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+The Project Gutenberg EBook of Medical Essays, by Oliver Wendell Holmes,
+Sr.
+
+This eBook is for the use of anyone anywhere at no cost and with almost
+no restrictions whatsoever. You may copy it, give it away or re-use
+it under the terms of the Project Gutenberg License included with this
+eBook or online at www.gutenberg.org
+
+
+Title: Medical Essays
+
+Author: Oliver Wendell Holmes, Sr.
+
+Release Date: August 16, 2006 [EBook #2700]
+Last Updated: February 18, 2018
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK MEDICAL ESSAYS ***
+
+
+Produced by David Widger
+
+
+
+
+
+
+
+MEDICAL ESSAYS
+
+By Oliver Wendell Holmes
+
+
+1842-1882
+
+
+
+
+
+ CONTENTS
+
+
+
+ PREFACE.
+
+ A SECOND PREFACE.
+
+ PREFACE TO THE NEW EDITION.
+
+ HOMOEOPATHY AND ITS KINDRED DELUSIONS
+
+ THE CONTAGIOUSNESS OF PUERPERAL FEVER
+
+ CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+ BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+
+ SCHOLASTIC AND BEDSIDE TEACHING.
+
+ THE MEDICAL PROFESSION IN MASSACHUSETTS.
+
+ THE YOUNG PRACTITIONER
+
+ MEDICAL LIBRARIES.
+
+ SOME OF MY EARLY TEACHERS
+
+ APPENDUM
+
+ NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE.
+
+
+
+
+
+
+
+
+PREFACE.
+
+The character of the opposition which some of these papers have met with
+suggests the inference that they contain really important, but unwelcome
+truths. Negatives multiplied into each other change their sign and
+become positives. Hostile criticisms meeting together are often
+equivalent to praise, and the square of fault-finding turns out to be
+the same thing as eulogy.
+
+But a writer has rarely so many enemies as it pleases him to believe.
+Self-love leads us to overrate the numbers of our negative constituency.
+The larger portion of my limited circle of readers must be quite
+indifferent to, if not ignorant of, the adverse opinions which have been
+expressed or recorded concerning any of these Addresses or Essays now
+submitted to their own judgment. It is proper, however, to inform
+them, that some of the positions maintained in these pages have been
+unsparingly attacked, with various degrees of ability, scholarship,
+and good-breeding. The tone of criticism naturally changes with local
+conditions in different parts of a country extended like our own, so
+that it is one of the most convenient gauges of the partial movements in
+the direction of civilization. It is satisfactory to add, that the views
+assailed have also been unflinchingly defended by unsought champions,
+among the ablest of whom it is pleasant to mention, at this moment of
+political alienation, the Editor of the Charleston Medical Journal.
+
+“Currents and Counter-Currents” was written and delivered as an Oration,
+a florid rhetorical composition, expressly intended to secure the
+attention of an audience not easy to hold as listeners. It succeeded
+in doing this, and also in being as curiously misunderstood and
+misrepresented as if it had been a political harangue. This gave it more
+local notoriety than it might otherwise have attained, so that, as I
+learn, one ingenious person made use of its title as an advertisement to
+a production of his own.
+
+The commonest mode of misrepresentation was this: qualified
+propositions, the whole meaning of which depended on the qualifications,
+were stripped of these and taken as absolute. Thus, the attempt to
+establish a presumption against giving poisons to sick persons was
+considered as equivalent to condemning the use of these substances.
+The only important inference the writer has been able to draw from the
+greater number of the refutations of his opinions which have been kindly
+sent him, is that the preliminary education of the Medical Profession is
+not always what it ought to be.
+
+One concession he is willing to make, whatever sacrifice of pride it
+may involve. The story of Massasoit, which has furnished a coral, as it
+were, for some teething critics, when subjected to a powerful logical
+analysis, though correct in its essentials, proves to have been told
+with exceptionable breadth of statement, and therefore (to resume
+the metaphor) has been slightly rounded off at its edges, so as to
+be smoother for any who may wish to bite upon it hereafter. In
+other respects the Discourse has hardly been touched. It is only an
+individual's expression, in his own way, of opinions entertained by
+hundreds of the Medical Profession in every civilized country, and has
+nothing in it which on revision the writer sees cause to retract or
+modify. The superstitions it attacks lie at the very foundation of
+Homoeopathy, and of almost every form of medical charlatanism. Still
+the mere routinists and unthinking artisans in most callings dislike
+whatever shakes the dust out of their traditions, and it may be
+unreasonable to expect that Medicine will always prove an exception to
+the rule. One half the opposition which the numerical system of Louis
+has met with, as applied to the results of treatment, has been owing
+to the fact that it showed the movements of disease to be far more
+independent of the kind of practice pursued than was agreeable to the
+pride of those whose self-confidence it abated.
+
+The statement, that medicines are more sparingly used in physicians'
+families than in most others, admits of a very natural explanation,
+without putting a harsh construction upon it, which it was not
+intended to admit. Outside pressure is less felt in the physician'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 who have more
+confidence in drugging than his own family commonly has, the learned
+Professor Dunglison is hereby requested to apologize for his definition
+of the word Placebo, or to expunge it from his Medical Dictionary.
+
+One thing is certain. A loud outcry on a slight touch reveals the weak
+spot in a profession, as well as in a patient. It is a doubtful policy
+to oppose the freest speech in those of our own number who are trying to
+show us where they honestly believe our weakness lies. Vast as are
+the advances of our Science and Art, may it not possibly prove on
+examination that we retain other old barbarisms beside the use of the
+astrological sign of Jupiter, with which we endeavor to insure good luck
+to our prescriptions? Is it the act of a friend or a foe to try to point
+them out to our brethren when asked to address them, and is the speaker
+to subdue the constitutional habit of his style to a given standard,
+under penalty of giving offence to a grave assembly?
+
+“Homoeopathy and its Kindred Delusions” was published nearly twenty
+years ago, and has been long out of print, so that the author tried in
+vain to procure a copy until the kindness of a friend supplied him with
+the only one he has had for years. A foolish story reached his ears that
+he was attempting to buy up stray copies for the sake of suppressing it.
+This edition was in the press at that very time.
+
+Many of the arguments contained in the Lectures have lost whatever
+novelty they may have possessed. All its predictions have been submitted
+to the formidable test of time. They appear to have stood it, so far,
+about as well as most uninspired prophecies; indeed, some of them
+require much less accommodation than certain grave commentators employ
+in their readings of the ancient Prophets.
+
+If some statistics recently published are correct, Homoeopathy has made
+very slow progress in Europe.
+
+In all England, as it appears, there are hardly a fifth more
+Homoeopathic practitioners than there are students attending Lectures at
+the Massachusetts Medical College at the present time. In America it has
+undoubtedly proved more popular and lucrative, yet how loose a hold it
+has on the public confidence is shown by the fact that, when a specially
+valued life, which has been played with by one of its agents, is
+seriously threatened, the first thing we expect to hear is that a
+regular practitioner is by the patient's bed, and the Homoeopathic
+counsellor overruled or discarded. Again, how many of the ardent and
+capricious persons who embraced Homoeopathy have run the whole round of
+pretentious novelties;--have been boarded at water-cure establishments,
+closeted with uterine and other specialists, and finally wandered over
+seas to put themselves in charge of foreign celebrities, who dosed them
+as lustily as they were ever dosed before they took to globules! It
+will surprise many to learn to what a shadow of a shade Homoeopathy
+has dwindled in the hands of many of its noted practitioners. The
+itch-doctrine is treated with contempt. Infinitesimal doses are replaced
+by full ones whenever the fancy-practitioner chooses. Good Homoeopathic
+reasons can be found for employing anything that anybody wants to
+employ. Homoeopathy 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 cases where we would thankfully sacrifice all our
+prejudices and give the world to have them true to their promises.
+
+Homoeopathy has not died out so rapidly as Tractoration. Perhaps it was
+well that it should not, for it has taught us a lesson of the healing
+faculty of Nature which was needed, and for which many of us have made
+proper acknowledgments. But it probably does more harm than good to
+medical science at the present time, by keeping up the delusion of
+treating everything by specifics,--the old barbarous notion that sick
+people should feed on poisons [Lachesis, arrow-poison, obtained from a
+serpent (Pulte). Crotalus horridus, rattlesnake's venom (Neidhard). The
+less dangerous Pediculus capitis is the favorite remedy of Dr. Mure, the
+English “Apostle of Homoeopathy.” These are examples of the retrograde
+current setting towards barbarism] against which a part of the Discourse
+at the beginning of this volume is directed.
+
+The infinitesimal globules have not become a curiosity as yet, like
+Perkins's Tractors. But time is a very elastic element in Geology and
+Prophecy. If Daniel's seventy weeks mean four hundred and ninety years,
+as the learned Prideaux and others have settled it that they do, the
+“not many years” of my prediction may be stretched out a generation or
+two beyond our time, if necessary, when the prophecy will no doubt prove
+true.
+
+It might be fitting to add a few words with regard to the Essay on the
+Contagiousness of Puerperal Fever. But the whole question I consider
+to be now transferred from the domain of medical inquiry to the
+consideration of Life Insurance agencies and Grand Juries. For the
+justification of this somewhat sharply accented language I must refer
+the reader to the paper itself for details which I regret to have been
+forced to place on permanent record.
+
+BOSTON, January, 1861.
+
+
+
+
+
+
+A SECOND PREFACE.
+
+These Lectures and Essays are arranged in the order corresponding to
+the date of their delivery or publication. They must, of course, be read
+with a constant reference to these dates, by such as care to read
+them. I have not attempted to modernize their aspect or character in
+presenting them, in this somewhat altered connection, to the public.
+Several of them were contained in a former volume which received its
+name from the Address called “Currents and Counter-Currents.” Some of
+those contained in the former volume have been replaced by others. The
+Essay called “Mechanism of Vital Actions” has been transferred to a
+distinct collection of Miscellaneous essays, forming a separate volume.
+
+I had some intention of including with these papers an Essay on
+Intermittent Fever in New England, which received one of the Boylston
+prizes in 1837, and was published in the following year. But as this
+was upon a subject of local interest, chiefly, and would have taken up a
+good deal of room, I thought it best to leave it out, trusting that
+the stray copies to be met with in musty book-shops would sufficiently
+supply the not very extensive or urgent demand for a paper almost half a
+century old.
+
+Some of these papers created a little stir when they first fell from
+the press into the pool of public consciousness. They will slide in very
+quietly now in this new edition, and find out for themselves whether the
+waters are those of Lethe, or whether they are to live for a time as not
+wholly unvalued reminiscences.
+
+March 21, 1883.
+
+
+
+
+
+
+PREFACE TO THE NEW EDITION.
+
+These Essays are old enough now to go alone without staff or crutch
+in the shape of Prefaces. A very few words may be a convenience to the
+reader who takes up the book and wishes to know what he is likely to
+find in it.
+
+
+        HOMOEOPATHY AND ITS KINDRED DELUSIONS.
+
+Homoeopathy has proved lucrative, and so long as it continues to be so
+will surely exist,--as surely as astrology, palmistry, and other methods
+of getting a living out of the weakness and credulity of mankind and
+womankind. Though it has no pretensions to be considered as belonging
+among the sciences, it may be looked upon by a scientific man as a
+curious object 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 studied it in the Essay before the reader, under
+the aspect of an extravagant and purely imaginative creation of its
+founder. Since that first essay was written, nearly half a century ago,
+we have all had a chance to witness its practical working. Two opposite
+inferences 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 by a much larger
+number of persons. As they see that patients are very commonly getting
+well under treatment by infinitesimal drugging, which they consider
+equivalent to no medication at all, they come to disbelieve in every
+form of drugging and put their whole trust in “nature.” Thus experience,
+
+
+     “From seeming evil still educing good,”
+
+has shown that the dealers in this preposterous system of
+pseudo-therapeutics have cooperated with the wiser class of
+practitioners in breaking up the system of over-dosing and over-drugging
+which has been one of the standing reproaches of medical practice. While
+keeping up the miserable delusion that diseases were all to be “cured”
+ by drugging, Homoeopathy has been unintentionally showing that they
+would very generally get well without any drugging at all. In the mean
+time the newer doctrines of the “mind cure,” the “faith cure,” and the
+rest are encroaching on the territory so long monopolized by that most
+ingenious of the pseudo-sciences. It would not be surprising if its
+whole ground should be taken possession of by these new claimants with
+their flattering appeals to the imaginative class of persons open to
+such attacks. Similia similabus may prove fatally true for once, if
+Homoeopathy is killed out by its new-born rivals.
+
+It takes a very moderate amount of erudition to unearth a charlatan
+like the supposed father of the infinitesimal dosing system. The real
+inventor of that specious trickery was an Irishman by the name of
+Butler. The whole story is to be found in the “Ortus Medicinae” of Van
+Helmont. I have given some account of his chapter “Butler” in different
+articles, but I would refer the students of our Homoeopathic educational
+institutions to the original, which they will find very interesting and
+curious.
+
+
+          CURRENTS AND COUNTER-CURRENTS
+
+My attack on over-drugging brought out some hostile comments and
+treatment. Thirty years ago I expressed myself with more vivacity than
+I should show if I were writing on the same subjects today. Some of
+my more lively remarks called out very sharp animadversion. Thus
+my illustration of prevention as often better than treatment in the
+mother's words to her child which had got a poisonous berry in its
+mouth,--“Spit it out!” gave mortal offence to a well-known New York
+practitioner and writer, who advised the Massachusetts Medical Society
+to spit out the offending speaker. 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 and in excess, as then used “could be sunk to the bottom of
+the sea, it would be all the better for mankind and all the worse
+for the fishes.” This was too bad. The sentence was misquoted, quoted
+without its qualifying conditions, and frightened some of my worthy
+professional brethren as much as if I had told them to throw all physic
+to the dogs. But for the epigrammatic sting the sentiment would have
+been unnoticed as a harmless overstatement at the very worst.
+
+Since this lecture was delivered a great and, as I think, beneficial
+change has taken place in the practice of medicine. The habit of the
+English “general practitioner” of making his profit out of the pills and
+potions he administered was ruinous to professional advancement and the
+dignity of the physician. When a half-starving medical man felt that he
+must give his patient draught and boluses for which he could charge him,
+he was in a pitiable position and too likely to persuade himself that
+his drugs were useful to 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 the errors I combated.
+
+
+        THE CONTAGIOUSNESS 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
+but a single year. It naturally attracted less attention than it would
+have done if published in such a periodical as the “American Journal of
+Medical Sciences.” Still it had its effect, as I have every reason
+to believe. I cannot doubt that it has saved the lives of many young
+mothers by calling attention to the existence and propagation of
+“Puerperal Fever as a Private Pestilence,” and laying down rules for
+taking the necessary precautions against it. The case has long been
+decided in favor of the views I advocated, but, at the time when I wrote
+two of the most celebrated professors of Obstetrics in this country
+opposed my conclusions with all the weight of their experience and
+position.
+
+This paper was written in a great heat and with passionate indignation.
+If I touched it at all I might trim its rhetorical exuberance, but I
+prefer to leave it all its original strength of expression. I could not,
+if I had tried, have disguised the feelings with which I regarded the
+attempt to put out of sight the frightful facts which I brought forward
+and the necessary conclusions to which they led. Of course the whole
+matter has been looked at in a new point of view since the microbe as
+a vehicle of contagion has been brought into light, and explained the
+mechanism of that which was plain enough as a fact to all who were not
+blind or who did not shut their eyes.
+
+O. W. H.
+
+BEVERLY Farms, Mass., August 3, 1891
+
+
+
+
+
+
+HOMOEOPATHY AND ITS KINDRED DELUSIONS
+
+[Two lectures delivered before the Boston Society for the Diffusion of
+Useful Knowledge. 1842.]
+
+[When a physician attempts to convince a person, who has fallen into the
+Homoeopathic delusion, of the emptiness of its pretensions, he is often
+answered by a statement of cases in which its practitioners are thought
+to have effected wonderful cures. The main object of the first of these
+Lectures is to show, by abundant facts, that such statements, made by
+persons unacquainted with the fluctuations of disease and the fallacies
+of observation, are to be considered in general as of little or no value
+in establishing the truth of a medical doctrine or the utility of a
+method of practice.
+
+Those kind friends who suggest to a person suffering from a tedious
+complaint, that he “Had better try Homoeopathy,” are apt to enforce
+their suggestion by 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 community to encourage ignorance, error, or
+deception in a profession which deals with the life and health of our
+fellow-creatures. Whether or not those who countenance Homoeopathy are
+guilty of this injustice towards others, the second of these Lectures
+may afford them some means of determining.
+
+To deny that good effects may happen from the observance of diet and
+regimen when prescribed by Homoeopathists as well as by others, would be
+very unfair to them. But to suppose that men with minds so constituted
+as to accept such statements and embrace such doctrines as make up
+the so-called science of Homoeopathy are more competent than others to
+regulate the circumstances which influence the human body in health and
+disease, would be judging very harshly the average capacity of ordinary
+practitioners.
+
+To deny that some patients may have been actually benefited through
+the influence exerted upon their imaginations, would be to refuse
+to Homoeopathy what all are willing to concede to every one of those
+numerous modes of practice known to all intelligent persons by an
+opprobrious title.
+
+So long as the body is affected through the mind, no audacious device,
+even of the most manifestly dishonest character, can fail of producing
+occasional good to those who yield it an implicit or even a partial
+faith. The argument founded on this occasional good would be as
+applicable in justifying the counterfeiter and giving circulation to
+his base coin, on the ground that a spurious dollar had often relieved a
+poor man's necessities.
+
+Homoeopathy has come before our public at a period when the growing
+spirit of eclecticism has prepared many ingenious and honest minds to
+listen to all new doctrines with a candor liable to degenerate into
+weakness. It is not impossible that the pretended evolution of great and
+mysterious virtues from infinitely attenuated atoms may have enticed a
+few over-refining philosophers, who have slid into a vague belief
+that matter subdivided grows less material, and approaches nearer to
+a spiritual nature as it requires a more powerful microscope for its
+detection.
+
+However this may be, some persons seem disposed to take the ground of
+Menzel that the Laity must pass formal judgment between the Physician
+and the Homoeopathist, 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 in these Lectures upon this shadowy
+system; which, in the calm and serious judgment of many of the wisest
+members of the medical profession, is not entitled by anything it has
+ever said or done to the notoriety of a public rebuke, still less to the
+honors of critical martyrdom.]
+
+I.
+
+I have selected four topics for this lecture, the first three of which I
+shall touch but slightly, the last more fully. They are
+
+1. The Royal cure of the King's Evil, or Scrofula.
+
+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 numerous facts are
+accumulated to prove the most fanciful and senseless extravagances.
+
+The third exhibits the entire insufficiency of exalted wisdom,
+immaculate honesty, and vast general acquirements to make a good
+physician of a great bishop.
+
+The fourth shows us the intimate machinery of an extinct delusion, which
+flourished only forty years ago; drawn in all its details, as being
+a rich and comparatively recent illustration of the pretensions, the
+arguments, the patronage, by means of which windy errors have long been,
+and will long continue to be, swollen into transient consequence.
+All display in superfluous abundance the boundless credulity and
+excitability of mankind upon subjects connected with medicine.
+
+“From the time of Edward the Confessor to Queen Anne, the monarchs of
+England were in the habit of touching those who were brought to them
+suffering with the scrofula, for the cure of that distemper. William
+the Third had good sense enough to discontinue the practice, but Anne
+resumed it, and, among her other patients, performed the royal operation
+upon a child, who, in spite of his, disease, grew up at last into Samuel
+Johnson. After laying his hand upon the sufferers, it was customary for
+the monarch to hang a gold piece around the neck of each patient. Very
+strict precautions were adopted to prevent those who thought more of the
+golden angel hung round the neck by a white ribbon, than of relief of
+their bodily infirmities, from making too many calls, as they sometimes
+attempted to do. According to the statement of the advocates and
+contemporaries of this remedy, none ever failed of receiving benefit
+unless their little faith and credulity starved their merits. Some are
+said to have been cured immediately on the very touch, 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 for
+several weeks, and months, and obliged even to be led to Whitehall, yet
+recovered their sight immediately upon being touched, so as to walk away
+without any guide.” So widely, at one period, was the belief diffused,
+that, in the course of twelve years, nearly a hundred thousand persons
+were touched by Charles the Second. Catholic divines; in disputes upon
+the orthodoxy of their church, did not deny that the power had descended
+to protestant princes;--Dr. Harpsfield, in his “Ecclesiastical History
+of England,” admitted it, and in Wiseman's words, “when Bishop Tooker
+would make use of this Argument to prove the Truth of our Church,
+Smitheus doth not thereupon go about to deny the Matter of fact; nay,
+both he and Cope acknowledge it.” “I myself,” says Wiseman, the best
+English surgical writer of his day,[Edinburgh Medical and Surgical
+Journal, vol. iii. p. 103.]--“I my self have been a frequent Eye-witness
+of many hundred of Cures performed by his Majesties Touch alone, without
+any assistance of Chirurgery; and those, many of them such as had tired
+out the endeavours of able Chirurgeons before they came hither. It were
+endless to recite what I myself have seen, and what I have received
+acknowledgments of by Letter, not only from the severall parts of this
+Nation, but also from Ireland, Scotland, Jersey, Garnsey. It is needless
+also to remember what Miracles of this nature were performed by the very
+Bloud of his late Majesty of Blessed memory, after whose decollation
+by the inhuman Barbarity of the Regicides, the reliques of that were
+gathered on Chips and in Handkerchieffs by the pious Devotes, who could
+not but think so great a suffering in so honourable and pious a Cause,
+would be attended by an extraordinary assistance 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, accounted for these cures
+in three ways: by the journey and change of air the patients obtained
+in coming to London; by the influence of imagination; and the wearing of
+gold.
+
+To these objections he answers, 1st. That many of those cured were
+inhabitants of the city. 2d. That the subjects of treatment were
+frequently infants. 3d. That sometimes silver was given, and sometimes
+nothing, yet the patients were cured.
+
+A superstition resembling this probably exists at the present time
+in some ignorant districts of England and this country. A writer in a
+Medical Journal in the year 1807, speaks of a farmer in Devonshire, who,
+being a ninth son of a ninth son, is thought endowed with healing powers
+like those of ancient royalty, and who is accustomed one day in every
+week to strike for the evil.
+
+I remember that one of my schoolmates told me, when a boy, of a seventh
+son of a seventh son, somewhere in Essex County, who touched for the
+scrofula, and who used to hang a silver fourpence halfpenny about the
+neck of those who came to him, which fourpence halfpenny it was solemnly
+affirmed became of a remarkably black color after having been some time
+worn, and that his own brother had been subjected to this extraordinary
+treatment; but I must add that my schoolmate drew a bow of remarkable
+length, strength, and toughness for his tender years.
+
+One of the most curious examples of the fallacy of popular belief and
+the uncertainty of asserted facts in medical experience is to be found
+in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
+
+Fabricius Hildanus, whose name is familiar to every surgical scholar,
+and Lord Bacon, who frequently dipped a little into medicine, are
+my principal authorities for the few circumstances I shall mention
+regarding it. The Weapon Ointment was a preparation used for the healing
+of wounds, but instead of its being applied to them, the injured
+part was washed and bandaged, and the weapon with which the wound was
+inflicted was carefully anointed with the unguent. Empirics, ignorant
+barbers, and men of that sort, are said to have especially employed it.
+Still there were not wanting some among the more respectable members of
+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, rather
+than the wound or weapon, entered into all. Such were portions of mummy,
+of human blood, and of moss from the skull of a thief hung in chains.
+
+Hildanus was a wise and learned man, one of the best surgeons of his
+time. He was fully aware that a part of the real secret of the Unguentum
+Armarium consisted in the washing and bandaging the wound and then
+letting it alone. But he could not resist the solemn assertions
+respecting its efficacy; he gave way before the outcry of facts, and
+therefore, instead of denying all their pretensions, he admitted and
+tried to account for them upon supernatural grounds. As the virtue of
+those applications, he says, which are made to the weapon cannot
+reach the wound, and as they can produce no effect without contact, it
+follows, of necessity, that the Devil must have a hand in the
+business; and as he is by far the most long headed and experienced of
+practitioners, he cannot find this a matter of any great difficulty.
+Hildanus himself reports, in detail, the case of a lady who had received
+a moderate wound, for which the Unguentum Armarium was employed without
+the slightest use. Yet instead of receiving this flat case of failure as
+any evidence against the remedy, he accounts for its not succeeding
+by the devout character of the lady, and her freedom from that
+superstitious and over-imaginative tendency which the Devil requires in
+those who are to be benefited by his devices.
+
+Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
+having in its favor the testimony of men of credit, though, in his own
+language, he himself “as yet is not fully inclined to believe it.” His
+remarks upon the asserted facts respecting it show a mixture of wise
+suspicion and partial belief. He does not like the precise directions
+given as to the circumstances under which the animals from which some of
+the materials were obtained were to be killed; for he thought it looked
+like a provision for an excuse in case of failure, by laying the fault
+to the omission of some of these circumstances. But he likes well that
+“they do not observe the confecting of the Ointment under any certain
+constellation; which is commonly the excuse of magical medicines, when
+they fail, that they were not made under a fit figure of heaven.” [This
+was a mistake, however, since the two recipes given by Hildanus are both
+very explicit as to the aspect of the heavens required for different
+stages of the process.] “It was pretended that if the offending weapon
+could not be had, it would serve the purpose to anoint a wooden one made
+like it.” “This,” says Bacon, “I should doubt to be a device to keep
+this strange form of cure in request and use; because many times you
+cannot come by the weapon itself.” And in closing his remarks on the
+statements of the advocates of the ointment, he says, “Lastly, it
+will cure a beast as well as a man, which I like best of all the
+rest, because it subjecteth the matter to an easy trial.” It is worth
+remembering, that more than two hundred years ago, when an absurd and
+fantastic remedy was asserted to possess wonderful power, and when
+sensible persons ascribed its pretended influence to imagination, it was
+boldly answered that the cure took place when the wounded party did not
+know of the application made to the weapon, and even when a brute animal
+was the subject of the experiment, and that this assertion, as we all
+know it was, came in such a shape as to shake the incredulity of the
+keenest thinker of his time. The very same assertion has been since
+repeated in favor of Perkinism, and, since that, of Homoeopathy.
+
+The same essential idea as that of the Weapon Ointment reproduced itself
+in the still more famous SYMPATHETIC POWDER. This Powder was said to
+have the faculty, if applied to the blood-stained garments of a wounded
+person, to cure his injuries, even though he were at a great distance at
+the time. A friar, returning from the East, brought the recipe to Europe
+somewhat before the middle of the seventeenth century. The Grand Duke of
+Florence, in which city the friar was residing, heard of his cures, and
+tried, but without success, to obtain his secret. Sir Kenehn Digby, an
+Englishman well known to fame, was fortunate enough to do him a favor,
+which wrought upon his feelings and induced him to impart to his
+benefactor the composition of his extraordinary Powder. This English
+knight was at different periods of his life an admiral, a theologian, a
+critic, a metaphysician, a politician, and a disciple of Alchemy. As is
+not unfrequent with versatile and inflammable people, he caught fire at
+the first spark of a new medical discovery, and no sooner got home to
+England than he began to spread the conflagration.
+
+An opportunity soon offered itself to try the powers of the famous
+powder. Mr. J. Howell, having been wounded in endeavoring to part two
+of his friends who were fighting a duel, submitted himself to a trial
+of the Sympathetic Powder. Four days after he received 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 were very painful,
+grew easy, although the patient, who was 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 hands of Sir Kenelm, who
+had hung it up to dry, when Mr. Howell sent his servant in a great hurry
+to tell him that his wounds were paining him horribly; the garter was
+therefore replaced in the solution of the Powder, “and the patient got
+well after five or six days of its continued immersion.”
+
+King James First, his son Charles the First, the Duke of Buckingham,
+then prime minister, and all the principal personages of the time, were
+cognizant of this fact; and James himself, being curious to know the
+secret of this remedy, asked it of Sir Kenelm, who revealed it to him,
+and his Majesty had the opportunity of making several trials of its
+efficacy, “which all succeeded in a surprising manner.” [Dict. des
+Sciences Medieales.]
+
+The king's physician, Dr. Mayerne, was made master of the secret,
+which he carried to France and communicated to the Duke of Mayenne, who
+performed many cures by means of it, and taught it to his surgeon, who,
+after the Duke's death, sold it to many distinguished persons, by whose
+agency it soon ceased to be a secret. What was this wonderful substance
+which so astonished kings, princes, dukes, knights, and doctors? Nothing
+but powdered blue vitriol. But it was made to undergo several processes
+that conferred on it extraordinary virtues. Twice or thrice it was to be
+dissolved, filtered, and crystallized. The crystals were to be laid in
+the sun during the months of June, July, and August, taking care to
+turn them carefully that all should be exposed. Then they were to be
+powdered, triturated, and again exposed to the sun, again reduced to a
+very fine powder, and secured in a vessel, while hot, from the sunshine.
+If there seem anything remarkable in the fact of such astonishing
+properties being developed by this process, it must be from our
+short-sightedness, for common salt and charcoal develop powers quite as
+marvellous after a certain number of thumps, stirs, and shakes, from the
+hands of modern workers of miracles. In fact the Unguentum Armarium and
+Sympathetic Powder resemble some more recent prescriptions; the latter
+consisting in an infinite dilution of the common dose in which remedies
+are given, and the two former in an infinite dilution of the common
+distance at which they are applied.
+
+Whether philosophers, and more especially metaphysicians, have any
+peculiar tendency to dabble in drugs and dose themselves with physic,
+is a question which might suggest itself to the reader of their
+biographies.
+
+When Bishop Berkeley visited the illustrious Malebranche at Paris,
+he found him in his cell, cooking in a small pipkin a medicine for an
+inflammation of the lungs, from which he was suffering; and the disease,
+being unfortunately aggravated by the vehemence of their discussion, or
+the contents of the pipkin, carried him off in the course of a few days.
+Berkeley himself afforded a remarkable illustration of a truth which
+has long been known to the members of one of the learned professions,
+namely, that no amount of talent, or of acquirements in other
+departments, can rescue from lamentable folly those who, without
+something of the requisite preparation, undertake to experiment with
+nostrums upon themselves and their neighbors. The exalted character of
+Berkeley is thus drawn by Sir James Mackintosh: Ancient learning,
+exact science, polished society, modern literature, and the fine arts,
+contributed to adorn and enrich the mind of this accomplished man. All
+his contemporaries agreed with the satirist in ascribing
+
+“'To Berkeley every virtue under heaven.'
+
+“Even the discerning, fastidious, and turbulent Atterbury said, after an
+interview with him, 'So much understanding, so much knowledge, so much
+innocence, and such humility, I did not think had been the portion of
+any but angels, till I saw this gentleman.'”
+
+But among the writings of this great and good man is an Essay of the
+most curious character, illustrating his weakness upon the point in
+question, and entitled, “Siris, a Chain of Philosophical Reflections
+and Inquiries concerning the Virtues of TAR WATER, and divers other
+Subjects,”--an essay which begins with a recipe for his favorite fluid,
+and slides by gentle gradations into an examination of the sublimest
+doctrines of Plato. To show how far a man of honesty and benevolence,
+and with a mind of singular acuteness and depth, may be run away with by
+a favorite notion on a subject which his habits and education do not fit
+him to investigate, I shall give a short account of this Essay, merely
+stating that as all the supposed virtues of Tar Water, made public in
+successive editions of his treatise by so illustrious an author, have
+not saved it from neglect and disgrace, it may be fairly assumed that
+they were mainly imaginary.
+
+The bishop, as is usual in such cases, speaks of himself as
+indispensably obliged, by the duty he owes to mankind, to make his
+experience public. Now this was by no means evident, nor does it follow
+in general, that because a man has formed a favorable opinion of
+a person or a thing he has not the proper means of thoroughly
+understanding, he shall be bound to print it, and thus give currency
+to his impressions, which may be erroneous, and therefore injurious.
+He would have done much better to have laid his impressions before some
+experienced physicians and surgeons, such as Dr. Mead and Mr. Cheselden,
+to have asked them to try his experiment over again, and have been
+guided by their answers. But the good bishop got excited; he pleased
+himself with the thought that he had discovered a great panacea; and
+having once tasted the bewitching cup of self-quackery, like many before
+and since his time, he was so infatuated with the draught that he would
+insist on pouring it down the throats of his neighbors and all mankind.
+
+The precious fluid was made by stirring a gallon of water with a quart
+of tar, leaving it forty-eight hours, and pouring off the clear water.
+Such was the specific which the great metaphysician recommended for
+averting and curing all manner of diseases. It was, if he might be
+believed, a preventive of the small-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 gout and fevers, and was an excellent preservative of
+the teeth and gums; answered all the purpose of Elixir Proprietatis,
+Stoughton's drops, diet drinks, and mineral waters; was particularly to
+be recommended to sea-faring persons, ladies, and men of studious and
+sedentary lives; could never be taken too long, but, on the contrary,
+produced advantages which sometimes did not begin to show themselves for
+two or three months.
+
+“From my representing Tar Water as good for so many things,” says
+Berkeley, “some perhaps may conclude it is good for nothing. But charity
+obligeth me to say what I know, and what I think, however it may be
+taken. Men may censure and object as they please, but I appeal to time
+and experiment. Effects misimputed, cases wrong told, circumstances
+overlooked, perhaps, too, prejudices and partialities against truth, may
+for a time prevail and keep her at the bottom of her well, from whence
+nevertheless she emergeth sooner or later, and strikes the eyes of
+all who do not keep them shut.” I cannot resist the temptation of
+illustrating the bishop's belief in the wonderful powers of his remedy,
+by a few sentences from different parts of his essay. “The hardness
+of stubbed vulgar constitutions renders them insensible of a thousand
+things that fret and gall those delicate people, who, as if their skin
+was peeled off, feel to the quick everything that touches them. The
+tender nerves and low spirits of such poor creatures would be much
+relieved by the use of Tar Water, which might prolong and cheer their
+lives.” “It [the Tar Water] may be made stronger for brute beasts, as
+horses, in whose disorders I have found it very useful.” “This same
+water will also give charitable relief to the ladies, who often want it
+more than the parish poor; being many of them never able to make a good
+meal, and sitting pale, puny, and forbidden, like ghosts, at their own
+table, victims of vapors and indigestion.” It does not appear among the
+virtues of Tar Water that “children cried for it,” as for some of our
+modern remedies, but the bishop says, “I have known children take it
+for above six months together with great benefit, and without any
+inconvenience; and after long and repeated experience I do esteem it
+a most excellent diet drink, fitted to all seasons and ages.” After
+mentioning its usefulness in febrile complaints, he says: “I have had
+all this confirmed by my own experience in the late sickly season of the
+year one thousand seven hundred and forty-one, having had twenty-five
+fevers in my own family cured by this medicinal water, drunk copiously.”
+ And to finish these extracts with a most important suggestion for the
+improvement of the British nation: “It is much to be lamented that our
+Insulars who act and think so much for themselves, should yet, from
+grossness of air and diet, grow stupid or doat sooner than other people,
+who, by virtue of elastic air, water-drinking, and light food, preserve
+their faculties to extreme old 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 might have lived longer,
+but his fatal illness was so sudden that there was not time enough to
+stir up a quart of the panacea. He was an illustrious man, but he held
+two very odd opinions; that tar water was everything, and that the whole
+material universe was nothing.
+
+                        *****
+
+Most of those present have at some time in their lives heard mention
+made of the METALLIC TRACTORS, invented by one Dr. Perkins, an American,
+and formerly enjoying great repute for the cure of various diseases.
+Many have seen or heard of a satirical poem, written by one of our
+own countrymen also, about forty years since, and called “Terrible
+Tractoration.” The Metallic Tractors are now so utterly abandoned that
+I have only by good fortune fallen upon a single one of a pair, to show
+for the sake of illustration. For more than thirty years this great
+discovery, which was to banish at least half the evils which afflict
+humanity, has been sleeping undisturbed in the grave of 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, its
+brilliant promises are all covered with the dust of silent neglect;
+and of the generation which has sprung up since the period when it
+flourished, very few know anything of its history, and hardly even
+the title which in its palmy days it bore of PERKINISM. Taking it as
+settled, then, as no one appears to answer for 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 absolutely
+defunct, I select it for anatomical examination. If this pretended
+discovery was made public; if it was long kept before the public; if it
+was addressed to the people of different countries; if it was formally
+investigated by scientific men, and systematically adopted by benevolent
+persons, who did everything in their power to diffuse the knowledge
+and practice of it; if various collateral motives, such as interest
+and vanity, were embarked in its cause; if, notwithstanding all these
+things, it gradually sickened and died, then the conclusion seems a fair
+one, that it did not 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 historically shown 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 and by what means a
+considerable part of the community may be led into the belief of that
+which is to be eventually considered as an idle folly. If there is any
+existing folly, fraudulent or innocent in its origin, which appeals to
+certain arguments for its support; provided that the very same arguments
+can be shown to have been used for Perkinism with as good reason, they
+will at once fall to the ground. Still more, if it shall appear that the
+general course of any existing delusion bears a strong resemblance to
+that of Perkinism, that the former is most frequently advocated by the
+same class of persons who were conspicuous in behalf of the latter, and
+treated with contempt or opposed by the same kind of persons who thus
+treated Perkinism; if the facts in favor of both have a similar aspect;
+if the motives of their originators and propagators may be presumed
+to have been similar; then there is every reason to suppose that the
+existing folly will follow in the footsteps of the past, and after
+displaying a given amount of cunning and credulity in those deceiving
+and deceived, will drop from the public view like a fruit which has
+ripened into spontaneous rottenness, and be succeeded by the fresh bloom
+of some other delusion required by the same excitable portion of the
+community.
+
+Dr. Elisha Perkins was born at Norwich, Connecticut, in the year 1740.
+He had practised his profession with a good local reputation for many
+years, when he fell upon a course of experiments, as it is related,
+which led to his great discovery. He conceived the idea that metallic
+substances might have the effect of removing diseases, if applied in
+a certain manner; a notion probably suggested by the then recent
+experiments of Galvani, in which muscular contractions were found to be
+produced by the contact of two metals with the living fibre. It was in
+1796 that his discovery was promulgated in the shape of the Metallic
+Tractors, two pieces of metal, one apparently iron and the other brass,
+about three inches long, blunt at one end and pointed at the other.
+These instruments were applied for the cure of different complaints,
+such as rheumatism, local pains, inflammations, and even tumors, by
+drawing them over the affected part very lightly for about twenty
+minutes. Dr. Perkins took out a patent for his discovery, and travelled
+about the country to diffuse the new practice. He soon found numerous
+advocates of his discovery, many of them of high standing and influence.
+In the year 1798 the tractors had crossed the Atlantic, and were
+publicly employed in the Royal Hospital at Copenhagen. About the same
+time the son of the inventor, Mr. Benjamin Douglass Perkins, carried
+them to London, where they soon attracted attention. The Danish
+physicians published an account of their cases, containing numerous
+instances of alleged success, in a respectable octavo volume. In the
+year 1804 an establishment, honored with the name of the Perkinean
+Institution, was founded in London. The transactions of this institution
+were published in pamphlets, the Perkinean Society had public dinners
+at the Crown and Anchor, and a poet celebrated their medical triumph in
+strains like these:
+
+
+  “See, pointed metals, blest with power t' appease
+   The ruthless rage of merciless disease,
+   O'er the frail part a subtle fluid pour,
+   Drenched with invisible Galvanic shower,
+   Till the arthritic staff and crutch forego,
+   And leap exulting like the bounding roe!”
+
+While all these things were going on, Mr. Benjamin Douglass Perkins was
+calmly pocketing money, so that after some half a dozen years he left
+the country with more than ten thousand pounds, which had been paid him
+by the believers in Great Britain. But in spite of all this success, and
+the number of those interested and committed in its behalf, Perkinism
+soon began to decline, and in 1811 the Tractors are spoken of by an
+intelligent writer as being almost forgotten. Such was the origin and
+duration of this doctrine and practice, into the history of which we
+will now look a little more narrowly.
+
+Let us see, then, by whose agency this delusion was established and kept
+up; whether it was principally by 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 learned bodies usually
+supposed to take an interest in scientific discoveries, or only of
+individuals whose claims to distinction were founded upon their position
+in society, or political station, or literary eminence; whether the
+judicious or excitable classes entered most deeply into it; whether, in
+short, the scientific men of that time were deceived, or only intruded
+upon, and shouted down for the moment by persons who had no particular
+call to invade their precincts.
+
+Not much, perhaps, was to be expected of the Medical Profession in the
+way of encouragement. One Dr. Fuller, who wrote in England, himself
+a Perkinist, thus expressed his opinion: “It must be an extraordinary
+exertion of virtue and humanity for a medical man, whose livelihood
+depends either on the sale of drugs, or on receiving a guinea for
+writing a prescription, which must relate to those drugs, to say to
+his patient, 'You had better purchase a set of Tractors to keep in your
+family; they will cure you without the expense of my attendance, or the
+danger of the common medical practice.' For very obvious reasons medical
+men must never be expected to recommend the use of Perkinism. The
+Tractors must trust for their patronage to the enlightened and
+philanthropic out of the profession, or to medical men retired from
+practice, and who know of no other interest than the luxury of relieving
+the distressed. And I do not despair of seeing the day when but very few
+of this description as well as private families will be without them.”
+
+Whether the motives assigned by this medical man to his professional
+brethren existed or not, it is true that Dr. Perkins did not gain a
+great deal at their hands. The Connecticut Medical Society expelled him
+in 1797 for violating their law against the use of nostrums, or secret
+remedies. The leading English physicians appear to have looked on with
+singular apathy or contempt at the miracles which it was pretended were
+enacting in the hands of the apostles of the new practice. In looking
+over the reviews of the time, I have found little beyond brief
+occasional notices of their pretensions; the columns of these journals
+being occupied with subjects of more permanent interest. The state of
+things in London is best learned, however, from the satirical poem
+to which I have already alluded as having been written at the period
+referred to. This was entitled, “Terrible Tractoration!! A Poetical
+Petition against Galvanizing Trumpery and the Perkinistic Institution.
+Most respectfully 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 learned Societies.” Two editions of this work were
+published in London in the years 1803 and 1804, and one or two have been
+published in this country.
+
+“Terrible Tractoration” is supposed, by those who never read it, to be
+a satire upon the follies of Perkins and his followers. It is, on the
+contrary, a most zealous defence of Perkinism, and a fierce attack upon
+its opponents, most especially upon such of the medical profession
+as treated the subject with neglect or ridicule. The Royal College of
+Physicians was the more peculiar object of the attack, but with this
+body, the editors of some of the leading periodicals, and several
+physicians distinguished at that time, and even now remembered for
+their services to science and humanity, were involved in unsparing
+denunciations. The work is by no means of the simply humorous character
+it might be supposed, but is overloaded with notes of the most seriously
+polemical nature. Much of the history of the subject, indeed, is to be
+looked for in this volume.
+
+It appears from this work that the principal members of 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 it
+is now evident that, though they were much abused for so doing, they
+knew very well what they had to deal with, and were altogether in the
+right. The delusion at last attracted such an amount of attention as to
+induce Dr. Haygarth and some others of respectable standing to institute
+some experiments which I shall mention in their proper place, the result
+of which might have seemed sufficient to show the emptiness of the whole
+contrivance.
+
+The Royal Society, that learned body which for ages has constituted
+the best tribunal to which Britain can appeal in questions of science,
+accepted Mr. Perkins's Tractors and the book written about them, passed
+the customary vote of thanks, and never thought of troubling itself
+further in the investigation of pretensions of such an aspect. It is
+not to be denied that a considerable number of physicians did avow
+themselves advocates of the new practice; but out of the whole catalogue
+of those who were publicly proclaimed as such, no one has ever been
+known, so far as I am aware, to the scientific world, except in
+connection with the short-lived notoriety of Perkinism. Who were
+the people, then, to whose activity, influence, or standing with
+the community was owing all the temporary excitement produced by the
+Metallic Tractors?
+
+First, those persons who had been induced to purchase a pair of
+Tractors. These little bits of brass and 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 whistle is 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
+metropolis to concur in the establishment of a public institution for
+the use of these instruments upon the poor, “it was found that only five
+out of above a hundred objected to subscribe, on account of their want
+of confidence in the efficacy of the practice; and these,” the committee
+observes, “there is reason to believe, never gave them a fair trial,
+probably never used them in more than one case, and that perhaps a
+case in which the Tractors had never been recommended as serviceable.”
+ “Purchasers of the Tractors,” said one of their ardent advocates, “would
+be among the last to approve of them if they had reason to suppose
+themselves defrauded of five guineas.” He forgot poor Moses, with his
+“gross of green spectacles, with silver rims and shagreen cases.” “Dear
+mother,” cried the boy, “why won't you listen to reason? I had them a
+dead bargain, or I should not have bought them. The silver rims alone
+will sell for double the money.”
+
+But it is an undeniable fact, that many persons of considerable
+standing, and in some instances holding the most elevated positions in
+society, openly patronized the new practice. In a translation of a work
+entitled “Experiments with the Metallic Tractors,” originally published
+in Danish, thence rendered successively into German and English, Mr.
+Benjamin Perkins, who edited the English edition, has given a copious
+enumeration of the distinguished individuals, both in America and
+Europe, whose patronage he enjoyed. He goes so far as to signify that
+ROYALTY itself was to be included among the number. When the Perkinean
+Institution was founded, no less a person than Lord Rivers was elected
+President, and eleven other individuals of distinction, among them
+Governor Franklin, son of Dr. Franklin, figured as Vice-Presidents. Lord
+Henniker, a member of the Royal Society, who is spoken of as a man
+of judgment and talents, condescended to patronize the astonishing
+discovery, and at different times bought three pairs of Tractors. When
+the Tractors were introduced into Europe, a large number of testimonials
+accompanied them from various distinguished characters in America, the
+list of whom is given in the translation of the Danish work referred to
+as follows:
+
+“Those who have individually stated cases, or who have presented their
+names to the public as men who approved of this remedy, and acknowledged
+themselves instrumental in circulating the Tractors, are fifty-six in
+number; thirty-four of whom are physicians and surgeons, 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, one professor of
+natural philosophy in a college, etc., etc.” It seemed to be taken
+rather hardly by Mr. Perkins that the translators of the work which he
+edited, in citing the names of the advocates of the Metallic Practice,
+frequently omitted the honorary titles which should have been annexed.
+The testimonials were obtained by the Danish writer, from a pamphlet
+published in America, in which these titles were given in full. Thus
+one of these testimonials is from “John Tyler, Esq., a magistrate in the
+county of New London, and late Brigadier-General of the militia in
+that State.” The “omission of the General's title” is the subject of
+complaint, as if this title were sufficient evidence of the commanding
+powers of one of the patrons of tractoration. A similar complaint is
+made when “Calvin Goddard, Esq., of Plainfield, Attorney at Law, and
+a member of the Legislature of the State of Connecticut,” is mentioned
+without his titular honors, and even on account of the omission of the
+proper official titles belonging to “Nathan Pierce, Esq., Governor and
+Manager of the Almshouse of Newburyport.” These instances show the great
+importance to be attached to civil and military dignities, in qualifying
+their holders to judge of scientific subjects, a truth which has not
+been overlooked by the legitimate successors of the Perkinists. In Great
+Britain, the Tractors were not less honored than in America, by the
+learned and the illustrious. The “Perkinistic Committee” made this
+statement in their report: “Mr. Perkins has annually laid before the
+public a large collection of new cases communicated to him for that
+purpose by disinterested and intelligent characters, from almost every
+quarter of Great Britain. In regard to the competency of these vouchers,
+it will be sufficient simply to state that, amongst others whose 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 that the number of
+clergymen both in America and Great Britain who thrust forward their
+evidence on this medical topic was singularly large in proportion
+to that of the members of the medical profession. Whole pages are
+contributed by such worthies as the Rev. Dr. Trotter of Hans Place,
+the Rear. Waring Willett, Chaplain to the Earl of Dunmore, the Rev.
+Dr. Clarke, Chaplain to the Prince of Wales. The style of these
+theologico-medical communications may be seen in the following from a
+divine who was also professor in one of the colleges of New England.
+“I have used the Tractors with success in several other cases in my
+own family, and although, like Naaman the Syrian, I cannot tell why
+the waters of Jordan should be better than Abana and Pharpar, rivers
+of Damascus; yet since experience has proved them so, no reasoning
+can change the opinion. Indeed, the causes of all common facts are, we
+think, perfectly well known to us; and it is very probable, fifty or
+a hundred years hence, we shall as well know why the Metallic Tractors
+should in a few minutes remove violent pains, as we now know why
+cantharides and opium will produce opposite effects, namely, we shall
+know very little about either excepting facts.” Fifty or a hundred years
+hence! if he could have looked forward forty years, he would have
+seen the descendants of the “Perkinistic” philosophers swallowing
+infinitesimal globules, and knowing and caring as much about the
+Tractors as the people at Saratoga Springs do about the waters of Abana
+and Pharpar.
+
+I trust it will not be thought in any degree disrespectful to a
+profession which we all honor, that I have mentioned the great zeal
+of many clergymen in the cause of Perkinism. I hope, too, that I may
+without offence suggest the causes which have often led them out of
+their own province into one to which their education has no special
+reference. The members of that profession ought to 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 them are
+suffering from bodily illness. It is natural enough that a strong desire
+should be excited to alleviate sufferings which may have defied
+the efforts of professional skill; as natural that any remedy which
+recommends itself to the belief or the fancy of the spiritual physician
+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 him to take the most flattering view of its effects upon the
+patient; his own sagacity and judgment being staked upon the success of
+the trial. The inventor of the Tractors was aware of these truths. He
+therefore sent the Tractors gratuitously to many clergymen, accompanied
+with a formal certificate that the holder had become entitled to their
+possession by the payment of five guineas. This was practised in our
+own neighborhood, and I remember finding one of these certificates,
+so presented, which proved that amongst the risks of infancy I had to
+encounter Perkins's Tractors. Two clergymen of Boston and the vicinity,
+both well known to local fame, gave in their testimony to the value
+of the instruments thus presented to them; an unusually moderate
+proportion, when it is remembered that to the common motives of which
+I have spoken was added the seduction of a gift for which the profane
+public was expected to pay so largely.
+
+It was remarkable, also, that Perkinism, which had so little success
+with the medical and scientific part of the community, found great favor
+in the eyes of its more lovely and less obstinate portion. “The lady of
+Major Oxholin,”--I quote from Mr. Perkins's volume,--“having been lately
+in America, had seen and heard much of the great effects of Perkinism.
+Influenced by a most benevolent disposition, she brought these Tractors
+and the pamphlet with her to Europe, with a laudable desire of extending
+their utility to her suffering countrymen.” Such was the channel by
+which the Tractors were conveyed to Denmark, where they soon became the
+ruling passion. The workmen, says a French writer, could not manufacture
+them fast enough. Women carried them about their persons, and delighted
+in bringing them into general use. To what extent the Tractors were
+favored with the patronage of English and American ladies, it is of
+course not easy to say, except on general principles, as their names
+were not brought before the public. But one of Dr. Haygarth's stories
+may lead us to conjecture that there was a class of female practitioners
+who went about doing good with the Tractors in England as well as in
+Denmark. A certain lady had the misfortune to have a spot as big as a
+silver penny at the corner of her eye, caused by a bruise, or some such
+injury. Another lady, who was a friend of hers, and a strong believer in
+Perkinism, was very anxious to try the effects of tractoration upon
+this unfortunate blemish. The patient consented; the lady “produced the
+instruments, and, after drawing them four or five times over the spot,
+declared that it changed to a paler color, and on repeating the use of
+them a few minutes longer, that it had almost vanished, and was scarcely
+visible, and departed in high triumph at her success.” The lady who
+underwent the operation assured the narrator “that she looked in the
+glass immediately after, and that not the least visible alteration had
+taken place.”
+
+It would be a very interesting question, what was the intellectual
+character of those persons most conspicuous in behalf of the Perkinistic
+delusion? Such an inquiry might bring to light some principles which
+we could hereafter apply to the study of other popular errors. But the
+obscurity into which nearly all these enthusiasts have subsided renders
+the question easier to ask than to answer. I believe it would have
+been found that most of these persons were of ardent temperament and
+of considerable imagination, and that their history would show
+that Perkinism was not the first nor the last hobby-horse they rode
+furiously. Many of them may very probably have been persons of more than
+common talent, of active and ingenious minds, of versatile powers and
+various acquirements. Such, for instance, was the estimable man to whom
+I have repeatedly referred as a warm defender of tractoration, and
+a bitter assailant of its enemies. The story tells itself in the
+biographical preface to his poem. He went to London with the view
+of introducing a hydraulic machine, which he and his Vermont friends
+regarded as a very important invention. He found, however, that the
+machine was already in common use in that metropolis. A brother Yankee,
+then in London, had started the project of a mill, which was to be
+carried by the water of the Thames. He was sanguine enough to purchase
+one fifth of this concern, which also proved a failure. At about the
+same period he wrote the work which proved the great excitement of his
+mind upon the subject of the transient folly then before the public.
+Originally a lawyer, he was in succession a mechanician, a poet, and an
+editor, meeting with far less success in each of these departments
+than usually attends men of less varied gifts, but of more tranquil and
+phlegmatic composition. But who is ignorant that there is a class of
+minds characterized by qualities like those I have mentioned; minds with
+many bright and even beautiful traits; but aimless and fickle as the
+butterfly; that settle upon every gayly-colored illusion as it opens
+into flower, and flutter away to another when the first has dropped its
+leaves, and stands naked in the icy air of truth!
+
+Let us now look at the general tenor of the arguments addressed by
+believers to sceptics and opponents. Foremost of all, emblazoned at the
+head of every column, loudest shouted by every triumphant disputant,
+held up as paramount to all other considerations, stretched like an
+impenetrable shield to protect the weakest advocate of the great cause
+against the weapons of the adversary, was that omnipotent monosyllable
+which has been the patrimony of cheats and the currency of dupes from
+time immemorial,--Facts! Facts! Facts! First came the published cases
+of the American clergymen, brigadier-generals, almshouse governors,
+representatives, attorneys, and esquires. Then came the published
+cases of the surgeons of Copenhagen. Then followed reports of about
+one hundred and fifty cases published in England, “demonstrating the
+efficacy of the metallic practice in a variety of complaints both upon
+the human body and on horses, etc.” But the progress of facts in Great
+Britain did not stop here. Let those who rely upon the numbers of their
+testimonials, as being alone sufficient to prove the soundness and
+stability of a medical novelty, digest the following from the report
+of the Perkinistic Committee. “The cases published [in Great Britain]
+amounted, in March last, the date of Mr. Perkins's last publication,
+to about five thousand. Supposing that not more than one cure in three
+hundred which the Tractors have performed has been published, and the
+proportion is probably much greater, it will be seen that the number, to
+March last, will have exceeded one million five hundred thousand!”
+
+Next in order after the appeal to what were called facts, came a series
+of arguments, which have been so long bruised and battered round in the
+cause of every doctrine or pretension, new, monstrous, or deliriously
+impossible, that each of them is as odiously familiar to the scientific
+scholar as the faces of so many old acquaintances, among the less
+reputable classes, to the officers of police.
+
+No doubt many of my hearers will recognize, in the following passages,
+arguments they may have heard brought forward with triumphant confidence
+in behalf of some doctrine not yet extinct. No doubt some may have
+honestly thought they proved something; may have used them with the
+purpose of convincing their friends, or of silencing the opponents
+of their favorite doctrine, whatever that might be. But any train
+of arguments which was contrived for Perkinism, which was just as
+applicable to it as to any other new doctrine in the same branch of
+science, and which was fully employed against its adversaries forty
+years since, might, in common charity, be suffered to slumber in the
+grave of Perkinism. Whether or not the following sentences, taken
+literally from the work of Mr. Perkins, were the originals of some of
+the idle propositions we hear bandied about from time to time, let those
+who listen judge.
+
+The following is the test assumed for the new practice: “If diseases are
+really removed, as those persons who have practised extensively with
+the Tractors declare, it should seem there would be but little doubt
+of their being generally adopted; but if the numerous reports of 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 judging and uncandid
+class of individuals who buy their dinners without tasting all the
+food there is in the market. “On all discoveries there are persons who,
+without descending to any inquiry into the truth, pretend to know, as it
+were by intuition, that newly asserted facts are founded in the
+grossest errors. These were those who knew that Harvey's report of the
+circulation of the blood was a preposterous and ridiculous suggestion,
+and in latter later days there were others who knew that Franklin
+deserved reproach for declaring that points were preferable to balls for
+protecting buildings from lightning.”
+
+Again: “This unwarrantable mode of offering assertion for proof, so
+unauthorized and even unprecedented except in the condemnation of
+a Galileo, the persecution of a Copernicus, and a few other acts of
+inquisitorial authority, 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 Materia Medica act on principles of
+which we are totally ignorant. None have ever yet been able to explain
+how opium produces sleep, or how bark cures intermittent fevers; and yet
+few, it is hoped, will be so absurd as to desist from the use of these
+important articles because they know nothing of the principle of their
+operations.” Or if the argument is preferred, in the eloquent language
+of the Perkinistic poet:
+
+
+  “What though the CAUSES may not be explained,
+   Since these EFFECTS are duly ascertained,
+   Let not self-interest, prejudice, or pride,
+   Induce mankind to set the means aside;
+   Means which, though simple, are by
+   Heaven designed to alleviate the woes of human kind.”
+
+This course of argument is so often employed, that it deserves to be
+expanded a little, so that its length and breadth may be fairly seen.
+A series of what are called facts is brought forward to prove some very
+improbable doctrine. It is objected by judicious people, or such as have
+devoted themselves to analogous subjects, that these assumed facts are
+in direct opposition to all that is known of the course of nature, that
+the universal experience of the past affords a powerful presumption
+against their truth, and that in proportion to the gravity of these
+objections, should be the number and competence of the witnesses. The
+answer is a ready one. What do we know of the mysteries of Nature? Do
+we understand the intricate machinery of the Universe? When to this is
+added the never-failing quotation,
+
+
+  “There are more things in heaven and 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. It is in itself strange and
+incredible that the relations of the heavenly bodies to each other at a
+given moment of time, perhaps half a century ago, should have anything
+to do with my success or misfortune in any undertaking of to-day.
+But what right have I to say it cannot be so? Can I bind the sweet
+influences of Pleiades, or loose the bands of Orion? I do not know by
+what mighty magic the planets roll in their fluid paths, confined to
+circles as unchanging as if they were rings of steel, nor why the great
+wave of ocean follows in a sleepless round upon the skirts of moonlight;
+nor can I say from any certain knowledge that the phases of the heavenly
+bodies, or even the falling of the leaves of the forest, or the manner
+in which the sands lie upon the sea-shore, may not be knit up by
+invisible threads with the web of human destiny. There is a class
+of minds much more ready to believe that which is at first sight
+incredible, and because it is incredible, than what is generally thought
+reasonable. Credo quia impossibile est,--“I believe, because it is
+impossible,”--is an old paradoxical expression which might be literally
+applied to this tribe of persons. And they always succeed in finding
+something marvellous, to call out the exercise of their robust faith.
+The old Cabalistic teachers maintained that there was not a verse,
+line, word, or even letter in the Bible which had not a special efficacy
+either to defend the person who rightly employed it, or to injure his
+enemies; always provided the original Hebrew was made use of. In the
+hands of modern Cabalists every substance, no matter how inert, acquires
+wonderful medicinal virtues, provided it be used in a proper state of
+purity and subdivision.
+
+I have already mentioned the motives attributed by the Perkinists to the
+Medical Profession, as preventing its members from receiving the new
+but unwelcome truths. This accusation is repeated in different forms and
+places, as, for instance, in the following passage: “Will the medical
+man who has spent much money and labor in the pursuit of the arcana
+of Physic, and on the exercise of which depends his support in life,
+proclaim the inefficacy of his art, and recommend a remedy to
+his patient which the most unlettered in society can employ as
+advantageously as himself? and a remedy, too, which, unlike the drops,
+the pills, the powders, etc., of the Materia Medica, is inconsumable,
+and ever in readiness to be employed in successive diseases?”
+
+As usual with these people, much indignation was expressed at any
+parallel between their particular doctrine and practice and those of
+their exploded predecessors. “The motives,” says the disinterested
+Mr. Perkins, “which must have impelled to this attempt at classing the
+METALLIC PRACTICE with the most paltry of empyrical projects, are but
+too thinly veiled to escape detection.”
+
+To all these arguments was added, as a matter of course, an appeal to
+the feelings of the benevolent in behalf of suffering humanity, in the
+shape of a notice that the poor would be treated gratis. It is pretty
+well understood that this gratuitous treatment of the poor does not
+necessarily imply an excess of benevolence, any more than the gratuitous
+distribution of a trader's shop-bills is an evidence of remarkable
+generosity; in short, that it is one of those things which honest men
+often do from the best motives, but which rogues and impostors never
+fail to announce as one of their special recommendations. It is
+astonishing to see how these things brighten up at the touch of Mr.
+Perkins's poet:
+
+
+  “Ye worthy, honored, philanthropic few,
+   The muse shall weave her brightest wreaths for you,
+   Who in Humanity's bland cause unite,
+   Nor heed the shaft by interest aimed or spite;
+   Like the great Pattern of Benevolence,
+   Hygeia's blessings to the poor dispense;
+   And though opposed by folly's servile brood,
+   ENJOY THE LUXURY OF DOING GOOD.”
+
+Having thus sketched the history of Perkinism in its days of prosperity;
+having seen how it sprung into being, and by what means it maintained
+its influence, it only remains to tell the brief story of its
+discomfiture and final downfall. The vast majority of the sensible part
+of the medical profession were contented, so far as we can judge, to
+let it die out of itself. It was in vain that the advocates of this
+invaluable discovery exclaimed over their perverse and interested
+obstinacy,--in vain that they called up the injured ghosts of Harvey,
+Galileo, and Copernicus to shame that unbelieving generation; the
+Baillies and the Heberdens,--men whose names have come down to us
+as synonymous with honor and wisdom,--bore their reproaches in meek
+silence, and left them unanswered to 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 would be broken by an open trial of
+its virtue, as compared with that of some less hallowed formula. It
+must be remembered that a peculiar value was attached to the Metallic
+Tractors, as made and patented by Mr. Perkins. Dr. Haygarth, of Bath,
+performed various experiments upon patients afflicted with different
+complaints,--the patients supposing that the real five-guinea Tractors
+were employed. Strange to relate, he obtained equally wonderful effects
+with Tractors of lead and of wood; with nails, pieces of bone, slate
+pencil, and tobacco-pipe. Dr. Alderson employed sham Tractors made of
+wood, and produced such effects upon five patients that they returned
+solemn thanks in church for their cures. A single specimen of these
+cases may stand for all of them. Ann Hill had suffered for some months
+from pain in the right arm and shoulder. The Tractors (wooden ones) were
+applied, and in the space of five minutes she expressed herself relieved
+in the following apostrophe: “Bless me! why, who could have thought it,
+that them little things could pull the pain from one. Well, to be sure,
+the longer one lives, the more one sees; ah, dear!”
+
+These experiments did not result in the immediate extinction of
+Perkinism. Doubtless they were a great comfort to many obstinate
+unbelievers, and helped to settle some sceptical minds; but for the real
+Perkinistic enthusiasts, it may be questioned whether they would at that
+time have changed their opinion though one had risen from the dead to
+assure them that it was an error. It perished without violence, by an
+easy and natural process. Like the famous toy of Mongolfier, it rose by
+means of heated air,--the fevered breath of enthusiastic ignorance,--and
+when this grew cool, as it always does in a little while, it collapsed
+and fell.
+
+And now, on reviewing the whole subject, how shall we account for the
+extraordinary prevalence of the belief in Perkinism among a portion of
+what is supposed to be the thinking part of the community?
+
+Could the cures have been real ones, produced by the principle of ANIMAL
+MAGNETISM? To this it may be answered that the Perkinists ridiculed the
+idea of approximating Mesmer and the founder of their own doctrine, that
+nothing like the somnambulic condition seems to have followed the use of
+the Tractors, and that neither the exertion of the will nor the powers
+of the individual who operated seem to have been considered of any
+consequence. Besides, the absolute neglect into which the Tractors soon
+declined is good evidence that they were incapable of affording any
+considerable and permanent relief in the complaints for the cure of
+which they were applied.
+
+Of course a large number of apparent cures were due solely to nature;
+which is true under every form of treatment, orthodox or empirical.
+Of course many persons experienced at least temporary relief from the
+strong impression made upon their minds by this novel and marvellous
+method of treatment.
+
+Many, again, influenced by the sanguine hopes of those about them, like
+dying people, who often say sincerely, from day to day, that they are
+getting better, cheated themselves into a false and short-lived belief
+that they were cured; and as happens in such cases, the public never
+knew more than the first half of the story.
+
+When it was said to the Perkinists, that whatever effects they produced
+were merely through the imagination, they declared (like the advocates
+of the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this explanation
+was sufficiently disproved by the fact of numerous and successful cures
+which had been witnessed in infants and brute animals. Dr. Haygarth
+replied to this, that “in these cases it is not the Patient, but the
+Observer, who is deceived by his own imagination,” and that such may be
+the fact, we have seen in the case of the good lady who thought she had
+conjured away the spot from her friend's countenance, when it remained
+just as before.
+
+As to the motives of the inventor and vender of the Tractors, 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 that they
+are a peculiar compound, when they are artfully associated with a new
+and brilliant discovery (which then happened to be Galvanism), when they
+are sold at many hundred times their value, and the seller prints his
+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 practise on each other,” one cannot but suspect that they were
+contrived in the neighborhood of a wooden nutmeg factory; that legs of
+ham in that region are not made of the best mahogany; and that such as
+buy their cucumber seed in that vicinity have to wait for the fruit as
+long as the Indians for their crop of gunpowder.
+
+                         *****
+
+The succeeding lecture will be devoted to an examination of 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, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, and
+the claims of which are considered by some as infinitely important, and
+by many as immeasurably ridiculous.
+
+I wish to state, for the sake of any who may be interested in the
+subject, that I shall treat it, not by ridicule, but by argument;
+perhaps with great freedom, but with good temper and in peaceable
+language; with very little hope of reclaiming converts, with no desire
+of making enemies, but with a firm belief that its pretensions and
+assertions cannot stand before a single hour of calm investigation.
+
+II.
+
+It may be thought that a direct attack upon the pretensions of
+HOMOEOPATHY is an uncalled-for aggression upon an unoffending doctrine
+and its peaceful advocates.
+
+But a little inquiry will show that it has long assumed so hostile a
+position with respect to the Medical Profession, that any trouble I, or
+any other member of that profession, may choose to bestow upon it may be
+considered merely as a matter of self-defence. It began with an attempt
+to show the insignificance of all existing medical knowledge. It not
+only laid claim to wonderful powers of its own, but it declared the
+common practice to be attended with the most positively injurious
+effects, that by it acute diseases are aggravated, and chronic diseases
+rendered incurable. It has at various times brought forward collections
+of figures having the air of statistical documents, pretending to show
+a great proportional mortality among the patients of the Medical
+Profession, as compared with those treated according to its own rules.
+Not contented with choosing a name of classical origin for itself, it
+invented one for the whole community of innocent physicians, assuring
+them, to their great surprise, that they were all ALLOPATHISTS, whether
+they knew it or not, and including all the illustrious masters of the
+past, from Hippocrates down to Hunter, under the same gratuitous title.
+The line, then, has been drawn by the champions of the new doctrine;
+they have lifted the lance, they have sounded the charge, and are
+responsible for any little skirmishing which may happen.
+
+But, independently of any such grounds of active resistance, the subject
+involves interests so disproportioned to its intrinsic claims, that it
+is no more than an act 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, and acquires the same degree of influence that we
+have often seen obtained by other illusions, there is not one of my
+audience who may not have occasion to deplore the fatal credulity which
+listened to its promises.
+
+I shall therefore undertake a sober examination of its principles, its
+facts, and some points of its history. The limited time at my disposal
+requires me to condense as much as possible what I have to say, but
+I shall endeavor to be plain and direct in expressing it. Not one
+statement shall be made which cannot be supported by unimpeachable
+reference: not one word shall be uttered which I am not as willing to
+print as to speak. I have no quibbles to utter, and I shall stoop
+to answer none; but, with full faith in the sufficiency of a plain
+statement of facts and reasons, I submit the subject to the discernment
+of my audience.
+
+The question may be asked in the outset,--Have you submitted the
+doctrines you are professing to examine 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, from what has often
+happened, that it would be of no manner of use for me to allege the
+results of any experiments I might have instituted. Again and again have
+the most explicit statements been made by the most competent persons of
+the utter failure of all their trials, and there were the same abundant
+explanations offered as used to be for the Unguentum Armarium and the
+Metallic Tractors. I could by no possibility perform any experiments
+the result of which could not be easily explained away so as to be of no
+conclusive significance. Besides, as arguments in favor of Homoeopathy
+are constantly addressed to the public in journals, pamphlets, and even
+lectures, by inexperienced dilettanti, the same channel must be open to
+all its opponents.
+
+It is necessary, for the sake of those to whom the whole subject may
+be new, to give in the smallest possible compass the substance of
+the Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German
+physician, now living in Paris, [Hahnemann died in 1843 at the age of
+eighty-seven years. In 1796 he published the first paper containing his
+peculiar notions; in 1805 his first work on the subject; in 1810 his
+somewhat famous “Organon of the Healing Art;” the next year what
+he called the “Pure Materia Medica;” and in 1828 his last work, the
+“Treatise on Chronic Diseases.” He has therefore been writing at
+intervals on his favorite subject for nearly half a century.
+
+The one great doctrine which constitutes the basis of Homoeopathy as a
+system is expressed by the Latin aphorism, “SIMILIA SIBILIBUS CURANTUR,”
+ or like cures like, that is, diseases are cured by agents capable
+of producing symptoms resembling those found in the disease under
+treatment. A disease for Hahnemann consists essentially in a group
+of symptoms. The proper medicine for any disease is the one which is
+capable of producing a similar group of symptoms when given to a healthy
+person.
+
+It is of course necessary to know what are the trains of symptoms
+excited by different substances, when administered to persons in health,
+if any such can be shown to exist. Hahnemann and his disciples give
+catalogues of the symptoms which they affirm were produced upon
+themselves or others by a large number of drugs which they submitted to
+experiment.
+
+The second great fact which Hahnemann professes to have established is
+the efficacy of medicinal substances reduced to a wonderful degree of
+minuteness or dilution. The following account of his mode of preparing
+his medicines is from his work on Chronic Diseases, which has not, I
+believe, yet been translated into English. A grain of the substance,
+if it is solid, a drop if it is liquid, is to be added to about a third
+part of one hundred grains of sugar of milk in an unglazed porcelain
+capsule which has had the polish removed from the lower part of its
+cavity by rubbing it with wet sand; they are to be mingled for an
+instant with a bone or horn spatula, and then rubbed together for six
+minutes; then the mass is to be scraped together from 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 the powder into
+a heap, and the second third of the hundred grains of sugar of milk
+to be added. Then they are to be stirred an instant and rubbed six
+minutes,--again to be scraped together four minutes and forcibly rubbed
+six; once more scraped together for four minutes, when the last third
+of the hundred grains of sugar of milk is to be added and mingled by
+stirring with the spatula; six minutes of forcible rubbing, four of
+scraping together, and six more (positively the last six) of rubbing,
+finish this part of the process.
+
+Every grain of this powder contains the hundredth of a grain of the
+medicinal substance mingled with the sugar of milk. If, therefore, a
+grain of the powder just prepared is mingled with another hundred grains
+of sugar of milk, and the process just described repeated, we shall have
+a powder of which every grain contains the hundredth of the hundredth,
+or the ten thousandth part of a grain of the medicinal substance. Repeat
+the same process with the same quantity of fresh sugar of milk, and
+every grain of your powder will contain the millionth of a grain of the
+medicinal substance. When the powder is of this strength, it is ready
+to employ in the further solutions and dilutions to be made use of in
+practice.
+
+A grain of the powder is to be taken, a hundred drops of alcohol are
+to be poured on it, the vial is to be slowly turned for a few minutes,
+until the powder is 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 observations upon the sick lead me within the last few
+years to prefer giving only two shakes to medicinal liquids, whereas I
+formerly used to give ten.” The process of dilution is carried on in
+the same way as the attenuation of the powder was done; each successive
+dilution with alcohol reducing the medicine to a hundredth part of the
+quantity of that which preceded it. In this way the dilution of the
+original millionth of a grain of medicine contained in the grain of
+powder operated on is carried successively to the billionth, trillionth,
+quadrillionth, quintillionth, and very often much higher fractional
+divisions. A dose of any of these medicines is a minute fraction of a
+drop, obtained by moistening with them one or more little globules of
+sugar, of which Hahnemann says it takes about two hundred to weigh a
+grain.
+
+As an instance of the strength of the medicines prescribed by Hahnemann,
+I will mention carbonate of lime. He does not employ common chalk, but
+prefers a little portion 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 mentioned can convey is a common dose. But for
+persons of very delicate nerves it is proper that the dilution should
+be carried to the decillionth degree. That is, an important medicinal
+effect is to be expected from the two hundredth or hundredth part of
+the millionth of the millionth of the millionth of the millionth of
+the millionth of the millionth of the millionth of the millionth of the
+millionth of the millionth of a grain of oyster-shell. This is only
+the tenth degree of potency, but some of his disciples profess to have
+obtained palpable effects from “much higher dilutions.”
+
+The third great doctrine of Hahnemann is the following. Seven eighths
+at least of all chronic diseases are produced by the existence in the
+system of that infectious disorder known in the language of science
+by the appellation of PSORA, but to the less refined portion of the
+community by the name of ITCH. In the words of Hahnemann's “Organon,”
+ “This Psora is the sole true and fundamental cause that produces 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 the bones,
+or rickets, scoliosis and cyphosis, caries, cancer, fungua haematodes,
+gout,--yellow jaundice and cyanosis, dropsy,--”
+
+[“The degrees of DILUTION must not be confounded with those of POTENCY.
+Their relations may be seen by this table:
+
+lst dilution,--One hundredth of a drop or grain.
+
+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.,--and so on indefinitely.
+
+The large figures denote the degrees of POTENCY.]
+
+“gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the
+lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of
+sense, pains of every kind, etc., appear in our pathology as so many
+peculiar, distinct, and independent diseases.”
+
+For the last three centuries, if the same authority may be trusted,
+under the influence of the more refined personal habits which have
+prevailed, and the application of various external remedies which repel
+the affection from the skin; Psora has revealed itself in these numerous
+forms of internal disease, instead of appearing, as in former periods,
+under the aspect of an external malady.
+
+These are the three cardinal doctrines of Hahnemann, as laid down in
+those standard works of Homoeopathy, the “Organon” and the “Treatise on
+Chronic Diseases.”
+
+Several other principles may be added, upon all of which he insists with
+great force, and which are very generally received by his disciples.
+
+1. Very little power is allowed to the curative efforts of nature.
+Hahnemann goes so far as to say that no one has ever seen the simple
+efforts of nature effect the durable recovery of a patient from a
+chronic disease. In general, the Homoeopathist calls every recovery
+which happens under his treatment a cure.
+
+2. Every medicinal substance must be administered in a state of the
+most perfect purity, and uncombined with any other. The union of several
+remedies in a single prescription destroys its utility, and, according
+to the “Organon,” frequently adds a new disease.
+
+3. A large number of substances commonly thought to be inert develop
+great medicinal powers when prepared in the manner already described;
+and a great proportion of them are ascertained to have specific
+antidotes in 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
+collections of symptoms, each of which differs from every other
+collection.
+
+5. The symptoms of any complaint must be described with the most
+minute exactness, and so far as possible in the patient's own words. To
+illustrate the kind of circumstances the patient is expected to record,
+I will mention one or two from the 313th page of the “Treatise on
+Chronic Diseases,”--being the first one at which I opened accidentally.
+
+“After dinner, disposition to sleep; the patient winks.”
+
+“After dinner, prostration and feeling of weakness (nine days after
+taking the remedy).”
+
+This remedy was that same oyster-shell which is to be prescribed
+“fractions of the sextillionth or decillionth degree.” According to
+Hahnemann, the action of a single dose of the size mentioned does not
+fully display itself in some cases until twenty-four or even thirty
+days after it is taken, and in such instances has not exhausted its good
+effects until towards the fortieth or fiftieth day,--before which time
+it would be absurd and injurious to administer a new remedy.
+
+So much for the doctrines of Hahnemann, which have been stated without
+comment, or exaggeration of any of their features, very much as any
+adherent of his opinions might have stated them, if obliged to compress
+them into so narrow a space.
+
+Does Hahnemann himself represent Homoeopathy as it now exists? He
+certainly ought to be its best representative, after having created it,
+and devoted his life to it for half a century. He is spoken of as the
+great physician of the time, in most, if not all Homoeopathic works. If
+he is not authority on the subject of his own doctrines, who is? So far
+as I am aware, not one tangible discovery in the so-called science has
+ever been ascribed to any other observer; at least, no general principle
+or law, of consequence enough to claim any prominence in Homoeopathic
+works, has ever been pretended to have originated with any of his
+illustrious disciples. He is one of the only two Homoeopathic writers
+with whom, as I shall mention, the Paris publisher will have anything to
+do upon his own account. The other is Jahr, whose Manual is little more
+than a catalogue of symptoms and remedies. If any persons choose to
+reject Hahnemann as not in the main representing Homoeopathy, if they
+strike at his authority, if they wink out of sight his deliberate and
+formally announced results, it is an act of suicidal rashness; for upon
+his sagacity and powers of observation, and experience, as embodied in
+his works, and especially in his Materia Medica, repose the foundations
+of Homoeopathy as a practical system.
+
+So far as I can learn from the conflicting statements made upon the
+subject, the following is the present condition of belief.
+
+1. All of any note agree that the law Similia similibus is the only
+fundamental principle in medicine. Of course if any man does not agree
+to this the name Homoeopathist can no longer be applied to him with
+propriety.
+
+2. The belief in and employment of the infinitesimal doses is general,
+and in some places universal, among the advocates of Homoeopathy; but a
+distinct movement has been made in Germany to get rid of any restriction
+to the use of these doses, and to employ medicines with the same license
+as other practitioners.
+
+3. The doctrine of the origin of most chronic diseases in Psora,
+notwithstanding Hahnemann says it cost him twelve years of study and
+research to establish the fact and its practical consequences, has
+met with great neglect and even opposition from very many of his own
+disciples.
+
+It is true, notwithstanding, that, throughout most of their writings
+which I have seen, there runs a prevailing tone of great deference to
+Hahnemann's opinions, a constant reference to his authority, a general
+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's Translation of Jahr's Manual may observe how little
+comparative space is given to remedies resting upon 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 consider it vastly more probable that any observer in so
+fallacious and difficult a field of inquiry as medicine had been led
+into error, or walked into it of his own accord, than that such numerous
+and extraordinary facts had really just come to light. They would feel a
+right to exercise the same obduracy towards them as the French Institute
+is in the habit of displaying when memoirs or models are offered to it
+relating to 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 philosophers must have felt when, some half a dozen years ago,
+an unknown man came forward, and asked for an opportunity to demonstrate
+to Arago and his colleagues that the moon and planets were at a distance
+of a little more than a hundred miles from the earth. And so they would
+not even look into Homoeopathy, though all its advocates should exclaim
+in the words of Mr. Benjamin Douglass 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 newly asserted facts are founded in the grossest
+errors.” And they would lay their heads upon their pillows with a
+perfectly clear conscience, although they were assured that they were
+behaving in the same way that people of 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 these assertions is
+not sufficient to deter many, from examining their claims to belief.
+I therefore lean but very slightly on the extravagance and extreme
+apparent singularity of their pretensions. I might have omitted them,
+but on the whole it seemed more just to the claims of my argument
+to suggest the vast complication of improbabilities involved in the
+statements enumerated. Every one must of course judge for himself as to
+the weight of these objections, which are by no means brought forward as
+a proof of the extravagance of Homoeopathy, but simply as entitled to
+a brief consideration before the facts of the case are submitted to our
+scrutiny.
+
+The three great asserted discoveries of Hahnemann are entirely
+unconnected with and independent of each other. Were there any natural
+relation between them it would seem probable enough that the discovery
+of the first would have led to that of the others. But assuming it to be
+a fact that diseases are cured by remedies capable of producing symptoms
+like their own, no manifest relation exists between this fact and
+the next assertion, namely, the power of the infinitesimal doses. And
+allowing both these to be true, neither has the remotest affinity to
+the third new doctrine, that which declares seven eighths of all chronic
+diseases to be owing to Psora.
+
+This want of any obvious relation between Hahnemann's three cardinal
+doctrines appears to be self-evident upon inspection. But if, as is
+often true with his disciples, they prefer the authority of one of their
+own number, I will refer them to Dr. Trinks's paper on the present state
+of Homoeopathy in Europe, with which, of course, they are familiar, as
+his name is mentioned as one of the most prominent champions of 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
+three such unconnected and astonishing discoveries, each of them a
+complete revolution of all that ages of the most varied experience had
+been taught to believe, should spring full formed from the brain of a
+single individual.
+
+Let us look a moment at the first of his doctrines. Improbable though
+it may seem to some, there is no essential absurdity involved in the
+proposition that diseases yield to remedies capable of producing like
+symptoms. There are, on the other hand, some analogies which lend a
+degree of plausibility to the statement. There are well-ascertained
+facts, known from the earliest periods of medicine, showing that, under
+certain circumstances, the very medicine which, from its known effects,
+one would expect to aggravate the disease, may contribute to its relief.
+I may be permitted to allude, in the most general way, to the case in
+which the spontaneous efforts of an overtasked stomach are quieted by
+the agency of a drug which that organ refuses to entertain upon any
+terms. But that every cure ever performed by medicine should have
+been founded upon this principle, although without the knowledge of a
+physician; that the Homoeopathic axiom is, as Hahnemann asserts, “the
+sole law of nature in therapeutics,” a law of which nothing more than
+a transient glimpse ever presented itself to the innumerable host of
+medical observers, is a dogma of such sweeping extent, and pregnant
+novelty, that it demands a corresponding breadth and depth of
+unquestionable facts to cover its vast pretensions.
+
+So much ridicule has been thrown upon the pretended powers of the
+minute doses that I shall only touch upon this point for the purpose of
+conveying, by illustrations, some shadow of ideas far transcending the
+powers of the imagination to realize. It must be remembered that these
+comparisons are not matters susceptible of dispute, being founded
+on simple arithmetical computations, level to the capacity of any
+intelligent schoolboy. A person who once wrote a very small pamphlet
+made some show of objecting to calculations of thus kind, on the ground
+that the highest dilutions could easily be made with a few ounces of
+alcohol. But he should have remembered that at every successive dilution
+he lays aside or throws away ninety-nine hundredths of the fluid on
+which he is operating, and that, although he begins with a drop, he only
+prepares a millionth, billionth, trillionth, and similar fractions of
+it, all of which, added together, would constitute but a vastly minute
+portion of the drop with which he began. But now let us suppose we take
+one single drop of the Tincture of Camomile, and that the whole of this
+were to be carried through the common series of dilutions.
+
+A calculation nearly like the following was made by Dr. Panvini, and may
+be readily followed in its essential particulars by any one who chooses.
+
+For the first dilution it would take 100 drops of alcohol.
+
+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 ninth dilution, which would take ten billion
+gallons, which he computed would fill the basin of Lake Agnano, a body
+of water two miles in circumference. The twelfth dilution would of
+course fill a million such lakes. By the time the seventeenth degree of
+dilution should be reached, the alcohol required would equal in quantity
+the waters of ten thousand Adriatic seas. Trifling errors must be
+expected, but they are as likely to be on one side as the other, and any
+little matter like Lake Superior or the Caspian would be but a drop in
+the bucket.
+
+Swallowers of globules, one of your little pellets, moistened in
+the mingled waves of one million lakes of alcohol, each two miles in
+circumference, with which had been blended that one drop of Tincture
+of Camomile, would be of precisely the strength recommended for that
+medicine in your favorite Jahr's Manual, “against the most sudden,
+frightful, and fatal diseases!” [In the French edition of 1834, the
+proper doses of the medicines are mentioned, and Camomile is marked
+IV. Why are the doses omitted in Hull's Translation, except in three
+instances out of the whole two hundred remedies, notwithstanding the
+promise in the preface that “some remarks upon the doses used may
+be found at the head of each medicine”? Possibly because it makes
+no difference whether they are employed in one Homoeopathic dose or
+another; but then it is very singular that such precise directions
+were formerly given in the same work, and that Hahnemann's “experience”
+ should have led him to draw the nice distinctions we have seen in a
+former part of this Lecture (p. 44).]
+
+And proceeding on the common data, I have just made a calculation
+which shows that this single drop of Tincture of Camomile, given in the
+quantity ordered by Jahr's Manual, would have supplied every individual
+of the whole human family, past and present, with more than five billion
+doses each, the action of each dose lasting about four days.
+
+Yet this is given only at the quadrillionth, or fourth degree of
+potency, and various substances are frequently administered at
+the decillionth or tenth degree, and occasionally at still higher
+attenuations with professed medicinal results. Is there not in this as
+great an exception to all the hitherto received laws of nature as in the
+miracle of the loaves and fishes? Ask this question of a Homoeopathist,
+and he will answer by referring to the effects produced by a very minute
+portion of vaccine matter, or the extraordinary diffusion of odors. But
+the vaccine matter is one of those substances called morbid poisons, of
+which it is a peculiar character to multiply themselves, when introduced
+into the system, as a seed does in the soil. Therefore the hundredth
+part of a grain of the vaccine matter, if no more than this is employed,
+soon increases in quantity, until, in the course of about a week, it is
+a grain or more, and can be removed in considerable drops. And what is
+a very curious illustration of Homoeopathy, it does not produce its most
+characteristic effects until it is already in sufficient quantity
+not merely to be visible, but to be collected for further use. The
+thoughtlessness which can allow an inference to be extended from a
+product of disease possessing this susceptibility of multiplication when
+conveyed into the living body, to substances of inorganic origin, such
+as silex or sulphur, would be capable of arguing that a pebble may
+produce a mountain, because an acorn can become a forest.
+
+As to the analogy to be found between the alleged action of the
+infinitely attenuated doses, and the effects of some odorous substances
+which possess the extraordinary power of diffusing their imponderable
+emanations through a very wide space, however it may be abused in
+argument, and rapidly as it evaporates on examination, it is not like
+that just mentioned, wholly without meaning. The fact of the vast
+diffusion of some odors, as that of musk or the rose, for instance, has
+long been cited as the most remarkable illustration of the divisibility
+of matter, and the nicety of the senses. And if this were compared with
+the effects of a very minute dose of morphia on the whole system, or the
+sudden and fatal impression of a single drop of prussic acid, or,
+with what comes still nearer, the poisonous influence of an atmosphere
+impregnated with invisible malaria, we should find in each of these
+examples an evidence of the degree to which nature, in some few
+instances, concentrates powerful qualities in minute or subtile forms of
+matter. But if a man comes to me with a pestle and mortar in his hand,
+and tells me that he will take a little speck of some substance which
+nobody ever thought to have any smell at all, as, for instance, a grain
+of chalk or of charcoal, and that he will, after an hour or two of
+rubbing and scraping, develop in a portion of it an odor which, if the
+whole grain were used, would be capable of pervading an apartment, a
+house, a village, a province, an empire, nay, the entire atmosphere of
+this broad planet upon which we tread; and that from each of fifty or
+sixty substances he can in this way develop a distinct and hitherto
+unknown odor: and if he tries to show that all this is rendered quite
+reasonable by the analogy of musk and roses, I shall certainly be
+justified in considering him incapable of reasoning, and beyond the
+reach of my argument. What if, instead of this, he professes to develop
+new and wonderful medicinal powers from the same speck of chalk or
+charcoal, in such proportions as would impregnate every pond, lake,
+river, sea, and ocean of our globe, and appeals to the same analogy in
+favor of the probability of his assertion.
+
+All this may be true, notwithstanding these considerations. But so
+extraordinary would be the fact, that a single atom of substances which
+a child might swallow without harm by the teaspoonful could, by an easy
+mechanical process, be made to develop such inconceivable powers, that
+nothing but the strictest agreement of the most cautious experimenters,
+secured by every guaranty that they were honest and faithful, appealing
+to repeated experiments in public, with every precaution to guard
+against error, and with the most plain and peremptory results, should
+induce us to lend any credence to such pretensions.
+
+The third doctrine, that Psora, the other name of which you remember, is
+the cause of the great majority of chronic diseases, is a startling
+one, to say the least. That an affection always recognized as a
+very unpleasant personal companion, but generally regarded as a
+mere temporary incommodity, readily yielding to treatment in those
+unfortunate enough to suffer from it, and hardly known among the
+better classes of society, should be all at once found out by a German
+physician to be the great scourge of mankind, the cause of their
+severest bodily and mental calamities, cancer and consumption, idiocy
+and madness, must excite our unqualified surprise. And when the
+originator of this singular truth ascribes, as in the page now open
+before me, the declining health of a disgraced courtier, the chronic
+malady of a bereaved mother, even the melancholy of the love-sick
+and slighted maiden, to nothing more nor less than the insignificant,
+unseemly, and almost unmentionable ITCH, does it not seem as if the
+very soil upon which we stand were dissolving into chaos, over the
+earthquake-heaving of discovery?
+
+And when one man claims to have established these three independent
+truths, which are about as remote from each other as the discovery
+of the law of gravitation, the invention of printing, and that of the
+mariner's compass, unless the facts in their favor are overwhelming
+and unanimous, the question naturally arises, Is not this man deceiving
+himself, or trying to deceive others?
+
+I proceed to examine the proofs of the leading ideas of Hahnemann and
+his school.
+
+In order to show the axiom, similia similibus curantur (or like is cured
+by like), to be the basis of the healing art,--“the sole law of nature
+in therapeutics,”--it is necessary,
+
+1. That the symptoms produced by drugs in healthy persons should be
+faithfully studied and recorded.
+
+2. That drugs should be shown to be always capable of curing those
+diseases most like their own symptoms.
+
+3. That remedies should be shown not to cure diseases when they do not
+produce symptoms resembling those presented in these diseases.
+
+1. The effects of drugs upon healthy persons have 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 experimentation appears to
+have been, to take the substance on trial, either in common or minute
+doses, and then to set down every little sensation, every little
+movement of mind or body, which occurred within many succeeding hours
+or days, as being produced solely by the substance employed. When I have
+enumerated some of the symptoms attributed to the power of the drugs
+taken, you will be able to judge how much value is to be ascribed to the
+assertions of such observers.
+
+The following list was taken literally from the Materia Medica of
+Hahnemann, by my friend M. Vernois, for whose 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 of the work. I
+shall be very brief in my citations.
+
+“After stooping some time, sense of painful weight about the head upon
+resuming the erect posture.”
+
+“An itching, tickling sensation at the outer edge of the palm of the
+left hand, which obliges the person to scratch.” The medicine was
+acetate of lime, and as the action of the globule taken is said to last
+twenty-eight days, you may judge how many such symptoms as the last
+might be supposed to happen.
+
+Among the symptoms attributed to muriatic acid are these: a catarrh,
+sighing, pimples; “after having written a long time with the back a
+little bent over, violent pain in the back and shoulder-blades, as
+if from a strain,”--“dreams which are not remembered,--disposition to
+mental dejection,--wakefulness before and after midnight.”
+
+I might extend this catalogue almost indefinitely. I have not cited
+these specimens with any view to exciting a sense of the ridiculous,
+which many others of those mentioned would not fail to do, but to show
+that the common accidents of sensation, the little bodily inconveniences
+to which all of us are subject, are seriously and systematically
+ascribed to whatever medicine may have been exhibited, even in the
+minute doses 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 hereafter illustrate, to be
+produced by the substance in question.
+
+The effects of sixty-four medicinal substances, ascertained by one
+or both of these methods, are enumerated in the Materia Medica
+of Hahnemann, which may be considered as the basis of practical
+Homoeopathy. In the Manual of Jahr, which is the common guide, so far as
+I know, of those who practise Homoeopathy in these regions, two hundred
+remedies are enumerated, many of which, however, have never been
+employed in practice. In at least one edition there were no means of
+distinguishing those which had been tried upon the sick from the others.
+It is true that marks have been added in the edition employed here,
+which serve to distinguish them; but what are we to think of a standard
+practical author on Materia Medica, who at one time omits to designate
+the proper doses of his remedies, and at another to let us have any
+means of knowing whether a remedy has ever been tried or not, while
+he is recommending its employment in the most critical and threatening
+diseases?
+
+I think that, from what I have shown of the character of Hahnemann's
+experiments, it would be a satisfaction to any candid inquirer to
+know whether other persons, to whose assertions he could look
+with confidence, confirm these pretended facts. Now there are many
+individuals, long and well known to the scientific world, who have tried
+these experiments upon healthy subjects, and utterly deny that their
+effects have at 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 experiments in his hospital) as to
+the result of his own trials. This distinguished physician is Professor
+of Medicine in the School of Paris, and one of the most widely known and
+valued authors upon practical and theoretical subjects the profession
+can claim in any country. He is a man of great kindness of character,
+a most liberal eclectic by nature and habit, of unquestioned integrity,
+and is called, in the leading article of the first number of the
+“Homoepathic 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 extolled remedies. His experiments lasted a year, and he stated
+publicly to the Academy of Medicine that they never produced the
+slightest appearance of the symptoms attributed to them. The results of
+a man like this, so extensively known as one of the most philosophical
+and candid, as well as brilliant of instructors, and whose admirable
+abilities and signal liberality are generally conceded, ought to be of
+great weight in deciding the question.
+
+M. Double, a well-known medical writer and a physician of high standing
+in Paris, had occasion so long ago as 1801, before he had heard of
+Homoeopathy, to make experiments upon Cinchona, or Peruvian bark. He and
+several others took the drug in every kind of dose for four months, and
+the fever it is pretended by Hahnemann to excite never was produced.
+
+M. Bonnet, President of the Royal Society of Medicine of Bordeaux, had
+occasion to observe many soldiers during the Peninsular War, who made
+use of Cinchona as a preservative against different diseases, but he
+never 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 of the Homoeopathic substances, which
+were given to healthy persons with every precaution as to diet and
+regimen, by M. Louis Fleury, without being followed by the slightest of
+the pretended consequences. And let me mention as a curious fact, that
+the same quantity of arsenic given to one animal in the common form of
+the unprepared powder, and to another after having been rubbed up into
+six hundred globules, offered no particular difference of activity in
+the two cases.
+
+This is a strange contradiction to the doctrine of the development of
+what they call dynamic power, by means of friction and subdivision.
+
+In 1835 a public challenge was offered to the best known Homoeopathic
+physician in Paris to select any ten substances asserted to produce the
+most striking effects; to prepare them himself; to choose one by lot
+without knowing which of them he had taken, and try it upon himself or
+any intelligent and devoted Homoeopathist, and, waiting his own time,
+to come forward and tell what substance had been employed. The challenge
+was at first accepted, but the acceptance retracted before the time of
+trial arrived.
+
+From all this I think it fair to conclude that the catalogues of
+symptoms attributed in Homoeopathic works to the influence of various
+drugs upon healthy persons are not entitled to any confidence.
+
+2. It is necessary to show, in the next place, that medicinal substances
+are always capable of curing diseases most like their own symptoms.
+For facts relating to this question we must look to two sources; the
+recorded experience of the medical profession in general, and the
+results of trials made according to Homoeopathic principles, and capable
+of testing the truth of the doctrine.
+
+No person, that I am aware of, has ever denied that in some cases there
+exists a resemblance between the effects of a remedy and the symptoms
+of diseases in which 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 true of only a very small proportion of useful
+remedies. Nor has it ever been considered as an established truth that
+the efficacy of even these few remedies was in any definite ratio to
+their power of producing symptoms more or less like those they cured.
+
+Such was the state of opinion when Hahnemann came forward with the
+proposition that all the cases of successful treatment found in the
+works of all preceding medical writers were to be ascribed solely to the
+operation of the Homoeopathic principle, which had effected the cure,
+although without the physician's knowledge that this was the real
+secret. And strange as it may seem, he was enabled to give such a
+degree of plausibility to this assertion, that any person not acquainted
+somewhat with medical literature, not quite familiar, I should rather
+say, with the relative value of medical evidence, according to the
+sources whence it is derived, would be almost frightened into the
+belief, at seeing the pages upon pages of Latin names he has summoned as
+his witnesses.
+
+It has hitherto been customary, when examining the writings of authors
+of preceding ages, upon subjects as to which they were less enlightened
+than ourselves, and which they were very liable to misrepresent, to
+exercise some little discretion; to discriminate, in some measure,
+between writers deserving confidence and those not entitled to it. But
+there is not the least appearance of any such delicacy on the part of
+Hahnemann. A large majority of the names of old authors he cites
+are wholly unknown to science. With some of them I have been long
+acquainted, and I know that their accounts of diseases are no more to be
+trusted than their contemporary Ambroise Pare's stories of mermen,
+and similar absurdities. But if my judgment is rejected, as being
+a prejudiced one, I can refer to Cullen, who mentioned three of
+Hahnemann's authors in one sentence, as being “not necessarily bad
+authorities; but certainly such when they delivered very improbable
+events;” and as this was said more than half a century ago, it could not
+have had any reference to Hahnemann. But although not the slightest
+sign of discrimination is visible in his quotations,--although for him
+a handful of chaff from Schenck is all the same thing as a measure of
+wheat from Morgagni,--there is a formidable display of authorities, and
+an abundant proof of ingenious researches to be found in each of
+the great works of Hahnemann with which I am familiar. [Some painful
+surmises might arise as to the erudition of Hahnemann's English
+Translator, who makes two individuals of “Zacutus, Lucitanus,” as
+well as respecting that of the conductors of an American Homoeopathic
+periodical, who suffer the name of the world-renowned Cardanus to be
+spelt Cardamus in at least three places, were not this gross ignorance
+of course attributable only to the printer.]
+
+It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
+proved many of Hahnemann's quotations from old authors to be adulterate
+and false. What particular instances he has pointed out I have no means
+of learning. And it is probably wholly impossible on this side of the
+Atlantic, and even in most of the public libraries of Europe, to
+find anything more than a small fraction of the innumerable obscure
+publications which the neglect of grocers and trunkmakers has spared
+to be ransacked by the all-devouring genius of Homoeopathy. I have
+endeavored to verify such passages as my own library afforded me the
+means of doing. For some I have looked in vain, for want, as I am
+willing to believe, of more exact references. But this I am able to
+affirm, that, out of the very small number which I have been able, to
+trace back to their original authors, I have found two to be wrongly
+quoted, one of them being a gross misrepresentation.
+
+The first is from the ancient Roman author, Caelius Aurelianus;
+the second from the venerable folio of Forestus. Hahnemann uses the
+following expressions,--if he is not misrepresented in the English
+Translation of the 'Organon': “Asclepiades on one occasion cured an
+inflammation of the brain by 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 treatment employed by Asclepiades, into both of which the
+use of wine entered, as being “in the highest degree irrational 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 says that Forestus
+observed violent colic caused by its administration. But, as the author
+tells the story, a young man took, by the counsel of a surgeon, an acrid
+and virulent medicine, the name of which is not given, which brought on
+a most cruel fit of the gripes and colic. After this another surgeon was
+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 Homoeopathic remedy, as Hahnemann pretends,
+it might be a fair question why the young man was not cured by it. But
+it is a much graver question why a man who has shrewdness and learning
+enough to go so far after his facts, should think it right to treat them
+with such astonishing negligence or such artful unfairness.
+
+Even if every word he had pretended to take from his old authorities
+were to be found in them, even if the authority of every one of these
+authors were beyond question, the looseness with which they are used to
+prove whatever Hahnemann chooses is beyond the bounds of credibility.
+Let me give one instance to illustrate the character of this man's
+mind. Hahnemann asserts, in a note annexed to the 110th paragraph of
+the “Organon,” that the smell of the rose will cause certain persons to
+faint. And he says in the text that substances which produce peculiar
+effects of this nature on particular constitutions cure the same
+symptoms in people in general. Then in another note to the same
+paragraph he quotes the following fact from one of the last sources one
+would have looked to for medical information, the Byzantine Historians.
+
+“It was by these means (i.e. Homoeopathically) that the Princess Eudosia
+with rose-water restored a person who had fainted!”
+
+Is it possible that a man who is guilty of such pedantic folly as
+this,--a man who can see a confirmation of his doctrine in such a
+recovery as this,--a recovery which is happening every day, from
+a breath of 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 a man, of whose pages, not here and there
+one, but hundreds upon hundreds are loaded with such trivialities, is
+the Newton, the Columbus, the Harvey of the nineteenth century!
+
+The whole process of demonstration he employs is this. An experiment is
+instituted with some drug upon one or more healthy persons. Everything
+that happens for a number of days or weeks is, as we have seen, set
+down as an effect of the medicine. Old volumes are then ransacked
+promiscuously, and every morbid sensation or change that anybody ever
+said was produced by the drug in question is added to the list of
+symptoms. By one or both of these methods, each of the sixty-four
+substances enumerated by Hahnemann is shown to produce a very large
+number of symptoms, the lowest in his scale being ninety-seven, and the
+highest fourteen hundred and ninety-one. And having made out this
+list respecting any drug, a catalogue which, as you may observe in any
+Homoeopathic manual, contains various symptoms belonging to every organ
+of the body, what can be easier than to find alleged cures in every
+medical author which can at once be attributed to the Homoeopathic
+principle; still more if the grave of extinguished credulity is called
+upon to give up its dead bones as living witnesses; and worst of all, if
+the monuments of the past are to be mutilated in favor of “the sole law
+of Nature in therapeutics”?
+
+There are a few familiar facts of which great use has been made as an
+entering wedge for the Homoeopathic doctrine. They have been suffered
+to pass current so long that it is time they should be nailed to
+the counter, a little operation which I undertake, with perfect
+cheerfulness, to perform for them.
+
+The first is a supposed illustration of the Homoeopathic law found in
+the precept given for the treatment of parts which have been frozen, by
+friction with snow or similar means. But we deceive ourselves by names,
+if we suppose the frozen part to be treated by cold, and not by heat.
+The snow may even be actually 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 to a frozen part, except as
+a mode of regulating the application of what? of heat. But the heat must
+be applied gradually, just as food must be given a little at a time to
+those perishing with hunger. If the patient were brought into a warm
+room, heat would be applied very rapidly, were not something interposed
+to prevent this, and allow its gradual admission. Snow or iced water is
+exactly what is wanted; it is not cold to the part; it is very possibly
+warm, on the contrary, for these terms are relative, and if it does not
+melt and let the heat in, or is not taken away, the part will remain
+frozen up until doomsday. Now the treatment of a frozen limb by heat, in
+large or small quantities, is not Homoeopathy.
+
+The next supposed illustration of the Homoeopathic law is the alleged
+successful management of burns, by holding them to the fire. This is a
+popular mode of treating those burns which are of too little consequence
+to require any more efficacious remedy, and would inevitably get well of
+themselves, without any trouble being bestowed upon them. It produces
+a most acute pain in the part, which is followed by some loss of
+sensibility, as happens with the eye after exposure to strong light, and
+the ear after being subjected to very intense sounds. This is all it
+is capable of doing, and all further notions of its efficacy must be
+attributed merely to the vulgar love of paradox. If this example affords
+any comfort to the Homoeopathist, it seems as cruel to deprive him of
+it as it would be to convince the mistress of the smoke-jack or the
+flatiron that the fire does not literally “draw the fire out,” which is
+her hypothesis.
+
+But if it were true that frost-bites were cured by cold and burns by
+heat, it would be subversive, so far as it went, of the great principle
+of Homoeopathy.
+
+For you will remember that this principle is that Like cures Like, and
+not that Same cures Same; that there is resemblance and not identity
+between the symptoms of the disease and those produced by the drug which
+cures it, and none have been readier to insist upon this distinction
+than the Homoeopathists themselves. For if Same cures Same, then every
+poison must be its own antidote,--which is neither a part of their
+theory nor their so-called experience. They have been asked often
+enough, why it was that arsenic could not cure the mischief which
+arsenic had caused, and why the infectious cause of small-pox did not
+remedy the disease it had produced, and then they were ready enough to
+see the distinction I have pointed out. O no! it was not the hair of the
+same dog, but only of one very much like him!
+
+A third instance in proof of the Homoeopathic law is sought for in the
+acknowledged efficacy of vaccination. And how does the law apply to
+this? It is granted by the advocates of Homoeopathy that there is a
+resemblance between the effects of the vaccine virus on a person in
+health and the symptoms of small-pox. Therefore, according to the rule,
+the vaccine virus will cure the small-pox, which, as everybody knows, is
+entirely untrue. But it prevents small-pox, say the Homoeopathists. Yes,
+and so does small-pox prevent itself from ever happening again, and we
+know just as much of the principle involved in the one case as in the
+other. For this is only one of a series of facts which we are wholly
+unable to explain. Small-pox, measles, scarlet-fever, hooping-cough,
+protect those who have them once from future attacks; but nettle-rash
+and catarrh and lung fever, each of which is just as Homoeopathic to
+itself as any one of the others, have no such preservative power. We
+are obliged to accept the fact, unexplained, and we can do no more for
+vaccination than for the rest.
+
+I come now to the most directly practical point connected with the
+subject, namely,--
+
+What is the state of the evidence as to the efficacy of the proper
+Homoeopathic treatment in the cure of diseases.
+
+As the treatment adopted by the Homoeopathists has been almost
+universally by means of the infinitesimal doses, the question of their
+efficacy is thrown open, in common with that of the truth of their
+fundamental axiom, as both are tested in practice.
+
+We must look for facts as to the actual working of Homoeopathy to three
+sources.
+
+1. The statements of the unprofessional public.
+
+2. The assertions of Homoeopathic practitioners.
+
+3. The results of trials by competent and honest physicians, not pledged
+to the system.
+
+I think, after what we have seen of medical facts, as they are
+represented by incompetent persons, we are disposed to attribute little
+value to all statements of wonderful cures, coming from those who have
+never been accustomed to watch the caprices of disease, and have not
+cooled down their young enthusiasm by the habit of tranquil observation.
