest, chiefly, and wouldhave taken up a good deal of room, I thought it bestto leave it out, trusting that the stray copies tobe met with in musty book-shops would sufficientlysupply the not very extensive or urgent demand fora paper almost half a century old.
Some of these papers created a little stir when theyfirst fell from the press into the pool of publicconsciousness. They will slide in very quietlynow in this new edition, and find out for themselveswhether the waters are those of Lethe, or whetherthey are to live for a time as not wholly unvaluedreminiscences.
March 21, 1883.
PREFACE TO THE NEW EDITION.
These Essays are old enough now to go alone withoutstaff or crutch in the shape of Prefaces. A veryfew words may be a convenience to the reader who takesup the book and wishes to know what he is likely tofind in it.
hom*oeopathyand its Kindred delusions.
hom*oeopathy has proved lucrative, and so long as itcontinues to be so will surely exist,—assurely as astrology, palmistry, and other methodsof getting a living out of the weakness and credulityof mankind and womankind. Though it has no pretensionsto be considered as belonging among the sciences,it may be looked upon by a scientific man as a curiousobject of study among the vagaries of the human mind.Its influence for good or the contrary may be made
a matter of calm investigation. I have studiedit in the Essay before the reader, under the aspectof an extravagant and purely imaginative creation ofits founder. Since that first essay was written,nearly half a century ago, we have all had a chanceto witness its practical working. Two oppositeinferences may be drawn from its doctrines and practice.The first is that which is accepted by its disciples.This is that all diseases are “cured”by drugs. The opposite conclusion is drawn bya much larger number of persons. As they seethat patients are very commonly getting well undertreatment by infinitesimal drugging, which they considerequivalent to no medication at all, they come to disbelievein every form of drugging and put their whole trustin “nature.” Thus experience,“From seemingevil still educing good,”
has shown that the dealers in this preposterous systemof pseudo-therapeutics have cooperated with the wiserclass of practitioners in breaking up the system ofover-dosing and over-drugging which has been one ofthe standing reproaches of medical practice. While.keeping up the miserable delusion that diseases wereall to be “cured” by drugging, hom*oeopathyhas been unintentionally showing that they would verygenerally get well without any drugging at all.In the mean time the newer doctrines of the “mindcure,” the “faith cure,” and therest are encroaching on the territory so long monopolizedby that most ingenious of the pseudo-sciences.It would not be surprising if its whole ground shouldbe taken possession of by these new claimants withtheir flattering appeals to the imaginative classof persons open to such attacks. Similia similabusmay prove fatally true for once, if hom*oeopathy iskilled out by its new-born rivals.
It takes a very moderate amount of erudition to uneartha charlatan like the supposed father of the infinitesimaldosing system. The real inventor of that specioustrickery was an Irishman by the name of Butler.The whole story is to be found in the “OrtusMedicinm” of Van Helmont. I have givensome account of his chapter “Butler” indifferent articles, but I would refer the studentsof our hom*oeopathic educational institutions to theoriginal, which they will find very interesting andcurious.
Currentsand counter-currents
My attack on over-drugging brought out some hostilecomments and treatment. Thirty years ago I expressedmyself with more vivacity than I should show if Iwere writing on the same subjects today. Someof my more lively remarks called out very sharp animadversion.Thus my illustration of prevention as often betterthan treatment in the mother’s words to herchild which had got a poisonous berry in its mouth,—“Spitit out!” gave mortal offence to a well-knownNew York practitioner and writer, who advised theMassachusetts Medical Society to spit out the offendingspeaker. Worse than this was my statement of my
belief that if a ship-load of miscellaneous drugs,with certain very important exceptions,—drugs,many of which were then often given needlessly andin excess, as then used “could be sunk to thebottom of the sea, it would be all the better formankind and all the worse for the fishes.”This was too bad. The sentence was misquoted,quoted without its qualifying conditions, and frightenedsome of my worthy professional brethren as much asif I had told them to throw all physic to the dogs.But for the epigrammatic sting the sentiment wouldhave been unnoticed as a harmless overstatement atthe very worst.Since this lecture was delivered a great and, as Ithink, beneficial change has taken place in the practiceof medicine. The habit of the English “generalpractitioner” of making his profit out of thepills and potions he administered was ruinous to professionaladvancement and the dignity of the physician.When a half-starving medical man felt that he mustgive his patient draught and boluses for which he couldcharge him, he was in a pitiable position and toolikely to persuade himself that his drugs were usefulto his patient because they were profitable to him.This practice has prevailed a good deal in America,and was doubtless the source in some measure of theerrors I combated.
Thecontagiousness of puerperal fever.
This Essay was read before a small Association called“The Society for Medical Improvement,”and published in a Medical Journal which lasted buta single year. It naturally attracted less attentionthan it would have done if published in such a periodicalas the “American Journal of Medical Sciences.”Still it had its effect, as I have every reason tobelieve. I cannot doubt that it has saved thelives of many young mothers by calling attention tothe existence and propagation of “PuerperalFever as a Private Pestilence,” and laying downrules for taking the necessary precautions againstit. The case has long been decided in favor ofthe views I advocated, but, at the time when I wrotetwo of the most celebrated professors of Obstetricsin this country opposed my conclusions with all theweight of their experience and position.
This paper was written in a great heat and with passionateindignation. If I touched it at all I might trimits rhetorical exuberance, but I prefer to leave itall its original strength of expression. I couldnot, if I had tried, have disguised the feelings withwhich I regarded the attempt to put out of sight thefrightful facts which I brought forward and the necessaryconclusions to which they led. Of course the wholematter has been looked at in a new point of view sincethe microbe as a vehicle of contagion has been broughtinto light, and explained the mechanism of that whichwas plain enough as a fact to all who were not blindor who did not shut their eyes.
O. W. H.
Beverly Farms, Mass., August 3, 1891
hom*oEOPATHY AND ITS KINDRED DELUSIONS
[Two lectures delivered before the Boston Societyfor the Diffusion of Useful Knowledge. 1842.]
[When a physician attempts to convince a person, whohas fallen into the hom*oeopathic delusion, of theemptiness of its pretensions, he is often answeredby a statement of cases in which its practitionersare thought to have effected wonderful cures.The main object of the first of these Lectures isto show, by abundant facts, that such statements, madeby persons unacquainted with the fluctuations of diseaseand the fallacies of observation, are to be consideredin general as of little or no value in establishingthe truth of a medical doctrine or the utility of amethod of practice.
Those kind friends who suggest to a person sufferingfrom a tedious complaint, that he “Had bettertry hom*oeopathy,” are apt to enforce their suggestionby adding, that “at any rate it can do no harm.”This may or may not be true as regards the individual.But it always does very great harm to the communityto encourage ignorance, error, or deception in a professionwhich deals with the life and health of our fellow-creatures.Whether or not those who countenance hom*oeopathy areguilty of this injustice towards others, the secondof these Lectures may afford them some means of determining.
To deny that good effects may happen from the observanceof diet and regimen when prescribed by hom*oeopathistsas well as by others, would be very unfair to them.But to suppose that men with minds so constitutedas to accept such statements and embrace such doctrinesas make up the so-called science of hom*oeopathy aremore competent than others to regulate the circ*mstanceswhich influence the human body in health and disease,would be judging very harshly the average capacityof ordinary practitioners.
To deny that some patients may have been actuallybenefited through the influence exerted upon theirimaginations, would be to refuse to hom*oeopathy whatall are willing to concede to every one of those numerousmodes of practice known to all intelligent personsby an opprobrious title.
So long as the body is affected through the mind,no audacious device, even of the most manifestly dishonestcharacter, can fail of producing occasional good tothose who yield it an implicit or even a partial faith.The argument founded on this occasional good wouldbe as applicable in justifying the counterfeiter andgiving circulation to his base coin, on the groundthat a spurious dollar had often relieved a poor man’snecessities.
hom*oeopathy has come before our public at a periodwhen the growing spirit of eclecticism has preparedmany ingenious and honest minds to listen to all newdoctrines with a candor liable to degenerate intoweakness. It is not impossible that the pretendedevolution of great and mysterious virtues from infinitelyattenuated atoms may have enticed a few over-refiningphilosophers, who have slid into a vague belief thatmatter subdivided grows less material, and approachesnearer to a spiritual nature as it requires a morepowerful microscope for its detection.
However this may be, some persons seem disposed totake the ground of Menzel that the Laity must passformal judgment between the Physician and the hom*oeopathist,as it once did between Luther and the Romanists.The practitioner and the scholar must not, therefore,smile at the amount of time and labor expended inthese Lectures upon this shadowy system; which, inthe calm and serious judgment of many of the wisestmembers of the medical profession, is not entitledby anything it has ever said or done to the notorietyof a public rebuke, still less to the honors of criticalmartyrdom.]
I
I have selected four topics for this lecture, thefirst three of which I shall touch but slightly, thelast more fully. They are
1. The Royal cure of the King’s Evil, orScrofula.
2. The Weapon Ointment, and its twin absurdity,the Sympathetic Powder.
3. The Tar-water mania of Bishop Berkeley.
4. The History of the Metallic Tractors, or Perkinism.
The first two illustrate the ease with which numerousfacts are accumulated to prove the most fanciful andsenseless extravagances.
The third exhibits the entire insufficiency of exaltedwisdom, immaculate honesty, and vast general acquirementsto make a good physician of a great bishop.
The fourth shows us the intimate machinery of an extinctdelusion, which flourished only forty years ago; drawnin all its details, as being a rich and comparativelyrecent illustration of the pretensions, the arguments,the patronage, by means of which windy errors havelong been, and will long continue to be, swollen intotransient consequence. All display in superfluousabundance the boundless credulity and excitabilityof mankind upon subjects connected with medicine.
“From the time of Edward the Confessor to QueenAnne, the monarchs of England were in the habit oftouching those who were brought to them sufferingwith the scrofula, for the cure of that distemper.William the Third had good sense enough to discontinuethe practice, but Anne resumed it, and, among herother patients, performed the royal operation upona child, who, in spite of his, disease, grew up atlast into Samuel Johnson. After laying his handupon the sufferers, it was customary for the monarchto hang a gold piece around the neck of each patient.Very strict precautions were adopted to prevent thosewho thought more of the golden angel hung round theneck by a white ribbon, than of relief of their bodilyinfirmities, from making too many calls, as they sometimesattempted to do. According to the statement ofthe advocates and contemporaries of this remedy, noneever failed of receiving benefit unless their littlefaith and credulity starved their merits. Someare said to have been cured immediately on the verytouch, others did not so easily get rid of their swellings,until they were touched a second time. Several
cases are related, of persons who had been blind forseveral weeks, and months, and obliged even to beled to Whitehall, yet recovered their sight immediatelyupon being touched, so as to walk away without anyguide.” So widely, at one period, was thebelief diffused, that, in the course of twelve years,nearly a hundred thousand persons were touched byCharles the Second. Catholic divines; in disputesupon the orthodoxy of their church, did not deny thatthe power had descended to protestant princes;—Dr.Harpsfield, in his “Ecclesiastical History ofEngland,” admitted it, and in Wiseman’swords, “when Bishop Tooker would make use ofthis Argument to prove the Truth of our Church, Smitheusdoth not thereupon go about to deny the Matter offact; nay, both he and Cope acknowledge it.”“I myself,” says Wiseman, the best Englishsurgical writer of his day,[Edinburgh Medical andSurgical Journal, vol. iii. p. 103.]—“Imy self have been a frequent Eye-witness of many hundredof Cures performed by his Majesties Touch alone, withoutany assistance of Chirurgery; and those, many of themsuch as had tired out the endeavours of able Chirurgeonsbefore they came hither. It were endless to recitewhat I myself have seen, and what I have received acknowledgmentsof by Letter, not only from the severall parts ofthis Nation, but also from Ireland, Scotland, Jersey,Garnsey. It is needless also to remember whatMiracles of this nature were performed by the veryBloud of his late Majesty of Blessed memory, afterwhose decollation by the inhuman Barbarity of theRegicides, the reliques of that were gathered on Chipsand in Handkerchieffs by the pious Devotes, who couldnot but think so great a suffering in so honourableand pious a Cause, would be attended by an extraordinaryassistance of God, and some more then ordinary a miracle:nor did their Faith deceive them in this there point,being so many hundred that found the benefit of it.”[Severall Chirurgicall Treatises. London.1676.p. 246.]Obstinate and incredulous men, as he tells us, accountedfor these cures in three ways: by the journeyand change of air the patients obtained in comingto London; by the influence of imagination; and thewearing of gold.
To these objections he answers, 1st. That manyof those cured were inhabitants of the city. 2d.That the subjects of treatment were frequently infants.3d. That sometimes silver was given, and sometimesnothing, yet the patients were cured.
A superstition resembling this probably exists atthe present time in some ignorant districts of Englandand this country. A writer in a Medical Journalin the year 1807, speaks of a farmer in Devonshire,who, being a ninth son of a ninth son, is thoughtendowed with healing powers like those of ancientroyalty, and who is accustomed one day in every weekto strike for the evil.
I remember that one of my schoolmates told me, whena boy, of a seventh son of a seventh son, somewherein Essex County, who touched for the scrofula, andwho used to hang a silver fourpence halfpenny aboutthe neck of those who came to him, which fourpencehalfpenny it was solemnly affirmed became of a remarkablyblack color after having been some time worn, andthat his own brother had been subjected to this extraordinarytreatment; but I must add that my schoolmate drew abow of remarkable length, strength, and toughnessfor his tender years.
One of the most curious examples of the fallacy ofpopular belief and the uncertainty of asserted factsin medical experience is to be found in the historyof the Unguentum Armarium, or weaponointment.
Fabricius Hildanus, whose name is familiar to everysurgical scholar, and Lord Bacon, who frequently dippeda little into medicine, are my principal authoritiesfor the few circ*mstances I shall mention regardingit. The Weapon Ointment was a preparation usedfor the healing of wounds, but instead of its beingapplied to them, the injured part was washed and bandaged,and the weapon with which the wound was inflictedwas carefully anointed with the unguent. Empirics,ignorant barbers, and men of that sort, are said tohave especially employed it. Still there werenot wanting some among the more respectable membersof the medical profession who supported its claims.The composition of this ointment was complicated,in the different formulae given by different authorities;but some substances addressed to the imagination, ratherthan the wound or weapon, entered into all. Suchwere portions of mummy, of human blood, and of mossfrom the skull of a thief hung in chains.
Hildanus was a wise and learned man, one of the bestsurgeons of his time. He was fully aware thata part of the real secret of the Unguentum Armariumconsisted in the washing and bandaging the wound andthen letting it alone. But he could not resistthe solemn assertions respecting its efficacy; hegave way before the outcry of facts, and therefore,instead of denying all their pretensions, he admittedand tried to account for them upon supernatural grounds.As the virtue of those applications, he says, whichare made to the weapon cannot reach the wound, andas they can produce no effect without contact, it follows,of necessity, that the Devil must have a hand in thebusiness; and as he is by far the most long headedand experienced of practitioners, he cannot find thisa matter of any great difficulty. Hildanus himselfreports, in detail, the case of a lady who had receiveda moderate wound, for which the Unguentum Armariumwas employed without the slightest use. Yet insteadof receiving this flat case of failure as any evidenceagainst the remedy, he accounts for its not succeedingby the devout character of the lady, and her freedomfrom that superstitious and over-imaginative tendencywhich the Devil requires in those who are to be benefitedby his devices.
Lord Bacon speaks of the Weapon Ointment, in his NaturalHistory, as having in its favor the testimony of menof credit, though, in his own language, he himself“as yet is not fully inclined to believe it.”His remarks upon the asserted facts respecting itshow a mixture of wise suspicion and partial belief.He does not like the precise directions given as tothe circ*mstances under which the animals from whichsome of the materials were obtained were to be killed;for he thought it looked like a provision for an excusein case of failure, by laying the fault to the omissionof some of these circ*mstances. But he likes wellthat “they do not observe the confecting ofthe Ointment under any certain constellation; whichis commonly the excuse of magical medicines, whenthey fail, that they were not made under a fit figureof heaven.” [This was a mistake, however, sincethe two recipes given by Hildanus are both very explicitas to the aspect of the heavens required for differentstages of the process.] “It was pretended thatif the offending weapon could not be had, it wouldserve the purpose to anoint a wooden one made likeit.” “This,” says Bacon, “Ishould doubt to be a device to keep this strange formof cure in request and use; because many times youcannot come by the weapon itself.” And inclosing his remarks on the statements of the advocatesof the ointment, he says, “Lastly, it will curea beast as well as a man, which I like best of allthe rest, because it subjecteth the matter to an easytrial.” It is worth remembering, that morethan two hundred years ago, when an absurd and fantasticremedy was asserted to possess wonderful power, andwhen sensible persons ascribed its pretended influenceto imagination, it was boldly answered that the curetook place when the wounded party did not know of theapplication made to the weapon, and even when a bruteanimal was the subject of the experiment, and thatthis assertion, as we all know it was, came in sucha shape as to shake the incredulity of the keenestthinker of his time. The very same assertion hasbeen since repeated in favor of Perkinism, and, sincethat, of hom*oeopathy.
The same essential idea as that of the Weapon Ointmentreproduced itself in the still more famous sympatheticpowder. This Powder was said to have thefaculty, if applied to the blood-stained garments ofa wounded person, to cure his injuries, even thoughhe were at a great distance at the time. A friar,returning from the East, brought the recipe to Europesomewhat before the middle of the seventeenth century.The Grand Duke of Florence, in which city the friarwas residing, heard of his cures, and tried, but withoutsuccess, to obtain his secret. Sir Kenehn Digby,an Englishman well known to fame, was fortunate enoughto do him a favor, which wrought upon his feelingsand induced him to impart to his benefactor the compositionof his extraordinary Powder. This English knightwas at different periods of his life an admiral, atheologian, a critic, a metaphysician, a politician,and a disciple of Alchemy. As is not unfrequentwith versatile and inflammable people, he caught fireat the first spark of a new medical discovery, andno sooner got home to England than he began to spreadthe conflagration.
An opportunity soon offered itself to try the powersof the famous powder. Mr. J. Howell, having beenwounded in endeavoring to part two of his friendswho were fighting a duel, submitted himself to a trialof the Sympathetic Powder. Four days after hereceived his wounds, Sir Kenehn dipped one of Mr.Howell’s gaiters in a solution of the Powder,and immediately, it is said, the wounds, which werevery painful, grew easy, although the patient, whowas conversing in a corner of the chamber, had not,the least idea of what was doing with his garter.He then returned home, leaving his garter in the handsof Sir Kenelm, who had hung it up to dry, when Mr.Howell sent his servant in a great hurry to tell himthat his wounds were paining him horribly; the garterwas therefore replaced in the solution of the Powder,“and the patient got well after five or sixdays of its continued immersion.”
King James First, his son Charles the First, the Dukeof Buckingham, then prime minister, and all the principalpersonages of the time, were cognizant of this fact;and James himself, being curious to know the secretof this remedy, asked it of Sir Kenelm, who revealedit to him, and his Majesty had the opportunity ofmaking several trials of its efficacy, “whichall succeeded in a surprising manner.” [Dict.des Sciences Medieales.]
The king’s physician, Dr. Mayerne, was mademaster of the secret, which he carried to France andcommunicated to the Duke of Mayenne, who performedmany cures by means of it, and taught it to his surgeon,who, after the Duke’s death, sold it to manydistinguished persons, by whose agency it soon ceasedto be a secret. What was this wonderful substancewhich so astonished kings, princes, dukes, knights,and doctors? Nothing but powdered blue vitriol.But it was made to undergo several processes thatconferred on it extraordinary virtues. Twice orthrice it was to be dissolved, filtered, and crystallized.The crystals were to be laid in the sun during themonths of June, July, and August, taking care to turnthem carefully that all should be exposed. Thenthey were to be powdered, triturated, and again exposedto the sun, again reduced to a very fine powder, andsecured in a vessel, while hot, from the sunshine.If there seem anything remarkable in the fact of suchastonishing properties being developed by this process,it must be from our short-sightedness, for commonsalt and charcoal develop powers quite as marvellousafter a certain number of thumps, stirs, and shakes,from the hands of modern workers of miracles.In fact the Unguentum Armarium and Sympathetic Powderresemble some more recent prescriptions; the latterconsisting in an infinite dilution of the common dosein which remedies are given, and the two former inan infinite dilution of the common distance at whichthey are applied.
Whether philosophers, and more especially metaphysicians,have any peculiar tendency to dabble in drugs anddose themselves with physic, is a question which mightsuggest itself to the reader of their biographies.
When Bishop Berkeley visited the illustrious Malebrancheat Paris, he found him in his cell, cooking in a smallpipkin a medicine for an inflammation of the lungs,from which he was suffering; and the disease, beingunfortunately aggravated by the vehemence of theirdiscussion, or the contents of the pipkin, carriedhim off in the course of a few days. Berkeleyhimself afforded a remarkable illustration of a truthwhich has long been known to the members of one ofthe learned professions, namely, that no amount oftalent, or of acquirements in other departments, canrescue from lamentable folly those who, without somethingof the requisite preparation, undertake to experimentwith nostrums upon themselves and their neighbors.The exalted character of Berkeley is thus drawn bySir James Mackintosh: Ancient learning, exactscience, polished society, modern literature, andthe fine arts, contributed to adorn and enrich themind of this accomplished man. All his contemporariesagreed with the satirist in ascribing
“‘To Berkeley everyvirtue under heaven.’
“Even the discerning, fastidious, and turbulentAtterbury said, after an interview with him, ’Somuch understanding, so much knowledge, so much innocence,and such humility, I did not think had been the portionof any but angels, till I saw this gentleman.’”
But among the writings of this great and good manis an Essay of the most curious character, illustratinghis weakness upon the point in question, and entitled,“Siris, a Chain of Philosophical Reflectionsand Inquiries concerning the Virtues of tar water,and divers other Subjects,”—an essaywhich begins with a recipe for his favorite fluid,and slides by gentle gradations into an examinationof the sublimest doctrines of Plato. To showhow far a man of honesty and benevolence, and witha mind of singular acuteness and depth, may be runaway with by a favorite notion on a subject whichhis habits and education do not fit him to investigate,I shall give a short account of this Essay, merelystating that as all the supposed virtues of Tar Water,made public in successive editions of his treatiseby so illustrious an author, have not saved it fromneglect and disgrace, it may be fairly assumed thatthey were mainly imaginary.
The bishop, as is usual in such cases, speaks of himselfas indispensably obliged, by the duty he owes to mankind,to make his experience public. Now this was byno means evident, nor does it follow in general, thatbecause a man has formed a favorable opinion of a personor a thing he has not the proper means of thoroughlyunderstanding, he shall be bound to print it, andthus give currency to his impressions, which may beerroneous, and therefore injurious. He would havedone much better to have laid his impressions beforesome experienced physicians and surgeons, such asDr. Mead and Mr. Cheselden, to have asked them to tryhis experiment over again, and have been guided bytheir answers. But the good bishop got excited;he pleased himself with the thought that he had discovereda great panacea; and having once tasted the bewitchingcup of self-quackery, like many before and since histime, he was so infatuated with the draught that hewould insist on pouring it down the throats of hisneighbors and all mankind.
The precious fluid was made by stirring a gallon ofwater with a quart of tar, leaving it forty-eighthours, and pouring off the clear water. Suchwas the specific which the great metaphysician recommendedfor averting and curing all manner of diseases.It was, if he might be believed, a preventive of thesmall-pox, and of great use in the course of the disease.It was a cure for impurities of the blood, coughs,pleurisy, peripneumony, erysipelas, asthma, indigestion,carchexia, hysterics, dropsy, mortification, scurvy,and hypochondria. It was of great use in goutand fevers, and was an excellent preservative of theteeth and gums; answered all the purpose of ElixirProprietatis, Stoughton’s drops, diet drinks,and mineral waters; was particularly to be recommendedto sea-faring persons, ladies, and men of studiousand sedentary lives; could never be taken too long,but, on the contrary, produced advantages which sometimesdid not begin to show themselves for two or three months.
“From my representing Tar Water as good forso many things,” says Berkeley, “someperhaps may conclude it is good for nothing. Butcharity obligeth me to say what I know, and what Ithink, however it may be taken. Men may censureand object as they please, but I appeal to time andexperiment. Effects misimputed, cases wrong told,circ*mstances overlooked, perhaps, too, prejudicesand partialities against truth, may for a time prevailand keep her at the bottom of her well, from whencenevertheless she emergeth sooner or later, and strikesthe eyes of all who do not keep them shut.”I cannot resist the temptation of illustrating thebishop’s belief in the wonderful powers of hisremedy, by a few sentences from different parts ofhis essay. “The hardness of stubbed vulgarconstitutions renders them insensible of a thousandthings that fret and gall those delicate people, who,as if their skin was peeled off, feel to the quickeverything that touches them. The tender nervesand low spirits of such poor creatures would be muchrelieved by the use of Tar Water, which might prolongand cheer their lives.” “It [theTar Water] may be made stronger for brute beasts, ashorses, in whose disorders I have found it very useful.”“This same water will also give charitable reliefto the ladies, who often want it more than the parishpoor; being many of them never able to make a goodmeal, and sitting pale, puny, and forbidden, likeghosts, at their own table, victims of vapors andindigestion.” It does not appear among thevirtues of Tar Water that “children cried forit,” as for some of our modern remedies, butthe bishop says, “I have known children takeit for above six months together with great benefit,and without any inconvenience; and after long andrepeated experience I do esteem it a most excellentdiet drink, fitted to all seasons and ages.”After mentioning its usefulness in febrile complaints,he says: “I have had all this confirmedby my own experience in the late sickly season of the
year one thousand seven hundred and forty-one, havinghad twenty-five fevers in my own family cured by thismedicinal water, drunk copiously.” And tofinish these extracts with a most important suggestionfor the improvement of the British nation: “Itis much to be lamented that our Insulars who act andthink so much for themselves, should yet, from grossnessof air and diet, grow stupid or doat sooner than otherpeople, who, by virtue of elastic air, water-drinking,and light food, preserve their faculties to extremeold age; an advantage which may perhaps be approached,if not equaled, even in these regions, by Tar Water,temperance, and early hours.”Berkeley died at the age of about seventy; he mighthave lived longer, but his fatal illness was so suddenthat there was not time enough to stir up a quartof the panacea. He was an illustrious man, buthe held two very odd opinions; that tar water waseverything, and that the whole material universe wasnothing.
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Most of those present have at some time in their livesheard mention made of the metallic tractors,invented by one Dr. Perkins, an American, and formerlyenjoying great repute for the cure of various diseases.Many have seen or heard of a satirical poem, writtenby one of our own countrymen also, about forty yearssince, and called “Terrible Tractoration.”The Metallic Tractors are now so utterly abandonedthat I have only by good fortune fallen upon a singleone of a pair, to show for the sake of illustration.For more than thirty years this great discovery, whichwas to banish at least half the evils which afflicthumanity, has been sleeping undisturbed in the graveof oblivion. Not a voice has, for this long period,been raised in its favor; its noble and learned patrons,its public institutions, its eloquent advocates, itsbrilliant promises are all covered with the dust ofsilent neglect; and of the generation which has sprungup since the period when it flourished, very few knowanything of its history, and hardly even the titlewhich in its palmy days it bore of Perkinism.Taking it as settled, then, as no one appears to answerfor it, that Perkinism is entirely dead and gone,that both in public and private, officially and individually,its former adherents even allow it to be absolutelydefunct, I select it for anatomical examination.If this pretended discovery was made public; if itwas long kept before the public; if it was addressedto the people of different countries; if it was formallyinvestigated by scientific men, and systematicallyadopted by benevolent persons, who did everythingin their power to diffuse the knowledge and practiceof it; if various collateral motives, such as interestand vanity, were embarked in its cause; if, notwithstandingall these things, it gradually sickened and died,then the conclusion seems a fair one, that it didnot deserve to live. Contrasting its failure with
its high pretensions, it is fair to call it an imposition;whether an expressly fraudulent contrivance or not,some might be ready to question. Everything historicallyshown to have happened concerning the mode of promulgation,the wide diffusion, the apparent success of this delusion,the respectability and enthusiasm of its advocates,is of great interest in showing to what extent andby what means a considerable part of the communitymay be led into the belief of that which is to be eventuallyconsidered’ as an idle folly. If there isany existing folly, fraudulent or innocent in itsorigin, which appeals to certain arguments for itssupport; provided that the very same arguments canbe shown to have been used for Perkinism with as goodreason, they will at once fall to the ground.Still more, if it shall appear that the general courseof any existing delusion bears a strong resemblanceto that of Perkinism, that the former is most frequentlyadvocated by the same class of persons who were conspicuousin behalf of the latter, and treated with contemptor opposed by the same kind of persons who thus treatedPerkinism; if the facts in favor of both have a similaraspect; if the motives of their originators and propagatorsmay be presumed to have been similar; then there isevery reason to suppose that the existing folly willfollow in the footsteps of the past, and after displayinga given amount of cunning and credulity in those deceivingand deceived, will drop from the public view likea fruit which has ripened into spontaneous rottenness,and be succeeded by the fresh bloom of some otherdelusion required by the same excitable portion ofthe community.Dr. Elisha Perkins was born at Norwich, Connecticut,in the year 1740. He had practised his professionwith a good local reputation for many years, whenhe fell upon a course of experiments, as it is related,which led to his great discovery. He conceivedthe idea that metallic substances might have the effectof removing diseases, if applied in a certain manner;a notion probably suggested by the then recent experimentsof Galvani, in which muscular contractions were foundto be produced by the contact of two metals with theliving fibre. It was in 1796 that his discoverywas promulgated in the shape of the Metallic Tractors,two pieces of metal, one apparently iron and the otherbrass, about three inches long, blunt at one end andpointed at the other. These instruments wereapplied for the cure of different complaints, suchas rheumatism, local pains, inflammations, and eventumors, by drawing them over the affected part verylightly for about twenty minutes. Dr. Perkinstook out a patent for his discovery, and travelledabout the country to diffuse the new practice.He soon found numerous advocates of his discovery,many of them of high standing and influence. Inthe year 1798 the tractors had crossed the Atlantic,and were publicly employed in the Royal Hospital atCopenhagen. About the same time the son of the
inventor, Mr. Benjamin Douglass Perkins, carried themto London, where they soon attracted attention.The Danish physicians published an account of theircases, containing numerous instances of alleged success,in a respectable octavo volume. In the year 1804an establishment, honored with the name of the PerkineanInstitution, was founded in London. The transactionsof this institution were published in pamphlets, thePerkinean Society had public dinners at the Crown andAnchor, and a poet celebrated their medical triumphin strains like these:“See, pointed metals, blest withpower t’ appease
The ruthless rage of merciless disease,
O’er the frail part a subtlefluid pour,
Drenched with invisible Galvanicshower,
Till the arthritic staff and crutchforego,
And leap exulting like the boundingroe!”
While all these things were going on, Mr. BenjaminDouglass Perkins was calmly pocketing money, so thatafter some half a dozen years he left the countrywith more than ten thousand pounds, which had beenpaid him by the believers in Great Britain. Butin spite of all this success, and the number of thoseinterested and committed in its behalf, Perkinismsoon began to decline, and in 1811 the Tractors arespoken of by an intelligent writer as being almostforgotten. Such was the origin and duration ofthis doctrine and practice, into the history of whichwe will now look a little more narrowly.
Let us see, then, by whose agency this delusion wasestablished and kept up; whether it was principallyby those who were accustomed to medical pursuits,or those whose habits and modes of reasoning were different;whether it was with the approbation of those learnedbodies usually supposed to take an interest in scientificdiscoveries, or only of individuals whose claims todistinction were founded upon their position in society,or political station, or literary eminence; whetherthe judicious or excitable classes entered most deeplyinto it; whether, in short, the scientific men ofthat time were deceived, or only intruded upon, andshouted down for the moment by persons who had no particularcall to invade their precincts.
Not much, perhaps, was to be expected of the MedicalProfession in the way of encouragement. One Dr.Fuller, who wrote in England, himself a Perkinist,thus expressed his opinion: “It must bean extraordinary exertion of virtue and humanity fora medical man, whose livelihood depends either onthe sale of drugs, or on receiving a guinea for writinga prescription, which must relate to those drugs, tosay to his patient, ’You had better purchasea set of Tractors to keep in your family; they willcure you without the expense of my attendance, or thedanger of the common medical practice.’For very obvious reasons medical men must never beexpected to recommend the use of Perkinism. TheTractors must trust for their patronage to the enlightenedand philanthropic out of the profession, or to medicalmen retired from practice, and who know of no otherinterest than the luxury of relieving the distressed.And I do not despair of seeing the day when but veryfew of this description as well as private familieswill be without them.”
Whether the motives assigned by this medical man tohis professional brethren existed or not, it is truethat Dr. Perkins did not gain a great deal at theirhands. The Connecticut Medical Society expelledhim in 1797 for violating their law against the useof nostrums, or secret remedies. The leadingEnglish physicians appear to have looked on with singularapathy or contempt at the miracles which it was pretendedwere enacting in the hands of the apostles of thenew practice. In looking over the reviews ofthe time, I have found little beyond brief occasionalnotices of their pretensions; the columns of thesejournals being occupied with subjects of more permanentinterest. The state of things in London is bestlearned, however, from the satirical poem to whichI have already alluded as having been written at theperiod referred to. This was entitled, “TerribleTractoration!! A Poetical Petition against GalvanizingTrumpery and the Perkinistic Institution. Mostrespectfully addressed to the Royal College of Physicians,by Christopher Caustic, M. D., LL. D., A. S.S., Fellow of the Royal College of Physicians, Aberdeen,and Honorary Member of no less than nineteen very learnedSocieties.” Two editions of this work werepublished in London in the years 1803 and 1804, andone or two have been published in this country.
“Terrible Tractoration” is supposed, bythose who never read it, to be a satire upon the folliesof Perkins and his followers. It is, on the contrary,a most zealous defence of Perkinism, and a fierce attackupon its opponents, most especially upon such of themedical profession as treated the subject with neglector ridicule. The Royal College of Physicianswas the more peculiar object of the attack, but withthis body, the editors of some of the leading periodicals,and several physicians distinguished at that time,and even now remembered for their services to scienceand humanity, were involved in unsparing denunciations.The work is by no means of the simply humorous characterit might be supposed, but is overloaded with notesof the most seriously polemical nature. Muchof the history of the subject, indeed, is to be lookedfor in this volume.
It appears from this work that the principal membersof the medical profession, so far from hailing Mr.Benjamin Douglass Perkins as another Harvey or Jenner,looked very coldly upon him and his Tractors; and itis now evident that, though they were much abusedfor so doing, they knew very well what they had todeal with, and were altogether in the right.The delusion at last attracted such an amount of attentionas to induce Dr. Haygarth and some others of respectablestanding to institute some experiments which I shallmention in their proper place, the result of whichmight have seemed sufficient to show the emptinessof the whole contrivance.
The Royal Society, that learned body which for ageshas constituted the best tribunal to which Britaincan appeal in questions of science, accepted Mr. Perkins’sTractors and the book written about them, passed thecustomary vote of thanks, and never thought of troublingitself further in the investigation of pretensionsof such an aspect. It is not to be denied thata considerable number of physicians did avow themselvesadvocates of the new practice; but out of the wholecatalogue of those who were publicly proclaimed assuch, no one has ever been known, so far as I am aware,to the scientific world, except in connection withthe short-lived notoriety of Perkinism. Who werethe people, then, to whose activity, influence, orstanding with the community was owing all the temporaryexcitement produced by the Metallic Tractors?
First, those persons who had been induced to purchasea pair of Tractors. These little bits of brassand iron, the intrinsic value of which might, perhaps,amount to ninepence, were sold at five guineas a pair!A man who has paid twenty-five dollars for his whistleis apt to blow it louder and longer than other people.So it appeared that when the “Perkinean Society”applied to the possessors of Tractors in the metropolisto concur in the establishment of a public institutionfor the use of these instruments upon the poor, “itwas found that only five out of above a hundred objectedto subscribe, on account of their want of confidencein the efficacy of the practice; and these,”the committee observes, “there is reason tobelieve, never gave them a fair trial, probably neverused them in more than one case, and that perhapsa case in which the Tractors had never been recommendedas serviceable.” “Purchasers of theTractors,” said one of their ardent advocates,“would be among the last to approve of themif they had reason to suppose themselves defraudedof five guineas.” He forgot poor Moses,with his “gross of green spectacles, with silverrims and shagreen cases.” “Dear mother,”cried the boy, “why won’t you listen toreason? I had them a dead bargain, or I shouldnot have bought them. The silver rims alone willsell for double the money.”
But it is an undeniable fact, that many persons ofconsiderable standing, and in some instances holdingthe most elevated positions in society, openly patronizedthe new practice. In a translation of a work entitled“Experiments with the Metallic Tractors,”originally published in Danish, thence rendered successivelyinto German and English, Mr. Benjamin Perkins, whoedited the English edition, has given a copious enumerationof the distinguished individuals, both in America andEurope, whose patronage he enjoyed. He goes sofar as to signify that royalty itself was tobe included among the number. When the PerkineanInstitution was founded, no less a person than LordRivers was elected President, and eleven other individualsof distinction, among them Governor Franklin, son
of Dr. Franklin, figured as Vice-Presidents. LordHenniker, a member of the Royal Society, who is spokenof as a man of judgment and talents, condescendedto patronize the astonishing discovery, and at differenttimes bought three pairs of Tractors. When theTractors were introduced into Europe, a large numberof testimonials accompanied them from various distinguishedcharacters in America, the list of whom is given inthe translation of the Danish work referred to asfollows:“Those who have individually stated cases, orwho have presented their names to the public as menwho approved of this remedy, and acknowledged themselvesinstrumental in circulating the Tractors, are fifty-sixin number; thirty-four of whom are physicians andsurgeons, and many of them of the first eminence,thirteen clergymen, most of whom are doctors of divinity,and connected with the literary institutions of America;among the remainder are two members of Congress, oneprofessor of natural philosophy in a college, etc.,etc.” It seemed to be taken ratherhardly by Mr. Perkins that the translators of thework which he edited, in citing the names of the advocatesof the Metallic Practice, frequently omitted the honorarytitles which should have been annexed. The testimonialswere obtained by the Danish writer, from a pamphletpublished in America, in which these titles were givenin full. Thus one of these testimonials is from“John Tyler, Esq., a magistrate in the countyof New London, and late Brigadier-General of the militiain that State.” The “omission ofthe General’s title” is the subject ofcomplaint, as if this title were sufficient evidenceof the commanding powers of one of the patrons oftractoration. A similar complaint is made when“Calvin Goddard, Esq., of Plainfield, Attorneyat Law, and a member of the Legislature of the Stateof Connecticut,” is mentioned without his titularhonors, and even on account of the omission of theproper official titles belonging to “Nathan Pierce,Esq., Governor and Manager of the Almshouse of Newburyport.”These instances show the great importance to be attachedto civil and military dignities, in qualifying theirholders to judge of scientific subjects, a truth whichhas not been overlooked by the legitimate successorsof the Perkinists. In Great Britain, the Tractorswere not less honored than in America, by the learnedand the illustrious. The “Perkinistic Committee”made this statement in their report: “Mr.Perkins has annually laid before the public a largecollection of new cases communicated to him for thatpurpose by disinterested and intelligent characters,from almost every quarter of Great Britain. Inregard to the competency of these vouchers, it willbe sufficient simply to state that, amongst otherswhose names have been attached to their communications,are eight professors, in four different universities,twenty-one regular Physicians, nineteen Surgeons,thirty Clergymen, twelve of whom are Doctors of Divinity,and numerous other characters of equal respectability.”
It cannot but excite our notice and surprise thatthe number of clergymen both in America and GreatBritain who thrust forward their evidence on thismedical topic was singularly large in proportion tothat of the members of the medical profession.Whole pages are contributed by such worthies as theRev. Dr. Trotter of Hans Place, the Rear. WaringWillett, Chaplain to the Earl of Dunmore, the Rev.Dr. Clarke, Chaplain to the Prince of Wales.The style of these theologico-medical communicationsmay be seen in the following from a divine who wasalso professor in one of the colleges of New England.“I have used the Tractors with success in severalother cases in my own family, and although, like Naamanthe Syrian, I cannot tell why the waters of Jordanshould be better than Abana and Pharpar, rivers ofDamascus; yet since experience has proved them so,no reasoning can change the opinion. Indeed,the causes of all common facts are, we think, perfectlywell known to us; and it is very probable, fifty ora hundred years hence, we shall as well know why theMetallic Tractors should in a few minutes remove violentpains, as we now know why cantharides and opium willproduce opposite effects, namely, we shall know verylittle about either excepting facts.” Fiftyor a hundred years hence! if he could have lookedforward forty years, he would have seen the descendantsof the “Perkinistic” philosophers swallowinginfinitesimal globules, and knowing and caring asmuch about the Tractors as the people at Saratoga Springsdo about the waters of Abana and Pharpar.
I trust it will not be thought in any degree disrespectfulto a profession which we all honor, that I have mentionedthe great zeal of many clergymen in the cause of Perkinism.I hope, too, that I may without offence suggest thecauses which have often led them out of their ownprovince into one to which their education has no specialreference. The members of that profession oughtto be, and commonly are, persons of benevolent character.Their duties carry them into the midst of families,and particularly at times when the members of themare suffering from bodily illness. It is naturalenough that a strong desire should be excited to alleviatesufferings which may have defied the efforts of professionalskill; as natural that any remedy which recommendsitself to the belief or the fancy of the spiritualphysician should be applied with the hope of benefit;and perfectly certain that the weakness of human nature,from which no profession is exempt, will lead himto take the most flattering view of its effects uponthe patient; his own sagacity and judgment being stakedupon the success of the trial. The inventor ofthe Tractors was aware of these truths. He thereforesent the Tractors gratuitously to many clergymen, accompaniedwith a formal certificate that the holder had becomeentitled to their possession by the payment of fiveguineas. This was practised in our own neighborhood,
and I remember finding one of these certificates, sopresented, which proved that amongst the risks of infancyI had to encounter Perkins’s Tractors.Two clergymen of Boston and the vicinity, both wellknown to local fame, gave in their testimony to thevalue of the instruments thus presented to them; anunusually moderate proportion, when it is rememberedthat to the common motives of which I have spokenwas added the seduction of a gift for which the profanepublic was expected to pay so largely.It was remarkable, also, that Perkinism, which hadso little success with the medical and scientificpart of the community, found great favor in the eyesof its more lovely and less obstinate portion.“The lady of Major Oxholin,”—Iquote from Mr. Perkins’s volume,—“havingbeen lately in America, had seen and heard much ofthe great effects of Perkinism. Influenced bya most benevolent disposition, she brought these Tractorsand the pamphlet with her to Europe, with a laudabledesire of extending their utility to her sufferingcountrymen.” Such was the channel by whichthe Tractors were conveyed to Denmark, where they soonbecame the ruling passion. The workmen, saysa French writer, could not manufacture them fast enough.Women carried them about their persons, and delightedin bringing them into general use. To what extentthe Tractors were favored with the patronage of Englishand American ladies, it is of course not easy to say,except on general principles, as their names werenot brought before the public. But one of Dr.Haygarth’s stories may lead us to conjecturethat there was a class of female practitioners whowent about doing good with the Tractors in Englandas well as in Denmark. A certain lady had themisfortune to have a spot as big as a silver pennyat the corner of her eye, caused by a bruise, or somesuch injury. Another lady, who was a friend ofhers, and a strong believer in Perkinism, was veryanxious to try the effects of tractoration upon thisunfortunate blemish. The patient consented; thelady “produced the instruments, and, after drawingthem four or five times over the spot, declared thatit changed to a paler color, and on repeating the useof them a few minutes longer, that it had almost vanished,and was scarcely visible, and departed in high triumphat her success.” The lady who underwentthe operation assured the narrator “that shelooked in the glass immediately after, and that notthe least visible alteration had taken place.”
It would be a very interesting question, what wasthe intellectual character of those persons most conspicuousin behalf of the Perkinistic delusion? Such aninquiry might bring to light some principles whichwe could hereafter apply to the study of other popularerrors. But the obscurity into which nearly allthese enthusiasts have subsided renders the questioneasier to ask than to answer. I believe it wouldhave been found that most of these persons were of
ardent temperament and of considerable imagination,and that their history would show that Perkinism wasnot the first nor the last hobby-horse they rode furiously.Many of them may very probably have been persons ofmore than common talent, of active and ingenious minds,of versatile powers and various acquirements.Such, for instance, was the estimable man to whom Ihave repeatedly referred as a warm defender of tractoration,and a bitter assailant of its enemies. The storytells itself in the biographical preface to his poem.He went to London with the view of introducing a hydraulicmachine, which he and his Vermont friends regardedas a very important invention. He found, however,that the machine was already in common use in thatmetropolis. A brother Yankee, then in London,had started the project of a mill, which was to becarried by the water of the Thames. He was sanguineenough to purchase one fifth of this concern, whichalso proved a failure. At about the same periodhe wrote the work which proved the great excitementof his mind upon the subject of the transient follythen before the public. Originally a lawyer, hewas in succession a mechanician, a poet, and an editor,meeting with far less success in each of these departmentsthan usually attends men of less varied gifts, butof more tranquil and phlegmatic composition. Butwho is ignorant that there is a class of minds characterizedby qualities like those I have mentioned; minds withmany bright and even beautiful traits; but aimlessand fickle as the butterfly; that settle upon everygayly-colored illusion as it opens into flower, andflutter away to another when the first has droppedits leaves, and stands naked in the icy air of truth!Let us now look at the general tenor of the argumentsaddressed by believers to sceptics and opponents.Foremost of all, emblazoned at the head of every column,loudest shouted by every triumphant disputant, heldup as paramount to all other considerations, stretchedlike an impenetrable shield to protect the weakestadvocate of the great cause against the weapons ofthe adversary, was that omnipotent monosyllable whichhas been the patrimony of cheats and the currency ofdupes from time immemorial,—Facts!Facts! Facts! First came the published casesof the American clergymen, brigadier-generals, almshousegovernors, representatives, attorneys, and esquires.Then came the published cases of the surgeons of Copenhagen.Then followed reports of about one hundred and fiftycases published in England, “demonstrating theefficacy of the metallic practice in a variety ofcomplaints both upon the human body and on horses,etc.” But the progress of facts inGreat Britain did not stop here. Let those whor*ly upon the numbers of their testimonials, as beingalone sufficient to prove the soundness and stabilityof a medical novelty, digest the following from thereport of the Perkinistic Committee. “Thecases published [in Great Britain] amounted, in Marchlast, the date of Mr. Perkins’s last publication,to about five thousand. Supposing that not morethan one cure in three hundred which the Tractorshave performed has been published, and the proportionis probably much greater, it will be seen that thenumber, to March last, will have exceeded one millionfive hundred thousand!”
Next in order after the appeal to what were calledfacts, came a series of arguments, which have beenso long bruised and battered round in the cause ofevery doctrine or pretension, new, monstrous, or deliriouslyimpossible, that each of them is as odiously familiarto the scientific scholar as the faces of so manyold acquaintances, among the less reputable classes,to the officers of police.
No doubt many of my hearers will recognize, in thefollowing passages, arguments they may have heardbrought forward with triumphant confidence in behalfof some doctrine not yet extinct. No doubt somemay have honestly thought they proved something; mayhave used them with the purpose of convincing theirfriends, or of silencing the opponents of their favoritedoctrine, whatever that might be. But any trainof arguments which was contrived for Perkinism, whichwas just as applicable to it as to any other new doctrinein the same branch of science, and which was fullyemployed against its adversaries forty years since,might, in common charity, be suffered to slumber inthe grave of Perkinism. Whether or not the followingsentences, taken literally from the work of Mr. Perkins,were the originals of some of the idle propositionswe hear bandied about from time to time, let thosewho listen judge.
The following is the test assumed for the new practice:“If diseases are really removed, as those personswho have practised extensively with the Tractors declare,it should seem there would be but little doubt of theirbeing generally adopted; but if the numerous reportsof their efficacy which have been published are forgeries,or are unfounded, the practice ought to be crushed.”To this I merely add, it has been crushed.
The following sentence applies to that a priori judgingand uncandid class of individuals who buy their dinnerswithout tasting all the food there is in the market.“On all discoveries there are persons who, withoutdescending to any inquiry into the truth, pretend toknow, as it were by intuition, that newly assertedfacts are founded in the grossest errors. Thesewere those who knew that Harvey’s report of thecirculation of the blood was a preposterous and ridiculoussuggestion, and in latter later days there were otherswho knew that Franklin deserved reproach for declaringthat points were preferable to balls for protectingbuildings from lightning.”
Again: “This unwarrantable mode of offeringassertion for proof, so unauthorized and even unprecedentedexcept in the condemnation of a Galileo, the persecutionof a Copernicus, and a few other acts of inquisitorialauthority, in the times of ignorance and superstition,affords but a lamentable instance of one of his remarks,that this is far from being the Age of Reason.”
“The most valuable medicines in the MateriaMedica act on principles of which we are totally ignorant.None have ever yet been able to explain how opiumproduces sleep, or how bark cures intermittent fevers;and yet few, it is hoped, will be so absurd as todesist from the use of these important articles becausethey know nothing of the principle of their operations.”Or if the argument is preferred, in the eloquent languageof the Perkinistic poet:
“What though the causes maynot be explained,
Since these effects are dulyascertained,
Let not self-interest, prejudice,or pride,
Induce mankind to set the meansaside;
Means which, though simple, areby
Heaven designed to alleviate thewoes of human kind.”
This course of argument is so often employed, thatit deserves to be expanded a little, so that its lengthand breadth may be fairly seen. A series of whatare called facts is brought forward to prove some veryimprobable doctrine. It is objected by judiciouspeople, or such as have devoted themselves to analogoussubjects, that these assumed facts are in direct oppositionto all that is known of the course of nature, thatthe universal experience of the past affords a powerfulpresumption against their truth, and that in proportionto the gravity of these objections, should be thenumber and competence of the witnesses. The answeris a ready one. What do we know of the mysteriesof Nature? Do we understand the intricate machineryof the Universe? When to this is added the never-failingquotation,
“There are more things in heavenand earth, Horatio,
Than are dreamt of in your philosophy,”—
the question is thought to be finally disposed of.
Take the case of astrology as an example. Itis in itself strange and incredible that the relationsof the heavenly bodies to each other at a given momentof time, perhaps half a century ago, should have anythingto do with my success or misfortune in any undertakingof to-day. But what right have I to say it cannotbe so? Can I bind the sweet influences of Pleiades,or loose the bands of Orion? I do not know bywhat mighty magic the planets roll in their fluidpaths, confined to circles as unchanging as if theywere rings of steel, nor why the great wave of oceanfollows in a sleepless round upon the skirts of moonlight;nor cam I say from any certain knowledge that thephases of the heavenly bodies, or even the fallingof the leaves of the forest, or the manner in whichthe sands lie upon the sea-shore, may not be knit upby invisible threads with the web of human destiny.There is a class of minds much more ready to believethat which is at first sight incredible, and becauseit is incredible, than what is generally thought reasonable.Credo quia impossibile est,—“I believe,because it is impossible,”—is an oldparadoxical expression which might be literally appliedto this tribe of persons. And they always succeedin finding something marvellous, to call out the exerciseof their robust faith. The old Cabalistic teachersmaintained that there was not a verse, line, word,or even letter in the Bible which had not a specialefficacy either to defend the person who rightly employedit, or to injure his enemies; always provided theoriginal Hebrew was made use of. In the handsof modern Cabalists every substance, no matter howinert, acquires wonderful medicinal virtues, providedit be used in a proper state of purity and subdivision.
I have already mentioned the motives attributed bythe Perkinists to the Medical Profession, as preventingits members from receiving the new but unwelcome truths.This accusation is repeated in different forms andplaces, as, for instance, in the following passage:“Will the medical man who has spent much moneyand labor in the pursuit of the arcana of Physic,and on the exercise of which depends his support inlife, proclaim the inefficacy of his art, and recommenda remedy to his patient which the most unletteredin society can employ as advantageously as himself?and a remedy, too, which, unlike the drops, the pills,the powders, etc., of the Materia Medica, isinconsumable, and ever in readiness to be employedin successive diseases?”
As usual with these people, much indignation was expressedat any parallel between their particular doctrineand practice and those of their exploded predecessors.“The motives,” says the disinterested Mr.Perkins, “which must have impelled to this attemptat classing the metallic practice with themost paltry of empyrical projects, are but too thinlyveiled to escape detection.”
To all these arguments was added, as a matter of course,an appeal to the feelings of the benevolent in behalfof suffering humanity, in the shape of a notice thatthe poor would be treated gratis. It is prettywell understood that this gratuitous treatment ofthe poor does not necessarily imply an excess of benevolence,any more than the gratuitous distribution of a trader’sshop-bills is an evidence of remarkable generosity;in short, that it is one of those things which honestmen often do from the best motives, but which roguesand impostors never fail to announce as one of theirspecial recommendations. It is astonishing tosee how these things brighten up at the touch of Mr.Perkins’s poet:
“Ye worthy, honored, philanthropicfew,
The muse shall weave her brightestwreaths for you,
Who in Humanity’s bland causeunite,
Nor heed the shaft by interest aimedor spite;
Like the great Pattern of Benevolence,
Hygeia’s blessings to thepoor dispense;
And though opposed by folly’sservile brood,
enjoy the luxuryof doing good.”
Having thus sketched the history of Perkinism in itsdays of prosperity; having seen how it sprung intobeing, and by what means it maintained its influence,it only remains to tell the brief story of its discomfitureand final downfall. The vast majority of the sensiblepart of the medical profession were contented, sofar as we can judge, to let it die out of itself.It was in vain that the advocates of this invaluablediscovery exclaimed over their perverse and interestedobstinacy,—in vain that they called upthe injured ghosts of Harvey, Galileo, and Copernicusto shame that unbelieving generation; the Bailliesand the Heberdens,—men whose names have
come down to us as synonymous with honor and wisdom,—boretheir reproaches in meek silence, and left them unansweredto their fate. There were some others, however,who, believing the public to labor under a delusion,thought it worth while to see whether the charm wouldbe broken by an open trial of its virtue, as comparedwith that of some less hallowed formula. It mustbe remembered that a peculiar value was attached tothe Metallic Tractors, as made and patented by Mr.Perkins. Dr. Haygarth, of Bath, performed variousexperiments upon patients afflicted with differentcomplaints,—the patients supposing thatthe real five-guinea Tractors were employed.Strange to relate, he obtained equally wonderful effectswith Tractors of lead and of wood; with nails, piecesof bone, slate pencil, and tobacco-pipe. Dr.Alderson employed sham Tractors made of wood, andproduced such effects upon five patients that theyreturned solemn thanks in church for their cures.A single specimen of these cases may stand for allof them. Ann Hill had suffered for some monthsfrom pain in the right arm and shoulder. TheTractors (wooden ones) were applied, and in the spaceof five minutes she expressed herself relieved in thefollowing apostrophe: “Bless me! why, whocould have thought it, that them little things couldpull the pain from one. Well, to be sure, thelonger one lives, the more one sees; ah, dear!”These experiments did not result in the immediateextinction of Perkinism. Doubtless they werea great comfort to many obstinate unbelievers, andhelped to settle some sceptical minds; but for thereal Perkinistic enthusiasts, it may be questionedwhether they would at that time have changed theiropinion though one had risen from the dead to assurethem that it was an error. It perished withoutviolence, by an easy and natural process. Likethe famous toy of Mongolfier, it rose by means ofheated air,—the fevered breath of enthusiasticignorance,—and when this grew cool, asit always does in a little while, it collapsed andfell.
And now, on reviewing the whole subject, how shallwe account for the extraordinary prevalence of thebelief in Perkinism among a portion of what is supposedto be the thinking part of the community?
Could the cures have been real ones, produced by theprinciple of animal magnetism? To thisit may be answered that the Perkinists ridiculed theidea of approximating Mesmer and the founder of theirown doctrine, that nothing like the somnambulic conditionseems to have followed the use of the Tractors, andthat neither the exertion of the will nor the powersof the individual who operated seem to have been consideredof any consequence. Besides, the absolute neglectinto which the Tractors soon declined is good evidencethat they were incapable of affording any considerableand permanent relief in the complaints for the cureof which they were applied.
Of course a large number of apparent cures were duesolely to nature; which is true under every form oftreatment, orthodox or empirical. Of course manypersons experienced at least temporary relief fromthe strong impression made upon their minds by thisnovel and marvellous method of treatment.
Many, again, influenced by the sanguine hopes of thoseabout them, like dying people, who often say sincerely,from day to day, that they are getting better, cheatedthemselves into a false and short-lived belief thatthey were cured; and as happens in such cases, thepublic never knew more than the first half of thestory.
When it was said to the Perkinists, that whatevereffects they produced were merely through the imagination,they declared (like the advocates of the royaltouch and the Unguentum Armarium) thatthis explanation was sufficiently disproved by thefact of numerous and successful cures which had beenwitnessed in infants and brute animals. Dr. Haygarthreplied to this, that “in these cases it isnot the Patient, but the Observer, who is deceivedby his own imagination,” and that such may bethe fact, we have seen in the case of the good ladywho thought she had conjured away the spot from herfriend’s countenance, when it remained just asbefore.
As to the motives of the inventor and vender of theTractors, the facts must be allowed to speak for themselves.But when two little bits of brass and iron are patented,as an invention, as the result of numerous experiments,when people are led, or even allowed, to infer thatthey are a peculiar compound, when they are artfullyassociated with a new and brilliant discovery (whichthen happened to be Galvanism), when they are soldat many hundred times their value, and the seller printshis opinion that a Hospital will suffer inconvenience,“unless it possesses many sets of the Tractors,and these placed in the hands of the patients to practiseon each other,” one cannot but suspect that theywere contrived in the neighborhood of a wooden nutmegfactory; that legs of ham in that region are not madeof the best mahogany; and that such as buy their cucumberseed in that vicinity have to wait for the fruit aslong as the Indians for their crop of gunpowder.
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The succeeding lecture will be devoted to an examinationof the doctrines of Samuel Hahnemann and his disciples;doctrines which some consider new and others old;the common title of which is variously known as Ho-moeopathy,hom*oe-op-athy, hom*oeo-paith-y, or Hom’pathy,and the claims of which are considered by some asinfinitely important, and by many as immeasurablyridiculous.
I wish to state, for the sake of any who may be interestedin the subject, that I shall treat it, not by ridicule,but by argument; perhaps with great freedom, but withgood temper and in peaceable language; with very littlehope of reclaiming converts, with no desire of makingenemies, but with a firm belief that its pretensionsand assertions cannot stand before a single hour ofcalm investigation.
II.
It may be thought that a direct attack upon the pretensionsof hom*oeopathy is an uncalled-for aggressionupon an unoffending doctrine and its peaceful advocates.
But a little inquiry will show that it has long assumedso hostile a position with respect to the MedicalProfession, that any trouble I, or any other memberof that profession, may choose to bestow upon it maybe considered merely as a matter of self-defence.It began with an attempt to show the insignificanceof all existing medical knowledge. It not onlylaid claim to wonderful powers of its own, but it declaredthe common practice to be attended with the most positivelyinjurious effects, that by it acute diseases are aggravated,and chronic diseases rendered incurable. It hasat various times brought forward collections of figureshaving the air of statistical documents, pretendingto show a great proportional mortality among the patientsof the Medical Profession, as compared with thosetreated according to its own rules. Not contentedwith choosing a name of classical origin for itself,it invented one for the whole community of innocentphysicians, assuring them, to their great surprise,that they were all ALLOPATHISTS, whether they knewit or not, and including all the illustrious mastersof the past, from Hippocrates down to Hunter, underthe same gratuitous title. The line, then, hasbeen drawn by the champions of the new doctrine; theyhave lifted the lance, they have sounded the charge,and are responsible for any little skirmishing whichmay happen.
But, independently of any such grounds of active resistance,the subject involves interests so disproportionedto its intrinsic claims, that it is no more than anact of humanity to give it a public examination.If the new doctrine is not truth, it is a dangerous,a deadly error. If it is a mere illusion, andacquires the same degree of influence that we haveoften seen obtained by other illusions, there is notone of my audience who may not have occasion to deplorethe fatal credulity which listened to its promises.
I shall therefore undertake a sober examination ofits principles, its facts, and some points of itshistory. The limited time at my disposal requiresme to condense as much as possible what I have to say,but I shall endeavor to be plain and direct in expressingit. Not one statement shall be made which cannotbe supported by unimpeachable reference: notone word shall be uttered which I am not as willingto print as to speak. I have no quibbles to utter,and I shall stoop to answer none; but, with full faithin the sufficiency of a plain statement of facts andreasons, I submit the subject to the discernment ofmy audience.
The question may be asked in the outset,—Haveyou submitted the doctrines you are professing toexamine to the test of long-repeated and careful experiment;have you tried to see whether they were true or not?To this I answer, that it is abundantly evident, fromwhat has often happened, that it would be of no mannerof use for me to allege the results of any experimentsI might have instituted. Again and again have
the most explicit statements been made by the mostcompetent persons of the utter failure of all theirtrials, and there were the same abundant explanationsoffered as used to be for the Unguentum Armarium andthe Metallic Tractors. I could by no possibilityperform any experiments the result of which couldnot be easily explained away so as to be of no conclusivesignificance. Besides, as arguments in favor ofhom*oeopathy are constantly addressed to the publicin journals, pamphlets, and even lectures, by inexperienceddilettanti, the same channel must be open to all itsopponents.It is necessary, for the sake of those to whom thewhole subject may be new, to give in the smallestpossible compass the substance of the hom*oeopathicDoctrine. Samuel Hahnemann, its founder, is aGerman physician, now living in Paris, [Hahnemanndied in 1843.] at the age of eighty-seven years.In 1796 he published the first paper containing hispeculiar notions; in 1805 his first work on the subject;in 1810 his somewhat famous “Organon of theHealing Art;” the next year what he called the“Pure Materia Medica;” and in 1828 hislast work, the “Treatise on Chronic Diseases.”He has therefore been writing at intervals on hisfavorite subject for nearly half a century.
The one great doctrine which constitutes the basisof hom*oeopathy as a system is expressed by the Latinaphorism,
“SimiliaSIBILIBUS curantur,”
or like cures like, that is, diseases are cured byagents capable of producing symptoms resembling thosefound in the disease under treatment. A diseasefor Hahnemann consists essentially in a group of symptoms.The proper medicine for any disease is the one whichis capable of producing a similar group of symptomswhen given to a healthy person.
It is of course necessary to know what are the trainsof symptoms excited by different substances, whenadministered to persons in health, if any such canbe shown to exist. Hahnemann and his disciplesgive catalogues of the symptoms which they affirmwere produced upon themselves or others by a largenumber of drugs which they submitted to experiment.
The second great fact which Hahnemann professes tohave established is the efficacy of medicinal substancesreduced to a wonderful degree of minuteness or dilution.The following account of his mode of preparing hismedicines is from his work on Chronic Diseases, whichhas not, I believe, yet been translated into English.A grain of the substance, if it is solid, a drop ifit is liquid, is to be added to about a third partof one hundred grains of sugar of milk in an unglazedporcelain capsule which has had the polish removedfrom the lower part of its cavity by rubbing it withwet sand; they are to be mingled for an instant witha bone or horn spatula, and then rubbed together forsix minutes; then the mass is to be scraped togetherfrom the mortar and pestle, which is to take four
minutes; then to be again rubbed for six minutes.Four minutes are then to be devoted to scraping thepowder into a heap, and the second third of the hundredgrains of sugar of milk to be added. Then theyare to be stirred an instant and rubbed six minutes,—againto be scraped together four minutes and forcibly rubbedsix; once more scraped together for four minutes,when the last third of the hundred grains of sugarof milk is to be added and mingled by stirring withthe spatula; six minutes of forcible rubbing, fourof scraping together, and six more (positively thelast six) of rubbing, finish this part of the process.Every grain of this powder contains the hundredthof a grain of the medicinal substance mingled withthe sugar of milk. If, therefore, a grain ofthe powder just prepared is mingled with another hundredgrains of sugar of milk, and the process just describedrepeated, we shall have a powder of which every graincontains the hundredth of the hundredth, or the tenthousandth part of a grain of the medicinal substance.Repeat the same process with the same quantity offresh sugar of milk, and every grain of your powderwill contain the millionth of a grain of the medicinalsubstance. When the powder is of this strength,it is ready to employ in the further solutions anddilutions to be made use of in practice.
A grain of the powder is to be taken, a hundred dropsof alcohol are to be poured on it, the vial is tobe slowly turned for a few minutes, until the powderis dissolved, and two shakes are to be given to it.On this point I will quote Hahnemann’s own words.“A long experience and multiplied observationsupon the sick lead me within the last few years toprefer giving only two shakes to medicinal liquids,whereas I formerly used to give ten.” Theprocess of dilution is carried on in the same wayas the attenuation of the powder was done; each successivedilution with alcohol reducing the medicine to a hundredthpart of the quantity of that which preceded it.In this way the dilution of the original millionthof a grain of medicine contained in the grain of powderoperated on is carried successively to the billionth,trillionth, quadrillionth, quintillionth, and veryoften much higher fractional divisions. A doseof any of these medicines is a minute fraction of adrop, obtained by moistening with them one or morelittle globules of sugar, of which Hahnemann saysit takes about two hundred to weigh a grain.
As an instance of the strength of the medicines prescribedby Hahnemann, I will mention carbonate of lime.He does not employ common chalk, but prefers a littleportion of the friable part of an oystershell.Of this substance, carried to the sextillionth degree,so much as one or two globules of the size mentionedcan convey is a common dose. But for personsof very delicate nerves it is proper that the dilutionshould be carried to the decillionth degree.That is, an important medicinal effect is to be expectedfrom the two hundredth or hundredth part of the millionthof the millionth of the millionth of the millionthof the millionth of the millionth of the millionthof the millionth of the millionth of the millionthof a grain of oyster-shell. This is only thetenth degree of potency, but some of his disciplesprofess to have obtained palpable effects from “muchhigher dilutions.”
The third great doctrine of Hahnemann is the following.Seven eighths at least of all chronic diseases areproduced by the existence in the system of that infectiousdisorder known in the language of science by the appellationof psora, but to the less refined portion of thecommunity by the name of itch. In the wordsof Hahnemann’s “Organon,” “ThisPsora is the sole true and fundamental cause thatproduces all the other countless forms of disease,which, under the names of nervous debility, hysteria,hypochondriasis, insanity, melancholy, idiocy, madness,epilepsy, and spasms of all kinds, softening of thebones, or rickets, scoliosis and cyphosis, caries,cancer, fungua haematodes, gout,—yellowjaundice and cyanosis, dropsy,—”
["The degrees of dilution must not be confoundedwith those of potency. Their relations maybe seen by this table:
lst dilution,—One hundredth of a drop orgrain.
2d " One ten thousandth.
3d " One millionth, marked I.
4th " One hundred millionth.
5th " One ten thousand millionth.
6th " One million millionth, or one billionth,marked ii.
7th " One hundred billionth.
8th " One ten thousand billionth.
9th " One million billionth, or one trillionth,marked iii.
10th " One hundred trillionth.
11th " One ten thousand trillionth.
12th " One million trillionth, or one quadrillionth,marked
IV.,—andso on indefinitely.
The large figures denote the degrees of potency.]
“gastralgia, epistaxis, haemoptysis,—asthmaand suppuration of the lungs,—megrim, deafness,cataract and amaurosis,—paralysis, lossof sense, pains of every kind, etc., appear inour pathology as so many peculiar, distinct, and independentdiseases.”
For the last three centuries, if the same authoritymay be trusted, under the influence of the more refinedpersonal habits which have prevailed, and the applicationof various external remedies which repel the affectionfrom the skin; Psora has revealed itself in these numerousforms of internal disease, instead of appearing, asin former periods, under the aspect of an externalmalady.
These are the three cardinal doctrines of Hahnemann,as laid down in those standard works of hom*oeopathy,the “Organon” and the “Treatise onChronic Diseases.”
Several other principles may be added, upon all ofwhich he insists with great force, and which are verygenerally received by his disciples.
1. Very little power is allowed to the curativeefforts of nature. Hahnemann goes so far as tosay that no one has ever seen the simple efforts ofnature effect the durable recovery of a patient froma chronic disease. In general, the hom*oeopathistcalls every recovery which happens under his treatmenta cure.
2. Every medicinal substance must be administeredin a state of the most perfect purity, and uncombinedwith any other. The union of several remediesin a single prescription destroys its utility, and,according to the “Organon,” frequentlyadds a new disease.
3. A large number of substances commonly thoughtto be inert develop great medicinal powers when preparedin the manner already described; and a great proportionof them are ascertained to have specific antidotesin case their excessive effects require to be neutralized.
4. Diseases should be recognized, as far as possible,not by any of the common names imposed upon them,as fever or epilepsy, but as individual collectionsof symptoms, each of which differs from every othercollection.
5. The symptoms of any complaint must be describedwith the most minute exactness, and so far as possiblein the patient’s own words. To illustratethe kind of circ*mstances the patient is expected torecord, I will mention one or two from the 313th pageof the “Treatise on Chronic Diseases,”—beingthe first one at which I opened accidentally.
“After dinner, disposition to sleep; the patientwinks.”
“After dinner, prostration and feeling of weakness(nine days after taking the remedy).”
This remedy was that same oyster-shell which is tobe prescribed “fractions of the sextillionthor decillionth degree.” According to Hahnemann,the action of a single dose of the size mentioned doesnot fully display itself in some cases until twenty-fouror even thirty days after it is taken, and in suchinstances has not exhausted its good effects untiltowards the fortieth or fiftieth day,—beforewhich time it would be absurd and injurious to administera new remedy.
So much for the doctrines of Hahnemann, which havebeen stated without comment, or exaggeration of anyof their features, very much as any adherent of hisopinions might have stated them, if obliged to compressthem into so narrow a space.
Does Hahnemann himself represent hom*oeopathy as itnow exists? He certainly ought to be its bestrepresentative, after having created it, and devotedhis life to it for half a century. He is spokenof as the great physician of the time, in most, ifnot all hom*oeopathic works. If he is not authorityon the subject of his own doctrines, who is? Sofar as I am aware, not one tangible discovery in theso-called science has ever been ascribed to any otherobserver; at least, no general principle or law, ofconsequence enough to claim any prominence in hom*oeopathicworks, has ever been pretended to have originated withany of his illustrious disciples. He is one ofthe only two hom*oeopathic writers with whom, as Ishall mention, the Paris publisher will have anythingto do upon his own account. The other is Jahr,whose Manual is little more than a catalogue of symptomsand remedies. If any persons choose to rejectHahnemann as not in the main representing hom*oeopathy,if they strike at his authority, if they wink outof sight his deliberate and formally announced results,it is an act of suicidal rashness; for upon his sagacityand powers of observation, and experience, as embodiedin his works, and especially in his Materia Medica,repose the foundations of hom*oeopathy as a practicalsystem.
So far as I can learn from the conflicting statementsmade upon the subject, the following is the presentcondition of belief.
1. All of any note agree that the law Similiasimilibus is the only fundamental principle in medicine.Of course if any man does not agree to this the namehom*oeopathist can no longer be applied to him withpropriety.
2. The belief in and employment of the infinitesimaldoses is general, and in some places universal, amongthe advocates of hom*oeopathy; but a distinct movementhas been made in Germany to get rid of any restrictionto the use of these doses, and to employ medicineswith the same license as other practitioners.
3. The doctrine of the origin of most chronicdiseases in Psora, notwithstanding Hahnemann saysit cost him twelve years of study and research toestablish the fact and its practical consequences,has met with great neglect and even opposition fromvery many of his own disciples.
It is true, notwithstanding, that, throughout mostof their writings which I have seen, there runs aprevailing tone of great deference to Hahnemann’sopinions, a constant reference to his authority, ageneral agreement with the minor points of his belief,and a pretence of harmonious union in a common faith.[Those who will take the trouble to look over Hull’sTranslation of Jahr’s Manual may observe howlittle comparative space is given to remedies restingupon any other authority than that of Hahnemann.]
Many persons, and most physicians and scientific men,would be satisfied with the statement of these doctrines,and examine them no further. They would considerit vastly more probable that any observer in so fallaciousand difficult a field of inquiry as medicine had beenled into error, or walked into it of his own accord,than that such numerous and extraordinary facts hadreally just come to light. They would feel aright to exercise the same obduracy towards them asthe French Institute is in the habit of displayingwhen memoirs or models are offered to it relatingto the squaring of the circle or perpetual motion;which it is the rule to pass over without notice.They would feel as astronomers and natural philosophersmust have felt when, some half a dozen years ago, anunknown man came forward, and asked for an opportunityto demonstrate to Arago and his colleagues that themoon and planets were at a distance of a little morethan a hundred miles from the earth. And so theywould not even look into hom*oeopathy, though all itsadvocates should exclaim in the words of Mr. BenjaminDouglass Perkins, vender of the Metallic Tractors,that “On all discoveries there are persons who,without descending to any inquiry into the truth,pretend to know, as it were by intuition, that newlyasserted facts are founded in the grossest errors.”And they would lay their heads upon their pillows witha perfectly clear conscience, although they were assuredthat they were behaving in the same way that peopleof old did towards Harvey, Galileo, and Copernicus,the identical great names which were invoked by Mr.Benjamin Douglass Perkins.
But experience has shown that the character of theseassertions is not sufficient to deter many, from examiningtheir claims to belief. I therefore lean butvery slightly on the extravagance and extreme apparentsingularity of their pretensions. I might haveomitted them, but on the whole it seemed more justto the claims of my argument to suggest the vast complicationof improbabilities involved in the statements enumerated.Every one must of course judge for himself as to theweight of these objections, which are by no meansbrought forward as a proof of the extravagance ofhom*oeopathy, but simply as entitled to a brief considerationbefore the facts of the case are submitted to our scrutiny.
The three great asserted discoveries of Hahnemannare entirely unconnected with and independent of eachother. Were there any natural relation betweenthem it would seem probable enough that the discoveryof the first would have led to that of the others.But assuming it to be a fact that diseases are curedby remedies capable of producing symptoms like theirown, no manifest relation exists between this factand the next assertion, namely, the power of the infinitesimaldoses. And allowing both these to be true, neitherhas the remotest affinity to the third new doctrine,that which declares seven eighths of all chronic diseasesto be owing to Psora.
This want of any obvious relation between Hahnemann’sthree cardinal doctrines appears to be self-evidentupon inspection. But if, as is often true withhis disciples, they prefer the authority of one oftheir own number, I will refer them to Dr. Trinks’spaper on the present state of hom*oeopathy in Europe,with which, of course, they are familiar, as his nameis mentioned as one of the most prominent championsof their faith, in their American official organ.It would be a fact without a parallel in the history,not merely of medicine, but of science, that threesuch unconnected and astonishing discoveries, eachof them a complete revolution of all that ages ofthe most varied experience had been taught to believe,should spring full formed from the brain of a singleindividual.