+Those who know nothing of the natural progress of a malady, of its
+ordinary duration, of its various modes of terminating, of its liability
+to accidental complications, of the signs which mark its insignificance
+or severity, of what is to be expected of it when left to itself, of how
+much or how little is to be anticipated from remedies, those who know
+nothing or next to nothing of all these things, and who are in a great
+state of excitement from benevolence, sympathy, or zeal for a new
+medical discovery, can hardly be expected to be sound judges of facts
+which have misled so many sagacious men, who have spent their lives in
+the daily study and observation of them. I believe that, after having
+drawn the portrait of defunct Perkinism, with its five thousand printed
+cures, and its million and a half computed ones, its miracles blazoned
+about through America, Denmark, and England; after relating that forty
+years ago women carried the Tractors about in their pockets, and workmen
+could not make them fast enough 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 lucky accident, so utterly lost is the
+memory of all their wonderful achievements; I believe, after all this, I
+need not waste time in showing that medical accuracy is not to be looked
+for in the florid reports of benevolent associations, the assertions
+of illustrious patrons, the lax effusions of daily journals, or the
+effervescent gossip of the tea-table.
+
+Dr. Hering, whose name is somewhat familiar to the champions of
+Homoeopathy, has said that “the new healing art is not to be judged
+by its success in isolated cases only, but according to its success in
+general, its innate truth, and the incontrovertible nature of its innate
+principles.”
+
+We have seen something of “the incontrovertible nature of its innate
+principles,” and it seems probable, on the whole, that its success in
+general must be made up of its success in isolated cases. Some attempts
+have been made, however, to finish the whole matter by sweeping
+statistical documents, which are intended to prove its triumphant
+success over the common practice.
+
+It is well known to those who have had the good fortune to see the
+“Homoeopathic Examiner,” that this journal led off, in its first number,
+with a grand display of everything the newly imported doctrine had to
+show for itself. It is well remarked, on the twenty-third page of this
+article, that “the comparison of bills of mortality among an equal
+number of sick, treated by divers methods, is a most poor and lame
+way to get at conclusions touching principles of the healing art.” In
+confirmation of which, the author proceeds upon the twenty-fifth page
+to prove the superiority of the Homoeopathic treatment of cholera,
+by precisely these very bills of mortality. Now, every intelligent
+physician is aware that the poison of cholera differed so much in its
+activity at different times and, places, that it was next to impossible
+to form any opinion as to the results of treatment, unless every
+precaution was taken to secure the most perfectly corresponding
+conditions in the patients treated, and hardly even then. Of course,
+then, a Russian Admiral, by the name of Mordvinov, backed by a number
+of so-called physicians practising in Russian villages, is singularly
+competent to the task of settling the whole question of the utility of
+this or that kind of treatment; to prove that, if not more than eight
+and a half per cent. of those attacked with the disease perished, the
+rest owed their immunity to Hahnemann. I can remember when more than
+a hundred patients in a public institution were attacked with what, I
+doubt not, many Homoeopathic physicians (to say nothing of Homoeopathic
+admirals) would have called cholera, and not one of them died, though
+treated in the common way, and it is my firm belief that, if such a
+result had followed the administration of the omnipotent globules, it
+would have been in the mouth of every adept in Europe, from Quin of
+London to Spohr of Gandersheim. No longer ago than yesterday, in one of
+the most widely circulated papers of this city, there was published an
+assertion that the mortality in several Homoeopathic Hospitals was
+not quite five in a hundred, whereas, in what are called by the writer
+Allopathic Hospitals, it is said to be eleven in a hundred. An honest
+man should be ashamed of such an argumentum ad ignorantiam. The
+mortality of a hospital depends not merely on the treatment of the
+patients, but on the class of diseases it is in the habit of receiving,
+on the place where it is, on the season, and many other circumstances.
+For instance, there are many hospitals in the great cities of Europe
+that receive few diseases of a nature to endanger life, and, on the
+other hand, there are others where dangerous diseases are accumulated
+out of the common proportion. Thus, in the wards of Louis, at the
+Hospital of La Pitie, a vast number of patients in the last stages of
+consumption were constantly entering, to swell the mortality of that
+hospital. It was because he was known to pay particular attention to
+the diseases of the chest that patients laboring under those fatal
+affections to an incurable extent were so constantly coming in upon him.
+It is always a miserable appeal to the thoughtlessness of the vulgar, to
+allege the naked fact of the less comparative mortality in the practice
+of one hospital or of one physician than another, as an evidence of the
+superiority of their treatment. Other things being equal, it must always
+be expected that those institutions and individuals enjoying to the
+highest degree the confidence of the community will lose the largest
+proportion of their patients; for the simple reason that they will
+naturally be looked to by those suffering from the gravest class
+of diseases; that many, who know that they are affected with mortal
+disease, will choose to die under their care or shelter, while the
+subjects of trifling maladies, and merely troublesome symptoms, amuse
+themselves to any extent among the fancy practitioners. When, therefore,
+Dr. Mublenbein, as stated in the “Homoeopathic Examiner,” and quoted
+in yesterday's “Daily Advertiser,” asserts that the mortality among
+his patients is only one per cent. since he has practised Homoeopathy,
+whereas it was six per cent. when he employed the common mode of
+practice, I am convinced by this, his own statement, that the citizens
+of Brunswick, whenever they are seriously 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 detailed examination of the very numerous cases
+reported in the Homoeopathic Treatises and Journals. Having been in the
+habit of receiving the French “Archives of Homoeopathic Medicine” until
+the premature decease of that Journal, I have had the opportunity of
+becoming acquainted somewhat with the style of these documents, and
+experiencing whatever degree of conviction they were calculated to
+produce. Although of course I do not wish any value to be assumed for my
+opinion, such as it is, I consider that you are entitled to hear it. So
+far, then, as I am acquainted with the general character of the cases
+reported by the Homoeopathic physicians, they would for the most part
+be considered as wholly undeserving a place in any English, French,
+or American periodical of high standing, if, instead of favoring the
+doctrine they were intended to support, they were brought forward to
+prove the efficacy of any common remedy administered by any common
+practitioner. There are occasional exceptions to this remark; but the
+general truth of it is rendered probable by the fact that these cases
+are always, or almost always, written with the single object of showing
+the efficacy of the medicine used, or the skill of the practitioner, and
+it is recognized as a general rule that such cases deserve very little
+confidence. Yet they may sound well enough, one at a time, to those who
+are not fully aware of the fallacies of medical evidence. Let me state
+a case in illustration. Nobody doubts that some patients 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 as
+a physician is called to in daily practice, would recover, sooner or
+later, with more or less difficulty, provided nothing were done to
+interfere seriously with the efforts of nature.
+
+Suppose, then, a physician who has a hundred patients prescribes to
+each of them pills made of some entirely inert substance, as starch,
+for instance. Ninety of them get well, or if he chooses to use such
+language, he cures ninety of them. It is evident, according to the
+doctrine of chances, that there must be a considerable number of
+coincidences between the relief of the patient and the administration
+of the remedy. It is altogether probable that there will happen two or
+three very striking coincidences out of the whole ninety cases, in which
+it would seem evident that the medicine produced the relief, though
+it had, as we assumed, nothing to do with it. Now suppose that the
+physician publishes these cases, will they not have a plausible
+appearance of proving that which, as we granted at the outset, was
+entirely false? Suppose that instead of pills of starch he employs
+microscopic sugarplums, with the five' million billion trillionth
+part of a suspicion of aconite or pulsatilla, and then publishes his
+successful cases, through the leaden lips of the press, or the living
+ones of his female acquaintances,--does that make the impression a less
+erroneous one? But so it is that in Homoeopathic works and journals and
+gossip one can never, or next to never, find anything but successful
+cases, which might do very well as a proof of superior skill, did it not
+prove as much for the swindling advertisers whose certificates disgrace
+so many of our newspapers. How long will it take mankind to learn that
+while they listen to “the speaking hundreds and units,” who make the
+world ring with the pretended triumphs they have witnessed, the “dumb
+millions” of deluded and injured victims are paying the daily forfeit of
+their misplaced confidence!
+
+I am sorry to see, also, that a degree of ignorance as to the natural
+course of diseases is often shown in these published cases, which,
+although it may not be detected by the unprofessional reader, conveys an
+unpleasant impression to those who are acquainted with the subject. Thus
+a young woman affected with jaundice is mentioned in the German “Annals
+of Clinical Homoeopathy” as having been cured in twenty-nine days by
+pulsatilla and nux vomica. Rummel, a well-known writer of the same
+school, speaks of curing a case of jaundice in thirty-four days by
+Homoeopathic doses of pulsatilla, aconite, and cinchona. I happened to
+have a case in my own household, a few weeks since, which lasted about
+ten days, and this was longer than I have repeatedly seen it in hospital
+practice, so that it was nothing to boast of.
+
+Dr. Munneche of Lichtenburg in Saxony is called to a patient with
+sprained ankle who had been a fortnight under the common treatment. The
+patient gets well by the use of arnica in a little more than a month
+longer, and this extraordinary fact is published in the French “Archives
+of Homoeopathic Medicine.”
+
+In the same Journal is recorded the case of a patient who with nothing
+more, so far as any proof goes, than influenza, gets down to her shop
+upon the sixth day.
+
+And again, the cool way in which everything favorable in a case is set
+down by these people entirely to their treatment, may be seen in a case
+of croup reported in the “Homoeopathic 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 of some Homoeopathic fluid.
+
+I need not multiply these quotations, which illustrate the grounds of
+an opinion which the time does not allow me to justify more at length;
+other such cases are lying open before me; there is no end to them if
+more were wanted; for nothing is necessary but to look into any of the
+numerous broken-down Journals of Homoeopathy, the volumes of which may
+be found on the shelves of those curious in such matters.
+
+A number of public trials of Homoeopathy have been made in different
+parts of the world. Six of these are mentioned in the Manifesto of the
+“Homoeopathic Examiner.” Now to suppose that any trial can absolutely
+silence people, would be to forget the whole experience of the past.
+Dr. Haygarth and Dr. Alderson could not stop the sale of the five-guinea
+Tractors, although they proved that they could work the same miracles
+with pieces of wood and tobacco-pipe. It takes time for truth to operate
+as well as Homoeopathic globules. Many persons thought the results of
+these trials were decisive enough of the nullity of the treatment; those
+who wish to see the kind of special pleading and evasion by which it is
+attempted to cover results which, stated by the “Homoeopathic 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 trials at all, having abundant other evidence on the point.
+But I think it best, on the whole, to mention two of them in a few
+words,--that instituted at Naples and that of Andral.
+
+There have been few names in the medical profession, for the last half
+century, so widely known throughout the world of science as that of M.
+Esquirol, whose life was devoted to the treatment of insanity, and who
+was without a rival in that department of practical medicine. It is from
+an analysis communicated by him to the “Gazette Medicale de Paris” that
+I derive my acquaintance with the account of the trial at Naples by Dr.
+Panvini, physician to the Hospital della Pace. This account seems to
+be entirely deserving of credit. Ten patients were set apart, and not
+allowed to take any medicine at all,--much against the wish of the
+Homoeopathic physician. All of them got well, and of course all of them
+would have been claimed as triumphs if they had been submitted to the
+treatment. Six other slight cases (each of which is specified) got well
+under the Homoeopathic treatment, none of its asserted specific effects
+being manifested.
+
+All the rest were cases of grave disease; and so far as the trial, which
+was interrupted about the fortieth day, extended, the patients grew
+worse, or received no benefit. A case is reported on the page before
+me of a soldier affected with acute inflammation in the chest, who took
+successively aconite, bryonia, nux vomica, and pulsatilla, and after
+thirty-eight days of treatment remained without any important change in
+his disease. The Homoeopathic physician who treated these patients was
+M. de Horatiis, who had the previous year been announcing his wonderful
+cures. And M. Esquirol asserted to the Academy of Medicine in 1835,
+that this M. de Horatiis, who is one of the prominent personages in the
+“Examiner's” Manifesto published in 1840, had subsequently renounced
+Homoeopathy. I may remark, by the way, that this same periodical, which
+is so very easy in explaining away the results of these trials, makes a
+mistake of only six years or a little more as to the time when this at
+Naples was instituted.
+
+M. Andral, the “eminent and very enlightened allopathist” of the
+“Homoeopathic Examiner,” made the following statement in March, 1835, to
+the Academy of Medicine: “I have submitted this doctrine to experiment;
+I can reckon at this time from one hundred and thirty to one hundred and
+forty cases, recorded with perfect fairness, in a great hospital, under
+the eye of numerous witnesses; to avoid every objection--I obtained my
+remedies of M. Guibourt, who keeps a Homoeopathic pharmacy, and whose
+strict exactness is well known; the regimen has been scrupulously
+observed, and I obtained from the sisters attached to the hospital a
+special regimen, such as Hahnemann orders. I was told, however, some
+months since, that I had not been faithful to all the rules of the
+doctrine. I therefore took the trouble to begin again; I have studied
+the practice of the Parisian Homoeopathists, as I had studied their
+books, and I became convinced that they treated their patients as I had
+treated mine, and I affirm that I have been as rigorously exact in the
+treatment as any other person.”
+
+And he expressly asserts the entire nullity of the influence of all
+the Homoeopathic remedies tried by him in modifying, so far as he could
+observe, the progress or termination of diseases. It deserves notice
+that he experimented with the most boasted substances,--cinchona,
+aconite, mercury, bryonia, belladonna. Aconite, for instance, he says
+he administered in more than forty cases of that collection of feverish
+symptoms in which it exerts so much power, according to Hahnemann, and
+in not one of them did it have the slightest influence, the pulse and
+heat remaining as before.
+
+These statements look pretty honest, and would seem hard to be explained
+away, but it is calmly said that he “did not know enough of the method
+to select the remedies with any tolerable precision.” [“Homoeopathic
+Examiner, vol. i. p. 22.]
+
+“Nothing is left to the caprice of the physician.” (In a word, instead
+of being dependent upon blind chance, that there is an infallible
+law, guided by which; the physician MUST select the proper remedies.')
+['Ibid.,' in a notice of Menzel's paper.] Who are they that practice
+Homoeopathy, and say this of a man with the Materia Medica of Hahnemann
+lying before him? Who are they that send these same globules, on which
+he experimented, accompanied by a little book, into families, whose
+members are thought competent to employ them, when they deny any such
+capacity to a man whose life has been passed at the bedside of patients,
+the most prominent teacher in the first Medical Faculty in the world,
+the consulting physician of the King of France, and one of the most
+renowned practical writers, not merely of his nation, but of his age?
+I leave the quibbles by which such persons would try to creep out from
+under the crushing weight of these conclusions to the unfortunates who
+suppose that a reply is equivalent to an answer.
+
+Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
+invited two Homoeopathic practitioners to experiment in his wards. One
+of these was Curie, now of London, whose works are on the counters
+of some of our bookstores, and probably in the hands of some of my
+audience. This gentleman, whom Dr. Baillie declares to be an enlightened
+man, and perfectly sincere in his convictions, brought his own medicines
+from the pharmacy which furnished Hahnemann himself, and employed them
+for four or five months upon patients in his ward, and with results
+equally unsatisfactory, as appears from Dr. Baillie's statement at
+a meeting of the Academy of Medicine. And a similar experiment was
+permitted by the Clinical Professor of the Hotel Dieu of Lyons, with the
+same complete failure.
+
+But these are old and prejudiced practitioners. Very well, then take the
+statement of Dr. Fleury, a most intelligent young physician, who treated
+homoeopathically more than fifty patients, suffering from diseases
+which it was not dangerous to treat in this way, taking every kind of
+precaution as to regimen, removal of disturbing influences, and the
+state of the atmosphere, insisted upon by the most vigorous partisans
+of the doctrine, and found not the slightest effect produced by the
+medicines. And more than this, read nine of these cases, 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
+are pretended to exert such palpable, such obvious, such astonishing
+influences. In the view of these statements, it is impossible not to
+realize the entire futility of attempting to silence this asserted
+science by the flattest and most peremptory results of experiment. Were
+all the hospital physicians of Europe and America to devote themselves,
+for the requisite period, to this sole pursuit, and were their results
+to be unanimous as to the total worthlessness of the whole system in
+practice, this slippery delusion would slide through their fingers
+without the slightest discomposure, when, as they supposed, they had
+crushed every joint in its tortuous and trailing body.
+
+3. I have said, that to show the truth of the Homoeopathic doctrine,
+as announced by Hahnemann, it would be necessary to show, in the third
+place, that remedies never cure diseases when they are not capable of
+producing similar symptoms! The burden of this somewhat comprehensive
+demonstration lying entirely upon the advocates of this doctrine, it may
+be left to their mature reflections.
+
+It entered into my original plan to treat of the doctrine relating to
+Psora, or itch,--an almost insane conception, which I am glad to get rid
+of, for this is a subject one does not care to handle without gloves. I
+am saved this trouble, however, by finding that many of the disciples
+of Hahnemann, those disciples the very gospel of whose faith stands upon
+his word, make very light of his authority on this point, although he
+himself says, “It has cost me twelve years of study and research to
+trace out the source of this incredible number of chronic affections,
+to discover this great truth, which remained concealed from all
+my predecessors and contemporaries, to establish the basis of its
+demonstration, and find out, at the same time, the curative medicines
+that were fit to combat this hydra in all its different forms.”
+
+But, in the face of all this, the following remarks are made by Wolff,
+of Dresden, whose essays, according to the editor of the “Homoeopathic
+Examiner,” “represent the opinions of a large majority of Homoeopathists
+in Europe.”
+
+“It cannot be unknown to any one at all familiar with Homoeopathic
+literature, that Hahnemann's idea of tracing the large majority of
+chronic diseases to actual itch has met with the greatest opposition
+from Homoeopathic physicians themselves.” And again, “If the Psoric
+theory has led to no proper schism, the reason is to be found in the
+fact that it is almost without any influence in practice.”
+
+We are told by Jahr, that Dr. Griesselich, “Surgeon to the Grand Duke
+of Baden,” and a “distinguished” Homoeopathist, actually asked Hahnemann
+for the proof that chronic diseases, such as dropsy, for instance, never
+arise from any other cause than itch; and that, according to common
+report, the venerable sage was highly incensed (fort courrouce) with
+Dr. Hartmann, of Leipsic, another “distinguished” Homoeopathist, for
+maintaining that they certainly did arise from other causes.
+
+And Dr. Fielitz, in the “Homoeopathic Gazette” of Leipsic, after saying,
+in a good-natured way, that Psora is the Devil in medicine, and that
+physicians are 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 Hahnemann who may honor me with his presence, by not attacking a
+doctrine on which some of the disciples of his creed would be very happy
+to have its adversaries waste their time and strength. I will not meddle
+with this excrescence, which, though often used in time of 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
+heavily to my sickle, that I should blunt it upon straw and stubble.
+
+I will close the subject with a brief examination of some of the
+statements made in Homoeopathic works, and more particularly in the
+brilliant Manifesto of the “Examiner,” before referred to. And first, it
+is there stated under the head of “Homoeopathic Literature,” that
+“SEVEN HUNDRED volumes have been issued from the press developing the
+peculiarities of the system, and many of them possessed of a scientific
+character that savans know well how to respect.” If my assertion were
+proper evidence in the case, I should declare, that, having seen a good
+many of these publications, from the year 1834, when I bought the work
+of the Rev. Thomas Everest, [Dr. Curie speaks of this silly pamphlet as
+having been published in 1835.] to within a few weeks, when I received
+my last importation of Homaeopathic literature, I have found that all,
+with a very few exceptions, were stitched pamphlets varying from
+twenty or thirty pages to somewhat less than a hundred, and generally
+resembling each other as much as so many spelling-books.
+
+But not being evidence in the case, I will give you the testimony of
+Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the same
+Manifesto as one of the most distinguished among the Homoeopathists
+of Europe. I translate the sentence literally from the “Archives de la
+Medecine Homoeopathique.”
+
+“The literature of Homoeopathy, if that honorable name must be applied
+to all kinds of book-making, has been degraded to the condition of the
+humblest servitude. Productions without talent, without spirit, without
+discrimination, flat and pitiful eulogies, exaggerations surpassing the
+limits of the most robust faith, invectives against such as dared to
+doubt the dogmas which had been proclaimed, or catalogues of remedies;
+of such materials is it composed! From distance to distance only, have
+appeared some memoirs useful to science or practice, which appear as so
+many green oases in the midst of this literary desert.”
+
+It is a very natural as well as a curious question to ask, What has been
+the success of Homoeopathy in the different countries of Europe, and
+what is its present condition?
+
+The greatest reliance of the advocates of Homoeopathy is of course
+on Germany. We know very little of its medical schools, its medical
+doctrines, or its medical men, compared with those of England and
+France. And, therefore, when an intelligent traveller gives a direct
+account from personal inspection of the miserable condition of the
+Homoeopathic hospital at Leipsic, the first established in Europe, and
+the first on the list of the ever-memorable Manifesto, it is easy enough
+answer or elude the fact by citing various hard names of “distinguished”
+ practitioners, which sound just as well to the uninformed public as if
+they were Meckel, or Tiedemann, or Langenbeck. Dr. Leo-Wolf, who, to be
+sure, is opposed to Homoeopathy, but who is a scholar, and ought to know
+something of his own countrymen, assures us that “Dr. Kopp is the only
+German Homoeopathist, if we can call him so, who has been distinguished
+as an author and practitioner before he examined this method.” And Dr.
+Lee, the same gentleman in whose travels the paragraph relating to
+the Leipsic Hospital is to be found, says the same thing. And I will
+cheerfully expose myself to any impertinent remark which it might
+suggest, to assure my audience that I never heard or saw one authentic
+Homoeopathic name of any country in Europe, which I had ever heard
+mentioned before as connected with medical science by a single word or
+deed sufficient to make it in any degree familiar to my ears, unless
+Arnold of Heidelberg is the anatomist who discovered a little nervous
+centre, called the otic ganglion. But you need ask no better proof of
+who and what the German adherents of this doctrine must be, than the
+testimony of a German Homoeopathist as to the wretched character of the
+works they manufacture to enforce its claims.
+
+As for the act of this or that government tolerating or encouraging
+Homoeopathy, every person of common intelligence knows that it is a mere
+form granted or denied according to the general principles of policy
+adopted in different states, or the degree of influence which some few
+persons who have adopted it may happen to have at court. What may be
+the value of certain pompous titles with which many of the advocates of
+Homoeopathy are honored, it might be disrespectful to question. But in
+the mean time the judicious inquirer may ponder over an extract which
+I translate from a paper relating to a personage well known to the
+community as Williams the Oculist, with whom I had the honor of crossing
+the Atlantic some years since, and who himself handed me two copies of
+the paper in question.
+
+“To say that he was oculist of Louis XVIII. and of Charles X., and
+that he now enjoys the same title with respect to His Majesty, Louis
+Philippe, and the King of the Belgians, is unquestionably to say a great
+deal; and yet it is one of the least of his titles to public confidence.
+His reputation rests upon a basis more substantial even than the
+numerous diplomas with which he is provided, than the membership of the
+different medical societies which have chosen him as their associate,”
+ etc., etc.
+
+And as to one more point, it is time that the public should fully
+understand that the common method of supporting barefaced imposture
+at the present day, both in Europe and in this country, consists in
+trumping up “Dispensaries,” “Colleges of Health,” and other advertising
+charitable clap-traps, which use the poor as decoy-ducks for the rich,
+and the proprietors of which have a strong predilection for the title
+of “Professor.” These names, therefore, have come to be of little or
+no value as evidence of the good character, still less of the high
+pretensions of those who invoke their authority. Nor does it
+follow, even when a chair is founded in connection with a well-known
+institution, that it has either a salary or an occupant; so that it may
+be, and probably is, a mere harmless piece of toleration on the part of
+the government if a Professorship of Homoeopathy is really in existence
+at Jena or Heidelberg. And finally, in order to correct the error of any
+who might suppose that the whole Medical Profession of Germany has long
+since fallen into the delusions of Hahnemann, I will quote two lines
+which a celebrated anatomist and surgeon (whose name will occur again in
+this lecture in connection with a very pleasing letter) addressed to the
+French Academy of Medicine in 1835. “I happened to be in Germany some
+months since, at a meeting of nearly six hundred physicians; one of
+them wished to bring up the question of Homoeopathy; they would not even
+listen to him.” This may have been very impolite and bigoted, but
+that is not precisely the point in reference to which I mention the
+circumstance.
+
+But if we cannot easily get at Germany, we can very easily obtain exact
+information from France and England. I took the trouble to write some
+months ago to two friends in Paris, in whom I could place confidence,
+for information upon the subject. One of them answered briefly to the
+effect that nothing was said about it. When the late Curator of the
+Lowell Institute, at his request, asked about the works upon the
+subject, he was told that they had remained a long time on the shelves
+quite unsalable, and never spoken of.
+
+The other gentleman, [Dr. Henry T. Bigelow, now Professor of Surgery
+in Harvard University] whose name is well known to my audience, and who
+needs no commendation of mine, had the kindness to procure for me many
+publications upon the subject, and some information which sets the whole
+matter at rest, so far as Paris is concerned. He went directly to the
+Baillieres, the principal and almost the only publishers of all the
+Homoeopathic books and journals in that city. The following facts
+were taken by him from the account-books of this publishing firm. Four
+Homoeopathic Journals have been published in Paris; three of them by the
+Baillieres.
+
+The reception they met with may be judged of by showing the number of
+subscribers to each on the books of the publishing firm.
+
+A Review published by some other house, which lasted one year, and had
+about fifty subscribers, appeared in 1834, 1835.
+
+There were only four Journals of Homoeopathy ever published in Paris.
+The Baillieres informed my correspondent that the sale of Homoeopathic
+books was much less than formerly, and that consequently they should
+undertake to publish no new books upon the subject, except those of Jahr
+or Hahnemann. “This man,” says my correspondent,--referring to one of
+the brothers,--“the publisher and headquarters of Homoeopathy in Paris,
+informs me that it is going down in England and Germany as well as
+in Paris.” For all the facts he had stated he pledged himself as
+responsible.
+
+Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
+since then has been going down.
+
+Louis told my correspondent that no person of distinction in Paris had
+embraced Homoeopathy, and that it was declining. If you ask who Louis
+is, I refer you to the well-known Homoeopathist, Peschier of Geneva, who
+says, addressing him, “I respect no one more than yourself; the feeling
+which guides your researches, your labors, and your pen, is so honorable
+and rare, that I could not but bow down before it; and I own, if there
+were any allopathist who inspired me with higher veneration, it would be
+him and not yourself whom I should address.”
+
+Among the names of “Distinguished Homoeopathists,” however, displayed in
+imposing columns, in the index of the “Homoeopathic Examiner,” are those
+of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the world of
+science, and the last of them identified with some of the most valuable
+contributions which anatomical knowledge has received since the
+commencement of the present century. One Dr. Chrysaora, who stands
+sponsor for many facts in that Journal, makes the following statement
+among the rest: “Professors, who are esteemed among the most
+distinguished of the Faculty (Faculty de Medicine), both as to knowledge
+and reputation, have openly confessed the power of Homoeopathia in
+forms of disease where the ordinary method of practice proved totally
+insufficient. It affords me the highest 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 Homoeopathists to my correspondent:--
+
+“DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
+
+“You have had the kindness to inform me in your letter that a new
+American Journal, the 'New World,' has made use of my name in support of
+the pretended Homoeopathic doctrines, and that I am represented as one
+of the warmest partisans of Homoeopathy in France.
+
+“I am vastly surprised at the reputation manufactured for me upon the
+new continent; but I am obliged, in deference to truth, to reject it
+with my whole energy. I spurn far from me everything which relates to
+that charlatanism called Homoeopathy, for these pretended doctrines
+cannot endure the scrutiny of wise and enlightened persons, who are
+guided by honorable sentiments in the practice of the noblest of arts.
+
+“PARIS, 3d November, 1841
+
+“I am, etc., etc.,
+
+“G. BRESCHET,
+
+“Professor in the Faculty of Medicine, Member of the Institute, Surgeon
+of Hotel Dieu, and Consulting Surgeon to the King, etc.” [I first saw M.
+Breschet's name mentioned in that Journal]
+
+Concerning Amussat, my correspondent writes, that he was informed by
+Madame Hahnemann, who converses in French more readily than her husband,
+and therefore often speaks for him, that “he was not a physician,
+neither Homoeopathist nor Allopathist, but that he was the surgeon
+of their own establishment; that is, performed as a surgeon all the
+operations they had occasion for in their practice.”
+
+I regret not having made any inquiries as to Marjolin, who, I doubt not,
+would strike his ponderous snuff-box until it resounded like the Grecian
+horse, at hearing such a doctrine associated with his respectable name.
+I was not aware, when writing to Paris, that this worthy Professor,
+whose lectures I long attended, was included in these audacious claims;
+but after the specimens I have given of the accuracy of the foreign
+correspondence of the “Homoeopathic Examiner,” any further information
+I might obtain would seem so superfluous as hardly to be worth the
+postage.
+
+Homoeopathy may be said, then, to be in a sufficiently miserable
+condition in Paris. Yet there lives, and there has lived for years, the
+illustrious Samuel Hahnemann, who himself assured my correspondent that
+no 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. Curie in October, 1839,
+about eight years after its introduction into the country, that there
+were eighteen Homoeopathic physicians in the United Kingdom, of whom
+only three were to be found out of London, and that many of these
+practised Homoeopathy in secret.
+
+It will be seen, therefore, that, according to the recent statement of
+one of its leading English advocates, Homoeopathy had obtained not quite
+half as many practical disciples in England as Perkinism could show for
+itself in a somewhat less period from the time of its first promulgation
+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, Homoeopathy is commencing to make an inroad into England by
+the way of Ireland. At Dublin, distinguished physicians have already
+embraced the new system, and a great part of the nobility and gentry
+of that city have emancipated themselves from the English fashion and
+professional authority.”
+
+But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
+Homoeopathy; the Queen Dowager Adelaide has been treated by a
+Homoeopathic 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 than two Lords, and
+if the Dowager of Royalty is better than Royalty itself, all of which
+illustrious dignities were claimed in behalf of Benjamin Douglass
+Perkins?
+
+But if the balance is thought too evenly suspended in this case, another
+instance can be given in which the evidence of British noblemen and
+their ladies is shown to be as valuable in establishing the character of
+a medical man or doctrine, as would be the testimony of the Marquis of
+Waterford concerning the present condition and prospects of missionary
+enterprise. I have before me an octavo volume of more than four hundred
+pages, in which, among much similar matter, I find highly commendatory
+letters from the Marchioness of Ormond, Lady Harriet Kavanagh, the
+Countess of Buckinghamshire, the Right Hon. Viscount Ingestre, M. P.,
+and the Most Noble, the Marquis of Sligo,--all addressed to “John
+St. John Long, Esq,” a wretched charlatan, twice tried for, and once
+convicted of, manslaughter at the Old Bailey.
+
+This poor creature, too, like all of his tribe, speaks of the medical
+profession as a great confederation of bigoted monopolists. He, too,
+says that “If an innovator should appear, holding out hope to those
+in despair, and curing disorders which the faculty have recorded as
+irremediable, he is at once, and without inquiry, denounced as an
+empiric and an impostor.” He, too, cites the inevitable names of Galileo
+and Harvey, and refers to the feelings excited by the great discovery of
+Jenner. From the treatment of the great astronomer who was visited with
+the punishment of other heretics by the ecclesiastical authorities of a
+Catholic country some centuries since, there is no very direct inference
+to be drawn to the medical profession of the present time. His name
+should be babbled no longer, after having been placarded for the
+hundredth time in the pages of St. John Long. But if we are doomed
+to see constant reference to the names of Harvey and Jenner in every
+worthless pamphlet containing the prospectus of some new trick upon the
+public, let us, once for all, stare the facts in the face, and see how
+the discoveries of these great men were actually received by the medical
+profession.
+
+In 1628, Harvey published his first work upon the circulation. His
+doctrines were a complete revolution of the prevailing opinions of all
+antiquity. They immediately found both champions and opponents; of
+which last, one only, Riolanus, seemed to Harvey worthy of an answer, on
+account of his “rank, fame, and learning.” Controversy in science, as in
+religion, was not, in those days, carried on with all the courtesy which
+our present habits demand, and it is possible that some hard words may
+have been applied to Harvey, as it is very certain that he used the 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 hearing it both well and ill spoken of; some attack it with
+great hostility, others defend it with high encomiums; one party believe
+that I have abundantly proved the truth of the doctrine against all
+the weight of opposing arguments, by experiments, observations, and
+dissections; others think it not yet sufficiently cleared up, and free
+from objections.” Two really eminent Professors, 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, dissolved away, gradually, but certainly, before
+the demonstrations of Harvey. Twenty-four years after the publication of
+his first work, and six years before his death, his bust in marble
+was placed in the Hall of the College of Physicians, with a suitable
+inscription recording his discoveries.
+
+Two years after this he was unanimously invited to accept the Presidency
+of that body; and he lived to see his doctrine established, and all
+reputable opposition withdrawn.
+
+There were many circumstances connected with the discovery of Dr. Jenner
+which were of a nature to excite repugnance and opposition. The practice
+of inoculation for the small-pox had already disarmed that disease of
+many of its terrors. The introduction of a contagious disease from a
+brute creature into the human system naturally struck the public mind
+with a sensation of disgust and apprehension, and a part of the medical
+public may have shared these feelings. I find that Jenner's discovery of
+vaccination was made public in June, 1798. In July of the same year the
+celebrated surgeon, Mr. Cline, vaccinated a child with virus received
+from Dr. Jenner, and in communicating the 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 published his “Inquiry,” containing the
+testimony of numerous practitioners in different parts of the kingdom,
+to the efficacy of the practice. Dr. HAYGARTH, who was so conspicuous
+in exposing the follies of Perkinism, was among the very earliest
+to express his opinion in favor of vaccination. In 1801, Dr. Lettsom
+mentions the circumstance “as being to the honor of the medical
+professors, that they have very generally encouraged this salutary
+practice, although it is certainly calculated to lessen their pecuniary
+advantages by its tendency to extirpate a fertile source of professional
+practice.”
+
+In the same year the Medical Committee of Paris spoke of vaccination in
+a public letter, as “the most brilliant and most important discovery
+of the eighteenth century.” The Directors of a Society for the
+Extermination of the Small-Pox, in a Report dated October 1st, 1807,
+“congratulate the public on the very favorable opinion which the Royal
+College of Physicians of London, after a most minute and laborious
+investigation 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 of
+which the sum of twenty thousand pounds was voted to 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 up against the Medical
+Profession, are only one mode in which is manifested a spirit of
+opposition not merely to medical science, but to all science, and to all
+sound knowledge. It is a spirit which neither understands itself nor the
+object at which it is aiming. It gropes among the loose records of 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 have passed their lives in the study of a branch of knowledge
+the very essence of which must always consist in long and accurate
+observation, are less competent to judge of new doctrines in their own
+department than the rest of the community. It belongs to the clown in
+society, the destructive in politics, and the rogue in practice.
+
+The name of Harvey, whose great discovery was the legitimate result of
+his severe training and patient study, should be mentioned only to check
+the pretensions of presumptuous ignorance. The example of Jenner,
+who gave his inestimable secret, the result of twenty-two years of
+experiment and researches, unpurchased, to the public,--when, as was
+said in Parliament, he might have made a hundred thousand pounds by it
+as well as any smaller sum,--should be referred to only to rebuke the
+selfish venders of secret remedies, among whom his early history obliges
+us reluctantly to record Samuel Hahnemann. Those who speak of the great
+body of physicians as if they were united in a league to support the
+superannuated notions of the past against the progress of improvement,
+have read 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 ambitious and plausible innovators. If at the present
+time ten years of public notoriety have passed over any doctrine
+professing to be of importance in medical science, and if it has not
+succeeded in raising up a powerful body of able, learned, and ingenious
+advocates for its claims, the fault must be in the doctrine and not in
+the medical profession.
+
+Homoeopathy has had a still more extended period of trial than this,
+and we have seen with what results. It only remains to throw out a few
+conjectures as to the particular manner in which it is to break up and
+disappear.
+
+1. The confidence of the few believers in this delusion will never
+survive the loss of friends who may die of any acute disease, under a
+treatment such as that prescribed by Homoeopathy. It is doubtful how far
+cases of this kind will be trusted to its tender mercies, but wherever
+it acquires any considerable foothold, such cases must come, and with
+them the ruin of those who practise it, should any highly valued life be
+thus sacrificed.
+
+2. After its novelty has worn out, the ardent and capricious individuals
+who constitute the most prominent class of its patrons will return to
+visible doses, were it only for the sake of a change.
+
+3. The Semi-Homoeopathic practitioner will gradually withdraw from
+the rotten half of his business and try to make the public forget his
+connection with it.
+
+4. The ultra Homoeopathist will either recant and try to rejoin the
+medical profession; or he will embrace some newer and if possible
+equally extravagant doctrine; or he will stick to his colors and go
+down with his sinking doctrine. Very few will pursue the course last
+mentioned.
+
+A single fact may serve to point out in what direction there will
+probably be a movement of the dissolving atoms of Homoeopathy. On the
+13th page of the too frequently cited Manifesto of the “Examiner” I read
+the following stately paragraph:
+
+“Bigelius, M. D., physician to the Emperor of Russia, whose elevated
+reputation is well known in Europe, has been an acknowledged advocate
+of Hahnemann's doctrines for several years. He abandoned Allopathia for
+Homoeopathia.” The date of this statement is January, 1840. I find on
+looking at the booksellers' catalogues that one Bigel, or Bigelius,
+to speak more classically, has been at various times publishing
+Homoeopathic books for some years.
+
+Again, on looking into the “Encyclographie des Sciences Medicales” for
+April, 1840, I find a work entitled “Manual of HYDROSUDOPATHY, or the
+Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel, Physician
+of the School of Strasburg, Member of the Medico-Chirurgical Institute
+of Naples, of the Academy of St. Petersburg,--Assessor of the College of
+the Empire of Russia, Physician of 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 sprung up in Germany since Homoeopathy, which it
+bids fair to drive out of the market, if, as Dr. Bigel says, fourteen
+physicians afflicted with diseases which defied themselves and their
+colleagues came to Graefenberg, in the year 1836 alone, and were cured.
+Now Dr. Bigel, “whose elevated reputation is well known in Europe,”
+ writes as follows: “The reader will not fail to see in this defence of
+the curative method of Graefenberg a profession of medical faith, and
+he will be correct in so doing.” And his work closes with the following
+sentence, worthy of so distinguished an individual: “We believe, with
+religion, that the water of baptism purifies the soul from its original
+sin; let us believe also, with experience, that it is for our corporeal
+sins the redeemer of the human body.” If Bigel, Physician to the late
+Grand Duke Constantine, is identical with Bigel whom the “Examiner”
+ calls Physician to the Emperor of Russia, it appears that he is now
+actively engaged in throwing cold water at once upon his patients and
+the future prospects of Homoeopathy.
+
+If, as must be admitted, no one of Hahnemann's doctrines is received
+with tolerable unanimity among his disciples, except the central axiom,
+Similia similibus curantur; if this axiom itself relies mainly for its
+support upon the folly and trickery of Hahnemann, what can we think of
+those who announce themselves ready to relinquish all the accumulated
+treasures of our art, to trifle with life upon the strength of these
+fantastic theories? What shall we think of professed practitioners of
+medicine, if, in the words of Jahr, “from ignorance, for their personal
+convenience, or through charlatanism, they treat their patients one
+day Homoeopathically and the next Allopathically;” if they parade their
+pretended new science before the unguarded portion of the community;
+if they suffer their names to be coupled with it wherever it may gain a
+credulous patient; and deny all responsibility for its character, refuse
+all argument for its doctrines, allege no palliation for the ignorance
+and deception interwoven with every thread of its flimsy tissue, when
+they are questioned by those competent to judge and entitled to an
+answer?
+
+Such is the pretended science of Homoeopathy, to which you are asked to
+trust your lives and the lives of those dearest to you. A mingled mass
+of perverse ingenuity, of tinsel erudition, of imbecile credulity, and
+of artful misrepresentation, too often mingled in practice, if we
+may trust the authority of its founder, with heartless and shameless
+imposition. Because it is suffered so often to appeal unanswered to the
+public, because it has its journals, its patrons, its apostles, some
+are weak enough to suppose it can escape the inevitable doom of utter
+disgrace and oblivion. Not many years can pass away before the same
+curiosity excited by one of Perkins's Tractors will be awakened at the
+sight of one of the Infinitesimal Globules. If it should claim a longer
+existence, it can only be by falling into the hands of the sordid
+wretches who wring their bread from the cold grasp of disease and death
+in the hovels of ignorant poverty.
+
+As one humble member of a profession which for more than two thousand
+years has devoted itself to the pursuit of the best earthly interests
+of mankind, always assailed and insulted from without by such as are
+ignorant of its infinite perplexities and labors, always striving in
+unequal contest with the hundred-armed giant who walks in the noonday,
+and sleeps not in the midnight, yet still toiling, not merely for itself
+and 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 noble science 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 so far contagious as to be
+frequently carried from patient to patient by physicians and nurses.” O.
+W. Holmes, 1843.
+
+THE NEGATIVE.
+
+“The result of the whole discussion will, I trust, serve, not only to
+exalt your views of the value and dignity of our profession, but to
+divest your minds of the overpowering dread that you can ever become,
+especially to woman, under the extremely interesting circumstances
+of gestation and parturition, the minister of evil; that you can ever
+convey, in any possible manner, a horrible virus, so destructive in
+its effects, and so mysterious in its operations as that attributed to
+puerperal fever.”--Professor Hodge, 1852.
+
+“I prefer to attribute them to accident, or Providence, of which I can
+form a conception, rather than to a contagion of which I cannot form any
+clear idea, at least as to this particular malady.”--Professor Meigs,
+1852.
+
+“... in the propagation of which they have no more to do, than with the
+propagation of cholera from Jessore to San Francisco, and from Mauritius
+to St. Petersburg.”--Professor Meigs, 1854.
+
+
+          ---------------------
+
+“I arrived at that certainty in the matter, that I could venture to
+foretell what women would be affected with the disease, upon hearing by
+what midwife they were to be delivered, or by what nurse they 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 every year by the contagion of
+puerperal fever, communicated by the nurses and medical attendants.”
+ Farr, in Fifth Annual Report of Registrar-General of England, 1843.
+
+“... boards of health, if such exist, or, without them, the medical
+institutions of a country, should have the power of coercing, or of
+inflicting some kind of punishment on those who recklessly go from cases
+of puerperal fevers to parturient or puerperal females, without
+using due precaution; and who, having been shown the risk, criminally
+encounter it, and convey pestilence and death to the persons they are
+employed to aid in the most interesting and suffering period of female
+existence.” --Copland's Medical Dictionary, Art. Puerperal States and
+Diseases, 1852.
+
+“We conceive it unnecessary to go into detail to prove the contagious
+nature of this disease, as there are few, if any, American practitioners
+who do not believe in this doctrine.”--Dr. Lee, in Additions to Article
+last cited.
+
+
+         -----------------------
+
+[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
+arose in a Medical Society of which I was a member, involving the
+subject of a certain supposed cause of disease, about which something
+was known, a good deal suspected, and not a little feared. The
+discussion was suggested by a case, reported at the preceding meeting,
+of a physician who made an examination of the body of a patient who had
+died with puerperal fever, and who himself died in less than a week,
+apparently in consequence of a wound received at the examination, having
+attended several women in confinement in the mean time, all of whom, as
+it was alleged, were attacked with puerperal fever.
+
+Whatever apprehensions and beliefs were entertained, it was plain that
+a fuller knowledge of the facts relating to the subject would be
+acceptable to all present. I therefore felt that it would be doing a
+good service to look into the best records I could find, and inquire of
+the most trustworthy practitioners I knew, to learn what experience
+had to teach in the matter, and arrived at the results contained in the
+following pages.
+
+The Essay was read before the Boston Society for Medical Improvement,
+and, at the request of the Society, printed in the “New England
+Quarterly Journal of Medicine and Surgery” for April, 1843. As this
+Journal never obtained a large circulation, and ceased to be published
+after a year's existence, and as the few copies I had struck off
+separately were soon lost sight of among the friends to whom they were
+sent, the Essay can hardly be said to have been fully brought before the
+Profession.
+
+The subject of this Paper has the same profound interest for me at
+the present moment as it had when I was first collecting the terrible
+evidence out of which, as it seems to me, the commonest exercise of
+reason could not help shaping the truth it involved. It is not merely on
+account of the bearing of the question,--if there is a question,--on all
+that is most sacred in human life and happiness, that the subject cannot
+lose its interest. It is because it seems evident that a fair statement
+of the facts must produce its proper influence on a very large
+proportion of well-constituted and unprejudiced minds. Individuals may,
+here and there, resist the practical bearing of the evidence on their
+own feelings or interests; some may fail to see its meaning, as some
+persons may be found who cannot tell red from green; but I cannot doubt
+that most readers will be satisfied and convinced, to loathing, long
+before they have finished the dark obituary calendar laid before them.
+
+I do not know that I shall ever again have so good an opportunity of
+being useful as was granted me by the raising of the question which
+produced this Essay. For I have abundant evidence that it has made many
+practitioners more cautious in their relations with puerperal females,
+and I have no doubt it will do so still, if it has a chance of being
+read, though it should call out a hundred counterblasts, proving to the
+satisfaction of their authors that it proved nothing. And for my part, I
+had rather rescue one mother from being poisoned by her attendant, than
+claim to have saved forty out of fifty patients to whom I had carried
+the disease. Thus, I am willing to avail myself of any hint coming from
+without to offer this paper once more to the press. The occasion
+has presented itself, as will be seen, in a convenient if 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
+eliminates those secondary questions which cannot be entertained for a
+moment until the one great point of fact is peremptorily settled. In its
+very statement of the doctrine maintained it avoids all discussion
+of the nature of the disease “known as puerperal fever,” and all the
+somewhat stale philology of the word contagion. It mentions, fairly
+enough, the names of sceptics, or unbelievers as to the reality of
+personal transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque,
+and others; of course, not including those whose works were then
+unwritten or unpublished; nor enumerating all the Continental writers
+who, in ignorance of the great mass of evidence accumulated by British
+practitioners, could hardly be called well informed on this subject. It
+meets all the array of negative cases,--those in which disease did not
+follow exposure,--by the striking example of small-pox, which,
+although one of the most contagious of diseases, is subject to the most
+remarkable irregularities and seeming caprices in its transmission. It
+makes full allowance for other causes besides personal transmission,
+especially for epidemic influences. It allows for the possibility
+of different modes of conveyance of the destructive principle. It
+recognizes and supports the belief that a series of cases may originate
+from a single primitive source which affects each new patient in turn;
+and especially from cases of Erysipelas. It does not undertake to
+discuss the theoretical aspect of the subject; that is a secondary
+matter of consideration. Where facts are numerous, and unquestionable,
+and unequivocal in their significance, theory must follow them as it
+best may, keeping time with their step, and not go before them, marching
+to the sound of its own drum and trumpet. Having thus narrowed its area
+to a limited practical platform of discussion, a matter of life and
+death, and not of phrases or theories, it covers every inch of it with a
+mass of evidence which I conceive a Committee of Husbands, who can count
+coincidences and draw conclusions as well as a Synod of Accoucheurs,
+would justly consider as affording ample reasons for an unceremonious
+dismissal of a practitioner (if it is conceivable that such a step could
+be waited for), after five or six funerals had marked the path of his
+daily visits, while other practitioners 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 hands this Essay may fall, some
+words of introduction may be appropriate, and perhaps, to a small number
+of them, necessary. There are some among them who, from youth, or want
+of training, are easily bewildered and confused in any conflict of
+opinions into which their studies lead them. They are liable to lose
+sight of the main question in collateral issues, and to be run away with
+by suggestive speculations. They confound belief with evidence, often
+trusting the first because it is expressed with energy, and slighting
+the latter because it is calm and unimpassioned. They are not satisfied
+with proof; they cannot believe a point is settled so long as everybody
+is not silenced. They have not learned that error is got out of the
+minds that cherish it, as the taenia is removed from the body, one
+joint, or a few joints at a time, for the most part, rarely the whole
+evil at once. They naturally have faith in their instructors, turning to
+them for truth, and taking what they may choose to give them; babes in
+knowledge, not yet able to tell the breast from the bottle, pumping away
+for the milk of truth at all that offers, were it nothing better than a
+Professor's shrivelled forefinger.
+
+In the earliest and embryonic stage of professional development, any
+violent impression on the instructor's mind is apt to be followed by
+some lasting effect on that of the pupil. No mother's mark is more
+permanent than the mental naevi and moles, and excrescences, and
+mutilations, that students carry with them out of the lecture-room, if
+once the teeming intellect which nourishes theirs has been scared from
+its propriety by any misshapen fantasy. Even an impatient or petulant
+expression, which to a philosopher would be a mere index of the low
+state of amiability of the speaker at the moment of its utterance, may
+pass into the young mind as an element of its future constitution, to
+injure its temper or corrupt its judgment. It is a duty, therefore,
+which we owe to this younger class of students, to clear any important
+truth which may have been rendered questionable in their minds by such
+language, or any truth-teller against whom they may have been prejudiced
+by hasty epithets, 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 this
+prejudice is local or personal, and not an acknowledged conviction with
+the public at large. It may be necessary to break through our usual
+habits of reserve to do this, but this is the fault of the position in
+which others have placed us.
+
+Two widely-known and highly-esteemed practitioners, Professors in two
+of the largest Medical Schools of the Union, teaching the branch of
+art which includes the Diseases of Women, and therefore speaking with
+authority; addressing in their lectures and printed publications large
+numbers of young men, many of them in the tenderest immaturity of
+knowledge, have recently taken ground in a formal way against the
+doctrine maintained 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 of his Class. By Charles D. Meigs,
+M. D., Professor of Midwifery and the Diseases of Women and Children in
+Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854.
+Letter VI.
+
+The first of the two publications, Dr. Hodge's Lecture, while its
+theoretical considerations and negative experiences do not seem to me to
+require any further notice than such as lay ready for them in my Essay
+written long before, is, I am pleased to say, unobjectionable in tone
+and language, and may be read without offence.
+
+This can hardly be said of the chapter of Dr. Meigs's volume which
+treats of Contagion in Childbed Fever. There are expressions used in it
+which might well put a stop to all scientific discussions, were they
+to form the current coin in our exchange of opinions. I leave the “very
+young gentlemen,” whose careful expositions of the results of practice
+in more than six thousand cases are characterized as “the jejune and
+fizenless dreamings of sophomore writers,” to the sympathies of those
+“dear young friends,” and “dear young gentlemen,” who will judge how
+much to value their instructor's counsel to think for themselves,
+knowing what they are to expect if they happen not to think as he does.
+
+One unpalatable expression I suppose the laws of construction oblige
+me to appropriate to myself, as my reward for a certain amount of labor
+bestowed on the investigation of a very important question of evidence,
+and a statement of my own practical conclusions. I take no offence, and
+attempt no retort. No man makes a quarrel with me over the counterpane
+that covers a mother, with her new-born infant at her breast. There is
+no epithet in the vocabulary of slight and sarcasm that can reach my
+personal sensibilities in such a controversy. Only just so far as a
+disrespectful phrase may turn the student aside from the examination of
+the evidence, by discrediting or dishonoring the witness, does it call
+for any word of notice.
+
+I appeal from the disparaging language by which the Professor in the
+Jefferson School of Philadelphia would dispose of my claims to be
+listened to. I appeal, not to the vote of the Society for Medical
+Improvement, although this was an unusual evidence of interest in the
+paper in question, for it was a vote passed among my own townsmen; nor
+to the opinion of any American, for none know better than the Professors
+in the great Schools of Philadelphia how cheaply the praise of native
+contemporary criticism is obtained. I appeal to the recorded opinions
+of those whom I do 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 spoken of my Essay in phrases to which
+the pamphlets of American “scribblers” are seldom used from European
+authorities; to Ramsbotham, whose compendious eulogy is all
+that self-love could ask; to the “Fifth Annual Report” of the
+Registrar-General of England, in which the second-hand abstract of
+my Essay figures largely, and not without favorable comment, in an
+important appended paper. These testimonies, half forgotten until
+this circumstance recalled them, are dragged into the light, not in a
+paroxysm of vanity, but to show that there may be food for thought in
+the small pamphlet which the Philadelphia Teacher treats so lightly.
+They were at least unsought for, and would never have been proclaimed
+but for the sake of securing the privilege of a decent and unprejudiced
+hearing.
+
+I will take it for granted that they have so far counterpoised the
+depreciating language of my fellow-countryman and fellow-teacher as to
+gain me a reader here and there among the youthful class of students I
+am now addressing. It is only for their sake that I think it 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 for
+beginners; and as I do not expect the practitioner, or even the more
+mature student, to take the trouble to follow me through an Introduction
+which I consider wholly unnecessary and superfluous for them, I shall
+not hesitate to stoop to the most elementary simplicity for the benefit
+of the younger student. I do this more willingly because it affords a
+good opportunity, as it seems to me, of exercising the untrained mind
+in that medical logic which does not seem to have been either taught or
+practised in our schools of late, to the extent that might be desired.
+
+I will now exhibit, in a series of propositions reduced to their
+simplest expression, the same essential statements and conclusions as
+are contained in the Essay, with such commentaries and explanations as
+may be profitable to the inexperienced class of readers addressed.
+
+I. It has been long believed, by many competent observers, that
+Puerperal Fever (so called) is sometimes carried from patient to patient
+by medical assistants.
+
+II. The express object of this Essay is to prove that it is so carried.
+
+III. In order to prove this point, it is not necessary to consult
+any medical theorist as to whether or not it is consistent with his
+preconceived notions that such a mode of transfer should exist.
+
+IV. If the medical theorist insists on being consulted, and we see fit
+to indulge him, he cannot be allowed to assume that the alleged laws of
+contagion, deduced from observation in other diseases, shall be cited
+to disprove the alleged laws deduced from observation in this. Science
+would never make progress under such conditions. Neither the long
+incubation of hydrophobia, nor the protecting power of vaccination,
+would ever have been admitted, if the results of observation in
+these affections had been rejected as contradictory to 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 which I have examined.
+
+VI. When an unusually large number of cases of this disease occur about
+the same time, it is inferred, therefore, that there exists some special
+cause for this increased frequency. If the disease prevails extensively
+over a wide region of country, it is attributed without dispute to
+an epidemic influence. If it prevails in a single locality, as in a
+hospital, and not elsewhere, this is considered proof that some local
+cause is there active in its production.
+
+VII. When a large number of cases of this disease occur in rapid
+succession, in one individual's ordinary practice, and few or none
+elsewhere, these cases appearing in scattered localities, in patients of
+the same average condition as those who escape under the care of others,
+there is the same reason for connecting the cause of the disease with
+the person in this instance, as with the place in that last mentioned.
+
+VIII. Many series of cases, answering to these conditions, are given
+in this Essay, and many others will be referred to which have occurred
+since it was written.
+
+IX. The alleged results of observation may be set aside; first, because
+the so-called facts are in their own nature equivocal; secondly, because
+they stand on insufficient authority; thirdly, because they are not
+sufficiently numerous. But, in this case, the disease is one of striking
+and well-marked character; the witnesses are experts, interested in
+denying and disbelieving the facts; the number of consecutive cases in
+many instances frightful, and the number of series of cases such that I
+have no room for many of them except 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 effect of chance. I have had the chances calculated by
+a competent person, that a given practitioner, A., shall have sixteen
+fatal cases in a month, on the following data: A. to average attendance
+upon two hundred and fifty births in a year; three deaths in one
+thousand births to be assumed as the average from puerperal fever; no
+epidemic to be at the time prevailing. It follows, from the answer given
+me, that if we suppose every one of the five hundred thousand annual
+births of England to have been recorded during the last half-century,
+there would not be one chance in a million million million millions that
+one such series should be noted. No possible fractional error in this
+calculation can render the chance a working probability. Applied to
+dozens of series of various lengths, it is obviously an absurdity.
+Chance, therefore, is out of the question as an explanation of the
+admitted coincidences.
+
+XI. There is, therefore, some relation of cause and effect between the
+physician's presence and the patient's disease.
+
+XII. Until it is proved to what removable condition attaching to the
+attendant the disease is owing, he is bound to stay away from his
+patients so soon as he finds himself singled out to be tracked by the
+disease. How long, and with what other precautions, I have suggested,
+without dictating, at the close of my Essay. If the physician does
+not at once act on any reasonable suspicion of his being the medium of
+transfer, the families where he is engaged, if they are allowed to know
+the facts, should decline his services for the time. His feelings on the
+occasion, however interesting to himself, should not be even named in
+this connection. A physician who talks about ceremony and gratitude, and
+services rendered, and the treatment he got, surely forgets himself;
+it is impossible that he should seriously think of these small matters
+where there is even a question 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 mode in which he may
+relieve his mind of any confusion, or possibly, if very young, any
+doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised in
+his mind.
+
+The most prominent ideas of the Letter are, first, that the
+transmissible nature of puerperal fever appears improbable, and,
+secondly, that it would be very inconvenient to the writer. Dr.
+Woodville, Physician to the Small-Pox and Inoculation Hospital in
+London, found it improbable, and exceedingly inconvenient to himself,
+that cow pox should prevent small-pox; but Dr. Jenner took the liberty
+to prove the fact, notwithstanding.
+
+I will first call the young student's attention to the show of negative
+facts (exposure without subsequent disease), of which much seems to be
+thought. And I may at the same time refer him to Dr. Hodge's Lecture,
+where he will find the same kind of facts and reasoning. Let him now
+take up Watson's Lectures, the good sense and spirit of which have made
+his book a universal favorite, and open to the chapter on Continued
+Fever. He will find a paragraph containing the following sentence: “A
+man might say, 'I was in the battle of Waterloo, and saw many men around
+me fall down and die, and it was said that they were struck down by
+musket-balls; but I know better than that, for I was there all the
+time, and so were many of my friends, and we were never hit by any
+musket-balls. Musket-balls, therefore, could not have been the cause of
+the deaths we witnessed.' And if, like contagion, they were not palpable
+to the senses, such a person might go on to affirm that no proof existed
+of there being any such thing as musket-balls.” Now let the student turn
+back to the chapter on Hydrophobia in the same volume. He will find that
+John Hunter knew a case in which, of twenty-one persons bitten, only one
+died of the disease. He will find that one dog at Charenton was bitten
+at different times by 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
+rabid animal, because so many escape? Or let him look at “Underwood on
+Diseases of Children,” [Philadelphia, 1842, p. 244, note.] and he will
+find the case of a young woman who was inoculated eight times in thirty
+days, at the same time attending several children with smallpox, and yet
+was not infected. But seven weeks afterwards she took the disease and
+died.
+
+It would seem as if the force of this argument could hardly fail to be
+seen, if it were granted that every one of these series of cases were so
+reported as to prove that there could have been no transfer of disease.
+There is not one of them so reported, in the Lecture or the Letter, as
+to prove that the disease may not have been carried by the practitioner.
+I strongly suspect that it was so carried in some of these cases, but
+from the character of the very imperfect evidence the question can never
+be settled without further disclosures.
+
+Although the Letter is, as I have implied, principally taken 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 touch
+some of these questions briefly, as an illustration of its logical
+character.
+
+The first thing to be done, as I thought when I wrote my Essay, was
+to throw out all discussions of the word contagion, and this I did
+effectually by the careful wording of my statement of the subject to be
+discussed. My object was not to settle the etymology or definition of
+a word, but to show that women had often died in childbed, poisoned in
+some way by their medical attendants. On the other point, I, at least,
+have no controversy with anybody, and I think the student will do well
+to avoid it in this connection. If I must define my position, however,
+as well as the term in question, I am contented with Worcester's
+definition; provided always this avowal do not open another 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 the laws of the
+eruptive fevers must necessarily hold true of this peculiar disease
+of puerperal women. If there were any such propriety, the laws of the
+eruptive fevers must at least be stated correctly. It is not true,
+for instance, as Dr. Meigs states, that contagion is “no respecter of
+persons;” that “it attacks all individuals alike.” To give one example:
+Dr. Gregory, of the Small-Pox Hospital, who ought to know, says that
+persons pass through life apparently insensible to or unsusceptible of
+the small-pox virus, and that the same persons do not take the vaccine
+disease.
+
+As to the short time of incubation, of which so much is made, we have
+no right to decide beforehand whether it shall be long or short, in the
+cases we are considering. A dissection wound may produce symptoms of
+poisoning in six hours; the bite of a rabid animal may take as many
+months.
+
+After the student has read the case in Dr. Meigs's 136th paragraph, and
+the following one, in which he exclaims against the idea of contagion,
+because the patient, delivered on the 26th of December, was attacked in
+twenty-four hours, and died on the third day, let him read what happened
+at the “Black Assizes” of 1577 and 1750. In the first case, six hundred
+persons sickened the same night of the exposure, and three hundred more
+in three days. [Elliotson's Practice, p. 298.] Of those attacked in the
+latter year, the exposure being on the 11th of May, Alderman Lambert
+died on the 13th, Under-Sheriff Cox on the 14th, and many of note before
+the 20th. But these are old stories. Let the student listen then to Dr.
+Gerhard, whose reputation as a cautious observer he may be supposed to
+know. “The nurse was shaving a man, who died in a few hours after his
+entrance; he inhaled his breath, which had a nauseous taste, and in an
+hour afterwards was taken with nausea, cephalalgia, and singing of the
+ears. From that moment the attack began, and assumed a severe character.
+The assistant was supporting another patient, who died soon afterwards;
+he felt the pungent heat upon his skin, and was taken immediately with
+the symptoms of typhus.” [Am. Jour. Med. Sciences, Feb. 1837, p. 299.]
+It is by notes of cases, rather than notes of admiration, that we must
+be guided, when we study the Revised Statutes of Nature, as laid down
+from the curule chairs of Medicine.
+
+Let the student read Dr. Meigs's 140th paragraph soberly, and then
+remember, that not only does he infer, suspect, and surmise, but he
+actually asserts (page 154), “there was poison in the house,” because
+three out of five patients admitted into a ward had puerperal fever and
+died. Have I not as much right to draw a positive inference from “Dr.
+A.'s” seventy exclusive cases as he from the 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 know that the
+patients he bled in puerperal fever would not have all got well if he
+had not bled them?
+
+“You see a man discharge a gun at another; you see the flash, you hear
+the report, you see the person fall a lifeless corpse; and you infer,
+from all these circumstances, that there was a ball discharged from the
+gun, which entered his body and caused his death, because such is the
+usual and natural cause of such an effect. But you did not see the ball
+leave the gun, pass through the air, and enter the body of the
+slain; and your testimony to the fact of killing is, therefore, only
+inferential,--in other words, circumstantial. It is possible that no
+ball was in the gun; and we infer that there was, only because 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: Is the circumstance of intercourse
+with the sick followed by the appearance of the disease in a proportion
+of cases so much greater than any other circumstance common to any
+portion of the inhabitants of the place under observation, as to make it
+inconceivable that the succession of cases occurring in persons having
+that intercourse should have been the result of chance? If so, the
+inference is unavoidable, that that intercourse must have acted as a
+cause of the disease. All observations which do not bear strictly
+on that point are irrelevant, and, in the case of an epidemic first
+appearing in a town or district, a succession of two cases is sometimes
+sufficient to furnish evidence which, on the principle I have stated, is
+nearly irresistible.”
+
+Possibly an inexperienced youth may be awe-struck by the quotation from
+Cuvier. These words, or their equivalent, are certainly to be found in
+his Introduction. So are the words “top not come down”! to be found in
+the Bible, and they were as much meant for the ladies' head-dresses as
+the words of Cuvier were meant to make clinical observation wait for a
+permit from anybody to look with its eyes and count on its fingers. Let
+the inquiring youth read the whole Introduction, and he will see what
+they mean.
+
+I intend no breach of courtesy, but this is a proper place to warn the
+student against skimming the prefaces and introductions of works for
+mottoes and embellishments to his thesis. He cannot learn anatomy by
+thrusting an exploring needle into the body. He will be very liable
+to misquote his author's meaning while he is picking off his outside
+sentences. He may make as great a blunder as that simple prince who
+praised the conductor of his orchestra for the piece just before the
+overture; the musician was too good a courtier to tell him that it was
+only the tuning of the instruments.
+
+To the six propositions in the 142d paragraph, and the remarks about
+“specific” diseases, the answer, if any is necessary, seems very simple.
+An inflammation of a serous membrane may give rise to secretions which
+act as a poison, whether that be a “specific” poison or not, as Dr.
+Homer has told his young readers, and as dissectors know too well; and
+that poison may produce its symptoms in a few hours after the system has
+received it, as any may see in Druitt's “Surgery,” if they care to look.
+Puerperal peritonitis may produce such a poison, and puerperal women may
+be very sensible to its influences, conveyed by contact or exhalation.
+Whether this is so or not, facts alone can determine, and to facts we
+have had recourse to settle it.
+
+The following statement is made by Dr. Meigs in his 142d paragraph, and
+developed more at length, with rhetorical amplifications, in the 134th.
+“No human being, save a pregnant or parturient woman, is susceptible to
+the poison.” This statement is wholly incorrect, as I am sorry to have
+to point out to a Teacher in Dr. Meigs's position. I do not object to
+the erudition which quotes Willis and Fernelius, the last of whom was
+pleasantly said to have “preserved the dregs of the Arabs in the honey
+of his Latinity.” But I could wish that more modern authorities had not
+been overlooked. On this point, for instance, among the numerous facts
+disproving the statement, the “American Journal of Medical Sciences,”
+ published not far from his lecture-room, would have presented him with
+a respectable catalog of such cases. Thus he might refer to Mr. Storrs's
+paper “On the Contagious Effects of Puerperal Fever on the Male Subject;
+or on Persons not Childbearing” (Jan. 1846), or to Dr. Reid's case
+(April, 1846), or to Dr. Barron's statement of the children's dying
+of peritonitis in an epidemic of puerperal fever at the Philadelphia
+Hospital (Oct. 1842), or to various instances cited in Dr. Kneeland's
+article (April, 186). Or, if he would have referred to the “New York
+Journal,” he might have seen Prof. Austin Flint's cases. Or, if he had
+honored my Essay so far, he might have found striking instances of the
+same kind in the first of the new series of cases there reported and
+elsewhere. I do not see the bearing of his proposition, if it were true.
+But it is one of those assertions that fall in a moment before a slight
+examination of the facts; and I confess my surprise, that a professor
+who lectures on the Diseases of Women should have ventured to make it.
+
+Nearly seven pages are devoted to showing that I was wrong in saying I
+would not be “understood to imply that there exists a doubt in the mind
+of any well-informed member of the medical profession as to the fact
+that puerperal fever is sometimes communicated from one person to
+another, both directly and indirectly.” I will devote seven lines to
+these seven pages, which seven 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.--Believes the disease is sometimes communicable by contagion.
+Tonnelle, Baudelocque. Both cited by me. Jacquemier.--Published three
+years after my Essay. Kiwisch. “Behindhand in knowledge of Puerperal
+Fever.” [B. & F. Med. Rev. Jan. 1842.] Paul Dubois.--Scanzoni.
+
+These Continental writers not well informed on this point.[See Dr.
+Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. Oct.
+1851.)]
+
+The story of Von Busch is of interest and value, but there is nothing in
+it which need perplex the student. It is not pretended that the disease
+is always, or even, it may be, in the majority of cases, carried about
+by attendants; only that it is so carried in certain cases. That it may
+have local and epidemic causes, as well as that depending on personal
+transmission, is not disputed. Remember how small-pox often disappears
+from a community in spite of its contagious character, and the necessary
+exposure of many persons to those suffering from it; in both diseases
+contagion is 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 puerperal fever 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 by Dr. Condie, as given
+in my Essay, and say whether or not a man should allow his wife to be
+attended by a practitioner in whose hands “scarcely a female that has
+been delivered for weeks past has escaped an attack,” “while no instance
+of the disease has occurred in the patients of any other accoucheur
+practising in the same district.” If I understand Dr. Meigs and Dr.
+Hodge, they would not warn the physician or spare the patient under such
+circumstances. 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 respectfully ask them to
+state what they do mean, to their next classes, in the name of humanity,
+if not of science!
+
+I might repeat the question asked concerning Dr. Rutter's cases, with
+reference to those reported by Dr. Roberton. Perhaps, however, the
+student would like to know the opinion of a person in the habit of
+working at matters of this kind in a practical point of view. To satisfy
+him on this ground, I addressed the following question to the President
+of one of our principal Insurance Companies, leaving Dr. Meigs's book
+and my Essay in his hands at the same time.
+
+Question. “If such facts as Roberton's cases were before you, and the
+attendant had had ten, or even five fatal cases, or three, or two even,
+would you, or would you not, if insuring the life of the next patient to
+be taken care of by that attendant, expect an extra premium over that of
+an average case of childbirth?”
+
+Answer. “Of course I should require a very large extra premium, if I
+would take take risk at all.”
+
+But I do not choose to add the expressions of indignation which the
+examination of the facts before him called out. I was satisfied from the
+effect they produced on him, that if all the hideous catalogues of
+cases now accumulated were fully brought to the knowledge of the public,
+nothing, since the days of Burke and Hare, has raised such a cry of
+horror as would be shrieked 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 through the agency of secondary
+causes, as in other diseases, or not. If through such causes, let us
+find out what 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 of bringing
+them! But if Providence does not act through secondary causes in this
+particular sphere of etiology, then why does Dr. Meigs take such pains
+to reason so extensively about the laws of contagion, which, on that
+supposition, have no more to do with this case than with the plague
+which destroyed the people after David had numbered them? Above all,
+what becomes of the theological aspect of the question, when he asserts
+that a practitioner was “only unlucky in meeting with the epidemic
+cases?” (Op. cit. p. 633.) We do not deny that the God of battles
+decides the fate of nations; but we like to have the biggest squadrons
+on our side, and we are particular that our soldiers should not only say
+their prayers, but also keep their powder dry. We do not deny the agency
+of Providence in the disaster at Norwalk, but we turn off the engineer,
+and charge the Company five thousand dollars apiece for every life that
+is sacrificed.
+
+Why a grand jury should not bring in a bill against a physician who
+switches off a score of women one after the other along his private
+track, when he knows that there is a black gulf at the end of it, down
+which they are to plunge, while the great highway is clear, is more than
+I can answer. It is not by laying the open draw to Providence that he is
+to escape the charge of manslaughter.
+
+To finish with all these lesser matters of question, I am unable to see
+why a female must necessarily be unattended in her confinement, because
+she declines the services of a particular practitioner. In all the
+series of cases mentioned, the death-carrying attendant was surrounded
+by others not tracked by disease and its consequences. Which, I would
+ask, is worse,--to call in another, even a rival practitioner, or to
+submit an unsuspecting female to a risk which an Insurance Company would
+have nothing to do with?
+
+I do not expect ever to return to this subject. There is a point of
+mental saturation, beyond which argument cannot be forced without
+breeding impatient, if not harsh, feelings towards those who refuse to
+be convinced. If I have so far manifested neither, it is well to stop
+here, and leave the rest to those younger friends who may have more
+stomach for the dregs of a stale argument.
+
+The extent of my prefatory remarks may lead some to think that I attach
+too much importance to my own Essay. Others may wonder that I should
+expend so many words upon the two productions referred to, the Letter
+and the Lecture. I do consider my Essay of much importance so long as
+the doctrine it maintains is treated as a question, and so long as any
+important part of the defence of that doctrine is thought to rest on
+its evidence or arguments. I cannot treat as insignificant any opinions
+bearing on life, and interests dearer than life, proclaimed yearly to
+hundreds of young men, who will carry them to their legitimate results
+in practice.
+
+The teachings of the two Professors in the great schools of Philadelphia
+are sure to be listened to, not only by their immediate pupils, but by
+the Profession at large. I am too much in earnest for either humility
+or vanity, but I do entreat those who hold the keys of life and death to
+listen to me also for this once. I ask no personal favor; but I beg to
+be heard in behalf of the women whose lives are at stake, until some
+stronger voice shall plead for them.
+
+I trust that I have made the issue perfectly distinct and intelligible.
+And let it be remembered that this is no subject to be smoothed over by
+nicely adjusted phrases of half-assent and half-censure divided between
+the parties. The balance must be struck boldly and the result declared
+plainly. If I have been hasty, presumptuous, ill-informed, illogical; if
+my array of facts means nothing; if there is no reason for any caution
+in the view of these facts; let me be told so on such authority that I
+must believe it, and I will be silent henceforth, recognizing that my
+mind is in a state of disorganization. If the doctrine I have maintained
+is a mournful truth; if to 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 carry it, into confiding
+families, let it be proclaimed as plainly what is to be thought of the
+teachings of those who sneer at the alleged dangers, and scout the very
+idea of precaution. Let it be remembered that persons are nothing in
+this matter; better that twenty pamphleteers should be silenced, or as
+many professors unseated, than that one mother's life should be
+taken. There is no quarrel here between men, but there is deadly
+incompatibility and exterminating warfare between doctrines.
+Coincidences meaning nothing, though a man have a monopoly of the
+disease for weeks or months; or cause and effect, the cause being in
+some way connected with the person; this is the question. If I am wrong,
+let me be put down by such a rebuke as no rash declaimer has received
+since there has been a public opinion in the medical profession of
+America; if I am right, let doctrines which lead to professional
+homicide be no longer taught from the chairs of those two great
+Institutions. Indifference will not do here; our Journalists and
+Committees have no right to take up their pages with minute anatomy
+and tediously detailed cases, while it is a question whether or not the
+“blackdeath” of child-bed is to be scattered broadcast by the agency of
+the mother's friend and adviser. Let the men who mould opinions look to
+it; if there is any voluntary blindness, any interested oversight, any
+culpable negligence, even, in such a matter, and the facts shall reach
+the public ear; the pestilence-carrier of the lying-in chamber must look
+to God for pardon, for man will never forgive him.
+
+
+        THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+In collecting, enforcing, and adding to the evidence accumulated upon
+this most serious subject, I would not be understood to imply that there
+exists a doubt in the mind of any well-informed member of the medical
+profession as to the fact that puerperal fever is sometimes communicated
+from one person to another, both directly and indirectly. In the present
+state of our knowledge upon this point I should consider such doubts
+merely as a proof that the sceptic had either not examined the evidence,
+or, having examined it, refused to accept its plain and unavoidable
+consequences. I should be sorry to think, with Dr. Rigby, that it was
+a case of “oblique vision;” I should be unwilling to force home the
+argumentum ad hominem of Dr. Blundell, but I would not consent to make
+a question of a momentous fact which is no longer to be considered as
+a subject for trivial discussions, but to be acted upon with
+silent promptitude. It signifies nothing that wise and experienced
+practitioners have sometimes doubted the reality of the danger in
+question; no man has the right to doubt it any longer. No negative
+facts, no opposing opinions, be they what they may, or whose they may,
+can form any answer to the series of cases now within the reach of all
+who choose to explore the records of medical science.
+
+If there are some who conceive that any important end would be answered
+by recording such opinions, or by collecting the history of all the
+cases they could find in which no evidence of the influence of contagion
+existed, I believe they are in error. Suppose a few writers of authority
+can be found to profess a disbelief in contagion,--and they are very few
+compared with those who think differently,--is it quite clear that they
+formed their opinions on a view of all the facts, or is it not apparent
+that they relied mostly on their own solitary experience? Still further,
+of those whose names are quoted, is it not true that scarcely a single
+one could by any possibility have known the half or the tenth of the
+facts bearing on the subject which have reached such a frightful amount
+within the last few years? Again, as to the utility of negative facts,
+as we may briefly call them,--instances, namely, in which exposure has
+not been followed by disease,--although, like other truths, they may
+be worth knowing, I do not see that they are like to shed any important
+light upon the subject before us. Every such instance requires a good
+deal of circumstantial explanation before it can be accepted. It is not
+enough that a practitioner should have had a single case of puerperal
+fever not followed by others. It must be known whether he attended
+others while this case was in progress, whether he went directly from
+one chamber to others, whether he took any, and what precautions. It is
+important to know that several women were exposed to infection
+derived from the patient, so that allowance may be made for want of
+predisposition. Now if of negative facts so sifted there could be
+accumulated a hundred for every one plain instance of communication here
+recorded, I trust it need not be said that we are bound to guard and
+watch over the hundredth tenant of our fold, though the ninety and
+nine may be sure of escaping the wolf at its entrance. If any one is
+disposed, then, to take a hundred instances of lives endangered or
+sacrificed out of those I have mentioned, and make it reasonably clear
+that within a similar time and compass ten thousand escaped the same
+exposure, I shall thank him for his industry, but I must be permitted to
+hold to my own practical conclusions, and beg him to adopt or at least
+to examine them also. Children that walk in calico before open fires are
+not always burned to death; the instances to the contrary may be worth
+recording; but by no means if they are to be used as arguments against
+woollen frocks and high fenders.
+
+I am not sure that this paper will escape another remark which it might
+be wished were founded in justice. It may be said that the facts are
+too generally known and acknowledged to require any formal argument or
+exposition, that there is nothing new in the positions advanced, and
+no need of laying additional statements before the Profession. But on
+turning to two works, one almost universally, and the other extensively
+appealed to as authority in this country, I see ample reason to
+overlook this objection. In the last edition of Dewees's Treatise on the
+“Diseases of Females,” it is expressly said, “In this country, under no
+circumstance that puerperal fever has appeared hitherto, does it afford
+the slightest ground for the belief that it is contagious.” In the
+“Philadelphia Practice of Midwifery” not one word can be found in the
+chapter devoted to this disease which would lead the reader to suspect
+that the idea of contagion had ever been entertained. It seems proper,
+therefore, to remind those who are in the habit of referring to these
+works for guidance, that there may possibly be some sources of danger
+they have slighted or omitted, quite as important as a trifling
+irregularity of diet, or a confined state of the bowels, and that
+whatever confidence a physician may have in his own mode of treatment,
+his services are of questionable value whenever he carries the bane as
+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 contagious as to be
+frequently carried from patient to patient by physicians and nurses.
+
+Let me begin by throwing out certain incidental questions, which,
+without being absolutely essential, would render the subject more
+complicated, and by making such concessions and assumptions as may be
+fairly supposed to be without the pale of discussion.
+
+1. It is granted that all the forms of what is called puerperal fever
+may not be, and probably are not, equally contagious or infectious. I
+do not enter into the distinctions which have been drawn by authors,
+because the facts do not appear to me sufficient to establish any
+absolute line of demarcation between such forms as may be propagated by
+contagion and those which are never so propagated. This general result I
+shall only support by the authority of Dr. Ramsbotham, who gives, as the
+result of his experience, that the same symptoms belong to what he calls
+the infectious and the sporadic forms of the disease, and the opinion
+of Armstrong in his original Essay. If others can show any such
+distinction, I leave it to them to do it. But there are cases enough
+that show the prevalence of the disease among the patients of a single
+practitioner when it was in no degree epidemic, in the proper sense
+of the term. I may refer to those of Mr. Roberton and of Dr. Peirson,
+hereafter to be cited, as examples.
+
+2. I shall not enter into any dispute about the particular mode of
+infection, whether it be by the atmosphere the physician carries about
+him into the sick-chamber, or by the direct application of the virus to
+the absorbing surfaces with which his hand comes in contact. Many facts
+and opinions are in favor of each of these modes of transmission. But it
+is obvious that in the majority of cases it must be impossible to decide
+by which of these channels the disease is conveyed, from the nature of
+the intercourse between the physician and the patient.
+
+3. It is not pretended that the contagion of puerperal fever must always
+be followed by the disease. It is true of all contagious diseases, that
+they frequently spare those who appear to be fully submitted to their
+influence. Even the vaccine virus, fresh from the subject, fails every
+day to produce its legitimate effect, though every precaution is taken
+to insure its action. This is still more remarkably the case with
+scarlet fever and some other diseases.
+
+4. It is granted that the disease may be produced and 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 a great extent by
+contagion, yet it goes through the same periods of periodical increase
+and diminution which have been remarked in puerperal fever. If the
+question is asked how we are to reconcile the great variations in the
+mortality of puerperal fever in different seasons and places with the
+supposition of contagion, I will answer it by another question from
+Mr. Farr's letter to the Registrar-General. He makes the statement that
+“five die weekly of small-pox in the metropolis when the disease is not
+epidemic,”--and adds, “The problem for solution is,--Why do the five
+deaths become 10, 15, 20, 31, 58, 88, weekly, and then progressively
+fall through the same measured steps?”
+
+5. I take it for granted, that if it can be shown that great numbers
+of lives have been and are sacrificed to ignorance or blindness on this
+point, no other error of which physicians or nurses may be occasionally
+suspected will be alleged in palliation of this; but that whenever and
+wherever they can be shown to carry disease and death instead of health
+and safety, the common instincts of humanity will silence every attempt
+to explain away their responsibility.
+
+The treatise of Dr. Gordon of Aberdeen was published in the year 1795,
+being among the earlier special works upon the disease. Apart of
+his testimony has been occasionally copied into other works, but his
+expressions are so clear, his experience is given with such manly
+distinctness and disinterested honesty, that it may be quoted as a model
+which might have been often followed with advantage.
+
+“This disease seized such women only as were visited, or delivered by a
+practitioner, or taken care of by a nurse, who had previously attended
+patients affected with the disease.”
+
+“I had evident proofs of its infectious nature, and that the infection
+was as readily communicated as that of the small-pox or measles,
+and operated more speedily than any other infection with which I am
+acquainted.”
+
+“I had evident proofs that every person who had been with a patient
+in the puerperal fever became charged with an atmosphere of infection,
+which was communicated to every pregnant woman who happened to come
+within its sphere. This is not an assertion, but a fact, admitting
+of demonstration, as may be seen by a perusal of the foregoing
+table,”--referring to a table of seventy-seven cases, in many of which
+the channel of propagation was evident.
+
+He adds, “It is a disagreeable declaration for me to mention, that I
+myself was the means of carrying the infection to a great number of
+women.” He then enumerates a number of instances in which the disease
+was conveyed by midwives and others to the neighboring villages, and
+declares that “these facts fully prove that the cause of the puerperal
+fever, of which I treat, was a specific contagion, or infection,
+altogether unconnected with a noxious constitution 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 FORETELL WHAT
+WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT MIDWIFE
+THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE ATTENDED,
+DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY PREDICTION WAS
+VERIFIED.”
+
+Even previously to Gordon, Mr. White of Manchester had said, “I am
+acquainted with two gentlemen in another town, where the whole business
+of midwifery is divided betwixt them, and it is very remarkable that one
+of them loses several patients every year of the puerperal fever, and
+the other never so much as meets with the disorder,”--a difference
+which he seems to attribute to their various modes of treatment. [On the
+Management of Lying-in Women, p. 120.]
+
+Dr. Armstrong has given a number of instances in his Essay on Puerperal
+Fever, of the prevalence of the disease among the patients of a single
+practitioner. At Sunderland, “in all, forty-three cases occurred from
+the 1st of January to the 1st of October, when the disease ceased; and
+of this number forty were witnessed by Mr. Gregson and his assistant,
+Mr. Gregory, the remainder having been separately seen by three
+accoucheurs.” There is appended to the London edition of this Essay, a
+letter from Mr. Gregson, in which that gentleman says, in reference to
+the great number of cases occurring in his practice, “The cause of this
+I cannot pretend fully to explain, but I should be wanting in common
+liberality if I were to make any hesitation in asserting, that the
+disease which appeared in my practice was highly contagious, and
+communicable from one puerperal woman to another.” “It is customary
+among the lower and middle ranks of people to make frequent personal
+visits to puerperal women resident in the same neighborhood, and I have
+ample evidence for affirming that the infection of the disease was often
+carried about in that manner; and, however painful to my feelings,
+I must in candor declare, that it is very probable the contagion was
+conveyed, in some instances, by myself, though I took every possible
+care to prevent such a thing from happening, the moment that I
+ascertained that the distemper was infectious.” Dr. Armstrong goes on to
+mention six other instances within his knowledge, in which the disease
+had at different times and places been limited, in the same singular
+manner, to the practice of individuals, while it existed scarcely if
+at all among the patients of others around them. Two of the gentlemen
+became so convinced of their conveying the contagion, that they withdrew
+for a time from practice.
+
+I find a brief notice, in an American Journal, of another series of
+cases, first mentioned by Mr. Davies, in the “Medical Repository.” This
+gentleman stated his conviction that the disease is contagious.
+
+“In the autumn of 1822 he met with twelve cases, while his medical
+friends in the neighborhood did not meet with any, 'or at least very
+few.' He could attribute this circumstance to no other cause than his
+having been present at the examination, after death, of two cases, some
+time previous, and of his having imparted the disease to his patients,
+notwithstanding every precaution.”
+
+Dr. Gooch says, “It is not uncommon for the greater number of cases to
+occur in the practice of one man, whilst the other practitioners of the
+neighborhood, who are not more skilful or more busy, meet with few
+or none. A practitioner opened the body of a woman who had died of
+puerperal fever, and continued to wear the same clothes. A lady whom he
+delivered a few days afterwards was attacked with and died of a similar
+disease; two more of his lying-in patients, in rapid succession, met
+with the same fate; struck by the thought, that he might have carried
+contagion in his clothes, he instantly changed them, and 'met with no
+more cases of the kind.' A woman in the country, who was employed as
+washerwoman and nurse, washed the linen of one who had died of puerperal
+fever; the next lying-in patient she nursed died of the same disease;
+a third nursed by her met with the same fate, till the neighborhood,
+getting afraid of her, ceased to employ her.”
+
+In the winter of the year 1824, “Several instances occurred of its
+prevalence among the patients of particular practitioners, whilst others
+who were equally busy met with few or none. One instance of this
+kind was very remarkable. A general practitioner, in large midwifery
+practice, lost so many patients from puerperal fever, that he determined
+to deliver no more for some time, but that his partner should attend in
+his place. This plan was pursued for one month, during which not a case
+of the disease occurred in their practice. The elder practitioner, being
+then sufficiently recovered, returned to his practice, but the first
+patient he attended was attacked by the disease and died. A physician,
+who met him in consultation soon afterwards, about a case of a different
+kind, and who knew nothing of his misfortune, asked him whether
+puerperal fever was at all prevalent in his neighborhood, on which he
+burst into tears, and related the above circumstances.
+
+“Among the cases which I saw this season in consultation, four occurred
+in one month in the practice of one medical man, and all of them
+terminated fatally.” [Lond. Med. Gaz. May 2, 1835.]
+
+Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that
+he had known the disease spread through a particular district, or be
+confined to the practice of a particular person, almost every patient
+being attacked with it, while others had not a single case. It seemed
+capable, he thought, of conveyance, not only by common modes; but
+through the dress of the attendants upon the patient.
+
+In a letter to be found in the “London Medical Gazette” for January,
+1840, Mr. Roberton of Manchester makes the statement which I here give
+in a somewhat condensed form.
+
+A midwife delivered a woman on the 4th of December, 1830, who died soon
+after with the symptoms of puerperal fever. In one month from this date
+the same midwife delivered thirty women, residing in different parts of
+an extensive suburb, of which number sixteen caught the disease and all
+died. These were the only cases which had occurred for a considerable
+time in Manchester. The other midwives connected with the same
+charitable institution as the woman already mentioned are twenty-five in
+number, and deliver, on an average, ninety women a week, or about three
+hundred and eighty a month. None of these women had a case of puerperal
+fever. “Yet all this time this woman was crossing the other midwives in
+every direction, scores of the patients of the charity being delivered
+by them in the very same quarters where her cases of fever were
+happening.”
+
+Mr. Roberton remarks, that little more than half the women she delivered
+during this month took the fever; that on some days all escaped, on
+others only one or more out of three or four; a circumstance similar to
+what is seen in other infectious maladies.
+
+Dr. Blundell says, “Those who have never made the experiment can have
+but a faint conception how difficult it is to obtain the exact truth
+respecting any occurrence in which feelings and interests are concerned.
+Omitting particulars, then, I content myself with remarking, generally,
+that from more than one district I have received accounts of the
+prevalence of puerperal fever in the practice of some individuals, while
+its occurrence in that of others, in the same neighborhood, was not
+observed. Some, as I have been told, have lost ten, twelve, or a greater
+number of patients, in scarcely broken succession; like their evil
+genius, the puerperal fever has seemed to stalk behind them wherever
+they went. Some have deemed it prudent to retire for a time from
+practice. In fine, that this fever may occur spontaneously, I admit;
+that its infectious nature may be plausibly disputed, I do not deny; but
+I add, considerately, that in my own family I had rather that those
+I esteemed the most should be delivered, unaided, in a stable, by the
+manger-side, than that they should receive the best help, in the fairest
+apartment, but exposed to the vapors of this pitiless disease. Gossiping
+friends, wet-nurses, monthly nurses, the practitioner himself, these
+are the channels by which, as I suspect, the infection is principally
+conveyed.”
+
+At a meeting of the Royal Medical and Chirurgical Society, Dr. King
+mentioned that some years since a practitioner at Woolwich lost sixteen
+patients from puerperal fever in the same year. He was compelled to give
+up practice for one or two years, his business being divided among
+the neighboring practitioners. No case of puerperal fever occurred
+afterwards, neither had any of the neighboring surgeons any cases of
+this disease.
+
+At the same meeting Mr. Hutchinson mentioned the occurrence of three
+consecutive cases of puerperal fever, followed subsequently by two
+others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]
+
+Dr. Lee makes the following statement: “In the last two weeks of
+September, 1827, five fatal cases of uterine inflammation came under our
+observation. All the individuals so attacked had been attended in labor
+by the same midwife, and no example of a febrile or inflammatory disease
+of a serious nature occurred during that period among the other patients
+of the Westminster General Dispensary, who had been attended by the
+other midwives belonging to that institution.”
+
+The recurrence of long series of cases like those I have cited, reported
+by those most interested to disbelieve in contagion, scattered
+along through an interval of half a century, might have been thought
+sufficient to satisfy the minds of all inquirers that here was
+something more than a singular coincidence. But if, on a more extended
+observation, it should be found that the same ominous groups of cases
+clustering about individual practitioners were observed in a remote
+country, at different times, and in widely separated regions, it would
+seem incredible that any should be found too prejudiced or indolent to
+accept the solemn truth knelled into their ears by the funeral bells
+from both sides of the ocean,--the plain conclusion that the physician
+and the disease entered, hand in hand, into the chamber of the
+unsuspecting patient.
+
+That such series of cases have been observed in this country, and in
+this neighborhood, I proceed to show.
+
+In Dr. Francis's “Notes to Denman's Midwifery,” a passage is cited from
+Dr. Hosack, in which he refers to certain puerperal cases which proved
+fatal to several lying-in women, and in some of which the disease was
+supposed to be conveyed by the accoucheurs themselves.
+
+A writer in the “New York Medical and Physical Journal” for October,
+1829, in speaking of the occurrence of puerperal fever, confined to one
+man's practice, remarks, “We have known cases of this kind occur, though
+rarely, in New York.”
+
+I mention these little hints about the occurrence of such cases,
+partly because they are the first I have met with in American medical
+literature, but more especially because they serve to remind us that
+behind the fearful array of published facts there lies a dark list of
+similar events, unwritten in the records of science, but long remembered
+by many a desolated fireside.
+
+Certainly nothing can be more open and explicit than the account given
+by Dr. Peirson of Salem, of the cases seen by him. In the first nineteen
+days of January, 1829, he had five consecutive cases of puerperal fever,
+every patient he attended being attacked, and the three first cases
+proving fatal. In March of 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, “I am not informed that a single case had
+occurred in the practice of any other physician. Since that period
+I have had no fatal case in my practice, although I have had several
+dangerous cases. I have attended in all twenty cases of this disease, of
+which four have been fatal. I am not aware that there has been any
+other case in the town of distinct puerperal peritonitis, although I am
+willing to admit my information may be very defective on this point.
+I have been told of some 'mixed cases,' and 'morbid affections after
+delivery.'”
+
+In the “Quarterly Summary of the Transactions of the College of
+Physicians of Philadelphia” may be found some most extraordinary
+developments respecting a series of cases occurring in the practice of a
+member of that body.
+
+Dr. Condie called the attention of the Society to the prevalence, at the
+present time, of puerperal fever of a peculiarly insidious and malignant
+character. “In the practice of one gentleman extensively engaged as an
+obstetrician, nearly every female he has attended in confinement, during
+several weeks past, within the above limits” (the southern sections and
+neighboring districts), “had been attacked by the fever.”
+
+“An important query presents itself, the Doctor observed, in reference
+to the particular form of fever now prevalent. Is it, namely, capable
+of being propagated by contagion, and is a physician who has been in
+attendance upon a case of the disease warranted in continuing, without
+interruption, his practice as an obstetrician? Dr. C., although not
+a believer in the contagious character of many of those affections
+generally supposed to be propagated in this manner, has nevertheless
+become convinced by the facts that have fallen under his notice, that
+the puerperal fever now prevailing is capable of being communicated by
+contagion. How otherwise can be explained the very curious circumstance
+of the disease in one district being exclusively confined to the
+practice of a single physician, a Fellow of this College, extensively
+engaged in obstetrical practice,--while no instance of the disease
+has occurred in the patients under the care of any other accoucheur
+practising within the same district; scarcely a female that has been
+delivered for weeks past has escaped an attack?”
+
+Dr. Rutter, the practitioner referred to, “observed that, after the
+occurrence of a number of cases of the disease in his practice, he
+had left the city and remained absent for a week, but on returning, no
+article of clothing he then wore having been used by him before, one
+of the very first cases of parturition he attended was followed by
+an attack of the fever, and terminated fatally; he cannot, readily,
+therefore, believe in the transmission of the disease from female to
+female, in the person or clothes of the physician.”
+
+The meeting at which these remarks were made was held on the 3d of May,
+1842. In a letter dated December 20, 1842, addressed to Dr. Meigs, and
+to be found in the “Medical Examiner,” he speaks of “those horrible
+cases of puerperal fever, some of which you did me the favor to see with
+me during the past summer,” and talks of his experience in the disease,
+“now numbering nearly seventy cases, all of which have occurred within
+less than a twelvemonth past.”
+
+And Dr. Meigs asserts, on the same page, “Indeed, I believe that his
+practice in that department of the profession was greater than that
+of any other gentleman, which was probably the cause of his seeing a
+greater number of the cases.” This from a professor of midwifery, who
+some time ago assured a gentleman whom he met in consultation, that the
+night on which they met was the eighteenth in succession that he himself
+had been summoned from his repose, seems hardly satisfactory.
+
+I must call the attention of the inquirer most particularly to the
+Quarterly Report above referred to, and the letters of Dr. Meigs and Dr.
+Rutter, to be found in the “Medical Examiner.” Whatever impression they
+may produce upon his mind, I trust they will at least convince him
+that there is some reason for looking into this apparently uninviting
+subject.
+
+At a meeting of the College of Physicians just mentioned, Dr. Warrington
+stated, that a few days after assisting at an autopsy of puerperal
+peritonitis, in which he laded out the contents of the abdominal cavity
+with his hands, he was called upon to deliver three women in rapid
+succession. All of these women were attacked with different forms of
+what is commonly called puerperal fever. Soon after these he saw two
+other patients, both on the same day, with the same disease. Of these
+five patients two died.
+
+At the same meeting, Dr. West mentioned a fact related to him by Dr.
+Samuel Jackson of Northumberland. Seven females, delivered by Dr.
+Jackson in rapid succession, while practising in Northumberland County,
+were all attacked with puerperal fever, and five of them died. “Women,”
+ he said, “who had expected me to attend upon them, now becoming alarmed,
+removed out of my reach, and others sent for a physician residing
+several miles distant. These women, as well as those attended by
+midwives; all did well; nor did we hear of any deaths in child-bed
+within a radius of fifty miles, excepting two, and these I afterwards
+ascertained to have been caused by other diseases.” He underwent, as
+he thought, a thorough purification, and still his next patient was
+attacked with the disease and died. He was led to suspect that the
+contagion might have been carried in the gloves which he had worn in
+attendance upon the previous cases. Two months or more after this he had
+two other cases. He could find nothing to account for these, unless it
+were the instruments for giving enemata, which had been used in two of
+the former cases, and were employed by these patients. When the
+first case occurred, he was attending and dressing a limb extensively
+mortified from erysipelas, and went immediately to the accouchement with
+his clothes and gloves most thoroughly imbued with its efluvia. And here
+I may mention, that this very Dr. Samuel Jackson of Northumberland is
+one of Dr. Dewees's authorities against contagion.
+
+The three following statements are now for the first time given to the
+public. All of the cases referred to occurred within this State, and two
+of the three series in Boston and its immediate vicinity.
+
+I. The first is a series of cases which took place during the last
+spring in a town at some distance from 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 physician during the period
+referred to. “They were all attended by him until their termination,
+with the exception of the patient No. 6, who fell into the hands 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-named periods, none of which, however, presented any peculiar
+symptoms of the disease.”
+
+About the 1st of July he attended another patient in a neighboring
+village, who died two or three days after delivery.
+
+The first patient, it is stated, was delivered on the 20th of March. “On
+the 19th, Dr. C. made the autopsy of a man who died suddenly, sick only
+forty-eight hours; had oedema of the thigh, and gangrene extending from
+a little above the ankle into the cavity of the abdomen.” Dr. C. wounded
+himself, very slightly, in the right hand during the autopsy. The hand
+was quite painful the night following, during his attendance on the
+patient No. 1. He did not see this patient after the 20th, being
+confined to the house, and very sick from the wound just mentioned, from
+this time until the 3d of April.
+
+Several cases of erysipelas occurred in the house where the autopsy
+mentioned above took place, soon after the examination. There were also
+many cases of erysipelas in town at the time of the fatal puerperal
+cases 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 sore throat and erysipelas, and died in ten
+days from the first attack.
+
+The nurse who laid out the body of the patient No. 4 was taken on the
+day following with symptoms like those of this patient, and died in a
+week, without any external marks of erysipelas.
+
+“No other cases of similar character with those of Dr. C. occurred in
+the practice of any of the physicians in the town or vicinity at the
+time. Deaths following confinement have occurred in the practice of
+other physicians during the past year, but they were not cases of
+puerperal fever. No post-mortem examinations were held in any of these
+puerperal cases.”
+
+Some additional statements in this letter are deserving of insertion.
+
+“A physician attended a woman in the immediate neighborhood 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 doubtful whether this
+should be considered a case of puerperal fever. She had suffered from
+canker, indigestion, and diarrhoea for a year previous to her delivery.
+Her complaints were much aggravated for two or three months previous
+to delivery; she had become greatly emaciated, and weakened to such an
+extent that it had not been expected that she would long survive her
+confinement, if indeed she reached that period. Her labor was easy
+enough; she flowed a good deal, seemed exceedingly prostrated, had
+ringing in the ears, and other symptoms of exhaustion; the pulse was
+quick and small. On the second and third day there was some tenderness
+and tumefaction of the abdomen, which increased somewhat on the fourth
+and fifth. He had cases in midwifery before and after this, which
+presented nothing peculiar.”
+
+It is also mentioned in the same letter, that another physician had
+a case during the last summer and another last fall, both of which
+recovered.
+
+Another gentleman reports a case last December, a second case five
+weeks, and another three weeks since. All these recovered. A case also
+occurred very recently in the practice of a physician in the village
+where the eighth patient of Dr. C. resides, which proved fatal. “This
+patient had some patches of erysipelas on the legs and arms. The same
+physician has delivered three cases since, which have all done well.
+There have been no other cases in this town or its vicinity recently.
+There have been some few cases of erysipelas.” It deserves notice
+that the partner of Dr. C., who attended the autopsy of the man above
+mentioned and took an active part in it; who also suffered very slightly
+from a prick under the thumb-nail received during the examination, had
+twelve cases of midwifery between March 26th and April 12th, all of
+which did well, and presented no peculiar symptoms. It should also be
+stated, that during these seventeen days he was in attendance on all the
+cases of erysipelas in the house where the autopsy had been performed.
+
+I owe these facts to the prompt kindness of a gentleman whose
+intelligence and character are sufficient guaranty for their accuracy.
+
+The two following letters were addressed to my friend Dr. Scorer, by the
+gentleman in whose practice the cases of puerperal fever occurred.
+His name renders it unnecessary to refer more particularly to these
+gentlemen, who on their part have manifested the most perfect freedom
+and courtesy in affording these accounts of their painful experience.
+
+“January 28, 1843.
+
+II.... “The time to which you allude was in 1830. The first case was in
+February, during a very cold time. She was confined the 4th, and died
+the 12th. Between the 10th and 28th of this month, I attended six women
+in labor, all of whom did well except the last, as also two who were
+confined March 1st and 5th. Mrs. E., confined February 28th, sickened,
+and died March 8th. The next day, 9th, I inspected the body, and the
+night after attended a lady, Mrs. B., who sickened, and died 16th. The
+10th, I attended another, Mrs. G., who sickened, but recovered. March
+16th, I went from Mrs. G.'s room to attend a Mrs. H., who sickened, and
+died 21st. The 17th, I inspected Mrs. B. On the 19th, I went directly
+from Mrs. H.'s room to 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 attended another woman, who was not sick. Up to
+20th of this month I wore the same clothes. I now refused to 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.
+The others were from two to three miles apart, and nearly that distance
+from my residence. There were no other cases in their immediate vicinity
+which came to my knowledge. The general health of all the women was
+pretty good, and all the labors as good as common, except the first.
+This woman, in consequence of my not arriving in season, and the child
+being half-born at some time before I arrived, was very much exposed to
+the cold at the time of confinement, and afterwards, 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 had puerperal fever, one very
+badly, the other not so badly. Both recovered. One other had swelled
+leg, or phlegmasia dolens, and one or two others did not recover as well
+as usual.
+
+“In the summer of 1835 another disastrous period occurred in my
+practice. July 1st, I attended a lady in labor, who was afterwards quite
+ill and feverish; but at the time I did not consider her case a decided
+puerperal fever. On the 8th, I attended one who did well. On the 12th,
+one who was seriously sick. This was also an equivocal case, apparently
+arising from constipation and irritation of the rectum. These women were
+ten miles apart and five from my residence. On 15th and 20th, two who
+did well. On 25th, I attended another. This was a severe labor, and
+followed by unequivocal puerperal fever, or peritonitis. She recovered.
+August 2d and 3d, in about twenty-four hours I attended four persons.
+Two of them did very well; one was attacked with some of the common
+symptoms, which however subsided in a day or two, and the other had
+decided puerperal fever, but recovered. This woman resided five miles
+from me. Up to this time I wore the same coat. All my other clothes had
+frequently been changed. On 6th, I attended two women, one of whom was
+not sick at all; but the other, Mrs. L., was afterwards taken ill. On
+10th, I attended a lady, who did very well. I had previously changed all
+my clothes, and had no garment on which had been in a puerperal room. On
+12th, I was called to Mrs. S., in labor. While she was ill, I left her
+to visit Mrs. L., one of the ladies who was confined on 6th. Mrs. L. had
+been more unwell than usual, but I had not considered her case anything
+more than common till this visit. I had on a surtout at this visit,
+which, on my return to Mrs. S., I left in another room. Mrs. S. was
+delivered on 13th with forceps. These women both died of decided
+puerperal fever.
+
+“While I attended these women in their fevers, I changed my clothes, and
+washed my hands in a solution of chloride of lime after each visit. I
+attended seven women in labor during this period, all of whom recovered
+without sickness.
+
+“In my practice I have had several single cases of puerperal fever, some
+of whom have died and some have recovered. Until the year 1830 I had
+no suspicion that the disease could be communicated from one patient
+to another by a nurse or midwife; but I now think the foregoing facts
+strongly favor that idea. I was so much convinced of this fact, that I
+adopted the plan before related.
+
+“I believe my own health was as good as usual at each of the above
+periods. I have no recollections to the contrary.
+
+“I believe I have answered all your questions. I have been more
+particular on some points perhaps than necessary; but I thought you
+could form your own opinion better than to take mine. In 1830 I wrote
+to Dr. Charming a more particular statement of my cases. If I have not
+answered your questions sufficiently, perhaps Dr. C. may have my letter
+to him, and you can find your answer there.” [In a letter to myself,
+this gentleman also stated, “I do not recollect that there was any
+erysipelas or any other disease particularly prevalent at the time.”]
+
+“BOSTON, February 3, 1843.
+
+III. “MY DEAR SIR,--I received a note from you last evening, requesting
+me to answer certain questions therein proposed, touching the cases
+of puerperal fever which came under my observation the past summer. It
+gives me pleasure to comply with your request, so far as it is in my
+power so to do, but, owing to the hurry in preparing for a journey, the
+notes of the cases I had then taken were lost or mislaid. The principal
+facts, however, are too vivid upon my recollection to be soon forgotten.
+I think, therefore, that I shall be able to give you all the information
+you may require.
+
+“All the cases that occurred in my practice took place between the 7th
+of May and the 17th of June 1842.
+
+“They were not confined to any particular part of the city. The first
+two cases were patients residing at the South End, the next was at the
+extreme North End, one living in Sea Street and the other in Roxbury.
+The following is the order in which they 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 the
+circumstances. She died on the 10th.
+
+“Case 2. Mrs.______ was confined on the 10th of June (four weeks after
+Mrs. C.), at 11 A. M., after a natural, but somewhat severe labor of
+five 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 until
+the 18th, when symptoms of puerperal fever were manifest. She died on
+the 20th.
+
+“Case 4. Mrs.______, confined June 17th, at 5 o'clock, A. M., was doing
+well 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 of
+June, at 6 o'clock in the evening. This patient had been attacked with
+puerperal fever, at three of her previous confinements, but the disease
+yielded to depletion and other remedies without difficulty. This time, I
+regret to say, I was not so fortunate. She was not attacked, as were the
+other 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
+she died in great distress on the 22d of the same month. Owing to
+the extreme heat of the season, and my own indisposition, none of the
+subjects were examined after death. Dr. Channing, who was in attendance
+with me on the three last cases, proposed to have a post-mortem
+examination of the subject of case No. 5, but from some cause which I do
+not now recollect it was not obtained.
+
+“You wish to know whether I wore the same clothes when attending the
+different cases. I cannot positively say, but I should think I did not,
+as the weather became warmer after the first two cases; I therefore
+think it probable that I made a change of at least a part of my dress.
+I have had no other case of puerperal fever in my own practice for three
+years, save those above related, and I do not remember to have lost a
+patient before with this disease. While absent, last July, I visited
+two patients sick with puerperal fever, with a friend of mine in the
+country. Both of them recovered.
+
+“The cases that I have recorded were not confined to any particular
+constitution or temperament, but it seized upon the strong and the weak,
+the old and the young,--one being over forty years, and the youngest
+under eighteen years of age.... If the disease is of an erysipelatous
+nature, as many suppose, contagionists may perhaps find some ground for
+their belief in the fact, that, for two weeks previous to my first case
+of puerperal fever, I had been attending a severe case of erysipelas,
+and the infection may have been conveyed through me to the patient; but,
+on the other hand, why is not this the case with other physicians,
+or with the same physician at all times, for since my return from
+the country I have had a more inveterate case of erysipelas than ever
+before, and no difficulty whatever has attended any of my midwifery
+cases?”
+
+I am assured, on unquestionable authority, that “About three years
+since, a gentleman in extensive midwifery business, in a neighboring
+State, lost in the course of a few weeks eight patients in child-bed,
+seven of them being undoubted cases of puerperal fever. No other
+physician of the town lost a single patient of this disease during the
+same period.” And from what I have heard in conversation with some of
+our most experienced practitioners, I am inclined to think many cases of
+the kind might be brought to light by extensive inquiry.
+
+This long catalogue of melancholy histories assumes a still darker
+aspect when we remember how kindly nature deals with the parturient
+female, when she is not immersed in the virulent atmosphere of an impure
+lying-in hospital, or poisoned in her chamber by the unsuspected breath
+of contagion. From all causes together, not more than four deaths in a
+thousand births and miscarriages happened in England and Wales during
+the period embraced by the first “Report of the Registrar-General.”
+ In the second Report the mortality was shown to be about five in one
+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 from this
+disease in 278 cases, or between three and four to the thousand a yet
+during this period the disease was endemic in the hospital, and might
+have gone on to 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 cases that are to be
+ascribed to the self-acting system of propagation, it would seem that
+the disease must be far from common. Mr. White of Manchester says, “Out
+of the whole number of lying-in patients whom I have delivered (and I
+may safely call it a great one), I have never lost one, nor to the best
+of my recollection has one been greatly endangered, by the puerperal,
+miliary, low nervous, putrid malignant, or milk fever.” Dr. Joseph
+Clarke informed Dr. Collins, that in the course of forty-five years'
+most extensive practice he lost but four patients from this disease. One
+of the most eminent practitioners of Glasgow, who has been engaged in
+very extensive practice for upwards of a quarter of a century, testifies
+that he never saw more than twelve cases of real puerperal fever.
+[Lancet, May 4, 1833]
+
+I have myself been told by two gentlemen practising in this city, and
+having for many years a large midwifery business, that they had neither
+of them lost a patient from this disease, and by one of them that he
+had only seen it in consultation with other physicians. In five hundred
+cases of midwifery, of which Dr. Storer has given an abstract in the
+first number of this Journal, there was only one instance of fatal
+puerperal peritonitis.
+
+In the view of these facts, it does appear a singular coincidence, that
+one man or woman should have ten, twenty, thirty, or seventy cases of
+this rare disease following his or her footsteps with the keenness of
+a beagle, through the streets and lanes of a crowded city, while the
+scores that cross the same paths on the same errands know it only
+by name. It is a series of similar coincidences which has led us to
+consider the dagger, the musket, and certain innocent-looking white
+powders as having some little claim to be regarded as dangerous. It is
+the practical inattention to similar coincidences which has given rise
+to the unpleasant but often necessary documents called indictments,
+which has sharpened a form of the cephalotome sometimes employed in
+the case of adults, and adjusted that modification of the fillet which
+delivers the world of those who happen to be too much in the way while
+such striking coincidences are taking place.
+
+I shall now mention a few instances in which the disease appears to have
+been conveyed by the process of direct inoculation.
+
+Dr. Campbell of Edinburgh states that in October, 1821, he assisted at
+the post-mortem examination of a patient who died with puerperal fever.
+He carried the pelvic viscera in his pocket to the class-room. The same
+evening he attended a woman in labor without previously 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 with the
+disease within a few weeks, three shared the same fate in succession.
+
+In June, 1823, he assisted some of his pupils at the autopsy of a case
+of puerperal fever. He was unable to wash his hands with proper care,
+for want of the necessary accommodations. On getting home he found that
+two patients required his assistance. He went without further ablution,
+or changing his clothes; both these patients died with puerperal fever.
+This same Dr. Campbell is one of Dr. Churchill's authorities against
+contagion.
+
+Mr. Roberton says that in one instance within his knowledge a
+practitioner passed the catheter for a patient with puerperal fever late
+in the evening; the same night he attended a lady who had the symptoms
+of the disease on the second day. In another instance a surgeon was
+called while in the act of inspecting the body of a woman who had died
+of this fever, to attend a labor; within forty-eight hours this patient
+was seized with the fever.'
+
+On the 16th of March, 1831, a medical practitioner examined the body
+of a woman who had died a few days after delivery, from puerperal
+peritonitis. On the evening of the 17th he delivered a patient, who was
+seized with puerperal fever on the 19th, and died on the 24th. Between
+this period and the 6th of April, the same practitioner attended two
+other patients, both of whom were attacked with the same disease and
+died.
+
+In the autumn of 1829 a physician was present at the examination of
+a case of puerperal fever, dissected out the organs, and assisted in
+sewing up the body. He had scarcely reached home when he was summoned to
+attend a young lady in labor. In sixteen hours she was attacked with the
+symptoms of puerperal fever, and narrowly escaped with her life.
+
+In December, 1830, a midwife, who had attended two fatal cases of
+puerperal fever at the British Lying-in Hospital, examined a patient
+who had just been admitted, to ascertain if labor had commenced. This
+patient remained two days in the expectation that labor would come
+on, when she returned home and was then suddenly taken in labor and
+delivered before she could set out for the hospital. She went on
+favorably for two days, and was then taken with puerperal fever and died
+in thirty-six hours.
+
+“A young practitioner, contrary to advice, examined the body of a
+patient who had died from puerperal fever; there was no epidemic at the
+time; the case appeared to be purely sporadic. He delivered three
+other women shortly afterwards; they all died with puerperal fever, the
+symptoms of which broke out very soon after labor. The patients of his
+colleague did well, except one, where he assisted to remove some coagula
+from the uterus; she was attacked in the same manner as those whom he
+had attended, and died also.” The writer in the “British and Foreign
+Medical Review,” from whom I quote this statement,--and who is no
+other than Dr. Rigby, adds, “We trust that this fact alone will forever
+silence such doubts, and stamp the well-merited epithet of 'criminal,'
+as above quoted, upon such attempts.” [Brit. and For. Medical Review for
+Jan. 1842, p. 112.]
+
+From the cases given by Mr. Ingleby, I select the following. Two
+gentlemen, after having been engaged in conducting the post-mortem
+examination of a case of puerperal fever, went in the same dress, each
+respectively, to a case of midwifery. “The one patient was seized with
+the rigor about thirty hours afterwards. The other patient was seized
+with a rigor the third morning after delivery. One recovered, one died.”
+ [Edin. Med. and Surg. Journal, April, 1838.] One of these same gentlemen
+attended another woman in the same clothes two days after the autopsy
+referred to. “The rigor did not take place until the evening of the
+fifth day from the first visit. Result fatal.” These cases belonged to a
+series of seven, the first of which was thought to have originated in
+a case of erysipelas. “Several cases of a mild character followed the
+foregoing seven, and their nature being now most unequivocal, my friend
+declined visiting all midwifery cases for a time, and there was no
+recurrence of the disease.” These cases occurred in 1833. Five of them
+proved fatal. Mr. Ingleby gives another series of seven cases which
+occurred to a practitioner in 1836, the first of which was also
+attributed to his having opened several erysipelatous abscesses a short
+time previously.
+
+I need not refer to the case lately read before this Society, in which a
+physician went, soon after performing an autopsy of a case of puerperal
+fever, to a woman in labor, who was seized with the same disease and
+perished. The forfeit of that error has been already paid.
+
+At a meeting of the Medical and Chirurgical Society before referred to,
+Dr. Merriman related an instance occurring in his own practice, which
+excites a reasonable suspicion that two lives were sacrificed to a
+still less dangerous experiment. He was at the examination of a case
+of puerperal fever at two o'clock in the afternoon. He took care not to
+touch the body. At nine o'clock the same evening he attended a woman in
+labor; she was so nearly delivered that he had scarcely anything to do.
+The next morning she had severe rigors, and in forty-eight hours she was
+a corpse. Her infant had erysipelas and died 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 often fatal effects which have followed from
+wounds received in the post-mortem examination of patients who have died
+of puerperal fever. The fact that such wounds are attended with peculiar
+risk has been long noticed. I find that Chaussier was in the habit of
+cautioning his students against the danger to which they were exposed in
+these dissections. [Stein, L'Art d'Accoucher, 1794; Dict. des Sciences
+Medicales, art. “Puerperal.”] The head pharmacien of the Hotel Dieu, in
+his analysis of the fluid effused in puerperal peritonitis, says that
+practitioners are convinced of its deleterious qualities, and that it is
+very dangerous to apply it to the denuded skin. [Journal de Pharmacie,
+January, 1836.] Sir Benjamin Brodie speaks of it as being well known
+that the inoculation of lymph or pus from the peritoneum of a puerperal
+patient is often attended with dangerous and even fatal symptoms. Three
+cases in confirmation of this statement, two of them fatal, have been
+reported to this Society within a few months.
+
+Of about fifty cases of injuries of this kind, of various degrees of
+severity, which I have collected from different sources, at least twelve
+were instances of infection from puerperal peritonitis. Some of the
+others are so stated as to render it probable that they may have been of
+the same nature. Five other cases were of peritoneal inflammation;
+three in males. Three were what was called enteritis, in one instance
+complicated with erysipelas; but it is well known that this term has
+been often used to signify inflammation of the peritoneum covering the
+intestines. On the other hand, no case of typhus or typhoid fever is
+mentioned as giving rise to dangerous consequences, with the exception
+of the single instance of an undertaker mentioned by Mr. Travers, who
+seems to have been poisoned by a fluid which exuded from the body.
+The other accidents were produced by dissection, or some other mode of
+contact with bodies of patients who had died of various affections.
+They also differed much in severity, the cases of puerperal origin being
+among the most formidable and fatal. Now a moment's reflection will
+show that the number of cases of serious consequences ensuing from the
+dissection of the bodies of those who had perished of puerperal fever
+is so vastly disproportioned to the relatively small number of autopsies
+made in this complaint as compared with typhus or pneumonia (from which
+last disease not one case of poisoning happened), and still more from
+all diseases put together, that the conclusion is irresistible that
+a most fearful morbid poison is often generated in the course of this
+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 following statement of Dr.
+Rigby. “That the discharges from a patient under puerperal fever are in
+the highest degree contagious we have abundant evidence in the history
+of lying-in hospitals. The puerperal abscesses are also contagious, and
+may be communicated to healthy lying-in women by washing with the same
+sponge; this fact has been repeatedly proved in the Vienna Hospital; but
+they are equally communicable to women not pregnant; on more than
+one occasion the women engaged in washing the soiled bed-linen of the
+General Lying-in Hospital have been attacked with abscess in the fingers
+or hands, attended with rapidly spreading inflammation of the cellular
+tissue.”
+
+Now add to all this the undisputed fact, that within the walls of
+lying-in hospitals there is often generated a miasm, palpable as the
+chlorine used to destroy it, tenacious so as in some cases almost to
+defy extirpation, deadly in some institutions as the plague; which has
+killed women in a private hospital of London so fast that they were
+buried two in one coffin to conceal its horrors; which enabled Tonnelle
+to record two hundred and twenty-two autopsies at the Maternite of
+Paris; which has led Dr. Lee to express his deliberate conviction that
+the loss of life occasioned by these institutions completely defeats the
+objects of their founders; and out of this train of cumulative evidence,
+the multiplied groups of cases clustering about individuals, the deadly
+results of autopsies, the inoculation by fluids from the living patient,
+the murderous poison of hospitals,--does there not result a conclusion
+that laughs all sophistry to scorn, and renders all argument an insult?
+
+I have had occasion to mention some instances in which there was an
+apparent relation between puerperal fever and erysipelas. The length
+to which this paper has extended does not allow me to enter into the
+consideration of this most important subject. I will only say, that
+the evidence appears to me altogether satisfactory that some most fatal
+series of puerperal fever have been produced by an infection originating
+in the matter or effluvia of erysipelas. In evidence of some connection
+between the two diseases, I need not go back to the older authors, as
+Pouteau or Gordon, but will content myself with giving the following
+references, with their dates; from which it will be seen that the
+testimony has been constantly coming before the profession for the last
+few years.
+
+“London Cyclopaedia of Practical Medicine,” article Puerperal Fever,
+1833.
+
+Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. “Lancet,”
+ 1835.
+
+Dr. Ramsbotham's Lecture. “London Medical Gazette,” 1835.
+
+Mr. Yates Ackerly's Letter in the same Journal, 1838.
+
+Mr. Ingleby on Epidemic Puerperal Fever. “Edinburgh Medical and Surgical
+Journal,” 1838.
+
+Mr. Paley's Letter. “London Medical Gazette,” 1839.
+
+Remarks at the Medical and Chirurgical Society. “Lancet,” 1840.
+
+Dr. Rigby's “System of Midwifery.” 1841.
+
+“Nunneley on Erysipelas,”--a work which contains a large number of
+references on the subject. 1841.
+
+“British and Foreign Quarterly Review,” 1842.
+
+Dr. S. Jackson of Northumberland, as already quoted from the Summary of
+the College of Physicians, 1842.
+
+And lastly, a startling series of cases by Mr. Storrs of Doncaster, to
+be found in the “American Journal of the Medical Sciences” for January,
+1843.
+
+The relation of puerperal fever with other continued fevers would seem
+to be remote and rarely obvious. Hey refers to two cases of synochus
+occurring in the Royal Infirmary of Edinburgh, in women who had attended
+upon puerperal patients. Dr. Collins refers to several instances
+in which puerperal fever has appeared to originate from a continued
+proximity to patients suffering with typhus.
+
+Such occurrences as those just mentioned, though most important to be
+remembered and guarded against, hardly attract our notice in the midst
+of the gloomy facts by which they are surrounded. Of these facts, at the
+risk of fatiguing repetitions, I have summoned a sufficient number, as I
+believe, to convince the most incredulous that every attempt to disguise
+the truth 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 to have found puerperal fever contagious. At the
+most they give us mere negative facts, worthless against an extent of
+evidence which now overlaps the widest range of doubt, and doubles
+upon itself in the redundancy of superfluous demonstration. Examined in
+detail, this and much of the show of testimony brought up to 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. Nor do I feel the necessity of enforcing the conclusion
+which arises spontaneously from the facts which have been enumerated, by
+formally citing the opinions of those grave authorities who have for the
+last half-century been sounding the unwelcome truth it has cost so many
+lives to establish.
+
+“It is to the British practitioner,” says Dr. Rigby, “that we are
+indebted for strongly insisting upon this important and dangerous
+character of puerperal fever.”
+
+The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
+Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
+Ingleby, Locock, Abercrombie, Alison, Travers, Rigby, and Watson, many
+of whose writings I have already referred to, may have some influence
+with those who prefer the weight of authorities to the simple deductions
+of their own reason from the facts laid before them. A few Continental
+writers have adopted similar conclusions. It gives me pleasure to
+remember, that while the doctrine has been unceremoniously discredited
+in one of the leading Journals, and made very light of by teachers in
+two of the principal Medical Schools, of this country, Dr. Channing has
+for many years inculcated, and enforced by examples, the danger to
+be apprehended and the precautions to be taken in the disease under
+consideration.
+
+I have no wish to express any harsh feeling with regard to the painful
+subject which has come before us. If there are any so far excited by the
+story of these dreadful events that they ask for some word of indignant
+remonstrance to show that science does not turn the hearts of its
+followers into ice or stone, let me remind them that such words have
+been uttered by those who speak with an authority I could not claim. It
+is as a lesson rather than as a reproach that I call up the memory
+of these irreparable errors and wrongs. No tongue can tell the
+heart-breaking calamity they have caused; they have closed the eyes
+just 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 the stranger's arms, or bequeathed it, with less cruelty,
+the death of its dying parent. There is no tone deep enough for regret,
+and no voice loud enough for warning. The woman about to become a
+mother, or with her new-born infant upon her bosom, should be the object
+of trembling care and sympathy wherever she bears her tender burden,
+or stretches her aching limbs. The very outcast of the streets has pity
+upon her sister in degradation, when the seal of promised maternity is
+impressed upon her. The remorseless vengeance of the law, brought down
+upon its victim by a machinery as sure as destiny, is arrested in its
+fall at a word which reveals her transient claim for mercy. The solemn
+prayer of the liturgy singles out her sorrows from the multiplied trials
+of life, to plead for her in the hour of peril. God forbid that any
+member of the profession to which she trusts her life, doubly precious
+at that eventful period, should hazard it negligently, unadvisedly, or
+selfishly!
+
+There may be some among those whom I address who are disposed to ask the
+question, What course are we to follow in relation to this matter? The
+facts are before them, and the answer must be left to their own judgment
+and conscience. If any should care to know my own conclusions, they are
+the following; and in taking the liberty to state them very freely and
+broadly, I would ask the inquirer to examine them as freely in the light
+of the evidence which has been laid before him.
+
+1. A physician holding himself in readiness to attend cases of midwifery
+should never take any active part in the post-mortem examination of
+cases of puerperal fever.
+
+2. If a physician is present at such autopsies, he should use thorough
+ablution, change every article of dress, and allow twenty-four hours or
+more to elapse before attending to any case of midwifery. It may be well
+to extend the same caution to cases of simple peritonitis.
+
+3. Similar precautions should be taken after the autopsy or surgical
+treatment of cases of erysipelas, if the physician is obliged to unite
+such offices with his obstetrical duties, which is in the highest degree
+inexpedient.
+
+4. On the occurrence of a single case of puerperal fever in his
+practice, the physician is bound to consider the next female he attends
+in labor, unless some weeks at least have elapsed, as in danger of being
+infected by him, and it is his duty to take every precaution to diminish
+her risk of disease and death.
+
+5. If within a short period two cases of puerperal fever happen close
+to each other, in the practice of the same physician, the disease
+not existing or prevailing in the neighborhood, he would do wisely to
+relinquish his obstetrical practice for at least one month, and endeavor
+to free himself by every available means from any noxious influence he
+may carry about with him.
+
+6. The occurrence of three or more closely connected cases, in the
+practice of one individual, no others existing in the neighborhood, and
+no other sufficient cause being alleged for the coincidence, is prima
+facie evidence that he is the vehicle of contagion.
+
+7. It is the duty of the physician to take every precaution that the
+disease shall not be introduced by nurses or other assistants, by making
+proper inquiries concerning them, and giving timely warning of every
+suspected source of danger.
+
+8. Whatever indulgence may be granted to those who have heretofore
+been the ignorant causes of so much misery, the time has come when the
+existence of a private pestilence in the sphere of a single physician
+should be looked upon, not as a misfortune, but a crime; and in the
+knowledge of such occurrences the duties of the practitioner to his
+profession should give way 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 given in the Letter of Mr. Stows, contained in the Appendix to
+this Report. Mr. Stows suggests precautions similar to those I have laid
+down, and these precautions are 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
+puerperal fever seeming to originate in erysipelas.
+
+Elkington, of Birmingham, in Provincial Med. Journal, cited in Am.
+Journ. Med. Sc. for April, 1844.--Six cases in less than a fortnight,
+seeming to originate in a case of erysipelas.
+
+West's Reports, in Brit. and For. Med. Review for October, 1845, and
+January, 1847.--Affection of the arm, resembling malignant pustule,
+after removing the 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 Journal for February, 1846, as showing connection
+of puerperal fever and erysipelas.
+
+Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med. Se.,
+January, 1846. Also, Connection between Puerperal Fever and Epidemic
+Erysipelas. Ibid., April, 1846.
+
+Robert Storrs.--Contagious Effects of Puerperal Fever on the Male
+Subject; or on Persons not Child-bearing. (From Provincial Med. and
+Surg. Journal.) Am. Jour. Med. Sc., January, 1846. Numerous cases. See
+also Dr. Reid's case in same Journal 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 illustrating the Contagious Nature
+of Erysipelas and of Puerperal Fever, and their Intimate Pathological
+Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. Se., July,
+1850.
+
+Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from
+inoculation with different morbid secretions.) Am. Jour. Med. Se.,
+October, 1850.
+
+Arneth. Paper read before the National Academy of Medicine. Annales
+d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M.
+“Semmeliveis” (Semmelweiss.) Lotions of chloride of lime and use of
+nail-brush before admission to lying-in wards. Alleged sudden and great
+decrease of mortality from puerperal fever. Cause of disease attributed
+to inoculation with cadaveric matters.) See also Routh's paper,
+mentioned above.
+
+Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society.
+Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all
+fatal. Also to several instances of individual pupils having had a
+succession of cases in various quarters of the town, while others,
+practising as extensively in the same localities, had none. Also to
+several special cases not mentioned elsewhere. Am. Jour. Med. Se. for
+October, 1851. (From New Monthly Journal of Med. Science.)
+
+Simpson.--Observations at a Meeting of the Edinburgh Obstetrical
+Society. (An “eminent gentleman,” according to Dr. Meigs, whose “name
+is as well known in America as in (his) native land.” Obstetrics.
+Phil. 1852, pp. 368, 375.) The student is referred to this paper for
+a valuable resume of many of the facts, and the necessary inferences,
+relating to 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 diseased parts. His
+next four child-bed patients were affected with puerperal fever, and
+it was the first time he had seen it in practice. As Dr. Simpson is a
+gentleman (Dr. Meigs, as above), and as “a gentleman's hands are clean”
+ (Dr. Meigs' Sixth Letter), it follows that a gentleman with clean hands
+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 the series. A practitioner in Leith having examined
+in Dr. Simpson's house, a portion of the uterus obtained from one of
+the patients, had immediately afterwards three fatal cases of puerperal
+fever. Dr. Veddie referred to two distinct series of consecutive cases
+in his own practice. He had since taken precautions, and not met with
+any such cases. Am. Jour. Med. Sc., October, 1851.
+
+Copland. Considers it proved that puerperal fever maybe propagated by
+the hands and the clothes, or either, of a third person, the bed-clothes
+or body-clothes of a patient. Mentions a new series of cases, one of
+which he saw, with the practitioner who had attended them. She was the
+sixth he had had within a few days. All died. Dr. Copland insisted that
+contagion had caused these cases; advised precautionary measures, and
+the practitioner had no other cases for a considerable time. Considers
+it criminal, after the evidence adduced,--which he could have
+quadrupled,--and the weight of authority brought forward, for a
+practitioner to be the medium of transmitting contagion and death to
+his patients. Dr. Copland lays down rules similar to those suggested
+by myself, and is therefore entitled to the same epithet for so doing.
+Medical Dictionary, New York, 1852. Article, Puerperal States and
+Diseases.
+
+If there is any appetite for facts so craving as to be yet
+unappeased,--Lesotho, necdum satiata,--more can be obtained. Dr. Hodge
+remarks that “the frequency and importance of this singular circumstance
+(that the disease is occasionally more prevalent with one practitioner
+than another) has been exceedingly overrated.” More than thirty strings
+of cases, more than two hundred and fifty sufferers from puerperal
+fever, more than one hundred and thirty deaths appear as the results of
+a sparing estimate of such among the facts I have gleaned as could be
+numerically valued. These facts constitute, we may take it for granted,
+but a small fraction of those that have actually occurred. The number of
+them might be greater, but “'t is enough, 't will serve,” in Mercutio's
+modest phrase, so far as frequency is concerned. For a just estimate
+of the importance of the singular circumstance, it might be proper to
+consult the languid survivors, the widowed husbands, and the motherless
+children, as well as “the unfortunate accoucheur.”
+
+
+
+
+
+
+CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+An Address delivered before the Massachusetts Medical Society, at the
+Annual Meeting, May 30, 1860.
+
+
+        “Facultate magis quam violentia.”
+                   HIPPOCRATES.
+
+Our Annual Meeting never fails to teach us at least one lesson. The art
+whose province it is to heal and to save cannot protect its own ranks
+from the inroads of disease and the waste of the Destroyer.
+
+Seventeen of our associates have been taken from us since our last
+Anniversary. Most of them followed their calling in the villages or
+towns that lie among the hills or along the inland streams. Only those
+who have lived the kindly, mutually dependent life of the country, can
+tell how near the physician who is the main reliance in sickness of all
+the families throughout a thinly settled region comes to the hearts of
+the people among whom he labors, how they value him while living, how
+they cherish his memory when dead. For these friends of ours who have
+gone before, there is now no more toil; they start from their slumbers
+no more at the cry of pain; they sally forth no more into the storms;
+they ride no longer over the lonely roads that knew them so well; their
+wheels are rusting on their axles or rolling with other burdens; their
+watchful eyes are closed to all the sorrows they lived to soothe. Not
+one of these was famous in the great world; some were almost unknown
+beyond their own immediate circle. But they have left behind them that
+loving remembrance which is better than fame, and if their epitaphs are
+chiselled briefly in stone, they are written at full length on living
+tablets in a thousand homes to which they carried their ever-welcome aid
+and sympathy.
+
+One whom we have lost, very widely known and honored, was a leading
+practitioner of this city. His image can hardly be dimmed in your
+recollection, as he stood before you only three years ago, filling the
+same place with which I am now honored. To speak of him at all worthily,
+would be to write the history of professional success, won without
+special aid at starting, by toil, patience, good sense, pure character,
+and pleasing manners; won in a straight uphill ascent, without one
+breathing-space until he sat down, not to rest, but to die. If prayers
+could have shielded him from the stroke, if love could have drawn forth
+the weapon, and skill could have healed the wound, this passing tribute
+might have been left to other lips and to another generation.
+
+Let us hope that our dead have at last found that rest which neither
+summer nor winter, nor day nor night, had granted to their unending
+earthly labors! And let us remember that our duties to our brethren do
+not cease when they become unable to share our toils, or leave behind
+them in want and woe those whom their labor had supported. It is
+honorable to the Profession that it has organized an Association for the
+relief of its suffering members and their families; it owes this tribute
+to the ill-rewarded industry and sacrifices of its less fortunate
+brothers who wear out health and life in the service of humanity. I have
+great pleasure in referring to this excellent movement, which gives our
+liberal profession a chance to 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 business after twenty years of
+practice, is apt to suppose that he treats his patients according to the
+teachings of his experience. No doubt this is true to some extent; to
+what extent depending much on the qualities of the individual. But it
+is easy to prove that the prescriptions of even wise physicians are
+very commonly founded on something quite different from experience.
+Experience must be based on the permanent facts of nature. But a glance
+at the prevalent modes of treatment of any two successive generations
+will show that there is a changeable as well as a permanent element in
+the art of healing; not merely changeable as diseases vary, or as new
+remedies are introduced, but changeable by the going out of fashion of
+special remedies, by the decadence of a popular theory from which their
+fitness was deduced, or other cause not more significant. There is no
+reason to suppose that the present time is essentially different in
+this respect from any other. Much, therefore, which is now very commonly
+considered to be the result of experience, will be recognized in the
+next, or in some succeeding generation, as no such result at all, but as
+a foregone conclusion, based on some prevalent belief or fashion of the
+time.
+
+There are, of course, in every calling, those who go about the work of
+the day before them, doing it according to the rules of their craft, and
+asking no questions of the past or of the future, or of the aim and end
+to which their special labor is contributing. These often consider and
+call themselves practical men. They pull the oars of society, and have
+no leisure to watch the currents running this or that way; let theorists
+and philosophers attend to them. In the mean time, however, these
+currents are carrying the practical men, too, and all their work may be
+thrown away, and worse than thrown away, if they do not take knowledge
+of them and get out of the wrong ones and into the right ones as soon as
+they may. Sir Edward Parry and his party were going straight towards the
+pole in one of their arctic expeditions, travelling at the rate of ten
+miles a day. But the ice over which they travelled was drifting straight
+towards the equator, at the rate of twelve miles a day, and yet no
+man among them would have known that he was travelling two miles a day
+backward unless he had lifted his eyes from the track in which he was
+plodding. It is not only going backward that the plain practical workman
+is liable to, if he will not look up and look around; he may go forward
+to ends he little dreams of. It is a simple business for a 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 Jewish artisan
+to fit two pieces of timber together according to the legal pattern in
+the time of Pontius Pilate; he asked no questions, perhaps, but we know
+what burden the cross bore on the morrow! And so, with subtler tools
+than trowels or axes, the statesman who works in policy without
+principle, the theologian who works in forms without a soul, the
+physician who, calling himself a practical man, refuses to recognize the
+larger laws which govern his changing practice, may all find that they
+have been building truth into the wall, and hanging humanity upon the
+cross.
+
+The truth is, that medicine, professedly founded on observation, 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 straightforward inductive path,
+without regard to changes of government or to fluctuations of public
+opinion. But look a moment while I clash a few facts together, and see
+if some sparks do not reveal by their light a closer relation between
+the Medical Sciences and the conditions of Society and the general
+thought of the time, than would at first be suspected.
+
+Observe the coincidences between certain great political and
+intellectual periods and the appearance of illustrious medical reformers
+and teachers. It was in the age of Pericles, of Socrates, of Plato, of
+Phidias, that Hippocrates gave to medical knowledge the form which it
+retained for twenty centuries. With the world-conquering Alexander, the
+world-embracing Aristotle, appropriating anatomy and physiology, among
+his manifold spoils of study, marched abreast of his royal pupil to
+wider conquests. Under the same Ptolemies who founded the Alexandrian
+Library and Museum, and ordered the Septuagint version of the Hebrew
+Scriptures, the infallible Herophilus [“Contradicere Herophilo in
+anatomicis, est contradicere evangelium,” was a saying of Fallopius.]
+made those six hundred dissections of which Tertullian accused him, and
+the sagacious Erasistratus introduced his mild antiphlogistic treatment
+in opposition to the polypharmacy and antidotal practice of his time.
+It is significant that the large-minded Galen should have been the
+physician and friend of the imperial philosopher Marcus Aurelius. The
+Arabs gave laws in various branches of knowledge to those whom their
+arms had invaded, or the terror of their spreading dominion had reached,
+and the point from which they started was, as Humboldt acknowledges,
+“the study of medicine, by which they long ruled the Christian Schools,”
+ and to which they added the department of chemical pharmacy.
+
+Look at Vesalius, the contemporary of Luther. Who can fail to see
+one common spirit in the radical ecclesiastic and the reforming
+court-physician? Both still to some extent under the dominion of the
+letter: Luther holding to the real presence; Vesalius actually causing
+to be drawn and engraved two muscles which he knew were not found in
+the human subject, because they had been described by Galen, from
+dissections of the lower animals. Both breaking through old traditions
+in the search of truth; one, knife in hand, at the risk of life and
+reputation, the other at the risk of fire and fagot, with that mightier
+weapon which all the devils could not silence, though they had been
+thicker than the tiles on the house-tops. How much the physician of the
+Catholic Charles V. had in common with the great religious destructive,
+may be 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 ill repute, the favorite of a monk of the order of St. Anthony, who
+does not seem to have resisted temptation so well as the founder of
+his order. We have always ranked the physician Rabelais among the early
+reformers, but I do not know that Vesalius has ever been thanked for his
+hit at the morals of the religious orders, or for turning to the good of
+science what was intended for the “benefit of clergy.”
+
+Our unfortunate medical brother, Michael Servetus, the spiritual patient
+to whom the theological moxa was applied over the entire surface for
+the cure of his heresy, came very near anticipating Harvey. The same
+quickened thought of the time which led him to dispute the dogma of the
+Church, opened his mind to the facts which contradicted the dogmas of
+the Faculty.
+
+Harvey himself was but the posthumous child of the great Elizabethan
+period. Bacon was at once his teacher and his patient. The founder
+of the new inductive philosophy had only been dead two years when the
+treatise on the Circulation, the first-fruit of the 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 political world, Bichat was revolutionizing
+the science of life and the art that is based upon it; that while the
+young general was scaling the Alps, the young surgeon was climbing
+the steeper summits of unexplored nature; that the same year read the
+announcement of those admirable “Researches on Life and Death,” and the
+bulletins of the battle of Marengo?
+
+If we come to our own country, who can fail to recognize that Benjamin
+Rush, the most conspicuous of American physicians, was the intellectual
+offspring of the movement which produced the Revolution? “The same
+hand,” says one of his biographers, “which subscribed the declaration
+of the political independence of these States, accomplished their
+emancipation from medical systems formed in foreign countries, and
+wholly unsuitable to the state of diseases in America.”
+
+Following this general course of remark, I propose to indicate in a few
+words the direction of the main intellectual current of the time, and
+to point out more particularly some of the eddies which tend to keep the
+science and art of medicine from moving with it, 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 being in which we live. Statistics have
+tabulated everything,--population, growth, wealth, crime, disease. We
+have shaded maps showing the geographical distribution of larceny and
+suicide. Analysis and classification have been at work upon all tangible
+and visible objects. The Positive Philosophy of Comte has only given
+expression to the observing and computing mind of the nineteenth
+century.
+
+In the mean time, the great stronghold of intellectual conservatism,
+traditional belief, has been assailed by facts which would have been
+indicted as blasphemy but a few generations ago. Those new tables of
+the law, placed in the hands of the geologist by the same living God who
+spoke from Sinai to the Israelites of old, have remodelled the beliefs
+of half the civilized world. The solemn scepticism of science has
+replaced the sneering doubts of witty philosophers. The more positive
+knowledge we gain, the more we incline to question all that has been
+received without absolute proof.
+
+As a matter of course, this movement has its partial reactions. The
+province of faith is claimed as a port free of entry to unsupported
+individual convictions. The tendency to question is met by the
+unanalyzing instinct of reverence. The old church calls back its
+frightened truants. Some who have lost their hereditary religious
+belief find a resource in the revelations of Spiritualism. By a parallel
+movement, some of those who have become medical infidels pass over to
+the mystic band of believers in the fancied miracles of Homoeopathy.
+
+Under these influences transmitted to, or at least shared by, the
+medical profession, the old question between “Nature,” so called, and
+“Art,” or professional tradition, has reappeared with new interest. I
+say the old question, for Hippocrates stated the case on the side
+of “Nature” more than two thousand years ago. Miss Florence
+Nightingale,--and if I name her next to the august Father of the Healing
+Art, its noblest daughter well deserves that place of honor,--Miss
+Florence Nightingale begins her late volume with a paraphrase of his
+statement. But from a very early time to this there has always been
+a strong party against “Nature.” Themison called the practice of
+Hippocrates “a meditation upon death.” Dr. Rush says: “It is impossible
+to calculate the mischief which Hippocrates has done, by first marking
+Nature with his name and afterwards letting her loose upon sick people.
+Millions have perished by her hands in all ages and countries.” Sir John
+Forbes, whose defence of “Nature” in disease you all know, and to the
+testimonial in whose 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 years sooner, and the opinion that no man
+had done so much to destroy the confidence of the public in the medical
+profession.
+
+In this Society we have had the Hippocratic and the Themisonic side
+fairly represented. The treatise of one of your early Presidents on the
+Mercurial Treatment is familiar to my older listeners. Others who have
+held the same office have been noted for the boldness of their practice,
+and even for partiality to the use of complex medication.
+
+On the side of “Nature” we have had, first of all, that remarkable
+discourse on Self-Limited Diseases, [On Self-Limited Diseases. A
+Discourse delivered before the Massachusetts Medical Society, at their
+Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which has given
+the key-note to the prevailing medical tendency of this neighborhood, at
+least, for the quarter of a century since it was delivered. Nor have
+we forgotten the address delivered at Springfield twenty 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. Worthington Hooker. [Rational
+Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New Haven.
+Boston. 1857.] We should not omit from the list the important address of
+another of our colleagues, [On the Treatment of Compound and Complicated
+Fractures. By William J. Walker, M. D. Read at the Annual Meeting, May
+29, 1845.] showing by numerous cases the power of Nature in
+healing compound fractures to be much greater than is frequently
+supposed,--affording, indeed, more striking illustrations than can be
+obtained from the history of visceral disease, of the supreme wisdom,
+forethought, and adaptive dexterity of that divine Architect, as shown
+in repairing the shattered columns which support the living temple of
+the body.
+
+We who are on the side of “Nature” please ourselves with the idea that
+we are in the great current in which the true intelligence of the time
+is moving. We believe that some who oppose, or fear, or denounce our
+movement are themselves caught in various eddies that set back against
+the truth. And we do most earnestly desire and most actively strive,
+that Medicine, which, it is painful to remember, has been spoken of
+as “the withered branch of science” at a meeting of the British
+Association, shall be at length brought fully to share, if not to lead,
+the great wave of knowledge which rolls with the tides that circle the
+globe.
+
+If there is any State or city which might claim to be the American
+headquarters of the nature-trusting heresy, provided it be one, that
+State is Massachusetts, and that city is its capital. The effect which
+these doctrines have upon the confidence reposed in the profession is a
+matter of opinion. For myself, I do not believe this confidence can be
+impaired by any investigations which tend to limit the application of
+troublesome, painful, uncertain, or dangerous remedies. Nay, I will
+venture to say this, that if every specific were to fail utterly, if the
+cinchona trees all died out, and the arsenic mines were exhausted, and
+the sulphur regions were burned up, if every drug from the vegetable,
+animal, and mineral kingdom were to disappear from the market, a body of
+enlightened men, organized as a distinct profession, would be required
+just as much as now, and respected and trusted as now, whose province
+should be to guard against the causes of disease, to eliminate them if
+possible when still present, to order all the conditions of the patient
+so as to favor the efforts of the system to right itself, and to give
+those predictions of the course of disease which only experience can
+warrant, and which in so many cases relieve the exaggerated fears of
+sufferers and their friends, or warn them in season of impending danger.
+Great as the loss would be if certain active remedies could no longer be
+obtained, it would leave the medical profession the most essential part
+of its duties, and all, and more than all, its present share of honors;
+for it would be the death-blow to charlatanism, which depends for its
+success almost entirely on drugs, or at least on a nomenclature that
+suggests them.
+
+There is no offence, then, or danger in expressing the opinion, that,
+after all which has been said, the community is still overdosed: The
+best proof of it is, that “no families take so little medicine as those
+of doctors, except those of apothecaries, and that old practitioners are
+more sparing of active medicines than younger ones.” [Dr. James Jackson
+has kindly permitted me to make the following extract from a letter
+just received by him from Sir James Clark, and dated May 26, 1860: “As a
+physician advances in age, he generally, I think, places less confidence
+in the ordinary medical treatment than he did, not only during his
+early, but even his middle period of life.”] The conclusion from these
+facts is one which the least promising of Dr. Howe's pupils in the
+mental department could hardly help drawing.
+
+Part of the blame of over-medication must, I fear, rest with the
+profession, for yielding to the tendency to self-delusion, which seems
+inseparable from the practice of the art of healing. I need only touch
+on the common modes of misunderstanding or misapplying the evidence of
+nature.
+
+First, there is the natural incapacity for sound observation, which is
+like a faulty ear in music. We see this in many persons who know a good
+deal about books, but who are not sharp-sighted enough to buy a horse or
+deal with human diseases.
+
+Secondly, there is in some persons a singular inability to weigh the
+value of testimony; of which, I think, from a pretty careful examination
+of his books, Hahnemann affords the best specimen outside the walls of
+Bedlam.
+
+The inveterate logical errors to which physicians have always been
+subject are chiefly these:
+
+The mode of inference per enumerationem simplicem, in scholastic phrase;
+that is, counting only their favorable cases. This is the old trick
+illustrated in Lord Bacon's story of the gifts of the shipwrecked
+people, hung up in the temple.--Behold! they vowed these gifts to the
+altar, and the gods saved them. Ay, said a doubting bystander, but
+how many made vows of gifts and were shipwrecked notwithstanding? The
+numerical system is the best corrective of this and similar errors. The
+arguments commonly brought against its application to all matters of
+medical observation, treatment included, seem to apply rather to the
+tabulation of facts ill observed, or improperly classified, than to the
+method itself.
+
+The post hoc ergo propter hoc error: he got well after taking my
+medicine; therefore in consequence of taking it.
+
+The false induction from genuine facts of observation, leading to the
+construction of theories which are then deductively applied in the
+face of the results of direct observation. The school of Broussais has
+furnished us with a good example of this error.
+
+And lastly, the error which Sir Thomas Browne calls giving “a reason of
+the golden tooth;” that is, assuming a falsehood as a fact, and giving
+reasons for it, commonly fanciful ones, as is constantly done by that
+class of incompetent observers who find their “golden tooth” in the
+fabulous effects of the homoeopathie materia medica,--which consists of
+sugar of milk and a nomenclature.
+
+Another portion of the blame rests with the public itself, which insists
+on being poisoned. Somebody buys all the quack medicines that build
+palaces for the mushroom, say rather, the toadstool millionaires. Who is
+it? These people have a constituency of millions. The popular belief is
+all but universal that sick persons should feed on noxious substances.
+One of our members was called not long since to a man with a terribly
+sore mouth. On inquiry he found that the man had picked up a box of
+unknown pills, in Howard Street, and had proceeded to take them, on
+general principles, pills being good for people. They happened to
+contain mercury, and hence the trouble for which he consulted our
+associate.
+
+The outside pressure, therefore, is immense upon the physician,
+tending to force him to active treatment of some kind. Certain old
+superstitions, still lingering in the mind of the public, and not yet
+utterly expelled from that of the profession, are at the bottom of this,
+or contribute to it largely. One of the most ancient is, that disease is
+a malignant agency, or entity, to be driven out of the body by offensive
+substances, as the smoke of the fish's heart and liver drove the devil
+out of Tobit's bridal chamber, according to the Apochrypha. Epileptics
+used to suck the blood from the wounds of dying gladiators. [Plinii
+Hist. Mundi. lib. xxviii. c. 4.] The Hon. Robert Boyle's little book
+was published some twenty or thirty years before our late President, Dr.
+Holyoke, was born. [A Collection of Choice and Safe Remedies. The Fifth
+Edition, corrected. London, 1712. Dr. Holyoke was born in 1728.] In it
+he recommends, as internal medicines, most of the substances commonly
+used as fertilizers of the soil. His “Album Graecum” is best
+left untranslated, and his “Zebethum Occidentale” is still more
+transcendentally unmentionable except in a strange dialect. It sounds
+odiously to us to hear him recommend for dysentery a powder made from
+“the sole 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 neck at night for a sore throat. The same idea
+of virtue in unlovely secretions! [The idea is very ancient. “Sordes
+hominis” “Sudore et oleo medicinam facientibus.”--Plin. xxviii. 4.]
+
+Even now the Homoeopathists have been introducing the venom of serpents,
+under the learned title of Lachesis, and outraging human nature with
+infusions of the pediculus capitis; that is, of course, as we understand
+their dilutions, the names of these things; for if a fine-tooth-comb
+insect were drowned in Lake Superior, we cannot agree with them in
+thinking that every drop of its waters would be impregnated with all the
+pedicular virtues they so highly value. They know what they are doing.
+They are appealing to the detestable old superstitious presumption in
+favor of whatever is nauseous and noxious as being good for the sick.
+
+Again, we all occasionally meet persons stained with nitrate of silver,
+given for epilepsy. Read what Dr. Martin says, about the way in which
+it came to be used, in his excellent address before the Norfolk County
+Medical Society, and the evidence I can show, but have not time for now,
+and then say what you think of the practice which on such presumptions
+turns a white man as blue as the double-tattooed King of the Cannibal
+Islands! [Note A.]
+
+If medical superstitions have fought their way down through all the
+rationalism and scepticism of the nineteenth century, of course the
+theories of the schools, supported by great names, adopted into the
+popular belief and incorporated with the general mass of misapprehension
+with reference to disease, must be expected to meet us at every turn in
+the shape of bad practice founded on false doctrine. A French patient
+complains that his blood heats him, and expects his doctor to bleed
+him. An English or American one says he is bilious, and will not be easy
+without a dose of calomel. A doctor looks at a patient's tongue, sees it
+coated, and says the stomach is foul; his head full of the old saburral
+notion which the extreme inflammation-doctrine of Broussais did so
+much to root out, but which still leads, probably, to much needless and
+injurious wrong of the stomach and bowels by evacuants, when all they
+want is to be let alone. It is so hard to get anything out of the dead
+hand of medical tradition! The mortmain of theorists extinct in science
+clings as close as that of ecclesiastics defunct in law.
+
+One practical hint may not be out of place here. It seems to be
+sometimes forgotten, by those who must know the fact, that the tongue is
+very different, anatomically and physiologically, from the stomach.
+Its condition does not in the least imply a similar one of the stomach,
+which is a very different structure, covered with a different kind
+of epithelium, and furnished with entirely different secretions. A
+silversmith will, for a dollar, make a small hoe, of solid silver, which
+will last for centuries, and will give a patient more comfort, used
+for the removal of the accumulated epithelium and fungous growths which
+constitute the “fur,” than many a prescription with a split-footed Rx
+before it, addressed to the parts out of reach.
+
+I think more of this little implement on account of its agency in saving
+the Colony at Plymouth in the year 1623. Edward Winslow heard that
+Massasoit was sick and like to die. He found him with a houseful of
+people about him, women rubbing his arms and legs, and friends “making
+such a hellish noise” as they probably thought would scare away the
+devil of sickness. Winslow gave him some conserve, washed his mouth,
+scraped his tongue, which was in a horrid state, got down some drink,
+made him some broth, dosed him with an infusion of strawberry leaves and
+sassafras root, and had the satisfaction of seeing him rapidly recover.
+Massasoit, full of gratitude, revealed the plot which had been formed
+to destroy the colonists, whereupon the Governor ordered Captain Miles
+Standish to see to them; who thereupon, as everybody remembers, stabbed
+Pecksuot with his own knife, broke up the plot, saved the colony, and
+thus rendered Massachusetts and the Massachusetts Medical Society
+a possibility, as they now are a fact before us. So much for this
+parenthesis of the tongue-scraper, which helped to save the young
+colony from a much more serious scrape, and may save the Union yet, if a
+Presidential candidate should happen to be taken sick as Massasoit was,
+and his tongue wanted cleaning,--which process would not hurt a good
+many politicians, with or without a typhoid fever.
+
+Again, see how the “bilious” theory works in every-day life here and
+now, illustrated by a case from actual life. A youthful practitioner,
+whose last molars have not been a great while cut, meets an experienced
+and noted physician in consultation. This is the case. A slender,
+lymphatic young woman is suckling two lusty twins, the intervals
+of suction being occupied on her part with palpitations, headaches,
+giddiness, throbbing in the head, and various nervous symptoms, her
+cheeks meantime getting bloodless, and her strength running away
+in company with her milk. The old experienced physician, seeing the
+yellowish waxy look which is common in anaemic patients, considers it a
+“bilious” case, and is for giving a rousing emetic. Of course, he has to
+be wheedled out of this, a recipe is written for beefsteaks and porter,
+the twins are ignominiously expelled from the anaemic bosom, and forced
+to take prematurely to the bottle, and this prolific mother is saved for
+future usefulness in the line of maternity.
+
+The practice of making a profit on the medicine ordered has been held up
+to reprobation by one at least of the orators who have preceded me. That
+the effect of this has been ruinous in English practice I cannot
+doubt, and that in this country the standard of practice was in former
+generations lowered through the same agency is not unlikely. I have seen
+an old account-book in which the physician charged an extra price for
+gilding his rich patients' pills. If all medicine were very costly,
+and the expense of it always came out of the physician's fee, it
+would really be a less objectionable arrangement than this other most
+pernicious one. He would naturally think twice before he gave an emetic
+or cathartic which evacuated his own pocket, and be sparing of the
+cholagogues that emptied the biliary ducts of his own wallet, unless he
+were sure they were needed. If there is any temptation, it should not be
+in favor of giving noxious agents, as it clearly must be in the case of
+English druggists and “General Practitioners.” The complaint against
+the other course is a very old one. Pliny, inspired with as truly Roman
+horror of quackery as the elder Cato,--who declared that the Greek
+doctors had sworn to exterminate all barbarians, including the Romans,
+with their drugs, but is said to have physicked his own wife to death,
+notwithstanding,--Pliny says, in so many words, 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 sober observation of nature, in the direction
+of old superstitions and fancies, of exploded theories, of old ways of
+making money, which are very slow to pass out of fashion.
+
+But there are other special American influences which we are bound to
+take cognizance of. If I wished to show a student the difficulties of
+getting at truth from medical experience, I would give him the history
+of epilepsy to read. If I wished him to understand the tendencies of the
+American medical mind, its sanguine enterprise, its self-confidence, its
+audacious handling of Nature, its impatience with her old-fashioned ways
+of taking time to get a sick man well, I would make him read the life
+and writings of Benjamin Rush. Dr. Rush thought and said that there were
+twenty times more intellect and a hundred times more knowledge in
+the country in 1799 than before the Revolution. His own mind was in a
+perpetual state of exaltation produced by the stirring scenes in which
+he had taken a part, and the quickened life of the time in which he
+lived. It was not the state to favor sound, calm observation. He was
+impatient, and Nature is profoundly imperturbable. We may adjust the
+beating of our hearts to her pendulum if we will and can, but we may be
+very sure that she will not change the pendulum's rate of going because
+our hearts are palpitating. He thought he had mastered yellow-fever.
+“Thank God,” he said, “out of one hundred patients whom I have visited
+or prescribed for this day, I have lost none.” Where was all his legacy
+of knowledge when Norfolk was decimated? Where was it when the blue
+flies were buzzing over the coffins of the unburied dead piled up in
+the cemetery of New Orleans, at the edge of the huge trenches yawning to
+receive them?
+
+One such instance will do as well as twenty. Dr. Rush must have been a
+charming teacher, as he was an admirable man. He was observing, rather
+than a sound observer; eminently observing, curious, even, about all
+manner of things. But he could not help feeling as if Nature had been a
+good deal shaken by the Declaration of Independence, and that
+American art was getting to be rather too much for her,--especially
+as illustrated in his own practice. He taught thousands of American
+students, he gave a direction to the medical mind of the country more
+than any other one man; perhaps he typifies it better than any other. It
+has clearly tended to extravagance in remedies and trust in remedies,
+as in everything else. How could a people which has a revolution once in
+four years, which has contrived the Bowie-knife and the revolver, which
+has chewed the juice out of all the superlatives in the language in
+Fourth of July orations, and so used up its epithets in the rhetoric of
+abuse that it takes two great quarto dictionaries to supply the demand;
+which insists in sending out yachts and horses and boys to out-sail,
+out-run, out-fight, and checkmate all the rest of creation; how could
+such a people be content with any but “heroic” practice? What wonder
+that the stars and stripes wave over doses of ninety grains of sulphate
+of quinine, [More strictly, ninety-six grains in two hours. Dunglison's
+Practice, 1842, vol. ii. p. 520. Eighty grains in one dose. Ibid. p.
+536. Ninety-six grains of sulphate of quinine are equal to eight ounces
+of good bark.--Wood & Bache.] and that the American eagle screams with
+delight to see three drachms of calomel given at a single 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 which must find something to fill their columns, and so
+print all the new plans of treatment and new remedies they can get hold
+of, as the newspapers, from a similar necessity, print the shocking
+catastrophes and terrible murders.
+
+Besides all this, here are we, the great body of teachers in the
+numberless medical schools of the Union, some of us lecturing to crowds
+who clap and stamp in the cities, some of us wandering over the country,
+like other professional fertilizers, to fecundate the minds of less
+demonstrative audiences at various scientific stations; all of us
+talking habitually to those supposed to know less than ourselves, and
+loving to claim as much for our art as we can, not to say for our own
+schools, and possibly indirectly for our own practical skill. Hence that
+annual crop of introductory lectures; the useful blossoming into the
+ornamental, as the cabbage becomes glorified in the cauliflower; that
+lecture-room literature of adjectives, that declamatory exaggeration,
+that splendid show of erudition borrowed from D'Israeli, and credited
+to Lord Bacon and the rest, which have suggested to our friends of
+the Medical Journals an occasional epigram at our expense. Hence the
+tendency in these productions, and in medical lectures generally,
+to overstate the efficacy of favorite methods of cure, and hence the
+premium offered for showy talkers rather than sagacious observers,
+for the men of adjectives rather than of nouns substantive in the more
+ambitious of these institutions.
+
+Such are some of the eddies in which we are liable to become involved
+and carried back out of the broad stream of philosophical, or, in other
+words, truth-loving, investigations. The causes of disease, in the mean
+time, have been less earnestly studied in the eagerness 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-house
+might not be known, while the very men who were discussing the treatment
+of the disease were stupidly conveying the infection from bed to bed,
+as rat-killers carry their poisons from one household to another. Do not
+some of you remember that I have had to fight this private-pestilence
+question against a scepticism which sneered in the face of a mass of
+evidence such as the calm statisticians of the Insurance office could
+not listen to without horror and indignation? [“The Contagiousness of
+Puerperal Fever.”--N. E. Quar. Jour. of Medicine and Surgery, April,
+1843. Reprinted, with Additions. Boston: Ticknor & Fields. 1855.] Have
+we forgotten what is told 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's lives in a
+single hospital? How long would it have taken small doses of calomel and
+rhubarb to save as many children? These may be useful in prudent hands,
+but how insignificant compared to the great hygienic conditions! Causes,
+causes, and again causes,--more and more we fall back on these as the
+chief objects of our attention. The shortest system 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 it to the
+first mother when she saw her first-born child putting some ugly pebble
+or lurid berry into its mouth. I know not in what language it was
+spoken, but I know that in English it would sound thus: Spit it out!
+
+Art can do something more than say this. It can sometimes reach the
+pebble or berry after it has been swallowed. But the great thing is
+to keep these things out of children's mouths, and as soon as they are
+beyond our reach, to be reasonable and patient with Nature, who means
+well, but does not like to hurry, and who took nine calendar months,
+more or less, to every mother's son among us, before she thought he was
+fit to be shown to the public.
+
+Suffer me now to lay down a few propositions, whether old or new it
+matters little, not for your immediate acceptance, nor yet for your
+hasty rejection, but for your calm consideration.
+
+But first, there are a number of terms which we are in the habit of
+using in a vague though not unintelligible way, and which it is as well
+now to define. These terms are the tools with which we are to work, and
+the first thing is to sharpen them. It is nothing to us that they have
+been sharpened a thousand times before; they always get dull in the
+using, and every new workman has a right to carry them to the grindstone
+and sharpen them to suit himself.
+
+Nature, in medical language, as opposed to Art, means trust in the
+reactions of the living system against ordinary normal impressions.
+
+Art, in the same language, as opposed to Nature, means an intentional
+resort to extraordinary abnormal impressions for the relief of disease.
+
+The reaction of the living system is the essence of both. Food is
+nothing, if there is no digestive act to respond to it. We cannot raise
+a blister on a dead man, or hope that a carminative forced between his
+lips will produce its ordinary happy effect.
+
+Disease, dis-ease,--disturbed quiet, uncomfortableness,--means imperfect
+or abnormal reaction of the living system, and its more or less
+permanent results.
+
+Food, in its largest sense, is whatever helps to build up the normal
+structures, or to maintain their natural actions.
+
+Medicine, in distinction from food, is every unnatural or noxious agent
+applied for the relief of disease.
+
+Physic means properly the Natural art, and Physician is only the Greek
+synonyme of Naturalist.
+
+With these few explanations I proceed to unfold the propositions I have
+mentioned.
+
+Disease and death, if we may judge by the records of creation, are
+inherently and essentially necessary in the present order of things. A
+perfect intelligence, trained by a perfect education, could do no more
+than keep the laws of the physical and spiritual universe. An imperfect
+intelligence, imperfectly taught,--and this is the condition of our
+finite humanity,--will certainly fail to keep all these laws perfectly.
+Disease is one of the penalties of one of the forms of such failure. It
+is prefigured in the perturbations of the planets, in the disintegration
+of the elemental masses; it has left its traces in the fossil organisms
+of extinct creations. [Professor Agassiz has kindly handed me the
+following note: “There are abnormal structures in animals of all ages
+anterior to the creation of mankind. Malformed specimens of Crinoids are
+known from the Triassic and Jurassic deposits. Malformed and diseased
+bones of tertiary mammalia have been collected in the caverns of
+Gailenreuth with traces of healing.”]
+
+But it is especially the prerogative, I had almost said 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 get rid
+of those who will not mind or cannot be kept subject to these laws.
+
+Disease, being always an effect, is always in exact proportion to the
+sum of its causes, as much in the case of Spigelius, who dies of a
+scratch, as in that of the man who recovers after an iron bar has been
+shot through his brain. The one prevalent failing of the medical art is
+to neglect the causes and quarrel with the effect.
+
+There are certain general facts which include a good deal of what is
+called and treated as disease. Thus, there are two opposite movements of
+life to be seen in cities and elsewhere, belonging to races which, from
+various persistent causes, are breeding down and tending to run out,
+and to races which are breeding up, or accumulating vital capital,--a
+descending and an ascending series. Let me give an example of each; and
+that I may incidentally remove a common impression about this country as
+compared with the Old World, an impression which got tipsy with conceit
+and staggered into the attitude of a formal proposition in the work of
+Dr. Robert Knox, I will illustrate the downward movement from English
+experience, and the upward movement from a family history belonging to
+this immediate neighborhood.
+
+Miss Nightingale speaks of “the fact so often seen of a
+great-grandmother, who was a tower of physical vigor, descending into a
+grandmother perhaps a little less vigorous, but still sound as a bell,
+and healthy to the core, into a mother languid and confined to her
+carriage and house; and lastly into a daughter sickly and confined
+to her bed.” So much for the descending English series; now for the
+ascending American series.
+
+Something more than one hundred and thirty years ago there graduated at
+Harvard College a delicate youth, who lived an invalid life and died at
+the age of about fifty. His two children were both of moderate physical
+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 of its members. The fourth generation was of fair average
+endowment. The fifth generation, great-great-grandchildren of the
+slender invalid, are several of, them of extraordinary bodily and mental
+power; large in stature, formidable alike with their brains and their
+arms, organized on a more extensive scale than either of their parents.
+
+This brief account illustrates incidentally the fallacy of the
+universal-degeneration theory applied to American life; the same on
+which one of our countrymen has lately brought some very forcible facts
+to bear in a muscular discussion of which we have heard rather more than
+is good for us. But the two series, American and English, ascending and
+descending, were adduced with the main purpose of showing the immense
+difference of vital endowments in different strains of blood; a
+difference to which all ordinary medication is in all probability a
+matter of comparatively trivial purport. Many affections which art has
+to strive against might be easily shown to be vital to the well-being of
+society. Hydrocephalus, tabes mesenterica, and other similar maladies,
+are natural agencies which cut off the children of races that are
+sinking below the decent minimum which nature has established as the
+condition of viability, before they reach the age of reproduction.
+They are really not so much diseases, as manifestations of congenital
+incapacity for life; the race would be ruined if art could ever learn
+always to preserve the individuals subject to them. We must do the best
+we can for them, but we 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 absolute health by medicinal
+appliances. There are many ladies, ancient and recent, who are
+perpetually taking remedies for irremediable pains and aches. They ought
+to have headaches and back-aches and stomach-aches; they are not well if
+they do not have them. To expect them to live without frequent twinges
+is like expecting a doctor's old chaise to go without creaking; if it
+did, we might be sure the springs were broken. There is no doubt that
+the constant demand for medicinal remedies from patients of this class
+leads to their over-use; often in the case of cathartics, sometimes in
+that of opiates. I have been told by an intelligent practitioner in
+a Western town, that the constant prescription of opiates by certain
+physicians in his vicinity has rendered the habitual use of that drug
+in all that region very prevalent; more common, I should think, than
+alcoholic drunkenness in the most intemperate localities of which I have
+known anything. A frightful endemic demoralization betrays itself in the
+frequency with which the haggard features and drooping shoulders of the
+opium-drunkards are met with in the streets.
+
+The next proposition I would ask you to consider is this: The
+presumption always is that every noxious agent, including medicines
+proper, which hurts a well man, hurts a sick one. [Note B.]
+
+Let me illustrate this proposition before you decide upon it. If it were
+known that a prize-fighter were to have a drastic purgative administered
+two or three days before a contest, or a large blister applied to his
+back, no one will question that it would affect the betting on his side
+unfavorably; we will say to the amount of five per cent. Now the drain
+upon the resources of the system produced in such a case must be at its
+minimum, for the subject is a powerful man, in the prime of life, and
+in admirable condition. If the drug or the blister takes five per cent.
+from his force of resistance, it will take at least as large a fraction
+from any invalid. But this invalid has to fight a champion who strikes
+hard but cannot be hit in return, who will press him sharply for breath,
+but will never pant himself while the wind can whistle through his
+fleshless ribs. The suffering combatant is liable to want all his
+stamina, and five per cent. may lose him the battle.
+
+All noxious agents, all appliances which are not natural food 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
+force produced by any of them, that is, would exactly kill him, nothing
+less than kill him, and nothing more. If this, or something like this,
+is true, then all these medications are, prima facie, injurious.
+
+In the game of Life-or-Death, Rouge et Noir, as played between the
+Doctor and the Sexton, this five per cent., this certain small injury
+entering into the chances is clearly the sexton's perquisite for keeping
+the green table, over which the game is played, and where he hoards
+up his gains. Suppose a blister to diminish a man's pain, effusion or
+dyspnoea to the saving of twenty per cent. in vital force; his profit
+from it is fifteen, in that case, for it always hurts him five to begin
+with, according to our previous assumption.
+
+Presumptions are of vast importance in medicine, as in law. A man is
+presumed innocent until he is proved guilty. A medicine--that is,
+a noxious agent, like a blister, a seton, an emetic, or a cathartic
+--should always be presumed to be hurtful. It always is directly
+hurtful; it may sometimes be indirectly beneficial. If this presumption
+were established, and disease always assumed to be the innocent victim
+of circumstances, and not punishable by medicines, that is, noxious
+agents, or poisons, until the contrary was shown, we should not so
+frequently hear the remark commonly, perhaps erroneously, attributed to
+Sir Astley Cooper, but often repeated by sensible persons, that, on the
+whole, more harm than good is done by medication. Throw out opium, which
+the Creator himself seems to prescribe, for we often see the scarlet
+poppy growing in the cornfields, as if it were foreseen that wherever
+there is hunger to be fed there must also be pain to be soothed; throw
+out a few specifics which our art did not discover, and is hardly needed
+to apply [ Note C.]; throw out wine, which is a food, and the vapors
+which produce the miracle of anaesthesia, and I firmly believe that if
+the whole materia medica, as now used, could be sunk to the bottom of
+the sea, it would be all the better for mankind,--and all the worse for
+the fishes.
+
+But to justify this proposition, I must add that the injuries inflicted
+by over-medication are to a great extent masked by disease. Dr. Hooker
+believes that the typhus syncopatia of a preceding generation in
+New England “was often in fact a brandy and opium disease.” How is a
+physician to distinguish the irritation produced by his blister from
+that caused by the inflammation it was meant to cure? How can he tell
+the exhaustion produced by his evacuants from the collapse belonging to
+the disease they were meant to remove?
+
+Lastly, medication without insuring favorable hygienic conditions is
+like amputation without ligatures. I had a chance to learn this well
+of old, when physician to the Broad Street district of the Boston
+Dispensary. There, there was no help for the utter want of wholesome
+conditions, and if anybody got well under my care, it must have been
+in virtue of the rough-and-tumble constitution which emerges from the
+struggle for life in the street gutters, rather than by the aid of my
+prescriptions.
+
+But if the materia medica were lost overboard, how much more pains would
+be taken in ordering all the circumstances surrounding the patient (as
+can be done everywhere out of the crowded pauper districts), than are
+taken now by too many who think they do their duty and earn their money
+when they write a recipe for a patient left in an atmosphere of domestic
+malaria, or to the most negligent kind of nursing! I confess that I
+should think my chance of recovery from illness less with Hippocrates
+for my physician and Mrs. Gamp for my nurse, than if I were in the hands
+of Hahnemann himself, with Florence Nightingale or good Rebecca Taylor
+to care for me.
+
+If I am right in maintaining that the presumption is always against
+the use of noxious agents in disease, and if any whom I might influence
+should adopt this as a principle of practice, they will often find
+themselves embarrassed by the imperative demand of patients and their
+friends for such agents where a case is not made out against this
+standing presumption. I must be permitted to say, that I think the
+French, a not wholly uncivilized people, are in advance of the English
+and ourselves in the art of prescribing for the sick without hurting
+them. And I do confess that I think their varied ptisans and syrups are
+as much preferable to the mineral regimen of bug-poison and ratsbane,
+so long in favor on the other side of the Channel, as their art of
+preparing food for the table to the rude cookery of those hard-feeding
+and much-dosing islanders. We want a reorganized cuisine of invalidism
+perhaps as much as the culinary, reform, for which our lyceum lecturers,
+and others who live much at hotels and taverns, are so urgent. Will you
+think I am disrespectful if I ask whether, even in Massachusetts, a dose
+of calomel is not sometimes given by a physician on the same principle
+as that upon which a landlord occasionally prescribes bacon and
+eggs,--because he cannot think of anything else quite so handy? I leave
+my suggestion of borrowing a hint from French practice to your mature
+consideration.
+
+I may, however, call your attention, briefly, to the singular fact,
+that English and American practitioners are 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 less effective” than that of his own
+country. Mr. S. Cooper, again, defends the simple British practice of
+procuring union by the first intention against the attacks of M. Roux
+and Baron Larrey. [Cooper's Surg. Diet. art. “Wounds.” Yet Mr. John
+Bell gives the French surgeons credit for introducing this doctrine of
+adhesion, and accuses O'Halloran of “rudeness and ignorance,” and “bold,
+uncivil language,” in disputing their teaching. Princ. of Surgery, vol.
+i. p. 42. Mr. Hunter succeeded at last in naturalizing the doctrine and
+practice, but even he had to struggle against the perpetual jealousy
+of rivals, and died at length assassinated by an insult.] We have
+often heard similar opinions maintained by our own countrymen. While
+Anglo-American criticism blows hot or cold on the two departments of
+French practice, it is not, I hope, indecent to question whether all the
+wisdom is necessarily with us in both cases.
+
+Our art has had two or three lessons which have a deep meaning to those
+who are willing to read them honestly. The use of water-dressings in
+surgery completed the series of reforms by which was abolished the
+“coarse and cruel practice” of the older surgeons, who with their
+dressings and acrid balsams, their tents and leaden tubes, “absolutely
+delayed the cure.” The doctrine of Broussais, transient as was its
+empire, reversed the practice of half of Christendom for a season, and
+taught its hasty disciples to shun their old favorite remedies as mortal
+poisons. This was not enough permanently to shift the presumption about
+drugs where it belonged, and so at last, just as the sympathetic powder
+and the Unguentum Armarium came in a superstitious age to kill out the
+abuses of external over-medication, the solemn farce of Homoeopathy was
+enacted in the face of our own too credulous civilization, that under
+shelter of its pretences the “inward bruises” of over-drugged viscera
+might be allowed to heal by the first intention. Its lesson we must
+accept, whether we will or not; its follies we are tired of talking
+about. The security of the medical profession against this and all
+similar fancies is in the average constitution of the human mind with
+regard to the laws of evidence.
+
+My friends and brothers in Art! There is nothing to be feared from the
+utterance of any seeming heresy to which you may have listened. I cannot
+compromise your collective wisdom. If I have strained the truth one
+hair's breadth for the sake of an epigram or an antithesis, you are
+accustomed to count the normal pulse-beats of sound judgment, and know
+full well how to recognize the fever-throbs of conceit and the nervous
+palpitations of rhetoric.
+
+The freedom with which each of us speaks his thought in this presence,
+belongs in part to the assured position of the Profession in our
+Commonwealth, to the attitude of Science, which is always fearless, and
+to the genius of the soil on which we stand, from which Nature withheld
+the fatal gift of malaria only to fill it with exhalations that breed
+the fever of inquiry in our blood and in our brain. But mainly we owe
+the large license of speech we enjoy to those influences and privileges
+common to us all as self-governing Americans.
+
+This Republic is the chosen home of minorities, of the less power in
+the presence of the greater. It is a common error to speak of our
+distinction as consisting 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 death treading down the tenfold more numerous minorities. In
+the old civilizations they root themselves like oaks in the soil; men
+must live in their shadow or cut them down. With us the majority is only
+the flower of the passing noon, and the minority is the bud which may
+open in the next morning's sun. We must be tolerant, for the thought
+which stammers on a single tongue today may organize itself in the
+growing consciousness of the time, and come back to us like the voice of
+the multitudinous waves of the ocean on the morrow.
+
+Twenty-five years have passed since one of your honored Presidents spoke
+to this Society of certain limitations to the power of our Art, now very
+generally conceded. Some were troubled, some were almost angry, thinking
+the Profession might suffer from such concessions. It has certainly not
+suffered here; if, as some affirm, it has lost respect anywhere, it was
+probably for other, and no doubt sufficient reasons.
+
+Since that time the civilization of this planet has changed hands.
+Strike out of existence at this moment every person who was breathing on
+that day, May 27, 1835, and every institution of society, every art and
+every science would remain intact and complete in the living that would
+be left. Every idea the world then held has been since dissolved and
+recrystallized.
+
+We are repeating the same process. Not to make silver shrines for our
+old divinities, even though by this craft we should have our wealth, was
+this Society organized and carried on by the good men and true who went
+before us. Not for this, but to melt the gold out of the past, though
+its dross should fly in dust to all the winds of heaven, to save all our
+old treasures of knowledge and mine deeply for new, to cultivate that
+mutual respect of which outward courtesy is the sign, to work together,
+to feel together, to take counsel together, and to stand together
+for the truth, now, always, here, everywhere; for this our fathers
+instituted, and we accept, the offices and duties of this time-honored
+Society.
+
+
+
+
+
+
+BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+
+An Introductory Lecture delivered before the Medical Class of Harvard
+University, November 6, 1861.
+
+[This Lecture appears as it would have been delivered had the time
+allowed been less strictly, limited. Passages necessarily omitted
+have been restored, and points briefly touched have been more fully
+considered. A few notes have been added for the benefit of that limited
+class of students who care to track an author through the highways and
+by-ways of his reading. I owe my thanks to several of my professional
+brethren who have communicated with me on subjects with which they are
+familiar; especially to Dr. John Dean, for the opportunity of profiting
+by his unpublished labors, and to Dr. Hasket Derby, for information and
+references to recent authorities relating to the anatomy and physiology
+of the eye.]
+
+The entrance upon a new course of Lectures is always a period of
+interest to instructors and pupils. As the birth of a child to a parent,
+so is the advent of a new class to a teacher. As the light of the
+untried world to the infant, so is the dawning of the light resting
+over the unexplored realms of science to the student. In the name of the
+Faculty I welcome you, Gentlemen of the Medical Class, new-born babes of
+science, or lustier nurslings, to this morning of your medical life, and
+to the arms and the bosom of this ancient University. Fourteen years ago
+I stood in this place for the first time to address those who occupied
+these benches. As I recall these past seasons of our joint labors, I
+feel that they have been on the whole prosperous, and not undeserving of
+their prosperity.
+
+For it has been my privilege to be associated with a body of true and
+faithful workers; I cannot praise them freely to their faces, or I
+should be proud to discourse of the harmonious diligence and the noble
+spirit in which they have toiled together, not merely to teach their
+several branches, but to elevate the whole standard of teaching.
+
+I may speak with less restraint of those gentlemen who have aided me in
+the most laborious part of my daily duties, the Demonstrators, to whom
+the successive classes have owed so much of their instruction. They rise
+before me, the dead and the living, in the midst of the most grateful
+recollections. The fair, manly face and stately figure of my friend,
+Dr. Samuel Parkman, himself fit for the highest offices of teaching, yet
+willing to be my faithful assistant in the time of need, come back to
+me with the long sigh of regret for his early loss to our earthly
+companionship. Every year I speak the eulogy of Dr. Ainsworth's patient
+toil as I show his elaborate preparations: When I take down my “American
+Cyclopaedia” and borrow instruction from the learned articles of Dr.
+Kneeland, I cease to regret that his indefatigable and intelligent
+industry was turned into a broader channel. And what can I say too
+cordial of my long associated companion and friend, Dr. Hodges, whose
+admirable skill, working through the swiftest and surest fingers that
+ever held a scalpel among us, has delighted class after class, and
+filled our Museum with monuments which 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 their mysteries, or timid neophytes just
+entering the portals of 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 alcoves remain in darkness.
+
+SCIENCE is the topography of ignorance. From a few elevated points we
+triangulate vast spaces, inclosing infinite unknown details. We cast the
+lead, and draw up a little sand from abysses we may never reach with our
+dredges.
+
+The best part of our knowledge is that which teaches us where knowledge
+leaves off and ignorance begins. Nothing more clearly separates a vulgar
+from a superior mind, than the confusion in the first between the little
+that it truly knows, on the one hand, and what it half knows and what it
+thinks it knows on the other.
+
+That which is true of every subject is especially true of the branch of
+knowledge which deals with living beings. Their existence is a perpetual
+death and 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.
+
+
+        “Thou art not thyself;
+   For thou exist'st on many a thousand grains
+   That issue out of dust.”
+
+If it is true that we understand ourselves but imperfectly in health,
+this truth is more signally manifested in disease, where natural actions
+imperfectly understood, disturbed in an obscure way by half-seen causes,
+are creeping and winding along in the dark toward their destined issue,
+sometimes using our remedies as safe stepping-stones, occasionally, it
+may be, stumbling over them as obstacles.
+
+I propose in this lecture to show you some points of contact between our
+ignorance and our knowledge in several of the branches upon the study
+of which you are entering. I may teach you a very little directly, but I
+hope much more from the trains of thought I shall suggest. Do not expect
+too much ground to be covered in this rapid survey. Our task is only
+that of sending out a few pickets under the starry flag of science to
+the edge of that dark domain where the ensigns of the obstinate rebel,
+Ignorance, are flying undisputed. We are not making a reconnoissance
+in force, still less advancing with the main column. But here are a few
+roads along which we have to march together, and we wish to see clearly
+how far our lines extend, and where the enemy's outposts begin.
+
+Before touching the branches of knowledge that deal with organization
+and vital functions, let us glance at that science which meets you at
+the threshold of your study, and prepares you in some measure to deal
+with the more complex problems of the living laboratory.
+
+CHEMISTRY includes the art of separating and combining the elements of
+matter, and the study of the changes produced by these operations. We
+can hardly say too much of what it has contributed to our knowledge of
+the universe and our power of dealing with its materials. It has given
+us a catalogue raisonne of the substances found upon our planet, and
+shown how everything living and dead is put together from them. It is
+accomplishing wonders before us every day, such as Arabian story-tellers
+used to string together in their fables. It spreads the sensitive film
+on the artificial retina which looks upon us through the optician's lens
+for a few seconds, and fixes an image that will outlive its original.
+It questions the light of the sun, and detects the vaporized metals
+floating around the great luminary,--iron, sodium, lithium, and
+the rest,--as if the chemist of our remote planet could fill his
+bell-glasses from its fiery atmosphere. It lends the power which flashes
+our messages in thrills that leave the lazy chariot of day behind them.
+It seals up a few dark grains in iron vases, and lo! at the touch of a
+single spark, rises in smoke and flame a mighty Afrit with a voice
+like thunder and an arm that shatters like an earthquake. The dreams of
+Oriental fancy have 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 each other through an almost boundless
+range of combinations. It has given us a most ingenious theory to
+account for certain fixed relations in these combinations. It has
+successfully eliminated a great number of proximate compounds, more or
+less stable, from organic structures. It has invented others which form
+the basis of long series of well-known composite substances. In fact, we
+are perhaps becoming overburdened with our list of proximate principles,
+demonstrated and hypothetical.
+
+How much nearer have we come to the secret of force than Lully and Geber
+and the whole crew of juggling alchemists? We have learned a great deal
+about the how, what have we learned about the why?
+
+Why does iron rust, while gold remains untarnished, and gold amalgamate,
+while iron refuses the alliance of mercury?
+
+The alchemists called gold Sol, the sun, and iron Mars, and pleased
+themselves with fancied relations between these substances and the
+heavenly bodies, by which they pretended to explain the facts they
+observed. Some of their superstitions have lingered in practical
+medicine to the present day, but chemistry has grown wise enough to
+confess the fact of absolute ignorance.
+
+What is it that makes common salt crystallize in the form of cubes,
+and saltpetre in the shape of six-sided prisms? We see no reason why it
+should not have been just the other way, salt in prisms and saltpetre in
+cubes, or why either should take an exact geometrical outline, any more
+than coagulating albumen.
+
+But although we had given up attempting to explain the essential nature
+of affinities and of crystalline types, we might have supposed that we
+had at least fixed the identity of the substances with which we deal,
+and determined the laws of their combination. All at once we find that a
+simple substance changes face, puts off its characteristic qualities and
+resumes them at will;--not merely when we liquefy or vaporize a solid,
+or reverse the process; but that a solid is literally transformed into
+another solid under our own eyes. We thought we knew phosphorus. We warm
+a portion of it sealed in an empty tube, for about a week. It has
+become a brown infusible substance, which does not shine in the dark
+nor oxidate in the air. We heat it to 500 F., and it becomes common
+phosphorus again. We transmute sulphur in the same singular way. Nature,
+you know, gives us 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 connected with them
+rather startling to us of the nineteenth century. There may be other
+transmutations possible besides those of phosphorus and sulphur. When
+Dr. Prout, in 1840, talked about azote and carbon being “formed” in the
+living system, it was looked upon as one of those freaks of fancy to
+which philosophers, like other men, are subject. But when Professor
+Faraday, in 1851, says, at a meeting of the British Association, that
+“his hopes are in the direction of proving that bodies called simple
+were really compounds, and may be formed artificially as soon as we
+are masters of the laws influencing their combinations,”--when he comes
+forward and says that he has tried experiments at transmutation,
+and means, if his life is spared, to try them again,--how can we
+be surprised at the popular story of 1861, that Louis Napoleon has
+established a gold-factory and is glutting the mints of Europe with
+bullion of his 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 glass vessel, c, we do not expect the glass to change them, unless
+a or b or the compound a b has the power of dissolving 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 signs of
+combustion and form water, the third in the mean time undergoing no
+perceptible change. It has played the part of the unwedded priest, who
+marries a pair without taking a fee or having any further relation with
+the parties. We call this catalysis, catalytic action, the action of
+presence, or by what learned name we choose. Give what name to it we
+will, it is a manifestation of power which crosses our established laws
+of combination at a very open angle of intersection. I think we may
+find an analogy for it in electrical induction, the disturbance of the
+equilibrium of the electricity of a body by the approach of a charged
+body to it, without interchange of electrical conditions between the
+two bodies. But an analogy is not an explanation, and why a few drops
+of yeast should change a saccharine mixture to carbonic acid and
+alcohol,--a little leaven leavening the whole lump,--not by combining
+with it, but by setting a movement at work, we not only cannot explain,
+but the fact is such an exception to the recognized laws of combination
+that Liebig is unwilling to admit the new force at all to which
+Berzelius had given the name so generally accepted.
+
+The phenomena of isomerism, or identity of composition and proportions
+of constituents with difference of qualities, and of isomorphism, or
+identity of form in crystals which have one element substituted for
+another, were equally surprises to science; and although the mechanism
+by which they are brought about can be to a certain extent explained
+by a reference to the hypothetical atoms of which the elements are
+constituted, yet this is only turning the difficulty into a fraction
+with an infinitesimal denominator and an infinite numerator.
+
+So far we have studied the working of force and its seeming anomalies
+in purely chemical phenomena. But we soon find that chemical force is
+developed by various other physical agencies,--by heat, by light, by
+electricity, by magnetism, by mechanical agencies; and, vice versa, that
+chemical action develops heat, light, electricity, magnetism, mechanical
+force, as we see in our matches, galvanic batteries, and explosive
+compounds. Proceeding with our experiments, we find that every kind
+of force is capable of producing all other kinds, or, in Mr. Faraday's
+language, that “the various forms under which the forces of matter are
+made manifest have a common origin, or, in other words, are so directly
+related and mutually dependent that they are convertible one into
+another.”
+
+Out of this doctrine naturally springs that of the conservation of
+force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. Faraday.
+This idea is no novelty, though it seems so at first sight. It was
+maintained and disputed among the giants of philosophy. Des Cartes and
+Leibnitz denied that any new motion originated in nature, or that any
+ever ceased to exist; all motion being in a circle, passing from one
+body to another, one losing what the other gained. Newton, on the
+other hand, believed that new motions were generated and existing ones
+destroyed. On the first supposition, there is a fixed amount of force
+always circulating in the universe. On the second, the total amount may
+be increasing or diminishing. You will find in the “Annual of Scientific
+Discovery” for 1858 a very interesting lecture by Professor Helmholtz of
+Bonn, in which it is maintained that a certain portion of force is lost
+in every natural process, being converted into unchangeable heat, so
+that the universe will come to a stand-still at last, all force passing
+into heat, and all heat into a state of equilibrium.
+
+The doctrines of the convertibility or specific equivalence of the
+various forms of force, and of its conservation, which is its logical
+consequence, are very generally accepted, as I believe, at the present
+time, among physicists. We are naturally led to the question, What is
+the nature of force? The three illustrious philosophers just referred
+to agree in attributing the general movements of the universe to the
+immediate Divine action. The doctrine of “preestablished harmony” was
+an especial contrivance of Leibnitz to remove the Creator from unworthy
+association with the less divine acts of living beings. Obsolete as this
+expression sounds to our ears, the phrase laws of the universe, which
+we use so constantly with a wider application, appears to me essentially
+identical with it.
+
+Force does not admit of explanation, nor of proper definition, any more
+than the hypothetical substratum of matter. If we assume the Infinite as
+omnipresent, omniscient, omnipotent, we cannot suppose Him excluded from
+any part of His creation, except from rebellious souls which voluntarily
+exclude Him by the exercise of their fatal prerogative of free-will.
+Force, then, is the act of immanent Divinity. I find no meaning in
+mechanical explanations. Newton's hypothesis of an ether filling the
+heavenly spaces does 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 prefer to encounter
+it in the world of physical phenomena before reaching that of living
+actions. It is only the name for the incomprehensible cause of certain
+changes known to our consciousness, and assumed to be outside of it. For
+me it is the Deity Himself in action.
+
+I can therefore see a large significance in the somewhat bold language
+of Burdach: “There is for me but one miracle, that of infinite
+existence, and but one mystery, the manner in which the finite proceeds
+from the infinite. So soon as we recognize this incomprehensible act as
+the general and primordial miracle, 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 by experience in this
+light, there is for us no other impenetrable miracle or mystery.”
+
+Let us turn to a branch of knowledge which deals with certainties up to
+the limit of the senses, and is involved in no speculations beyond them.
+In certain points of view, HUMAN ANATOMY may be considered an almost
+exhausted science. From time to time some small organ which had escaped
+earlier observers has been pointed out,--such parts as the tensor
+tarsi, the otic ganglion, or the Pacinian bodies; but some of our best
+anatomical works are those which have been classic for many generations.
+The plates of the bones in Vesalius, three centuries old, are still
+masterpieces of accuracy, as of art. The magnificent work of Albinus on
+the muscles, published in 1747, is still supreme in its department,
+as the constant references of the most thorough recent treatise on
+the subject, that of Theile, sufficiently show. More has been done in
+unravelling the mysteries of the fasciae, but there has been a tendency
+to overdo this kind of material analysis. Alexander Thomson split them
+up into cobwebs, as you may see in the plates to Velpeau's Surgical
+Anatomy. I well remember how he used to shake his head over the coarse
+work of Scarpa and Astley Cooper,--as if Denner, who painted the
+separate hairs of the beard and pores of the skin in his portraits, had
+spoken lightly of the pictures of Rubens and Vandyk.
+
+Not only has little been added to the catalogue of parts, but some
+things long known had become half-forgotten. Louis and others confounded
+the solitary glands of the 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
+brain seemed a novelty as shown by Spurzheim. One is startled to find
+the method anticipated by Raymond Vieussens nearly two centuries ago. I
+can hardly think Gordon had ever looked at his figures, though he names
+their author, when he wrote the captious and sneering article which
+attracted so much attention in the pages of the “Edinburgh Review.”
+
+This is the place, if anywhere, to mention any observations I could
+pretend to have made in the course of my teaching the structure of the
+human body. I can make no better show than most of my predecessors in
+this well-reaped field. The nucleated cells found connected with the
+cancellated structure of the bones, which I first pointed out and had
+figured in 1847, and have shown yearly from that time to the present,
+and the fossa masseterica, a shallow concavity on the ramus of the
+lower jaw, for the lodgment of the masseter muscle, which acquires
+significance when examined by the side of the deep cavity on the
+corresponding part in some carnivora to which it answers, may perhaps be
+claimed as deserving attention. I have also pleased myself by making a
+special group of the six radiating muscles which diverge from the spine
+of the axis, or second cervical vertebra, and by giving to it the name
+stella musculosa nuchae. But this scanty catalogue is only an evidence
+that one may teach long and see little that has not been noted by those
+who have gone before him. Of course I do not think it necessary to
+include rare, but already described anomalies, such as the episternal
+bones, the rectus sternalis, and other interesting exceptional
+formations I have encountered, which have shown a curious tendency to
+present themselves several times in the same season, perhaps because the
+first specimen found calls our attention 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 human body has changed its old aspect, and become fertile
+in new observations. This rejuvenescence was effected by means of two
+principal agencies,--new methods 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 as when Arrowsmith, who was born in 1750, published his admirable
+maps. But in that same year was born Werner, who taught a new way of
+studying the earth, since become familiar to us all under the name of
+Geology.
+
+What geology has done for our knowledge of the earth, has been done for
+our knowledge of the body by that method of study to which is given the
+name of General Anatomy. It studies, not the organs as such, but the
+elements out of which the organs are constructed. It is the geology of
+the body, as that is the general anatomy of the earth. The extraordinary
+genius of Bichat, to whom more than any other we owe this new method
+of study, does not require Mr. Buckle's testimony to impress the
+practitioner with the importance of its achievements. I have heard a
+very wise physician question whether any important result had accrued
+to practical medicine from Harvey's discovery of the circulation. But
+Anatomy, Physiology, and Pathology have received a new light from this
+novel method of contemplating the living structures, which has had a
+vast influence in enabling the practitioner at least to distinguish
+and predict the course of disease. We know as well what differences
+to expect in the habits of a mucous and of a serous membrane, as what
+mineral substances to look for in the chalk or the coal measures. You
+have only to read Cullen's description of inflammation of the lungs or
+of the bowels, and compare it with such as you may find in Laennec
+or Watson, to see the immense gain which diagnosis and 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 this century. It does not deal with organs, as did the
+earlier anatomists, nor with tissues, after the manner of Bichat. It
+maps the whole surface of the body into an arbitrary number of regions,
+and studies each region successively from the surface to the bone, or
+beneath it. This hardly deserves the name of a science, although
+Velpeau has dignified it with that title, but it furnishes an admirable
+practical way for the surgeon who has to operate on a particular region
+of the body to study that region. If we are buying a farm, we are not
+content with the State map 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 sometimes called, surgical anatomy, does for the surgeon with
+reference to the part on which his skill is to be exercised. It enables
+him to see with the mind's eye through the opaque tissues down to the
+bone on which they lie, as if the skin were transparent as the cornea,
+and the organs it covers translucent as the gelatinous pulp of a medusa.
+
+It is curious that the Japanese should have anticipated Europe in a kind
+of rude regional anatomy. I have seen a manikin of Japanese make traced
+all over with lines, and points marking their intersection. By this
+their doctors are guided in the performance of acupuncture, marking the
+safe places to thrust in needles, as we buoy out our ship-channels, and
+doubtless indicating to learned eyes the spots where incautious meddling
+had led to those little accidents of shipwreck to which patients are
+unfortunately liable.
+
+A change of method, then, has given us General and Regional Anatomy.
+These, too, have been worked so thoroughly, that, if not exhausted, they
+have at least become to a great extent fixed and positive branches of
+knowledge. But the first of them, General Anatomy, would never have
+reached this positive condition but for the introduction of that
+instrument which I have mentioned as the second great aid to modern
+progress.
+
+This instrument is the achromatic microscope. For the history of the
+successive steps by which it became the effective scientific implement
+we now possess, I must refer you to the work of Mr. Quekett, to an
+excellent article in the “Penny Cyclopaedia,” or to that of Sir David
+Brewster in the “Encyclopaedia Britannica.” It is a most interesting
+piece of scientific history, which shows how the problem which Biot in
+1821 pronounced insolvable was in the course of a few years practically
+solved, with a success equal to that which Dollond had long before
+obtained with the telescope. It is enough for our purpose that we
+are now in possession of an instrument freed from all confusions and
+illusions, which magnifies a thousand diameters,--a million times in
+surface,--without serious distortion or discoloration of its object.
+
+A quarter of a century ago, or a little more, an instructor would not
+have hesitated to put John Bell's “Anatomy” and Bostock's “Physiology”
+ into a student's hands, as good authority on their respective subjects.
+Let us not be unjust to either of these authors. John Bell is the
+liveliest medical writer that I can remember who has written since the
+days of delightful old Ambroise Pare. His picturesque descriptions and
+bold figures are as good now as they ever were, and his book can never
+become obsolete. But listen to what John Bell says of the microscope:
+
+“Philosophers of the last age had been at infinite pains to find the
+ultimate fibre of muscles, thinking to discover its properties in its
+form; but they saw just in proportion to the glasses which they used, or
+to their practice and skill in that art, which is now almost forsaken.”
+
+Dr. Bostock's work, neglected as it is, is one which I value very highly
+as a really learned compilation, full of original references. But
+Dr. Bostock says: “Much as the naturalist has been indebted to the
+microscope, by bringing into view many beings of which he could not
+otherwise have ascertained the existence, the physiologist has not yet
+derived any great benefit from the instrument.”
+
+These are only specimens of the manner in which the microscope and its
+results were generally regarded by the generation just preceding our
+own.
+
+I have referred you to the proper authorities for the account of those
+improvements which about the year 1830 rendered the compound microscope
+an efficient and trustworthy instrument. It was now for the first time
+that a true general anatomy became possible. As early as 1816 Treviranus
+had attempted to resolve the tissues, of which Bichat had admitted no
+less than 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 all the tissues, the areolar, was not at all
+understood? All that method could do had been accomplished by Bichat and
+his followers. It was for the optician to take the next step. The future
+of anatomy and physiology, as an enthusiastic micrologist of the time
+said, was in the hands of Messrs. Schieck and Pistor, famous opticians
+of Berlin.
+
+In those earlier days of which I am speaking, all the points of minute
+anatomy were involved in obscurity. Some found globules everywhere,
+some fibres. Students disputed whether the conjunctiva extended over
+the cornea or not, and worried themselves over Gaultier de Claubry's
+stratified layers of the skin, or Breschet's blennogenous and
+chromatogenous organs. The dartos was a puzzle, the central spinal canal
+a myth, the decidua clothed in fable as much as the golden fleece. The
+structure of bone, now so beautifully made out,--even that of the teeth,
+in which old Leeuwenhoek, peeping with his octogenarian eyes through the
+minute lenses wrought with 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 mists of an uncertain microscopic vision. The
+intimate recesses of the animal system were to the students of anatomy
+what the anterior of Africa long was to geographers, and the stories of
+microscopic explorers were 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 the first place, the minute
+structure of all the organs has been made out in the most satisfactory
+way. The special arrangements of the vessels and the ducts of all the
+glands, of the air-tubes and vesicles of the lungs, of the parts which
+make up the skin and other membranes, all the details of those complex
+parenchymatous organs which had confounded investigation so long, have
+been lifted out of the invisible into the sight of all observers. It
+is fair to mention here, that we owe a great deal to the art of minute
+injection, by which we are enabled to trace the smallest vessels in the
+midst of the tissues where they are distributed. This is an old artifice
+of anatomists. The famous Ruysch, who died a hundred and thirty years
+ago, showed that each of the viscera has its terminal vessels arranged
+in its own peculiar way; the same fact which you may see illustrated in
+Gerber's figures 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
+a very rich collection of injected preparations sent him by Professor
+Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
+of which I had a number of microscopes made expressly, by Mr. Grunow,
+during the past season. All this illustrates what has been done for the
+elucidation of the intimate details of formation of the organs.
+
+But the great triumph of the microscope as applied to anatomy has
+been in the resolution of the organs and the tissues into their simple
+constituent anatomical elements. It has taken up general anatomy where
+Bichat left it. He had succeeded in reducing the structural language of
+nature to syllables, if you will permit me to use so bold an image. The
+microscopic observers who have come after him have analyzed these into
+letters, as we may call them,--the simple elements by the combination of
+which Nature spells 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, until she binds up in one living
+whole that wondrous volume of 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 repeating it, 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, already referred to. Very commonly they
+have undergone a change of figure, most frequently a flattening which
+reduces them to scales, as in the epidermis and the epithelium.
+
+B. Simple, translucent, homogeneous solid, such as is found at the back
+of the cornea, or forming the intercellular substance of cartilage.
+
+C. The white fibrous element, consisting of very delicate, tenacious
+threads. This is the long staple textile substance of the body. It is to
+the organism what 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-work together. It furnishes the sinews, which are
+the 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 made of it.
+
+D. The yellow elastic, fibrous element, the caoutchouc of the animal
+mechanism, which pulls things back into place, as the India-rubber band
+shuts the door we have opened.
+
+E. The striped muscular fibre,--the red flesh, which shortens itself in
+obedience to the will, and thus produces all voluntary active motion.
+
+F. The unstriped muscular fibre, more properly the fusiform-cell fibre,
+which carries on the involuntary internal movements.
+
+G. The nerve-cylinder, a glassy tube, with a pith of some firmness,
+which conveys sensation to the brain and the principle which induces
+motion from it.
+
+H. The nerve-corpuscle, the centre of nervous power.
+
+I. The mucous tissue, as Virchow calls it, common in embryonic
+structures, seen in the vitreous humor of the adult.
+
+To these add X, granules, of indeterminate shape and size, Y, for
+inorganic matters, such as the salts of bone and teeth, and Z, to stand
+as a symbol of the fluids, and you have the letters of what I have
+ventured to call the alphabet of the body.
+
+But just as in language certain diphthongs and syllables are frequently
+recurring, so we have in the body certain secondary and tertiary
+combinations, which we meet more frequently than the solitary elements
+of which they are composed.
+
+Thus A B, or a collection of cells united by simple structureless
+solid, is seen to be extensively employed in the body under the name of
+cartilage. Out of this the surfaces of the articulations and the springs
+of the breathing apparatus are formed. But when Nature came to the
+buffers of the spinal column (intervertebral disks) and the washers of
+the joints (semilunar fibrocartilages of the knee, etc.), she required
+more tenacity than common cartilage possessed. What did she do? What
+does man do in a similar case of need? I need hardly tell you. The mason
+lays his bricks in simple mortar. But the plasterer works some hair into
+the mortar which he is going to lay in large sheets on the walls. The
+children of Israel complained that they had no straw to make their
+bricks with, though portions of it may still be seen in the crumbling
+pyramid of Darshour, which they are said to have built. I visited the
+old house on Witch Hill in Salem a year or two ago, and there I found
+the walls coated with clay in which straw was abundantly mingled;--the
+old Judaizing witch-hangers copied the Israelites in a good many things.
+The Chinese and the Corsicans blend the fibres of amianthus in their
+pottery to give it tenacity. Now to return to Nature. To make her
+buffers and washers hold together in the shocks to which they would
+be subjected, she took common cartilage and mingled the white fibrous
+tissue with it, to serve the same purpose as the hair in the mortar,
+the straw in the bricks and in the plaster of the old wall, and the
+amianthus in the earthen vessels. Thus we have the combination A B C, or
+fibro-cartilage. Again, the bones were once only gristle or cartilage,
+A B. To give them solidity they were infiltrated with stone, in the form
+of salts of lime, an inorganic element, so that bone would be spelt out
+by the letters A, B, and Y.
+
+If from these organic syllables we proceed to form organic words, we
+shall find that Nature employs three principal forms; namely, Vessels,
+Membranes, and Parenchyma, or visceral tissue. The most complex of
+them can be resolved into a combination of these few simple anatomical
+constituents.
+
+Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
+the same elements in morbid growths that we have met with in normal
+structures. The pus-corpuscle and the white blood-corpuscle can only
+be distinguished by tracing them to their origin. A frequent form of
+so-called malignant disease proves to 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,--the crowding together of the elements, the size
+of the cell-nuclei, and similar variable characters.
+
+Let us turn to PHYSIOLOGY. The microscope, which has made a new science
+of the intimate structure of the organs, has at the same time cleared up
+many uncertainties concerning the mechanism of the special functions. Up
+to the time of the living generation of observers, Nature had kept over
+all her inner workshops the forbidding inscription, No Admittance! If
+any prying observer ventured to spy through his magnifying tubes into
+the mysteries of her glands and canals and fluids, she covered up her
+work in blinding mists and bewildering halos, as the deities of old
+concealed their favored heroes in the moment of danger.
+
+Science has at length sifted the turbid light of her lenses, and
+blanched their delusive rainbows.
+
+Anatomy studies the organism in space. Physiology studies it also in
+time. After the study of form and composition follows close that of
+action, and this leads us along back to the first moment of the germ,
+and forward to the resolution of the living frame into its lifeless
+elements. In this way Anatomy, or rather that branch of it which we call
+Histology, has become inseparably blended with the study of function.
+The connection between the science of life and that of intimate
+structure on the one hand, and composition on the other, is illustrated
+in the titles of two recent works of remarkable excellence,--“the
+Physiological Anatomy” of Todd and Bowman, and the “Physiological
+Chemistry” of Lehmann.
+
+Let me briefly recapitulate a few of our acquisitions in Physiology, due
+in large measure to our new instruments and methods of research, and
+at the same time indicate the limits which form the permanent or the
+temporary boundaries of our knowledge. I will begin with the largest
+fact and with the most absolute and universally encountered limitation.
+
+The “largest truth in Physiology” Mr. Paget considers to be “the
+development of ova through multiplication and division of their cells.”
+ I would state it more broadly as the agency of the cell in all living
+processes. It seems at present necessary to abandon the original idea of
+Schwann, that we can observe the building up of a cell from the simple
+granules of a blastema, or formative fluid. The evidence points rather
+towards the axiom, Omnis cellula a cellula; that is, the germ of a new
+cell is always derived from a preexisting cell. The doctrine 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 plasterer in fibro-cartilage,
+so we see her beforehand with the 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 Nature shapes her hyaline vesicles and
+modifies them to serve the needs of the part where they are found. The
+artisan whirls his rod, and his glass bubble becomes a flattened disk,
+with its bull's-eye for a nucleus. These lips of ours are all glazed
+with microscopic tiles formed of flattened cells, each one of them with
+its nucleus still as plain and relatively as prominent, to the eye of
+the microscopist, as the bull's-eye in the old-fashioned windowpane.
+Everywhere we find cells, modified or unchanged. They roll in
+inconceivable multitudes (five millions and more to the cubic
+millimetre, according to Vierordt) as blood-disks through our vessels.
+A close-fitting mail of flattened cells coats our surface with a panoply
+of imbricated scales (more than twelve thousand millions), as Harting
+has computed, as true a defence against our enemies as the buckler of
+the armadillo or the carapace of the tortoise against theirs. The same
+little protecting organs pave all the great highways of the interior
+system. Cells, again, preside over the chemical processes which
+elaborate the living fluids; they change their form to become the agents
+of voluntary and involuntary motion; the soul itself sits on a throne
+of nucleated cells, and flashes its mandates through skeins of glassy
+filaments which once were simple chains of vesicles. And, as if to
+reduce the problem of living force to its simplest expression, we see
+the yolk of a transparent egg dividing itself in whole or in part, and
+again dividing and subdividing, until it becomes a mass of cells, out
+of which the harmonious diversity of the organs arranges itself, worm or
+man, as God has willed from the beginning.
+
+This differentiation having been effected, each several part assumes its
+special office, having a life of its own adjusted to that of other parts
+and the whole. “Just as a tree constitutes a mass arranged in a definite
+manner, in which, in every single part, in the leaves as in the root,
+in the trunk as in the blossom, cells are discovered to be the ultimate
+elements, so is it also with the forms of animal life. Every animal
+presents itself as a sum of vital unities, every one of which manifests
+all the characteristics of life.”
+
+The mechanism is as clear, as unquestionable, as absolutely settled and
+universally accepted, as the order of movement of the heavenly bodies,
+which we compute backward to the days of the observatories on the plains
+of Shinar, and on the faith of which we regulate the movements of war
+and trade by the predictions of our ephemeris.
+
+The mechanism, and that is all. We see the workman and the tools, but
+the skill that guides the work and the power that performs it are as
+invisible as ever. I fear that not every listener took the
+significance of those pregnant words in the passage I quoted from
+John Bell,--“thinking to discover its properties in its form.” We have
+discovered the working bee in this great hive of organization. We have
+detected the cell in the very act of forming itself from a nucleus, of
+transforming itself into various tissues, of selecting the elements of
+various secretions. But why one cell becomes nerve and another muscle,
+why one selects bile and another fat, we can no more pretend to tell,
+than why one grape sucks out of the soil the generous juice which
+princes hoard in their cellars, and another the wine which it takes
+three men to drink,--one to pour it down, another to swallow it, and a
+third to hold him while it is going down. Certain analogies between
+this selecting power and the phenomena of endosmosis in the elective
+affinities of chemistry we can find, but the problem of force remains
+here, as everywhere, unsolved and insolvable.
+
+Do we gain anything by attempting to get rid of the idea of a special
+vital force because we find certain mutually convertible relations
+between forces in the body and out of it? I think not, any more than we
+should gain by getting rid of the idea and expression Magnetism because
+of its correlation with electricity. We may concede the unity of all
+forms of force, but we cannot overlook the fixed differences of its
+manifestations according to the conditions under which it acts. It is a
+mistake, however, to think the mystery is greater in an organized body
+than in any other. We see a stone fall or a crystal form, and there is
+nothing stranger left to wonder at, for we have seen the Infinite in
+action.
+
+Just so far as we can recognize the ordinary modes of operation of the
+common forces of nature,--gravity, cohesion, elasticity, transudation,
+chemical action, and the rest,--we see the so-called vital acts in
+the light of a larger range of known facts and familiar analogies.
+Matteuecci's well-remembered lectures contain many and striking examples
+of the working of physical forces in physiological processes. Wherever
+rigid experiment carries us, we are safe in following this lead; but
+the moment we begin to theorize beyond our strict observation, we are in
+danger of falling into those mechanical follies which true science has
+long outgrown.
+
+Recognizing the fact, then, that we have learned nothing but the
+machinery of life, and are no nearer to its essence, what is it that we
+have gained by this great discovery of the cell formation and function?
+
+It would have been reward enough to learn the method Nature pursues
+for its own sake. If the sovereign Artificer lets us into his own
+laboratories and workshops, we need not ask more than the privilege
+of looking on at his work. We do not know where we now stand in the
+hierarchy of created intelligences. We were made a little lower than the
+angels. I speak it not irreverently; as the lower animals surpass man
+in some of their attributes, so it may be that not every angel's eye
+can see as broadly and as deeply into the material works of God as
+man himself, looking at the firmament through an equatorial of fifteen
+inches' aperture, and searching into the tissues with a twelfth of an
+inch objective.
+
+But there are other positive gains of a more practical character. Thus
+we are no longer permitted to place the seat of the living actions in
+the extreme vessels, which are only the carriers from which each part
+takes what it wants by the divine right of the omnipotent nucleated
+cell. The organism has become, in the words already borrowed from
+Virchow, “a sum of vital unities.” The strictum and laxum, the increased
+and diminished action of the vessels, out of which medical theories
+and methods of treatment have grown up, have yielded to the doctrine
+of local cell-communities, belonging to this or that vascular 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 of the points of
+contact between our ignorance and our knowledge which present particular
+interest in the existing state of our physiological acquisitions.
+Some of them involve the microscopic discoveries of which I have
+been speaking, some belong to the domain of chemistry, and some have
+relations with other departments of physical science.
+
+If we should begin with the digestive function, we should find that the
+long-agitated question of the nature of the acid of the gastric juice is
+becoming settled in favor of the lactic. But the whole solvent agency of
+the digestive fluid enters into the category of that exceptional mode of
+action already familiar to us in chemistry as catalysis. It is therefore
+doubly difficult of explanation; first, as being, like all reactions,
+a fact not to be accounted for except by the imaginative appeal to
+“affinity,” and secondly, as being one of those peculiar reactions
+provoked by an element which stands outside and looks on without
+compromising itself.
+
+The doctrine of Mulder, so widely diffused in popular and scientific
+belief, of the existence of a common base of all albuminous substances,
+the so-called protein, has not stood the test of rigorous analysis. The
+division of food into azotized and non-azotized is no doubt important,
+but the attempt to show that the first only is plastic or nutritive,
+while the second is simply calorifacient, or heat-producing, fails
+entirely in the face of the facts revealed by the study of man in
+different climates, and of numerous experiments in the feeding
+of animals. I must return to this subject 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 out of its own substance;--why?
+
+
+     Quia est in eo
+     Virtus saccharitiva.
+
+Just what becomes of the sugar beyond the fact of its disappearance
+before it can get into the general circulation and sweeten our tempers,
+it is hard to say.
+
+The pancreatic fluid makes an emulsion of the fat contained in our food,
+but just how the fatty particles get into the villi we must leave Brucke
+and Kolliker to settle if they can.
+
+No one has shown satisfactorily the process by which the
+blood-corpuscles are formed out of the lymph-corpuscles, nor what
+becomes of them. These two questions are like those famous household
+puzzles,--Where do the flies come from? and, Where do the pins go to?
+
+There is a series of organs in the body which has long puzzled
+physiologists,--organs of glandular aspect, but having no ducts,--the
+spleen, the thyroid and thymus bodies, and the suprarenal capsules. We
+call them vascular glands, and we believe that they elaborate colored
+and uncolored blood-cells; but just what changes they effect, and
+just how they effect them, it has proved a very difficult matter to
+determine. So of the noted glandules which form Peyer's patches, their
+precise office, though seemingly like those of the lymphatic glands,
+cannot be positively assigned, so far as I know, at the present time.
+It is of obvious interest to learn it with reference to the pathology of
+typhoid fever. It will be remarked that the coincidence of their changes
+in this disease with enlargement of the spleen suggests the idea of a
+similarity of function in these two organs.
+
+The theories of the production of animal heat, from the times of Black,
+Lavoisier, and Crawford to those of Liebig, are familiar to all who have
+paid any attention to physiological studies. The simplicity of Liebig's
+views, and the popular form in which they have been presented, have
+given them wide currency, and incorporated them in the common belief and
+language of our text-books. Direct oxidation or combustion of the carbon
+and hydrogen contained in the food, or in the tissues themselves; the
+division of alimentary substances into respiratory, or non-azotized,
+and azotized,--these doctrines are 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 than with sulphur and azote. Such is the
+well-grounded statement of Robin and Verdeil. “It is very probable that
+animal heat is entirely produced by the chemical actions which take
+place in the organism, but the phenomenon is too complex to admit of our
+calculating it according to the quality of oxygen consumed.” These last
+are the words of Regnault, as cited by Mr. Lewes, whose intelligent
+discussion of this and many of the most interesting physiological
+problems I strongly recommend to your attention.