Let us look a moment at the first of his doctrines.Improbable though it may seem to some, there is noessential absurdity involved in the proposition thatdiseases yield to remedies capable of producing likesymptoms. There are, on the other hand, some analogieswhich lend a degree of plausibility to the statement.There are well-ascertained facts, known from the earliestperiods of medicine, showing that, under certain circ*mstances,the very medicine which, from its known effects, onewould expect to aggravate the disease, may contributeto its relief. I may be permitted to allude,in the most general way, to the case in which thespontaneous efforts of an overtasked stomach are quietedby the agency of a drug which that organ refuses toentertain upon any terms. But that every cure
ever performed by medicine should have been foundedupon this principle, although without the knowledgeof a physician; that the hom*oeopathic axiom is, asHahnemann asserts, “the sole law of nature intherapeutics,” a law of which nothing more thana transient glimpse ever presented itself to the innumerablehost of medical observers, is a dogma of such sweepingextent, and pregnant novelty, that it demands a correspondingbreadth and depth of unquestionable facts to coverits vast pretensions.So much ridicule has been thrown upon the pretendedpowers of the minute doses that I shall only touchupon this point for the purpose of conveying, by illustrations,some shadow of ideas far transcending the powers ofthe imagination to realize. It must be rememberedthat these comparisons are not matters susceptibleof dispute, being founded on simple arithmetical computations,level to the capacity of any intelligent schoolboy.A person who once wrote a very small pamphlet madesome show of objecting to calculations of thus kind,on the ground that the highest dilutions could easilybe made with a few ounces of alcohol. But heshould have remembered that at every successive dilutionhe lays aside or throws away ninety-nine hundredthsof the fluid on which he is operating, and that, althoughhe begins with a drop, he only prepares a millionth,billionth, trillionth, and similar fractions of it,all of which, added together, would constitute buta vastly minute portion of the drop with which hebegan. But now let us suppose we take one singledrop of the Tincture of Camomile, and that the wholeof this were to be carried through the common seriesof dilutions.
A calculation nearly like the following was made byDr. Panvini, and may be readily followed in its essentialparticulars by any one who chooses.
For the first dilution it would take 100 drops ofalcohol.
For the second dilution it would take 10;000 drops,or about a pint.
For the third dilution it would take 100 pints.
For the fourth dilution it would take 10,000 pints,or more than 1,000 gallons, and so on to the ninthdilution, which would take ten billion gallons, whichhe computed would fill the basin of Lake Agnano, abody of water two miles in circumference. Thetwelfth dilution would of course fill a million suchlakes. By the time the seventeenth degree ofdilution should be reached, the alcohol required wouldequal in quantity the waters of ten thousand Adriaticseas. Trifling errors must be expected, but theyare as likely to be on one side as the other, and anylittle matter like Lake Superior or the Caspian wouldbe but a drop in the bucket.
Swallowers of globules, one of your little pellets,moistened in the mingled waves of one million lakesof alcohol, each two miles in circumference, withwhich had been blended that one drop of Tincture ofCamomile, would be of precisely the strength recommendedfor that medicine in your favorite Jahr’s Manual,“against the most sudden, frightful, and fataldiseases!” [In the French edition of 1834, theproper doses of the medicines are mentioned, and Camomileis marked IV. Why are the doses omitted in Hull’sTranslation, except in three instances out of thewhole two hundred remedies, notwithstanding the promisein the preface that “some remarks upon the dosesused may be found at the head of each medicine”?Possibly because it makes no difference whether theyare employed in one hom*oeopathic dose or another;but then it is very singular that such precise directionswere formerly given in the same work, and that Hahnemann’s“experience” should have led him to drawthe nice distinctions we have seen in a former partof this Lecture (p. 44).]
And proceeding on the common data, I have just madea calculation which shows that this single drop ofTincture of Camomile, given in the quantity orderedby Jahr’s Manual, would have supplied every individualof the whole human family, past and present, with morethan five billion doses each, the action of each doselasting about four days.
Yet this is given only at the quadrillionth, or fourthdegree of potency, and various substances are frequentlyadministered at the decillionth or tenth degree, andoccasionally at still higher attenuations with professedmedicinal results. Is there not in this as greatan exception to all the hitherto received laws ofnature as in the miracle of the loaves and fishes?Ask this question of a hom*oeopathist, and he willanswer by referring to the effects produced by a veryminute portion of vaccine matter, or the extraordinarydiffusion of odors. But the vaccine matter isone of those substances called morbid poisons, of whichit is a peculiar character to multiply themselves,when introduced into the system, as a seed does inthe soil. Therefore the hundredth part of a grainof the vaccine matter, if no more than this is employed,soon increases in quantity, until, in the course ofabout a week, it is a grain or more, and can be removedin considerable drops. And what is a very curiousillustration of hom*oeopathy, it does not produce itsmost. characteristic effects until it is already insufficient quantity not merely to be visible, butto be collected for further use. The thoughtlessnesswhich can allow an inference to be extended from aproduct of disease possessing this susceptibility ofmultiplication when conveyed into the living body,to substances of inorganic origin, such as silex orsulphur, would be capable of arguing that a pebblemay produce a mountain, because an acorn can becomea forest.
As to the analogy to be found between the allegedaction of the infinitely attenuated doses, and theeffects of some odorous substances which possess theextraordinary power of diffusing their imponderableemanations through a very wide space, however it maybe abused in argument, and rapidly as it evaporateson examination, it is not like that just mentioned,wholly without meaning. The fact of the vastdiffusion of some odors, as that of musk or the rose,for instance, has long been cited as the most remarkableillustration of the divisibility of matter, and thenicety of the senses. And if this were comparedwith the effects of a very minute dose of morphiaon the whole system, or the sudden and fatal impressionof a single drop of prussic acid, or, with what comesstill nearer, the poisonous influence of an atmosphereimpregnated with invisible malaria, we should findin each of these examples an evidence of the degreeto which nature, in some few instances, concentratespowerful qualities in minute or subtile forms of matter.But if a man comes to me with a pestle and mortar inhis hand, and tells me that he will take a littlespeck of some substance which nobody ever thoughtto have any smell at all, as, for instance, a grainof chalk or of charcoal, and that he will, after anhour or two of rubbing and scraping, develop in aportion of it an odor which, if the whole grain wereused, would be capable of pervading an apartment, ahouse, a village, a province, an empire, nay, the entireatmosphere of this broad planet upon which we tread;and that from each of fifty or sixty substances hecan in this way develop a distinct and hitherto unknownodor: and if he tries to show that all this isrendered quite reasonable by the analogy of musk androses, I shall certainly be justified in consideringhim incapable of reasoning, and beyond the reach ofmy argument. What if, instead of this, he professesto develop new and wonderful medicinal powers fromthe same speck of chalk or charcoal, in such proportionsas would impregnate every pond, lake, river, sea, andocean of our globe, and appeals to the same analogyin favor of the probability of his assertion.
All this may be true, notwithstanding these considerations.But so extraordinary would be the fact, that a singleatom of substances which a child might swallow withoutharm by the teaspoonful could, by an easy mechanicalprocess, be made to develop such inconceivable powers,that nothing but the strictest agreement of the mostcautious experimenters, secured by every guarantythat they were honest and faithful, appealing to repeatedexperiments in public, with every precaution to guardagainst error, and with the most plain and peremptoryresults, should induce us to lend any credence tosuch pretensions.
The third doctrine, that Psora, the other name ofwhich you remember, is the cause of the great majorityof chronic diseases, is a startling one, to say theleast. That an affection always recognized asa very unpleasant personal companion, but generallyregarded as a mere temporary incommodity, readilyyielding to treatment in those unfortunate enough tosuffer from it, and hardly known among the better classesof society, should be all at once found out by a Germanphysician to be the great scourge of mankind, thecause of their severest bodily and mental calamities,cancer and consumption, idiocy and madness, must exciteour unqualified surprise. And when the originatorof this singular truth ascribes, as in the page nowopen before me, the declining health of a disgracedcourtier, the chronic malady of a bereaved mother,even the melancholy of the love-sick and slightedmaiden, to nothing more nor less than the insignificant,unseemly, and almost unmentionable itch, doesit not seem as if the very soil upon which we standwere dissolving into chaos, over the earthquake-heavingof discovery?
And when one man claims to have established thesethree independent truths, which are about as remotefrom each other as the discovery of the law of gravitation,the invention of printing, and that of the mariner’scompass, unless the facts in their favor are overwhelmingand unanimous, the question naturally arises, Is notthis man deceiving himself, or trying to deceive others?
I proceed to examine the proofs of the leading ideasof Hahnemann and his school.
In order to show the axiom, similia similibus curantur(or like is cured by like), to be the basis of thehealing art,—“the sole law of naturein therapeutics,”—it is necessary,
1. That the symptoms produced by drugs in healthypersons should be faithfully studied and recorded.
2. That drugs should be shown to be always capableof curing those diseases most like their own symptoms.
3. That remedies should be shown not to curediseases when they do not produce symptoms resemblingthose presented in these diseases.
1. The effects of drugs upon healthy personshave been studied by Hahnemann and his associates.Their results were made known in his Materia Medica,a work in three large volumes in the French translation,published about eight years ago. The mode of experimentationappears to have been, to take the substance on trial,either in common or minute doses, and then to setdown every little sensation, every little movementof mind or body, which occurred within many succeedinghours or days, as being produced solely by the substanceemployed. When I have enumerated some of thesymptoms attributed to the power of the drugs taken,you will be able to judge how much value is to beascribed to the assertions of such observers.
The following list was taken literally from the MateriaMedica of Hahnemann, by my friend M. Vernois, forwhose accuracy I am willing to be responsible.He has given seven pages of these symptoms, not selected,but taken at hazard from the French translation ofthe work. I shall be very brief in my citations.
“After stooping some time, sense of painfulweight about the head upon resuming the erect posture.”
“An itching, tickling sensation at the outeredge of the palm of the left hand, which obliges theperson to scratch.” The medicine was acetateof lime, and as the action of the globule taken issaid to last twenty-eight days, you may judge howmany such symptoms as the last might be supposed tohappen.
Among the symptoms attributed to muriatic acid arethese: a catarrh, sighing, pimples; “afterhaving written a long time with the back a littlebent over, violent pain in the back and shoulder-blades,as if from a strain,”—“dreamswhich are not remembered,—disposition tomental dejection,—wakefulness before andafter midnight.”
I might extend this catalogue almost indefinitely.I have not cited these specimens with any view toexciting a sense of the ridiculous, which many othersof those mentioned would not fail to do, but to showthat the common accidents of sensation, the littlebodily inconveniences to which all of us are subject,are seriously and systematically ascribed to whatevermedicine may have been exhibited, even in the minutedoses I have mentioned, whole days or weeks previously.
To these are added all the symptoms ever said by anybody,whether deserving confidence or not, as I shall hereafterillustrate, to be produced by the substance in question.
The effects of sixty-four medicinal substances, ascertainedby one or both of these methods, are enumerated inthe Materia Medica of Hahnemann, which may be consideredas the basis of practical hom*oeopathy. In theManual of Jahr, which is the common guide, so far asI know, of those who practise hom*oeopathy in theseregions, two hundred remedies are enumerated, manyof which, however, have never been employed in practice.In at least one edition there were no means of distinguishingthose which had been tried upon the sick from theothers. It is true that marks have been addedin the edition employed here, which serve to distinguishthem; but what are we to think of a standard practicalauthor on Materia Medica, who at one time omits todesignate the proper doses of his remedies, and atanother to let us have any means of knowing whethera remedy has ever been tried or not, while he is recommendingits employment in the most critical and threateningdiseases?
I think that, from what I have shown of the characterof Hahnemann’s experiments, it would be a satisfactionto any candid inquirer to know whether other persons,to whose assertions he could look with confidence,confirm these pretended facts. Now there are manyindividuals, long and well known to the scientificworld, who have tried these experiments upon healthysubjects, and utterly deny that their effects haveat all corresponded to Hahnemann’s assertions.
I will take, for instance, the statements of Andral(and I am not referring to his well-known public experimentsin his hospital) as to the result of his own trials.This distinguished physician is Professor of Medicinein the School of Paris, and one of the most widelyknown and valued authors upon practical and theoreticalsubjects the profession can claim in any country.He is a man of great kindness of character, a mostliberal eclectic by nature and habit, of unquestionedintegrity, and is called, in the leading article ofthe first number of the “hom*oepathic Examiner,”“an eminent and very enlightened allopathist.”Assisted by a number of other persons in good health,he experimented on the effects of cinchona, aconite,sulphur, arnica, and the other most highly extolledremedies. His experiments lasted a year, and hestated publicly to the Academy of Medicine that theynever produced the slightest appearance of the symptomsattributed to them. The results of a man likethis, so extensively known as one of the most philosophicaland candid, as well as brilliant of instructors, andwhose admirable abilities and signal liberality aregenerally conceded, ought to be of great weight indeciding the question.
M. Double, a well-known medical writer and a physicianof high standing in Paris, had occasion so long agoas 1801, before he had heard of hom*oeopathy, to makeexperiments upon Cinchona, or Peruvian bark. Heand several others took the drug in every kind ofdose for four months, and the fever it is pretendedby Hahnemann to excite never was produced.
M. Bonnet, President of the Royal Society of Medicineof Bordeaux, had occasion to observe many soldiersduring the Peninsular War, who made use of Cinchonaas a preservative against different diseases, but henever found it to produce the pretended paroxysms.
If any objection were made to evidence of this kind,I would refer to the express experiments on many ofthe hom*oeopathic substances, which were given to healthypersons with every precaution as to diet and regimen,by M. Louis Fleury, without being followed by theslightest of the pretended consequences. Andlet me mention as a curious fact, that the same quantityof arsenic given to one animal in the common form ofthe unprepared powder, and to another after havingbeen rubbed up into six hundred globules, offeredno particular difference of activity in the two cases.
This is a strange contradiction to the doctrine ofthe development of what they call dynamic power, bymeans of friction and subdivision.
In 1835 a public challenge was offered to the bestknown hom*oeopathic physician in Paris to select anyten substances asserted to produce the most strikingeffects; to prepare them himself; to choose one bylot without knowing which of them he had taken, andtry it upon himself or any intelligent and devotedhom*oeopathist, and, waiting his own time, to comeforward and tell what substance had been employed.The challenge was at first accepted, but the acceptanceretracted before the time of trial arrived.
From all this I think it fair to conclude that thecatalogues of symptoms attributed in hom*oeopathicworks to the influence of various drugs upon healthypersons are not entitled to any confidence.
2. It is necessary to show, in the next place,that medicinal substances are always capable of curingdiseases most like their own symptoms. For factsrelating to this question we must look to two sources;the recorded experience of the medical professionin general, and the results of trials made accordingto hom*oeopathic principles, and capable of testingthe truth of the doctrine.
No person, that I am aware of, has ever denied thatin some cases there exists a resemblance between theeffects of a remedy and the symptoms of diseases inwhich it is beneficial. This has been recognized,as Hahnemann himself has shown, from the time of Hippocrates.But according to the records of the medical profession,as they have been hitherto interpreted, this is trueof only a very small proportion of useful remedies.Nor has it ever been considered as an established truththat the efficacy of even these few remedies was inany definite ratio to their power of producing symptomsmore or less like those they cured.
Such was the state of opinion when Hahnemann cameforward with the proposition that all the cases ofsuccessful treatment found in the works of all precedingmedical writers were to be ascribed solely to theoperation of the hom*oeopathic principle, which hadeffected the cure, although without the physician’sknowledge that this was the real secret. Andstrange as it may seem, he was enabled to give sucha degree of plausibility to this assertion, that anyperson not acquainted somewhat with medical literature,not quite familiar, I should rather say, with therelative value of medical evidence, according to thesources whence it is derived, would be almost frightenedinto the belief, at seeing the pages upon pages ofLatin names he has summoned as his witnesses.
It has hitherto been customary, when examining thewritings of authors of preceding ages, upon subjectsas to which they were less enlightened than ourselves,and which they were very liable to misrepresent, toexercise some little discretion; to discriminate,in some measure, between writers deserving confidenceand those not entitled to it. But there is notthe least appearance of any such delicacy on the partof Hahnemann. A large majority of the names ofold authors he cites are wholly unknown to science.With some of them I have been long acquainted, andI know that their accounts of diseases are no moreto be trusted than their contemporary Ambroise Pare’sstories of mermen, and similar absurdities. Butif my judgment is rejected, as being a prejudiced one,I can refer to Cullen, who mentioned three of Hahnemann’sauthors in one sentence, as being “not necessarilybad authorities; but certainly such when they deliveredvery improbable events;” and as this was said
more than half a century ago, it could not have hadany reference to Hahnemann. But although notthe slightest sign of discrimination is visible inhis quotations,—although for him a handfulof chaff from Schenck is all the same thing as a measureof wheat from Morgagni,—there is a formidabledisplay of authorities, and an abundant proof of ingeniousresearches to be found in each of the great worksof Hahnemann with which I am familiar. [Some painfulsurmises might arise as to the erudition of Hahnemann’sEnglish Translator, who makes two individuals of “Zacutus,Lucitanus,” as well as respecting that of theconductors of an American hom*oeopathic periodical,who suffer the name of the world-renowned Cardanusto be spelt Cardamus in at least three places, werenot this gross ignorance of course attributable onlyto the printer.]It is stated by Dr. Leo-Wolf, that Professor Joerg,of Leipsic, has proved many of Hahnemann’s quotationsfrom old authors to be adulterate and false.What particular instances he has pointed out I haveno means of learning. And it is probably whollyimpossible on this side of the Atlantic, and evenin most of the public libraries of Europe, to findanything more than a small fraction of the innumerableobscure publications which the neglect of grocersand trunkmakers has spared to be ransacked by theall-devouring genius of hom*oeopathy. I have endeavoredto verify such passages as my own library affordedme the means of doing. For some I have lookedin vain, for want, as I am willing to believe, ofmore exact references. But this I am able toaffirm, that, out of the very small number which Ihave been able, to trace back to their original authors,I have found two to be wrongly quoted, one of thembeing a gross misrepresentation.
The first is from the ancient Roman author, CaeliusAurelianus; the second from the venerable folio ofForestus. Hahnemann uses the following expressions,—ifhe is not misrepresented in the English Translationof the ‘Organon’: “Asclepiadeson one occasion cured an inflammation of the brainby administering a small quantity of wine.”After correcting the erroneous reference of the Translator,I can find no such case alluded to in the chapter.But Caelius Aurelianus mentions two modes of treatmentemployed by Asclepiades, into both of which the useof wine entered, as being “in the highest degreeirrational and dangerous.” [Caelius Aurel.De Morb. Acut. et Chron. lib. I. cap. xv.not xvi. Amsterdam. Wetstein, 1755.]
In speaking of the oil of anise-seed, Hahnemann saysthat Forestus observed violent colic caused by itsadministration. But, as the author tells thestory, a young man took, by the counsel of a surgeon,an acrid and virulent medicine, the name of whichis not given, which brought on a most cruel fit ofthe gripes and colic. After this another surgeonwas called, who gave him oil of anise-seed and wine,“which increased his suffering.” [Observ.et Curat. Med. lib. XXI obs. xiii. Frankfort,1614.] Now if this was the hom*oeopathic remedy, asHahnemann pretends, it might be a fair question whythe young man was not cured by it. But it isa much graver question why a man who has shrewdnessand learning enough to go so far after his facts,should think it right to treat them with such astonishingnegligence or such artful unfairness.
Even if every word he had pretended to take from hisold authorities were to be found in them, even ifthe authority of every one of these authors were beyondquestion, the looseness with which they are used toprove whatever Hahnemann chooses is beyond the boundsof credibility. Let me give one instance to illustratethe character of this man’s mind. Hahnemannasserts, in a note annexed to the 110th paragraph ofthe “Organon,” that the smell of the rosewill cause certain persons to faint. And he saysin the text that substances which produce peculiareffects of this nature on particular constitutionscure the same symptoms in people in general.Then in another note to the same paragraph he quotesthe following fact from one of the last sources onewould have looked to for medical information, theByzantine Historians.
“It was by these means (i.e. hom*oeopathically)that the Princess Eudosia with rose-water restoreda person who had fainted!”
Is it possible that a man who is guilty of such pedanticfolly as this,—a man who can see a confirmationof his doctrine in such a recovery as this,—arecovery which is happening every day, from a breathof air, a drop or two of water, untying a bonnet-string,loosening a stay-lace, and which can hardly help happening,whatever is done,—is it possible that aman, of whose pages, not here and there one, but hundredsupon hundreds are loaded with such trivialities, isthe Newton, the Columbus, the Harvey of the nineteenthcentury!
The whole process of demonstration he employs is this.An experiment is instituted with some drug upon oneor more healthy persons. Everything that happensfor a number of days or weeks is, as we have seen,set down as an effect of the medicine. Old volumesare then ransacked promiscuously, and every morbidsensation or change that anybody ever said was producedby the drug in question is added to the list of symptoms.By one or both of these methods, each of the sixty-foursubstances enumerated by Hahnemann is shown to producea very large number of symptoms, the lowest in hisscale being ninety-seven, and the highest fourteenhundred and ninety-one. And having made out thislist respecting any drug, a catalogue which, as youmay observe in any hom*oeopathic manual, contains varioussymptoms belonging to every organ of the body, whatcan be easier than to find alleged cures in everymedical author which can at once be attributed to thehom*oeopathic principle; still more if the grave ofextinguished credulity is called upon to give up itsdead bones as living witnesses; and worst of all, ifthe monuments of the past are to be mutilated in favorof “the sole law of Nature in therapeutics”?
There are a few familiar facts of which great usehas been made as an entering wedge for the hom*oeopathicdoctrine. They have been suffered to pass currentso long that it is time they should be nailed to thecounter, a little operation which I undertake, withperfect cheerfulness, to perform for them.
The first is a supposed illustration of the hom*oeopathiclaw found in the precept given for the treatment ofparts which have been frozen, by friction with snowor similar means. But we deceive ourselves bynames, if we suppose the frozen part to be treatedby cold, and not by heat. The snow may even beactually warmer than the part to which it is applied.But even if it were at the same temperature when applied,it never did and never could do the least good toa frozen part, except as a mode of regulating theapplication of what? of heat. But the heat mustbe applied gradually, just as food must be given alittle at a time to those perishing with hunger.If the patient were brought into a warm room, heatwould be applied very rapidly, were not something interposedto prevent this, and allow its gradual admission.Snow or iced water is exactly what is wanted; it isnot cold to the part; it is very possibly warm, onthe contrary, for these terms are relative, and ifit does not melt and let the heat in, or is not takenaway, the part will remain frozen up until doomsday.Now the treatment of a frozen limb by heat, in largeor small quantities, is not hom*oeopathy.
The next supposed illustration of the hom*oeopathiclaw is the alleged successful management of burns,by holding them to the fire. This is a popularmode of treating those burns which are of too littleconsequence to require any more efficacious remedy,and would inevitably get well of themselves, withoutany trouble being bestowed upon them. It producesa most acute pain in the part, which is followed bysome loss of sensibility, as happens with the eyeafter exposure to strong light, and the ear afterbeing subjected to very intense sounds. This isall it is capable of doing, and all further notionsof its efficacy must be attributed merely to the vulgarlove of paradox. If this example affords anycomfort to the hom*oeopathist, it seems as cruel todeprive him of it as it would be to convince the mistressof the smoke-jack or the flatiron that the fire doesnot literally “draw the fire out,” whichis her hypothesis.
But if it were true that frost-bites were cured bycold and burns by heat, it would be subversive, sofar as it went, of the great principle of hom*oeopathy.
For you will remember that this principle is thatLike cures Like, and not that Same cures Same; thatthere is resemblance and not identity between thesymptoms of the disease and those produced by the drugwhich cures it, and none have been readier to insistupon this distinction than the hom*oeopathists themselves.For if Same cures Same, then every poison must beits own antidote,—which is neither a partof their theory nor their so-called experience.They have been asked often enough, why it was thatarsenic could not cure the mischief which arsenic hadcaused, and why the infectious cause of small-poxdid not remedy the disease it had produced, and thenthe; were ready enough to see the distinction I havepointed out. O no! it was not the hair of thesame dog, but only of one very much like him!
A third instance in proof of the hom*oeopathic lawis sought for in the acknowledged efficacy of vaccination.And how does the law apply to this? It is grantedby the advocates of hom*oeopathy that there is a resemblancebetween the effects of the vaccine virus on a personin health and the symptoms of small-pox. Therefore,according to the rule, the vaccine virus will curethe small-pox, which, as everybody knows, is entirelyuntrue. But it prevents small-pox, say the hom*oeopathists.Yes, and so does small-pox prevent itself from everhappening again, and we know just as much of the principleinvolved in the one case as in the other. Forthis is only one of a series of facts which we arewholly unable to explain. Small-pox, measles,scarlet-fever, hooping-cough, protect those who havethem once from future attacks; but nettle-rash andcatarrh and lung fever, each of which is just as hom*oeopathicto itself as any one of the others, have no such preservativepower. We are obliged to accept the fact, unexplained,and we can do no more for vaccination than for therest.
I come now to the most directly practical point connectedwith the subject, namely,—
What is the state of the evidence as to the efficacyof the proper hom*oeopathic treatment in the cure ofdiseases.
As the treatment adopted by the hom*oeopathists hasbeen almost universally by means of the infinitesimaldoses, the question of their efficacy is thrown open,in common with that of the truth of their fundamentalaxiom, as both are tested in practice.
We must look for facts as to the actual working ofhom*oeopathy to three sources.
1. The statements of the unprofessional public.
2. The assertions of hom*oeopathic practitioners.
3. The results of trials by competent and honestphysicians, not pledged to the system.
I think, after what we have seen of medical facts,as they are represented by incompetent persons, weare disposed to attribute little value to all statementsof wonderful cures, coming from those who have neverbeen accustomed to watch the caprices of disease, andhave not cooled down their young enthusiasm by thehabit of tranquil observation. Those who knownothing of the natural progress of a malady, of itsordinary duration, of its various modes of terminating,of its liability to accidental complications, of thesigns which mark its insignificance or severity, ofwhat is to be expected of it when left to itself, ofhow much or how little is to be anticipated from remedies,those who know nothing or next to nothing of all thesethings, and who are in a great state of excitementfrom benevolence, sympathy, or zeal for a new medicaldiscovery, can hardly be expected to be sound judgesof facts which have misled so many sagacious men,who have spent their lives in the daily study andobservation of them. I believe that, after havingdrawn the portrait of defunct Perkinism, with its
five thousand printed cures, and its million and ahalf computed ones, its miracles blazoned about throughAmerica, Denmark, and England; after relating thatforty years ago women carried the Tractors about intheir pockets, and workmen could not make them fastenough for the public demand; and then showing you,as a curiosity, a single one of these instruments,an odd one of a pair, which I obtained only by a luckyaccident, so utterly lost is the memory of all theirwonderful achievements; I believe, after all this,I need not waste time in showing that medical accuracyis not to be looked for in the florid reports of benevolentassociations, the assertions of illustrious patrons,the lax effusions of daily journals, or the effervescentgossip of the tea-table.Dr. Hering, whose name is somewhat familiar to thechampions of hom*oeopathy, has said that “thenew healing art is not to be judged by its successin isolated cases only, but according to its successin general, its innate truth, and the incontrovertiblenature of its innate principles.”
We have seen something of “the incontrovertiblenature of its innate principles,” and it seemsprobable, on the whole, that its success in generalmust be made up of its success in isolated cases.Some attempts have been made, however, to finish thewhole matter by sweeping statistical documents, whichare intended to prove its triumphant success overthe common practice.
It is well known to those who have had the good fortuneto see the “hom*oeopathic Examiner,” thatthis journal led off, in its first number, with agrand display of everything the newly imported doctrinehad to show for itself. It is well remarked,on the twenty-third page of this article, that “thecomparison of bills of mortality among an equal numberof sick, treated by divers methods, is a most poorand lame way to get at conclusions touching principlesof the healing art.” In confirmation ofwhich, the author proceeds upon the twenty-fifth pageto prove the superiority of the hom*oeopathic treatmentof cholera, by precisely these very bills of mortality.Now, every intelligent physician is aware that thepoison of cholera differed so much in its activityat different times and, places, that it was next toimpossible to form any opinion as to the results oftreatment, unless every precaution was taken to securethe most perfectly corresponding conditions in thepatients treated, and hardly even then. Of course,then, a Russian Admiral, by the name of Mordvinov,backed by a number of so-called physicians practisingin Russian villages, is singularly competent to thetask of settling the whole question of the utilityof this or that kind of treatment; to prove that,if not more than eight and a half per cent. of thoseattacked with the disease perished, the rest owedtheir immunity to Hahnemann. I can remember whenmore than a hundred patients in a public institutionwere attacked with what, I doubt not, many hom*oeopathic
physicians (to say nothing of hom*oeopathic admirals)would have called cholera, and not one of them died,though treated in the common way, and it is my firmbelief that, if such a result had followed the administrationof the omnipotent globules, it would have been inthe mouth of every adept in Europe, from Quin of Londonto Spohr of Gandersheim. No longer ago than yesterday,in one of the most widely circulated papers of thiscity, there was published an assertion that the mortalityin several hom*oeopathic Hospitals was not quite fivein a hundred, whereas, in what are called by the writerAllopathic Hospitals, it is said to be eleven in ahundred. An honest man should be ashamed of suchan argumentum ad ignorantiam. The mortality ofa hospital depends not merely on the treatment of thepatients, but on the class of diseases it is in thehabit of receiving, on the place where it is, on theseason, and many other circ*mstances. For instance,there are many hospitals in the great cities of Europethat receive few diseases of a nature to endangerlife, and, on the other hand, there are others wheredangerous diseases are accumulated out of the commonproportion. Thus, in the wards of Louis, at theHospital of La Pitie, a vast number of patients inthe last stages of consumption were constantly entering,to swell the mortality of that hospital. It wasbecause he was known to pay particular attention tothe diseases of the chest that patients laboring underthose fatal affections to an incurable extent wereso constantly coming in upon him. It is alwaysa miserable appeal to the thoughtlessness of the vulgar,to allege the naked fact of the less comparative mortalityin the practice of one hospital or of one physicianthan another, as an evidence of the superiority oftheir treatment. Other things being equal, itmust always be expected that those institutions andindividuals enjoying to the highest degree the confidenceof the community will lose the largest proportionof their patients; for the simple reason that theywill naturally be looked to by those suffering fromthe gravest class of diseases; that many, who knowthat they are affected with mortal disease, will chooseto die under their care or shelter, while the subjectsof trifling maladies, and merely troublesome symptoms,amuse themselves to any extent among the fancy practitioners.When, therefore, Dr. Mublenbein, as stated in the“hom*oeopathic Examiner,” and quoted inyesterday’s “Daily Advertiser,” assertsthat the mortality among his patients is only oneper cent. since he has practised hom*oeopathy, whereasit was six per cent. when he employed the common modeof practice, I am convinced by this, his own statement,that the citizens of Brunswick, whenever they areseriously sick, take good care not to send for Dr.Muhlenbein!It is evidently impossible that I should attempt,within the compass of a single lecture, any detailedexamination of the very numerous cases reported inthe hom*oeopathic Treatises and Journals. Havingbeen in the habit of receiving the French “Archivesof hom*oeopathic Medicine” until the prematuredecease of that Journal, I have had the opportunityof becoming acquainted somewhat with the style ofthese documents, and experiencing whatever degreeof conviction they were calculated to produce.Although of course I do not wish any value to be assumedfor my opinion, such as it is, I consider that youare entitled to hear it. So far, then, as I amacquainted with the general character of the casesreported by the hom*oeopathic physicians, they wouldfor the most part be considered as wholly undeservinga place in any English, French, or American periodicalof high standing, if, instead of favoring the doctrinethey were intended to support, they were brought forwardto prove the efficacy of any common remedy administeredby any common practitioner. There are occasionalexceptions to this remark; but the general truth ofit is rendered probable by the fact that these casesare always, or almost always, written with the singleobject of showing the efficacy of the medicine used,or the skill of the practitioner, and it is recognizedas a general rule that such cases deserve very littleconfidence. Yet they may sound well enough, oneat a time, to those who are not fully aware of thefallacies of medical evidence. Let me state acase in illustration. Nobody doubts that somepatients recover under every form of practice.Probably all are willing to allow that a large majority,for instance, ninety in a hundred, of such cases asa physician is called to in daily practice, wouldrecover, sooner or later, with more or less difficulty,provided nothing were done to interfere seriouslywith the efforts of nature.
Suppose, then, a physician who has a hundred patientsprescribes to each of them pills made of some entirelyinert substance, as starch, for instance. Ninetyof them get well, or if he chooses to use such language,he cures ninety of them. It is evident, accordingto the doctrine of chances, that there must be a considerablenumber of coincidences between the relief of the patientand the administration of the remedy. It is altogetherprobable that there will happen two or three verystriking coincidences out of the whole ninety cases,in which it would seem evident that the medicine producedthe relief, though it had, as we assumed, nothingto do with it. Now suppose that the physicianpublishes these cases, will they not have a plausibleappearance of proving that which, as we granted atthe outset, was entirely false? Suppose thatinstead of pills of starch he employs microscopicsugarplums, with the five’ million billion trillionthpart of a suspicion of aconite or pulsatilla, andthen publishes his successful cases, through the leaden
lips of the press, or the living ones of his femaleacquaintances,—does that make the impressiona less erroneous one? But so it is that in hom*oeopathicworks and journals and gossip one can never, or nextto never, find anything but successful cases, whichmight do very well as a proof of superior skill, didit not prove as much for the swindling advertiserswhose certificates disgrace so many of our newspapers.How long will it take mankind to learn that while theylisten to “the speaking hundreds and units,”who make the world ring with the pretended triumphsthey have witnessed, the “dumb millions”of deluded and injured victims are paying the dailyforfeit of their misplaced confidence!I am sorry to see, also, that a degree of ignoranceas to the natural course of diseases is often shownin these published cases, which, although it may notbe detected by the unprofessional reader, conveys anunpleasant impression to those who are acquainted withthe subject. Thus a young woman affected withjaundice is mentioned in the German “Annalsof Clinical hom*oeopathy” as having been curedin twenty-nine days by pulsatilla and nux vomica.Rummel, a well-known writer of the same school, speaksof curing a case of jaundice in thirty-four days byhom*oeopathic doses of pulsatilla, aconite, and cinchona.I happened to have a case in my own household, a fewweeks since, which lasted about ten days, and thiswas longer than I have repeatedly seen it in hospitalpractice, so that it was nothing to boast of.
Dr. Munneche of Lichtenburg in Saxony is called toa patient with sprained ankle who had been a fortnightunder the common treatment. The patient getswell by the use of arnica in a little more than a monthlonger, and this extraordinary fact is published inthe French “Archives of hom*oeopathic Medicine.”
In the same Journal is recorded the case of a patientwho with nothing more, so far as any proof goes, thaninluenza, gets down to her shop upon the sixth day.
And again, the cool way in which everything favorablein a case is set down by these people entirely totheir treatment, may be seen in a case of croup reportedin the “hom*oeopathic Gazette” of Leipsic,in which leeches, blistering, inhalation of hot vapor,and powerful internal medicine had been employed,and yet the merit was all attributed to one drop ofsome hom*oeopathic fluid.
I need not multiply these quotations, which illustratethe grounds of an opinion which the time does notallow me to justify more at length; other such casesare lying open before me; there is no end to them ifmore were wanted; for nothing is necessary but tolook into any of the numerous broken-down Journalsof hom*oeopathy, the volumes of which may be found onthe shelves of those curious in such matters.
A number of public trials of hom*oeopathy have beenmade in different parts of the world. Six ofthese are mentioned in the Manifesto of the “hom*oeopathicExaminer.” Now to suppose that any trialcan absolutely silence people, would be to forgetthe whole experience of the past. Dr. Haygarthand Dr. Alderson could not stop the sale of the five-guineaTractors, although they proved that they could workthe same miracles with pieces of wood and tobacco-pipe.It takes time for truth to operate as well as hom*oeopathicglobules. Many persons thought the results ofthese trials were decisive enough of the nullity ofthe treatment; those who wish to see the kind of specialpleading and evasion by which it is attempted to coverresults which, stated by the “hom*oeopathic Examiner”itself, look exceedingly like a miserable failure,may consult the opening flourish of that Journal.I had not the intention to speak of these public trialsat all, having abundant other evidence on the point.But I think it best, on the whole, to mention two ofthem in a few words,—that instituted atNaples and that of Andral.
There have been few names in the medical profession,for the last half century, so widely known throughoutthe world of science as that of M. Esquirol, whoselife was devoted to the treatment of insanity, andwho was without a rival in that department of practicalmedicine. It is from an analysis communicatedby him to the “Gazette Medicale de Paris”that I derive my acquaintance with the account ofthe trial at Naples by Dr. Panvini, physician to theHospital della Pace. This account seems to beentirely deserving of credit. Ten patients wereset apart, and not allowed to take any medicine atall,—much against the wish of the hom*oeopathicphysician. All of them got well, and of courseall of them would have been claimed as triumphs ifthey had been submitted to the treatment. Sixother slight cases (each of which is specified) gotwell under the hom*oeopathic treatment, none of itsasserted specific effects being manifested.
All the rest were cases of grave disease; and so faras the trial, which was interrupted about the fortiethday, extended, the patients grew worse, or receivedno benefit. A case is reported on the page beforeme of a soldier affected with acute inflammation inthe chest, who took successively aconite, bryonia,nux vomica, and pulsatilla, and after thirty-eightdays of treatment remained without any important changein his disease. The hom*oeopathic physician whotreated these patients was M. de Horatiis, who hadthe previous year been announcing his wonderful cures.And M. Esquirol asserted to the Academy of Medicinein 1835, that this M. de Horatiis, who is one of theprominent personages in the “Examiner’s”Manifesto published in 1840, had subsequently renouncedhom*oeopathy. I may remark, by the way, that thissame periodical, which is so very easy in explainingaway the results of these trials, makes a mistakeof only six years or a little more as to the time whenthis at Naples was instituted.
M. Andral, the “eminent and very enlightenedallopathist” of the “hom*oeopathic Examiner,”made the following statement in March, 1835, to theAcademy of Medicine: “I have submitted thisdoctrine to experiment; I can reckon at this timefrom one hundred and thirty to one hundred and fortycases, recorded with perfect fairness, in a great hospital,under the eye of numerous witnesses; to avoid everyobjection—I obtained my remedies of M.Guibourt, who keeps a hom*oeopathic pharmacy, and whosestrict exactness is well known; the regimen has beenscrupulously observed, and I obtained from the sistersattached to the hospital a special regimen, such asHahnemann orders. I was told, however, some monthssince, that I had not been faithful to all the rulesof the doctrine. I therefore took the troubleto begin again; I have studied the practice of theParisian hom*oeopathists, as I had studied their books,and I became convinced that they treated their patientsas I had treated mine, and I affirm that I have beenas rigorously exact in the treatment as any otherperson.”
And he expressly asserts the entire nullity of theinfluence of all the hom*oeopathic remedies tried byhim in modifying, so far as he could observe, theprogress or termination of diseases. It deservesnotice that he experimented with the most boastedsubstances,—cinchona, aconite, mercury,bryonia, belladonna. Aconite, for instance, hesays he administered in more than forty cases of thatcollection of feverish symptoms in which it exertsso much power, according to Hahnemann, and in notone of them did it have the slightest influence, thepulse and heat remaining as before.
These statements look pretty honest, and would seemhard to be explained away, but it is calmly said thathe “did not know enough of the method to selectthe remedies with any tolerable precision.” ["hom*oeopathicExaminer, vol. i. p. 22.]
“Nothing is left to the caprice of the physician.”(In a word, instead of being dependent upon blindchance, that there is an infallible law, guided bywhich; the physician must select the proper remedies.’)[’Ibid.,’ in a notice of Menzel’spaper.] Who are they that practice hom*oeopathy, andsay this of a man with the Materia Medica of Hahnemannlying before him? Who are they that send thesesame globules, on which he experimented, accompaniedby a little book, into families, whose members arethought competent to employ them, when they deny anysuch capacity to a man whose life has been passedat the bedside of patients, the most prominent teacherin the first Medical Faculty in the world, the consultingphysician of the King of France, and one of the mostrenowned practical writers, not merely of his nation,but of his age? I leave the quibbles by whichsuch persons would try to creep out from under thecrushing weight of these conclusions to the unfortunateswho suppose that a reply is equivalent to an answer.
Dr. Baillie, one of the physicians in the great HotelDieu of Paris, invited two hom*oeopathic practitionersto experiment in his wards. One of these wasCurie, now of London, whose works are on the countersof some of our bookstores, and probably in the handsof some of my audience. This gentleman, whomDr. Baillie declares to be an enlightened man, andperfectly sincere in his convictions, brought his ownmedicines from the pharmacy which furnished Hahnemannhimself, and employed them for four or five monthsupon patients in his ward, and with results equallyunsatisfactory, as appears from Dr. Baillie’sstatement at a meeting of the Academy of Medicine.And a similar experiment was permitted by the ClinicalProfessor of the Hotel Dieu of Lyons, with the samecomplete failure.
But these are old and prejudiced practitioners.Very well, then take the statement of Dr. Fleury,a most intelligent young physician, who treated hom*oeopathicallymore than fifty patients, suffering from diseases whichit was not dangerous to treat in this way, taking everykind of precaution as to regimen, removal of disturbinginfluences, and the state of the atmosphere, insistedupon by the most vigorous partisans of the doctrine,and found not the slightest effect produced by themedicines. And more than this, read nine of thesecases, which he has published, as I have just done,and observe the absolute nullity of aconite, belladonna,and bryonia, against the symptoms over which they arepretended to exert such palpable, such obvious, suchastonishing influences. In the view of thesestatements, it is impossible not to realize the entirefutility of attempting to silence this asserted scienceby the flattest and most peremptory results of experiment.Were all the hospital physicians of Europe and Americato devote themselves, for the requisite period, tothis sole pursuit, and were their results to be unanimousas to the total worthlessness of the whole system inpractice, this slippery delusion would slide throughtheir fingers without the slightest discomposure,when, as they supposed, they had crushed every jointin its tortuous and trailing body.
3. I have said, that to show the truth of thehom*oeopathic doctrine, as announced by Hahnemann,it would be necessary to show, in the third place,that remedies never cure diseases when they are notcapable of producing similar symptoms! The burdenof this somewhat comprehensive demonstration lyingentirely upon the advocates of this doctrine, it maybe left to their mature reflections.
It entered into my original plan to treat of the doctrinerelating to Psora, or itch,—an almost insaneconception, which I am glad to get rid of, for thisis a subject one does not care to handle without gloves.I am saved this trouble, however, by finding thatmany of the disciples of Hahnemann, those disciplesthe very gospel of whose faith stands upon his word,make very light of his authority on this point, althoughhe himself says, “It has cost me twelve yearsof study and research to trace out the source of thisincredible number of chronic affections, to discoverthis great truth, which remained concealed from allmy predecessors and contemporaries, to establish thebasis of its demonstration, and find out, at the sametime, the curative medicines that were fit to combatthis hydra in all its different forms.”
But, in the face of all this, the following remarksare made by Wolff, of Dresden, whose essays, accordingto the editor of the “hom*oeopathic Examiner,”“represent the opinions of a large majority ofhom*oeopathists in Europe.”
“It cannot be unknown to any one at all familiarwith hom*oeopathic literature, that Hahnemann’sidea of tracing the large majority of chronic diseasesto actual itch has met with the greatest oppositionfrom hom*oeopathic physicians themselves.”And again, “If the Psoric theory has led tono proper schism, the reason is to be found in thefact that it is almost without any influence in practice.”
We are told by Jahr, that Dr. Griesselich, “Surgeonto the Grand Duke of Baden,” and a “distinguished”hom*oeopathist, actually asked Hahnemann for the proofthat chronic diseases, such as dropsy, for instance,never arise from any other cause than itch; and that,according to common report, the venerable sage washighly incensed (fort courrouce) with Dr. Hartmann,of Leipsic, another “distinguished” hom*oeopathist,for maintaining that they certainly did arise fromother causes.
And Dr. Fielitz, in the “hom*oeopathic Gazette”of Leipsic, after saying, in a good-natured way, thatPsora is the Devil in medicine, and that physiciansare divided on this point into diabolists and exorcists,declares that, according to a remark of Hahnemann,the whole civilized world is affected with Psora.I must therefore disappoint any advocate of Hahnemannwho may honor me with his presence, by not attackinga doctrine on which some of the disciples of his creedwould be very happy to have its adversaries wastetheir time and strength. I will not meddle withthis excrescence, which, though often used in timeof peace, would be dropped, like the limb of a shell-fish,the moment it was assailed; time is too precious,and the harvest of living extravagances nods too heavilyto my sickle, that I should blunt it upon straw andstubble.
I will close the subject with a brief examinationof some of the statements made in hom*oeopathic works,and more particularly in the brilliant Manifesto ofthe “Examiner,” before referred to.And first, it is there stated under the head of “hom*oeopathicl*terature,” that “Seven hundredvolumes have been issued from the press developingthe peculiarities of the system, and many of thempossessed of a scientific character that savans knowwell how to respect.” If my assertion wereproper evidence in the case, I should declare, that,having seen a good many of these publications, fromthe year 1834, when I bought the work of the Rev.Thomas Everest, [Dr. Curie speaks of this silly pamphletas having been published in 1835.] to within a fewweeks, when I received my last importation of Homaeopathicl*terature, I have found that all, with a very fewexceptions, were stitched pamphlets varying from twentyor thirty pages to somewhat less than a hundred, andgenerally resembling each other as much as so manyspelling-books.
But not being evidence in the case, I will give youthe testimony of Dr. Trinks, of Dresden, who flourisheson the fifteenth page of the same Manifesto as oneof the most distinguished among the hom*oeopathistsof Europe. I translate the sentence literallyfrom the “Archives de la Medecine hom*oeopathique.”
“The literature of hom*oeopathy, if that honorablename must be applied to all kinds of book-making,has been degraded to the condition of the humblestservitude. Productions without talent, withoutspirit, without discrimination, flat and pitiful eulogies,exaggerations surpassing the limits of the most robustfaith, invectives against such as dared to doubt thedogmas which had been proclaimed, or catalogues ofremedies; of such materials is it composed! Fromdistance to distance only, have appeared some memoirsuseful to science or practice, which appear as somany green oases in the midst of this literary desert.”
It is a very natural as well as a curious questionto ask, What has been the success of hom*oeopathy inthe different countries of Europe, and what is itspresent condition?
The greatest reliance of the advocates of hom*oeopathyis of course on Germany. We know very littleof its medical schools, its medical doctrines, orits medical men, compared with those of England andFrance. And, therefore, when an intelligent travellergives a direct account from personal inspection ofthe miserable condition of the hom*oeopathic hospitalat Leipsic, the first established in Europe, and thefirst on the list of the ever-memorable Manifesto,it is easy enough answer or elude the fact by citingvarious hard names of “distinguished”practitioners, which sound just as well to the uninformedpublic as if they were Meckel, or Tiedemann, or Langenbeck.Dr. Leo-Wolf, who, to be sure, is opposed to hom*oeopathy,but who is a scholar, and ought to know somethingof his own countrymen, assures us that “Dr. Koppis the only German hom*oeopathist, if we can call himso, who has been distinguished as an author and practitionerbefore he examined this method.” And Dr.Lee, the same gentleman in whose travels the paragraphrelating to the Leipsic Hospital is to be found, saysthe same thing. And I will cheerfully exposemyself to any impertinent remark which it might suggest,to assure my audience that I never heard or saw oneauthentic hom*oeopathic name of any country in Europe,which I had ever heard mentioned before as connectedwith medical science by a single word or deed sufficientto make it in any degree familiar to my ears, unlessArnold of Heidelberg is the anatomist who discovereda little nervous centre, called the otic ganglion.But you need ask no better proof of who and what theGerman adherents of this doctrine must be, than thetestimony of a German hom*oeopathist as to the wretchedcharacter of the works they manufacture to enforceits claims.
As for the act of this or that government toleratingor encouraging hom*oeopathy, every person of commonintelligence knows that it is a mere form grantedor denied according to the general principles of policyadopted in different states, or the degree of influencewhich some few persons who have adopted it may happento have at court. What may be the value of certainpompous titles with which many of the advocates ofhom*oeopathy are honored, it might be disrespectfulto question. But in the mean time the judiciousinquirer may ponder over an extract which I translatefrom a paper relating to a personage well known tothe community as Williams the Oculist, with whom Ihad the honor of crossing the Atlantic some yearssince, and who himself handed me two copies of thepaper in question.
“To say that he was oculist of Louis XVIII.and of Charles X., and that he now enjoys the sametitle with respect to His Majesty, Louis Philippe,and the King of the Belgians, is unquestionably tosay a great deal; and yet it is one of the least ofhis titles to public confidence. His reputationrests upon a basis more substantial even than the numerousdiplomas with which he is provided, than the membershipof the different medical societies which have chosenhim as their associate,” etc., etc.
And as to one more point, it is time that the publicshould fully understand that the common method ofsupporting barefaced imposture at the present day,both in Europe and in this country, consists in trumpingup “Dispensaries,” “Colleges of Health,”and other advertising charitable clap-traps, whichuse the poor as decoy-ducks for the rich, and theproprietors of which have a strong predilection forthe title of “Professor.” These names,therefore, have come to be of little or no value asevidence of the good character, still less of the highpretensions of those who invoke their authority.Nor does it follow, even when a chair is founded inconnection with a well-known institution, that ithas either a salary or an occupant; so that it maybe, and probably is, a mere harmless piece of tolerationon the part of the government if a Professorship ofhom*oeopathy is really in existence at Jena or Heidelberg.And finally, in order to correct the error of any whomight suppose that the whole Medical Profession ofGermany has long since fallen into the delusions ofHahnemann, I will quote two lines which a celebratedanatomist and surgeon (whose name will occur againin this lecture in connection with a very pleasingletter) addressed to the French Academy of Medicinein 1835. “I happened to be in Germany somemonths since, at a meeting of nearly six hundred physicians;one of them wished to bring up the question of hom*oeopathy;they would not even listen to him.” Thismay have been very impolite and bigoted, but thatis not precisely the point in reference to which Imention the circ*mstance.
But if we cannot easily get at Germany, we can veryeasily obtain exact information from France and England.I took the trouble to write some months ago to twofriends in Paris, in whom I could place confidence,for information upon the subject. One of themanswered briefly to the effect that nothing was saidabout it. When the late Curator of the LowellInstitute, at his request, asked about the works uponthe subject, he was told that they had remained along time on the shelves quite unsalable, and neverspoken of.
The other gentleman, [Dr. Henry T. Bigelow, now Professorof Surgery in Harvard University] whose name is wellknown to my audience, and who needs no commendationof mine, had the kindness to procure for me many publicationsupon the subject, and some information which sets thewhole matter at rest, so far as Paris is concerned.He went directly to the Baillieres, the principaland almost the only publishers of all the hom*oeopathicbooks and journals in that city. The followingfacts were taken by him from the account-books ofthis publishing firm. Four hom*oeopathic Journalshave been published in Paris; three of them by theBaillieres.
The reception they met with may be judged of by showingthe number of subscribers to each on the books ofthe publishing firm.
A Review published by some other house, which lastedone year, and had about fifty subscribers, appearedin 1834, 1835.
There were only four Journals of hom*oeopathy everpublished in Paris. The Baillieres informed mycorrespondent that the sale of hom*oeopathic bookswas much less than formerly, and that consequentlythey should undertake to publish no new books uponthe subject, except those of Jahr or Hahnemann.“This man,” says my correspondent,—referringto one of the brothers,—“the publisherand headquarters of hom*oeopathy in Paris, informsme that it is going down in England and Germany aswell as in Paris.” For all the facts hehad stated he pledged himself as responsible.
hom*oeopathy was in its prime in Paris, he said, in1836 and 1837, and since then has been going down.
Louis told my correspondent that no person of distinctionin Paris had embraced hom*oeopathy, and that it wasdeclining. If you ask who Louis is, I refer youto the well-known hom*oeopathist, Peschier of Geneva,who says, addressing him, “I respect no onemore than yourself; the feeling which guides yourresearches, your labors, and your pen, is so honorableand rare, that I could not but bow down before it;and I own, if there were any allopathist who inspiredme with higher veneration, it would be him and notyourself whom I should address.”
Among the names of “Distinguished hom*oeopathists,”however, displayed in imposing columns, in the indexof the “hom*oeopathic Examiner,” are thoseof Marjolin, Amussat, and Breschet,names well known to the world of science, and thelast of them identified with some of the most valuablecontributions which anatomical knowledge has receivedsince the commencement of the present century.One Dr. Chrysaora, who stands sponsor for many factsin that Journal, makes the following statement amongthe rest: “Professors, who are esteemedamong the most distinguished of the Faculty (Facultyde Medicine), both as to knowledge and reputation,have openly confessed the power of hom*oeopathia informs of disease where the ordinary method of practiceproved totally insufficient. It affords me thehighest pleasure to select from among these gentlemen,Marjolin, Amussat, and Breschet.”
Here is a literal translation of an original letter,now in my possession, from one of these hom*oeopathiststo my correspondent:—
“Dear sir, and respectedprofessional brother:
“You have had the kindness to inform me in yourletter that a new American Journal, the ‘NewWorld,’ has made use of my name in support ofthe pretended hom*oeopathic doctrines, and that I amrepresented as one of the warmest partisans of hom*oeopathyin France.
“I am vastly surprised at the reputation manufacturedfor me upon the new continent; but I am obliged, indeference to truth, to reject it with my whole energy.I spurn far from me everything which relates to thatcharlatanism called hom*oeopathy, for these pretendeddoctrines cannot endure the scrutiny of wise and enlightenedpersons, who are guided by honorable sentiments inthe practice of the noblest of arts.
“Paris, 3d November, 1841
“I am, etc., etc.,
“G. Breschet,
“Professor in the Faculty of Medicine, Memberof the Institute, Surgeon of Hotel Dieu, and ConsultingSurgeon to the King, etc.” [I first sawM. Breschet’s name mentioned in that Journal]
Concerning Amussat, my correspondent writes, thathe was informed by Madame Hahnemann, who conversesin French more readily than her husband, and thereforeoften speaks for him, that “he was not a physician,neither hom*oeopathist nor Allopathist, but that hewas the surgeon of their own establishment; that is,performed as a surgeon all the operations they hadoccasion for in their practice.”
I regret not having made any inquiries as to Marjolin,who, I doubt not, would strike his ponderous snuff-boxuntil it resounded like the Grecian horse, at hearingsuch a doctrine associated with his respectable name.I was not aware, when writing to Paris, that this worthyProfessor, whose lectures I long attended, was includedin these audacious claims; but after the specimensI have given of the accuracy of the foreign correspondenceof the “hom*oeopathic Examiner,” any furtherinformation I might obtain would seem so superfluousas hardly to be worth the postage.
hom*oeopathy may be said, then, to be in a sufficientlymiserable condition in Paris. Yet there lives,and there has lived for years, the illustrious SamuelHahnemann, who himself assured my correspondent thatno place offered the advantages of Paris in its investigation,by reason of the attention there paid to it.
In England, it appears by the statement of Dr. Curiein October, 1839, about eight years after its introductioninto the country, that there were eighteen hom*oeopathicphysicians in the United Kingdom, of whom only threewere to be found out of London, and that many of thesepractised hom*oeopathy in secret.
It will be seen, therefore, that, according to therecent statement of one of its leading English advocates,hom*oeopathy had obtained not quite half as many practicaldisciples in England as Perkinism could show for itselfin a somewhat less period from the time of its firstpromulgation in that country.
Dr. Curie’s letter, dated London, October 30,1839, says there is “one in Dublin, Dr. Luther;at Glasgow, Dr. Scott.” The “distinguished”Chrysaora writes from Paris, dating October 20, 1839,“On the other hand, hom*oeopathy is commencingto make an inroad into England by the way of Ireland.At Dublin, distinguished physicians have already embracedthe new system, and a great part of the nobility andgentry of that city have emancipated themselves fromthe English fashion and professional authority.”
But the Marquis of Anglesea and Sir Edward LyttonBulwer patronize hom*oeopathy; the Queen Dowager Adelaidehas been treated by a hom*oeopathic physician.“Jarley is the delight of the nobility and gentry.”“The Royal Family are the patrons of Jarley.”
Let me ask if a Marquis and a Knight are better thantwo Lords, and if the Dowager of Royalty is betterthan Royalty itself, all of which illustrious dignitieswere claimed in behalf of Benjamin Douglass Perkins?
But if the balance is thought too evenly suspendedin this case, another instance can be given in whichthe evidence of British noblemen and their ladiesis shown to be as valuable in establishing the characterof a medical man or doctrine, as would be the testimonyof the Marquis of Waterford concerning the presentcondition and prospects of missionary enterprise.I have before me an octavo volume of more than fourhundred pages, in which, among much similar matter,I find highly commendatory letters from the Marchionessof Ormond, Lady Harriet Kavanagh, the Countess ofBuckinghamshire, the Right Hon. Viscount Ingestre,M. P., and the Most Noble, the Marquis of Sligo,—alladdressed to “John St. John Long, Esq,”a wretched charlatan, twice tried for, and once convictedof, manslaughter at the Old Bailey.
This poor creature, too, like all of his tribe, speaksof the medical profession as a great confederationof bigoted monopolists. He, too, says that “Ifan innovator should appear, holding out hope to thosein despair, and curing disorders which the facultyhave recorded as irremediable, he is at once, andwithout inquiry, denounced as an empiric and an impostor.”He, too, cites the inevitable names of Galileo andHarvey, and refers to the feelings excited by the greatdiscovery of Jenner. From the treatment of thegreat astronomer who was visited with the punishmentof other heretics by the ecclesiastical authoritiesof a Catholic country some centuries since, thereis no very direct inference to be drawn to the medicalprofession of the present time. His name shouldbe babbled no longer, after having been placarded forthe hundredth time in the pages of St. John Long.But if we are doomed to see constant reference tothe names of Harvey and Jenner in every worthlesspamphlet containing the prospectus of some new trickupon the public, let us, once for all, stare the factsin the face, and see how the discoveries of thesegreat men were actually received by the medical profession.
In 1628, Harvey published his first work upon thecirculation. His doctrines were a complete revolutionof the prevailing opinions of all antiquity.They immediately found both champions and opponents;of which last, one only, Riolanus, seemed to Harveyworthy of an answer, on account of his “rank,fame, and learning.” Controversy in science,as in religion, was not, in those days, carried onwith all the courtesy which our present habits demand,and it is possible that some hard words may have beenapplied to Harvey, as it is very certain that he usedthe most contemptuous expressions towards others.
Harvey declares in his second letter to Riolanus,“Since the first discovery of the circulation,hardly a day, or a moment, has passed without my hearingit both well and ill spoken of; some attack it withgreat hostility, others defend it with high encomiums;one party believe that I have abundantly proved thetruth of the doctrine against all the weight of opposingarguments, by experiments, observations, and dissections;others think it not yet sufficiently cleared up, andfree from objections.” Two really eminentProfessors, Plempius of Louvain, and Walaeus of Leyden,were among its early advocates.
The opinions sanctioned by the authority of long ages,and the names of Hippocrates and Galen, dissolvedaway, gradually, but certainly, before the demonstrationsof Harvey. Twenty-four years after the publicationof his first work, and six years before his death,his bust in marble was placed in the Hall of the Collegeof Physicians, with a suitable inscription recordinghis discoveries.
Two years after this he was unanimously invited toaccept the Presidency of that body; and he lived tosee his doctrine established, and all reputable oppositionwithdrawn.
There were many circ*mstances connected with the discoveryof Dr. Jenner which were of a nature to excite repugnanceand opposition. The practice of inoculation forthe small-pox had already disarmed that disease ofmany of its terrors. The introduction of a contagiousdisease from a brute creature into the human systemnaturally struck the public mind with a sensationof disgust and apprehension, and a part of the medicalpublic may have shared these feelings. I findthat Jenner’s discovery of vaccination was madepublic in June, 1798. In July of the same yearthe celebrated surgeon, Mr. Cline, vaccinated a childwith virus received from Dr. Jenner, and in communicatingthe success of this experiment, he mentions that Dr.Lister, formerly of the Small-Pox Hospital, and himself,are convinced of the efficacy of the cow-pox.In November of the same year, Dr. Pearson publishedhis “Inquiry,” containing the testimonyof numerous practitioners in different parts of thekingdom, to the efficacy of the practice. Dr.Haygarth, who was so conspicuous in exposingthe follies of Perkinism, was among the very earliestto express his opinion in favor of vaccination.In 1801, Dr. Lettsom mentions the circ*mstance “asbeing to the honor of the medical professors, thatthey have very generally encouraged this salutarypractice, although it is certainly calculated to lessentheir pecuniary advantages by its tendency to extirpatea fertile source of professional practice.”
In the same year the Medical Committee of Paris spokeof vaccination in a public letter, as “the mostbrilliant and most important discovery of the eighteenthcentury.” The Directors of a Society forthe Extermination of the Small-Pox, in a Report datedOctober 1st, 1807, “congratulate the publicon the very favorable opinion which the Royal Collegeof Physicians of London, after a most minute and laboriousinvestigation made by the command of his Majesty,have a second time expressed on the subject of vaccination,in their Report laid before the House of Commons,in the last session of Parliament; in consequence ofwhich the sum of twenty thousand pounds was votedto Dr. Jenner, as a remuneration for his discovery,in addition to ten thousand pounds before granted.”(In June, 1802.)
These and similar accusations, so often brought upagainst the Medical Profession, are only one modein which is manifested a spirit of opposition notmerely to medical science, but to all science, andto all sound knowledge. It is a spirit whichneither understands itself nor the object at whichit is aiming. It gropes among the loose recordsof the past, and the floating fables of the moment,to glean a few truths or falsehoods tending to prove,if they prove anything, that the persons who havepassed their lives in the study of a branch of knowledgethe very essence of which must always consist in longand accurate observation, are less competent to judgeof new doctrines in their own department than therest of the community. It belongs to the clownin society, the destructive in politics, and the roguein practice.
The name of Harvey, whose great discovery was thelegitimate result of his severe training and patientstudy, should be mentioned only to check the pretensionsof presumptuous ignorance. The example of Jenner,who gave his inestimable secret, the result of twenty-twoyears of experiment and researches, unpurchased, tothe public,—when, as was said in Parliament,he might have made a hundred thousand pounds by itas well as any smaller sum,—should be referredto only to rebuke the selfish venders of secret remedies,among whom his early history obliges us reluctantlyto record Samuel Hahnemann. Those who speak ofthe great body of physicians as if they were unitedin a league to support the superannuated notions ofthe past against the progress of improvement, haveread the history of medicine to little purpose.The prevalent failing of this profession has been,on the contrary, to lend a too credulous ear to ambitiousand plausible innovators. If at the present timeten years of public notoriety have passed over anydoctrine professing to be of importance in medicalscience, and if it has not succeeded in raising upa powerful body of able, learned, and ingenious advocatesfor its claims, the fault must be in the doctrine andnot in the medical profession.
hom*oeopathy has had a still more extended period oftrial than this, and we have seen with what results.It only remains to throw out a few conjectures asto the particular manner in which it is to break upand disappear.
1. The confidence of the few believers in thisdelusion will never survive the loss of friends whomay die of any acute disease, under a treatment suchas that prescribed by hom*oeopathy. It is doubtfulhow far cases of this kind will be trusted to itstender mercies, but wherever it acquires any considerablefoothold, such cases must come, and with them theruin of those who practise it, should any highly valuedlife be thus sacrificed.
2. After its novelty has worn out, the ardentand capricious individuals who constitute the mostprominent class of its patrons will return to visibledoses, were it only for the sake of a change.
3. The Semi-hom*oeopathic practitioner will graduallywithdraw from the rotten half of his business andtry to make the public forget his connection withit.
4. The ultra hom*oeopathist will either recantand try to rejoin the medical profession; or he willembrace some newer and if possible equally extravagantdoctrine; or he will stick to his colors and go downwith his sinking doctrine. Very few will pursuethe course last mentioned.
A single fact may serve to point out in what directionthere will probably be a movement of the dissolvingatoms of hom*oeopathy. On the 13th page of thetoo frequently cited Manifesto of the “Examiner”I read the following stately paragraph:
“Bigelius, M. D., physician to the Emperor ofRussia, whose elevated reputation is well known inEurope, has been an acknowledged advocate of Hahnemann’sdoctrines for several years. He abandoned Allopathiafor hom*oeopathia.” The date of this statementis January, 1840. I find on looking at the booksellers’catalogues that one Bigel, or Bigelius, to speak moreclassically, has been at various times publishing hom*oeopathicbooks for some years.
Again, on looking into the “Encyclographie desSciences Medicales” for April, 1840, I finda work entitled “Manual of Hydrosudopathy,or the Treatment of Diseases by Cold Water, etc.,etc., by Dr. Bigel, Physician of the School ofStrasburg, Member of the Medico-Chirurgical Instituteof Naples, of the Academy of St. Petersburg,—Assessorof the College of the Empire of Russia, Physicianof his late Imperial Highness the Grand Duke Constantine,Chevalier of the Legion of Honor, etc.”Hydrosudopathy or Hydropathy, as it is sometimes called,is a new medical doctrine or practice which has sprungup in Germany since hom*oeopathy, which it bids fairto drive out of the market, if, as Dr. Bigel says,fourteen physicians afflicted with diseases whichdefied themselves and their colleagues came to Graefenberg,in the year 1836 alone, and were cured. Now Dr.Bigel, “whose elevated reputation is well knownin Europe,” writes as follows: “Thereader will not fail to see in this defence of thecurative method of Graefenberg a profession of medicalfaith, and he will be correct in so doing.”And his work closes with the following sentence, worthyof so distinguished an individual: “We believe,with religion, that the water of baptism purifiesthe soul from its original sin; let us believe also,with experience, that it is for our corporeal sinsthe redeemer of the human body.” If Bigel,Physician to the late Grand Duke Constantine, is identicalwith Bigel whom the “Examiner” calls Physicianto the Emperor of Russia, it appears that he is nowactively engaged in throwing cold water at once uponhis patients and the future prospects of hom*oeopathy.
If, as must be admitted, no one of Hahnemann’sdoctrines is received with tolerable unanimity amonghis disciples, except the central axiom, Similia similibuscurantur; if this axiom itself relies mainly for itssupport upon the folly and trickery of Hahnemann, whatcan we think of those who announce themselves readyto relinquish all the accumulated treasures of ourart, to trifle with life upon the strength of thesefantastic theories? What shall we think of professedpractitioners of medicine, if, in the words of Jahr,“from ignorance, for their personal convenience,or through charlatanism, they treat their patientsone day hom*oeopathically and the next Allopathically;”if they parade their pretended new science beforethe unguarded portion of the community; if they suffertheir names to be coupled with it wherever it may gaina credulous patient; and deny all responsibility forits character, refuse all argument for its doctrines,allege no palliation for the ignorance and deceptioninterwoven with every thread of its flimsy tissue,when they are questioned by those competent to judgeand entitled to an answer?
Such is the pretended science of hom*oeopathy, to whichyou are asked to trust your lives and the lives ofthose dearest to you. A mingled mass of perverseingenuity, of tinsel erudition, of imbecile credulity,and of artful misrepresentation, too often mingledin practice, if we may trust the authority of itsfounder, with heartless and shameless imposition.Because it is suffered so often to appeal unansweredto the public, because it has its journals, its patrons,its apostles, some are weak enough to suppose it canescape the inevitable doom of utter disgrace and oblivion.Not many years can pass away before the same curiosityexcited by one of Perkins’s Tractors will beawakened at the sight of one of the InfinitesimalGlobules. If it should claim a longer existence,it can only be by falling into the hands of the sordidwretches who wring their bread from the cold graspof disease and death in the hovels of ignorant poverty.
As one humble member of a profession which for morethan two thousand years has devoted itself to thepursuit of the best earthly interests of mankind,always assailed and insulted from without by such asare ignorant of its infinite perplexities and labors,always striving in unequal contest with the hundred-armedgiant who walks in the noonday, and sleeps not inthe midnight, yet still toiling, not merely for itselfand the present moment, but for the race and the future,I have lifted my voice against this lifeless delusion,rolling its shapeless bulk into the path of a noblescience it is too weak to strike, or to injure.
THE CONTAGIOUSNESS OF PUERPERAL FEVER
Printed in 1843; reprinted with additions, 1855.
The point at issue.
THE AFFIRMATIVE.
“The disease known as Puerperal Fever is sofar contagious as to be frequently carried from patientto patient by physicians and nurses.” O.W. Holmes, 1843.
THE NEGATIVE.
“The result of the whole discussion will, Itrust, serve, not only to exalt your views of thevalue and dignity of our profession, but to divestyour minds of the overpowering dread that you can everbecome, especially to woman, under the extremely interestingcirc*mstances of gestation and parturition, the ministerof evil; that you can ever convey, in any possiblemanner, a horrible virus, so destructive in its effects,and so mysterious in its operations as that attributedto puerperal fever.”—Professor Hodge,1852.
“I prefer to attribute them to accident, orProvidence, of which I can form a conception, ratherthan to a contagion of which I cannot form any clearidea, at least as to this particular malady.”—ProfessorMeigs, 1852.
" . . . in the propagation of which they have no moreto do, than with the propagation of cholera from Jessoreto San Francisco, and from Mauritius to St. Petersburg.”—ProfessorMeigs, 1854.
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“I arrived at that certainty in the matter,that I could venture to foretell what women wouldbe affected with the disease, upon hearing by whatmidwife they were to be delivered, or by what nursethey were to be attended, during their lying-in; and,almost in every instance, my prediction was verified.”—Gordon,1795.
“A certain number of deaths is caused everyyear by the contagion of puerperal fever, communicatedby the nurses and medical attendants.”Farr, in Fifth Annual Report of Registrar-General ofEngland, 1843.
“. . . boards of health, if such exist, or,without them, the medical institutions of a country,should have the power of coercing, or of inflictingsome kind of punishment on those who recklessly gofrom cases of puerperal fevers to parturient or puerperalfemales, without using due precaution; and who, havingbeen shown the risk, criminally encounter it, andconvey pestilence and death to the persons they areemployed to aid in the most interesting and sufferingperiod of female existence.” —Copland’sMedical Dictionary, Art. Puerperal States andDiseases, 1852.
“We conceive it unnecessary to go into detailto prove the contagious nature of this disease, asthere are few, if any, American practitioners whodo not believe in this doctrine.”—Dr.Lee, in Additions to Article last cited.
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[Introductory note.] It happened, some yearsago, that a discussion arose in a Medical Societyof which I was a member, involving the subject of acertain supposed cause of disease, about which somethingwas known, a good deal suspected, and not a littlefeared. The discussion was suggested by a case,reported at the preceding meeting, of a physicianwho made an examination of the body of a patient whohad died with puerperal fever, and who himself diedin less than a week, apparently in consequence ofa wound received at the examination, having attendedseveral women in confinement in the mean time, allof whom, as it was alleged, were attacked with puerperalfever.
Whatever apprehensions and beliefs were entertained,it was plain that a fuller knowledge of the factsrelating to the subject would be acceptable to allpresent. I therefore felt that it would be doinga good service to look into the best records I couldfind, and inquire of the most trustworthy practitionersI knew, to learn what experience had to teach in thematter, and arrived at the results contained in thefollowing pages.
The Essay was read before the Boston Society for MedicalImprovement, and, at the request of the Society, printedin the “New England Quarterly Journal of Medicineand Surgery” for April, 1843. As this Journalnever obtained a large circulation, and ceased tobe published after a year’s existence, and asthe few copies I had struck off separately were soonlost sight of among the friends to whom they were sent,the Essay can hardly be said to have been fully broughtbefore the Profession.
The subject of this Paper has the same profound interestfor me at the present moment as it had when I wasfirst collecting the terrible evidence out of which,as it seems to me, the commonest exercise of reasoncould not help shaping the truth it involved.It is not merely on account of the bearing of thequestion,—if there is a question,—onall that is most sacred in human life and happiness,that the subject cannot lose its interest. Itis because it seems evident that a fair statementof the facts must produce its proper influence on avery large proportion of well-constituted and unprejudicedminds. Individuals may, here and there, resistthe practical bearing of the evidence on their ownfeelings or interests; some may fail to see its meaning,as some persons may be found who cannot tell red fromgreen; but I cannot doubt that most readers will besatisfied and convinced, to loathing, long before theyhave finished the dark obituary calendar laid beforethem.
I do not know that I shall ever again have so goodan opportunity of being useful as was granted me bythe raising of the question which produced this Essay.For I have abundant evidence that it has made manypractitioners more cautious in their relations withpuerperal females, and I have no doubt it will doso still, if it has a chance of being read, thoughit should call out a hundred counterblasts, provingto the satisfaction of their authors that it provednothing. And for my part, I had rather rescueone mother from being poisoned by her attendant, thanclaim to have saved forty out of fifty patients towhom I had carried the disease. Thus, I am willingto avail myself of any hint coming from without tooffer this paper once more to the press. The occasionhas presented itself, as will be seen, in a convenientif not in a flattering form.
I send this Essay again to the medical profession,without the change of a word or syllable. I find,on reviewing it, that it anticipates and eliminatesthose secondary questions which cannot be entertainedfor a moment until the one great point of fact isperemptorily settled. In its very statement ofthe doctrine maintained it avoids all discussion ofthe nature of the disease “known as puerperalfever,” and all the somewhat stale philologyof the word contagion. It mentions, fairly enough,the names of sceptics, or unbelievers as to the realityof personal transmission; of Dewees, of Tonnelle,of Duges, of Baudelocque, and others; of course, notincluding those whose works were then unwritten orunpublished; nor enumerating all the Continental writerswho, in ignorance of the great mass of evidence accumulatedby British practitioners, could hardly be called wellinformed on this subject. It meets all the arrayof negative cases,—those in which diseasedid not follow exposure,—by the strikingexample of small-pox, which, although one of the mostcontagious of diseases, is subject to the most remarkable
irregularities and seeming caprices in its transmission.It makes full allowance for other causes besides personaltransmission, especially for epidemic influences.It allows for the possibility of different modes ofconveyance of the destructive principle. It recognizesand supports the belief that a series of cases mayoriginate from a single primitive source which affectseach new patient in turn; and especially from casesof Erysipelas. It does not undertake to discussthe theoretical aspect of the subject; that is a secondarymatter of consideration. Where facts are numerous,and unquestionable, and unequivocal in their significance,theory must follow them as it best may, keeping timewith their step, and not go before them, marchingto the sound of its own drum and trumpet. Havingthus narrowed its area to a limited practical platformof discussion, a matter of life and death, and notof phrases or theories, it covers every inch of itwith a mass of evidence which I conceive a Committeeof Husbands, who can count coincidences and draw conclusionsas well as a Synod of Accoucheurs, would justly consideras affording ample reasons for an unceremonious dismissalof a practitioner (if it is conceivable that sucha step could be waited for), after five or six funeralshad marked the path of his daily visits, while otherpractitioners were not thus escorted. To the Profession,therefore, I submit the paper in its original form,and leave it to take care of itself.To the medical students, into whose handsthis Essay may fall, some words of introduction maybe appropriate, and perhaps, to a small number ofthem, necessary. There are some among them who,from youth, or want of training, are easily bewilderedand confused in any conflict of opinions into whichtheir studies lead them. They are liable to losesight of the main question in collateral issues, andto be run away with by suggestive speculations.They confound belief with evidence, often trustingthe first because it is expressed with energy, andslighting the latter because it is calm and unimpassioned.They are not satisfied with proof; they cannot believea point is settled so long as everybody is not silenced.They have not learned that error is got out of theminds that cherish it, as the taenia is removed fromthe body, one joint, or a few joints at a time, forthe most part, rarely the whole evil at once.They naturally have faith in their instructors, turningto them for truth, and taking what they may chooseto give them; babes in knowledge, not yet able totell the breast from the bottle, pumping away for themilk of truth at all that offers, were it nothingbetter than a Professor’s shrivelled forefinger.