+
+This single illustration covers a wider ground than the special function
+to which it belongs. We are learning that the chemistry of the body must
+be studied, not simply by its ingesta and egesta, but that there is a
+long intermediate series of changes which must be investigated in their
+own light, under their own special conditions. The expression “sum of
+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 just cited entitle their work a treatise on the immediate
+principles of the body, they only indicate the nature of that
+profound and subtile analysis which must take the place of all hasty
+generalizations founded on a comparison of the food with residual
+products.
+
+I will only call your attention to the fact, that the exceptional
+phenomenon of the laboratory is the prevailing law of the organism.
+Nutrition itself is but one great catalytic process. As the blood
+travels its rounds, each part selects its appropriate element and
+transforms it to its own likeness. Whether the appropriating agent
+be cell or nucleus, or a structureless solid like the intercellular
+substance of cartilage, the fact of its presence determines the
+separation of its proper constituents from the circulating fluid, so
+that even when we are wounded bone is replaced by bone, skin by skin,
+and nerve by nerve.
+
+It is hardly without a smile that we resuscitate the old question of
+the 'vis insita' of the muscular fibre, so famous in the discussions of
+Haller and his contemporaries. Speaking generally, I think we may say
+that Haller's doctrine is the one now commonly received; namely, that
+the muscles contract in virtue of their own inherent endowments. It
+is true that Kolliker says no perfectly decisive fact has been brought
+forward to prove that the striated muscles contract without having been
+acted on by nerves. Yet Mr. Bowman's observations on the contraction
+of isolated fibres appear decisive enough (unless we consider them
+invalidated by Dr. Lionel Beale's recent researches), tending to show
+that each elementary fibre is supplied with nerves; and as to the
+smooth muscular fibres, we have Virchow's statement respecting the
+contractility of those of the umbilical cord, where there is not a trace
+of any nerves.
+
+In the investigation of the nervous system, anatomy and physiology have
+gone hand in hand. It is very singular that so important, and seemingly
+simple, a fact as the connection of the nerve-tubes, at their origin or
+in their course, with the nerve-cells, should have so long remained open
+to doubt, as you may see that it did by referring to the very complete
+work of Sharpey and Quain (edition of 1849), the histological portion of
+which is cordially approved by Kolliker himself.
+
+Several most interesting points of the minute anatomy of the nervous
+centres have been laboriously and skilfully worked out by a recent
+graduate of this Medical School, in a monograph worthy to stand in line
+with those of Lockhart Clarke, Stilling, and Schroder van der Kolk. I
+have had the privilege of examining and of showing some of you a number
+of Dr. Dean's skilful preparations. I have no space to give even an
+abstract of his conclusions. I can only refer to his proof of the fact,
+that a single cell may send its processes into several different bundles
+of nerve-roots, and to his demonstration of the curved ascending and
+descending fibres from the posterior nerveroots, to reach what he has
+called the longitudinal columns of the cornea. I must also mention Dr.
+Dean's exquisite microscopic photographs from sections of the medulla
+oblongata, which appear to me to promise a new development, if not a new
+epoch, in anatomical art.
+
+It having been settled that the nerve-tubes can very commonly be traced
+directly to the nerve-cells, the object of all the observers in this
+department of anatomy is to follow these tubes to their origin. We have
+an infinite snarl of telegraph wires, and we may be reasonably sure,
+that, if we can follow them up, we shall find each of them ends in a
+battery somewhere. One of the most interesting problems is to find the
+ganglionic origin of the great nerves of the medulla oblongata, and this
+is the end to which, by the aid of the most delicate sections, colored
+so as to bring out their details, mounted so as to be imperishable,
+magnified by the best instruments, and now self-recorded in the light
+of the truth-telling sunbeam, our fellow-student is making a steady
+progress in a labor which I think bids fair to rank with the most
+valuable contributions to histology that we have had from this side of
+the Atlantic.
+
+It is interesting to see how old questions are incidentally settled in
+the course of these new investigations. Thus, Mr. Clarke's dissections,
+confirmed by preparations of Mr. Dean's which I have myself examined,
+placed the fact of the decussation of the pyramids--denied by Haller, by
+Morgagni, and even by Stilling--beyond doubt. So the spinal canal, the
+existence of which, at least in the adult, has been so often disputed,
+appears as a coarse and unequivocal anatomical fact in many of the
+preparations referred to.
+
+While these studies of the structure of the cord have been going on,
+the ingenious and indefatigable Brown-Sequard has been investigating the
+functions of its different parts with equal diligence. The microscopic
+anatomists had shown that the ganglionic corpuscles of the gray matter
+of the cord are connected with each other by their processes, as well
+as with the nerve-roots. M. Brown-Sequard has proved by numerous
+experiments that the gray substance transmits sensitive impressions and
+muscular stimulation. The oblique ascending and descending fibres from
+the posterior nerve-roots, joining the “longitudinal columns of the
+cornua,” account for the results of Brown-Sequard's sections of the
+posterior columns. The physiological experimenter has also made it
+evident that the decussation of the conductors of sensitive impressions
+has its seat in the spinal core, and not in the encephalon, as had been
+supposed. Not less remarkable than these results are the facts, which
+I with others of my audience have had the opportunity of observing, as
+shown by M. Brown-Sequard, of the artificial production of epilepsy in
+animals by injuring the spinal cord, and the induction of the paroxysm
+by pinching a certain portion of the skin. I would also call the
+student's attention to his account of the relations of the nervous
+centres to nutrition and secretion, the last of which relations has been
+made the subject of an extended essay by our fellow countryman, Dr. H.
+F. Campbell of Georgia.
+
+The physiology of the spinal cord seems a simple matter as you study it
+in Longet. The experiments of Brown-Sequard have shown the problem to
+be a complex one, and raised almost as many doubts as they have solved
+questions; at any rate, I believe all lecturers on physiology agree that
+there is no part of their task they dread so much as the analysis of the
+evidence relating to the special offices of the different portions of
+the medulla spinalis. In the brain we are sure 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 crossed paralysis of
+sensation, and the conducting agency of the gray substance, I am afraid
+we retain no cardinal principles discovered since the development of the
+reflex function took its place by Sir Charles Bell's great discovery.
+
+By the manner in which I spoke of the brain, you will see that I am
+obliged to leave phrenology sub Jove,--out in the cold,--as not one of
+the household of science. I am not one of its haters; on the contrary, I
+am grateful for the incidental good it has done. I love to amuse myself
+in its plaster Golgothas, and listen to the glib professor, as he
+discovers by his manipulations
+
+
+   “All that disgraced my betters met in me.”
+
+I loved of old to see square-headed, heavy-jawed Spurzheim make a brain
+flower out into a corolla of marrowy filaments, as Vieussens had done
+before him, and to hear the dry-fibred but human-hearted George Combe
+teach good sense under the disguise of his equivocal system. But the
+pseudo-sciences, phrenology and the rest, seem to me only appeals to
+weak minds and the weak points of strong ones. There is a pica or false
+appetite in many intelligences; they take to odd fancies in place of
+wholesome truth, as girls gnaw at chalk and charcoal. Phrenology juggles
+with nature. It is so adjusted as to soak up all evidence 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 boundary of our
+ignorance, it seems to me, but is one of the will-o'-the-wisps of its
+undisputed central domain of bog and quicksand. Yet I should not have
+devoted so many words to it, did I not recognize the light it has thrown
+on human actions by its study of congenital organic tendencies. Its maps
+of the surface of the head are, I feel sure, founded on a delusion,
+but its studies of individual character are always interesting and
+instructive.
+
+The “snapping-turtle” strikes after its natural fashion when it first
+comes out of the egg. Children betray their tendencies in their way of
+dealing with the breasts that nourish them; nay, lean venture to affirm,
+that long before they are born they teach their mothers something of
+their turbulent or quiet tempers.
+
+
+   “Castor gaudet equis, ovo proanatus eodem
+     Pugnis.”
+
+Strike out the false pretensions of phrenology; call it anthropology;
+let it study man the individual in distinction from man the abstraction,
+the metaphysical or theological lay-figure; and it becomes “the proper
+study of mankind,” one of the noblest and most interesting of pursuits.
+
+The whole physiology of the nervous system, from the simplest
+manifestation of its power in an insect up to the supreme act of the
+human intelligence working through the brain, is full of the most
+difficult yet profoundly interesting questions. The singular relations
+between electricity and nerve-force, relations which it has been
+attempted to interpret as meaning identity, in the face of palpable
+differences, require still more extended studies. You may be interested
+by Professor Faraday's statement of his opinion on the matter. “Though
+I am not satisfied that the nervous fluid is only electricity, still I
+think that the agent in the nervous system maybe an inorganic force; and
+if there be reason for supposing that magnetism is a higher relation
+of force than electricity, so it may well be imagined that the nervous
+power may be of a still more exalted character, and yet within the reach
+of experiment.”
+
+In connection with this statement, it is interesting to refer to the
+experiments of Helmholtz on the rapidity of transmission of the nervous
+actions. The rate is given differently in Valentin's report of these
+experiments and in that found in the “Scientific Annual” for 1858.
+One hundred and eighty to three hundred feet per second is the rate
+of movement assigned for sensation, but all such results must be very
+vaguely approximative. Boxers, fencers, players at the Italian game
+of morn, “prestidigitators,” and all who depend for their success on
+rapidity of motion, know what differences there are in the personal
+equation of movement.
+
+Reflex action, the mechanical sympathy, if I may so call it, of distant
+parts; Instinct, which is crystallized intelligence,--an absolute law
+with its invariable planes and angles introduced into the sphere of
+consciousness, as raphides are inclosed in the living cells of plants;
+Intellect,--the operation of the thinking principle through material
+organs, with an appreciable waste of tissue in every act of thought, so
+that our clergymen's blood has more phosphates to get rid of on Monday
+than on any other day of the week; Will,--theoretically the absolute
+determining power, practically limited in different degrees by the
+varying organization of races and individuals, annulled or perverted
+by different ill-understood organic changes; on all these subjects our
+knowledge is in its infancy, and from the study of some of them the
+interdict of the Vatican is hardly yet removed.
+
+I must allude to one or two points in the histology and physiology of
+the organs of sense. The anterior continuation of the retina beyond
+the ora serrata has been a subject of much discussion. If H. Muller and
+Kolliker can be relied upon, this question is settled by recognizing
+that a layer of cells, continued from the retina, passes over the
+surface of the zonula Zinnii, but that no proper nervous element is so
+prolonged forward.
+
+I observe that Kolliker calls the true nervous elements of the retina
+“the layer of gray cerebral substance.” In fact, the ganglionic
+corpuscles of each eye may be considered as constituting a little brain,
+connected with the masses behind by the commissure, commonly called the
+optic nerve. We are prepared, therefore, to find these two little brains
+in the most intimate relations with each other, as we find the cerebral
+hemispheres. We know that they are directly connected by fibres that
+arch round through the chiasma.
+
+I mention these anatomical facts to introduce a physiological
+observation of my own, first announced in one of the lectures before the
+Medical Class, subsequently communicated to the American Academy of Arts
+and Sciences, and printed in its “Transactions” for February 14, 1860.
+I refer to the apparent transfer of impressions from one retina to
+the other, to which I have given the name reflex vision. The idea was
+suggested to me in consequence of certain effects noticed in employing
+the stereoscope. Professor William B. Rodgers has since called the
+attention of the American Scientific Association to some facts bearing
+on the subject, and to a very curious experiment of Leonardo da Vinci's,
+which enables the observer to look through the palm of his hand (or seem
+to), as if it had a hole bored through it. As he and others hesitated
+to accept my explanation, I was not sorry to find recently the following
+words in the “Observations on Man” of that acute observer and thinker,
+David Hartley. “An impression made on the right eye alone by a single
+object may propagate itself into the left, and there raise up an image
+almost equal in vividness to itself; and consequently when we see with
+one eye only, we may, however, have pictures in both eyes.” Hartley,
+in 1784, had anticipated many of the doctrines which have since been
+systematized into the theory of reflex actions, and with which I have
+attempted to associate this act of reflex vision. My sixth experiment,
+however, in the communication referred to, appears to me to be a crucial
+one, proving the correctness of my explanation, and I am not aware that
+it has been before instituted.
+
+Another point of great interest connected with the physiology of
+vision, and involved for a long time in great obscurity, is that of the
+adjustment of the eye to different distances. Dr. Clay Wallace of New
+York, who published a very ingenious little book on the eye about twenty
+years ago, with vignettes reminding one of Bewick, was among the first,
+if not the first, to describe the ciliary muscle, to which the power of
+adjustment is generally ascribed. It is ascertained, by exact experiment
+with the phacueidoscope, that accommodation depends on change of form of
+the crystalline lens. Where the crystalline is wanting, as Mr. Ware long
+ago taught, no power of accommodation remains. The ciliary muscle is
+generally thought to effect the change of form of the crystalline. The
+power of accommodation is lost after the application of atropine, in
+consequence, as is supposed, of the paralysis of this muscle. This,
+I believe, is the nearest approach to a demonstration we have on this
+point.
+
+I have only time briefly to refer to Professor Draper's most ingenious
+theory as to the photographic nature of vision, for an account of which
+I must refer to his original and interesting Treatise on Physiology.
+
+It were to be wished that the elaborate and very interesting researches
+of the Marquis Corti, which have revealed such singular complexity
+of structure in the cochlea of the ear, had done more to clear up its
+doubtful physiology; but I am afraid we have nothing but hypotheses for
+the special part it plays in the act of hearing, and that we must say
+the same respecting the office of the semicircular canals.
+
+The microscope has achieved some of its greatest triumphs in teaching
+us the changes which occur in the development of the embryo. No more
+interesting discovery stands recorded in the voluminous literature
+of this subject than the one originally announced by Martin Barry,
+afterwards discredited, and still later confirmed by Mr. Newport and
+others; namely the fact that the fertilizing filament reaches the
+interior of the ovum in various animals;--a striking parallel to the
+action of the pollen-tube in the vegetable. But beyond the mechanical
+facts all is mystery in the movements of organization, as profound as in
+the fall of a stone or the formation of a crystal.
+
+To the chemist and the microscopist the living body presents the same
+difficulties, arising from the fact that everything is in perpetual
+change in the organism. The fibrine of the blood puzzles the one as much
+as its globules puzzle the other. The difference between the branches of
+science which deal with space only, and those which deal with space and
+time, is this: we have no glasses that can magnify time. The figure I
+here show you a was photographed from an object (pleurosigma angulatum)
+magnified a thousand diameters, or presenting a million times its
+natural surface. This other figure of the same object, enlarged from
+the one just shown, is magnified seven thousand diameters, or forty-nine
+million times in surface. When we can make the forty-nine millionth of
+a second as long as its integer, physiology and chemistry will approach
+nearer the completeness of anatomy.
+
+Our reverence becomes more worthy, or, if you will, less unworthy of its
+Infinite Object in proportion as our intelligence is lifted and expanded
+to a higher and broader understanding of the Divine methods of action.
+If Galen called his heathen readers to admire, the power, the wisdom,
+the providence, the goodness of the “Framer of the animal body,”--if Mr.
+Boyle, the student of nature, as Addison and that friend of his who had
+known him for forty years tell us, never uttered the name of the Supreme
+Being without making a distinct pause in his speech, in token of his
+devout recognition of its awful meaning,--surely we, who inherit the
+accumulated wisdom of nearly two hundred 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 study to their
+great Artificer. These wonderful discoveries which we owe to that mighty
+little instrument, the telescope of the inner firmament with all
+its included worlds; these simple formulae by which we condense the
+observations of a generation in a single axiom; these logical analyses
+by which we fence out the ignorance we cannot reclaim, and fix the
+limits of our knowledge,--all lead us up to the inspiration of the
+Almighty, which gives understanding to the world's great teachers. To
+fear science or knowledge, lest it disturb our old beliefs, is to fear
+the influx of the Divine wisdom into the souls of our fellow-men; for
+what is science but the piecemeal revelation,--uncovering,--of the plan
+of creation, by the agency of those chosen prophets of nature whom God
+has illuminated from the central light of truth for that single purpose?
+
+The studies which we have glanced at are preliminary in your
+education to the practical arts which make use of them,--the arts of
+healing,--surgery and medicine. The more you examine the structure of
+the organs and the laws of life, the more you will find how resolutely
+each of the cell-republics which make up the E pluribus unum of the body
+maintains its independence. Guard it, feed it, air it, warm it, exercise
+or rest it properly, and the working elements will do their best to keep
+well or to get well. 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
+side of the fence looking in good health, while those on the other side
+were scraggy and miserable. How do 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, and supplying them with the right kind of food in fitting
+quantities.
+
+Now a man is not a plant, or, at least, he is a very curious 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. He has,
+besides, a singularly complex nutritive apparatus and a nervous system.
+But recollect the doctrine already enunciated in the language of
+Virchow, that an animal, like a tree, is a sum of vital unities, of
+which the cell is the ultimate element. Every healthy cell, whether in
+a vegetable or an animal, necessarily performs its function properly
+so long as 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 normal state. But if originally sound and subsequently
+diseased, there has certainly been some excess, deficiency, or wrong
+quality in the materials or stimuli applied to it. You remove this
+injurious influence and substitute a normal one; remove the baked
+coal-ashes, for instance, from the roots of a tree, and replace them
+with loam; take away the salt meat from the patient's table, and replace
+it with fresh meat and vegetables, and the cells of the tree or the man
+return to their duty.
+
+I do not know that we ever apply to a plant any element which is not
+a natural constituent of the vegetable structure, except perhaps
+externally, for the accidental purpose of killing parasites. The whole
+art of cultivation consists in learning the proper food and conditions
+of plants, and supplying them. We give them water, earths, salts of
+various kinds such as they are made of, with a chance to help themselves
+to air and light. The farmer would be laughed at who undertook to
+manure his fields or his trees with a salt of lead or of arsenic. These
+elements are not constituents of healthy plants. The gardener uses the
+waste of the arsenic furnaces to kill the weeds 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 the vegetable, we might expect
+that we should treat all morbid conditions of any of the vital unities
+belonging to an animal in the same way, by increasing, diminishing, or
+changing its natural food or stimuli.
+
+That is an aliment which nourishes; whatever we find in the organism, as
+a constant and integral element, either forming part of its structure,
+or one of the conditions of vital processes, that and that only deserves
+the name of aliment. I see no reason, therefore, why iron, phosphate of
+lime, sulphur, should not be considered food for man, as much as guano
+or poudrette for vegetables. Whether one or another of them is best in
+any given case,--whether they shall be taken alone or in combination, in
+large or small quantities, are separate questions. But they are elements
+belonging to the body, and even in moderate excess will produce little
+disturbance. There is no presumption against any of this class of
+substances, any more than against water or salt, provided they are used
+in fitting combinations, proportions, and forms.
+
+But when it comes to substances alien to the healthy system, which never
+belong to it as normal constituents, the case is very different. There
+is a presumption against putting lead or arsenic into the human body, as
+against putting them into plants, because they do 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 they get into the system we cannot always
+tell. But in the case of silver, from the accident of its changing color
+under the influence of light, we do know what happens. It is thrown
+out, in part at least, under the epidermis, and there it remains to the
+patient's dying day. This is a striking illustration of the difficulty
+which the system finds in dealing with non-assimilable elements, and
+justifies in some measure the vulgar prejudice against mineral poisons.
+
+I trust the youngest student on these benches will not commit the
+childish error of confounding a presumption against a particular class
+of agents with a condemnation of them. Mercury, for instance, is alien
+to the system, and eminently disturbing in its influence. Yet its
+efficacy in certain forms of specific disease is acknowledged by all
+but the most sceptical theorists. Even the esprit moqueur of Ricord,
+the Voltaire of pelvic literature, submits to the time-honored
+constitutional authority of this great panacea in the class of cases
+to which he has devoted his brilliant intelligence. Still, there is
+no telling what evils have arisen from the abuse of this mineral.
+Dr. Armstrong long ago pointed out some of them, and they have become
+matters of common notoriety. I am pleased, therefore, when I find so
+able and experienced a practitioner as Dr. Williams of this city proving
+that iritis is best treated without mercury, and Dr. Vanderpoel showing
+the same thing to be true for pericarditis.
+
+Whatever elements nature does not introduce into vegetables, the
+natural food of all animal life,--directly of herbivorous, indirectly of
+carnivorous animals,--are to be regarded with suspicion. Arsenic-eating
+may seem to improve the condition of horses for a time,--and even of
+human beings, if Tschudi's stories can be trusted,--but it soon appears
+that its alien qualities are at war with the animal organization. So of
+copper, antimony, and other non-alimentary simple substances; everyone
+of them is an intruder in the living system, as much as a constable
+would be, quartered in our household. This does not mean that they may
+not, any of them, be called in for a special need, as we send for the
+constable when we have good reason to think we have a thief under our
+roof; but a man's body is his castle, as well as his house, and the
+presumption is that we are to keep our alimentary doors bolted against
+these perturbing agents.
+
+Now the feeling is very apt to be just contrary to this. The habit has
+been very general with well-taught practitioners, to have recourse to
+the introduction of these alien elements into the system on the occasion
+of any slight disturbance. The tongue was a little coated, and mercury
+must be given; the skin was a little dry, and the patient must take
+antimony. It was like sending for the constable and the posse comitatus
+when there is only a carpet to shake or a refuse-barrel to empty. [Dr.
+James Johnson advises persons not ailing to take five grains of blue
+pill with one or two of aloes twice a week for three or four months in
+the year, with half a pint of compound decoction of sarsaparilla every
+day for the same period, to preserve health and prolong life. Pract.
+Treatise on Dis. of Liver, etc. p. 272.] The constitution bears slow
+poisoning a great deal better than might be expected; yet the most
+intelligent men in the profession have gradually got out of the habit of
+prescribing these powerful alien substances in the old routine way.
+Mr. Metcalf will tell you how much more sparingly they are given by our
+practitioners at the present time, than when he first inaugurated
+the new era of pharmacy among us. Still, the presumption in favor of
+poisoning out every spontaneous reaction of outraged nature is
+not extinct in those who are trusted with the lives of their
+fellow-citizens. “On examining the file of prescriptions at the
+hospital, I discovered that they were rudely written, and indicated a
+treatment, as they consisted chiefly of tartar emetic, ipecacuanha, and
+epsom salts, hardly favorable to the cure of the prevailing diarrhoea
+and dysenteries.” In a report of a poisoning case now on trial, where we
+are told that arsenic enough was found in the stomach to produce death
+in twenty-four hours, the patient is said to have been treated by
+arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
+acid,--by a practitioner of what school it may be imagined.
+
+The traditional idea of always poisoning out disease, as we smoke out
+vermin, is now seeking its last refuge behind the wooden cannon and
+painted port-holes of that unblushing system of false scientific
+pretences which I do not care to name in a discourse addressed to an
+audience devoted to the study of the laws of nature 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, has accustomed all who
+have sense enough to see through its thin artifices to the idea that
+diseases get well without being “cured,” should now be the main support
+of the tottering poison-cure doctrine. It has unquestionably helped
+to teach wise people that nature heals most diseases without help from
+pharmaceutic art, but it continues to persuade fools that art can arrest
+them all with its specifics.
+
+It is worse than useless to attempt in any way to check the freest
+expression of opinion as to the efficacy of any or all of the “heroic”
+ means of treatment employed by practitioners of different schools and
+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 larger jurisdiction; that, namely, in which the laws of human
+belief are summoned to the witness-box, and obliged to testify to the
+sources of error which beset the medical practitioner. The verdict is as
+old as the father of medicine, who announces it in the words, “judgment
+is difficult.” Physicians differed so in his time, that some denied that
+there was any such thing as an art of medicine.
+
+One man's best remedies were held as mischievous by another. The art of
+healing was like soothsaying, so the common people said; “the same bird
+was lucky or unlucky, according as he flew to the right or left.”
+
+The practice of medicine has undergone great changes within 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 Bellevue
+and the Massachusetts General Hospitals, it is almost obsolete in
+these institutions, at least in medical practice. The old Brunonian
+stimulating treatment has come into vogue again in the practice of Dr.
+Todd and his followers. The compounds of mercury have yielded their
+place as drugs of all work, and specifics for that very frequent
+subjective complaint, nescio quid faciam,--to compounds of iodine. [Sir
+Astley Cooper has the boldness,--or honesty,--to speak of medicines
+which “are given as much to assist the medical man as his patient.”
+ Lectures (London, 1832), p. 14.] Opium is believed in, and quinine,
+and “rum,” using that expressive 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 English and American
+evacuant and alterative practice, in which 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-fashioned medical art,
+counted them with opium and Peruvian bark as his chief remedies; with
+the moderately expectant practice of Louis; the blood-letting “coup
+sur coup” of Bouillaud; the contra-stimulant method of Rasori and his
+followers; the anti-irritant system of Broussais, with its leeching
+and gum-water; I have heard from our own students of the simple opium
+practice of the renowned German teacher, Oppolzer; and now I find the
+medical community brought round by the revolving cycle of opinion to
+that same old plan of treatment which John Brown taught in Edinburgh
+in the last quarter of the last century, and Miner and Tully fiercely
+advocated among ourselves in the early years of the present. The
+worthy physicians last mentioned, and their antagonist Dr. Gallup, used
+stronger language than we of these degenerate days permit ourselves.
+“The lancet is a weapon which annually slays more than the sword,” says
+Dr. Tully. “It is probable that, for forty years past, opium and
+its preparations have done seven times the injury they have rendered
+benefit, on the great scale of the world,” says Dr. Gallup.
+
+What is the meaning of these perpetual changes and conflicts of medical
+opinion and practice, from an early antiquity to our own time? Simply
+this: all “methods” of treatment end in disappointment of those
+extravagant expectations which men are wont to entertain of medical art.
+The bills of mortality are more obviously affected by drainage, than by
+this or that method of practice. The insurance companies do not commonly
+charge a different percentage on the lives of the patients of this or
+that physician. In the course of a generation, more or less, physicians
+themselves are liable to get tired of a practice which has so little
+effect upon the average movement of vital decomposition. Then they are
+ready for a change, even if it were back again to a method which has
+already been tried, and found wanting.
+
+Our practitioners, or many of them, have got back to the ways of old Dr.
+Samuel Danforth, who, as it is well known, had strong objections to
+the use of the lancet. By and by a new reputation will be made by some
+discontented practitioner, who, tired of seeing patients die with their
+skins full of whiskey and their brains muddy with opium, returns to a
+bold antiphlogistic treatment, and has the luck to see a few patients
+of note get well under it. So of the remedies which have gone out of
+fashion and been superseded by others. It can hardly be doubted that
+they will come into vogue again, more or less extensively, under the
+influence of that irresistible demand for change just referred to.
+
+Then will come the usual talk about a change in the character
+of disease, which has about as much meaning as that concerning
+“old-fashioned snow-storms.” “Epidemic constitutions” of disease mean
+something, no doubt; a great deal as applied to malarious affections;
+but that the whole type of diseases undergoes such changes that the
+practice must be reversed from depleting to stimulating, and vice versa,
+is much less likely than that methods of treatment go out of fashion and
+come in again. If there is any disease which claims its percentage with
+reasonable uniformity, it is phthisis. Yet I remember that the reverend
+and venerable Dr. Prince of Salem told me one Commencement day, as I was
+jogging along towards Cambridge with him, that he recollected the time
+when that disease was hardly known; and in confirmation of his
+statement mentioned a case in which it was told as a great event, that
+somebody down on “the Cape” had died of “a consumption.” This story does
+not sound probable to myself, as I repeat it, yet I assure you it is
+true, and it shows how cautiously we must receive all popular stories of
+great changes in the habits of disease.
+
+Is there no progress, then, but do we return to the same beliefs and
+practices which our forefathers wore out and threw away? I trust and
+believe that there 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 go back to the simple Brunonian pathology,
+since we have learned too much of diseased action to accept its
+convenient dualism. So of other doctrines, each new Avatar strips them
+of some of their old pretensions, until they take their fitting place
+at last, if they have any truth in them, or disappear, if they were mere
+phantasms of the imagination.
+
+In the mean time, while medical theories are coming in and going out,
+there is a set of sensible men who are never run away with by them, but
+practise their art sagaciously and faithfully in much the same way from
+generation to generation. From the time of Hippocrates to that of our
+own medical patriarch, there has been an apostolic succession of wise
+and good practitioners. If you will look at the first aphorism of the
+ancient Master you will see that before all remedies he places the
+proper conduct of the patient and his attendants, and the fit ordering
+of all the conditions surrounding him. The class of practitioners I have
+referred to have always been the most faithful in attending to these
+points. No doubt they have sometimes prescribed unwisely, in compliance
+with the prejudices of their time, but they have grown wiser as they
+have grown older, and learned to trust more in nature and less in their
+plans of interference. I believe common opinion confirms Sir James
+Clark's observation to this effect.
+
+The experience of the profession must, I think, run parallel with that
+of the wisest of its individual members. Each time a plan of treatment
+or a particular remedy comes up for trial, it is submitted to a sharper
+scrutiny. When Cullen wrote his Materia Medica, he had seriously to
+assail the practice of giving burnt toad, which was still countenanced
+by at least one medical authority of note. I have read recently in some
+medical journal, that an American practitioner, whose name is known to
+the country, is prescribing the hoof of a horse for epilepsy. It was
+doubtless suggested by that old fancy of wearing a portion of elk's hoof
+hung round the neck or in a ring, for this disease. But it is hard
+to persuade reasonable people to swallow the abominations of a former
+period. The evidence which satisfied Fernelius will not serve one of our
+hospital physicians.
+
+In this way those articles of the Materia Medica which had nothing but
+loathsomeness to recommend them have been gradually dropped, and are not
+like to obtain any 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 the utility of some of them, when properly
+employed. Though I believe that at present, taking the world at large,
+and leaving out a few powerful agents of such immense value that they
+rank next to food in importance, the poisons prescribed for disease do
+more hurt than good, I have no doubt, and never professed to have any,
+that they do much good in prudent and instructed hands. But I am very
+willing to confess a great jealousy of many agents, and I could almost
+wish to see the Materia Medica so classed as to call suspicion upon
+certain ones among them.
+
+Thus the alien elements, those which do not properly enter into
+the composition of any living tissue, are the most to be suspected,
+--mercury, lead, antimony, silver, and the rest, for the reasons I have
+before mentioned. Even iodine, which, as it is found in certain plants,
+seems less remote from the animal tissues, gives unequivocal proofs
+from time to time that it is hostile to some portions of the glandular
+system.
+
+There is, of course, less prima facie objection to those 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 sometimes poison to another, and
+vice versa; inert substances may act mechanically, so as to produce
+the effect of poisons; but this division holds exactly enough for our
+purpose.
+
+Strictly speaking, every poison consisting of assimilable elements 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's
+action, or some other symptom for which the subject of it would consult
+the physician, if it came on from any other cause than taking it under
+the name of medicine. Yet portions of this unwholesome food which
+we call medicine, we have reason to believe, are assimilated; thus,
+castor-oil appears to be partially digested by infants, so that they
+require large doses to affect them medicinally. Even that deadliest of
+poisons, hydrocyanic acid, is probably assimilated, and helps to make
+living tissue, if it do not kill the patient, for the assimilable
+elements which it contains, given in the separate forms of amygdalin and
+emulsin, produce no disturbance, unless, as in Bernard's experiments,
+they are suffered to meet in the digestive organs. A medicine consisting
+of assimilable substances being then simply unwholesome food, we
+understand what is meant by those cumulative effects of such remedies
+often observed, as in the case of digitalis and strychnia. They are
+precisely similar to the cumulative effects of a salt diet in producing
+scurvy, or of spurred rye in producing dry gangrene. As the effects of
+such substances are a violence to the organs, we should exercise the
+same caution with regard to their use that we would exercise about
+any other kind of poisonous food,--partridges at certain seasons, for
+instance. Even where these poisonous kinds of food seem to be useful, we
+should still regard them with great jealousy. Digitalis lowers the pulse
+in febrile conditions. Veratrum viride does the same thing. How do we
+know that a rapid pulse is not a normal adjustment of nature to the
+condition it accompanies? Digitalis has gone out of favor; how sure are
+we that Veratrum viride will not be found to 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
+use of opium in delirium tremens (which you remember is sometimes called
+delirium vigilans), where it seemed so obviously indicated, since the
+publication of Dr. Ware's admirable essay. I respect the evidence of
+my contemporaries, but I cannot forget the sayings of the Father of
+medicine,--Ars longa, judicium difficile.
+
+I am not presuming to express an opinion concerning Veratrum viride,
+which was little heard of when I was still practising medicine. I am
+only appealing to that higher court of experience which sits in judgment
+on all decisions of the lower medical tribunals, and which requires more
+than one generation for its final verdict.
+
+Once change the habit of mind so long prevalent among practitioners of
+medicine; once let it be everywhere understood that the presumption is
+in favor of food, and not of alien substances, of innocuous, and not
+of unwholesome food, for the sick; that this presumption requires very
+strong evidence in each particular case to overcome it; but that, when
+such evidence is afforded, the alien substance or the unwholesome food
+should be given boldly, in sufficient quantities, in the same spirit as
+that with which the surgeon lifts his knife against a patient,--that
+is, with the same reluctance and the same determination,--and I think
+we shall have and hear much less of charlatanism in and out of the
+profession. The disgrace of medicine has been that colossal system of
+self-deception, in obedience to which mines have been emptied of their
+cankering minerals, the vegetable kingdom robbed of all its noxious
+growths, the entrails of animals taxed for their impurities,
+the poison-bags of reptiles drained of their venom, and all the
+inconceivable abominations thus obtained thrust down the throats of
+human beings suffering from some fault of organization, nourishment, or
+vital stimulation.
+
+Much as we have gained, we have not yet thoroughly shaken off the notion
+that poison is the natural food of disease, as wholesome aliment is
+the support of health. Cowper's lines, in “The Task,” show the
+matter-of-course practice of his time:
+
+
+  “He does not scorn it, who has long endured
+   A fever's agonies, and fed on drugs.”
+
+Dr. Kimball of Lowell, who has been in the habit of seeing a great
+deal more of typhoid fever than most practitioners, and whose surgical
+exploits show him not to be wanting in boldness or enterprise, can tell
+you whether he finds it necessary to feed his patients on drugs or not.
+His experience is, I believe, that of the most enlightened and advanced
+portion of the profession; yet I think that even in typhoid fever, and
+certainly in many other complaints, the effects of ancient habits
+and prejudices may still be seen in the practice of some educated
+physicians.
+
+To you, young men, it belongs to judge all that has gone before you.
+You come nearer to the great fathers of modern medicine than some of you
+imagine. Three of my own instructors attended Dr. Rush's Lectures. The
+illustrious Haller mentions Rush's inaugural thesis in his “Bibliotheca
+Anatomica;” and this same Haller, brought so close to us, tells us he
+remembers Ruysch, then an old man, and used to carry letters between him
+and Boerhaave. Look through the history of medicine from Boerhaave
+to this present day. You will see at once that medical doctrine and
+practice have undergone a long series of changes. You will see that
+the doctrine and practice of our own time must probably change in their
+turn, and that, if we can trust at all to the indications of their
+course, it will be in the direction of an improved hygiene and a
+simplified treatment. Especially will the old habit of violating the
+instincts of the sick give place to a judicious study of these same
+instincts. It will be found that bodily, like mental insanity, is best
+managed, for the most part, by natural soothing agencies. Two centuries
+ago there was a prescription for scurvy containing “stercoris taurini
+et anserini par, quantitas trium magnarum nucum,” of the hell-broth
+containing which “guoties-cumque sitit oeger, large bibit.” When I
+have recalled the humane common-sense of Captain Cook in the matter
+of preventing this disease; when I have heard my friend, Mr. Dana,
+describing the avidity with which the scurvy-stricken sailors snuffed up
+the earthy fragrance of fresh raw potatoes, the food which was to supply
+the elements wanting to their spongy tissues, I have recognized that the
+perfection of art is often a return to nature, and seen in this single
+instance the germ of innumerable beneficent future medical reforms.
+
+I cannot help believing that medical curative treatment will by and
+by resolve itself in great measure into modifications of the food,
+swallowed and breathed, and of the natural stimuli, and that less will
+be expected from specifics and noxious disturbing agents, either alien
+or assimilable. The noted mineral-waters containing iron, sulphur,
+carbonic acid, supply nutritious or stimulating materials to the body
+as much as phosphate of lime and ammoniacal compounds do to the cereal
+plants. The effects of a milk and vegetable diet, of gluten bread
+in diabetes, of cod-liver oil in phthisis, even of such audacious
+innovations as the water-cure and the grape-cure, are only hints of
+what will be accomplished when we have learned to discover what organic
+elements are 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 his crops and modifies the
+composition of his soil. In acute febrile diseases we have long ago
+discovered that far above all drug-medication is the use of mild liquid
+diet in the period of excitement, and of stimulant and nutritious food
+in that of exhaustion. Hippocrates himself was as particular about his
+barley-ptisan as any Florence Nightingale of our time could be.
+
+The generation to which you, who are just entering the profession,
+belong, will make a vast stride forward, as I believe, in the direction
+of treatment by natural rather than violent agencies. What is it that
+makes the reputation of Sydenham, as the chief of English physicians?
+His prescriptions consisted principally of simples. An aperient or an
+opiate, a “cardiac” or a tonic, may be commonly found in the midst of
+a somewhat fantastic miscellany of garden herbs. It was not by his
+pharmaceutic prescriptions that he gained his great name. It was
+by daring to order fresh air for small-pox patients, and riding on
+horseback for consumptives, in place of the smothering system, and
+the noxious and often loathsome rubbish of the established schools. Of
+course Sydenham was much abused by his contemporaries, as he frequently
+takes occasion to remind his reader. “I must needs conclude,” he says,
+“either that I am void of merit, or that the candid and ingenuous part
+of mankind, who are formed with so excellent a temper of mind as to be
+no strangers to gratitude, make a very small part of the whole.” If in
+the fearless pursuit of truth you should find the world as ungracious in
+the nineteenth century as he found it in the seventeenth, you may learn
+a lesson of self-reliance from another utterance of the same illustrious
+physician: “'T is none of 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 writings with temper.”
+
+The physician has learned a great deal from the surgeon, who is
+naturally in advance of him, because he has a better opportunity of
+seeing the effects of his remedies. Let me shorten one of Ambroise
+Pare's stories for you. There had been a great victory at the pass of
+Susa, and they were riding into the city. The wounded cried out as the
+horses trampled them under their hoofs, which caused good Ambroise great
+pity, and made him wish himself back in Paris. Going into a stable he
+saw four dead soldiers, and three desperately wounded, placed with their
+backs against the wall. An old campaigner came up.--“Can these fellows
+get well?” he said. “No!” answered the surgeon. Thereupon, the old
+soldier walked 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, “somebody will
+do as much for me if I ever get into such a scrape” (accoustre de telle
+facon). “I was not much salted in those days” (bien doux de sel), says
+Ambroise, “and little acquainted with the treatment of wounds.” However,
+as he tells us, he proceeded to apply boiling oil of Sambuc (elder)
+after the approved fashion of the time,--with what torture to the
+patient may be guessed. At last his precious oil gave out, and he used
+instead an insignificant mixture of his own contrivance. He could not
+sleep that night for fear his patients who had not been scalded with
+the boiling oil would be poisoned by the gunpowder conveyed into their
+wounds by the balls. To his surprise, he found them much better than the
+others the next morning, and resolved never again to burn his patients
+with hot oil for gun-shot wounds.
+
+This was the beginning, as nearly as we can fix it, of that reform which
+has introduced plain water-dressings in the place of the farrago of
+external applications which had been a source of profit to apothecaries
+and disgrace to art from, and before, the time when Pliny complained
+of them. A young surgeon who was at Sudley Church, laboring among the
+wounded of Bull Run, tells me they had nothing but water for dressing,
+and he (being also doux de sel) was astonished to see how well the
+wounds did under that simple treatment.
+
+Let me here mention a fact or two which may be of use to some of you who
+mean to enter the public service. You will, as it seems, have gun-shot
+wounds almost exclusively to deal with. Three different surgeons, the
+one just mentioned and two who saw the wounded of Big Bethel, assured me
+that they found no sabre-cuts or bayonet wounds. It is the rifle-bullet
+from a safe distance which pierces the breasts of our soldiers, and not
+the gallant charge of broad platoons and sweeping squadrons, such as
+we have been in the habit of considering the chosen mode of warfare
+of ancient and modern chivalry. [Sir Charles James Napier had the same
+experience in Virginia in 1813. “Potomac. We have nasty sort of fighting
+here, amongst creeks and bushes, and lose men without show.” “Yankee
+never shows himself, he keeps in the thickest wood, fires and runs
+off.”--“These five thousand in the open field might be attacked,
+but behind works it would be throwing away lives.” He calls it “an
+inglorious warfare,”--says one of the leaders is “a little deficient in
+gumption,--but--still my opinion is, that if we tuck up our sleeves and
+lay our ears back we might thrash them; that is, if we caught them out
+of their trees, so as to slap at them with 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 your assistants. A chaplain told it
+to two of our officers personally known to myself. He overheard the
+examination of a man who wished to drive one of the “avalanche” wagons,
+as they call them. The man was asked if he knew how to deal with wounded
+men. “Oh yes,” he answered; “if they're hit here,” pointing to the
+abdomen, “knock 'em on the head,--they can't get well.”
+
+In art and outside of it you will meet the same barbarisms that Ambroise
+Pare met with,--for men differ less from century to century than we are
+apt to suppose; you will encounter the same opposition, if you attack
+any prevailing opinion, that Sydenham complained of. So far as possible,
+let not such experiences breed in you a contempt for those who are the
+subjects of folly or prejudice, or foster any love of dispute for its
+own sake. Should you become authors, express your opinions freely;
+defend them rarely. It is not often that an opinion is worth expressing,
+which cannot take care of itself. Opposition is the best mordant to fix
+the color of your thought in the general belief.
+
+It is time to bring these crowded remarks to a close. The day has been
+when at the beginning of a course of Lectures I should have thought it
+fitting to exhort you to diligence and entire devotion to your tasks
+as students. It is not so now. The young man who has not heard the
+clarion-voices of honor and of duty now sounding throughout the land,
+will heed 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 our own blood or stanching that of our wounded defenders,
+students or teachers, whatever our calling and our ability, we belong,
+not to ourselves, but to our imperilled country, whose danger is our
+calamity, whose ruin would be our enslavement, whose rescue shall be our
+earthly salvation!
+
+
+
+
+
+
+SCHOLASTIC AND BEDSIDE TEACHING.
+
+An Introductory Lecture delivered before the Medical Class of Harvard
+University, November 6, 1867.
+
+The idea is entertained by some of our most sincere professional
+brethren, that to lengthen and multiply our Winter Lectures will be
+of necessity to advance the cause of medical education. It is a fair
+subject for consideration whether they do not overrate the relative
+importance of that particular mode of instruction which forms the larger
+part of these courses.
+
+As this School could only lengthen its lecture term at the expense
+of its “Summer Session,” in which more direct, personal, and familiar
+teaching takes the place of our academic discourses, and in which more
+time can be given to hospitals, infirmaries, and practical instruction
+in various important specialties, whatever might be gained, a good deal
+would certainly be lost in our case by the exchange.
+
+The most essential part of a student's instruction is 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 indelibly in the memory. Before
+the student is aware of what he has acquired, he has learned the aspects
+and course and probable issue of the diseases he has seen with his
+teacher, and the proper mode of dealing with them, so far as his master
+knows it. On the other hand, our ex cathedra prelections have a strong
+tendency to run into details which, however interesting they may be to
+ourselves and a few of our more curious listeners, have nothing in them
+which will ever be of use to the student as a practitioner. It is a
+perfectly fair question whether I and some other American Professors do
+not teach quite enough that is useless already. Is it not well to remind
+the student from time to time that a physician's business is to avert
+disease, to heal the sick, to prolong life, and to diminish suffering?
+Is it not true that the young man of average ability will find it as
+much as he can do to fit himself for these simple duties? Is it not
+best to begin, at any rate, by making sure of such knowledge as he will
+require in his daily walk, by no means discouraging him from any study
+for which his genius fits him when he once feels that he has become
+master of his chosen art.
+
+I know that many branches of science are of the greatest value as
+feeders of our medical reservoirs. But the practising physician's office
+is to draw the healing waters, and while he gives his time to this
+labor he can hardly be expected to explore all the sources that spread
+themselves over the wide domain of science. The traveller who would not
+drink of the Nile until he had tracked it to its parent lakes, would be
+like to die of thirst; and the medical practitioner who would not use
+the results of many laborers in other departments without sharing their
+special toils, would find life far too short and art immeasurably too
+long.
+
+We owe much to Chemistry, one of the most captivating as well as
+important of studies; but the medical man must as a general rule content
+himself with a clear view of its principles and a limited acquaintance
+with its facts; such especially as are pertinent to his pursuits. I am
+in little danger of underrating Anatomy or Physiology; but as each of
+these branches splits up into specialties, any one of which may take up
+a scientific life-time, I would have them taught with a certain judgment
+and reserve, so that they shall not crowd the more immediately
+practical branches. So of all the other ancillary and auxiliary kinds
+of knowledge, I would have them strictly subordinated to that particular
+kind of knowledge for which the community looks to its medical advisers.
+
+A medical school is not a scientific school, except just 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 is implied in
+Hufeland's aphorism: “The physician must generalize the disease and
+individualize the patient.”
+
+The coordinated and classified results of empirical observation, in
+distinction from scientific experiment, have furnished almost all we
+know about food, the medicine of health, and medicine, the food of
+sickness. We eat the root of the Solanum tuberosum and throw away its
+fruit; we eat the fruit of the Solanum Lycopersicum and throw away its
+root. Nothing but vulgar experience has taught us to reject the potato
+ball and cook the tomato. So of most of our remedies. The subchloride
+of mercury, calomel, is the great British specific; the protochloride of
+mercury, corrosive sublimate, kills like arsenic, but no chemist could
+have told us it would be so.
+
+From observations like these we can obtain certain principles from which
+we can argue deductively to facts of a like nature, but the process
+is limited, and we are suspicious of all reasoning in that direction
+applied to the processes of healthy and diseased life. We are
+continually appealing to special facts. We are willing to give Liebig's
+artificial milk when we cannot do better, but we watch the child
+anxiously whose wet-nurse is a chemist's pipkin. A pair of substantial
+mammary glands has the advantage over the two hemispheres of the most
+learned Professor's brain, in the art of compounding a nutritious fluid
+for 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 not directly useful to the future
+practitioner. But the over ambitious and active student must not be led
+away by the seduction of knowledge for its own sake from his principal
+pursuit. The humble beginner, who is alarmed at the vast fields of
+knowledge opened to him, may be encouraged by the assurance that with a
+very slender provision of science, in distinction from practical skill,
+he may be a useful and acceptable member of the profession to which the
+health of the community is intrusted.
+
+To those who are not to engage in practice, the various pursuits
+of science hardly require to be commended. Only they must not be
+disappointed if they find many subjects treated in our courses as a
+medical class requires, rather than as a scientific class would expect,
+that is, with special limitations and constant reference to practical
+ends. Fortunately they are within easy reach of the highest scientific
+instruction. The business of a school like this is to make useful
+working physicians, and to succeed in this it is almost as important not
+to overcrowd the mind of the pupil with merely curious knowledge as it
+is to store it with useful information.
+
+In this direction I have written my lecture, not to undervalue any form
+of scientific labor in its place, an unworthy thought from which I hope
+I need not defend myself,--but to discourage any undue inflation of the
+scholastic programme, which even now asks more of the student than the
+teacher is able to obtain from the great majority of those who present
+themselves for examination. I wish to take a hint in education from the
+Secretary of the Massachusetts Board of Agriculture, who regards the
+cultivation of too much land as a great defect in our New England
+farming. I hope that our Medical Institutions may never lay themselves
+open to the kind of accusation Mr. Lowe brings against the English
+Universities, when he says that their education is made up “of words
+that few understand and most will shortly forget; of arts that can never
+be used, if indeed they can even be learnt; of histories inapplicable to
+our times; of languages dead and even mouldy; of grammatical rules
+that never had living use and are only post mortem examinations; and of
+statements fagoted with utter disregard of their comparative value.”
+
+This general thought will be kept in view throughout my somewhat
+discursive address, which will begin with an imaginary clinical lesson
+from the lips of an historical personage, and close with the portrait
+from real life of one who, both as teacher and practitioner, was long
+loved and honored among us. If I somewhat overrun my hour, you must
+pardon me, for I can say with Pascal that I have not had the time to
+make my lecture shorter.
+
+In the year 1647, that good man John Eliot, commonly called the Apostle
+Eliot, writing to Mr. Thomas Shepherd, the pious minister of Cambridge,
+referring to the great need of medical instruction for the Indians, used
+these words:
+
+“I have thought in my heart that it were a singular good work, if
+the Lord would stirre up the hearts of some or other of his people
+in England to give some maintenance toward some Schoole or Collegiate
+exercise this way, wherein there should be Anatomies and other
+instructions that way, and where there might be some recompence given to
+any that should bring in any vegetable or other thing that is vertuous
+in the way of Physick.
+
+“There is another reason which moves my thought and desires this way,
+namely that our young students in Physick may be trained up better then
+they yet bee, who have onely theoreticall knowledge, and are forced to
+fall to practise before ever they saw an Anatomy 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, did make and
+read upon very well, but no more of that now.”
+
+Since the time of the Apostle Eliot the Lord has stirred up the hearts
+of our people to the building of many Schools and Colleges where
+medicine is taught in all its branches. Mr. Giles Firmin's “Anatomy” may
+be considered the first ancestor of a long line of skeletons which have
+been dangling and rattling in our lecture-rooms for more than a century.
+
+Teaching in New England in 1647 was a grave but simple matter. A single
+person, combining in many cases, as in that of Mr. Giles Firmin,
+the offices of physician and preacher, taught what he knew to a few
+disciples whom he gathered about him. Of the making of that “Anatomy” on
+which my first predecessor in the branch I teach “did read very well”
+ we can know nothing. The body of some poor wretch who had swung upon the
+gallows, was probably conveyed by night to some lonely dwelling at the
+outskirts of the village, and there by the light of flaring torches
+hastily dissected by hands that trembled over the unwonted task.
+And ever and anon the master turned to his book, as he laid bare the
+mysteries of the hidden organs; to his precious Vesalius, it might be,
+or his figures repeated in the multifarious volume of Ambroise Pare; to
+the Aldine octavo in which Fallopius recorded his fresh observations; or
+that giant folio of Spigelius just issued from the press of Amsterdam,
+in which lovely ladies display their viscera with a coquettish grace
+implying that it is rather a pleasure than otherwise to show the
+lace-like omentum, and hold up their appendices epiploicae as if they
+were saying “these are our jewels.”
+
+His teaching of medicine was no doubt chiefly clinical, and received
+with the same kind of faith as that which accepted his words from the
+pulpit. His notions of disease were based on what he had observed, seen
+always in the light of the traditional doctrines in which he was bred.
+His discourse savored of the weighty doctrines of Hippocrates, diluted
+by the subtle speculations of Galen, reinforced by the curious comments
+of the Arabian schoolmen as they were conveyed in the mellifluous
+language of Fernelius, blended, it may be, with something of the lofty
+mysticism of Van Helmont, and perhaps stealing a flavor of that earlier
+form of Homoeopathy which had lately come to light in Sir Kenelm Digby's
+“Discourse concerning the 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 Licetus and saw
+figures of a lion with the head of a woman, and a man with the head of
+an elephant. He had offered to his gaze, as born of a human mother,
+the effigy of a winged cherub, a pterocephalous specimen, which our
+Professor of Pathological Anatomy would hardly know whether to treat
+with the reverence due to its celestial aspect, or to imprison in one of
+his immortalizing jars of alcohol.
+
+His pharmacopoeia consisted mainly of simples, such as the venerable
+“Herball” of Gerard describes and figures in abounding affluence. St.
+John's wort and Clown's All-heal, with Spurge and Fennel, Saffron and
+Parsley, Elder and Snake-root, with opium in some form, and roasted
+rhubarb and the Four Great Cold Seeds, and the two Resins, of which it
+used to be said that whatever the Tacamahaca has not cured, the Caranna
+will, with the more familiar Scammony and Jalap and Black Hellebore,
+made up a good part of his probable list of remedies. He would have
+ordered Iron now and then, and possibly an occasional dose of Antimony.
+He would perhaps have had a rheumatic patient wrapped in the skin of a
+wolf or a wild cat, and in case of a malignant fever with “purples” or
+petechiae, or of an obstinate king's evil, he might have prescribed
+a certain black powder, which had been made by calcining toads in
+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 doctoring as well as against some more modern
+styles of medication. Barbeyrac and his scholar Sydenham had not yet
+cleansed the Pharmacopoeia of its perilous stuff, but there is no doubt
+that the more sensible physicians of that day knew well enough that a
+good honest herb-tea which amused the patient and his nurses was all
+that was required to carry him through all common disorders.
+
+The student soon learned the physiognomy of disease by going about with
+his master; fevers, pleurisies, asthmas, dropsies, fluxes, small-pox,
+sore-throats, measles, consumptions. He saw what was done for them. 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 he could give his whole attention to them. Chirurgery was a separate
+specialty. Women in child-birth were cared for by midwives. There was
+no chemistry deserving the name to require his study. He did not learn a
+great deal, perhaps, but what he did learn was his business, namely, how
+to take care of sick people.
+
+Let me give you a picture of the old-fashioned way of instruction, by
+carrying you with me in imagination in the company of worthy Master
+Giles Firmin as he makes his round of visits among the good folk of
+Ipswich, followed by his one student, who shall answer to the scriptural
+name of Luke. It will not be for entertainment chiefly, but to
+illustrate the one mode of teaching which can never be superseded,
+and which, I venture to 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 fellow is bellowing with
+colic.
+
+“He will die, Master, of a surety, methinks,” says the timid youth in a
+whisper.
+
+“Nay, Luke,” the Master answers, “'t is but a dry belly-ache. Didst
+thou not mark that he stayed his roaring when I did press hard over the
+lesser bowels? Note that he hath not the pulse of them with fevers, and
+by what Dorcas telleth me there hath been no long shutting up of the
+vice naturales. We will steep certain comforting herbs which I will shew
+thee, and put them in a bag and lay them on his belly. Likewise he shall
+have my cordial julep with a portion of this confection which we do call
+Theriaca Andromachi, which hath juice of poppy in it, and is a great
+stayer of anguish. This fellow is at his prayers to-day, but I warrant
+thee he shall be swearing with the best of them to-morrow.”
+
+They jog along the bridle-path on their horses until they come to
+another lowly dwelling. They sit a while with a delicate looking girl
+in whom the ingenuous youth naturally takes a special interest. The good
+physician talks cheerfully with her, asks her a few questions. Then to
+her mother: “Good-wife, Margaret hath somewhat profited, as she telleth,
+by the goat's milk she hath taken night and morning. Do thou pluck a
+maniple--that is an handful--of the plant called Maidenhair, and make
+a syrup therewith as I have shewed thee. Let her take a cup full of
+the same, fasting, before she sleepeth, also before she riseth from her
+bed.” And so they leave the house.
+
+“What thinkest thou, Luke, of the maid we have been visiting?” “She
+seemeth not much ailing, Master, according to my poor judgment. For she
+did say she was better. And she had a red cheek and a bright eye, and
+she spake of being soon able to walk unto the meeting, and did seem
+greatly hopeful, but spare of flesh, methought, and her voice something
+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, and mayhap speedily. But it is
+not here with us she shall be well. For that redness of the cheek is
+but the sign of the fever which, after the Grecians, we do call the
+hectical; and that shining of the eyes is but a sickly glazing, and they
+which do every day get better and likewise thinner and weaker shall find
+that way leadeth to the church-yard gate. This is the malady which the
+ancients did call tubes, or the wasting disease, and some do name the
+consumption. A disease whereof most that fall ailing do perish. This
+Margaret is not long for earth--but she knoweth it not, and still
+hopeth.”
+
+“Why, then, Master, didst thou give her of thy medicine, seeing that her
+ail is unto death?”
+
+“Thou shalt learn, boy, that they which are sick must have somewhat
+wherewith to busy their thoughts. There be some who do give these tabid
+or consumptives a certain posset made with lime-water and anise and
+liquorice and raisins of the sun, and there be other some who do give
+the juice of craw-fishes boiled in barley-water with chicken-broth,
+but these be toys, as I do think, and ye shall find as good virtue, nay
+better, in this syrup of the simple called Maidenhair.”
+
+Something after this manner might Master Giles Firmin have delivered his
+clinical instructions. Somewhat in this way, a century and a half later,
+another New England physician, Dr. Edward Augustus Holyoke, taught a
+young man who came to study with him, a very diligent and intelligent
+youth, James Jackson by name, the same whose portrait in his advanced
+years hangs upon this wall, long the honored Professor of Theory and
+Practice in this Institution, of whom I shall say something in this
+Lecture. Our venerated Teacher studied assiduously 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. Woodville once.
+
+When I compare this direct transfer of the practical experience of a
+wise man into the mind of a student,--every fact one that he can use
+in the battle of life and death,--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 concede that our forefathers
+taught too little, there is not--a possibility that we may sometimes
+attempt to teach too much. I almost blush when I think of myself as
+describing the eight several facets on two slender processes of the
+palate bone, or the seven little twigs that branch off from the minute
+tympanic nerve, and I wonder whether my excellent colleague feels in the
+same way when he pictures himself as giving the constitution of
+neurin, which as he and I know very 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 students can
+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 addressing the Anatomist
+and the Chemist in tones of contemptuous indignation: “What is this
+stuff with which you are cramming the brains of young men who are to
+hold the lives of the community in their hands? Here is a man fallen in
+a fit; you can tell me all about the eight surfaces of the two processes
+of the palate bone, but you have not had the sense to loosen that man's
+neck-cloth, and the old women are all calling you a fool? Here is a
+fellow that has just swallowed poison. I want something to turn his
+stomach inside out at the shortest notice. Oh, you have forgotten the
+dose of the sulphate of zinc, but you remember the formula for the
+production of alloxan!”
+
+“Look you, Master Doctor,--if I go to a carpenter to come and stop
+a leak in my roof that is flooding the house, do you suppose I care
+whether he is a botanist or not? Cannot a man work in wood without
+knowing all about endogens and exogens, or must he attend Professor
+Gray's Lectures before he can be trusted to make a box-trap? If my horse
+casts a shoe, do you think I will not trust a blacksmith to shoe him
+until I have made sure that he is sound on the distinction between the
+sesquioxide and the protosesquioxide of iron?”
+
+--But my scientific labor is to lead to useful results by and by, in the
+next generation, or in some possible remote future.--
+
+“Diavolo!” as your Dr. Rabelais has it,--answers the iconoclast,--“what
+is that to me and my colic, to me and my strangury? I pay the Captain of
+the Cunard steamship to carry me quickly and safely to Liverpool, not
+to make a chart of the Atlantic for after voyagers! If Professor Peirce
+undertakes to pilot me into Boston Harbor and runs me on Cohasset rocks,
+what answer is it to tell me that he is Superintendent of the Coast
+Survey? No, Sir! I want a plain man in a pea-jacket and a sou'wester,
+who knows the channel of Boston Harbor, and the rocks of Boston Harbor,
+and the distinguished Professor is quite of my mind as to the matter,
+for I took the pains to ask him before I ventured to use his name in the
+way of illustration.”
+
+I do not know how the remarks of the image-breaker may strike others,
+but I feel that they put me on my defence with regard to much of my
+teaching. Some years ago I ventured to show in an introductory Lecture
+how very small a proportion of the anatomical facts taught in a regular
+course, as delivered by myself and others, had any practical bearing
+whatever on the treatment of disease. How can I, how can any medical
+teacher justify himself in teaching anything that is not like to be of
+practical use to a class of young men who are to hold in their hands
+the balance in which life and death, ease and anguish, happiness and
+wretchedness are to be daily weighed?
+
+I hope we are not all wrong. Oftentimes in finding how sadly ignorant
+of really essential and vital facts and rules were some of those whom
+we had been larding with the choicest scraps of science, I have doubted
+whether the old one-man system of teaching, when the one man was of the
+right sort, did not turn out better working physicians than our more
+elaborate method. The best practitioner I ever knew was mainly shaped
+to excellence in that way. I can understand perfectly the regrets of my
+friend Dr. John Brown of Edinburgh, for the good that was lost with the
+old apprenticeship system. I understand as well Dr. Latham's fear “that
+many men of the best abilities and good education will be deterred from
+prosecuting physic as a profession, in consequence of the necessity
+indiscriminately laid upon all for impossible attainments.”
+
+I feel therefore impelled to say a very few words in defence of
+that system of teaching adopted in our Colleges, by which we wish to
+supplement and complete the instruction given by private individuals or
+by what are often called Summer Schools.
+
+The reason why we teach so much that is not practical and in itself
+useful, is because we find that the easiest way of teaching what is
+practical and useful. If we could in any way eliminate all that would
+help a man to deal successfully with disease, and teach it by itself
+so that it should be as tenaciously rooted in the memory, as easily
+summoned when wanted, as fertile in suggestion of related facts, as
+satisfactory to the peremptory demands of the intelligence as if taught
+in its scientific connections, I think it would be our duty so to teach
+the momentous truths of medicine, and to regard all useless additions as
+an intrusion on the time which should be otherwise occupied.
+
+But we cannot successfully eliminate and teach by itself that which is
+purely practical. The easiest and surest way of acquiring facts is to
+learn them in groups, in systems, and systematized knowledge is science.
+You can very often carry two facts fastened together more easily than
+one by itself, as a housemaid can carry two pails of water with a hoop
+more easily than one without it. You can remember a man's face, made
+up of many features, better than you can his nose or his mouth or his
+eye-brow. Scores of proverbs show you that you can remember two lines
+that rhyme better than one without the jingle. The ancients, who knew
+the laws of memory, grouped the seven cities that contended for the
+honor of being Homer's birthplace in a line thus given by Aulus Gellius:
+
+Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
+
+I remember, in the earlier political days of Martin Van Buren,
+that Colonel Stone, of the “New York Commercial,” or one of his
+correspondents, said that six towns of New York would claim in the same
+way to have been the birth-place of the “Little Magician,” as he was
+then called; and thus he gave their names, any one of which I should
+long ago have forgotten, but which as a group have stuck tight in my
+memory from that day to this;
+
+Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
+
+If the memory gains so much by mere rhythmical association, how much
+more will it gain when isolated facts are brought together under laws
+and principles, when organs are examined in their natural connections,
+when structure is coupled with function, and healthy and diseased action
+are studied as they pass one into the other! Systematic, or scientific
+study is invaluable as supplying a natural kind of mnemonics, if for
+nothing else. You cannot properly learn the facts you want from Anatomy
+and Chemistry in any way so easily as by taking them in their regular
+order, with other allied facts, only there must be common sense
+exercised in leaving out a great deal which belongs to each of the two
+branches as pure science. The dullest of teachers is the one who does
+not know what to omit.
+
+The larger aim of scientific training is to furnish you with principles
+to which you will be able to refer isolated facts, and so bring these
+within the range of recorded experience. See what the “London Times”
+ said about the three Germans who cracked open John Bull Chatwood's
+strong-box at the Fair the other day, while the three Englishmen
+hammered away in vain at Brother Jonathan Herring's. The Englishmen
+represented brute force. The Germans had been trained to appreciate
+principle. The Englishman “knows his business by rote and rule of
+thumb”--science, which would “teach him to do in an hour what has
+hitherto occupied him two hours,” “is in a manner forbidden to him.” To
+this cause the “Times” attributes the falling off of English workmen in
+comparison with those of the Continent.
+
+Granting all this, we must not expect too much from “science”
+ as distinguished from common experience. There are ten thousand
+experimenters without special apparatus for every one in the laboratory.
+Accident is the great chemist and toxicologist. Battle is the great
+vivisector. Hunger has instituted researches on food such as no Liebig,
+no Academic Commission has ever recorded.
+
+Medicine, sometimes impertinently, often ignorantly, often carelessly
+called “allopathy,” appropriates everything from every source that can
+be of the slightest use to anybody who is ailing in any way, or like to
+be ailing from any cause. It learned from a monk how to use antimony,
+from a Jesuit how to cure agues, from a friar how to cut for stone, from
+a soldier how 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 from an old market-woman how to catch the
+itch-insect. It borrowed acupuncture and the moxa from the Japanese
+heathen, and was taught the use of lobelia by the American savage.
+It stands ready to-day to accept anything from any theorist, from any
+empiric who can make out a good case for his discovery or his remedy.
+“Science” is one of its benefactors, but only one, out of many. Ask the
+wisest practising physician you know, what branches of science help
+him habitually, and what amount of knowledge relating to each branch he
+requires for his professional duties. He will tell you that scientific
+training has a value independent of all the special knowledge acquired.
+He will tell you that many facts are explained by studying them in the
+wider range of related facts to which they belong. He will gratefully
+recognize that the anatomist has furnished him with indispensable data,
+that the physiologist has sometimes put him on the track of new modes
+of treatment, that the chemist has isolated the active principles of
+his medicines, has taught him how to combine them, has from time to time
+offered him new remedial agencies, and so of others of his allies. But
+he will also tell you, if I am not mistaken, that his own branch of
+knowledge is so extensive and so perplexing that he must accept most
+of his facts ready made at their hands. He will own to you that in the
+struggle for life which goes on day and night in our thoughts as in the
+outside world of nature, much that he learned under the name of science
+has died out, and that simple homely experience has largely taken the
+place of that scholastic knowledge to which he and perhaps some of his
+instructors once attached a paramount importance.
+
+This, then, is my view of scientific training as conducted in courses
+such as you are entering on. Up to a certain point I believe in set
+Lectures as excellent adjuncts to what is far more important, practical
+instruction at the bedside, in the operating room, and under the eye of
+the Demonstrator. But I am so far from wishing these courses extended,
+that I think some of them--suppose I say my own--would almost bear
+curtailing. Do you want me to describe more branches of the sciatic and
+crural nerves? I can take Fischer's plates, and lecturing on that scale
+fill up my whole course and not finish the nerves alone. We must stop
+somewhere, and for my own part I think the scholastic exercises of our
+colleges have already claimed their full share of the student's time
+without our seeking to extend them.
+
+I trust I have vindicated the apparent inconsequence of teaching young
+students a good deal that seems at first sight profitless, but which
+helps them to learn and retain what is profitable. But this is an
+inquisitive age, and if we insist on piling up beyond a certain height
+knowledge which is in itself mere trash and lumber to a man whose life
+is to be one long fight with death and disease, there will be some sharp
+questions asked by and by, and our quick-witted people will perhaps find
+they can get along as well without the professor's cap as without the
+bishop's mitre and the monarch's crown.
+
+I myself have nothing to do with clinical teaching. Yet I do not
+hesitate to say it is more essential than all the rest put together, so
+far as the ordinary practice of medicine is concerned; and this is by
+far the most important thing to be learned, because it deals with so
+many more lives than any other branch of the profession. So of personal
+instruction, such as we give and others give in the interval of
+lectures, much of it at the bedside, some of it in the laboratory, some
+in the microscope-room, some in the recitation-room, I think it has many
+advantages of its own over the winter course, and I do not wish to see
+it shortened for the sake of prolonging what seems to me long enough
+already.
+
+If I am jealous of the tendency to expand the time given to the
+acquisition of curious knowledge, at the expense of the plain
+old-fashioned bedside teachings, I only share the feeling which Sydenham
+expressed two hundred years ago, using an image I have already borrowed.
+“He would be no honest and successful pilot who was to apply himself
+with less industry to avoid rocks and sands and bring his vessel safely
+home, than to search into the causes of the ebbing and flowing of the
+sea, which, though very well for a philosopher, is foreign to him whose
+business it is to secure the ship. So neither will a physician, whose
+province it is to cure diseases, be able to do so, though he be a person
+of great genius, who bestows less time on the hidden and intricate
+method of nature, and adapting his means thereto, than on curious and
+subtle speculation.”
+
+“Medicine is my wife and Science is my mistress,” said Dr. Rush. I do
+not think that the breach of the seventh commandment can be shown to
+have been of 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 studied under him, whether Dr. Rush
+had ever learned the meaning of that saying of Lord Bacon, that man
+is the minister and interpreter of Nature, or whether he did not speak
+habitually of Nature as an intruder in the sick room, from which his art
+was to expel her as an incompetent and a meddler.
+
+All a man's powers are not too much for such a profession as Medicine.
+“He is a learned man,” said old Parson Emmons of Franklin, “who
+understands one subject, and he is a very learned man who understands
+two subjects.” Schonbein says he has been studying oxygen for thirty
+years. Mitscherlich said it took fourteen years to establish a new fact
+in chemistry. Aubrey says of Harvey, the discoverer of the circulation,
+that “though all his profession would allow him to be an excellent
+anatomist, I have never heard of any who admired his therapeutic
+way.” My learned and excellent friend before referred to, Dr. Brown
+of Edinburgh, from whose very lively and sensible Essay, “Locke and
+Sydenham,” I have borrowed several of my citations, contrasts Sir
+Charles Bell, the discoverer, the man of science, with Dr. Abercrombie,
+the master in the diagnosis and treatment of disease. It is through one
+of the rarest of combinations that we have in our Faculty a teacher
+on whom the scientific mantle of Bell has fallen, and who yet stands
+preeminent in the practical treatment of the class of diseases which
+his inventive and ardent experimental genius has illustrated. M.
+Brown-Sequard's example is as eloquent as his teaching in proof of the
+advantages of well directed scientific investigation. But those who
+emulate his success at once as a discoverer and a practitioner must be
+content like him to limit their field of practice. The highest genius
+cannot afford 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 dissecting an animal. I should not have cared to
+be his patient. His dissection would do me no good, and his thoughts
+would be too much upon it. I want a whole man for my doctor, not a half
+one. I would have sent for a humbler practitioner, who would have given
+himself entirely to me, and told the other--who was no less a man than
+John Hunter--to go on and finish the dissection of his tiger.
+
+Sydenham's “Read Don Quixote” should be addressed not to the student,
+but to the Professor of today. Aimed at him it means, “Do not be too
+learned.”
+
+Do not think you are going to lecture to picked young men who are
+training themselves to be scientific discoverers. They are of fair
+average capacity, and they are going to be working doctors.
+
+These young men are to have some very serious vital facts to deal with.
+I will mention a few of them.
+
+Every other resident adult you meet in these streets is or will be more
+or less tuberculous. This is not an extravagant estimate, as very
+nearly one third of the deaths of adults in Boston last year were from
+phthisis. If the relative number is less in our other northern cities,
+it is probably in a great measure because they are more unhealthy; that
+is, 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 ganglia and thinking-marrows brown as their
+own meerschaums, of whom you meet too many,--will ask all your wisdom to
+deal with their poisoned nerves and their enfeebled wills.
+
+Nearly seventeen hundred children under five years of age died last
+year in this city. A poor human article, no doubt, in many cases, still,
+worth an attempt to save them, especially when we remember the effect
+of Dr. Clarke's suggestion at the Dublin Hospital, by which some
+twenty-five or thirty thousand children's lives have probably been saved
+in a single city.
+
+Again, the complaint is often heard that the native population is not
+increasing so rapidly as in former generations. The breeding and nursing
+period of American women is one of peculiar delicacy and frequent
+infirmity. Many of them must require a considerable interval between the
+reproductive efforts, to repair damages and regain strength. This matter
+is not to be decided by an appeal to unschooled nature. It is the same
+question as that of the deformed pelvis,--one of degree. The facts
+of mal-vitalization are as much to be attended to as those of
+mal-formation. If the woman with a twisted pelvis is to be considered an
+exempt, the woman with a defective organization should be recognized as
+belonging to the invalid corps. We shudder to hear what is alleged as
+to the prevalence of criminal practices; if back of these there can be
+shown organic incapacity or overtaxing of too limited powers, the facts
+belong to the province of the practical physician, as well as of the
+moralist and the legislator, and require his gravest consideration.
+
+Take the important question of bleeding. Is venesection done with
+forever? Six years ago it was said here in an introductory Lecture that
+it would doubtless come back again sooner or later. A fortnight ago
+I found myself in the cars with one of the most sensible and esteemed
+practitioners in New England. He took out his wallet and showed me two
+lancets, which he 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
+does harm. The caution with reference to it on this ground was long
+ago recorded in the Lecture above referred to. See what Dr. John Hughes
+Bennett says of it in the recent edition of his work on Medicine.
+Nothing but the most careful clinical experience can settle this and
+such points of treatment.
+
+These are all practical questions--questions of life and death, and
+every day will be full of just such questions. Take the problem of
+climate. A patient comes to you with asthma and wants to know where he
+can breathe; another comes to you with phthisis and wants to know where
+he can live. What boy's play is nine tenths of all that is taught in
+many a pretentious course of lectures, compared with what an accurate
+and extensive knowledge of the advantages and disadvantages of different
+residences in these and 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, with the entire relief of certain obscure
+thoracic symptoms which troubled him while at home. I saw, two months
+ago, another gentleman from Minnesota, an observer and a man of sense,
+who considered that State as the great sanatorium for all pulmonary
+complaints. If half our grown population are or will be more or less
+tuberculous, the question of colonizing Florida assumes a new aspect.
+Even within the borders of our own State, the very interesting
+researches of Dr. Bowditch show that there is a great variation in the
+amount of tuberculous disease in different towns, apparently connected
+with local conditions. The hygienic map of a State is quite as valuable
+as its geological map, and it is the business of every practising
+physician to know it thoroughly. They understand this in England, and
+send a patient with a dry irritating cough to Torquay or Penzance,
+while they send another with relaxed bronchial membranes to Clifton or
+Brighton. Here is another great field 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 quantity and
+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 sleeping rooms, is the great cause of tubercle. It
+is sufficiently proved that the American,--the New Englander,--the
+Bostonian, can breed strong and sound children, generation after
+generation,--nay, I have shown by the record of a particular family that
+vital losses may be retrieved, and a feeble race grow to lusty vigor in
+this very climate and locality. Is not the question why our young men
+and women so often break down, and how they can be kept from breaking
+down, far more important for physicians to settle than whether there is
+one cranial vertebra, or whether there are four, or none?
+
+--But I have a taste for the homologies, I want to go deeply into the
+subject of embryology, I want to analyze the protonihilates precipitated
+from pigeon's milk by the action of the lunar spectrum,--shall I not
+follow my star,--shall I not obey my instinct,--shall I not give myself
+to the lofty pursuits of science for its own sake?
+
+Certainly you may, if you like. But take down your sign, or never put
+it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
+Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
+difficulty. We all admire the achievements of 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 six hundred at
+Balaclava, “C'est magnifique, mais ce n'est pas la guerre,”--it is very
+splendid, but it is not a practising doctor's business. His patient has
+a right to the cream of his life and not merely to the thin milk that is
+left after “science” has skimmed it off. The best a physician can give
+is never too good for the patient.
+
+It is often a disadvantage to a young practitioner to be known for any
+accomplishment outside of his profession. Haller lost his election as
+Physician to the Hospital in his native city of Berne, principally on
+the ground that he was a poet. In his later years the physician may
+venture more boldly. Astruc was sixty-nine years old when he published
+his “Conjectures,” the first attempt, we are told, to decide the
+authorship of the Pentateuch showing anything like a discerning
+criticism. Sir Benjamin Brodie was seventy years old before he left
+his physiological and surgical studies to indulge in psychological
+speculations. The period of pupilage will be busy enough in acquiring
+the knowledge needed, and the season of active practice will leave
+little leisure for any but professional studies.
+
+Dr. Graves of Dublin, one of the first clinical teachers of our
+time, always insisted on his students' beginning at once to visit the
+hospital. At the bedside the student must learn to treat disease, and
+just as certainly as we spin out and multiply our academic prelections
+we shall work in more and more stuffing, more and more rubbish, more and
+more irrelevant, useless detail which the student will get rid of just
+as soon as he leaves us. Then the next thing will be a new organization,
+with an examining board of first-rate practical men, who will ask the
+candidate questions that mean business,--who will make him operate if
+he is to be a surgeon, and try him at the bedside if he is to be a
+physician,--and not puzzle him with scientific conundrums which not more
+than one of the questioners could answer himself or ever heard of since
+he graduated.
+
+Or these women who are hammering at the gates on which is written “No
+admittance for the mothers of mankind,” will by and by organize an
+institution, which starting from that skilful kind of nursing which
+Florence Nightingale taught so well, will work backwards through
+anodynes, palliatives, curatives, preventives, until with little show
+of science it imparts most of what is most valuable in those branches of
+the healing art it professes to teach. When that time comes, the fitness
+of women for certain medical duties, which Hecquet advocated in 1708,
+which Douglas maintained in 1736, which Dr. John Ware, long the honored
+Professor of Theory and Practice in this Institution, upheld within
+our own recollection in the face of his own recorded opinion to the
+contrary, will very possibly be recognized.
+
+My advice to every teacher less experienced than myself would be,
+therefore: Do not fret over the details you have to omit; you probably
+teach altogether too many as it is. Individuals may learn a thing
+with once hearing it, but the only way of teaching a whole class is by
+enormous repetition, representation, and illustration in all possible
+forms. Now and then you will have a young man on your benches like the
+late Waldo Burnett,--not very often, if you lecture half a century. You
+cannot pretend to lecture chiefly for men like that,--a Mississippi raft
+might as well take an ocean-steamer in tow. To meet his wants you would
+have to leave the rest of your class behind and that you must not do.
+President Allen of Jefferson College says that his instruction has
+been successful in proportion as it has been elementary. It may be a
+humiliating statement, but it is one which I have found true in my own
+experience.
+
+To the student I would say, that however plain and simple may be our
+teaching, he must expect to forget much 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 voluntarily recall,--they are outside the
+limits of the will. But they sway our conscious thought as the unseen
+planets influence the movements of those within the sphere of vision. No
+man knows how much he knows,--how many ideas he has,--any more than
+he knows how many blood-globules roll in his veins. Sometimes accident
+brings back here and there one, but the mind is full of irrevocable
+remembrances and unthinkable thoughts, which take a part in all
+its judgments as indestructible forces. Some of you must feel your
+scientific deficiencies painfully after your best efforts. But every one
+can acquire what is most essential. A man of very moderate ability may
+be a good physician, if he devotes himself faithfully to the work. More
+than this, a positively dull man, in the ordinary acceptation of the
+term, sometimes makes a safer practitioner than one who has, we will
+say, five per cent. more brains than his average neighbor, but who
+thinks it is fifty per cent. more. Skulls belonging to this last variety
+of the human race are more common, I may remark, than specimens like the
+Neanderthal cranium, a cast of which you will find on the table in the
+Museum.
+
+Whether the average talent be high or low, the Colleges of the land must
+make the best commodity they can out of such material as the country and
+the cities furnish them. The community must have Doctors as it must
+have bread. It uses up its Doctors just as it wears out its shoes, and
+requires new ones. All the bread need not be French rolls, all the shoes
+need not be patent leather ones; but the bread must be something that
+can be eaten, and the shoes must be something that can be worn. Life
+must somehow find food for the two forces that rub everything to
+pieces, or burn it to ashes,--friction and oxygen. Doctors are oxydable
+products, and the schools must keep furnishing new ones as the old
+ones turn into oxyds; some of first-rate quality that burn with 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 competent worker in
+the healing art a hearty welcome. It is on the whole very loyal to the
+Medical Profession. Three successive years have borne witness to the
+feeling with which this Institution, representing it in its educational
+aspect, is regarded by those who are themselves most honored and
+esteemed. The great Master of Natural Science bade the last year's class
+farewell in our behalf, in those accents which delight every audience.
+The Head of our ancient University honored us in the same way in the
+preceding season. And how can we forget that other occasion when the
+Chief Magistrate of the Commonwealth, that noble citizen whom we have
+just lost, large-souled, sweet-natured, always ready for every kind
+office, came among us at our bidding, and talked to us of our duties in
+words as full of wisdom as his heart was of goodness?
+
+You have not much to fear, I think, from the fancy practitioners. The
+vulgar quackeries drop off, atrophied, one after another. Homoeopathy
+has long been encysted, and is carried on the body medical as quietly as
+an old wen. Every year gives you a more reasoning and reasonable people
+to deal with. See how it is in Literature. The dynasty of British
+dogmatists, after lasting a hundred years and more, is on its last legs.
+Thomas Carlyle, third in the line of descent, finds an audience very
+different from those which listened to the silver speech of Samuel
+Taylor Coleridge and the sonorous phrases of Samuel Johnson. We
+read him, we smile at his clotted English, his “swarmery” and other
+picturesque expressions, but we lay down his tirade as we do one of Dr.
+Cumming's interpretations of prophecy, which tells us that the world is
+coming to an end next week or next month, if the weather permits,--not
+otherwise,--feeling very sure that the weather will be unfavorable.
+
+It is the same common-sense public you will appeal to. The less
+pretension you make, the better they will like you in the long run. I
+hope we shall make everything as plain and as simple to you as we can.
+I would never use a long word, even, where a short one would answer
+the purpose. I know there are professors in this country who “ligate”
+ arteries. Other surgeons only tie them, and it stops the bleeding just
+as well. It is the familiarity and simplicity of bedside instruction
+which makes it so pleasant as well as so profitable. A good clinical
+teacher is himself a Medical School. We need not wonder that our young
+men are beginning to announce themselves not only as graduates of this
+or that College, but also as pupils of some one distinguished master.
+
+I wish to close this Lecture, if you will allow me a few moments longer,
+with a brief sketch of an instructor and practitioner whose character
+was as nearly a model one in both capacities as I can find anywhere
+recorded.
+
+Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
+in this University from 1812 to 1846, and whose name has been since
+retained on our rolls as Professor Emeritus, died on the 27th of August
+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
+physicians who have borne witness to their knowledge of the laws of life
+by living to complete their hundredth year. I think the student took
+his Old Master, as he always loved to call him, as his model; each was
+worthy of the other, and both were bright examples to all who come after
+them.
+
+I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke's
+death, one of the points most insisted upon as characteristic of that
+wise and good old man was the perfect balance of all his faculties. The
+same harmonious adjustment of powers, the same symmetrical arrangement
+of life, the same complete fulfilment of every day's duties, without
+haste and without needless delay, which characterized the master,
+equally distinguished the scholar. A glance at the life of our own Old
+Master, if I can do any justice at all to his excellences, will give
+you something to carry away from this hour's meeting not unworthy to be
+remembered.
+
+From December, 1797, to October, 1799, he remained with Dr. Holyoke as a
+student, a period which he has spoken of as a most interesting and
+most gratifying part of his life. After this he passed eight months
+in London, and on his return, in October, 1800, he began business in
+Boston.
+
+He had followed Mr. Cline, as I have mentioned, and was competent to
+practise Surgery. But he found Dr. John Collins Warren had already
+occupied the ground which at that day hardly called for more than
+one leading practitioner, and wisely chose the Medical branch of the
+profession. He had only himself to rely upon, but he had confidence in
+his prospects, conscious, doubtless, of his own powers, knowing his
+own industry and determination, and being of an eminently cheerful and
+hopeful disposition. No better proof of his spirit can be given
+than that, just a year from the time when he began to practise as a
+physician, he took that eventful step which in such a man implies that
+he sees his way clear to a position; he married a lady blessed with many
+gifts, but not bringing him a fortune to paralyze his industry.
+
+He had not miscalculated his chances in life. He very soon rose into a
+good practice, and began the founding of that reputation which grew with
+his years, until he stood by general consent at the head of his chosen
+branch of the profession, to say the least, in this city and in all this
+region of country. His skill and wisdom were the last tribunal to which
+the sick and suffering could appeal. The community trusted and loved
+him, the profession recognized him as the noblest type of the physician.
+The young men 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 older and began to think more of their ability
+to help the sick than their power of talking about phenomena, they began
+to look back to the teaching of Dr. Jackson, as he, after his London
+experience, looked back to that of Dr. Holyoke. And so it came to be at
+last that the bare mention of his name in any of our medical assemblies
+would call forth such a tribute of affectionate regard as is only
+yielded to age when it brings with it the record of a life spent in well
+doing.
+
+No accident ever carries a man to eminence such as his in the medical
+profession. He who looks for it must want it earnestly and work for it
+vigorously; Nature must have qualified him in many ways, and education
+must have equipped him with various knowledge, or his reputation will
+evaporate before it reaches the noon-day blaze of fame. How did Dr.
+Jackson gain the position which all conceded to him? In the answer to
+this question some among you may find a key that shall unlock the gate
+opening on that fair field of the future of 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 occupation enough to apply at the bedside the best of all that he
+knew for the good of his patient; to protect the community against the
+inroads of pestilence; to teach the young all that he himself had been
+taught, with all that his own experience had added; to leave on record
+some of the most important results of his long observation.
+
+With his patients he was so perfect at all points that it is hard to
+overpraise him. I have seen many noted British and French and American
+practitioners, but I never saw the man so altogether admirable at the
+bedside of the sick as Dr. James Jackson. His smile was itself a remedy
+better than the potable gold and the dissolved pearls that comforted the
+praecordia of mediaeval monarchs. Did a patient, alarmed without cause,
+need encouragement, it carried the sunshine of hope into his heart and
+put all his whims to flight, as David's harp cleared the haunted chamber
+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
+heart felt it. So gentle was he, so thoughtful, so calm, so absorbed
+in the case before him, not to turn round and look for a tribute to his
+sagacity, not to bolster himself in a favorite theory, but to find out
+all he could, and to weigh gravely and cautiously all that he found,
+that to follow him in his morning visit was 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 visit with Dr. Jackson was a
+medical education.
+
+He was very firm, with all his kindness. He would have the truth about
+his patients. The nurses found it out; and the shrewder ones never
+ventured to tell him anything but a straight story. A clinical dialogue
+between Dr. Jackson and Miss Rebecca Taylor, sometime nurse in the
+Massachusetts General Hospital, a mistress in her calling, was as good
+questioning and answering as one would be like to hear outside of the
+court-room.
+
+Of his practice you can form an opinion from his book called “Letters to
+a Young Physician.” Like all sensible men from the days of Hippocrates
+to the present, he knew that diet and regimen were more important
+than any drug or than all drugs put together. Witness his treatment of
+phthisis and of epilepsy. He retained, however, more confidence in some
+remedial agents than most of the younger generation would concede to
+them. Yet his materia medica was 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 of
+medicines here, and that it will take you long to get acquainted with
+them, but most of them are unimportant. There are four which are equal
+to all the rest, namely, Mercury, Antimony, Bark and Opium.'” And Dr.
+Jackson adds, “I can only say of his practice, the longer I have lived,
+I have thought better and better of it.” When he thought it necessary to
+give medicine, he gave it in earnest. He hated half-practice--giving
+a little of this or that, so as to be able to say that one had done
+something, in case a consultation was held, or a still more ominous
+event occurred. He would give opium, for instance, as boldly as the late
+Dr. Fisher of Beverly, but he followed the aphorism of the Father of
+Medicine, and kept extreme remedies for extreme cases.
+
+When it came to the “non-naturals,” as he would sometimes call them,
+after the old physicians,--namely, air, meat and drink, sleep and
+watching, motion and rest, the retentions and excretions, and the
+affections of the mind,--he was, as I have said, of the school of
+sensible practitioners, in distinction from that vast community of
+quacks, with or without the diploma, who think the chief end of man is
+to support apothecaries, and are never easy until they can get every
+patient upon a regular course of something nasty or noxious. Nobody
+was so precise in his directions about diet, air, and exercise, as Dr.
+Jackson. He had the same dislike to the a peu pres, the about so much,
+about so often, about so long, which I afterwards found among the
+punctilious adherents of the numerical system at La Pitie.
+
+He used to insist on one small point with a certain philological
+precision, namely, the true meaning of the word “cure.” He would have
+it that to cure a patient was simply to care for him. I refer to it
+as showing what his idea was of the relation of the physician to the
+patient. It was indeed to care for him, as if his life were bound up
+in him, to watch his incomings and outgoings, to stand guard at every
+avenue that disease might enter, to leave nothing to chance; not merely
+to throw a few pills and powders into one pan of the scales of Fate,
+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 human power to do it. Such devotion as this is only to be
+looked for in the man who gives himself wholly up to the business of
+healing, who considers Medicine itself a Science, or if not a science,
+is willing to follow it as an art,--the noblest of arts, which the gods
+and demigods of ancient religions did not disdain to practise and to
+teach.
+
+The same zeal made him always ready to listen to any new suggestion
+which promised to be useful, at a period of life when many men find
+it hard to learn new methods and accept new doctrines. Few of
+his generation became so accomplished as he in the arts of direct
+exploration; coming straight from the Parisian experts, I have examined
+many patients with him, and have had frequent opportunities of observing
+his skill in percussion and auscultation.
+
+One element in his success, a trivial one compared with others, but not
+to be despised, was his punctuality. He always carried two watches,--I
+doubt if he told why, any more than Dr. Johnson told what he did with
+the orange-peel,--but probably with reference to this virtue. He was as
+much to be depended upon at the appointed time as the solstice or
+the equinox. There was another point I have heard him speak of as an
+important rule with him; to come at the hour when he was expected; if
+he had made his visit for several days successively at ten o'clock, for
+instance, not to put it off, if he could possibly help it, until eleven,
+and so keep a nervous patient and an anxious family waiting for him
+through a long, weary hour.
+
+If I should attempt to characterize his teaching, I should say that
+while it conveyed the best results of his sagacious and extended
+observation, it was singularly modest, cautious, simple, sincere.
+Nothing was for show, for self-love; there was no rhetoric, no
+declamation, no triumphant “I told you so,” but the plain statement of
+a clear-headed honest man, who knows that he is handling one of the
+gravest subjects that interest humanity. His positive instructions were
+full of value, but the spirit in which he taught inspired that loyal
+love of truth which lies at the bottom of all real excellence.
+
+I will not say that, during his long career, Dr. Jackson never made
+an enemy. I have heard him tell how, in his very early days, old Dr.
+Danforth got into a towering passion with him about some professional
+consultation, and exploded a monosyllable or two of the more energetic
+kind on the occasion. I remember that that somewhat peculiar personage,
+Dr. Waterhouse, took it hardly when Dr. Jackson succeeded to his place
+as Professor of Theory and Practice. A young man of Dr. Jackson's talent
+and energy could hardly take the position that belonged to him without
+crowding somebody in a profession where three in a bed is the common
+rule of the household. But he was a peaceful man and a peace-maker all
+his days. No man ever did more, if so much, to produce and maintain
+the spirit of harmony for which we consider our medical community as
+somewhat exceptionally distinguished.
+
+If this harmony should ever be threatened, I could wish that every
+impatient and irritable member of the profession would read that
+beautiful, that noble Preface to the “Letters,” addressed to John
+Collins Warren. I know nothing finer in the medical literature of all
+time than this Prefatory Introduction. It is a golden prelude, fit to
+go with the three great Prefaces which challenge the admiration of
+scholars,--Calvin's to his Institutes, De Thou's to his History, and
+Casaubon's to his Polybius,--not because of any learning or rhetoric,
+though it is charmingly written, but for a spirit flowing through it to
+which learning and rhetoric are but as the breath that is wasted on the
+air to the Mood that warms the heart.
+
+Of a similar character is this short extract which I am permitted
+to make from a private letter of his to a dear young friend. He was
+eighty-three years old 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 characters of all men and women. At first I must
+have done this from something in my own nature, for I was not aware of
+it, and yet was doing it without any plan, when one day, sixty years
+ago, a friend whom I loved and respected said this to me, 'Ah, James, I
+see that you are destined to succeed in the world, and to make friends,
+because you are so ready to see the good point in the characters of
+those you meet.'”
+
+I close this imperfect notice of some features in the character of this
+most honored and beloved of physicians by applying to him the words
+which were written of William Heberden, whose career was not unlike his
+own, and who lived to the same patriarchal age.
+
+“From his early youth he had always entertained a deep sense of
+religion, a consummate love of virtue, an ardent thirst after knowledge,
+and an earnest desire to promote the welfare and happiness of all
+mankind. By these qualities, accompanied with great sweetness of
+manners, he acquired the love and esteem of all good men, in a degree
+which perhaps very few have experienced; and after passing an active
+life with the uniform testimony of a good conscience, he became an
+eminent example of its influence, in the cheerfulness and serenity of
+his latest age.”
+
+Such was the man whom I offer to you as a model, young gentlemen, at the
+outset of your medical career. I hope that many of you will recognize
+some traits of your own special teachers scattered through various parts
+of the land in the picture I have drawn. Let me assure you that whatever
+you may learn in this or any other course of public lectures,--and
+I trust you will learn a great deal,--the daily guidance, counsel,
+example, of your medical father, for such the Oath of Hippocrates tells
+you to consider your preceptor, will, if he is in any degree like him
+of whom I have spoken, be the foundation on which all that we teach is
+reared, and perhaps outlive most of our teachings, as in Dr. Jackson's
+memory the last lessons that remained with him were those of his Old
+Master.
+
+
+
+
+
+
+THE MEDICAL PROFESSION IN MASSACHUSETTS.
+
+A Lecture of a Course by members of the Massachusetts Historical
+Society, delivered before the Lowell Institute, January 29, 1869.
+
+The medical history of eight generations, told in an hour, must be in
+many parts a mere outline. The details I shall give will relate chiefly
+to the first century. I shall only indicate the leading occurrences,
+with the more prominent names of the two centuries which follow, and
+add some considerations suggested by the facts which have been passed in
+review.
+
+A geographer who was asked to describe the tides of Massachusetts
+Bay, would have to recognize the circumstance that they are a limited
+manifestation of a great oceanic movement. To consider them apart from
+this, would be to localize a planetary phenomenon, and to provincialize
+a law of the universe. The art of healing in Massachusetts has shared
+more or less fully and readily the movement which, with its periods of
+ebb and flow, has been raising its level from age to age throughout the
+better part of Christendom. Its practitioners brought with them much of
+the knowledge and many of the errors of the Old World; they have always
+been in communication with its wisdom and its folly; it is not
+without interest to see how far the new conditions in which they found
+themselves have been favorable or unfavorable to the growth of sound
+medical knowledge and practice.
+
+The state of medicine is an index of the civilization of an age and
+country,--one of the best, perhaps, by which it can be judged. Surgery
+invokes the aid of all the mechanical arts. From the rude violences
+of the age of stone,--a relic of which we may find in the practice of
+Zipporah, the wife of Moses,--to the delicate operations of to-day
+upon patients lulled into temporary insensibility, is a progress which
+presupposes a skill in metallurgy and in the labors of the workshop and
+the laboratory it 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, can find their place in our pharmacies,
+commerce must have perfected its machinery, and science must have
+refined its processes, through periods only to be counted by the life of
+nations. Before the means which nature and art have put in the hands of
+the medical practitioner can be fairly brought into use, the prejudices
+of the vulgar must be overcome, the intrusions of false philosophy must
+be fenced out, and the partnership with the priesthood dissolved. All
+this implies that freedom and activity of thought which belong only to
+the most advanced conditions of society; and the progress towards this
+is by gradations as significant of wide-spread changes, as are the
+varying states of the barometer of far-extended conditions of 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 trivial and almost unworthy of record. A medical entry in
+Governor Winthrop's journal may seem at first sight a mere curiosity;
+but, rightly interpreted, it is a key to his whole system of belief
+as to the order of the universe and the relations between man and his
+Maker. Nothing sheds such light on the superstitions of an age as the
+prevailing interpretation and treatment of disease. When the touch of
+a profligate monarch was a cure for one of the most inveterate of
+maladies, when the common symptoms of hysteria were prayed over as marks
+of demoniacal possession, we might well expect the spiritual realms of
+thought to be peopled with still stranger delusions.
+
+Let us go before the Pilgrims of the Mayflower, and look at the shores
+on which they were soon to land. A wasting pestilence had so thinned
+the savage tribes that it was sometimes piously interpreted as having
+providentially prepared the way for the feeble band of exiles. Cotton
+Mather, who, next to the witches, hated the “tawnies,” “wild beasts,”
+ “blood-hounds,” “rattlesnakes,” “infidels,” as in different places he
+calls the unhappy Aborigines, describes the condition of things in his
+lively way, thus: “The Indians in these Parts had newly, even about a
+Year or Two before, been visited with such a prodigious Pestilence; as
+carried away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen
+of Twenty) among them so that the Woods were almost cleared of those
+pernicious Creatures to make Room for a better Growth.”
+
+What this pestilence was has been much discussed. It is variously
+mentioned by different early writers as “the plague,” “a great and
+grievous plague,” “a sore consumption,” as attended with spots which
+left unhealed places on those who recovered, as making the “whole
+surface yellow as with a garment.” Perhaps no disease answers all these
+conditions so well as smallpox. We know from different sources what
+frightful havoc it made among the Indians in after years,--in 1631,
+for instance, when it swept away the aboriginal inhabitants of “whole
+towns,” and in 1633. We have seen a whole tribe, the Mandans, extirpated
+by it in our own day. The word “plague” was used very vaguely, as in
+the description of the “great sickness” found among the Indians by the
+expedition of 1622. This same great sickness could hardly have been
+yellow fever, as it occurred in the month of November. I cannot think,
+therefore, that either the scourge of the East or our Southern
+malarial pestilence was the disease that wasted the Indians. As for the
+yellowness like a garment, that is too familiar to the eyes of all who
+have ever looked on the hideous mask of confluent variola.
+
+Without the presence or the fear of these exotic maladies, the forlorn
+voyagers of the Mayflower had sickness enough to contend with. At their
+first landing at Cape Cod, gaunt and hungry and longing for fresh food,
+they found upon the sandy shore “great mussels, and very fat and full of
+sea-pearl.” Sailors and passengers indulged in the treacherous delicacy;
+which seems to have been the sea-clam; and found that these mollusks,
+like the shell the poet tells of, remembered their august abode, and
+treated the way-worn adventurers to a gastric reminiscence of the
+heaving billows. In the mean time it blew and snowed and froze. The
+water turned to ice on their clothes, and made them many times like
+coats of iron. Edward Tilley had like to have “sounded” with cold. The
+gunner, too, was sick unto death, but “hope of trucking” kept him on his
+feet,--a Yankee, it should seem, when he first touched the shore of New
+England. Most, if not all, got colds and coughs, which afterwards turned
+to scurvy, whereof many died.
+
+How can we wonder that the crowded and tempest-tossed voyagers, many
+of them already suffering, should have fallen before the trials of the
+first winter in Plymouth? Their imperfect shelter, their insufficient
+supply of bread, their salted food, now in unwholesome condition,
+account too well for the diseases and the mortality that marked this
+first dreadful season; weakness, swelling of the limbs, and other signs
+of scurvy, betrayed the want of proper nourishment and protection from
+the elements. In December six of their number died, in January eight, in
+February, seventeen, in March thirteen. With the advance of spring
+the mortality 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 colonists must have been
+that of physicians and surgeons. In Mr. Savage's remarkable Genealogical
+Dictionary of the first settlers who came over before 1692 and their
+descendants to the third generation, I find scattered through the
+four crowded volumes the names of one hundred and thirty-four medical
+practitioners. Of these, twelve, and probably many more, practised
+surgery; three were barber-surgeons. A little incident throws a glimmer
+from the dark lantern of memory upon William Direly, one of these
+practitioners with the razor and the lancet. He was lost between Boston
+and Roxbury in a violent tempest of wind and snow; ten days afterwards
+a son was born to his widow, and with a touch of homely sentiment, I had
+almost said 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
+into the Connecticut River, and so ended. One was not only doctor, but
+also schoolmaster and poet. One practised medicine and kept a tavern.
+One was 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,--Ann Moore,--was the precursor of that intrepid
+sisterhood whose cause it has long been my pleasure and privilege to
+advocate on all fitting occasions.
+
+Outside of this list I must place the name of Thomas Wilkinson, who was
+complained of, in 1676, for practising contrary to law.
+
+Many names in the catalogue of these early physicians have been
+associated, in later periods, with the practice of the profession,
+--among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
+Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
+Woodward. Touton was a Huguenot, Burchsted a German from Silesia,
+Lunerus a German or a Pole; “Pighogg Churrergeon,” I hope, for the honor
+of the profession, was only Peacock disguised under this alias, which
+would not, I fear, prove very attractive to patients.
+
+What doctrines and practice were these colonists likely to bring, with
+them?
+
+Two principal schools of medical practice prevailed in the Old World
+during the greater part of the seventeenth century. The first held to
+the old methods of Galen: 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 qualities hot, dry, moist, cold. The body
+was to be preserved in health by keeping each of these qualities in its
+natural proportion; heat, by the proper temperature; moisture, by the
+due amount of fluid; and so as to the rest. Diseases which arose from
+excess of heat were to be attacked by cooling remedies; those from
+excess of cold, by heating ones; and so of the other derangements of
+balance. This was truly the principle of contraries contrariis, which
+ill-informed persons have attempted to make out to be the general
+doctrine of medicine, whereas there is no general dogma other than this:
+disease is to be treated by anything that is proved to cure it. The
+means the Galenist employed were chiefly diet and vegetable remedies,
+with the use of the lancet and other depleting agents. He attributed the
+four fundamental qualities to different vegetables, in four different
+degrees; thus chicory was cold in the fourth degree, pepper was hot in
+the fourth, endive was cold and dry in the second, and bitter almonds
+were hot in the first and dry in the second degree. When we say “cool as
+a cucumber,” we are talking Galenism. The seeds of that vegetable ranked
+as one of “the four greater cold seeds” of this system.
+
+Galenism prevailed mostly in the south of Europe and France. The readers
+of Moliere will have no difficulty in 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 credit after a time; their absurdly
+complicated mixtures excited contempt, and their nauseous prescriptions
+provoked loathing and disgust. A simpler and bolder practice found
+welcome in Germany, depending chiefly on 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 limits we may assign to the
+use of these long-trusted mineral drugs, there can be no doubt that
+the chemical school, as it was called, did a great deal towards the
+expurgation of the old, overloaded, and repulsive pharmacopoeia. We
+shall find evidence in the practice of our New-England physicians of the
+first century, that they often employed chemical remedies, and that, by
+the early part of the following century, their chief trust was in the
+few 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 existed from a very early period; from the
+Egyptian priest to the Indian medicine-man, the alliance has been
+maintained in one form or another. The partnership was very common among
+our British ancestors. Mr. Ward, the Vicar of Stratford-on-Avon, himself
+a notable example of the union of the two characters, writing about
+1660, says,
+
+“The Saxons had their blood-letters, but under the Normans physicke,
+begunne in England; 300 years agoe itt was not a distinct profession by
+itself, but practised by men in orders, witness Nicholas de Ternham,
+the chief English physician and Bishop of Durham; Hugh of Evesham, a
+physician and cardinal; Grysant, physician and pope; John Chambers, Dr.
+of Physick, was the first Bishop of Peterborough; Paul Bush, a bachelor
+of divinitie in Oxford, was a man well read in physick as well as
+divinitie, he was the first bishop of Bristol.”
+
+“Again in King Richard the Second's time physicians 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 and keeping up the many
+superstitions which have figured so largely in the history of medicine.
+It is curious to see that a medical work left in manuscript by the Rev.
+Cotton Mather and hereafter to be referred to, is running over
+with follies and superstitious fancies; while his contemporary and
+fellow-townsman, William Douglass, relied on the same few simple
+remedies which, through Dr. Edward Holyoke and Dr. James Jackson, have
+come down to our own time, as the most important articles of the materia
+medica.
+
+Let us now take a general glance at some of the conditions of the
+early settlers; and first, as to the healthfulness of the climate. The
+mortality of the season that followed the landing of the Pilgrims at
+Plymouth has been sufficiently accounted for. After this, the colonists
+seem to have found the new country agreeing very well with their English
+constitutions. Its clear air is the subject of eulogy. Its dainty
+springs of sweet water are praised not only by Higginson and Wood, but
+even the mischievous Morton says, that for its delicate waters “Canaan
+came not near this country.” There is a tendency to dilate on these
+simple blessings, which reminds one a little of the Marchioness in
+Dickens's story, with her orange-peel-and-water beverage. Still more
+does one feel the warmth of coloring,--such as we expect from converts
+to a new faith, and settlers who want to entice others over to their
+clearings, when Winslow speaks, in 1621, of “abundance of roses, white,
+red, and damask; single, but very sweet indeed;” a most of all, however,
+when, in the same connection, he says, “Here are grapes white and
+red, and very sweet and strong also.” This of our wild grape, a little
+vegetable Indian, which scalps a civilized man's mouth, as his animal
+representative scalps his cranium. But there is something quite charming
+in Winslow's picture of the luxury in which they are living. Lobsters,
+oysters, eels, mussels, fish and fowl, delicious fruit, including the
+grapes aforesaid,--if they only had “kine, horses, and sheep,” he makes
+no question but men would live as contented here as in any part of the
+world. We cannot help admiring the way in which they took their trials,
+and made the most of their blessings.
+
+“And how Content they were,” says Cotton Mather, “when an Honest Man, as
+I have heard, inviting his Friends to a Dish of Clams, at the Table gave
+Thanks to Heaven, who had given them to suck the abundance of the Seas,
+and of the Treasures Hid in the Sands!”
+
+Strangely enough, as it would seem, except for this buoyant
+determination to make the best of everything, they hardly appear to
+recognize the difference of the climate from that which they had left.
+After almost 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 a
+difference), is sharper and longer; but yet he may be deceived by the
+want of the comforts he enjoyed at home. He cannot conceive any
+climate to agree better with the constitution of the English, not being
+oppressed with extremity of heats, nor nipped by biting cold:
+
+“By which means, blessed be God, we enjoy our health, notwithstanding
+those difficulties we have undergone, 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 which they 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 their fill of bread.”
+
+Higginson, himself a dyspeptic, “continually in physic,” as he says, and
+accustomed to dress in thick clothing, and to comfort his stomach with
+drink that was “both strong and stale,”--the “jolly good ale and old,” I
+suppose, of free and easy Bishop Still's song,--found that he both could
+and did oftentimes drink New England water very well,--which he seems
+to look upon as a remarkable feat. He could go as lightclad as any,
+too, with only a light stuff cassock upon his shirt, and stuff breeches
+without linings. Two of his children were sickly: one,--little misshapen
+Mary,--died on the passage, and, in her father's words, “was the first
+in our ship that was buried in the bowels of the great Atlantic sea;”
+ the other, who had been “most lamentably handled” by disease, recovered
+almost entirely “by the very wholesomeness of the air, altering,
+digesting, and drying up the cold and crude humors of the body.”
+ Wherefore, he thinks it a wise course for all cold complexions to come
+to take physic in New England, and ends with those often quoted words,
+that “a sup of New England's air is better than a whole draught of Old
+England's ale.” Mr. Higginson died, however, “of a hectic fever,” a
+little more than a year after his arrival.
+
+The medical records which I shall cite show that the colonists were not
+exempt from the complaints of the Old World. Besides the common diseases
+to which their descendants are subject, there were two others, to
+say nothing of the dreaded small-pox, which later medical science has
+disarmed,--little known among us at the present day, but frequent
+among the first 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 into discontent, and lingered after their former
+conditions in England; the poor homesick creatures in fact, whom we so
+forget in our florid pictures of the early times of the little band in
+the wilderness. Many who were suffering from scurvy got well when
+the Lyon arrived from England, bringing store of juice of lemons. The
+Governor speaks of another case in 1644; and it seems probable that the
+disease was not of rare occurrence.
+
+The other complaint from which they suffered, but which has nearly
+disappeared from among us, was intermittent fever, or fever and ague.
+I investigated the question as to the prevalence of this disease in New
+England, in a dissertation, which was published in a 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 “Old Men's Tears,”
+ dated 1691, speaks of “shaking agues,” as among the trials to which they
+had been subjected. The outline map of New England, accompanying the
+dissertation above referred to, indicates all the places where I had
+evidence that the disease had originated. It was plain enough that
+it used to be known in many localities where it has long ceased to
+be feared. Still it was and is remarkable to see what a clean bill of
+health in this particular respect our barren soil inherited with its
+sterility. There are some malarious spots on the edge of Lake Champlain,
+and there have been some temporary centres of malaria, within the
+memory of man, on one or more of our Massachusetts rivers, but these are
+harmless enough, for the most part, unless the millers dam them, when
+they are apt to retaliate with a whiff from their meadows, that sets the
+whole neighborhood shaking with fever and ague.
+
+The Pilgrims of the Mayflower had with them a good physician, 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 and
+bad food, and, probably enough, desperate homesickness in some of the
+feebler sort, from doing their work. No detailed record remains of what
+they suffered or what was attempted for their relief during the first
+sad winter. The graves of those who died were levelled and sowed with
+grain that the losses of the little band might not be suspected by the
+savage tenants of 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 Governor Bradford, dated June, 1630. “I have been to
+Matapan” (now Dorchester), he says, “and let some twenty of those people
+blood.” Such wholesale depletion as this, except with avowed homicidal
+intent, is quite unknown in these days; though I once saw the noted
+French surgeon, Lisfranc, in a fine phlebotomizing frenzy, order some
+ten or fifteen patients, taken almost indiscriminately, to be bled in a
+single morning.
+
+Dr. Fuller's two visits to Salem, at the request of Governor Endicott,
+seem to have been very satisfactory to that gentleman. Morton, the
+wild fellow of Merry Mount, gives a rather questionable reason for the
+Governor's being so well pleased with the physician's doings. The names
+under which he mentions the two personages, it will be seen, are not
+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 spoken of as “a right godly man and
+skilful chyrurgeon, but died of a malignant fever not very long after
+his arrival.”
+
+Two practitioners of the ancient town of Newbury are entitled to special
+notice, for different reasons. The first is Dr. John Clark, who is said
+by tradition to have been the first regularly educated physician who
+resided in New England. His portrait, in close-fitting skull-cap, with
+long locks and venerable flowing beard, is familiar to our eyes on the
+wall of our Society's antechamber. His left hand rests upon a skull, his
+right hand holds an instrument which deserves a passing comment. It is
+a trephine, a surgical implement for cutting round pieces out of broken
+skulls, so as to get at the fragments which have been driven in, and
+lift them up. It has a handle like that of a gimlet, with a claw like
+a hammer, to lift with, I suppose, which last contrivance I do not
+see figured in my books. But the point I refer to is this: the old
+instrument, the trepan, had a handle like a wimble, what we call a brace
+or bit-stock. The trephine is not mentioned at all in Peter Lowe's book,
+London, 1634; nor in Wiseman's great work on Surgery, London, 1676; nor
+in the translation of 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 of the last century. As John Clark died
+in 1661, it is remarkable to see the last fashion in the way of
+skull-sawing contrivances in his hands,--to say nothing of the claw on
+the handle, and a Hey's saw, so called in England, lying on the table
+by him, and painted there more than a hundred years before Hey was born.
+This saw is an old invention, perhaps as 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 before he 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 more or less traditional
+authority, give us the feeling that the people of Newbury, and
+afterwards of Boston, had a wise and skilful medical adviser and surgeon
+in Dr. John Clark.
+
+The venerable town of Newbury had another physician who was less
+fortunate. The following is a court record of 1652:
+
+“This is to certify whom it may concern, that we the subscribers, being
+called upon to testify against doctor William Snelling for words by him
+uttered, affirm that being in way of merry discourse, a health being
+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 their feet.]
+
+“Since when he hath affirmed that he only intended the proverb used in
+the west country, nor do we believe he intended otherwise.
+
+“[Signed] WILLIAM THOMAS.
+
+“THOMAS MILWARD.”
+
+“March 12th 1651, All which I acknowledge, and am sorry I did not
+expresse my intent, or that I was so weak as to use so foolish a
+proverb.
+
+“[Signed] GULIELMUS SNELLING.”
+
+Notwithstanding this confession and apology, the record tells us that
+“William Snelling in his presentment for cursing is fined ten shillings
+and the fees of court.”
+
+I will mention one other name among those of the Fathers of 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 and read upon very well.”
+
+Giles Firmin, as the name is commonly spelled, practised physic in this
+country for a time. He seems to have found it a poor business; for, in a
+letter to Governor Winthrop, he says, “I am strongly sett upon to studye
+divinitie: my studyes else must be lost, for physick is but a meene
+helpe.”
+
+Giles Firmin's Lectures on Anatomy were the first scientific teachings
+of the New World. While the Fathers were enlightened enough to permit
+such instructions, they were severe in dealing with quackery; for, in
+1631, our court records show that one Nicholas Knopp, or Knapp, was
+sentenced to be fined or whipped “for taking upon him to cure the
+scurvey by a water of noe worth nor value, which he solde att a very
+deare rate.” Empty purses or sore backs would be common with us to-day
+if such a rule were enforced.
+
+Besides the few worthies spoken of, and others whose names I have not
+space to record, we must remember that there were many clergymen who
+took charge of the bodies as well as the souls of their patients, among
+them two Presidents of Harvard College, Charles Chauncy and Leonard
+Hoar,--and Thomas Thacher, first minister of the “Old South,” author of
+the earliest medical treatises printed in the country, [A Brief Rule to
+Guide the Common People in Small pox and Measles. 1674.] whose epitaph
+in Latin and Greek, said to have been written by Eleazer, an “Indian
+Youth” and a member of the Senior Class of Harvard College, may be found
+in the “Magnalia.” I miss this noble savage's name in our triennial
+catalogue; and as there is many a slip between the cup and lip, one is
+tempted to guess that he may have lost his degree by some display of his
+native instinct,--possibly a flourish of the tomahawk or scalping-knife.
+However this may have been, the good man he celebrated was a notable
+instance of the Angelical Conjunction, as the author of the “Magnalia”
+ calls it, of the offices of clergyman and medical practitioner.
+
+Michael Wigglesworth, author of the “Day of Doom,” attended the sick,
+“not only as a Pastor, but as a Physician too, and this, not only in
+his own town, but also in all those of the vicinity.” Mather says of the
+sons of Charles Chauncy, “All of these did, while they had Opportunity,
+Preach the Gospel; and most, if not all of them, like their excellent
+Father before them, had an eminent skill in physick added unto their
+other accomplishments,” etc. Roger Williams is said to have saved many
+in a kind of pestilence which swept away many Indians.
+
+To these names must be added, as sustaining a certain relation to the
+healing art, that of the first Governor Winthrop, who is said by John
+Cotton to have been “Help for our Bodies by Physick [and] for our
+Estates by Law,” and that of his son, the Governor of Connecticut, who,
+as we shall see, was as much physician as magistrate.
+
+I had submitted to me for examination, in 1862, a manuscript found among
+the Winthrop Papers, marked with the superscription, “For my worthy
+friend Mr. Wintrop,” dated in 1643, London, signed Edward Stafford, and
+containing medical directions and prescriptions. It may be remembered by
+some present that I wrote a report on this paper, which was published
+in the “Proceedings” of this Society. Whether the paper was written for
+Governor John Winthrop of Massachusetts, or for his son, Governor John
+of Connecticut, there is no positive evidence that I have been able
+to obtain. It is very interesting, however, as giving short and simple
+practical directions, such as 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. The remedies are of
+three kinds: simples, such as St. John's wort, Clown's all-heal, elder,
+parsley, maidenhair, mineral drugs, such as lime, saltpetre, Armenian
+bole, crocus metallorum, or sulphuret of antimony; and thaumaturgic or
+mystical, of which the chief 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 toads into an earthen pot so as to half fill it, and baking
+and burning them “in the open ayre, not in an house,”--concerning which
+latter possibility I suspect Madam Winthrop would have had something to
+say,--until they could be reduced by pounding, first into a brown, and
+then into a black, powder. Blood-letting in some inflammations, fasting
+in the early stage of fevers, and some of those peremptory drugs with
+which most of us have been well acquainted in our time, the infragrant
+memories of which I will not pursue beyond this slight allusion, are
+among his remedies.
+
+The Winthrops, to one of whom Dr. Stafford's directions were
+addressed, were the medical as well as the political advisers of their
+fellow-citizens for three or four successive generations. One of them,
+Governor John of Connecticut, practised so extensively, that, but for
+his more distinguished title in the State, he would have been remembered
+as the Doctor. The fact that he practised in another colony, for the
+most part, makes little difference in the value of the records we have
+of his medical experience, which have fortunately been preserved, and
+give a very fair idea, in all probability, of the way in which patients
+were treated in Massachusetts, when they fell into intelligent and
+somewhat educated hands, a little after the middle of the seventeenth
+century:
+
+I have before me, while writing, a manuscript collection of the medical
+cases treated by him, and recorded at the time in his own hand, which
+has been intrusted to me by our President, his descendant.
+
+They are generally marked Hartford, and extend from the year 1657 to
+1669. From these, manuscripts, and from the letters printed in the
+Winthrop Papers published by our Society, I have endeavored to obtain
+some idea of the practice of Governor John Winthrop, Junior. The learned
+eye of Mr. Pulsifer would have helped me, no doubt, as it has done in
+other cases; but I have ventured this time to attempt finding my own
+way among the hieroglyphics of these old pages. By careful comparison
+of many prescriptions, and by the aid of Schroder, Salmon, Culpeper, and
+other old compilers, I have deciphered many of his difficult paragraphs
+with their mysterious recipes.
+
+The Governor employed a number of the simples dear to ancient women,
+--elecampane and elder and wormwood and anise and the rest; but he also
+employed certain mineral remedies, which he almost always indicates by
+their ancient symbols, or by a name which should leave them a mystery
+to the vulgar. I am now prepared to reveal the mystic secrets of the
+Governor's beneficent art, which rendered so many good and great as well
+as so many poor and dependent people his debtors,--at least, in their
+simple belief,--for their health and their lives.
+
+His great remedy, which he gave oftener than any other, was nitre; which
+he ordered in doses of twenty or thirty grains to adults, and of three
+grains to infants. Measles, colics, sciatica, headache, giddiness, and
+many other ailments, all found themselves treated, and I trust bettered,
+by nitre; a pretty safe medicine in moderate doses, and one not likely
+to keep the good Governor awake at night, thinking whether it might not
+kill, if it did not cure. We may say as much for spermaceti, which he
+seems to have considered “the sovereign'st thing on earth” for inward
+bruises, and often prescribes after falls and similar injuries.
+
+One of the next remedies, in point of frequency, which he was in the
+habit of giving, was (probably diaphoretic) antimony; a mild form of
+that very active metal, and which, mild as it was, left his patients
+very commonly with a pretty strong conviction that they had been taking
+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 dose of rhubarb or jalap; a taste of stinging horseradish,
+oftener of warming guiacum; sometimes an anodyne, in the shape of
+mithridate,--the famous old farrago, which owed its virtue to poppy
+juice; [This is the remedy which a Boston divine tried to simplify. See
+Electuarium Novum Alexipharmacum, by Rev. Thomas Harward, lecturer
+at the Royal Chappell. Boston, 1732. This tract is in our Society's
+library.] very often, a harmless powder of coral; less frequently, an
+inert prescription of pleasing amber; and (let me say it softly within
+possible hearing of his honored descendant), twice or oftener,--let us
+hope as a last resort,--an electuary of millipedes,--sowbugs, if we must
+give them their homely English name. One or two other prescriptions,
+of the many unmentionable ones which disgraced the pharmacopoeia of the
+seventeenth century, are to be found, but only in very rare instances,
+in the faded characters of the manuscript.
+
+The excellent Governor's accounts of diseases are so brief, that we get
+only a very general notion of the complaints for which he prescribed.
+Measles and their consequences are at first more prominent than any
+other one affection, but the common infirmities of both sexes and of all
+ages seem to have come under his healing hand. Fever and ague appears to
+have been of frequent occurrence.
+
+His published correspondence shows that many noted people were in
+communication with him as his patients. Roger Williams wants a little
+of his medicine for Mrs. Weekes's daughter; worshipful John Haynes is
+in receipt of his powders; troublesome Captain Underhill wants “a little
+white vitterall” for his wife, and something to cure his wife's friend's
+neuralgia, (I think his wife's friend's husband had a little rather have
+had it sent by the hands of Mrs. Underhill, than by those of the gallant
+and discursive captain); and pious John Davenport says, his wife “tooke
+but one halfe of one of the papers” (which probably contained the
+medicine he called rubila), “but could not beare the taste of it, and
+is discouraged from taking any more;” and honored William Leete asks for
+more 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 of all the
+bitter things she swallowed,--God help all little children in the hands
+of dosing doctors and 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 relief he 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 little to sence in operation, should beget and bring forth
+such efects,” that we repent our hasty exclamation, and bless the memory
+of the good Governor, who gave relief to the worn-out frame of our
+long-departed brother, the sturdy old heretic of Rhode Island.
+
+What was that medicine which so frequently occurs in the printed letters
+under the name of “rubila”? It is evidently a secret remedy, and, so
+far as I know, has not yet been made out. I had almost given it up in
+despair, when I found what appears to be a key to the mystery. In the
+vast multitude of prescriptions contained in the manuscripts, most of
+them written in symbols, I find one which I thus interpret:
+
+“Four grains of (diaphoretic) antimony, with twenty grains of nitre,
+with a little salt of tin, making rubila.” Perhaps something was
+added to redden the powder, as he constantly speaks of “rubifying” or
+“viridating” his prescriptions; a very common practice of prescribers,
+when their powders look a little too much like plain salt or sugar.
+
+Waitstill Winthrop, the Governor's son, “was a skilful physician,” says
+Mr. Sewall, in his funeral sermon; “and generously gave, not only his
+advice, but also his Medicines, for the healing of the Sick, which, by
+the Blessing of God, were made successful for the recovery of many.”
+ “His son John, a member of the Royal Society, speaks of himself as 'Dr.
+Winthrop,' and mentions one of his own prescriptions in a letter to
+Cotton Mather.” Our President tells me that there was an heirloom of the
+ancient skill in his family, within his own remembrance, in the form of
+a certain precious eye-water, to which the late President John Quincy
+Adams ascribed rare virtue, and which he used to obtain from the
+possessor of the ancient recipe.
+
+These inherited prescriptions are often treasured in 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
+Cambridgeport schoolmates used to call the “ager,”--meaning thereby
+toothache or face-ache,--I used to get relief from a certain plaster
+which never went by any other name in the family than “Dr. Oliver.”
+
+Dr. James Oliver was my great-great-grandfather, graduated in 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 particular
+medicine, or other possession or secret, and physicians in old times
+used to keep their choice recipes to themselves a good deal, as we have
+had occasion to see.
+
+Some years ago I found among my old books a small manuscript marked
+“James Oliver. This Book Begun Aug. 12, 1685.” It is a rough sort of
+account-book, containing among other things prescriptions for patients,
+and charges for the same, with counter-charges for the purchase of
+medicines and other matters. Dr. Oliver practised in Cambridge, where
+may be seen his tomb with inscriptions, and with sculptured figures that
+look more like Diana of the Ephesians, as given in Calmet's Dictionary,
+than like any angels admitted into good society here or elsewhere.
+
+I do not find any particular record of what his patients suffered from,
+but I have carefully copied out the remedies he mentions, and find
+that they form a very respectable catalogue. Besides the usual simples,
+elder, parsley, fennel, saffron, snake-root, wormwood, I find the Elixir
+Proprietatis, with other elixire and cordials, as if he rather fancied
+warming medicines; but he called in the aid of some of the more
+energetic remedies, including iron, and probably mercury, as he bought
+two pounds of it at one time.
+
+The most interesting item is his bill against the estate of Samuel
+Pason of Roxbury, for services during his last illness. He attended this
+gentleman,--for such he must have been, by the amount of physic which he
+took, and which his heirs paid for,--from June 4th, 1696, to September
+3d of the same year, three months. I observe he charges for visits as
+well as for medicines, which is not the case in most of his bills. He
+opens the attack with a carminative appeal to the visceral conscience,
+and follows it up with good hard-hitting remedies for dropsy,--as I
+suppose the disease would have been called,--and finishes off with a
+rallying dose of hartshorn and iron.
+
+It is a source of honest pride to his descendant that his bill, which
+was honestly paid, as it seems to have been honorably earned, amounted
+to the handsome total of seven pounds and two shillings. Let me add that
+he repeatedly prescribes plaster, one of which was very probably the
+“Dr. Oliver” that soothed my infant griefs, and for which I blush to say
+that my venerated ancestor received from Goodman Hancock the painfully
+exiguous sum of no pounds, no shillings, and sixpence.
+
+I have illustrated the practice of the first century, from the two
+manuscripts I have examined, as giving an impartial idea of its
+every-day methods. The Governor, Johannes Secundus, it is fair to
+remember, was an amateur practitioner, while my ancestor was a professed
+physician. Comparing their modes of treatment with the many scientific
+follies still prevailing in the Old World, and still more with the
+extraordinary theological superstitions of the community in which they
+lived, we shall find reason, I think, to consider the art of healing
+as in a comparatively creditable state during the first century of New
+England.
+
+In addition to the evidence as to methods of treatment furnished by the
+manuscripts I have cited, I subjoin the following document, to which
+my attention was called by Dr. Shurtleff, our present Mayor. This is a
+letter of which the original is to be found in vol. lxix. page 10 of the
+“Archives” preserved at the State House in Boston. It will be seen
+that what the surgeon wanted consisted chiefly of opiates, stimulants,
+cathartics, plasters, and materials for bandages. The complex and varied
+formulae have given place to simpler and often more effective forms of
+the same remedies; but the list and the manner in which it is made out
+are proofs of the good sense and 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 upon which he wrote, a great
+body of Indians--supposed to be six or seven hundred--appeared before
+Hatfield; and twenty-five resolute young men of Hadley, from which town
+he wrote, crossed the river and drove them away.
+
+HADLY May 30: 76
+
+Mr RAWSON Sr
+
+What we have recd by Tho: Houey the past month is not the chiefest of
+our wants as you have love for poor wounded I pray let us not want for
+these following medicines if you have not a speedy conveyance of them I
+pray send on purpose they are those things mentioned in my former letter
+but to prevent future mistakes I have wrote them att large wee have
+great want 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 obtaine any thing to be sent in answer thereto. 13
+June 1676.
+
+I have given some idea of the chief remedies used by our earlier
+physicians, which were both Galenic and chemical; that is, vegetable and
+mineral. They, of course, employed the usual perturbing medicines
+which Montaigne says are the chief reliance of their craft. There were,
+doubtless, individual practitioners who employed special remedies with
+exceptional boldness and perhaps success. Mr. Eliot is spoken of, in
+a letter of William Leete to Winthrop, Junior, as being under Mr.
+Greenland's mercurial administrations. The latter was probably enough
+one of these specialists.
+
+There is another class of remedies which appears to have been employed
+occasionally, but, on the whole, is so little prominent as to imply a
+good deal of common sense among the medical practitioners, as compared
+with 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 incredible fact
+that they were retained in the materia medica so late as when Rees's
+Cyclopaedia was published, and we there find the directions formerly
+given by the College of Edinburgh for their preparation. Once or twice
+we have found him admitting still more objectionable articles into his
+materia medica; in doing which, I am sorry to say that he could
+plead grave and learned authority. But these instances are very rare
+exceptions in a medical practice of many years, which is, on the whole,
+very respectable, considering the time and circumstances.
+
+Some remedies of questionable though not odious character appear
+occasionally to have been employed by the early practitioners, but they
+were such as still had the support of the medical profession. Governor
+John Winthrop, the first, sends for East Indian bezoar, with other
+commodities he is writing for. Governor Endicott sends him one he had of
+Mr. Humfrey. I hope it was genuine, for they cheated infamously in
+the matter of this concretion, which ought to come out of an animal's
+stomach, but the real history of which resembles what is sometimes told
+of modern sausages.
+
+There is a famous law-case of James the First's time, in which a
+goldsmith sold a hundred pounds' worth of what he called bezoar, which
+was proved to be false, and the purchaser got a verdict against him.
+Governor Endicott also sends Winthrop a unicorn's horn, which was the
+property of a certain Mrs. Beggarly, who, in spite of her name, seems to
+have been rich in medical knowledge and possessions. The famous Thomas
+Bartholinus wrote a treatise on the virtues of this fabulous-sounding
+remedy, which was published in 1641, and republished in 1678.
+
+The “antimonial cup,” a drinking vessel made of that metal, which, like
+our quassia-wood cups, might be filled and emptied in saecula saeculorum
+without exhausting its virtues, is mentioned by Matthew Cradock, in a
+letter to the elder Winthrop, but in a doubtful way, as it was thought,
+he says, to have shortened the days of Sir Nathaniel Riche; and Winthrop
+himself, as I think, refers to its use, calling it simply “the cup.” An
+antimonial cup is included in the inventory of Samuel Seabury, who died
+1680, and is valued at five shillings. There is a treatise entitled “The
+Universall Remedy, or the Vertues of the Antimoniall Cup, By John Evans,
+Minister and Preacher of God's Word, London, 1634,” in our own Society's
+library.
+
+One other special remedy deserves notice, because of native growth. I
+do not know when Culver's root, Leptandra Virginica of our National
+Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
+John Winthrop of New London, speaks of it as famous for the cure of
+consumptions, and wishes to get some of it, through his mediation, for
+Katharine, his eldest daughter. He gets it, and gives it to the
+“poor damsel,” who is languishing, as he says, and who dies the next
+month,--all the sooner, I have little doubt, for this uncertain and
+violent drug, with which the meddlesome pedant tormented her in that
+spirit of well-meant but restless quackery, which could touch nothing
+without making mischief, not even a quotation, and yet proved at length
+the means of bringing a great blessing to our community, as we shall see
+by and by; so does Providence use our very vanities and infirmities for
+its wise purposes.
+
+Externally, I find the practitioners on whom I have chiefly relied
+used the plasters of Paracelsus, of melilot, diachylon, and probably
+diaphoenicon, all well known to the old pharmacopoeias, and some of them
+to the modern ones,--to say nothing of “my yellow salve,” of Governor
+John, the second, for the composition of which we must apply to his
+respected descendant.
+
+The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
+and Wecherus, of all whom notices may be found in the pages of Haller
+and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
+Practice of Physic and Anatomy, the last as belonging to Samuel Seabury,
+chirurgeon, before mentioned. Nicholas Culpeper was a shrewd charlatan,
+and as impudent a varlet as ever prescribed for a colic; but knew very
+well what he was about, and badgers the College with great vigor. A copy
+of Spigelius's famous Anatomy, in the Boston Athenaeum, has the names
+of Increase and Samuel Mather written in it, and was doubtless early
+overhauled by the youthful Cotton, who refers to the great anatomist's
+singular death, among his curious stories in the “Magnalia,” and quotes
+him among nearly a hundred authors whom he cites in his manuscript
+“The Angel of Bethesda.” Dr. John Clark's “books and instruments,
+with several chirurgery materials in the closet,” were valued in his
+inventory at sixty pounds; Dr. Matthew Fuller, who died in 1678, left a
+library valued at ten pounds; and a surgeon's chest and drugs valued at
+sixteen pounds.'
+
+Here we leave the first century and all attempts at any further detailed
+accounts of medicine and its practitioners. It is necessary to show in a
+brief glance what had been going on in Europe during the latter part of
+that century, the first quarter of which had been made illustrious in
+the history of medical science by the discovery of the circulation.
+
+Charles Barbeyrac, a Protestant in his religion, was a 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, until it
+becomes hard to tell the family of one from that of the other. Barbeyrac
+threw overboard the old complex medical farragos of the pharmacopoeias,
+as his church had disburdened itself of the popish ceremonies.
+
+Among the students who followed his instructions were two Englishmen:
+one of them, John Locke, afterwards author of an “Essay on the Human
+Understanding,” three years younger than his teacher; the other, Thomas
+Sydenham, five years older. Both returned to England. Locke, whose
+medical knowledge is borne witness to by Sydenham, had the good
+fortune to form a correct opinion on a disease from which the Earl of
+Shaftesbury was suffering, which led to an operation that saved
+his life. Less felicitous was his experience with a certain ancilla
+culinaria virgo,--which I am afraid would in those days have
+been translated kitchen-wench, instead of lady of the culinary
+department,--who turned him off after she had got tired of him, and
+called 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, and took to other studies.
+
+The name of Thomas Sydenham is as distinguished in the history of
+medicine as that of John Locke in philosophy. As Barbeyrac was found in
+opposition to the established religion, as Locke took the rational side
+against orthodox Bishop Stillingfleet, so Sydenham went with Parliament
+against Charles, and was never admitted a Fellow by the College of
+Physicians, which, after he was dead, placed his bust in their hall by
+the side of that of Harvey.
+
+What Sydenham did for medicine was briefly this: he studied the course
+of diseases carefully, and especially as affected by the particular
+season; to patients with fever he gave air and cooling drinks, instead
+of smothering and heating them, with the idea of sweating out their
+disease; he ordered horseback exercise to consumptives; he, like his
+teacher, used few and comparatively simple remedies; he did not give any
+drug at all, if he thought none was needed, but let well enough alone.
+He was a sensible man, in short, who applied his common sense to
+diseases which he had studied with the best light of science that he
+could obtain.
+
+The influence of the reform he introduced must have been more or
+less felt in this country, but not much before the beginning of the
+eighteenth century, as his great work was not published until 1675, and
+then in Latin. I very strongly suspect that there was not so much to
+reform in the simple practice of the physicians of the new community, as
+there was in that of the learned big-wigs of the “College,” who valued
+their remedies too much in proportion to their complexity, and the
+extravagant and fantastic ingredients which went to their making.
+
+During the memorable century which bred and bore the Revolution, the
+medical profession gave great names to our history. But John Brooks
+belonged to the State, and Joseph Warren belongs to the country and
+mankind, and to speak of them would lead me beyond my limited subject.
+There would be little pleasure in dwelling on the name of Benjamin
+Church; and as for the medical politicians, like Elisha Cooke in the
+early part of the century, or Charles Jarvis, the bald eagle of Boston,
+in its later years, whether their practice was heroic or not, their
+patients were, for he is a bold man who trusts one that is making
+speeches and coaxing voters, to meddle with the internal politics of his
+corporeal republic.
+
+One great event stands out in the medical history of this eighteenth
+century; namely, the introduction of the practice of inoculation for
+small-pox. Six epidemics of this complaint had visited Boston in the
+course of a hundred years. Prayers had been asked in the churches for
+more than a hundred sick in a single day, and this many times. About a
+thousand persons had died in a twelvemonth, we are told, and, as we may
+infer, chiefly from this cause.
+
+In 1721, this disease, after a respite of nineteen years, again appeared
+as an epidemic. In that year it was that Cotton Mather, browsing, as
+was his wont, on all the printed fodder that came within reach of
+his ever-grinding mandibles, came upon an account of inoculation as
+practised in Turkey, contained in the “Philosophical Transactions.” He
+spoke of it to several physicians, who paid little heed 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 of Bethesda,” and
+satiated with his speculations on the Nishmath Chajim.
+
+The Reverend Mather,--I use a mode of expression he often employed when
+speaking of his honored brethren,--the Reverend Mather was right this
+time, and the irreverent doctors who laughed at him were wrong. One only
+of their number disputes his claim to giving the first impulse to the
+practice in Boston. This is what that person says: “The Small-Pox spread
+in Boston, New England, 1721, and the Reverend Dr. Cotton Mather, having
+had the use of these Communications from Dr. William Douglass (that is,
+the writer of these words); surreptitiously, without the knowledge of
+his Informer, that he might have the honour of a New fangled notion,
+sets an Undaunted Operator to work, and in this Country about 290 were
+inoculated.”
+
+All this has not deprived Cotton Mather of the credit of suggesting, and
+a bold and intelligent physician of the honor of carrying out, the new
+practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston
+of Boston inoculated his only son for smallpox,--the first person ever
+submitted to the operation in the New World. The story of the fierce
+resistance to the introduction of the practice; of how Boylston was
+mobbed, and Mather had a hand-grenade thrown in at his window; of
+how William Douglass, the Scotchman, “always positive, and sometimes
+accurate,” as was neatly said of him, at once depreciated the practice
+and tried to get the credit of suggesting it, and how Lawrence Dalhonde,
+the Frenchman, testified to its destructive consequences; of how Edmund
+Massey, lecturer at St. Albans, preached against sinfully endeavoring to
+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 his sermon, afterwards reprinted in Boston, many of our
+New England clergy stood up boldly in defence of the practice,--all this
+has been told so well and so often that I spare you its details. Set
+this good hint of Cotton Mather against that letter of his to John
+Richards, recommending the search after witch-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, the Lord have mercy on her soul!
+
+Thus did America receive this great discovery, destined to save
+thousands of lives, via Boston, from the hands of one of our own
+Massachusetts physicians.
+
+The year 1735 was rendered sadly memorable by the epidemic of the
+terrible disease known as “throat distemper,” and regarded by many as
+the same as our “diphtheria.” Dr. Holyoke thinks the more general use
+of mercurials in inflammatory complaints dates from the time of their
+employment in this disease, in which they were thought to have proved
+specially useful.
+
+At some time in the course of this century medical practice had settled
+down on four remedies as its chief reliance. I must repeat an incident
+which I have related in another of these Essays. When Dr. Holyoke,
+nearly seventy years ago, received young Mr. James Jackson as his
+student, he showed him the formidable array of bottles, jars, and
+drawers around his office, and then named the four remedies referred to
+as being of more importance than all the rest put together. These were
+“Mercury, Antimony, Opium, and Peruvian Bark.” I doubt if either of
+them remembered that, nearly seventy years before, in 1730, Dr.
+William Douglass, the disputatious Scotchman, mentioned those same four
+remedies, in the dedication of his quarrelsome essay on inoculation, as
+the most important ones in the hands of the physicians of his time.
+
+In the “Proceedings” of this Society for the year 1863 is a very
+pleasant paper by the late Dr. Ephraim Eliot, giving an account of
+the leading physicians of Boston during the last quarter of the last
+century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth,
+John Warren, Jeffries, are all famous in local history, and are
+commemorated in our medical biographies. One of them, at least, appears
+to have been more widely known, not only as one of the first aerial
+voyagers, but as an explorer in the almost equally hazardous realm of
+medical theory. Dr. John Jeffries, the first of that name, is considered
+by Broussais as a leader of medical opinion in America, and so referred
+to in his famous “Examen des Doctrines Medicales.”
+
+Two great movements took place in this eighteenth century, the effect of
+which has been chiefly felt in our own time; namely, the establishment
+of the Massachusetts Medical Society, and the founding of the Medical
+School of Harvard University.
+
+The third century of our medical history began with the introduction of
+the second great medical discovery of modern times,--of all time up to
+that date, I may say,--once more via Boston, if we count the University
+village as its suburb, and once more by one of our Massachusetts
+physicians. In the month of July, 1800, Dr. Benjamin Waterhouse of
+Cambridge submitted four of his own children to the new process of
+vaccination,--the first persons vaccinated, as Dr. Zabdiel Boylston's
+son had been the first person inoculated in the New World.
+
+A little before the first half of this century was completed, in the
+autumn of 1846, the great discovery went forth from the Massachusetts
+General Hospital, which repaid the debt of America to the science of the
+Old World, and gave immortality to the place of its origin in the memory
+and the heart of mankind. The production of temporary insensibility at
+will--tuto, cito, jucunde, safely, quickly, pleasantly--is one of those
+triumphs over the infirmities of our mortal condition which change the
+aspect of life ever afterwards. Rhetoric can add nothing to its glory;
+gratitude, and the pride permitted to human weakness, that our Bethlehem
+should have been chosen as the birthplace of this new embodiment of the
+divine mercy, are all we can yet find room for.
+
+The present century has seen the establishment of all those great
+charitable institutions for the cure of diseases of the body and of the
+mind, which our State and our city have a right to consider as among the
+chief ornaments of their civilization.
+
+The last century had very little to show, in our State, in the way of
+medical literature. The worthies who took care of our grandfathers and
+great-grandfathers, like the Revolutionary heroes, fought (with disease)
+and bled (their patients) and died (in spite of their own remedies); but
+their names, once familiar, are heard only at rare intervals. Honored
+in their day, not unremembered by a few solitary students of the past,
+their memories are going sweetly to sleep in the arms of the patient
+old dry-nurse, whose “blackdrop” is the never-failing anodyne of
+the restless generations of men. Except the lively controversy on
+inoculation, and floating papers in journals, we have not much of value
+for that long period, in the shape of medical records.
+
+But while the trouble with the last century is to find authors to
+mention, the trouble of this would be to name all that we find. Of
+these, a very few claim unquestioned preeminence.
+
+Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School
+of our University, did a great work for the advancement of medicine and
+surgery in New England, by his labors as teacher and author, greater,
+it is claimed by some, than was ever done by any other man. The two
+Warrens, of our time, each left a large and permanent record of a most
+extended surgical practice. James Jackson not only educated a whole
+generation by his lessons of wisdom, but bequeathed some of the most
+valuable results of his experience to those who came after him, in a
+series of letters singularly pleasant and kindly as well as instructive.
+John Ware, keen and cautious, earnest and deliberate, wrote the two
+remarkable essays which have identified his 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 by referring to the many
+important contributions to medical science by Dr. Jacob Bigelow, and
+especially to his discourse on “Self-limited Diseases,” an address which
+can be read in a single hour, but the influence of which will be felt
+for a century.
+
+Nor would the profession forgive me if I forgot to mention the admirable
+museum of pathological anatomy, created almost entirely by the hands
+of Dr. John Barnard Swett Jackson, and illustrated by his own printed
+descriptive catalogue, justly spoken of by a distinguished professor in
+the University of Pennsylvania as the most important contribution which
+had ever been made in 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 Massachusetts or
+placed at the head of her institutions for the treatment of the insane.
+
+We have a right to claim also one who is known all over the civilized
+world as a philanthropist, to us as a townsman and a graduate of our own
+Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of
+a great multitude who were born to a world of inward or of outward
+darkness.
+
+I cannot pass over in silence the part taken by our own physicians
+in those sanitary movements which are assuming every year greater
+importance. Two diseases especially 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, both of which have been faithfully studied and
+reported on by physicians of our own State and city. The cultivation of
+medical and surgical specialties, which is fast becoming prevalent, is
+beginning to show its effects in the literature of the profession,
+which is every year growing richer in original observations and
+investigations.
+
+To these benefactors who have labored for us in their peaceful vocation,
+we must add the noble army of surgeons, who went with the soldiers who
+fought the battles of their country, sharing many of their dangers, not
+rarely falling victims to fatigue, disease, or the deadly volleys to
+which they often exposed themselves in the discharge of their duties.
+
+The pleasant biographies of the venerable Dr. Thacher, and the worthy
+and kind-hearted gleaner, Dr. Stephen W. Williams, who came after him,
+are filled with the names of men who served their generation well, and
+rest from their labors, followed by the blessing of those for whom
+they endured the toils and fatigues inseparable from their calling. The
+hardworking, intelligent country physician more especially deserves
+the gratitude of his own generation, for he rarely leaves any permanent
+record in the literature of his profession. Books are hard to obtain;
+hospitals, which are always centres of intelligence, are remote;
+thoroughly educated and superior men are separated by wide intervals;
+and long rides, though favorable to reflection, take up much of the time
+which might otherwise 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 a great and deserved reputation, become the oracles of
+large districts, and yet leave nothing, or next to nothing, by which
+their names shall be preserved from blank oblivion.
+
+One or two other facts deserve mention, as showing the readiness of our
+medical community to receive and adopt any important idea or discovery.
+The new science of Histology, as it is now called, was first brought
+fully before the profession of this country by the translation of
+Bichat's great work, “Anatomie Generale,” by the late Dr. George
+Hayward.
+
+The first work printed in this country on Auscultation,--that wonderful
+art of discovering disease, which, as it were, puts a window in the
+breast, through which the vital organs can be seen, to all intents
+and purposes, was the manual published anonymously by “A Member of the
+Massachusetts Medical Society.”
+
+We are now in some slight measure prepared to weigh the record of the
+medical profession in Massachusetts, and pass our judgment upon it. But
+in order to do justice to the first generation of practitioners, we must
+compare what we know of their treatment of disease with the state of the
+art in England, and the superstitions which they saw all around them in
+other departments of knowledge or belief.
+
+English medical literature must have been at a pretty low ebb
+when Sydenham recommended Don Quixote to Sir Richard Blackmore for
+professional reading. The College Pharmacopoeia was loaded with the most
+absurd compound mixtures, one of the most complex of which (the same
+which the Reverend Mr. Harward, “Lecturer at the Royal Chappel in
+Boston,” tried to simplify), was not dropped until the year 1801. Sir
+Kenelm Digby was playing his fantastic tricks with the Sympathetic
+powder, and teaching Governor Winthrop, the second, how to cure fever
+and ague, which some may like to know. “Pare the patient's nails; put
+the parings in a little bag, and hang the bag round the 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 eloquently on the efficacy
+of the royal touch in scrofula. The founder of the Ashmolean Museum at
+Oxford, consorting with alchemists and astrologers, was treasuring
+the manuscripts of the late pious Dr. Richard Napier, in which certain
+letters (Rx Ris) were understood to mean Responsum Raphaelis,--the
+answer of the angel Raphael to the good man's medical questions. The
+illustrious Robert Boyle was making his collection of choice and safe
+remedies, including the sole of an old shoe, the thigh bone of a hanged
+man, and things far 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 of standing in London; yet toad-powder was his
+sovereign remedy.
+
+See what was the state of belief in other matters among the most
+intelligent persons of the colonies, magistrates and clergymen. Jonathan
+Brewster, son of the church-elder, writes the wildest letters to John
+Winthrop about alchemy,--“mad for making gold as the Lynn rock-borers
+are for finding it.”
+
+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 with an upper chamber of saints, and a tremendous opposition
+in the lower house; the leader of which may have been equalled, but
+cannot have been surpassed by any of our earth-born politicians. The
+demons were prowling round the houses every night, as the foxes were
+sneaking about the hen-roosts. The men of Gloucester fired whole flasks
+of gunpowder at devils disguised as Indians and Frenchmen.
+
+How deeply the notion of miraculous interference with the course of
+nature was rooted, is shown by the tenacity of the superstition about
+earthquakes. We can hardly believe that our Professor Winthrop, father
+of the old judge and the “squire,” whom many of us Cambridge people
+remember so well, had to defend himself against the learned and
+excellent Dr. Prince, of the Old South Church, for discussing their
+phenomena as if they belonged to the province of natural science.
+
+Not for the sake of degrading the aspect of the noble men who founded
+our State, do I refer to their idle beliefs and painful delusions,
+but to show against what influences the common sense of the medical
+profession had to assert itself.
+
+Think, then, of the blazing stars, that shook their horrid hair in the
+sky; the phantom ship, that brought its message direct from the other
+world; the story of the mouse and the snake at Watertown; of the mice
+and the prayer-book; of the snake in church; of the calf with two heads;
+and of the cabbage in the perfect form of a cutlash,--all which innocent
+occurrences were accepted or feared as alarming portents.
+
+We can smile at these: but we cannot smile at the account of unhappy
+Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic
+misfortune of 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 fifteen alarming pages about an
+unfortunate young woman suffering with hysteria. Or go a little
+deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, first
+admonished, then whipped; at last, taking her own little daughter's
+life; put on trial, and standing mute, threatened to be pressed to
+death, confessing, sentenced, praying to be beheaded; and none the less
+pitilessly swung from the fatal ladder.
+
+The cooper's crazy wife--crazy in the belief that she has committed the
+unpardonable sin--tries to drown her child, to save it from misery;
+and the poor lunatic, who would be tenderly cared for to-day in a quiet
+asylum, is judged to be acting under the instigation of Satan himself.
+Yet, after all, what can we say, who put Bunyan's “Pilgrim's Progress,”
+ full of nightmare dreams of horror, into all our children's hands; a
+story in which the awful image of the man in the cage might well turn
+the nursery where it is read into a madhouse?
+
+The miserable delusion of witchcraft illustrates, in a still more
+impressive way, the false ideas which governed the supposed relation of
+men with the spiritual world. I have no doubt many physicians shared in
+these superstitions. Mr. Upham says they--that is, some of them--were
+in the habit of attributing their want of success to the fact, that an
+“evil hand” was on their patient. The temptation was strong, no doubt,
+when magistrates and ministers and all that followed their lead were
+contented with such an explanation. But how was it in Salem, according
+to Mr. Upham's own statement? Dr. John Swinnerton was, he says, for
+many years the principal physician of Salem. And he says, also, “The
+Swinnerton family were all along opposed to Mr. Parris, and kept
+remarkably clear from the witchcraft delusion.” Dr. John Swinnerton--the
+same, by the way, whose memory is illuminated by a ray from the genius
+of Hawthorne--died the very year before the great witchcraft explosion
+took place. But who can doubt that it was from him that the family had
+learned to despise and to resist the base superstition; or that Bridget
+Bishop, whose house he rented, as Mr. Upham tells me, the first person
+hanged in the time of the delusion, would have found an efficient
+protector in her tenant, had he been living, to head the opposition of
+his family to the misguided clergymen and magistrates?
+
+I cannot doubt that our early physicians brought with them many
+Old-World medical superstitions, and I have no question that they were
+more or less involved in the prevailing errors of the community in which
+they lived. But, on the whole, their record is a clean one, so far as we
+can get at it; and where it is questionable we must remember that there
+must have been many little-educated persons among them; and that all
+must have felt, to some extent, the influence of those sincere and
+devoted but unsafe men, the physic-practising clergymen, who often used
+spiritual means as a substitute for temporal ones, who looked upon a
+hysteric patient as possessed by the devil, and treated a fractured
+skull by prayers and plasters, following the advice of a ruling elder in
+opposition to the “unanimous opinion of seven surgeons.”
+
+To what results the union of the two professions was liable to lead, may
+be seen by the example of a learned and famous person, who has left on
+record the product of his labors in the double capacity of clergyman and
+physician.
+
+I have had the privilege of examining a manuscript of Cotton Mather's
+relating to medicine, by the kindness of the librarian of the American
+Antiquarian Society, to which society it belongs. A brief notice 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 Approved REMEDIES for the
+Maladies.” There are sixty-six “Capsula's,” as he calls them, or
+chapters, in his table of contents; of which, five--from the fifteenth
+to the nineteenth, inclusive--are missing. This is a most unfortunate
+loss, as the eighteenth capsula treated of agues, and we could have
+learned from it something of their degree of frequency in this part of
+New England. There is no date to the manuscript; which, however, refers
+to a case observed Nov. 14, 1724.
+
+The divine takes precedence of the physician in this extraordinary
+production. He begins by preaching a sermon at his unfortunate patient.
+Having thrown him into a cold sweat by his spiritual sudorific, he
+attacks him with his material remedies, which are often quite as
+unpalatable. The simple and cleanly practice of Sydenham, with whose
+works he was acquainted, seems to have been thrown away upon him.
+Everything he could find mentioned in the seventy or eighty authors he
+cites, all that the old women of both sexes had ever told him of, gets
+into his text, or squeezes itself into his margin.
+
+Evolving disease out of sin, he hates it, one would say, as he hates its
+cause, and would drive it out of the body with all noisome appliances.
+“Sickness is in Fact Flagellum Dei pro peccatis mundi.” So saying, he
+encourages the young mother whose babe is wasting away upon her breast
+with these reflections:
+
+“Think; oh the grievous Effects of Sin! This wretched Infant has not
+arrived unto years of sense enough, to sin after the similitude of the
+transgression committed by Adam. Nevertheless the Transgression of 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
+infected Adam when he fell into his Transgression, by hearkening to the
+Tempter, has corrupted all mankind, and is a seed unto such diseases as
+this Infant is now laboring under. Lord, what are we, and what are our
+children, but a Generation of Vipers?”
+
+Many of his remedies are at least harmless, but his pedantry and
+utter want of judgment betray themselves everywhere. He piles his
+prescriptions one upon another, without the least discrimination. He is
+run away with by all sorts of fancies and superstitions. He prescribes
+euphrasia, eye-bright, for disease of the eyes; appealing confidently to
+the strange old doctrine of signatures, which inferred its use from the
+resemblance of its flower to the organ of vision. For the scattering of
+wens, the efficacy of a Dead Hand has been out of measure wonderful. But
+when he once comes to the odious class of remedies, he revels in them
+like a scarabeus. This allusion will bring us quite near enough to the
+inconceivable abominations with which he proposed to outrage the sinful
+stomachs of the unhappy confederates and accomplices of Adam.
+
+It is well that the treatise was never printed, yet there are passages
+in it worth preserving. He speaks of some remedies which have since
+become more universally known:
+
+“Among the plants of our soyl, Sir William Temple singles out Five [Six]
+as being of the greatest virtue and most friendly to health: and his
+favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder.”
+
+“But these Five [Six] plants may admitt of some competitors. The
+QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!”
+
+Of Ipecacuanha, he says,--“This is now in its reign; the most
+fashionable vomit.”
+
+“I am not sorry that antimonial emetics begin to be disused.”
+
+He quotes “Mr. Lock” as recommending red poppy-water and abstinence from
+flesh as often useful in children's diseases.
+
+One of his “Capsula's” is devoted to the animalcular origin of diseases,
+at the end of which he says, speaking of remedies for this supposed
+source of our distempers:
+
+“Mercury we know thee: But we are afraid thou wilt kill us too, if we
+employ thee to kill them that kill us.
+
+“And yett, for the cleansing of the small Blood Vessels, and making way
+for the free circulation of the Blood and Lymph--there is nothing like
+Mercurial Deobstruents.”
+
+From this we learn that mercury was already in common use, and the
+subject of the same popular prejudice as 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 proper than such thoughts as these?”...
+
+If there is pathos in this, there is bathos in his apostrophe to the
+millipede, beginning “Poor sowbug!” and eulogizing the healing virtues
+of that odious little beast; of which he tells us to take “half a pound,
+putt 'em alive into a quart or two of wine,” with saffron and other
+drugs, and take two ounces twice a day.
+
+The “Capsula” entitled “Nishmath Chajim” was printed in 1722, at New
+London, and is in the possession of our own Society. He means, by these
+words, something like the Archxus of Van Helmont, of which he discourses
+in a style wonderfully resembling that of Mr. Jenkinson in the “Vicar
+of Wakefield.” “Many of the Ancients thought there was much of a Real
+History in the Parable, and their Opinion was that there is, DIAPHORA
+KATA TAS MORPHAS, A Distinction (and so a Resemblance) of men as
+to their Shapes after Death.” And so on, with Ireaeus, Tertullian,
+Thespesius, and “the TA TONE PSEUCONE CROMATA,” in the place of
+“Sanconiathon, Manetho, Berosus,” and “Anarchon ara kai ateleutaion to
+pan.”
+
+One other passage deserves notice, as it relates to the single medical
+suggestion which does honor to Cotton Mather's memory. It does not
+appear that he availed himself of the information which he says he
+obtained from his slave, for such I suppose he was.
+
+In his appendix to “Variolae Triumphatae,” he says,--
+
+“There has been a wonderful practice lately used in several parts of the
+world, which indeed is not yet become common in our nation.
+
+“I was first informed of it by a Garamantee servant of my own, long
+before I knew that any Europeans or Asiaticks had the least acquaintance
+with it, and some years before I was enriched with the communications
+of the learned Foreigners, whose accounts I found agreeing with what I
+received of my servant, when he 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 Number of these Africans, who
+all agree in one story; That in their countrey grandy-many dy of the
+small-pox: But now they learn this way: people take juice of smallpox
+and cutty-skin and put in a Drop; then by'nd by a little sicky, sicky:
+then very few little things like small-pox; and nobody dy of it;
+and nobody have small-pox any more. Thus, in Africa, where the poor
+creatures dy of the smallpox like Rotten Sheep, a merciful God has
+taught them an Infallible preservative. 'T is a common practice, and is
+attended with a constant success.”
+
+What has come down to us of the first century of medical practice,
+in the hands of Winthrop and Oliver, is comparatively simple and
+reasonable. I suspect that the conditions of rude, stern life, in which
+the colonists found themselves in the wilderness, took the nonsense out
+of them, as the exigencies of a campaign did out of our physicians
+and surgeons in the late war. Good food and enough of it, pure air
+and water, cleanliness, good attendance, an anaesthetic, an opiate,
+a stimulant, quinine, and two or three common drugs, proved to be the
+marrow of medical treatment; and the fopperies of the pharmacopoeia went
+the way of embroidered shirts and white kid gloves and malacca joints,
+in their time of need. “Good wine is the best cordiall for her,” said
+Governor John Winthrop, Junior, to Samuel Symonds, speaking of that
+gentleman's wife,--just as Sydenham, instead of physic, once ordered a
+roast chicken and a pint of canary for his patient in male hysterics.
+
+But the profession of medicine never could reach its full development
+until it became entirely separated from that of divinity. The spiritual
+guide, the consoler in affliction, the confessor who is admitted into
+the secrets of our souls, has his own noble sphere of duties; but the
+healer of men must confine himself solely to the revelations of God
+in nature, as he sees their miracles with his own eyes. No doctrine
+of prayer or special providence is to be his excuse for not looking
+straight at secondary causes, and acting, exactly so far as experience
+justifies him, as if he were himself the divine agent which antiquity
+fabled him to be. While pious men were praying--humbly, sincerely,
+rightly, according to their knowledge--over the endless succession
+of little children dying of spasms in the great Dublin Hospital, a
+sagacious physician knocked some holes in the walls of the ward, let
+God's blessed air in on the little creatures, and so had already saved
+in that single hospital, as it was soberly calculated thirty years ago,
+more than sixteen thousand lives of these infant heirs of immortality.
+[Collins's Midwifery, p. 312. Published by order of the Massachusetts
+Medical Society. Boston, 1841.]
+
+Let it be, if you will, that the wise inspiration of the physician was
+granted in virtue of the clergyman's supplications. Still, the habit
+of dealing with things seen generates another kind of knowledge, and
+another way of thought, from that of dealing with things unseen; which
+knowledge and way of thought are special means granted by Providence,
+and to be thankfully accepted.
+
+The mediaeval ecclesiastics expressed a great truth in that saying,
+so often quoted, as carrying a reproach with it: “Ubi tres medici, duo
+athei,”--“Where there are three physicians, there are two atheists.”
+
+It was true then, it is true to-day, that the physician very commonly,
+if not very generally, denies and repudiates the deity of ecclesiastical
+commerce. The Being whom Ambroise Pare meant when he spoke those
+memorable words, which you may read over the professor's chair in the
+French School of Medicine, “Te le pensay, et Dieu le guarit,” “I dressed
+his wound, and God healed it,”--is a different being from the God that
+scholastic theologians have projected from their consciousness, or
+shaped even from the sacred pages which have proved so plastic in
+their hands. He is a God who never leaves himself without witness, who
+repenteth him of the evil, who never allows a disease or an injury,
+compatible with the enjoyment of life, to take its course without
+establishing an effort, limited by certain fixed conditions, it is true,
+but an effort, always, to restore the broken body or the shattered mind.
+In the perpetual presence of this great Healing Agent, who stays
+the bleeding of wounds, who knits the fractured bone, who expels the
+splinter by a gentle natural process, who walls in the inflammation that
+might involve the vital organs, who draws a cordon to separate the dead
+part from the living, who sends his three natural anaesthetics to the
+over-tasked frame in due order, according to its need,--sleep, fainting,
+death; in this perpetual presence, it is doubtless hard for the
+physician to realize the theological fact 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 has abrogated the
+pardoning power, and mercy forgets its errand; where the omnipotent is
+unfelt save in malignant agencies, and the omnipresent is unseen and
+unrepresented; hard to accept the God of Dante's “Inferno,” and of
+Bunyan's caged lunatic. If this is atheism, 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 injurious effect of the
+materializing influences to which the physician is subjected. A
+spiritual guild is absolutely necessary to keep him, to keep us all,
+from becoming the “fingering slaves” that Wordsworth treats with such
+shrivelling scorn. But it is well that the two callings have been
+separated, and it is fitting that they remain apart. In settling the
+affairs of the late concern, I am afraid our good friends remain a
+little in our debt. We lent them our physician Michael Servetus in
+fair condition, and they returned him so damaged by fire as to be quite
+useless for our purposes. Their Reverend Samuel Willard wrote us a not
+over-wise report of a case of hysteria; and our Jean Astruc gave
+them (if we may trust Dr. Smith's Dictionary of the Bible) the first
+discerning criticism on the authorship of the Pentateuch. Our John
+Locke enlightened them with his letters concerning toleration; and their
+Cotton Mather obscured our twilight with his “Nishmath Chajim.”
+
+Yet we must remember that the name of Basil Valentine, the monk, is
+associated with whatever good and harm we can ascribe to antimony;
+and that the most remarkable of our specifics long bore the name of
+“Jesuit's Bark,” from an old legend connected with its introduction.
+“Frere Jacques,” who taught the lithotomists of Paris, owes his
+ecclesiastical title to courtesy, as he did not belong to a religious
+order.
+
+Medical science, and especially the study of mental disease, is
+destined, I believe, to react to much greater advantage on the theology
+of the future than theology has acted on medicine in the past. The
+liberal spirit very generally prevailing in both professions, and the
+good understanding between their most enlightened members, promise well
+for the future of both in a community which holds every point of human
+belief, every institution in human hands, and every word written in a
+human dialect, open to free discussion today, to-morrow, and to the end
+of time. Whether the world at large will ever be cured of trusting
+to specifics as a substitute for observing the laws of health, and to
+mechanical or intellectual formula as a substitute for character, may
+admit of question. Quackery and idolatry are all but immortal.
+
+We can find most of the old beliefs alive amongst us to-day, only having
+changed their dresses and the social spheres in which they thrive.
+We think the quarrels of Galenists and chemists belong to the past,
+forgetting that Thomsonism has its numerous apostles in our community;
+that it is common to see remedies vaunted as purely vegetable, and
+that the prejudice against “mineral poisons,” especially mercury, is
+as strong in many quarters now as it was at the beginning of the
+seventeenth century. Names are only air, and blow away with a change of
+wind; 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 for a
+very moderate compensation. Nostradamus and Lilly seem impossible in our
+time; but we have seen the advertisements of an astrologer in our Boston
+papers year after year, which seems to imply that he found believers and
+patrons. You smiled when I related Sir Kenelm Digby's prescription with
+the live eel in it; but if each of you were to empty his or her pockets,
+would there not roll out, from more than one of them, a horse-chestnut,
+carried about as a cure for rheumatism? The brazen head of Roger Bacon
+is mute; but is not “Planchette” uttering her responses in a hundred
+houses of this city? We think of palmistry or chiromancy as belonging to
+the days of Albertus Magnus, or, if existing in our time, as given over
+to the gypsies; but a very distinguished person has recently shown me
+the line of life, and the line of fortune, on the palm of his hand, with
+a seeming confidence in the sanguine predictions of his career which
+had been drawn from them. What shall we say of the plausible and
+well-dressed charlatans of our own time, who trade in false pretences,
+like Nicholas Knapp of old, but without any fear of being fined or
+whipped; or of the many follies and inanities, imposing on the credulous
+part of the community, each of them gaping with eager, open mouth for
+a gratuitous advertisement by the mention of its foolish name in any
+respectable connection?
+
+I turn from this less pleasing aspect of the common intelligence which
+renders such follies possible, to close the honorable record of the
+medical profession in this, our ancient Commonwealth.
+
+We have seen it in the first century divided among clergymen,
+magistrates, and regular practitioners; yet, on the whole, for the
+time, and under the circumstances, respectable, except where it invoked
+supernatural agencies to account for natural phenomena.
+
+In the second century it simplified its practice, educated many
+intelligent practitioners, and began the work of organizing for
+concerted action, and for medical teaching.
+
+In this, our own century, it has built hospitals, perfected and
+multiplied its associations and educational institutions, enlarged and
+created museums, and challenged a place in the world of science by its
+literature.
+
+In reviewing the whole course of its history we read a long list of
+honored names, and a precious record written in private memories, in
+public charities, in permanent contributions to medical science, in
+generous sacrifices for the country. We can point to our capital as the
+port of entry for the New World of the great medical discoveries of two
+successive centuries, and we can claim for it the triumph over the most
+dreaded foe that assails the human body,--a triumph which the annals of
+the race can hardly match in three thousand years of medical history.
+
+
+
+
+
+
+THE YOUNG PRACTITIONER
+
+[A Valedictory Address delivered to the Graduating Class of the
+Bellevue Hospital College, March 2, 1871.]
+
+The occasion which calls us together reminds us not a little of that
+other ceremony which unites a man and woman for life. The banns have
+already been pronounced which have wedded our young friends to the
+profession of their choice. It remains only to address 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 ambitious eloquence. We
+must forget ourselves, and think only of them. To us it is an occasion;
+to them it is an epoch. The spectators at the wedding look curiously at
+the bride and bridegroom; at the bridal veil, the orange-flower garland,
+the giving and receiving of the ring; they listen for the tremulous
+“I will,” and wonder what are the mysterious syllables the clergyman
+whispers in the ear of the married maiden. But to the newly-wedded pair
+what meaning in those words, “for better, for worse,” “in sickness and
+in health,” “till death us do part!” To the father, to the mother, who
+know too well how often the deadly nightshade is interwoven with the
+wreath of orange-blossoms, how empty the pageant, how momentous the
+reality!
+
+You will not wonder that I address myself chiefly to those who are just
+leaving academic life for the sterner struggle and the larger tasks of
+matured and instructed manhood. The hour belongs to them; if others find
+patience to listen, they will kindly remember that, after all, they are
+but as the spectators at the wedding, and that the priest is thinking
+less of them than of their friends who are kneeling at the altar.
+
+I speak more directly to you, then, gentlemen of the graduating class.
+The days of your education, as pupils of trained instructors, are over.
+Your first harvest is all garnered. Henceforth you are to be sowers as
+well as reapers, and your field is the world. How does your knowledge
+stand to-day? What have you gained as a permanent possession? What
+must you expect to forget? What remains for you yet to learn? These are
+questions which it may interest you to consider.
+
+There is another question which must force itself on the thoughts
+of many among you: “How am I to obtain patients and to keep their
+confidence?” You have chosen a laborious calling, and made many
+sacrifices to fit yourselves for its successful pursuit. You wish to be
+employed that you may be useful, and that you may receive the reward of
+your industry. I would take advantage of these most receptive moments
+to give you some hints which may help you to realize your hopes and
+expectations. Such is the outline of the familiar talk I shall offer
+you.
+
+Your acquaintance with some of the accessory branches is probably
+greater now than it will be in a year from now,--much greater than it
+will be ten years from now. The progress of knowledge, it may be feared,
+or hoped, will have outrun the text-books in which you studied these
+branches. Chemistry, for instance, is very apt to spoil on one's hands.
+“Nous avons change tout cela” might serve as the standing motto of many
+of our manuals. Science is a great traveller, and wears her shoes out
+pretty 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 large practice all around you would find a more potent
+sudorific than any in the Pharmacopceia. These masters of the art of
+healing were once as ready with their answers as you are now, but they
+have got rid of a great deal of 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 trains off the fat of a
+prize-fighter.
+
+Yet, pause a moment before you infer that your teachers must have
+been in fault when they furnished you with mental stores not directly
+convertible to practical purposes, and likely in a few years to lose
+their place in your memory. All systematic knowledge involves much that
+is not practical, yet it is the only kind of knowledge which satisfies
+the mind, and systematic study proves, in the long-run, the easiest way
+of acquiring 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 condition is not the same as if you had never known what
+you now try in vain to recall. There is a perpetual metempsychosis of
+thought, and the knowledge of to-day finds a soil in the forgotten facts
+of yesterday. You cannot see anything in the new season of the guano
+you placed last year about the roots of your climbing plants, but it is
+blushing and breathing fragrance in your trellised roses; it has scaled
+your porch in the bee-haunted honey-suckle; it has found its way where
+the ivy is green; it is gone where the woodbine expands its luxuriant
+foliage.
+
+Your diploma seems very broad to-day with your list of accomplishments,
+but it begins to shrink from this hour like the Peau de Chagrin of
+Balzac's story. Do not worry about it, for all the while there will be
+making out for you an ampler and fairer parchment, signed by old Father
+Time himself as President of that great University in which experience
+is the one perpetual and all-sufficient professor.
+
+Your present plethora of acquirements will soon cure itself. Knowledge
+that is not wanted dies out like the eyes of the fishes of the Mammoth
+Cave. When you come to handle life and death as your daily business,
+your memory will of itself bid good-by to such inmates as the
+well-known foramina of the sphenoid bone and the familiar oxides of
+methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known
+them, and remember that even the learned ignorance of a nomenclature
+is something to have mastered, and may furnish pegs to hang facts
+upon which would otherwise have strewed the floor of memory in loose
+disorder.
+
+But your education has, after all, been very largely practical. You have
+studied medicine and surgery, not chiefly in books, but at the bedside
+and in the operating amphitheatre. It is the special advantage of
+large cities that they afford the opportunity of seeing a great deal of
+disease in a short space of time, and of seeing many cases of the same
+kind of disease brought together. Let us not be unjust to the claims of
+the schools remote from the larger centres of population. Who among us
+has taught better than Nathan Smith, better than Elisha Bartlett? who
+teaches better than some of our living contemporaries who divide their
+time between city and country schools? I am afraid we do not always do
+justice to our country brethren, whose merits are less conspicuously
+exhibited than those of the great city physicians and surgeons,
+such especially as have charge of large hospitals. There are modest
+practitioners living in remote rural districts who are gifted by nature
+with such sagacity and wisdom, trained so well in what is most essential
+to the practice of their art, taught so thoroughly by varied experience,
+forced to such manly self-reliance by their comparative isolation,
+that, from converse with them alone, from riding with them on their long
+rounds as they pass from village to village, from talking over cases
+with them, putting up their prescriptions, watching their expedients,
+listening to their cautions, marking the event of their predictions,
+hearing them tell of their mistakes, and now and then glory a little
+in the detection of another's blunder, a young man would find himself
+better fitted for his real work than many who have followed long
+courses of lectures and passed a showy examination. But the young man is
+exceptionally fortunate who enjoys the intimacy of such a teacher.
+And it must be confessed that the great hospitals, infirmaries, and
+dispensaries of large cities, where men of well-sifted reputations are
+in constant attendance, are the true centres of medical education. No
+students, I believe, are more thoroughly aware of this than those who
+have graduated at this institution. Here, as in all our larger city
+schools, the greatest pains are taken to teach things as well as names.
+You have entered into the inheritance of a vast amount of transmitted
+skill and wisdom, which you have taken, warm, as it were, 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 many of
+those whose names we hardly mention without a genuflection. I had
+rather be cared for in a fever by the best-taught among you than by the
+renowned Fernelius or the illustrious Boerhaave, could they come back to
+us from that better world where there are no physicians needed, and, if
+the old adage can be trusted, not many within call. I had rather have
+one of you exercise his surgical skill upon me than find myself in the
+hands of a resuscitated Fabricius 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 alderman in an apoplexy, for
+a girl that has fainted, for a woman in hysterics, for a leg that is
+broken, for an arm that is out of joint, for fevers of every color, for
+the sailor's rheumatism, and the tailor's cachexy. In fact you do really
+know so much at this very hour, that nothing but the searching test of
+time can fully teach you the limitations of your knowledge.
+
+Of some of these you will permit me to remind you. You will never have
+outgrown the possibility of new acquisitions, for Nature is endless in
+her variety. But even the knowledge which you may be said to possess
+will be a different thing after long habit has made it a part of your
+existence. The tactus eruditus extends 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 wise in 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 Shipman brought home with him from the
+sea--
+
+
+   “In many a tempest had his berd be shake.”
+
+This is the knowledge we place most confidence in, in the practical
+affairs of life.
+
+Our training has two stages. The first stage deals with our
+intelligence, which takes the idea of what is to be done with the
+most charming ease and 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 glance from that ball and hit that other ball,
+and to knock that ball with this ball into a certain caecal sacculus or
+diverticulum which our professional friend calls a pocket. Nothing can
+be clearer; it is as easy as “playing upon this pipe,” for which Hamlet
+gives Guildenstern such lucid directions. But this intelligent Me, who
+steps forward as the senior partner in our dual personality, turns
+out to be a terrible bungler. He misses those glancing hits which the
+hard-featured young professional person calls “carroms,” and insists on
+pocketing his own ball instead of the other one.
+
+It is the unintelligent Me, stupid as an idiot, that has to try a thing
+a thousand times before he can do it, and then never knows how he does
+it, that at last does it well. We have to educate ourselves through the
+pretentious claims of intellect, into the humble accuracy of instinct,
+and we end at last by 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 not only in the brain, it is in the senses,
+in the muscles, in the ganglia of the sympathetic nerves,--all over the
+man, as one may say, as instinct seems diffused through every part of
+those lower animals that have no such distinct organ as a brain. See
+a skilful surgeon handle a broken limb; see a wise old physician smile
+away a case that looks to a novice as if the sexton would soon be sent
+for; mark what a large experience has 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 in medical practice,
+something in the way the man painted the lion, that is, the lion under?
+
+The young man knows the rules, but the old man knows the exceptions. The
+young man knows his patient, but the old man knows also his patient's
+family, dead and alive, up and down for generations. He can tell
+beforehand what diseases their unborn children will be subject to, what
+they will die of if they live long enough, and whether they had better
+live at all, or remain unrealized possibilities, as belonging to a stock
+not worth being perpetuated. The young man feels uneasy if he is
+not continually doing something to stir up his patient's internal
+arrangements. The old man takes things more quietly, and is much more
+willing to let well enough alone: All these superiorities, if such they
+are, you must wait for time to bring you. In the meanwhile (if we will
+let the lion be uppermost for a moment), the young man's senses
+are quicker than those of his older rival. His education in all the
+accessory branches is more recent, and therefore nearer the existing
+condition of knowledge. He finds it easier than his seniors to accept
+the improvements which every year is bringing forward. New ideas build
+their nests in young men's brains. “Revolutions are not made by men in
+spectacles,” as I once heard it remarked, and the first whispers of
+a new truth are not caught by those who begin to feel the need of an
+ear-trumpet. Granting all these advantages to the young man, he
+ought, nevertheless, to go on improving, on the whole, as a medical
+practitioner, with every year, until he has ripened into a well-mellowed
+maturity. But, to improve, he must be good for something at the start.
+If you ship a poor cask of wine to India and back, if you keep it a half
+a century, 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
+look to you as its authorized champions in the struggle of life against
+its numerous enemies?
+
+In the first place, the persons who seek the aid of the physician are
+very honest and sincere in their wish to get rid of their complaints,
+and, generally speaking, to live as long as they can. However
+attractively the future is painted to them, they are attached to the
+planet with which they are already acquainted. They are addicted to the
+daily use of this empirical and unchemical mixture which we call air;
+and would hold on to it as a tippler does to his alcoholic drinks. There
+is nothing men will not do, there is nothing they have not done, to
+recover their health and save their lives. They have submitted to be
+half-drowned in water, and half-choked with gases, to be buried up to
+their chins in earth, to be seared with hot irons like galley-slaves, to
+be crimped with knives, like cod-fish, to have needles thrust into
+their flesh, and bonfires kindled on their skin, to swallow all sorts
+of abominations, and to pay for all this, as if to be singed and scalded
+were a costly privilege, as if blisters were a blessing, and leeches
+were a luxury. What more can be asked to prove their honesty and
+sincerity?
+
+This same community is very intelligent with respect to a great many
+subjects--commerce, mechanics, manufactures, politics. But with regard
+to medicine it is hopelessly ignorant and never finds it out. I do not
+know that it is any worse in this country than in Great Britain, where
+Mr. Huxley speaks very freely of “the utter ignorance of the simplest
+laws of their own animal life, which prevails among even the most highly
+educated persons.” And Cullen said before him “Neither the acutest
+genius nor the soundest judgment 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 sometimes with reasons, and I have found
+that any will pass, even with able divines and acute lawyers; the same
+will pass with the husbands as with the wives.” If the community could
+only be made aware of its own utter ignorance, and incompetence to form
+opinions on medical subjects, difficult enough to those who give their
+lives to the study of them, the practitioner would have an easier task.
+But it will form opinions of its own, it cannot help it, and we cannot
+blame it, even though we know how slight and deceptive are their
+foundations.
+
+This is the way it happens: Every grown-up person has either been
+ill himself or had a friend suffer from illness, from which he has
+recovered. Every sick person has done something or other by somebody's
+advice, or of his own accord, a little before getting better. There
+is an irresistible tendency to associate the thing done, and the
+improvement which followed it, as cause and effect. This is the great
+source of fallacy in medical practice. But the physician has some chance
+of correcting his hasty inference. He thinks his prescription cured a
+single case of a particular complaint; he tries it in twenty similar
+cases without effect, and sets down the first as probably nothing more
+than a coincidence. The unprofessional experimenter or observer has
+no large experience to correct his hasty generalization. He wants to
+believe that the means he employed effected his cure. He feels grateful
+to the person who advised it, he loves to praise the pill or potion
+which helped him, and he has a kind of monumental pride in himself as
+a living testimony to its efficacy. So it is that you will find the
+community in which you live, be it in town or country, full of brands
+plucked from the burning, as they believe, by some agency which, with
+your better training, you feel reasonably confident had nothing to
+do with it. Their disease went out of itself, and the stream from the
+medical fire-annihilator had never even touched it.
+
+You cannot and need not expect to disturb the public in 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 ninth chapter of St. John's Gospel,
+and you will find that the logic of a restored patient was very simple
+then, as it is now, and very hard to deal with. My clerical friends
+will forgive me for poaching on their sacred territory, in return for an
+occasional raid upon the medical domain of which they have now and then
+been accused.
+
+A blind man was said to have been restored to sight by a young person
+whom the learned doctors of the Jewish law considered a sinner, and, as
+such, very unlikely to have been endowed with a divine gift of healing.
+They visited the patient repeatedly, and evidently teased him with their
+questions about the treatment, and their insinuations about the young
+man, until he lost his temper. At last he turned sharply upon them:
+“Whether he be a sinner or no, I know not: one thing I know, that,
+whereas I was blind, now I see.”
+
+This is the answer that always has been and always will be given by most
+persons when they find themselves getting well after doing anything, no
+matter what,--recommended by anybody, no matter whom. Lord Bacon, Robert
+Boyle, Bishop Berkeley, all put their faith in panaceas which we should
+laugh to scorn. They had seen people get well after using them. Are we
+any wiser than those great men? Two years ago, in a lecture before the
+Massachusetts Historical Society, I mentioned this recipe of Sir Kenelm
+Digby for fever and ague: Pare the patient's nails; put the parings in a
+little bag, and hang the bag round the neck of a live eel, and place him
+in a tub of water. The eel will die, and the patient will recover.
+
+Referring to this prescription in the course of the same lecture, I
+said: “You smiled when I related Sir Kenehn Digby's prescription, with
+the live eel in it; but if each of you were to empty his or her pockets,
+would there not roll out, from more than one of them, a horse-chestnut,
+carried about as a cure for rheumatism?” Nobody saw fit to empty his or
+her pockets, and my question brought no response. But two months ago
+I was in a company of educated persons, college graduates every one of
+them, 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 his
+breeches-pocket, and laid them on the table, telling us how, having
+suffered from the complaint in question, he had, by the advice of a
+friend, procured these two horse-chestnuts on a certain time a year or
+more ago, and carried them about him ever since; from which very 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 to meet wherever you go, and you need not
+think you can answer it. In the natural course of things some thousands
+of persons must be getting well or better of slight attacks of colds,
+of rheumatic pains, every week, in this city alone. Hundreds of them do
+something or other in the way of remedy, by medical or other advice, or
+of their own motion, and the last thing they do gets the credit of the
+recovery. Think what a crop of remedies this must furnish, if it were
+all harvested!
+
+Experience has taught, or will teach you, that most of the wonderful
+stories patients and others tell of sudden and signal cures are like
+Owen Glendower's story of the portents that announced his birth. The
+earth shook at your nativity, did it? Very likely, and
+
+
+        “So it would have done,
+   At the same season, if your mother's cat
+   Had kittened, though yourself had ne'er been born.”
+
+You must listen more meekly than Hotspur did to the babbling Welshman,
+for ignorance is a solemn and sacred fact, and, like infancy, which it
+resembles, should be respected. Once in a while you will have a patient
+of sense, born with the gift of observation, from whom you may learn
+something. When you find yourself in the presence of one who is fertile
+of medical opinions, and affluent in stories of marvellous cures,--of
+a member of Congress whose name figures in certificates to the value of
+patent medicines, of a voluble dame who discourses on the miracles she
+has wrought or seen wrought with the little jokers of the sugar-of-milk
+globule-box, take out your watch and count the pulse; also note the time
+of day, and charge 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 dispensation into a double blessing, for this class
+of patients loves dearly to talk, and it does them a deal of good, and
+you feel as if you had earned your money by the dose you have taken,
+quite as honestly as by any dose you may have ordered.
+
+You must take the community just as it is, and make the best of it.
+You wish to obtain its confidence; there is a short rule for doing this
+which you will find useful,--deserve it. But, to deserve it in full
+measure, you must unite many excellences, natural and acquired.
+
+As the basis of all the rest, you must have all those traits of
+character which fit you to enter into the most intimate and confidential
+relations with the families of which you are the privileged friend and
+counsellor. Medical Christianity, if I may use such a term, is of very
+early date. By the oath of Hippocrates, the practitioner of ancient
+times bound himself to enter his patient's house with the sole purpose
+of doing him good, and so to conduct himself as to avoid the very
+appearance of evil. Let the physician of to-day begin by coming up to
+this standard, and add to it all the more recently discovered virtues
+and graces.
+
+A certain amount of natural ability is requisite to make you a good
+physician, but by no means that disproportionate development of some
+special faculty which goes by the name of genius. A just balance of the
+mental powers is a great deal more likely to be useful than any single
+talent, even were it the power of observation, in excess. For a mere
+observer is liable to be too fond of facts for their own sake, so that,
+if he told the real truth, he would confess that he takes more pleasure
+in a post-mortem examination which shows him what was the matter with a
+patient, than in a case which insists on getting well and leaving him in
+the dark as to its nature. Far more likely to interfere with the sound
+practical balance of the mind is that speculative, theoretical tendency
+which has made so many men noted in their day, whose fame has passed
+away with their dissolving theories. Read Dr. Bartlett's comparison of
+the famous Benjamin Rush with his modest fellow-townsman Dr. William
+Currie, and see the dangers into which a passion for grandiose
+generalizations betrayed a man of many admirable qualities.
+
+I warn you against all ambitious aspirations outside of your profession.
+Medicine is the most difficult of sciences and the most laborious of
+arts. It will task all your powers of body and mind if you are faithful
+to it. Do not dabble in the muddy sewer of politics, nor linger by
+the enchanted streams of literature, nor dig in far-off fields for the
+hidden waters of alien sciences. The great practitioners are generally
+those who concentrate all their powers on their business. If there
+are here and there brilliant exceptions, it is only in virtue of
+extraordinary gifts, and industry to which very few are equal.
+
+To get business a man must really want it; and do you suppose that when
+you are in the middle of a heated caucus, or half-way through a delicate
+analysis, or in the spasm of an unfinished ode, your eyes rolling in the
+fine frenzy of poetical composition, you want to be called to a teething
+infant, or an ancient person groaning under the griefs of a lumbago?
+I think I have known more than one young man whose doctor's sign
+proclaimed his readiness to serve mankind in that capacity, but who
+hated the sound of a patient's knock, and as he sat with his book or his
+microscope, felt exactly as the old party expressed himself in my 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 of those diplomaed dilettanti who like
+the amusement of quasi medical studies, but have no idea of wasting
+their precious time in putting their knowledge in practice for the
+benefit of their suffering fellow-creatures.
+
+The public is a very incompetent judge of your skill and knowledge, but
+it gives its confidence most readily to those who stand well with their
+professional brethren, whom they call upon when they themselves or their
+families 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 yet have defects which prevent his becoming a favorite
+practitioner, but no popularity can be depended upon as permanent which
+is not sanctioned by the judgment of professional experts, and with
+these you will always stand on your substantial merits.
+
+What shall I say of the personal habits you must form if you wish for
+success? Temperance is first upon the list. Intemperance in a physician
+partakes of the guilt of homicide, for the muddled brain may easily
+make a fatal blunder in a prescription and the unsteady hand transfix
+an artery in an operation. Tippling doctors have been too common in the
+history of medicine. Paracelsus was a sot, Radcliffe was much too fond
+of his glass, and Dr. James Hurlbut of Wethersfield, Connecticut, a
+famous man in his time, used to drink a square bottle of rum a day,
+with a corresponding allowance of opium to help steady his nerves. We
+commonly speak of a man as being the worse for liquor, but I was asking
+an Irish laborer one day about his doctor, who, as he said, was somewhat
+given to drink. “I like him best when he's a little that way,” he said;
+“then I can spake to him.” I pitied the poor patient who could not
+venture to allude to his colic or his pleurisy until his physician was
+tipsy.
+
+There are personal habits of less gravity than the one I have
+mentioned which it is well to guard against, or, if they are formed,
+to relinquish. A man who may be called at a moment's warning into
+the fragrant boudoir of suffering loveliness should not unsweeten its
+atmosphere with reminiscences of extinguished meerschaums. He should
+remember that the sick are sensitive and fastidious, that they love the
+sweet odors and the pure tints of flowers, and if his presence is not
+like the breath of the rose, if his hands are not like the leaf of the
+lily, his visit may be unwelcome, and if he looks behind him he may see
+a window thrown open after he has left the sick-chamber. I remember too
+well the old doctor who sometimes came to help me through those inward
+griefs to which childhood is liable. “Far off his coming “--shall I say
+“shone,” and finish the Miltonic phrase, or leave the verb to the happy
+conjectures of my audience? Before him came a soul-subduing whiff
+of ipecacuanha, and after him lingered a shuddering consciousness of
+rhubarb. He had lived so much among his medicaments that he had at last
+become himself a drug, and to have him pass through a sick-chamber was a
+stronger dose than a conscientious disciple of Hahnemann would think it
+safe to administer.
+
+Need I remind you of the importance of punctuality in your engagements,
+and of the worry and distress to patients and their friends which the
+want of it occasions? One of my old teachers always carried two watches,
+to make quite sure of being exact, and not only kept his appointments
+with the regularity of a chronometer, but took great pains to be at
+his patient's house at the time when he had reason to believe he was
+expected, even if no express appointment was made. It is a good rule;
+if you call too early, my lady's hair may not be so smooth as could be
+wished, and, if you keep her waiting too long, her hair may be smooth,
+but her temper otherwise.
+
+You will remember, of course, always to get the weather-gage of your
+patient. I mean, to place him so that the light falls on his face and
+not on yours. It is a kind of, ocular duel that is about to take
+place between you; you are going to look through his features into his
+pulmonary and hepatic and other internal machinery, and he is going
+to look into yours quite as sharply to see what you think about his
+probabilities for 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, and serene 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 benevolent old hypocrite; she cheats the sick
+and the dying with illusions better than any anodynes. If there are
+cogent reasons why a patient should be undeceived, do it deliberately
+and advisedly, but do not betray your apprehensions through your
+tell-tale features.
+
+We had a physician in our city whose smile was commonly reckoned as
+being worth five thousand dollars a year to him, in the days, too, of
+moderate incomes. You cannot put on such a smile as that any more than
+you can get sunshine without sun; there was a tranquil and kindly nature
+under it that irradiated the pleasant face it made one happier to meet
+on his daily rounds. But you can cultivate the disposition, and it will
+work its way through to the surface, nay, more,--you can try to wear a
+quiet and encouraging look, and it will react on your disposition and
+make you like what you seem to be, or at least bring you nearer to its
+own likeness.
+
+Your patient has no more right to all the truth you know than he has
+to all the medicine in your saddlebags, if you carry that kind of
+cartridge-box for the ammunition that slays disease. He should get only
+just so much as is good for him. I have seen a physician examining a
+patient's chest stop all at once, as he brought out a particular sound
+with a tap on the collarbone, in the attitude of a pointer who has just
+come on the scent or sight of a woodcock. You remember the Spartan boy,
+who, with unmoved countenance, hid the fox that was tearing his vitals
+beneath his mantle. What he could do in his own suffering you must
+learn to do for others on whose vital organs disease has fastened its
+devouring teeth. It is a terrible thing to take away hope, even earthly
+hope, from a fellow-creature. Be very careful what names you let fall
+before your patient. He knows what it means when you tell him he has
+tubercles or Bright's disease, and, if he hears the word carcinoma,
+he will certainly look it out in a medical dictionary, if he does
+not interpret its dread significance on the instant. Tell him he has
+asthmatic symptoms, or a tendency to the gouty diathesis, and he will
+at once think of all the asthmatic and gouty old patriarchs he has ever
+heard of, and be comforted. You need not be so cautious in speaking
+of the health of rich and remote relatives, if he is in the line of
+succession.
+
+Some shrewd old doctors have a few phrases always on hand for patients
+that will insist on knowing the pathology of their complaints without
+the slightest capacity of understanding the scientific explanation. I
+have known the term “spinal irritation” serve well on such occasions,
+but I think nothing on the whole has covered so much ground, and meant
+so little, and given such profound satisfaction to all parties, as the
+magnificent phrase “congestion of the portal system.”
+
+Once more, let me recommend you, as far as possible, to keep your
+doubts to yourself, and give the patient the benefit of your decision.
+Firmness, gentle firmness, is absolutely necessary in this and certain
+other relations. Mr. Rarey with Cruiser, Richard with Lady Ann, Pinel
+with his crazy people, show what steady nerves can do with the most
+intractable of animals, the most irresistible of despots, and the most
+unmanageable of invalids.
+
+If you cannot acquire and keep the confidence of your patient, it is
+time for you to give place to some other practitioner who can. If you
+are wise and diligent, you can establish relations with the best of them
+which they will find it very hard to break. But, if they wish to employ
+another person, who, as they think, knows more than you do, do not take
+it as a personal wrong. A patient believes another man 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, it is a
+great impertinence to think you have any property in him. Your estimate
+of your own ability is not the question, it is what the patient thinks
+of it. All your wisdom is to him like the lady's virtue 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 found a good physician,
+sticks to him till he dies. But there are many very good people who are
+not what I call good patients. I was once requested to call 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-sixth member of the faculty into whose arms,
+professionally speaking, she had successively thrown herself. Not
+being a believer in such a rapid rotation of scientific crops, I gently
+deposited the burden, commending it to the care of number twenty-seven,
+and, him, whoever he might be, to the care of Heaven.
+
+If there happened to be among my audience any person who wished to know
+on what principles the patient should choose his physician, I should
+give him these few precepts to think over:
+
+Choose a man who is personally agreeable, for a daily visit from an
+intelligent, amiable, pleasant, sympathetic person will cost you no more
+than one from a sloven or a boor, and his presence will do more for you
+than any prescription the other will order.
+
+Let him be a man of recognized good sense in other matters, and the
+chance is that he will be sensible as a practitioner.
+
+Let him be a man who stands well with his professional brethren, whom
+they approve as honest, able, courteous.
+
+Let him be one whose patients are willing to die in his hands, not one
+whom they go to for trifles, and leave 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 regular profession, unless
+you wish to go farther and fare worse, for you may be assured that
+its members recognize no principle which hinders their accepting any
+remedial agent proved to be useful, no matter from what quarter it
+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 as an anesthetic, they will find no
+difficulty in procuring its recognition.
+
+Some of you will probably be more or less troubled by the pretensions
+of that parody of mediaeval theology which finds its dogma of hereditary
+depravity in the doctrine of psora, its miracle of transubstantiation in
+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
+to accept these curious medical superstitions. The saturation-point
+of individual minds with reference to evidence, and especially medical
+evidence, differs, and must always continue to differ, very widely.
+There are those whose minds are satisfied with the decillionth dilution
+of a scientific proof. No wonder they believe in the efficacy of a
+similar attenuation of bryony or pulsatilla. You have no fulcrum you
+can rest upon to lift an error out of such minds as these, often highly
+endowed with knowledge and talent, sometimes with genius, but commonly
+richer in the imaginative than the observing and reasoning faculties.
+
+Let me return once more to the young graduate. Your relations to your
+professional brethren may be a source of lifelong happiness and growth
+in knowledge and character, or they may make you wretched and end
+by leaving you isolated from those who should be your friends and
+counsellors. The life of a physician becomes ignoble when he suffers
+himself to feed on petty jealousies and sours his temper in perpetual
+quarrels. You will be liable to meet an uncomfortable man here and there
+in the profession,--one who is so fond of being in hot water that it is
+a wonder all the albumen in his body is not coagulated. There are common
+barrators among doctors as there are among lawyers,--stirrers up of
+strife under one pretext and another, but in reality because they like
+it. They are their own worst enemies, and do themselves a mischief each
+time they assail their neighbors. In my student days I remember a good
+deal of this Donnybrook-Fair style of quarrelling, more especially in
+Paris, where some of the noted surgeons were always at loggerheads, and
+in one of our lively Western cities. Soon after I had set up an office,
+I had a trifling experience which may serve to point a moral in this
+direction. I had placed a lamp behind the glass in the entry to indicate
+to the passer-by where relief from all curable infirmities was to be
+sought and found. Its brilliancy attracted the attention of a devious
+youth, who dashed his fist through the glass and upset my modest
+luminary. All he got by his vivacious assault was that he left portions
+of integument from his knuckles upon the glass, had a lame hand, was
+very easily identified, and had to pay the glazier's bill. The moral is
+that, if the brilliancy of another's reputation excites your belligerent
+instincts, it is not worth your while to strike at it, without
+calculating which of you is likely to suffer most, if you do.
+
+You may be assured that when an ill-conditioned neighbor is always
+complaining of a bad taste in his mouth and an evil atmosphere about
+him, there is something wrong about his own secretions. In such
+cases there is an alterative regimen of remarkable efficacy: it is a
+starvation-diet of letting alone. The great majority of the profession
+are peacefully inclined. Their pursuits are eminently humanizing, and
+they look with disgust on the personalities which intrude themselves
+into the placid domain of an art whose province it is to heal and not to
+wound.
+
+The intercourse of teacher and student in a large school is necessarily
+limited, but it should be, and, so far as my experience goes, it is,
+eminently cordial and kindly. You will leave with regret, and hold
+in tender remembrance, those who have taken you by the hand at your
+entrance on your chosen path, and led you patiently and faithfully,
+until the great gates at its end have swung upon their hinges, and the
+world lies open before you. That venerable oath to which I have before
+referred bound the student to regard his instructor in the light of a
+parent, to treat his children like brothers, to succor him in his day of
+need. I trust the spirit of the oath of Hippocrates is not dead in the
+hearts of the students of to-day. They will remember with gratitude
+every earnest effort, every encouraging word, which has helped them in
+their difficult and laborious career of study. The names they read on
+their diplomas will recall faces that are like family-portraits in their
+memory, and the echo of voices they have listened to so long will linger
+in their memories far into the still evening of their lives.
+
+One voice will be heard no more which has been familiar to many among
+you. It is not for me, a stranger to these scenes, to speak his eulogy.
+I have no right to sadden this hour by dwelling on the deep regrets
+of friendship, or to bid the bitter tears of sorrow flow afresh. Yet I
+cannot help remembering what a void the death of such a practitioner as
+your late instructor must leave in the wide circle of those who leaned
+upon his counsel and assistance in their hour of need, in a community
+where he was so widely known and esteemed, in a school where he bore so
+important a part. There is no exemption from the common doom for him
+who holds the shield to protect others. The student is called from his
+bench, the professor from his chair, the practitioner in his busiest
+period hears a knock more peremptory than any patient's midnight
+summons, and goes on that unreturning visit which admits of no excuse,
+and suffers no delay. The call of such a man away from us is the
+bereavement of a great family. Nor can we help regretting the loss
+for him of a bright and cheerful earthly future; for the old age of a
+physician is one of the happiest periods of his life. He is loved and
+cherished for what he has been, and even in the decline of his faculties
+there are occasions when his experience is still appealed to, and his
+trembling hands are looked to with renewing hope and trust, as being yet
+able to 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 among those whom I count as listeners one by
+whose side I have sat as a fellow-teacher, and by whose instructions
+I have felt myself not too old to profit. As we borrowed him from
+your city, I must take this opportunity of telling you that his zeal,
+intelligence, and admirable faculty as an instructor were heartily and
+universally recognized among us. We return him, as we trust, uninjured,
+to the fellow-citizens who have the privilege of claiming him as their
+own.
+
+And now, gentlemen of the graduating class, nothing remains but for
+me to bid you, in the name of those for 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's accession are proclaimed by the same voice at
+the same moment. You would hardly excuse me if I stooped to any meaner
+dialect than the classical and familiar language of your prescriptions,
+the same in which your title to the name of physician is, if, like
+our own institution, you follow the ancient usage, engraved upon 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 Medical Library in Boston,
+December 3, 1878.]
+
+It is my appointed task, my honorable privilege, this evening, to speak
+of what has been done by others. No one can bring his tribute of words
+into the presence of great deeds, or try with them to embellish the
+memory of any inspiring achievement, without feeling and leaving
+with others a sense of their insufficiency. So felt Alexander when he
+compared even his adored Homer with the hero the poet had sung. So felt
+Webster when he contrasted the phrases of rhetoric with the eloquence
+of patriotism and of self-devotion. So felt Lincoln when on the field of
+Gettysburg he spoke those immortal words which Pericles could not have
+bettered, which Aristotle could not have criticised. So felt he who
+wrote the epitaph of the builder of the dome which looks down on the
+crosses and weathercocks that glitter over London.
+
+We are not met upon a battle-field, except so far as every laborious
+achievement means a victory over opposition, 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 every
+building whose walls are lined with the products of useful and ennobling
+thought is a temple of the Almighty, whose inspiration has given us
+understanding. But we have gathered within walls which bear testimony to
+the self-sacrificing, persevering efforts of a few young men, to whom
+we owe the origin and development of all that excites our admiration in
+this completed enterprise; and I might consider my task as finished if I
+contented myself with borrowing the last word of the architect's epitaph
+and only saying, Look around you!
+
+The reports of the librarian have told or will tell you, in some detail,
+what has been accomplished since the 21st of December, 1874, when six
+gentlemen met at the house of Dr. Henry Ingersoll Bowditch to discuss
+different projects for a medical library. In less than four years from
+that time, by the liberality of associations and of individuals, this
+collection of nearly ten thousand volumes, of five thousand pamphlets,
+and of one hundred and twenty-five journals, regularly received,--all
+worthily sheltered beneath this lofty roof,--has come into being under
+our eyes. It has sprung up, as it were, in the night like a mushroom; it
+stands before us in full daylight as lusty as an oak, and promising to
+grow and flourish in the perennial freshness of an evergreen.
+
+To whom does our profession owe this already large collection of books,
+exceeded in numbers only by four or five of the most extensive medical
+libraries in the country, and lodged in a building so well adapted to
+its present needs? We will not point out individually all those younger
+members of the profession who have accomplished what their fathers and
+elder brethren had attempted and partially achieved. We need not write
+their names on these walls, after the fashion of those civic dignitaries
+who immortalize themselves on tablets of marble and gates of iron. But
+their contemporaries know them well, and their descendants will not
+forget them,--the men who first met together, the men who have given
+their time and their money, the faithful workers, worthy associates of
+the strenuous agitator who gave no sleep to his eyes, no slumber to
+his eyelids, until he had gained his ends; the untiring, imperturbable,
+tenacious, irrepressible, all-subduing agitator who neither rested
+nor let others rest until the success of the project was assured. If,
+against his injunctions, I name Dr. James Read Chadwick, it is only my
+revenge for his having kept me awake so often and so long while he was
+urging on the undertaking in which he has been preeminently active and
+triumphantly successful.
+
+We must not forget the various medical libraries which preceded this:
+that of an earlier period, when Boston contained about seventy regular
+practitioners, the collection afterwards transferred to the Boston
+Athenaeum; the two collections belonging to the University; the
+Treadwell Library at the Massachusetts General Hospital; the collections
+of the two societies, that for Medical Improvement and that for Medical
+Observation; and more especially the ten thousand volumes relating to
+medicine belonging to our noble public city library,--too many blossoms
+on the tree of knowledge, perhaps, for the best fruit to ripen. But the
+Massachusetts Medical Society now numbers nearly four hundred members in
+the city of Boston. The time had arrived for a new and larger movement.
+There was needed a place to which every respectable member of the
+medical profession could obtain easy access; where, under one roof, all
+might find the special information they were seeking; where the latest
+medical intelligence should be spread out daily as the shipping news is
+posted on the bulletins of the exchange; where men engaged in a common
+pursuit could meet, surrounded by the mute oracles of science and art;
+where the whole atmosphere should be as full of professional knowledge
+as the apothecary's shop is of the odor of his medicaments. This was
+what the old men longed for,--the prophets and kings of the profession,
+who
+
+
+        “Desired it long,
+   But died without the sight.”
+
+This is what the young men and those who worked under their guidance
+undertook to give us. And now such 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 profession of our city, and, let us
+add, of all those neighboring places which it can reach with its iron
+arms, is united as never before by the commune vinculum, the common bond
+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
+centralized libraries; abreast of them, but not promising to be content
+with that position. What glorifies a town like a cathedral? What
+dignifies a province like a university? What illuminates a country
+like its scholarship, and what is the nest that hatches scholars but a
+library?
+
+The physician, some may say, is a practical man and has little use for
+all this book-learning. Every student has heard Sydenham's reply to Sir
+Richard Blackmore's question as to what books he should read,--meaning
+medical books. “Read Don Quixote,” was his famous answer. But Sydenham
+himself made medical books and may be presumed to have thought those at
+least worth reading. Descartes was asked where was his library, and in
+reply held up the dissected body of an animal. But Descartes made books,
+great books, and a great many of them. A physician of common sense
+without erudition is better than a learned one without common sense, but
+the thorough master of his profession must have learning added to his
+natural gifts.
+
+It is not necessary to maintain the direct practical utility of all
+kinds of learning. Our shelves contain many books which only a certain
+class of medical scholars will be likely to consult. There is a dead
+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 has no living value for the student, will not teach him
+something by its autopsy. But it is with the live literature of his
+profession that the medical practitioner is first of all concerned.
+
+Now there has come a great change in our time over the form in
+which living thought presents itself. The first printed books,--the
+incunabula,--were inclosed in boards of solid oak, with brazen clasps
+and corners; the boards by and by were replaced by pasteboard covered
+with calf or sheepskin; then cloth came in and took the place of
+leather; then the pasteboard was covered with paper instead of cloth;
+and at this day the quarterly, the monthly, the weekly periodical in its
+flimsy unsupported dress of paper, and the daily journal, naked as
+it came from the womb of the press, hold the larger part of the fresh
+reading we live upon. We must have the latest thought in its latest
+expression; the page must be newly turned like the morning bannock; the
+pamphlet must be newly opened like the ante-prandial oyster.
+
+Thus a library, to meet the need of our time, must take, and must spread
+out in a convenient form, a great array of periodicals. Our active
+practitioners read these by preference over almost everything else. Our
+specialists, more particularly, depend on the month's product, on the
+yearly crop of new facts, new suggestions, new contrivances, as much
+as the farmer on the annual yield of his acres. One of the first wants,
+then, of the profession is supplied by our library in its great array of
+periodicals from many lands, in many languages. Such a number of medical
+periodicals no private library would have room for, no private person
+would pay for, or flood his tables with if they were sent him for
+nothing. These, I think, with the reports of medical societies and the
+papers contributed to them, will form the most attractive part of
+our accumulated medical treasures. They will be also one of our chief
+expenses, for these journals must be bound in volumes and they require
+a great amount of shelf-room; all this, in addition to the cost of
+subscription for those which are not furnished us gratuitously.
+
+It is true that the value of old scientific periodicals is, other things
+being equal, in the inverse ratio of their age, for the obvious reason
+that what is most valuable in the earlier volumes of a series is drained
+off into the standard works with which the intelligent practitioner is
+supposed to be familiar. But no extended record of facts grows too old
+to be useful, provided only that we have a ready and sure way of getting
+at the particular fact or facts we are in search of.
+
+And this leads me to speak of what I conceive to be one of the principal
+tasks to be performed by the present and the coming generation of
+scholars, not only in the medical, but in every department of knowledge.
+I mean the formation of indexes, and more especially of 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 special subject. I have a right to
+speak of it, for I long ago attempted to supply the want of indexes in
+some small measure for my own need. I had a very complete set of the
+“American Journal of the Medical Sciences;” an entire set of the “North
+American Review,” and many volumes of the reprints of the three leading
+British quarterlies. Of what use were they to me without general
+indexes? I looked them all through carefully and made classified lists
+of all the articles I thought I should most care to read. But they soon
+outgrew my lists. The “North American Review” kept filling up shelf
+after shelf, rich in articles which I often wanted to consult, but what
+a labor to find them, until the index of Mr. Gushing, published a few
+months since, made the contents of these hundred and twenty volumes 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 lost its value for me in later years. But where to look for what I
+wanted? I wished to know, for instance, what Dr. Burney had to say about
+singing. Who would have looked for it under the Italian word cantare? I
+was curious to learn something of the etchings of Rembrandt, and
+where should I find it but under the head “Low Countries, Engravers
+of the,”--an elaborate and most valuable article of a hundred
+double-columned close-printed quarto pages, to which no reference, even,
+is made under the title Rembrandt.
+
+There was nothing to be done, if I wanted to know where that which I
+specially cared for was to be found in my Rees's Cyclopaedia, but to
+look over every page of its forty-one quarto volumes and make out
+a brief list of matters of interest which I could not find by their
+titles, and this I did, at no small expense of time and trouble.
+
+Nothing, therefore, could be more pleasing to me than to see the
+attention which has been given of late years to the great work of
+indexing. It is a quarter of a century since Mr. Poole published his
+“Index to Periodical Literature,” which it is much to be hoped is soon
+to appear in a new edition, grown as it must be to formidable dimensions
+by the additions of so long a period. The “British and Foreign Medical
+Review,” edited by the late Sir John Forties, contributed to by Huxley,
+Carpenter, Laycock, and others of the most distinguished scientific men
+of Great Britain, has an index to its twenty-four volumes, and by its
+aid I find this valuable series as manageable as a lexicon. The last
+edition of the “Encyclopaedia Britannica” had a complete index in a
+separate volume, and the publishers of Appletons' “American Cyclopaedia”
+ have recently issued an index to their useful work, which must greatly
+add to its value. I have already referred to the index to the “North
+American Review,” which to an American, and especially to a New
+Englander, is the most interesting and most valuable addition of its
+kind to our literary apparatus since the publication of Mr. Allibone's
+“Dictionary of Authors.” I might almost dare to parody Mr. Webster's
+words in speaking of Hamilton, to describe what Mr. Gushing did for the
+solemn rows of back volumes of our honored old Review which had been
+long fossilizing on our shelves: “He touched the dead corpse of the
+'North American,' and it sprang to its feet.” A library of the best
+thought of the best American scholars during the greater portion of the
+century was brought to light by the work of the indexmaker as truly as
+were the Assyrian tablets by the labors of Layard.
+
+A great portion of the best writing and reading--literary, scientific,
+professional, miscellaneous--comes to 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-binder puts a coat on
+his back, and he joins the forlorn brotherhood of “back volumes,” than
+which, so long as they are unindexed, nothing can be more exasperating.
+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 a
+goldback behind it?
+
+I have referred chiefly to the medical journals, but I would include
+with these the reports of medical associations, and those separate
+publications which, coming in the form of pamphlets, heap themselves
+into chaotic piles and bundles which are worse than useless, taking up a
+great deal of room, and frightening everything away but mice and mousing
+antiquarians, or possibly at long intervals some terebrating specialist.
+
+Arranged, bound, indexed, all these at once become accessible and
+valuable. I will take the first instance which happens to suggest
+itself. How many who know all about osteoblasts and the experiments of
+Ollier, and all that has grown out of them, know where to go for a paper
+by the late Dr. A. L. Peirson of Salem, published in the year 1840,
+under the modest title, Remarks on Fractures? And if any practitioner
+who has to deal with broken bones does not know that most excellent
+and practical essay, it is a great pity, for it answers very numerous
+questions which will be sure to suggest themselves to the surgeon and
+the patient as no one of the recent treatises, on my own shelves, at
+least, can do.
+
+But if indexing is the special need of our time in medical literature,
+as in every department of knowledge, it must be remembered that it
+is not only an immense labor, but one that never ends. It requires,
+therefore, the cooperation of a large number of individuals to do the
+work, and a large amount of money to pay for making its results public
+through the press. When it is remembered that the catalogue of the
+library of the British Museum is contained in nearly three thousand
+large folios of manuscript, and not all its books are yet included, the
+task of indexing any considerable branch of science or literature looks
+as if it were well nigh impossible. But many hands make light work. An
+“Index Society” has been formed in England, already numbering about one
+hundred and seventy members. It aims at “supplying thorough indexes
+to valuable works and collections which have hitherto lacked them; at
+issuing indexes to the literature of special subjects; and at gathering
+materials for a general reference index.” This society has published a
+little treatise setting forth the history and the art of indexing, which
+I trust is in the hands of some of our members, if not upon our shelves.
+
+Something has been done in the same direction by individuals in our own
+country, as we have already seen. The need of it in the department of
+medicine is beginning to be clearly felt. Our library has already an
+admirable catalogue with cross references, the work of a number of its
+younger members cooperating in the task. A very intelligent medical
+student, Mr. William D. Chapin, whose excellent project is indorsed by
+well-known New York physicians and professors, proposes to publish a
+yearly index to original communications in the medical journals of the
+United States, classified by authors and subjects. But it is from the
+National Medical Library at Washington that we have the best promise
+and the largest expectations. That great and growing collection of fifty
+thousand volumes is under the eye and hand of a librarian who knows
+books and how to manage them. For libraries are the standing armies
+of civilization, and an army is but a mob without a general who can
+organize and marshal it so as to make it effective. The “Specimen
+Fasciculus of a Catalogue of the National Medical Library,” prepared
+under the direction of Dr. Billings, the librarian, would have excited
+the admiration of Haller, the master scholar in medical science of
+the last century, or rather of the profession in all centuries, and if
+carried out as it is begun will be to the nineteenth all and more
+than all that the three Bibliothecae--Anatomica, Chirurgica, and
+Medicinae-Practicae--were to the eighteenth century. I cannot forget
+the story that Agassiz was so fond of telling of the king of Prussia and
+Fichte. It was after the humiliation and spoliation of the kingdom by
+Napoleon that the monarch asked the philosopher what could be done
+to regain the lost position of the nation. “Found a great university,
+Sire,” was the answer, and so it was that in the year 1810 the
+world-renowned University of Berlin came into being. I believe that we
+in this country can do better than found a national university, whose
+professors shall be nominated in caucuses, go in and out, perhaps, like
+postmasters, with every change of administration, and deal with science
+in the face of their constituency as the courtier did with time when
+his sovereign asked him what o'clock it was: “Whatever hour your majesty
+pleases.” But when we have a noble library like that at Washington, and
+a librarian of exceptional qualifications like the gentleman who now
+holds that office, I believe that a liberal appropriation by Congress
+to carry out a conscientious work for the advancement of sound knowledge
+and the bettering of human conditions, like this which Dr. Billings
+has so well begun, would redound greatly to the honor of the nation. It
+ought to be willing to be at some charge to make its treasures useful to
+its citizens, and, for its own sake, especially to that class which has
+charge of health, public and private. This country abounds in what
+are called “self-made men,” and is justly proud of many whom it thus
+designates. In one sense no man is self-made who breathes the air of a
+civilized community. In another sense every man who is anything other
+than a phonograph on legs is self-made. But if we award his just praise
+to the man who has attained any kind of excellence without having had
+the same advantages as others whom, nevertheless, he has equalled or
+surpassed, let us not be betrayed into undervaluing the mechanic's
+careful training to his business, the thorough and laborious education
+of the scholar and the professional man.
+
+Our American atmosphere is vocal with the flippant loquacity of half
+knowledge. We must accept whatever good can be got out of it, and keep
+it under as we do sorrel and mullein and witchgrass, by enriching the
+soil, and sowing good seed in plenty; by good teaching and good books,
+rather than by wasting our time in talking against it. Half knowledge
+dreads nothing but whole knowledge.
+
+I have spoken of the importance and the predominance of periodical
+literature, and have attempted to do justice to its value. But the
+almost exclusive reading of it is not without its dangers. The journals
+contain much that is crude and unsound; the presumption, it might be
+maintained, is against their novelties, unless they come from observers
+of established credit. Yet I have known a practitioner,--perhaps more
+than one,--who was as much under the dominant influence of the last
+article he had read in his favorite medical journal as a milliner under
+the sway of the last fashion-plate. The difference between green and
+seasoned knowledge is very great, and such practitioners never hold long
+enough to any of their knowledge to have it get seasoned.
+
+It is needless to say, then, that all the substantial and permanent
+literature of the profession should be represented upon our shelves.