In the earliest and embryonic stage of professionaldevelopment, any violent impression on the instructor’smind is apt to be followed by some lasting effecton that of the pupil. No mother’s mark ismore permanent than the mental naevi and moles, andexcrescences, and mutilations, that students carrywith them out of the lecture-room, if once the teemingintellect which nourishes theirs has been scared fromits propriety by any misshapen fantasy. Evenan impatient or petulant expression, which to a philosopherwould be a mere index of the low state of amiabilityof the speaker at the moment of its utterance, maypass into the young mind as an element of its futureconstitution, to injure its temper or corrupt itsjudgment. It is a duty, therefore, which we oweto this younger class of students, to clear any importanttruth which may have been rendered questionable intheir minds by such language, or any truth-telleragainst whom they may have been prejudiced by hastyepithets, from the impressions such words have left.Until this is done, they are not ready for the question,where there is a question, for them to decide.Even if we ourselves are the subjects of the prejudice,there seems to be no impropriety in showing that thisprejudice is local or personal, and not an acknowledgedconviction with the public at large. It may benecessary to break through our usual habits of reserveto do this, but this is the fault of the positionin which others have placed us.
Two widely-known and highly-esteemed practitioners,Professors in two of the largest Medical Schools ofthe Union, teaching the branch of art which includesthe Diseases of Women, and therefore speaking withauthority; addressing in their lectures and printedpublications large numbers of young men, many of themin the tenderest immaturity of knowledge, have recentlytaken ground in a formal way against the doctrinemaintained in this paper:
On the Non-Contagious Character of Puerperal Fever:An Introductory Lecture. By Hugh L. Hodge, M.D., Professor of Obstetrics in the University of Pennsylvania.Delivered Monday, October 11, 1852. Philadelphia,1852.
On the Nature, Signs, and Treatment of Childbed Fevers:in a Series of Letters addressed to the Students ofhis Class. By Charles D. Meigs, M. D., Professorof Midwifery and the Diseases of Women and Childrenin Jefferson Medical College, Philadelphia, etc.,etc. Philadelphia, 1854. Letter vi.
The first of the two publications, Dr. Hodge’sLecture, while its theoretical considerations andnegative experiences do not seem to me to requireany further notice than such as lay ready for themin my Essay written long before, is, I am pleasedto say, unobjectionable in tone and language, andmay be read without offence.
This can hardly be said of the chapter of Dr. Meigs’svolume which treats of Contagion in Childbed Fever.There are expressions used in it which might wellput a stop to all scientific discussions, were theyto form the current coin in our exchange of opinions.I leave the “very young gentlemen,” whosecareful expositions of the results of practice in morethan six thousand cases are characterized as “thejejune and fizenless dreamings of sophom*ore writers,”to the sympathies of those “dear young friends,”and “dear young gentlemen,” who will judgehow much to value their instructor’s counselto think for themselves, knowing what they are toexpect if they happen not to think as he does.
One unpalatable expression I suppose the laws of constructionoblige me to appropriate to myself, as my reward fora certain amount of labor bestowed on the investigationof a very important question of evidence, and a statementof my own practical conclusions. I take no offence,and attempt no retort. No man makes a quarrelwith me over the counterpane that covers a mother,with her new-born infant at her breast. Thereis no epithet in the vocabulary of slight and sarcasmthat can reach my personal sensibilities in such acontroversy. Only just so far as a disrespectfulphrase may turn the student aside from the examinationof the evidence, by discrediting or dishonoring thewitness, does it call for any word of notice.
I appeal from the disparaging language by which theProfessor in the Jefferson School of Philadelphiaworld dispose of my claims to be listened to.I appeal, not to the vote of the Society for MedicalImprovement, although this was an unusual evidenceof interest in the paper in question, for it was avote passed among my own townsmen; nor to the opinionof any American, for none know better than the Professorsin the great Schools of Philadelphia how cheaply thepraise of native contemporary criticism is obtained.I appeal to the recorded opinions of those whom Ido not know, and who do not know me, nor care for me,except for the truth that I may have uttered; to Copland,in his “Medical Dictionary,” who has spokenof my Essay in phrases to which the pamphlets of American“scribblers” are seldom used from Europeanauthorities; to Ramsbotham, whose compendious eulogyis all that self-love could ask; to the “FifthAnnual Report” of the Registrar-General of England,in which the second-hand abstract of my Essay figureslargely, and not without favorable comment, in animportant appended paper. These testimonies,half forgotten until this circ*mstance recalled them,are dragged into the light, not in a paroxysm of vanity,but to show that there may be food for thought inthe small pamphlet which the Philadelphia Teachertreats so lightly. They were at least unsoughtfor, and would never have been proclaimed but forthe sake of securing the privilege of a decent andunprejudiced hearing.
I will take it for granted that they have so far counterpoisedthe depreciating language of my fellow-countrymanand fellow-teacher as to gain me a reader here andthere among the youthful class of students I am nowaddressing. It is only for their sake that I thinkit necessary to analyze, or explain, or illustrate,or corroborate any portion of the following Essay.But I know that nothing can be made too plain forbeginners; and as I do not expect the practitioner,or even the more mature student, to take the troubleto follow me through an Introduction which I considerwholly unnecessary and superfluous for them, I shallnot hesitate to stoop to the most elementary simplicityfor the benefit of the younger student. I dothis more willingly because it affords a good opportunity,as it seems to me, of exercising the untrained mindin that medical logic which does not seem to havebeen either taught or practised in our schools oflate, to the extent that might be desired.
I will now exhibit, in a series of propositions reducedto their simplest expression, the same essential statementsand conclusions as are contained in the Essay, withsuch commentaries and explanations as may be profitableto the inexperienced class of readers addressed.
I. It has been long believed, by many competent observers,that Puerperal Fever (so called) is sometimes carriedfrom patient to patient by medical assistants.
II. The express object of this Essay is to provethat it is so carried.
III. In order to prove this point, it is notnecessary to consult any medical theorist as to whetheror not it is consistent with his preconceived notionsthat such a mode of transfer should exist.
IV. If the medical theorist insists on beingconsulted, and we see fit to indulge him, he cannotbe allowed to assume that the alleged laws of contagion,deduced from observation in other diseases, shall becited to disprove the alleged laws deduced from observationin this. Science would never make progress undersuch conditions. Neither the long incubationof hydrophobia, nor the protecting power of vaccination,would ever have been admitted, if the results of observationin these affections had been rejected as contradictoryto the previously ascertained laws of contagion.
V. The disease in question is not a common one; producing,on the average, about three deaths in a thousand births,according to the English Registration returns whichI have examined.
VI. When an unusually large number of cases ofthis disease occur about the same time, it is inferred,therefore, that there exists some special cause forthis increased frequency. If the disease prevailsextensively over a wide region of country, it is attributedwithout dispute to an epidemic influence. Ifit prevails in a single locality, as in a hospital,and not elsewhere, this is considered proof that somelocal cause is there active in its production.
VII. When a large number of cases of this diseaseoccur in rapid succession, in one individual’sordinary practice, and few or none elsewhere, thesecases appearing in scattered localities, in patientsof the same average condition as those who escapeunder the care of others, there is the same reasonfor connecting the cause of the disease with the personin this instance, as with the place in that last mentioned.
VIII. Many series of cases, answering to theseconditions, are given in this Essay, and many otherswill be referred to which have occurred since it waswritten.
IX. The alleged results of observation may beset aside; first, because the so-called facts arein their own nature equivocal; secondly, because theystand on insufficient authority; thirdly, because theyare not sufficiently numerous. But, in this case,the disease is one of striking and well-marked character;the witnesses are experts, interested in denying anddisbelieving the facts; the number of consecutive casesin many instances frightful, and the number of seriesof cases such that I have no room for many of themexcept by mere reference.
X. These results of observation, being admitted, may,we will suppose, be interpreted in different methods.Thus the coincidences may be considered the effectof chance. I have had the chances calculated bya competent person, that a given practitioner, A.,shall have sixteen fatal cases in a month, on thefollowing data: A. to average attendance upontwo hundred and fifty births in a year; three deathsin one thousand births to be assumed as the averagefrom puerperal fever; no epidemic to be at the timeprevailing. It follows, from the answer givenme, that if we suppose every one of the five hundredthousand annual births of England to have been recordedduring the last half-century, there would not be onechance in a million million million millions that onesuch series should be noted. No possible fractionalerror in this calculation can render the chance aworking probability. Applied to dozens of seriesof various lengths, it is obviously an absurdity.Chance, therefore, is out of the question as an explanationof the admitted coincidences.
XI. There is, therefore, some relation of causeand effect between the physician’s presenceand the patient’s disease.
XII. Until it is proved to what removable conditionattaching to the attendant the disease is owing, heis bound to stay away from his patients so soon ashe finds himself singled out to be tracked by thedisease. How long, and with what other precautions,I have suggested, without dictating, at the closeof my Essay. If the physician does not at onceact on any reasonable suspicion of his being the mediumof transfer, the families where he is engaged, ifthey are allowed to know the facts, should declinehis services for the time. His feelings on theoccasion, however interesting to himself, should notbe even named in this connection. A physicianwho talks about ceremony and gratitude, and servicesrendered, and the treatment he got, surely forgetshimself; it is impossible that he should seriouslythink of these small matters where there is even aquestion whether he may not carry disease, and death,and bereavement into any one of “his families,”as they are sometimes called.
I will now point out to the young student the modein which he may relieve his mind of any confusion,or possibly, if very young, any doubt, which the perusalof Dr. Meigs’s Sixth Letter may have raised inhis mind.
The most prominent ideas of the Letter are, first,that the transmissible nature of puerperal fever appearsimprobable, and, secondly, that it would be very inconvenientto the writer. Dr. Woodville, Physician to theSmall-Pox and Inoculation Hospital in London, foundit improbable, and exceedingly inconvenient to himself,that cow pox should prevent small-pox; but Dr. Jennertook the liberty to prove the fact, notwithstanding.
I will first call the young student’s attentionto the show of negative facts (exposure without subsequentdisease), of which much seems to be thought.And I may at the same time refer him to Dr. Hodge’sLecture, where he will find the same kind of factsand reasoning. Let him now take up Watson’sLectures, the good sense and spirit of which have madehis book a universal favorite, and open to the chapteron Continued Fever. He will find a paragraphcontaining the following sentence: “A manmight say, ’I was in the battle of Waterloo,and saw many men around me fall down and die, andit was said that they were struck down by musket-balls;but I know better than that, for I was there all thetime, and so were many of my friends, and we werenever hit by any musket-balls. Musket-balls,therefore, could not have been the cause of the deathswe witnessed.’ And if, like contagion, theywere not palpable to the senses, such a person mightgo on to affirm that no proof existed of there beingany such thing as musket-balls.” Now letthe student turn back to the chapter on Hydrophobiain the same volume. He will find that John Hunterknew a case in which, of twenty-one persons bitten,only one died of the disease. He will find thatone dog at Charenton was bitten at different timesby thirty different mad dogs, and outlived it all.Is there no such thing, then, as hydrophobia?Would one take no especial precautions if his wife,about to become a mother, had been bitten by a rabidanimal, because so many escape? Or let him lookat “Underwood on Diseases of Children,”[Philadelphia, 1842, p. 244, note.] and he will findthe case of a young woman who was inoculated eighttimes in thirty days, at the same time attending severalchildren with smallpox, and yet was not infected.But seven weeks afterwards she took the disease anddied.
It would seem as if the force of this argument couldhardly fail to be seen, if it were granted that everyone of these series of cases were so reported as toprove that there could have been no transfer of disease.There is not one of them so reported, in the Lectureor the Letter, as to prove that the disease may nothave been carried by the practitioner. I stronglysuspect that it was so carried in some of these cases,but from the character of the very imperfect evidencethe question can never be settled without furtherdisclosures.
Although the Letter is, as I have implied, principallytaken up with secondary and collateral questions,and might therefore be set aside as in the main irrelevant,I am willing, for the student’s sake, to touchsome of these questions briefly, as an illustrationof its logical character.
The first thing to be done, as I thought when I wrotemy Essay, was to throw out all discussions of theword contagion, and this I did effectually by thecareful wording of my statement of the subject to bediscussed. My object was not to settle the etymologyor definition of a word, but to show that women hadoften died in childbed, poisoned in some way by theirmedical attendants. On the other point, I, atleast, have no controversy with anybody, and I thinkthe student will do well to avoid it in this connection.If I must define my position, however, as well asthe term in question, I am contented with Worcester’sdefinition; provided always this avowal do not openanother side controversy on the merits of his Dictionary,which Dr. Meigs has not cited, as compared with Webster’s,which he has.
I cannot see the propriety of insisting that all thelaws of the eruptive fevers must necessarily holdtrue of this peculiar disease of puerperal women.If there were any such propriety, the laws of the eruptivefevers must at least be stated correctly. Itis not true, for instance, as Dr. Meigs states, thatcontagion is “no respecter of persons;”that “it attacks all individuals alike.”To give one example: Dr. Gregory, of the Small-PoxHospital, who ought to know, says that persons passthrough life apparently insensible to or unsusceptibleof the small-pox virus, and that the same personsdo not take the vaccine disease.
As to the short time of incubation, of which so muchis made, we have no right to decide beforehand whetherit shall be long or short, in the cases we are considering.A dissection wound may produce symptoms of poisoningin six hours; the bite of a rabid animal may take asmany months.
After the student has read the case in Dr. Meigs’s136th paragraph, and the following one, in which heexclaims against the idea of contagion, because thepatient, delivered on the 26th of December, was attackedin twenty-four hours, and died on the third day, lethim read what happened at the “Black Assizes”of 1577 and 1750. In the first case, six hundredpersons sickened the same night of the exposure, andthree hundred more in three days. [Elliotson’sPractice, p. 298.] Of those attacked in the latteryear, the exposure being on the 11th of May, AldermanLambert died on the 13th, Under-Sheriff Cox on the14th, and many of note before the 20th. But theseare old stories. Let the student listen then toDr. Gerhard, whose reputation as a cautious observerhe may be supposed to know. “The nursewas shaving a man, who died in a few hours after hisentrance; he inhaled his breath, which had a nauseoustaste, and in an hour afterwards was taken with nausea,
cephalalgia, and singing of the ears. From thatmoment the attack began, and assumed a severe character.The assistant was supporting another patient, who diedsoon afterwards; he felt the pungent heat upon hisskin, and was taken immediately with the symptomsof typhus.” [Am. Jour. Med. Sciences,Feb. 1837, p. 299.] It is by notes of cases, ratherthan notes of admiration, that we must be guided,when we study the Revised Statutes of Nature, as laiddown from the curule chairs of Medicine.Let the student read Dr. Meigs’s 140th paragraphsoberly, and then remember, that not only does heinfer, suspect, and surmise, but he actually asserts(page 154), “there was poison in the house,”because three out of five patients admitted into award had puerperal fever and died. Have I notas much right to draw a positive inference from “Dr.A.’s” seventy exclusive cases as he fromthe three cases in the ward of the Dublin Hospital?All practical medicine, and all action in common affairs,is founded on inferences. How does Dr. Meigs knowthat the patients he bled in puerperal fever wouldnot have all got well if he had not bled them?
“You see a man discharge a gun at another; yousee the flash, you hear the report, you see the personfall a lifeless corpse; and you infer, from all thesecirc*mstances, that there was a ball discharged fromthe gun, which entered his body and caused his death,because such is the usual and natural cause of suchan effect. But you did not see the ball leavethe gun, pass through the air, and enter the body ofthe slain; and your testimony to the fact of killingis, therefore, only inferential,—in otherwords, circ*mstantial. It is possible that noball was in the gun; and we infer that there was, onlybecause we cannot account for death on any other supposition.”[Chief Justice Gibson, in Am. Law Journal, vol.vi. p. 123.]
“The question always comes to this: Isthe circ*mstance of intercourse with the sick followedby the appearance of the disease in a proportion ofcases so much greater than any other circ*mstance commonto any portion of the inhabitants of the place underobservation, as to make it inconceivable that thesuccession of cases occurring in persons having thatintercourse should have been the result of chance?If so, the inference is unavoidable, that that intercoursemust have acted as a cause of the disease. Allobservations which do not bear strictly on that pointare irrelevant, and, in the case of an epidemic firstappearing in a town or district, a succession of twocases is sometimes sufficient to furnish evidencewhich, on the principle I have stated, is nearly irresistible.”
Possibly an inexperienced youth may be awe-struckby the quotation from Cuvier. These words, ortheir equivalent, are certainly to be found in hisIntroduction. So are the words “top notcome down”! to be found in the Bible, and theywere as much meant for the ladies’ head-dressesas the words of Cuvier were meant to make clinicalobservation wait for a permit from anybody to lookwith its eyes and count on its fingers. Let theinquiring youth read the whole Introduction, and hewill see what they mean.
I intend no breach of courtesy, but this is a properplace to warn the student against skimming the prefacesand introductions of works for mottoes and embellishmentsto his thesis. He cannot learn anatomy by thrustingan exploring needle into the body. He will bevery liable to misquote his author’s meaningwhile he is picking off his outside sentences.He may make as great a blunder as that simple princewho praised the conductor of his orchestra for thepiece just before the overture; the musician was toogood a courtier to tell him that it was only the tuningof the instruments.
To the six propositions in the 142d paragraph, andthe remarks about “specific” diseases,the answer, if any is necessary, seems very simple.An inflammation of a serous membrane may give riseto secretions which act as a poison, whether thatbe a “specific” poison or not, as Dr. Homerhas told his young readers, and as dissectors knowtoo well; and that poison may produce its symptomsin a few hours after the system has received it, asany may see in Druitt’s “Surgery,”if they care to look. Puerperal peritonitis mayproduce such a poison, and puerperal women may bevery sensible to its influences, conveyed by contactor exhalation. Whether this is so or not, factsalone can determine, and to facts we have had recourseto settle it.
The following statement is made by Dr. Meigs in his142d paragraph, and developed more at length, withrhetorical amplifications, in the 134th. “Nohuman being, save a pregnant or parturient woman, issusceptible to the poison.” This statementis wholly incorrect, as I am sorry to have to pointout to a Teacher in Dr. Meigs’s position.I do not object to the erudition which quotes Willisand Fernelius, the last of whom was pleasantly saidto have “preserved the dregs of the Arabs inthe honey of his Latinity.” But I couldwish that more modern authorities had not been overlooked.On this point, for instance, among the numerous factsdisproving the statement, the “American Journalof Medical Sciences,” published not far fromhis lecture-room, would have presented him with arespectable catalog of such cases. Thus he mightrefer to Mr. Storrs’s paper “On the ContagiousEffects of Puerperal Fever on the Male Subject; oron Persons not Childbearing” (Jan. 1846), orto Dr. Reid’s case (April, 1846), or to Dr.Barron’s statement of the children’s dyingof peritonitis in an epidemic of puerperal fever atthe Philadelphia Hospital (Oct. 1842), or to variousinstances cited in Dr. Kneeland’s article (April,186). Or, if he would have referred to the “NewYork Journal,” he might have seen Prof.Austin Flint’s cases. Or, if he had honoredmy Essay so far, he might have found striking instancesof the same kind in the first of the new series ofcases there reported and elsewhere. I do notsee the bearing of his proposition, if it were true.But it is one of those assertions that fall in a momentbefore a slight examination of the facts; and I confessmy surprise, that a professor who lectures on theDiseases of Women should have ventured to make it.
Nearly seven pages are devoted to showing that I waswrong in saying I would not be “understood toimply that there exists a doubt in the mind of anywell-informed member of the medical profession as tothe fact that puerperal fever is sometimes communicatedfrom one person to another, both directly and indirectly.”I will devote seven lines to these seven pages, whichseven lines, if I may say it without offence, are,as it seems to me, six more than are strictly necessary.
The following authors are cited as sceptics by Dr.Meigs: Dewees.—I cited the same passage.Did not know half the facts. Robert Lee.—Believesthe disease is sometimes communicable by contagion.Tonnelle, Baudelocque. Both cited by me.Jacquemier.—Published three years aftermy Essay. Kiwisch. " Behindhand in knowledge ofPuerperal Fever.” [B. & F. Med. Rev. Jan.1842.] Paul Dubois.—Scanzoni.
These Continental writers not well informed on thispoint.[See Dr. Simpson’s Remarks at Meetingof Edin. Med. Chir. Soc. (Am. Jour.Oct. 1851.)]
The story of Von Busch is of interest and value, butthere is nothing in it which need perplex the student.It is not pretended that the disease is always, oreven, it may be, in the majority of cases, carriedabout by attendants; only that it is so carried incertain cases. That it may have local and epidemiccauses, as well as that depending on personal transmission,is not disputed. Remember how small-pox oftendisappears from a community in spite of its contagiouscharacter, and the necessary exposure of many personsto those suffering from it; in both diseases contagionis only one of the coefficients of the disease.
I have already spoken of the possibility that Dr.Meigs may have been the medium of transfer of puerperalfever in some of the cases he has briefly catalogued.Of Dr. Rutter’s cases I do not know how to speak.I only ask the student to read the facts stated byDr. Condie, as given in my Essay, and say whetheror not a man should allow his wife to be attendedby a practitioner in whose hands “scarcely afemale that has been delivered for weeks past hasescaped an attack,” “while no instanceof the disease has occurred in the patients of anyother accoucheur practising in the same district.”If I understand Dr. Meigs and Dr. Hodge, they wouldnot warn the physician or spare the patient under suchcirc*mstances. They would “go on,”if I understand them, not to seven, or seventy, only,but to seventy times seven, if they could find patients.If this is not what they mean, may we respectfullyask them to state what they do mean, to their nextclasses, in the name of humanity, if not of science!
I might repeat the question asked concerning Dr. Rutter’scases, with reference to those reported by Dr. Roberton.Perhaps, however, the student would like to know theopinion of a person in the habit of working at mattersof this kind in a practical point of view. Tosatisfy him on this ground, I addressed the followingquestion to the President of one of our principalInsurance Companies, leaving Dr. Meigs’s bookand my Essay in his hands at the same time.
Question. “If such facts as Roberton’scases were before you, and the attendant had had ten,or even five fatal cases, or three, or two even, wouldyou, or would you not, if insuring the life of thenext patient to be taken care of by that attendant,expect an extra premium over that of an average caseof childbirth?”
Answer. “Of course I should require a verylarge extra premium, if I would take take risk atall.”
But I do not choose to add the expressions of indignationwhich the examination of the facts before him calledout. I was satisfied from the effect they producedon him, that if all the hideous catalogues of casesnow accumulated were fully brought to the knowledgeof the public, nothing, since the days of Burke andHare, has raised such a cry of horror as would beshrieked in the ears of the Profession.
Dr. Meigs has elsewhere invoked “Providence”as the alternative of accident, to account for the“coincidences.” ("Obstetrics,” Phil.1852, p. 631.) If so, Providence either acts throughthe agency of secondary causes, as in other diseases,or not. If through such causes, let us find outwhat they are, as we try to do in other cases.It may be true that offences, or diseases, will come,but “woe unto him through whom they come,”if we catch him in the voluntary or careless act ofbringing them! But if Providence does not actthrough secondary causes in this particular sphereof etiology, then why does Dr. Meigs take such painsto reason so extensively about the laws of contagion,which, on that supposition, have no more to do withthis case than with the plague which destroyed thepeople after David had numbered them? Above all,what becomes of the theological aspect of the question,when he asserts that a practitioner was “onlyunlucky in meeting with the epidemic cases?”(Op. cit. p. 633.) We do not deny that the God ofbattles decides the fate of nations; but we like tohave the biggest squadrons on our side, and we areparticular that our soldiers should not only say theirprayers, but also keep their powder dry. We donot deny the agency of Providence in the disasterat Norwalk, but we turn off the engineer, and chargethe Company five thousand dollars apiece for everylife that is sacrificed.
Why a grand jury should not bring in a bill againsta physician who switches off a score of women oneafter the other along his private track, when he knowsthat there is a black gulf at the end of it, downwhich they are to plunge, while the great highway isclear, is more than I can answer. It is not bylaying the open draw to Providence that he is to escapethe charge of manslaughter.
To finish with all these lesser matters of question,I am unable to see why a female must necessarily beunattended in her confinement, because she declinesthe services of a particular practitioner. Inall the series of cases mentioned, the death-carryingattendant was surrounded by others not tracked bydisease and its consequences. Which, I would ask,is worse,—to call in another, even a rivalpractitioner, or to submit an unsuspecting femaleto a risk which an Insurance Company would have nothingto do with?
I do not expect ever to return to this subject.There is a point of mental saturation, beyond whichargument cannot be forced without breeding impatient,if not harsh, feelings towards those who refuse tobe convinced. If I have so far manifested neither,it is well to stop here, and leave the rest to thoseyounger friends who may have more stomach for thedregs of a stale argument.
The extent of my prefatory remarks may lead some tothink that I attach too much importance to my ownEssay. Others may wonder that I should expendso many words upon the two productions referred to,the Letter and the Lecture. I do consider myEssay of much importance so long as the doctrine itmaintains is treated as a question, and so long asany important part of the defence of that doctrineis thought to rest on its evidence or arguments.I cannot treat as insignificant any opinions bearingon life, and interests dearer than life, proclaimedyearly to hundreds of young men, who will carry themto their legitimate results in practice.
The teachings of the two Professors in the great schoolsof Philadelphia are sure to be listened to, not onlyby their immediate pupils, but by the Profession atlarge. I am too much in earnest for either humilityor vanity, but I do entreat those who hold the keysof life and death to listen to me also for this once.I ask no personal favor; but I beg to be heard inbehalf of the women whose lives are at stake, untilsome stronger voice shall plead for them.
I trust that I have made the issue perfectly distinctand intelligible. And let it be remembered thatthis is no subject to be smoothed over by nicely adjustedphrases of half-assent and half-censure divided betweenthe parties. The balance must be struck boldlyand the result declared plainly. If I have beenhasty, presumptuous, ill-informed, illogical; if myarray of facts means nothing; if there is no reasonfor any caution in the view of these facts; let mebe told so on such authority that I must believe it,and I will be silent henceforth, recognizing that mymind is in a state of disorganization. If thedoctrine I have maintained is a mournful truth; ifto disbelieve it, and to practise on this disbelief,and to teach others so to disbelieve and practise,is to carry desolation, and to charter others to carryit, into confiding families, let it be proclaimedas plainly what is to be thought of the teachings ofthose who sneer at the alleged dangers, and scout thevery idea of precaution. Let it be rememberedthat persons are nothing in this matter; better thattwenty pamphleteers should be silenced, or as manyprofessors unseated, than that one mother’s lifeshould be taken. There is no quarrel here betweenmen, but there is deadly incompatibility and exterminatingwarfare between doctrines. Coincidences meaningnothing, though a man have a monopoly of the diseasefor weeks or months; or cause and effect, the causebeing in some way connected with the person; this
is the question. If I am wrong, let me be putdown by such a rebuke as no rash declaimer has receivedsince there has been a public opinion in the medicalprofession of America; if I am right, let doctrineswhich lead to professional homicide be no longer taughtfrom the chairs of those two great Institutions.Indifference will not do here; our Journalists andCommittees have no right to take up their pages withminute anatomy and tediously detailed cases, whileit is a question whether or not the “blackdeath”of child-bed is to be scattered broadcast by the agencyof the mother’s friend and adviser. Letthe men who mould opinions look to it; if there isany voluntary blindness, any interested oversight,any culpable negligence, even, in such a matter, andthe facts shall reach the public ear; the pestilence-carrierof the lying-in chamber must look to God for pardon,for man will never forgive him.Thecontagiousness of puerperal fever.
In collecting, enforcing, and adding to the evidenceaccumulated upon this most serious subject, I wouldnot be understood to imply that there exists a doubtin the mind of any well-informed member of the medicalprofession as to the fact that puerperal fever is sometimescommunicated from one person to another, both directlyand indirectly. In the present state of our knowledgeupon this point I should consider such doubts merelyas a proof that the sceptic had either not examinedthe evidence, or, having examined it, refused to acceptit* plain and unavoidable consequences. I shouldbe sorry to think, with Dr. Rigby, that it was a caseof “oblique vision;” I should be unwillingto force home the argumentum ad hominem of Dr. Blundell,but I would not consent to make a question of a momentousfact which is no longer to be considered as a subjectfor trivial discussions, but to be acted upon withsilent promptitude. It signifies nothing thatwise and experienced practitioners have sometimesdoubted the reality of the danger in question; noman has the right to doubt it any longer. No negativefacts, no opposing opinions, be they what they may,or whose they may, can form any answer to the seriesof cases now within the reach of all who choose toexplore the records of medical science.
If there are some who conceive that any importantend would be answered by recording such opinions,or by collecting the history of all the cases theycould find in which no evidence of the influence ofcontagion existed, I believe they are in error.Suppose a few writers of authority can be found toprofess a disbelief in contagion,—and theyare very few compared with those who think differently,—isit quite clear that they formed their opinions ona view of all the facts, or is it not apparent thatthey relied mostly on their own solitary experience?Still further, of those whose names are quoted, isit not true that scarcely a single one could by any
possibility have known the half or the tenth of thefacts bearing on the subject which have reached sucha frightful amount within the last few years?Again, as to the utility of negative facts, as wemay briefly call them,—instances, namely,in which exposure has not been followed by disease,—although,like other truths, they may be worth knowing, I donot see that they are like to shed any important lightupon the subject before us. Every such instancerequires a good deal of circ*mstantial explanationbefore it can be accepted. It is not enough thata practitioner should have had a single case of puerperalfever not followed by others. It must be knownwhether he attended others while this case was inprogress, whether he went directly from one chamberto others, whether he took any, and what precautions.It is important to know that several women were exposedto infection derived from the patient, so that allowancemay be made for want of predisposition. Now ifof negative facts so sifted there could be accumulateda hundred for every one plain instance of communicationhere recorded, I trust it need not be said that weare bound to guard and watch over the hundredth tenantof our fold, though the ninety and nine may be sureof escaping the wolf at its entrance. If any oneis disposed, then, to take a hundred instances oflives endangered or sacrificed out of those I havementioned, and make it reasonably clear that withina similar time and compass ten thousand escaped thesame exposure, I shall thank him for his industry,but I must be permitted to hold to my own practicalconclusions, and beg him to adopt or at least to examinethem also. Children that walk in calico beforeopen fires are not always burned to death; the instancesto the contrary may be worth recording; but by nomeans if they are to be used as arguments againstwoollen frocks and high fenders.I am not sure that this paper will escape anotherremark which it might be wished were founded in justice.It may be said that the facts are too generally knownand acknowledged to require any formal argument orexposition, that there is nothing new in the positionsadvanced, and no need of laying additional statementsbefore the Profession. But on turning to twoworks, one almost universally, and the other extensivelyappealed to as authority in this country, I see amplereason to overlook this objection. In the lastedition of Dewees’s Treatise on the “Diseasesof Females,” it is expressly said, “Inthis country, under no circ*mstance that puerperalfever has appeared hitherto, does it afford the slightestground for the belief that it is contagious.”In the “Philadelphia Practice of Midwifery”not one word can be found in the chapter devoted tothis disease which would lead the reader to suspectthat the idea of contagion had ever been entertained.It seems proper, therefore, to remind those who arein the habit of referring to these works for guidance,that there may possibly be some sources of dangerthey have slighted or omitted, quite as important asa trifling irregularity of diet, or a confined stateof the bowels, and that whatever confidence a physicianmay have in his own mode of treatment, his servicesare of questionable value whenever he carries the baneas well as the antidote about his person.
The practical point to be illustrated is the following:
The disease known as Puerperal Fever is so far contagiousas to be frequently carried from patient to patientby physicians and nurses.
Let me begin by throwing out certain incidental questions,which, without being absolutely essential, would renderthe subject more complicated, and by making such concessionsand assumptions as may be fairly supposed to be withoutthe pale of discussion.
1. It is granted that all the forms of what iscalled puerperal fever may not be, and probably arenot, equally contagious or infectious. I do notenter into the distinctions which have been drawn byauthors, because the facts do not appear to me sufficientto establish any absolute line of demarcation betweensuch forms as may be propagated by contagion and thosewhich are never so propagated. This general resultI shall only support by the authority of Dr. Ramsbotham,who gives, as the result of his experience, that thesame symptoms belong to what he calls the infectiousand the sporadic forms of the disease, and the opinionof Armstrong in his original Essay. If otherscan show any such distinction, I leave it to themto do it. But there are cases enough that showthe prevalence of the disease among the patients ofa single practitioner when it was in no degree epidemic,in the proper sense of the term. I may referto those of Mr. Roberton and of Dr. Peirson, hereafterto be cited, as examples.
2. I shall not enter into any dispute about theparticular mode of infection, whether it be by theatmosphere the physician carries about him into thesick-chamber, or by the direct application of the virusto the absorbing surfaces with which his hand comesin contact. Many facts and opinions are in favorof each of these modes of transmission. But itis obvious that in the majority of cases it must beimpossible to decide by which of these channels thedisease is conveyed, from the nature of the intercoursebetween the physician and the patient.
3. It is not pretended that the contagion ofpuerperal fever must always be followed by the disease.It is true of all contagious diseases, that they frequentlyspare those who appear to be fully submitted to theirinfluence. Even the vaccine virus, fresh fromthe subject, fails every day to produce its legitimateeffect, though every precaution is taken to insureits action. This is still more remarkably thecase with scarlet fever and some other diseases.
4. It is granted that the disease may be producedand variously modified by many causes besides contagion,and more especially by epidemic and endemic influences.But this is not peculiar to the disease in question.There is no doubt that small-pox is propagated to agreat extent by contagion, yet it goes through thesame periods of periodical increase and diminutionwhich have been remarked in puerperal fever. Ifthe question is asked how we are to reconcile the
great variations in the mortality of puerperal feverin different seasons and places with the suppositionof contagion, I will answer it by another questionfrom Mr. Farr’s letter to the Registrar-General.He makes the statement that “five die weeklyof small-pox in the metropolis when the disease isnot epidemic,”—and adds, “Theproblem for solution is,—Why do the fivedeaths become 10, 15, 20, 31, 58, 88, weekly, and thenprogressively fall through the same measured steps?”5. I take it for granted, that if it can be shownthat great numbers of lives have been and are sacrificedto ignorance or blindness on this point, no othererror of which physicians or nurses may be occasionallysuspected will be alleged in palliation of this; butthat whenever and wherever they can be shown to carrydisease and death instead of health and safety, thecommon instincts of humanity will silence every attemptto explain away their responsibility.
The treatise of Dr. Gordon of Aberdeen was publishedin the year 1795, being among the earlier specialworks upon the disease. Apart of his testimonyhas been occasionally copied into other works, buthis expressions are so clear, his experience is givenwith such manly distinctness and disinterested honesty,that it may be quoted as a model which might havebeen often followed with advantage.
“This disease seized such women only as werevisited, or delivered by a practitioner, or takencare of by a nurse, who had previously attended patientsaffected with the disease.”
“I had evident proofs of its infectious nature,and that the infection was as readily communicatedas that of the small-pox or measles, and operatedmore speedily than any other infection with which Iam acquainted.”
“I had evident proofs that every person whohad been with a patient in the puerperal fever becamecharged with an atmosphere of infection, which wascommunicated to every pregnant woman who happened tocome within its sphere. This is not an assertion,but a fact, admitting of demonstration, as may beseen by a perusal of the foregoing table,”—referringto a table of seventy-seven cases, in many of whichthe channel of propagation was evident.
He adds, “It is a disagreeable declaration forme to mention, that I myself was the means of carryingthe infection to a great number of women.”He then enumerates a number of instances in which thedisease was conveyed by midwives and others to theneighboring villages, and declares that “thesefacts fully prove that the cause of the puerperalfever, of which I treat, was a specific contagion,or infection, altogether unconnected with a noxiousconstitution of the atmosphere.”
But his most terrible evidence is given in these words:“I arrived at
that certainty in the matter,that I could venture to foretellwhat women
would be affected with thedisease, upon hearing by whatmidwife they
were to be delivered, orby what nurse they were tobe attended, during
their lying-in: And almostin every instance, my predictionwas
verified.”
Even previously to Gordon, Mr. White of Manchesterhad said, “I am acquainted with two gentlemenin another town, where the whole business of midwiferyis divided betwixt them, and it is very remarkablethat one of them loses several patients every yearof the puerperal fever, and the other never so muchas meets with the disorder,”—a differencewhich he seems to attribute to their various modesof treatment. [On the Management of Lying-in Women,p. 120.]
Dr. Armstrong has given a number of instances in hisEssay on Puerperal Fever, of the prevalence of thedisease among the patients of a single practitioner.At Sunderland, “in all, forty-three cases occurredfrom the 1st of January to the 1st of October, whenthe disease ceased; and of this number forty werewitnessed by Mr. Gregson and his assistant, Mr. Gregory,the remainder having been separately seen by threeaccoucheurs.” There is appended to theLondon edition of this Essay, a letter from Mr. Gregson,in which that gentleman says, in reference to the greatnumber of cases occurring in his practice, “Thecause of this I cannot pretend fully to explain, butI should be wanting in common liberality if I wereto make any hesitation in asserting, that the diseasewhich appeared in my practice was highly contagious,and communicable from one puerperal woman to another.”“It is customary among the lower and middle ranksof people to make frequent personal visits to puerperalwomen resident in the same neighborhood, and I haveample evidence for affirming that the infection ofthe disease was often carried about in that manner;and, however painful to my feelings, I must in candordeclare, that it is very probable the contagion wasconveyed, in some instances, by myself, though I tookevery possible care to prevent such a thing from happening,the moment that I ascertained that the distemper wasinfectious.” Dr. Armstrong goes on to mentionsix other instances within his knowledge, in whichthe disease had at different times and places beenlimited, in the same singular manner, to the practiceof individuals, while it existed scarcely if at allamong the patients of others around them. Twoof the gentlemen became so convinced of their conveyingthe contagion, that they withdrew for a time frompractice.
I find a brief notice, in an American Journal, ofanother series of cases, first mentioned by Mr. Davies,in the “Medical Repository.” Thisgentleman stated his conviction that the disease iscontagious.
“In the autumn of 1822 he met with twelve cases,while his medical friends in the neighborhood didnot meet with any, ’or at least very few.’He could attribute this circ*mstance to no other causethan his having been present at the examination, afterdeath, of two cases, some time previous, and of hishaving imparted the disease to his patients, notwithstandingevery precaution.”
Dr. Gooch says, “It is not uncommon for thegreater number of cases to occur in the practice ofone man, whilst the other practitioners of the neighborhood,who are not more skilful or more busy, meet with fewor none. A practitioner opened the body of awoman who had died of puerperal fever, and continuedto wear the same clothes. A lady whom he delivereda few days afterwards was attacked with and died ofa similar disease; two more of his lying-in patients,in rapid succession, met with the same fate; struckby the thought, that he might have carried contagionin his clothes, he instantly changed them, and ’metwith no more cases of the kind.’ A womanin the country, who was employed as washerwoman andnurse, washed the linen of one who had died of puerperalfever; the next lying-in patient she nursed died ofthe same disease; a third nursed by her met with thesame fate, till the neighborhood, getting afraid ofher, ceased to employ her.”
In the winter of the year 1824, “Several instancesoccurred of its prevalence among the patients of particularpractitioners, whilst others who were equally busymet with few or none. One instance of this kindwas very remarkable. A general practitioner, inlarge midwifery practice, lost so many patients frompuerperal fever, that he determined to deliver nomore for some time, but that his partner should attendin his place. This plan was pursued for one month,during which not a case of the disease occurred intheir practice. The elder practitioner, beingthen sufficiently recovered, returned to his practice,but the first patient he attended was attacked bythe disease and died. A physician, who met himin consultation soon afterwards, about a case of adifferent kind, and who knew nothing of his misfortune,asked him whether puerperal fever was at all prevalentin his neighborhood, on which he burst into tears,and related the above circ*mstances.
“Among the cases which I saw this season inconsultation, four occurred in one month in the practiceof one medical man, and all of them terminated fatally.”[Lond. Med. Gaz. May 2, 1835.]
Dr. Ramsbotham asserted, in a Lecture at the LondonHospital, that he had known the disease spread througha particular district, or be confined to the practiceof a particular person, almost every patient beingattacked with it, while others had not a single case.It seemed capable, he thought, of conveyance, notonly by common modes; but through the dress of theattendants upon the patient.
In a letter to be found in the “London MedicalGazette” for January, 1840, Mr. Roberton ofManchester makes the statement which I here give ina somewhat condensed form.
A midwife delivered a woman on the 4th of December,1830, who died soon after with the symptoms of puerperalfever. In one month from this date the same midwifedelivered thirty women, residing in different partsof an extensive suburb, of which number sixteen caughtthe disease and all died. These were the onlycases which had occurred for a considerable time inManchester. The other midwives connected withthe same charitable institution as the woman alreadymentioned are twenty-five in number, and deliver,on an average, ninety women a week, or about threehundred and eighty a month. None of these womenhad a case of puerperal fever. “Yet allthis time this woman was crossing the other midwivesin every direction, scores of the patients of thecharity being delivered by them in the very same quarterswhere her cases of fever were happening.”
Mr. Roberton remarks, that little more than half thewomen she delivered during this month took the fever;that on some days all escaped, on others only oneor more out of three or four; a circ*mstance similarto what is seen in other infectious maladies.
Dr. Blundell says, “Those who have never madethe experiment can have but a faint conception howdifficult it is to obtain the exact truth respectingany occurrence in which feelings and interests areconcerned. Omitting particulars, then, I contentmyself with remarking, generally, that from more thanone district I have received accounts of the prevalenceof puerperal fever in the practice of some individuals,while its occurrence in that of others, in the sameneighborhood, was not observed. Some, as I havebeen told, have lost ten, twelve, or a greater numberof patients, in scarcely broken succession; like theirevil genius, the puerperal fever has seemed to stalkbehind them wherever they went. Some have deemedit prudent to retire for a time from practice.In fine, that this fever may occur spontaneously, Iadmit; that its infectious nature may be plausiblydisputed, I do not deny; but I add, considerately,that in my own family I had rather that those I esteemedthe most should be delivered, unaided, in a stable,by the manger-side, than that they should receivethe best help, in the fairest apartment, but exposedto the vapors of this pitiless disease. Gossipingfriends, wet-nurses, monthly nurses, the practitionerhimself, these are the channels by which, as I suspect,the infection is principally conveyed.”
At a meeting of the Royal Medical and ChirurgicalSociety, Dr. King mentioned that some years sincea practitioner at Woolwich lost sixteen patients frompuerperal fever in the same year. He was compelledto give up practice for one or two years, his businessbeing divided among the neighboring practitioners.No case of puerperal fever occurred afterwards, neitherhad any of the neighboring surgeons any cases of thisdisease.
At the same meeting Mr. Hutchinson mentioned the occurrenceof three consecutive cases of puerperal fever, followedsubsequently by two others, all in the practice ofone accoucheur.[Lancet, May 2, 1840.]
Dr. Lee makes the following statement: “Inthe last two weeks of September, 1827, five fatalcases of uterine inflammation came under our observation.All the individuals so attacked had been attended inlabor by the same midwife, and no example of a febrileor inflammatory disease of a serious nature occurredduring that period among the other patients of theWestminster General Dispensary, who had been attendedby the other midwives belonging to that institution.”
The recurrence of long series of cases like thoseI have cited, reported by those most interested todisbelieve in contagion, scattered along through aninterval of half a century, might have been thoughtsufficient to satisfy the minds of all inquirers thathere was something more than a singular coincidence.But if, on a more extended observation, it shouldbe found that the same ominous groups of cases clusteringabout individual practitioners were observed in aremote country, at different times, and in widelyseparated regions, it would seem incredible that anyshould be found too prejudiced or indolent to acceptthe solemn truth knelled into their ears by the funeralbells from both sides of the ocean,—theplain conclusion that the physician and the diseaseentered, hand in hand, into the chamber of the unsuspectingpatient.
That such series of cases have been observed in thiscountry, and in this neighborhood, I proceed to show.
In Dr. Francis’s “Notes to Denman’sMidwifery,” a passage is cited from Dr. Hosack,in which he refers to certain puerperal cases whichproved fatal to several lying-in women, and in someof which the disease was supposed to be conveyed bythe accoucheurs themselves.
A writer in the “New York Medical and PhysicalJournal” for October, 1829, in speaking of theoccurrence of puerperal fever, confined to one man’spractice, remarks, “We have known cases of thiskind occur, though rarely, in New York.”
I mention these little hints about the occurrenceof such cases, partly because they are the first Ihave met with in American medical literature, butmore especially because they serve to remind us thatbehind the fearful array of published facts there liesa dark list of similar events, unwritten in the recordsof science, but long remembered by many a desolatedfireside.
Certainly nothing can be more open and explicit thanthe account given by Dr. Peirson of Salem, of thecases seen by him. In the first nineteen daysof January, 1829, he had five consecutive cases ofpuerperal fever, every patient he attended being attacked,and the three first cases proving fatal. In Marchof the same year he had two moderate cases, in June,another case, and in July, another, which proved fatal.
“Up to this period,” he remarks, “Iam not informed that a single case had occurred inthe practice of any other physician. Since thatperiod I have had no fatal case in my practice, althoughI have had several dangerous cases. I have attendedin all twenty cases of this disease, of which fourhave been fatal. I am not aware that there hasbeen any other case in the town of distinct puerperalperitonitis, although I am willing to admit my informationmay be very defective on this point. I have beentold of some I ‘mixed cases,’ and ‘morbidaffections after delivery.’”In the “Quarterly Summary of the Transactionsof the College of Physicians of Philadelphia”may be found some most extraordinary developmentsrespecting a series of cases occurring in the practiceof a member of that body.
Dr. Condie called the attention of the Society tothe prevalence, at the present time, of puerperalfever of a peculiarly insidious and malignant character.“In the practice of one gentleman extensivelyengaged as an obstetrician, nearly every female hehas attended in confinement, during several weekspast, within the above limits” (the southernsections and neighboring districts), “had beenattacked by the fever.”
“An important query presents itself, the Doctorobserved, in reference to the particular form of fevernow prevalent. Is it, namely, capable of beingpropagated by contagion, and is a physician who hasbeen in attendance upon a case of the disease warrantedin continuing, without interruption, his practiceas an obstetrician? Dr. C., although not a believerin the contagious character of many of those affectionsgenerally supposed to be propagated in this manner,has nevertheless become convinced by the facts thathave fallen under his notice, that the puerperal fevernow prevailing is capable of being communicated bycontagion. How otherwise can be explained thevery curious circ*mstance of the disease in one districtbeing exclusively confined to the practice of a singlephysician, a Fellow of this College, extensively engagedin obstetrical practice,—while no instanceof the disease has occurred in the patients underthe care of any other accoucheur practising withinthe same district; scarcely a female that has beendelivered for weeks past has escaped an attack?”
Dr. Rutter, the practitioner referred to, “observedthat, after the occurrence of a number of cases ofthe disease in his practice, he had left the cityand remained absent for a week, but on returning, noarticle of clothing he then wore having been used byhim before, one of the very first cases of parturitionhe attended was followed by an attack of the fever,and terminated fatally; he cannot, readily, therefore,believe in the transmission of the disease from femaleto female, in the person or clothes of the physician.”
The meeting at which these remarks were made was heldon the 3d of May, 1842. In a letter dated December20, 1842, addressed to Dr. Meigs, and to be foundin the “Medical Examiner,” he speaks of“those horrible cases of puerperal fever, someof which you did me the favor to see with me duringthe past summer,” and talks of his experiencein the disease, “now numbering nearly seventycases, all of which have occurred within less thana twelvemonth past.”
And Dr. Meigs asserts, on the same page, “Indeed,I believe that his practice in that department ofthe profession was greater than that of any othergentleman, which was probably the cause of his seeinga greater number of the cases.” This froma professor of midwifery, who some time ago assureda gentleman whom he met in consultation, that the nighton which they met was the eighteenth in successionthat he himself had been summoned from his repose,seems hardly satisfactory.
I must call the attention of the inquirer most particularlyto the Quarterly Report above referred to, and theletters of Dr. Meigs and Dr. Rutter, to be found inthe “Medical Examiner.” Whatever impressionthey may produce upon his mind, I trust they willat least convince him that there is some reason forlooking into this apparently uninviting subject.
At a meeting of the College of Physicians just mentioned,Dr. Warrington stated, that a few days after assistingat an autopsy of puerperal peritonitis, in which heladed out the contents of the abdominal cavity withhis hands, he was called upon to deliver three womenin rapid succession. All of these women wereattacked with different forms of what is commonlycalled puerperal fever. Soon after these he sawtwo other patients, both on the same day, with thesame disease. Of these five patients two died.
At the same meeting, Dr. West mentioned a fact relatedto him by Dr. Samuel Jackson of Northumberland.Seven females, delivered by Dr. Jackson in rapid succession,while practising in Northumberland County, were allattacked with puerperal fever, and five of them died.“Women,” he said, “who had expectedme to attend upon them, now becoming alarmed, removedout of my reach, and others sent for a physician residingseveral miles distant. These women, as well asthose attended by midwives; all did well; nor didwe hear of any deaths in child-bed within a radiusof fifty miles, excepting two, and these I afterwardsascertained to have been caused by other diseases.”He underwent, as he thought, a thorough purification,and still his next patient was attacked with the diseaseand died. He was led to suspect that the contagionmight have been carried in the gloves which he hadworn in attendance upon the previous cases. Twomonths or more after this he had two other cases.He could find nothing to account for these, unlessit were the instruments for giving enemata, whichhad been used in two of the former cases, and wereemployed by these patients. When the first caseoccurred, he was attending and dressing a limb extensivelymortified from erysipelas, and went immediately tothe accouchement with his clothes and gloves mostthoroughly imbued with its efluvia. And here Imay mention, that this very Dr. Samuel Jackson ofNorthumberland is one of Dr. Dewees’s authoritiesagainst contagion.
The three following statements are now for the firsttime given to the public. All of the cases referredto occurred within this State, and two of the threeseries in Boston and its immediate vicinity.
I. The first is a series of cases which took placeduring the last spring in a town at some distancefrom this neighborhood. A physician of that town,Dr. C., had the following consecutive cases.
No. 1, delivered March 20, died March 24." 2, " April 9, " April 14." 3, " " 10, " " 14." 4, " " 11, " " 18." 5, " " 27, " May 3." 6, " " 28, had some symptoms,(recovered.)" 7, " May 8, had some symptoms,(also recovered.)
These were the only cases attended by this physicianduring the period referred to. “They wereall attended by him until their termination, withthe exception of the patient No. 6, who fell into thehands of another physician on the 2d of May. (Dr.C. left town for a few days at this time.) Dr. C.attended cases immediately before and after the above-namedperiods, none of which, however, presented any peculiarsymptoms of the disease.”
About the 1st of July he attended another patientin a neighboring village, who died two or three daysafter delivery.
The first patient, it is stated, was delivered onthe 20th of March. “On the 19th, Dr. C.made the autopsy of a man who died suddenly, sick onlyforty-eight hours; had oedema of the thigh, and gangreneextending from a little above the ankle into the cavityof the abdomen.” Dr. C. wounded himself,very slightly, in the right hand during the autopsy.The hand was quite painful the night following, duringhis attendance on the patient No. 1. He did notsee this patient after the 20th, being confined tothe house, and very sick from the wound just mentioned,from this time until the 3d of April.
Several cases of erysipelas occurred in the housewhere the autopsy mentioned above took place, soonafter the examination. There were also many casesof erysipelas in town at the time of the fatal puerperalcases which have been mentioned.
The nurse who laid out the body of the patient No.3 was taken on the evening of the same day with sorethroat and erysipelas, and died in ten days from thefirst attack.
The nurse who laid out the body of the patient No.4 was taken on the day following with symptoms likethose of this patient, and died in a week, withoutany external marks of erysipelas.
“No other cases of similar character with thoseof Dr. C. occurred in the practice of any of the physiciansin the town or vicinity at the time. Deaths followingconfinement have occurred in the practice of otherphysicians during the past year, but they were notcases of puerperal fever. No post-mortem examinationswere held in any of these puerperal cases.”
Some additional statements in this letter are deservingof insertion.
“A physician attended a woman in the immediateneighborhood of the cases numbered 2, 3, and 4.This patient was confined the morning of March 1st,and died on the night of March 7th. It is doubtfulwhether this should be considered a case of puerperalfever. She had suffered from canker, indigestion,and diarrhoea for a year previous to her delivery.Her complaints were much aggravated for two or threemonths previous to delivery; she had become greatlyemaciated, and weakened to such an extent that ithad not been expected that she would long survive herconfinement, if indeed she reached that period.Her labor was easy enough; she flowed a good deal,seemed exceedingly prostrated, had ringing in theears, and other symptoms of exhaustion; the pulse wasquick and small. On the second and third day therewas some tenderness and tumefaction of the abdomen,which increased somewhat on the fourth and fifth.He had cases in midwifery before and after this, whichpresented nothing peculiar.”
It is also mentioned in the same letter, that anotherphysician had a case during the last summer and anotherlast fall, both of which recovered.
Another gentleman reports a case last December, asecond case five weeks, and another three weeks since.All these recovered. A case also occurred veryrecently in the practice of a physician in the villagewhere the eighth patient of Dr. C. resides, which provedfatal. “This patient had some patches oferysipelas on the legs and arms. The same physicianhas delivered three cases since, which have all donewell. There have been no other cases in thistown or its vicinity recently. There have beensome few cases of erysipelas.” It deservesnotice that the partner of Dr. C., who attended theautopsy of the man above mentioned and took an activepart in it; who also suffered very slightly from aprick under the thumb-nail received during the examination,had twelve cases of midwifery between March 26th andApril 12th, all of which did well, and presented nopeculiar symptoms. It should also be stated,that during these seventeen days he was in attendanceon all the cases of erysipelas in the house wherethe autopsy had been performed.
I owe these facts to the prompt kindness of a gentlemanwhose intelligence and character are sufficient guarantyfor their accuracy.
The two following letters were addressed to my friendDr. Scorer, by the gentleman in whose practice thecases of puerperal fever occurred. His name rendersit unnecessary to refer more particularly to thesegentlemen, who on their part have manifested the mostperfect freedom and courtesy in affording these accountsof their painful experience.
“January 28, 1843.
II. . . . “The time to which you alludewas in 1830. The first case was in February,during a very cold time. She was confined the4th, and died the 12th. Between the 10th and28th of this month, I attended six women in labor,all of whom did well except the last, as also two whowere confined March 1st and 5th. Mrs. E., confinedFebruary 28th, sickened, and died March 8th.The next day, 9th, I inspected the body, and the nightafter attended a lady, Mrs. B., who sickened, and died16th. The 10th, I attended another, Mrs. G., whosickened, but recovered. March 16th, I went fromMrs. G.’s room to attend a Mrs. H., who sickened,and died 21st. The 17th, I inspected Mrs. B. Onthe 19th, I went directly from Mrs. H.’s roomto attend another lady, Mrs. G., who also sickened,and died 22d. While Mrs. B. was sick, on 15th,I went directly from her room a few rods, and attendedanother woman, who was not sick. Up to 20th ofthis month I wore the same clothes. I now refusedto attend any labor, and did not till April 21st, when,having thoroughly cleansed myself, I resumed my practice,and had no more puerperal fever.
“The cases were not confined to a narrow space.The two nearest were half a mile from each other,and half that distance from my residence. Theothers were from two to three miles apart, and nearlythat distance from my residence. There were noother cases in their immediate vicinity which cameto my knowledge. The general health of all thewomen was pretty good, and all the labors as goodas common, except the first. This woman, in consequenceof my not arriving in season, and the child beinghalf-born at some time before I arrived, was very muchexposed to the cold at the time of confinement, andafterwards, being confined in a very open, cold room.Of the six cases you perceive only one recovered.
“In the winter of 1817 two of my patients hadpuerperal fever, one very badly, the other not sobadly. Both recovered. One other had swelledleg, or phlegmasia dolens, and one or two others didnot recover as well as usual.
“In the summer of 1835 another disastrous periodoccurred in my practice. July 1st, I attendeda lady in labor, who was afterwards quite ill andfeverish; but at the time I did not consider her casea decided puerperal fever. On the 8th, I attendedone who did well. On the 12th, one who was seriouslysick. This was also an equivocal case, apparentlyarising from constipation and irritation of the rectum.These women were ten miles apart and five from myresidence. On 15th and 20th, two who did well.On 25th, I attended another. This was a severelabor, and followed by unequivocal puerperal fever,or peritonitis. She recovered. August 2dand 3d, in about twenty-four hours I attended fourpersons. Two of them did very well; one was attackedwith some of the common symptoms, which however subsidedin a day or two, and the other had decided puerperalfever, but recovered. This woman resided five
miles from me. Up to this time I wore the samecoat. All my other clothes had frequently beenchanged. On 6th, I attended two women, one ofwhom was not sick at all; but the other, Mrs. L.,was afterwards taken ill. On 10th, I attendeda lady, who did very well. I had previously changedall my clothes, and had no garment on which had beenin a puerperal room. On 12th, I was called toMrs. S., in labor. While she was ill, I left herto visit Mrs. L., one of the ladies who was confinedon 6th. Mrs. L. had been more unwell than usual,but I had not considered her case anything more thancommon till this visit. I had on a surtout atthis visit, which, on my return to Mrs. S., I leftin another room. Mrs. S. was delivered on 13thwith forceps. These women both died of decidedpuerperal fever.“While I attended these women in their fevers,I changed my clothes, and washed my hands in a solutionof chloride of lime after each visit. I attendedseven women in labor during this period, all of whomrecovered without sickness.
“In my practice I have had several single casesof puerperal fever, some of whom have died and somehave recovered. Until the year 1830 I had nosuspicion that the disease could be communicated fromone patient to another by a nurse or midwife; butI now think the foregoing facts strongly favor thatidea. I was so much convinced of this fact, thatI adopted the plan before related.
“I believe my own health was as good as usualat each of the above periods. I have no recollectionsto the contrary.
“I believe I have answered all your questions.I have been more particular on some points perhapsthan necessary; but I thought you could form yourown opinion better than to take mine. In 1830I wrote to Dr. Charming a more particular statementof my cases. If I have not answered your questionssufficiently, perhaps Dr. C. may have my letter tohim, and you can find your answer there.” [Ina letter to myself, this gentleman also stated, “Ido not recollect that there was any erysipelas orany other disease particularly prevalent at the time.”]
“Boston, February 3, 1843.
III. “My dear sir,—Ireceived a note from you last evening, requestingme to answer certain questions therein proposed, touchingthe cases of puerperal fever which came under my observationthe past summer. It gives me pleasure to complywith your request, so far as it is in my power soto do, but, owing to the hurry in preparing for a journey,the notes of the cases I had then taken were lostor mislaid. The principal facts, however, aretoo vivid upon my recollection to be soon forgotten.I think, therefore, that I shall be able to give youall the information you may require.
“All the cases that occurred in my practicetook place between the 7th of May and the 17th ofJune 1842.
“They were not confined to any particular partof the city. The first two cases were patientsresiding at the South End, the next was at the extremeNorth End, one living in Sea Street and the other inRoxbury. The following is the order in whichthey occurred:
“Case 1. Mrs._____ was confined on the 7th of May, at 5 o’clock, P. M.,after a natural labor of six hours. At 12 o’clock at night, on the 9th(thirty-one hours after confinement), she was taken with severe chill,previous to which she was as comfortable as women usually are under thecirc*mstances. She died on the 10th.
“Case 2. Mrs._____ was confined on the 10th of June (four weeks afterMrs. C.), at 11 A. M., after a natural, but somewhat severe labor offive hours. At 7 o’clock, on the morning of the 11th, she had a chill.Died on the 12th.
“Case 3. Mrs._____ , confined on the 14th of June, was comfortable untilthe 18th, when symptoms of puerperal fever were manifest. She died onthe 20th.
“Case 4. Mrs._____ , confined June 17th, at 5 o’clock, A. M., was doingwell until the morning of the 19th. She died on the evening of the 21st.
“Case 5. Mrs._____ was confined with her fifth child on the 17th ofJune, at 6 o’clock in the evening. This patient had been attacked withpuerperal fever, at three of her previous confinements, but the diseaseyielded to depletion and other remedies without difficulty. This time, Iregret to say, I was not so fortunate. She was not attacked, as were theother patients, with a chill, but complained of extreme pain in abdomen,and tenderness on pressure, almost from the moment of her confinement.In this as in the other cases, the disease resisted all remedies, and shedied in great distress on the 22d of the same month. Owing to theextreme heat of the season, and my own indisposition, none of thesubjects were examined after death. Dr. Channing, who was in attendancewith me on the three last cases, proposed to have a post-mortemexamination of the subject of case No. 5, but from some cause which I donot now recollect it was not obtained.
“You wish to know whether I wore the same clotheswhen attending the different cases. I cannotpositively say, but I should think I did not, as theweather became warmer after the first two cases; Itherefore think it probable that I made a change ofat least a part of my dress. I have had no othercase of puerperal fever in my own practice for threeyears, save those above related, and I do not rememberto have lost a patient before with this disease.While absent, last July, I visited two patients sickwith puerperal fever, with a friend of mine in thecountry. Both of them recovered.
“The cases that I have recorded were not confinedto any particular constitution or temperament, butit seized upon the strong and the weak, the old andthe young,—one being over forty years, andthe youngest under eighteen years of age . . . .If the disease is of an erysipelatous nature, as manysuppose, contagionists may perhaps find some groundfor their belief in the fact, that, for two weeks previousto my first case of puerperal fever, I had been attendinga severe case of erysipelas, and the infection mayhave been conveyed through me to the patient; but,on the other hand, why is not this the case with otherphysicians, or with the same physician at all times,for since my return from the country I have had amore inveterate case of erysipelas than ever before,and no difficulty whatever has attended any of my midwiferycases?”
I am assured, on unquestionable authority, that “Aboutthree years since, a gentleman in extensive midwiferybusiness, in a neighboring State, lost in the courseof a few weeks eight patients in child-bed, seven ofthem being undoubted cases of puerperal fever.No other physician of the town lost a single patientof this disease during the same period.”And from what I have heard in conversation with someof our most experienced practitioners, I am inclinedto think many cases of the kind might be brought tolight by extensive inquiry.
This long catalogue of melancholy histories assumesa still darker aspect when we remember how kindlynature deals with the parturient female, when sheis not immersed in the virulent atmosphere of an impurelying-in hospital, or poisoned in her chamber by theunsuspected breath of contagion. From all causestogether, not more than four deaths in a thousandbirths and miscarriages happened in England and Walesduring the period embraced by the first “Reportof the Registrar-General.” In the secondReport the mortality was shown to be about five inone thousand. In the Dublin Lying-in Hospital,during the seven years of Dr. Collins’s mastership,there was one case of puerperal fever to 178 deliveries,or less than six to the thousand, and one death fromthis disease in 278 cases, or between three and fourto the thousand a yet during this period the diseasewas endemic in the hospital, and might have gone onto rival the horrors of the pestilence of the Maternite,had not the poison been destroyed by a thorough purification.
In private practice, leaving out of view the casesthat are to be ascribed to the self-acting systemof propagation, it would seem that the disease mustbe far from common. Mr. White of Manchester says,“Out of the whole number of lying-in patientswhom I have delivered (and I may safely call it agreat one), I have never lost one, nor to the bestof my recollection has one been greatly endangered,by the puerperal, miliary, low nervous, putrid malignant,or milk fever.” Dr. Joseph Clarke informedDr. Collins, that in the course of forty-five years’most extensive practice he lost but four patientsfrom this disease. One of the most eminent practitionersof Glasgow, who has been engaged in very extensivepractice for upwards of a quarter of a century, testifiesthat he never saw more than twelve cases of real puerperalfever.[Lancet, May 4, 1833]
I have myself been told by two gentlemen practisingin this city, and having for many years a large midwiferybusiness, that they had neither of them lost a patientfrom this disease, and by one of them that he hadonly seen it in consultation with other physicians.In five hundred cases of midwifery, of which Dr. Storerhas given an abstract in the first number of thisJournal, there was only one instance of fatal puerperalperitonitis.
In the view of these facts, it does appear a singularcoincidence, that one man or woman should have ten,twenty, thirty, or seventy cases of this rare diseasefollowing his or her footsteps with the keenness ofa beagle, through the streets and lanes of a crowdedcity, while the scores that cross the same paths onthe same errands know it only by name. It isa series of similar coincidences which has led us toconsider the dagger, the musket, and certain innocent-lookingwhite powders as having some little claim to be regardedas dangerous. It is the practical inattentionto similar coincidences which has given rise to theunpleasant but often necessary documents called indictments,which has sharpened a form of the cephalotome sometimesemployed in the case of adults, and adjusted thatmodification of the fillet which delivers the worldof those who happen to be too much in the way whilesuch striking coincidences are taking place.
I shall now mention a few instances in which the diseaseappears to have been conveyed by the process of directinoculation.
Dr. Campbell of Edinburgh states that in October,1821, he assisted at the post-mortem examination ofa patient who died with puerperal fever. He carriedthe pelvic viscera in his pocket to the class-room.The same evening he attended a woman in labor withoutpreviously changing his clothes; this patient died.The next morning he delivered a woman with the forceps;she died also, and of many others who were seized withthe disease within a few weeks, three shared the samefate in succession.
In June, 1823, he assisted some of his pupils at theautopsy of a case of puerperal fever. He wasunable to wash his hands with proper care, for wantof the necessary accommodations. On getting homehe found that two patients required his assistance.He went without further ablution, or changing hisclothes; both these patients died with puerperal fever.This same Dr. Campbell is one of Dr. Churchill’sauthorities against contagion.
Mr. Roberton says that in one instance within hisknowledge a practitioner passed the catheter for apatient with puerperal fever late in the evening;the same night he attended a lady who had the symptomsof the disease on the second day. In anotherinstance a surgeon was called while in the act ofinspecting the body of a woman who had died of thisfever, to attend a labor; within forty-eight hoursthis patient was seized with the fever.’
On the 16th of March, 1831, a medical practitionerexamined the body of a woman who had died a few daysafter delivery, from puerperal peritonitis. Onthe evening of the 17th he delivered a patient, whowas seized with puerperal fever on the 19th, and diedon the 24th. Between this period and the 6thof April, the same practitioner attended two otherpatients, both of whom were attacked with the samedisease and died.
In the autumn of 1829 a physician was present at theexamination of a case of puerperal fever, dissectedout the organs, and assisted in sewing up the body.He had scarcely reached home when he was summoned toattend a young lady in labor. In sixteen hoursshe was attacked with the symptoms of puerperal fever,and narrowly escaped with her life.
In December, 1830, a midwife, who had attended twofatal cases of puerperal fever at the British Lying-inHospital, examined a patient who had just been admitted,to ascertain if labor had commenced. This patientremained two days in the expectation that labor wouldcome on, when she returned home and was then suddenlytaken in labor and delivered before she could setout for the hospital. She went on favorably fortwo days, and was then taken with puerperal feverand died in thirty-six hours.
“A young practitioner, contrary to advice, examinedthe body of a patient who had died from puerperalfever; there was no epidemic at the time; the caseappeared to be purely sporadic. He delivered threeother women shortly afterwards; they all died withpuerperal fever, the symptoms of which broke out verysoon after labor. The patients of his colleaguedid well, except one, where he assisted to removesome coagula from the uterus; she was attacked inthe same manner as those whom he had attended, anddied also.” The writer in the “Britishand Foreign Medical Review,” from whom I quotethis statement,—and who is no other thanDr. Rigby, adds, “We trust that this fact alonewill forever silence such doubts, and stamp the well-meritedepithet of ‘criminal,’ as above quoted,upon such attempts.” [Brit. and For. MedicalReview for Jan. 1842, p. 112.]
From the cases given by Mr. Ingleby, I select thefollowing. Two gentlemen, after having been engagedin conducting the post-mortem examination of a caseof puerperal fever, went in the same dress, each respectively,to a case of midwifery. “The one patientwas seized with the rigor about thirty hours afterwards.The other patient was seized with a rigor the thirdmorning after delivery. One recovered, one died.”[Edin. Med. and Surg. Journal, April, 1838.]
One of these same gentlemen attended another womanin the same clothes two days after the autopsy referredto. “The rigor did not take place untilthe evening of the fifth day from the first visit.Result fatal.” These cases belonged toa series of seven, the first of which was thoughtto have originated in a case of erysipelas. “Severalcases of a mild character followed the foregoing seven,and their nature being now most unequivocal, my frienddeclined visiting all midwifery cases for a time,and there was no recurrence of the disease.”These cases occurred in 1833. Five of them provedfatal. Mr. Ingleby gives another series of seveneases which occurred to a practitioner in 1836, thefirst of which was also attributed to his having openedseveral erysipelatous abscesses a short time previously.
I need not refer to the case lately read before thisSociety, in which a physician went, soon after performingan autopsy of a case of puerperal fever, to a womanin labor, who was seized with the same disease andperished. The forfeit of that error has been alreadypaid.
At a meeting of the Medical and Chirurgical Societybefore referred to, Dr. Merriman related an instanceoccurring in his own practice, which excites a reasonablesuspicion that two lives were sacrificed to a stillless dangerous experiment. He was at the examinationof a case of puerperal fever at two o’clockin the afternoon. He took care not to touch thebody. At nine o’clock the same evening heattended a woman in labor; she was so nearly deliveredthat he had scarcely anything to do. The nextmorning she had severe rigors, and in forty-eight hoursshe was a corpse. Her infant had erysipelas anddied in two days. [Lancet, May 2, 1840.]
In connection with the facts which have been stated,it seems proper to allude to the dangerous and oftenfatal effects which have followed from wounds receivedin the post-mortem examination of patients who havedied of puerperal fever. The fact that such woundsare attended with peculiar risk has been long noticed.I find that Chaussier was in the habit of cautioninghis students against the danger to which they wereexposed in these dissections. [Stein, L’Artd’Accoucher, 1794; Dict. des Sciences Medicales,art. “Puerperal.”] The head pharmacienof the Hotel Dieu, in his analysis of the fluid effusedin puerperal peritonitis, says that practitionersare convinced of its deleterious qualities, and thatit is very dangerous to apply it to the denuded skin.[Journal de Pharmacie, January, 1836.] Sir BenjaminBrodie speaks of it as being well known that the inoculationof lymph or pus from the peritoneum of a puerperalpatient is often attended with dangerous and even fatalsymptoms. Three cases in confirmation of thisstatement, two of them fatal, have been reported tothis Society within a few months.
Of about fifty cases of injuries of this kind, ofvarious degrees of severity, which I have collectedfrom different sources, at least twelve were instancesof infection from puerperal peritonitis. Someof the others are so stated as to render it probablethat they may have been of the same nature. Fiveother cases were of peritoneal inflammation; threein males. Three were what was called enteritis,in one instance complicated with erysipelas; but itis well known that this term has been often used tosignify inflammation of the peritoneum covering theintestines. On the other hand, no case of typhusor typhoid fever is mentioned as giving rise to dangerousconsequences, with the exception of the single instanceof an undertaker mentioned by Mr. Travers, who seemsto have been poisoned by a fluid which exuded fromthe body. The other accidents were produced bydissection, or some other mode of contact with bodiesof patients who had died of various affections.They also differed much in severity, the cases ofpuerperal origin being among the most formidable andfatal. Now a moment’s reflection will showthat the number of cases of serious consequences ensuingfrom the dissection of the bodies of those who had
perished of puerperal fever is so vastly disproportionedto the relatively small number of autopsies made inthis complaint as compared with typhus or pneumonia(from which last disease not one case of poisoninghappened), and still more from all diseases put together,that the conclusion is irresistible that a most fearfulmorbid poison is often generated in the course ofthis disease. Whether or not it is sui generis,confined to this disease, or produced in some others,as, for instance, erysipelas, I need, not stop to inquire.In connection with this may be taken the followingstatement of Dr. Rigby. “That the dischargesfrom a patient under puerperal fever are in the highestdegree contagious we have abundant evidence in thehistory of lying-in hospitals. The puerperalabscesses are also contagious, and may be communicatedto healthy lying-in women by washing with the samesponge; this fact has been repeatedly proved in theVienna Hospital; but they are equally communicableto women not pregnant; on more than one occasion thewomen engaged in washing the soiled bed-linen of theGeneral Lying-in Hospital have been attacked withabscess in the fingers or hands, attended with rapidlyspreading inflammation of the cellular tissue.”
Now add to all this the undisputed fact, that withinthe walls of lying-in hospitals there is often generateda miasm, palpable as the chlorine used to destroyit, tenacious so as in some cases almost to defy extirpation,deadly in some institutions as the plague; which haskilled women in a private hospital of London so fastthat they were buried two in one coffin to concealits horrors; which enabled Tonnelle to record twohundred and twenty-two autopsies at the Maternite ofParis; which has led Dr. Lee to express his deliberateconviction that the loss of life occasioned by theseinstitutions completely defeats the objects of theirfounders; and out of this train of cumulative evidence,the multiplied groups of cases clustering about individuals,the deadly results of autopsies, the inoculation byfluids from the living patient, the murderous poisonof hospitals,—does there not result a conclusionthat laughs all sophistry to scorn, and renders allargument an insult?
I have had occasion to mention some instances in whichthere was an apparent relation between puerperal feverand erysipelas. The length to which this paperhas extended does not allow me to enter into the considerationof this most important subject. I will only say,that the evidence appears to me altogether satisfactorythat some most fatal series of puerperal fever havebeen produced by an infection originating in the matteror effluvia of erysipelas. In evidence of someconnection between the two diseases, I need not goback to the older authors, as Pouteau or Gordon, butwill content myself with giving the following references,with their dates; from which it will be seen that thetestimony has been constantly coming before the professionfor the last few years.
“London Cyclopaedia of Practical Medicine,”article Puerperal Fever, 1833.