+Much of it is there already, and as one private library after another
+falls into this by the natural law of gravitation, it will gradually
+acquire all that is most valuable almost without effort. A scholar
+should not be in a hurry to part with his books. They are probably
+more valuable to him than they can be to any other individual. What
+Swedenborg called “correspondence” has established itself between
+his intelligence and the volumes which wall him within their sacred
+inclosure. Napoleon said that his mind was as if furnished with
+drawers,--he drew out each as he wanted its contents, and closed it
+at will when done with them. The scholar's mind, to use a similar
+comparison, is furnished with shelves, like his library. Each book knows
+its place in the brain as well as against the wall or in the alcove. His
+consciousness is doubled by the books which encircle him, as the trees
+that surround a lake repeat themselves in its unruffled waters. Men talk
+of the nerve that runs to the pocket, but one who loves his books, and
+has lived long with them, has a nervous filament which runs 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 temple is to the
+worshipper who frequents it. There is the altar sacred to his holiest
+experiences. There is the font where his new-born thought was baptized
+and first had a name in his consciousness. There is the monumental
+tablet of a dead belief, sacred still in the memory of what it was while
+yet alive. No visitor can read all this on the lettered backs of the
+books that have gathered around the scholar, but for him, from the Aldus
+on the lowest shelf to the Elzevir on the highest, every volume has
+a language which none but he can interpret. Be patient with the
+book-collector who loves his companions too well to let them go. Books
+are not buried with their owners, and the veriest book-miser that ever
+lived was probably doing far more for his successors than his more
+liberal neighbor who despised his learned or unlearned avarice. Let
+the fruit fall with the leaves still clinging round it. Who would have
+stripped Southey's walls of the books that filled them, when, his mind
+no longer capable of taking in their meaning, he would still pat and
+fondle them with the vague loving sense of what they had once been
+to him,--to him, the great scholar, now like a little child among his
+playthings?
+
+We need in this country not only the scholar, but the virtuoso, who
+hoards the treasures which he loves, it may be chiefly for their rarity
+and because others who know more than he does of their value set a high
+price upon them. As the wine of old vintages is gently decanted out
+of its cobwebbed bottles with their rotten corks into clean new
+receptacles, so the wealth of the New World is quietly emptying many
+of the libraries and galleries of the Old World into its 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 before
+the New Zealander takes his stand on a broken arch of London Bridge
+to sketch the ruins of St. Paul's in the midst of a vast solitude, the
+treasures of the British Museum will have found a new shelter in the
+halls of New York or Boston. No Catholic will think hardly of my saying
+that before the Coliseum falls, and with it the imperial city, whose
+doom prophecy has linked with that of the almost eternal amphitheatre,
+the marbles, the bronzes, the paintings, the manuscripts of the Vatican
+will have left the shores of the Tiber for those of the Potomac, the
+Hudson, the Mississippi, or the Sacramento. And what a delight in the
+pursuit of the rarities which the eager book-hunter follows with the
+scent of a beagle!
+
+Shall I ever forget that rainy day in Lyons, that dingy bookshop, where
+I found the Aetius, long missing from my Artis bledicae Principes, and
+where I bought for a small pecuniary consideration, though it was marked
+rare, and was really tres rare, the Aphorisms of Hippocrates, edited
+by and with a preface from the hand of Francis Rabelais? And the
+vellum-bound Tulpius, which I came upon in Venice, afterwards my only
+reading when imprisoned in quarantine at Marseilles, so that the two
+hundred and twenty-eight cases he has recorded are, many of them, to
+this day still fresh in my memory. And the Schenckius,--the folio filled
+with casus rariores, which had strayed in among the rubbish of the
+bookstall on the boulevard,--and the noble old Vesalius with its grand
+frontispiece not unworthy of Titian, and the fine old Ambroise Pare,
+long waited for even in Paris and long ago, and the colossal Spigelius
+with his eviscerated beauties, and Dutch Bidloo with its miracles of
+fine engraving and bad dissection, and Italian Mascagni, the despair of
+all would-be imitators, and pre-Adamite John de Ketam, and antediluvian
+Berengarius Carpensis,--but why multiply names, every one of which
+brings back the accession of a book which was an event almost like the
+birth of an infant?
+
+A library like ours must exercise the largest hospitality. A great many
+books may be found in every large collection which remind us of those
+apostolic looking old men who figure on the platform at our political
+and other assemblages. Some of them have spoken words of wisdom in their
+day, but they have ceased to be oracles; some of them never had any
+particularly important message for humanity, but they add dignity to the
+meeting by their presence; they look wise, whether they are so or not,
+and no one grudges them their places of honor. Venerable figure-heads,
+what would our platforms be without you?
+
+Just so with our libraries. Without their rows of folios in creamy
+vellum, or showing their black backs with antique lettering of tarnished
+gold, our shelves would look as insufficient and unbalanced as a column
+without its base, as a statue without its pedestal. And do not think
+they are kept only to be spanked and dusted during that dreadful period
+when their owner is but too thankful to become an exile and a wanderer
+from the scene of single combats between dead authors and living
+housemaids. Men were not all cowards before Agamemnon or all fools
+before the days of Virchow and Billroth. And apart from any practical
+use to be derived from the older medical authors, is there not a true
+pleasure in reading the accounts of great discoverers in their own
+words? I do not pretend to hoist up the Bibliotheca Anatomica of
+Mangetus and spread it on my table every day. I do not get out my great
+Albinus before every lecture on the muscles, nor disturb the majestic
+repose of Vesalius every time I speak of the bones he has so admirably
+described and figured. But it does please me to read the first
+descriptions of parts to which the names of their discoverers or those
+who have first described them have become so joined that not even modern
+science can part them; to listen to the talk of my old volume as Willis
+describes his circle and Fallopius his aqueduct and Varolius his bridge
+and Eustachius his tube and Monro his foramen,--all so well known to
+us in the human body; it does please me to know the very words in which
+Winslow described the opening which bears his name, and Glisson his
+capsule and De Graaf his vesicle; I am not content until I know in what
+language Harvey announced his discovery of the circulation, and how
+Spigelius made the liver his perpetual memorial, and Malpighi found a
+monument more enduring than brass in the corpuscles of the spleen and
+the kidney.
+
+But after all, the readers who care most for the early records of
+medical science and art are the specialists who are dividing up the
+practice of medicine and surgery as 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 others is applicable the saying of
+D'Alembert that the author kills himself in lengthening out what the
+reader kills himself in trying to shorten.
+
+There are practical books among these ancient volumes which can never
+grow old. Would you know how to recognize “male hysteria” and to
+treat it, take down your Sydenham; would you read the experience of
+a physician who was himself the subject of asthma, and who,
+notwithstanding that, in the words of Dr. Johnson, “panted on till
+ninety,” you will find it in the venerable treatise of Sir John Floyer;
+would you listen to the story of the King's Evil cured by the royal
+touch, as told by a famous chirurgeon who fully believed in it, go
+to Wiseman; would you get at first hand the description of the spinal
+disease which long bore his name, do not be startled if I tell you to go
+to Pott,--to Percival Pott, the great surgeon of the last century.
+
+There comes a time for every book in a library when it is wanted
+by somebody. It is but a few weeks since one of the most celebrated
+physicians in the country wrote to me from a great centre of medical
+education to know if I had the works of Sanctorius, which he had tried
+in vain to find. I could have lent him the “Medicina Statica,” with its
+frontispiece showing Sanctorius with his dinner on the table before
+him, in his balanced chair which sunk with him below the level of his
+banquet-board when he had swallowed a certain number of ounces,--an
+early foreshadowing of Pettenkofer's chamber and quantitative
+physiology,--but the “Opera Omnia” of Sanctorius I had never met with,
+and I fear he had to do without it.
+
+I would extend the hospitality of these shelves to a class of works
+which we are in the habit of considering as being outside of the pale
+of medical science, properly so called, and sometimes of coupling with
+a disrespectful name. Such has always been my own practice. I have
+welcomed Culpeper and Salmon to my bookcase as willingly as Dioscorides
+or Quincy, or Paris or Wood and Bache. I have found a place for St.
+John Long, and read the story of his trial for manslaughter with as
+much interest as the laurel-water case in which John Hunter figured as
+a witness. I would give Samuel Hahnemann a place by the side of Samuel
+Thomson. Am I not afraid that some student of imaginative turn and
+not provided with the needful cerebral strainers without which all the
+refuse of gimcrack intelligences gets into the mental drains and chokes
+them up,--am I not afraid that some such student will get hold of
+the “Organon” or the “Maladies Chroniques” and be won over by their
+delusions, and so be lost to those that love him as a man of common
+sense and a brother in their high calling? Not in the least. If he
+showed any symptoms of infection I would for once have recourse to
+the principle of similia similibus. To cure him of Hahnemann I would
+prescribe my favorite homoeopathic antidote, Okie's Bonninghausen.
+If that failed, I would order Grauvogl as a heroic remedy, and if he
+survived that uncured, I would give him my blessing, if I thought
+him honest, and bid him depart in peace. For me he is no longer an
+individual. He belongs to a class of minds which we are bound to be
+patient with if their Maker sees fit to indulge them with existence. We
+must accept the conjuring ultra-ritualist, the dreamy second adventist,
+the erratic spiritualist, the fantastic homoeopathist, as not unworthy
+of philosophic study; not more unworthy of it than the squarers of the
+circle and the inventors of perpetual motion, and the other whimsical
+visionaries to whom De Morgan has devoted his most instructive and
+entertaining “Budget of Paradoxes.” I hope, therefore, that our library
+will admit the works of the so-called Eclectics, of the Thomsonians, if
+any are in existence, of the Clairvoyants, if they have a literature,
+and especially of the Homoeopathists. This country seems to be the place
+for such a collection, which will by and by be curious and of more value
+than at present, for Homoeopathy seems to be following the pathological
+law of erysipelas, fading out where it originated as it spreads to new
+regions. At least I judge so by the following translated extract from
+a criticism of an American work in the “Homoeopatische Rundschau” of
+Leipzig for October, 1878, which I find in the “Homoeopathic Bulletin”
+ for the month of November just passed: “While we feel proud of
+the spread and rise of Homoeopathy across the ocean, and while the
+Homoeopathic works reaching us from there, and published in a style
+such as is unknown in Germany, bear eloquent testimony to the eminent
+activity of our transatlantic colleagues, we are overcome by sorrowful
+regrets at the position Homoeopathy occupies in Germany. Such a work [as
+the American one referred to] with us would be impossible; it would lack
+the necessary support.”
+
+By all means let our library secure a good representation of the
+literature of Homoeopathy before it leaves us its “sorrowful regrets”
+ and migrates with its sugar of milk pellets, which have taken the place
+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 of a Librarian? Where
+have they ever been better performed than in our own public city
+library, where the late Mr. Jewett and the living Mr. Winsor have shown
+us what a librarian ought to be,--the organizing head, the vigilant
+guardian, the seeker's index, the scholar's counsellor? His work is not
+merely that of administration, manifold and laborious as its duties are.
+He must have a quick intelligence and a retentive memory. He is a
+public carrier of knowledge in its germs. His office is like that which
+naturalists attribute to the bumble-bee,--he lays up little honey for
+himself, but he conveys the fertilizing pollen from flower to flower.
+
+Our undertaking, just completed,--and just begun--has come at the right
+time, not a day too soon. Our practitioners need a library like this,
+for with all their skill and devotion there is too little genuine
+erudition, such as a liberal profession ought to be able to claim for
+many of its members. In reading the recent obituary notices of the late
+Dr. Geddings of South Carolina, I recalled what our lamented friend Dr.
+Coale used to tell me of his learning and accomplishments, and I could
+not help reflecting how few such medical scholars we had to show in
+Boston or New England. We must clear up this unilluminated atmosphere,
+and here,--here is the true electric light which will irradiate its
+darkness.
+
+The public will catch the rays reflected from the same source of
+light, and it needs instruction on the great subjects of health and
+disease,--needs it sadly. It is preyed upon by every kind of imposition
+almost without hindrance. Its ignorance and prejudices react upon
+the profession to the great injury of both. The jealous feeling, for
+instance, with regard to such provisions for the study of anatomy as are
+sanctioned by the laws in this State and carried out with strict
+regard to those laws, threatens the welfare, if not the existence of
+institutions for medical instruction wherever it is not held in check by
+enlightened intelligence. And on the other hand the profession has
+just been startled by a verdict against a physician, ruinous in its
+amount,--enough to drive many a hard-working young practitioner out
+of house and home,--a verdict which leads to the fear that suits for
+malpractice may take the place of the panel game and child-stealing as a
+means of extorting money. If the profession in this State, which claims
+a high standard of civilization, is to be crushed and ground beneath the
+upper millstone of the dearth of educational advantages and the lower
+millstone of ruinous penalties for what the ignorant ignorantly shall
+decide to be ignorance, all I can say is
+
+
+     God save the Commonhealth of Massachusetts!
+
+Once more, we cannot fail to see that just as astrology has given place
+to astronomy, so theology, the science of Him whom by searching no man
+can find out, is fast being replaced by what we may not improperly call
+theonomy, or the science of the laws according to which the Creator
+acts. And since these laws find their fullest manifestations for us, at
+least, in rational human natures, the study of anthropology is largely
+replacing that of scholastic divinity. We must contemplate our Maker
+indirectly in human attributes as we talk of Him in human parts of
+speech. And this gives a sacredness to the study of man in his physical,
+mental, moral, social, and religious nature which elevates the faithful
+students of anthropology to the dignity of a priesthood, and sheds a
+holy light on the recorded results of their labors, brought together as
+they are in such a collection as this which is now spread out before us.
+
+Thus, then, our library is a temple as truly as the dome-crowned
+cathedral hallowed by the breath of prayer and praise, where the dead
+repose and the living worship. May it, with all its treasures, be
+consecrated like that to the glory of God, through the contributions it
+shall make to the advancement of sound knowledge, to the relief of human
+suffering, to the promotion of harmonious relations between the members
+of the two noble professions which deal with the diseases of the soul
+and with those of the body, and to the common cause in which all
+good men are working, the furtherance of the well-being of their
+fellow-creatures!
+
+NOTE.--As an illustration of the statement in the last paragraph but
+one, I take the following notice from the “Boston Daily Advertiser,” of
+December 4th, the day after the delivery of the address: “Prince Lucien
+Bonaparte is now living in London, and is devoting himself to the work
+of collecting the creeds of all religions and sects, with a view
+to their classification,--his object being simply scientific or
+anthropological.”
+
+Since delivering the address, also, I find a leading article in the
+“Cincinnati Lancet and Clinic” of November 30th, headed “The
+Decadence of Homoeopathy,” abundantly illustrated by extracts from the
+“Homoeopathic Times,” the leading American organ of that sect.
+
+In the New York “Medical Record” of the same date, which I had not seen
+before the delivery of my address, is an account of the action of the
+Homoeopathic Medical Society of Northern New York, in which Hahnemann's
+theory of “dynamization” is characterized in a formal resolve as
+“unworthy the confidence of the Homoeopathic profession.”
+
+It will be a disappointment to the German Homoeopathists to read in the
+“Homoeopathic Times” such a statement as the following: “Whatever the
+influences have been which have checked the outward development of
+Homoeopathy, it is plainly evident that the Homoeopathic school, as
+regards the number of its openly avowed representatives, has attained
+its majority, and has begun to decline both in this country and in
+England.”
+
+All which is an additional reason for making a collection of the
+incredibly curious literature of Homoeopathy before that pseudological
+inanity has faded out like so many other delusions.
+
+
+
+
+
+
+SOME OF MY EARLY TEACHERS
+
+[A Farewell Address to the Medical School of Harvard University,
+November 28, 1882.]
+
+I had intended that the recitation of Friday last should be followed by
+a few parting words to my class and any friends who might happen to be
+in the lecture-room. But I learned on the preceding evening that there
+was an expectation, a desire, that my farewell should take a somewhat
+different form; and not to disappoint the wishes of those whom I was
+anxious to gratify, I made up my mind to appear before you with such
+hasty preparation as the scanty time admitted.
+
+There are three occasions upon which a human being has a right to
+consider himself as a centre of interest to those about him: when he is
+christened, when he is married, and when he is buried. Every one is the
+chief personage, the hero, of his own baptism, his own wedding, and his
+own funeral.
+
+There are other occasions, less momentous, in which one may make more
+of himself than under ordinary circumstances he would think it proper
+to do; when he may talk about himself, and tell his own experiences,
+in fact, indulge in a more or less egotistic monologue without fear or
+reproach.
+
+I think I may claim that this is one of those occasions. I have
+delivered my last anatomical lecture and heard my class recite for the
+last time. They wish to hear from me again in a less scholastic mood
+than that in which they have known me. Will you not indulge me in
+telling you something of my own story?
+
+This is the thirty-sixth Course of Lectures in which I have taken my
+place and performed my duties as Professor of Anatomy. For more than
+half of my term of office I gave instruction in Physiology, after the
+fashion of my predecessors and in the manner then generally prevalent in
+our schools, where the physiological laboratory was not a necessary part
+of the apparatus of instruction. It was with my hearty approval that the
+teaching of Physiology was constituted a separate department and made
+an independent Professorship. Before my time, Dr. Warren had taught
+Anatomy, Physiology, and Surgery in the same course of Lectures, lasting
+only three or four months. As the boundaries of science are enlarged,
+new divisions and subdivisions of its territories become necessary. In
+the place of six Professors in 1847, when I first became a member of
+the Faculty, I count twelve upon the Catalogue before me, and I find the
+whole number engaged in the work of instruction in the Medical School
+amounts to no less than fifty.
+
+Since I began teaching in this school, the aspect of many branches of
+science has undergone a very remarkable transformation. Chemistry and
+Physiology are no longer what they were, as taught by the instructors
+of that time. We are looking forward to the synthesis of new organic
+compounds; our artificial madder is already in the market, and the
+indigo-raisers are now fearing that their crop will be supplanted by the
+manufactured article. In the living body we talk of fuel supplied and
+work done, in movement, in heat, just as if we were dealing with a
+machine of our own contrivance.
+
+A physiological laboratory of to-day is equipped with instruments of
+research of such ingenious contrivance, such elaborate construction,
+that one might suppose himself in a workshop where some exquisite fabric
+was to be wrought, such as Queens love to wear, and Kings do not always
+love to pay for. They are, indeed, weaving a charmed web, for these are
+the looms from which comes the knowledge that clothes the nakedness of
+the intellect. Here are the mills that grind food for its hunger, and
+“is not the life more than meat, and the body than raiment?”
+
+But while many of the sciences have so changed that the teachers of the
+past would hardly know them, it has not been so with the branch I teach,
+or, rather, with that division of it which is chiefly taught in this
+amphitheatre. General anatomy, or histology, on the other hand, is
+almost all new; it has grown up, mainly, since I began my medical
+studies. I never saw a compound microscope during my years of study in
+Paris. Individuals had begun to use the instrument, but I never heard
+it alluded to by either Professors or students. In descriptive anatomy I
+have found little to unlearn, and not a great deal that was both new and
+important to learn. Trifling additions are made from year to year, not
+to be despised and not to be overvalued. Some of the older anatomical
+works are still admirable, some of the newer ones very much the
+contrary. I have had recent anatomical plates brought me for inspection,
+and I have actually button-holed the book-agent, a being commonly as
+hard to get rid of as the tar-baby in the negro legend, that I might put
+him to shame with the imperial illustrations of the bones and muscles
+in the great folio of Albinus, published in 1747, and the unapproached
+figures of the lymphatic system of Mascagni, now within a very few years
+of a century old, and still copied, or, rather, pretended to be copied,
+in the most recent works on anatomy.
+
+I am afraid that it is a good plan to get rid of old Professors, and I
+am thankful to hear that there is a movement for making provision
+for those who are left in need when they lose their offices and their
+salaries. I remember one of our ancient Cambridge Doctors once asked me
+to get into his rickety chaise, and said to me, half humorously, half
+sadly, that he was like an old horse,--they had taken off his saddle and
+turned him out to pasture. I fear the grass was pretty short where that
+old servant of the public found himself grazing. If I myself needed an
+apology for holding my office so long, I should find it in the fact that
+human anatomy is much the same study that it was in the days of Vesalius
+and Fallopius, and that the greater part of my teaching was of such a
+nature that it could never become antiquated.
+
+Let me begin with my first experience as a medical student. I had come
+from the lessons of Judge Story and Mr. Ashmun in the Law School at
+Cambridge. I had been busy, more or less, with the pages of Blackstone
+and Chitty, and other text-books of the first year of legal study. More
+or less, I say, but I am afraid it was less rather than more. For during
+that year I first tasted the intoxicating pleasure of authorship. A
+college periodical, conducted by friends of mine, still undergraduates,
+tempted me into print, and there is no form of lead-poisoning which more
+rapidly and thoroughly pervades the blood and bones and marrow than that
+which reaches the young author through mental contact with type-metal.
+Qui a bu, boira,--he who has once been a drinker will drink again, says
+the French proverb. So the man or woman who has tasted type is sure to
+return 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 of it from that day to this. But for that I might have applied
+myself more diligently to my legal studies, and carried a green bag in
+place of a stethoscope and a thermometer up to the present day.
+
+What determined me to give up Law and apply myself to Medicine I can
+hardly say, but I had from the first looked upon that year's study as
+an experiment. At any rate, I made the change, and soon found myself
+introduced to new scenes and new companionships.
+
+I can scarcely credit my memory when I recall the first impressions
+produced upon me by sights afterwards become so familiar that they
+could no more disturb a 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 devoted to the students of the school
+I had joined, just as the fleshless figure of Time, with the hour-glass
+and scythe, used to glare upon me in my childhood from the “New England
+Primer.” The white faces in the beds at the Hospital found their
+reflection in my own cheeks, which lost their color as I looked upon
+them. All this had to pass away in a little time; I had chosen my
+profession, and must meet its painful and repulsive aspects until they
+lost their power over my sensibilities.
+
+The private medical school which I had joined was one 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 either
+spoken elsewhere or may find occasion to speak hereafter. The two
+younger members of this association of teachers were both graduates of
+our University, one of the year 1819, the other of 1818.
+
+Dr. Lewis was a great favorite with students. He was a man of very
+lively temperament, fond of old books and young people, open-hearted,
+free-spoken, an enthusiast in teaching, and especially at home in that
+apartment of the temple of science where nature is seen in undress, the
+anthropotomic laboratory, known to common speech as the dissecting-room.
+He had that quality which is the special gift of the man born for a
+teacher,--the power of exciting an interest in that which he taught.
+While he was present the apartment I speak of was the sunniest of
+studios in spite of its mortuary spectacles. Of the students I met there
+I best remember James Jackson, Junior, full of zeal and playful as a
+boy, a young man whose early death was a calamity to the profession of
+which he promised to be a chief ornament; the late Reverend J. S. C.
+Greene, who, as the prefix to his name signifies, afterwards changed his
+profession, but one of whose dissections I remember looking upon with
+admiration; and my friend Mr. Charles Amory, as we call him, Dr. Charles
+Amory, as he is entitled to be called, then, as now and always, a
+favorite with all about him. He had come to us from the schools
+of Germany, and brought with him recollections of the 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 say as important as a good Professor
+in the teaching of Anatomy, because I am not sure that he is not
+more important. He comes into direct personal relations with the
+students,--he is one of them, in fact, as the Professor cannot be from
+the nature of his duties. The Professor's chair is an insulating stool,
+so to speak; his age, his knowledge, real or supposed, his official
+station, are like the glass legs which support the electrician's piece
+of furniture, and cut it off from the common currents of the floor upon
+which it stands. Dr. Lewis enjoyed teaching and made his students enjoy
+being taught. He delighted in those anatomical conundrums to answer
+which keeps the student's eyes open and his wits awake. He was happy as
+he dexterously performed the tour de maitre of the old barber-surgeons,
+or applied the spica bandage and taught his scholars to do it, so neatly
+and symmetrically that the aesthetic missionary from the older centre of
+civilization would bend over it in blissful contemplation, as if it were
+a sunflower. Dr. Lewis had many other tastes, and was a favorite, not
+only with students, but in a wide circle, professional, antiquarian,
+masonic, and social.
+
+Dr. Otis was less widely known, but was a fluent and agreeable lecturer,
+and esteemed as a good surgeon.
+
+I must content myself with this glimpse at myself and a few of my
+fellow-students in Boston. After attending two courses of Lectures in
+the school of the University, I went to Europe to continue my studies.
+
+You may like to hear something of the famous Professors of Paris in the
+days when I was a student in the Ecole de Medicine, and following the
+great Hospital teachers.
+
+I can hardly believe my own memory when I recall the old practitioners
+and Professors who were still going round the hospitals when I mingled
+with the train of students that attended the morning visits. See that
+bent old man who is groping his way through the wards of La Charity.
+That is the famous Baron Boyer, author of the great work on surgery in
+nine volumes, a writer whose clearness of style commends his treatise to
+general admiration, and makes it a kind of classic. He slashes away at a
+terrible rate, they say, when he gets hold of the subject of fistula in
+its most frequent habitat,--but I never saw him do more than look as if
+he wanted to cut a good dollop out of a patient he was examining. The
+short, square, substantial man with iron-gray hair, ruddy face, and
+white apron is Baron Larrey, Napoleon's favorite surgeon, the most
+honest man he ever saw,--it is reputed that he called him. To go round
+the Hotel des Invalides with Larrey was to live over the campaigns
+of Napoleon, to look on the sun of Austerlitz, to hear the cannons of
+Marengo, to struggle through the icy waters of the Beresina, to shiver
+in the snows of the Russian retreat, and to gaze through the battle
+smoke upon the last charge of the red lancers on the redder field of
+Waterloo. Larrey was still strong and sturdy as I saw him, and few
+portraits remain printed in livelier colors on the tablet of my memory.
+
+Leave the little group of students which gathers about Larrey beneath
+the gilded dome of the Invalides and follow me to the Hotel Dieu, where
+rules and reigns the master-surgeon of his day, at least so far as
+Paris and France are concerned,--the illustrious Baron Dupuytren. No
+man disputed his reign, some envied his supremacy. Lisfranc shrugged his
+shoulders as he spoke of “ce grand homme de l'autre cote de la riviere,”
+ that great man on the other side of the river, but the great man he
+remained, until he bowed before the mandate which none may disobey.
+“Three times,” said Bouillaud, “did the apoplectic thunderbolt fall on
+that robust brain,”--it yielded at last as the old bald cliff that
+is riven and crashes down into the valley. I saw him before the
+first thunderbolt had descended: a square, solid man, with a high and
+full-domed head, oracular in his utterances, indifferent to those around
+him, sometimes, it was said, very rough with them. He spoke in low, even
+tones, with quiet fluency, and was listened to with that hush of rapt
+attention which I have hardly seen in any circle of listeners unless
+when such men as ex-President John Quincy Adams or Daniel Webster were
+the speakers. I do not think that Dupuytren has left a record which
+explains his influence, but in point of fact he dominated those around
+him in a remarkable manner. You must have all witnessed something of the
+same kind. The personal presence of some men carries command with it,
+and their accents silence the crowd around them, when the same words
+from other lips might fall comparatively unheeded.
+
+As for Lisfranc, I can say little more of him than that he was a
+great drawer of blood and hewer of members. I remember his ordering a
+wholesale bleeding of his patients, right and left, whatever might be
+the matter with them, one morning when a phlebotomizing fit was on
+him. I recollect his regretting the splendid guardsmen 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 I ceased 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 name widely known. Coming to Paris in wooden
+shoes, starving, almost, at first, he raised himself to great eminence
+as a surgeon and as an author, and at last obtained the Professorship
+to which his talents and learning entitled him. His example may be an
+encouragement to some of my younger hearers who are born, not with the
+silver spoon in their mouths, but with the two-tined iron fork in their
+hands. It is a poor thing to take up their milk porridge with in
+their young days, but in after years it will often transfix the solid
+dumplings that roll out of the silver spoon. So Velpeau found it. He
+had not what is called genius, he was far from prepossessing in aspect,
+looking as if he might have wielded the sledge-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
+distinction and prosperity, as some of you sitting on these benches and
+wondering anxiously what is to become of you in the struggle for life
+will have done before the twentieth century has got halfway through its
+first quarter. A good sound head over a pair of wooden shoes is a great
+deal better than a wooden head belonging to an owner who cases his feet
+in calf-skin, but a good brain is not enough without a stout heart to
+fill the four great conduits which carry at once fuel and fire to that
+mightiest of engines.
+
+How many of you who are before me are familiarly acquainted with the
+name of Broussais, or even with that of Andral? Both were lecturing at
+the Ecole de Medicine, and I often heard them. Broussais was in those
+days like an old volcano, which has pretty nearly used up its fire and
+brimstone, but is still boiling and bubbling in its interior, and now
+and then sends up a spirt of lava and a volley of pebbles. His theories
+of gastro-enteritis, of irritation and inflammation as the cause of
+disease, and the practice which sprang from them, ran over the fields of
+medicine for a time like flame over the grass of the prairies. The way
+in which that knotty-featured, savage old man would bring out the word
+irritation--with rattling and rolling reduplication of the resonant
+letter r--might have taught a lesson in articulation to Salvini. But
+Broussais's theory was languishing and well-nigh become obsolete, and
+this, no doubt, added vehemence to his defence of his cherished dogmas.
+
+Old theories, and old men who cling to them, must take themselves out of
+the way as the new generation with its fresh thoughts and altered habits
+of mind comes forward to take the place of that which is dying out. This
+was a truth which the fiery old theorist found it very hard to learn,
+and harder to bear, as it was forced upon him. For the hour of his
+lecture was succeeded by that of a younger and far more popular
+professor. As his lecture drew towards its close, the benches, thinly
+sprinkled with students, began to fill up; the doors creaked open and
+banged back oftener and oftener, until at last the sound grew almost
+continuous, and the voice of the lecturer became a leonine growl as he
+strove in vain to be heard over the noise of doors and footsteps.
+
+Broussais was now sixty-two years old. The new generation had outgrown
+his doctrines, and the Professor for whose hour the benches had filled
+themselves belonged to that new generation. Gabriel Andral was little
+more than half the age of Broussais, in the full prime and vigor of
+manhood at thirty-seven years. He was a rapid, fluent, fervid, and
+imaginative speaker, pleasing in aspect and manner,--a strong contrast
+to the harsh, vituperative old man who had just preceded him. His
+Clinique Medicale is still valuable as a collection of cases, and
+his researches on the blood, conducted in association with Gavarret,
+contributed new and valuable facts to science. But I remember him
+chiefly as one of those instructors whose natural eloquence made it
+delightful to listen to him. I doubt if I or my fellow-students did full
+justice either to him or to the famous physician of Hotel Dieu, Chomel.
+We had addicted ourselves almost too closely to the words of another
+master, by whom we were ready to swear as against all teachers that 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 young men before me, even to those who
+may know comparatively little of his works and teachings. Pierre Charles
+Alexandre Louis, at the age of forty-seven, as I recall him, was a tall,
+rather spare, dignified personage, of serene and grave aspect, but with
+a pleasant smile and kindly voice for the student with whom he came
+into personal relations. If I summed up the lessons of Louis in two
+expressions, they would be these; I do not hold him answerable for the
+words, but I will condense them after my own fashion in French, and then
+give them to you, expanded somewhat, in English:
+
+
+     Formez toujours des idees nettes.
+     Fuyez toujours les a peu pres.
+
+Always make sure that you form a distinct and clear idea of the matter
+you are considering.
+
+Always avoid vague approximations where exact estimates are possible;
+about so many,--about so much, instead of the precise number and
+quantity.
+
+Now, if there is anything on which the biological sciences have prided
+themselves in these latter years it is the substitution of quantitative
+for qualitative formulae. The “numerical system,” of which Louis was
+the great advocate, if not the absolute originator, was an attempt
+to substitute series of carefully recorded facts, rigidly counted and
+closely compared, for those never-ending records of vague, unverifiable
+conclusions with which the classics of the healing art were overloaded.
+The history of practical medicine had been like the story of the
+Danaides. “Experience” had been, from time immemorial, pouring its
+flowing treasures into buckets full of holes. At the existing rate of
+supply and leakage they would never be filled; nothing would ever be
+settled in medicine. But cases thoroughly recorded and mathematically
+analyzed would always be available for future use, and when accumulated
+in sufficient number would lead to results which would be trustworthy,
+and belong to science.
+
+You young men who are following the hospitals hardly know how much you
+are indebted to Louis. I say nothing of his Researches on Phthisis or
+his great work on Typhoid Fever. But I consider his modest and brief
+Essay on Bleeding in some Inflammatory Diseases, based on cases
+carefully observed and numerically analyzed, one of the most important
+written contributions to practical medicine, to the treatment of
+internal disease, of this century, if not since the days of Sydenham.
+The lancet was the magician's wand of the dark ages of medicine. The old
+physicians not only believed in its general efficacy as a wonder-worker
+in disease, but they believed that each malady could be successfully
+attacked from some special part of the body,--the strategic point which
+commanded the seat of the morbid affection. On a figure given in the
+curious old work of John de Ketam, no less than thirty-eight separate
+places are marked as the 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 suffering from headache should be bled
+in the foot, in preference to any other part.
+
+But what Louis did was this: he showed by a strict analysis of numerous
+cases that bleeding did not strangle,--jugulate was the word then
+used,--acute diseases, more especially pneumonia. This was not a
+reform,--it was a revolution. It was followed up in this country by the
+remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited Diseases,
+which has, I believe, done more than any other work or essay in our
+own language to rescue the practice of medicine from the slavery to the
+drugging system which was a part of the inheritance of the profession.
+
+Yes, I say, as I look back on the long hours of the many days I spent
+in the wards and in the autopsy room of La Pitie, where Louis was one
+of the attending physicians,--yes, Louis did a great work for practical
+medicine. Modest in the presence of nature, fearless in the face of
+authority, unwearying in the pursuit of truth, he was a man whom any
+student might be happy and proud to claim as his teacher and his friend,
+and yet, as I look back on the days when I followed his teachings, I
+feel that I gave myself up too exclusively to his methods of thought and
+study.
+
+There is one part of their business which certain medical practitioners
+are too apt to forget; namely, that what they should most of all try to
+do is to ward off disease, to alleviate suffering, to preserve life, or
+at least to prolong it if possible. It is not of the slightest interest
+to the patient to know whether three or three and a quarter cubic inches
+of his lung are hepatized. His mind is not occupied with thinking of
+the curious problems which are to be solved by his own autopsy,--whether
+this or that strand of the spinal marrow is the seat of this or that
+form of degeneration. He wants something to relieve his pain, to
+mitigate the anguish of dyspnea, to bring back motion and sensibility
+to the dead limb, to still the tortures of neuralgia. What is it to him
+that you can localize and name by some uncouth term the disease which
+you could not prevent and which you cannot cure? An old woman who knows
+how to make a poultice and how to put it on, and does it tuto, eito,
+jucunde, just when and where it is wanted, is better,--a thousand times
+better in many cases,--than a staring pathologist, who explores and
+thumps and doubts and guesses, and tells his patient he will be better
+tomorrow, and so goes home to tumble his books over and make out a
+diagnosis.
+
+But in those days, I, like most of my fellow students, was thinking much
+more of “science” than of practical medicine, and I believe if we had
+not clung so closely to the skirts of Louis and had followed some of
+the courses of men like Trousseau,--therapeutists, who gave special
+attention to curative methods, and not chiefly to diagnosis,--it would
+have been better for me and others. One thing, at any rate, we did
+learn in the wards of Louis. We learned that a very large proportion of
+diseases get well of themselves, without any special medication,--the
+great fact formulated, enforced, and popularized by Dr. Jacob Bigelow
+in the Discourse referred to. We unlearned the habit of drugging for its
+own sake. This detestable practice, which I was almost proscribed for
+condemning somewhat too epigrammatically a little more than twenty years
+ago, came to us, I suspect, in a considerable measure from the English
+“general practitioners,” a sort of prescribing apothecaries. You
+remember how, when the city was besieged, each artisan who was called
+upon in council to suggest the best means of defence recommended the
+articles he dealt in: the carpenter, wood; the blacksmith, iron; the
+mason, brick; until it came to be a puzzle to know which to adopt. Then
+the shoemaker said, “Hang your walls with new boots,” and gave good
+reasons why these should be the best of all possible defences. Now the
+“general practitioner” charged, as I understand, for his medicine,
+and in that way got paid for his visit. Wherever this is the practice,
+medicine is sure to become a trade, and the people learn to expect
+drugging, and to consider it necessary, because drugs are so universally
+given to the patients of the man who gets his living by them.
+
+It was something to have unlearned the pernicious habit of constantly
+giving poisons to a patient, as if they were good in themselves, of
+drawing off the blood 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 draught and mixtures,--only because he
+was sick and something must be done. But there were positive as well as
+negative facts to be learned, and some of us, I fear, came home rich
+in the negatives of the expectant practice, poor in the resources which
+many a plain country practitioner had ready in abundance for the relief
+and the cure of disease. No one instructor can be expected to do all for
+a student which he requires. Louis taught us who followed him the love
+of truth, the habit of passionless listening to the teachings of nature,
+the most careful and searching methods of observation, and the sure
+means of getting at the results to be obtained from them in the constant
+employment of accurate tabulation. He was not a showy, or eloquent, or,
+I should say, a very generally popular man, though the favorite, almost
+the idol, of many students, especially Genevese and Bostonians. But he
+was a man of lofty and admirable scientific character, and his work will
+endure in its influences long after his name is lost sight of save to
+the faded eyes of the student of medical literature.
+
+Many other names of men more or less famous in their day, and who were
+teaching while I was in Paris, come up before me. They are but empty
+sounds for the most part in the ears of persons of not more than middle
+age. Who of you knows anything of Richerand, author of a very popular
+work on Physiology, commonly put into the student's hands when I first
+began to ask for medical text-books? I heard him lecture once, and have
+had his image with me ever since as that of an old, worn-out man,--a
+venerable but dilapidated relic of an effete antiquity. To verify this
+impression I have just looked out the dates of his birth and death,
+and find that he was eighteen years younger than the speaker who is now
+addressing you. There is a terrible parallax between the period before
+thirty and that after threescore and ten, as two men of those ages look,
+one with naked eyes, one through his spectacles, at the man of fifty and
+thereabout. Magendie, I doubt not you have all heard of. I attended but
+one of his lectures. I question if one here, unless some contemporary
+of my own has strayed into the amphitheatre,--knows anything about
+Marjolin. I remember two things about his lectures on surgery, the deep
+tones of his voice as he referred to his oracle,--the earlier writer,
+Jean Louis Petit,--and his formidable snuffbox. What he taught me lies
+far down, 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 now is the fame of Bouillaud, Professor and Deputy, the
+Sangrado of his time? Where is the renown of Piorry, percussionist and
+poet, expert alike in the resonances of the thoracic cavity and those
+of the rhyming vocabulary?--I think life has not yet done with the
+vivacious Ricord, whom I remember calling the Voltaire of pelvic
+literature,--a sceptic as to the morality of the race in general, who
+would have submitted Diana to treatment with his mineral specifics, and
+ordered a course of blue pills for the vestal virgins.
+
+Ricord was born at the beginning of the century, and Piorry some years
+earlier. Cruveilhier, who died in 1874, is still remembered by his great
+work on pathological anatomy; his work on descriptive anatomy has some
+things which I look in vain for elsewhere. But where is Civiale,--where
+are Orfila, Gendrin, Rostan, Biett, Alibert,--jolly old Baron Alibert,
+whom I remember so well in his broad-brimmed hat, worn a little jauntily
+on one side, calling out to the students in the court-yard of the
+Hospital St. Louis, “Enfans de la methode naturelle, etes-vous tous
+ici?” “Children of the natural method [his own method of classification
+of skin diseases,] are you all here?” All here, then, perhaps; all
+where, now?
+
+My show of ghosts is over. It is always the same story that old men tell
+to younger ones, some few of whom will in their turn repeat the tale,
+only with altered names, to their children's children.
+
+
+   Like phantoms painted on the magic slide,
+   Forth from the darkness of the past we glide,
+   As living shadows for a moment seen
+   In airy pageant on the eternal screen,
+   Traced by a ray from one unchanging flame,
+   Then seek the dust and stillness whence we came.
+
+Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
+where he had written his Latin graduating thesis, talking of the learned
+Gaubius and the late illustrious Boerhaave and other dead Dutchmen, of
+whom you know as much, most of you, as you do of Noah's apothecary and
+the family physician of Methuselah, whose prescriptions seem to have
+been lost to posterity. Dr. Lloyd came back to Boston full of the
+teachings of Cheselden and Sharpe, William Hunter, Smellie, and Warner;
+Dr. James Jackson loved to tell of Mr. Cline and to talk of Mr. John
+Hunter; Dr. Reynolds would give you his recollections of Sir Astley
+Cooper and Mr. Abernethy; I have named the famous Frenchmen of my
+student days; Leyden, Edinburgh, London, Paris, were each in turn the
+Mecca of medical students, just as at the present day Vienna and Berlin
+are the centres where our young men crowd for instruction. These also
+must sooner or later yield their precedence and pass the torch they
+hold to other hands. Where shall it next flame at the head of the long
+procession? Shall it find its old place on the shores of the Gulf of
+Salerno, or shall it mingle its rays with the northern aurora up among
+the fiords of Norway,--or shall it be borne across the Atlantic and
+reach the banks of the Charles, where Agassiz and Wyman have taught,
+where Hagen still teaches, glowing like his own Lampyris splendidula,
+with enthusiasm, where the first of American botanists and the ablest
+of American surgeons are still counted in the roll of honor of our great
+University?
+
+Let me add a few words which shall not be other than cheerful, as I bid
+farewell to this edifice which I have known so long. I am grateful to
+the roof which has sheltered me, to the floors which have sustained me,
+though I have thought it safest always to abstain from anything like
+eloquence, lest a burst of too emphatic applause might land my class
+and myself in the cellar of the collapsing structure, and bury us in the
+fate of Korah, Dathan, and Abiram. I have helped to wear these stairs
+into hollows,--stairs which I trod when they were smooth and level,
+fresh from the plane. There are just thirty-two of them, as there were
+five and thirty years ago, but they are steeper and harder to climb, it
+seems to me, than they were then. I remember that in the early 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's room,
+that some day or other a whole class would go heels over head down this
+graded precipice, like the herd told of in Scripture story. This has
+never happened as yet; I trust it never will. I have never 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, and I
+resign it, with a wish that it were more worthy of regret, into the
+hands of my successor, with my parting benediction. Within its twilight
+precincts I have often prayed for light, like Ajax, for the daylight
+found scanty entrance, and the gaslight never illuminated its dark
+recesses. May it prove to him who comes after me like the cave of the
+Sibyl, out of the gloomy depths of which came the oracles which shone
+with the rays of truth and wisdom!
+
+This temple of learning is not surrounded by the mansions of the
+great and the wealthy. No stately avenues lead up to its facades
+and porticoes. I have sometimes felt, when convoying a distinguished
+stranger through its precincts to its door, that he might question
+whether star-eyed Science had not missed her way when she found herself
+in this not too attractive locality. I cannot regret that we--you, I
+should say--are soon to migrate to a more favored region, and carry on
+your work as teachers and as learners in ampler halls and under far more
+favorable conditions.
+
+I hope that I may have the privilege of meeting you there, possibly may
+be allowed to add my words of welcome to those of my former colleagues,
+and in that pleasing anticipation I bid good-by to this scene of my long
+labors, and, for the present at least, to the friends with whom I have
+been associated.
+
+
+
+
+
+
+APPENDUM
+
+
+
+
+NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL
+SCIENCE.
+
+Some passages contained in the original manuscript of the Address, and
+omitted in the delivery on account of its length, are restored in the
+text or incorporated with these Notes.
+
+NOTE A.--
+
+There is good reason to doubt whether the nitrate of silver has any real
+efficacy in epilepsy. It has seemed to cure many cases, but epilepsy
+is a very uncertain disease, and there is hardly anything which has
+not been supposed to cure it. Dr. Copland cites many authorities in its
+favor, most especially Lombard's cases. But De la Berge and Monneret
+(Comp. de Med. Paris), 1839, analyze these same cases, eleven in number,
+and can only draw the inference of a very questionable value in the
+supposed remedy. Dr. James Jackson says that relief of epilepsy is not
+to 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, Professor at the Royal College, Author of the Antimonial
+Martyrology, a wit and a man of sense and learning, who died almost two
+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 cured by nitrate of silver?” I said to one of the oldest and
+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 given for epilepsy? Because, as Dr. Martin
+has so well reminded us, lunatics were considered formerly to be under
+the special influence of Luna, the moon (which Esquirol, be it observed,
+utterly denies), and lunar caustic, or nitrate of silver, is a salt of
+that metal which was called luna from its whiteness, and of course
+must be in the closest relations with the moon. It follows beyond all
+reasonable question that the moon's metal, silver, and its preparations,
+must be the specific remedy for moonblasted maniacs and epileptics!
+
+Yet the practitioner who prescribes the nitrate of silver supposes he
+is guided by the solemn experience of the past, instead of by its idle
+fancies. He laughs at those old physicians who placed such confidence
+in the right hind hoof of an elk as a remedy for the same disease, and
+leaves the record of his own belief in a treatment quite as fanciful and
+far more objectionable, written in indelible ink upon a living tablet
+where he who runs may read it for a whole generation, if nature spares
+his walking advertisement so long.
+
+NOTE B.--
+
+The presumption that a man is innocent until he is proved guilty, does
+not mean that there are no rogues, but lays the onus probandi on the
+party to which it properly belongs. So with this proposition. A noxious
+agent should never be employed in sickness unless there is ample
+evidence in the particular case to overcome the general presumption
+against all such agents, and the evidence is very apt to be defective.
+
+The miserable delusion of Homoeopathy builds itself upon an axiom
+directly the opposite of this; namely, that the sick are to be cured by
+poisons. Similia similibus curantur means exactly this. It is simply
+a theory of universal poisoning, nullified in practice by the
+infinitesimal contrivance. The only way to kill it and all similar
+fancies, and to throw every quack nostrum into discredit, is to root out
+completely the suckers of the old rotten superstition that whatever is
+odious or noxious is likely to be good for disease. The current of sound
+practice with ourselves is, I believe, setting fast in the direction
+I have indicated in the above proposition. To uphold the exhibition
+of noxious agents in disease, as the rule, instead of admitting them
+cautiously and reluctantly as the exception, is, as I think, an eddy of
+opinion in the direction of the barbarism out of which we believe our
+art is escaping. It is only through the enlightened sentiment and
+action of the Medical Profession that the community can be brought to
+acknowledge that drugs should always be regarded as evils.
+
+It is true that some suppose, and our scientific and thoughtful
+associate, Dr. Gould, has half countenanced the opinion, that there may
+yet be discovered a specific for every disease. Let us not despair of
+the future, but let us be moderate in our expectations. When an oil is
+discovered that will make a bad watch keep good time; when a recipe is
+given which will turn an acephalous foetus into a promising child; when
+a man can enter the second time into his mother's womb and give her back
+the infirmities which twenty generations have stirred into her blood,
+and infused into his own through hers, we may be prepared to enlarge the
+National Pharmacopoeia with a list of specifies for everything but old
+age,--and possibly for that also.
+
+NOTE C.--
+
+The term specific is used here in its ordinary sense, without raising
+the question of the propriety of its application to these or other
+remedies.
+
+The credit of introducing Cinchona rests between the Jesuits, the
+Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
+who employed it as a secret remedy. (Pereira.) Mercury as an internal
+specific remedy was brought into use by that impudent and presumptuous
+quack, as he was considered, Paracelsus. (Encyc. Brit. art.
+“Paracelsus.”) Arsenic was introduced into England as a remedy for
+intermittents by Dr. Fowler, in consequence of the success of a patent
+medicine, the Tasteless Ague Drops, which were supposed, “probably
+with reason,” to be a preparation of that mineral. (Rees's Cyc. art.
+“Arsenic.”) Colchicum came into notice in a similar way, from the
+success of the Eau Medicinale of M. Husson, a French military officer.
+(Pereira.) Iodine was discovered by a saltpetre manufacturer, but
+applied by a physician in place of the old remedy, burnt sponge, which
+seems to owe its efficacy to it. (Dunglison, New Remedies.) As for
+Sulphur, “the common people have long used it as an ointment” for
+scabies. (Rees's Cyc. art. “Scabies.”) The modern cantiscorbutic regimen
+is credited to Captain Cook. “To his sagacity we are indebted for the
+first impulse to those regulations by which scorbutus is so successfully
+prevented in our navy.” (Lond. Cyc. Prac. Med. art. “Scorbutus.”) Iron
+and various salts which enter into the normal composition of the human
+body do not belong to the materia medica by our definition, but to the
+materia alimentaria.
+
+For the first introduction of iron as a remedy, see Pereira, who gives a
+very curious old story.
+
+The statement in the text concerning a portion of the materia medica
+stands exactly as delivered, and is meant exactly as it stands. No
+denunciation of drugs, as sparingly employed by a wise physician, was
+or is intended. If, however, as Dr. Gould stated in his “valuable
+and practical discourse” to which the Massachusetts Medical Society
+“listened with profit as well as interest,” “Drugs, in themselves
+considered, may always be regarded as evils,”--any one who chooses may
+question whether the evils from their abuse are, on the whole, greater
+or less than the undoubted benefits obtained from their proper use. The
+large exception of opium, wine, specifics, and anaesthetics, made in the
+text, takes off enough from the useful side, as I fully believe, to turn
+the balance; so that a vessel containing none of these, but loaded with
+antimony, strychnine, acetate of lead, aloes, aconite, lobelia, lapis
+infernalis, stercus diaboli, tormentilla, and other approved, and, in
+skilful hands, really useful remedies, brings, on the whole, more harm
+than good to the port it enters.
+
+It is a very narrow and unjust view of the practice of medicine, to
+suppose it to consist altogether in the use of powerful drugs, or of
+drugs of any kind. Far from it. “The physician may do very much for the
+welfare of the sick, more than others can do, although he does not,
+even in the major part of cases, undertake to control and overcome
+the disease by art. It was with these views that I never reported any
+patient cured at our hospital. Those who recovered their health were
+reported as well; not implying that they were made so by the active
+treatment they had received there. But it was to be understood that all
+patients received in that house were to be cured, that is, taken care
+of.” (Letters to a Young Physician, by James Jackson, M. D., Boston,
+1855.)
+
+“Hygienic rules, properly enforced, fresh air, change of air, travel,
+attention to diet, good and appropriate food judiciously regulated,
+together with the administration of our tonics, porter, ale, wine, iron,
+etc., supply the diseased or impoverished system with what Mr. Gull, of
+St. Bartholomew's Hospital, aptly calls the 'raw material of the blood;'
+and we believe that if any real improvement has taken place in medical
+practice, independently of those truly valuable contributions we have
+before described, it is in the substitution of tonics, stimulants, and
+general management, for drastic cathartics, for bleeding, depressing
+agents, including mercury, tartar emetics, etc., so much in vogue during
+the early part even of this century.” (F. P. Porcher, in Charleston Med.
+Journal and Review for January, 1860.)
+
+
+
+
+
+End of Project Gutenberg's Medical Essays, by Oliver Wendell Holmes, Sr.
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+
+<html xmlns="http://www.w3.org/1999/xhtml" lang="en">
+  <head>
+    <title>
+      Medical Essays, by Oliver Wendell Holmes
+    </title>
+    <style type="text/css" xml:space="preserve">
+
+    body { margin:5%; background:#faebd0; text-align:justify}
+    P { text-indent: 1em; margin-top: .25em; margin-bottom: .25em; }
+    H1,H2,H3,H4,H5,H6 { text-align: center; margin-left: 15%; margin-right: 15%; }
+    hr  { width: 50%; text-align: center;}
+    .foot { margin-left: 20%; margin-right: 20%; text-align: justify; text-indent: -3em; font-size: 90%; }
+    blockquote {font-size: 97%; font-style: italic; margin-left: 10%; margin-right: 10%;}
+    .mynote    {background-color: #DDE; color: #000; padding: .5em; margin-left: 10%; margin-right: 10%; font-family: sans-serif; font-size: 95%;}
+    .toc       { margin-left: 10%; margin-bottom: .75em;}
+    .toc2      { margin-left: 20%;}
+    div.fig { display:block; margin:0 auto; text-align:center; }
+    .figleft   {float: left; margin-left: 0%; margin-right: 1%;}
+    .figright  {float: right; margin-right: 0%; margin-left: 1%;}
+    pre     { font-style: italic; font-size: 90%; margin-left: 10%;}
+
+</style>
+  </head>
+  <body>
+    <p>
+      <br /><br />
+    </p>
+<pre xml:space="preserve">
+The Project Gutenberg EBook of Medical Essays, by Oliver Wendell Holmes, Sr.
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Medical Essays
+
+Author: Oliver Wendell Holmes, Sr.
+
+Release Date: August 16, 2006 [EBook #2700]
+Last Updated: February 18, 2018
+
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK MEDICAL ESSAYS ***
+
+
+Produced by David Widger
+
+
+
+
+
+</pre>
+
+    <h1>
+      MEDICAL ESSAYS
+    </h1>
+    <h2>
+      By Oliver Wendell Holmes
+    </h2>
+    <p>
+      <br /><br />
+    </p>
+    <h3>
+      1842-1882
+    </h3>
+    <p>
+      <br /> <br />
+    </p>
+    <hr />
+    <p>
+      <br /> <br />
+    </p>
+    <blockquote>
+      <p class="toc">
+        <big><b>CONTENTS</b></big>
+      </p>
+      <p>
+        <br />
+      </p>
+      <p class="toc">
+        <a href="#link2H_PREF"> PREFACE. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0002"> A SECOND PREFACE. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_PREF2"> PREFACE TO THE NEW EDITION. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0004"> HOMOEOPATHY AND ITS KINDRED DELUSIONS </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0005"> THE CONTAGIOUSNESS OF PUERPERAL FEVER </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0006"> CURRENTS AND COUNTER-CURRENTS IN MEDICAL
+        SCIENCE </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0008"> BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF
+        MEDICAL SCIENCE. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0009"> SCHOLASTIC AND BEDSIDE TEACHING. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0010"> THE MEDICAL PROFESSION IN MASSACHUSETTS. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0011"> THE YOUNG PRACTITIONER </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0012"> MEDICAL LIBRARIES. </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0013"> SOME OF MY EARLY TEACHERS </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_4_0014"> APPENDUM </a>
+      </p>
+      <p class="toc">
+        <a href="#link2H_NOTE"> NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
+        CURRENTS IN MEDICAL SCIENCE. </a>
+      </p>
+    </blockquote>
+    <p>
+      <br /> <br />
+    </p>
+    <hr />
+    <p>
+      <br /> <br /> <a name="link2H_PREF" id="link2H_PREF">
+      <!--  H2 anchor --> </a>
+    </p>
+    <h2>
+      PREFACE.
+    </h2>
+    <p>
+      The character of the opposition which some of these papers have met with
+      suggests the inference that they contain really important, but unwelcome
+      truths. Negatives multiplied into each other change their sign and become
+      positives. Hostile criticisms meeting together are often equivalent to
+      praise, and the square of fault-finding turns out to be the same thing as
+      eulogy.
+    </p>
+    <p>
+      But a writer has rarely so many enemies as it pleases him to believe.
+      Self-love leads us to overrate the numbers of our negative constituency.
+      The larger portion of my limited circle of readers must be quite
+      indifferent to, if not ignorant of, the adverse opinions which have been
+      expressed or recorded concerning any of these Addresses or Essays now
+      submitted to their own judgment. It is proper, however, to inform them,
+      that some of the positions maintained in these pages have been unsparingly
+      attacked, with various degrees of ability, scholarship, and good-breeding.
+      The tone of criticism naturally changes with local conditions in different
+      parts of a country extended like our own, so that it is one of the most
+      convenient gauges of the partial movements in the direction of
+      civilization. It is satisfactory to add, that the views assailed have also
+      been unflinchingly defended by unsought champions, among the ablest of
+      whom it is pleasant to mention, at this moment of political alienation,
+      the Editor of the Charleston Medical Journal.
+    </p>
+    <p>
+      &ldquo;Currents and Counter-Currents&rdquo; was written and delivered as an Oration, a
+      florid rhetorical composition, expressly intended to secure the attention
+      of an audience not easy to hold as listeners. It succeeded in doing this,
+      and also in being as curiously misunderstood and misrepresented as if it
+      had been a political harangue. This gave it more local notoriety than it
+      might otherwise have attained, so that, as I learn, one ingenious person
+      made use of its title as an advertisement to a production of his own.
+    </p>
+    <p>
+      The commonest mode of misrepresentation was this: qualified propositions,
+      the whole meaning of which depended on the qualifications, were stripped
+      of these and taken as absolute. Thus, the attempt to establish a
+      presumption against giving poisons to sick persons was considered as
+      equivalent to condemning the use of these substances. The only important
+      inference the writer has been able to draw from the greater number of the
+      refutations of his opinions which have been kindly sent him, is that the
+      preliminary education of the Medical Profession is not always what it
+      ought to be.
+    </p>
+    <p>
+      One concession he is willing to make, whatever sacrifice of pride it may
+      involve. The story of Massasoit, which has furnished a coral, as it were,
+      for some teething critics, when subjected to a powerful logical analysis,
+      though correct in its essentials, proves to have been told with
+      exceptionable breadth of statement, and therefore (to resume the metaphor)
+      has been slightly rounded off at its edges, so as to be smoother for any
+      who may wish to bite upon it hereafter. In other respects the Discourse
+      has hardly been touched. It is only an individual's expression, in his own
+      way, of opinions entertained by hundreds of the Medical Profession in
+      every civilized country, and has nothing in it which on revision the
+      writer sees cause to retract or modify. The superstitions it attacks lie
+      at the very foundation of Homoeopathy, and of almost every form of medical
+      charlatanism. Still the mere routinists and unthinking artisans in most
+      callings dislike whatever shakes the dust out of their traditions, and it
+      may be unreasonable to expect that Medicine will always prove an exception
+      to the rule. One half the opposition which the numerical system of Louis
+      has met with, as applied to the results of treatment, has been owing to
+      the fact that it showed the movements of disease to be far more
+      independent of the kind of practice pursued than was agreeable to the
+      pride of those whose self-confidence it abated.
+    </p>
+    <p>
+      The statement, that medicines are more sparingly used in physicians'
+      families than in most others, admits of a very natural explanation,
+      without putting a harsh construction upon it, which it was not intended to
+      admit. Outside pressure is less felt in the physician'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 who have more confidence in
+      drugging than his own family commonly has, the learned Professor Dunglison
+      is hereby requested to apologize for his definition of the word Placebo,
+      or to expunge it from his Medical Dictionary.
+    </p>
+    <p>
+      One thing is certain. A loud outcry on a slight touch reveals the weak
+      spot in a profession, as well as in a patient. It is a doubtful policy to
+      oppose the freest speech in those of our own number who are trying to show
+      us where they honestly believe our weakness lies. Vast as are the advances
+      of our Science and Art, may it not possibly prove on examination that we
+      retain other old barbarisms beside the use of the astrological sign of
+      Jupiter, with which we endeavor to insure good luck to our prescriptions?
+      Is it the act of a friend or a foe to try to point them out to our
+      brethren when asked to address them, and is the speaker to subdue the
+      constitutional habit of his style to a given standard, under penalty of
+      giving offence to a grave assembly?
+    </p>
+    <p>
+      &ldquo;Homoeopathy and its Kindred Delusions&rdquo; was published nearly twenty years
+      ago, and has been long out of print, so that the author tried in vain to
+      procure a copy until the kindness of a friend supplied him with the only
+      one he has had for years. A foolish story reached his ears that he was
+      attempting to buy up stray copies for the sake of suppressing it. This
+      edition was in the press at that very time.
+    </p>
+    <p>
+      Many of the arguments contained in the Lectures have lost whatever novelty
+      they may have possessed. All its predictions have been submitted to the
+      formidable test of time. They appear to have stood it, so far, about as
+      well as most uninspired prophecies; indeed, some of them require much less
+      accommodation than certain grave commentators employ in their readings of
+      the ancient Prophets.
+    </p>
+    <p>
+      If some statistics recently published are correct, Homoeopathy has made
+      very slow progress in Europe.
+    </p>
+    <p>
+      In all England, as it appears, there are hardly a fifth more Homoeopathic
+      practitioners than there are students attending Lectures at the
+      Massachusetts Medical College at the present time. In America it has
+      undoubtedly proved more popular and lucrative, yet how loose a hold it has
+      on the public confidence is shown by the fact that, when a specially
+      valued life, which has been played with by one of its agents, is seriously
+      threatened, the first thing we expect to hear is that a regular
+      practitioner is by the patient's bed, and the Homoeopathic counsellor
+      overruled or discarded. Again, how many of the ardent and capricious
+      persons who embraced Homoeopathy have run the whole round of pretentious
+      novelties;&mdash;have been boarded at water-cure establishments, closeted
+      with uterine and other specialists, and finally wandered over seas to put
+      themselves in charge of foreign celebrities, who dosed them as lustily as
+      they were ever dosed before they took to globules! It will surprise many
+      to learn to what a shadow of a shade Homoeopathy has dwindled in the hands
+      of many of its noted practitioners. The itch-doctrine is treated with
+      contempt. Infinitesimal doses are replaced by full ones whenever the
+      fancy-practitioner chooses. Good Homoeopathic reasons can be found for
+      employing anything that anybody wants to employ. Homoeopathy 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 cases
+      where we would thankfully sacrifice all our prejudices and give the world
+      to have them true to their promises.
+    </p>
+    <p>
+      Homoeopathy has not died out so rapidly as Tractoration. Perhaps it was
+      well that it should not, for it has taught us a lesson of the healing
+      faculty of Nature which was needed, and for which many of us have made
+      proper acknowledgments. But it probably does more harm than good to
+      medical science at the present time, by keeping up the delusion of
+      treating everything by specifics,&mdash;the old barbarous notion that sick
+      people should feed on poisons [Lachesis, arrow-poison, obtained from a
+      serpent (Pulte). Crotalus horridus, rattlesnake's venom (Neidhard). The
+      less dangerous Pediculus capitis is the favorite remedy of Dr. Mure, the
+      English &ldquo;Apostle of Homoeopathy.&rdquo; These are examples of the retrograde
+      current setting towards barbarism] against which a part of the Discourse
+      at the beginning of this volume is directed.
+    </p>
+    <p>
+      The infinitesimal globules have not become a curiosity as yet, like
+      Perkins's Tractors. But time is a very elastic element in Geology and
+      Prophecy. If Daniel's seventy weeks mean four hundred and ninety years, as
+      the learned Prideaux and others have settled it that they do, the &ldquo;not
+      many years&rdquo; of my prediction may be stretched out a generation or two
+      beyond our time, if necessary, when the prophecy will no doubt prove true.
+    </p>
+    <p>
+      It might be fitting to add a few words with regard to the Essay on the
+      Contagiousness of Puerperal Fever. But the whole question I consider to be
+      now transferred from the domain of medical inquiry to the consideration of
+      Life Insurance agencies and Grand Juries. For the justification of this
+      somewhat sharply accented language I must refer the reader to the paper
+      itself for details which I regret to have been forced to place on
+      permanent record.
+    </p>
+    <p>
+      BOSTON, January, 1861.
+    </p>
+    <p>
+      <a name="link2H_4_0002" id="link2H_4_0002">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      A SECOND PREFACE.
+    </h2>
+    <p>
+      These Lectures and Essays are arranged in the order corresponding to the
+      date of their delivery or publication. They must, of course, be read with
+      a constant reference to these dates, by such as care to read them. I have
+      not attempted to modernize their aspect or character in presenting them,
+      in this somewhat altered connection, to the public. Several of them were
+      contained in a former volume which received its name from the Address
+      called &ldquo;Currents and Counter-Currents.&rdquo; Some of those contained in the
+      former volume have been replaced by others. The Essay called &ldquo;Mechanism of
+      Vital Actions&rdquo; has been transferred to a distinct collection of
+      Miscellaneous essays, forming a separate volume.
+    </p>
+    <p>
+      I had some intention of including with these papers an Essay on
+      Intermittent Fever in New England, which received one of the Boylston
+      prizes in 1837, and was published in the following year. But as this was
+      upon a subject of local interest, chiefly, and would have taken up a good
+      deal of room, I thought it best to leave it out, trusting that the stray
+      copies to be met with in musty book-shops would sufficiently supply the
+      not very extensive or urgent demand for a paper almost half a century old.
+    </p>
+    <p>
+      Some of these papers created a little stir when they first fell from the
+      press into the pool of public consciousness. They will slide in very
+      quietly now in this new edition, and find out for themselves whether the
+      waters are those of Lethe, or whether they are to live for a time as not
+      wholly unvalued reminiscences.
+    </p>
+    <p>
+      March 21, 1883.
+    </p>
+    <p>
+      <a name="link2H_PREF2" id="link2H_PREF2">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      PREFACE TO THE NEW EDITION.
+    </h2>
+    <p>
+      These Essays are old enough now to go alone without staff or crutch in the
+      shape of Prefaces. A very few words may be a convenience to the reader who
+      takes up the book and wishes to know what he is likely to find in it.
+    </p>
+<pre xml:space="preserve">
+        HOMOEOPATHY AND ITS KINDRED DELUSIONS.
+</pre>
+    <p>
+      Homoeopathy has proved lucrative, and so long as it continues to be so
+      will surely exist,&mdash;as surely as astrology, palmistry, and other
+      methods of getting a living out of the weakness and credulity of mankind
+      and womankind. Though it has no pretensions to be considered as belonging
+      among the sciences, it may be looked upon by a scientific man as a curious
+      object 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
+      studied it in the Essay before the reader, under the aspect of an
+      extravagant and purely imaginative creation of its founder. Since that
+      first essay was written, nearly half a century ago, we have all had a
+      chance to witness its practical working. Two opposite inferences may be
+      drawn from its doctrines and practice. The first is that which is accepted
+      by its disciples. This is that all diseases are &ldquo;cured&rdquo; by drugs. The
+      opposite conclusion is drawn by a much larger number of persons. As they
+      see that patients are very commonly getting well under treatment by
+      infinitesimal drugging, which they consider equivalent to no medication at
+      all, they come to disbelieve in every form of drugging and put their whole
+      trust in &ldquo;nature.&rdquo; Thus experience,
+    </p>
+<pre xml:space="preserve">
+     &ldquo;From seeming evil still educing good,&rdquo;
+ </pre>
+    <p>
+      has shown that the dealers in this preposterous system of
+      pseudo-therapeutics have cooperated with the wiser class of practitioners
+      in breaking up the system of over-dosing and over-drugging which has been
+      one of the standing reproaches of medical practice. While keeping up the
+      miserable delusion that diseases were all to be &ldquo;cured&rdquo; by drugging,
+      Homoeopathy has been unintentionally showing that they would very
+      generally get well without any drugging at all. In the mean time the newer
+      doctrines of the &ldquo;mind cure,&rdquo; the &ldquo;faith cure,&rdquo; and the rest are
+      encroaching on the territory so long monopolized by that most ingenious of
+      the pseudo-sciences. It would not be surprising if its whole ground should
+      be taken possession of by these new claimants with their flattering
+      appeals to the imaginative class of persons open to such attacks. Similia
+      similabus may prove fatally true for once, if Homoeopathy is killed out by
+      its new-born rivals.
+    </p>
+    <p>
+      It takes a very moderate amount of erudition to unearth a charlatan like
+      the supposed father of the infinitesimal dosing system. The real inventor
+      of that specious trickery was an Irishman by the name of Butler. The whole
+      story is to be found in the &ldquo;Ortus Medicinae&rdquo; of Van Helmont. I have given
+      some account of his chapter &ldquo;Butler&rdquo; in different articles, but I would
+      refer the students of our Homoeopathic educational institutions to the
+      original, which they will find very interesting and curious.
+    </p>
+<pre xml:space="preserve">
+          CURRENTS AND COUNTER-CURRENTS
+</pre>
+    <p>
+      My attack on over-drugging brought out some hostile comments and
+      treatment. Thirty years ago I expressed myself with more vivacity than I
+      should show if I were writing on the same subjects today. Some of my more
+      lively remarks called out very sharp animadversion. Thus my illustration
+      of prevention as often better than treatment in the mother's words to her
+      child which had got a poisonous berry in its mouth,&mdash;&ldquo;Spit it out!&rdquo;
+       gave mortal offence to a well-known New York practitioner and writer, who
+      advised the Massachusetts Medical Society to spit out the offending
+      speaker. Worse than this was my statement of my belief that if a ship-load
+      of miscellaneous drugs, with certain very important exceptions,&mdash;drugs,
+      many of which were then often given needlessly and in excess, as then used
+      &ldquo;could be sunk to the bottom of the sea, it would be all the better for
+      mankind and all the worse for the fishes.&rdquo; This was too bad. The sentence
+      was misquoted, quoted without its qualifying conditions, and frightened
+      some of my worthy professional brethren as much as if I had told them to
+      throw all physic to the dogs. But for the epigrammatic sting the sentiment
+      would have been unnoticed as a harmless overstatement at the very worst.
+    </p>
+    <p>
+      Since this lecture was delivered a great and, as I think, beneficial
+      change has taken place in the practice of medicine. The habit of the
+      English &ldquo;general practitioner&rdquo; of making his profit out of the pills and
+      potions he administered was ruinous to professional advancement and the
+      dignity of the physician. When a half-starving medical man felt that he
+      must give his patient draught and boluses for which he could charge him,
+      he was in a pitiable position and too likely to persuade himself that his
+      drugs were useful to 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 the errors I combated.
+    </p>
+<pre xml:space="preserve">
+        THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+</pre>
+    <p>
+      This Essay was read before a small Association called &ldquo;The Society for
+      Medical Improvement,&rdquo; and published in a Medical Journal which lasted but
+      a single year. It naturally attracted less attention than it would have
+      done if published in such a periodical as the &ldquo;American Journal of Medical
+      Sciences.&rdquo; Still it had its effect, as I have every reason to believe. I
+      cannot doubt that it has saved the lives of many young mothers by calling
+      attention to the existence and propagation of &ldquo;Puerperal Fever as a
+      Private Pestilence,&rdquo; and laying down rules for taking the necessary
+      precautions against it. The case has long been decided in favor of the
+      views I advocated, but, at the time when I wrote two of the most
+      celebrated professors of Obstetrics in this country opposed my conclusions
+      with all the weight of their experience and position.
+    </p>
+    <p>
+      This paper was written in a great heat and with passionate indignation. If
+      I touched it at all I might trim its rhetorical exuberance, but I prefer
+      to leave it all its original strength of expression. I could not, if I had
+      tried, have disguised the feelings with which I regarded the attempt to
+      put out of sight the frightful facts which I brought forward and the
+      necessary conclusions to which they led. Of course the whole matter has
+      been looked at in a new point of view since the microbe as a vehicle of
+      contagion has been brought into light, and explained the mechanism of that
+      which was plain enough as a fact to all who were not blind or who did not
+      shut their eyes.
+    </p>
+    <p>
+      O. W. H.
+    </p>
+    <p>
+      BEVERLY Farms, Mass., August 3, 1891
+    </p>
+    <p>
+      <a name="link2H_4_0004" id="link2H_4_0004">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      HOMOEOPATHY AND ITS KINDRED DELUSIONS
+    </h2>
+    <p>
+      [Two lectures delivered before the Boston Society for the Diffusion of
+      Useful Knowledge. 1842.]
+    </p>
+    <p>
+      [When a physician attempts to convince a person, who has fallen into the
+      Homoeopathic delusion, of the emptiness of its pretensions, he is often
+      answered by a statement of cases in which its practitioners are thought to
+      have effected wonderful cures. The main object of the first of these
+      Lectures is to show, by abundant facts, that such statements, made by
+      persons unacquainted with the fluctuations of disease and the fallacies of
+      observation, are to be considered in general as of little or no value in
+      establishing the truth of a medical doctrine or the utility of a method of
+      practice.
+    </p>
+    <p>
+      Those kind friends who suggest to a person suffering from a tedious
+      complaint, that he &ldquo;Had better try Homoeopathy,&rdquo; are apt to enforce their
+      suggestion by adding, that &ldquo;at any rate it can do no harm.&rdquo; This may or
+      may not be true as regards the individual. But it always does very great
+      harm to the community to encourage ignorance, error, or deception in a
+      profession which deals with the life and health of our fellow-creatures.
+      Whether or not those who countenance Homoeopathy are guilty of this
+      injustice towards others, the second of these Lectures may afford them
+      some means of determining.
+    </p>
+    <p>
+      To deny that good effects may happen from the observance of diet and
+      regimen when prescribed by Homoeopathists as well as by others, would be
+      very unfair to them. But to suppose that men with minds so constituted as
+      to accept such statements and embrace such doctrines as make up the
+      so-called science of Homoeopathy are more competent than others to
+      regulate the circumstances which influence the human body in health and
+      disease, would be judging very harshly the average capacity of ordinary
+      practitioners.
+    </p>
+    <p>
+      To deny that some patients may have been actually benefited through the
+      influence exerted upon their imaginations, would be to refuse to
+      Homoeopathy what all are willing to concede to every one of those numerous
+      modes of practice known to all intelligent persons by an opprobrious
+      title.
+    </p>
+    <p>
+      So long as the body is affected through the mind, no audacious device,
+      even of the most manifestly dishonest character, can fail of producing
+      occasional good to those who yield it an implicit or even a partial faith.
+      The argument founded on this occasional good would be as applicable in
+      justifying the counterfeiter and giving circulation to his base coin, on
+      the ground that a spurious dollar had often relieved a poor man's
+      necessities.
+    </p>
+    <p>
+      Homoeopathy has come before our public at a period when the growing spirit
+      of eclecticism has prepared many ingenious and honest minds to listen to
+      all new doctrines with a candor liable to degenerate into weakness. It is
+      not impossible that the pretended evolution of great and mysterious
+      virtues from infinitely attenuated atoms may have enticed a few
+      over-refining philosophers, who have slid into a vague belief that matter
+      subdivided grows less material, and approaches nearer to a spiritual
+      nature as it requires a more powerful microscope for its detection.
+    </p>
+    <p>
+      However this may be, some persons seem disposed to take the ground of
+      Menzel that the Laity must pass formal judgment between the Physician and
+      the Homoeopathist, 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 in these Lectures upon this shadowy system; which,
+      in the calm and serious judgment of many of the wisest members of the
+      medical profession, is not entitled by anything it has ever said or done
+      to the notoriety of a public rebuke, still less to the honors of critical
+      martyrdom.]
+    </p>
+    <p>
+      I.
+    </p>
+    <p>
+      I have selected four topics for this lecture, the first three of which I
+      shall touch but slightly, the last more fully. They are
+    </p>
+    <p>
+      1. The Royal cure of the King's Evil, or Scrofula.
+    </p>
+    <p>
+      2. The Weapon Ointment, and its twin absurdity, the Sympathetic Powder.
+    </p>
+    <p>
+      3. The Tar-water mania of Bishop Berkeley.
+    </p>
+    <p>
+      4. The History of the Metallic Tractors, or Perkinism.
+    </p>
+    <p>
+      The first two illustrate the ease with which numerous facts are
+      accumulated to prove the most fanciful and senseless extravagances.
+    </p>
+    <p>
+      The third exhibits the entire insufficiency of exalted wisdom, immaculate
+      honesty, and vast general acquirements to make a good physician of a great
+      bishop.
+    </p>
+    <p>
+      The fourth shows us the intimate machinery of an extinct delusion, which
+      flourished only forty years ago; drawn in all its details, as being a rich
+      and comparatively recent illustration of the pretensions, the arguments,
+      the patronage, by means of which windy errors have long been, and will
+      long continue to be, swollen into transient consequence. All display in
+      superfluous abundance the boundless credulity and excitability of mankind
+      upon subjects connected with medicine.
+    </p>
+    <p>
+      &ldquo;From the time of Edward the Confessor to Queen Anne, the monarchs of
+      England were in the habit of touching those who were brought to them
+      suffering with the scrofula, for the cure of that distemper. William the
+      Third had good sense enough to discontinue the practice, but Anne resumed
+      it, and, among her other patients, performed the royal operation upon a
+      child, who, in spite of his, disease, grew up at last into Samuel Johnson.
+      After laying his hand upon the sufferers, it was customary for the monarch
+      to hang a gold piece around the neck of each patient. Very strict
+      precautions were adopted to prevent those who thought more of the golden
+      angel hung round the neck by a white ribbon, than of relief of their
+      bodily infirmities, from making too many calls, as they sometimes
+      attempted to do. According to the statement of the advocates and
+      contemporaries of this remedy, none ever failed of receiving benefit
+      unless their little faith and credulity starved their merits. Some are
+      said to have been cured immediately on the very touch, 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 for several
+      weeks, and months, and obliged even to be led to Whitehall, yet recovered
+      their sight immediately upon being touched, so as to walk away without any
+      guide.&rdquo; So widely, at one period, was the belief diffused, that, in the
+      course of twelve years, nearly a hundred thousand persons were touched by
+      Charles the Second. Catholic divines; in disputes upon the orthodoxy of
+      their church, did not deny that the power had descended to protestant
+      princes;&mdash;Dr. Harpsfield, in his &ldquo;Ecclesiastical History of England,&rdquo;
+       admitted it, and in Wiseman's words, &ldquo;when Bishop Tooker would make use of
+      this Argument to prove the Truth of our Church, Smitheus doth not
+      thereupon go about to deny the Matter of fact; nay, both he and Cope
+      acknowledge it.&rdquo; &ldquo;I myself,&rdquo; says Wiseman, the best English surgical
+      writer of his day,[Edinburgh Medical and Surgical Journal, vol. iii. p.
+      103.]&mdash;&ldquo;I my self have been a frequent Eye-witness of many hundred of
+      Cures performed by his Majesties Touch alone, without any assistance of
+      Chirurgery; and those, many of them such as had tired out the endeavours
+      of able Chirurgeons before they came hither. It were endless to recite
+      what I myself have seen, and what I have received acknowledgments of by
+      Letter, not only from the severall parts of this Nation, but also from
+      Ireland, Scotland, Jersey, Garnsey. It is needless also to remember what
+      Miracles of this nature were performed by the very Bloud of his late
+      Majesty of Blessed memory, after whose decollation by the inhuman
+      Barbarity of the Regicides, the reliques of that were gathered on Chips
+      and in Handkerchieffs by the pious Devotes, who could not but think so
+      great a suffering in so honourable and pious a Cause, would be attended by
+      an extraordinary assistance 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.&rdquo; [Severall Chirurgicall Treatises.
+      London.1676. p. 246.]
+    </p>
+    <p>
+      Obstinate and incredulous men, as he tells us, accounted for these cures
+      in three ways: by the journey and change of air the patients obtained in
+      coming to London; by the influence of imagination; and the wearing of
+      gold.
+    </p>
+    <p>
+      To these objections he answers, 1st. That many of those cured were
+      inhabitants of the city. 2d. That the subjects of treatment were
+      frequently infants. 3d. That sometimes silver was given, and sometimes
+      nothing, yet the patients were cured.
+    </p>
+    <p>
+      A superstition resembling this probably exists at the present time in some
+      ignorant districts of England and this country. A writer in a Medical
+      Journal in the year 1807, speaks of a farmer in Devonshire, who, being a
+      ninth son of a ninth son, is thought endowed with healing powers like
+      those of ancient royalty, and who is accustomed one day in every week to
+      strike for the evil.
+    </p>
+    <p>
+      I remember that one of my schoolmates told me, when a boy, of a seventh
+      son of a seventh son, somewhere in Essex County, who touched for the
+      scrofula, and who used to hang a silver fourpence halfpenny about the neck
+      of those who came to him, which fourpence halfpenny it was solemnly
+      affirmed became of a remarkably black color after having been some time
+      worn, and that his own brother had been subjected to this extraordinary
+      treatment; but I must add that my schoolmate drew a bow of remarkable
+      length, strength, and toughness for his tender years.
+    </p>
+    <p>
+      One of the most curious examples of the fallacy of popular belief and the
+      uncertainty of asserted facts in medical experience is to be found in the
+      history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
+    </p>
+    <p>
+      Fabricius Hildanus, whose name is familiar to every surgical scholar, and
+      Lord Bacon, who frequently dipped a little into medicine, are my principal
+      authorities for the few circumstances I shall mention regarding it. The
+      Weapon Ointment was a preparation used for the healing of wounds, but
+      instead of its being applied to them, the injured part was washed and
+      bandaged, and the weapon with which the wound was inflicted was carefully
+      anointed with the unguent. Empirics, ignorant barbers, and men of that
+      sort, are said to have especially employed it. Still there were not
+      wanting some among the more respectable members of 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, rather than the wound or
+      weapon, entered into all. Such were portions of mummy, of human blood, and
+      of moss from the skull of a thief hung in chains.
+    </p>
+    <p>
+      Hildanus was a wise and learned man, one of the best surgeons of his time.
+      He was fully aware that a part of the real secret of the Unguentum
+      Armarium consisted in the washing and bandaging the wound and then letting
+      it alone. But he could not resist the solemn assertions respecting its
+      efficacy; he gave way before the outcry of facts, and therefore, instead
+      of denying all their pretensions, he admitted and tried to account for
+      them upon supernatural grounds. As the virtue of those applications, he
+      says, which are made to the weapon cannot reach the wound, and as they can
+      produce no effect without contact, it follows, of necessity, that the
+      Devil must have a hand in the business; and as he is by far the most long
+      headed and experienced of practitioners, he cannot find this a matter of
+      any great difficulty. Hildanus himself reports, in detail, the case of a
+      lady who had received a moderate wound, for which the Unguentum Armarium
+      was employed without the slightest use. Yet instead of receiving this flat
+      case of failure as any evidence against the remedy, he accounts for its
+      not succeeding by the devout character of the lady, and her freedom from
+      that superstitious and over-imaginative tendency which the Devil requires
+      in those who are to be benefited by his devices.
+    </p>
+    <p>
+      Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
+      having in its favor the testimony of men of credit, though, in his own
+      language, he himself &ldquo;as yet is not fully inclined to believe it.&rdquo; His
+      remarks upon the asserted facts respecting it show a mixture of wise
+      suspicion and partial belief. He does not like the precise directions
+      given as to the circumstances under which the animals from which some of
+      the materials were obtained were to be killed; for he thought it looked
+      like a provision for an excuse in case of failure, by laying the fault to
+      the omission of some of these circumstances. But he likes well that &ldquo;they
+      do not observe the confecting of the Ointment under any certain
+      constellation; which is commonly the excuse of magical medicines, when
+      they fail, that they were not made under a fit figure of heaven.&rdquo; [This
+      was a mistake, however, since the two recipes given by Hildanus are both
+      very explicit as to the aspect of the heavens required for different
+      stages of the process.] &ldquo;It was pretended that if the offending weapon
+      could not be had, it would serve the purpose to anoint a wooden one made
+      like it.&rdquo; &ldquo;This,&rdquo; says Bacon, &ldquo;I should doubt to be a device to keep this
+      strange form of cure in request and use; because many times you cannot
+      come by the weapon itself.&rdquo; And in closing his remarks on the statements
+      of the advocates of the ointment, he says, &ldquo;Lastly, it will cure a beast
+      as well as a man, which I like best of all the rest, because it subjecteth
+      the matter to an easy trial.&rdquo; It is worth remembering, that more than two
+      hundred years ago, when an absurd and fantastic remedy was asserted to
+      possess wonderful power, and when sensible persons ascribed its pretended
+      influence to imagination, it was boldly answered that the cure took place
+      when the wounded party did not know of the application made to the weapon,
+      and even when a brute animal was the subject of the experiment, and that
+      this assertion, as we all know it was, came in such a shape as to shake
+      the incredulity of the keenest thinker of his time. The very same
+      assertion has been since repeated in favor of Perkinism, and, since that,
+      of Homoeopathy.
+    </p>
+    <p>
+      The same essential idea as that of the Weapon Ointment reproduced itself
+      in the still more famous SYMPATHETIC POWDER. This Powder was said to have
+      the faculty, if applied to the blood-stained garments of a wounded person,
+      to cure his injuries, even though he were at a great distance at the time.
+      A friar, returning from the East, brought the recipe to Europe somewhat
+      before the middle of the seventeenth century. The Grand Duke of Florence,
+      in which city the friar was residing, heard of his cures, and tried, but
+      without success, to obtain his secret. Sir Kenehn Digby, an Englishman
+      well known to fame, was fortunate enough to do him a favor, which wrought
+      upon his feelings and induced him to impart to his benefactor the
+      composition of his extraordinary Powder. This English knight was at
+      different periods of his life an admiral, a theologian, a critic, a
+      metaphysician, a politician, and a disciple of Alchemy. As is not
+      unfrequent with versatile and inflammable people, he caught fire at the
+      first spark of a new medical discovery, and no sooner got home to England
+      than he began to spread the conflagration.
+    </p>
+    <p>
+      An opportunity soon offered itself to try the powers of the famous powder.
+      Mr. J. Howell, having been wounded in endeavoring to part two of his
+      friends who were fighting a duel, submitted himself to a trial of the
+      Sympathetic Powder. Four days after he received 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 were very painful, grew easy,
+      although the patient, who was 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 hands of Sir Kenelm, who had hung it up to
+      dry, when Mr. Howell sent his servant in a great hurry to tell him that
+      his wounds were paining him horribly; the garter was therefore replaced in
+      the solution of the Powder, &ldquo;and the patient got well after five or six
+      days of its continued immersion.&rdquo;
+     </p>
+    <p>
+      King James First, his son Charles the First, the Duke of Buckingham, then
+      prime minister, and all the principal personages of the time, were
+      cognizant of this fact; and James himself, being curious to know the
+      secret of this remedy, asked it of Sir Kenelm, who revealed it to him, and
+      his Majesty had the opportunity of making several trials of its efficacy,
+      &ldquo;which all succeeded in a surprising manner.&rdquo; [Dict. des Sciences
+      Medieales.]
+    </p>
+    <p>
+      The king's physician, Dr. Mayerne, was made master of the secret, which he
+      carried to France and communicated to the Duke of Mayenne, who performed
+      many cures by means of it, and taught it to his surgeon, who, after the
+      Duke's death, sold it to many distinguished persons, by whose agency it
+      soon ceased to be a secret. What was this wonderful substance which so
+      astonished kings, princes, dukes, knights, and doctors? Nothing but
+      powdered blue vitriol. But it was made to undergo several processes that
+      conferred on it extraordinary virtues. Twice or thrice it was to be
+      dissolved, filtered, and crystallized. The crystals were to be laid in the
+      sun during the months of June, July, and August, taking care to turn them
+      carefully that all should be exposed. Then they were to be powdered,
+      triturated, and again exposed to the sun, again reduced to a very fine
+      powder, and secured in a vessel, while hot, from the sunshine. If there
+      seem anything remarkable in the fact of such astonishing properties being
+      developed by this process, it must be from our short-sightedness, for
+      common salt and charcoal develop powers quite as marvellous after a
+      certain number of thumps, stirs, and shakes, from the hands of modern
+      workers of miracles. In fact the Unguentum Armarium and Sympathetic Powder
+      resemble some more recent prescriptions; the latter consisting in an
+      infinite dilution of the common dose in which remedies are given, and the
+      two former in an infinite dilution of the common distance at which they
+      are applied.
+    </p>
+    <p>
+      Whether philosophers, and more especially metaphysicians, have any
+      peculiar tendency to dabble in drugs and dose themselves with physic, is a
+      question which might suggest itself to the reader of their biographies.
+    </p>
+    <p>
+      When Bishop Berkeley visited the illustrious Malebranche at Paris, he
+      found him in his cell, cooking in a small pipkin a medicine for an
+      inflammation of the lungs, from which he was suffering; and the disease,
+      being unfortunately aggravated by the vehemence of their discussion, or
+      the contents of the pipkin, carried him off in the course of a few days.
+      Berkeley himself afforded a remarkable illustration of a truth which has
+      long been known to the members of one of the learned professions, namely,
+      that no amount of talent, or of acquirements in other departments, can
+      rescue from lamentable folly those who, without something of the requisite
+      preparation, undertake to experiment with nostrums upon themselves and
+      their neighbors. The exalted character of Berkeley is thus drawn by Sir
+      James Mackintosh: Ancient learning, exact science, polished society,
+      modern literature, and the fine arts, contributed to adorn and enrich the
+      mind of this accomplished man. All his contemporaries agreed with the
+      satirist in ascribing
+    </p>
+<p>
+   &ldquo;'To Berkeley every virtue under heaven.'
+</p>
+    <p>
+      &ldquo;Even the discerning, fastidious, and turbulent Atterbury said, after an
+      interview with him, 'So much understanding, so much knowledge, so much
+      innocence, and such humility, I did not think had been the portion of any
+      but angels, till I saw this gentleman.'&rdquo;
+     </p>
+    <p>
+      But among the writings of this great and good man is an Essay of the most
+      curious character, illustrating his weakness upon the point in question,
+      and entitled, &ldquo;Siris, a Chain of Philosophical Reflections and Inquiries
+      concerning the Virtues of TAR WATER, and divers other Subjects,&rdquo;&mdash;an
+      essay which begins with a recipe for his favorite fluid, and slides by
+      gentle gradations into an examination of the sublimest doctrines of Plato.
+      To show how far a man of honesty and benevolence, and with a mind of
+      singular acuteness and depth, may be run away with by a favorite notion on
+      a subject which his habits and education do not fit him to investigate, I
+      shall give a short account of this Essay, merely stating that as all the
+      supposed virtues of Tar Water, made public in successive editions of his
+      treatise by so illustrious an author, have not saved it from neglect and
+      disgrace, it may be fairly assumed that they were mainly imaginary.
+    </p>
+    <p>
+      The bishop, as is usual in such cases, speaks of himself as indispensably
+      obliged, by the duty he owes to mankind, to make his experience public.
+      Now this was by no means evident, nor does it follow in general, that
+      because a man has formed a favorable opinion of a person or a thing he has
+      not the proper means of thoroughly understanding, he shall be bound to
+      print it, and thus give currency to his impressions, which may be
+      erroneous, and therefore injurious. He would have done much better to have
+      laid his impressions before some experienced physicians and surgeons, such
+      as Dr. Mead and Mr. Cheselden, to have asked them to try his experiment
+      over again, and have been guided by their answers. But the good bishop got
+      excited; he pleased himself with the thought that he had discovered a
+      great panacea; and having once tasted the bewitching cup of self-quackery,
+      like many before and since his time, he was so infatuated with the draught
+      that he would insist on pouring it down the throats of his neighbors and
+      all mankind.
+    </p>
+    <p>
+      The precious fluid was made by stirring a gallon of water with a quart of
+      tar, leaving it forty-eight hours, and pouring off the clear water. Such
+      was the specific which the great metaphysician recommended for averting
+      and curing all manner of diseases. It was, if he might be believed, a
+      preventive of the small-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
+      gout and fevers, and was an excellent preservative of the teeth and gums;
+      answered all the purpose of Elixir Proprietatis, Stoughton's drops, diet
+      drinks, and mineral waters; was particularly to be recommended to
+      sea-faring persons, ladies, and men of studious and sedentary lives; could
+      never be taken too long, but, on the contrary, produced advantages which
+      sometimes did not begin to show themselves for two or three months.
+    </p>
+    <p>
+      &ldquo;From my representing Tar Water as good for so many things,&rdquo; says
+      Berkeley, &ldquo;some perhaps may conclude it is good for nothing. But charity
+      obligeth me to say what I know, and what I think, however it may be taken.
+      Men may censure and object as they please, but I appeal to time and
+      experiment. Effects misimputed, cases wrong told, circumstances
+      overlooked, perhaps, too, prejudices and partialities against truth, may
+      for a time prevail and keep her at the bottom of her well, from whence
+      nevertheless she emergeth sooner or later, and strikes the eyes of all who
+      do not keep them shut.&rdquo; I cannot resist the temptation of illustrating the
+      bishop's belief in the wonderful powers of his remedy, by a few sentences
+      from different parts of his essay. &ldquo;The hardness of stubbed vulgar
+      constitutions renders them insensible of a thousand things that fret and
+      gall those delicate people, who, as if their skin was peeled off, feel to
+      the quick everything that touches them. The tender nerves and low spirits
+      of such poor creatures would be much relieved by the use of Tar Water,
+      which might prolong and cheer their lives.&rdquo; &ldquo;It [the Tar Water] may be
+      made stronger for brute beasts, as horses, in whose disorders I have found
+      it very useful.&rdquo; &ldquo;This same water will also give charitable relief to the
+      ladies, who often want it more than the parish poor; being many of them
+      never able to make a good meal, and sitting pale, puny, and forbidden,
+      like ghosts, at their own table, victims of vapors and indigestion.&rdquo; It
+      does not appear among the virtues of Tar Water that &ldquo;children cried for
+      it,&rdquo; as for some of our modern remedies, but the bishop says, &ldquo;I have
+      known children take it for above six months together with great benefit,
+      and without any inconvenience; and after long and repeated experience I do
+      esteem it a most excellent diet drink, fitted to all seasons and ages.&rdquo;
+       After mentioning its usefulness in febrile complaints, he says: &ldquo;I have
+      had all this confirmed by my own experience in the late sickly season of
+      the year one thousand seven hundred and forty-one, having had twenty-five
+      fevers in my own family cured by this medicinal water, drunk copiously.&rdquo;
+       And to finish these extracts with a most important suggestion for the
+      improvement of the British nation: &ldquo;It is much to be lamented that our
+      Insulars who act and think so much for themselves, should yet, from
+      grossness of air and diet, grow stupid or doat sooner than other people,
+      who, by virtue of elastic air, water-drinking, and light food, preserve
+      their faculties to extreme old age; an advantage which may perhaps be
+      approached, if not equaled, even in these regions, by Tar Water,
+      temperance, and early hours.&rdquo;
+     </p>
+    <p>
+      Berkeley died at the age of about seventy; he might have lived longer, but
+      his fatal illness was so sudden that there was not time enough to stir up
+      a quart of the panacea. He was an illustrious man, but he held two very
+      odd opinions; that tar water was everything, and that the whole material
+      universe was nothing.
+    </p>
+<pre xml:space="preserve">
+         &mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;
+</pre>
+    <p>
+      Most of those present have at some time in their lives heard mention made
+      of the METALLIC TRACTORS, invented by one Dr. Perkins, an American, and
+      formerly enjoying great repute for the cure of various diseases. Many have
+      seen or heard of a satirical poem, written by one of our own countrymen
+      also, about forty years since, and called &ldquo;Terrible Tractoration.&rdquo; The
+      Metallic Tractors are now so utterly abandoned that I have only by good
+      fortune fallen upon a single one of a pair, to show for the sake of
+      illustration. For more than thirty years this great discovery, which was
+      to banish at least half the evils which afflict humanity, has been
+      sleeping undisturbed in the grave of 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, its brilliant promises are
+      all covered with the dust of silent neglect; and of the generation which
+      has sprung up since the period when it flourished, very few know anything
+      of its history, and hardly even the title which in its palmy days it bore
+      of PERKINISM. Taking it as settled, then, as no one appears to answer for
+      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 absolutely defunct, I select it for anatomical examination. If this
+      pretended discovery was made public; if it was long kept before the
+      public; if it was addressed to the people of different countries; if it
+      was formally investigated by scientific men, and systematically adopted by
+      benevolent persons, who did everything in their power to diffuse the
+      knowledge and practice of it; if various collateral motives, such as
+      interest and vanity, were embarked in its cause; if, notwithstanding all
+      these things, it gradually sickened and died, then the conclusion seems a
+      fair one, that it did not 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 historically shown 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 and by what means a considerable part of the
+      community may be led into the belief of that which is to be eventually
+      considered as an idle folly. If there is any existing folly, fraudulent
+      or innocent in its origin, which appeals to certain arguments for its
+      support; provided that the very same arguments can be shown to have been
+      used for Perkinism with as good reason, they will at once fall to the
+      ground. Still more, if it shall appear that the general course of any
+      existing delusion bears a strong resemblance to that of Perkinism, that
+      the former is most frequently advocated by the same class of persons who
+      were conspicuous in behalf of the latter, and treated with contempt or
+      opposed by the same kind of persons who thus treated Perkinism; if the
+      facts in favor of both have a similar aspect; if the motives of their
+      originators and propagators may be presumed to have been similar; then
+      there is every reason to suppose that the existing folly will follow in
+      the footsteps of the past, and after displaying a given amount of cunning
+      and credulity in those deceiving and deceived, will drop from the public
+      view like a fruit which has ripened into spontaneous rottenness, and be
+      succeeded by the fresh bloom of some other delusion required by the same
+      excitable portion of the community.
+    </p>
+    <p>
+      Dr. Elisha Perkins was born at Norwich, Connecticut, in the year 1740. He
+      had practised his profession with a good local reputation for many years,
+      when he fell upon a course of experiments, as it is related, which led to
+      his great discovery. He conceived the idea that metallic substances might
+      have the effect of removing diseases, if applied in a certain manner; a
+      notion probably suggested by the then recent experiments of Galvani, in
+      which muscular contractions were found to be produced by the contact of
+      two metals with the living fibre. It was in 1796 that his discovery was
+      promulgated in the shape of the Metallic Tractors, two pieces of metal,
+      one apparently iron and the other brass, about three inches long, blunt at
+      one end and pointed at the other. These instruments were applied for the
+      cure of different complaints, such as rheumatism, local pains,
+      inflammations, and even tumors, by drawing them over the affected part
+      very lightly for about twenty minutes. Dr. Perkins took out a patent for
+      his discovery, and travelled about the country to diffuse the new
+      practice. He soon found numerous advocates of his discovery, many of them
+      of high standing and influence. In the year 1798 the tractors had crossed
+      the Atlantic, and were publicly employed in the Royal Hospital at
+      Copenhagen. About the same time the son of the inventor, Mr. Benjamin
+      Douglass Perkins, carried them to London, where they soon attracted
+      attention. The Danish physicians published an account of their cases,
+      containing numerous instances of alleged success, in a respectable octavo
+      volume. In the year 1804 an establishment, honored with the name of the
+      Perkinean Institution, was founded in London. The transactions of this
+      institution were published in pamphlets, the Perkinean Society had public
+      dinners at the Crown and Anchor, and a poet celebrated their medical
+      triumph in strains like these:
+    </p>
+<pre xml:space="preserve">
+  &ldquo;See, pointed metals, blest with power t' appease
+   The ruthless rage of merciless disease,
+   O'er the frail part a subtle fluid pour,
+   Drenched with invisible Galvanic shower,
+   Till the arthritic staff and crutch forego,
+   And leap exulting like the bounding roe!&rdquo;
+ </pre>
+    <p>
+      While all these things were going on, Mr. Benjamin Douglass Perkins was
+      calmly pocketing money, so that after some half a dozen years he left the
+      country with more than ten thousand pounds, which had been paid him by the
+      believers in Great Britain. But in spite of all this success, and the
+      number of those interested and committed in its behalf, Perkinism soon
+      began to decline, and in 1811 the Tractors are spoken of by an intelligent
+      writer as being almost forgotten. Such was the origin and duration of this
+      doctrine and practice, into the history of which we will now look a little
+      more narrowly.
+    </p>
+    <p>
+      Let us see, then, by whose agency this delusion was established and kept
+      up; whether it was principally by 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 learned bodies usually
+      supposed to take an interest in scientific discoveries, or only of
+      individuals whose claims to distinction were founded upon their position
+      in society, or political station, or literary eminence; whether the
+      judicious or excitable classes entered most deeply into it; whether, in
+      short, the scientific men of that time were deceived, or only intruded
+      upon, and shouted down for the moment by persons who had no particular
+      call to invade their precincts.
+    </p>
+    <p>
+      Not much, perhaps, was to be expected of the Medical Profession in the way
+      of encouragement. One Dr. Fuller, who wrote in England, himself a
+      Perkinist, thus expressed his opinion: &ldquo;It must be an extraordinary
+      exertion of virtue and humanity for a medical man, whose livelihood
+      depends either on the sale of drugs, or on receiving a guinea for writing
+      a prescription, which must relate to those drugs, to say to his patient,
+      'You had better purchase a set of Tractors to keep in your family; they
+      will cure you without the expense of my attendance, or the danger of the
+      common medical practice.' For very obvious reasons medical men must never
+      be expected to recommend the use of Perkinism. The Tractors must trust for
+      their patronage to the enlightened and philanthropic out of the
+      profession, or to medical men retired from practice, and who know of no
+      other interest than the luxury of relieving the distressed. And I do not
+      despair of seeing the day when but very few of this description as well as
+      private families will be without them.&rdquo;
+     </p>
+    <p>
+      Whether the motives assigned by this medical man to his professional
+      brethren existed or not, it is true that Dr. Perkins did not gain a great
+      deal at their hands. The Connecticut Medical Society expelled him in 1797
+      for violating their law against the use of nostrums, or secret remedies.
+      The leading English physicians appear to have looked on with singular
+      apathy or contempt at the miracles which it was pretended were enacting in
+      the hands of the apostles of the new practice. In looking over the reviews
+      of the time, I have found little beyond brief occasional notices of their
+      pretensions; the columns of these journals being occupied with subjects of
+      more permanent interest. The state of things in London is best learned,
+      however, from the satirical poem to which I have already alluded as having
+      been written at the period referred to. This was entitled, &ldquo;Terrible
+      Tractoration!! A Poetical Petition against Galvanizing Trumpery and the
+      Perkinistic Institution. Most respectfully 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 learned Societies.&rdquo; Two editions of this work were
+      published in London in the years 1803 and 1804, and one or two have been
+      published in this country.
+    </p>
+    <p>
+      &ldquo;Terrible Tractoration&rdquo; is supposed, by those who never read it, to be a
+      satire upon the follies of Perkins and his followers. It is, on the
+      contrary, a most zealous defence of Perkinism, and a fierce attack upon
+      its opponents, most especially upon such of the medical profession as
+      treated the subject with neglect or ridicule. The Royal College of
+      Physicians was the more peculiar object of the attack, but with this body,
+      the editors of some of the leading periodicals, and several physicians
+      distinguished at that time, and even now remembered for their services to
+      science and humanity, were involved in unsparing denunciations. The work
+      is by no means of the simply humorous character it might be supposed, but
+      is overloaded with notes of the most seriously polemical nature. Much of
+      the history of the subject, indeed, is to be looked for in this volume.
+    </p>
+    <p>
+      It appears from this work that the principal members of 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 it is
+      now evident that, though they were much abused for so doing, they knew
+      very well what they had to deal with, and were altogether in the right.
+      The delusion at last attracted such an amount of attention as to induce
+      Dr. Haygarth and some others of respectable standing to institute some
+      experiments which I shall mention in their proper place, the result of
+      which might have seemed sufficient to show the emptiness of the whole
+      contrivance.
+    </p>
+    <p>
+      The Royal Society, that learned body which for ages has constituted the
+      best tribunal to which Britain can appeal in questions of science,
+      accepted Mr. Perkins's Tractors and the book written about them, passed
+      the customary vote of thanks, and never thought of troubling itself
+      further in the investigation of pretensions of such an aspect. It is not
+      to be denied that a considerable number of physicians did avow themselves
+      advocates of the new practice; but out of the whole catalogue of those who
+      were publicly proclaimed as such, no one has ever been known, so far as I
+      am aware, to the scientific world, except in connection with the
+      short-lived notoriety of Perkinism. Who were the people, then, to whose
+      activity, influence, or standing with the community was owing all the
+      temporary excitement produced by the Metallic Tractors?
+    </p>
+    <p>
+      First, those persons who had been induced to purchase a pair of Tractors.
+      These little bits of brass and 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 whistle is apt to blow it louder and
+      longer than other people. So it appeared that when the &ldquo;Perkinean Society&rdquo;
+       applied to the possessors of Tractors in the metropolis to concur in the
+      establishment of a public institution for the use of these instruments
+      upon the poor, &ldquo;it was found that only five out of above a hundred
+      objected to subscribe, on account of their want of confidence in the
+      efficacy of the practice; and these,&rdquo; the committee observes, &ldquo;there is
+      reason to believe, never gave them a fair trial, probably never used them
+      in more than one case, and that perhaps a case in which the Tractors had
+      never been recommended as serviceable.&rdquo; &ldquo;Purchasers of the Tractors,&rdquo; said
+      one of their ardent advocates, &ldquo;would be among the last to approve of them
+      if they had reason to suppose themselves defrauded of five guineas.&rdquo; He
+      forgot poor Moses, with his &ldquo;gross of green spectacles, with silver rims
+      and shagreen cases.&rdquo; &ldquo;Dear mother,&rdquo; cried the boy, &ldquo;why won't you listen
+      to reason? I had them a dead bargain, or I should not have bought them.