Mr. Ceeley’s Account of the Puerperal Feverat Aylesbury. “Lancet,” 1835.
Dr. Ramsbotham’s Lecture. “LondonMedical Gazette,” 1835.
Mr. Yates Ackerly’s Letter in the same Journal,1838.
Mr. Ingleby on Epidemic Puerperal Fever. “EdinburghMedical and Surgical
Journal,” 1838.
Mr. Paley’s Letter. “London MedicalGazette,” 1839.
Remarks at the Medical and Chirurgical Society.“Lancet,” 1840.
Dr. Rigby’s “System of Midwifery.”1841.
“Nunneley on Erysipelas,”—awork which contains a large number of references onthe subject. 1841.
“British and Foreign Quarterly Review,”1842.
Dr. S. Jackson of Northumberland, as already quotedfrom the Summary of the College of Physicians, 1842.
And lastly, a startling series of cases by Mr. Storrsof Doncaster, to be, found in the “AmericanJournal of the Medical Sciences” for January,1843.
The relation of puerperal fever with other continuedfevers would seem to be remote and rarely obvious.Hey refers to two cases of synochus occurring in theRoyal Infirmary of Edinburgh, in women who had attendedupon puerperal patients. Dr. Collins refers toseveral instances in which puerperal fever has appearedto originate from a continued proximity to patientssuffering with typhus.
Such occurrences as those just mentioned, though mostimportant to be remembered and guarded against, hardlyattract our notice in the midst of the gloomy factsby which they are surrounded. Of these facts,at the risk of fatiguing repetitions, I have summoneda sufficient number, as I believe, to convince themost incredulous that every attempt to disguise thetruth which underlies them all is useless.
It is true that some of the historians of the disease,especially Hulme, Hull, and Leake, in England; Tonnelle,Duges, and Baudelocque, in France, profess not tohave found puerperal fever contagious. At themost they give us mere negative facts, worthless againstan extent of evidence which now overlaps the widestrange of doubt, and doubles upon itself in the redundancyof superfluous demonstration. Examined in detail,this and much of the show of testimony brought upto stare the daylight of conviction out of countenance,proves to be in a great measure unmeaning and inapplicable,as might be easily shown were it necessary. Nordo I feel the necessity of enforcing the conclusionwhich arises spontaneously from the facts which havebeen enumerated, by formally citing the opinions ofthose grave authorities who have for the last half-centurybeen sounding the unwelcome truth it has cost so manylives to establish.
“It is to the British practitioner,” saysDr. Rigby, “that we are indebted for stronglyinsisting upon this important and dangerous characterof puerperal fever.”
The names of Gordon, John Clarke, Denman, Burns, Young,Hamilton, Haighton, Good, Waller; Blundell, Gooch,Ramsbotham, Douglas, Lee, Ingleby, Loco*ck, Abercrombie,Alison; Travers, Rigby, and Watson, many of whosewritings I have already referred to, may have someinfluence with those who prefer the weight of authoritiesto the simple deductions of their own reason fromthe facts laid before them. A few Continentalwriters have adopted similar conclusions. It givesme pleasure to remember, that while the doctrine hasbeen unceremoniously discredited in one of the leadingJournals, and made very light of by teachers in twoof the principal Medical Schools, of this country,Dr. Channing has for many years inculcated, and enforcedby examples, the danger to be apprehended and theprecautions to be taken in the disease under consideration.
I have no wish to express any harsh feeling with regardto the painful subject which has come before us.If there are any so far excited by the story of thesedreadful events that they ask for some word of indignantremonstrance to show that science does not turn thehearts of its followers into ice or stone, let meremind them that such words have been uttered by thosewho speak with an authority I could not claim.It is as a lesson rather than as a reproach that Icall up the memory of these irreparable errors andwrongs. No tongue can tell the heart-breakingcalamity they have caused; they have closed the eyesjust opened upon a new world of love and happiness;they have bowed the strength of manhood into the dust;they have cast the helplessness of infancy into thestranger’s arms, or bequeathed it, with lesscruelty, the death of its dying parent. Thereis no tone deep enough for regret, and no voice loudenough for warning. The woman about to becomea mother, or with her new-born infant upon her bosom,should be the object of trembling care and sympathywherever she bears her tender burden, or stretchesher aching limbs. The very outcast of the streetshas pity upon her sister in degradation, when theseal of promised maternity is impressed upon her.The remorseless vengeance of the law, brought downupon its victim by a machinery as sure as destiny,is arrested in its fall at a word which reveals hertransient claim for mercy. The solemn prayer ofthe liturgy singles out her sorrows from the multipliedtrials of life, to plead for her in the hour of peril.God forbid that any member of the profession to whichshe trusts her life, doubly precious at that eventfulperiod, should hazard it negligently, unadvisedly,or selfishly!
There may be some among those whom I address who aredisposed to ask the question, What course are we tofollow in relation to this matter? The factsare before them, and the answer must be left to theirown judgment and conscience. If any should careto know my own conclusions, they are the following;and in taking the liberty to state them very freelyand broadly, I would ask the inquirer to examine themas freely in the light of the evidence which has beenlaid before him.
1. A physician holding himself in readiness toattend cases of midwifery should never take any activepart in the post-mortem examination of cases of puerperalfever.
2. If a physician is present at such autopsies,he should use thorough ablution, change every articleof dress, and allow twenty-four hours or more to elapsebefore attending to any case of midwifery. Itmay be well to extend the same caution to cases ofsimple peritonitis.
3. Similar precautions should be taken afterthe autopsy or surgical treatment of cases of erysipelas,if the physician is obliged to unite such officeswith his obstetrical duties, which is in the highestdegree inexpedient.
4. On the occurrence of a single case of puerperalfever in his practice, the physician is bound to considerthe next female he attends in labor, unless some weeksat least have elapsed, as in danger of being infectedby him, and it is his duty to take every precautionto diminish her risk of disease and death.
5. If within a short period two cases of puerperalfever happen close to each other, in the practiceof the same physician, the disease not existing orprevailing in the neighborhood, he would do wiselyto relinquish his obstetrical practice for at leastone month, and endeavor to free himself by every availablemeans from any noxious influence he may carry aboutwith him.
6. The occurrence of three or more closely connectedcases, in the practice of one individual, no othersexisting in the neighborhood, and no other sufficientcause being alleged for the coincidence, is primafacie evidence that he is the vehicle of contagion.
7. It is the duty of the physician to take everyprecaution that the disease shall not be introducedby nurses or other assistants, by making proper inquiriesconcerning them, and giving timely warning of everysuspected source of danger.
8. Whatever indulgence may be granted to thosewho have heretofore been the ignorant causes of somuch misery, the time has come when the existenceof a private pestilence in the sphere of a single physicianshould be looked upon, not as a misfortune, but a crime;and in the knowledge of such occurrences the dutiesof the practitioner to his profession should giveway to his paramount obligations to society.Additional references and cases.
Fifth Annual Report of the Registrar-General of England.
1843. Appendix. Letter from William Farr,Esq.—Several new series of cases are givenin the Letter of Mr. Stows, contained in the Appendixto this Report. Mr. Stows suggests precautionssimilar to those I have laid down, and these precautionsare strongly enforced by Mr. Farr, who is, therefore,obnoxious to the same criticisms as myself.
Hall and Dexter, in Am. Journal of Med.Sc. for January, 1844.—Cases of puerperalfever seeming to originate in erysipelas.
Elkington, of Birmingham, in Provincial Med.Journal, cited in Am. Journ. Med. Se.for April, 1844.—Six cases in less thana fortnight, seeming to originate in a case of erysipelas.
West’s Reports, in Brit. and For. Med.Review for October, 1845, and January, 1847.—Affectionof the arm, resembling malignant pustule, after removingthe placenta of a patient who died from puerperal fever.Reference to cases at Wurzburg, as proving contagion,and to Keiller’s cases in the Monthly Journalfor February, 1846, as showing connection of puerperalfever and erysipelas.
Kneeland.—Contagiousness of Puerperal Fever.Am. Jour. Med. Se., January, 1846.Also, Connection between Puerperal Fever and EpidemicErysipelas. Ibid., April, 1846.
Robert Storrs.—Contagious Effects of PuerperalFever on the Male Subject; or on Persons not Child-bearing.(From Provincial Med. and Surg. Journal.) Am.Jour. Med. Sc., January, 184,6. Numerouscases. See also Dr. Reid’s case in sameJournal for April, 1846.
Routh’s paper in Proc. of Royal Med. Chir.Soc., Am. Jour. Med. Sc., April, 1849,also in B. and F. Med. Chir. Review, April,1850.
Hill, of Leuchars.—A Series of Cases illustratingthe Contagious Nature of Erysipelas and of PuerperalFever, and their Intimate Pathological Connection.(From Monthly Journal of Med. Sc.) Am. Jour.Med. Se., July, 1850.
Skoda on the Causes of Puerperal Fever. (Peritonitisin rabbits, from inoculation with different morbidsecretions.) Am. Jour. Med. Se., October,1850.
Arneth. Paper read before the National Academyof Medicine. Annales d’Hygiene, Tome LXV.2e Partie. (Means of Disinfection proposed by M.“Semmeliveis” (Semmelweiss.) Lotions ofchloride of lime and use of nail-brush before admissionto lying-in wards. Alleged sudden and great decreaseof mortality from puerperal fever. Cause of diseaseattributed to inoculation with cadaveric matters.)See also Routh’s paper, mentioned above.
Moir. Remarks at a meeting of the Edinburgh Medico-ChirurgicalSociety. Refers to cases of Dr. Kellie, of Leith.Sixteen in succession, all fatal. Also to severalinstances of individual pupils having had a successionof cases in various quarters of the town, while others,practising as extensively in the same localities, hadnone. Also to several special cases not mentionedelsewhere. Am. Jour. Med. Se. forOctober, 1851. (From New Monthly Journal of Med.Science.)
Simpson.—Observations at a Meeting of theEdinburgh Obstetrical Society. (An “eminentgentleman,” according to Dr. Meigs, whose “nameis as well known in America as in (his) native land.”Obstetrics. Phil. 1852, pp. 368, 375.) The studentis referred to this paper for a valuable resume ofmany of the facts, and the necessary inferences, relatingto this subject. Also for another series of cases,Mr. Sidey’s, five or six in rapid succession.
Dr. Simpson attended the dissection of two of Dr.Sidey’s cases, and freely handled the diseasedparts. His next four child-bed patients wereaffected with puerperal fever, and it was the firsttime he had seen it in practice. As Dr. Simpsonis a gentleman (Dr. Meigs, as above), and as “agentleman’s hands are clean” (Dr. Meigs’Sixth Letter), it follows that a gentleman with cleanhands may carry the disease. Am. Jour.Med. Sc., October, 1851.Peddle.—The five or six cases of Dr. Sidey,followed by the four of Dr. Simpson, did not end theseries. A practitioner in Leith having examinedin Dr. Simpson’s house, a portion of the uterusobtained from one of the patients, had immediatelyafterwards three fatal cases of puerperal fever.Dr. Veddie referred to two distinct series of consecutivecases in his own practice. He had since takenprecautions, and not met with any such cases.Am. Jour. Med. Sc., October, 1851.
Copland. Considers it proved that puerperal fevermaybe propagated by the hands and the clothes, oreither, of a third person, the bed-clothes or body-clothesof a patient. Mentions a new series of cases,one of which he saw, with the practitioner who hadattended them. She was the sixth he had had withina few days. All died. Dr. Copland insistedthat contagion had caused these cases; advised precautionarymeasures, and the practitioner had no other casesfor a considerable time. Considers it criminal,after the evidence adduced,—which he couldhave quadrupled,—and the weight of authoritybrought forward, for a practitioner to be the mediumof transmitting contagion and death to his patients.Dr. Copland lays down rules similar to those suggestedby myself, and is therefore entitled to the same epithetfor so doing. Medical Dictionary, New York, 1852.Article, Puerperal States and Diseases.
If there is any appetite for facts so craving as tobe yet unappeased,—Lesotho, necdum satiata,—morecan be obtained. Dr. Hodge remarks that “thefrequency and importance of this singular circ*mstance(that the disease is occasionally more prevalent withone practitioner than another) has been exceedinglyoverrated.” More than thirty strings ofcases, more than two hundred and fifty sufferers frompuerperal fever, more than one hundred and thirtydeaths appear as the results of a sparing estimateof such among the facts I have gleaned as could benumerically valued. These facts constitute, wemay take it for granted, but a small fraction of thosethat have actually occurred. The number of themmight be greater, but “’t is enough, ’twill serve,” in Mercutio’s modest phrase,so far as frequency is concerned. For a just estimateof the importance of the singular circ*mstance, itmight be proper to consult the languid survivors,the widowed husbands, and the motherless children,as well as “the unfortunate accoucheur.”
III
CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
An Address delivered before the Massachusetts MedicalSociety, at the Annual Meeting, May 30, 1860.
“Facultate magis quamviolentia.”
Hippocrates.
Our Annual Meeting never fails to teach us at leastone lesson. The art whose province it is to healand to save cannot protect its own ranks from theinroads of disease and the waste of the Destroyer.
Seventeen of our associates have been taken from ussince our last Anniversary. Most of them followedtheir calling in the villages or towns that lie amongthe hills or along the inland streams. Only thosewho have lived the kindly, mutually dependent lifeof the country, can tell how near the physician whois the main reliance in sickness of all the familiesthroughout a thinly settled region comes to the heartsof the people among whom he labors, how they valuehim while living, how they cherish his memory whendead. For these friends of ours who have gonebefore, there is now no more toil; they start fromtheir slumbers no more at the cry of pain; they sallyforth no more into the storms; they ride no longerover the lonely roads that knew them so well; theirwheels are rusting on their axles or rolling withother burdens; their watchful eyes are closed to allthe sorrows they lived to soothe. Not one ofthese was famous in the great world; some were almostunknown beyond their own immediate circle. Butthey have left behind them that loving remembrancewhich is better than fame, and if their epitaphs arechiselled briefly in stone, they are written at fulllength on living tablets in a thousand homes to whichthey carried their ever-welcome aid and sympathy.
One whom we have lost, very widely known and honored,was a leading practitioner of this city. Hisimage can hardly be dimmed in your recollection, ashe stood before you only three years ago, filling thesame place with which I am now honored. To speakof him at all worthily, would be to write the historyof professional success, won without special aid atstarting, by toil, patience, good sense, pure character,and pleasing manners; won in a straight uphill ascent,without one breathing-space until he sat down, notto rest, but to die. If prayers could have shieldedhim from the stroke, if love could have drawn forththe weapon, and skill could have healed the wound,this passing tribute might have been left to otherlips and to another generation.
Let us hope that our dead have at last found thatrest which neither summer nor winter, nor day nornight, had granted to their unending earthly labors!And let us remember that our duties to our brethrendo not cease when they become unable to share ourtoils, or leave behind them in want and woe thosewhom their labor had supported. It is honorableto the Profession that it has organized an Associationa for the relief of its suffering members and theirfamilies; it owes this tribute to the ill-rewardedindustry and sacrifices of its less fortunate brotherswho wear out health and life in the service of humanity.I have great pleasure in referring to this excellentmovement, which gives our liberal profession a chanceto show its liberality, and serves to unite us all,the successful and those whom fortune has cast down,in the bonds of a true brotherhood.
A medical man, as he goes about his daily businessafter twenty years of practice, is apt to supposethat he treats his patients according to the teachingsof his experience. No doubt this is true to someextent; to what extent depending much on the qualitiesof the individual. But it is easy to prove thatthe prescriptions of even wise physicians are verycommonly founded on something quite different fromexperience. Experience must be based on the permanentfacts of nature. But a glance at the prevalentmodes of treatment of any two successive generationswill show that there is a changeable as well as a permanentelement in the art of healing; not merely changeableas diseases vary, or as new remedies are introduced,but changeable by the going out of fashion of specialremedies, by the decadence of a popular theory fromwhich their fitness was deduced, or other cause notmore significant. There is no reason to supposethat the present time is essentially different in thisrespect from any other. Much, therefore, whichis now very commonly considered to be the result ofexperience, will be recognized in the next, or insome succeeding generation, as no such result at all,but as a foregone conclusion, based on some prevalentbelief or fashion of the time.
There are, of course, in every calling, those whogo about the work of the day before them, doing itaccording to the rules of their craft, and askingno questions of the past or of the future, or of theaim and end to which their special labor is contributing.These often consider and call themselves practicalmen. They pull the oars of society, and haveno leisure to watch the currents running this or thatway; let theorists and philosophers attend to them.In the mean time, however, these currents are carryingthe practical men, too, and all their work may bethrown away, and worse than thrown away, if they donot take knowledge of them and get out of the wrongones and into the right ones as soon as they may.Sir Edward Parry and his party were going straighttowards the pole in one of their arctic expeditions,travelling at the rate of ten miles a day. Butthe ice over which they travelled was drifting straighttowards the equator, at the rate of twelve miles aday, and yet no man among them would have known thathe was travelling two miles a day backward unlesshe had lifted his eyes from the track in which he wasplodding. It is not only going backward that theplain practical workman is liable to, if he will notlook up and look around; he may go forward to endshe little dreams of. It is a simple business fora mason to build up a niche in a wall; but what if,a hundred years afterwards when the wall is torn down,the skeleton of a murdered man drop out of the niche?It was a plain practical piece of carpentry for a Jewishartisan to fit two pieces of timber together accordingto the legal pattern in the time of Pontius Pilate;he asked no questions, perhaps, but we know what burdenthe cross bore on the morrow! And so, with subtlertools than trowels or axes, the statesman who worksin policy without principle, the theologian who worksin forms without a soul, the physician who, callinghimself a practical man, refuses to recognize thelarger laws which govern his changing practice, mayall find that they have been building truth into thewall, and hanging humanity upon the cross.
The truth is, that medicine, professedly founded onobservation, is as sensitive to outside influences,political, religious, philosophical, imaginative,as is the barometer to the changes of atmospheric density.Theoretically it ought to go on its own straightforwardinductive path, without regard to changes of governmentor to fluctuations of public opinion. But looka moment while I clash a few facts together, and seeif some sparks do not reveal by their light a closerrelation between the Medical Sciences and the conditionsof Society and the general thought of the time, thanwould at first be suspected.
Observe the coincidences between certain great politicaland intellectual periods and the appearance of illustriousmedical reformers and teachers. It was in theage of Pericles, of Socrates, of Plato, of Phidias,that Hippocrates gave to medical knowledge the formwhich it retained for twenty centuries. Withthe world-conquering Alexander, the world-embracingAristotle, appropriating anatomy and physiology, amonghis manifold spoils of study, marched abreast of hisroyal pupil to wider conquests. Under the samePtolemies who founded the Alexandrian Library andMuseum, and ordered the Septuagint version of the HebrewScriptures, the infallible Herophilus ["ContradicereHerophilo in anatomicis, est contradicere evangelium,”was a saying of Fallopius.] made those six hundreddissections of which Tertullian accused him, and thesagacious Erasistratus introduced his mild antiphlogistictreatment in opposition to the polypharmacy and antidotalpractice of his time. It is significant thatthe large-minded Galen should have been the physicianand friend of the imperial philosopher Marcus Aurelius.The Arabs gave laws in various branches of knowledgeto those whom their arms had invaded, or the terrorof their spreading dominion had reached, and the pointfrom which they started was, as Humboldt acknowledges,“the study of medicine, by which they long ruledthe Christian Schools,” and to which they addedthe department of chemical pharmacy.
Look at Vesalius, the contemporary of Luther.Who can fail to see one common spirit in the radicalecclesiastic and the reforming court-physician?Both still to some extent under the dominion of theletter: Luther holding to the real presence; Vesaliusactually causing to be drawn and engraved two muscleswhich he knew were not found in the human subject,because they had been described by Galen, from dissectionsof the lower animals. Both breaking through oldtraditions in the search of truth; one, knife in hand,at the risk of life and reputation, the other at therisk of fire and fa*got, with that mightier weapon whichall the devils could not silence, though they hadbeen thicker than the tiles on the house-tops.How much the physician of the Catholic Charles V. hadin common with the great religious destructive, maybe guessed by the relish with which he tells the story
how certain Pavian students exhumed the body of an“elegans scortum,” or lovely dame of illrepute, the favorite of a monk of the order of St.Anthony, who does not seem to have resisted temptationso well as the founder of his order. We have alwaysranked the physician Rabelais among the early reformers,but I do not know that Vesalius has ever been thankedfor his hit at the morals of the religious orders,or for turning to the good of science what was intendedfor the “benefit of clergy.”Our unfortunate medical brother, Michael Servetus,the spiritual patient to whom the theological moxawas applied over the entire surface for the cure ofhis heresy, came very near anticipating Harvey.The same quickened thought of the time which led himto dispute the dogma of the Church, opened his mindto the facts which contradicted the dogmas of theFaculty.
Harvey himself was but the posthumous child of thegreat Elizabethan period. Bacon was at once histeacher and his patient. The founder of the newinductive philosophy had only been dead two years whenthe treatise on the Circulation, the first-fruit ofthe Restoration of Science, was given to the world.
And is it to be looked at as a mere accidental coincidence,that while Napoleon was modernizing the politicalworld, Bichat was revolutionizing the science of lifeand the art that is based upon it; that while theyoung general was scaling the Alps, the young surgeonwas climbing the steeper summits of unexplored nature;that the same year read the announcement of thoseadmirable “Researches on Life and Death,”and the bulletins of the battle of Marengo?
If we come to our own country, who can fail to recognizethat Benjamin Rush, the most conspicuous of Americanphysicians, was the intellectual offspring of themovement which produced the Revolution? “Thesame hand,” says one of his biographers, “whichsubscribed the declaration of the political independenceof these States, accomplished their emancipation frommedical systems formed in foreign countries, and whollyunsuitable to the state of diseases in America.”
Following this general course of remark, I proposeto indicate in a few words the direction of the mainintellectual current of the time, and to point outmore particularly some of the eddies which tend tokeep the science and art of medicine from moving withit, or even to carry them backwards.
The two dominant words of our time are law and average,both pointing to the uniformity of the order of beingin which we live. Statistics have tabulated everything,—population,growth, wealth, crime, disease. We have shadedmaps showing the geographical distribution of larcenyand suicide. Analysis and classification havebeen at work upon all tangible and visible objects.The Positive Philosophy of Comte has only given expressionto the observing and computing mind of the nineteenthcentury.
In the mean time, the great stronghold of intellectualconservatism, traditional belief, has been assailedby facts which would have been indicted as blasphemybut a few generations ago. Those new tables ofthe law, placed in the hands of the geologist by thesame living God who spoke from Sinai to the Israelitesof old, have remodelled the beliefs of half the civilizedworld. The solemn scepticism of science has replacedthe sneering doubts of witty philosophers. Themore positive knowledge we gain, the more we inclineto question all that has been received without absoluteproof.
As a matter of course, this movement has its partialreactions. The province of faith is claimed asa port free of entry to unsupported individual convictions.The tendency to question is met by the unanalyzinginstinct of reverence. The old church calls backits frightened truants. Some who have lost theirhereditary religious belief find a resource in therevelations of Spiritualism. By a parallel movement,some of those who have become medical infidels passover to the mystic band of believers in the fanciedmiracles of hom*oeopathy.
Under these influences transmitted to, or at leastshared by, the medical profession, the old questionbetween “Nature,” so called, and “Art,”or professional tradition, has reappeared with newinterest. I say the old question, for Hippocratesstated the case on the side of “Nature”more than two thousand years ago. Miss FlorenceNightingale,—and if I name her next tothe august Father of the Healing Art, its noblest daughterwell deserves that place of honor,—MissFlorence Nightingale begins her late volume with aparaphrase of his statement. But from a very earlytime to this there has always been a strong party against“Nature.” Themison called the practiceof Hippocrates “a meditation upon death.”Dr. Rush says: “It is impossible to calculatethe mischief which Hippocrates, has done, by firstmarking Nature with his name and afterwards lettingher loose upon sick people. Millions have perishedby her hands in all ages and countries.”Sir John Forbes, whose defence of “Nature”in disease you all know, and to the testimonial inwhose honor four of your Presidents have contributed,has been recently greeted, on retiring from the profession,with a wish that his retirement had been twenty yearssooner, and the opinion that no man had done so muchto destroy the confidence of the public in the medicalprofession.
In this Society we have had the Hippocratic and theThemisonic side fairly represented. The treatiseof one of your early Presidents on the Mercurial Treatmentis familiar to my older listeners. Others whohave held the same office have been noted for theboldness of their practice, and even for partialityto the use of complex medication.
On the side of “Nature” we have had, firstof all, that remarkable discourse on Self-LimitedDiseases, [On Self-Limited Diseases. A Discoursedelivered before the Massachusetts Medical Society,at their Annual Meeting, May 27, 1835. By JacobBigelow, M. D.] which has given the key-note to theprevailing medical tendency of this neighborhood, atleast, for the quarter of a century since it was delivered.Nor have we forgotten the address delivered at Springfieldtwenty years later, [Search out the Secrets, of Nature.By Augustus A. Gould, M. D. Read at the Annual Meeting,June 27, 1855.] full of good sense and useful suggestions,to one of which suggestions we owe the learned, impartial,judicious, well-written Prize Essay of Dr. WorthingtonHooker. [Rational Therapeutics. A Prize Essay.By Worthington Hooker, M. D., of New Haven. Boston.1857.] We should not omit from the list the importantaddress of another of our colleagues, [On the Treatmentof Compound and Complicated Fractures. By WilliamJ. Walker, M. D. Read at the Annual Meeting, May 29,1845.] showing by numerous cases the power of Naturein healing compound fractures to be much greater thanis frequently supposed,—affording, indeed,more striking illustrations than can be obtained fromthe history of visceral disease, of the supreme wisdom,forethought, and adaptive dexterity of that divineArchitect, as shown in repairing the shattered columnswhich support the living temple of the body.
We who are on the side of “Nature” pleaseourselves with the idea that we are in the great currentin which the true intelligence of the time is moving.We believe that some who oppose, or fear, or denounceour movement are themselves caught in various eddiesthat set back against the truth. And we do mostearnestly desire and most actively strive, that Medicine,which, it is painful to remember, has been spoken ofas “the withered branch of science” ata meeting of the British Association, shall be atlength brought fully to share, if not to lead, thegreat wave of knowledge which rolls with the tidesthat circle the globe.
If there is any State or city which might claim tobe the American headquarters of the nature-trustingheresy, provided it be one, that State is Massachusetts,and that city is its capital. The effect whichthese doctrines have upon the confidence reposed inthe profession is a matter of opinion. For myself,I do not believe this confidence can be impaired byany investigations which tend to limit the applicationof troublesome, painful, uncertain, or dangerous remedies.Nay, I will venture to say this, that if every specificwere to fail utterly, if the cinchona trees all diedout, and the arsenic mines were exhausted, and thesulphur regions were burned up, if every drug fromthe vegetable, animal, and mineral kingdom were todisappear from the market, a body of enlightened men,organized as a distinct profession, would be requiredjust as much as now, and respected and trusted as now,
whose province should be to guard against the causesof disease, to eliminate them if possible when stillpresent, to order all the conditions of the patientso as to favor the efforts of the system to right itself,and to give those predictions of the course of diseasewhich only experience can warrant, and which in somany cases relieve the exaggerated fears of sufferersand their friends, or warn them in season of impendingdanger. Great as the loss would be if certainactive remedies could no longer be obtained, it wouldleave the medical profession the most essential partof it’s duties, and all, and more than all, itspresent share of honors; for it would be the death-blowto charlatanism, which depends for its success almostentirely on drugs, or at least on a nomenclature thatsuggests them.There is no offence, then, or danger in expressingthe opinion, that, after all which has been said,the community is still overdosed: The best proofof it is, that “no families take so little medicineas those of doctors, except those of apothecaries,and that old practitioners are more sparing of activemedicines than younger ones.” [Dr. James Jacksonhas kindly permitted me to make the following extractfrom a letter just received by him from Sir JamesClark, and dated May 26, 1860: “As a physicianadvances in age, he generally, I think, places lessconfidence in the ordinary medical treatment thanhe did, not only during his early, but even his middleperiod of life.”] The conclusion from these factsis one which the least promising of Dr. Howe’spupils in the mental department could hardly helpdrawing.
Part of the blame of over-medication must, I fear,rest with the profession, for yielding to the tendencyto self-delusion, which seems inseparable from thepractice of the art of healing. I need only touchon the common modes of misunderstanding or misapplyingthe evidence of nature.
First, there is the natural incapacity for sound observation,which is like a faulty ear in music. We see thisin many persons who know a good deal about books,but who are not sharp-sighted enough to buy a horseor deal with human diseases.
Secondly, there is in some persons a singular inabilityto weigh the value of testimony; of which, I think,from a pretty careful examination of his books, Hahnemannaffords the best specimen outside the walls of Bedlam.
The inveterate logical errors to which physicianshave always been subject are chiefly these:
The mode of inference per enumerationem simplicem,in scholastic phrase; that is, counting only theirfavorable cases. This is the old trick illustratedin Lord Bacon’s story of the gifts of the shipwreckedpeople, hung up in the temple.—Behold!they vowed these gifts to the altar, and the godssaved them. Ay, said a doubting bystander, buthow many made vows of gifts and were shipwrecked notwithstanding?The numerical system is the best corrective of thisand similar errors. The arguments commonly broughtagainst its application to all matters of medicalobservation, treatment included, seem to apply ratherto the tabulation of facts ill observed, or improperlyclassified, than to the method itself.
The post hoc ergo propter hoc error: he got wellafter taking my medicine; therefore in consequenceof taking it.
The false induction from genuine facts of observation,leading to the construction of theories which arethen deductively applied in the face of the resultsof direct observation. The school of Broussaishas furnished us with a good example of this error.
And lastly, the error which Sir Thomas Browne callsgiving “a reason of the golden tooth;”that is, assuming a falsehood as a fact, and givingreasons for it, commonly fanciful ones, as is constantlydone by that class of incompetent observers who findtheir “golden tooth” in the fabulous effectsof the hom*oeopathie materia medica,—whichconsists of sugar of milk and a nomenclature.
Another portion of the blame rests with the publicitself, which insists on being poisoned. Somebodybuys all the quack medicines that build palaces forthe mushroom, say rather, the toadstool millionaires.Who is it? These people have a constituency ofmillions. The popular belief is all but universalthat sick persons should feed on noxious substances.One of our members was called not long since to a manwith a terribly sore mouth. On inquiry he foundthat the man had picked up a box of unknown pills,in Howard Street, and had proceeded to take them, ongeneral principles, pills being good for people.They happened to contain mercury, and hence the troublefor which he consulted our associate.
The outside pressure, therefore, is immense upon thephysician, tending to force him to active treatmentof some kind. Certain old superstitions, stilllingering in the mind of the public, and not yet utterlyexpelled from that of the profession, are at the bottomof this, or contribute to it largely. One ofthe most ancient is, that disease is a malignant agency,or entity, to be driven out of the body by offensivesubstances, as the smoke of the fish’s heartand liver drove the devil out of Tobit’s bridalchamber, according to the Apochrypha. Epilepticsused to suck the blood from the wounds of dying gladiators.[Plinii Hist. Mundi. lib. xxviii. c. 4.] TheHon. Robert Boyle’s little book was publishedsome twenty or thirty years before our late President,Dr. Holyoke, was born. [A Collection of Choice andSafe Remedies. The Fifth Edition, corrected.London, 1712. Dr. Holyoke was born in 1728.] Init he recommends, as internal medicines, most of thesubstances commonly used as fertilizers of the soil.His “Album Graecum” is best left untranslated,and his “Zebethum Occidentale” is stillmore transcendentally unmentionable except in a strangedialect. It sounds odiously to us to hear himrecommend for dysentery a powder made from “thesole of an old shoe worn by some man that walks much.”Perhaps nobody here ever heard of tying a stocking,which had been worn during the day, round the neckat night for a sore throat. The same idea ofvirtue in unlovely secretions! [The idea is very ancient.“Sordes hominis” “Sudore et oleomedicinam facientibus.”—Plin. xxviii.4.]
Even now the hom*oeopathists have been introducingthe venom of serpents, under the learned title ofLachesis, and outraging human nature with infusionsof the pediculus capitis; that is, of course, as weunderstand their dilutions, the names of these things;for if a fine-tooth-comb insect were drowned in LakeSuperior, we cannot agree with them in thinking thatevery drop of its waters would be impregnated withall the pedicular virtues they so highly value.They know what they are doing. They are appealingto the detestable old superstitious presumption infavor of whatever is nauseous and noxious as beinggood for the sick.
Again, we all occasionally meet persons stained withnitrate of silver, given for epilepsy. Read whatDr. Martin says, about the way in which it came tobe used, in his excellent address before the NorfolkCounty Medical Society, and the evidence I can show,but have not time for now, and then say what you thinkof the practice which on such presumptions turns awhite man as blue as the double-tattooed King of theCannibal Islands! [Note A.]
If medical superstitions have fought their way downthrough all the rationalism and scepticism of thenineteenth century, of course the theories of theschools, supported by great names, adopted into thepopular belief and incorporated with the general massof misapprehension with reference to disease, mustbe expected to meet us at every turn in the shapeof bad practice founded on false doctrine. A Frenchpatient complains that his blood heats him, and expectshis doctor to bleed him. An English or Americanone says he is bilious, and will not be easy withouta dose of calomel. A doctor looks at a patient’stongue, sees it coated, and says the stomach is foul;his head full of the old saburral notion which theextreme inflammation-doctrine of Broussais did so muchto root out, but which still leads, probably, to muchneedless and injurious wrong of the stomach and bowelsby evacuants, when all they want is to be let alone.It is so hard to get anything out of the dead handof medical tradition! The mortmain of theoristsextinct in science clings as close as that of ecclesiasticsdefunct in law.
One practical hint may not be out of place here.It seems to be sometimes forgotten, by those who mustknow the fact, that the tongue is very different,anatomically and physiologically, from the stomach.Its condition does not in the least imply a similarone of the stomach, which is a very different structure,covered with a different kind of epithelium, and furnishedwith entirely different secretions. A silversmithwill, for a dollar, make a small hoe, of solid silver,which will last for centuries, and will give a patientmore comfort, used for the removal of the accumulatedepithelium and fungous growths which constitute the“fur,” than many a prescription with asplit-footed Rx before it, addressed to the partsout of reach.
I think more of this little implement on account ofits agency in saving the Colony at Plymouth in theyear 1623. Edward Winslow heard that Massasoitwas sick and like to die. He found him with ahouseful of people about him, women rubbing his armsand legs, and friends “making such a hellishnoise” as they probably thought would scare awaythe devil of sickness. Winslow gave him someconserve, washed his mouth, scraped his tongue, whichwas in a horrid state, got down some drink, made himsome broth, dosed him with an infusion of strawberryleaves and sassafras root, and had the satisfactionof seeing him rapidly recover. Massasoit, fullof gratitude, revealed the plot which had been formedto destroy the colonists, whereupon the Governor orderedCaptain Miles Standish to see to them; who thereupon,as everybody remembers, stabbed Pecksuot with hisown knife, broke up the plot, saved the colony, andthus rendered Massachusetts and the MassachusettsMedical Society a possibility, as they now are a factbefore us. So much for this parenthesis of thetongue-scraper, which helped to save the young colonyfrom a much more serious scrape, and may save theUnion yet, if a Presidential candidate should happento be taken sick as Massasoit was, and his tongue wantedcleaning,—which process would not hurt agood many politicians, with or without a typhoid fever.
Again, see how the “bilious” theory worksin every-day life here and now, illustrated by a casefrom actual life. A youthful practitioner, whoselast molars have not been a great while cut, meetsan experienced and noted physician in consultation.This is the case. A slender, lymphatic youngwoman is suckling two lusty twins, the intervals ofsuction being occupied on her part with palpitations,headaches, giddiness, throbbing in the head, and variousnervous symptoms, her cheeks meantime getting bloodless,and her strength running away in company with her milk.The old experienced physician, seeing the yellowishwaxy look which is common in anaemic patients, considersit a “bilious” case, and is for givinga rousing emetic. Of course, he has to be wheedledout of this, a recipe is written for beefsteaks andporter, the twins are ignominiously expelled fromthe anaemic bosom, and forced to take prematurely tothe bottle, and this prolific mother is saved forfuture usefulness in the line of maternity.
The practice of making a profit on the medicine orderedhas been held up to reprobation by one at least ofthe orators who have preceded me. That the effectof this has been ruinous in English practice I cannotdoubt, and that in this country the standard of practicewas in former generations lowered through the sameagency is not unlikely. I have seen an old account-bookin which the physician charged an extra price forgilding his rich patients’ pills. If allmedicine were very costly, and the expense of it alwayscame out of the physician’s fee, it would really
be a less objectionable arrangement than this othermost pernicious one. He would naturally thinktwice before he gave an emetic or cathartic whichevacuated his own pocket, and be sparing of the cholagoguesthat emptied the biliary ducts of his own wallet,unless he were sure they were needed. If thereis any temptation, it should not be in favor of givingnoxious agents, as it clearly must be in the case ofEnglish druggists and “General Practitioners.”The complaint against the other course is a very oldone. Pliny, inspired with as truly Roman horrorof quackery as the elder Cato,—who declaredthat the Greek doctors had sworn to exterminate allbarbarians, including the Romans, with their drugs,but is said to have physicked his own wife to death,notwithstanding,—Pliny says, in so manywords, that the cerates and cataplasms, plasters,collyria, and antidotes, so abundant in his time,as in more recent days, were mere tricks to make money.A pretty strong eddy, then, or rather many eddies,setting constantly back from the current of soberobservation of nature, in the direction of old superstitionsand fancies, of exploded theories, of old ways ofmaking money, which are very slow to pass out of fashion.
But there are other special American influences whichwe are bound to take cognizance of. If I wishedto show a student the difficulties of getting at truthfrom medical experience, I would give him the historyof epilepsy to read. If I wished him to understandthe tendencies of the American medical mind, its sanguineenterprise, its self-confidence, its audacious handlingof Nature, its impatience with her old-fashioned waysof taking time to get a sick man well, I would makehim read the life and writings of Benjamin Rush.Dr. Rush thought and said that there were twenty timesmore intellect and a hundred times more knowledge inthe country in 1799 than before the Revolution.His own mind was in a perpetual state of exaltationproduced by the stirring scenes in which he had takena part, and the quickened life of the time in whichhe lived. It was not the state to favor sound,calm observation. He was impatient, and Natureis profoundly imperturbable. We may adjust thebeating of our hearts to her pendulum if we will andcan, but we may be very sure that she will not changethe pendulum’s rate of going because our heartsare palpitating. He thought he had mastered yellow-fever.“Thank God,” he said, “out of onehundred patients whom I have visited or prescribedfor this day, I have lost none.” Wherewas all his legacy of knowledge when Norfolk was decimated?Where was it when the blue flies were buzzing overthe coffins of the unburied dead piled up in the cemeteryof New Orleans, at the edge of the huge trenches yawningto receive them?
One such instance will do as well as twenty.Dr. Rush must have been a charming teacher, as hewas an admirable man. He was observing, ratherthan a sound observer; eminently observing, curious,even, about all manner of things. But he couldnot help feeling as if Nature had been a good dealshaken by the Declaration of Independence, and thatAmerican art was getting to be rather too much forher,—especially as illustrated in his ownpractice. He taught thousands of American students,he gave a direction to the medical mind of the countrymore than any other one man; perhaps he typifies itbetter than any other. It has clearly tended toextravagance in remedies and trust in remedies, asin everything else. How could a people whichhas a revolution once in four years, which has contrivedthe Bowie-knife and the revolver, which has chewedthe juice out of all the superlatives in the languagein Fourth of July orations, and so used up its epithetsin the rhetoric of abuse that it takes two great quartodictionaries to supply the demand; which insists insending out yachts and horses and boys to out-sail,out-run, out-fight, and checkmate all the rest ofcreation; how could such a people be content withany but “heroic” practice? What wonderthat the stars and stripes wave over doses of ninetygrains of sulphate of quinine, [More strictly, ninety-sixgrains in two hours. Dunglison’s Practice,1842, vol. ii. p. 520. Eighty grains in one dose.Ibid. p. 536. Ninety-six grains of sulphate ofquinine are equal to eight ounces of good bark.—Wood& Bache.] and that the American eagle screams withdelight to see three drachms of calomel given at asingle mouthful?
Add to this the great number of Medical Journals,all useful, we hope, most of them necessary, we trust,many of them excellently well conducted, but whichmust find something to fill their columns, and soprint all the new plans of treatment and new remediesthey can get hold of, as the newspapers, from a similarnecessity, print the shocking catastrophes and terriblemurders.
Besides all this, here are we, the great body of teachersin the numberless medical schools of the Union, someof us lecturing to crowds who clap and stamp in thecities, some of us wandering over the country, likeother professional fertilizers, to fecundate the mindsof less demonstrative audiences at various scientificstations; all of us talking habitually to those supposedto know less than ourselves, and loving to claim asmuch for our art as we can, not to say for our ownschools, and possibly indirectly for our own practicalskill. Hence that annual crop of introductorylectures; the useful blossoming into the ornamental,as the cabbage becomes glorified in the cauliflower;that lecture-room literature of adjectives, that declamatoryexaggeration, that splendid show of erudition borrowedfrom D’Israeli, and credited to Lord Bacon andthe rest, which have suggested to our friends of theMedical Journals an occasional epigram at our expense.Hence the tendency in these productions, and in medicallectures generally, to overstate the efficacy of favoritemethods of cure, and hence the premium offered forshowy talkers rather than sagacious observers, forthe men of adjectives rather than of nouns substantivein the more ambitious of these institutions.
Such are some of the eddies in which we are liableto become involved and carried back out of the broadstream of philosophical, or, in other words, truth-loving,investigations. The causes of disease, in themean time, have been less earnestly studied in theeagerness of the search for remedies. Speak softly!Women have been borne out from an old-world hospital,two in one coffin, that the horrors of their prison-housemight not be known, while the very men who were discussingthe treatment of the disease were stupidly conveyingthe infection from bed to bed, as rat-killers carrytheir poisons from one household to another. Donot some of you remember that I have had to fightthis private-pestilence question against a scepticismwhich sneered in the face of a mass of evidence suchas the calm statisticians of the Insurance office couldnot listen to without horror and indignation? ["TheContagiousness of Puerperal Fever.”—N.E. Quar. Jour. of Medicine and Surgery, April,1843. Reprinted, with Additions. Boston:Ticknor & Fields. 1855.] Have we forgotten what istold in one of the books published under our own sanction,that a simple measure of ventilation, proposed by Dr.John Clark, had saved more than sixteen thousand children’slives in a single hospital? How long would ithave taken small doses of calomel and rhubarb to saveas many children? These may be useful in prudenthands, but how insignificant compared to the greathygienic conditions! Causes, causes, and againcauses,—more and more we fall back on theseas the chief objects of our attention. The shortestsystem of medical practice that I know of is the oldest,but not the worst. It is older than Hippocrates,older than Chiron the Centaur. Nature taught itto the first mother when she saw her first-born childputting some ugly pebble or lurid berry into its mouth.I know not in what language it was spoken, but I knowthat in English it would sound thus: Spit it out!
Art can do something more than say this. It cansometimes reach the pebble or berry after it has beenswallowed. But the great thing is to keep thesethings out of children’s mouths, and as soonas they are beyond our reach, to be reasonable andpatient with Nature, who means well, but does notlike to hurry, and who took nine calendar months, moreor less, to every mother’s son among us, beforeshe thought he was fit to be shown to the public.
Suffer me now to lay down a few propositions, whetherold or new it matters little, not for your immediateacceptance, nor yet for your hasty rejection, butfor your calm consideration.
But first, there are a number of terms which we arein the habit of using in a vague though not unintelligibleway, and which it is as well now to define. Theseterms are the tools with which we are to work, andthe first thing is to sharpen them. It is nothingto us that they have been sharpened a thousand timesbefore; they always get dull in the using, and everynew workman has a right to carry them to the grindstoneand sharpen them to suit himself.
Nature, in medical language, as opposed to Art, meanstrust in the reactions of the living system against,ordinary normal impressions.
Art, in the same language, as opposed to Nature, meansan intentional resort to extraordinary abnormal impressionsfor the relief of disease.
The reaction of the living system is the essence ofboth. Food is nothing, if there is no digestiveact to respond to it. We cannot raise a blisteron a dead man, or hope that a carminative forced betweenhis lips will produce its ordinary happy effect.
Disease, dis-ease,—disturbed quiet, uncomfortableness,—meansimperfect or abnormal reaction of the living system,and its more or less permanent results.
Food, in its largest sense, is whatever helps to buildup the normal structures, or to maintain their naturalactions.
Medicine, in distinction from food, is every unnaturalor noxious agent applied for the relief of disease.
Physic means properly the Natural art, and Physicianis only the Greek synonyme of Naturalist.
With these few explanations I proceed to unfold thepropositions I have mentioned.
Disease and death, if we may judge by the recordsof creation, are inherently and essentially necessaryin the present order of things. A perfect intelligence,trained by a perfect education, could do no more thankeep the laws of the physical and spiritual universe.An imperfect intelligence, imperfectly taught,—andthis is the condition of our finite humanity,—willcertainly fail to keep all these laws perfectly.Disease is one of the penalties of one of the formsof such failure. It is prefigured in the perturbationsof the planets, in the disintegration of the elementalmasses; it has left its traces in the fossil organismsof extinct creations. [Professor Agassiz has kindlyhanded me the following note: “There areabnormal structures in animals of all ages anteriorto the creation of mankind. Malformed specimensof Crinoids are known from the Triassic and Jurassicdeposits. Malformed and diseased bones of tertiarymammalia have been collected in the caverns of Gailenreuthwith traces of healing.”]
But it is especially the prerogative, I had almostsaid privilege, of educated and domesticated beings,from man down to the potato, serving to teach them,and such as train them, the laws of life, and to getrid of those who will not mind or cannot be kept subjectto these laws.
Disease, being always an effect, is always in exactproportion to the sum of its causes, as much in thecase of Spigelius, who dies of a scratch, as in thatof the man who recovers after an iron bar has beenshot through his brain. The one prevalent failingof the medical art is to neglect the causes and quarrelwith the effect.
There are certain general facts which include a gooddeal of what is called and treated as disease.Thus, there are two opposite movements of life tobe seen in cities and elsewhere, belonging to raceswhich, from various persistent causes, are breedingdown and tending to run out, and to races which arebreeding up, or accumulating vital capital,—adescending and an ascending series. Let me givean example of each; and that I may incidentally removea common impression about this country as comparedwith the Old World, an impression which got tipsy withconceit and staggered into the attitude of a formalproposition in the work of Dr. Robert Knox, I willillustrate the downward movement from English experience,and the upward movement from a family history belongingto this immediate neighborhood.
Miss Nightingale speaks of “the fact so oftenseen of a great-grandmother, who was a tower of physicalvigor, descending into a grandmother perhaps a littleless vigorous, but still sound as a bell, and healthyto the core, into a mother languid and confined toher carriage and house; and lastly into a daughtersickly and confined to her bed.” So muchfor the descending English series; now for the ascendingAmerican series.
Something more than one hundred and thirty years agothere graduated at Harvard College a delicate youth,who lived an invalid life and died at the age of aboutfifty. His two children were both of moderatephysical power, and one of them diminutive in stature.The next generation rose in physical development,and reached eighty years of age and more in some ofits members. The fourth generation was of fairaverage endowment. The fifth generation, great-great-grandchildrenof the slender invalid, are several of, them of extraordinarybodily and mental power; large in stature, formidablealike with their brains and their arms, organized ona more extensive scale than either of their parents.
This brief account illustrates incidentally the fallacyof the universal-degeneration theory applied to Americanlife; the same on which one of our countrymen haslately brought some very forcible facts to bear ina muscular discussion of which we have heard rathermore than is good for us. But the two series,American and English, ascending and descending, wereadduced with the main purpose of showing the immensedifference of vital endowments in different strainsof blood; a difference to which all ordinary medicationis in all probability a matter of comparatively trivialpurport. Many affections which art has to striveagainst might be easily shown to be vital to the well-beingof society. Hydrocephalus, tabes mesenterica,and other similar maladies, are natural agencies whichcut off the children of races that are sinking belowthe decent minimum which nature has established asthe condition of viability, before they reach theage of reproduction. They are really not so muchdiseases, as manifestations of congenital incapacityfor life; the race would be ruined if art could everlearn always to preserve the individuals subject tothem. We must do the best we can for them, butwe ought also to know what these “diseases”mean.
Again, invalidism is the normal state of many organizations.It can be changed to disease, but never to absolutehealth by medicinal appliances. There are manyladies, ancient and recent, who are perpetually takingremedies for irremediable pains and aches. Theyought to have headaches and back-aches and stomach-aches;they are not well if they do not have them. Toexpect them to live without frequent twinges is likeexpecting a doctor’s old chaise to go withoutcreaking; if it did, we might be sure the springswere broken. There is no doubt that the constantdemand for medicinal remedies from patients of thisclass leads to their over-use; often in the case ofcathartics, sometimes in that of opiates. I havebeen told by an intelligent practitioner in a Westerntown, that the constant prescription of opiates bycertain physicians in his vicinity has rendered thehabitual use of that drug in all that region veryprevalent; more common, I should think, than alcoholicdrunkenness in the most intemperate localities ofwhich I have known anything. A frightful endemicdemoralization betrays itself in the frequency withwhich the haggard features and drooping shouldersof the opium-drunkards are met with in the streets.
The next proposition I would ask you to consider isthis: The presumption always is that every noxiousagent, including medicines proper, which hurts a wellman, hurts a sick one. [ Note B.]
Let me illustrate this proposition before you decideupon it. If it were known that a prize-fighterwere to have a drastic purgative administered twoor three days before a contest, or a large blisterapplied to his back, no one will question that itwould affect the betting on his side unfavorably;we will say to the amount of five per cent. Nowthe drain upon the resources of the system producedin such a case must be at its minimum, for the subjectis a powerful man, in the prime of life, and in admirablecondition. If the drug or the blister takes fiveper cent. from his force of resistance, it will takeat least as large a fraction from any invalid.But this invalid has to fight a champion who strikeshard but cannot be hit in return, who will press himsharply for breath, but will never pant himself whilethe wind can whistle through his fleshless ribs.The suffering combatant is liable to want all hisstamina, and five per cent. may lose him the battle.
All noxious agents, all appliances which are not naturalfood or stimuli, all medicines proper, cost a patient,on the average, five per cent. of his vital force,let us say. Twenty times as much waste of forceproduced by any of them, that is, would exactly killhim, nothing less than kill him, and nothing more.If this, or something like this, is true, then allthese medications are, prima facie, injurious.
In the game of Life-or-Death, Rouge et Noir, as playedbetween the Doctor and the Sexton, this five per cent.,this certain small injury entering into the chancesis clearly the sexton’s perquisite for keepingthe green table, over which the game is played, andwhere he hoards up his gains. Suppose a blisterto diminish a man’s pain, effusion or dyspnoeato the saving of twenty per cent. in vital force;his profit from it is fifteen, in that case, for italways hurts him five to begin with, according toour previous assumption.
Presumptions are of vast importance in medicine, asin law. A man is presumed innocent until he isproved guilty. A medicine—that is,a noxious agent, like a blister, a seton, an emetic,or a cathartic —should always be presumedto be hurtful. It always is directly hurtful;it may sometimes be indirectly beneficial. Ifthis presumption were established, and disease alwaysassumed to be the innocent victim of circ*mstances,and not punishable by medicines, that is, noxious agents,or poisons, until the contrary was shown, we shouldnot so frequently hear the remark commonly, perhapserroneously, attributed to Sir Astley Cooper, butoften repeated by sensible persons, that, on the whole,more harm than good is done by medication. Throwout opium, which the Creator himself seems to prescribe,for we often see the scarlet poppy growing in thecornfields, as if it were foreseen that wherever thereis hunger to be fed there must also be pain to besoothed; throw out a few specifics which our art didnot discover, and is hardly needed to apply [ NoteC.]; throw out wine, which is a food, and the vaporswhich produce the miracle of anaesthesia, and I firmlybelieve that if the whole materia medica, as now used,could be sunk to the bottom of the sea, it would beall the better for mankind,—and all theworse for the fishes.
But to justify this proposition, I must add that theinjuries inflicted by over-medication are to a greatextent masked by disease. Dr. Hooker believesthat the typhus syncopatia of a preceding generationin New England “was often in fact a brandy andopium disease.” How is a physician to distinguishthe irritation produced by his blister from that causedby the inflammation it was meant to cure? Howcan he tell the exhaustion produced by his evacuantsfrom the collapse belonging to the disease they weremeant to remove?
Lastly, medication without insuring favorable hygienicconditions is like amputation without ligatures.I had a chance to learn this well of old, when physicianto the Broad Street district of the Boston Dispensary.There, there was no help for the utter want of wholesomeconditions, and if anybody got well under my care,it must have been in virtue of the rough-and-tumbleconstitution which emerges from the struggle for lifein the street gutters, rather than by the aid of myprescriptions.
But if the materia medica were lost overboard, howmuch more pains would be taken in ordering all thecirc*mstances surrounding the patient (as can be doneeverywhere out of the crowded pauper districts), thanare taken now by too many who think they do theirduty and earn their money when they write a recipefor a patient left in an atmosphere of domestic malaria,or to the most negligent kind of nursing! I confessthat I should think my chance of recovery from illnessless with Hippocrates for my physician and Mrs. Gampfor my nurse, than if I were in the hands of Hahnemannhimself, with Florence Nightingale or good RebeccaTaylor to care for me.
If I am right in maintaining that the presumptionis always against the use of noxious agents in disease,and if any whom I might influence should adopt thisas a principle of practice, they will often find themselvesembarrassed by the imperative demand of patients andtheir friends for such agents where a case is notmade out against this standing presumption. Imust be permitted to say, that I think the French,a not wholly uncivilized people, are in advance ofthe English and ourselves in the art of prescribingfor the sick without hurting them. And I do confessthat I think their varied ptisans and syrups are asmuch preferable to the mineral regimen of bug-poisonand ratsbane, so long in favor on the other side ofthe Channel, as their art of preparing food for thetable to the rude cookery of those hard-feeding andmuch-dosing islanders. We want a reorganized cuisineof invalidism perhaps as much as the culinary, reform,for which our lyceum lecturers, and others who livemuch at hotels and taverns, are so urgent. Willyou think I am disrespectful if I ask whether, evenin Massachusetts, a dose of calomel is not sometimesgiven by a physician on the same principle as thatupon which a landlord occasionally prescribes baconand eggs,—because he cannot think of anythingelse quite so handy? I leave my suggestion ofborrowing a hint from French practice to your matureconsideration.
I may, however, call your attention, briefly, to thesingular fact, that English and American practitionersare apt to accuse French medical practice of inertness,and French surgical practice of unnecessary activity.Thus, Dr. Bostock considers French medical treatment,with certain exceptions, as “decidedly lesseffective” than that of his own country. Mr. S. Cooper, again, defends the simple British practiceof procuring union by the first intention againstthe attacks of M. Roux and Baron Larrey. [Cooper’sSurg. Diet. art. “Wounds.”Yet Mr. John Bell gives the French surgeons creditfor introducing this doctrine of adhesion, and accusesO’Halloran of “rudeness and ignorance,”and “bold, uncivil language,” in disputingtheir teaching. Princ. of Surgery, vol. i. p.42. Mr. Hunter succeeded at last in naturalizingthe doctrine and practice, but even he had to struggleagainst the perpetual jealousy of rivals, and diedat length assassinated by an insult.] We have oftenheard similar opinions maintained by our own countrymen.While Anglo-American criticism blows hot or cold onthe two departments of French practice, it is not,I hope, indecent to question whether all the wisdomis necessarily with us in both cases.
Our art has had two or three lessons which have adeep meaning to those who are willing to read themhonestly. The use of water-dressings in surgerycompleted the series of reforms by which was abolishedthe “coarse and cruel practice” of theolder surgeons, who with their dressings and acridbalsams, their tents and leaden tubes, “absolutelydelayed the cure.” The doctrine of Broussais,transient as was its empire, reversed the practiceof half of Christendom for a season, and taught itshasty disciples to shun their old favorite remediesas mortal poisons. This was not enough permanentlyto shift the presumption about drugs where it belonged,and so at last, just as the sympathetic powder andthe Unguentum Armarium came in a superstitious ageto kill out the abuses of external over-medication,the solemn farce of hom*oeopathy was enacted in theface of our own too credulous civilization, that undershelter of its pretences the “inward bruises”of over-drugged viscera might be allowed to heal bythe first intention. Its lesson we must accept,whether we will or not; its follies we are tired oftalking about. The security of the medical professionagainst this and all similar fancies is in the averageconstitution of the human mind with regard to thelaws of evidence.
My friends and brothers in Art! There is nothingto be feared from the utterance of any seeming heresyto which you may have listened. I cannot compromiseyour collective wisdom. If I have strained thetruth one hair’s breadth for the sake of anepigram or an antithesis, you are accustomed to countthe normal pulse-beats of sound judgment, and knowfull well how to recognize the fever-throbs of conceitand the nervous palpitations of rhetoric.
The freedom with which each of us speaks his thoughtin this presence, belongs in part to the assured positionof the Profession in our Commonwealth, to the attitudeof Science, which is always fearless, and to the geniusof the soil on which we stand, from which Nature withheldthe fatal gift of malaria only to fill it with exhalationsthat breed the fever of inquiry in our blood and inour brain. But mainly we owe the large licenseof speech we enjoy to those influences and privilegescommon to us all as self-governing Americans.
This Republic is the chosen home of minorities, ofthe less power in the presence of the greater.It is a common error to speak of our distinction asconsisting in the rule of the majority. Majorities,the greater material powers, have always ruled before.The history of most countries has been that of majorities,mounted majorities, clad in iron, armed with deathtreading down the tenfold more numerous minorities.In the old civilizations they root themselves likeoaks in the soil; men must live in their shadow orcut them down. With us the majority is only theflower of the passing noon, and the minority is thebud which may open in the next morning’s sun.We must be tolerant, for the thought which stammerson a single tongue today may organize itself in thegrowing consciousness of the time, and come back tous like the voice of the multitudinous waves of theocean on the morrow.
Twenty-five years have passed since one of your honoredPresidents spoke to this Society of certain limitationsto the power of our Art, now very generally conceded.Some were troubled, some were almost angry, thinkingthe Profession might suffer from such concessions.It has certainly not suffered here; if, as some affirm,it has lost respect anywhere, it was probably forother, and no doubt sufficient reasons.
Since that time the civilization of this planet haschanged hands. Strike out of existence at thismoment every person who was breathing on that day,May 27, 1835, and every institution of society, everyart and every science would remain intact and completein the living that would be left. Every ideathe world then held has been since dissolved and recrystallized.
We are repeating the same process. Not to makesilver shrines for our old divinities, even thoughby this craft we should have our wealth, was thisSociety organized and carried on by the good men andtrue who went before us. Not for this, but tomelt the gold out of the past, though its dross shouldfly in dust to all the winds of heaven, to save allour old treasures of knowledge and mine deeply fornew, to cultivate that mutual respect of which outwardcourtesy is the sign, to work together, to feel together,to take counsel together, and to stand together forthe truth, now, always, here, everywhere; for thisour fathers instituted, and we accept, the officesand duties of this time-honored Society.
BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
An Introductory Lecture delivered before the MedicalClass of Harvard University, November 6, 1861.
[This Lecture appears as it would have been deliveredhad the time allowed been less strictly, limited.Passages necessarily omitted have been restored, andpoints briefly touched have been more fully considered.A few notes have been added for the benefit of thatlimited class of students who care to track an authorthrough the highways and by-ways of his reading.I owe my thanks to several of my professional brethrenwho have communicated with me on subjects with whichthey are familiar; especially to Dr. John Dean, forthe opportunity of profiting by his unpublished labors,and to Dr. Hasket Derby, for information and referencesto recent authorities relating to the anatomy and physiologyof the eye.]
The entrance upon a new course of Lectures is alwaysa period of interest to instructors and pupils.As the birth of a child to a parent, so is the adventof a new class to a teacher. As the light of theuntried world to the infant, so is the dawning ofthe light resting over the unexplored realms of scienceto the student. In the name of the Faculty Iwelcome you, Gentlemen of the Medical Class, new-bornbabes of science, or lustier nurslings, to this morningof your medical life, and to the arms and the bosomof this ancient University. Fourteen years agoI stood in this place for the first time to addressthose who occupied these benches. As I recallthese past seasons of our joint labors, I feel thatthey have been on the whole prosperous, and not undeservingof their prosperity.
For it has been my privilege to be associated witha body of true and faithful workers; I cannot praisethem freely to their faces, or I should be proud todiscourse of the harmonious diligence and the noblespirit in which they have toiled together, not merelyto teach their several branches, but to elevate thewhole standard of teaching.
I may speak with less restraint of those gentlemenwho have aided me in the most laborious part of mydaily duties, the Demonstrators, to whom the successiveclasses have owed so much of their instruction.They rise before me, the dead and the living, in themidst of the most grateful recollections. Thefair, manly face and stately figure of my friend, Dr.Samuel Parkman, himself fit for the highest officesof teaching, yet willing to be my faithful assistantin the time of need, come back to me with the longsigh of regret for his early loss to our earthly companionship.Every year I speak the eulogy of Dr. Ainsworth’spatient toil as I show his elaborate preparations:When I take down my “American Cyclopaedia”and borrow instruction from the learned articles ofDr. Kneeland, I cease to regret that his indefatigableand intelligent industry was turned into a broaderchannel. And what can I say too cordial of mylong associated companion and friend, Dr. Hodges, whoseadmirable skill, working through the swiftest and surestfingers that ever held a scalpel among us, has delightedclass after class, and filled our Museum with monumentswhich will convey his name to unborn generations?
This day belongs, however, not to myself and my recollections,but to all of us who teach and all of you who listen,whether experts in our specialties or aliens to theirmysteries, or timid neophytes just entering the portalsof the hall of science. Look in with me, then,while I attempt to throw some rays into its interior,which shall illuminate a few of its pillars and cornices,and show at the same time how many niches and alcovesremain in darkness.
Science is the topography of ignorance.From a few elevated points we triangulate vast spaces,inclosing infinite unknown details. We cast thelead, and draw up a little sand from abysses we maynever reach with our dredges.
The best part of our knowledge is that which teachesus where knowledge leaves off and ignorance begins.Nothing more clearly separates a vulgar from a superiormind, than the confusion in the first between the littlethat it truly knows, on the one hand, and what it halfknows and what it thinks it knows on the other.
That which is true of every subject is especiallytrue of the branch of knowledge which deals with livingbeings. Their existence is a perpetual deathand reanimation. Their identity is only an idea,for we put off our bodies many times during our lives,and dress in new suits of bones and muscles.
“Thouart not thyself;
For thou exist’st on manya thousand grains
That issue out of dust.”
If it is true that we understand ourselves but imperfectlyin health, this truth is more signally manifestedin disease, where natural actions imperfectly understood,disturbed in an obscure way by half-seen causes, arecreeping and winding along in the dark toward theirdestined issue, sometimes using our remedies as safestepping-stones, occasionally, it may be, stumblingover them as obstacles.
I propose in this lecture to show you some pointsof contact between our ignorance and our knowledgein several of the branches upon the study of whichyou are entering. I may teach you a very littledirectly, but I hope much more from the trains ofthought I shall suggest. Do not expect too muchground to be covered in this rapid survey. Ourtask is only that of sending out a few pickets underthe starry flag of science to the edge of that darkdomain where the ensigns of the obstinate rebel, Ignorance,are flying undisputed. We are not making a reconnoissancein force, still less advancing with the main column.But here are a few roads along which we have to marchtogether, and we wish to see clearly how far our linesextend, and where the enemy’s outposts begin.
Before touching the branches of knowledge that dealwith organization and vital functions, let us glanceat that science which meets you at the threshold ofyour study, and prepares you in some measure to dealwith the more complex problems of the living laboratory.
Chemistry. includes the art of separating andcombining the elements of matter, and the study ofthe changes produced by these operations. We canhardly say too much of what it has contributed to ourknowledge of the universe and our power of dealingwith its materials. It has given us a catalogueraisonne of the substances found upon our planet, andshown how everything living and dead is put togetherfrom them. It is accomplishing wonders beforeus every day, such as Arabian story-tellers used tostring together in their fables. It spreads the,sensitive film on the artificial retina which looksupon us through the optician’s lens for a fewseconds, and fixes an image that will outlive its original.It questions the light of the sun, and detects thevaporized metals floating around the great luminary,—iron,sodium, lithium, and the rest,—as if thechemist of our remote planet could fill his bell-glassesfrom its fiery atmosphere. It lends the powerwhich flashes our messages in thrills that leave thelazy chariot of day behind them. It seals up afew dark grains in iron vases, and lo! at the touchof a single spark, rises in smoke and flame a mightyAfrit with a voice like thunder and an arm that shatterslike an earthquake. The dreams of Oriental fancyhave become the sober facts of our every-day life,and the chemist is the magician to whom we owe them.
To return to the colder scientific aspect of chemistry.It has shown us how bodies stand affected to eachother through an almost boundless range of combinations.It has given us a most ingenious theory to accountfor certain fixed relations in these combinations.It has successfully eliminated a great number of proximatecompounds, more or less stable, from organic structures.It has invented others which form the basis of longseries of well-known composite substances. Infact, we are perhaps becoming overburdened with ourlist of proximate principles, demonstrated and hypothetical.
How much nearer have we come to the secret of forcethan Lully and Geber and the whole crew of jugglingalchemists? We have learned a great deal aboutthe how, what have we learned about the why?
Why does iron rust, while gold remains untarnished,and gold amalgamate, while iron refuses the allianceof mercury?
The alchemists called gold Sol, the sun, and ironMars, and pleased themselves with fancied relationsbetween these substances and the heavenly bodies,by which they pretended to explain the facts theyobserved. Some of their superstitions have lingeredin practical medicine to the present day, but chemistryhas grown wise enough to confess the fact of absoluteignorance.
What is it that makes common salt crystallize in theform of cubes, and saltpetre in the shape of six-sidedprisms? We see no reason why it should not havebeen just the other way, salt in prisms and saltpetrein cubes, or why either should take an exact geometricaloutline, any more than coagulating albumen.
But although we had given up attempting to explainthe essential nature of affinities and of crystallinetypes, we might have supposed that we had at leastfixed the identity of the substances with which wedeal, and determined the laws of their combination.All at once we find that a simple substance changesface, puts off its characteristic qualities and resumesthem at will;—not merely when we liquefyor vaporize a solid, or reverse the process; but thata solid is literally transformed into another solidunder our own eyes. We thought we knew phosphorus.We warm a portion of it sealed in an empty tube, forabout a week. It has become a brown infusiblesubstance, which does not shine in the dark nor oxidatein the air. We heat it to 500 F., and it becomescommon phosphorus again. We transmute sulphurin the same singular way. Nature, you know, givesus carbon in the shape of coal and in that of the diamond.It is easy to call these changes by the name allotropism,but not the less do they confound our hasty generalizations.
These facts of allotropism have some corollaries connectedwith them rather startling to us of the nineteenthcentury. There may be other transmutations possiblebesides those of phosphorus and sulphur. WhenDr. Prout, in 1840, talked about azote and carbonbeing “formed” in the living system, itwas looked upon as one of those freaks of fancy towhich philosophers, like other men, are subject.But when Professor Faraday, in 1851, says, at a meetingof the British Association, that “his hopesare in the direction of proving that bodies calledsimple were really compounds, and may be formed artificiallyas soon as we are masters of the laws influencingtheir combinations,”—when he comesforward and says that he has tried experiments at transmutation,and means, if his life is spared, to try them again,—howcan we be surprised at the popular story of 1861,that Louis Napoleon has established a gold-factoryand is glutting the mints of Europe with bullion ofhis own making?
And so with reference to the law of combinations.The old maxim was, Corpora non agunt nisi soluta.If two substances, a and b, are inclosed in a glassvessel, c, we do not expect the glass to change them,unless a or b or the compound a b has the power ofdissolving the glass. But if for a I take oxygen,for b hydrogen, and for c a piece of spongy platinum,I find the first two combine with the common signsof combustion and form water, the third in the meantime undergoing no perceptible change. It hasplayed the part of the unwedded priest, who marriesa pair without taking a fee or having any further relationwith the parties. We call this catalysis, catalyticaction, the action of presence, or by what learnedname we choose. Give what name to it we will,it is a manifestation of power which crosses our establishedlaws of combination at a very open angle of intersection.I think we may find an analogy for it in electricalinduction, the disturbance of the equilibrium of theelectricity of a body by the approach of a chargedbody to it, without interchange of electrical conditionsbetween the two bodies. But an analogy is notan explanation, and why a few drops of yeast shouldchange a saccharine mixture to carbonic acid and alcohol,—alittle leaven leavening the whole lump,—notby combining with it, but by setting a movement atwork, we not only cannot explain, but the fact issuch an exception to the recognized laws of combinationthat Liebig is unwilling to admit the new force atall to which Berzelius had given the name so generallyaccepted.
The phenomena of isomerism, or identity of compositionand proportions of constituents with difference ofqualities, and of isomorphism, or identity of formin crystals which have one element substituted foranother, were equally surprises to science; and althoughthe mechanism by which they are brought about canbe to a certain extent explained by a reference tothe hypothetical atoms of which the elements are constituted,yet this is only turning the difficulty into a fractionwith an infinitesimal denominator and an infinitenumerator.
So far we have studied the working of force and itsseeming anomalies in purely chemical phenomena.But we soon find that chemical force is developedby various other physical agencies,—by heat,by light, by electricity, by magnetism, by mechanicalagencies; and, vice versa, that chemical action developsheat, light, electricity, magnetism, mechanical force,as we see in our matches, galvanic batteries, and explosivecompounds. Proceeding with our experiments, wefind that every kind of force is capable of producingall other kinds, or, in Mr. Faraday’s language,that “the various forms under which the forcesof matter are made manifest have a common origin,or, in other words, are so directly related and mutuallydependent that they are convertible one into another.”
Out of this doctrine naturally springs that of theconservation of force, so ably illustrated by Mr.Grove, Dr. Carpenter, and Mr. Faraday. This ideais no novelty, though it seems so at first sight.It was maintained and disputed among the giants ofphilosophy. Des Cartes and Leibnitz denied thatany new motion originated in nature, or that any everceased to exist; all motion being in a circle, passingfrom one body to another, one losing what the othergained. Newton, on the other hand, believed thatnew motions were generated and existing ones destroyed.On the first supposition, there is a fixed amountof force always circulating in the universe.On the second, the total amount may be increasing ordiminishing. You will find in the “Annualof Scientific Discovery” for 1858 a very interestinglecture by Professor Helmholtz of Bonn, in which itis maintained that a certain portion of force is lostin every natural process, being converted into unchangeableheat, so that the universe will come to a stand-stillat last, all force passing into heat, and all heatinto a state of equilibrium.
The doctrines of the convertibility or specific equivalenceof the various forms of force, and of its conservation,which is its logical consequence, are very generallyaccepted, as I believe, at the present time, amongphysicists. We are naturally led to the question,What is the nature of force? The three illustriousphilosophers just referred to agree in attributingthe general movements of the universe to the immediateDivine action. The doctrine of “preestablishedharmony” was an especial contrivance of Leibnitzto remove the Creator from unworthy association withthe less divine acts of living beings. Obsoleteas this expression sounds to our ears, the phraselaws of the universe, which we use so constantly witha wider application, appears to me essentially identicalwith it.
Force does not admit of explanation, nor of properdefinition, any more than the hypothetical substratumof matter. If we assume the Infinite as omnipresent,omniscient, omnipotent, we cannot suppose Him excludedfrom any part of His creation, except from rebellioussouls which voluntarily exclude Him by the exerciseof their fatal prerogative of free-will. Force,then, is the act of immanent Divinity. I findno meaning in mechanical explanations. Newton’shypothesis of an ether filling the heavenly spacesdoes not, I confess, help my conceptions. I will,and the muscles of my vocal organs shape my speech.God wills, and the universe articulates His power,wisdom, and goodness. That is all I know.There is no bridge my mind can throw from the “immaterial”cause to the “material” effect.
The problem of force meets us everywhere, and I preferto encounter it in the world of physical phenomenabefore reaching that of living actions. It isonly the name for the incomprehensible cause of certainchanges known to our consciousness, and assumed tobe outside of it. For me it is the Deity Himselfin action.
I can therefore see a large significance in the somewhatbold language of Burdach: “There is forme but one miracle, that of infinite existence, andbut one mystery, the manner in which the finite proceedsfrom the infinite. So soon as we recognize thisincomprehensible act as the general and primordialmiracle, of which our reason perceives the necessity,but the manner of which our intelligence cannot grasp,so soon as we contemplate the nature known to us byexperience in this light, there is for us no otherimpenetrable miracle or mystery.”
Let us turn to a branch of knowledge which deals withcertainties up to the limit of the senses, and isinvolved in no speculations beyond them. In certainpoints of view, human anatomy may be consideredan almost exhausted science. From time to timesome small organ which had escaped earlier observershas been pointed out,—such parts as thetensor tarsi, the otic ganglion, or the Pacinian bodies;but some of our best anatomical works are those whichhave been classic for many generations. The platesof the bones in Vesalius, three centuries old, arestill masterpieces of accuracy, as of art. Themagnificent work of Albinus on the muscles, publishedin 1747, is still supreme in its department, as theconstant references of the most thorough recent treatiseon the subject, that of Theile, sufficiently show.More has been done in unravelling the mysteries ofthe fasciae, but there has been a tendency to overdothis kind of material analysis. Alexander Thomsonsplit them up into cobwebs, as you may see in theplates to Velpeau’s Surgical Anatomy. Iwell remember how he used to shake his head over thecoarse work of Scarpa and Astley Cooper,—asif Denner, who painted the separate hairs of the beardand pores of the skin in his portraits, had spokenlightly of the pictures of Rubens and Vandyk.
Not only has little been added to the catalogue ofparts, but some things long known had become half-forgotten.Louis and others confounded the solitary glands ofthe lower part of the small intestine with those which“the great Brunner,” as Haller calls him,described in 1687 as being found in the duodenum.The display of the fibrous structure of the brainseemed a novelty as shown by Spurzheim. One isstartled to find the method anticipated by RaymondVieussens nearly two centuries ago. I can hardlythink Gordon had ever looked at his figures, thoughhe names their author, when he wrote the captiousand sneering article which attracted so much attentionin the pages of the “Edinburgh Review.”
This is the place, if anywhere, to mention any observationsI could pretend to have made in the course of my teachingthe structure of the human body. I can make nobetter show than most of my predecessors in this well-reapedfield. The nucleated cells found connected withthe cancellated structure of the bones, which I firstpointed out and had figured in 1847, and have shownyearly from that time to the present, and the fossamasseterica, a shallow concavity on the ramus of thelower jaw, for the lodgment of the masseter muscle,which acquires significance when examined by the sideof the deep cavity on the corresponding part in somecarnivora to which it answers, may perhaps be claimedas deserving attention. I have also pleased myselfby making a special group of the six radiating muscleswhich diverge from the spine of the axis, or secondcervical vertebra, and by giving to it the name stellamusculosa nuchaee. But this scanty catalogueis only an evidence that one may teach long and seelittle that has not been noted by those who have gonebefore him. Of course I do not think it necessaryto include rare, but already described anomalies,such as the episternal bones, the rectus sternalis,and other interesting exceptional formations I haveencountered, which have shown a curious tendency topresent themselves several times in the same season,perhaps because the first specimen found calls ourattention to any we may subsequently meet with.
The anatomy of the scalpel and the amphitheatre was,then, becoming an exhausted branch of investigation.But during the present century the study of the humanbody has changed its old aspect, and become fertilein new observations. This rejuvenescence waseffected by means of two principal agencies,—newmethods and a new instrument.
Descriptive anatomy, as known from an early date,is to the body what geography is to the planet.Now geography was pretty well known so long ago aswhen Arrowsmith, who was born in 1750, published hisadmirable maps. But in that same year was bornWerner, who taught a new way of studying the earth,since become familiar to us all under the name ofGeology.
What geology has done for our knowledge of the earth,has been done for our knowledge of the body by thatmethod of study to which is given the name of GeneralAnatomy. It studies, not the organs as such, butthe elements out of which the organs are constructed.It is the geology of the body, as that is the generalanatomy of the earth. The extraordinary geniusof Bichat, to whom more than any other we owe thisnew method of study, does not require Mr. Buckle’stestimony to impress the practitioner with the importanceof its achievements. I have heard a very wisephysician question whether any important result hadaccrued to practical medicine from Harvey’sdiscovery of the circulation. But Anatomy, Physiology,and Pathology have received a new light from thisnovel method of contemplating the living structures,which has had a vast influence in enabling the practitionerat least to distinguish and predict the course ofdisease. We know as well what differences toexpect in the habits of a mucous and of a serous membrane,as what mineral substances to look for in the chalkor the coal measures. You have only to read Cullen’sdescription of inflammation of the lungs or of thebowels, and compare it with such as you may find inLaennec or Watson, to see the immense gain which diagnosisand prognosis have derived from general anatomy.
The second new method of studying the human structure,beginning with the labors of Scarpa, Burns, and Colles,grew up principally during the first third of thiscentury. It does not deal with organs, as didthe earlier anatomists, nor with tissues, after themanner of Bichat. It maps the whole surface ofthe body into an arbitrary number of regions, andstudies each region successively from the surface tothe bone, or beneath it. This hardly deservesthe name of a science, although Velpeau has dignifiedit with that title, but it furnishes an admirable practicalway for the surgeon who has to operate on a particularregion of the body to study that region. If weare buying a farm, we are not content with the Statemap or a geological chart including the estate in question.We demand an exact survey of that particular property,so that we may know what we are dealing with.This is just what regional, or, as it is sometimescalled, surgical anatomy, does for the surgeon withreference to the part on which his skill is to beexercised. It enables him to see with the mind’seye through the opaque tissues down to the bone onwhich they lie, as if the skin were transparent asthe cornea, and the organs it covers translucent asthe gelatinous pulp of a medusa.
It is curious that the Japanese should have anticipatedEurope in a kind of rude regional anatomy. Ihave seen a manikin of Japanese make traced all overwith lines, and points marking their intersection.By this their doctors are guided in the performanceof acupuncture, marking the safe places to thrustin needles, as we buoy out our ship-channels, anddoubtless indicating to learned eyes the spots whereincautious meddling had led to those little accidentsof shipwreck to which patients are unfortunately liable.
A change of method, then, has given us General andRegional Anatomy. These, too, have been workedso thoroughly, that, if not exhausted, they have atleast become to a great extent fixed and positive branchesof knowledge. But the first of them, GeneralAnatomy, would never, have reached this positive conditionbut for the introduction of that, instrument whichI have mentioned as the second great aid to modernprogress.
This instrument is the achromatic microscope.For the history of the successive steps by which itbecame the effective scientific implement we now possess,I must refer you to the work of Mr. Quekett, to anexcellent article in the “Penny Cyclopaedia,”or to that of Sir David Brewster in the “EncyclopaediaBritannica.” It is a most interesting pieceof scientific history, which shows how the problemwhich Biot in 1821 pronounced insolvable was in thecourse of a few years practically solved, with a successequal to that which Dollond had long before obtainedwith the telescope. It is enough for our purposethat we are now in possession of an instrument freedfrom all confusions and illusions, which magnifiesa thousand diameters,—a million times insurface,—without serious distortion or discolorationof its object.
A quarter of a century ago, or a little more, an instructorwould not have hesitated to put John Bell’s“Anatomy” and Bostock’s “Physiology”into a student’s hands, as good authority ontheir respective subjects. Let us not be unjustto either of these authors. John Bell is theliveliest medical writer that I can remember who haswritten since the days of delightful old AmbroisePare. His picturesque descriptions and bold figuresare as good now as they ever were, and his book cannever become obsolete. But listen to what JohnBell says of the microscope:
“Philosophers of the last age had been at infinitepains to find the ultimate fibre of muscles, thinkingto discover its properties in its form; but they sawjust in proportion to the glasses which they used,or to their practice and skill in that art, whichis now almost forsaken.”
Dr. Bostock’s work, neglected as it is, is onewhich I value very highly as a really learned compilation,full of original references. But Dr. Bostocksays: “Much as the naturalist has been indebtedto the microscope, by bringing into view many beingsof which he could not otherwise have ascertained theexistence, the physiologist has not yet derived anygreat benefit from the instrument.”
These are only specimens of the manner in which themicroscope and its results were generally regardedby the generation just preceding our own.
I have referred you to the proper authorities forthe account of those improvements which about theyear 1830 rendered the compound microscope an efficientand trustworthy instrument. It was now for thefirst time that a true general anatomy became possible.As early as 1816 Treviranus had attempted to resolvethe tissues, of which Bichat had admitted no lessthan twenty-one, into their simple microscopic elements.How could such an attempt succeed, Henle well asks,at a time when the most extensively diffused of allthe tissues, the areolar, was not at all understood?All that method could do had been accomplished by Bichatand his followers. It was for the optician totake the next step. The future of anatomy andphysiology, as an enthusiastic micrologist of thetime said, was in the hands of Messrs. Schieck andPistor, famous opticians of Berlin.
In those earlier days of which I am speaking, allthe points of minute anatomy were involved in obscurity.Some found globules everywhere, some fibres.Students disputed whether the conjunctiva extendedover the cornea or not, and worried themselves overGaultier de Claubry’s stratified layers of theskin, or Breschet’s blennogenous and chromatogenousorgans. The dartos was a puzzle, the central spinalcanal a myth, the decidua clothed in fable as muchas the golden fleece. The structure of bone,now so beautifully made out,—even that ofthe teeth, in which old Leeuwenhoek, peeping withhis octogenarian eyes through the minute lenses wroughtwith his own hands, had long ago seen the “pipes,”as he called them,—was hardly known at all.The minute structure of the viscera lay in the mistsof an uncertain microscopic vision. The intimaterecesses of the animal system were to the studentsof anatomy what the anterior of Africa long was togeographers, and the stories of microscopic explorerswere as much sneered at as those of Bruce or Du Chailly,and with better reason.
Now what have we come to in our own day? In thefirst place, the minute structure of all the organshas been made out in the most satisfactory way.The special arrangements of the vessels and the ductsof all the glands, of the air-tubes and vesicles ofthe lungs, of the parts which make up the skin andother membranes, all the details of those complexparenchymatous organs which had confounded investigationso long, have been lifted out of the invisible intothe sight of all observers. It is fair to mentionhere, that we owe a great deal to the art of minuteinjection, by which we are enabled to trace the smallestvessels in the midst of the tissues where they aredistributed. This is an old artifice of anatomists.The famous Ruysch, who died a hundred and thirty yearsago, showed that each of the viscera has its terminalvessels arranged in its own peculiar way; the samefact which you may see illustrated in Gerber’sfigures after the minute injections of Berres.I hope to show you many specimens of this kind in
the microscope, the work of English and American hands.Professor Agassiz allows me also to make use of avery rich collection of injected preparations senthim by Professor Hyrtl, formerly of Prague, now ofVienna, for the proper exhibition of which I had anumber of microscopes made expressly, by Mr. Grunow,during the past season. All this illustrateswhat has been done for the elucidation of the intimatedetails of formation of the organs.But the great triumph of the microscope as appliedto anatomy has been in the resolution of the organsand the tissues into their simple constituent anatomicalelements. It has taken up general anatomy whereBichat left it. He had succeeded in reducing thestructural language of nature to syllables, if youwill permit me to use so bold an image. The microscopicobservers who have come after him have analyzed theseinto letters, as we may call them,—thesimple elements by the combination of which Naturespells out successively tissues, which are her syllables,organs which are her words, systems which are her chapters,and so goes on from the simple to the complex, untilshe binds up in one living whole that wondrous volumeof power and wisdom which we call the human body.
The alphabet of the organization is so short and simple,that I will risk fatiguing your attention by repeatingit, according to the plan I have long adopted.
A. Cells, either floating, as in the blood, or fixed,like those in the cancellated structure of bone, alreadyreferred to. Very commonly they have undergonea change of figure, most frequently a flattening whichreduces them to scales, as in the epidermis and theepithelium.
B. Simple, translucent, hom*ogeneous solid, such asis found at the back of the cornea, or forming theintercellular substance of cartilage.
C. The white fibrous element, consisting of very delicate,tenacious threads. This is the long staple textilesubstance of the body. It is to the organismwhat cotton is pretended to be to our Southern States.It pervades the whole animal fabric as areolar tissue,which is the universal packing and wrapping material.It forms the ligaments which bind the whole frame-worktogether. It furnishes the sinews, which arethe channels of power. It enfolds every muscle.It wraps the brain in its hard, insensible folds,and the heart itself beats in a purse that is madeof it.
D. The yellow elastic, fibrous element, the caoutchoucof the animal mechanism, which pulls things back intoplace, as the India-rubber band shuts the door wehave opened.
E. The striped muscular fibre,—the redflesh, which shortens itself in obedience to the will,and thus produces all voluntary active motion.
F. The unstriped muscular fibre, more properly thefusiform-cell fibre, which carries on the involuntaryinternal movements.
G. The nerve-cylinder, a glassy tube, with a pithof some firmness, which conveys sensation to the brainand the principle which induces motion from it.
H. The nerve-corpuscle, the centre of nervous power.
I. The mucous tissue, as Virchow calls it, commonin embryonic structures, seen in the vitreous humorof the adult.
To these add X, granules, of indeterminate shape andsize, Y, for inorganic matters, such as the saltsof bone and teeth, and Z, to stand as a symbol ofthe fluids, and you have the letters of what I haveventured to call the alphabet of the body.
But just as in language certain diphthongs and syllablesare frequently recurring, so we have in the body certainsecondary and tertiary combinations, which we meetmore frequently than the solitary elements of whichthey are composed.
Thus A B, or a collection of cells united by simplestructureless solid, is seen to be extensively employedin the body under the name of cartilage. Outof this the surfaces of the articulations and the springsof the breathing apparatus are formed. But whenNature came to the buffers of the spinal column (intervertebraldisks) and the washers of the joints (semilunar fibrocartilagesof the knee, etc.), she required more tenacitythan common cartilage possessed. What did shedo? What does man do in a similar case of need?I need hardly tell you. The mason lays his bricksin simple mortar. But the plasterer works somehair into the mortar which he is going to lay in largesheets on the walls. The children of Israel complainedthat they had no straw to make their bricks with,though portions of it may still be seen in the crumblingpyramid of Darshour, which they are said to have built.I visited the old house on Witch Hill in Salem a yearor two ago, and there I found the walls coated withclay in which straw was abundantly mingled;—theold Judaizing witch-hangers copied the Israelites ina good many things. The Chinese and the Corsicansblend the fibres of amianthus in their pottery togive it tenacity. Now to return to Nature.To make her buffers and washers hold together in theshocks to which they would be subjected, she tookcommon cartilage and mingled the white fibrous tissuewith it, to serve the same purpose as the hair in themortar, the straw in the bricks and in the plasterof the old wall, and the amianthus in the earthenvessels. Thus we have the combination A B C, orfibro-cartilage. Again, the bones were once onlygristle or cartilage, A B. To give them solidity theywere infiltrated with stone, in the form of saltsof lime, an inorganic element, so that bone would bespelt out by the letters A, B, and Y.
If from these organic syllables we proceed to formorganic words, we shall find that Nature employs threeprincipal forms; namely, Vessels, Membranes, and Parenchyma,or visceral tissue. The most complex of themcan be resolved into a combination of these few simpleanatomical constituents.
Passing for a moment into the domain of pathologicalanatomy, we find the same elements in morbidgrowths that we have met with in normal structures.The pus-corpuscle and the white blood-corpuscle canonly be distinguished by tracing them to their origin.A frequent form of so-called malignant disease provesto be only a collection of altered epithelium-cells.Even cancer itself has no specific anatomical element,and the diagnosis of a cancerous tumor by the microscope,though tolerably sure under the eye of an expert,is based upon accidental, and not essential points,—thecrowding together of the elements, the size of thecell-nuclei, and similar variable characters.
Let us turn to physiology. The microscope,which has made a new science of the intimate structureof the organs, has at the same time cleared up manyuncertainties concerning the mechanism of the specialfunctions. Up to the time of the living generationof observers, Nature had kept over all her inner workshopsthe forbidding inscription, No Admittance! Ifany prying observer ventured to spy through his magnifyingtubes into the mysteries of her glands and canalsand fluids, she covered up her work in blinding mistsand bewildering halos, as the deities of old concealedtheir favored heroes in the moment of danger.
Science has at length sifted the turbid light of herlenses, and blanched their delusive rainbows.
Anatomy studies the organism in space. Physiologystudies it also in time. After the study of formand composition follows close that of action, andthis leads us along back to the first moment of thegerm, and forward to the resolution of the livingframe into its lifeless elements. In this wayAnatomy, or rather that branch of it which we callHistology, has become inseparably blended with thestudy of function. The connection between thescience of life and that of intimate structure onthe one hand, and composition on the other, is illustratedin the titles of two recent works of remarkable excellence,—“thePhysiological Anatomy” of Todd and Bowman, andthe “Physiological Chemistry” of Lehmann.
Let me briefly recapitulate a few of our acquisitionsin Physiology, due in large measure to our new instrumentsand methods of research, and at the same time indicatethe limits which form the permanent or the temporaryboundaries of our knowledge. I will begin withthe largest fact and with the most absolute and universallyencountered limitation.
The “largest truth in Physiology” Mr.Paget considers to be “the development of ovathrough multiplication and division of their cells.”I would state it more broadly as the agency of thecell in all living processes. It seems at presentnecessary to abandon the original idea of Schwann,that we can observe the building up of a cell fromthe simple granules of a blastema, or formative fluid.The evidence points rather towards the axiom, Omniscellula a cellula; that is, the germ of a new cellis always derived from a preexisting cell. Thedoctrine of Schwann, as I remarked long ago (1844),runs parallel with the nebular theory in astronomy,and they may yet stand or fall together.
As we have seen Nature anticipating the plastererin fibro-cartilage, so we see her beforehand withthe glassblower in her dealings with the cell.The artisan blows his vitreous bubbles, large or small,to be used afterwards as may be wanted. So Natureshapes her hyaline vesicles and modifies them to servethe needs of the part where they are found. Theartisan whirls his rod, and his glass bubble becomesa flattened disk, with its bull’s-eye for anucleus. These lips of ours are all glazed withmicroscopic tiles formed of flattened cells, each oneof them with its nucleus still as plain and relativelyas prominent, to the eye of the microscopist, as thebull’s-eye in the old-fashioned windowpane.Everywhere we find cells, modified or unchanged.They roll in inconceivable multitudes (five millionsand more to the cubic millimetre, according to Vierordt)as blood-disks through our vessels. A close-fittingmail of flattened cells coats our surface with a panoplyof imbricated scales (more than twelve thousand millions),as Harting has computed, as true a defence againstour enemies as the buckler of the armadillo or thecarapace of the tortoise against theirs. The samelittle protecting organs pave all the great highwaysof the interior system. Cells, again, presideover the chemical processes which elaborate the livingfluids; they change their form to become the agentsof voluntary and involuntary motion; the soul itselfsits on a throne of nucleated cells, and flashes itsmandates through skeins of glassy filaments whichonce were simple chains of vesicles. And, as ifto reduce the problem of living force to its simplestexpression, we see the yolk of a transparent egg dividingitself in whole or in part, and again dividing andsubdividing, until it becomes a mass of cells, outof which the harmonious diversity of the organs arrangesitself, worm or man, as God has willed from the beginning.
This differentiation having been effected, each severalpart assumes its special office, having a life ofits own adjusted to that of other parts and the whole.“Just as a tree constitutes a mass arranged ina definite manner, in which, in every single part,in the leaves as in the root, in the trunk as in theblossom, cells are discovered to be the ultimate elements,so is it also with the forms of animal life. Everyanimal presents itself as a sum of vital unities,every one of which manifests all the characteristicsof life.”
The mechanism is as clear, as unquestionable, as absolutelysettled and universally accepted, as the order ofmovement of the heavenly bodies, which we computebackward to the days of the observatories on the plainsof Shinar, and on the faith of which we regulate themovements of war and trade by the predictions of ourephemeris.
The mechanism, and that is all. We see the workmanand the tools, but the skill that guides the workand the power that performs it are as invisible asever. I fear that not every listener took thesignificance of those pregnant words in the passageI quoted from John Bell,—“thinkingto discover its properties in its form.”We have discovered the working bee in this great hiveof organization. We have detected the cell inthe very act of forming itself from a nucleus, oftransforming itself into various tissues, of selectingthe elements of various secretions. But why onecell becomes nerve and another muscle, why one selectsbile and another fat, we can no more pretend to tell,than why one grape sucks out of the soil the generousjuice which princes hoard in their cellars, and anotherthe wine which it takes three men to drink,—oneto pour it down, another to swallow it, and a thirdto hold him while it is going down. Certain analogiesbetween this selecting power and the phenomena ofendosmosis in the elective affinities of chemistrywe can find, but the problem of force remains here,as everywhere, unsolved and insolvable.
Do we gain anything by attempting to get rid of theidea of a special vital force because we find certainmutually convertible relations between forces in thebody and out of it? I think not, any more thanwe should gain by getting rid of the idea and expressionMagnetism because of its correlation with electricity.We may concede the unity of all forms of force, butwe cannot overlook the fixed differences of its manifestationsaccording to the conditions under which it acts.It is a mistake, however, to think the mystery isgreater in an organized body than in any other.We see a stone fall or a crystal form, and there isnothing stranger left to wonder at, for we have seenthe Infinite in action.
Just so far as we can recognize the ordinary modesof operation of the common forces of nature,—gravity,cohesion, elasticity, transudation, chemical action,and the rest,—we see the so-called vitalacts in the light of a larger range of known factsand familiar analogies. Matteuecci’s well-rememberedlectures contain many and striking examples of theworking of physical forces in physiological processes.Wherever rigid experiment carries us, we are safein following this lead; but the moment we begin totheorize beyond our strict observation, we are indanger of falling into those mechanical follies whichtrue science has long outgrown.
Recognizing the fact, then, that we have learned nothingbut the machinery of life, and are no nearer to itsessence, what is it that we have gained by this greatdiscovery of the cell formation and function?
It would have been reward enough to learn the methodNature pursues for its own sake. If the sovereignArtificer lets us into his own laboratories and workshops,we need not ask more than the privilege of lookingon at his work. We do not know where we now standin the hierarchy of created intelligences. Wewere made a little lower than the angels. I speakit not irreverently; as the lower animals surpass manin some of their attributes, so it may be that notevery angel’s eye can see as broadly and asdeeply into the material works of God as man himself,looking at the firmament through an equatorial of fifteeninches’ aperture, and searching into the tissueswith a twelfth of an inch objective.
But there are other positive gains of a more practicalcharacter. Thus we are no longer permitted toplace the seat of the living actions in the extremevessels, which are only the carriers from which eachpart takes what it wants by the divine right of theomnipotent nucleated cell. The organism has become,in the words already borrowed from Virchow, “asum of vital unities.” The strictum andlaxum, the increased and diminished action of thevessels, out of which medical theories and methodsof treatment have grown up, have yielded to the doctrineof local cell-communities, belonging to this or thatvascular district, from which they help themselves,as contractors are wont to do from the national treasury.
I cannot promise to do more than to select a few ofthe points of contact between our ignorance and ourknowledge which present particular interest in theexisting state of our physiological acquisitions.Some of them involve the microscopic discoveries ofwhich I have been speaking, some belong to the domainof chemistry, and some have relations with other departmentsof physical science.
If we should begin with the digestive function, weshould find that the long-agitated question of thenature of the acid of the gastric juice is becomingsettled in favor of the lactic. But the wholesolvent agency of the digestive fluid enters intothe category of that exceptional mode of action alreadyfamiliar to us in chemistry as catalysis. It istherefore doubly difficult of explanation; first,as being, like all reactions, a fact not to be accountedfor except by the imaginative appeal to “affinity,”and secondly, as being one of those peculiar reactionsprovoked by an element which stands outside and lookson without compromising itself.
The doctrine of Mulder, so widely diffused in popularand scientific belief, of the existence of a commonbase of all albuminous substances, the so-called protein,has not stood the test of rigorous analysis. Thedivision of food into azotized and non-azotized isno doubt important, but the attempt to show that thefirst only is plastic or nutritive, while the secondis simply calorifacient, or heat-producing, failsentirely in the face of the facts revealed by the studyof man in different climates, and of numerous experimentsin the feeding of animals. I must return to thissubject in connection with the respiratory function.
The sugar-making faculty of the liver is another “catalytic”mystery, as great as the rest of them, and no greater.Liver-tissue brings sugar out of the blood, or outof its own substance;—why?
Quia est in eo
Virtus saccharitiva.
Just what becomes of the sugar beyond the fact ofits disappearance before it can get into the generalcirculation and sweeten our tempers, it is hard tosay.
The pancreatic fluid makes an emulsion of the fatcontained in our food, but just how the fatty particlesget into the villi we must leave Brucke and Kollikerto settle if they can.
No one has shown satisfactorily the process by whichthe blood-corpuscles are formed out of the lymph-corpuscles,nor what becomes of them. These two questionsare like those famous household puzzles,—Wheredo the flies come from? and, Where do the pins goto?
There is a series of organs in the body which haslong puzzled physiologists,—organs of glandularaspect, but having no ducts,—the spleen,the thyroid and thymus bodies, and the suprarenal capsules.We call them vascular glands, and we believe thatthey elaborate colored and uncolored blood-cells;but just what changes they effect, and just how theyeffect them, it has proved a very difficult matterto determine. So of the noted glandules whichform Peyer’s patches, their precise office,though seemingly like those of the lymphatic glands,cannot be positively assigned, so far as I know, atthe present time. It is of obvious interest tolearn it with reference to the pathology of typhoidfever. It will be remarked that the coincidenceof their changes in this disease with enlargementof the spleen suggests the idea of a similarity offunction in these two organs.
The theories of the production of animal heat, fromthe times of Black, Lavoisier, and Crawford to thoseof Liebig, are familiar to all who have paid any attentionto physiological studies. The simplicity of Liebig’sviews, and the popular form in which they have beenpresented, have given them wide currency, and incorporatedthem in the common belief and language of our text-books.Direct oxidation or combustion of the carbon and hydrogencontained in the food, or in the tissues themselves;the division of alimentary substances into respiratory,or non-azotized, and azotized,—these doctrinesare familiar even to the classes in our high-schools.But this simple statement is boldly questioned.Nothing proves that oxygen combines (in the system)with hydrogen and carbon in particular, rather thanwith sulphur and azote. Such is the well-groundedstatement of Robin and Verdeil. “It is veryprobable that animal heat is entirely produced bythe chemical actions which take place in the organism,but the phenomenon is too complex to admit of ourcalculating it according to the quality of oxygen consumed.”These last are the words of Regnault, as cited byMr. Lewes, whose intelligent discussion of this andmany of the most interesting physiological problemsI strongly recommend to your attention.
This single illustration covers a wider ground thanthe special function to which it belongs. Weare learning that the chemistry of the body must bestudied, not simply by its ingesta and egesta, butthat there is a long intermediate series of changeswhich must be investigated in their own light, undertheir own special conditions. The expression “sumof vital unities” applies to the chemical actions,as well as to other actions localized in special parts;and when the distinguished chemists whom I have justcited entitle their work a treatise on the immediateprinciples of the body, they only indicate the natureof that profound and subtile analysis which must takethe place of all hasty generalizations founded ona comparison of the food with residual products.
I will only call your attention to the fact, thatthe exceptional phenomenon of the laboratory is theprevailing law of the organism. Nutrition itselfis but one great catalytic process. As the bloodtravels its rounds, each part selects its appropriateelement and transforms it to its own likeness.Whether the appropriating agent be cell or nucleus,or a structureless solid like the intercellular substanceof cartilage, the fact of its presence determines theseparation of its proper constituents from the circulatingfluid, so that even when we are wounded bone is replacedby bone, skin by skin, and nerve by nerve.
It is hardly without a smile that we resuscitate theold question of the ‘vis insita’ of themuscular fibre, so famous in the discussions of Hallerand his contemporaries. Speaking generally, Ithink we may say that Haller’s doctrine is theone now commonly received; namely, that the musclescontract in virtue of their own inherent endowments.It is true that Kolliker says no perfectly decisivefact has been brought forward to prove that the striatedmuscles contract without having been acted on by nerves.Yet Mr. Bowman’s observations on the contractionof isolated fibres appear decisive enough (unlesswe consider them invalidated by Dr. Lionel Beale’srecent researches), tending to show that each elementaryfibre is supplied with nerves; and as to the smoothmuscular fibres, we have Virchow’s statementrespecting the contractility of those of the umbilicalcord, where there is not a trace of any nerves.
In the investigation of the nervous system, anatomyand physiology have gone hand in hand. It isvery singular that so important, and seemingly simple,a fact as the connection of the nerve-tubes, at theirorigin or in their course, with the nerve-cells, shouldhave so long remained open to doubt, as you may seethat it did by referring to the very complete workof Sharpey and Quain (edition of 1849), the histologicalportion of which is cordially approved by Kollikerhimself.
Several most interesting points of the minute anatomyof the nervous centres have been laboriously and skilfullyworked out by a recent graduate of this Medical School,in a monograph worthy to stand in line with thoseof Lockhart Clarke, Stilling, and Schroder van derKolk. I have had the privilege of examining andof showing some of you a number of Dr. Dean’sskilful preparations. I have no space to giveeven an abstract of his conclusions. I can onlyrefer to his proof of the fact, that a single cellmay send its processes into several different bundlesof nerve-roots, and to his demonstration of the curvedascending and descending fibres from the posteriornerveroots, to reach what he has called the longitudinalcolumns of the cornea. I must also mention Dr.Dean’s exquisite microscopic photographs fromsections of the medulla oblongata, which appear tome to promise a new development, if not a new epoch,in anatomical art.
It having been settled that the nerve-tubes can verycommonly be traced directly to the nerve-cells, theobject of all the observers in this department ofanatomy is to follow these tubes to their origin.We have an infinite snarl of telegraph wires, andwe may be reasonably sure, that, if we can followthem up, we shall find each of them ends in a batterysomewhere. One of the most interesting problemsis to find the ganglionic origin of the great nervesof the medulla oblongata, and this is the end to which,by the aid of the most delicate sections, colored soas to bring out their details, mounted so as to beimperishable, magnified by the best instruments, andnow self-recorded in the light of the truth-tellingsunbeam, our fellow-student is making a steady progressin a labor which I think bids fair to rank with themost valuable contributions to histology that we havehad from this side of the Atlantic.
It is interesting to see how old questions are incidentallysettled in the course of these new investigations.Thus, Mr. Clarke’s dissections, confirmed bypreparations of Mr. Dean’s which I have myselfexamined, placed the fact of the decussation of thepyramids—denied by Haller, by Morgagni,and even by Stilling—beyond doubt.So the spinal canal, the existence of which, at leastin the adult, has been so often disputed, appearsas a coarse and unequivocal anatomical fact in manyof the preparations referred to.
While these studies of the structure of the cord havebeen going on, the ingenious and indefatigable Brown-Sequardhas been investigating the functions of its differentparts with equal diligence. The microscopic anatomistshad shown that the ganglionic corpuscles of the graymatter of the cord are connected with each other bytheir processes, as well as with the nerve-roots.M. Brown-Sequard has proved by numerous experimentsthat the gray substance transmits sensitive impressionsand muscular stimulation. The oblique ascendingand descending fibres from the posterior nerve-roots,
joining the “longitudinal columns of the cornua,”account for the results of Brown-Sequard’s sectionsof the posterior columns. The physiological experimenterhas also made it evident that the decussation of theconductors of sensitive impressions has its seat inthe spinal core, and not in the encephalon, as hadbeen supposed. Not less remarkable than theseresults are the facts, which I with others of my audiencehave had the opportunity of observing, as shown byM. Brown-Sequard, of the artificial production of epilepsyin animals by injuring the spinal cord, and the inductionof the paroxysm by pinching a certain portion of theskin. I would also call the student’s attentionto his account of the relations of the nervous centresto nutrition and secretion, the last of which relationshas been made the subject of an extended essay byour fellow countryman, Dr. H. F. Campbell of Georgia.The physiology of the spinal cord seems a simple matteras you study it in Longet. The experiments ofBrown-Sequard have shown the problem to be a complexone, and raised almost as many doubts as they havesolved questions; at any rate, I believe all lecturerson physiology agree that there is no part of theirtask they dread so much as the analysis of the evidencerelating to the special offices of the different portionsof the medulla spinalis. In the brain we aresure that we do not know how to localize functions;in the spinal cord, we think we do know something;but there are so many anomalies, and seeming contradictions,and sources of fallacy, that beyond the facts of crossedparalysis of sensation, and the conducting agencyof the gray substance, I am afraid we retain no cardinalprinciples discovered since the development of thereflex function took its place by Sir Charles Bell’sgreat discovery.
By the manner in which I spoke of the brain, you willsee that I am obliged to leave phrenology sub Jove,—outin the cold,—as not one of the householdof science. I am not one of its haters; on thecontrary, I am grateful for the incidental good ithas done. I love to amuse myself in its plasterGolgothas, and listen to the glib professor, as hediscovers by his manipulations
“All that disgraced my bettersmet in me.”
I loved of old to see square-headed, heavy-jawed Spurzheimmake a brain flower out into a corolla of marrowyfilaments, as Vieussens had done before him, and tohear the dry-fibred but human-hearted George Combeteach good sense under the disguise of his equivocalsystem. But the pseudo-sciences, phrenology andthe rest, seem to me only appeals to weak minds andthe weak points of strong ones. There is a picaor false appetite in many intelligences; they taketo odd fancies in place of wholesome truth, as girlsgnaw at chalk and charcoal. Phrenology juggleswith nature. It is so adjusted as to soak up allevidence that helps it, and shed all that harms it.It crawls forward in all weathers, like Richard Edgeworth’s
hygrometer. It does not stand at the boundaryof our ignorance, it seems to me, but is one of thewill-o’-the-wisps of its undisputed centraldomain of bog and quicksand. Yet I should nothave devoted so many words to it, did I not recognizethe light it has thrown on human actions by its studyof congenital organic tendencies. Its maps ofthe surface of the head are, I feel sure, founded ona delusion, but its studies of individual characterare always interesting and instructive.The “snapping-turtle” strikes after itsnatural fashion when it first comes out of the egg.Children betray their tendencies in their way of dealingwith the breasts that nourish them; nay, lean ventureto affirm, that long before they are born they teachtheir mothers something of their turbulent or quiettempers.
“Castor gaudet equis, ovoproanatus eodem
Pugnis.”
Strike out the false pretensions of phrenology; callit anthropology; let it study man the individual indistinction from man the abstraction, the metaphysicalor theological lay-figure; and it becomes “theproper study of mankind,” one of the noblestand most interesting of pursuits.
The whole physiology of the nervous system, from thesimplest manifestation of its power in an insect upto the supreme act of the human intelligence workingthrough the brain, is full of the most difficult yetprofoundly interesting questions. The singularrelations between electricity and nerve-force, relationswhich it has been attempted to interpret as meaningidentity, in the face of palpable differences, requirestill more extended studies. You may be interestedby Professor Faraday’s statement of his opinionon the matter. “Though I am not satisfiedthat the nervous fluid is only electricity, still Ithink that the agent in the nervous system maybe aninorganic force; and if there be reason for supposingthat magnetism is a higher relation of force thanelectricity, so it may well be imagined that the nervouspower may be of a still more exalted character, andyet within the reach of experiment.”
In connection with this statement, it is interestingto refer to the experiments of Helmholtz on the rapidityof transmission of the nervous actions. The rateis given differently in Valentin’s report ofthese experiments and in that found in the “ScientificAnnual” for 1858. One hundred and eightyto three hundred feet per second is the rate of movementassigned for sensation, but all such results must bevery vaguely approximative. Boxers, fencers,players at the Italian game of morn, “prestidigitators,”and all who depend for their success on rapidity ofmotion, know what differences there are in the personalequation of movement.
Reflex action, the mechanical sympathy, if I may socall it, of distant parts; Instinct, which is crystallizedintelligence,—an absolute law with itsinvariable planes and angles introduced into the sphereof consciousness, as raphides are inclosed in theliving cells of plants; Intellect,—theoperation of the thinking principle through materialorgans, with an appreciable waste of tissue in everyact of thought, so that our clergymen’s bloodhas more phosphates to get rid of on Monday than onany other day of the week; Will,—theoreticallythe absolute determining power, practically limitedin different degrees by the varying organization ofraces and individuals, annulled or perverted by differentill-understood organic changes; on all these subjectsour knowledge is in its infancy, and from the studyof some of them the interdict of the Vatican is hardlyyet removed.
I must allude to one or two points in the histologyand physiology of the organs of sense. The anteriorcontinuation of the retina beyond the ora serratahas been a subject of much discussion. If H. Mullerand Kolliker can be relied upon, this question issettled by recognizing that a layer of cells, continuedfrom the retina, passes over the surface of the zonulaZinnii, but that no proper nervous element is so prolongedforward.
I observe that Kolliker calls the true nervous elementsof the retina “the layer of gray cerebral substance.”In fact, the ganglionic corpuscles of each eye maybe considered as constituting a little brain, connectedwith the masses behind by the commissure, commonlycalled the optic nerve. We are prepared, therefore,to find these two little brains in the most intimaterelations with each other, as we find the cerebralhemispheres. We know that they are directly connectedby fibres that arch round through the chiasma.
I mention these anatomical facts to introduce a physiologicalobservation of my own, first announced in one of thelectures before the Medical Class, subsequently communicatedto the American Academy of Arts and Sciences, andprinted in its “Transactions” for February14, 1860. I refer to the apparent transfer ofimpressions from one retina to the other, to whichI have given the name reflex vision. The ideawas suggested to me in consequence of certain effectsnoticed in employing the stereoscope. ProfessorWilliam B. Rodgers has since called the attentionof the American Scientific Association to some factsbearing on the subject, and to a very curious experimentof Leonardo da Vinci’s, which enables the observerto look through the palm of his hand (or seem to),as if it had a hole bored through it. As he andothers hesitated to accept my explanation, I was notsorry to find recently the following words in the“Observations on Man” of that acute observerand thinker, David Hartley. “An impressionmade on the right eye alone by a single object maypropagate itself into the left, and there raise up
an image almost equal in vividness to itself; andconsequently when we see with one eye only, we may,however, have pictures in both eyes.” Hartley,in 1784, had anticipated many of the doctrines whichhave since been systematized into the theory of reflexactions, and with which I have attempted to associatethis act of reflex vision. My sixth experiment,however, in the communication referred to, appearsto me to be a crucial one, proving the correctnessof my explanation, and I am not aware that it hasbeen before instituted.Another point of great interest connected with thephysiology of vision, and involved for a long timein great obscurity, is that of the adjustment of theeye to different distances. Dr. Clay Wallace ofNew York, who published a very ingenious little bookon the eye about twenty years ago, with vignettesreminding one of Bewick, was among the first, if notthe first, to describe the ciliary muscle, to whichthe power of adjustment is generally ascribed.It is ascertained, by exact experiment with the phacueidoscope,that accommodation depends on change of form of thecrystalline lens. Where the crystalline is wanting,as Mr. Ware long ago taught, no power of accommodationremains. The ciliary muscle is generally thoughtto effect the change of form of the crystalline.The power of accommodation is lost after the applicationof atropine, in consequence, as is supposed, of theparalysis of this muscle. This, I believe, isthe nearest approach to a demonstration we have onthis point.
I have only time briefly to refer to Professor Draper’smost ingenious theory as to the photographic natureof vision, for an account of which I must refer tohis original and interesting Treatise on Physiology.
It were to be wished that the elaborate and very interestingresearches of the Marquis Corti, which have revealedsuch singular complexity of structure in the cochleaof the ear, had done more to clear up its doubtfulphysiology; but I am afraid we have nothing but hypothesesfor the special part it plays in the act of hearing,and that we must say the same respecting the officeof the semicircular canals.
The microscope has achieved some of its greatest triumphsin teaching us the changes which occur in the developmentof the embryo. No more interesting discoverystands recorded in the voluminous literature of thissubject than the one originally announced by MartinBarry, afterwards discredited, and still later confirmedby Mr. Newport and others; namely the fact that thefertilizing filament reaches the interior of the ovumin various animals;—a striking parallelto the action of the pollen-tube in the vegetable.But beyond the mechanical facts all is mystery inthe movements of organization, as profound as in thefall of a stone or the formation of a crystal.
To the chemist and the microscopist the living bodypresents the same difficulties, arising from the factthat everything is in perpetual change in the organism.The fibrine of the blood puzzles the one as much asits globules puzzle the other. The differencebetween the branches of science which deal with spaceonly, and those which deal with space and time, isthis: we have no glasses that can magnify time.The figure I here show you a was photographed froman object (pleurosigma angulatum) magnified a thousanddiameters, or presenting a million times its naturalsurface. This other figure of the same object,enlarged from the one just shown, is magnified seventhousand diameters, or forty-nine million times insurface. When we can make the forty-nine millionthof a second as long as its integer, physiology andchemistry will approach nearer the completeness ofanatomy.
Our reverence becomes more worthy, or, if you will,less unworthy of its Infinite Object in proportionas our intelligence is lifted and expanded to a higherand broader understanding of the Divine methods ofaction. If Galen called his heathen readers toadmire, the power, the wisdom, the providence, thegoodness of the “Framer of the animal body,”—ifMr. Boyle, the student of nature, as Addison and thatfriend of his who had known him for forty years tellus, never uttered the name of the Supreme Being withoutmaking a distinct pause in his speech, in token ofhis devout recognition of its awful meaning,—surelywe, who inherit the accumulated wisdom of nearly twohundred years since the time of the British philosopher,and of almost two thousand since the Greek physician,may well lift our thoughts from the works we studyto their great Artificer. These wonderful discoverieswhich we owe to that mighty little instrument, thetelescope of the inner firmament with all its includedworlds; these simple formulae by which we condensethe observations of a generation in a single axiom;these logical analyses by which we fence out the ignorancewe cannot reclaim, and fix the limits of our knowledge,—alllead us up to the inspiration of the Almighty, whichgives understanding to the world’s great teachers.To fear science or knowledge, lest it disturb ourold beliefs, is to fear the influx of the Divine wisdominto the souls of our fellow-men; for what is sciencebut the piecemeal revelation,—uncovering,—ofthe plan of creation, by the agency of those chosenprophets of nature whom God has illuminated from thecentral light of truth for that single purpose?
The studies which we have glanced at are preliminaryin your education to the practical arts which makeuse of them,—the arts of healing,—surgeryand medicine. The more you examine the structureof the organs and the laws of life, the more you willfind how resolutely each of the cell-republics whichmake up the E pluribus unum of the body maintainsits independence. Guard it, feed it, air it, warm
it, exercise or rest it properly, and the workingelements will do their best to keep well or to getwell. What do we do with ailing vegetables?Dr. Warren, my honored predecessor in this chair,bought a country-place, including half of an old orchard.A few years afterwards I saw the trees on his sideof the fence looking in good health, while those onthe other side were scraggy and miserable. Howdo you suppose this change was brought about?By watering them with Fowler’s solution?By digging in calomel freely about their roots?Not at all; but by loosening the soil round them, andsupplying them with the right kind of food in fittingquantities.Now a man is not a plant, or, at least, he is a verycurious one, for he carries his soil in his stomach,which is a kind—of portable flower-pot,and he grows round it, instead of out of it. Hehas, besides, a singularly complex nutritive apparatusand a nervous system. But recollect the doctrinealready enunciated in the language of Virchow, thatan animal, like a tree, is a sum of vital unities,of which the cell is the ultimate element. Everyhealthy cell, whether in a vegetable or an animal,necessarily performs its function properly so longas it is supplied with its proper materials and stimuli.A cell may, it is true, be congenitally defective,in which case disease is, so to speak, its normalstate. But if originally sound and subsequentlydiseased, there has certainly been some excess, deficiency,or wrong quality in the materials or stimuli appliedto it. You remove this injurious influence andsubstitute a normal one; remove the baked coal-ashes,for instance, from the roots of a tree, and replacethem with loam; take away the salt meat from the patient’stable, and replace it with fresh meat and vegetables,and the cells of the tree or the man return to theirduty.
I do not know that we ever apply to a plant any elementwhich is not a natural constituent of the vegetablestructure, except perhaps externally, for the accidentalpurpose of killing parasites. The whole art ofcultivation consists in learning the proper food andconditions of plants, and supplying them. Wegive them water, earths, salts of various kinds suchas they are made of, with a chance to help themselvesto air and light. The farmer would be laughedat who undertook to manure his fields or his treeswith a salt of lead or of arsenic. These elementsare not constituents of healthy plants. The gardeneruses the waste of the arsenic furnaces to kill theweeds in his walks.
If the law of the animal cell, and of the animal organism,which is built up of such cells, is like that of thevegetable, we might expect that we should treat allmorbid conditions of any of the vital unities belongingto an animal in the same way, by increasing, diminishing,or changing its natural food or stimuli.
That is an aliment which nourishes; whatever we findin the organism, as a constant and integral element,either forming part of its structure, or one of theconditions of vital processes, that and that only deservesthe name of aliment. I see no reason, therefore,why iron, phosphate of lime, sulphur, should not beconsidered food for man, as much as guano or poudrettefor vegetables. Whether one or another of themis best in any given case,—whether theyshall be taken alone or in combination, in large orsmall quantities, are separate questions. Butthey are elements belonging to the body, and evenin moderate excess will produce little disturbance.There is no presumption against any of this class ofsubstances, any more than against water or salt, providedthey are used in fitting combinations, proportions,and forms.
But when it comes to substances alien to the healthysystem, which never belong to it as normal constituents,the case is very different. There is a presumptionagainst putting lead or arsenic into the human body,as against putting them into plants, because theydo not belong there, any more than pounded glass,which, it is said, used to be given as a poison.The same thing is true of mercury and silver.What becomes of these alien substances after theyget into the system we cannot always tell. Butin the case of silver, from the accident of its changingcolor under the influence of light, we do know whathappens. It is thrown out, in part at least,under the epidermis, and there it remains to the patient’sdying day. This is a striking illustration ofthe difficulty which the system finds in dealing withnon-assimilable elements, and justifies in some measurethe vulgar prejudice against mineral poisons.
I trust the youngest student on these benches willnot commit the childish error of confounding a presumptionagainst a particular class of agents with a condemnationof them. Mercury, for instance, is alien to thesystem, and eminently disturbing in its influence.Yet its efficacy in certain forms of specific diseaseis acknowledged by all but the most sceptical theorists.Even the esprit moqueur of Ricord, the Voltaire ofpelvic literature, submits to the time-honored constitutionalauthority of this great panacea in the class of casesto which he has devoted his brilliant intelligence.Still, there is no telling what evils have arisenfrom the abuse of this mineral. Dr. Armstronglong ago pointed out some of them, and they have becomematters of common notoriety. I am pleased, therefore,when I find so able and experienced a practitioneras Dr. Williams of this city proving that iritis isbest treated without mercury, and Dr. Vanderpoel showingthe same thing to be true for pericarditis.
Whatever elements nature does not introduce into vegetables,the natural food of all animal life,—directlyof herbivorous, indirectly of carnivorous animals,—areto be regarded with suspicion. Arsenic-eatingmay seem to improve the condition of horses for a time,—andeven of human beings, if Tschudi’s stories canbe trusted,—but it soon appears that itsalien qualities are at war with the animal organization.So of copper, antimony, and other non-alimentary simplesubstances; everyone of them is an intruder in theliving system, as much as a constable would be, quarteredin our household. This does not mean that theymay not, any of them, be called in for a special need,as we send for the constable when we have good reasonto think we have a thief under our roof; but a man’sbody is his castle, as well as his house, and the presumptionis that we are to keep our alimentary doors boltedagainst these perturbing agents.
Now the feeling is very apt to be just contrary tothis. The habit has been very general with well-taughtpractitioners, to have recourse to the introductionof these alien elements into the system on the occasionof any slight disturbance. The tongue was a littlecoated, and mercury must be given; the skin was alittle dry, and the patient must take antimony.It was like sending for the constable and the possecomitatus when there is only a carpet to shake ora refuse-barrel to empty. [Dr. James Johnson advisespersons not ailing to take five grains of blue pillwith one or two of aloes twice a week for three orfour months in the year, with half a pint of compounddecoction of sarsaparilla every day for the same period,to preserve health and prolong life. Pract.Treatise on Dis. of Liver, etc. p. 272.] Theconstitution bears slow poisoning a great deal betterthan might be expected; yet the most intelligent menin the profession have gradually got out of the habitof prescribing these powerful alien substances inthe old routine way. Mr. Metcalf will tell youhow much more sparingly they are given by our practitionersat the present time, than when he first inauguratedthe new era of pharmacy among us. Still, thepresumption in favor of poisoning out every spontaneousreaction of outraged nature is not extinct in thosewho are trusted with the lives of their fellow-citizens.“On examining the file of prescriptions at thehospital, I discovered that they were rudely written,and indicated a treatment, as they consisted chieflyof tartar emetic, ipecacuanha, and epsom salts, hardlyfavorable to the cure of the prevailing diarrhoeaand dysenteries.” In a report of a poisoningcase now on trial, where we are told that arsenicenough was found in the stomach to produce death intwenty-four hours, the patient is said to have beentreated by arsenic, phosphorus, bryonia, aconite, nuxvomica, and muriatic acid,—by a practitionerof what school it may be imagined.
The traditional idea of always poisoning out disease,as we smoke out vermin, is now seeking its last refugebehind the wooden cannon and painted port-holes ofthat unblushing system of false scientific pretenceswhich I do not care to name in a discourse addressedto an audience devoted to the study of the laws ofnature in the light of the laws of evidence.It is extraordinary to observe that the system which,by its reducing medicine to a name and a farce, hasaccustomed all who have sense enough to see throughits thin artifices to the idea that diseases get wellwithout being “cured,” should now be themain support of the tottering poison-cure doctrine.It has unquestionably helped to teach wise peoplethat nature heals most diseases without help frompharmaceutic art, but it continues to persuade foolsthat art can arrest them all with its specifics.
It is worse than useless to attempt in any way tocheck the freest expression of opinion as to the efficacyof any or all of the “heroic” means oftreatment employed by practitioners of different schoolsand periods. Medical experience is a great thing,but we must not forget that there is a higher experience,which tries its results in a court of a still largerjurisdiction; that, namely, in which the laws of humanbelief are summoned to the witness-box, and obligedto testify to the sources of error which beset themedical practitioner. The verdict is as old asthe father of medicine, who announces it in the words,“judgment is difficult.” Physiciansdiffered so in his time, that some denied that therewas any such thing as an art of medicine.
One man’s best remedies were held as mischievousby another. The art of healing was like soothsaying,so the common people said; “the same bird waslucky or unlucky, according as he flew to the rightor left.”
The practice of medicine has undergone great changeswithin the period of my own observation. Venesection,for instance, has so far gone out of fashion, that,as I am told by residents of the New York Bellevueand the Massachusetts General Hospitals, it is almostobsolete in these institutions, at least in medicalpractice. The old Brunonian stimulating treatmenthas come into vogue again in the practice of Dr. Toddand his followers. The compounds of mercury haveyielded their place as drugs of all work, and specificsfor that very frequent subjective complaint, nescioquid faciam,—to compounds of iodine. [SirAstley Cooper has the boldness,—or honesty,—tospeak of medicines which “are given as muchto assist the medical man as his patient.”Lectures (London, 1832), p. 14.] Opium is believedin, and quinine, and “rum,” using thatexpressive monosyllable to mean all alcoholic cordials.If Moliere were writing now, instead of saignare,purgare, and the other, he would be more like to say,Stimulare, opium dare et potassio-iodizare.
I have been in relation successively with the Englishand American evacuant and alterative practice, inwhich calomel and antimony figured so largely that,as you may see in Dr. Jackson’s last “Letter,”Dr. Holyoke, a good representative of sterling old-fashionedmedical art, counted them with opium and Peruvianbark as his chief remedies; with the moderately expectantpractice of Louis; the blood-letting “coup surcoup” of Bouillaud; the contra-stimulant methodof Rasori and his followers; the anti-irritant systemof Broussais, with its leeching and gum-water; I haveheard from our own students of the simple opium practiceof the renowned German teacher, Oppolzer; and nowI find the medical community brought round by therevolving cycle of opinion to that same old plan oftreatment which John Brown taught in Edinburgh in thelast quarter of the last century, and Miner and Tullyfiercely advocated among ourselves in the early yearsof the present. The worthy physicians last mentioned,and their antagonist Dr. Gallup, used stronger languagethan we of these degenerate days permit ourselves.“The lancet is a weapon which annually slaysmore than the sword,” says Dr. Tully. “Itis probable that, for forty years past, opium andits preparations have done seven times the injurythey have rendered benefit, on the great scale of theworld,” says Dr. Gallup.
What is the meaning of these perpetual changes andconflicts of medical opinion and practice, from anearly antiquity to our own time? Simply this:all “methods” of treatment end in disappointmentof those extravagant expectations which men are wontto entertain of medical art. The bills of mortalityare more obviously affected by drainage, than by thisor that method of practice. The insurance companiesdo not commonly charge a different percentage on thelives of the patients of this or that physician.In the course of a generation, more or less, physiciansthemselves are liable to get tired of a practice whichhas so little effect upon the average movement ofvital decomposition. Then they are ready fora change, even if it were back again to a method whichhas already been tried, and found wanting.
Our practitioners, or many of them, have got backto the ways of old Dr. Samuel Danforth, who, as itis well known, had strong objections to the use ofthe lancet. By and by a new reputation will bemade by some discontented practitioner, who, tiredof seeing patients die with their skins full of whiskeyand their brains muddy with opium, returns to a boldantiphlogistic treatment, and has the luck to see afew patients of note get well under it. So ofthe remedies which have gone out of fashion and beensuperseded by others. It can hardly be doubtedthat they will come into vogue again, more or lessextensively, under the influence of that irresistibledemand for change just referred to.
Then will come the usual talk about a change in thecharacter of disease, which has about as much meaningas that concerning “old-fashioned snow-storms.”“Epidemic constitutions” of disease meansomething, no doubt; a great deal as applied to malariousaffections; but that the whole type of diseases undergoessuch changes that the practice must be reversed fromdepleting to stimulating, and vice versa, is much lesslikely than that methods of treatment go out of fashionand come in again. If there is any disease whichclaims its percentage with reasonable uniformity,it is phthisis. Yet I remember that the reverendand venerable Dr. Prince of Salem told me one Commencementday, as I was jogging along towards Cambridge withhim, that he recollected the time when that diseasewas hardly hardly known; and in confirmation of hisstatement mentioned a case in which it was told asa great event, that somebody down on “the Cape”had died of “a consumption.” Thisstory does not sound probable to myself, as I repeatit, yet I assure you it is true, and it shows howcautiously we must receive all popular stories ofgreat changes in the habits of disease.
Is there no progress, then, but do we return to thesame beliefs and practices which our forefathers woreout and threw away? I trust and believe thatthere is a real progress. We may, for instance,return in a measure to the Brunonian stimulating system,but it must be in a modified way, for we cannot goback to the simple Brunonian pathology, since we havelearned too much of diseased action to accept its convenientdualism. So of other doctrines, each new Avatarstrips them of some of their old pretensions, untilthey take their fitting place at last, if they haveany truth in them, or disappear, if they were merephantasms of the imagination.
In the mean time, while medical theories are comingin and going out, there is a set of sensible men whoare never run away with by them, but practise theirart sagaciously and faithfully in much the same wayfrom generation to generation. From the timeof Hippocrates to that of our own medical patriarch,there has been an apostolic succession of wise andgood practitioners. If you will look at the firstaphorism of the ancient Master you will see that beforeall remedies he places the proper conduct of the patientand his attendants, and the fit ordering of all theconditions surrounding him. The class of practitionersI have referred to have always been the most faithfulin attending to these points. No doubt they havesometimes prescribed unwisely, in compliance withthe prejudices of their time, but they have grown wiseras they have grown older, and learned to trust morein nature and less in their plans of interference.I believe common opinion confirms Sir James Clark’sobservation to this effect.
The experience of the profession must, I think, runparallel with that of the wisest of its individualmembers. Each time a plan of treatment or a particularremedy comes up for trial, it is submitted to a sharperscrutiny. When Cullen wrote his Materia Medica,he had seriously to assail the practice of givingburnt toad, which was still countenanced by at leastone medical authority of note. I have read recentlyin some medical journal, that an American practitioner,whose name is known to the country, is prescribingthe hoof of a horse for epilepsy. It was doubtlesssuggested by that old fancy of wearing a portion ofelk’s hoof hung round the neck or in a ring,for this disease. But it is hard to persuadereasonable people to swallow the abominations of aformer period. The evidence which satisfied Ferneliuswill not serve one of our hospital physicians.
In this way those articles of the Materia Medica whichhad nothing but loathsomeness to recommend them havebeen gradually dropped, and are not like to obtainany general favor again with civilized communities.The next culprits to be tried are the poisons.I have never been in the least sceptical as to theutility of some of them, when properly employed.Though I believe that at present, taking the worldat large, and leaving out a few powerful agents ofsuch immense value that they rank next to food inimportance, the poisons prescribed for disease domore hurt than good, I have no doubt, and never professedto have any, that they do much good in prudent andinstructed hands. But I am very willing to confessa great jealousy of many agents, and I could almostwish to see the Materia Medica so classed as to callsuspicion upon certain ones among them.
Thus the alien elements, those which do not properlyenter into the composition of any living tissue, arethe most to be suspected, —mercury, lead,antimony, silver, and the rest, for the reasons I havebefore mentioned. Even iodine, which, as it isfound in certain plants, seems less remote from theanimal tissues, gives unequivocal proofs from timeto time that it is hostile to some portions of theglandular system.
There is, of course, less prima facie objection tothose agents which consist of assimilable elements,such as are found making a part of healthy tissues.These are divisible into three classes,—foods,poisons, and inert, mostly because insoluble, substances.The food of one animal or of one human being is sometimespoison to another, and vice versa; inert substancesmay act mechanically, so as to produce the effectof poisons; but this division holds exactly enoughfor our purpose.
Strictly speaking, every poison consisting of assimilableelements may be considered as unwholesome food.It is rejected by the stomach, or it produces diarrhoea,or it causes vertigo or disturbance of the heart’saction, or some other symptom for which the subjectof it would consult the physician, if it came on fromany other cause than taking it under the name of medicine.Yet portions of this unwholesome food which we callmedicine, we have reason to believe, are assimilated;thus, castor-oil appears to be partially digestedby infants, so that they require large doses to affectthem medicinally. Even that deadliest of poisons,hydrocyanic acid, is probably assimilated, and helpsto make living tissue, if it do not kill the patient,for the assimilable elements which it contains, givenin the separate forms of amygdalin and emulsin, produceno disturbance, unless, as in Bernard’s experiments,they are suffered to meet in the digestive organs.A medicine consisting of assimilable substances beingthen simply unwholesome food, we understand what ismeant by those cumulative effects of such remediesoften observed, as in the case of digitalis and strychnia.They are precisely similar to the cumulative effectsof a salt diet in producing scurvy, or of spurredrye in producing dry gangrene. As the effectsof such substances are a violence to the organs, weshould exercise the same caution with regard to theiruse that we would exercise about any other kind ofpoisonous food,—partridges at certain seasons,for instance. Even where these poisonous kindsof food seem to be useful, we should still regardthem with great jealousy. Digitalis lowers thepulse in febrile conditions. Veratrum viridedoes the same thing. How do we know that a rapidpulse is not a normal adjustment of nature to the conditionit accompanies? Digitalis has gone out of favor;how sure are we that Veratrum viride will not be foundto do more harm than good in a case of internal inflammation,taking the whole course of the disease into consideration?Think of the change of opinion with regard to the useof opium in delirium tremens (which you remember issometimes called delirium vigilans), where it seemedso obviously indicated, since the publication of Dr.Ware’s admirable essay. I respect the evidenceof my contemporaries, but I cannot forget the sayingsof the Father of medicine,—Ars longa, judiciumdiffcile.
I am not presuming to express an opinion concerningVeratrum viride, which was little heard of when Iwas still practising medicine. I am only appealingto that higher court of experience which sits in judgmenton all decisions of the lower medical tribunals, andwhich requires more than one generation for its finalverdict.
Once change the habit of mind so long prevalent amongpractitioners of medicine; once let it be everywhereunderstood that the presumption is in favor of food,and not of alien substances, of innocuous, and notof unwholesome food, for the sick; that this presumptionrequires very strong evidence in each particular caseto overcome it; but that, when such evidence is afforded,the alien substance or the unwholesome food shouldbe given boldly, in sufficient quantities, in the samespirit as that with which the surgeon lifts his knifeagainst a patient,—that is, with the samereluctance and the same determination,—andI think we shall have and hear much less of charlatanismin and out of the profession. The disgrace ofmedicine has been that colossal system of self-deception,in obedience to which mines have been emptied of theircankering minerals, the vegetable kingdom robbed ofall its noxious growths, the entrails of animals taxedfor their impurities, the poison-bags of reptilesdrained of their venom, and all the inconceivableabominations thus obtained thrust down the throatsof human beings suffering from some fault of organization,nourishment, or vital stimulation.
Much as we have gained, we have not yet thoroughlyshaken off the notion that poison is the natural foodof disease, as wholesome aliment is the support ofhealth. Cowper’s lines, in “The Task,”show the matter-of-course practice of his time:
“He does not scorn it, who has longendured
A fever’s agonies, and fedon drugs.”
Dr. Kimball of Lowell, who has been in the habit ofseeing a great deal more of typhoid fever than mostpractitioners, and whose surgical exploits show himnot to be wanting in boldness or enterprise, can tellyou whether he finds it necessary to feed his patientson drugs or not. His experience is, I believe,that of the most enlightened and advanced portionof the profession; yet I think that even in typhoidfever, and certainly in many other complaints, theeffects of ancient habits and prejudices may stillbe seen in the practice of some educated physicians.
To you, young men, it belongs to judge all that hasgone before you. You come nearer to the greatfathers of modern medicine than some of you imagine.Three of my own instructors attended Dr. Rush’sLectures. The illustrious Haller mentions Rush’sinaugural thesis in his “Bibliotheca Anatomica;”and this same Haller, brought so close to us, tellsus he remembers Ruysch, then an old man, and usedto carry letters between him and Boerhaave. Lookthrough the history of medicine from Boerhaave tothis present day. You will see at once that medicaldoctrine and practice have undergone a long seriesof changes. You will see that the doctrine andpractice of our own time must probably change in theirturn, and that, if we can trust at all to the indicationsof their course, it will be in the direction of animproved hygiene and a simplified treatment.
Especially will the old habit of violating the instinctsof the sick give place to a judicious study of thesesame instincts. It will be found that bodily,like mental insanity, is best managed, for the mostpart, by natural soothing agencies. Two centuriesago there was a prescription for scurvy containing“stercoris taurini et anserini par, quantitastrium magnarum nucum,” of the hell-broth containingwhich “guoties-cumque sitit oeger, large bibit.” When I have recalled the humane common-sense of CaptainCook in the matter of preventing this disease; whenI have heard my friend, Mr. Dana, describing the aviditywith which the scurvy-stricken sailors snuffed up theearthy fragrance of fresh raw potatoes, the food whichwas to supply the elements wanting to their spongytissues, I have recognized that the perfection of artis often a return to nature, and seen in this singleinstance the germ of innumerable beneficent futuremedical reforms.I cannot help believing that medical curative treatmentwill by and by resolve itself in great measure intomodifications of the food, swallowed and breathed,and of the natural stimuli, and that less will be expectedfrom specifics and noxious disturbing agents, eitheralien or assimilable. The noted mineral-waterscontaining iron, sulphur, carbonic acid, supply nutritiousor stimulating materials to the body as much as phosphateof lime and ammoniacal compounds do to the cereal plants.The effects of a milk and vegetable diet, of glutenbread in diabetes, of cod-liver oil in phthisis, evenof such audacious innovations as the water-cure andthe grape-cure, are only hints of what will be accomplishedwhen we have learned to discover what organic elementsare deficient or in excess in a case of chronic disease,and the best way of correcting the abnormal condition,just as an agriculturist ascertains the wants of hiscrops and modifies the composition of his soil.In acute febrile diseases we have long ago discoveredthat far above all drug-medication is the use of mildliquid diet in the period of excitement, and of stimulantand nutritious food in that of exhaustion. Hippocrateshimself was as particular about his barley-ptisan asany Florence Nightingale of our time could be.
The generation to which you, who are just enteringthe profession, belong, will make a vast stride forward,as I believe, in the direction of treatment by naturalrather than violent agencies. What is it thatmakes the reputation of Sydenham, as the chief of Englishphysicians? His prescriptions consisted principallyof simples. An aperient or an opiate, a “cardiac”or a tonic, may be commonly found in the midst of asomewhat fantastic miscellany of garden herbs.It was not by his pharmaceutic prescriptions thathe gained his great name. It was by daring toorder fresh air for small-pox patients, and ridingon horseback for consumptives, in place of the smotheringsystem, and the noxious and often loathsome rubbish
of the established schools. Of course Sydenhamwas much abused by his contemporaries, as he frequentlytakes occasion to remind his reader. “Imust needs conclude,” he says, “eitherthat I am void of merit, or that the candid and ingenuouspart of mankind, who are formed with so excellenta temper of mind as to be no strangers to gratitude,make a very small part of the whole.” Ifin the fearless pursuit of truth you should find theworld as ungracious in the nineteenth century as hefound it in the seventeenth, you may learn a lessonof self-reliance from another utterance of the sameillustrious physician: “’T is noneof my business to inquire what other persons think,but to establish my own observations; in order to which,I ask no favor of the reader but to peruse my writingswith temper.”The physician has learned a great deal from the surgeon,who is naturally in advance of him, because he hasa better opportunity of seeing the effects of hisremedies. Let me shorten one of Ambroise Pare’sstories for you. There had been a great victoryat the pass of Susa, and they were riding into thecity. The wounded cried out as the horses trampledthem under their hoofs, which caused good Ambroisegreat pity, and made him wish himself back in Paris.Going into a stable he saw four dead soldiers, andthree desperately wounded, placed with their backsagainst the wall. An old campaigner came up.—“Canthese fellows get well?” he said. “No!”answered the surgeon. Thereupon, the old soldierwalked up to them and cut all their throats, sweetly,and without wrath (doulcement et sans cholere).Ambroise told him he was a bad man to do such a thing.“I hope to God;” he said, “somebodywill do as much for me if I ever get into such a scrape”(accoustre de telle facon). “I was not muchsalted in those days” (bien doux de sel), saysAmbroise, “and little acquainted with the treatmentof wounds.” However, as he tells us, heproceeded to apply boiling oil of Sambuc (elder) afterthe approved fashion of the time,—withwhat torture to the patient may be guessed. Atlast his precious oil gave out, and he used insteadan insignificant mixture of his own contrivance.He could not sleep that night for fear his patientswho had not been scalded with the boiling oil wouldbe poisoned by the gunpowder conveyed into their woundsby the balls. To his surprise, he found themmuch better than the others the next morning, and resolvednever again to burn his patients with hot oil for gun-shotwounds.
This was the beginning, as nearly as we can fix it,of that reform which has introduced plain water-dressingsin the place of the farrago of external applicationswhich had been a source of profit to apothecariesand disgrace to art from, and before, the time whenPliny complained of them. A young surgeon whowas at Sudley Church, laboring among the wounded ofBull Run, tells me they had nothing but water for dressing,and he (being also doux de sel) was astonished to seehow well the wounds did under that simple treatment.
Let me here mention a fact or two which may be ofuse to some of you who mean to enter the public service.You will, as it seems, have gun-shot wounds almostexclusively to deal with. Three different surgeons,the one just mentioned and two who saw the woundedof Big Bethel, assured me that they found no sabre-cutsor bayonet wounds. It is the rifle-bullet froma safe distance which pierces the breasts of our soldiers,and not the gallant charge of broad platoons and sweepingsquadrons, such as we have been in the habit of consideringthe chosen mode of warfare of ancient and modern chivalry.[Sir Charles James Napier had the same experiencein Virginia in 1813. “Potomac. We havenasty sort of fighting here, amongst creeks and bushes,and lose men without show.” “Yankeenever shows himself, he keeps in the thickest wood,fires and runs off.”—“Thesefive thousand in the open field might be attacked,but behind works it would be throwing away lives.”He calls it “an inglorious warfare,”—saysone of the leaders is “a little deficient ingumption,”—but—still myopinion is, that if we tuck up our sleeves and layour ears back we might thrash them; that is, if wecaught them out of their trees, so as to slap at themwith the bayonet.”—Life, etc.vol. i. p. 218 et seq.]
Another fact parallels the story of the old campaigner,and may teach some of you caution in selecting yourassistants. A chaplain told it to two of ourofficers personally known to myself. He overheardthe examination of a man who wished to drive one ofthe “avalanche” wagons, as they call them.The man was asked if he knew how to deal with woundedmen. “Oh yes,” he answered; “ifthey’re hit here,” pointing to the abdomen,“knock ’em on the head,—theycan’t get well.”
In art and outside of it you will meet the same barbarismsthat Ambroise Pare met with,—for men differless from century to century than we are apt to suppose;you will encounter the same opposition, if you attackany prevailing opinion, that Sydenham complained of.So far as possible, let not such experiences breedin you a contempt for those who are the subjects offolly or prejudice, or foster any love of dispute forits own sake. Should you become authors, expressyour opinions freely; defend them rarely. Itis not often that an opinion is worth expressing, whichcannot take care of itself. Opposition is thebest mordant to fix the color of your thought in thegeneral belief.
It is time to bring these crowded remarks to a close.The day has been when at the beginning of a courseof Lectures I should have thought it fitting to exhortyou to diligence and entire devotion to your tasksas students. It is not so now. The youngman who has not heard the clarion-voices of honorand of duty now sounding throughout the land, willheed no word of mine. In the camp or the city,in the field or the hospital, under sheltering roof,or half-protecting canvas, or open sky, shedding ourown blood or stanching that of our wounded defenders,students or teachers, whatever our calling and ourability, we belong, not to ourselves, but to our imperilledcountry, whose danger is our calamity, whose ruinwould be our enslavement, whose rescue shall be ourearthly salvation!
SCHOLASTIC AND BEDSIDE TEACHING.
An Introductory Lecture delivered before the MedicalClass of Harvard University, November 6, 1867.
The idea is entertained by some of our most sincereprofessional brethren, that to lengthen and multiplyour Winter Lectures will be of necessity to advancethe cause of medical education. It is a fairsubject for consideration whether they do not overratethe relative importance of that particular mode ofinstruction which forms the larger part of these courses.
As this School could only lengthen its lecture termat the expense of its “Summer Session,”in which more direct, personal, and familiar teachingtakes the place of our academic discourses, and inwhich more time can be given to hospitals, infirmaries,and practical instruction in various important specialties,whatever might be gained, a good deal would certainlybe lost in our case by the exchange.
The most essential part of a student’s instructionis obtained, as I believe, not in the lecture-room,but at the bedside. Nothing seen there is lost;the rhythms of disease are learned by frequent repetition;its unforeseen occurrences stamp themselves indeliblyin the memory. Before the student is aware ofwhat he has acquired, he has learned the aspects andcourse and probable issue of the diseases he has seenwith his teacher, and the proper mode of dealing withthem, so far as his master knows it. On the otherhand, our ex cathedra prelections have a strong tendencyto run into details which, however interesting theymay be to ourselves and a few of our more curiouslisteners, have nothing in them which will ever beof use to the student as a practitioner. It isa perfectly fair question whether I and some otherAmerican Professors do not teach quite enough thatis useless already. Is it not well to remindthe student from time to time that a physician’sbusiness is to avert disease, to heal the sick, toprolong life, and to diminish suffering? Is itnot true that the young man of average ability willfind it as much as he can do to fit himself for thesesimple duties? Is it not best to begin, at anyrate, by making sure of such knowledge as he will requirein his daily walk, by no means discouraging him fromany study for which his genius fits him when he oncefeels that he has become master of his chosen art.
I know that many branches of science are of the greatestvalue as feeders of our medical reservoirs. Butthe practising physician’s office is to drawthe healing waters, and while he gives his time tothis labor he can hardly be expected to explore allthe sources that spread themselves over the wide domainof science. The traveller who would not drinkof the Nile until he had tracked it to its parentlakes, would be like to die of thirst; and the medicalpractitioner who would not use the results of manylaborers in other departments without sharing theirspecial toils, would find life far too short and artimmeasurably too long.
We owe much to Chemistry, one of the most captivatingas well as important of studies; but the medical manmust as a general rule content himself with a clearview of its principles and a limited acquaintancewith its facts; such especially as are pertinent tohis pursuits. I am in little danger of underratingAnatomy or Physiology; but as each of these branchessplits up into specialties, any one of which may takeup a scientific life-time, I would have them taughtwith a certain judgment and reserve, so that theyshall not crowd the more immediately practical branches.So of all the other ancillary and auxiliary kinds ofknowledge, I would have them strictly subordinatedto that particular kind of knowledge for which thecommunity looks to its medical advisers.
A medical school is not a scientific school, exceptjust so far as medicine itself is a science.On the natural history side, medicine is a science;on the curative side, chiefly an art. This isimplied in Hufeland’s aphorism: “Thephysician must generalize the disease and individualizethe patient.”
The coordinated and classified results of empiricalobservation, in distinction from scientific experiment,have furnished almost all we know about food, themedicine of health, and medicine, the food of sickness.We eat the root of the Solanum tuberosum and throwaway its fruit; we eat the fruit of the Solanum Lycopersicumand throw away its root. Nothing but vulgar experiencehas taught us to reject the potato ball and cook thetomato. So of most of our remedies. The subchlorideof mercury, calomel, is the great British specific;the protochloride of mercury, corrosive sublimate,kills like arsenic, but no chemist could have toldus it would be so.
From observations like these we can obtain certainprinciples from which we can argue deductively tofacts of a like nature, but the process is limited,and we are suspicious of all reasoning in that directionapplied to the processes of healthy and diseased life.We are continually appealing to special facts.We are willing to give Liebig’s artificial milkwhen we cannot do better, but we watch the child anxiouslywhose wet-nurse is a chemist’s pipkin.A pair of substantial mammary glands has the advantageover the two hemispheres of the most learned Professor’sbrain, in the art of compounding a nutritious fluidfor infants.
The bedside is always the true centre of medical teaching.Certain branches must be taught in the lecture-room,and will necessarily involve a good deal that is notdirectly useful to the future practitioner. Butthe over ambitious and active student must not be ledaway by the seduction of knowledge for its own sakefrom his principal pursuit. The humble beginner,who is alarmed at the vast fields of knowledge openedto him, may be encouraged by the assurance that witha very slender provision of science, in distinctionfrom practical skill, he may be a useful and acceptablemember of the profession to which the health of thecommunity is intrusted.
To those who are not to engage in practice, the variouspursuits of science hardly require to be commended.Only they must not be disappointed if they find manysubjects treated in our courses as a medical classrequires, rather than as a scientific class would expect,that is, with special limitations and constant referenceto practical ends. Fortunately they are withineasy reach of the highest scientific instruction.The business of a school like this is to make usefulworking physicians, and to succeed in this it is almostas important not to overcrowd the mind of the pupilwith merely curious knowledge as it is to store itwith useful information.
In this direction I have written my lecture, not toundervalue any form of scientific labor in its place,an unworthy thought from which I hope I need not defendmyself,—but to discourage any undue inflationof the scholastic programme, which even now asks moreof the student than the teacher is able to obtainfrom the great majority of those who present themselvesfor examination. I wish to take a hint in educationfrom the Secretary of the Massachusetts Board of Agriculture,who regards the cultivation of too much land as agreat defect in our New England farming. I hopethat our Medical Institutions may never lay themselvesopen to the kind of accusation Mr. Lowe brings againstthe English Universities, when he says that theireducation is made up “of words that few understandand most will shortly forget; of arts that can neverbe used, if indeed they can even be learnt; of historiesinapplicable to our times; of languages dead and evenmouldy; of grammatical rules that never had livinguse and are only post mortem examinations; and of statementsfa*goted with utter disregard of their comparative value.”
This general thought will be kept in view throughoutmy somewhat discursive address, which will begin withan imaginary clinical lesson from the lips of an historicalpersonage, and close with the portrait from real lifeof one who, both as teacher and practitioner, was longloved and honored among us. If I somewhat overrunmy hour, you must pardon me, for I can say with Pascalthat I have not had the time to make my lecture shorter.
In the year 1647, that good man John Eliot, commonlycalled the Apostle Eliot, writing to Mr. Thomas Shepherd,the pious minister of Cambridge, referring to thegreat need of medical instruction for the Indians,used these words:
“I have thought in my heart that it were a singulargood work, if the Lord would stirre up the heartsof some or other of his people in England to givesome maintenance toward some Schoole or Collegiateexercise this way, wherein there should be Anatomiesand other instructions that way, and where there mightbe some recompence given to any that should bringin any vegetable or other thing that is vertuous inthe way of Physick.
“There is another reason which moves my thoughtand desires this way, namely that our young studentsin Physick may be trained up better then they yetbee, who have onely theoreticall knowledge, and areforced to fall to practise before ever they saw anAnatomy made, or duely trained up in making experiments,for we never had but one Anatomy in the countrey,which Mr. Giles Firman [Firmin] now in England, didmake and read upon very well, but no more of thatnow.”