+      The silver rims alone will sell for double the money.&rdquo;
+     </p>
+    <p>
+      But it is an undeniable fact, that many persons of considerable standing,
+      and in some instances holding the most elevated positions in society,
+      openly patronized the new practice. In a translation of a work entitled
+      &ldquo;Experiments with the Metallic Tractors,&rdquo; originally published in Danish,
+      thence rendered successively into German and English, Mr. Benjamin
+      Perkins, who edited the English edition, has given a copious enumeration
+      of the distinguished individuals, both in America and Europe, whose
+      patronage he enjoyed. He goes so far as to signify that ROYALTY itself was
+      to be included among the number. When the Perkinean Institution was
+      founded, no less a person than Lord Rivers was elected President, and
+      eleven other individuals of distinction, among them Governor Franklin, son
+      of Dr. Franklin, figured as Vice-Presidents. Lord Henniker, a member of
+      the Royal Society, who is spoken of as a man of judgment and talents,
+      condescended to patronize the astonishing discovery, and at different
+      times bought three pairs of Tractors. When the Tractors were introduced
+      into Europe, a large number of testimonials accompanied them from various
+      distinguished characters in America, the list of whom is given in the
+      translation of the Danish work referred to as follows:
+    </p>
+    <p>
+      &ldquo;Those who have individually stated cases, or who have presented their
+      names to the public as men who approved of this remedy, and acknowledged
+      themselves instrumental in circulating the Tractors, are fifty-six in
+      number; thirty-four of whom are physicians and surgeons, 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, one professor of natural
+      philosophy in a college, etc., etc.&rdquo; It seemed to be taken rather hardly
+      by Mr. Perkins that the translators of the work which he edited, in citing
+      the names of the advocates of the Metallic Practice, frequently omitted
+      the honorary titles which should have been annexed. The testimonials were
+      obtained by the Danish writer, from a pamphlet published in America, in
+      which these titles were given in full. Thus one of these testimonials is
+      from &ldquo;John Tyler, Esq., a magistrate in the county of New London, and late
+      Brigadier-General of the militia in that State.&rdquo; The &ldquo;omission of the
+      General's title&rdquo; is the subject of complaint, as if this title were
+      sufficient evidence of the commanding powers of one of the patrons of
+      tractoration. A similar complaint is made when &ldquo;Calvin Goddard, Esq., of
+      Plainfield, Attorney at Law, and a member of the Legislature of the State
+      of Connecticut,&rdquo; is mentioned without his titular honors, and even on
+      account of the omission of the proper official titles belonging to &ldquo;Nathan
+      Pierce, Esq., Governor and Manager of the Almshouse of Newburyport.&rdquo; These
+      instances show the great importance to be attached to civil and military
+      dignities, in qualifying their holders to judge of scientific subjects, a
+      truth which has not been overlooked by the legitimate successors of the
+      Perkinists. In Great Britain, the Tractors were not less honored than in
+      America, by the learned and the illustrious. The &ldquo;Perkinistic Committee&rdquo;
+       made this statement in their report: &ldquo;Mr. Perkins has annually laid before
+      the public a large collection of new cases communicated to him for that
+      purpose by disinterested and intelligent characters, from almost every
+      quarter of Great Britain. In regard to the competency of these vouchers,
+      it will be sufficient simply to state that, amongst others whose 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.&rdquo;
+     </p>
+    <p>
+      It cannot but excite our notice and surprise that the number of clergymen
+      both in America and Great Britain who thrust forward their evidence on
+      this medical topic was singularly large in proportion to that of the
+      members of the medical profession. Whole pages are contributed by such
+      worthies as the Rev. Dr. Trotter of Hans Place, the Rear. Waring Willett,
+      Chaplain to the Earl of Dunmore, the Rev. Dr. Clarke, Chaplain to the
+      Prince of Wales. The style of these theologico-medical communications may
+      be seen in the following from a divine who was also professor in one of
+      the colleges of New England. &ldquo;I have used the Tractors with success in
+      several other cases in my own family, and although, like Naaman the
+      Syrian, I cannot tell why the waters of Jordan should be better than Abana
+      and Pharpar, rivers of Damascus; yet since experience has proved them so,
+      no reasoning can change the opinion. Indeed, the causes of all common
+      facts are, we think, perfectly well known to us; and it is very probable,
+      fifty or a hundred years hence, we shall as well know why the Metallic
+      Tractors should in a few minutes remove violent pains, as we now know why
+      cantharides and opium will produce opposite effects, namely, we shall know
+      very little about either excepting facts.&rdquo; Fifty or a hundred years hence!
+      if he could have looked forward forty years, he would have seen the
+      descendants of the &ldquo;Perkinistic&rdquo; philosophers swallowing infinitesimal
+      globules, and knowing and caring as much about the Tractors as the people
+      at Saratoga Springs do about the waters of Abana and Pharpar.
+    </p>
+    <p>
+      I trust it will not be thought in any degree disrespectful to a profession
+      which we all honor, that I have mentioned the great zeal of many clergymen
+      in the cause of Perkinism. I hope, too, that I may without offence suggest
+      the causes which have often led them out of their own province into one to
+      which their education has no special reference. The members of that
+      profession ought to 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 them are suffering from bodily illness. It is
+      natural enough that a strong desire should be excited to alleviate
+      sufferings which may have defied the efforts of professional skill; as
+      natural that any remedy which recommends itself to the belief or the fancy
+      of the spiritual physician 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 him to take the most flattering view of
+      its effects upon the patient; his own sagacity and judgment being staked
+      upon the success of the trial. The inventor of the Tractors was aware of
+      these truths. He therefore sent the Tractors gratuitously to many
+      clergymen, accompanied with a formal certificate that the holder had
+      become entitled to their possession by the payment of five guineas. This
+      was practised in our own neighborhood, and I remember finding one of these
+      certificates, so presented, which proved that amongst the risks of infancy
+      I had to encounter Perkins's Tractors. Two clergymen of Boston and the
+      vicinity, both well known to local fame, gave in their testimony to the
+      value of the instruments thus presented to them; an unusually moderate
+      proportion, when it is remembered that to the common motives of which I
+      have spoken was added the seduction of a gift for which the profane public
+      was expected to pay so largely.
+    </p>
+    <p>
+      It was remarkable, also, that Perkinism, which had so little success with
+      the medical and scientific part of the community, found great favor in the
+      eyes of its more lovely and less obstinate portion. &ldquo;The lady of Major
+      Oxholin,&rdquo;&mdash;I quote from Mr. Perkins's volume,&mdash;&ldquo;having been
+      lately in America, had seen and heard much of the great effects of
+      Perkinism. Influenced by a most benevolent disposition, she brought these
+      Tractors and the pamphlet with her to Europe, with a laudable desire of
+      extending their utility to her suffering countrymen.&rdquo; Such was the channel
+      by which the Tractors were conveyed to Denmark, where they soon became the
+      ruling passion. The workmen, says a French writer, could not manufacture
+      them fast enough. Women carried them about their persons, and delighted in
+      bringing them into general use. To what extent the Tractors were favored
+      with the patronage of English and American ladies, it is of course not
+      easy to say, except on general principles, as their names were not brought
+      before the public. But one of Dr. Haygarth's stories may lead us to
+      conjecture that there was a class of female practitioners who went about
+      doing good with the Tractors in England as well as in Denmark. A certain
+      lady had the misfortune to have a spot as big as a silver penny at the
+      corner of her eye, caused by a bruise, or some such injury. Another lady,
+      who was a friend of hers, and a strong believer in Perkinism, was very
+      anxious to try the effects of tractoration upon this unfortunate blemish.
+      The patient consented; the lady &ldquo;produced the instruments, and, after
+      drawing them four or five times over the spot, declared that it changed to
+      a paler color, and on repeating the use of them a few minutes longer, that
+      it had almost vanished, and was scarcely visible, and departed in high
+      triumph at her success.&rdquo; The lady who underwent the operation assured the
+      narrator &ldquo;that she looked in the glass immediately after, and that not the
+      least visible alteration had taken place.&rdquo;
+     </p>
+    <p>
+      It would be a very interesting question, what was the intellectual
+      character of those persons most conspicuous in behalf of the Perkinistic
+      delusion? Such an inquiry might bring to light some principles which we
+      could hereafter apply to the study of other popular errors. But the
+      obscurity into which nearly all these enthusiasts have subsided renders
+      the question easier to ask than to answer. I believe it would have been
+      found that most of these persons were of ardent temperament and of
+      considerable imagination, and that their history would show that Perkinism
+      was not the first nor the last hobby-horse they rode furiously. Many of
+      them may very probably have been persons of more than common talent, of
+      active and ingenious minds, of versatile powers and various acquirements.
+      Such, for instance, was the estimable man to whom I have repeatedly
+      referred as a warm defender of tractoration, and a bitter assailant of its
+      enemies. The story tells itself in the biographical preface to his poem.
+      He went to London with the view of introducing a hydraulic machine, which
+      he and his Vermont friends regarded as a very important invention. He
+      found, however, that the machine was already in common use in that
+      metropolis. A brother Yankee, then in London, had started the project of a
+      mill, which was to be carried by the water of the Thames. He was sanguine
+      enough to purchase one fifth of this concern, which also proved a failure.
+      At about the same period he wrote the work which proved the great
+      excitement of his mind upon the subject of the transient folly then before
+      the public. Originally a lawyer, he was in succession a mechanician, a
+      poet, and an editor, meeting with far less success in each of these
+      departments than usually attends men of less varied gifts, but of more
+      tranquil and phlegmatic composition. But who is ignorant that there is a
+      class of minds characterized by qualities like those I have mentioned;
+      minds with many bright and even beautiful traits; but aimless and fickle
+      as the butterfly; that settle upon every gayly-colored illusion as it
+      opens into flower, and flutter away to another when the first has dropped
+      its leaves, and stands naked in the icy air of truth!
+    </p>
+    <p>
+      Let us now look at the general tenor of the arguments addressed by
+      believers to sceptics and opponents. Foremost of all, emblazoned at the
+      head of every column, loudest shouted by every triumphant disputant, held
+      up as paramount to all other considerations, stretched like an
+      impenetrable shield to protect the weakest advocate of the great cause
+      against the weapons of the adversary, was that omnipotent monosyllable
+      which has been the patrimony of cheats and the currency of dupes from time
+      immemorial,&mdash;Facts! Facts! Facts! First came the published cases of
+      the American clergymen, brigadier-generals, almshouse governors,
+      representatives, attorneys, and esquires. Then came the published cases of
+      the surgeons of Copenhagen. Then followed reports of about one hundred and
+      fifty cases published in England, &ldquo;demonstrating the efficacy of the
+      metallic practice in a variety of complaints both upon the human body and
+      on horses, etc.&rdquo; But the progress of facts in Great Britain did not stop
+      here. Let those who rely upon the numbers of their testimonials, as being
+      alone sufficient to prove the soundness and stability of a medical
+      novelty, digest the following from the report of the Perkinistic
+      Committee. &ldquo;The cases published [in Great Britain] amounted, in March
+      last, the date of Mr. Perkins's last publication, to about five thousand.
+      Supposing that not more than one cure in three hundred which the Tractors
+      have performed has been published, and the proportion is probably much
+      greater, it will be seen that the number, to March last, will have
+      exceeded one million five hundred thousand!&rdquo;
+     </p>
+    <p>
+      Next in order after the appeal to what were called facts, came a series of
+      arguments, which have been so long bruised and battered round in the cause
+      of every doctrine or pretension, new, monstrous, or deliriously
+      impossible, that each of them is as odiously familiar to the scientific
+      scholar as the faces of so many old acquaintances, among the less
+      reputable classes, to the officers of police.
+    </p>
+    <p>
+      No doubt many of my hearers will recognize, in the following passages,
+      arguments they may have heard brought forward with triumphant confidence
+      in behalf of some doctrine not yet extinct. No doubt some may have
+      honestly thought they proved something; may have used them with the
+      purpose of convincing their friends, or of silencing the opponents of
+      their favorite doctrine, whatever that might be. But any train of
+      arguments which was contrived for Perkinism, which was just as applicable
+      to it as to any other new doctrine in the same branch of science, and
+      which was fully employed against its adversaries forty years since, might,
+      in common charity, be suffered to slumber in the grave of Perkinism.
+      Whether or not the following sentences, taken literally from the work of
+      Mr. Perkins, were the originals of some of the idle propositions we hear
+      bandied about from time to time, let those who listen judge.
+    </p>
+    <p>
+      The following is the test assumed for the new practice: &ldquo;If diseases are
+      really removed, as those persons who have practised extensively with the
+      Tractors declare, it should seem there would be but little doubt of their
+      being generally adopted; but if the numerous reports of their efficacy
+      which have been published are forgeries, or are unfounded, the practice
+      ought to be crushed.&rdquo; To this I merely add, it has been crushed.
+    </p>
+    <p>
+      The following sentence applies to that a priori judging and uncandid class
+      of individuals who buy their dinners without tasting all the food there is
+      in the market. &ldquo;On all discoveries there are persons who, without
+      descending to any inquiry into the truth, pretend to know, as it were by
+      intuition, that newly asserted facts are founded in the grossest errors.
+      These were those who knew that Harvey's report of the circulation of the
+      blood was a preposterous and ridiculous suggestion, and in latter later
+      days there were others who knew that Franklin deserved reproach for
+      declaring that points were preferable to balls for protecting buildings
+      from lightning.&rdquo;
+     </p>
+    <p>
+      Again: &ldquo;This unwarrantable mode of offering assertion for proof, so
+      unauthorized and even unprecedented except in the condemnation of a
+      Galileo, the persecution of a Copernicus, and a few other acts of
+      inquisitorial authority, 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.&rdquo;
+     </p>
+    <p>
+      &ldquo;The most valuable medicines in the Materia Medica act on principles of
+      which we are totally ignorant. None have ever yet been able to explain how
+      opium produces sleep, or how bark cures intermittent fevers; and yet few,
+      it is hoped, will be so absurd as to desist from the use of these
+      important articles because they know nothing of the principle of their
+      operations.&rdquo; Or if the argument is preferred, in the eloquent language of
+      the Perkinistic poet:
+    </p>
+<pre xml:space="preserve">
+  &ldquo;What though the CAUSES may not be explained,
+   Since these EFFECTS are duly ascertained,
+   Let not self-interest, prejudice, or pride,
+   Induce mankind to set the means aside;
+   Means which, though simple, are by
+   Heaven designed to alleviate the woes of human kind.&rdquo;
+ </pre>
+    <p>
+      This course of argument is so often employed, that it deserves to be
+      expanded a little, so that its length and breadth may be fairly seen. A
+      series of what are called facts is brought forward to prove some very
+      improbable doctrine. It is objected by judicious people, or such as have
+      devoted themselves to analogous subjects, that these assumed facts are in
+      direct opposition to all that is known of the course of nature, that the
+      universal experience of the past affords a powerful presumption against
+      their truth, and that in proportion to the gravity of these objections,
+      should be the number and competence of the witnesses. The answer is a
+      ready one. What do we know of the mysteries of Nature? Do we understand
+      the intricate machinery of the Universe? When to this is added the
+      never-failing quotation,
+    </p>
+<pre xml:space="preserve">
+  &ldquo;There are more things in heaven and earth, Horatio,
+   Than are dreamt of in your philosophy,&rdquo;&mdash;
+</pre>
+    <p>
+      the question is thought to be finally disposed of.
+    </p>
+    <p>
+      Take the case of astrology as an example. It is in itself strange and
+      incredible that the relations of the heavenly bodies to each other at a
+      given moment of time, perhaps half a century ago, should have anything to
+      do with my success or misfortune in any undertaking of to-day. But what
+      right have I to say it cannot be so? Can I bind the sweet influences of
+      Pleiades, or loose the bands of Orion? I do not know by what mighty magic
+      the planets roll in their fluid paths, confined to circles as unchanging
+      as if they were rings of steel, nor why the great wave of ocean follows in
+      a sleepless round upon the skirts of moonlight; nor can I say from any
+      certain knowledge that the phases of the heavenly bodies, or even the
+      falling of the leaves of the forest, or the manner in which the sands lie
+      upon the sea-shore, may not be knit up by invisible threads with the web
+      of human destiny. There is a class of minds much more ready to believe
+      that which is at first sight incredible, and because it is incredible,
+      than what is generally thought reasonable. Credo quia impossibile est,&mdash;&ldquo;I
+      believe, because it is impossible,&rdquo;&mdash;is an old paradoxical expression
+      which might be literally applied to this tribe of persons. And they always
+      succeed in finding something marvellous, to call out the exercise of their
+      robust faith. The old Cabalistic teachers maintained that there was not a
+      verse, line, word, or even letter in the Bible which had not a special
+      efficacy either to defend the person who rightly employed it, or to injure
+      his enemies; always provided the original Hebrew was made use of. In the
+      hands of modern Cabalists every substance, no matter how inert, acquires
+      wonderful medicinal virtues, provided it be used in a proper state of
+      purity and subdivision.
+    </p>
+    <p>
+      I have already mentioned the motives attributed by the Perkinists to the
+      Medical Profession, as preventing its members from receiving the new but
+      unwelcome truths. This accusation is repeated in different forms and
+      places, as, for instance, in the following passage: &ldquo;Will the medical man
+      who has spent much money and labor in the pursuit of the arcana of Physic,
+      and on the exercise of which depends his support in life, proclaim the
+      inefficacy of his art, and recommend a remedy to his patient which the
+      most unlettered in society can employ as advantageously as himself? and a
+      remedy, too, which, unlike the drops, the pills, the powders, etc., of the
+      Materia Medica, is inconsumable, and ever in readiness to be employed in
+      successive diseases?&rdquo;
+     </p>
+    <p>
+      As usual with these people, much indignation was expressed at any parallel
+      between their particular doctrine and practice and those of their exploded
+      predecessors. &ldquo;The motives,&rdquo; says the disinterested Mr. Perkins, &ldquo;which
+      must have impelled to this attempt at classing the METALLIC PRACTICE with
+      the most paltry of empyrical projects, are but too thinly veiled to escape
+      detection.&rdquo;
+     </p>
+    <p>
+      To all these arguments was added, as a matter of course, an appeal to the
+      feelings of the benevolent in behalf of suffering humanity, in the shape
+      of a notice that the poor would be treated gratis. It is pretty well
+      understood that this gratuitous treatment of the poor does not necessarily
+      imply an excess of benevolence, any more than the gratuitous distribution
+      of a trader's shop-bills is an evidence of remarkable generosity; in
+      short, that it is one of those things which honest men often do from the
+      best motives, but which rogues and impostors never fail to announce as one
+      of their special recommendations. It is astonishing to see how these
+      things brighten up at the touch of Mr. Perkins's poet:
+    </p>
+<pre xml:space="preserve">
+  &ldquo;Ye worthy, honored, philanthropic few,
+   The muse shall weave her brightest wreaths for you,
+   Who in Humanity's bland cause unite,
+   Nor heed the shaft by interest aimed or spite;
+   Like the great Pattern of Benevolence,
+   Hygeia's blessings to the poor dispense;
+   And though opposed by folly's servile brood,
+   ENJOY THE LUXURY OF DOING GOOD.&rdquo;
+ </pre>
+    <p>
+      Having thus sketched the history of Perkinism in its days of prosperity;
+      having seen how it sprung into being, and by what means it maintained its
+      influence, it only remains to tell the brief story of its discomfiture and
+      final downfall. The vast majority of the sensible part of the medical
+      profession were contented, so far as we can judge, to let it die out of
+      itself. It was in vain that the advocates of this invaluable discovery
+      exclaimed over their perverse and interested obstinacy,&mdash;in vain that
+      they called up the injured ghosts of Harvey, Galileo, and Copernicus to
+      shame that unbelieving generation; the Baillies and the Heberdens,&mdash;men
+      whose names have come down to us as synonymous with honor and wisdom,&mdash;bore
+      their reproaches in meek silence, and left them unanswered to 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 would be
+      broken by an open trial of its virtue, as compared with that of some less
+      hallowed formula. It must be remembered that a peculiar value was attached
+      to the Metallic Tractors, as made and patented by Mr. Perkins. Dr.
+      Haygarth, of Bath, performed various experiments upon patients afflicted
+      with different complaints,&mdash;the patients supposing that the real
+      five-guinea Tractors were employed. Strange to relate, he obtained equally
+      wonderful effects with Tractors of lead and of wood; with nails, pieces of
+      bone, slate pencil, and tobacco-pipe. Dr. Alderson employed sham Tractors
+      made of wood, and produced such effects upon five patients that they
+      returned solemn thanks in church for their cures. A single specimen of
+      these cases may stand for all of them. Ann Hill had suffered for some
+      months from pain in the right arm and shoulder. The Tractors (wooden ones)
+      were applied, and in the space of five minutes she expressed herself
+      relieved in the following apostrophe: &ldquo;Bless me! why, who could have
+      thought it, that them little things could pull the pain from one. Well, to
+      be sure, the longer one lives, the more one sees; ah, dear!&rdquo;
+     </p>
+    <p>
+      These experiments did not result in the immediate extinction of Perkinism.
+      Doubtless they were a great comfort to many obstinate unbelievers, and
+      helped to settle some sceptical minds; but for the real Perkinistic
+      enthusiasts, it may be questioned whether they would at that time have
+      changed their opinion though one had risen from the dead to assure them
+      that it was an error. It perished without violence, by an easy and natural
+      process. Like the famous toy of Mongolfier, it rose by means of heated
+      air,&mdash;the fevered breath of enthusiastic ignorance,&mdash;and when
+      this grew cool, as it always does in a little while, it collapsed and
+      fell.
+    </p>
+    <p>
+      And now, on reviewing the whole subject, how shall we account for the
+      extraordinary prevalence of the belief in Perkinism among a portion of
+      what is supposed to be the thinking part of the community?
+    </p>
+    <p>
+      Could the cures have been real ones, produced by the principle of ANIMAL
+      MAGNETISM? To this it may be answered that the Perkinists ridiculed the
+      idea of approximating Mesmer and the founder of their own doctrine, that
+      nothing like the somnambulic condition seems to have followed the use of
+      the Tractors, and that neither the exertion of the will nor the powers of
+      the individual who operated seem to have been considered of any
+      consequence. Besides, the absolute neglect into which the Tractors soon
+      declined is good evidence that they were incapable of affording any
+      considerable and permanent relief in the complaints for the cure of which
+      they were applied.
+    </p>
+    <p>
+      Of course a large number of apparent cures were due solely to nature;
+      which is true under every form of treatment, orthodox or empirical. Of
+      course many persons experienced at least temporary relief from the strong
+      impression made upon their minds by this novel and marvellous method of
+      treatment.
+    </p>
+    <p>
+      Many, again, influenced by the sanguine hopes of those about them, like
+      dying people, who often say sincerely, from day to day, that they are
+      getting better, cheated themselves into a false and short-lived belief
+      that they were cured; and as happens in such cases, the public never knew
+      more than the first half of the story.
+    </p>
+    <p>
+      When it was said to the Perkinists, that whatever effects they produced
+      were merely through the imagination, they declared (like the advocates of
+      the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this explanation was
+      sufficiently disproved by the fact of numerous and successful cures which
+      had been witnessed in infants and brute animals. Dr. Haygarth replied to
+      this, that &ldquo;in these cases it is not the Patient, but the Observer, who is
+      deceived by his own imagination,&rdquo; and that such may be the fact, we have
+      seen in the case of the good lady who thought she had conjured away the
+      spot from her friend's countenance, when it remained just as before.
+    </p>
+    <p>
+      As to the motives of the inventor and vender of the Tractors, 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 that they are
+      a peculiar compound, when they are artfully associated with a new and
+      brilliant discovery (which then happened to be Galvanism), when they are
+      sold at many hundred times their value, and the seller prints his opinion
+      that a Hospital will suffer inconvenience, &ldquo;unless it possesses many sets
+      of the Tractors, and these placed in the hands of the patients to practise
+      on each other,&rdquo; one cannot but suspect that they were contrived in the
+      neighborhood of a wooden nutmeg factory; that legs of ham in that region
+      are not made of the best mahogany; and that such as buy their cucumber
+      seed in that vicinity have to wait for the fruit as long as the Indians
+      for their crop of gunpowder.
+    </p>
+<pre xml:space="preserve">
+         &mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;
+</pre>
+    <p>
+      The succeeding lecture will be devoted to an examination of 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, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, and the claims
+      of which are considered by some as infinitely important, and by many as
+      immeasurably ridiculous.
+    </p>
+    <p>
+      I wish to state, for the sake of any who may be interested in the subject,
+      that I shall treat it, not by ridicule, but by argument; perhaps with
+      great freedom, but with good temper and in peaceable language; with very
+      little hope of reclaiming converts, with no desire of making enemies, but
+      with a firm belief that its pretensions and assertions cannot stand before
+      a single hour of calm investigation.
+    </p>
+    <p>
+      II.
+    </p>
+    <p>
+      It may be thought that a direct attack upon the pretensions of HOMOEOPATHY
+      is an uncalled-for aggression upon an unoffending doctrine and its
+      peaceful advocates.
+    </p>
+    <p>
+      But a little inquiry will show that it has long assumed so hostile a
+      position with respect to the Medical Profession, that any trouble I, or
+      any other member of that profession, may choose to bestow upon it may be
+      considered merely as a matter of self-defence. It began with an attempt to
+      show the insignificance of all existing medical knowledge. It not only
+      laid claim to wonderful powers of its own, but it declared the common
+      practice to be attended with the most positively injurious effects, that
+      by it acute diseases are aggravated, and chronic diseases rendered
+      incurable. It has at various times brought forward collections of figures
+      having the air of statistical documents, pretending to show a great
+      proportional mortality among the patients of the Medical Profession, as
+      compared with those treated according to its own rules. Not contented with
+      choosing a name of classical origin for itself, it invented one for the
+      whole community of innocent physicians, assuring them, to their great
+      surprise, that they were all ALLOPATHISTS, whether they knew it or not,
+      and including all the illustrious masters of the past, from Hippocrates
+      down to Hunter, under the same gratuitous title. The line, then, has been
+      drawn by the champions of the new doctrine; they have lifted the lance,
+      they have sounded the charge, and are responsible for any little
+      skirmishing which may happen.
+    </p>
+    <p>
+      But, independently of any such grounds of active resistance, the subject
+      involves interests so disproportioned to its intrinsic claims, that it is
+      no more than an act 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, and acquires the same degree of influence that we have
+      often seen obtained by other illusions, there is not one of my audience
+      who may not have occasion to deplore the fatal credulity which listened to
+      its promises.
+    </p>
+    <p>
+      I shall therefore undertake a sober examination of its principles, its
+      facts, and some points of its history. The limited time at my disposal
+      requires me to condense as much as possible what I have to say, but I
+      shall endeavor to be plain and direct in expressing it. Not one statement
+      shall be made which cannot be supported by unimpeachable reference: not
+      one word shall be uttered which I am not as willing to print as to speak.
+      I have no quibbles to utter, and I shall stoop to answer none; but, with
+      full faith in the sufficiency of a plain statement of facts and reasons, I
+      submit the subject to the discernment of my audience.
+    </p>
+    <p>
+      The question may be asked in the outset,&mdash;Have you submitted the
+      doctrines you are professing to examine 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, from what has often
+      happened, that it would be of no manner of use for me to allege the
+      results of any experiments I might have instituted. Again and again have
+      the most explicit statements been made by the most competent persons of
+      the utter failure of all their trials, and there were the same abundant
+      explanations offered as used to be for the Unguentum Armarium and the
+      Metallic Tractors. I could by no possibility perform any experiments the
+      result of which could not be easily explained away so as to be of no
+      conclusive significance. Besides, as arguments in favor of Homoeopathy are
+      constantly addressed to the public in journals, pamphlets, and even
+      lectures, by inexperienced dilettanti, the same channel must be open to
+      all its opponents.
+    </p>
+    <p>
+      It is necessary, for the sake of those to whom the whole subject may be
+      new, to give in the smallest possible compass the substance of the
+      Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German
+      physician, now living in Paris, [Hahnemann died in 1843 at the age of
+      eighty-seven years. In 1796 he published the first paper containing his
+      peculiar notions; in 1805 his first work on the subject; in 1810 his
+      somewhat famous &ldquo;Organon of the Healing Art;&rdquo; the next year what he called
+      the &ldquo;Pure Materia Medica;&rdquo; and in 1828 his last work, the &ldquo;Treatise on
+      Chronic Diseases.&rdquo; He has therefore been writing at intervals on his
+      favorite subject for nearly half a century.
+    </p>
+    <p>
+      The one great doctrine which constitutes the basis of Homoeopathy as a
+      system is expressed by the Latin aphorism,
+        &ldquo;SIMILIA SIBILIBUS CURANTUR,&rdquo;
+     <p>
+      or like cures like, that is, diseases are cured by agents capable of
+      producing symptoms resembling those found in the disease under treatment.
+      A disease for Hahnemann consists essentially in a group of symptoms. The
+      proper medicine for any disease is the one which is capable of producing a
+      similar group of symptoms when given to a healthy person.
+    </p>
+    <p>
+      It is of course necessary to know what are the trains of symptoms excited
+      by different substances, when administered to persons in health, if any
+      such can be shown to exist. Hahnemann and his disciples give catalogues of
+      the symptoms which they affirm were produced upon themselves or others by
+      a large number of drugs which they submitted to experiment.
+    </p>
+    <p>
+      The second great fact which Hahnemann professes to have established is the
+      efficacy of medicinal substances reduced to a wonderful degree of
+      minuteness or dilution. The following account of his mode of preparing his
+      medicines is from his work on Chronic Diseases, which has not, I believe,
+      yet been translated into English. A grain of the substance, if it is
+      solid, a drop if it is liquid, is to be added to about a third part of one
+      hundred grains of sugar of milk in an unglazed porcelain capsule which has
+      had the polish removed from the lower part of its cavity by rubbing it
+      with wet sand; they are to be mingled for an instant with a bone or horn
+      spatula, and then rubbed together for six minutes; then the mass is to be
+      scraped together from 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 the powder into a heap, and the second third of the
+      hundred grains of sugar of milk to be added. Then they are to be stirred
+      an instant and rubbed six minutes,&mdash;again to be scraped together four
+      minutes and forcibly rubbed six; once more scraped together for four
+      minutes, when the last third of the hundred grains of sugar of milk is to
+      be added and mingled by stirring with the spatula; six minutes of forcible
+      rubbing, four of scraping together, and six more (positively the last six)
+      of rubbing, finish this part of the process.
+    </p>
+    <p>
+      Every grain of this powder contains the hundredth of a grain of the
+      medicinal substance mingled with the sugar of milk. If, therefore, a grain
+      of the powder just prepared is mingled with another hundred grains of
+      sugar of milk, and the process just described repeated, we shall have a
+      powder of which every grain contains the hundredth of the hundredth, or
+      the ten thousandth part of a grain of the medicinal substance. Repeat the
+      same process with the same quantity of fresh sugar of milk, and every
+      grain of your powder will contain the millionth of a grain of the
+      medicinal substance. When the powder is of this strength, it is ready to
+      employ in the further solutions and dilutions to be made use of in
+      practice.
+    </p>
+    <p>
+      A grain of the powder is to be taken, a hundred drops of alcohol are to be
+      poured on it, the vial is to be slowly turned for a few minutes, until the
+      powder is dissolved, and two shakes are to be given to it. On this point I
+      will quote Hahnemann's own words. &ldquo;A long experience and multiplied
+      observations upon the sick lead me within the last few years to prefer
+      giving only two shakes to medicinal liquids, whereas I formerly used to
+      give ten.&rdquo; The process of dilution is carried on in the same way as the
+      attenuation of the powder was done; each successive dilution with alcohol
+      reducing the medicine to a hundredth part of the quantity of that which
+      preceded it. In this way the dilution of the original millionth of a grain
+      of medicine contained in the grain of powder operated on is carried
+      successively to the billionth, trillionth, quadrillionth, quintillionth,
+      and very often much higher fractional divisions. A dose of any of these
+      medicines is a minute fraction of a drop, obtained by moistening with them
+      one or more little globules of sugar, of which Hahnemann says it takes
+      about two hundred to weigh a grain.
+    </p>
+    <p>
+      As an instance of the strength of the medicines prescribed by Hahnemann, I
+      will mention carbonate of lime. He does not employ common chalk, but
+      prefers a little portion 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 mentioned can convey is a common dose. But for
+      persons of very delicate nerves it is proper that the dilution should be
+      carried to the decillionth degree. That is, an important medicinal effect
+      is to be expected from the two hundredth or hundredth part of the
+      millionth of the millionth of the millionth of the millionth of the
+      millionth of the millionth of the millionth of the millionth of the
+      millionth of the millionth of a grain of oyster-shell. This is only the
+      tenth degree of potency, but some of his disciples profess to have
+      obtained palpable effects from &ldquo;much higher dilutions.&rdquo;
+     </p>
+    <p>
+      The third great doctrine of Hahnemann is the following. Seven eighths at
+      least of all chronic diseases are produced by the existence in the system
+      of that infectious disorder known in the language of science by the
+      appellation of PSORA, but to the less refined portion of the community by
+      the name of ITCH. In the words of Hahnemann's &ldquo;Organon,&rdquo; &ldquo;This Psora is
+      the sole true and fundamental cause that produces 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 the bones, or rickets, scoliosis and
+      cyphosis, caries, cancer, fungua haematodes, gout,&mdash;yellow jaundice
+      and cyanosis, dropsy,&mdash;&rdquo;
+     </p>
+    <p>
+      [&ldquo;The degrees of DILUTION must not be confounded with those of POTENCY.
+      Their relations may be seen by this table:
+    </p>
+    <p>
+      lst dilution,&mdash;One hundredth of a drop or grain.
+    </p>
+    <p>
+      2d &ldquo; One ten thousandth.
+    </p>
+    <p>
+      3d &ldquo; One millionth, marked I.
+    </p>
+    <p>
+      4th &ldquo; One hundred millionth.
+    </p>
+    <p>
+      5th &ldquo; One ten thousand millionth.
+    </p>
+    <p>
+      6th &ldquo; One million millionth, or one billionth, marked II.
+    </p>
+    <p>
+      7th &ldquo; One hundred billionth.
+    </p>
+    <p>
+      8th &ldquo; One ten thousand billionth.
+    </p>
+    <p>
+      9th &ldquo; One million billionth, or one trillionth, marked III.
+    </p>
+    <p>
+      10th &ldquo; One hundred trillionth.
+    </p>
+    <p>
+      11th &ldquo; One ten thousand trillionth.
+    </p>
+<pre xml:space="preserve">
+12th &ldquo; One million trillionth, or one quadrillionth, marked
+        IV.,&mdash;and so on indefinitely.
+</pre>
+    <p>
+      The large figures denote the degrees of POTENCY.]
+    </p>
+    <p>
+      &ldquo;gastralgia, epistaxis, haemoptysis,&mdash;asthma and suppuration of the
+      lungs,&mdash;megrim, deafness, cataract and amaurosis,&mdash;paralysis,
+      loss of sense, pains of every kind, etc., appear in our pathology as so
+      many peculiar, distinct, and independent diseases.&rdquo;
+     </p>
+    <p>
+      For the last three centuries, if the same authority may be trusted, under
+      the influence of the more refined personal habits which have prevailed,
+      and the application of various external remedies which repel the affection
+      from the skin; Psora has revealed itself in these numerous forms of
+      internal disease, instead of appearing, as in former periods, under the
+      aspect of an external malady.
+    </p>
+    <p>
+      These are the three cardinal doctrines of Hahnemann, as laid down in those
+      standard works of Homoeopathy, the &ldquo;Organon&rdquo; and the &ldquo;Treatise on Chronic
+      Diseases.&rdquo;
+     </p>
+    <p>
+      Several other principles may be added, upon all of which he insists with
+      great force, and which are very generally received by his disciples.
+    </p>
+    <p>
+      1. Very little power is allowed to the curative efforts of nature.
+      Hahnemann goes so far as to say that no one has ever seen the simple
+      efforts of nature effect the durable recovery of a patient from a chronic
+      disease. In general, the Homoeopathist calls every recovery which happens
+      under his treatment a cure.
+    </p>
+    <p>
+      2. Every medicinal substance must be administered in a state of the most
+      perfect purity, and uncombined with any other. The union of several
+      remedies in a single prescription destroys its utility, and, according to
+      the &ldquo;Organon,&rdquo; frequently adds a new disease.
+    </p>
+    <p>
+      3. A large number of substances commonly thought to be inert develop great
+      medicinal powers when prepared in the manner already described; and a
+      great proportion of them are ascertained to have specific antidotes in
+      case their excessive effects require to be neutralized.
+    </p>
+    <p>
+      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
+      collections of symptoms, each of which differs from every other
+      collection.
+    </p>
+    <p>
+      5. The symptoms of any complaint must be described with the most minute
+      exactness, and so far as possible in the patient's own words. To
+      illustrate the kind of circumstances the patient is expected to record, I
+      will mention one or two from the 313th page of the &ldquo;Treatise on Chronic
+      Diseases,&rdquo;&mdash;being the first one at which I opened accidentally.
+    </p>
+    <p>
+      &ldquo;After dinner, disposition to sleep; the patient winks.&rdquo;
+     </p>
+    <p>
+      &ldquo;After dinner, prostration and feeling of weakness (nine days after taking
+      the remedy).&rdquo;
+     </p>
+    <p>
+      This remedy was that same oyster-shell which is to be prescribed
+      &ldquo;fractions of the sextillionth or decillionth degree.&rdquo; According to
+      Hahnemann, the action of a single dose of the size mentioned does not
+      fully display itself in some cases until twenty-four or even thirty days
+      after it is taken, and in such instances has not exhausted its good
+      effects until towards the fortieth or fiftieth day,&mdash;before which
+      time it would be absurd and injurious to administer a new remedy.
+    </p>
+    <p>
+      So much for the doctrines of Hahnemann, which have been stated without
+      comment, or exaggeration of any of their features, very much as any
+      adherent of his opinions might have stated them, if obliged to compress
+      them into so narrow a space.
+    </p>
+    <p>
+      Does Hahnemann himself represent Homoeopathy as it now exists? He
+      certainly ought to be its best representative, after having created it,
+      and devoted his life to it for half a century. He is spoken of as the
+      great physician of the time, in most, if not all Homoeopathic works. If he
+      is not authority on the subject of his own doctrines, who is? So far as I
+      am aware, not one tangible discovery in the so-called science has ever
+      been ascribed to any other observer; at least, no general principle or
+      law, of consequence enough to claim any prominence in Homoeopathic works,
+      has ever been pretended to have originated with any of his illustrious
+      disciples. He is one of the only two Homoeopathic writers with whom, as I
+      shall mention, the Paris publisher will have anything to do upon his own
+      account. The other is Jahr, whose Manual is little more than a catalogue
+      of symptoms and remedies. If any persons choose to reject Hahnemann as not
+      in the main representing Homoeopathy, if they strike at his authority, if
+      they wink out of sight his deliberate and formally announced results, it
+      is an act of suicidal rashness; for upon his sagacity and powers of
+      observation, and experience, as embodied in his works, and especially in
+      his Materia Medica, repose the foundations of Homoeopathy as a practical
+      system.
+    </p>
+    <p>
+      So far as I can learn from the conflicting statements made upon the
+      subject, the following is the present condition of belief.
+    </p>
+    <p>
+      1. All of any note agree that the law Similia similibus is the only
+      fundamental principle in medicine. Of course if any man does not agree to
+      this the name Homoeopathist can no longer be applied to him with
+      propriety.
+    </p>
+    <p>
+      2. The belief in and employment of the infinitesimal doses is general, and
+      in some places universal, among the advocates of Homoeopathy; but a
+      distinct movement has been made in Germany to get rid of any restriction
+      to the use of these doses, and to employ medicines with the same license
+      as other practitioners.
+    </p>
+    <p>
+      3. The doctrine of the origin of most chronic diseases in Psora,
+      notwithstanding Hahnemann says it cost him twelve years of study and
+      research to establish the fact and its practical consequences, has met
+      with great neglect and even opposition from very many of his own
+      disciples.
+    </p>
+    <p>
+      It is true, notwithstanding, that, throughout most of their writings which
+      I have seen, there runs a prevailing tone of great deference to
+      Hahnemann's opinions, a constant reference to his authority, a general
+      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's Translation of Jahr's Manual may observe how little
+      comparative space is given to remedies resting upon any other authority
+      than that of Hahnemann.]
+    </p>
+    <p>
+      Many persons, and most physicians and scientific men, would be satisfied
+      with the statement of these doctrines, and examine them no further. They
+      would consider it vastly more probable that any observer in so fallacious
+      and difficult a field of inquiry as medicine had been led into error, or
+      walked into it of his own accord, than that such numerous and
+      extraordinary facts had really just come to light. They would feel a right
+      to exercise the same obduracy towards them as the French Institute is in
+      the habit of displaying when memoirs or models are offered to it relating
+      to 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
+      philosophers must have felt when, some half a dozen years ago, an unknown
+      man came forward, and asked for an opportunity to demonstrate to Arago and
+      his colleagues that the moon and planets were at a distance of a little
+      more than a hundred miles from the earth. And so they would not even look
+      into Homoeopathy, though all its advocates should exclaim in the words of
+      Mr. Benjamin Douglass Perkins, vender of the Metallic Tractors, that &ldquo;On
+      all discoveries there are persons who, without descending to any inquiry
+      into the truth, pretend to know, as it were by intuition, that newly
+      asserted facts are founded in the grossest errors.&rdquo; And they would lay
+      their heads upon their pillows with a perfectly clear conscience, although
+      they were assured that they were behaving in the same way that people of
+      old did towards Harvey, Galileo, and Copernicus, the identical great names
+      which were invoked by Mr. Benjamin Douglass Perkins.
+    </p>
+    <p>
+      But experience has shown that the character of these assertions is not
+      sufficient to deter many, from examining their claims to belief. I
+      therefore lean but very slightly on the extravagance and extreme apparent
+      singularity of their pretensions. I might have omitted them, but on the
+      whole it seemed more just to the claims of my argument to suggest the vast
+      complication of improbabilities involved in the statements enumerated.
+      Every one must of course judge for himself as to the weight of these
+      objections, which are by no means brought forward as a proof of the
+      extravagance of Homoeopathy, but simply as entitled to a brief
+      consideration before the facts of the case are submitted to our scrutiny.
+    </p>
+    <p>
+      The three great asserted discoveries of Hahnemann are entirely unconnected
+      with and independent of each other. Were there any natural relation
+      between them it would seem probable enough that the discovery of the first
+      would have led to that of the others. But assuming it to be a fact that
+      diseases are cured by remedies capable of producing symptoms like their
+      own, no manifest relation exists between this fact and the next assertion,
+      namely, the power of the infinitesimal doses. And allowing both these to
+      be true, neither has the remotest affinity to the third new doctrine, that
+      which declares seven eighths of all chronic diseases to be owing to Psora.
+    </p>
+    <p>
+      This want of any obvious relation between Hahnemann's three cardinal
+      doctrines appears to be self-evident upon inspection. But if, as is often
+      true with his disciples, they prefer the authority of one of their own
+      number, I will refer them to Dr. Trinks's paper on the present state of
+      Homoeopathy in Europe, with which, of course, they are familiar, as his
+      name is mentioned as one of the most prominent champions of 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 three such
+      unconnected and astonishing discoveries, each of them a complete
+      revolution of all that ages of the most varied experience had been taught
+      to believe, should spring full formed from the brain of a single
+      individual.
+    </p>
+    <p>
+      Let us look a moment at the first of his doctrines. Improbable though it
+      may seem to some, there is no essential absurdity involved in the
+      proposition that diseases yield to remedies capable of producing like
+      symptoms. There are, on the other hand, some analogies which lend a degree
+      of plausibility to the statement. There are well-ascertained facts, known
+      from the earliest periods of medicine, showing that, under certain
+      circumstances, the very medicine which, from its known effects, one would
+      expect to aggravate the disease, may contribute to its relief. I may be
+      permitted to allude, in the most general way, to the case in which the
+      spontaneous efforts of an overtasked stomach are quieted by the agency of
+      a drug which that organ refuses to entertain upon any terms. But that
+      every cure ever performed by medicine should have been founded upon this
+      principle, although without the knowledge of a physician; that the
+      Homoeopathic axiom is, as Hahnemann asserts, &ldquo;the sole law of nature in
+      therapeutics,&rdquo; a law of which nothing more than a transient glimpse ever
+      presented itself to the innumerable host of medical observers, is a dogma
+      of such sweeping extent, and pregnant novelty, that it demands a
+      corresponding breadth and depth of unquestionable facts to cover its vast
+      pretensions.
+    </p>
+    <p>
+      So much ridicule has been thrown upon the pretended powers of the minute
+      doses that I shall only touch upon this point for the purpose of
+      conveying, by illustrations, some shadow of ideas far transcending the
+      powers of the imagination to realize. It must be remembered that these
+      comparisons are not matters susceptible of dispute, being founded on
+      simple arithmetical computations, level to the capacity of any intelligent
+      schoolboy. A person who once wrote a very small pamphlet made some show of
+      objecting to calculations of thus kind, on the ground that the highest
+      dilutions could easily be made with a few ounces of alcohol. But he should
+      have remembered that at every successive dilution he lays aside or throws
+      away ninety-nine hundredths of the fluid on which he is operating, and
+      that, although he begins with a drop, he only prepares a millionth,
+      billionth, trillionth, and similar fractions of it, all of which, added
+      together, would constitute but a vastly minute portion of the drop with
+      which he began. But now let us suppose we take one single drop of the
+      Tincture of Camomile, and that the whole of this were to be carried
+      through the common series of dilutions.
+    </p>
+    <p>
+      A calculation nearly like the following was made by Dr. Panvini, and may
+      be readily followed in its essential particulars by any one who chooses.
+    </p>
+    <p>
+      For the first dilution it would take 100 drops of alcohol.
+    </p>
+    <p>
+      For the second dilution it would take 10,000 drops, or about a pint.
+    </p>
+    <p>
+      For the third dilution it would take 100 pints.
+    </p>
+    <p>
+      For the fourth dilution it would take 10,000 pints, or more than 1,000
+      gallons, and so on to the ninth dilution, which would take ten billion
+      gallons, which he computed would fill the basin of Lake Agnano, a body of
+      water two miles in circumference. The twelfth dilution would of course
+      fill a million such lakes. By the time the seventeenth degree of dilution
+      should be reached, the alcohol required would equal in quantity the waters
+      of ten thousand Adriatic seas. Trifling errors must be expected, but they
+      are as likely to be on one side as the other, and any little matter like
+      Lake Superior or the Caspian would be but a drop in the bucket.
+    </p>
+    <p>
+      Swallowers of globules, one of your little pellets, moistened in the
+      mingled waves of one million lakes of alcohol, each two miles in
+      circumference, with which had been blended that one drop of Tincture of
+      Camomile, would be of precisely the strength recommended for that medicine
+      in your favorite Jahr's Manual, &ldquo;against the most sudden, frightful, and
+      fatal diseases!&rdquo; [In the French edition of 1834, the proper doses of the
+      medicines are mentioned, and Camomile is marked IV. Why are the doses
+      omitted in Hull's Translation, except in three instances out of the whole
+      two hundred remedies, notwithstanding the promise in the preface that
+      &ldquo;some remarks upon the doses used may be found at the head of each
+      medicine&rdquo;? Possibly because it makes no difference whether they are
+      employed in one Homoeopathic dose or another; but then it is very singular
+      that such precise directions were formerly given in the same work, and
+      that Hahnemann's &ldquo;experience&rdquo; should have led him to draw the nice
+      distinctions we have seen in a former part of this Lecture (p. 44).]
+    </p>
+    <p>
+      And proceeding on the common data, I have just made a calculation which
+      shows that this single drop of Tincture of Camomile, given in the quantity
+      ordered by Jahr's Manual, would have supplied every individual of the
+      whole human family, past and present, with more than five billion doses
+      each, the action of each dose lasting about four days.
+    </p>
+    <p>
+      Yet this is given only at the quadrillionth, or fourth degree of potency,
+      and various substances are frequently administered at the decillionth or
+      tenth degree, and occasionally at still higher attenuations with professed
+      medicinal results. Is there not in this as great an exception to all the
+      hitherto received laws of nature as in the miracle of the loaves and
+      fishes? Ask this question of a Homoeopathist, and he will answer by
+      referring to the effects produced by a very minute portion of vaccine
+      matter, or the extraordinary diffusion of odors. But the vaccine matter is
+      one of those substances called morbid poisons, of which it is a peculiar
+      character to multiply themselves, when introduced into the system, as a
+      seed does in the soil. Therefore the hundredth part of a grain of the
+      vaccine matter, if no more than this is employed, soon increases in
+      quantity, until, in the course of about a week, it is a grain or more, and
+      can be removed in considerable drops. And what is a very curious
+      illustration of Homoeopathy, it does not produce its most characteristic
+      effects until it is already in sufficient quantity not merely to be
+      visible, but to be collected for further use. The thoughtlessness which
+      can allow an inference to be extended from a product of disease possessing
+      this susceptibility of multiplication when conveyed into the living body,
+      to substances of inorganic origin, such as silex or sulphur, would be
+      capable of arguing that a pebble may produce a mountain, because an acorn
+      can become a forest.
+    </p>
+    <p>
+      As to the analogy to be found between the alleged action of the infinitely
+      attenuated doses, and the effects of some odorous substances which possess
+      the extraordinary power of diffusing their imponderable emanations through
+      a very wide space, however it may be abused in argument, and rapidly as it
+      evaporates on examination, it is not like that just mentioned, wholly
+      without meaning. The fact of the vast diffusion of some odors, as that of
+      musk or the rose, for instance, has long been cited as the most remarkable
+      illustration of the divisibility of matter, and the nicety of the senses.
+      And if this were compared with the effects of a very minute dose of
+      morphia on the whole system, or the sudden and fatal impression of a
+      single drop of prussic acid, or, with what comes still nearer, the
+      poisonous influence of an atmosphere impregnated with invisible malaria,
+      we should find in each of these examples an evidence of the degree to
+      which nature, in some few instances, concentrates powerful qualities in
+      minute or subtile forms of matter. But if a man comes to me with a pestle
+      and mortar in his hand, and tells me that he will take a little speck of
+      some substance which nobody ever thought to have any smell at all, as, for
+      instance, a grain of chalk or of charcoal, and that he will, after an hour
+      or two of rubbing and scraping, develop in a portion of it an odor which,
+      if the whole grain were used, would be capable of pervading an apartment,
+      a house, a village, a province, an empire, nay, the entire atmosphere of
+      this broad planet upon which we tread; and that from each of fifty or
+      sixty substances he can in this way develop a distinct and hitherto
+      unknown odor: and if he tries to show that all this is rendered quite
+      reasonable by the analogy of musk and roses, I shall certainly be
+      justified in considering him incapable of reasoning, and beyond the reach
+      of my argument. What if, instead of this, he professes to develop new and
+      wonderful medicinal powers from the same speck of chalk or charcoal, in
+      such proportions as would impregnate every pond, lake, river, sea, and
+      ocean of our globe, and appeals to the same analogy in favor of the
+      probability of his assertion.
+    </p>
+    <p>
+      All this may be true, notwithstanding these considerations. But so
+      extraordinary would be the fact, that a single atom of substances which a
+      child might swallow without harm by the teaspoonful could, by an easy
+      mechanical process, be made to develop such inconceivable powers, that
+      nothing but the strictest agreement of the most cautious experimenters,
+      secured by every guaranty that they were honest and faithful, appealing to
+      repeated experiments in public, with every precaution to guard against
+      error, and with the most plain and peremptory results, should induce us to
+      lend any credence to such pretensions.
+    </p>
+    <p>
+      The third doctrine, that Psora, the other name of which you remember, is
+      the cause of the great majority of chronic diseases, is a startling one,
+      to say the least. That an affection always recognized as a very unpleasant
+      personal companion, but generally regarded as a mere temporary
+      incommodity, readily yielding to treatment in those unfortunate enough to
+      suffer from it, and hardly known among the better classes of society,
+      should be all at once found out by a German physician to be the great
+      scourge of mankind, the cause of their severest bodily and mental
+      calamities, cancer and consumption, idiocy and madness, must excite our
+      unqualified surprise. And when the originator of this singular truth
+      ascribes, as in the page now open before me, the declining health of a
+      disgraced courtier, the chronic malady of a bereaved mother, even the
+      melancholy of the love-sick and slighted maiden, to nothing more nor less
+      than the insignificant, unseemly, and almost unmentionable ITCH, does it
+      not seem as if the very soil upon which we stand were dissolving into
+      chaos, over the earthquake-heaving of discovery?
+    </p>
+    <p>
+      And when one man claims to have established these three independent
+      truths, which are about as remote from each other as the discovery of the
+      law of gravitation, the invention of printing, and that of the mariner's
+      compass, unless the facts in their favor are overwhelming and unanimous,
+      the question naturally arises, Is not this man deceiving himself, or
+      trying to deceive others?
+    </p>
+    <p>
+      I proceed to examine the proofs of the leading ideas of Hahnemann and his
+      school.
+    </p>
+    <p>
+      In order to show the axiom, similia similibus curantur (or like is cured
+      by like), to be the basis of the healing art,&mdash;&ldquo;the sole law of
+      nature in therapeutics,&rdquo;&mdash;it is necessary,
+    </p>
+    <p>
+      1. That the symptoms produced by drugs in healthy persons should be
+      faithfully studied and recorded.
+    </p>
+    <p>
+      2. That drugs should be shown to be always capable of curing those
+      diseases most like their own symptoms.
+    </p>
+    <p>
+      3. That remedies should be shown not to cure diseases when they do not
+      produce symptoms resembling those presented in these diseases.
+    </p>
+    <p>
+      1. The effects of drugs upon healthy persons have 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 experimentation appears to have been,
+      to take the substance on trial, either in common or minute doses, and then
+      to set down every little sensation, every little movement of mind or body,
+      which occurred within many succeeding hours or days, as being produced
+      solely by the substance employed. When I have enumerated some of the
+      symptoms attributed to the power of the drugs taken, you will be able to
+      judge how much value is to be ascribed to the assertions of such
+      observers.
+    </p>
+    <p>
+      The following list was taken literally from the Materia Medica of
+      Hahnemann, by my friend M. Vernois, for whose 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 of the work. I shall be very
+      brief in my citations.
+    </p>
+    <p>
+      &ldquo;After stooping some time, sense of painful weight about the head upon
+      resuming the erect posture.&rdquo;
+     </p>
+    <p>
+      &ldquo;An itching, tickling sensation at the outer edge of the palm of the left
+      hand, which obliges the person to scratch.&rdquo; The medicine was acetate of
+      lime, and as the action of the globule taken is said to last twenty-eight
+      days, you may judge how many such symptoms as the last might be supposed
+      to happen.
+    </p>
+    <p>
+      Among the symptoms attributed to muriatic acid are these: a catarrh,
+      sighing, pimples; &ldquo;after having written a long time with the back a little
+      bent over, violent pain in the back and shoulder-blades, as if from a
+      strain,&rdquo;&mdash;&ldquo;dreams which are not remembered,&mdash;disposition to
+      mental dejection,&mdash;wakefulness before and after midnight.&rdquo;
+     </p>
+    <p>
+      I might extend this catalogue almost indefinitely. I have not cited these
+      specimens with any view to exciting a sense of the ridiculous, which many
+      others of those mentioned would not fail to do, but to show that the
+      common accidents of sensation, the little bodily inconveniences to which
+      all of us are subject, are seriously and systematically ascribed to
+      whatever medicine may have been exhibited, even in the minute doses I have
+      mentioned, whole days or weeks previously.
+    </p>
+    <p>
+      To these are added all the symptoms ever said by anybody, whether
+      deserving confidence or not, as I shall hereafter illustrate, to be
+      produced by the substance in question.
+    </p>
+    <p>
+      The effects of sixty-four medicinal substances, ascertained by one or both
+      of these methods, are enumerated in the Materia Medica of Hahnemann, which
+      may be considered as the basis of practical Homoeopathy. In the Manual of
+      Jahr, which is the common guide, so far as I know, of those who practise
+      Homoeopathy in these regions, two hundred remedies are enumerated, many of
+      which, however, have never been employed in practice. In at least one
+      edition there were no means of distinguishing those which had been tried
+      upon the sick from the others. It is true that marks have been added in
+      the edition employed here, which serve to distinguish them; but what are
+      we to think of a standard practical author on Materia Medica, who at one
+      time omits to designate the proper doses of his remedies, and at another
+      to let us have any means of knowing whether a remedy has ever been tried
+      or not, while he is recommending its employment in the most critical and
+      threatening diseases?
+    </p>
+    <p>
+      I think that, from what I have shown of the character of Hahnemann's
+      experiments, it would be a satisfaction to any candid inquirer to know
+      whether other persons, to whose assertions he could look with confidence,
+      confirm these pretended facts. Now there are many individuals, long and
+      well known to the scientific world, who have tried these experiments upon
+      healthy subjects, and utterly deny that their effects have at all
+      corresponded to Hahnemann's assertions.
+    </p>
+    <p>
+      I will take, for instance, the statements of Andral (and I am not
+      referring to his well-known public experiments in his hospital) as to the
+      result of his own trials. This distinguished physician is Professor of
+      Medicine in the School of Paris, and one of the most widely known and
+      valued authors upon practical and theoretical subjects the profession can
+      claim in any country. He is a man of great kindness of character, a most
+      liberal eclectic by nature and habit, of unquestioned integrity, and is
+      called, in the leading article of the first number of the &ldquo;Homoepathic
+      Examiner,&rdquo; &ldquo;an eminent and very enlightened allopathist.&rdquo; 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 extolled
+      remedies. His experiments lasted a year, and he stated publicly to the
+      Academy of Medicine that they never produced the slightest appearance of
+      the symptoms attributed to them. The results of a man like this, so
+      extensively known as one of the most philosophical and candid, as well as
+      brilliant of instructors, and whose admirable abilities and signal
+      liberality are generally conceded, ought to be of great weight in deciding
+      the question.
+    </p>
+    <p>
+      M. Double, a well-known medical writer and a physician of high standing in
+      Paris, had occasion so long ago as 1801, before he had heard of
+      Homoeopathy, to make experiments upon Cinchona, or Peruvian bark. He and
+      several others took the drug in every kind of dose for four months, and
+      the fever it is pretended by Hahnemann to excite never was produced.
+    </p>
+    <p>
+      M. Bonnet, President of the Royal Society of Medicine of Bordeaux, had
+      occasion to observe many soldiers during the Peninsular War, who made use
+      of Cinchona as a preservative against different diseases, but he never
+      found it to produce the pretended paroxysms.
+    </p>
+    <p>
+      If any objection were made to evidence of this kind, I would refer to the
+      express experiments on many of the Homoeopathic substances, which were
+      given to healthy persons with every precaution as to diet and regimen, by
+      M. Louis Fleury, without being followed by the slightest of the pretended
+      consequences. And let me mention as a curious fact, that the same quantity
+      of arsenic given to one animal in the common form of the unprepared
+      powder, and to another after having been rubbed up into six hundred
+      globules, offered no particular difference of activity in the two cases.
+    </p>
+    <p>
+      This is a strange contradiction to the doctrine of the development of what
+      they call dynamic power, by means of friction and subdivision.
+    </p>
+    <p>
+      In 1835 a public challenge was offered to the best known Homoeopathic
+      physician in Paris to select any ten substances asserted to produce the
+      most striking effects; to prepare them himself; to choose one by lot
+      without knowing which of them he had taken, and try it upon himself or any
+      intelligent and devoted Homoeopathist, and, waiting his own time, to come
+      forward and tell what substance had been employed. The challenge was at
+      first accepted, but the acceptance retracted before the time of trial
+      arrived.
+    </p>
+    <p>
+      From all this I think it fair to conclude that the catalogues of symptoms
+      attributed in Homoeopathic works to the influence of various drugs upon
+      healthy persons are not entitled to any confidence.
+    </p>
+    <p>
+      2. It is necessary to show, in the next place, that medicinal substances
+      are always capable of curing diseases most like their own symptoms. For
+      facts relating to this question we must look to two sources; the recorded
+      experience of the medical profession in general, and the results of trials
+      made according to Homoeopathic principles, and capable of testing the
+      truth of the doctrine.
+    </p>
+    <p>
+      No person, that I am aware of, has ever denied that in some cases there
+      exists a resemblance between the effects of a remedy and the symptoms of
+      diseases in which 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 true of only a very small proportion of useful remedies. Nor has
+      it ever been considered as an established truth that the efficacy of even
+      these few remedies was in any definite ratio to their power of producing
+      symptoms more or less like those they cured.
+    </p>
+    <p>
+      Such was the state of opinion when Hahnemann came forward with the
+      proposition that all the cases of successful treatment found in the works
+      of all preceding medical writers were to be ascribed solely to the
+      operation of the Homoeopathic principle, which had effected the cure,
+      although without the physician's knowledge that this was the real secret.
+      And strange as it may seem, he was enabled to give such a degree of
+      plausibility to this assertion, that any person not acquainted somewhat
+      with medical literature, not quite familiar, I should rather say, with the
+      relative value of medical evidence, according to the sources whence it is
+      derived, would be almost frightened into the belief, at seeing the pages
+      upon pages of Latin names he has summoned as his witnesses.
+    </p>
+    <p>
+      It has hitherto been customary, when examining the writings of authors of
+      preceding ages, upon subjects as to which they were less enlightened than
+      ourselves, and which they were very liable to misrepresent, to exercise
+      some little discretion; to discriminate, in some measure, between writers
+      deserving confidence and those not entitled to it. But there is not the
+      least appearance of any such delicacy on the part of Hahnemann. A large
+      majority of the names of old authors he cites are wholly unknown to
+      science. With some of them I have been long acquainted, and I know that
+      their accounts of diseases are no more to be trusted than their
+      contemporary Ambroise Pare's stories of mermen, and similar absurdities.
+      But if my judgment is rejected, as being a prejudiced one, I can refer to
+      Cullen, who mentioned three of Hahnemann's authors in one sentence, as
+      being &ldquo;not necessarily bad authorities; but certainly such when they
+      delivered very improbable events;&rdquo; and as this was said more than half a
+      century ago, it could not have had any reference to Hahnemann. But
+      although not the slightest sign of discrimination is visible in his
+      quotations,&mdash;although for him a handful of chaff from Schenck is all
+      the same thing as a measure of wheat from Morgagni,&mdash;there is a
+      formidable display of authorities, and an abundant proof of ingenious
+      researches to be found in each of the great works of Hahnemann with which
+      I am familiar. [Some painful surmises might arise as to the erudition of
+      Hahnemann's English Translator, who makes two individuals of &ldquo;Zacutus,
+      Lucitanus,&rdquo; as well as respecting that of the conductors of an American
+      Homoeopathic periodical, who suffer the name of the world-renowned
+      Cardanus to be spelt Cardamus in at least three places, were not this
+      gross ignorance of course attributable only to the printer.]
+    </p>
+    <p>
+      It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has proved
+      many of Hahnemann's quotations from old authors to be adulterate and
+      false. What particular instances he has pointed out I have no means of
+      learning. And it is probably wholly impossible on this side of the
+      Atlantic, and even in most of the public libraries of Europe, to find
+      anything more than a small fraction of the innumerable obscure
+      publications which the neglect of grocers and trunkmakers has spared to be
+      ransacked by the all-devouring genius of Homoeopathy. I have endeavored to
+      verify such passages as my own library afforded me the means of doing. For
+      some I have looked in vain, for want, as I am willing to believe, of more
+      exact references. But this I am able to affirm, that, out of the very
+      small number which I have been able, to trace back to their original
+      authors, I have found two to be wrongly quoted, one of them being a gross
+      misrepresentation.
+    </p>
+    <p>
+      The first is from the ancient Roman author, Caelius Aurelianus; the second
+      from the venerable folio of Forestus. Hahnemann uses the following
+      expressions,&mdash;if he is not misrepresented in the English Translation
+      of the 'Organon': &ldquo;Asclepiades on one occasion cured an inflammation of
+      the brain by administering a small quantity of wine.&rdquo; 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 treatment
+      employed by Asclepiades, into both of which the use of wine entered, as
+      being &ldquo;in the highest degree irrational and dangerous.&rdquo; [Caelius Aurel. De
+      Morb. Acut. et Chron. lib. I. cap. xv. not xvi. Amsterdam. Wetstein,
+      1755.]
+    </p>
+    <p>
+      In speaking of the oil of anise-seed, Hahnemann says that Forestus
+      observed violent colic caused by its administration. But, as the author
+      tells the story, a young man took, by the counsel of a surgeon, an acrid
+      and virulent medicine, the name of which is not given, which brought on a
+      most cruel fit of the gripes and colic. After this another surgeon was
+      called, who gave him oil of anise-seed and wine, &ldquo;which increased his
+      suffering.&rdquo; [Observ. et Curat. Med. lib. XXI obs. xiii. Frankfort, 1614.]
+      Now if this was the Homoeopathic remedy, as Hahnemann pretends, it might
+      be a fair question why the young man was not cured by it. But it is a much
+      graver question why a man who has shrewdness and learning enough to go so
+      far after his facts, should think it right to treat them with such
+      astonishing negligence or such artful unfairness.
+    </p>
+    <p>
+      Even if every word he had pretended to take from his old authorities were
+      to be found in them, even if the authority of every one of these authors
+      were beyond question, the looseness with which they are used to prove
+      whatever Hahnemann chooses is beyond the bounds of credibility. Let me
+      give one instance to illustrate the character of this man's mind.
+      Hahnemann asserts, in a note annexed to the 110th paragraph of the
+      &ldquo;Organon,&rdquo; that the smell of the rose will cause certain persons to faint.
+      And he says in the text that substances which produce peculiar effects of
+      this nature on particular constitutions cure the same symptoms in people
+      in general. Then in another note to the same paragraph he quotes the
+      following fact from one of the last sources one would have looked to for
+      medical information, the Byzantine Historians.
+    </p>
+    <p>
+      &ldquo;It was by these means (i.e. Homoeopathically) that the Princess Eudosia
+      with rose-water restored a person who had fainted!&rdquo;
+     </p>
+    <p>
+      Is it possible that a man who is guilty of such pedantic folly as this,&mdash;a
+      man who can see a confirmation of his doctrine in such a recovery as this,&mdash;a
+      recovery which is happening every day, from a breath of air, a drop or two
+      of water, untying a bonnet-string, loosening a stay-lace, and which can
+      hardly help happening, whatever is done,&mdash;is it possible that a man,
+      of whose pages, not here and there one, but hundreds upon hundreds are
+      loaded with such trivialities, is the Newton, the Columbus, the Harvey of
+      the nineteenth century!
+    </p>
+    <p>
+      The whole process of demonstration he employs is this. An experiment is
+      instituted with some drug upon one or more healthy persons. Everything
+      that happens for a number of days or weeks is, as we have seen, set down
+      as an effect of the medicine. Old volumes are then ransacked
+      promiscuously, and every morbid sensation or change that anybody ever said
+      was produced by the drug in question is added to the list of symptoms. By
+      one or both of these methods, each of the sixty-four substances enumerated
+      by Hahnemann is shown to produce a very large number of symptoms, the
+      lowest in his scale being ninety-seven, and the highest fourteen hundred
+      and ninety-one. And having made out this list respecting any drug, a
+      catalogue which, as you may observe in any Homoeopathic manual, contains
+      various symptoms belonging to every organ of the body, what can be easier
+      than to find alleged cures in every medical author which can at once be
+      attributed to the Homoeopathic principle; still more if the grave of
+      extinguished credulity is called upon to give up its dead bones as living
+      witnesses; and worst of all, if the monuments of the past are to be
+      mutilated in favor of &ldquo;the sole law of Nature in therapeutics&rdquo;?
+    </p>
+    <p>
+      There are a few familiar facts of which great use has been made as an
+      entering wedge for the Homoeopathic doctrine. They have been suffered to
+      pass current so long that it is time they should be nailed to the counter,
+      a little operation which I undertake, with perfect cheerfulness, to
+      perform for them.
+    </p>
+    <p>
+      The first is a supposed illustration of the Homoeopathic law found in the
+      precept given for the treatment of parts which have been frozen, by
+      friction with snow or similar means. But we deceive ourselves by names, if
+      we suppose the frozen part to be treated by cold, and not by heat. The
+      snow may even be actually 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 to a frozen part, except as a mode of
+      regulating the application of what? of heat. But the heat must be applied
+      gradually, just as food must be given a little at a time to those
+      perishing with hunger. If the patient were brought into a warm room, heat
+      would be applied very rapidly, were not something interposed to prevent
+      this, and allow its gradual admission. Snow or iced water is exactly what
+      is wanted; it is not cold to the part; it is very possibly warm, on the
+      contrary, for these terms are relative, and if it does not melt and let
+      the heat in, or is not taken away, the part will remain frozen up until
+      doomsday. Now the treatment of a frozen limb by heat, in large or small
+      quantities, is not Homoeopathy.
+    </p>
+    <p>
+      The next supposed illustration of the Homoeopathic law is the alleged
+      successful management of burns, by holding them to the fire. This is a
+      popular mode of treating those burns which are of too little consequence
+      to require any more efficacious remedy, and would inevitably get well of
+      themselves, without any trouble being bestowed upon them. It produces a
+      most acute pain in the part, which is followed by some loss of
+      sensibility, as happens with the eye after exposure to strong light, and
+      the ear after being subjected to very intense sounds. This is all it is
+      capable of doing, and all further notions of its efficacy must be
+      attributed merely to the vulgar love of paradox. If this example affords
+      any comfort to the Homoeopathist, it seems as cruel to deprive him of it
+      as it would be to convince the mistress of the smoke-jack or the flatiron
+      that the fire does not literally &ldquo;draw the fire out,&rdquo; which is her
+      hypothesis.
+    </p>
+    <p>
+      But if it were true that frost-bites were cured by cold and burns by heat,
+      it would be subversive, so far as it went, of the great principle of
+      Homoeopathy.
+    </p>
+    <p>
+      For you will remember that this principle is that Like cures Like, and not
+      that Same cures Same; that there is resemblance and not identity between
+      the symptoms of the disease and those produced by the drug which cures it,
+      and none have been readier to insist upon this distinction than the
+      Homoeopathists themselves. For if Same cures Same, then every poison must
+      be its own antidote,&mdash;which is neither a part of their theory nor
+      their so-called experience. They have been asked often enough, why it was
+      that arsenic could not cure the mischief which arsenic had caused, and why
+      the infectious cause of small-pox did not remedy the disease it had
+      produced, and then they were ready enough to see the distinction I have
+      pointed out. O no! it was not the hair of the same dog, but only of one
+      very much like him!
+    </p>
+    <p>
+      A third instance in proof of the Homoeopathic law is sought for in the
+      acknowledged efficacy of vaccination. And how does the law apply to this?
+      It is granted by the advocates of Homoeopathy that there is a resemblance
+      between the effects of the vaccine virus on a person in health and the
+      symptoms of small-pox. Therefore, according to the rule, the vaccine virus
+      will cure the small-pox, which, as everybody knows, is entirely untrue.
+      But it prevents small-pox, say the Homoeopathists. Yes, and so does
+      small-pox prevent itself from ever happening again, and we know just as
+      much of the principle involved in the one case as in the other. For this
+      is only one of a series of facts which we are wholly unable to explain.
+      Small-pox, measles, scarlet-fever, hooping-cough, protect those who have
+      them once from future attacks; but nettle-rash and catarrh and lung fever,
+      each of which is just as Homoeopathic to itself as any one of the others,
+      have no such preservative power. We are obliged to accept the fact,
+      unexplained, and we can do no more for vaccination than for the rest.
+    </p>
+    <p>
+      I come now to the most directly practical point connected with the
+      subject, namely,&mdash;
+    </p>
+    <p>
+      What is the state of the evidence as to the efficacy of the proper
+      Homoeopathic treatment in the cure of diseases.
+    </p>
+    <p>
+      As the treatment adopted by the Homoeopathists has been almost universally
+      by means of the infinitesimal doses, the question of their efficacy is
+      thrown open, in common with that of the truth of their fundamental axiom,
+      as both are tested in practice.
+    </p>
+    <p>
+      We must look for facts as to the actual working of Homoeopathy to three
+      sources.
+    </p>
+    <p>
+      1. The statements of the unprofessional public.
+    </p>
+    <p>
+      2. The assertions of Homoeopathic practitioners.
+    </p>
+    <p>
+      3. The results of trials by competent and honest physicians, not pledged
+      to the system.
+    </p>
+    <p>
+      I think, after what we have seen of medical facts, as they are represented
+      by incompetent persons, we are disposed to attribute little value to all
+      statements of wonderful cures, coming from those who have never been
+      accustomed to watch the caprices of disease, and have not cooled down
+      their young enthusiasm by the habit of tranquil observation. Those who
+      know nothing of the natural progress of a malady, of its ordinary
+      duration, of its various modes of terminating, of its liability to
+      accidental complications, of the signs which mark its insignificance or
+      severity, of what is to be expected of it when left to itself, of how much
+      or how little is to be anticipated from remedies, those who know nothing
+      or next to nothing of all these things, and who are in a great state of
+      excitement from benevolence, sympathy, or zeal for a new medical
+      discovery, can hardly be expected to be sound judges of facts which have
+      misled so many sagacious men, who have spent their lives in the daily
+      study and observation of them. I believe that, after having drawn the
+      portrait of defunct Perkinism, with its five thousand printed cures, and
+      its million and a half computed ones, its miracles blazoned about through
+      America, Denmark, and England; after relating that forty years ago women
+      carried the Tractors about in their pockets, and workmen could not make
+      them fast enough 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 lucky accident, so utterly lost is the memory of all
+      their wonderful achievements; I believe, after all this, I need not waste
+      time in showing that medical accuracy is not to be looked for in the
+      florid reports of benevolent associations, the assertions of illustrious
+      patrons, the lax effusions of daily journals, or the effervescent gossip
+      of the tea-table.
+    </p>
+    <p>
+      Dr. Hering, whose name is somewhat familiar to the champions of
+      Homoeopathy, has said that &ldquo;the new healing art is not to be judged by its
+      success in isolated cases only, but according to its success in general,
+      its innate truth, and the incontrovertible nature of its innate
+      principles.&rdquo;
+     </p>
+    <p>
+      We have seen something of &ldquo;the incontrovertible nature of its innate
+      principles,&rdquo; and it seems probable, on the whole, that its success in
+      general must be made up of its success in isolated cases. Some attempts
+      have been made, however, to finish the whole matter by sweeping
+      statistical documents, which are intended to prove its triumphant success
+      over the common practice.
+    </p>
+    <p>
+      It is well known to those who have had the good fortune to see the
+      &ldquo;Homoeopathic Examiner,&rdquo; that this journal led off, in its first number,
+      with a grand display of everything the newly imported doctrine had to show
+      for itself. It is well remarked, on the twenty-third page of this article,
+      that &ldquo;the comparison of bills of mortality among an equal number of sick,
+      treated by divers methods, is a most poor and lame way to get at
+      conclusions touching principles of the healing art.&rdquo; In confirmation of
+      which, the author proceeds upon the twenty-fifth page to prove the
+      superiority of the Homoeopathic treatment of cholera, by precisely these
+      very bills of mortality. Now, every intelligent physician is aware that
+      the poison of cholera differed so much in its activity at different times
+      and, places, that it was next to impossible to form any opinion as to the
+      results of treatment, unless every precaution was taken to secure the most
+      perfectly corresponding conditions in the patients treated, and hardly
+      even then. Of course, then, a Russian Admiral, by the name of Mordvinov,
+      backed by a number of so-called physicians practising in Russian villages,
+      is singularly competent to the task of settling the whole question of the
+      utility of this or that kind of treatment; to prove that, if not more than
+      eight and a half per cent. of those attacked with the disease perished,
+      the rest owed their immunity to Hahnemann. I can remember when more than a
+      hundred patients in a public institution were attacked with what, I doubt
+      not, many Homoeopathic physicians (to say nothing of Homoeopathic
+      admirals) would have called cholera, and not one of them died, though
+      treated in the common way, and it is my firm belief that, if such a result
+      had followed the administration of the omnipotent globules, it would have
+      been in the mouth of every adept in Europe, from Quin of London to Spohr
+      of Gandersheim. No longer ago than yesterday, in one of the most widely
+      circulated papers of this city, there was published an assertion that the
+      mortality in several Homoeopathic Hospitals was not quite five in a
+      hundred, whereas, in what are called by the writer Allopathic Hospitals,
+      it is said to be eleven in a hundred. An honest man should be ashamed of
+      such an argumentum ad ignorantiam. The mortality of a hospital depends not
+      merely on the treatment of the patients, but on the class of diseases it
+      is in the habit of receiving, on the place where it is, on the season, and
+      many other circumstances. For instance, there are many hospitals in the
+      great cities of Europe that receive few diseases of a nature to endanger
+      life, and, on the other hand, there are others where dangerous diseases
+      are accumulated out of the common proportion. Thus, in the wards of Louis,
+      at the Hospital of La Pitie, a vast number of patients in the last stages
+      of consumption were constantly entering, to swell the mortality of that
+      hospital. It was because he was known to pay particular attention to the
+      diseases of the chest that patients laboring under those fatal affections
+      to an incurable extent were so constantly coming in upon him. It is always
+      a miserable appeal to the thoughtlessness of the vulgar, to allege the
+      naked fact of the less comparative mortality in the practice of one
+      hospital or of one physician than another, as an evidence of the
+      superiority of their treatment. Other things being equal, it must always
+      be expected that those institutions and individuals enjoying to the
+      highest degree the confidence of the community will lose the largest
+      proportion of their patients; for the simple reason that they will
+      naturally be looked to by those suffering from the gravest class of
+      diseases; that many, who know that they are affected with mortal disease,
+      will choose to die under their care or shelter, while the subjects of
+      trifling maladies, and merely troublesome symptoms, amuse themselves to
+      any extent among the fancy practitioners. When, therefore, Dr. Mublenbein,
+      as stated in the &ldquo;Homoeopathic Examiner,&rdquo; and quoted in yesterday's &ldquo;Daily
+      Advertiser,&rdquo; asserts that the mortality among his patients is only one per
+      cent. since he has practised Homoeopathy, whereas it was six per cent.
+      when he employed the common mode of practice, I am convinced by this, his
+      own statement, that the citizens of Brunswick, whenever they are seriously
+      sick, take good care not to send for Dr. Muhlenbein!
+    </p>
+    <p>
+      It is evidently impossible that I should attempt, within the compass of a
+      single lecture, any detailed examination of the very numerous cases
+      reported in the Homoeopathic Treatises and Journals. Having been in the
+      habit of receiving the French &ldquo;Archives of Homoeopathic Medicine&rdquo; until
+      the premature decease of that Journal, I have had the opportunity of
+      becoming acquainted somewhat with the style of these documents, and
+      experiencing whatever degree of conviction they were calculated to
+      produce. Although of course I do not wish any value to be assumed for my
+      opinion, such as it is, I consider that you are entitled to hear it. So
+      far, then, as I am acquainted with the general character of the cases
+      reported by the Homoeopathic physicians, they would for the most part be
+      considered as wholly undeserving a place in any English, French, or
+      American periodical of high standing, if, instead of favoring the doctrine
+      they were intended to support, they were brought forward to prove the
+      efficacy of any common remedy administered by any common practitioner.
+      There are occasional exceptions to this remark; but the general truth of
+      it is rendered probable by the fact that these cases are always, or almost
+      always, written with the single object of showing the efficacy of the
+      medicine used, or the skill of the practitioner, and it is recognized as a
+      general rule that such cases deserve very little confidence. Yet they may
+      sound well enough, one at a time, to those who are not fully aware of the
+      fallacies of medical evidence. Let me state a case in illustration. Nobody
+      doubts that some patients 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 as a physician is called to in daily practice,
+      would recover, sooner or later, with more or less difficulty, provided
+      nothing were done to interfere seriously with the efforts of nature.
+    </p>
+    <p>
+      Suppose, then, a physician who has a hundred patients prescribes to each
+      of them pills made of some entirely inert substance, as starch, for
+      instance. Ninety of them get well, or if he chooses to use such language,
+      he cures ninety of them. It is evident, according to the doctrine of
+      chances, that there must be a considerable number of coincidences between
+      the relief of the patient and the administration of the remedy. It is
+      altogether probable that there will happen two or three very striking
+      coincidences out of the whole ninety cases, in which it would seem evident
+      that the medicine produced the relief, though it had, as we assumed,
+      nothing to do with it. Now suppose that the physician publishes these
+      cases, will they not have a plausible appearance of proving that which, as
+      we granted at the outset, was entirely false? Suppose that instead of
+      pills of starch he employs microscopic sugarplums, with the five' million
+      billion trillionth part of a suspicion of aconite or pulsatilla, and then
+      publishes his successful cases, through the leaden lips of the press, or
+      the living ones of his female acquaintances,&mdash;does that make the
+      impression a less erroneous one? But so it is that in Homoeopathic works
+      and journals and gossip one can never, or next to never, find anything but
+      successful cases, which might do very well as a proof of superior skill,
+      did it not prove as much for the swindling advertisers whose certificates
+      disgrace so many of our newspapers. How long will it take mankind to learn
+      that while they listen to &ldquo;the speaking hundreds and units,&rdquo; who make the
+      world ring with the pretended triumphs they have witnessed, the &ldquo;dumb
+      millions&rdquo; of deluded and injured victims are paying the daily forfeit of
+      their misplaced confidence!
+    </p>
+    <p>
+      I am sorry to see, also, that a degree of ignorance as to the natural
+      course of diseases is often shown in these published cases, which,
+      although it may not be detected by the unprofessional reader, conveys an
+      unpleasant impression to those who are acquainted with the subject. Thus a
+      young woman affected with jaundice is mentioned in the German &ldquo;Annals of
+      Clinical Homoeopathy&rdquo; as having been cured in twenty-nine days by
+      pulsatilla and nux vomica. Rummel, a well-known writer of the same school,
+      speaks of curing a case of jaundice in thirty-four days by Homoeopathic
+      doses of pulsatilla, aconite, and cinchona. I happened to have a case in
+      my own household, a few weeks since, which lasted about ten days, and this
+      was longer than I have repeatedly seen it in hospital practice, so that it
+      was nothing to boast of.
+    </p>
+    <p>
+      Dr. Munneche of Lichtenburg in Saxony is called to a patient with sprained
+      ankle who had been a fortnight under the common treatment. The patient
+      gets well by the use of arnica in a little more than a month longer, and
+      this extraordinary fact is published in the French &ldquo;Archives of
+      Homoeopathic Medicine.&rdquo;
+     </p>
+    <p>
+      In the same Journal is recorded the case of a patient who with nothing
+      more, so far as any proof goes, than influenza, gets down to her shop upon
+      the sixth day.
+    </p>
+    <p>
+      And again, the cool way in which everything favorable in a case is set
+      down by these people entirely to their treatment, may be seen in a case of
+      croup reported in the &ldquo;Homoeopathic Gazette&rdquo; 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 of some
+      Homoeopathic fluid.
+    </p>
+    <p>
+      I need not multiply these quotations, which illustrate the grounds of an
+      opinion which the time does not allow me to justify more at length; other
+      such cases are lying open before me; there is no end to them if more were
+      wanted; for nothing is necessary but to look into any of the numerous
+      broken-down Journals of Homoeopathy, the volumes of which may be found on
+      the shelves of those curious in such matters.
+    </p>
+    <p>
+      A number of public trials of Homoeopathy have been made in different parts
+      of the world. Six of these are mentioned in the Manifesto of the
+      &ldquo;Homoeopathic Examiner.&rdquo; Now to suppose that any trial can absolutely
+      silence people, would be to forget the whole experience of the past. Dr.
+      Haygarth and Dr. Alderson could not stop the sale of the five-guinea
+      Tractors, although they proved that they could work the same miracles with
+      pieces of wood and tobacco-pipe. It takes time for truth to operate as
+      well as Homoeopathic globules. Many persons thought the results of these
+      trials were decisive enough of the nullity of the treatment; those who
+      wish to see the kind of special pleading and evasion by which it is
+      attempted to cover results which, stated by the &ldquo;Homoeopathic Examiner&rdquo;
+       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
+      trials at all, having abundant other evidence on the point. But I think it
+      best, on the whole, to mention two of them in a few words,&mdash;that
+      instituted at Naples and that of Andral.
+    </p>
+    <p>
+      There have been few names in the medical profession, for the last half
+      century, so widely known throughout the world of science as that of M.
+      Esquirol, whose life was devoted to the treatment of insanity, and who was
+      without a rival in that department of practical medicine. It is from an
+      analysis communicated by him to the &ldquo;Gazette Medicale de Paris&rdquo; that I
+      derive my acquaintance with the account of the trial at Naples by Dr.
+      Panvini, physician to the Hospital della Pace. This account seems to be
+      entirely deserving of credit. Ten patients were set apart, and not allowed
+      to take any medicine at all,&mdash;much against the wish of the
+      Homoeopathic physician. All of them got well, and of course all of them
+      would have been claimed as triumphs if they had been submitted to the
+      treatment. Six other slight cases (each of which is specified) got well
+      under the Homoeopathic treatment, none of its asserted specific effects
+      being manifested.
+    </p>
+    <p>
+      All the rest were cases of grave disease; and so far as the trial, which
+      was interrupted about the fortieth day, extended, the patients grew worse,
+      or received no benefit. A case is reported on the page before me of a
+      soldier affected with acute inflammation in the chest, who took
+      successively aconite, bryonia, nux vomica, and pulsatilla, and after
+      thirty-eight days of treatment remained without any important change in
+      his disease. The Homoeopathic physician who treated these patients was M.
+      de Horatiis, who had the previous year been announcing his wonderful
+      cures. And M. Esquirol asserted to the Academy of Medicine in 1835, that
+      this M. de Horatiis, who is one of the prominent personages in the
+      &ldquo;Examiner's&rdquo; Manifesto published in 1840, had subsequently renounced
+      Homoeopathy. I may remark, by the way, that this same periodical, which is
+      so very easy in explaining away the results of these trials, makes a
+      mistake of only six years or a little more as to the time when this at
+      Naples was instituted.
+    </p>
+    <p>
+      M. Andral, the &ldquo;eminent and very enlightened allopathist&rdquo; of the
+      &ldquo;Homoeopathic Examiner,&rdquo; made the following statement in March, 1835, to
+      the Academy of Medicine: &ldquo;I have submitted this doctrine to experiment; I
+      can reckon at this time from one hundred and thirty to one hundred and
+      forty cases, recorded with perfect fairness, in a great hospital, under
+      the eye of numerous witnesses; to avoid every objection&mdash;I obtained
+      my remedies of M. Guibourt, who keeps a Homoeopathic pharmacy, and whose
+      strict exactness is well known; the regimen has been scrupulously
+      observed, and I obtained from the sisters attached to the hospital a
+      special regimen, such as Hahnemann orders. I was told, however, some
+      months since, that I had not been faithful to all the rules of the
+      doctrine. I therefore took the trouble to begin again; I have studied the
+      practice of the Parisian Homoeopathists, as I had studied their books, and
+      I became convinced that they treated their patients as I had treated mine,
+      and I affirm that I have been as rigorously exact in the treatment as any
+      other person.&rdquo;
+     </p>
+    <p>
+      And he expressly asserts the entire nullity of the influence of all the
+      Homoeopathic remedies tried by him in modifying, so far as he could
+      observe, the progress or termination of diseases. It deserves notice that
+      he experimented with the most boasted substances,&mdash;cinchona, aconite,
+      mercury, bryonia, belladonna. Aconite, for instance, he says he
+      administered in more than forty cases of that collection of feverish
+      symptoms in which it exerts so much power, according to Hahnemann, and in
+      not one of them did it have the slightest influence, the pulse and heat
+      remaining as before.
+    </p>
+    <p>
+      These statements look pretty honest, and would seem hard to be explained
+      away, but it is calmly said that he &ldquo;did not know enough of the method to
+      select the remedies with any tolerable precision.&rdquo; [&ldquo;Homoeopathic
+      Examiner, vol. i. p. 22.]
+    </p>
+    <p>
+      &ldquo;Nothing is left to the caprice of the physician.&rdquo; (In a word, instead of
+      being dependent upon blind chance, that there is an infallible law, guided
+      by which; the physician MUST select the proper remedies.') ['Ibid.,' in a
+      notice of Menzel's paper.] Who are they that practice Homoeopathy, and say
+      this of a man with the Materia Medica of Hahnemann lying before him? Who
+      are they that send these same globules, on which he experimented,
+      accompanied by a little book, into families, whose members are thought
+      competent to employ them, when they deny any such capacity to a man whose
+      life has been passed at the bedside of patients, the most prominent
+      teacher in the first Medical Faculty in the world, the consulting
+      physician of the King of France, and one of the most renowned practical
+      writers, not merely of his nation, but of his age? I leave the quibbles by
+      which such persons would try to creep out from under the crushing weight
+      of these conclusions to the unfortunates who suppose that a reply is
+      equivalent to an answer.
+    </p>
+    <p>
+      Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
+      invited two Homoeopathic practitioners to experiment in his wards. One of
+      these was Curie, now of London, whose works are on the counters of some of
+      our bookstores, and probably in the hands of some of my audience. This
+      gentleman, whom Dr. Baillie declares to be an enlightened man, and
+      perfectly sincere in his convictions, brought his own medicines from the
+      pharmacy which furnished Hahnemann himself, and employed them for four or
+      five months upon patients in his ward, and with results equally
+      unsatisfactory, as appears from Dr. Baillie's statement at a meeting of
+      the Academy of Medicine. And a similar experiment was permitted by the
+      Clinical Professor of the Hotel Dieu of Lyons, with the same complete
+      failure.
+    </p>
+    <p>
+      But these are old and prejudiced practitioners. Very well, then take the
+      statement of Dr. Fleury, a most intelligent young physician, who treated
+      homoeopathically more than fifty patients, suffering from diseases which
+      it was not dangerous to treat in this way, taking every kind of precaution
+      as to regimen, removal of disturbing influences, and the state of the
+      atmosphere, insisted upon by the most vigorous partisans of the doctrine,
+      and found not the slightest effect produced by the medicines. And more
+      than this, read nine of these cases, 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 are pretended to exert such
+      palpable, such obvious, such astonishing influences. In the view of these
+      statements, it is impossible not to realize the entire futility of
+      attempting to silence this asserted science by the flattest and most
+      peremptory results of experiment. Were all the hospital physicians of
+      Europe and America to devote themselves, for the requisite period, to this
+      sole pursuit, and were their results to be unanimous as to the total
+      worthlessness of the whole system in practice, this slippery delusion
+      would slide through their fingers without the slightest discomposure,
+      when, as they supposed, they had crushed every joint in its tortuous and
+      trailing body.
+    </p>
+    <p>
+      3. I have said, that to show the truth of the Homoeopathic doctrine, as
+      announced by Hahnemann, it would be necessary to show, in the third place,
+      that remedies never cure diseases when they are not capable of producing
+      similar symptoms! The burden of this somewhat comprehensive demonstration
+      lying entirely upon the advocates of this doctrine, it may be left to
+      their mature reflections.
+    </p>
+    <p>
+      It entered into my original plan to treat of the doctrine relating to
+      Psora, or itch,&mdash;an almost insane conception, which I am glad to get
+      rid of, for this is a subject one does not care to handle without gloves.
+      I am saved this trouble, however, by finding that many of the disciples of
+      Hahnemann, those disciples the very gospel of whose faith stands upon his
+      word, make very light of his authority on this point, although he himself
+      says, &ldquo;It has cost me twelve years of study and research to trace out the
+      source of this incredible number of chronic affections, to discover this
+      great truth, which remained concealed from all my predecessors and
+      contemporaries, to establish the basis of its demonstration, and find out,
+      at the same time, the curative medicines that were fit to combat this
+      hydra in all its different forms.&rdquo;
+     </p>
+    <p>
+      But, in the face of all this, the following remarks are made by Wolff, of
+      Dresden, whose essays, according to the editor of the &ldquo;Homoeopathic
+      Examiner,&rdquo; &ldquo;represent the opinions of a large majority of Homoeopathists
+      in Europe.&rdquo;
+     </p>
+    <p>
+      &ldquo;It cannot be unknown to any one at all familiar with Homoeopathic
+      literature, that Hahnemann's idea of tracing the large majority of chronic
+      diseases to actual itch has met with the greatest opposition from
+      Homoeopathic physicians themselves.&rdquo; And again, &ldquo;If the Psoric theory has
+      led to no proper schism, the reason is to be found in the fact that it is
+      almost without any influence in practice.&rdquo;
+     </p>
+    <p>
+      We are told by Jahr, that Dr. Griesselich, &ldquo;Surgeon to the Grand Duke of
+      Baden,&rdquo; and a &ldquo;distinguished&rdquo; Homoeopathist, actually asked Hahnemann for
+      the proof that chronic diseases, such as dropsy, for instance, never arise
+      from any other cause than itch; and that, according to common report, the
+      venerable sage was highly incensed (fort courrouce) with Dr. Hartmann, of
+      Leipsic, another &ldquo;distinguished&rdquo; Homoeopathist, for maintaining that they
+      certainly did arise from other causes.
+    </p>
+    <p>
+      And Dr. Fielitz, in the &ldquo;Homoeopathic Gazette&rdquo; of Leipsic, after saying,
+      in a good-natured way, that Psora is the Devil in medicine, and that
+      physicians are 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
+      Hahnemann who may honor me with his presence, by not attacking a doctrine
+      on which some of the disciples of his creed would be very happy to have
+      its adversaries waste their time and strength. I will not meddle with this
+      excrescence, which, though often used in time of 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 heavily to my
+      sickle, that I should blunt it upon straw and stubble.
+    </p>
+    <p>
+      I will close the subject with a brief examination of some of the
+      statements made in Homoeopathic works, and more particularly in the
+      brilliant Manifesto of the &ldquo;Examiner,&rdquo; before referred to. And first, it
+      is there stated under the head of &ldquo;Homoeopathic Literature,&rdquo; that &ldquo;SEVEN
+      HUNDRED volumes have been issued from the press developing the
+      peculiarities of the system, and many of them possessed of a scientific
+      character that savans know well how to respect.&rdquo; If my assertion were
+      proper evidence in the case, I should declare, that, having seen a good
+      many of these publications, from the year 1834, when I bought the work of
+      the Rev. Thomas Everest, [Dr. Curie speaks of this silly pamphlet as
+      having been published in 1835.] to within a few weeks, when I received my
+      last importation of Homaeopathic literature, I have found that all, with a
+      very few exceptions, were stitched pamphlets varying from twenty or thirty
+      pages to somewhat less than a hundred, and generally resembling each other
+      as much as so many spelling-books.
+    </p>
+    <p>
+      But not being evidence in the case, I will give you the testimony of Dr.
+      Trinks, of Dresden, who flourishes on the fifteenth page of the same
+      Manifesto as one of the most distinguished among the Homoeopathists of
+      Europe. I translate the sentence literally from the &ldquo;Archives de la
+      Medecine Homoeopathique.&rdquo;
+     </p>
+    <p>
+      &ldquo;The literature of Homoeopathy, if that honorable name must be applied to
+      all kinds of book-making, has been degraded to the condition of the
+      humblest servitude. Productions without talent, without spirit, without
+      discrimination, flat and pitiful eulogies, exaggerations surpassing the
+      limits of the most robust faith, invectives against such as dared to doubt
+      the dogmas which had been proclaimed, or catalogues of remedies; of such
+      materials is it composed! From distance to distance only, have appeared
+      some memoirs useful to science or practice, which appear as so many green
+      oases in the midst of this literary desert.&rdquo;
+     </p>
+    <p>
+      It is a very natural as well as a curious question to ask, What has been
+      the success of Homoeopathy in the different countries of Europe, and what
+      is its present condition?
+    </p>
+    <p>
+      The greatest reliance of the advocates of Homoeopathy is of course on
+      Germany. We know very little of its medical schools, its medical
+      doctrines, or its medical men, compared with those of England and France.
+      And, therefore, when an intelligent traveller gives a direct account from
+      personal inspection of the miserable condition of the Homoeopathic
+      hospital at Leipsic, the first established in Europe, and the first on the
+      list of the ever-memorable Manifesto, it is easy enough answer or elude
+      the fact by citing various hard names of &ldquo;distinguished&rdquo; practitioners,
+      which sound just as well to the uninformed public as if they were Meckel,
+      or Tiedemann, or Langenbeck. Dr. Leo-Wolf, who, to be sure, is opposed to
+      Homoeopathy, but who is a scholar, and ought to know something of his own
+      countrymen, assures us that &ldquo;Dr. Kopp is the only German Homoeopathist, if
+      we can call him so, who has been distinguished as an author and
+      practitioner before he examined this method.&rdquo; And Dr. Lee, the same
+      gentleman in whose travels the paragraph relating to the Leipsic Hospital
+      is to be found, says the same thing. And I will cheerfully expose myself
+      to any impertinent remark which it might suggest, to assure my audience
+      that I never heard or saw one authentic Homoeopathic name of any country
+      in Europe, which I had ever heard mentioned before as connected with
+      medical science by a single word or deed sufficient to make it in any
+      degree familiar to my ears, unless Arnold of Heidelberg is the anatomist
+      who discovered a little nervous centre, called the otic ganglion. But you
+      need ask no better proof of who and what the German adherents of this
+      doctrine must be, than the testimony of a German Homoeopathist as to the
+      wretched character of the works they manufacture to enforce its claims.
+    </p>
+    <p>
+      As for the act of this or that government tolerating or encouraging
+      Homoeopathy, every person of common intelligence knows that it is a mere
+      form granted or denied according to the general principles of policy
+      adopted in different states, or the degree of influence which some few
+      persons who have adopted it may happen to have at court. What may be the
+      value of certain pompous titles with which many of the advocates of
+      Homoeopathy are honored, it might be disrespectful to question. But in the
+      mean time the judicious inquirer may ponder over an extract which I
+      translate from a paper relating to a personage well known to the community
+      as Williams the Oculist, with whom I had the honor of crossing the
+      Atlantic some years since, and who himself handed me two copies of the
+      paper in question.
+    </p>
+    <p>
+      &ldquo;To say that he was oculist of Louis XVIII. and of Charles X., and that he
+      now enjoys the same title with respect to His Majesty, Louis Philippe, and
+      the King of the Belgians, is unquestionably to say a great deal; and yet
+      it is one of the least of his titles to public confidence. His reputation
+      rests upon a basis more substantial even than the numerous diplomas with
+      which he is provided, than the membership of the different medical
+      societies which have chosen him as their associate,&rdquo; etc., etc.
+    </p>
+    <p>
+      And as to one more point, it is time that the public should fully
+      understand that the common method of supporting barefaced imposture at the
+      present day, both in Europe and in this country, consists in trumping up
+      &ldquo;Dispensaries,&rdquo; &ldquo;Colleges of Health,&rdquo; and other advertising charitable
+      clap-traps, which use the poor as decoy-ducks for the rich, and the
+      proprietors of which have a strong predilection for the title of
+      &ldquo;Professor.&rdquo; These names, therefore, have come to be of little or no value
+      as evidence of the good character, still less of the high pretensions of
+      those who invoke their authority. Nor does it follow, even when a chair is
+      founded in connection with a well-known institution, that it has either a
+      salary or an occupant; so that it may be, and probably is, a mere harmless
+      piece of toleration on the part of the government if a Professorship of
+      Homoeopathy is really in existence at Jena or Heidelberg. And finally, in
+      order to correct the error of any who might suppose that the whole Medical
+      Profession of Germany has long since fallen into the delusions of
+      Hahnemann, I will quote two lines which a celebrated anatomist and surgeon
+      (whose name will occur again in this lecture in connection with a very
+      pleasing letter) addressed to the French Academy of Medicine in 1835. &ldquo;I
+      happened to be in Germany some months since, at a meeting of nearly six
+      hundred physicians; one of them wished to bring up the question of
+      Homoeopathy; they would not even listen to him.&rdquo; This may have been very
+      impolite and bigoted, but that is not precisely the point in reference to
+      which I mention the circumstance.
+    </p>
+    <p>
+      But if we cannot easily get at Germany, we can very easily obtain exact
+      information from France and England. I took the trouble to write some
+      months ago to two friends in Paris, in whom I could place confidence, for
+      information upon the subject. One of them answered briefly to the effect
+      that nothing was said about it. When the late Curator of the Lowell
+      Institute, at his request, asked about the works upon the subject, he was
+      told that they had remained a long time on the shelves quite unsalable,
+      and never spoken of.
+    </p>
+    <p>
+      The other gentleman, [Dr. Henry T. Bigelow, now Professor of Surgery in
+      Harvard University] whose name is well known to my audience, and who needs
+      no commendation of mine, had the kindness to procure for me many
+      publications upon the subject, and some information which sets the whole
+      matter at rest, so far as Paris is concerned. He went directly to the
+      Baillieres, the principal and almost the only publishers of all the
+      Homoeopathic books and journals in that city. The following facts were
+      taken by him from the account-books of this publishing firm. Four
+      Homoeopathic Journals have been published in Paris; three of them by the
+      Baillieres.
+    </p>
+    <p>
+      The reception they met with may be judged of by showing the number of
+      subscribers to each on the books of the publishing firm.
+    </p>
+    <p>
+      A Review published by some other house, which lasted one year, and had
+      about fifty subscribers, appeared in 1834, 1835.
+    </p>
+    <p>
+      There were only four Journals of Homoeopathy ever published in Paris. The
+      Baillieres informed my correspondent that the sale of Homoeopathic books
+      was much less than formerly, and that consequently they should undertake
+      to publish no new books upon the subject, except those of Jahr or
+      Hahnemann. &ldquo;This man,&rdquo; says my correspondent,&mdash;referring to one of
+      the brothers,&mdash;&ldquo;the publisher and headquarters of Homoeopathy in
+      Paris, informs me that it is going down in England and Germany as well as
+      in Paris.&rdquo; For all the facts he had stated he pledged himself as
+      responsible.
+    </p>
+    <p>
+      Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
+      since then has been going down.
+    </p>
+    <p>
+      Louis told my correspondent that no person of distinction in Paris had
+      embraced Homoeopathy, and that it was declining. If you ask who Louis is,
+      I refer you to the well-known Homoeopathist, Peschier of Geneva, who says,
+      addressing him, &ldquo;I respect no one more than yourself; the feeling which
+      guides your researches, your labors, and your pen, is so honorable and
+      rare, that I could not but bow down before it; and I own, if there were
+      any allopathist who inspired me with higher veneration, it would be him
+      and not yourself whom I should address.&rdquo;
+     </p>
+    <p>
+      Among the names of &ldquo;Distinguished Homoeopathists,&rdquo; however, displayed in
+      imposing columns, in the index of the &ldquo;Homoeopathic Examiner,&rdquo; are those
+      of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the world of
+      science, and the last of them identified with some of the most valuable
+      contributions which anatomical knowledge has received since the
+      commencement of the present century. One Dr. Chrysaora, who stands sponsor
+      for many facts in that Journal, makes the following statement among the
+      rest: &ldquo;Professors, who are esteemed among the most distinguished of the
+      Faculty (Faculty de Medicine), both as to knowledge and reputation, have
+      openly confessed the power of Homoeopathia in forms of disease where the
+      ordinary method of practice proved totally insufficient. It affords me the
+      highest pleasure to select from among these gentlemen, Marjolin, Amussat,
+      and Breschet.&rdquo;
+     </p>
+    <p>
+      Here is a literal translation of an original letter, now in my possession,
+      from one of these Homoeopathists to my correspondent:&mdash;
+    </p>
+    <p>
+      &ldquo;DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
+    </p>
+    <p>
+      &ldquo;You have had the kindness to inform me in your letter that a new American
+      Journal, the 'New World,' has made use of my name in support of the
+      pretended Homoeopathic doctrines, and that I am represented as one of the
+      warmest partisans of Homoeopathy in France.
+    </p>
+    <p>
+      &ldquo;I am vastly surprised at the reputation manufactured for me upon the new
+      continent; but I am obliged, in deference to truth, to reject it with my
+      whole energy. I spurn far from me everything which relates to that
+      charlatanism called Homoeopathy, for these pretended doctrines cannot
+      endure the scrutiny of wise and enlightened persons, who are guided by
+      honorable sentiments in the practice of the noblest of arts.
+    </p>
+    <p>
+      &ldquo;PARIS, 3d November, 1841
+    </p>
+    <p>
+      &ldquo;I am, etc., etc.,
+    </p>
+    <p>
+      &ldquo;G. BRESCHET,
+    </p>
+    <p>
+      &ldquo;Professor in the Faculty of Medicine, Member of the Institute, Surgeon of
+      Hotel Dieu, and Consulting Surgeon to the King, etc.&rdquo; [I first saw M.
+      Breschet's name mentioned in that Journal]
+    </p>
+    <p>
+      Concerning Amussat, my correspondent writes, that he was informed by
+      Madame Hahnemann, who converses in French more readily than her husband,
+      and therefore often speaks for him, that &ldquo;he was not a physician, neither
+      Homoeopathist nor Allopathist, but that he was the surgeon of their own
+      establishment; that is, performed as a surgeon all the operations they had
+      occasion for in their practice.&rdquo;
+     </p>
+    <p>
+      I regret not having made any inquiries as to Marjolin, who, I doubt not,
+      would strike his ponderous snuff-box until it resounded like the Grecian
+      horse, at hearing such a doctrine associated with his respectable name. I
+      was not aware, when writing to Paris, that this worthy Professor, whose
+      lectures I long attended, was included in these audacious claims; but
+      after the specimens I have given of the accuracy of the foreign
+      correspondence of the &ldquo;Homoeopathic Examiner,&rdquo; any further information I
+      might obtain would seem so superfluous as hardly to be worth the postage.
+    </p>
+    <p>
+      Homoeopathy may be said, then, to be in a sufficiently miserable condition
+      in Paris. Yet there lives, and there has lived for years, the illustrious
+      Samuel Hahnemann, who himself assured my correspondent that no place
+      offered the advantages of Paris in its investigation, by reason of the
+      attention there paid to it.
+    </p>
+    <p>
+      In England, it appears by the statement of Dr. Curie in October, 1839,
+      about eight years after its introduction into the country, that there were
+      eighteen Homoeopathic physicians in the United Kingdom, of whom only three
+      were to be found out of London, and that many of these practised
+      Homoeopathy in secret.
+    </p>
+    <p>
+      It will be seen, therefore, that, according to the recent statement of one
+      of its leading English advocates, Homoeopathy had obtained not quite half
+      as many practical disciples in England as Perkinism could show for itself
+      in a somewhat less period from the time of its first promulgation in that
+      country.
+    </p>
+    <p>
+      Dr. Curie's letter, dated London, October 30, 1839, says there is &ldquo;one in
+      Dublin, Dr. Luther; at Glasgow, Dr. Scott.&rdquo; The &ldquo;distinguished&rdquo; Chrysaora
+      writes from Paris, dating October 20, 1839, &ldquo;On the other hand,
+      Homoeopathy is commencing to make an inroad into England by the way of
+      Ireland. At Dublin, distinguished physicians have already embraced the new
+      system, and a great part of the nobility and gentry of that city have
+      emancipated themselves from the English fashion and professional
+      authority.&rdquo;
+     </p>
+    <p>
+      But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
+      Homoeopathy; the Queen Dowager Adelaide has been treated by a Homoeopathic
+      physician. &ldquo;Jarley is the delight of the nobility and gentry.&rdquo; &ldquo;The Royal
+      Family are the patrons of Jarley.&rdquo;
+     </p>
+    <p>
+      Let me ask if a Marquis and a Knight are better than two Lords, and if the
+      Dowager of Royalty is better than Royalty itself, all of which illustrious
+      dignities were claimed in behalf of Benjamin Douglass Perkins?
+    </p>
+    <p>
+      But if the balance is thought too evenly suspended in this case, another
+      instance can be given in which the evidence of British noblemen and their
+      ladies is shown to be as valuable in establishing the character of a
+      medical man or doctrine, as would be the testimony of the Marquis of
+      Waterford concerning the present condition and prospects of missionary
+      enterprise. I have before me an octavo volume of more than four hundred
+      pages, in which, among much similar matter, I find highly commendatory
+      letters from the Marchioness of Ormond, Lady Harriet Kavanagh, the
+      Countess of Buckinghamshire, the Right Hon. Viscount Ingestre, M. P., and
+      the Most Noble, the Marquis of Sligo,&mdash;all addressed to &ldquo;John St.