Since the time of the Apostle Eliot the Lord has stirredup the hearts of our people to the building of manySchools and Colleges where medicine is taught in allits branches. Mr. Giles Firmin’s “Anatomy”may be considered the first ancestor of a long lineof skeletons which have been dangling and rattlingin our lecture-rooms for more than a century.
Teaching in New England in 1647 was a grave but simplematter. A single person, combining in many cases,as in that of Mr. Giles Firmin, the offices of physicianand preacher, taught what he knew to a few discipleswhom he gathered about him. Of the making of that“Anatomy” on which my first predecessorin the branch I teach “did read very well”we can know nothing. The body of some poor wretchwho had swung upon the gallows, was probably conveyedby night to some lonely dwelling at the outskirtsof the village, and there by the light of flaring torcheshastily dissected by hands that trembled over theunwonted task. And ever and anon the master turnedto his book, as he laid bare the mysteries of thehidden organs; to his precious Vesalius, it might be,or his figures repeated in the multifarious volumeof Ambroise Pare; to the Aldine octavo in which Fallopiusrecorded his fresh observations; or that giant folioof Spigelius just issued from the press of Amsterdam,in which lovely ladies display their viscera witha coquettish grace implying that it is rather a pleasurethan otherwise to show the lace-like omentum, andhold up their appendices epiploicae as if they weresaying “these are our jewels.”
His teaching of medicine was no doubt chiefly clinical,and received with the same kind of faith as that whichaccepted his words from the pulpit. His notionsof disease were based on what he had observed, seenalways in the light of the traditional doctrines inwhich he was bred. His discourse savored of theweighty doctrines of Hippocrates, diluted by the subtlespeculations of Galen, reinforced by the curious commentsof the Arabian schoolmen as they were conveyed inthe mellifluous language of Fernelius, blended, itmay be, with something of the lofty mysticism of VanHelmont, and perhaps stealing a flavor of that earlierform of hom*oeopathy which had lately come to lightin Sir Kenelm Digby’s “Discourse concerningthe Cure of Wounds by the Sympathetic Powder.”
His Pathology was mythology. A malformed foetus,as the readers of Winthrop’s Journal may remember,was enough to scare the colonists from their propriety,and suggest the gravest fears of portended disaster.The student of the seventeenth century opened his Licetusand saw figures of a lion with the head of a woman,and a man with the head of an elephant. He hadoffered to his gaze, as born of a human mother, theeffigy of a winged cherub, a pterocephalous specimen,which our Professor of Pathological Anatomy wouldhardly know whether to treat with the reverence dueto its celestial aspect, or to imprison in one of hisimmortalizing jars of alcohol.
His pharmacopoeia consisted mainly of simples, suchas the venerable “Herball” of Gerard describesand figures in abounding affluence. St. John’swort and Clown’s All-heal, with Spurge and Fennel,Saffron and Parsley, Elder and Snake-root, with opiumin some form, and roasted rhubarb and the Four GreatCold Seeds, and the two Resins, of which it used tobe said that whatever the Tacamahaca has not cured,the Caranna will, with the more familiar Scammonyand Jalap and Black Hellebore, made up a good partof his probable list of remedies. He would haveordered Iron now and then, and possibly an occasionaldose of Antimony. He would perhaps have had arheumatic patient wrapped in the skin of a wolf ora wild cat, and in case of a malignant fever with“purples” or petechiae, or of an obstinateking’s evil, he might have prescribed a certainblack powder, which had been made by calcining toadsin an earthen pot; a choice remedy, taken internally,or applied to any outward grief.
Except for the toad-powder and the peremptory drastics,one might have borne up against this herb doctoringas well as against some more modern styles of medication.Barbeyrac and his scholar Sydenham had not yet cleansedthe Pharmacopoeia of its perilous stuff, but thereis no doubt that the more sensible physicians of thatday knew well enough that a good honest herb-tea whichamused the patient and his nurses was all that wasrequired to carry him through all common disorders.
The student soon learned the physiognomy of diseaseby going about with his master; fevers, pleurisies,asthmas, dropsies, fluxes, small-pox, sore-throats,measles, consumptions. He saw what was done forthem. He put up the medicines, gathered the herbs,and so learned something of materia medico and botany.He learned these few things easily and well, for hecould give his whole attention to them. Chirurgerywas a separate specialty. Women in child-birthwere cared for by midwives. There was no chemistrydeserving the name to require his study. He didnot learn a great deal, perhaps, but what he did learnwas his business, namely, how to take care of sickpeople.
Let me give you a picture of the old=fashioned wayof instruction, by carrying you with me in imaginationin the company of worthy Master Giles Firmin as hemakes his round of visits among the good folk of Ipswich,followed by his one student, who shall answer to thescriptural name of Luke. It will not be for entertainmentchiefly, but to illustrate the one mode of teachingwhich can never be superseded, and which, I ventureto say, is more important than all the rest put together.The student is a green hand, as you will perceive.
In the first dwelling they come to, a stout fellowis bellowing with colic.
“He will die, Master, of a surety, methinks,”says the timid youth in a whisper.
“Nay, Luke,” the Master answers, “’tis but a dry belly-ache. Didst thou not markthat he stayed his roaring when I did press hard overthe lesser bowels? Note that he hath not thepulse of them with fevers, and by what Dorcas tellethme there hath been no long shutting up of the vicenaturales. We will steep certain comforting herbswhich I will shew thee, and put them in a bag andlay them on his belly. Likewise he shall havemy cordial julep with a portion of this confectionwhich we do call Theriaca Andromachi, which hath juiceof poppy in it, and is a great stayer of anguish.This fellow is at his prayers to-day, but I warrantthee he shall be swearing with the best of them to-morrow.”
They jog along the bridle-path on their horses untilthey come to another lowly dwelling. They sita while with a delicate looking girl in whom the ingenuousyouth naturally takes a special interest. Thegood physician talks cheerfully with her, asks hera few questions. Then to her mother: “Good-wife,Margaret hath somewhat profited, as she telleth, bythe goat’s milk she hath taken night and morning.Do thou pluck a maniple—that is an handful—ofthe plant called Maidenhair, and make a syrup therewithas I have shewed thee. Let her take a cup fullof the same, fasting, before she sleepeth, also beforeshe riseth from her bed.” And so they leavethe house.
“What thinkest thou, Luke, of the maid we havebeen visiting?” “She seemeth not muchailing, Master, according to my poor judgment.For she did say she was better. And she had ared cheek and a bright eye, and she spake of beingsoon able to walk unto the meeting, and did seem greatlyhopeful, but spare of flesh, methought, and her voicesomething hoarse, as of one that hath a defluxion,with some small coughing from a cold, as she did say.Speak I not truly, Master, that she will be well speedily?”
“Yea, Luke, I do think she shall be well, andmayhap speedily. But it is not here with us sheshall be well. For that redness of the cheek isbut the sign of the fever which, after the Grecians,we do call the hectical; and that shining of the eyesis but a sickly glazing, and they which do every dayget better and likewise thinner and weaker shall findthat way leadeth to the church-yard gate. Thisis the malady which the ancients did call tubes, orthe wasting disease, and some do name the consumption.A disease whereof most that fall ailing do perish.This Margaret is not long for earth—butshe knoweth it not, and still hopeth.”
“Why, then, Master, didst thou give her of thymedicine, seeing that her ail is unto death?”
“Thou shalt learn, boy, that they which aresick must have somewhat wherewith to busy their thoughts.There be some who do give these tabid or consumptivesa certain posset made with lime-water and anise andliquorice and raisins of the sun, and there be othersome who do give the juice of craw-fishes boiled inbarley-water with chicken-broth, but these be toys,as I do think, and ye shall find as good virtue, naybetter, in this syrup of the simple called Maidenhair.”
Something after this manner might Master Giles Firminhave delivered his clinical instructions. Somewhatin this way, a century and a half later, another NewEngland physician, Dr. Edward Augustus Holyoke, taughta young man who came to study with him, a very diligentand intelligent youth, James Jackson by name, thesame whose portrait in his advanced years hangs uponthis wall, long the honored Professor of Theory andPractice in this Institution, of whom I shall say somethingin this Lecture. Our venerated Teacher studiedassiduously afterwards in the great London Hospitals,but I think he used to quote his “old Master”ten times where he quoted Mr. Cline or Dr. Woodvilleonce.
When I compare this direct transfer of the practicalexperience of a wise man into the mind of a student,—everyfact one that he can use in the battle of life anddeath,—with the far off, unserviceable “scientific”truths that I and some others are in the habit of teaching,I cannot help asking myself whether, if we concedethat our forefathers taught too little, there is not—apossibility that we may sometimes attempt to teachtoo much. I almost blush when I think of myselfas describing the eight several facets on two slenderprocesses of the palate bone, or the seven littletwigs that branch off from the minute tympanic nerve,and I wonder whether my excellent colleague feelsin the same way when he pictures himself as givingthe constitution of neurin, which as he and I knowvery well is that of the hydrate of trimethyle-oxethyle-ammonium,or the formula for the production of alloxan, which,though none but the Professors and older studentscan be expected to remember it, is C10 H4 N4 O6+ 2Ho,no5=C8 H4 N2 O10+2Co2+N2+NH4 O, no5.
I can bear the voice of some rough iconoclast addressingthe Anatomist and the Chemist in tones of contemptuousindignation: “What is this stuff with whichyou are cramming the brains of young men who are tohold the lives of the community in their hands?Here is a man fallen in a fit; you can tell me allabout the eight surfaces of the two processes of thepalate bone, but you have not had the sense to loosenthat man’s neck-cloth, and the old women areall calling you a fool? Here is a fellow thathas just swallowed poison. I want something toturn his stomach inside out at the shortest notice.Oh, you have forgotten the dose of the sulphate ofzinc, but you remember the formula for the productionof alloxan!”
“Look you, Master Doctor,—if I goto a carpenter to come and stop a leak in my roofthat is flooding the house, do you suppose I care whetherhe is a botanist or not? Cannot a man work inwood without knowing all about endogens and exogens,or must he attend Professor Gray’s Lecturesbefore he can be trusted to make a box-trap? Ifmy horse casts a shoe, do you think I will not trusta blacksmith to shoe him until I have made sure thathe is sound on the distinction between the sesquioxideand the protosesquioxide of iron?”
—But my scientific labor is to lead touseful results by and by, in the next generation,or in some possible remote future.—
“Diavolo!” as your Dr. Rabelais has it,—answersthe iconoclast,—“what is that tome and my colic, to me and my strangury? I paythe Captain of the Cunard steamship to carry me quicklyand safely to Liverpool, not to make a chart of theAtlantic for after voyagers! If Professor Peirceundertakes to pilot me into Boston Harbor and runsme on Cohasset rocks, what answer is it to tell methat he is Superintendent of the Coast Survey?No, Sir! I want a plain man in a pea-jacket anda sou’wester, who knows the channel of BostonHarbor, and the rocks of Boston Harbor, and the distinguishedProfessor is quite of my mind as to the matter, forI took the pains to ask him before I ventured to usehis name in the way of illustration.”
I do not know how the remarks of the image-breakermay strike others, but I feel that they put me onmy defence with regard to much of my teaching.Some years ago I ventured to show in an introductoryLecture how very small a proportion of the anatomicalfacts taught in a regular course, as delivered bymyself and others, had any practical bearing whateveron the treatment of disease. How can I, how canany medical teacher justify himself in teaching anythingthat is not like to be of practical use to a classof young men who are to hold in their hands the balancein which life and death, ease and anguish, happinessand wretchedness are to be daily weighed?
I hope we are not all wrong. Oftentimes in findinghow sadly ignorant of really essential and vital factsand rules were some of those whom we had been lardingwith the choicest scraps of science, I have doubtedwhether the old one-man system of teaching, when theone man was of the right sort, did not turn out betterworking physicians than our more elaborate method.The best practitioner I ever knew was mainly shapedto excellence in that way. I can understand perfectlythe regrets of my friend Dr. John Brown of Edinburgh,for the good that was lost with the old apprenticeshipsystem. I understand as well Dr. Latham’sfear “that many men of the best abilities andgood education will be deterred from prosecuting physicas a profession, in consequence of the necessity indiscriminatelylaid upon all for impossible attainments.”
I feel therefore impelled to say a very few wordsin defence of that system of teaching adopted in ourColleges, by which we wish to supplement and completethe instruction given by private individuals or bywhat are often called Summer Schools.
The reason why we teach so much that is not practicaland in itself useful, is because we find that theeasiest way of teaching what is practical and useful.If we could in any way eliminate all that would helpa man to deal successfully with disease, and teachit by itself so that it should be as tenaciously rootedin the memory, as easily summoned when wanted, asfertile in suggestion of related facts, as satisfactoryto the peremptory demands of the intelligence as iftaught in its scientific connections, I think it wouldbe our duty so to teach the momentous truths of medicine,and to regard all useless additions as an intrusionon the time which should be otherwise occupied.
But we cannot successfully eliminate and teach byitself that which is purely practical. The easiestand surest why of acquiring facts is to learn themin groups, in systems, and systematized knowledge isscience. You can very often carry two facts fastenedtogether more easily than one by itself, as a housemaidcan carry two pails of water with a hoop more easilythan one without it. You can remember a man’sface, made up of many features, better than you canhis nose or his mouth or his eye-brow. Scoresof proverbs show you that you can remember two linesthat rhyme better than one without the jingle.The ancients, who knew the laws of memory, groupedthe seven cities that contended for the honor of beingHomer’s birthplace in a line thus given by AulusGellius:
Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
I remember, in the earlier political days of MartinVan Buren, that Colonel Stone, of the “New YorkCommercial,” or one of his correspondents, saidthat six towns of New York would claim in the sameway to have been the birth-place of the “LittleMagician,” as he was then called; and thus hegave their names, any one of which I should long agohave forgotten, but which as a group have stuck tightin my memory from that day to this;
Catskill, Saugerties, Redhook, Kinderhook, Scaghtico*ke,Schodac.
If the memory gains so much by mere rhythmical association,how much more will it gain when isolated facts arebrought together under laws and principles, when organsare examined in their natural connections, when structureis coupled with function, and healthy and diseasedaction are studied as they pass one into the other!Systematic, or scientific study is invaluable as supplyinga natural kind of mnemonics, if for nothing else.You cannot properly learn the facts you want from Anatomyand Chemistry in any way so easily as by taking themin their regular order, with other allied facts, onlythere must be common sense exercised in leaving outa great deal which belongs to each of the two branchesas pure science. The dullest of teachers is theone who does not know what to omit.
The larger aim of scientific training is to furnishyou with principles to which you will be able to referisolated facts, and so bring these within the rangeof recorded experience. See what the “LondonTimes” said about the three Germans who crackedopen John Bull Chatwood’s strong-box at theFair the other day, while the three Englishmen hammeredaway in vain at Brother Jonathan Herring’s.The Englishmen represented brute force. The Germanshad been trained to appreciate principle. TheEnglishman “knows his business by rote and ruleof thumb”—science, which would “teachhim to do in an hour what has hitherto occupied himtwo hours,” “is in a manner forbiddento him.” To this cause the “Times”attributes the falling off of English workmen in comparisonwith those of the Continent.
Granting all this, we must not expect too much from“science” as distinguished from commonexperience. There are ten thousand experimenterswithout special apparatus for every one in the laboratory.Accident is the great chemist and toxicologist.Battle is the great vivisector. Hunger has institutedresearches on food such as no Liebig, no AcademicCommission has ever recorded.
Medicine, sometimes impertinently, often ignorantly,often carelessly called “allopathy,” appropriateseverything from every source that can be of the slightestuse to anybody who is ailing in any way, or like tobe ailing from any cause. It learned from a monkhow to use antimony, from a Jesuit how to cure agues,from a friar how to cut for stone, from a soldierhow to treat gout, from a sailor how to keep off scurvy,from a postmaster how to sound the Eustachian tube,from a dairy-maid how to prevent small-pox, and froman old market-woman how to catch the itch-insect.It borrowed acupuncture and the moxa from the Japaneseheathen, and was taught the use of lobelia by the Americansavage. It stands ready to-day to accept anythingfrom any theorist, from any empiric who can make outa good case for his discovery or his remedy.“Science” is one of its benefactors, butonly one, out of many. Ask the wisest practisingphysician you know, what branches of science help himhabitually, and what amount of knowledge relating toeach branch he requires for his professional duties.He will tell you that scientific training has a valueindependent of all the special knowledge acquired.He will tell you that many facts are explained by studyingthem in the wider range of related facts to whichthey belong. He will gratefully recognize thatthe anatomist has furnished him with indispensabledata, that the physiologist has sometimes put himon the track of new modes of treatment, that the chemisthas isolated the active principles of his medicines,has taught him how to combine them, has from time totime offered him new remedial agencies, and so ofothers of his allies. But he will also tell you,if I am not mistaken, that his own branch of knowledgeis so extensive and so perplexing that he must acceptmost of his facts ready made at their hands.He will own to you that in the struggle for life whichgoes on day and night in our thoughts as in the outsideworld of nature, much that he learned under the nameof science has died out, and that simple homely experiencehas largely taken the place of that scholastic knowledgeto which he and perhaps some of his instructors onceattached a paremount importance.
This, then, is my view of scientific training as conductedin courses such as you are entering on. Up toa certain point I believe in set Lectures as excellentadjuncts to what is far more important, practicalinstruction at the bedside, in the operating room,and under the eye of the Demonstrator. But Iam so far from wishing these courses extended, thatI think some of them—suppose I say my own—wouldalmost bear curtailing. Do you want me to describemore branches of the sciatic and crural nerves?I can take Fischer’s plates, and lecturing onthat scale fill up my whole course and not finishthe nerves alone. We must stop somewhere, andfor my own part I think the scholastic exercises ofour colleges have already claimed their full shareof the student’s time without our seeking toextend them.
I trust I have vindicated the apparent inconsequenceof teaching young students a good deal that seemsat first sight profitless, but which helps them tolearn and retain what is profitable. But thisis an inquisitive age, and if we insist on pilingup beyond a certain height knowledge which is in itselfmere trash and lumber to a man whose life is to beone long fight with death and disease, there will besome sharp questions asked by and by, and our quick-wittedpeople will perhaps find they can get along as wellwithout the professor’s cap as without the bishop’smitre and the monarch’s crown.
I myself have nothing to do with clinical teaching.Yet I do not hesitate to say it is more essentialthan all the rest put together, so far as the ordinarypractice of medicine is concerned; and this is by farthe most important thing to be learned, because itdeals with so many more lives than any other branchof the profession. So of personal instruction,such as we give and others give in the interval oflectures, much of it at the bedside, some of it inthe laboratory, some in the microscope-room, somein the recitation-room, I think it has many advantagesof its own over the winter course, and I do not wishto see it shortened for the sake of prolonging whatseems to me long enough already.
If I am jealous of the tendency to expand the timegiven to the acquisition of curious knowledge, atthe expense of the plain old-fashioned bedside teachings,I only share the feeling which Sydenham expressedtwo hundred years ago, using an image I have alreadyborrowed. “He would be no honest and successfulpilot who was to apply himself with less industryto avoid rocks and sands and bring his vessel safelyhome, than to search into the causes of the ebbingand flowing of the sea, which, though very well fora philosopher, is foreign to him whose business itis to secure the ship. So neither will a physician,whose province it is to cure diseases, be able todo so, though he be a person of great genius, whobestows less time on the hidden and intricate methodof nature, and adapting his means thereto, than oncurious and subtle speculation.”
“Medicine is my wife and Science is my mistress,”said Dr. Rush. I do not think that the breachof the seventh commandment can be shown to have beenof advantage to the legitimate owner of his affections.Read what Dr. Elisha Bartlett says of him as a practitioner,or ask one of our own honored ex-professors, who studiedunder him, whether Dr. Rush had ever learned the meaningof that saying of Lord Bacon, that man is the ministerand interpreter of Nature, or whether he did not speakhabitually of Nature as an intruder in the sick room,from which his art was to expel her as an incompetentand a meddler.
All a man’s powers are not too much for sucha profession as Medicine. “He is a learnedman,” said old Parson Emmons of Franklin, “whounderstands one subject, and he is a very learned manwho understands two subjects.” Schonbeinsays he has been studying oxygen for thirty years.Mitscherlich said it took fourteen years to establisha new fact in chemistry. Aubrey says of Harvey,the discoverer of the circulation, that “thoughall his profession would allow him to be an excellentanatomist, I have never heard of any who admired histherapeutic way.” My learned and excellentfriend before referred to, Dr. Brown of Edinburgh,from whose very lively and sensible Essay, “Lockeand Sydenham,” I have borrowed several of mycitations, contrasts Sir Charles Bell, the discoverer,the man of science, with Dr. Abercrombie, the masterin the diagnosis and treatment of disease. Itis through one of the rarest of combinations thatwe have in our Faculty a teacher on whom the scientificmantle of Bell has fallen, and who yet stands preeminentin the practical treatment of the class of diseaseswhich his inventive and ardent experimental geniushas illustrated. M. Brown-Sequard’s exampleis as, eloquent as his teaching in proof of the advantagesof well directed scientific investigation. Butthose who emulate his success at once as a discovererand a practitioner must be content like him to limittheir field of practice. The highest genius cannotafford in our time to forget the ancient precept,Divide et impera.
“I suppose I must go and earn this guinea,”said a medical man who was sent for while he was dissectingan animal. I should not have cared to be hispatient. His dissection would do me no good, andhis thoughts would be too much upon it. I wanta whole man for my doctor, not a half one. Iwould have sent for a humbler practitioner, who wouldhave given himself entirely to me, and told the other—whowas no less a man than John Hunter—to goon and finish the dissection of his tiger.
Sydenham’s “Read Don Quixote” shouldbe addressed not to the student, but to the Professorof today. Aimed at him it means, “Do notbe too learned.”
Do not think you are going to lecture to picked youngmen who are training themselves to be scientific discoverers.They are of fair average capacity, and they are goingto be working doctors.
These young men are to have some very serious vitalfacts to deal with. I will mention a few of them.
Every other resident adult you meet in these streetsis or will be more or less tuberculous. Thisis not an extravagant estimate, as very nearly onethird of the deaths of adults in Boston last year werefrom phthisis. If the relative number is lessin our other northern cities, it is probably in agreat measure because they are more unhealthy; thatis, they have as much, or nearly as much, consumption,but they have more fevers or other fatal diseases.
These heavy-eyed men with the alcoholized brains,these pallid youths with the nicotized optic gangliaand thinking-marrows brown as their own meerschaums,of whom you meet too many,—will ask allyour wisdom to deal with their poisoned nerves andtheir enfeebled wills.
Nearly seventeen hundred children under five yearsof age died last year in this city. A poor humanarticle, no doubt, in many cases, still, worth anattempt to save them, especially when we remember theeffect of Dr. Clarke’s suggestion at the DublinHospital, by which some twenty-five or thirty thousandchildren’s lives have probably been saved ina single city.
Again, the complaint is often heard that the nativepopulation is not increasing so rapidly as in formergenerations. The breeding and nursing periodof American women is one of peculiar delicacy and frequentinfirmity. Many of them must require a considerableinterval between the reproductive efforts, to repairdamages and regain strength. This matter is notto be decided by an appeal to unschooled nature.It is the same question as that of the deformed pelvis,—oneof degree. The facts of mal-vitalization areas much to be attended to as those of mal-formation.If the woman with a twisted pelvis is to be consideredan exempt, the woman with a defective organizationshould be recognized as belonging to the invalid corps.We shudder to hear what is alleged as to the prevalenceof criminal practices; if back of these there can beshown organic incapacity or overtaxing of too limitedpowers, the facts belong to the province of the practicalphysician, as well as of the moralist and the legislator,and require his gravest consideration.
Take the important question of bleeding. Is venesectiondone with forever? Six years ago it was saidhere in an introductory Lecture that it would doubtlesscome back again sooner or later. A fortnight agoI found myself in the cars with one of the most sensibleand esteemed practitioners in New England. Hetook out his wallet and showed me two lancets, whichhe carried with him; he had never given up their use.This is a point you will have to consider.
Or, to mention one out of many questionable remedies,shall you give Veratrum Viride in fevers and inflammations?It makes the pulse slower in these affections.Then the presumption would naturally be that it doesharm. The caution with reference to it on thisground was long ago recorded in the Lecture abovereferred to. See what Dr. John Hughes Bennettsays of it in the recent edition of his work on Medicine.Nothing but the most careful clinical experience cansettle this and such points of treatment.
These are all practical questions—questionsof life and death, and every day will be full of justsuch questions. Take the problem of climate.A patient comes to you with asthma and wants to knowwhere he can breathe; another comes to you with phthisisand wants to know where he can live. What boy’splay is nine tenths of all that is taught in many apretentious course of lectures, compared with whatan accurate and extensive knowledge of the advantagesand disadvantages of different residences in theseand other complaints would be to a practising physician.
I saw the other day a gentleman living in Canada,who had spent seven successive winters in Egypt, withthe entire relief of certain obscure thoracic symptomswhich troubled him while at home. I saw, two monthsago, another gentleman from Minnesota, an observerand a man of sense, who considered that State as thegreat sanatorium for all pulmonary complaints.If half our grown population are or will be more orless tuberculous, the question of colonizing Floridaassumes a new aspect. Even within the bordersof our own State, the very interesting researchesof Dr. Bowditch show that there is a great variationin the amount of tuberculous disease in differenttowns, apparently connected with local conditions.The hygienic map of a State is quite as valuable asits geological map, and it is the business of everypractising physician to know it thoroughly. Theyunderstand this in England, and send a patient witha dry irritating cough to Torquay or Penzance, whilethey send another with relaxed bronchial membranesto Clifton or Brighton. Here is another greatfield for practical study.
So as to the all-important question of diet.“Of all the means of cure at our command,”says Dr. Bennett, “a regulation of the quantityand quality of the diet is by far the most powerful.”Dr. MacCormac would perhaps except the air we breathe,for he thinks that impure air, especially in sleepingrooms, is the great cause of tubercle. It issufficiently proved that the American,—theNew Englander,—the Bostonian, can breedstrong and sound children, generation after generation,—nay,I have shown by the record of a particular family thatvital losses may be retrieved, and a feeble race growto lusty vigor in this very climate and locality.Is not the question why our young men and women sooften break down, and how they can be kept from breakingdown, far more important for physicians to settle thanwhether there is one cranial vertebra, or whetherthere are four, or none?
—But I have a taste for the hom*ologies,I want to go deeply into the subject of embryology,I want to analyze the protonihilates precipitatedfrom pigeon’s milk by the action of the lunarspectrum,—shall I not follow my star,—shallI not obey my instinct,—shall I not givemyself to the lofty pursuits of science for its ownsake?
Certainly you may, if you like. But take downyour sign, or never put it up. That is the wayDr. Owen and Dr. Huxley, Dr. Agassiz and Dr. JeffriesWyman, Dr. Gray and Dr. Charles T. Jackson settledthe difficulty. We all admire the achievementsof this band of distinguished doctors who do not practise.But we say of their work and of all pure science,as the French officer said of the charge of the sixhundred at Balaclava, “C’est magnifique,mais ce n’est pas la guerre,”—itis very splendid, but it is not a practising doctor’sbusiness. His patient has a right to the creamof his life and not merely to the thin milk that isleft after “science” has skimmed it off.The best a physician can give is never too good forthe patient.
It is often a disadvantage to a young practitionerto be known for any accomplishment outside of hisprofession. Haller lost his election as Physicianto the Hospital in his native city of Berne, principallyon the ground that he was a poet. In his lateryears the physician may venture more boldly.Astruc was sixty-nine years old when he published his“Conjectures,” the first attempt, we aretold, to decide the authorship of the Pentateuch showinganything like a discerning criticism. Sir BenjaminBrodie was seventy years old before he left his physiologicaland surgical studies to indulge in psychological speculations.The period of pupilage will be busy enough in acquiringthe knowledge needed, and the season of active practicewill leave little leisure for any but professionalstudies.
Dr. Graves of Dublin, one of the first clinical teachersof our time, always insisted on his students’beginning at once to visit the hospital. At thebedside the student must learn to treat disease, andjust as certainly as we spin out and multiply ouracademic prelections we shall work in more and morestuffing, more and more rubbish, more and more irrelevant,useless detail which the student will get rid of justas soon as he leaves us. Then the next thingwill be a new organization, with an examining boardof first-rate practical men, who will ask the candidatequestions that mean business,—who will makehim operate if he is to be a surgeon, and try himat the bedside if he is to be a physician,—andnot puzzle him with scientific conundrums which notmore than one of the questioners could answer himselfor ever heard of since he graduated.
Or these women who are hammering at the gates on whichis written “No admittance for the mothers ofmankind,” will by and by organize an institution,which starting from that skilful kind of nursing whichFlorence Nightingale taught so well, will work backwardsthrough anodynes, palliatives, curatives, preventives,until with little show of science it imparts mostof what is most valuable in those branches of thehealing art it professes to teach. When that timecomes, the fitness of women for certain medical duties,which Hecquet advocated in 1708, which Douglas maintainedin 1736, which Dr. John Ware, long the honored Professorof Theory and Practice in this Institution, upheldwithin our own recollection in the face of his ownrecorded opinion to the contrary, will very possiblybe recognized.
My advice to every teacher less experienced than myselfwould be, therefore: Do not fret over the detailsyou have to omit; you probably teach altogether toomany as it is. Individuals may learn a thing withonce hearing it, but the only way of teaching a wholeclass is by enormous repetition, representation, andillustration in all possible forms. Now and thenyou will have a young man on your benches like thelate Waldo Burnett,—not very often, if youlecture half a century. You cannot pretend tolecture chiefly for men like that,—a Mississippiraft might as well take an ocean-steamer in tow.To meet his wants you would have to leave the restof your class behind and that you must not do.President Allen of Jefferson College says that hisinstruction has been successful in proportion as ithas been elementary. It may be a humiliatingstatement, but it is one which I have found true inmy own experience.
To the student I would say, that however plain andsimple may be our teaching, he must expect to forgetmuch which he follows intelligently in the lecture-room.But it is not the same as if he had never learned it.A man must get a thing before he can forget it.There is a great world of ideas we cannot voluntarilyrecall,—they are outside the limits ofthe will. But they sway our conscious thoughtas the unseen planets influence the movements of thosewithin the sphere of vision. No man knows howmuch he knows,—how many ideas he has,—anymore than he knows how many blood-globules roll inhis veins. Sometimes accident brings back hereand there one, but the mind is full of irrevocableremembrances and unthinkable thoughts, which takea part in all its judgments as indestructible forces.Some of you must feel your scientific deficienciespainfully after your best efforts. But every onecan acquire what is most essential. A man ofvery moderate ability may be a good physician, ifhe devotes himself faithfully to the work. Morethan this, a positively dull man, in the ordinaryacceptation of the term, sometimes makes a safer practitionerthan one who has, we will say, five per cent. morebrains than his average neighbor, but who thinks itis fifty per cent. more. Skulls belonging tothis last variety of the human race are more common,I may remark, than specimens like the Neanderthalcranium, a cast of which you will find on the tablein the Museum.
Whether the average talent be high or low, the Collegesof the land must make the best commodity they canout of such material as the country and the citiesfurnish them. The community must have Doctorsas it must have bread. It uses up its Doctorsjust as it wears out its shoes, and requires new ones.All the bread need not be French rolls, all the shoesneed not be patent leather ones; but the bread mustbe something that can be eaten, and the shoes mustbe something that can be worn. Life must somehowfind food for the two forces that rub everything topieces, or burn it to ashes,—friction andoxygen. Doctors are oxydable products, and theschools must keep furnishing new ones as the old onesturn into oxyds; some of first-rate quality that burnwith a great light, some of a lower grade of brilliancy,some honestly, unmistakably, by the grace of God,of moderate gifts, or in simpler phrase, dull.
The public will give every honest and reasonably competentworker in the healing art a hearty welcome. Itis on the whole very loyal to the Medical Profession.Three successive years have borne witness to the feelingwith which this Institution, representing it in itseducational aspect, is regarded by those who are themselvesmost honored and esteemed. The great Master ofNatural Science bade the last year’s class farewellin our behalf, in those accents which delight everyaudience. The Head of our ancient Universityhonored us in the same way in the preceding season.And how can we forget that other occasion when theChief Magistrate of the Commonwealth, that noble citizenwhom we have just lost, large-souled, sweet-natured,always ready for every kind office, came among usat our bidding, and talked to us of our duties inwords as full of wisdom as his heart was of goodness?
You have not much to fear, I think, from the fancypractitioners. The vulgar quackeries drop off,atrophied, one after another. hom*oeopathy haslong been encysted, and is carried on the body medicalas quietly as an old wen. Every year gives youa more reasoning and reasonable people to deal with.See how it is in Literature. The dynasty of Britishdogmatists, after lasting a hundred years and more,is on its last legs. Thomas Carlyle, third inthe line of descent, finds an audience very differentfrom those which listened to the silver speech of SamuelTaylor Coleridge and the sonorous phrases of SamuelJohnson. We read him, we smile at his clottedEnglish, his “swarmery” and other picturesqueexpressions, but we lay down his tirade as we do oneof Dr. Cumming’s interpretations of prophecy,which tells us that the world is coming to an endnext week or next month, if the weather permits,—nototherwise,—feeling very sure that the weatherwill be unfavorable.
It is the same common-sense public you will appealto. The less pretension you make, the betterthey will like you in the long run. I hope weshall make everything as plain and as simple to youas we can. I would never use a long word, even,where a short one would answer the purpose. Iknow there are professors in this country who “ligate”arteries. Other surgeons only tie them, and itstops the bleeding just as well. It is the familiarityand simplicity of bedside instruction which makesit so pleasant as well as so profitable. A goodclinical teacher is himself a Medical School.We need not wonder that our young men are beginningto announce themselves not only as graduates of thisor that College, but also as pupils of some one distinguishedmaster.
I wish to close this Lecture, if you will allow mea few moments longer, with a brief sketch of an instructorand practitioner whose character was as nearly a modelone in both capacities as I can find anywhere recorded.
Dr. James Jackson, Professor of the Theoryand Practice of Medicine in this University from 1812to 1846, and whose name has been since retained onour rolls as Professor Emeritus, died on the 27th ofAugust last, in the ninetieth year of his age.He studied his profession, as I have already mentioned,with Dr. Holyoke of Salem, one of the few physicianswho have borne witness to their knowledge of the lawsof life by living to complete their hundredth year.I think the student took his Old Master, as he alwaysloved to call him, as his model; each was worthy ofthe other, and both were bright examples to all whocome after them.
I remember that in the sermon preached by Dr. Grazerafter Dr. Holyoke’s death, one of the pointsmost insisted upon as characteristic of that wiseand good old man was the perfect balance of all hisfaculties. The same harmonious adjustment ofpowers, the same symmetrical arrangement of life,the same complete fulfilment of every day’s duties,without haste and without needless delay, which characterizedthe master, equally distinguished the scholar.A glance at the life of our own Old Master, if I cando any justice at all to his excellences, will giveyou something to carry away from this hour’smeeting not unworthy to be remembered.
From December, 1797, to October, 1799, he remainedwith Dr. Holyoke as a student, a period which he hasspoken of as a most interesting and most gratifyingpart of his life. After this he passed eight monthsin London, and on his return, in October, 1800, hebegan business in Boston.
He had followed Mr. Cline, as I have mentioned, andwas competent to practise Surgery. But he foundDr. John Collins Warren had already occupied the groundwhich at that day hardly called for more than oneleading practitioner, and wisely chose the Medicalbranch of the profession. He had only himselfto rely upon, but he had confidence in his prospects,conscious, doubtless, of his own powers, knowing hisown industry and determination, and being of an eminentlycheerful and hopeful disposition. No better proofof his spirit can be given than that, just a yearfrom the time when he began to practise as a physician,he took that eventful step which in such a man impliesthat he sees his way clear to a position; he marrieda lady blessed with many gifts, but not bringing hima fortune to paralyze his industry.
He had not miscalculated his chances in life.He very soon rose into a good practice, and beganthe founding of that reputation which grew with hisyears, until he stood by general consent at the headof his chosen branch of the profession, to say theleast, in this city and in all this region of country.His skill and wisdom were the last tribunal to whichthe sick and suffering could appeal. The communitytrusted and loved him, the profession recognized himas the noblest type of the physician. The youngmen whom he had taught wandered through foreign hospitals;
where they learned many things that were valuable,and many that were curious; but as they grew olderand began to think more of their ability to help thesick than their power of talking about phenomena, theybegan to look back to the teaching of Dr. Jackson,as he, after his London experience, looked back tothat of Dr. Holyoke. And so it came to be atlast that the bare mention of his name in any of ourmedical assemblies would call forth such a tributeof affectionate regard as is only yielded to age whenit brings with it the record of a life spent in welldoing.No accident ever carries a man to eminence such ashis in the medical profession. He who looks forit must want it earnestly and work for it vigorously;Nature must have qualified him in many ways, and educationmust have equipped him with various knowledge, or hisreputation will evaporate before it reaches the noon-dayblaze of fame. How did Dr. Jackson gain the positionwhich all conceded to him? In the answer to thisquestion some among you may find a key that shall unlockthe gate opening on that fair field of the futureof which all dream but which not all will ever reach.
First of all, he truly loved his profession.He had no intellectual ambitions outside of it, literary,scientific or political. To him it was occupationenough to apply at the bedside the best of all thathe knew for the good of his patient; to protect thecommunity against the inroads of pestilence; to teachthe young all that he himself had been taught, withall that his own experience had added; to leave onrecord some of the most important results of his longobservation.
With his patients he was so perfect at all pointsthat it is hard to overpraise him. I have seenmany noted British and French and American practitioners,but I never saw the man so altogether admirable atthe bedside of the sick as Dr. James Jackson.His smile was itself a remedy better than the potablegold and the dissolved pearls that comforted the praecordiaof mediaeval monarchs. Did a patient, alarmedwithout cause, need encouragement, it carried thesunshine of hope into his heart and put all his whimsto flight, as David’s harp cleared the hauntedchamber of the sullen king. Had the hour come,not for encouragement, but for sympathy, his face,his voice, his manner all showed it, because his heartfelt it. So gentle was he, so thoughtful, so calm,so absorbed in the case before him, not to turn roundand look for a tribute to his sagacity, not to bolsterhimself in a favorite theory, but to find out allhe could, and to weigh gravely and cautiously all thathe found, that to follow him in his morning visitwas not only to take a lesson in the healing art,it was learning how to learn, how to move, how to look,how to feel, if that can be learned. To visitwith Dr. Jackson was a medical education.
He was very firm, with all his kindness. He wouldhave the truth about his patients. The nursesfound it out; and the shrewder ones never venturedto tell him anything but a straight story. A clinicaldialogue between Dr. Jackson and Miss Rebecca Taylor,sometime nurse in the Massachusetts General Hospital,a mistress in her calling, was as good questioningand answering as one would be like to hear outsideof the court-room.
Of his practice you can form an opinion from his bookcalled “Letters to a Young Physician.”Like all sensible men from the days of Hippocratesto the present, he knew that diet and regimen weremore important than any drug or than all drugs puttogether. Witness his treatment of phthisis andof epilepsy. He retained, however, more confidencein some remedial agents than most of the younger generationwould concede to them. Yet his materia medicawas a simple one.
“When I first went to live with Dr. Holyoke,”he says, “in 1797, showing me his shop, he said,’There seems to you to be a great variety ofmedicines here, and that it will take you long to getacquainted with them, but most of them are unimportant.There are four which are equal to all the rest, namely,Mercury, Antimony, Bark and Opium.’” AndDr. Jackson adds, “I can only say of his practice,the longer I have lived, I have thought better andbetter of it.” When he thought it necessaryto give medicine, he gave it in earnest. He hatedhalf-practice—giving a little of this orthat, so as to be able to say that one had done something,in case a consultation was held, or a still more ominousevent occurred. He would give opium, for instance,as boldly as the late Dr. Fisher of Beverly, but hefollowed the aphorism of the Father of Medicine, andkept extreme remedies for extreme cases.
When it came to the “non-naturals,” ashe would sometimes call them, after the old physicians,—namely,air, meat and drink, sleep and watching, motion andrest, the retentions and excretions, and the affectionsof the mind,—he was, as I have said, ofthe school of sensible practitioners, in distinctionfrom that vast community of quacks, with or withoutthe diploma, who think the chief end of man is tosupport apothecaries, and are never easy until theycan get every patient upon a regular course of somethingnasty or noxious. Nobody was so precise in hisdirections about diet, air, and exercise, as Dr. Jackson.He had the same dislike to the a peu pres, the aboutso much, about so often, about so long, which I afterwardsfound among the punctilious adherents of the numericalsystem at La Pitie.
He used to insist on one small point with a certainphilological precision, namely, the true meaning ofthe word “cure.” He would have itthat to cure a patient was simply to care for him.I refer to it as showing what his idea was of therelation of the physician to the patient. Itwas indeed to care for him, as if his life were boundup in him, to watch his incomings and outgoings, tostand guard at every avenue that disease might enter,to leave nothing to chance; not merely to throw afew pills and powders into one pan of the scales ofFate, while Death the skeleton was seated in the other,but to lean with his whole weight on the side of life,and shift the balance in its favor if it lay in humanpower to do it. Such devotion as this is onlyto be looked for in the man who gives himself whollyup to the business of healing, who considers Medicineitself a Science, or if not a science, is willing tofollow it as an art,—the noblest of arts,which the gods and demigods of ancient religions didnot disdain to practise and to teach.
The same zeal made him always ready to listen to anynew suggestion which promised to be useful, at a periodof life when many men find it hard to learn new methodsand accept new doctrines. Few of his generationbecame so accomplished as he in the arts of directexploration; coming straight from the Parisian experts,I have examined many patients with him, and have hadfrequent opportunities of observing his skill in percussionand auscultation.
One element in his success, a trivial one comparedwith others, but not to be despised, was his punctuality.He always carried two watches,—I doubtif he told why, any more than Dr. Johnson told whathe did with the orange-peel,—but probablywith reference to this virtue. He was as muchto be depended upon at the appointed time as the solsticeor the equinox. There was another point I haveheard him speak of as an important rule with him;to come at the hour when he was expected; if he hadmade his visit for several days successively at teno’clock, for instance, not to put it off, ifhe could possibly help it, until eleven, and so keepa nervous patient and an anxious family waiting forhim through a long, weary hour.
If I should attempt to characterize his teaching,I should say that while it conveyed the best resultsof his sagacious and extended observation, it wassingularly modest, cautious, simple, sincere.Nothing was for show, for self-love; there was norhetoric, no declamation, no triumphant “I toldyou so,” but the plain statement of a clear-headedhonest man, who knows that he is handling one of thegravest subjects that interest humanity. Hispositive instructions were full of value, but the spiritin which he taught inspired that loyal love of truthwhich lies at the bottom of all real excellence.
I will not say that, during his long career, Dr. Jacksonnever made an enemy. I have heard him tell how,in his very early days, old Dr. Danforth got intoa towering passion with him about some professionalconsultation, and exploded a monosyllable or two ofthe more energetic kind on the occasion. I rememberthat that somewhat peculiar personage, Dr. Waterhouse,took it hardly when Dr. Jackson succeeded to his placeas Professor of Theory and Practice. A youngman of Dr. Jackson’s talent and energy couldhardly take the position that belonged to him withoutcrowding somebody in a profession where three in abed is the common rule of the household. Buthe was a peaceful man and a peace-maker all his days.No man ever did more, if so much, to produce and maintainthe spirit of harmony for which we consider our medicalcommunity as somewhat exceptionally distinguished.
If this harmony should ever be threatened, I couldwish that every impatient and irritable member ofthe profession would read that beautiful, that noblePreface to the “Letters,” addressed toJohn Collins Warren. I know nothing finer inthe medical literature of all time than this PrefatoryIntroduction. It is a golden prelude, fit to gowith the three great Prefaces which challenge theadmiration of scholars, —Calvin’sto his Institutes, De Thou’s to his History,and Casaubon’s to his Polybius,—notbecause of any learning or rhetoric, though it ischarmingly written, but for a spirit flowing throughit to which learning and rhetoric are but as the breaththat is wasted on the air to the Mood that warms theheart.
Of a similar character is this short extract whichI am permitted to make from a private letter of histo a dear young friend. He was eighty-three yearsold at the time of writing it.
“I have not loved everybody whom I have known,but I have striven to see the good points in the charactersof all men and women. At first I must have donethis from something in my own nature, for I was notaware of it, and yet was doing it without any plan,when one day, sixty years ago, a friend whom I lovedand respected said this to me, ’Ah, James, Isee that you are destined to succeed in the world,and to make friends, because you are so ready to seethe good point in the characters of those you meet.’”
I close this imperfect notice of some features inthe character of this most honored and beloved ofphysicians by applying to him the words which werewritten of William Heberden, whose career was not unlikehis own, and who lived to the same patriarchal age.
“From his early youth he had always entertaineda deep sense of religion, a consummate love of virtue,an ardent thirst after knowledge, and an earnest desireto promote the welfare and happiness of all mankind.By these qualities, accompanied with great sweetnessof manners, he acquired the love and esteem of allgood men, in a degree which perhaps very few haveexperienced; and after passing an active life withthe uniform testimony of a good conscience, he becamean eminent example of its influence, in the cheerfulnessand serenity of his latest age.”
Such was the man whom I offer to you as a model, younggentlemen, at the outset of your medical career.I hope that many of you will recognize some traitsof your own special teachers scattered through variousparts of the land in the picture I have drawn.Let me assure you that whatever you may learn in thisor any other course of public lectures,—andI trust you will learn a great deal,—thedaily guidance, counsel, example, of your medicalfather, for such the Oath of Hippocrates tells youto consider your preceptor, will, if he is in anydegree like him of whom I have spoken, be the foundationon which all that we teach is reared, and perhapsoutlive most of our teachings, as in Dr. Jackson’smemory the last lessons that remained with him werethose of his Old Master.
THE MEDICAL PROFESSION IN MASSACHUSETTS.
A Lecture of a Course by members of the MassachusettsHistorical Society, delivered before the Lowell Institute,January 29, 1869.
The medical history of eight generations, told inan hour, must be in many parts a mere outline.The details I shall give will relate chiefly to thefirst century. I shall only indicate the leadingoccurrences, with the more prominent names of thetwo centuries which follow, and add some considerationssuggested by the facts which have been passed in review.
A geographer who was asked to describe the tides ofMassachusetts Bay, would have to recognize the circ*mstancethat they are a limited manifestation of a great oceanicmovement. To consider them apart from this, wouldbe to localize a planetary phenomenon, and to provincializea law of the universe. The art of healing inMassachusetts has shared more or less fully and readilythe movement which, with its periods of ebb and flow,has been raising its level from age to age throughoutthe better part of Christendom. Its practitionersbrought with them much of the knowledge and many ofthe errors of the Old World; they have always beenin communication with its wisdom and its folly; itis not without interest to see how far the new conditionsin which they found themselves have been favorableor unfavorable to the growth of sound medical knowledgeand practice.
The state of medicine is an index of the civilizationof an age and country,—one of the best,perhaps, by which it can be judged. Surgery invokesthe aid of all the mechanical arts. From the rudeviolences of the age of stone,—a relicof which we may find in the practice of Zipporah,the wife of Moses,—to the delicate operationsof to-day upon patients lulled into temporary insensibility,is a progress which presupposes a skill in metallurgyand in the labors of the workshop and the laboratoryit has taken uncounted generations to accumulate.Before the morphia which deadens the pain of neuralgia,or the quinine which arrests the fit of an ague, canfind their place in our pharmacies, commerce musthave perfected its machinery, and science must haverefined its processes, through periods only to becounted by the life of nations. Before the meanswhich nature and art have put in the hands of themedical practitioner can be fairly brought into use,the prejudices of the vulgar must be overcome, theintrusions of false philosophy must be fenced out,and the partnership with the priesthood dissolved.All this implies that freedom and activity of thoughtwhich belong only to the most advanced conditionsof society; and the progress towards this is by gradationsas significant of wide-spread changes, as are the varyingstates of the barometer of far-extended conditionsof the atmosphere.
Apart, then, from its special and technical interest,my subject has a meaning which gives a certain importance,and even dignity, to details in themselves trivialand almost unworthy of record. A medical entryin Governor Winthrop’s journal may seem at firstsight a mere curiosity; but, rightly interpreted,it is a key to his whole system of belief as to theorder of the universe and the relations between manand his Maker. Nothing sheds such light on thesuperstitions of an age as the prevailing interpretationand treatment of disease. When the touch of aprofligate monarch was a cure for one of the mostinveterate of maladies, when the common symptoms ofhysteria were prayed over as marks of demoniacal possession,we might well expect the spiritual realms of thoughtto be peopled with still stranger delusions.
Let us go before the Pilgrims of the Mayflower, andlook at the shores on which they were soon to land.A wasting pestilence had so thinned the savage tribesthat it was sometimes piously interpreted as havingprovidentially prepared the way for the feeble bandof exiles. Cotton Mather, who, next to the witches,hated the “tawnies,” “wild beasts,”“blood-hounds,” “rattlesnakes,”“infidels,” as in different places hecalls the unhappy Aborigines, describes the conditionof things in his lively way, thus: “TheIndians in these Parts had newly, even about a Yearor Two before, been visited with such a prodigiousPestilence; as carried away not a Tenth, but NineParts of Ten (yea’t is said Nineteen of Twenty)among them so that the Woods were almost cleared ofthose pernicious Creatures to make Room for a betterGrowth.”
What this pestilence was has been much discussed.It is variously mentioned by different early writersas “the plague,” “a great and grievousplague,” “a sore consumption,” asattended with spots which left unhealed places onthose who recovered, as making the “whole surfaceyellow as with a garment.” Perhaps no diseaseanswers all these conditions so well as smallpox.We know from different sources what frightful havocit made among the Indians in after years,—in1631, for instance, when it swept away the aboriginalinhabitants of “whole towns,” and in 1633.We have seen a whole tribe, the Mandans, extirpatedby it in our own day. The word “plague”was used very vaguely, as in the description of the“great sickness” found among the Indiansby the expedition of 1622. This same great sicknesscould hardly have been yellow fever, as it occurredin the month of November. I cannot think, therefore,that either the scourge of the East or our Southernmalarial pestilence was the disease that wasted theIndians. As for the yellowness like a garment,that is too familiar to the eyes of all who have everlooked on the hideous mask of confluent variola.
Without the presence or the fear of these exotic maladies,the forlorn voyagers of the Mayflower had sicknessenough to contend with. At their first landingat Cape Cod, gaunt and hungry and longing for freshfood, they found upon the sandy shore “greatmussel’s, and very fat and full of sea-pearl.”Sailors and passengers indulged in the treacherousdelicacy; which seems to have been the sea-clam; andfound that these mollusks, like the shell the poettells of, remembered their august abode, and treatedthe way-worn adventurers to a gastric reminiscenceof the heaving billows. In the mean time it blewand snowed and froze. The water turned to iceon their clothes, and made them many times like coatsof iron. Edward Tilley had like to have “sounded”with cold. The gunner, too, was sick unto death,but “hope of trucking” kept him on hisfeet,—a Yankee, it should seem, when hefirst touched the shore of New England. Most,if not all, got colds and coughs, which afterwardsturned to scurvy, whereof many died.
How can we wonder that the crowded and tempest-tossedvoyagers, many of them already suffering, should havefallen before the trials of the first winter in Plymouth?Their imperfect shelter, their insufficient supplyof bread, their salted food, now in unwholesome condition,account too well for the diseases and the mortalitythat marked this first dreadful season; weakness,swelling of the limbs, and other signs of scurvy,betrayed the want of proper nourishment and protectionfrom the elements. In December six of their numberdied, in January eight, in February, seventeen, inMarch thirteen. With the advance of spring themortality diminished, the sick and lame began to recover,and the colonists, saddened but not disheartened,applied themselves to the labors of the opening year.
One of the most pressing needs of the early colonistsmust have been that of physicians and surgeons.In Mr. Savage’s remarkable Genealogical Dictionaryof the first settlers who came over before 1692 andtheir descendants to the third generation, I findscattered through the four crowded volumes the namesof one hundred and thirty-four medical practitioners.Of these, twelve, and probably many more, practisedsurgery; three were barber-surgeons. A littleincident throws a glimmer from the dark lantern ofmemory upon William Direly, one of these practitionerswith the razor and the lancet. He was lost betweenBoston and Roxbury in a violent tempest of wind andsnow; ten days afterwards a son was born to his widow,and with a touch of homely sentiment, I had almostsaid poetry, they called the little creature “Fathergone”Direly. Six or seven, probably a larger number,were ministers as well as physicians, one of whom,I am sorry to say, took to drink and tumbled intothe Connecticut River, and so ended. One was notonly doctor, but also schoolmaster and poet.One practised medicine and kept a tavern. Onewas a butcher, but calls himself a surgeon in his will,a union of callings which suggests an obvious pleasantry.One female practitioner, employed by her own sex,—AnnMoore,—was the precursor of that intrepidsisterhood whose cause it has long been my pleasureand privilege to advocate on all fitting occasions.
Outside of this list I must place the name of ThomasWilkinson, who was complained of, is 1676, for practisingcontrary to law.
Many names in the catalogue of these early physicianshave been associated, in later periods, with the practiceof the profession, —among them, Boylston,Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver,Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,Woodward. Touton was a Huguenot, Burchsted a Germanfrom Silesia, Lunerus a German or a Pole; “PighoggChurrergeon,” I hope, for the honor of the profession,was only Peaco*ck disguised under this alias, whichwould not, I fear, prove very attractive to patients.
What doctrines and practice were these colonists likelyto bring, with them?
Two principal schools of medical practice prevailedin the Old World during the greater part of the seventeenthcentury. The first held to the old methods ofGalen: its theory was that the body, the microcosm,like the macrocosm, was made up of the four elements—fire,air, water, earth; having respectively the qualitieshot, dry, moist, cold. The body was to be preservedin health by keeping each of these qualities in itsnatural proportion; heat, by the proper temperature;moisture, by the due amount of fluid; and so as tothe rest. Diseases which arose from excess ofheat were to be attacked by cooling remedies; thosefrom excess of cold, by heating ones; and so of theother derangements of balance. This was trulythe principle of contraries contrariis, which ill-informedpersons have attempted to make out to be the generaldoctrine of medicine, whereas there is no generaldogma other than this: disease is to be treatedby anything that is proved to cure it. The meansthe Galenist employed were chiefly diet and vegetableremedies, with the use of the lancet and other depletingagents. He attributed the four fundamental qualitiesto different vegetables, in four different degrees;thus chicory was cold in the fourth degree, pepperwas hot in the fourth, endive was cold and dry inthe second, and bitter almonds were hot in the firstand dry in the second degree. When we say “coolas a cucumber,” we are talking Galenism.The seeds of that vegetable ranked as one of “thefour greater cold seeds” of this system.
Galenism prevailed mostly in the south of Europe andFrance. The readers of Moliere will have no difficultyin recalling some of its favorite modes of treatment,and the abundant mirth he extracted from them.
These Galenists were what we should call “herb-doctors”to-day. Their insignificant infusions lost creditafter a time; their absurdly complicated mixturesexcited contempt, and their nauseous prescriptionsprovoked loathing and disgust. A simpler and bolderpractice found welcome in Germany, depending chieflyon mineral remedies, mercury, antimony, sulphur, arsenic,and the use, sometimes the secret use, of opium.Whatever we think of Paracelsus, the chief agent in
the introduction of these remedies, and whatever limitswe may assign to the use of these long-trusted mineraldrugs, there can be no doubt that the chemical school,as it was called, did a great deal towards the expurgationof the old, overloaded, and repulsive pharmacopoeia.We shall find evidence in the practice of our New-Englandphysicians of the first century, that they often employedchemical remedies, and that, by the early part ofthe following century, their chief trust was in thefew simple, potent drugs of Paracelsus.We have seen that many of the practitioners of medicine,during the first century of New England, were clergymen.This relation between medicine and theology has existedfrom a very early period; from the Egyptian priestto the Indian medicine-man, the alliance has been maintainedin one form or another. The partnership was verycommon among our British ancestors. Mr. Ward,the Vicar of Stratford-on-Avon, himself a notableexample of the union of the two characters, writingabout 1660, says,
“The Saxons had their blood-letters, but underthe Normans physicke, begunne in England; 300 yearsagoe itt was not a distinct profession by itself,but practised by men in orders, witness Nicholas deTernham, the chief English physician and Bishop ofDurham; Hugh of Evesham, a physician and cardinal;Grysant, physician and pope; John Chambers, Dr. ofPhysick, was the first Bishop of Peterborough; PaulBush, a bachelor of divinitie in Oxford, was a manwell read in physick as well as divinitie, he wasthe first bishop of Bristol.”
“Again in King Richard the Second’s timephysicians and divines were not distinct professions;for one Tydeman, Bishop of Landaph and Worcester,was physician to King Richard the Second.”
This alliance may have had its share in creating andkeeping up the many superstitions which have figuredso largely in the history of medicine. It iscurious to see that a medical work left in manuscriptby the Rev. Cotton Mather and hereafter to be referredto, is running over with follies and superstitiousfancies; while his contemporary and fellow-townsman,William Douglass, relied on the same few simple remedieswhich, through Dr. Edward Holyoke and Dr. James Jackson,have come down to our own time, as the most importantarticles of the materia medica.
Let us now take a general glance at some of the conditionsof the early settlers; and first, as to the healthfulnessof the climate. The mortality of the season thatfollowed the landing of the Pilgrims at Plymouth hasbeen sufficiently accounted for. After this, thecolonists seem to have found the new country agreeingvery well with their English constitutions. Itsclear air is the subject of eulogy. Its daintysprings of sweet water are praised not only by Higginsonand Wood, but even the mischievous Morton says, thatfor its delicate waters “Canaan came not nearthis country.” There is a tendency to dilate
on these simple blessings, which reminds one a littleof the Marchioness in Dickens’s story, withher orange-peel-and-water beverage. Still moredoes one feel the warmth of coloring,—suchas we expect from converts to a new faith, and settlerswho want to entice others over to their clearings,when Winslow speaks, in 1621, of “abundance ofroses, white, red, and damask; single, but very sweetindeed;” a most of all, however, when, in thesame connection, he says, “Here are grapes whiteand red, and very sweet and strong also.”This of our wild grape, a little vegetable Indian,which scalps a civilized man’s mouth, as hisanimal representative scalps his cranium. Butthere is something quite charming in Winslow’spicture of the luxury in which they are living.Lobsters, oysters, eels, mussels, fish and fowl, deliciousfruit, including the grapes aforesaid,—ifthey only had “kine, horses, and sheep,”he makes no question but men would live as contentedhere as in any part of the world. We cannot helpadmiring the way in which they took their trials,and made the most of their blessings.“And how Content they were,” says CottonMather, “when an Honest Man, as I have heard,inviting his Friends to a Dish of Clams, at the Tablegave Thanks to Heaven, who had given them to suckthe abundance of the Seas, and of the Treasures Aidin the Sands!”
Strangely enough, as it would seem, except for thisbuoyant determination to make the best of everything,they hardly appear to recognize the difference ofthe climate from that which they had left. Afteralmost three years’ experience, Winslow says,he can scarce distinguish New England from Old England,in respect of heat and cold, frost, snow, rain, winds,etc. The winter, he thinks (if there is adifference), is sharper and longer; but yet he maybe deceived by the want of the comforts he enjoyedat home. He cannot conceive any climate to agreebetter with the constitution of the English, not beingoppressed with extremity of heats, nor nipped by bitingcold:
“By which means, blessed be God, we enjoy ourhealth, notwithstanding those difficulties we haveundergone, in such a measure as would have been admired,if we had lived in England with the like means.”
Edward Johnson, after mentioning the shifts to whichthey were put for food, says,—
“And yet, methinks, our children are as cheerful,fat, and lusty, with feeding upon those mussels, clams,and other fish, as they were in England with theirfill of bread.”
Higginson, himself a dyspeptic, “continuallyin physic,” as he says, and accustomed to dressin thick clothing, and to comfort his stomach withdrink that was “both strong and stale,”—the“jolly good ale and old,” I suppose, offree and easy Bishop Still’s song,—foundthat he both could and did oftentimes drink New Englandwater very well,—which he seems to lookupon as a remarkable feat. He could go as lightclad
as any, too, with only a light stuff cassock uponhis shirt, and stuff breeches without linings.Two of his children were sickly: one,—littlemisshapen Mary,—died on the passage, and,in her father’s words, “was the first inour ship that was buried in the bowels of the greatAtlantic sea;” the other, who had been “mostlamentably handled” by disease, recovered almostentirely “by the very wholesomeness of the air,altering, digesting, and drying up the cold and crudehumors of the body.” Wherefore, he thinksit a wise course for all cold complexions to come totake physic in New England, and ends with those oftenquoted words, that “a sup of New England’sair is better than a whole draught of Old England’sale.” Mr. Higginson died, however, “ofa hectic fever,” a little more than a year afterhis arrival.The medical records which I shall cite show that thecolonists were not exempt from the complaints of theOld World. Besides the common diseases to whichtheir descendants are subject, there were two others,to say nothing of the dreaded small-pox, which latermedical science has disarmed,—little knownamong us at the present day, but frequent among thefirst settlers. The first of these was the scurvy,already mentioned, of which Winthrop speaks in 1630,saying, that it proved fatal to those who fell intodiscontent, and lingered after their former conditionsin England; the poor homesick creatures in fact, whomwe so forget in our florid pictures of the early timesof the little band in the wilderness. Many whowere suffering from scurvy got well when the Lyonarrived from England, bringing store of juice of lemons.The Governor speaks of another case in 1644; and itseems probable that the disease was not of rare occurrence.
The other complaint from which they suffered, butwhich has nearly disappeared from among us, was intermittentfever, or fever and ague. I investigated thequestion as to the prevalence of this disease in NewEngland, in a dissertation, which was published ina volume with other papers, in the year 1838.I can add little to the facts there recorded.One which escaped me was, that Joshua Scottow, in “OldMen’s Tears,” dated 1691, speaks of “shakingagues,” as among the trials to which they hadbeen subjected. The outline map of New England,accompanying the dissertation above referred to, indicatesall the places where I had evidence that the diseasehad originated. It was plain enough that it usedto be known in many localities where it has long ceasedto be feared. Still it was and is remarkableto see what a clean bill of health in this particularrespect our barren soil inherited with its sterility.There are some malarious spots on the edge of LakeChamplain, and there have been some temporary centresof malaria, within the memory of man, on one or moreof our Massachusetts rivers, but these are harmlessenough, for the most part, unless the millers dam them,when they are apt to retaliate with a whiff from theirmeadows, that sets the whole neighborhood shakingwith fever and ague.
The Pilgrims of the Mayflower had with them a goodphysician, a man of standing, a deacon of their church,one whom they loved and trusted, Dr. Samuel Fuller.But no medical skill could keep cold and hunger andbad food, and, probably enough, desperate homesicknessin some of the feebler sort, from doing their work.No detailed record remains of what they suffered orwhat was attempted for their relief during the firstsad winter. The graves of those who died werelevelled and sowed with grain that the losses of thelittle band might not be suspected by the savage tenantsof the wilderness, and their story remains untold.
Of Dr. Fuller’s practice, at a later period,we have an account in a letter of his to GovernorBradford, dated June, 1630. “I have beento Matapan” (now Dorchester), he says, “andlet some twenty of those people blood.”Such wholesale depletion as this, except with avowedhomicidal intent, is quite unknown in these days;though I once saw the noted French surgeon, Lisfranc,in a fine phlebotomizing frenzy, order some ten orfifteen patients, taken almost indiscriminately, tobe bled in a single morning.
Dr. Fuller’s two visits to Salem, at the requestof Governor Endicott, seem to have been very satisfactoryto that gentleman. Morton, the wild fellow ofMerry Mount, gives a rather questionable reason forthe Governor’s being so well pleased with thephysician’s doings. The names under whichhe mentions the two personages, it will be seen, arenot intended to be complimentary. “Dr.Noddy did a great cure for Captain Littleworth.He cured him of a disease called a wife.” William Gager, who came out with Winthrop, is spokenof as “a right godly man and skilful chyrurgeon,but died of a malignant fever not very long after hisarrival.”
Two practitioners of the ancient town of Newbury areentitled to special notice, for different reasons.The first is Dr. John Clark, who is said by traditionto have been the first regularly educated physicianwho resided in New England. His portrait, inclose-fitting skull-cap, with long locks and venerableflowing beard, is familiar to our eyes on the wallof our Society’s antechamber. His left handrests upon a skull, his right hand holds an instrumentwhich deserves a passing comment. It is a trephine,a surgical implement for cutting round pieces out ofbroken skulls, so as to get at the fragments whichhave been driven in, and lift them up. It hasa handle like that of a gimlet, with a claw like ahammer, to lift with, I suppose, which last contrivanceI do not see figured in my books. But the pointI refer to is this: the old instrument, the trepan,had a handle like a wimble, what we call a brace orbit-stock. The trephine is not mentioned at allin Peter Lowe’s book, London, 1634; nor in Wiseman’sgreat work on Surgery, London, 1676; nor in the translationof Dionis, published by Jacob Tonson, in 1710.In fact it was only brought into more general use
by Cheselden and Sharpe so late as the beginning ofthe last century. As John Clark died in 1661,it is remarkable to see the last fashion in the wayof skull-sawing contrivances in his hands,—tosay nothing of the claw on the handle, and a Hey’ssaw, so called in England, lying on the table by him,and painted there more than a hundred years beforeHey was born. This saw is an old invention, perhapsas old as Hippocrates, and may be seen figured in the“Armamentarium Chirurgicum” of Scultetus,or in the Works of Ambroise Pare.Dr. Clark is said to have received a diploma beforehe came, for skill in lithotomy. He loved horses,as a good many doctors do, and left a good property,as they all ought to do. His grave and noble presence,with the few facts concerning him, told with moreor less traditional authority, give us the feelingthat the people of Newbury, and afterwards of Boston,had a wise and skilful medical adviser and surgeonin Dr. John Clark.
The venerable town of Newbury had another physicianwho was less fortunate. The following is a courtrecord of 1652:
“This is to certify whom it may concern, thatwe the subscribers, being called upon to testify againstdoctor William Snelling for words by him uttered,affirm that being in way of merry discourse, a healthbeing drank to all friends, he answered,
“I’ll pledge my friends,
And for my foes
A plague for their heels
And,’——
[a similar malediction on the other extremity of theirfeet.]
“Since when he hath affirmed that he only intendedthe proverb used in the west country, nor do we believehe intended otherwise.
“[Signed] “William Thomas.“Thomas Milward.
“March 12th 1651, All which I acknowledge, andam sorry I did not expresse my intent, or that I wasso weak as to use so foolish a proverb.
“[Signed] “GULIELMUS Snelling.”
Notwithstanding this confession and apology, the recordtells us that “William Snelling in his presentmentfor cursing is fined ten shillings and the fees ofcourt.”
I will mention one other name among those of the Fathersof the medical profession in New England. The“apostle” Eliot says, writing in 1647,“We never had but one anatomy in the country,which Mr. Giles Firman, now in England, did make andread upon very well.”
Giles Firmin, as the name is commonly spelled, practisedphysic in this country for a time. He seems tohave found it a poor business; for, in a letter toGovernor Winthrop, he says, “I am strongly settupon to studye divinitie: my studyes else mustbe lost, for physick is but a meene helpe.”
Giles Firmin’s Lectures on Anatomy were thefirst scientific teachings of the New World.While the Fathers were enlightened enough to permitsuch instructions, they were severe in dealing withquackery; for, in 1631, our court records show thatone Nicholas Knopp, or Knapp, was sentenced to befined or whipped “for taking upon him to curethe scurvey by a water of noe worth nor value, whichhe solde att a very deare rate.” Emptypurses or sore backs would be common with us to-dayif such a rule were enforced.
Besides the few worthies spoken of, and others whosenames I have not space to record, we must rememberthat there were many clergymen who took charge ofthe bodies as well as the souls of their patients,among them two Presidents of Harvard College, CharlesChauncy and Leonard Hoar,—and Thomas Thacher,first minister of the “Old South,” authorof the earliest medical treatises printed in the country,[ABrief Rule to Guide the Common People in Small poxand Measles. 1674.] whose epitaph in Latin and Greek,said to have been written by Eleazer, an “IndianYouth” and a member of the Senior Class of HarvardCollege, may be found in the “Magnalia.”I miss this noble savage’s name in our triennialcatalogue; and as there is many a slip between thecup and lip, one is tempted to guess that he may havelost his degree by some display of his native instinct,—possiblya flourish of the tomahawk or scalping-knife.However this may have been, the good man he celebratedwas a notable instance of the Angelical Conjunction,as the author of the “Magnalia” callsit, of the offices of clergyman and medical practitioner.
Michael Wigglesworth, author of the “Day ofDoom,” attended the sick, “not only asa Pastor, but as a Physician too, and this, not onlyin his own town, but also in all those of the vicinity.”Mather says of the sons of Charles Chauncy, “Allof these did, while they had Opportunity, Preach theGospel; and most, if not all of them, like their excellentFather before them, had an eminent skill in physickadded unto their other accomplishments,” etc.Roger Williams is said to have saved many in a kindof pestilence which swept away many Indians.
To these names must be added, as sustaining a certainrelation to the healing art, that of the first GovernorWinthrop, who is said by John Cotton to have been“Help for our Bodies by Physick [and] for ourEstates by Law,” and that of his son, the Governorof Connecticut, who, as we shall see, was as muchphysician as magistrate.
I had submitted to me for examination, in 1862, amanuscript found among the Winthrop Papers, markedwith the superscription, “For my worthy friendMr. Wintrop,” dated in 1643, London, signed EdwardStafford, and containing medical directions and prescriptions.It may be remembered by some present that I wrotea report on this paper, which was published in the“Proceedings” of this Society. Whetherthe paper was written for Governor John Winthrop ofMassachusetts, or for his son, Governor John of Connecticut,there is no positive evidence that I have been ableto obtain. It is very interesting, however, asgiving short and simple practical directions, suchas would be most like to be wanted and most useful,in the opinion of a physician in repute of that day.
The diseases prescribed for are plague, small-pox,fevers, king’s evil, insanity, falling-sickness,and the like; with such injuries as broken bones,dislocations, and burning with gunpowder. Theremedies are of three kinds: simples, such asSt. John’s wort, Clown’s all-heal, elder,parsley, maidenhair, mineral drugs, such as lime, saltpetre,Armenian bole, crocus metallorum, or sulphuret ofantimony; and thaumaturgic or mystical, of which thechief is, “My black powder against the plague,small-pox; purples, all sorts of feavers; Poyson; either,by Way of Prevention or after Infection.”This marvellous remedy was made by putting live toadsinto an earthen pot so as to half fill it, and bakingand burning them “in the open ayre, not in anhouse,”—concerning which latter possibilityI suspect Madam Winthrop would have had something tosay,—until they could be reduced by pounding,first into a brown, and then into a black, powder.Blood-letting in some inflammations, fasting in theearly stage of fevers, and some of those peremptorydrugs with which most of us have been well acquaintedin our time, the infragrant memories of which I willnot pursue beyond this slight allusion, are amonghis remedies.
The Winthrops, to one of whom Dr. Stafford’sdirections were addressed, were the medical as wellas the political advisers of their fellow-citizensfor three or four successive generations. Oneof them, Governor John of Connecticut, practised soextensively, that, but for his more distinguishedtitle in the State, he would have been remembered asthe Doctor. The fact that he practised in anothercolony, for the most part, makes little differencein the value of the records we have of his medicalexperience, which have fortunately been preserved,and give a very fair idea, in all probability, ofthe way in which patients were treated in Massachusetts,when they fell into intelligent and somewhat educatedhands, a little after the middle of the seventeenthcentury:
I have before me, while writing, a manuscript collectionof the medical cases treated by him, and recordedat the time in his own hand, which has been intrustedto me by our President, his descendant.
They are generally marked Hartford, and extend fromthe year 1657 to 1669. From these, manuscripts,and from the letters printed in the Winthrop Paperspublished by our Society, I have endeavored to obtainsome idea of the practice of Governor John Winthrop,Junior. The learned eye of Mr. Pulsifer wouldhave helped me, no doubt, as it has done in othercases; but I have ventured this time to attempt findingmy own way among the hieroglyphics of these old pages.By careful comparison of many prescriptions, and bythe aid of Schroder, Salmon, Culpeper, and other oldcompilers, I have deciphered many of his difficultparagraphs with their mysterious recipes.
The Governor employed a number of the simples dearto ancient women, —elecampane and elderand wormwood and anise and the rest; but he also employedcertain mineral remedies, which he almost always indicatesby their ancient symbols, or by a name which shouldleave them a mystery to the vulgar. I am nowprepared to reveal the mystic secrets of the Governor’sbeneficent art, which rendered so many good and greatas well as so many poor and dependent people his debtors,—atleast, in their simple belief,—for theirhealth and their lives.
His great remedy, which he gave oftener than any other,was nitre; which he ordered in doses of twenty orthirty grains to adults, and of three grains to infants.Measles, colics, sciatica, headache, giddiness, andmany other ailments, all found themselves treated,and I trust bettered, by nitre; a pretty safe medicinein moderate doses, and one not likely to keep thegood Governor awake at night, thinking whether it mightnot kill, if it did not cure. We may say as muchfor spermaceti, which he seems to have considered“the sovereign’st thing on earth”for inward bruises, and often prescribes after fallsand similar injuries.
One of the next remedies, in point of frequency, whichhe was in the habit of giving, was (probably diaphoretic)antimony; a mild form of that very active metal, andwhich, mild as it was, left his patients very commonlywith a pretty strong conviction that they had beentaking something that did not exactly agree with them.Now and then he gave a little iron or sulphur or calomel,but very rarely; occasionally, a good, honest doseof rhubarb or jalap; a taste of stinging horseradish,oftener of warming guiacum; sometimes an anodyne,in the shape of mithridate,—the famousold farrago, which owed its virtue to poppy juice;[This is the remedy which a Boston divine tried tosimplify. See Electuarium Novum Alexipharmacum,by Rev. Thomas Harward, lecturer at the Royal Chappell.Boston, 1732. This tract is in our Society’slibrary.] very often, a harmless powder of coral; lessfrequently, an inert prescription of pleasing amber;and (let me say it softly within possible hearingof his honored descendant), twice or oftener,—letus hope as a last resort,—an electuaryof millipedes,—sowbugs, if we must givethem their homely English name. One or two otherprescriptions, of the many unmentionable ones whichdisgraced the pharmacopoeia of the seventeenth century,are to be found, but only in very rare instances, inthe faded characters of the manuscript.
The excellent Governor’s accounts of diseasesare so brief, that we get only a very general notionof the complaints for which he prescribed. Measlesand their consequences are at first more prominentthan any other one affection, but the common infirmitiesof both sexes and of all ages seem to have come underhis healing hand. Fever and ague appears to havebeen of frequent occurrence.
His published correspondence shows that many notedpeople were in communication with him as his patients.Roger Williams wants a little of his medicine forMrs. Weekes’s daughter; worshipful John Haynesis in receipt of his powders; troublesome CaptainUnderhill wants “a little white vitterall”for his wife, and something to cure his wife’sfriend’s neuralgia, (I think his wife’sfriend’s husband had a little rather have hadit sent by the hands of Mrs. Underhill, than by thoseof the gallant and discursive captain); and piousJohn Davenport says, his wife “tooke but onehalfe of one of the papers” (which probably containedthe medicine he called rubila), “but could notbeare the taste of it, and is discouraged from takingany more;” and honored William Leete asks formore powders for his “poore little daughter Graciana,”though he found it “hard to make her take it,”delicate, and of course sensitive, child as she was,languishing and dying before her time, in spite ofall the bitter things she swallowed,—Godhelp all little children in the hands of dosing doctorsand howling dervishes! Restless Samuel Gorton,now tamed by the burden of fourscore and two years,writes so touching an account of his infirmities,and expresses such overflowing gratitude for the reliefhe has obtained from the Governor’s prescriptions,wondering how “a thing so little in quantity,so little in sent, so little in taste, and so littleto sence in operation, should beget and bring forthsuch efects,” that we repent our hasty exclamation,and bless the memory of the good Governor, who gaverelief to the worn-out frame of our long-departedbrother, the sturdy old heretic of Rhode Island.
What was that medicine which so frequently occursin the printed letters under the name of “rubila”?It is evidently a secret remedy, and, so far as Iknow, has not yet been made out. I had almostgiven it up in despair, when I found what appearsto be a key to the mystery. In the vast multitudeof prescriptions contained in the manuscripts, mostof them written in symbols, I find one which I thusinterpret:
“Four grains of (diaphoretic) antimony, withtwenty grains of nitre, with a little salt of tin,making rubila.” Perhaps something was addedto redden the powder, as he constantly speaks of “rubifying”or “viridating” his prescriptions; a verycommon practice of prescribers, when their powderslook a little too much like plain salt or sugar.
Waitstill Winthrop, the Governor’s son, “wasa skilful physician,” says Mr. Sewall, in hisfuneral sermon; “and generously gave, not onlyhis advice, but also his Medicines, for the healingof the Sick, which, by the Blessing of God, were madesuccessful for the recovery of many.” “Hisson John, a member of the Royal Society, speaks ofhimself as ’Dr. Winthrop,’ and mentionsone of his own prescriptions in a letter to CottonMather.” Our President tells me that therewas an heirloom of the ancient skill in his family,within his own remembrance, in the form of a certainprecious eye-water, to which the late President JohnQuincy Adams ascribed rare virtue, and which he usedto obtain from the possessor of the ancient recipe.
These inherited prescriptions are often treasuredin families, I do not doubt, for many generations.When I was yet of trivial age, and suffering occasionally,as many children do, from what one of my Cambridgeportschoolmates used to call the “ager,”—meaningthereby toothache or face-ache,—I usedto get relief from a certain plaster which never wentby any other name in the family than “Dr. Oliver.”
Dr. James Oliver was my great-great-grandfather, graduatedin 1680, and died in 1703. This was, no doubt,one of his nostrums; for nostrum, as is well known,means nothing more than our own or my own particularmedicine, or other possession or secret, and physiciansin old times used to keep their choice recipes tothemselves a good deal, as we have had occasion tosee.
Some years ago I found among my old books a smallmanuscript marked “James Oliver. This BookBegun Aug. 12, 1685.” It is a rough sortof account-book, containing among other things prescriptionsfor patients, and charges for the same, with counter-chargesfor the purchase of medicines and other matters.Dr. Oliver practised in Cambridge, where may be seenhis tomb with inscriptions, and with sculptured figuresthat look more like Diana of the Ephesians, as givenin Calmet’s Dictionary, than like any angelsadmitted into good society here or elsewhere.
I do not find any particular record of what his patientssuffered from, but I have carefully copied out theremedies he mentions, and find that they form a veryrespectable catalogue. Besides the usual simples,elder, parsley, fennel, saffron, snake-root, wormwood,I find the Elixir Proprietatis, with other elixireand cordials, as if he rather fancied warming medicines;but he called in the aid of some of the more energeticremedies, including iron, and probably mercury, ashe bought two pounds of it at one time.
The most interesting item is his bill against theestate of Samuel Pason of Roxbury, for services duringhis last illness. He attended this gentleman,—forsuch he must have been, by the amount of physic whichhe took, and which his heirs paid for,—fromJune 4th, 1696, to September 3d of the same year,three months. I observe he charges for visitsas well as for medicines, which is not the case inmost of his bills. He opens the attack with acarminative appeal to the visceral conscience, andfollows it up with good hard-hitting remedies for dropsy,—asI suppose the disease would have been called,—andfinishes off with a rallying dose of hartshorn andiron.
It is a source of honest pride to his descendant thathis bill, which was honestly paid, as it seems tohave been honorably earned, amounted to the handsometotal of seven pounds and two shillings. Let meadd that he repeatedly prescribes plaster, one ofwhich was very probably the “Dr. Oliver”that soothed my infant griefs, and for which I blushto say that my venerated ancestor received from GoodmanHanco*ck the painfully exiguous sum of no pounds, noshillings, and sixpence.
I have illustrated the practice of the first century,from the two manuscripts I have examined, as givingan impartial idea of its every-day methods. TheGovernor, Johannes Secundus, it is fair to remember,was an amateur practitioner, while my ancestor wasa professed physician. Comparing their modesof treatment with the many scientific follies stillprevailing in the Old World, and still more with theextraordinary theological superstitions of the communityin which they lived, we shall find reason, I think,to consider the art of healing as in a comparativelycreditable state during the first century of New England.
In addition to the evidence as to methods of treatmentfurnished by the manuscripts I have cited, I subjointhe following document, to which my attention wascalled by Dr. Shurtleff, our present Mayor. Thisis a letter of which the original is to be found invol. lxix. page 10 of the “Archives” preservedat the State House in Boston. It will be seenthat what the surgeon wanted consisted chiefly ofopiates, stimulants, cathartics, plasters, and materialsfor bandages. The complex and varied formulaehave given place to simpler and often more effectiveforms of the same remedies; but the list and the mannerin which it is made out are proofs of the good senseand schooling of the surgeon, who, it may be noted,was in such haste that he neglected all his stops.He might well be in a hurry, as on the very day uponwhich he wrote, a great body of Indians—supposedto be six or seven hundred—appeared beforeHatfield; and twenty-five resolute young men of Hadley,from which town he wrote, crossed the river and drovethem away.
HADLY May 30: 76
Mr Rawson Sr
What we have recd by Tho: Houey the past monthis not the cheifest of our wants as you have lovefor poor wounded I pray let us not want for thesefollowing medicines if you have not a speedy conveyanceof them I pray send on purpose they are those thingsmentioned in my former letter but to prevent futuremistakes I have wrote them att large wee have greatwant with the greatest halt and speed let us be supplyed.Sr Yr Sert will LOCHS
(Endorsed)
Mr. Lockes Letter Recd from the Governor 13 Jane &acquainted ye Council with it but could not obtaineany thing to be sent in answer thereto. 13 June 1676
I have given some idea of the chief remedies usedby our earlier physicians, which were both Galenicand chemical; that is, vegetable and mineral.They, of course, employed the usual perturbing medicineswhich Montaigne says are the chief reliance of theircraft. There were, doubtless, individual practitionerswho employed special remedies with exceptional boldnessand perhaps success. Mr. Eliot is spoken of, ina letter of William Leete to Winthrop, Junior, asbeing under Mr. Greenland’s mercurial administrations.The latter was probably enough one of these specialists.
There is another class of remedies which appears tohave been employed occasionally, but, on the whole,is so little prominent as to imply a good deal ofcommon sense among the medical practitioners, as comparedwith the superstitions prevailing around them.I have said that I have caught the good Governor,now and then, prescribing the electuary of millipedes;but he is entirely excused by the almost incrediblefact that they were retained in the materia medicaso late as when Rees’s Cyclopaedia was published,and we there find the directions formerly given bythe College of Edinburgh for their preparation.Once or twice we have found him admitting still moreobjectionable articles into his materia medica; indoing which, I am sorry to say that he could pleadgrave and learned authority. But these instancesare very rare exceptions in a medical practice ofmany years, which is, on the whole, very respectable,considering the time and circ*mstances.
Some remedies of questionable though not odious characterappear occasionally to have been employed by the earlypractitioners, but they were such as still had thesupport of the medical profession. Governor JohnWinthrop, the first, sends for East Indian bezoar,with other commodities he is writing for. GovernorEndicott sends him one he had of Mr. Humfrey.I hope it was genuine, for they cheated infamouslyin the matter of this concretion, which ought to comeout of an animal’s stomach, but the real historyof which resembles what is sometimes told of modernsausages.
There is a famous law-case of James the First’stime, in which a goldsmith sold a hundred pounds’worth of what he called bezoar, which was proved tobe false, and the purchaser got a verdict against him.Governor Endicott also sends Winthrop a unicorn’shorn, which was the property of a certain Mrs. Beggarly,who, in spite of her name, seems to have been richin medical knowledge and possessions. The famousThomas Bartholinus wrote a treatise on the virtuesof this fabulous-sounding remedy, which was publishedin 1641, and republished in 1678.
The “antimonial cup,” a drinking vesselmade of that metal, which, like our quassia-wood cups,might be filled and emptied in saecula saeculorumwithout exhausting its virtues, is mentioned by MatthewCradock, in a letter to the elder Winthrop, but ina doubtful way, as it was thought, he says, to haveshortened the days of Sir Nathaniel Riche; and Winthrophimself, as I think, refers to its use, calling itsimply “the cup.” An antimonialcup is included in the inventory of Samuel Seabury,who died 1680, and is valued at five shillings.There is a treatise entitled “The UniversallRemedy, or the Vertues of the Antimoniall Cup, By JohnEvans, Minister and Preacher of God’s Word,London, 1634,” in our own Society’s library.
One other special remedy deserves notice, becauseof native growth. I do not know when Culver’sroot, Leptandra Virginica of our National Pharmacopoeia,became noted, but Cotton Mather, writing in 1716 toJohn Winthrop of New London, speaks of it as famousfor the cure of consumptions, and wishes to get someof it, through his mediation, for Katharine, his eldestdaughter. He gets it, and gives it to the “poordamsel,” who is languishing, as he says, andwho dies the next month,—all the sooner,I have little doubt, for this uncertain and violentdrug, with which the meddlesome pedant tormented herin that spirit of well-meant but restless quackery,which could touch nothing without making mischief,not even a quotation, and yet proved at length themeans of bringing a great blessing to our community,as we shall see by and by; so does Providence useour very vanities and infirmities for its wise purposes.
Externally, I find the practitioners on whom I havechiefly relied used the plasters of Paracelsus, ofmelilot, diachylon, and probably diaphoenicon, allwell known to the old pharmacopoeias, and some of themto the modern ones,—to say nothing of “myyellow salve,” of Governor John, the second,for the composition of which we must apply to hisrespected descendant.
The authors I find quoted are Barbette’s Surgery,Camerarius on Gout, and Wecherus, of all whom noticesmay be found in the pages of Haller and Vanderlinden;also, Reed’s Surgery, and Nicholas Culpeper’sPractice of Physic and Anatomy, the last as belongingto Samuel Seabury, chirurgeon, before mentioned.Nicholas Culpeper was a shrewd charlatan, and as impudenta varlet as ever prescribed for a colic; but knew verywell what he was about, and badgers the College withgreat vigor. A copy of Spigelius’s famousAnatomy, in the Boston Athenaeum, has the names ofIncrease and Samuel Mather written in it, and was doubtlessearly overhauled by the youthful Cotton, who refersto the great anatomist’s singular death, amonghis curious stories in the “Magnalia,”and quotes him among nearly a hundred authors whomhe cites in his manuscript “The Angel of Bethesda.”Dr. John Clark’s “books and instruments,with several chirurgery materials in the closet,”a were valued in his inventory at sixty pounds; Dr.Matthew Fuller, who died in 1678, left a library valuedat ten pounds; and a surgeon’s chest and drugsvalued at sixteen pounds.’
Here we leave the first century and all attempts atany further detailed accounts of medicine and itspractitioners. It is necessary to show in a briefglance what had been going on in Europe during thelatter part of that century, the first quarter ofwhich had been made illustrious in the history ofmedical science by the discovery of the circulation.
Charles Barbeyrac, a Protestant in his religion, wasa practitioner and teacher of medicine at Montpellier.His creed was in the way of his obtaining office;but the young men followed his instructions with enthusiasm.Religious and scientific freedom breed in and in, untilit becomes hard to tell the family of one from thatof the other. Barbeyrac threw overboard the oldcomplex medical farragos of the pharmacopoeias, ashis church had disburdened itself of the popish ceremonies.
Among the students who followed his instructions weretwo Englishmen: one of them, John Locke, afterwardsauthor of an “Essay on the Human Understanding,”three years younger than his teacher; the other, ThomasSydenham, five years older. Both returned to England.Locke, whose medical knowledge is borne witness toby Sydenham, had the good fortune to form a correctopinion on a disease from which the Earl of Shaftesburywas suffering, which led to an operation that savedhis life. Less felicitous was his experiencewith a certain ancilla culinaria virgo,—whichI am afraid would in those days have been translatedkitchen-wench, instead of lady of the culinary department,—whoturned him off after she had got tired of him, andcalled in another practitioner. [Locke and Sydenham,p. 124. By John Brown, M. D. Edinburgh, 1866.]This helped, perhaps, to spoil a promising doctor,and make an immortal metaphysician. At any rate,Locke laid down the professional wig and cane, andtook to other studies.
The name of Thomas Sydenham is as distinguished inthe history of medicine as that of John Locke in philosophy.As Barbeyrac was found in opposition to the establishedreligion, as Locke took the rational side againstorthodox Bishop Stillingfleet, so Sydenham went withParliament against Charles, and was never admitteda Fellow by the College of Physicians, which, afterhe was dead, placed his bust in their hall by theside of that of Harvey.
What Sydenham did for medicine was briefly this hestudied the course of diseases carefully, and especiallyas affected by the particular season; to patientswith fever he gave air and cooling drinks, insteadof smothering and heating them, with the idea of sweatingout their disease; he ordered horseback exercise toconsumptives; he, like his teacher, used few and comparativelysimple remedies; he did not give any drug at all,if he thought none was needed, but let well enoughalone. He was a sensible man, in short, who appliedhis common sense to diseases which he had studiedwith the best light of science that he could obtain.
The influence of the reform he introduced must havebeen more or less felt in this country, but not muchbefore the beginning of the eighteenth century, ashis great work was not published until 1675, and thenin Latin. I very strongly suspect that therewas not so much to reform in the simple practice ofthe physicians of the new community, as there wasin that of the learned big-wigs of the “College,”who valued their remedies too much in proportion totheir complexity, and the extravagant and fantasticingredients which went to their making.
During the memorable century which bred and bore theRevolution, the medical profession gave great namesto our history. But John Brooks belonged to theState, and Joseph Warren belongs to the country andmankind, and to speak of them would lead me beyondmy limited—subject. There would belittle pleasure in dwelling on the name of BenjaminChurch; and as for the medical politicians, like ElishaCooke in the early part of the century, or CharlesJarvis, the bald eagle of Boston, in its later years,whether their practice was heroic or not, their patientswere, for he is a bold man who trusts one that is makingspeeches and coaxing voters, to meddle with the internalpolitics of his corporeal republic.
One great event stands out in the medical historyof this eighteenth century; namely, the introductionof the practice of inoculation for small-pox.Six epidemics of this complaint had visited Bostonin the course of a hundred years. Prayers hadbeen asked in the churches for more than a hundredsick in a single day, and this many times. Abouta thousand persons had died in a twelvemonth, we aretold, and, as we may infer, chiefly from this cause.
In 1721, this disease, after a respite of nineteenyears, again appeared as an epidemic. In thatyear it was that Cotton Mather, browsing, as was hiswont, on all the printed fodder that came within reachof his ever-grinding mandibles, came upon an accountof inoculation as practised in Turkey, contained inthe “Philosophical Transactions.”He spoke of it to several physicians, who paid littleheed to his story; for they knew his medical whims,and had probably been bored, as we say now-a-days,many of them, with listening to his “Angel ofBethesda,” and satiated with his speculationson the Nishmath Chajim.
The Reverend Mather,—I use a mode of expressionhe often employed when speaking of his honored brethren,—theReverend Mather was right this time, and the irreverentdoctors who laughed at him were wrong. One onlyof their number disputes his claim to giving the firstimpulse to the practice, in Boston. This is whatthat person says: “The Small-Pox spreadin Boston, New England, A.1721, and the Reverend Dr.Cotton Mather, having had the use of these Communicationsfrom Dr. William Douglass (that is, the writer ofthese words); surreptitiously, without the knowledgeof his Informer, that he might have the honour of aNew fangled notion, sets an Undaunted Operator towork, and in this Country about 290 were inoculated.”
All this has not deprived Cotton Mather of the creditof suggesting, and a bold and intelligent physicianof the honor of carrying out, the new practice.On the twenty-seventh day of June, 1721, Zabdiel Boylstonof Boston inoculated his only son for smallpox,—thefirst person ever submitted to the operation in theNew World. The story of the fierce resistanceto the introduction of the practice; of how Boylstonwas mobbed, and Mather had a hand-grenade thrown inat his window; of how William Douglass, the Scotchman,“always positive, and sometimes accurate,”as was neatly said of him, at once depreciated thepractice and tried to get the credit of suggestingit, and how Lawrence Dalhonde, the Frenchman, testifiedto its destructive consequences; of how Edmund Massey,lecturer at St. Albans, preached against sinfully endeavoringto alter the course of nature by presumptuous interposition,which he would leave to the atheist and the scoffer,the heathen and unbeliever, while in the face of hissermon, afterwards reprinted in Boston, many of ourNew England clergy stood up boldly in defence of thepractice,—all this has been told so welland so often that I spare you its details. Setthis good hint of Cotton Mather against that letterof his to John Richards, recommending the search afterwitch-marks, and the application of the water-ordeal,which means throw your grandmother into the water,if she has a mole on her arm;—if she swims,she is a witch and must be hanged; if she sinks, theLord have mercy on her soul!
Thus did America receive this great discovery, destinedto save thousands of lives, via Boston, from the handsof one of our own Massachusetts physicians.
The year 1735 was rendered sadly memorable by theepidemic of the terrible disease known as “throatdistemper,” and regarded by many as the sameas our “diphtheria.” Dr. Holyoke thinksthe more general use of mercurials in inflammatorycomplaints dates from the time of their employmentin this disease, in which they were thought to haveproved specially useful.
At some time in the course of this century medicalpractice had settled down on four remedies as itschief reliance. I must repeat an incident whichI have related in another of these Essays. WhenDr. Holyoke, nearly seventy years ago, received youngMr. James Jackson as his student, he showed him theformidable array of bottles, jars, and drawers aroundhis office, and then named the four remedies referredto as being of more importance than all the rest puttogether. These were “Mercury, Antimony,Opium, and Peruvian Bark.” I doubt if eitherof them remembered that, nearly seventy years before,in 1730, Dr. William Douglass, the disputatious Scotchman,mentioned those same four remedies, in the dedicationof his quarrelsome essay on inoculation, as the mostimportant ones in the hands of the physicians of histime.
In the “Proceedings” of this Society forthe year 1863 is a very pleasant paper by the lateDr. Ephraim Eliot, giving an account of the leadingphysicians of Boston during the last quarter of thelast century. The names of Lloyd, Gardiner, Welsh,Rand, Bulfinch, Danforth, John Warren, Jeffries, areall famous in local history, and are commemorated inour medical biographies. One of them, at least,appears to have been more widely known, not only asone of the first aerial voyagers, but as an explorerin the almost equally hazardous realm of medical theory.Dr. John Jeffries, the first of that name, is consideredby Broussais as a leader of medical opinion in America,and so referred to in his famous “Examen desDoctrines Medicales.”
Two great movements took place in this eighteenthcentury, the effect of which has been chiefly feltin our own time; namely, the establishment of theMassachusetts Medical Society, and the founding ofthe Medical School of Harvard University.
The third century of our medical history began withthe introduction of the second great medical discoveryof modern times,—of all time up to thatdate, I may say,—once more via Boston, ifwe count the University village as its suburb, andonce more by one of our Massachusetts physicians.In the month of July, 1800, Dr. Benjamin Waterhouseof Cambridge submitted four of his own children tothe new process of vaccination,—the firstpersons vaccinated, as Dr. Zabdiel Boylston’sson had been the first person inoculated in the NewWorld.
A little before the first half of this century wascompleted, in the autumn of 1846, the great discoverywent forth from the Massachusetts General Hospital,which repaid the debt of America to the science ofthe Old World, and gave immortality to the place ofits origin in the memory and the heart of mankind.The production of temporary insensibility at will—tuto,cito, jucunde, safely, quickly, pleasantly—isone of those triumphs over the infirmities of ourmortal condition which change the aspect of life everafterwards. Rhetoric can add nothing to its glory;gratitude, and the pride permitted to human weakness,that our Bethlehem should have been chosen as thebirthplace of this new embodiment of the divine mercy,are all we can yet find room for.
The present century has seen the establishment ofall those great charitable institutions for the cureof diseases of the body and of the mind, which ourState and our city have a right to consider as amongthe chief ornaments of their civilization.
The last century had very little to show, in our State,in the way of medical literature. The worthieswho took care of our grandfathers and great-grandfathers,like the Revolutionary heroes, fought (with disease)and bled (their patients) and died (in spite of theirown remedies); but their names, once familiar, areheard only at rare intervals. Honored in theirday, not unremembered by a few solitary students ofthe past, their memories are going sweetly to sleepin the arms of the patient old dry-nurse, whose “blackdrop”is the never-failing anodyne of the restless generationsof men. Except the lively controversy on inoculation,and floating papers in journals, we have not muchof value for that long period, in the shape of medicalrecords.
But while the trouble with the last century is tofind authors to mention, the trouble of this wouldbe to name all that we find. Of these, a veryfew claim unquestioned preeminence.
Nathan Smith, born in Rehoboth, Mass., a graduateof the Medical School of our University, did a greatwork for the advancement of medicine and surgery inNew England, by his labors as teacher and author, greater,it is claimed by some, than was ever done by any otherman. The two Warrens, of our time, each lefta large and permanent record of a most extended surgicalpractice. James Jackson not only educated a wholegeneration by his lessons of wisdom, but bequeathedsome of the most valuable results of his experienceto those who came after him, in a series of letterssingularly pleasant and kindly as well as instructive.John Ware, keen and cautious, earnest and deliberate,wrote the two remarkable essays which have identifiedhis name, for all time, with two important diseases,on which he has shed new light by his original observations.
I must do violence to the modesty of the living byreferring to the many important contributions to medicalscience by Dr. Jacob Bigelow, and especially to hisdiscourse on “Self-limited Diseases,” anaddress which can be read in a single hour, but theinfluence of which will be felt for a century.
Nor would the profession forgive me if I forgot tomention the admirable museum of pathological anatomy,created almost entirely by the hands of Dr. John BarnardSwett Jackson, and illustrated by his own printeddescriptive catalogue, justly spoken of by a distinguishedprofessor in the University of Pennsylvania as themost important contribution which had ever been madein this country to the branch to which it relates.
When we look at the literature of mental disease,as seen in hospital reports and special treatises,we can mention the names of Wyman, Woodward, Brigham,Bell, and Ray, all either natives of Massachusettsor placed at the head of her institutions for thetreatment of the insane.
We have a right to claim also one who is known allover the civilized world as a philanthropist, to usas a townsman and a graduate of our own Medical School,Dr. Samuel Gridley Howe, the guide and benefactor ofa great multitude who were born to a world of inwardor of outward darkness.
I cannot pass over in silence the part taken by ourown physicians in those sanitary movements which areassuming every year greater importance. Two diseasesespecially have attracted attention, above all others,with reference to their causes and prevention; cholera,the “black death” of the nineteenth century,and consumption, the white plague of the North, bothof which have been faithfully studied and reportedon by physicians of our own State and city. Thecultivation of medical and surgical specialties, whichis fast becoming prevalent, is beginning to show itseffects in the literature of the profession, whichis every year growing richer in original observationsand investigations.
To these benefactors who have labored for us in theirpeaceful vocation, we must add the noble army of surgeons,who went with the soldiers who fought the battlesof their country, sharing many of their dangers, notrarely falling victims to fatigue, disease, or thedeadly volleys to which they often exposed themselvesin the discharge of their duties.
The pleasant biographies of the venerable Dr. Thacher,and the worthy and kind-hearted gleaner, Dr. StephenW. Williams, who came after him, are filled with thenames of men who served their generation well, andrest from their labors, followed by the blessing ofthose for whom they endured the toils and fatiguesinseparable from their calling. The hardworking,intelligent country physician more especially deservesthe gratitude of his own generation, for he rarelyleaves any permanent record in the literature of hisprofession. Books are hard to obtain; hospitals,which are always centres of intelligence, are remote;thoroughly educated and superior men are separatedby wide intervals; and long rides, though favorableto reflection, take up much of the time which mightotherwise be given to the labors of the study.So it is that men of ability and vast experience,like the late Dr. Twitchell, for instance, make agreat and deserved reputation, become the oracles oflarge districts, and yet leave nothing, or next tonothing, by which their names shall be preserved fromblank oblivion.
One or two other facts deserve mention, as showingthe readiness of our medical community to receiveand adopt any important idea or discovery. Thenew science of Histology, as it is now called, wasfirst brought fully before the profession of thiscountry by the translation of Bichat’s greatwork, “Anatomie Generale,” by the lateDr. George Hayward.
The first work printed in this country on Auscultation,—thatwonderful art of discovering disease, which, as itwere, puts a window in the breast, through which thevital organs can be seen, to all intents and purposes,was the manual published anonymously by “A Memberof the Massachusetts Medical Society.”
We are now in some slight measure prepared to weighthe record of the medical profession in Massachusetts,and pass our judgment upon it. But in-order todo justice to the first generation of practitioners,we must compare what we know of their treatment ofdisease with the state of the art in England, andthe superstitions which they saw all around them inother departments of knowledge or belief.
English medical literature must have been at a prettylow ebb when Sydenham recommended Don Quixote to SirRichard Blackmore for professional reading. TheCollege Pharmacopoeia was loaded with the most absurdcompound mixtures, one of the most complex of which(the same which the Reverend Mr. Harward, “Lecturerat the Royal Chappel in Boston,” tried to simplify),was not dropped until the year 1801. Sir KenelmDigby was playing his fantastic tricks with the Sympatheticpowder, and teaching Governor Winthrop, the second,how to cure fever and ague, which some may like toknow. “Pare the patient’s nails; putthe parings in a little bag, and hang the bag roundthe neck of a live eel, and put him in a tub of water.The eel will die, and the patient will recover.”
Wiseman, the great surgeon, was discoursing eloquentlyon the efficacy of the royal touch in scrofula.The founder of the Ashmolean Museum at Oxford, consortingwith alchemists and astrologers, was treasuring themanuscripts of the late pious Dr. Richard Napier, inwhich certain letters (Rx Ris) were understood tomean Responsum Raphaelis,—the answer ofthe angel Raphael to the good man’s medical questions.The illustrious Robert Boyle was making his collectionof choice and safe remedies, including the sole ofan old shoe, the thigh bone of a hanged man, and thingsfar worse than these, as articles of his materia medica.Dr. Stafford, whose paper of directions to his “friend,Mr. Wintrop,” I cited, was probably a man ofstanding in London; yet toad-powder was his sovereignremedy.
See what was the state of belief in other mattersamong the most intelligent persons of the colonies,magistrates and clergymen. Jonathan Brewster,son of the church-elder, writes the wildest lettersto John Winthrop about alchemy,—“madfor making gold as the Lynn rock-borers are for findingit.”
Remember the theology and the diabology of the time.Mr. Cotton’s Theocracy was a royal government,with the King of kings as its nominal head, but withan upper chamber of saints, and a tremendous oppositionin the lower house; the leader of which may have beenequalled, but cannot have been surpassed by any ofour earth-born politicians. The demons were prowlinground the houses every night, as the foxes were sneakingabout the hen-roosts. The men of Gloucester firedwhole flasks of gunpowder at devils disguised as Indiansand Frenchmen.
How deeply the notion of miraculous interference withthe course of nature was rooted, is shown by the tenacityof the superstition about earthquakes. We canhardly believe that our Professor Winthrop, fatherof the old judge and the “squire,” whommany of us Cambridge people remember so well, hadto defend himself against the learned and excellentDr. Prince, of the Old South Church, for discussingtheir phenomena as if they belonged to the provinceof natural science:
Not for the sake of degrading the aspect of the noblemen who founded our State, do I refer to their idlebeliefs and painful delusions, but to show againstwhat influences the common sense of the medical professionhad to assert itself.
Think, then, of the blazing stars, that shook theirhorrid hair in the sky; the phantom ship, that broughtit* message direct from the other world; the storyof the mouse and the snake at Watertown; of the miceand the prayer-book; of the snake in church; of thecalf with two heads; and of the cabbage in the perfectform of a cutlash,—all which innocent occurrenceswere accepted or feared as alarming portents.
We can smile at these: but we cannot smile atthe account of unhappy Mary Dyer’s malformedoffspring; or of Mrs. Hutchinson’s domestic misfortuneof similar character, in the story of which the physician,Dr. John Clark of Rhode Island, alone appears to advantage;or as we read the Rev. Samuel Willard’s fifteenalarming pages about an unfortunate young woman sufferingwith hysteria. Or go a little deeper into tragedy,and see poor Dorothy Talby, mad as Ophelia, firstadmonished, then whipped; at last, taking her ownlittle daughter’s life; put on trial, and standingmute, threatened to be pressed to death, confessing,sentenced, praying to be beheaded; and none the lesspitilessly swung from the fatal ladder.
The cooper’s crazy wife—crazy inthe belief that she has committed the unpardonablesin—tries to drown her child, to save itfrom misery; and the poor lunatic, who would be tenderlycared for to-day in a quiet asylum, is judged to beacting under the instigation of Satan himself.Yet, after all, what can we say, who put Bunyan’s“Pilgrim’s Progress,” full of nightmaredreams of horror, into all our children’s hands;a story in which the awful image of the man in thecage might well turn the nursery where it is readinto a madhouse?
The miserable delusion of witchcraft illustrates,in a still more impressive way, the false ideas whichgoverned the supposed relation of men with the spiritualworld. I have no doubt many physicians sharedin these superstitions. Mr. Upham says they—thatis, some of them—were in the habit of attributingtheir want of success to the fact, that an “evilhand” was on their patient. The temptationwas strong, no doubt, when magistrates and ministersand all that followed their lead were contented withsuch an explanation. But how was it in Salem,according to Mr. Upham’s own statement?Dr. John Swinnerton was, he says, for many years theprincipal physician of Salem. And he says, also,“The Swinnerton family were all along opposedto Mr. Parris, and kept remarkably clear from thewitchcraft delusion.” Dr. John Swinnerton—thesame, by the way, whose memory is illuminated by aray from the genius of Hawthorne—died thevery year before the great witchcraft explosion tookplace. But who can doubt that it was from himthat the family had learned to despise and to resistthe base superstition; or that Bridget Bishop, whosehouse he rented, as Mr. Upham tells me, the first personhanged in the time of the delusion, would have foundan efficient protector in her tenant, had he beenliving, to head the opposition of his family to themisguided clergymen and magistrates?
I cannot doubt that our early physicians brought withthem many Old-World medical superstitions, and I haveno question that they were more or less involved inthe prevailing errors of the community in which theylived. But, on the whole, their record is a cleanone, so far as we can get at it; and where it is questionablewe must remember that there must have been many little-educatedpersons among them; and that all must have felt, tosome extent, the influence of those sincere and devotedbut unsafe men, the physic-practising clergymen, whooften used spiritual means as a substitute for temporalones, who looked upon a hysteric patient as possessedby the devil, and treated a fractured skull by prayersand plasters, following the advice of a ruling elderin opposition to the “unanimous opinion of sevensurgeons.”
To what results the union of the two professions wasliable to lead, may be seen by the example of a learnedand famous person, who has left on record the productof his labors in the double capacity of clergyman andphysician.
I have had the privilege of examining a manuscriptof Cotton Mather’s relating to medicine, bythe kindness of the librarian of the American AntiquarianSociety, to which society it belongs. A briefnotice of this curious document may prove not uninteresting.
It is entitled “The Angel of Bethesda:an Essay upon the Common Maladies of Mankind, offering,first, the sentiments of Piety,” etc., etc.,and “a collection of plain but potent and Approvedremedies for the Maladies.” Thereare sixty-six “Capsula’s,” as hecalls them, or chapters, in his table of contents;of which, five—from the fifteenth to thenineteenth, inclusive—are missing.This is a most unfortunate loss, as the eighteenthcapsula treated of agues, and we could have learnedfrom it something of their degree of frequency inthis part of New England. There is no date tothe manuscript; which, however, refers to a case observedNov. 14, 1724.
The divine takes precedence of the physician in thisextraordinary production. He begins by preachinga sermon at his unfortunate patient. Having thrownhim into a cold sweat by his spiritual sudorific, heattacks him with his material remedies, which are oftenquite as unpalatable. The simple and cleanlypractice of Sydenham, with whose works he was acquainted,seems to have been thrown away upon him. Everythinghe could find mentioned in the seventy or eighty authorshe cites, all that the old women of both sexes hadever told him of, gets into his text, or squeezesitself into his margin.
Evolving disease out of sin, he hates it, one wouldsay, as he hates its cause, and would drive it outof the body with all noisome appliances. “Sicknessis in Fact Flagellum Dei pro peccatis mundi.”So saying, he encourages the young mother whose babeis wasting away upon her breast with these reflections:
“Think; oh the grievous Effects of Sin!This wretched Infant has not arrived unto years ofsense enough, to sin after the similitude of the transgressioncommitted by Adam. Nevertheless the Transgressionof Adam, who had all mankind Foederally, yea, Naturally,in him, has involved this Infant in the guilt of it.And the poison of the old serpent, which infectedAdam when he fell into his Transgression, by hearkeningto the Tempter, has corrupted all mankind, and isa seed unto such diseases as this Infant is now laboringunder. Lord, what are we, and what are our children,but a Generation of Vipers?”
Many of his remedies are at least harmless, but hispedantry and utter want of judgment betray themselveseverywhere. He piles his prescriptions one uponanother, without the least discrimination. Heis run away with by all sorts of fancies and superstitions.He prescribes euphrasia, eye-bright, for disease ofthe eyes; appealing confidently to the strange olddoctrine of signatures, which inferred its use fromthe resemblance of its flower to the organ of vision.For the scattering of wens, the efficacy of a DeadHand has been out of measure wonderful. But whenhe once comes to the odious class of remedies, he revelsin them like a scarabeus. This allusion willbring us quite near enough to the inconceivable abominationswith which he proposed to outrage the sinful stomachsof the unhappy confederates and accomplices of Adam.
It is well that the treatise was never printed, yetthere are passages in it worth preserving. Hespeaks of some remedies which have since become moreuniversally known:
“Among the plants of our soyl, Sir William Templesingles out Five [Six] as being of the greatest virtueand most friendly to health: and his favoriteplants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder.”
“But these Five [Six] plants may admitt of somecompetitors. The QUINQUINA—How celebrated:Immoderately, Hyperbolically celebrated!”
Of Ipecacuanha, he says,—“This isnow in its reign; the most fashionable vomit.”
“I am not sorry that antimonial emetics beginto be disused.”
He quotes “Mr. Lock” as recommending redpoppy-water and abstinence from flesh as often usefulin children’s diseases.
One of his “Capsula’s” is devotedto the animalcular origin of diseases, at the endof which he says, speaking of remedies for this supposedsource of our distempers:
“Mercury we know thee: But we are afraidthou wilt kill us too, if we employ thee to kill themthat kill us.
“And yett, for the cleansing of the small BloodVessels, and making way for the free circulation ofthe Blood and Lymph—there is nothing likeMercurial Deobstruents.”
From this we learn that mercury was already in commonuse, and the subject of the same popular prejudiceas in our own time.
His poetical turn shows itself here and there:
“O Nightingale, with a Thorn at thy Breast;Under the trouble of a Cough, what can be more properthan such thoughts as these?"...
If there is pathos in this, there is bathos in hisapostrophe to the millipede, beginning “Poorsowbug!” and eulogizing the healing virtues ofthat odious little beast; of which he tells us to take“half a pound, putt ’em alive into a quartor two of wine,” with saffron and other drugs,and take two ounces twice a day.
The “Capsula” entitled “NishmathChajim” was printed in 1722, at New London,and is in the possession of our own Society. Hemeans, by these words, something like the Archxusof Van Helmont, of which he discourses in a stylewonderfully resembling that of Mr. Jenkinson in the“Vicar of Wakefield.” “Manyof the Ancients thought there was much of a Real Historyin the Parable, and their Opinion was that there is,DIAPHORA Kata TAS MORPHAS, A Distinction (andso a Resemblance) of men as to their Shapes afterDeath.” And so on, with Ireaeus, Tertullian,Thespesius, and “the Ta tone PSEUCONECROMATA,” in the place of “Sanconiathon,Manetho, Berosus,” and “Anarchon ara kaiateleutaion to pan.”
One other passage deserves notice, as it relates tothe single medical suggestion which does honor toCotton Mather’s memory. It does not appearthat he availed himself of the information which hesays, he obtained from his slave, for such I supposehe was.
In his appendix to “Variolae Triumphatae,”he says,—
“There has been a wonderful practice latelyused in several parts of the world, which indeed isnot yet become common in our nation.
“I was first informed of it by a Garamanteeservant of my own, long before I knew that any Europeansor Asiaticks had the least acquaintance with it, andsome years before I was enriched with the communicationsof the learned Foreigners, whose accounts I foundagreeing with what I received of my servant, whenhe shewed me the Scar of the Wound made for the operation;and said, That no person ever died of the smallpox,in their countrey, that had the courage to use it.
“I have since met with a considerable Numberof these Africans, who all agree in one story; Thatin their countrey grandy-many dy of the small-pox:But now they learn this way: people take juiceof smallpox and cutty-skin and put in a Drop; thenby’nd by a little sicky, sicky: then veryfew little things like small-pox; and nobody dy ofit; and nobody have small-pox any more. Thus,in Africa, where the poor creatures dy of the smallpoxlike Rotten Sheep, a merciful God has taught them anInfallible preservative. ’T is a commonpractice, and is attended with a constant success.”
What has come down to us of the first century of medicalpractice, in the hands of Winthrop and Oliver, iscomparatively simple and reasonable. I suspectthat the conditions of rude, stern life, in which thecolonists found themselves in the wilderness, tookthe nonsense out of them, as the exigencies of a campaigndid out of our physicians and surgeons in the latewar. Good food and enough of it, pure air andwater, cleanliness, good attendance, an anaesthetic,an opiate, a stimulant, quinine, and two or threecommon drugs, proved to be the marrow of medical treatment;and the fopperies of the pharmacopoeia went the wayof embroidered shirts and white kid gloves and malaccajoints, in their time of need. “Good wineis the best cordiall for her,” said GovernorJohn Winthrop, Junior, to Samuel Symonds, speakingof that gentleman’s wife,—just asSydenham, instead of physic, once ordered a roastchicken and a pint of canary for his patient in malehysterics.
But the profession of medicine never could reach itsfull development until it became entirely separatedfrom that of divinity. The spiritual guide, theconsoler in affliction, the confessor who is admittedinto the secrets of our souls, has his own noble sphereof duties; but the healer of men must confine himselfsolely to the revelations of God in nature, as hesees their miracles with his own eyes. No doctrineof prayer or special providence is to be his excusefor not looking straight at secondary causes, andacting, exactly so far as experience justifies him,as if he were himself the divine agent which antiquityfabled him to be. While pious men were praying—humbly,sincerely, rightly, according to their knowledge—over
the endless succession of little children dying ofspasms in the great Dublin Hospital, a sagacious physicianknocked some holes in the walls of the ward, let God’sblessed air in on the little creatures, and so hadalready saved in that single hospital, as it was soberlycalculated thirty years ago, more than sixteen thousandlives of these infant heirs of immortality. [Collins’sMidwifery, p. 312. Published by order of theMassachusetts Medical Society. Boston, 1841.]Let it be, if you will, that the wise inspirationof the physician was granted in virtue of the clergyman’ssupplications. Still, the habit of dealing withthings seen generates another kind of knowledge, andanother way of thought, from that of dealing withthings unseen; which knowledge and way of thoughtare special means granted by Providence, and to bethankfully accepted.
The mediaeval ecclesiastics expressed a great truthin that saying, so often quoted, as carrying a reproachwith it: “Ubi tres medici, duo athei,”—“Wherethere are three physicians, there are two atheists.”
It was true then, it is true to-day, that the physicianvery commonly, if not very generally, denies and repudiatesthe deity of ecclesiastical commerce. The Beingwhom Ambroise Pare meant when he spoke those memorablewords, which you may read over the professor’schair in the French School of Medicine, “Tele pensay, et Dieu le guarit,” “I dressedhis wound, and God healed it,”—isa different being from the God that scholastic theologianshave projected from their consciousness, or shapedeven from the sacred pages which have proved so plasticin their hands. He is a God who never leaveshimself without witness, who repenteth him of theevil, who never allows a disease or an injury, compatiblewith the enjoyment of life, to take its course withoutestablishing an effort, limited by certain fixed conditions,it is true, but an effort, always, to restore thebroken body or the shattered mind. In the perpetualpresence of this great Healing Agent, who stays thebleeding of wounds, who knits the fractured bone,who expels the splinter by a gentle natural process,who walls in the inflammation that might involve thevital organs, who draws a cordon to separate the deadpart from the living, who sends his three naturalanaesthetics to the over-tasked frame in due order,according to its need,—sleep, fainting,death; in this perpetual presence, it is doubtlesshard for the physician to realize the theologicalfact of a vast and permanent sphere of the universe,where no organ finds itself in its natural medium,where no wound heals kindly, where the executive hasabrogated the pardoning power, and mercy forgets itserrand; where the omnipotent is unfelt save in malignantagencies, and the omnipresent is unseen and unrepresented;hard to accept the God of Dante’s “Inferno,”and of Bunyan’s caged lunatic. If this isatheism, call three, instead of two of the trio, atheists,and it will probably come nearer the truth.
I am not disposed to deny the occasional injuriouseffect of the materializing influences to which thephysician is subjected. A spiritual guild isabsolutely necessary to keep him, to keep us all, frombecoming the “fingering slaves” that Wordsworthtreats with such shrivelling scorn. But it iswell that the two callings have been separated, andit is fitting that they remain apart. In settlingthe affairs of the late concern, I am afraid our goodfriends remain a little in our debt. We lentthem our physician Michael Servetus in fair condition,and they returned him so damaged by fire as to bequite useless for our purposes. Their ReverendSamuel Willard wrote us a not over-wise report of acase of hysteria; and our Jean Astruc gave them (ifwe may trust Dr. Smith’s Dictionary of the Bible)the first discerning criticism on the authorship ofthe Pentateuch. Our John Locke enlightened themwith his letters concerning toleration; and theirCotton Mather obscured our twilight with his “NishmathChajim.”
Yet we must remember that the name of Basil Valentine,the monk, is associated with whatever good and harmwe can ascribe to antimony; and that the most remarkableof our specifics long bore the name of “Jesuit’sBark,” from an old legend connected with itsintroduction. “Frere Jacques,” whotaught the lithotomists of Paris, owes his ecclesiasticaltitle to courtesy, as he did not belong to a religiousorder.
Medical science, and especially the study of mentaldisease, is destined, I believe, to react to muchgreater advantage on the theology of the future thantheology has acted on medicine in the past. Theliberal spirit very generally prevailing in both professions,and the good understanding between their most enlightenedmembers, promise well for the future of both in acommunity which holds every point of human belief,every institution in human hands, and every word writtenin a human dialect, open to free discussion today,to-morrow, and to the end of time. Whether theworld at large will ever be cured of trusting to specificsas a substitute for observing the laws of health, andto mechanical or intellectual formula as a substitutefor character, may admit of question. Quackeryand idolatry are all but immortal.
We can find most of the old beliefs alive amongstus to-day, only having changed their dresses and thesocial spheres in which they thrive. We thinkthe quarrels of Galenists and chemists belong to thepast, forgetting that Thomsonism has its numerousapostles in our community; that it is common to seeremedies vaunted as purely vegetable, and that theprejudice against “mineral poisons,” especiallymercury, is as strong in many quarters now as it wasat the beginning of the seventeenth century.Names are only air, and blow away with a change ofwind; but beliefs are rooted in human wants and weakness,and die hard. The oaks of Dodona are prostrate,and the shrine of Delphi is desolate; but the Pythoness
and the Sibyl may be consulted in Lowell Street fora very moderate compensation. Nostradamus andLilly seem impossible in our time; but we have seenthe advertisem*nts of an astrologer in our Boston papersyear after year, which seems to imply that he foundbelievers and patrons. You smiled when I relatedSir Kenelm Digby’s prescription with the liveeel in it; but if each of you were to empty his orher pockets, would there not roll out, from more thanone of them, a horse-chestnut, carried about as acure for rheumatism? The brazen head of RogerBacon is mute; but is not “Planchette”uttering her responses in a hundred houses of thiscity? We think of palmistry or chiromancy as belongingto the days of Albertus Magnus, or, if existing inour time, as given over to the gypsies; but a verydistinguished person has recently shown me the lineof life, and the line of fortune, on the palm of hishand, with a seeming confidence in the sanguine predictionsof his career which had been drawn from them.What shall we say of the plausible and well-dressedcharlatans of our own time, who trade in false pretences,like Nicholas Knapp of old, but without any fear ofbeing fined or whipped; or of the many follies andinanities, imposing on the credulous part of the community,each of them gaping with eager, open mouth for a gratuitousadvertisem*nt by the mention of its foolish name inany respectable connection?I turn from this less pleasing aspect of the commonintelligence which renders such follies possible,to close the honorable record of the medical professionin this, our ancient Commonwealth.
We have seen it in the first century divided amongclergymen, magistrates, and regular practitioners;yet, on the whole, for the time, and under the circ*mstances,respectable, except where it invoked supernaturalagencies to account for natural phenomena.
In the second century it simplified its practice,educated many intelligent practitioners, and beganthe work of organizing for concerted action, and formedical teaching.
In this, our own century, it has built hospitals,perfected and multiplied its associations and educationalinstitutions, enlarged and created museums, and challengeda place in the world of science by its literature.
In reviewing the whole course of its history we reada long list of honored names, and a precious recordwritten in private memories, in public charities,in permanent contributions to medical science, ingenerous sacrifices for the country. We can pointto our capital as the port of entry for the New Worldof the great medical discoveries of two successivecenturies, and we can claim for it the triumph overthe most dreaded foe that assails the human body,—atriumph which the annals of the race can hardly matchin three thousand years of medical history.
THE YOUNG PRACTITIONER
[A Valedictory Address delivered to the GraduatingClass of the Bellevue Hospital College, March 2, 1871.]
The occasion which calls us together reminds us nota little of that other ceremony which unites a manand woman for life. The banns have already beenpronounced which have wedded our young friends to theprofession of their choice. It remains only toaddress to them some friendly words of cheering counsel,and to bestow upon them the parting benediction.
This is not the time for rhetorical display or ambitiouseloquence. We must forget ourselves, and thinkonly of them. To us it is an occasion; to themit is an epoch. The spectators at the weddinglook curiously at the bride and bridegroom; at thebridal veil, the orange-flower garland, the givingand receiving of the ring; they listen for the tremulous“I will,” and wonder what are the mysterioussyllables the clergyman whispers in the ear of themarried maiden. But to the newly-wedded pairwhat meaning in those words, “for better, forworse,” “in sickness and in health,”“till death us do part!” To the father,to the mother, who know too well how often the deadlynightshade is interwoven with the wreath of orange-blossoms,how empty the pageant, how momentous the reality!
You will not wonder that I address myself chieflyto those who are just leaving academic life for thesterner struggle and the larger tasks of matured andinstructed manhood. The hour belongs to them;if others find patience to listen, they will kindlyremember that, after all, they are but as the spectatorsat the wedding, and that the priest is thinking lessof them than of their friends who are kneeling at thealtar.
I speak more directly to you, then, gentlemen of thegraduating class. The days of your education,as pupils of trained instructors, are over. Yourfirst harvest is all garnered. Henceforth youare to be sowers as well as reapers, and your fieldis the world. How does your knowledge stand to-day?What have you gained as a permanent possession?What must you expect to forget? What remainsfor you yet to learn? These are questions whichit may interest you to consider.
There is another question which must force itselfon the thoughts of many among you: “Howam I to obtain patients and to keep their confidence?”You have chosen a laborious calling, and made manysacrifices to fit yourselves for its successful pursuit.You wish to be employed that you may be useful, andthat you may receive the reward of your industry.I would take advantage of these most receptive momentsto give you some hints which may help you to realizeyour hopes and expectations. Such is the outlineof the familiar talk I shall offer you.
Your acquaintance with some of the accessory branchesis probably greater now than it will be in a yearfrom now,—much greater than it will by tenyears from now. The progress of knowledge, itmay be feared, or hoped, will have outrun the text-booksin which you studied these branches. Chemistry,for instance, is very apt to spoil on one’s hands.“Nous avons change tout cela” might serveas the standing motto of many of our manuals.Science is a great traveller, and wears her shoes outpretty fast, as might be expected.
You are now fresh from the lecture-room and the laboratory.You can pass an examination in anatomy, physiology,chemistry, materia medica, which the men in largepractice all around you would find a more potent sudorificthan any in the Pharmacopceia. These masters ofthe art of healing were once as ready with their answersas you are now, but they have got rid of a great dealof the less immediately practical part of their acquisitions,and you must undergo the same depleting process.Hard work will train it off, as sharp exercise trainsoff the fat of a prize-fighter.
Yet, pause a moment before you infer that your teachersmust have been in fault when they furnished you withmental stores not directly convertible to practicalpurposes, and likely in a few years to lose their placein your memory. All systematic knowledge involvesmuch that is not practical, yet it is the only kindof knowledge which satisfies the mind, and systematicstudy proves, in the long-run, the easiest way ofacquiring and retaining facts which are practical.There are many things which we can afford to forget,which yet it was well to learn. Your mental conditionis not the same as if you had never known what younow try in vain to recall. There is a perpetualmetempsychosis of thought, and the knowledge of to-dayfinds a soil in the forgotten facts of yesterday.You cannot see anything in the new season of the guanoyou placed last year about the roots of your climbingplants, but it is blushing and breathing fragrancein your trellised roses; it has scaled your porchin the bee-haunted honey-suckle; it has found its waywhere the ivy is green; it is gone where the woodbineexpands its luxuriant foliage.
Your diploma seems very broad to-day with your listof accomplishments, but it begins to shrink from thishour like the Peau de Chagrin of Balzac’s story.Do not worry about it, for all the while there willbe making out for you an ampler and fairer parchment,signed by old Father Time himself as President ofthat great University in which experience is the oneperpetual and all-sufficient professor.
Your present plethora of acquirements will soon cureitself. Knowledge that is not wanted dies outlike the eyes of the fishes of the Mammoth Cave.When you come to handle life and death as your dailybusiness, your memory will of itself bid good-by tosuch inmates as the well-known foramina of the sphenoidbone and the familiar oxides of methyl-ethylamyl-phenyl-ammonium.Be thankful that you have once known them, and rememberthat even the learned ignorance of a nomenclature issomething to have mastered, and may furnish pegs tohang facts upon which would otherwise have strewedthe floor of memory in loose disorder.
But your education has, after all, been very largelypractical. You have studied medicine and surgery,not chiefly in books, but at the bedside and in theoperating amphitheatre. It is the special advantageof large cities that they afford the opportunity ofseeing a great deal of disease in a short space oftime, and of seeing many cases of the same kind ofdisease brought together. Let us not be unjustto the claims of the schools remote from the largercentres of population. Who among us has taughtbetter than Nathan Smith, better than Elisha Bartlett?who teaches better than some of our living contemporarieswho divide their time between city and country schools?I am afraid we do not always do justice to our countrybrethren, whose merits are less conspicuously exhibitedthan those of the great city physicians and surgeons,such especially as have charge of large hospitals.There are modest practitioners living in remote ruraldistricts who are gifted by nature with such sagacityand wisdom, trained so well in what is most essentialto the practice of their art, taught so thoroughlyby varied experience, forced to such manly self-relianceby their comparative isolation, that, from conversewith them alone, from riding with them on their longrounds as they pass from village to village, fromtalking over cases with them, putting up their prescriptions,watching their expedients, listening to their cautions,marking the event of their predictions, hearing themtell of their mistakes, and now and then glory a littlein the detection of another’s blunder, a youngman would find himself better fitted for his realwork than many who have followed long courses of lecturesand passed a showy examination. But the youngman is exceptionally fortunate who enjoys the intimacyof such a teacher. And it must be confessed thatthe great hospitals, infirmaries, and dispensariesof large cities, where men of well-sifted reputationsare in constant attendance, are the true centres ofmedical education. No students, I believe, aremore thoroughly aware of this than those who havegraduated at this institution. Here, as in allour larger city schools, the greatest pains are takento teach things as well as names. You have enteredinto the inheritance of a vast amount of transmittedskill and wisdom, which you have taken, warm, as itwere, with the life of your well-schooled instructors.You have not learned all that art has to teach you,but you are safer practitioners to-day than were manyof those whose names we hardly mention without a genuflection.I had rather be cared for in a fever by the best-taughtamong you than by the renowned Fernelius or the illustriousBoerhaave, could they come back to us from that betterworld where there are no physicians needed, and, ifthe old adage can be trusted, not many within call.I had rather have one of you exercise his surgicalskill upon me than find myself in the hands of a resuscitatedFabricius Hildanus, or even of a wise Ambroise Pare,revisiting earth in the light of the nineteenth century.
You will not accuse me of underrating your accomplishments.You know what to do for a child in a fit, for an aldermanin an apoplexy, for a girl that has fainted, for awoman in hysterics, for a leg that is broken, foran arm that is out of joint, for fevers of every color,for the sailor’s rheumatism, and the tailor’scachexy. In fact you do really know so much atthis very hour, that nothing but the searching testof time can fully teach you the limitations of yourknowledge.
Of some of these you will permit me to remind you.You will never have outgrown the possibility of newacquisitions, for Nature is endless in her variety.But even the knowledge which you may be said to possesswill be a different thing after long habit has madeit a part of your existence. The tactus eruditusextends to the mind as well as to the finger-ends.Experience means the knowledge gained by habitual trial,and an expert is one who has been in the habit of trying.This is the kind of knowledge that made Ulysses wisein the ways of men. Many cities had he seen,and known the minds of those who dwelt in them.This knowledge it was that Chaucer’s Shipmanbrought home with him from the sea—
“In many a tempest had hisberd be shake.”
This is the knowledge we place most confidence in,in the practical affairs of life.
Our training has two stages. The first stagedeals with our intelligence, which takes the ideaof what is to be done with the most charming easeand readiness. Let it be a game of billiards,for instance, which the marker is going to teach us.We have nothing to do but to make this ball glancefrom that ball and hit that other ball, and to knockthat ball with this ball into a certain caecal sacculusor diverticulum which our professional friend callsa pocket. Nothing can be clearer; it is as easyas “playing upon this pipe,” for whichHamlet gives Guildenstern such lucid directions.But this intelligent Me, who steps forward as thesenior partner in our dual personality, turns out tobe a terrible bungler. He misses those glancinghits which the hard-featured young professional personcalls “carroms,” and insists on pocketinghis own ball instead of the other one.
It is the unintelligent Me, stupid as an idiot, thathas to try a thing a thousand times before he cando it, and then never knows how he does it, that atlast does it well. We have to educate ourselvesthrough the pretentious claims of intellect, intothe humble accuracy of instinct, and we end at lastby acquiring the dexterity, the perfection, the certainty,which those masters of arts, the bee and the spider,inherit from Nature.
Book-knowledge, lecture-knowledge, examination-knowledge,are all in the brain. But work-knowledge is notonly in the brain, it is in the senses, in the muscles,in the ganglia of the sympathetic nerves,—allover the man, as one may say, as instinct seems diffusedthrough every part of those lower animals that haveno such distinct organ as a brain. See a skilfulsurgeon handle a broken limb; see a wise old physiciansmile away a case that looks to a novice as if thesexton would soon be sent for; mark what a large experiencehas done for those who were fitted to profit by it,and you will feel convinced that, much as you know,something is still left for you to learn.
May I venture to contrast youth and experience inmedical practice, something in the way the man paintedthe lion, that is, the lion under?
The young man knows the rules, but the old man knows-theexceptions. The young man knows his patient,but the old man knows also his patient’s family,dead and alive, up and down for generations. Hecan tell beforehand what diseases their unborn childrenwill be subject to, what they will die of if theylive long enough, and whether they had better liveat all, or remain unrealized possibilities, as belongingto a stock not worth being perpetuated. The youngman feels uneasy if he is not continually doing somethingto stir up his patient’s internal arrangements.The old man takes things more quietly, and is muchmore willing to let well enough alone: All thesesuperiorities, if such they are,’you must waitfor time to bring you. In the meanwhile (if wewill let the lion be uppermost for a moment), theyoung man’s senses are quicker than those ofhis older rival. His education in all the accessorybranches is more recent, and therefore nearer the existingcondition of knowledge. He finds it easier thanhis seniors to accept the improvements which everyyear is bringing forward. New ideas build theirnests in young men’s brains. “Revolutionsare not made by men in spectacles,” as I onceheard it remarked, and the first whispers of a newtruth are not caught by those who begin to feel theneed of an ear-trumpet. Granting all these advantagesto the young man, he ought, nevertheless, to go onimproving, on the whole, as a medical practitioner,with every year, until he has ripened into a well-mellowedmaturity. But, to improve, he must be good forsomething at the start. If you ship a poor caskof wine to India and back, if you keep it a half acentury, it only grows thinner and sharper.
You are soon to enter into relations with the public,to expend your skill and knowledge for its benefit,and find your support in the rewards of your labor.What kind of a constituency is this which is to lookto you as its authorized champions in the struggleof life against its numerous enemies?
In the first place, the persons who seek the aid ofthe physician are very honest and sincere in theirwish to get rid of their complaints, and, generallyspeaking, to live as long as they can. Howeverattractively the future is painted to them, they areattached to the planet with which they are alreadyacquainted. They are addicted to the daily useof this empirical and unchemical mixture which we callair; and would hold on to it as a tippler does tohis alcoholic drinks. There is nothing men willnot do, there is nothing they have not done, to recovertheir health and save their lives. They have submittedto be half-drowned in water, and half-choked withgases, to be buried up to their chins in earth, tobe seared with hot irons like galley-slaves, to becrimped with knives, like cod-fish, to have needlesthrust into their flesh, and bonfires kindled on theirskin, to swallow all sorts of abominations, and topay for all this, as if to be singed and scalded werea costly privilege, as if blisters were a blessing,and leeches were a luxury. What more can be askedto prove their honesty and sincerity?
This same community is very intelligent with respectto a great many subjects-commerce, mechanics, manufactures,politics. But with regard to medicine it is hopelesslyignorant and never finds it out. I do not knowthat it is any worse in this country than in GreatBritain, where Mr. Huxley speaks very freely of “theutter ignorance of the simplest laws of their ownanimal life, which prevails among even the most highlyeducated persons.” And Cullen said beforehim “Neither the acutest genius nor the soundestjudgment will avail in judging of a particular science,in regard to which they have not been exercised.I have been obliged to please my patients sometimeswith reasons, and I have found that any will pass,even with able divines and acute lawyers; the samewill pass with the husbands as with the wives.”If the community could only be made aware of its ownutter ignorance, and incompetence to form opinionson medical subjects, difficult enough to those whogive their lives to the study of them, the practitionerwould have an easier task. But it will form opinionsof its own, it cannot help it, and we cannot blameit, even though we know how slight and deceptive aretheir foundations.
This is the way it happens: Every grown-up personhas either been ill himself or had a friend sufferfrom illness, from which he has recovered. Everysick person has done something or other by somebody’sadvice, or of his own accord, a little before gettingbetter. There is an irresistible tendency toassociate the thing done, and the improvement whichfollowed it, as cause and effect. This is thegreat source of fallacy in medical practice.But the physician has some chance of correcting hishasty inference. He thinks his prescription cureda single case of a particular complaint; he triesit in twenty similar cases without effect, and setsdown the first as probably nothing more than a coincidence.The unprofessional experimenter or observer has nolarge experience to correct his hasty generalization.He wants to believe that the means he employed effectedhis cure. He feels grateful to the person whoadvised it, he loves to praise the pill or potionwhich helped him, and he has a kind of monumentalpride in himself as a living testimony to its efficacy.So it is that you will find the community in whichyou live, be it in town or country, full of brandsplucked from the burning, as they believe, by someagency which, with your better training, you feelreasonably confident had nothing to do with it.Their disease went out of itself, and the stream fromthe medical fire-annihilator had never even touchedit.
You cannot and need not expect to disturb the publicin the possession of its medical superstitions.A man’s ignorance is as much his private property,and as precious in his own eyes, as his family Bible.You have only to open your own Bible at the ninthchapter of St. John’s Gospel, and you will findthat the logic of a restored patient was very simplethen, as it is now, and very hard to deal with.My clerical friends will forgive me for poaching ontheir sacred territory, in return for an occasionalraid upon the medical domain of which they have nowand then been accused.
A blind man was said to have been restored to sightby a young person whom the learned doctors of theJewish law considered a sinner, and, as such, veryunlikely to have been endowed with a divine gift ofhealing. They visited the patient repeatedly,and evidently teased him with their questions aboutthe treatment, and their insinuations about the youngman, until he lost his temper. At last he turnedsharply upon them: “Whether he be a sinneror no, I know not: one thing I know, that, whereasI was blind, now I see.”
This is the answer that always has been and alwayswill be given by most persons when they find themselvesgetting well after doing anything, no matter what,—recommendedby anybody, no matter whom. Lord Bacon, RobertBoyle, Bishop Berkeley, all put their faith in panaceaswhich we should laugh to scorn. They had seenpeople get well after using them. Are we anywiser than those great men? Two years ago, ina lecture before the Massachusetts Historical Society,I mentioned this recipe of Sir Kenelm Digby for feverand ague: Pare the patient’s nails; putthe parings in a little bag, and hang the bag roundthe neck of a live eel, and place him in a tub ofwater. The eel will die, and the patient willrecover.
Referring to this prescription in the course of thesame lecture, I said: “You smiled whenI related Sir Kenehn Digby’s prescription, withthe live eel in it; but if each of you were to emptyhis or her pockets, would there not roll out, frommore than one of them, a horse-chestnut, carried aboutas a cure for rheumatism?” Nobody saw fit toempty his or her pockets, and my question broughtno response. But two months ago I was in a companyof educated persons, college graduates every one ofthem, when a gentleman, well known in our community,a man of superior ability and strong common-sense,on the occasion of some talk arising about rheumatism,took a couple of very shiny horse-chestnuts from hisbreeches-pocket, and laid them on the table, tellingus how, having suffered from the complaint in question,he had, by the advice of a friend, procured thesetwo horse-chestnuts on a certain time a year or moreago, and carried them about him ever since; from whichvery day he had been entirely free from rheumatism.
This argument, from what looks like cause and effect,whether it be so or not, is what you will have tomeet wherever you go, and you need not think you cananswer it. In the natural course of things somethousands of persons must be getting well or betterof slight attacks of colds, of rheumatic pains, everyweek, in this city alone. Hundreds of them dosomething or other in the way of remedy, by medicalor other advice, or of their own motion, and the lastthing they do gets the credit of the recovery.Think what a crop of remedies this must furnish, ifit were all harvested!
Experience has taught, or will teach you, that mostof the wonderful stories patients and others tellof sudden and signal cures are like Owen Glendower’sstory of the portents that announced his birth.The earth shook at your nativity, did it? Verylikely, and
“Soit would have done,
At the same season, if your mother’scat
Had kittened, though yourself hadne’er been born.”
You must listen more meekly than Hotspur did to thebabbling Welshman, for ignorance is a solemn and sacredfact, and, like infancy, which it resembles, shouldbe respected. Once in a while you will have apatient of sense, born with the gift of observation,from whom you may learn something. When you findyourself in the presence of one who is fertile ofmedical opinions, and affluent in stories of marvellouscures,—of a member of Congress whose namefigures in certificates to the value of patent medicines,of a voluble dame who discourses on the miracles shehas wrought or seen wrought with the little jokersof the sugar-of-milk globule-box, take out your watchand count the pulse; also note the time of day, andcharge the price of a visit for every extra fifteen,or, if you are not very busy, every twenty minutes.In this way you will turn what seems a serious dispensationinto a double blessing, for this class of patientsloves dearly to talk, and it does them a deal of good,and you feel as if you had earned your money by thedose you have taken, quite as honestly as by any doseyou may have ordered.
You must take the community just as it is, and makethe best of it. You wish to obtain its confidence;there is a short rule for doing this which you willfind useful,—deserve it. But, to deserveit in full measure, you must unite many excellences,natural and acquired.
As the basis of all the rest, you must have all thosetraits of character which fit you to enter into themost intimate and confidential relations with thefamilies of which you are the privileged friend andcounsellor. Medical Christianity, if I may usesuch a term, is of very early date. By the oathof Hippocrates, the practitioner of ancient times boundhimself to enter his patient’s house with thesole purpose of doing him good, and so to conducthimself as to avoid the very appearance of evil.Let the physician of to-day begin by coming up to thisstandard, and add to it all the more recently discoveredvirtues and graces.
A certain amount of natural ability is requisite tomake you a good physician, but by no means that disproportionatedevelopment of some special faculty which goes bythe name of genius. A just balance of the mentalpowers is a great deal more likely to be useful thanany single talent, even were it the power of observation;in excess. For a mere observer is liable to betoo fond of facts for their own sake, so that, ifhe told the real truth, he would confess that he takesmore pleasure in a post-mortem examination which showshim what was the matter with a patient, than in acase which insists on getting well and leaving himin the dark as to its nature. Far more likelyto interfere with the sound practical balance of themind is that speculative, theoretical tendency whichhas made so many men noted in their day, whose famehas passed away with their dissolving theories.Read Dr. Bartlett’s comparison of the famousBenjamin Rush with his modest fellow-townsman Dr. WilliamCurrie, and see the dangers into which a passion forgrandiose generalizations betrayed a man of many admirablequalities.
I warn you against all ambitious aspirations outsideof your profession. Medicine is the most difficultof sciences and the most laborious of arts. Itwill task all your powers of body and mind if you arefaithful to it. Do not dabble in the muddy sewerof politics, nor linger by the enchanted streams ofliterature, nor dig in far-off fields for the hiddenwaters of alien sciences. The great practitionersare generally those who concentrate all their powerson their business. If there are here and therebrilliant exceptions, it is only in virtue of extraordinarygifts, and industry to which very few are equal.
To get business a man mast really want it; and doyou suppose that when you are in the middle of a heatedcaucus, or half-way through a delicate analysis, orin the spasm of an unfinished ode, your eyes rollingin the fine frenzy of poetical composition, you wantto be called to a teething infant, or an ancient persongroaning under the griefs of a lumbago? I thinkI have known more than one young man whose doctor’ssign proclaimed his readiness to serve mankind inthat capacity, but who hated the sound of a patient’sknock, and as he sat with his book or his microscope,felt exactly as the old party expressed himself inmy friend Mr. Brownell’s poem—
“All I axes is,let me alone.”
The community soon finds out whether you are in earnest,and really mean business, or whether you are one ofthose diplomaed dilettanti who like the amusem*ntof quasi medical studies, but have no idea of wastingtheir precious time in putting their knowledge inpractice for the benefit of their suffering fellow-creatures.
The public is a very incompetent judge of your skilland knowledge, but it gives its confidence most readilyto those who stand well with their professional brethren,whom they call upon when they themselves or theirfamilies are sick, whom they choose to honorable offices,whose writings and teachings they hold in esteem.A man may be much valued by the profession and yethave defects which prevent his becoming a favoritepractitioner, but no popularity can be depended uponas permanent which is not sanctioned by the judgmentof professional experts, and with these you will alwaysstand on your substantial merits.
What shall I say of the personal habits you must formif you wish for success? Temperance is firstupon the list. Intemperance in a physician partakesof the guilt of homicide, for the muddled brain mayeasily make a fatal blunder in a prescription andthe unsteady hand transfix an artery in an operation.Tippling doctors have been too common in the historyof medicine. Paracelsus was a sot, Radcliffe wasmuch too fond of his glass, and Dr. James Hurlbutof Wethersfield, Connecticut, a famous man in histime, used to drink a square bottle of rum a day, witha corresponding allowance of opium to help steady hisnerves. We commonly speak of a man as being theworse for liquor, but I was asking an Irish laborerone day about his doctor, who, as he said, was somewhatgiven to drink. “I like him best when he’sa little that way,” he said; “then I canspake to him.” I pitied the poor patientwho could not venture to allude to his colic or hispleurisy until his physician was tipsy.
There are personal habits of less gravity than theone I have mentioned which it is well to guard against,or, if they are formed, to relinquish. A manwho may be called at a moment’s warning intothe fragrant boudoir of suffering loveliness shouldnot unsweeten its atmosphere with reminiscences ofextinguished meerschaums. He should remember thatthe sick are sensitive and fastidious, that they lovethe sweet odors and the pure tints of flowers, andif his presence is not like the breath of the rose,if his hands are not like the leaf of the lily, hisvisit may be unwelcome, and if he looks behind himhe may see a window thrown open after he has leftthe sick-chamber. I remember too well the olddoctor who sometimes came to help me through thoseinward griefs to which childhood is liable. “Faroff his coming “—shall I say “shone,”and finish the Miltonic phrase, or leave the verbto the happy conjectures of my audience? Beforehim came a soul-subduing whiff of ipecacuanha, andafter him lingered a shuddering consciousness of rhubarb.He had lived so much among his medicaments that hehad at last become himself a drug, and to have himpass through a sick-chamber was a stronger dose thana conscientious disciple of Hahnemann would thinkit safe to administer.
Need I remind you of the importance of punctualityin your engagements, and of the worry and distressto patients and their friends which the want of itoccasions? One of my old teachers always carriedtwo watches, to make quite sure of being exact, andnot only kept his appointments with the regularityof a chronometer, but took great pains to be at hispatient’s house at the time when he had reasonto believe he was expected, even if no express appointmentwas made. It is a good rule; if you call tooearly, my lady’s hair may not be so smooth ascould be wished, and, if you keep her waiting toolong, her hair may be smooth, but her temper otherwise.
You will remember, of course, always to get the weather-gageof your patient. I mean, to place him so thatthe light falls on his face and not on yours.It is a kind of, ocular duel that is about to takeplace between you; you are going to look through hisfeatures into his pulmonary and hepatic and otherinternal machinery, and he is going to look into yoursquite as sharply to see what you think about his probabilitiesfor time or eternity.
No matter how hard he stares at your countenance,he should never be able to read his fate in it.It should be cheerful as long as there is hope, andserene in its gravity when nothing is left but resignation.The face of a physician, like that of a diplomatist,should be impenetrable. Nature is a benevolentold hypocrite; she cheats the sick and the dying withillusions better than any anodynes. If there arecogent reasons why a patient should be undeceived,do it deliberately and advisedly, but do not betrayyour apprehensions through your tell-tale features.
We had a physician in our city whose smile was commonlyreckoned as being worth five thousand dollars a yearto him, in the days, too, of moderate incomes.You cannot put on such a smile as that any more thanyou can get sunshine without sun; there was a tranquiland kindly nature under it that irradiated the pleasantface it made one happier to meet on his daily rounds.But you can cultivate the disposition, and it willwork its way through to the surface, nay, more,—youcan try to wear a quiet and encouraging look, andit will react on your disposition and make you likewhat you seem to be, or at least bring you nearer toits own likeness.
Your patient has no more right to all the truth youknow than he has to all the medicine in your saddlebags,if you carry that kind of cartridge-box for the ammunitionthat slays disease. He should get only just somuch as is good for him. I have seen a physicianexamining a patient’s chest stop all at once,as he brought out a particular sound with a tap onthe collarbone, in the attitude of a pointer who hasjust come on the scent or sight of a woodco*ck.You remember the Spartan boy, who, with unmoved countenance,hid the fox that was tearing his vitals beneath hismantle. What he could do in his own sufferingyou must learn to do for others on whose vital organsdisease has fastened its devouring teeth. Itis a terrible thing to take away hope, even earthlyhope, from a fellow-creature. Be very carefulwhat names you let fall before your patient.He knows what it means when you tell him he has tuberclesor Bright’s disease, and, if he hears the wordcarcinoma, he will certainly look it out in a medicaldictionary, if he does not interpret its dread significanceon the instant. Tell him he has asthmatic symptoms,or a tendency to the gouty diathesis, and he willat once think of all the asthmatic and gouty old patriarchshe has ever heard of, and be comforted. You neednot be so cautious in speaking of the health of richand remote relatives, if he is in the line of succession.
Some shrewd old doctors have a few phrases alwayson hand for patients that will insist on knowing thepathology of their complaints without the slightestcapacity of understanding the scientific explanation.I have known the term “spinal irritation”serve well on such occasions, but I think nothingon the whole has covered so much ground, and meantso little, and given such profound satisfaction toall parties, as the magnificent phrase “congestionof the portal system.”
Once more, let me recommend you, as far as possible,to keep your doubts to yourself, and give the patientthe benefit of your decision. Firmness, gentlefirmness, is absolutely necessary in this and certainother relations. Mr. Rarey with Cruiser, Richardwith Lady Ann, Pinel with his crazy people, show whatsteady nerves can do with the most intractable ofanimals, the most irresistible of despots, and themost unmanageable of invalids.
If you cannot acquire and keep the confidence of yourpatient, it is time for you to give place to someother practitioner who can. If you are wise anddiligent, you can establish relations with the bestof them which they will find it very hard to break.But, if they wish to employ another person, who, asthey think, knows more than you do, do not take itas a personal wrong. A patient believes anotherman can save his life, can restore him to health,which, as he thinks, you have not the skill to do.No matter whether the patient is right or wrong, itis a great impertinence to think you have any propertyin him. Your estimate of your own ability isnot the question, it is what the patient thinks ofit. All your wisdom is to him like the lady’svirtue in Raleigh’s song:
“If she seem not chaste to me,
What care I how chaste she be?”
What I call a good patient is one who, having founda good physician, sticks to him till he dies.But there are many very good people who are not whatI call good patients. I was once requested tocall on a lady suffering from nervous and other symptoms.It came out in the preliminary conversational skirmish,half medical, half social, that I was the twenty-sixthmember of the faculty into whose arms, professionallyspeaking, she had successively thrown herself.Not being a believer in such a rapid rotation of scientificcrops, I gently deposited the burden, commending itto the care of number twenty-seven, and, him, whoeverhe might be, to the care of Heaven.
If there happened to be among my audience any personwho wished to know on what principles the patientshould choose his physician, I should give him thesefew precepts to think over:
Choose a man who is personally agreeable, for a dailyvisit from an intelligent, amiable, pleasant, sympatheticperson will cost you no more than one from a slovenor a boor, and his presence will do more for you thanany prescription the other will order.
Let him be a man of recognized good sense in othermatters, and the chance is that he will be sensibleas a practitioner.
Let him be a man who stands well with his professionalbrethren, whom they approve as honest, able, courteous.
Let him be one whose patients are willing to die inhis hands, not one whom they go to for trifles, andleave as soon as they are in danger, and who can say,therefore, that he never loses a patient.
Do not leave the ranks of what is called the regularprofession, unless you wish to go farther and fareworse, for you may be assured that its members recognizeno principle which hinders their accepting any remedialagent proved to be useful, no matter from what quarterit comes. The difficulty is that the stragglers,organized under fantastic names in pretentious associations,or lurking in solitary dens behind doors left ajar,make no real contributions to the art of healing.When they bring forward a remedial agent like chloral,like the bromide of potassium, like ether, used asan anesthetic, they will find no difficulty in procuringits recognition.
Some of you will probably be more or less troubledby the pretensions of that parody of mediaeval theologywhich finds its dogma of hereditary depravity in thedoctrine of psora, its miracle of transubstantiationin the mystery of its triturations and dilutions,its church in the people who have mistaken their century,and its priests in those who have mistaken their calling.You can do little with persons who are disposed toaccept these curious medical superstitions. Thesaturation-point of individual minds with referenceto evidence, and especially medical evidence, differs,and must always continue to differ, very widely.There are those whose minds are satisfied with thedecillionth dilution of a scientific proof. Nowonder they believe in the efficacy of a similar attenuationof bryony or pulsatilla. You have no fulcrum youcan rest upon to lift an error out of such minds asthese, often highly endowed with knowledge and talent,sometimes with genius, but commonly richer in theimaginative than the observing and reasoning faculties.
Let me return once more to the young graduate.Your relations to your professional brethren may bea source of lifelong happiness and growth in knowledgeand character, or they may make you wretched and endby leaving you isolated from those who should be yourfriends and counsellors. The life of a physicianbecomes ignoble when he suffers himself to feed onpetty jealousies and sours his temper in perpetualquarrels. You will be liable to meet an uncomfortableman here and there in the profession,—onewho is so fond of being in hot water that it is a wonderall the albumen in his body is not coagulated.There are common barrators among doctors as thereare among lawyers,—stirrers up of strifeunder one pretext and another, but in reality becausethey like it. They are their own worst enemies,and do themselves a mischief each time they assailtheir neighbors. In my student days I remembera good deal of this Donnybrook-Fair style of quarrelling,more especially in Paris, where some of the notedsurgeons were always at loggerheads, and in one ofour lively Western cities. Soon after I had setup an office, I had a trifling experience which mayserve to point a moral in this direction. I hadplaced a lamp behind the glass in the entry to indicateto the passer-by where relief from all curable infirmitieswas to be sought and found. Its brilliancy attractedthe attention of a devious youth, who dashed his fistthrough the glass and upset my modest luminary.All he got by his vivacious assault was that he leftportions of integument from his knuckles upon theglass, had a lame hand, was very easily identified,and had to pay the glazier’s bill. The moralis that, if the brilliancy of another’s reputationexcites your belligerent instincts, it is not worthyour while to strike at it, without calculating whichof you is likely to suffer most, if you do.
You may be assured that when an ill-conditioned neighboris always complaining of a bad taste in his mouthand an evil atmosphere about him, there is somethingwrong about his own secretions. In such casesthere is an alterative regimen of remarkable efficacy:it is a starvation-diet of letting alone. Thegreat majority of the profession are peacefully inclined.Their pursuits are eminently humanizing, and they lookwith disgust on the personalities which intrude themselvesinto the placid domain of an art whose province itis to heal and not to wound.
The intercourse of teacher and student in a largeschool is necessarily limited, but it should be, and,so far as my experience goes, it is, eminently cordialand kindly. You will leave with regret, and holdin tender remembrance, those who have taken you bythe hand at your entrance on your chosen path, andled you patiently and faithfully, until the greatgates at its end have swung upon their hinges, andthe world lies open before you. That venerableoath to which I have before referred bound the studentto regard his instructor in the light of a parent,to treat his children like brothers, to succor himin his day of need. I trust the spirit of theoath of Hippocrates is not dead in the hearts of thestudents of to-day. They will remember with gratitudeevery earnest effort, every encouraging word, whichhas helped them in their difficult and laborious careerof study. The names they read on their diplomaswill recall faces that are like family-portraits intheir memory, and the echo of voices they have listenedto so long will linger in their memories far intothe still evening of their lives.
One voice will be heard no more which has been familiarto many among you. It is not for me, a strangerto these scenes, to speak his eulogy. I haveno right to sadden this hour by dwelling on the deepregrets of friendship, or to bid the bitter tearsof sorrow flow afresh. Yet I cannot help rememberingwhat a void the death of such a practitioner as yourlate instructor must leave in the wide circle of thosewho leaned upon his counsel and assistance in theirhour of need, in a community where he was so widelyknown and esteemed, in a school where he bore so importanta part. There is no exemption from the commondoom for him who holds the shield to protect others.The student is called from his bench, the professorfrom his chair, the practitioner in his busiest periodhears a knock more peremptory than any patient’smidnight summons, and goes on that unreturning visitwhich admits of no excuse, and suffers no delay.The call of such a man away from us is the bereavementof a great family. Nor can we help regrettingthe loss for him of a bright and cheerful earthlyfuture; for the old age of a physician is one of thehappiest periods of his life. He is loved andcherished for what he has been, and even in the declineof his faculties there are occasions when his experienceis still appealed to, and his trembling hands are lookedto with renewing hope and trust, as being yet ableto stay the arm of the destroyer.
But if there is so much left for age, how beautiful,how inspiring is the hope of youth! I see amongthose whom I count as listeners one by whose sideI have sat as a fellow-teacher, and by whose instructionsI have felt myself not too old to profit. Aswe borrowed him from your city, I must take this opportunityof telling you that his zeal, intelligence, and admirablefaculty as an instructor were heartily and universallyrecognized among us. We return him, as we trust,uninjured, to the fellow-citizens who have the privilegeof claiming him as their own.
And now, gentlemen of the graduating class, nothingremains but for me to bid you, in the name of thosefor whom I am commissioned and privileged to speak,farewell as students, and welcome as practitioners.I pronounce the two benedictions in the same breath,as the late king’s demise and the new king’saccession are proclaimed by the same voice at thesame moment. You would hardly excuse me if I stoopedto any meaner dialect than the classical and familiarlanguage of your prescriptions, the same in whichyour title to the name of physician is, if, like ourown institution, you follow the ancient usage, engravedupon your diplomas.
Valete, JUVENES, artis medicae studiosi; valete, discipuli,valete, filii!
Salvete, VIRI, artis medicae magister; Salvete amici;salvete fratres!
MEDICAL LIBRARIES.
[Dedicatory Address at the opening of the MedicalLibrary in Boston, December 3, 1878.]
It is my appointed task, my honorable privilege, thisevening, to speak of what has been done by others.No one can bring his tribute of words into the presenceof great deeds, or try with them to embellish thememory of any inspiring achievement, without feelingand leaving with others a sense of their insufficiency.So felt Alexander when he compared even his adoredHomer with the hero the poet had sung. So feltWebster when he contrasted the phrases of rhetoricwith the eloquence of patriotism and of self-devotion.So felt Lincoln when on the field of Gettysburg hespoke those immortal words which Pericles could nothave bettered, which Aristotle could not have criticised.So felt he who wrote the epitaph of the builder ofthe dome which looks down on the crosses and weatherco*cksthat glitter over London.
We are not met upon a battle-field, except so faras every laborious achievement means a victory overopposition, indifference, selfishness, faintheartedness,and that great property of mind as well as matter,—inertia.We are not met in a cathedral, except so far as everybuilding whose walls are lined with the products ofuseful and ennobling thought is a temple of the Almighty,whose inspiration has given us understanding.But we have gathered within walls which bear testimonyto the self-sacrificing, persevering efforts of afew young men, to whom we owe the origin and developmentof all that excites our admiration in this completedenterprise; and I might consider my task as finishedif I contented myself with borrowing the last wordof the architect’s epitaph and only saying,Look around you!
The reports of the librarian have told or will tellyou, in some detail, what has been accomplished sincethe 21st of December, 1874, when six gentlemen metat the house of Dr. Henry Ingersoll Bowditch to discussdifferent projects for a medical library. In lessthan four years from that time, by the liberalityof associations and of individuals, this collectionof nearly ten thousand volumes, of five thousand pamphlets,and of one hundred and twenty-five journals, regularlyreceived,—all worthily sheltered beneaththis lofty roof,—has come into being underour eyes. It has sprung up, as it were; in thenight like a mushroom; it stands before us in fulldaylight as lusty as an oak, and promising to growand flourish in the perennial freshness of an evergreen.
To whom does our profession owe this already largecollection of books, exceeded in numbers only by fouror five of the most extensive medical libraries inthe country, and lodged in a building so well adaptedto its present needs? We will not point out individuallyall those younger members of the profession who haveaccomplished what their fathers and elder brethrenhad attempted and partially achieved. We neednot write their names on these walls, after the fashionof those civic dignitaries who immortalize themselveson tablets of marble and gates of iron. But theircontemporaries know them well, and their descendantswill not forget them,—the men who firstmet together, the men who have given their time andtheir money, the faithful workers, worthy associatesof the strenuous agitator who gave no sleep to hiseyes, no slumber to his eyelids, until he had gainedhis ends; the untiring, imperturbable, tenacious,irrepressible, all-subduing agitator who neither restednor let others rest until the success of the projectwas assured. If, against his injunctions, I nameDr. James Read Chadwick, it is only my revenge forhis having kept me awake so often and so long whilehe was urging on the undertaking in which he has beenpreeminently active and triumphantly successful.
We must not forget the various medical libraries whichpreceded this: that of an earlier period, whenBoston contained about seventy regular practitioners,the collection afterwards transferred to the BostonAthenaeum; the two collections belonging to the University;the Treadwell Library at the Massachusetts GeneralHospital; the collections of the two societies, thatfor Medical Improvement and that for Medical Observation;and more especially the ten thousand volumes relatingto medicine belonging to our noble public city library,—toomany blossoms on the tree of knowledge, perhaps, forthe best fruit to ripen. But the MassachusettsMedical Society now numbers nearly four hundred membersin the city of Boston. The time had arrived fora new and larger movement. There was needed aplace to which every respectable member of the medicalprofession could obtain easy access; where, under one
roof, all might find the special information theywere seeking; where the latest medical intelligenceshould be spread out daily as the shipping news isposted on the bulletins of the exchange; where menengaged in a common pursuit could meet, surroundedby the mute oracles of science and art; where thewhole atmosphere should be as full of professionalknowledge as the apothecary’s shop is of theodor of his medicaments. This was what the oldmen longed for,—the prophets and kings ofthe profession, who“Desiredit long,
But died without the sight.”
This is what the young men and those who worked undertheir guidance undertook to give us. And nowsuch a library, such a reading-room, such an exchange,such an intellectual and social meeting place, we behold a fact, plain before us. The medical professionof our city, and, let us add, of all those neighboringplaces which it can reach with its iron arms, is unitedas never before by the commune vinculum, the commonbond of a large, enduring, ennobling, unselfish interest.It breathes a new air of awakened intelligence.It marches abreast of the other learned professions,which have long had their extensive and valuable centralizedlibraries; abreast of them, but not promising to becontent with that position. What glorifies atown like a cathedral? What dignifies a provincelike a university? What illuminates a countrylike its scholarship, and what is the nest that hatchesscholars but a library?
The physician, some may say, is a practical man andhas little use for all this book-learning. Everystudent has heard Sydenham’s reply to Sir RichardBlackmore’s question as to what books he shouldread,—meaning medical books. “ReadDon Quixote,” was his famous answer. ButSydenham himself made medical books and may be presumedto have thought those at least worth reading.Descartes was asked where was his library, and inreply held up the dissected body of an animal.But Descartes made books, great books, and a greatmany of them. A physician of common sense withouterudition is better than a learned one without commonsense, but the thorough master of his profession musthave learning added to his natural gifts.
It is not necessary to maintain the direct practicalutility of all kinds of learning. Our shelvescontain many books which only a certain class of medicalscholars will be likely to consult. There is adead medical literature, and there is a live one.The dead is not all ancient, the live is not all modern.There is none, modern or ancient, which, if it hasno living value for the student, will not teach himsomething by its autopsy. But it is with thelive literature of his profession that the medicalpractitioner is first of all concerned.
Now there has come a great change in our time overthe form in which living thought presents itself.The first printed books,—the incunabula,—wereinclosed in boards of solid oak, with brazen claspsand corners; the boards by and by were replaced bypasteboard covered with calf or sheepskin; then clothcame in and took the place of leather; then the pasteboardwas covered with paper instead of cloth; and at thisday the quarterly, the monthly, the weekly periodicalin its flimsy unsupported dress of paper, and thedaily journal, naked as it came from the womb of thepress, hold the larger part of the fresh reading welive upon. We must have the latest thought inits latest expression; the page must be newly turnedlike the morning bannock; the pamphlet must be newlyopened like the ante-prandial oyster.
Thus a library, to meet the need of our time, musttake, and must spread out in a convenient form, agreat array of periodicals. Our active practitionersread these by preference over almost everything else.Our specialists, more particularly, depend on themonth’s product, on the yearly crop of new facts,new suggestions, new contrivances, as much as thefarmer on the annual yield of his acres. One ofthe first wants, then, of the profession is suppliedby our library in its great array of periodicals frommany lands, in many languages. Such a number ofmedical periodicals no private library would haveroom for, no private person would pay for, or floodhis tables with if they were sent him for nothing.These, I think, with the reports of medical societiesand the papers contributed to them, will form themost attractive part of our accumulated medical treasures.They will be also one of our chief expenses, for thesejournals must be bound in volumes and they requirea great amount of shelf-room; all this, in additionto the cost of subscription for those which are notfurnished us gratuitously.
It is true that the value of old scientific periodicalsis, other things being equal, in the inverse ratioof their age, for the obvious reason that what ismost valuable in the earlier volumes of a series isdrained off into the standard works with which theintelligent practitioner is supposed to be familiar.But no extended record of facts grows too old to beuseful, provided only that we have a ready and sureway of getting at the particular fact or facts weare in search of.
And this leads me to speak of what I conceive to beone of the principal tasks to be performed by thepresent and the coming generation of scholars, notonly in the medical, but in every department of knowledge.I mean the formation of indexes, and more especiallyof indexes to periodical literature.
This idea has long been working in the minds of scholars,and all who have had occasion to follow out any specialsubject. I have a right to speak of it, for Ilong ago attempted to supply the want of indexes insome small measure for my own need. I had a verycomplete set of the “American Journal of theMedical Sciences;” an entire set of the “NorthAmerican Review,” and many volumes of the reprintsof the three leading British quarterlies. Ofwhat use were they to me without general indexes?I looked them all through carefully and made classifiedlists of all the articles I thought I should mostcare to read. But they soon outgrew my lists.The “North American Review” kept fillingup shelf after shelf, rich in articles which I oftenwanted to consult, but what a labor to find them,until the index of Mr. Gushing, published a few monthssince, made the contents of these hundred and twentyvolumes as easily accessible as the words in a dictionary!I had a, copy of good Dr. Abraham Rees’s Cyclopaedia,a treasure-house to my boyhood which has not lostit* value for me in later years. But where tolook for what I wanted? I wished to know, forinstance, what Dr. Burney had to say about singing.Who would have looked for it under the Italian wordcantare? I was curious to learn something ofthe etchings of Rembrandt, and where should I findit but under the head “Low Countries, Engraversof the,”—an elaborate and most valuablearticle of a hundred double-columned close-printedquarto pages, to which no reference, even, is madeunder the title Rembrandt.
There was nothing to be done, if I wanted to knowwhere that which I specially cared for was to be foundin my Rees’s Cyclopaedia, but to look over everypage of its forty-one quarto volumes and make out abrief list of matters of interest which I could notfind by their titles, and this I did, at no smallexpense of time and trouble.
Nothing, therefore, could be more pleasing to me thanto see the attention which has been given of lateyears to the great work of indexing. It is aquarter of a century since Mr. Poole published his“Index to Periodical Literature,” whichit is much to be hoped is soon to appear in a newedition, grown as it must be to formidable dimensionsby the additions of so long a period. The “Britishand Foreign Medical Review,” edited by the lateSir John Forties, contributed to by Huxley, Carpenter,Layco*ck, and others of the most distinguished scientificmen of Great Britain, has an index to its twenty-fourvolumes, and by its aid I find this valuable seriesas manageable as a lexicon. The last editionof the “Encyclopaedia Britannica” had acomplete index in a separate volume, and the publishersof Appletons’ “American Cyclopaedia”have recently issued an index to their useful work,which must greatly add to its value. I have alreadyreferred to the index to the “North AmericanReview,” which to an American, and especiallyto a New Englander, is the most interesting and most
valuable addition of its kind to our literary apparatussince the publication of Mr. Allibone’s “Dictionaryof Authors.” I might almost dare to parodyMr. Webster’s words in speaking of Hamilton,to describe what Mr. Gushing did for the solemn rowsof back volumes of our honored old Review which hadbeen long fossilizing on our shelves: “Hetouched the dead corpse of the ‘North American,’and it sprang to its feet.” A library ofthe best thought of the best American scholars duringthe greater portion of the century was brought to lightby the work of the indexmaker as truly as were theAssyrian tablets by the labors of Layard.A great portion of the best writing and reading literary,scientific, professional, miscellaneous—comesto us now, at stated intervals, in paper covers.The writer appears, as it were, in his shirt-sleeves.As soon as he has delivered his message the book-binderputs a coat on his back, and he joins the forlornbrotherhood of “back volumes,” than which,so long as they are unindexed, nothing can be moreexasperating. Who wants a lock without a key,a ship without a rudder, a binnacle without a compass,a check without a signature, a greenback without agoldback behind it?
I have referred chiefly to the medical journals, butI would include with these the reports of medicalassociations, and those separate publications which,coming in the form of pamphlets, heap themselves intochaotic piles and bundles which are worse than useless,taking up a great deal of room, and frightening everythingaway but mice and mousing antiquarians, or possiblyat long intervals some terebrating specialist.
Arranged, bound, indexed, all these at once becomeaccessible and valuable. I will take the firstinstance which happens to suggest itself. Howmany who know all about osteoblasts and the experimentsof Ollier, and all that has grown out of them, knowwhere to go for a paper by the late Dr. A. L. Peirsonof Salem, published in the year 1840, under the modesttitle, Remarks on Fractures? And if any practitionerwho has to deal with broken bones does not know thatmost excellent and practical essay, it is a greatpity, for it answers very numerous questions whichwill be sure to suggest themselves to the surgeon andthe patient as no one of the recent treatises, onmy own shelves, at least, can do.
But if indexing is the special need of our time inmedical literature, as in every department of knowledge,it must be remembered that it is not only an immenselabor, but one that never ends. It requires, therefore,the cooperation of a large number of individuals todo the work, and a large amount of money to pay formaking its results public through the press.When it is remembered that the catalogue of the libraryof the British Museum is contained in nearly threethousand large folios of manuscript, and not all itsbooks are yet included, the task of indexing any considerablebranch of science or literature looks as if it were
well nigh impossible. But many hands make lightwork. An “Index Society” has beenformed in England, already numbering about one hundredand seventy members. It aims at “supplyingthorough indexes to valuable works and collectionswhich have hitherto lacked them; at issuing indexesto the literature of special subjects; and at gatheringmaterials for a general reference index.”This society has published a little treatise settingforth the history and the art of indexing, which Itrust is in the hands of some of our members, if notupon our shelves.Something has been done in the same direction by individualsin our own country, as we have already seen.The need of it in the department of medicine is beginningto be clearly felt. Our library has already anadmirable catalogue with cross references, the workof a number of its younger members cooperating inthe task. A very intelligent medical student,Mr. William D. Chapin, whose excellent project is indorsedby well-known New York physicians and professors,proposes to publish a yearly index to original communicationsin the medical journals of the United States, classifiedby authors and subjects. But it is from the NationalMedical Library at Washington that we have the bestpromise and the largest expectations. That greatand growing collection of fifty thousand volumes isunder the eye and hand of a librarian who knows booksand how to manage them. For libraries are thestanding armies of civilization, and an army is buta mob without a general who can organize and marshalit so as to make it effective. The “SpecimenFasciculus of a Catalogue of the National MedicalLibrary,” prepared under the direction of Dr.Billings, the librarian, would have excited the admirationof Haller, the master scholar in medical science ofthe last century, or rather of the profession in allcenturies, and if carried out as it is begun willbe to the nineteenth all and more than all that thethree Bibliothecae—Anatomica, Chirurgica,and Medicinae-Practicae—were to the eighteenthcentury. I cannot forget the story that Agassizwas so fond of telling of the king of Prussia andFichte. It was after the humiliation and spoliationof the kingdom by Napoleon that the monarch askedthe philosopher what could be done to regain the lostposition of the nation. “Found a greatuniversity, Sire,” was the answer, and so itwas that in the year 1810 the world-renowned Universityof Berlin came into being. I believe that wein this country can do better than found a nationaluniversity, whose professors shall be nominated incaucuses, go in and out, perhaps, like postmasters,with every change of administration, and deal withscience in the face of their constituency as the courtierdid with time when his sovereign asked him what o’clockit was: “Whatever hour your majesty pleases.”But when we have a noble library like that at Washington,and a librarian of exceptional qualifications likethe gentleman who now holds that office, I believe
that a liberal appropriation by Congress to carry outa conscientious work for the advancement of soundknowledge and the bettering of human conditions, likethis which Dr. Billings has so well begun, would redoundgreatly to the honor of the nation. It ought tobe willing to be at some charge to make its treasuresuseful to its citizens, and, for its own sake, especiallyto that class which has charge of health, public andprivate. This country abounds in what are called“self-made men,” and is justly proud ofmany whom it thus designates. In one sense noman is self-made who breathes the air of a civilizedcommunity. In another sense every man who isanything other than a phonograph on legs is self-made.But if we award his just praise to the man who hasattained any kind of excellence without having hadthe same advantages as others whom, nevertheless,he has equalled or surpassed, let us not be betrayedinto undervaluing the mechanic’s careful trainingto his business, the thorough and laborious educationof the scholar and the professional man.Our American atmosphere is vocal with the flippantloquacity of half knowledge. We must accept whatevergood can be got out of it, and keep it under as wedo sorrel and mullein and witchgrass, by enrichingthe soil, and sowing good seed in plenty; by goodteaching and good books, rather than by wasting ourtime in talking against it. Half knowledge dreadsnothing but whole knowledge.
I have spoken of the importance and the predominanceof periodical literature, and have attempted to dojustice to its value. But the almost exclusivereading of it is not without its dangers. Thejournals contain much that is crude and unsound; thepresumption; it might be maintained, is against theirnovelties, unless they come from observers of establishedcredit. Yet I have known a practitioner,—perhapsmore than one,—who was as much under thedominant influence of the last article he had readin his favorite medical journal as a milliner underthe sway of the last fashion-plate. The differencebetween green and seasoned knowledge is very great,and such practitioners never hold long enough to anyof their knowledge to have it get seasoned.
It is needless to say, then, that all the substantialand permanent literature of the profession shouldbe represented upon our shelves. Much of it isthere already, and as one private library after anotherfalls into this by the natural law of gravitation,it will gradually acquire all that is most valuablealmost without effort. A scholar should not bein a hurry to part with his books. They are probablymore valuable to him than they can be to any otherindividual. What Swedenborg called “correspondence”has established itself between his intelligence andthe volumes which wall him within their sacred inclosure.Napoleon said that his mind was as if furnished withdrawers,—he drew out each as he wantedits contents, and closed it at will when done with
them. The scholar’s mind, to use a similarcomparison, is furnished with shelves, like his library.Each book knows its place in the brain as well as againstthe wall or in the alcove. His consciousnessis doubled by the books which encircle him, as thetrees that surround a lake repeat themselves in itsunruffled waters. Men talk of the nerve that runsto the pocket, but one who loves his books, and haslived long with them, has a nervous filament whichruns from his sensorium to every one of them.Or, if I may still let my fancy draw its pictures,a scholar’s library is to him what a templeis to the worshipper who frequents it. There isthe altar sacred to his holiest experiences.There is the font where his new-born thought was baptizedand first had a name in his consciousness. Thereis the monumental tablet of a dead belief, sacredstill in the memory of what it was while yet alive.No visitor can read all this on the lettered backsof the books that have gathered around the scholar,but for him, from the Aldus on the lowest shelf tothe Elzevir on the highest, every volume has a languagewhich none but he can interpret. Be patient withthe book-collector who loves his companions too wellto let them go. Books are not buried with theirowners, and the veriest book-miser that ever livedwas probably doing far more for his successors thanhis more liberal neighbor who despised his learnedor unlearned avarice. Let the fruit fall withthe leaves still clinging round it. Who wouldhave stripped Southey’s walls of the books thatfilled them, when, his mind no longer capable of takingin their meaning, he would still pat and fondle themwith the vague loving sense of what they had once beento him,—to him, the great scholar, nowlike a little child among his playthings?We need in this country not only the scholar, butthe virtuoso, who hoards the treasures which he loves,it may be chiefly for their rarity and because otherswho know more than he does of their value set a highprice upon them. As the wine of old vintages isgently decanted out of its cobwebbed bottles withtheir rotten corks into clean new receptacles, sothe wealth of the New World is quietly emptying manyof the libraries and galleries of the Old World intoits newly formed collections and newly raised edifices.And this process must go on in an accelerating ratio.No Englishman will be offended if I say that beforethe New Zealander takes his stand on a broken archof London Bridge to sketch the ruins of St. Paul’sin the midst of a vast solitude, the treasures of theBritish Museum will have found a new shelter in thehalls of New York or Boston. No Catholic willthink hardly of my saying that before the Coliseumfalls, and with it the imperial city, whose doom prophecyhas linked with that of the almost eternal amphitheatre,the marbles, the bronzes, the paintings, the manuscriptsof the Vatican will have left the shores of the Tiberfor those of the Potomac, the Hudson, the Mississippi,or the Sacramento. And what a delight in the pursuitof the rarities which the eager book-hunter followswith the scent of a beagle!
Shall I ever forget that rainy day in Lyons, thatdingy bookshop, where I found the Aetius, long missingfrom my Artis bledicae Principes, and where I boughtfor a small pecuniary consideration, though it wasmarked rare, and was really tres rare, the Aphorismsof Hippocrates, edited by and with a preface fromthe hand of Francis Rabelais? And the vellum-boundTulpius, which I came upon in Venice, afterwards myonly reading when imprisoned in quarantine at Marseilles,so that the two hundred and twenty-eight cases hehas recorded are, many of them, to this day stillfresh in my memory. And the Schenckius,—thefolio filled with casus rariores, which had strayedin among the rubbish of the bookstall on the boulevard,—andthe noble old Vesalius with its grand frontispiecenot unworthy of Titian, and the fine old Ambroise Pare,long waited for even in Paris and long ago, and thecolossal Spigelius with his eviscerated beauties,and Dutch Bidloo with its miracles of fine engravingand bad dissection, and Italian Mascagni, the despairof all would-be imitators, and pre-Adamite John deKetam, and antediluvian Berengarius Carpensis,—butwhy multiply names, every one of which brings backthe accession of a book which was an event almost likethe birth of an infant?
A library like ours must exercise the largest hospitality.A great many books may be found in every large collectionwhich remind us of those apostolic looking old menwho figure on the platform at our political and otherassemblages. Some of them have spoken words ofwisdom in their day, but they have ceased to be oracles;some of them never had any particularly importantmessage for humanity, but they add dignity to themeeting by their presence; they look wise, whetherthey are so or not, and no one grudges them theirplaces of honor. Venerable figure-heads, whatwould our platforms be without you?
Just so with our libraries. Without their rowsof folios in creamy vellum, or showing their blackbacks with antique lettering of tarnished gold, ourshelves would look as insufficient and unbalanced asa column without its base, as a statue without itspedestal. And do not think they are kept onlyto be spanked and dusted during that dreadful periodwhen their owner is but too thankful to become an exileand a wanderer from the scene of single combats betweendead authors and living housemaids. Men werenot all cowards before Agamemnon or all fools beforethe days of Virchow and Billroth. And apart fromany practical use to be derived from the older medicalauthors, is there not a true pleasure in reading theaccounts of great discoverers in their own words?I do not pretend to hoist up the Bibliotheca Anatomicaof Mangetus and spread it on my table every day.I do not get out my great Albinus before every lectureon the muscles, nor disturb the majestic repose ofVesalius every time I speak of the bones he has soadmirably described and figured. But it does
please me to read the first descriptions of partsto which the names of their discoverers or those whohave first described them have become so joined thatnot even modern science can part them; to listen tothe talk of my old volume as Willis describes hiscircle and Fallopius his aqueduct and Varolius hisbridge and Eustachius his tube and Monro his foramen,—allso well known to us in the human body; it does pleaseme to know the very words in which Winslow describedthe opening which bears his name, and Glisson his capsuleand De Graaf his vesicle; I am not content until Iknow in what language Harvey announced his discoveryof the circulation, and how Spigelius made the liverhis perpetual memorial, and Malpighi found a monumentmore enduring than brass in the corpuscles of thespleen and the kidney.But after all, the readers who care most for the earlyrecords of medical science and art are the specialistswho are dividing up the practice of medicine and surgeryas they were parcelled out, according to Herodotus,by the Egyptians. For them nothing is too old,nothing is too new, for to their books of all othersis applicable the saying of D’Alembert thatthe author kills himself in lengthening out what thereader kills himself in trying to shorten.
There are practical books among these ancient volumeswhich can never grow old. Would you know howto recognize “male hysteria” and to treatit, take down your Sydenham; would you read the experienceof a physician who was himself the subject of asthma,and who, notwithstanding that, in the words of Dr.Johnson, “panted on till ninety,” you willfind it in the venerable treatise of Sir John Floyer;would you listen to the story of the King’sEvil cured by the royal touch, as told by a famouschirurgeon who fully believed in it, go to Wiseman;would you get at first hand the description of thespinal disease which long bore his name, do not bestartled if I tell you to go to Pott,—toPercival Pott, the great surgeon of the last century.
There comes a time for every book in a library whenit is wanted by somebody. It is but a few weekssince one of the most celebrated physicians in thecountry wrote to me from a great centre of medicaleducation to know if I had the works of Sanctorius,which he had tried in vain to find. I could havelent him the “Medicina Statica,” with itsfrontispiece showing Sanctorius with his dinner onthe table before him, in his balanced chair whichsunk with him below the level of his banquet-boardwhen he had swallowed a certain number of ounces,—anearly foreshadowing of Pettenkofer’s chamberand quantitative physiology,—but the “OperaOmnia” of Sanctorius I had never met with, andI fear he had to do without it.
I would extend the hospitality of these shelves toa class of works which we are in the habit of consideringas being outside of the pale of medical science, properlyso called, and sometimes of coupling with a disrespectfulname. Such has always been my own practice.I have welcomed Culpeper and Salmon to my bookcaseas willingly as Dioscorides or Quincy, or Paris orWood and Bache. I have found a place for St. JohnLong, and read the story of his trial for manslaughterwith as much interest as the laurel-water case inwhich John Hunter figured as a witness. I wouldgive Samuel Hahnemann a place by the side of SamuelThomson. Am I not afraid that some student ofimaginative turn and not provided with the needfulcerebral strainers without which all the refuse ofgimcrack intelligences gets into the mental drainsand chokes them up,—am I not afraid thatsome such student will get hold of the “Organon”or the “Maladies Chroniques” and be wonover by their delusions, and so be lost to those thatlove him as a man of common sense and a brother intheir high calling? Not in the least. Ifhe showed any symptoms of infection I would for oncehave recourse to the principle of similia similibus.To cure him of Hahnemann I would prescribe my favoritehom*oeopathic antidote, Okie’s Bonninghausen.If that failed, I would order Grauvogl as a heroicremedy, and if he survived that uncured, I would givehim my blessing, if I thought him honest, and bid himdepart in peace. For me he is no longer an individual.He belongs to a class of minds which we are boundto be patient with if their Maker sees fit to indulgethem with existence. We must accept the conjuringultra-ritualist, the dreamy second adventist, the erraticspiritualist, the fantastic hom*oeopathist, as notunworthy of philosophic study; not more unworthy ofit than the squarers of the circle and the inventorsof perpetual motion, and the other whimsical visionariesto whom De Morgan has devoted his most instructiveand entertaining “Budget of Paradoxes.”I hope, therefore, that our library will admit theworks of the so-called Eclectics, of the Thomsonians,if any are in existence, of the Clairvoyants, if theyhave a literature, and especially of the hom*oeopathists.This country seems to be the place for such a collection,which will by and by be curious and of more value thanat present, for hom*oeopathy seems to be followingthe pathological law of erysipelas, fading out whereit originated as it spreads to new regions. Atleast I judge so by the following translated extractfrom a criticism of an American work in the “hom*oeopatischeRundschau” of Leipzig for October, 1878, whichI find in the “hom*oeopathic Bulletin” forthe month of November just passed: “Whilewe feel proud of the spread and rise of hom*oeopathyacross the ocean, and while the hom*oeopathic worksreaching us from there, and published in a style suchas is unknown in Germany, bear eloquent testimonyto the eminent activity of our transatlantic colleagues,we are overcome by sorrowful regrets at the positionhom*oeopathy occupies in Germany. Such a work [asthe American one referred to] with us would be impossible;it would lack the necessary support.”
By all means let our library secure a good representationof the literature of hom*oeopathy before it leavesus its “sorrowful regrets” and migrateswith its sugar of milk pellets, which have taken theplace of the old pilulae micae panis, to Alaska, to“Nova Zembla, or the Lord knows where.”
What shall I say in this presence of the duties ofa Librarian? Where have they ever been betterperformed than in our own public city library, wherethe late Mr. Jewett and the living Mr. Winsor haveshown us what a librarian ought to be,—theorganizing head, the vigilant guardian, the seeker’sindex, the scholar’s counsellor? His workis not merely that of administration, manifold andlaborious as its duties are. He must have a quickintelligence and a retentive memory. He is a publiccarrier of knowledge in its germs. His officeis like that which naturalists attribute to the bumble-bee,—helays up little honey for himself, but he conveys thefertilizing pollen from flower to flower.
Our undertaking, just completed,—and justbegun—has come at the right time, not aday too soon. Our practitioners need a librarylike this, for with all their skill and devotion thereis too little genuine erudition, such as a liberalprofession ought to be able to claim for many of itsmembers. In reading the recent obituary noticesof the late Dr. Geddings of South Carolina, I recalledwhat our lamented friend Dr. Coale used to tell meof his learning and accomplishments, and I could nothelp reflecting how few such medical scholars we hadto show in Boston or New England. We must clearup this unilluminated atmosphere, and here,—hereis the true electric light which will irradiate itsdarkness.
The public will catch the rays reflected from thesame source of light, and it needs instruction onthe great subjects of health and disease,—needsit sadly. It is preyed upon by every kind of impositionalmost without hindrance. Its ignorance and prejudicesreact upon the profession to the great injury of both.The jealous feeling, for instance, with regard tosuch provisions for the study of anatomy as are sanctionedby the laws in this State and carried out with strictregard to those laws, threatens the welfare, if notthe existence of institutions for medical instructionwherever it is not held in check by enlightened intelligence.And on the other hand the profession has just beenstartled by a verdict against a physician, ruinousin its amount,—enough to drive many a hard-workingyoung practitioner out of house and home,—averdict which leads to the fear that suits for malpracticemay take the place of the panel game and child-stealingas a means of extorting money. If the professionin this State, which claims a high standard of civilization,is to be crushed and ground beneath the upper millstoneof the dearth of educational advantages and the lowermillstone of ruinous penalties for what the ignorantignorantly shall decide to be ignorance, all I cansay is
God save the Commonhealthof Massachusetts!
Once more, we cannot fail to see that just as astrologyhas given place to astronomy, so theology, the scienceof Him whom by searching no man can find out, is fastbeing replaced by what we may not improperly calltheonomy, or the science of the laws according to whichthe Creator acts. And since these laws find theirfullest manifestations for us, at least, in rationalhuman natures, the study of anthropology is largelyreplacing that of scholastic divinity. We mustcontemplate our Maker indirectly in human attributesas we talk of Him in human parts of speech. Andthis gives a sacredness to the study of man in hisphysical, mental, moral, social, and religious naturewhich elevates the faithful students of anthropologyto the dignity of a priesthood, and sheds a holy lighton the recorded results of their labors, brought togetheras they are in such a collection as this which isnow spread out before us.
Thus, then, our library is a temple as truly as thedome-crowned cathedral hallowed by the breath of prayerand praise, where the dead repose and the living worship.May it, with all its treasures, be consecrated likethat to the glory of God, through the contributionsit shall make to the advancement of sound knowledge,to the relief of human suffering, to the promotionof harmonious relations between the members of thetwo noble professions which deal with the diseasesof the soul and with those of the body, and to thecommon cause in which all good men are working, thefurtherance of the well-being of their fellow-creatures!
Note.—As an illustration of the statementin the last paragraph but one, I take the followingnotice from the “Boston Daily Advertiser,”of December 4th, the day after the delivery of theaddress: “Prince Lucien Bonaparte is nowliving in London, and is devoting himself to the workof collecting the creeds of all religions and sects,with a view to their classification,—hisobject being simply scientific or anthropological.”
Since delivering the address, also, I find a leadingarticle in the “Cincinnati Lancet and Clinic”of November 30th, headed “The Decadence of hom*oeopathy,”abundantly illustrated by extracts from the “hom*oeopathicTimes,” the leading American organ of that sect.
In the New York “Medical Record” of thesame date, which I had not seen before the deliveryof my address, is an account of the action of thehom*oeopathic Medical Society of Northern New York,in which Hahnemann’s theory of “dynamization”is characterized in a formal resolve as “unworthythe confidence of the hom*oeopathic profession.”
It will be a disappointment to the German hom*oeopathiststo read in the “hom*oeopathic Times” sucha statement as the following: “Whateverthe influences have been which have checked the outwarddevelopment of hom*oeopathy, it is plainly evidentthat the hom*oeopathic school, as regards the numberof its openly avowed representatives, has attainedits majority, and has begun to decline both in thiscountry and in England.”
All which is an additional reason for making a collectionof the incredibly curious literature of hom*oeopathybefore that pseudological inanity has faded out likeso many other delusions.
SOME OF MY EARLY TEACHERS
[A Farewell Address to the Medical School of HarvardUniversity, November 28, 1882.]
I had intended that the recitation of Friday lastshould be followed by a few parting words to my classand any friends who might happen to be in the lecture-room.But I learned on the preceding evening that there wasan expectation, a desire, that my farewell should takea somewhat different form; and not to disappoint thewishes of those whom I was anxious to gratify, I madeup my mind to appear before you with such hasty preparationas the scanty time admitted.
There are three occasions upon which a human beinghas a right to consider himself as a centre of interestto those about him: when he is christened, whenhe is married, and when he is buried. Every oneis the chief personage, the hero, of his own baptism,his own wedding, and his own funeral.
There are other occasions, less momentous, in whichone may make more of himself than under ordinary circ*mstanceshe would think it proper to do; when he may talk abouthimself, and tell his own experiences, in fact, indulgein a more or less egotistic monologue without fearor reproach.
I think I may claim that this is one of those occasions.I have delivered my last anatomical lecture and heardmy class recite for the last time. They wishto hear from me again in a less scholastic mood thanthat in which they have known me. Will you notindulge me in telling you something of my own story?
This is the thirty-sixth Course of Lectures in whichI have taken my place and performed my duties as Professorof Anatomy. For more than half of my term ofoffice I gave instruction in Physiology, after thefashion of my predecessors and in the manner then generallyprevalent in our schools, where the physiologicallaboratory was not a necessary part of the apparatusof instruction. It was with my hearty approvalthat the teaching of Physiology was constituted aseparate department and made an independent Professorship.Before my time, Dr. Warren had taught Anatomy, Physiology,and Surgery in the same course of Lectures, lastingonly three or four months. As the boundaries ofscience are enlarged, new divisions and subdivisionsof its territories become necessary. In the placeof six Professors in 1847, when I first became a memberof the Faculty, I count twelve upon the Cataloguebefore me, and I find the whole number engaged inthe work of instruction in the Medical School amountsto no less than fifty.
Since I began teaching in this school, the aspectof many branches of science has undergone a very remarkabletransformation. Chemistry and Physiology areno longer what they were, as taught by the instructorsof that time. We are looking forward to the synthesisof new organic compounds; our artificial madder isalready in the market, and the indigo-raisers arenow fearing that their crop will be supplanted by themanufactured article. In the living body we talkof fuel supplied and work done, in movement, in heat,just as if we were dealing with a machine of our owncontrivance.
A physiological laboratory of to-day is equipped withinstruments of research of such ingenious contrivance,such elaborate construction, that one might supposehimself in a workshop where some exquisite fabric wasto be wrought, such as Queens love to wear, and Kingsdo not always love to pay for. They are, indeed,weaving a charmed web, for these are the looms fromwhich comes the knowledge that clothes the nakednessof the intellect. Here are the mills that grindfood for its hunger, and “is not the life morethan meat, and the body than raiment?”
But while many of the sciences have so changed thatthe teachers of the past would hardly know them, ithas not been so with the branch I teach, or, rather,with that division of it which is chiefly taught inthis amphitheatre. General anatomy, or histology,on the other hand, is almost all new; it has grownup, mainly, since I began my medical studies.I never saw a compound microscope during my years ofstudy in Paris. Individuals had begun to usethe instrument, but I never heard it alluded to byeither Professors or students. In descriptiveanatomy I have found little to unlearn, and not agreat deal that was both new and important to learn.Trifling additions are made from year to year, notto be despised and not to be overvalued. Someof the older anatomical works are still admirable,some of the newer ones very much the contrary.I have had recent anatomical plates brought me forinspection, and I have actually button-holed the book-agent,a being commonly as hard to get rid of as the tar-babyin the negro legend, that I might put him to shamewith the imperial illustrations of the bones and musclesin the great folio of Albinus, published in 1747,and the unapproached figures of the lymphatic systemof Mascagni, now within a very few years of a centuryold, and still copied, or, rather, pretended to becopied, in the most recent works on anatomy.
I am afraid that it is a good plan to get rid of oldProfessors, and I am thankful to hear that there isa movement for making provision for those who areleft in need when they lose their offices and theirsalaries. I remember one of our ancient CambridgeDoctors once asked me to get into his rickety chaise,and said to me, half humorously, half sadly, that hewas like an old horse,—they had taken offhis saddle and turned him out to pasture. I fearthe grass was pretty short where that old servant ofthe public found himself grazing. If I myselfneeded an apology for holding my office so long, Ishould find it in the fact that human anatomy is muchthe same study that it was in the days of Vesaliusand Fallopius, and that the greater part of my teachingwas of such a nature that it could never become antiquated.
Let me begin with my first experience as a medicalstudent. I had come from the lessons of JudgeStory and Mr. Ashmun in the Law School at Cambridge.I had been busy, more or less, with the pages of Blackstoneand Chitty, and other text-books of the first yearof legal study. More or less, I say, but I amafraid it was less rather than more. For duringthat year I first tasted the intoxicating pleasureof authorship. A college periodical, conductedby friends of mine, still undergraduates, temptedme into print, and there is no form of lead-poisoningwhich more rapidly and thoroughly pervades the bloodand bones and marrow than that which reaches the youngauthor through mental contact with type-metal.Qui a bu, boira,—he who has once been adrinker will drink again, says the French proverb.So the man or woman who has tasted type is sure toreturn to his old indulgence sooner or later.In that fatal year I had my first attack of authors’lead-poisoning, and I have never got quite rid ofit from that day to this. But for that I mighthave applied myself more diligently to my legal studies,and carried a green bag in place of a stethoscopeand a thermometer up to the present day.
What determined me to give up Law and apply myselfto Medicine I can hardly say, but I had from the firstlooked upon that year’s study as an experiment.At any rate, I made the change, and soon found myselfintroduced to new scenes and new companionships.
I can scarcely credit my memory when I recall thefirst impressions produced upon me by sights afterwardsbecome so familiar that they could no more disturba pulse-beat than the commonest of every-day experiences.The skeleton, hung aloft like a gibbeted criminal,looked grimly at me as I entered the room devotedto the students of the school I had joined, just asthe fleshless figure of Time, with the hour-glass andscythe, used to glare upon me in my childhood fromthe “New England Primer.” The whitefaces in the beds at the Hospital found their reflectionin my own cheeks, which lost their color as I lookedupon them. All this had to pass away in a littletime; I had chosen my profession, and must meet itspainful and repulsive aspects until they lost theirpower over my sensibilities.
The private medical school which I had joined wasone established by Dr. James Jackson, Dr. Walter Channing,Dr. John Ware, Dr. Winslow Lewis, and Dr. George W.Otis. Of the first three gentlemen I have eitherspoken elsewhere or may find occasion to speak hereafter.The two younger members of this association of teacherswere both graduates of our University, one of theyear 1819, the other of 1818.
Dr. Lewis was a great favorite with students.He was a man of very lively temperament, fond of oldbooks and young people, open-hearted, free-spoken,an enthusiast in teaching, and especially at home inthat apartment of the temple of science where natureis seen in undress, the anthropotomic laboratory,known to common speech as the dissecting-room.He had that quality which is the special gift of theman born for a teacher,—the power of excitingan interest in that which he taught. While hewas present the apartment I speak of was the sunniestof studios in spite of its mortuary spectacles.Of the students I met there I best remember JamesJackson, Junior, full of zeal and playful as a boy,a young man whose early death was a calamity to theprofession of which he promised to be a chief ornament;the late Reverend J. S. C. Greene, who, as the prefixto his name signifies, afterwards changed his profession,but one of whose dissections I remember looking uponwith admiration; and my friend Mr. Charles Amory,as we call him, Dr. Charles Amory, as he is entitledto be called, then, as now and always, a favorite withall about him. He had come to us from the schoolsof Germany, and brought with him recollections ofthe teachings of Blumenbach and the elder Langenbeck,father of him whose portrait hangs in our Museum.Dr. Lewis was our companion as well as our teacher.A good demonstrator is,—I will not sayas important as a good Professor in the teaching ofAnatomy, because I am not sure that he is not moreimportant. He comes into direct personal relationswith the students,—he is one of them, infact, as the Professor cannot be from the nature ofhis duties. The Professor’s chair is aninsulating stool, so to speak; his age, his knowledge,real or supposed, his official station, are like theglass legs which support the electrician’s pieceof furniture, and cut it off from the common currentsof the floor upon which it stands. Dr. Lewis enjoyedteaching and made his students enjoy being taught.He delighted in those anatomical conundrums to answerwhich keeps the student’s eyes open and his witsawake. He was happy as he dexterously performedthe tour de maitre of the old barber-surgeons, orapplied the spica bandage and taught his scholarsto do it, so neatly and symmetrically that the aestheticmissionary from the older centre of civilization wouldbend over it in blissful contemplation, as if it werea sunflower. Dr. Lewis had many other tastes,and was a favorite, not only with students, but ina wide circle, professional, antiquarian, masonic,and social.
Dr. Otis was less widely known, but was a fluent andagreeable lecturer, and esteemed as a good surgeon.
I must content myself with this glimpse at myselfand a few of my fellow-students in Boston. Afterattending two courses of Lectures in the school ofthe University, I went to Europe to continue my studies.
You may like to hear something of the famous Professorsof Paris in the days when I was a student in the Ecolede Medicine, and following the great Hospital teachers.
I can hardly believe my own memory when I recall theold practitioners and Professors who were still goinground the hospitals when I mingled with the trainof students that attended the morning visits.See that bent old man who is groping his way throughthe wards of La Charity. That is the famous BaronBoyer, author of the great work on surgery in ninevolumes, a writer whose clearness of style commendshis treatise to general admiration, and makes it akind of classic. He slashes away at a terriblerate, they say, when he gets hold of the subject offistula in its most frequent habitat,—butI never saw him do more than look as if he wantedto cut a good dollop out of a patient he was examining.The short, square, substantial man with iron-grayhair, ruddy face, and white apron is Baron Larrey,Napoleon’s favorite surgeon, the most honestman he ever saw,—it is reputed that hecalled him. To go round the Hotel des Invalideswith Larrey was to live over the campaigns of Napoleon,to look on the sun of Austerlitz, to hear the cannonsof Marengo, to struggle through the icy waters ofthe Beresina, to shiver in the snows of the Russianretreat, and to gaze through the battle smoke uponthe last charge of the red lancers on the redder fieldof Waterloo. Larrey was still strong and sturdyas I saw him, and few portraits remain printed inlivelier colors on the tablet of my memory.
Leave the little group of students which gathers aboutLarrey beneath the gilded dome of the Invalides andfollow me to the Hotel Dieu, where rules and reignsthe master-surgeon of his day, at least so far as Parisand France are concerned,—the illustriousBaron Dupuytren. No man disputed his reign, someenvied his supremacy. Lisfranc shrugged his shouldersas he spoke of “ce grand homme de l’autrecots de la riviere,” that great man on the otherside of the river, but the great man he remained, untilhe bowed before the mandate which none may disobey.“Three times,” said Bouillaud, “didthe apoplectic thunderbolt fall on that robust brain,”—ityielded at last as the old bald cliff that is rivenand crashes down into the valley. I saw him beforethe first thunderbolt had descended: a square,solid man, with a high and full-domed head, oracularin his utterances, indifferent to those around him,sometimes, it was said, very rough with them.He spoke in low, even tones, with quiet fluency, andwas listened to with that hush of rapt attention whichI have hardly seen in any circle of listeners unlesswhen such men as ex-President John Quincy Adams orDaniel Webster were the speakers. I do not thinkthat Dupuytren has left a record which explains hisinfluence, but in point of fact he dominated thosearound him in a remarkable manner. You must haveall witnessed something of the same kind. Thepersonal presence of some men carries command withit, and their accents silence the crowd around them,when the same words from other lips might fall comparativelyunheeded.
As for Lisfranc, I can say little more of him thanthat he was a great drawer of blood and hewer of members.I remember his ordering a wholesale bleeding of hispatients, right and left, whatever might be the matterwith them, one morning when a phlebotomizing fit wason him. I recollect his regretting the splendidguardsmen of the old Empire,—for what?because they had such magnificent thighs to amputate.I got along about as far as that with him, when Iceased to be a follower of M. Lisfranc.
The name of Velpeau must have reached many of you,for he died in 1867, and his many works made his namewidely known. Coming to Paris in wooden shoes,starving, almost, at first, he raised himself to greateminence as a surgeon and as an author, and at lastobtained the Professorship to which his talents andlearning entitled him. His example may be anencouragement to some of my younger hearers who areborn, not with the silver spoon in their mouths, butwith the two-tined iron fork in their hands.It is a poor thing to take up their milk porridge within their young days, but in after years it will oftentransfix the solid dumplings that roll out of thesilver spoon. So Velpeau found it. He hadnot what is called genius, he was far from prepossessingin aspect, looking as if he might have wielded thesledge-hammer (as I think he had done in early life)rather than the lancet, but he had industry, determination,intelligence, character, and he made his way to distinctionand prosperity, as some of you sitting on these benchesand wondering anxiously what is to become of you inthe struggle for life will have done before the twentiethcentury has got halfway through its first quarter.A good sound head over a pair of wooden shoes is agreat deal better than a wooden head belonging toan owner who cases his feet in calf-skin, but a goodbrain is not enough without a stout heart to fillthe four great conduits which carry at once fuel andfire to that mightiest of engines.
How many of you who are before me are familiarly acquaintedwith the name of Broussais, or even with that of Andral?Both were lecturing at the Ecole de Medicine, andI often heard them. Broussais was in those dayslike an old volcano, which has pretty nearly used upits fire and brimstone, but is still boiling and bubblingin its interior, and now and then sends up a spirtof lava and a volley of pebbles. His theoriesof gastro-enteritis, of irritation and inflammationas the cause of disease, and the practice which sprangfrom them, ran over the fields of medicine for a timelike flame over the grass of the prairies. Theway in which that knotty-featured, savage old manwould bring out the word irritation—withrattling and rolling reduplication of the resonantletter r—might have taught a lesson in articulationto Salvini. But Broussais’s theory waslanguishing and well-nigh become obsolete, and this,no doubt, added vehemence to his defence of his cherisheddogmas.
Old theories, and old men who cling to them, musttake themselves out of the way as the new generationwith its fresh thoughts and altered habits of mindcomes forward to take the place of that which is dyingout. This was a truth which the fiery old theoristfound it very hard to learn, and harder to bear, asit was forced upon him. For the hour of his lecturewas succeeded by that of a younger and far more popularprofessor. As his lecture drew towards its close,the benches, thinly sprinkled with students, beganto fill up; the doors creaked open and banged backoftener and oftener, until at last the sound grew almostcontinuous, and the voice of the lecturer became aleonine growl as he strove in vain to be heard overthe noise of doors and footsteps.
Broussais was now sixty-two years old. The newgeneration had outgrown his doctrines, and the Professorfor whose hour the benches had filled themselves belongedto that new generation. Gabriel Andral was littlemore than half the age of Broussais, in the full primeand vigor of manhood at thirty-seven years. Hewas a rapid, fluent, fervid, and imaginative speaker,pleasing in aspect and manner,—a strongcontrast to the harsh, vituperative old man who hadjust preceded him. His Clinique Medicale is stillvaluable as a collection of cases, and his researcheson the blood, conducted in association with Gavarret,contributed new and valuable facts to science.But I remember him chiefly as one of those instructorswhose natural eloquence made it delightful to listento him. I doubt if I or my fellow-students didfull justice either to him or to the famous physicianof Hotel Dieu, Chomel. We had addicted ourselvesalmost too closely to the words of another master,by whom we were ready to swear as against all teachersthat ever were or ever would be.
This object of our reverence, I might almost say idolatry,was one whose name is well known to most of the youngmen before me, even to those who may know comparativelylittle of his works and teachings. Pierre CharlesAlexandre Louis, at the age of forty-seven, as I recallhim, was a tall, rather spare, dignified personage,of serene and grave aspect, but with a pleasant smileand kindly voice for the student with whom he cameinto personal relations. If I summed up the lessonsof Louis in two expressions, they would be these;I do not hold him answerable for the words, but Iwill condense them after my own fashion in French,and then give them to you, expanded somewhat, in English:
Formez toujours desidees nettes.
Fuyez toujours les apeu pres.
Always make sure that you form a distinct and clearidea of the matter you are considering.
Always avoid vague approximations where exact estimatesare possible; about so many,—about so much,instead of the precise number and quantity.
Now, if there is anything on which the biologicalsciences have prided themselves in these latter yearsit is the substitution of quantitative for qualitativeformulae. The “numerical system,”of which Louis was the great advocate, if not theabsolute originator, was an attempt to substituteseries of carefully recorded facts, rigidly countedand closely compared, for those never-ending recordsof vague, unverifiable conclusions with which theclassics of the healing art were overloaded.The history of practical medicine had been like thestory of the Danaides. “Experience”had been, from time immemorial, pouring its flowingtreasures into buckets full of holes. At the existingrate of supply and leakage they would never be filled;nothing would ever be settled in medicine. Butcases thoroughly recorded and mathematically analyzedwould always be available for future use, and whenaccumulated in sufficient number would lead to resultswhich would be trustworthy, and belong to science.
You young men who are following the hospitals hardlyknow how much you are indebted to Louis. I saynothing of his Researches on Phthisis or his greatwork on Typhoid Fever. But I consider his modestand brief Essay on Bleeding in some Inflammatory Diseases,based on cases carefully observed and numericallyanalyzed, one of the most important written contributionsto practical medicine, to the treatment of internaldisease, of this century, if not since the days ofSydenham. The lancet was the magician’swand of the dark ages of medicine. The old physiciansnot only believed in its general efficacy as a wonder-workerin disease, but they believed that each malady couldbe successfully attacked from some special part ofthe body,—the strategic point which commandedthe seat of the morbid affection. On a figuregiven in the curious old work of John de Ketam, noless than thirty-eight separate places are marked asthe proper ones to bleed from, in different diseases.Even Louis, who had not wholly given up venesection,used now and then to order that a patient sufferingfrom headache should be bled in the foot, in preferenceto any other part.
But what Louis did was this: he showed by a strictanalysis of numerous cases that bleeding did not strangle,—jugulatewas the word then used,—acute diseases,more especially pneumonia. This was not a reform,—itwas a revolution. It was followed up in this countryby the remarkable Discourse of Dr. Jacob Bigelow uponSelf-Limited Diseases, which has, I believe, donemore than any other work or essay in our own languageto rescue the practice of medicine from the slaveryto the drugging system which was a part of the inheritanceof the profession.
Yes, I say, as I look back on the long hours of themany days I spent in the wards and in the autopsyroom of La Pitie, where Louis was one of the attendingphysicians,—yes, Louis did a great workfor practical medicine. Modest in the presenceof nature, fearless in the face of authority, unwearyingin the pursuit of truth, he was a man whom any studentmight be happy and proud to claim as his teacher andhis friend, and yet, as I look back on the days whenI followed his teachings, I feel that I gave myselfup too exclusively to his methods of thought and study.
There is one part of their business which certainmedical practitioners are too apt to forget; namely,that what they should most of all try to do is toward off disease, to alleviate suffering, to preservelife, or at least to prolong it if possible.It is not of the slightest interest to the patientto know whether three or three and a quarter cubicinches of his lung are hepatized. His mind isnot occupied with thinking of the curious problemswhich are to be solved by his own autopsy,—whetherthis or that strand of the spinal marrow is the seatof this or that form of degeneration. He wantssomething to relieve his pain, to mitigate the anguishof dyspnea, to bring back motion and sensibility tothe dead limb, to still the tortures of neuralgia.What is it to him that you can localize and name bysome uncouth term the disease which you could notprevent and which you cannot cure? An old womanwho knows how to make a poultice and how to put iton, and does it tuto, eito, jucunde, just when andwhere it is wanted, is better,—a thousandtimes better in many cases,—than a staringpathologist, who explores and thumps and doubts andguesses, and tells his patient be will be better tomorrow,and so goes home to tumble his books over and makeout a diagnosis.
But in those days, I, like most of my fellow students,was thinking much more of “science” thanof practical medicine, and I believe if we had notclung so closely to the skirts of Louis and had followedsome of the courses of men like Trousseau,—therapeutists,who gave special attention to curative methods, andnot chiefly to diagnosis,—it would havebeen better for me and others. One thing, atany rate, we did learn in the wards of Louis.We learned that a very large proportion of diseasesget well of themselves, without any special medication,—thegreat fact formulated, enforced, and popularized byDr. Jacob Bigelow in the Discourse referred to.We unlearned the habit of drugging for its own sake.This detestable practice, which I was almost proscribedfor condemning somewhat too epigrammatically a littlemore than twenty years ago, came to us, I suspect,in a considerable measure from the English “generalpractitioners,” a sort of prescribing apothecaries.You remember how, when the city was besieged, eachartisan who was called upon in council to suggestthe best means of defence recommended the articleshe dealt in: the carpenter, wood; the blacksmith,iron; the mason, brick; until it came to be a puzzleto know which to adopt. Then the shoemaker said,“Hang your walls with new boots,” and gavegood reasons why these should be the best of all possibledefences. Now the “general practitioner”charged, as I understand, for his medicine, and inthat way got paid for his visit. Wherever thisis the practice, medicine is sure to become a trade,and the people learn to expect drugging, and to considerit necessary, because drugs are so universally givento the patients of the man who gets his living by them.
It was something to have unlearned the pernicioushabit of constantly giving poisons to a patient, asif they were good in themselves, of drawing off theblood which he would want in his struggle with disease,of making him sore and wretched with needless blisters,of turning his stomach with unnecessary nauseous draughtand mixtures,—only because he was sickand something must be done. But there were positiveas well as negative facts to be learned, and someof us, I fear, came home rich in the negatives ofthe expectant practice, poor in the resources whichmany a plain country practitioner had ready in abundancefor the relief and the cure of disease. No oneinstructor can be expected to do all for a studentwhich he requires. Louis taught us who followedhim the love of truth, the habit of passionless listeningto the teachings of nature, the most careful and searchingmethods of observation, and the sure means of gettingat the results to be obtained from them in the constantemployment of accurate tabulation. He was nota showy, or eloquent, or, I should say, a very generallypopular man, though the favorite, almost the idol,of many students, especially Genevese and Bostonians.But he was a man of lofty and admirable scientificcharacter, and his work will endure in its influenceslong after his name is lost sight of save to the fadedeyes of the student of medical literature.
Many other names of men more or less famous in theirday, and who were teaching while I was in Paris, comeup before me. They are but empty sounds for themost part in the ears of persons of not more than middleage. Who of you knows anything of Richerand, authorof a very popular work on Physiology, commonly putinto the student’s hands when I first beganto ask for medical text-books? I heard him lectureonce, and have had his image with me ever since asthat of an old, worn-out man,—a venerablebut dilapidated relic of an effete antiquity.To verify this impression I have just looked out thedates of his birth and death, and find that he waseighteen years younger than the speaker who is nowaddressing you. There is a terrible parallax betweenthe period before thirty and that after threescoreand ten, as two men of those ages look, one with nakedeyes, one through his spectacles, at the man of fiftyand thereabout. Magendie, I doubt not you haveall heard of. I attended but one of his lectures.I question if one here, unless some contemporary ofmy own has strayed into the amphitheatre,—knowsanything about Marjolin. I remember two thingsabout his lectures on surgery, the deep tones of hisvoice as he referred to his oracle,—theearlier writer, Jean Louis Petit,—and hisformidable snuffbox. What he taught me lies fardown, I doubt not, among the roots of my knowledge,but it does not flower out in any noticeable blossoms,or offer me any very obvious fruits. Where nowis the fame of Bouillaud, Professor and Deputy, theSangrado of his time? Where is the renown of
Piorry, percussionist and poet, expert alike in theresonances of the thoracic cavity and those of therhyming vocabulary?—I think life has notyet done with the vivacious Ricord, whom I remembercalling the Voltaire of pelvic literature,—asceptic as to the morality of the race in general,who would have submitted Diana to treatment with hismineral specifics, and ordered a course of blue pillsfor the vestal virgins.Ricord was born at the beginning of the century, andPiorry some years earlier. Cruveilhier, who diedin 1874, is still remembered by his great work onpathological anatomy; his work on descriptive anatomyhas some things which I look in vain for elsewhere.But where is Civiale,—where are Orfila,Gendrin, Rostan, Biett, Alibert,—jolly oldBaron Alibert, whom I remember so well in his broad-brimmedhat, worn a little jauntily on one side, calling outto the students in the court-yard of the HospitalSt. Louis, “Enfans de la methode naturelle, etes-voustous ici?” “Children of the natural method[his own method of classification of skin diseases,]are you all here?” All here, then, perhaps; allwhere, now?
My show of ghosts is over. It is always the samestory that old men tell to younger ones, some fewof whom will in their turn repeat the tale, only withaltered names, to their children’s children.
Like phantoms painted on the magicslide,
Forth from the darkness of the pastwe glide,
As living shadows for a moment seen
In airy pageant on the eternal screen,
Traced by a ray from one unchangingflame,
Then seek the dust and stillnesswhence we came.
Dr. Benjamin Waterhouse, whom I well remember, cameback from Leyden, where he had written his Latin graduatingthesis, talking of the learned Gaubius and the lateillustrious Boerhaave and other dead Dutchmen, ofwhom you know as much, most of you, as you do of Noah’sapothecary and the family physician of Methuselah,whose prescriptions seem to have been lost to posterity.Dr. Lloyd came back to Boston full of the teachingsof Cheselden and Sharpe, William Hunter, Smellie, andWarner; Dr. James Jackson loved to tell of Mr. Clineand to talk of Mr. John Hunter; Dr. Reynolds wouldgive you his recollections of Sir Astley Cooper andMr. Abernethy; I have named the famous Frenchmen ofmy student days; Leyden, Edinburgh, London, Paris,were each in turn the Mecca of medical students, justas at the present day Vienna and Berlin are the centreswhere our young men crowd for instruction. Thesealso must sooner or later yield their precedence andpass the torch they hold to other hands. Whereshall it next flame at the head of the long procession?Shall it find its old place on the shores of the Gulfof Salerno, or shall it mingle its rays with the northernaurora up among the fiords of Norway,—orshall it be borne across the Atlantic and reach thebanks of the Charles, where Agassiz and Wyman havetaught, where Hagen still teaches, glowing like hisown Lampyris splendidula, with enthusiasm, where thefirst of American botanists and the ablest of Americansurgeons are still counted in the roll of honor ofour great University?
Let me add a few words which shall not be other thancheerful, as I bid farewell to this edifice whichI have known so long. I am grateful to the roofwhich has sheltered me, to the floors which have sustainedme, though I have thought it safest always to abstainfrom anything like eloquence, lest a burst of tooemphatic applause might land my class and myself inthe cellar of the collapsing structure, and bury usin the fate of Korah, Dathan, and Abiram. I havehelped to wear these stairs into hollows,—stairswhich I trod when they were smooth and level, freshfrom the plane. There are just thirty-two ofthem, as there were five and thirty years ago, butthey are steeper and harder to climb, it seems tome, than they were then. I remember that in theearly youth of this building, the late Dr. John K.Mitchell, father of our famous Dr. Weir Mitchell,said to me as we came out of the Demonstrator’sroom, that some day or other a whole class would goheels over head down this graded precipice, like theherd told of in Scripture story. This has neverhappened as yet; I trust it never will. I havenever been proud of the apartment beneath the seats,in which my preparations for lecture were made.But I chose it because I could have it to myself, andI resign it, with a wish that it were more worthyof regret, into the hands of my successor, with myparting benediction. Within its twilight precinctsI have often prayed for light, like Ajax, for thedaylight found scanty entrance, and the gaslight neverilluminated its dark recesses. May it prove tohim who comes after me like the cave of the Sibyl,out of the gloomy depths of which came the oracleswhich shone with the rays of truth and wisdom!
This temple of learning is not surrounded by the mansionsof the great and the wealthy. No stately avenueslead up to its facades and porticoes. I havesometimes felt, when convoying a distinguished strangerthrough its precincts to its door, that he might questionwhether star-eyed Science had not missed her way whenshe found herself in this not too attractive locality.I cannot regret that we—you, I should say—aresoon to migrate to a more favored region, and carryon your work as teachers and as learners in amplerhalls and under far more favorable conditions.
I hope that I may have the privilege of meeting youthere, possibly may be allowed to add my words ofwelcome to those of my former colleagues, and in thatpleasing anticipation I bid good-by to this scene ofmy long labors, and, for the present at least, tothe friends with whom I have been associated.
APPENDUM
NOTES TO THE ADDRESS ON CURRENTS AND COUNTERCURRENTS IN MEDICAL SCIENCE.
Some passages contained in the original manuscriptof the Address, and omitted in the delivery on accountof its length, are restored in the text or incorporatedwith these Notes.
NOTE A.—
There is good reason to doubt whether the nitrateof silver has any real efficacy in epilepsy.It has seemed to cure many cases, but epilepsy isa very uncertain disease, and there is hardly anythingwhich has not been supposed to cure it. Dr. Coplandcites many authorities in its favor, most especiallyLombard’s cases. But De la Berge and Monneret(Comp. de Med. Paris), 1839, analyze these samecases, eleven in number, and can only draw the inferenceof a very questionable value in the supposed remedy.Dr. James Jackson says that relief of epilepsy is notto be attained by any medicine with which he is acquainted,but by diet. (Letters to a Young Physician, p.67.) Guy Patin, Dean of the Faculty of Paris, Professorat the Royal College, Author of the Antimonial Martyrology,a wit and a man of sense and learning, who died almosttwo hundred years ago, had come to the same conclusion,though the chemists of his time boasted of their remedies.“Did, you ever see a case of epilepsy curedby nitrate of silver?” I said to one of the oldestand most experienced surgeons in this country.“Never,” was his instant reply. Dr.Twitchell’s experience was very similar.How, then, did nitrate of silver come to be givenfor epilepsy? Because, as Dr. Martin has so wellreminded us, lunatics were considered formerly to beunder the special influence of Luna, the moon (whichEsquirol, be it observed, utterly denies), and lunarcaustic, or nitrate of silver, is a salt of that metalwhich was called luna from its whiteness, and of coursemust be in the closest relations with the moon.It follows beyond all reasonable question that themoon’s metal, silver, and its preparations,must be the specific remedy for moonblasted maniacsand epileptics!
Yet the practitioner who prescribes the nitrate ofsilver supposes he is guided by the solemn experienceof the past, instead of by its idle fancies.He laughs at those old physicians who placed such confidencein the right hind hoof of an elk as a remedy for thesame disease, and leaves the record of his own beliefin a treatment quite as fanciful and far more objectionable,written in indelible ink upon a living tablet wherehe who runs may read it for a whole generation, ifnature spares his walking advertisem*nt so long.
NOTE B.—
The presumption that a man is innocent until he isproved guilty, does not mean that there are no rogues,but lays the onus probandi on the party to which itproperly belongs. So with this proposition.A noxious agent should never be employed in sicknessunless there is ample evidence in the particular caseto overcome the general presumption against all suchagents, and the evidence is very apt to be defective.
The miserable delusion of hom*oeopathy builds itselfupon an axiom directly the opposite of this; namely,that the sick are to be cured by poisons. Similiasimilibus curantur means exactly this. It is simplya theory of universal poisoning, nullified in practiceby the infinitesimal contrivance. The only wayto kill it and all similar fancies, and to throw everyquack nostrum into discredit, is to root out completelythe suckers of the old rotten superstition that whateveris odious or noxious is likely to be good for disease.The current of sound practice with ourselves is, Ibelieve, setting fast in the direction I have indicatedin the above proposition. To uphold the exhibitionof noxious agents in disease, as the rule, insteadof admitting them cautiously and reluctantly as theexception, is, as I think, an eddy of opinion in thedirection of the barbarism out of which we believeour art is escaping. It is only through the enlightenedsentiment and action of the Medical Profession thatthe community can be brought to acknowledge that drugsshould always be regarded as evils.
It is true that some suppose, and our scientific andthoughtful associate, Dr. Gould, has half countenancedthe opinion, that there may yet be discovered a specificfor every disease. Let us not despair of thefuture, but let us be moderate in our expectations.When an oil is discovered that will make a bad watchkeep good time; when a recipe is given which willturn an acephalous foetus into a promising child; whena man can enter the second time into his mother’swomb and give her back the infirmities which twentygenerations have stirred into her blood, and infusedinto his own through hers, we may be prepared to enlargethe National Pharmacopoeia with a list of specifiesfor everything but old age,—and possiblyfor that also.
NOTE C.—
The term specific is used here in its ordinary sense,without raising the question of the propriety of itsapplication to these or other remedies.
The credit of introducing Cinchona rests between theJesuits, the Countess of Chinchon, the Cardinal deLugo, and Sir Robert Talbor, who employed it as asecret remedy. (Pereira.) Mercury as an internal specificremedy was brought into use by that impudent and presumptuousquack, as he was considered, Paracelsus. (Encyc.Brit. art. “Paracelsus.”) Arsenicwas introduced into England as a remedy for intermittentsby Dr. Fowler, in consequence of the success of a patentmedicine, the Tasteless Ague Drops, which were supposed,“probably with reason,” to be a preparationof that mineral. (Rees’s Cyc. art. “Arsenic.”)Colchicum came into notice in a similar way, from thesuccess of the Eau Medicinale of M. Husson, a Frenchmilitary officer. (Pereira.) Iodine was discoveredby a saltpetre manufacturer, but applied by a physicianin place of the old remedy, burnt sponge, which seemsto owe its efficacy to it. (Dunglison, New Remedies.)
As for Sulphur, “the common people have longused it as an ointment” for scabies. (Rees’sCyc. art. “Scabies.”) The modern cantiscorbuticregimen is credited to Captain Cook. “Tohis sagacity we are indebted for the first impulseto those regulations by which scorbutus is so successfullyprevented in our navy.” (Lond. Cyc.Prac. Med. art. “Scorbutus.”)Iron and various salts which enter into the normalcomposition of the human body do not belong to themateria medica by our definition, but to the materiaalimentaria.For the first introduction of iron as a remedy, seePereira, who gives a very curious old story.
The statement in the text concerning a portion ofthe materia medica stands exactly as delivered, andis meant exactly as it stands. No denunciationof drugs, as sparingly employed by a wise physician,was or is intended. If, however, as Dr. Gouldstated in his “valuable and practical discourse”to which the Massachusetts Medical Society “listenedwith profit as well as interest,” “Drugs,in themselves considered, may always be regarded asevils,”—any one who chooses may questionwhether the evils from their abuse are, on the whole,greater or less than the undoubted benefits obtainedfrom their proper use. The large exception ofopium, wine, specifics, and anaesthetics, made in thetext, takes off enough from the useful side, as Ifully believe, to turn the balance; so that a vesselcontaining none of these, but loaded with antimony,strychnine, acetate of lead, aloes, aconite, lobelia,lapis infernalis, stercus diaboli, tormentilla, andother approved, and, in skilful hands, really usefulremedies, brings, on the whole, more harm than goodto the port it enters.
It is a very narrow and unjust view of the practiceof medicine, to suppose it to consist altogether inthe use of powerful drugs, or of drugs of any kind.Far from it. “The physician may do verymuch for the welfare of the sick, more than otherscan do, although he does not, even in the major partof cases, undertake to control and overcome the diseaseby art. It was with these views that I never reportedany patient cured at our hospital. Those whor*covered their health were reported as well; notimplying that they were made so by the active treatmentthey had received there. But it was to be understoodthat all patients received in that house were to becured, that is, taken care of.” (Letters to aYoung Physician, by James Jackson, M. D., Boston, 1855.)
“Hygienic rules, properly enforced, fresh air,change of air, travel, attention to diet, good andappropriate food judiciously regulated, together withthe administration of our tonics, porter, ale, wine,iron, etc., supply the diseased or impoverishedsystem with what Mr. Gull, of St. Bartholomew’sHospital, aptly calls the ‘raw material of theblood;’ and we believe that if any real improvementhas taken place in medical practice, independentlyof those truly valuable contributions we have beforedescribed, it is in the substitution of tonics, stimulants,and general management, for drastic cathartics, forbleeding, depressing agents, including mercury, tartaremetics, etc., so much in vogue during the earlypart even of this century.” (F. P. Porcher,in Charleston Med. Journal and Review for January,1860.) 1860.)