+      John Long, Esq,&rdquo; a wretched charlatan, twice tried for, and once convicted
+      of, manslaughter at the Old Bailey.
+    </p>
+    <p>
+      This poor creature, too, like all of his tribe, speaks of the medical
+      profession as a great confederation of bigoted monopolists. He, too, says
+      that &ldquo;If an innovator should appear, holding out hope to those in despair,
+      and curing disorders which the faculty have recorded as irremediable, he
+      is at once, and without inquiry, denounced as an empiric and an impostor.&rdquo;
+       He, too, cites the inevitable names of Galileo and Harvey, and refers to
+      the feelings excited by the great discovery of Jenner. From the treatment
+      of the great astronomer who was visited with the punishment of other
+      heretics by the ecclesiastical authorities of a Catholic country some
+      centuries since, there is no very direct inference to be drawn to the
+      medical profession of the present time. His name should be babbled no
+      longer, after having been placarded for the hundredth time in the pages of
+      St. John Long. But if we are doomed to see constant reference to the names
+      of Harvey and Jenner in every worthless pamphlet containing the prospectus
+      of some new trick upon the public, let us, once for all, stare the facts
+      in the face, and see how the discoveries of these great men were actually
+      received by the medical profession.
+    </p>
+    <p>
+      In 1628, Harvey published his first work upon the circulation. His
+      doctrines were a complete revolution of the prevailing opinions of all
+      antiquity. They immediately found both champions and opponents; of which
+      last, one only, Riolanus, seemed to Harvey worthy of an answer, on account
+      of his &ldquo;rank, fame, and learning.&rdquo; Controversy in science, as in religion,
+      was not, in those days, carried on with all the courtesy which our present
+      habits demand, and it is possible that some hard words may have been
+      applied to Harvey, as it is very certain that he used the most
+      contemptuous expressions towards others.
+    </p>
+    <p>
+      Harvey declares in his second letter to Riolanus, &ldquo;Since the first
+      discovery of the circulation, hardly a day, or a moment, has passed
+      without my hearing it both well and ill spoken of; some attack it with
+      great hostility, others defend it with high encomiums; one party believe
+      that I have abundantly proved the truth of the doctrine against all the
+      weight of opposing arguments, by experiments, observations, and
+      dissections; others think it not yet sufficiently cleared up, and free
+      from objections.&rdquo; Two really eminent Professors, Plempius of Louvain, and
+      Walaeus of Leyden, were among its early advocates.
+    </p>
+    <p>
+      The opinions sanctioned by the authority of long ages, and the names of
+      Hippocrates and Galen, dissolved away, gradually, but certainly, before
+      the demonstrations of Harvey. Twenty-four years after the publication of
+      his first work, and six years before his death, his bust in marble was
+      placed in the Hall of the College of Physicians, with a suitable
+      inscription recording his discoveries.
+    </p>
+    <p>
+      Two years after this he was unanimously invited to accept the Presidency
+      of that body; and he lived to see his doctrine established, and all
+      reputable opposition withdrawn.
+    </p>
+    <p>
+      There were many circumstances connected with the discovery of Dr. Jenner
+      which were of a nature to excite repugnance and opposition. The practice
+      of inoculation for the small-pox had already disarmed that disease of many
+      of its terrors. The introduction of a contagious disease from a brute
+      creature into the human system naturally struck the public mind with a
+      sensation of disgust and apprehension, and a part of the medical public
+      may have shared these feelings. I find that Jenner's discovery of
+      vaccination was made public in June, 1798. In July of the same year the
+      celebrated surgeon, Mr. Cline, vaccinated a child with virus received from
+      Dr. Jenner, and in communicating the 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 published his &ldquo;Inquiry,&rdquo; containing the testimony of
+      numerous practitioners in different parts of the kingdom, to the efficacy
+      of the practice. Dr. HAYGARTH, who was so conspicuous in exposing the
+      follies of Perkinism, was among the very earliest to express his opinion
+      in favor of vaccination. In 1801, Dr. Lettsom mentions the circumstance
+      &ldquo;as being to the honor of the medical professors, that they have very
+      generally encouraged this salutary practice, although it is certainly
+      calculated to lessen their pecuniary advantages by its tendency to
+      extirpate a fertile source of professional practice.&rdquo;
+     </p>
+    <p>
+      In the same year the Medical Committee of Paris spoke of vaccination in a
+      public letter, as &ldquo;the most brilliant and most important discovery of the
+      eighteenth century.&rdquo; The Directors of a Society for the Extermination of
+      the Small-Pox, in a Report dated October 1st, 1807, &ldquo;congratulate the
+      public on the very favorable opinion which the Royal College of Physicians
+      of London, after a most minute and laborious investigation 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 of which the sum of twenty thousand
+      pounds was voted to Dr. Jenner, as a remuneration for his discovery, in
+      addition to ten thousand pounds before granted.&rdquo; (In June, 1802.)
+    </p>
+    <p>
+      These and similar accusations, so often brought up against the Medical
+      Profession, are only one mode in which is manifested a spirit of
+      opposition not merely to medical science, but to all science, and to all
+      sound knowledge. It is a spirit which neither understands itself nor the
+      object at which it is aiming. It gropes among the loose records of 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
+      have passed their lives in the study of a branch of knowledge the very
+      essence of which must always consist in long and accurate observation, are
+      less competent to judge of new doctrines in their own department than the
+      rest of the community. It belongs to the clown in society, the destructive
+      in politics, and the rogue in practice.
+    </p>
+    <p>
+      The name of Harvey, whose great discovery was the legitimate result of his
+      severe training and patient study, should be mentioned only to check the
+      pretensions of presumptuous ignorance. The example of Jenner, who gave his
+      inestimable secret, the result of twenty-two years of experiment and
+      researches, unpurchased, to the public,&mdash;when, as was said in
+      Parliament, he might have made a hundred thousand pounds by it as well as
+      any smaller sum,&mdash;should be referred to only to rebuke the selfish
+      venders of secret remedies, among whom his early history obliges us
+      reluctantly to record Samuel Hahnemann. Those who speak of the great body
+      of physicians as if they were united in a league to support the
+      superannuated notions of the past against the progress of improvement,
+      have read 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 ambitious and plausible innovators. If at the present time ten years of
+      public notoriety have passed over any doctrine professing to be of
+      importance in medical science, and if it has not succeeded in raising up a
+      powerful body of able, learned, and ingenious advocates for its claims,
+      the fault must be in the doctrine and not in the medical profession.
+    </p>
+    <p>
+      Homoeopathy has had a still more extended period of trial than this, and
+      we have seen with what results. It only remains to throw out a few
+      conjectures as to the particular manner in which it is to break up and
+      disappear.
+    </p>
+    <p>
+      1. The confidence of the few believers in this delusion will never survive
+      the loss of friends who may die of any acute disease, under a treatment
+      such as that prescribed by Homoeopathy. It is doubtful how far cases of
+      this kind will be trusted to its tender mercies, but wherever it acquires
+      any considerable foothold, such cases must come, and with them the ruin of
+      those who practise it, should any highly valued life be thus sacrificed.
+    </p>
+    <p>
+      2. After its novelty has worn out, the ardent and capricious individuals
+      who constitute the most prominent class of its patrons will return to
+      visible doses, were it only for the sake of a change.
+    </p>
+    <p>
+      3. The Semi-Homoeopathic practitioner will gradually withdraw from the
+      rotten half of his business and try to make the public forget his
+      connection with it.
+    </p>
+    <p>
+      4. The ultra Homoeopathist will either recant and try to rejoin the
+      medical profession; or he will embrace some newer and if possible equally
+      extravagant doctrine; or he will stick to his colors and go down with his
+      sinking doctrine. Very few will pursue the course last mentioned.
+    </p>
+    <p>
+      A single fact may serve to point out in what direction there will probably
+      be a movement of the dissolving atoms of Homoeopathy. On the 13th page of
+      the too frequently cited Manifesto of the &ldquo;Examiner&rdquo; I read the following
+      stately paragraph:
+    </p>
+    <p>
+      &ldquo;Bigelius, M. D., physician to the Emperor of Russia, whose elevated
+      reputation is well known in Europe, has been an acknowledged advocate of
+      Hahnemann's doctrines for several years. He abandoned Allopathia for
+      Homoeopathia.&rdquo; The date of this statement is January, 1840. I find on
+      looking at the booksellers' catalogues that one Bigel, or Bigelius, to
+      speak more classically, has been at various times publishing Homoeopathic
+      books for some years.
+    </p>
+    <p>
+      Again, on looking into the &ldquo;Encyclographie des Sciences Medicales&rdquo; for
+      April, 1840, I find a work entitled &ldquo;Manual of HYDROSUDOPATHY, or the
+      Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel, Physician
+      of the School of Strasburg, Member of the Medico-Chirurgical Institute of
+      Naples, of the Academy of St. Petersburg,&mdash;Assessor of the College of
+      the Empire of Russia, Physician of his late Imperial Highness the Grand
+      Duke Constantine, Chevalier of the Legion of Honor, etc.&rdquo; Hydrosudopathy
+      or Hydropathy, as it is sometimes called, is a new medical doctrine or
+      practice which has sprung up in Germany since Homoeopathy, which it bids
+      fair to drive out of the market, if, as Dr. Bigel says, fourteen
+      physicians afflicted with diseases which defied themselves and their
+      colleagues came to Graefenberg, in the year 1836 alone, and were cured.
+      Now Dr. Bigel, &ldquo;whose elevated reputation is well known in Europe,&rdquo; writes
+      as follows: &ldquo;The reader will not fail to see in this defence of the
+      curative method of Graefenberg a profession of medical faith, and he will
+      be correct in so doing.&rdquo; And his work closes with the following sentence,
+      worthy of so distinguished an individual: &ldquo;We believe, with religion, that
+      the water of baptism purifies the soul from its original sin; let us
+      believe also, with experience, that it is for our corporeal sins the
+      redeemer of the human body.&rdquo; If Bigel, Physician to the late Grand Duke
+      Constantine, is identical with Bigel whom the &ldquo;Examiner&rdquo; calls Physician
+      to the Emperor of Russia, it appears that he is now actively engaged in
+      throwing cold water at once upon his patients and the future prospects of
+      Homoeopathy.
+    </p>
+    <p>
+      If, as must be admitted, no one of Hahnemann's doctrines is received with
+      tolerable unanimity among his disciples, except the central axiom, Similia
+      similibus curantur; if this axiom itself relies mainly for its support
+      upon the folly and trickery of Hahnemann, what can we think of those who
+      announce themselves ready to relinquish all the accumulated treasures of
+      our art, to trifle with life upon the strength of these fantastic
+      theories? What shall we think of professed practitioners of medicine, if,
+      in the words of Jahr, &ldquo;from ignorance, for their personal convenience, or
+      through charlatanism, they treat their patients one day Homoeopathically
+      and the next Allopathically;&rdquo; if they parade their pretended new science
+      before the unguarded portion of the community; if they suffer their names
+      to be coupled with it wherever it may gain a credulous patient; and deny
+      all responsibility for its character, refuse all argument for its
+      doctrines, allege no palliation for the ignorance and deception interwoven
+      with every thread of its flimsy tissue, when they are questioned by those
+      competent to judge and entitled to an answer?
+    </p>
+    <p>
+      Such is the pretended science of Homoeopathy, to which you are asked to
+      trust your lives and the lives of those dearest to you. A mingled mass of
+      perverse ingenuity, of tinsel erudition, of imbecile credulity, and of
+      artful misrepresentation, too often mingled in practice, if we may trust
+      the authority of its founder, with heartless and shameless imposition.
+      Because it is suffered so often to appeal unanswered to the public,
+      because it has its journals, its patrons, its apostles, some are weak
+      enough to suppose it can escape the inevitable doom of utter disgrace and
+      oblivion. Not many years can pass away before the same curiosity excited
+      by one of Perkins's Tractors will be awakened at the sight of one of the
+      Infinitesimal Globules. If it should claim a longer existence, it can only
+      be by falling into the hands of the sordid wretches who wring their bread
+      from the cold grasp of disease and death in the hovels of ignorant
+      poverty.
+    </p>
+    <p>
+      As one humble member of a profession which for more than two thousand
+      years has devoted itself to the pursuit of the best earthly interests of
+      mankind, always assailed and insulted from without by such as are ignorant
+      of its infinite perplexities and labors, always striving in unequal
+      contest with the hundred-armed giant who walks in the noonday, and sleeps
+      not in the midnight, yet still toiling, not merely for itself and 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 noble science it is too weak to strike, or to injure.
+    </p>
+    <p>
+      <a name="link2H_4_0005" id="link2H_4_0005">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      THE CONTAGIOUSNESS OF PUERPERAL FEVER
+    </h2>
+    <h3>
+      Printed in 1843; reprinted with additions, 1855.
+    </h3>
+    <p>
+      THE POINT AT ISSUE. THE AFFIRMATIVE.
+    </p>
+    <p>
+      &ldquo;The disease known as Puerperal Fever is so far contagious as to be
+      frequently carried from patient to patient by physicians and nurses.&rdquo; O.
+      W. Holmes, 1843.
+    </p>
+    <p>
+      THE NEGATIVE.
+    </p>
+    <p>
+      &ldquo;The result of the whole discussion will, I trust, serve, not only to
+      exalt your views of the value and dignity of our profession, but to divest
+      your minds of the overpowering dread that you can ever become, especially
+      to woman, under the extremely interesting circumstances of gestation and
+      parturition, the minister of evil; that you can ever convey, in any
+      possible manner, a horrible virus, so destructive in its effects, and so
+      mysterious in its operations as that attributed to puerperal fever.&rdquo;&mdash;Professor
+      Hodge, 1852.
+    </p>
+    <p>
+      &ldquo;I prefer to attribute them to accident, or Providence, of which I can
+      form a conception, rather than to a contagion of which I cannot form any
+      clear idea, at least as to this particular malady.&rdquo;&mdash;Professor Meigs,
+      1852.
+    </p>
+    <p>
+      &ldquo;... in the propagation of which they have no more to do, than with the
+      propagation of cholera from Jessore to San Francisco, and from Mauritius
+      to St. Petersburg.&rdquo;&mdash;Professor Meigs, 1854.
+    </p>
+<pre xml:space="preserve">
+          &mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;-
+</pre>
+    <p>
+      &ldquo;I arrived at that certainty in the matter, that I could venture to
+      foretell what women would be affected with the disease, upon hearing by
+      what midwife they were to be delivered, or by what nurse they were to be
+      attended, during their lying-in; and, almost in every instance, my
+      prediction was verified.&rdquo;&mdash;Gordon, 1795.
+    </p>
+    <p>
+      &ldquo;A certain number of deaths is caused every year by the contagion of
+      puerperal fever, communicated by the nurses and medical attendants.&rdquo; Farr,
+      in Fifth Annual Report of Registrar-General of England, 1843.
+    </p>
+    <p>
+      &ldquo;... boards of health, if such exist, or, without them, the medical
+      institutions of a country, should have the power of coercing, or of
+      inflicting some kind of punishment on those who recklessly go from cases
+      of puerperal fevers to parturient or puerperal females, without using due
+      precaution; and who, having been shown the risk, criminally encounter it,
+      and convey pestilence and death to the persons they are employed to aid in
+      the most interesting and suffering period of female existence.&rdquo; &mdash;Copland's
+      Medical Dictionary, Art. Puerperal States and Diseases, 1852.
+    </p>
+    <p>
+      &ldquo;We conceive it unnecessary to go into detail to prove the contagious
+      nature of this disease, as there are few, if any, American practitioners
+      who do not believe in this doctrine.&rdquo;&mdash;Dr. Lee, in Additions to
+      Article last cited.
+    </p>
+<pre xml:space="preserve">
+         &mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;-
+</pre>
+    <p>
+      [INTRODUCTORY NOTE.] It happened, some years ago, that a discussion arose
+      in a Medical Society of which I was a member, involving the subject of a
+      certain supposed cause of disease, about which something was known, a good
+      deal suspected, and not a little feared. The discussion was suggested by a
+      case, reported at the preceding meeting, of a physician who made an
+      examination of the body of a patient who had died with puerperal fever,
+      and who himself died in less than a week, apparently in consequence of a
+      wound received at the examination, having attended several women in
+      confinement in the mean time, all of whom, as it was alleged, were
+      attacked with puerperal fever.
+    </p>
+    <p>
+      Whatever apprehensions and beliefs were entertained, it was plain that a
+      fuller knowledge of the facts relating to the subject would be acceptable
+      to all present. I therefore felt that it would be doing a good service to
+      look into the best records I could find, and inquire of the most
+      trustworthy practitioners I knew, to learn what experience had to teach in
+      the matter, and arrived at the results contained in the following pages.
+    </p>
+    <p>
+      The Essay was read before the Boston Society for Medical Improvement, and,
+      at the request of the Society, printed in the &ldquo;New England Quarterly
+      Journal of Medicine and Surgery&rdquo; for April, 1843. As this Journal never
+      obtained a large circulation, and ceased to be published after a year's
+      existence, and as the few copies I had struck off separately were soon
+      lost sight of among the friends to whom they were sent, the Essay can
+      hardly be said to have been fully brought before the Profession.
+    </p>
+    <p>
+      The subject of this Paper has the same profound interest for me at the
+      present moment as it had when I was first collecting the terrible evidence
+      out of which, as it seems to me, the commonest exercise of reason could
+      not help shaping the truth it involved. It is not merely on account of the
+      bearing of the question,&mdash;if there is a question,&mdash;on all that
+      is most sacred in human life and happiness, that the subject cannot lose
+      its interest. It is because it seems evident that a fair statement of the
+      facts must produce its proper influence on a very large proportion of
+      well-constituted and unprejudiced minds. Individuals may, here and there,
+      resist the practical bearing of the evidence on their own feelings or
+      interests; some may fail to see its meaning, as some persons may be found
+      who cannot tell red from green; but I cannot doubt that most readers will
+      be satisfied and convinced, to loathing, long before they have finished
+      the dark obituary calendar laid before them.
+    </p>
+    <p>
+      I do not know that I shall ever again have so good an opportunity of being
+      useful as was granted me by the raising of the question which produced
+      this Essay. For I have abundant evidence that it has made many
+      practitioners more cautious in their relations with puerperal females, and
+      I have no doubt it will do so still, if it has a chance of being read,
+      though it should call out a hundred counterblasts, proving to the
+      satisfaction of their authors that it proved nothing. And for my part, I
+      had rather rescue one mother from being poisoned by her attendant, than
+      claim to have saved forty out of fifty patients to whom I had carried the
+      disease. Thus, I am willing to avail myself of any hint coming from
+      without to offer this paper once more to the press. The occasion has
+      presented itself, as will be seen, in a convenient if not in a flattering
+      form.
+    </p>
+    <p>
+      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
+      eliminates those secondary questions which cannot be entertained for a
+      moment until the one great point of fact is peremptorily settled. In its
+      very statement of the doctrine maintained it avoids all discussion of the
+      nature of the disease &ldquo;known as puerperal fever,&rdquo; and all the somewhat
+      stale philology of the word contagion. It mentions, fairly enough, the
+      names of sceptics, or unbelievers as to the reality of personal
+      transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque, and
+      others; of course, not including those whose works were then unwritten or
+      unpublished; nor enumerating all the Continental writers who, in ignorance
+      of the great mass of evidence accumulated by British practitioners, could
+      hardly be called well informed on this subject. It meets all the array of
+      negative cases,&mdash;those in which disease did not follow exposure,&mdash;by
+      the striking example of small-pox, which, although one of the most
+      contagious of diseases, is subject to the most remarkable irregularities
+      and seeming caprices in its transmission. It makes full allowance for
+      other causes besides personal transmission, especially for epidemic
+      influences. It allows for the possibility of different modes of conveyance
+      of the destructive principle. It recognizes and supports the belief that a
+      series of cases may originate from a single primitive source which affects
+      each new patient in turn; and especially from cases of Erysipelas. It does
+      not undertake to discuss the theoretical aspect of the subject; that is a
+      secondary matter of consideration. Where facts are numerous, and
+      unquestionable, and unequivocal in their significance, theory must follow
+      them as it best may, keeping time with their step, and not go before them,
+      marching to the sound of its own drum and trumpet. Having thus narrowed
+      its area to a limited practical platform of discussion, a matter of life
+      and death, and not of phrases or theories, it covers every inch of it with
+      a mass of evidence which I conceive a Committee of Husbands, who can count
+      coincidences and draw conclusions as well as a Synod of Accoucheurs, would
+      justly consider as affording ample reasons for an unceremonious dismissal
+      of a practitioner (if it is conceivable that such a step could be waited
+      for), after five or six funerals had marked the path of his daily visits,
+      while other practitioners were not thus escorted. To the Profession,
+      therefore, I submit the paper in its original form, and leave it to take
+      care of itself.
+    </p>
+    <p>
+      To the MEDICAL STUDENTS, into whose hands this Essay may fall, some words
+      of introduction may be appropriate, and perhaps, to a small number of
+      them, necessary. There are some among them who, from youth, or want of
+      training, are easily bewildered and confused in any conflict of opinions
+      into which their studies lead them. They are liable to lose sight of the
+      main question in collateral issues, and to be run away with by suggestive
+      speculations. They confound belief with evidence, often trusting the first
+      because it is expressed with energy, and slighting the latter because it
+      is calm and unimpassioned. They are not satisfied with proof; they cannot
+      believe a point is settled so long as everybody is not silenced. They have
+      not learned that error is got out of the minds that cherish it, as the
+      taenia is removed from the body, one joint, or a few joints at a time, for
+      the most part, rarely the whole evil at once. They naturally have faith in
+      their instructors, turning to them for truth, and taking what they may
+      choose to give them; babes in knowledge, not yet able to tell the breast
+      from the bottle, pumping away for the milk of truth at all that offers,
+      were it nothing better than a Professor's shrivelled forefinger.
+    </p>
+    <p>
+      In the earliest and embryonic stage of professional development, any
+      violent impression on the instructor's mind is apt to be followed by some
+      lasting effect on that of the pupil. No mother's mark is more permanent
+      than the mental naevi and moles, and excrescences, and mutilations, that
+      students carry with them out of the lecture-room, if once the teeming
+      intellect which nourishes theirs has been scared from its propriety by any
+      misshapen fantasy. Even an impatient or petulant expression, which to a
+      philosopher would be a mere index of the low state of amiability of the
+      speaker at the moment of its utterance, may pass into the young mind as an
+      element of its future constitution, to injure its temper or corrupt its
+      judgment. It is a duty, therefore, which we owe to this younger class of
+      students, to clear any important truth which may have been rendered
+      questionable in their minds by such language, or any truth-teller against
+      whom they may have been prejudiced by hasty epithets, 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 this prejudice is local or personal, and not
+      an acknowledged conviction with the public at large. It may be necessary
+      to break through our usual habits of reserve to do this, but this is the
+      fault of the position in which others have placed us.
+    </p>
+    <p>
+      Two widely-known and highly-esteemed practitioners, Professors in two of
+      the largest Medical Schools of the Union, teaching the branch of art which
+      includes the Diseases of Women, and therefore speaking with authority;
+      addressing in their lectures and printed publications large numbers of
+      young men, many of them in the tenderest immaturity of knowledge, have
+      recently taken ground in a formal way against the doctrine maintained in
+      this paper:
+    </p>
+    <p>
+      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.
+    </p>
+    <p>
+      On the Nature, Signs, and Treatment of Childbed Fevers: in a Series of
+      Letters addressed to the Students of his Class. By Charles D. Meigs, M.
+      D., Professor of Midwifery and the Diseases of Women and Children in
+      Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854.
+      Letter VI.
+    </p>
+    <p>
+      The first of the two publications, Dr. Hodge's Lecture, while its
+      theoretical considerations and negative experiences do not seem to me to
+      require any further notice than such as lay ready for them in my Essay
+      written long before, is, I am pleased to say, unobjectionable in tone and
+      language, and may be read without offence.
+    </p>
+    <p>
+      This can hardly be said of the chapter of Dr. Meigs's volume which treats
+      of Contagion in Childbed Fever. There are expressions used in it which
+      might well put a stop to all scientific discussions, were they to form the
+      current coin in our exchange of opinions. I leave the &ldquo;very young
+      gentlemen,&rdquo; whose careful expositions of the results of practice in more
+      than six thousand cases are characterized as &ldquo;the jejune and fizenless
+      dreamings of sophomore writers,&rdquo; to the sympathies of those &ldquo;dear young
+      friends,&rdquo; and &ldquo;dear young gentlemen,&rdquo; who will judge how much to value
+      their instructor's counsel to think for themselves, knowing what they are
+      to expect if they happen not to think as he does.
+    </p>
+    <p>
+      One unpalatable expression I suppose the laws of construction oblige me to
+      appropriate to myself, as my reward for a certain amount of labor bestowed
+      on the investigation of a very important question of evidence, and a
+      statement of my own practical conclusions. I take no offence, and attempt
+      no retort. No man makes a quarrel with me over the counterpane that covers
+      a mother, with her new-born infant at her breast. There is no epithet in
+      the vocabulary of slight and sarcasm that can reach my personal
+      sensibilities in such a controversy. Only just so far as a disrespectful
+      phrase may turn the student aside from the examination of the evidence, by
+      discrediting or dishonoring the witness, does it call for any word of
+      notice.
+    </p>
+    <p>
+      I appeal from the disparaging language by which the Professor in the
+      Jefferson School of Philadelphia would dispose of my claims to be listened
+      to. I appeal, not to the vote of the Society for Medical Improvement,
+      although this was an unusual evidence of interest in the paper in
+      question, for it was a vote passed among my own townsmen; nor to the
+      opinion of any American, for none know better than the Professors in the
+      great Schools of Philadelphia how cheaply the praise of native
+      contemporary criticism is obtained. I appeal to the recorded opinions of
+      those whom I do 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 &ldquo;Medical
+      Dictionary,&rdquo; who has spoken of my Essay in phrases to which the pamphlets
+      of American &ldquo;scribblers&rdquo; are seldom used from European authorities; to
+      Ramsbotham, whose compendious eulogy is all that self-love could ask; to
+      the &ldquo;Fifth Annual Report&rdquo; of the Registrar-General of England, in which
+      the second-hand abstract of my Essay figures largely, and not without
+      favorable comment, in an important appended paper. These testimonies, half
+      forgotten until this circumstance recalled them, are dragged into the
+      light, not in a paroxysm of vanity, but to show that there may be food for
+      thought in the small pamphlet which the Philadelphia Teacher treats so
+      lightly. They were at least unsought for, and would never have been
+      proclaimed but for the sake of securing the privilege of a decent and
+      unprejudiced hearing.
+    </p>
+    <p>
+      I will take it for granted that they have so far counterpoised the
+      depreciating language of my fellow-countryman and fellow-teacher as to
+      gain me a reader here and there among the youthful class of students I am
+      now addressing. It is only for their sake that I think it 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 for
+      beginners; and as I do not expect the practitioner, or even the more
+      mature student, to take the trouble to follow me through an Introduction
+      which I consider wholly unnecessary and superfluous for them, I shall not
+      hesitate to stoop to the most elementary simplicity for the benefit of the
+      younger student. I do this more willingly because it affords a good
+      opportunity, as it seems to me, of exercising the untrained mind in that
+      medical logic which does not seem to have been either taught or practised
+      in our schools of late, to the extent that might be desired.
+    </p>
+    <p>
+      I will now exhibit, in a series of propositions reduced to their simplest
+      expression, the same essential statements and conclusions as are contained
+      in the Essay, with such commentaries and explanations as may be profitable
+      to the inexperienced class of readers addressed.
+    </p>
+    <p>
+      I. It has been long believed, by many competent observers, that Puerperal
+      Fever (so called) is sometimes carried from patient to patient by medical
+      assistants.
+    </p>
+    <p>
+      II. The express object of this Essay is to prove that it is so carried.
+    </p>
+    <p>
+      III. In order to prove this point, it is not necessary to consult any
+      medical theorist as to whether or not it is consistent with his
+      preconceived notions that such a mode of transfer should exist.
+    </p>
+    <p>
+      IV. If the medical theorist insists on being consulted, and we see fit to
+      indulge him, he cannot be allowed to assume that the alleged laws of
+      contagion, deduced from observation in other diseases, shall be cited to
+      disprove the alleged laws deduced from observation in this. Science would
+      never make progress under such conditions. Neither the long incubation of
+      hydrophobia, nor the protecting power of vaccination, would ever have been
+      admitted, if the results of observation in these affections had been
+      rejected as contradictory to the previously ascertained laws of contagion.
+    </p>
+    <p>
+      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 which I have examined.
+    </p>
+    <p>
+      VI. When an unusually large number of cases of this disease occur about
+      the same time, it is inferred, therefore, that there exists some special
+      cause for this increased frequency. If the disease prevails extensively
+      over a wide region of country, it is attributed without dispute to an
+      epidemic influence. If it prevails in a single locality, as in a hospital,
+      and not elsewhere, this is considered proof that some local cause is there
+      active in its production.
+    </p>
+    <p>
+      VII. When a large number of cases of this disease occur in rapid
+      succession, in one individual's ordinary practice, and few or none
+      elsewhere, these cases appearing in scattered localities, in patients of
+      the same average condition as those who escape under the care of others,
+      there is the same reason for connecting the cause of the disease with the
+      person in this instance, as with the place in that last mentioned.
+    </p>
+    <p>
+      VIII. Many series of cases, answering to these conditions, are given in
+      this Essay, and many others will be referred to which have occurred since
+      it was written.
+    </p>
+    <p>
+      IX. The alleged results of observation may be set aside; first, because
+      the so-called facts are in their own nature equivocal; secondly, because
+      they stand on insufficient authority; thirdly, because they are not
+      sufficiently numerous. But, in this case, the disease is one of striking
+      and well-marked character; the witnesses are experts, interested in
+      denying and disbelieving the facts; the number of consecutive cases in
+      many instances frightful, and the number of series of cases such that I
+      have no room for many of them except by mere reference.
+    </p>
+    <p>
+      X. These results of observation, being admitted, may, we will suppose, be
+      interpreted in different methods. Thus the coincidences may be considered
+      the effect of chance. I have had the chances calculated by a competent
+      person, that a given practitioner, A., shall have sixteen fatal cases in a
+      month, on the following data: A. to average attendance upon two hundred
+      and fifty births in a year; three deaths in one thousand births to be
+      assumed as the average from puerperal fever; no epidemic to be at the time
+      prevailing. It follows, from the answer given me, that if we suppose every
+      one of the five hundred thousand annual births of England to have been
+      recorded during the last half-century, there would not be one chance in a
+      million million million millions that one such series should be noted. No
+      possible fractional error in this calculation can render the chance a
+      working probability. Applied to dozens of series of various lengths, it is
+      obviously an absurdity. Chance, therefore, is out of the question as an
+      explanation of the admitted coincidences.
+    </p>
+    <p>
+      XI. There is, therefore, some relation of cause and effect between the
+      physician's presence and the patient's disease.
+    </p>
+    <p>
+      XII. Until it is proved to what removable condition attaching to the
+      attendant the disease is owing, he is bound to stay away from his patients
+      so soon as he finds himself singled out to be tracked by the disease. How
+      long, and with what other precautions, I have suggested, without
+      dictating, at the close of my Essay. If the physician does not at once act
+      on any reasonable suspicion of his being the medium of transfer, the
+      families where he is engaged, if they are allowed to know the facts,
+      should decline his services for the time. His feelings on the occasion,
+      however interesting to himself, should not be even named in this
+      connection. A physician who talks about ceremony and gratitude, and
+      services rendered, and the treatment he got, surely forgets himself; it is
+      impossible that he should seriously think of these small matters where
+      there is even a question whether he may not carry disease, and death, and
+      bereavement into any one of &ldquo;his families,&rdquo; as they are sometimes called.
+    </p>
+    <p>
+      I will now point out to the young student the mode in which he may relieve
+      his mind of any confusion, or possibly, if very young, any doubt, which
+      the perusal of Dr. Meigs's Sixth Letter may have raised in his mind.
+    </p>
+    <p>
+      The most prominent ideas of the Letter are, first, that the transmissible
+      nature of puerperal fever appears improbable, and, secondly, that it would
+      be very inconvenient to the writer. Dr. Woodville, Physician to the
+      Small-Pox and Inoculation Hospital in London, found it improbable, and
+      exceedingly inconvenient to himself, that cow pox should prevent
+      small-pox; but Dr. Jenner took the liberty to prove the fact,
+      notwithstanding.
+    </p>
+    <p>
+      I will first call the young student's attention to the show of negative
+      facts (exposure without subsequent disease), of which much seems to be
+      thought. And I may at the same time refer him to Dr. Hodge's Lecture,
+      where he will find the same kind of facts and reasoning. Let him now take
+      up Watson's Lectures, the good sense and spirit of which have made his
+      book a universal favorite, and open to the chapter on Continued Fever. He
+      will find a paragraph containing the following sentence: &ldquo;A man might say,
+      'I was in the battle of Waterloo, and saw many men around me fall down and
+      die, and it was said that they were struck down by musket-balls; but I
+      know better than that, for I was there all the time, and so were many of
+      my friends, and we were never hit by any musket-balls. Musket-balls,
+      therefore, could not have been the cause of the deaths we witnessed.' And
+      if, like contagion, they were not palpable to the senses, such a person
+      might go on to affirm that no proof existed of there being any such thing
+      as musket-balls.&rdquo; Now let the student turn back to the chapter on
+      Hydrophobia in the same volume. He will find that John Hunter knew a case
+      in which, of twenty-one persons bitten, only one died of the disease. He
+      will find that one dog at Charenton was bitten at different times by
+      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 rabid animal, because so
+      many escape? Or let him look at &ldquo;Underwood on Diseases of Children,&rdquo;
+       [Philadelphia, 1842, p. 244, note.] and he will find the case of a young
+      woman who was inoculated eight times in thirty days, at the same time
+      attending several children with smallpox, and yet was not infected. But
+      seven weeks afterwards she took the disease and died.
+    </p>
+    <p>
+      It would seem as if the force of this argument could hardly fail to be
+      seen, if it were granted that every one of these series of cases were so
+      reported as to prove that there could have been no transfer of disease.
+      There is not one of them so reported, in the Lecture or the Letter, as to
+      prove that the disease may not have been carried by the practitioner. I
+      strongly suspect that it was so carried in some of these cases, but from
+      the character of the very imperfect evidence the question can never be
+      settled without further disclosures.
+    </p>
+    <p>
+      Although the Letter is, as I have implied, principally taken 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 touch some
+      of these questions briefly, as an illustration of its logical character.
+    </p>
+    <p>
+      The first thing to be done, as I thought when I wrote my Essay, was to
+      throw out all discussions of the word contagion, and this I did
+      effectually by the careful wording of my statement of the subject to be
+      discussed. My object was not to settle the etymology or definition of a
+      word, but to show that women had often died in childbed, poisoned in some
+      way by their medical attendants. On the other point, I, at least, have no
+      controversy with anybody, and I think the student will do well to avoid it
+      in this connection. If I must define my position, however, as well as the
+      term in question, I am contented with Worcester's definition; provided
+      always this avowal do not open another side controversy on the merits of
+      his Dictionary, which Dr. Meigs has not cited, as compared with Webster's,
+      which he has.
+    </p>
+    <p>
+      I cannot see the propriety of insisting that all the laws of the eruptive
+      fevers must necessarily hold true of this peculiar disease of puerperal
+      women. If there were any such propriety, the laws of the eruptive fevers
+      must at least be stated correctly. It is not true, for instance, as Dr.
+      Meigs states, that contagion is &ldquo;no respecter of persons;&rdquo; that &ldquo;it
+      attacks all individuals alike.&rdquo; To give one example: Dr. Gregory, of the
+      Small-Pox Hospital, who ought to know, says that persons pass through life
+      apparently insensible to or unsusceptible of the small-pox virus, and that
+      the same persons do not take the vaccine disease.
+    </p>
+    <p>
+      As to the short time of incubation, of which so much is made, we have no
+      right to decide beforehand whether it shall be long or short, in the cases
+      we are considering. A dissection wound may produce symptoms of poisoning
+      in six hours; the bite of a rabid animal may take as many months.
+    </p>
+    <p>
+      After the student has read the case in Dr. Meigs's 136th paragraph, and
+      the following one, in which he exclaims against the idea of contagion,
+      because the patient, delivered on the 26th of December, was attacked in
+      twenty-four hours, and died on the third day, let him read what happened
+      at the &ldquo;Black Assizes&rdquo; of 1577 and 1750. In the first case, six hundred
+      persons sickened the same night of the exposure, and three hundred more in
+      three days. [Elliotson's Practice, p. 298.] Of those attacked in the
+      latter year, the exposure being on the 11th of May, Alderman Lambert died
+      on the 13th, Under-Sheriff Cox on the 14th, and many of note before the
+      20th. But these are old stories. Let the student listen then to Dr.
+      Gerhard, whose reputation as a cautious observer he may be supposed to
+      know. &ldquo;The nurse was shaving a man, who died in a few hours after his
+      entrance; he inhaled his breath, which had a nauseous taste, and in an
+      hour afterwards was taken with nausea, cephalalgia, and singing of the
+      ears. From that moment the attack began, and assumed a severe character.
+      The assistant was supporting another patient, who died soon afterwards; he
+      felt the pungent heat upon his skin, and was taken immediately with the
+      symptoms of typhus.&rdquo; [Am. Jour. Med. Sciences, Feb. 1837, p. 299.] It is
+      by notes of cases, rather than notes of admiration, that we must be
+      guided, when we study the Revised Statutes of Nature, as laid down from
+      the curule chairs of Medicine.
+    </p>
+    <p>
+      Let the student read Dr. Meigs's 140th paragraph soberly, and then
+      remember, that not only does he infer, suspect, and surmise, but he
+      actually asserts (page 154), &ldquo;there was poison in the house,&rdquo; because
+      three out of five patients admitted into a ward had puerperal fever and
+      died. Have I not as much right to draw a positive inference from &ldquo;Dr.
+      A.'s&rdquo; seventy exclusive cases as he from the 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 know that the
+      patients he bled in puerperal fever would not have all got well if he had
+      not bled them?
+    </p>
+    <p>
+      &ldquo;You see a man discharge a gun at another; you see the flash, you hear the
+      report, you see the person fall a lifeless corpse; and you infer, from all
+      these circumstances, that there was a ball discharged from the gun, which
+      entered his body and caused his death, because such is the usual and
+      natural cause of such an effect. But you did not see the ball leave the
+      gun, pass through the air, and enter the body of the slain; and your
+      testimony to the fact of killing is, therefore, only inferential,&mdash;in
+      other words, circumstantial. It is possible that no ball was in the gun;
+      and we infer that there was, only because we cannot account for death on
+      any other supposition.&rdquo; [Chief Justice Gibson, in Am. Law Journal, vol.
+      vi. p. 123.]
+    </p>
+    <p>
+      &ldquo;The question always comes to this: Is the circumstance of intercourse
+      with the sick followed by the appearance of the disease in a proportion of
+      cases so much greater than any other circumstance common to any portion of
+      the inhabitants of the place under observation, as to make it
+      inconceivable that the succession of cases occurring in persons having
+      that intercourse should have been the result of chance? If so, the
+      inference is unavoidable, that that intercourse must have acted as a cause
+      of the disease. All observations which do not bear strictly on that point
+      are irrelevant, and, in the case of an epidemic first appearing in a town
+      or district, a succession of two cases is sometimes sufficient to furnish
+      evidence which, on the principle I have stated, is nearly irresistible.&rdquo;
+     </p>
+    <p>
+      Possibly an inexperienced youth may be awe-struck by the quotation from
+      Cuvier. These words, or their equivalent, are certainly to be found in his
+      Introduction. So are the words &ldquo;top not come down&rdquo;! to be found in the
+      Bible, and they were as much meant for the ladies' head-dresses as the
+      words of Cuvier were meant to make clinical observation wait for a permit
+      from anybody to look with its eyes and count on its fingers. Let the
+      inquiring youth read the whole Introduction, and he will see what they
+      mean.
+    </p>
+    <p>
+      I intend no breach of courtesy, but this is a proper place to warn the
+      student against skimming the prefaces and introductions of works for
+      mottoes and embellishments to his thesis. He cannot learn anatomy by
+      thrusting an exploring needle into the body. He will be very liable to
+      misquote his author's meaning while he is picking off his outside
+      sentences. He may make as great a blunder as that simple prince who
+      praised the conductor of his orchestra for the piece just before the
+      overture; the musician was too good a courtier to tell him that it was
+      only the tuning of the instruments.
+    </p>
+    <p>
+      To the six propositions in the 142d paragraph, and the remarks about
+      &ldquo;specific&rdquo; diseases, the answer, if any is necessary, seems very simple.
+      An inflammation of a serous membrane may give rise to secretions which act
+      as a poison, whether that be a &ldquo;specific&rdquo; poison or not, as Dr. Homer has
+      told his young readers, and as dissectors know too well; and that poison
+      may produce its symptoms in a few hours after the system has received it,
+      as any may see in Druitt's &ldquo;Surgery,&rdquo; if they care to look. Puerperal
+      peritonitis may produce such a poison, and puerperal women may be very
+      sensible to its influences, conveyed by contact or exhalation. Whether
+      this is so or not, facts alone can determine, and to facts we have had
+      recourse to settle it.
+    </p>
+    <p>
+      The following statement is made by Dr. Meigs in his 142d paragraph, and
+      developed more at length, with rhetorical amplifications, in the 134th.
+      &ldquo;No human being, save a pregnant or parturient woman, is susceptible to
+      the poison.&rdquo; This statement is wholly incorrect, as I am sorry to have to
+      point out to a Teacher in Dr. Meigs's position. I do not object to the
+      erudition which quotes Willis and Fernelius, the last of whom was
+      pleasantly said to have &ldquo;preserved the dregs of the Arabs in the honey of
+      his Latinity.&rdquo; But I could wish that more modern authorities had not been
+      overlooked. On this point, for instance, among the numerous facts
+      disproving the statement, the &ldquo;American Journal of Medical Sciences,&rdquo;
+       published not far from his lecture-room, would have presented him with a
+      respectable catalog of such cases. Thus he might refer to Mr. Storrs's
+      paper &ldquo;On the Contagious Effects of Puerperal Fever on the Male Subject;
+      or on Persons not Childbearing&rdquo; (Jan. 1846), or to Dr. Reid's case (April,
+      1846), or to Dr. Barron's statement of the children's dying of peritonitis
+      in an epidemic of puerperal fever at the Philadelphia Hospital (Oct.
+      1842), or to various instances cited in Dr. Kneeland's article (April,
+      186). Or, if he would have referred to the &ldquo;New York Journal,&rdquo; he might
+      have seen Prof. Austin Flint's cases. Or, if he had honored my Essay so
+      far, he might have found striking instances of the same kind in the first
+      of the new series of cases there reported and elsewhere. I do not see the
+      bearing of his proposition, if it were true. But it is one of those
+      assertions that fall in a moment before a slight examination of the facts;
+      and I confess my surprise, that a professor who lectures on the Diseases
+      of Women should have ventured to make it.
+    </p>
+    <p>
+      Nearly seven pages are devoted to showing that I was wrong in saying I
+      would not be &ldquo;understood to imply that there exists a doubt in the mind of
+      any well-informed member of the medical profession as to the fact that
+      puerperal fever is sometimes communicated from one person to another, both
+      directly and indirectly.&rdquo; I will devote seven lines to these seven pages,
+      which seven lines, if I may say it without offence, are, as it seems to
+      me, six more than are strictly necessary.
+    </p>
+    <p>
+      The following authors are cited as sceptics by Dr. Meigs: Dewees.&mdash;I
+      cited the same passage. Did not know half the facts. Robert Lee.&mdash;Believes
+      the disease is sometimes communicable by contagion. Tonnelle, Baudelocque.
+      Both cited by me. Jacquemier.&mdash;Published three years after my Essay.
+      Kiwisch. &ldquo;Behindhand in knowledge of Puerperal Fever.&rdquo; [B. &amp; F. Med.
+      Rev. Jan. 1842.] Paul Dubois.&mdash;Scanzoni.
+    </p>
+    <p>
+      These Continental writers not well informed on this point.[See Dr.
+      Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. Oct.
+      1851.)]
+    </p>
+    <p>
+      The story of Von Busch is of interest and value, but there is nothing in
+      it which need perplex the student. It is not pretended that the disease is
+      always, or even, it may be, in the majority of cases, carried about by
+      attendants; only that it is so carried in certain cases. That it may have
+      local and epidemic causes, as well as that depending on personal
+      transmission, is not disputed. Remember how small-pox often disappears
+      from a community in spite of its contagious character, and the necessary
+      exposure of many persons to those suffering from it; in both diseases
+      contagion is only one of the coefficients of the disease.
+    </p>
+    <p>
+      I have already spoken of the possibility that Dr. Meigs may have been the
+      medium of transfer of puerperal fever 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 by Dr. Condie, as given in my Essay,
+      and say whether or not a man should allow his wife to be attended by a
+      practitioner in whose hands &ldquo;scarcely a female that has been delivered for
+      weeks past has escaped an attack,&rdquo; &ldquo;while no instance of the disease has
+      occurred in the patients of any other accoucheur practising in the same
+      district.&rdquo; If I understand Dr. Meigs and Dr. Hodge, they would not warn
+      the physician or spare the patient under such circumstances. They would
+      &ldquo;go on,&rdquo; 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 respectfully ask them to state what they do mean, to their
+      next classes, in the name of humanity, if not of science!
+    </p>
+    <p>
+      I might repeat the question asked concerning Dr. Rutter's cases, with
+      reference to those reported by Dr. Roberton. Perhaps, however, the student
+      would like to know the opinion of a person in the habit of working at
+      matters of this kind in a practical point of view. To satisfy him on this
+      ground, I addressed the following question to the President of one of our
+      principal Insurance Companies, leaving Dr. Meigs's book and my Essay in
+      his hands at the same time.
+    </p>
+    <p>
+      Question. &ldquo;If such facts as Roberton's cases were before you, and the
+      attendant had had ten, or even five fatal cases, or three, or two even,
+      would you, or would you not, if insuring the life of the next patient to
+      be taken care of by that attendant, expect an extra premium over that of
+      an average case of childbirth?&rdquo;
+     </p>
+    <p>
+      Answer. &ldquo;Of course I should require a very large extra premium, if I would
+      take take risk at all.&rdquo;
+     </p>
+    <p>
+      But I do not choose to add the expressions of indignation which the
+      examination of the facts before him called out. I was satisfied from the
+      effect they produced on him, that if all the hideous catalogues of cases
+      now accumulated were fully brought to the knowledge of the public,
+      nothing, since the days of Burke and Hare, has raised such a cry of horror
+      as would be shrieked in the ears of the Profession.
+    </p>
+    <p>
+      Dr. Meigs has elsewhere invoked &ldquo;Providence&rdquo; as the alternative of
+      accident, to account for the &ldquo;coincidences.&rdquo; (&ldquo;Obstetrics,&rdquo; Phil. 1852, p.
+      631.) If so, Providence either acts through the agency of secondary
+      causes, as in other diseases, or not. If through such causes, let us find
+      out what they are, as we try to do in other cases. It may be true that
+      offences, or diseases, will come, but &ldquo;woe unto him through whom they
+      come,&rdquo; if we catch him in the voluntary or careless act of bringing them!
+      But if Providence does not act through secondary causes in this particular
+      sphere of etiology, then why does Dr. Meigs take such pains to reason so
+      extensively about the laws of contagion, which, on that supposition, have
+      no more to do with this case than with the plague which destroyed the
+      people after David had numbered them? Above all, what becomes of the
+      theological aspect of the question, when he asserts that a practitioner
+      was &ldquo;only unlucky in meeting with the epidemic cases?&rdquo; (Op. cit. p. 633.)
+      We do not deny that the God of battles decides the fate of nations; but we
+      like to have the biggest squadrons on our side, and we are particular that
+      our soldiers should not only say their prayers, but also keep their powder
+      dry. We do not deny the agency of Providence in the disaster at Norwalk,
+      but we turn off the engineer, and charge the Company five thousand dollars
+      apiece for every life that is sacrificed.
+    </p>
+    <p>
+      Why a grand jury should not bring in a bill against a physician who
+      switches off a score of women one after the other along his private track,
+      when he knows that there is a black gulf at the end of it, down which they
+      are to plunge, while the great highway is clear, is more than I can
+      answer. It is not by laying the open draw to Providence that he is to
+      escape the charge of manslaughter.
+    </p>
+    <p>
+      To finish with all these lesser matters of question, I am unable to see
+      why a female must necessarily be unattended in her confinement, because
+      she declines the services of a particular practitioner. In all the series
+      of cases mentioned, the death-carrying attendant was surrounded by others
+      not tracked by disease and its consequences. Which, I would ask, is worse,&mdash;to
+      call in another, even a rival practitioner, or to submit an unsuspecting
+      female to a risk which an Insurance Company would have nothing to do with?
+    </p>
+    <p>
+      I do not expect ever to return to this subject. There is a point of mental
+      saturation, beyond which argument cannot be forced without breeding
+      impatient, if not harsh, feelings towards those who refuse to be
+      convinced. If I have so far manifested neither, it is well to stop here,
+      and leave the rest to those younger friends who may have more stomach for
+      the dregs of a stale argument.
+    </p>
+    <p>
+      The extent of my prefatory remarks may lead some to think that I attach
+      too much importance to my own Essay. Others may wonder that I should
+      expend so many words upon the two productions referred to, the Letter and
+      the Lecture. I do consider my Essay of much importance so long as the
+      doctrine it maintains is treated as a question, and so long as any
+      important part of the defence of that doctrine is thought to rest on its
+      evidence or arguments. I cannot treat as insignificant any opinions
+      bearing on life, and interests dearer than life, proclaimed yearly to
+      hundreds of young men, who will carry them to their legitimate results in
+      practice.
+    </p>
+    <p>
+      The teachings of the two Professors in the great schools of Philadelphia
+      are sure to be listened to, not only by their immediate pupils, but by the
+      Profession at large. I am too much in earnest for either humility or
+      vanity, but I do entreat those who hold the keys of life and death to
+      listen to me also for this once. I ask no personal favor; but I beg to be
+      heard in behalf of the women whose lives are at stake, until some stronger
+      voice shall plead for them.
+    </p>
+    <p>
+      I trust that I have made the issue perfectly distinct and intelligible.
+      And let it be remembered that this is no subject to be smoothed over by
+      nicely adjusted phrases of half-assent and half-censure divided between
+      the parties. The balance must be struck boldly and the result declared
+      plainly. If I have been hasty, presumptuous, ill-informed, illogical; if
+      my array of facts means nothing; if there is no reason for any caution in
+      the view of these facts; let me be told so on such authority that I must
+      believe it, and I will be silent henceforth, recognizing that my mind is
+      in a state of disorganization. If the doctrine I have maintained is a
+      mournful truth; if to 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 carry it, into confiding families, let it be
+      proclaimed as plainly what is to be thought of the teachings of those who
+      sneer at the alleged dangers, and scout the very idea of precaution. Let
+      it be remembered that persons are nothing in this matter; better that
+      twenty pamphleteers should be silenced, or as many professors unseated,
+      than that one mother's life should be taken. There is no quarrel here
+      between men, but there is deadly incompatibility and exterminating warfare
+      between doctrines. Coincidences meaning nothing, though a man have a
+      monopoly of the disease for weeks or months; or cause and effect, the
+      cause being in some way connected with the person; this is the question.
+      If I am wrong, let me be put down by such a rebuke as no rash declaimer
+      has received since there has been a public opinion in the medical
+      profession of America; if I am right, let doctrines which lead to
+      professional homicide be no longer taught from the chairs of those two
+      great Institutions. Indifference will not do here; our Journalists and
+      Committees have no right to take up their pages with minute anatomy and
+      tediously detailed cases, while it is a question whether or not the
+      &ldquo;blackdeath&rdquo; of child-bed is to be scattered broadcast by the agency of
+      the mother's friend and adviser. Let the men who mould opinions look to
+      it; if there is any voluntary blindness, any interested oversight, any
+      culpable negligence, even, in such a matter, and the facts shall reach the
+      public ear; the pestilence-carrier of the lying-in chamber must look to
+      God for pardon, for man will never forgive him.
+    </p>
+<pre xml:space="preserve">
+        THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+</pre>
+    <p>
+      In collecting, enforcing, and adding to the evidence accumulated upon this
+      most serious subject, I would not be understood to imply that there exists
+      a doubt in the mind of any well-informed member of the medical profession
+      as to the fact that puerperal fever is sometimes communicated from one
+      person to another, both directly and indirectly. In the present state of
+      our knowledge upon this point I should consider such doubts merely as a
+      proof that the sceptic had either not examined the evidence, or, having
+      examined it, refused to accept its plain and unavoidable consequences. I
+      should be sorry to think, with Dr. Rigby, that it was a case of &ldquo;oblique
+      vision;&rdquo; I should be unwilling to force home the argumentum ad hominem of
+      Dr. Blundell, but I would not consent to make a question of a momentous
+      fact which is no longer to be considered as a subject for trivial
+      discussions, but to be acted upon with silent promptitude. It signifies
+      nothing that wise and experienced practitioners have sometimes doubted the
+      reality of the danger in question; no man has the right to doubt it any
+      longer. No negative facts, no opposing opinions, be they what they may, or
+      whose they may, can form any answer to the series of cases now within the
+      reach of all who choose to explore the records of medical science.
+    </p>
+    <p>
+      If there are some who conceive that any important end would be answered by
+      recording such opinions, or by collecting the history of all the cases
+      they could find in which no evidence of the influence of contagion
+      existed, I believe they are in error. Suppose a few writers of authority
+      can be found to profess a disbelief in contagion,&mdash;and they are very
+      few compared with those who think differently,&mdash;is it quite clear
+      that they formed their opinions on a view of all the facts, or is it not
+      apparent that they relied mostly on their own solitary experience? Still
+      further, of those whose names are quoted, is it not true that scarcely a
+      single one could by any possibility have known the half or the tenth of
+      the facts bearing on the subject which have reached such a frightful
+      amount within the last few years? Again, as to the utility of negative
+      facts, as we may briefly call them,&mdash;instances, namely, in which
+      exposure has not been followed by disease,&mdash;although, like other
+      truths, they may be worth knowing, I do not see that they are like to shed
+      any important light upon the subject before us. Every such instance
+      requires a good deal of circumstantial explanation before it can be
+      accepted. It is not enough that a practitioner should have had a single
+      case of puerperal fever not followed by others. It must be known whether
+      he attended others while this case was in progress, whether he went
+      directly from one chamber to others, whether he took any, and what
+      precautions. It is important to know that several women were exposed to
+      infection derived from the patient, so that allowance may be made for want
+      of predisposition. Now if of negative facts so sifted there could be
+      accumulated a hundred for every one plain instance of communication here
+      recorded, I trust it need not be said that we are bound to guard and watch
+      over the hundredth tenant of our fold, though the ninety and nine may be
+      sure of escaping the wolf at its entrance. If any one is disposed, then,
+      to take a hundred instances of lives endangered or sacrificed out of those
+      I have mentioned, and make it reasonably clear that within a similar time
+      and compass ten thousand escaped the same exposure, I shall thank him for
+      his industry, but I must be permitted to hold to my own practical
+      conclusions, and beg him to adopt or at least to examine them also.
+      Children that walk in calico before open fires are not always burned to
+      death; the instances to the contrary may be worth recording; but by no
+      means if they are to be used as arguments against woollen frocks and high
+      fenders.
+    </p>
+    <p>
+      I am not sure that this paper will escape another remark which it might be
+      wished were founded in justice. It may be said that the facts are too
+      generally known and acknowledged to require any formal argument or
+      exposition, that there is nothing new in the positions advanced, and no
+      need of laying additional statements before the Profession. But on turning
+      to two works, one almost universally, and the other extensively appealed
+      to as authority in this country, I see ample reason to overlook this
+      objection. In the last edition of Dewees's Treatise on the &ldquo;Diseases of
+      Females,&rdquo; it is expressly said, &ldquo;In this country, under no circumstance
+      that puerperal fever has appeared hitherto, does it afford the slightest
+      ground for the belief that it is contagious.&rdquo; In the &ldquo;Philadelphia
+      Practice of Midwifery&rdquo; not one word can be found in the chapter devoted to
+      this disease which would lead the reader to suspect that the idea of
+      contagion had ever been entertained. It seems proper, therefore, to remind
+      those who are in the habit of referring to these works for guidance, that
+      there may possibly be some sources of danger they have slighted or
+      omitted, quite as important as a trifling irregularity of diet, or a
+      confined state of the bowels, and that whatever confidence a physician may
+      have in his own mode of treatment, his services are of questionable value
+      whenever he carries the bane as well as the antidote about his person.
+    </p>
+    <p>
+      The practical point to be illustrated is the following:
+    </p>
+    <p>
+      The disease known as Puerperal Fever is so far contagious as to be
+      frequently carried from patient to patient by physicians and nurses.
+    </p>
+    <p>
+      Let me begin by throwing out certain incidental questions, which, without
+      being absolutely essential, would render the subject more complicated, and
+      by making such concessions and assumptions as may be fairly supposed to be
+      without the pale of discussion.
+    </p>
+    <p>
+      1. It is granted that all the forms of what is called puerperal fever may
+      not be, and probably are not, equally contagious or infectious. I do not
+      enter into the distinctions which have been drawn by authors, because the
+      facts do not appear to me sufficient to establish any absolute line of
+      demarcation between such forms as may be propagated by contagion and those
+      which are never so propagated. This general result I shall only support by
+      the authority of Dr. Ramsbotham, who gives, as the result of his
+      experience, that the same symptoms belong to what he calls the infectious
+      and the sporadic forms of the disease, and the opinion of Armstrong in his
+      original Essay. If others can show any such distinction, I leave it to
+      them to do it. But there are cases enough that show the prevalence of the
+      disease among the patients of a single practitioner when it was in no
+      degree epidemic, in the proper sense of the term. I may refer to those of
+      Mr. Roberton and of Dr. Peirson, hereafter to be cited, as examples.
+    </p>
+    <p>
+      2. I shall not enter into any dispute about the particular mode of
+      infection, whether it be by the atmosphere the physician carries about him
+      into the sick-chamber, or by the direct application of the virus to the
+      absorbing surfaces with which his hand comes in contact. Many facts and
+      opinions are in favor of each of these modes of transmission. But it is
+      obvious that in the majority of cases it must be impossible to decide by
+      which of these channels the disease is conveyed, from the nature of the
+      intercourse between the physician and the patient.
+    </p>
+    <p>
+      3. It is not pretended that the contagion of puerperal fever must always
+      be followed by the disease. It is true of all contagious diseases, that
+      they frequently spare those who appear to be fully submitted to their
+      influence. Even the vaccine virus, fresh from the subject, fails every day
+      to produce its legitimate effect, though every precaution is taken to
+      insure its action. This is still more remarkably the case with scarlet
+      fever and some other diseases.
+    </p>
+    <p>
+      4. It is granted that the disease may be produced and 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 a great extent by
+      contagion, yet it goes through the same periods of periodical increase and
+      diminution which have been remarked in puerperal fever. If the question is
+      asked how we are to reconcile the great variations in the mortality of
+      puerperal fever in different seasons and places with the supposition of
+      contagion, I will answer it by another question from Mr. Farr's letter to
+      the Registrar-General. He makes the statement that &ldquo;five die weekly of
+      small-pox in the metropolis when the disease is not epidemic,&rdquo;&mdash;and
+      adds, &ldquo;The problem for solution is,&mdash;Why do the five deaths become
+      10, 15, 20, 31, 58, 88, weekly, and then progressively fall through the
+      same measured steps?&rdquo;
+     </p>
+    <p>
+      5. I take it for granted, that if it can be shown that great numbers of
+      lives have been and are sacrificed to ignorance or blindness on this
+      point, no other error of which physicians or nurses may be occasionally
+      suspected will be alleged in palliation of this; but that whenever and
+      wherever they can be shown to carry disease and death instead of health
+      and safety, the common instincts of humanity will silence every attempt to
+      explain away their responsibility.
+    </p>
+    <p>
+      The treatise of Dr. Gordon of Aberdeen was published in the year 1795,
+      being among the earlier special works upon the disease. Apart of his
+      testimony has been occasionally copied into other works, but his
+      expressions are so clear, his experience is given with such manly
+      distinctness and disinterested honesty, that it may be quoted as a model
+      which might have been often followed with advantage.
+    </p>
+    <p>
+      &ldquo;This disease seized such women only as were visited, or delivered by a
+      practitioner, or taken care of by a nurse, who had previously attended
+      patients affected with the disease.&rdquo;
+     </p>
+    <p>
+      &ldquo;I had evident proofs of its infectious nature, and that the infection was
+      as readily communicated as that of the small-pox or measles, and operated
+      more speedily than any other infection with which I am acquainted.&rdquo;
+     </p>
+    <p>
+      &ldquo;I had evident proofs that every person who had been with a patient in the
+      puerperal fever became charged with an atmosphere of infection, which was
+      communicated to every pregnant woman who happened to come within its
+      sphere. This is not an assertion, but a fact, admitting of demonstration,
+      as may be seen by a perusal of the foregoing table,&rdquo;&mdash;referring to a
+      table of seventy-seven cases, in many of which the channel of propagation
+      was evident.
+    </p>
+    <p>
+      He adds, &ldquo;It is a disagreeable declaration for me to mention, that I
+      myself was the means of carrying the infection to a great number of
+      women.&rdquo; He then enumerates a number of instances in which the disease was
+      conveyed by midwives and others to the neighboring villages, and declares
+      that &ldquo;these facts fully prove that the cause of the puerperal fever, of
+      which I treat, was a specific contagion, or infection, altogether
+      unconnected with a noxious constitution of the atmosphere.&rdquo;
+     </p>
+    <p>
+      But his most terrible evidence is given in these words: &ldquo;I ARRIVED AT THAT
+      CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT WOMEN WOULD
+      BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT MIDWIFE THEY WERE TO BE
+      DELIVERED, OR BY WHAT NURSE THEY WERE TO BE ATTENDED, DURING THEIR
+      LYING-IN: AND ALMOST IN EVERY INSTANCE, MY PREDICTION WAS VERIFIED.&rdquo;
+     </p>
+    <p>
+      Even previously to Gordon, Mr. White of Manchester had said, &ldquo;I am
+      acquainted with two gentlemen in another town, where the whole business of
+      midwifery is divided betwixt them, and it is very remarkable that one of
+      them loses several patients every year of the puerperal fever, and the
+      other never so much as meets with the disorder,&rdquo;&mdash;a difference which
+      he seems to attribute to their various modes of treatment. [On the
+      Management of Lying-in Women, p. 120.]
+    </p>
+    <p>
+      Dr. Armstrong has given a number of instances in his Essay on Puerperal
+      Fever, of the prevalence of the disease among the patients of a single
+      practitioner. At Sunderland, &ldquo;in all, forty-three cases occurred from the
+      1st of January to the 1st of October, when the disease ceased; and of this
+      number forty were witnessed by Mr. Gregson and his assistant, Mr. Gregory,
+      the remainder having been separately seen by three accoucheurs.&rdquo; There is
+      appended to the London edition of this Essay, a letter from Mr. Gregson,
+      in which that gentleman says, in reference to the great number of cases
+      occurring in his practice, &ldquo;The cause of this I cannot pretend fully to
+      explain, but I should be wanting in common liberality if I were to make
+      any hesitation in asserting, that the disease which appeared in my
+      practice was highly contagious, and communicable from one puerperal woman
+      to another.&rdquo; &ldquo;It is customary among the lower and middle ranks of people
+      to make frequent personal visits to puerperal women resident in the same
+      neighborhood, and I have ample evidence for affirming that the infection
+      of the disease was often carried about in that manner; and, however
+      painful to my feelings, I must in candor declare, that it is very probable
+      the contagion was conveyed, in some instances, by myself, though I took
+      every possible care to prevent such a thing from happening, the moment
+      that I ascertained that the distemper was infectious.&rdquo; Dr. Armstrong goes
+      on to mention six other instances within his knowledge, in which the
+      disease had at different times and places been limited, in the same
+      singular manner, to the practice of individuals, while it existed scarcely
+      if at all among the patients of others around them. Two of the gentlemen
+      became so convinced of their conveying the contagion, that they withdrew
+      for a time from practice.
+    </p>
+    <p>
+      I find a brief notice, in an American Journal, of another series of cases,
+      first mentioned by Mr. Davies, in the &ldquo;Medical Repository.&rdquo; This gentleman
+      stated his conviction that the disease is contagious.
+    </p>
+    <p>
+      &ldquo;In the autumn of 1822 he met with twelve cases, while his medical friends
+      in the neighborhood did not meet with any, 'or at least very few.' He
+      could attribute this circumstance to no other cause than his having been
+      present at the examination, after death, of two cases, some time previous,
+      and of his having imparted the disease to his patients, notwithstanding
+      every precaution.&rdquo;
+     </p>
+    <p>
+      Dr. Gooch says, &ldquo;It is not uncommon for the greater number of cases to
+      occur in the practice of one man, whilst the other practitioners of the
+      neighborhood, who are not more skilful or more busy, meet with few or
+      none. A practitioner opened the body of a woman who had died of puerperal
+      fever, and continued to wear the same clothes. A lady whom he delivered a
+      few days afterwards was attacked with and died of a similar disease; two
+      more of his lying-in patients, in rapid succession, met with the same
+      fate; struck by the thought, that he might have carried contagion in his
+      clothes, he instantly changed them, and 'met with no more cases of the
+      kind.' A woman in the country, who was employed as washerwoman and nurse,
+      washed the linen of one who had died of puerperal fever; the next lying-in
+      patient she nursed died of the same disease; a third nursed by her met
+      with the same fate, till the neighborhood, getting afraid of her, ceased
+      to employ her.&rdquo;
+     </p>
+    <p>
+      In the winter of the year 1824, &ldquo;Several instances occurred of its
+      prevalence among the patients of particular practitioners, whilst others
+      who were equally busy met with few or none. One instance of this kind was
+      very remarkable. A general practitioner, in large midwifery practice, lost
+      so many patients from puerperal fever, that he determined to deliver no
+      more for some time, but that his partner should attend in his place. This
+      plan was pursued for one month, during which not a case of the disease
+      occurred in their practice. The elder practitioner, being then
+      sufficiently recovered, returned to his practice, but the first patient he
+      attended was attacked by the disease and died. A physician, who met him in
+      consultation soon afterwards, about a case of a different kind, and who
+      knew nothing of his misfortune, asked him whether puerperal fever was at
+      all prevalent in his neighborhood, on which he burst into tears, and
+      related the above circumstances.
+    </p>
+    <p>
+      &ldquo;Among the cases which I saw this season in consultation, four occurred in
+      one month in the practice of one medical man, and all of them terminated
+      fatally.&rdquo; [Lond. Med. Gaz. May 2, 1835.]
+    </p>
+    <p>
+      Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he had
+      known the disease spread through a particular district, or be confined to
+      the practice of a particular person, almost every patient being attacked
+      with it, while others had not a single case. It seemed capable, he
+      thought, of conveyance, not only by common modes; but through the dress of
+      the attendants upon the patient.
+    </p>
+    <p>
+      In a letter to be found in the &ldquo;London Medical Gazette&rdquo; for January, 1840,
+      Mr. Roberton of Manchester makes the statement which I here give in a
+      somewhat condensed form.
+    </p>
+    <p>
+      A midwife delivered a woman on the 4th of December, 1830, who died soon
+      after with the symptoms of puerperal fever. In one month from this date
+      the same midwife delivered thirty women, residing in different parts of an
+      extensive suburb, of which number sixteen caught the disease and all died.
+      These were the only cases which had occurred for a considerable time in
+      Manchester. The other midwives connected with the same charitable
+      institution as the woman already mentioned are twenty-five in number, and
+      deliver, on an average, ninety women a week, or about three hundred and
+      eighty a month. None of these women had a case of puerperal fever. &ldquo;Yet
+      all this time this woman was crossing the other midwives in every
+      direction, scores of the patients of the charity being delivered by them
+      in the very same quarters where her cases of fever were happening.&rdquo;
+     </p>
+    <p>
+      Mr. Roberton remarks, that little more than half the women she delivered
+      during this month took the fever; that on some days all escaped, on others
+      only one or more out of three or four; a circumstance similar to what is
+      seen in other infectious maladies.
+    </p>
+    <p>
+      Dr. Blundell says, &ldquo;Those who have never made the experiment can have but
+      a faint conception how difficult it is to obtain the exact truth
+      respecting any occurrence in which feelings and interests are concerned.
+      Omitting particulars, then, I content myself with remarking, generally,
+      that from more than one district I have received accounts of the
+      prevalence of puerperal fever in the practice of some individuals, while
+      its occurrence in that of others, in the same neighborhood, was not
+      observed. Some, as I have been told, have lost ten, twelve, or a greater
+      number of patients, in scarcely broken succession; like their evil genius,
+      the puerperal fever has seemed to stalk behind them wherever they went.
+      Some have deemed it prudent to retire for a time from practice. In fine,
+      that this fever may occur spontaneously, I admit; that its infectious
+      nature may be plausibly disputed, I do not deny; but I add, considerately,
+      that in my own family I had rather that those I esteemed the most should
+      be delivered, unaided, in a stable, by the manger-side, than that they
+      should receive the best help, in the fairest apartment, but exposed to the
+      vapors of this pitiless disease. Gossiping friends, wet-nurses, monthly
+      nurses, the practitioner himself, these are the channels by which, as I
+      suspect, the infection is principally conveyed.&rdquo;
+     </p>
+    <p>
+      At a meeting of the Royal Medical and Chirurgical Society, Dr. King
+      mentioned that some years since a practitioner at Woolwich lost sixteen
+      patients from puerperal fever in the same year. He was compelled to give
+      up practice for one or two years, his business being divided among the
+      neighboring practitioners. No case of puerperal fever occurred afterwards,
+      neither had any of the neighboring surgeons any cases of this disease.
+    </p>
+    <p>
+      At the same meeting Mr. Hutchinson mentioned the occurrence of three
+      consecutive cases of puerperal fever, followed subsequently by two others,
+      all in the practice of one accoucheur.[Lancet, May 2, 1840.]
+    </p>
+    <p>
+      Dr. Lee makes the following statement: &ldquo;In the last two weeks of
+      September, 1827, five fatal cases of uterine inflammation came under our
+      observation. All the individuals so attacked had been attended in labor by
+      the same midwife, and no example of a febrile or inflammatory disease of a
+      serious nature occurred during that period among the other patients of the
+      Westminster General Dispensary, who had been attended by the other
+      midwives belonging to that institution.&rdquo;
+     </p>
+    <p>
+      The recurrence of long series of cases like those I have cited, reported
+      by those most interested to disbelieve in contagion, scattered along
+      through an interval of half a century, might have been thought sufficient
+      to satisfy the minds of all inquirers that here was something more than a
+      singular coincidence. But if, on a more extended observation, it should be
+      found that the same ominous groups of cases clustering about individual
+      practitioners were observed in a remote country, at different times, and
+      in widely separated regions, it would seem incredible that any should be
+      found too prejudiced or indolent to accept the solemn truth knelled into
+      their ears by the funeral bells from both sides of the ocean,&mdash;the
+      plain conclusion that the physician and the disease entered, hand in hand,
+      into the chamber of the unsuspecting patient.
+    </p>
+    <p>
+      That such series of cases have been observed in this country, and in this
+      neighborhood, I proceed to show.
+    </p>
+    <p>
+      In Dr. Francis's &ldquo;Notes to Denman's Midwifery,&rdquo; a passage is cited from
+      Dr. Hosack, in which he refers to certain puerperal cases which proved
+      fatal to several lying-in women, and in some of which the disease was
+      supposed to be conveyed by the accoucheurs themselves.
+    </p>
+    <p>
+      A writer in the &ldquo;New York Medical and Physical Journal&rdquo; for October, 1829,
+      in speaking of the occurrence of puerperal fever, confined to one man's
+      practice, remarks, &ldquo;We have known cases of this kind occur, though rarely,
+      in New York.&rdquo;
+     </p>
+    <p>
+      I mention these little hints about the occurrence of such cases, partly
+      because they are the first I have met with in American medical literature,
+      but more especially because they serve to remind us that behind the
+      fearful array of published facts there lies a dark list of similar events,
+      unwritten in the records of science, but long remembered by many a
+      desolated fireside.
+    </p>
+    <p>
+      Certainly nothing can be more open and explicit than the account given by
+      Dr. Peirson of Salem, of the cases seen by him. In the first nineteen days
+      of January, 1829, he had five consecutive cases of puerperal fever, every
+      patient he attended being attacked, and the three first cases proving
+      fatal. In March of the same year he had two moderate cases, in June,
+      another case, and in July, another, which proved fatal. &ldquo;Up to this
+      period,&rdquo; he remarks, &ldquo;I am not informed that a single case had occurred in
+      the practice of any other physician. Since that period I have had no fatal
+      case in my practice, although I have had several dangerous cases. I have
+      attended in all twenty cases of this disease, of which four have been
+      fatal. I am not aware that there has been any other case in the town of
+      distinct puerperal peritonitis, although I am willing to admit my
+      information may be very defective on this point. I have been told of some
+      'mixed cases,' and 'morbid affections after delivery.'&rdquo;
+     </p>
+    <p>
+      In the &ldquo;Quarterly Summary of the Transactions of the College of Physicians
+      of Philadelphia&rdquo; may be found some most extraordinary developments
+      respecting a series of cases occurring in the practice of a member of that
+      body.
+    </p>
+    <p>
+      Dr. Condie called the attention of the Society to the prevalence, at the
+      present time, of puerperal fever of a peculiarly insidious and malignant
+      character. &ldquo;In the practice of one gentleman extensively engaged as an
+      obstetrician, nearly every female he has attended in confinement, during
+      several weeks past, within the above limits&rdquo; (the southern sections and
+      neighboring districts), &ldquo;had been attacked by the fever.&rdquo;
+     </p>
+    <p>
+      &ldquo;An important query presents itself, the Doctor observed, in reference to
+      the particular form of fever now prevalent. Is it, namely, capable of
+      being propagated by contagion, and is a physician who has been in
+      attendance upon a case of the disease warranted in continuing, without
+      interruption, his practice as an obstetrician? Dr. C., although not a
+      believer in the contagious character of many of those affections generally
+      supposed to be propagated in this manner, has nevertheless become
+      convinced by the facts that have fallen under his notice, that the
+      puerperal fever now prevailing is capable of being communicated by
+      contagion. How otherwise can be explained the very curious circumstance of
+      the disease in one district being exclusively confined to the practice of
+      a single physician, a Fellow of this College, extensively engaged in
+      obstetrical practice,&mdash;while no instance of the disease has occurred
+      in the patients under the care of any other accoucheur practising within
+      the same district; scarcely a female that has been delivered for weeks
+      past has escaped an attack?&rdquo;
+     </p>
+    <p>
+      Dr. Rutter, the practitioner referred to, &ldquo;observed that, after the
+      occurrence of a number of cases of the disease in his practice, he had
+      left the city and remained absent for a week, but on returning, no article
+      of clothing he then wore having been used by him before, one of the very
+      first cases of parturition he attended was followed by an attack of the
+      fever, and terminated fatally; he cannot, readily, therefore, believe in
+      the transmission of the disease from female to female, in the person or
+      clothes of the physician.&rdquo;
+     </p>
+    <p>
+      The meeting at which these remarks were made was held on the 3d of May,
+      1842. In a letter dated December 20, 1842, addressed to Dr. Meigs, and to
+      be found in the &ldquo;Medical Examiner,&rdquo; he speaks of &ldquo;those horrible cases of
+      puerperal fever, some of which you did me the favor to see with me during
+      the past summer,&rdquo; and talks of his experience in the disease, &ldquo;now
+      numbering nearly seventy cases, all of which have occurred within less
+      than a twelvemonth past.&rdquo;
+     </p>
+    <p>
+      And Dr. Meigs asserts, on the same page, &ldquo;Indeed, I believe that his
+      practice in that department of the profession was greater than that of any
+      other gentleman, which was probably the cause of his seeing a greater
+      number of the cases.&rdquo; This from a professor of midwifery, who some time
+      ago assured a gentleman whom he met in consultation, that the night on
+      which they met was the eighteenth in succession that he himself had been
+      summoned from his repose, seems hardly satisfactory.
+    </p>
+    <p>
+      I must call the attention of the inquirer most particularly to the
+      Quarterly Report above referred to, and the letters of Dr. Meigs and Dr.
+      Rutter, to be found in the &ldquo;Medical Examiner.&rdquo; Whatever impression they
+      may produce upon his mind, I trust they will at least convince him that
+      there is some reason for looking into this apparently uninviting subject.
+    </p>
+    <p>
+      At a meeting of the College of Physicians just mentioned, Dr. Warrington
+      stated, that a few days after assisting at an autopsy of puerperal
+      peritonitis, in which he laded out the contents of the abdominal cavity
+      with his hands, he was called upon to deliver three women in rapid
+      succession. All of these women were attacked with different forms of what
+      is commonly called puerperal fever. Soon after these he saw two other
+      patients, both on the same day, with the same disease. Of these five
+      patients two died.
+    </p>
+    <p>
+      At the same meeting, Dr. West mentioned a fact related to him by Dr.
+      Samuel Jackson of Northumberland. Seven females, delivered by Dr. Jackson
+      in rapid succession, while practising in Northumberland County, were all
+      attacked with puerperal fever, and five of them died. &ldquo;Women,&rdquo; he said,
+      &ldquo;who had expected me to attend upon them, now becoming alarmed, removed
+      out of my reach, and others sent for a physician residing several miles
+      distant. These women, as well as those attended by midwives; all did well;
+      nor did we hear of any deaths in child-bed within a radius of fifty miles,
+      excepting two, and these I afterwards ascertained to have been caused by
+      other diseases.&rdquo; He underwent, as he thought, a thorough purification, and
+      still his next patient was attacked with the disease and died. He was led
+      to suspect that the contagion might have been carried in the gloves which
+      he had worn in attendance upon the previous cases. Two months or more
+      after this he had two other cases. He could find nothing to account for
+      these, unless it were the instruments for giving enemata, which had been
+      used in two of the former cases, and were employed by these patients. When
+      the first case occurred, he was attending and dressing a limb extensively
+      mortified from erysipelas, and went immediately to the accouchement with
+      his clothes and gloves most thoroughly imbued with its efluvia. And here I
+      may mention, that this very Dr. Samuel Jackson of Northumberland is one of
+      Dr. Dewees's authorities against contagion.
+    </p>
+    <p>
+      The three following statements are now for the first time given to the
+      public. All of the cases referred to occurred within this State, and two
+      of the three series in Boston and its immediate vicinity.
+    </p>
+    <p>
+      I. The first is a series of cases which took place during the last spring
+      in a town at some distance from this neighborhood. A physician of that
+      town, Dr. C., had the following consecutive cases.
+    </p>
+<pre xml:space="preserve">
+   No. 1, delivered March 20, died March 24.
+    &ldquo; 2,  &ldquo;    April 9,  &ldquo; April 14.
+    &ldquo; 3,  &ldquo;     &ldquo;  10,  &ldquo;  &ldquo;  14.
+    &ldquo; 4,  &ldquo;     &ldquo;  11,  &ldquo;  &ldquo;  18.
+    &ldquo; 5,  &ldquo;     &ldquo;  27,  &ldquo;  May  3.
+    &ldquo; 6,  &ldquo;     &ldquo;  28, had some symptoms, (recovered.)
+    &ldquo; 7,  &ldquo;    May  8, had some symptoms, (also recovered.)
+</pre>
+    <p>
+      These were the only cases attended by this physician during the period
+      referred to. &ldquo;They were all attended by him until their termination, with
+      the exception of the patient No. 6, who fell into the hands 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-named
+      periods, none of which, however, presented any peculiar symptoms of the
+      disease.&rdquo;
+     </p>
+    <p>
+      About the 1st of July he attended another patient in a neighboring
+      village, who died two or three days after delivery.
+    </p>
+    <p>
+      The first patient, it is stated, was delivered on the 20th of March. &ldquo;On
+      the 19th, Dr. C. made the autopsy of a man who died suddenly, sick only
+      forty-eight hours; had oedema of the thigh, and gangrene extending from a
+      little above the ankle into the cavity of the abdomen.&rdquo; Dr. C. wounded
+      himself, very slightly, in the right hand during the autopsy. The hand was
+      quite painful the night following, during his attendance on the patient
+      No. 1. He did not see this patient after the 20th, being confined to the
+      house, and very sick from the wound just mentioned, from this time until
+      the 3d of April.
+    </p>
+    <p>
+      Several cases of erysipelas occurred in the house where the autopsy
+      mentioned above took place, soon after the examination. There were also
+      many cases of erysipelas in town at the time of the fatal puerperal cases
+      which have been mentioned.
+    </p>
+    <p>
+      The nurse who laid out the body of the patient No. 3 was taken on the
+      evening of the same day with sore throat and erysipelas, and died in ten
+      days from the first attack.
+    </p>
+    <p>
+      The nurse who laid out the body of the patient No. 4 was taken on the day
+      following with symptoms like those of this patient, and died in a week,
+      without any external marks of erysipelas.
+    </p>
+    <p>
+      &ldquo;No other cases of similar character with those of Dr. C. occurred in the
+      practice of any of the physicians in the town or vicinity at the time.
+      Deaths following confinement have occurred in the practice of other
+      physicians during the past year, but they were not cases of puerperal
+      fever. No post-mortem examinations were held in any of these puerperal
+      cases.&rdquo;
+     </p>
+    <p>
+      Some additional statements in this letter are deserving of insertion.
+    </p>
+    <p>
+      &ldquo;A physician attended a woman in the immediate neighborhood 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 doubtful whether this should be
+      considered a case of puerperal fever. She had suffered from canker,
+      indigestion, and diarrhoea for a year previous to her delivery. Her
+      complaints were much aggravated for two or three months previous to
+      delivery; she had become greatly emaciated, and weakened to such an extent
+      that it had not been expected that she would long survive her confinement,
+      if indeed she reached that period. Her labor was easy enough; she flowed a
+      good deal, seemed exceedingly prostrated, had ringing in the ears, and
+      other symptoms of exhaustion; the pulse was quick and small. On the second
+      and third day there was some tenderness and tumefaction of the abdomen,
+      which increased somewhat on the fourth and fifth. He had cases in
+      midwifery before and after this, which presented nothing peculiar.&rdquo;
+     </p>
+    <p>
+      It is also mentioned in the same letter, that another physician had a case
+      during the last summer and another last fall, both of which recovered.
+    </p>
+    <p>
+      Another gentleman reports a case last December, a second case five weeks,
+      and another three weeks since. All these recovered. A case also occurred
+      very recently in the practice of a physician in the village where the
+      eighth patient of Dr. C. resides, which proved fatal. &ldquo;This patient had
+      some patches of erysipelas on the legs and arms. The same physician has
+      delivered three cases since, which have all done well. There have been no
+      other cases in this town or its vicinity recently. There have been some
+      few cases of erysipelas.&rdquo; It deserves notice that the partner of Dr. C.,
+      who attended the autopsy of the man above mentioned and took an active
+      part in it; who also suffered very slightly from a prick under the
+      thumb-nail received during the examination, had twelve cases of midwifery
+      between March 26th and April 12th, all of which did well, and presented no
+      peculiar symptoms. It should also be stated, that during these seventeen
+      days he was in attendance on all the cases of erysipelas in the house
+      where the autopsy had been performed.
+    </p>
+    <p>
+      I owe these facts to the prompt kindness of a gentleman whose intelligence
+      and character are sufficient guaranty for their accuracy.
+    </p>
+    <p>
+      The two following letters were addressed to my friend Dr. Scorer, by the
+      gentleman in whose practice the cases of puerperal fever occurred. His
+      name renders it unnecessary to refer more particularly to these gentlemen,
+      who on their part have manifested the most perfect freedom and courtesy in
+      affording these accounts of their painful experience.
+    </p>
+    <p>
+      &ldquo;January 28, 1843.
+    </p>
+    <p>
+      II.... &ldquo;The time to which you allude was in 1830. The first case was in
+      February, during a very cold time. She was confined the 4th, and died the
+      12th. Between the 10th and 28th of this month, I attended six women in
+      labor, all of whom did well except the last, as also two who were confined
+      March 1st and 5th. Mrs. E., confined February 28th, sickened, and died
+      March 8th. The next day, 9th, I inspected the body, and the night after
+      attended a lady, Mrs. B., who sickened, and died 16th. The 10th, I
+      attended another, Mrs. G., who sickened, but recovered. March 16th, I went
+      from Mrs. G.'s room to attend a Mrs. H., who sickened, and died 21st. The
+      17th, I inspected Mrs. B. On the 19th, I went directly from Mrs. H.'s room
+      to 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
+      attended another woman, who was not sick. Up to 20th of this month I wore
+      the same clothes. I now refused to attend any labor, and did not till
+      April 21st, when, having thoroughly cleansed myself, I resumed my
+      practice, and had no more puerperal fever.
+    </p>
+    <p>
+      &ldquo;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. The
+      others were from two to three miles apart, and nearly that distance from
+      my residence. There were no other cases in their immediate vicinity which
+      came to my knowledge. The general health of all the women was pretty good,
+      and all the labors as good as common, except the first. This woman, in
+      consequence of my not arriving in season, and the child being half-born at
+      some time before I arrived, was very much exposed to the cold at the time
+      of confinement, and afterwards, being confined in a very open, cold room.
+      Of the six cases you perceive only one recovered.
+    </p>
+    <p>
+      &ldquo;In the winter of 1817 two of my patients had puerperal fever, one very
+      badly, the other not so badly. Both recovered. One other had swelled leg,
+      or phlegmasia dolens, and one or two others did not recover as well as
+      usual.
+    </p>
+    <p>
+      &ldquo;In the summer of 1835 another disastrous period occurred in my practice.
+      July 1st, I attended a lady in labor, who was afterwards quite ill and
+      feverish; but at the time I did not consider her case a decided puerperal
+      fever. On the 8th, I attended one who did well. On the 12th, one who was
+      seriously sick. This was also an equivocal case, apparently arising from
+      constipation and irritation of the rectum. These women were ten miles
+      apart and five from my residence. On 15th and 20th, two who did well. On
+      25th, I attended another. This was a severe labor, and followed by
+      unequivocal puerperal fever, or peritonitis. She recovered. August 2d and
+      3d, in about twenty-four hours I attended four persons. Two of them did
+      very well; one was attacked with some of the common symptoms, which
+      however subsided in a day or two, and the other had decided puerperal
+      fever, but recovered. This woman resided five miles from me. Up to this
+      time I wore the same coat. All my other clothes had frequently been
+      changed. On 6th, I attended two women, one of whom was not sick at all;
+      but the other, Mrs. L., was afterwards taken ill. On 10th, I attended a
+      lady, who did very well. I had previously changed all my clothes, and had
+      no garment on which had been in a puerperal room. On 12th, I was called to
+      Mrs. S., in labor. While she was ill, I left her to visit Mrs. L., one of
+      the ladies who was confined on 6th. Mrs. L. had been more unwell than
+      usual, but I had not considered her case anything more than common till
+      this visit. I had on a surtout at this visit, which, on my return to Mrs.
+      S., I left in another room. Mrs. S. was delivered on 13th with forceps.
+      These women both died of decided puerperal fever.
+    </p>
+    <p>
+      &ldquo;While I attended these women in their fevers, I changed my clothes, and
+      washed my hands in a solution of chloride of lime after each visit. I
+      attended seven women in labor during this period, all of whom recovered
+      without sickness.
+    </p>
+    <p>
+      &ldquo;In my practice I have had several single cases of puerperal fever, some
+      of whom have died and some have recovered. Until the year 1830 I had no
+      suspicion that the disease could be communicated from one patient to
+      another by a nurse or midwife; but I now think the foregoing facts
+      strongly favor that idea. I was so much convinced of this fact, that I
+      adopted the plan before related.
+    </p>
+    <p>
+      &ldquo;I believe my own health was as good as usual at each of the above
+      periods. I have no recollections to the contrary.
+    </p>
+    <p>
+      &ldquo;I believe I have answered all your questions. I have been more particular
+      on some points perhaps than necessary; but I thought you could form your
+      own opinion better than to take mine. In 1830 I wrote to Dr. Charming a
+      more particular statement of my cases. If I have not answered your
+      questions sufficiently, perhaps Dr. C. may have my letter to him, and you
+      can find your answer there.&rdquo; [In a letter to myself, this gentleman also
+      stated, &ldquo;I do not recollect that there was any erysipelas or any other
+      disease particularly prevalent at the time.&rdquo;]
+    </p>
+    <p>
+      &ldquo;BOSTON, February 3, 1843.
+    </p>
+    <p>
+      III. &ldquo;MY DEAR SIR,&mdash;I received a note from you last evening,
+      requesting me to answer certain questions therein proposed, touching the
+      cases of puerperal fever which came under my observation the past summer.
+      It gives me pleasure to comply with your request, so far as it is in my
+      power so to do, but, owing to the hurry in preparing for a journey, the
+      notes of the cases I had then taken were lost or mislaid. The principal
+      facts, however, are too vivid upon my recollection to be soon forgotten. I
+      think, therefore, that I shall be able to give you all the information you
+      may require.
+    </p>
+    <p>
+      &ldquo;All the cases that occurred in my practice took place between the 7th of
+      May and the 17th of June 1842.
+    </p>
+    <p>
+      &ldquo;They were not confined to any particular part of the city. The first two
+      cases were patients residing at the South End, the next was at the extreme
+      North End, one living in Sea Street and the other in Roxbury. The
+      following is the order in which they occurred:
+    </p>
+    <p>
+      &ldquo;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 the
+      circumstances. She died on the 10th.
+    </p>
+    <p>
+      &ldquo;Case 2. Mrs.______ was confined on the 10th of June (four weeks after
+      Mrs. C.), at 11 A. M., after a natural, but somewhat severe labor of five
+      hours. At 7 o'clock, on the morning of the 11th, she had a chill. Died on
+      the 12th.
+    </p>
+    <p>
+      &ldquo;Case 3. Mrs.______, confined on the 14th of June, was comfortable until
+      the 18th, when symptoms of puerperal fever were manifest. She died on the
+      20th.
+    </p>
+    <p>
+      &ldquo;Case 4. Mrs.______, confined June 17th, at 5 o'clock, A. M., was doing
+      well until the morning of the 19th. She died on the evening of the 21st.
+    </p>
+    <p>
+      &ldquo;Case 5. Mrs.______ was confined with her fifth child on the 17th of June,
+      at 6 o'clock in the evening. This patient had been attacked with puerperal
+      fever, at three of her previous confinements, but the disease yielded to
+      depletion and other remedies without difficulty. This time, I regret to
+      say, I was not so fortunate. She was not attacked, as were the other
+      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 she died in
+      great distress on the 22d of the same month. Owing to the extreme heat of
+      the season, and my own indisposition, none of the subjects were examined
+      after death. Dr. Channing, who was in attendance with me on the three last
+      cases, proposed to have a post-mortem examination of the subject of case
+      No. 5, but from some cause which I do not now recollect it was not
+      obtained.
+    </p>
+    <p>
+      &ldquo;You wish to know whether I wore the same clothes when attending the
+      different cases. I cannot positively say, but I should think I did not, as
+      the weather became warmer after the first two cases; I therefore think it
+      probable that I made a change of at least a part of my dress. I have had
+      no other case of puerperal fever in my own practice for three years, save
+      those above related, and I do not remember to have lost a patient before
+      with this disease. While absent, last July, I visited two patients sick
+      with puerperal fever, with a friend of mine in the country. Both of them
+      recovered.
+    </p>
+    <p>
+      &ldquo;The cases that I have recorded were not confined to any particular
+      constitution or temperament, but it seized upon the strong and the weak,
+      the old and the young,&mdash;one being over forty years, and the youngest
+      under eighteen years of age.... If the disease is of an erysipelatous
+      nature, as many suppose, contagionists may perhaps find some ground for
+      their belief in the fact, that, for two weeks previous to my first case of
+      puerperal fever, I had been attending a severe case of erysipelas, and the
+      infection may have been conveyed through me to the patient; but, on the
+      other hand, why is not this the case with other physicians, or with the
+      same physician at all times, for since my return from the country I have
+      had a more inveterate case of erysipelas than ever before, and no
+      difficulty whatever has attended any of my midwifery cases?&rdquo;
+     </p>
+    <p>
+      I am assured, on unquestionable authority, that &ldquo;About three years since,
+      a gentleman in extensive midwifery business, in a neighboring State, lost
+      in the course of a few weeks eight patients in child-bed, seven of them
+      being undoubted cases of puerperal fever. No other physician of the town
+      lost a single patient of this disease during the same period.&rdquo; And from
+      what I have heard in conversation with some of our most experienced
+      practitioners, I am inclined to think many cases of the kind might be
+      brought to light by extensive inquiry.
+    </p>
+    <p>
+      This long catalogue of melancholy histories assumes a still darker aspect
+      when we remember how kindly nature deals with the parturient female, when
+      she is not immersed in the virulent atmosphere of an impure lying-in
+      hospital, or poisoned in her chamber by the unsuspected breath of
+      contagion. From all causes together, not more than four deaths in a
+      thousand births and miscarriages happened in England and Wales during the
+      period embraced by the first &ldquo;Report of the Registrar-General.&rdquo; In the
+      second Report the mortality was shown to be about five in one 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 from this disease in 278
+      cases, or between three and four to the thousand a yet during this period
+      the disease was endemic in the hospital, and might have gone on to rival
+      the horrors of the pestilence of the Maternite, had not the poison been
+      destroyed by a thorough purification.
+    </p>
+    <p>
+      In private practice, leaving out of view the cases that are to be ascribed
+      to the self-acting system of propagation, it would seem that the disease
+      must be far from common. Mr. White of Manchester says, &ldquo;Out of the whole
+      number of lying-in patients whom I have delivered (and I may safely call
+      it a great one), I have never lost one, nor to the best of my recollection
+      has one been greatly endangered, by the puerperal, miliary, low nervous,
+      putrid malignant, or milk fever.&rdquo; Dr. Joseph Clarke informed Dr. Collins,
+      that in the course of forty-five years' most extensive practice he lost
+      but four patients from this disease. One of the most eminent practitioners
+      of Glasgow, who has been engaged in very extensive practice for upwards of
+      a quarter of a century, testifies that he never saw more than twelve cases
+      of real puerperal fever. [Lancet, May 4, 1833]
+    </p>
+    <p>
+      I have myself been told by two gentlemen practising in this city, and
+      having for many years a large midwifery business, that they had neither of
+      them lost a patient from this disease, and by one of them that he had only
+      seen it in consultation with other physicians. In five hundred cases of
+      midwifery, of which Dr. Storer has given an abstract in the first number
+      of this Journal, there was only one instance of fatal puerperal
+      peritonitis.
+    </p>
+    <p>
+      In the view of these facts, it does appear a singular coincidence, that
+      one man or woman should have ten, twenty, thirty, or seventy cases of this
+      rare disease following his or her footsteps with the keenness of a beagle,
+      through the streets and lanes of a crowded city, while the scores that
+      cross the same paths on the same errands know it only by name. It is a
+      series of similar coincidences which has led us to consider the dagger,
+      the musket, and certain innocent-looking white powders as having some
+      little claim to be regarded as dangerous. It is the practical inattention
+      to similar coincidences which has given rise to the unpleasant but often
+      necessary documents called indictments, which has sharpened a form of the
+      cephalotome sometimes employed in the case of adults, and adjusted that
+      modification of the fillet which delivers the world of those who happen to
+      be too much in the way while such striking coincidences are taking place.
+    </p>
+    <p>
+      I shall now mention a few instances in which the disease appears to have
+      been conveyed by the process of direct inoculation.
+    </p>
+    <p>
+      Dr. Campbell of Edinburgh states that in October, 1821, he assisted at the
+      post-mortem examination of a patient who died with puerperal fever. He
+      carried the pelvic viscera in his pocket to the class-room. The same
+      evening he attended a woman in labor without previously 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 with the
+      disease within a few weeks, three shared the same fate in succession.
+    </p>
+    <p>
+      In June, 1823, he assisted some of his pupils at the autopsy of a case of
+      puerperal fever. He was unable to wash his hands with proper care, for
+      want of the necessary accommodations. On getting home he found that two
+      patients required his assistance. He went without further ablution, or
+      changing his clothes; both these patients died with puerperal fever. This
+      same Dr. Campbell is one of Dr. Churchill's authorities against contagion.
+    </p>
+    <p>
+      Mr. Roberton says that in one instance within his knowledge a practitioner
+      passed the catheter for a patient with puerperal fever late in the
+      evening; the same night he attended a lady who had the symptoms of the
+      disease on the second day. In another instance a surgeon was called while
+      in the act of inspecting the body of a woman who had died of this fever,
+      to attend a labor; within forty-eight hours this patient was seized with
+      the fever.'
+    </p>
+    <p>
+      On the 16th of March, 1831, a medical practitioner examined the body of a
+      woman who had died a few days after delivery, from puerperal peritonitis.
+      On the evening of the 17th he delivered a patient, who was seized with
+      puerperal fever on the 19th, and died on the 24th. Between this period and
+      the 6th of April, the same practitioner attended two other patients, both
+      of whom were attacked with the same disease and died.
+    </p>
+    <p>
+      In the autumn of 1829 a physician was present at the examination of a case
+      of puerperal fever, dissected out the organs, and assisted in sewing up
+      the body. He had scarcely reached home when he was summoned to attend a
+      young lady in labor. In sixteen hours she was attacked with the symptoms
+      of puerperal fever, and narrowly escaped with her life.
+    </p>
+    <p>
+      In December, 1830, a midwife, who had attended two fatal cases of
+      puerperal fever at the British Lying-in Hospital, examined a patient who
+      had just been admitted, to ascertain if labor had commenced. This patient
+      remained two days in the expectation that labor would come on, when she
+      returned home and was then suddenly taken in labor and delivered before
+      she could set out for the hospital. She went on favorably for two days,
+      and was then taken with puerperal fever and died in thirty-six hours.
+    </p>
+    <p>
+      &ldquo;A young practitioner, contrary to advice, examined the body of a patient
+      who had died from puerperal fever; there was no epidemic at the time; the
+      case appeared to be purely sporadic. He delivered three other women
+      shortly afterwards; they all died with puerperal fever, the symptoms of
+      which broke out very soon after labor. The patients of his colleague did
+      well, except one, where he assisted to remove some coagula from the
+      uterus; she was attacked in the same manner as those whom he had attended,
+      and died also.&rdquo; The writer in the &ldquo;British and Foreign Medical Review,&rdquo;
+       from whom I quote this statement,&mdash;and who is no other than Dr.
+      Rigby, adds, &ldquo;We trust that this fact alone will forever silence such
+      doubts, and stamp the well-merited epithet of 'criminal,' as above quoted,
+      upon such attempts.&rdquo; [Brit. and For. Medical Review for Jan. 1842, p.
+      112.]
+    </p>
+    <p>
+      From the cases given by Mr. Ingleby, I select the following. Two
+      gentlemen, after having been engaged in conducting the post-mortem
+      examination of a case of puerperal fever, went in the same dress, each
+      respectively, to a case of midwifery. &ldquo;The one patient was seized with the
+      rigor about thirty hours afterwards. The other patient was seized with a
+      rigor the third morning after delivery. One recovered, one died.&rdquo; [Edin.
+      Med. and Surg. Journal, April, 1838.]
+      One of these same gentlemen attended another woman in the same clothes two
+      days after the autopsy referred to. &ldquo;The rigor did not take place until
+      the evening of the fifth day from the first visit. Result fatal.&rdquo; These
+      cases belonged to a series of seven, the first of which was thought to
+      have originated in a case of erysipelas. &ldquo;Several cases of a mild
+      character followed the foregoing seven, and their nature being now most
+      unequivocal, my friend declined visiting all midwifery cases for a time,
+      and there was no recurrence of the disease.&rdquo; These cases occurred in 1833.
+      Five of them proved fatal. Mr. Ingleby gives another series of seven cases
+      which occurred to a practitioner in 1836, the first of which was also
+      attributed to his having opened several erysipelatous abscesses a short
+      time previously.
+    </p>
+    <p>
+      I need not refer to the case lately read before this Society, in which a
+      physician went, soon after performing an autopsy of a case of puerperal
+      fever, to a woman in labor, who was seized with the same disease and
+      perished. The forfeit of that error has been already paid.
+    </p>
+    <p>
+      At a meeting of the Medical and Chirurgical Society before referred to,
+      Dr. Merriman related an instance occurring in his own practice, which
+      excites a reasonable suspicion that two lives were sacrificed to a still
+      less dangerous experiment. He was at the examination of a case of
+      puerperal fever at two o'clock in the afternoon. He took care not to touch
+      the body. At nine o'clock the same evening he attended a woman in labor;
+      she was so nearly delivered that he had scarcely anything to do. The next
+      morning she had severe rigors, and in forty-eight hours she was a corpse.
+      Her infant had erysipelas and died in two days. [Lancet, May 2, 1840.]
+    </p>
+    <p>
+      In connection with the facts which have been stated, it seems proper to
+      allude to the dangerous and often fatal effects which have followed from
+      wounds received in the post-mortem examination of patients who have died
+      of puerperal fever. The fact that such wounds are attended with peculiar
+      risk has been long noticed. I find that Chaussier was in the habit of
+      cautioning his students against the danger to which they were exposed in
+      these dissections. [Stein, L'Art d'Accoucher, 1794; Dict. des Sciences
+      Medicales, art. &ldquo;Puerperal.&rdquo;] The head pharmacien of the Hotel Dieu, in
+      his analysis of the fluid effused in puerperal peritonitis, says that
+      practitioners are convinced of its deleterious qualities, and that it is
+      very dangerous to apply it to the denuded skin. [Journal de Pharmacie,
+      January, 1836.] Sir Benjamin Brodie speaks of it as being well known that
+      the inoculation of lymph or pus from the peritoneum of a puerperal patient
+      is often attended with dangerous and even fatal symptoms. Three cases in
+      confirmation of this statement, two of them fatal, have been reported to
+      this Society within a few months.
+    </p>
+    <p>
+      Of about fifty cases of injuries of this kind, of various degrees of
+      severity, which I have collected from different sources, at least twelve
+      were instances of infection from puerperal peritonitis. Some of the others
+      are so stated as to render it probable that they may have been of the same
+      nature. Five other cases were of peritoneal inflammation; three in males.
+      Three were what was called enteritis, in one instance complicated with
+      erysipelas; but it is well known that this term has been often used to
+      signify inflammation of the peritoneum covering the intestines. On the
+      other hand, no case of typhus or typhoid fever is mentioned as giving rise
+      to dangerous consequences, with the exception of the single instance of an
+      undertaker mentioned by Mr. Travers, who seems to have been poisoned by a
+      fluid which exuded from the body. The other accidents were produced by
+      dissection, or some other mode of contact with bodies of patients who had
+      died of various affections. They also differed much in severity, the cases
+      of puerperal origin being among the most formidable and fatal. Now a
+      moment's reflection will show that the number of cases of serious
+      consequences ensuing from the dissection of the bodies of those who had
+      perished of puerperal fever is so vastly disproportioned to the relatively
+      small number of autopsies made in this complaint as compared with typhus
+      or pneumonia (from which last disease not one case of poisoning happened),
+      and still more from all diseases put together, that the conclusion is
+      irresistible that a most fearful morbid poison is often generated in the
+      course of this 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.
+    </p>
+    <p>
+      In connection with this may be taken the following statement of Dr. Rigby.
+      &ldquo;That the discharges from a patient under puerperal fever are in the
+      highest degree contagious we have abundant evidence in the history of
+      lying-in hospitals. The puerperal abscesses are also contagious, and may
+      be communicated to healthy lying-in women by washing with the same sponge;
+      this fact has been repeatedly proved in the Vienna Hospital; but they are
+      equally communicable to women not pregnant; on more than one occasion the
+      women engaged in washing the soiled bed-linen of the General Lying-in
+      Hospital have been attacked with abscess in the fingers or hands, attended
+      with rapidly spreading inflammation of the cellular tissue.&rdquo;
+     </p>
+    <p>
+      Now add to all this the undisputed fact, that within the walls of lying-in
+      hospitals there is often generated a miasm, palpable as the chlorine used
+      to destroy it, tenacious so as in some cases almost to defy extirpation,
+      deadly in some institutions as the plague; which has killed women in a
+      private hospital of London so fast that they were buried two in one coffin
+      to conceal its horrors; which enabled Tonnelle to record two hundred and
+      twenty-two autopsies at the Maternite of Paris; which has led Dr. Lee to
+      express his deliberate conviction that the loss of life occasioned by
+      these institutions completely defeats the objects of their founders; and
+      out of this train of cumulative evidence, the multiplied groups of cases
+      clustering about individuals, the deadly results of autopsies, the
+      inoculation by fluids from the living patient, the murderous poison of
+      hospitals,&mdash;does there not result a conclusion that laughs all
+      sophistry to scorn, and renders all argument an insult?
+    </p>
+    <p>
+      I have had occasion to mention some instances in which there was an
+      apparent relation between puerperal fever and erysipelas. The length to
+      which this paper has extended does not allow me to enter into the
+      consideration of this most important subject. I will only say, that the
+      evidence appears to me altogether satisfactory that some most fatal series
+      of puerperal fever have been produced by an infection originating in the
+      matter or effluvia of erysipelas. In evidence of some connection between
+      the two diseases, I need not go back to the older authors, as Pouteau or
+      Gordon, but will content myself with giving the following references, with
+      their dates; from which it will be seen that the testimony has been
+      constantly coming before the profession for the last few years.
+    </p>
+    <p>
+      &ldquo;London Cyclopaedia of Practical Medicine,&rdquo; article Puerperal Fever, 1833.
+    </p>
+    <p>
+      Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. &ldquo;Lancet,&rdquo; 1835.
+    </p>
+    <p>
+      Dr. Ramsbotham's Lecture. &ldquo;London Medical Gazette,&rdquo; 1835.
+    </p>
+    <p>
+      Mr. Yates Ackerly's Letter in the same Journal, 1838.
+    </p>
+    <p>
+      Mr. Ingleby on Epidemic Puerperal Fever. &ldquo;Edinburgh Medical and Surgical
+      Journal,&rdquo; 1838.
+    </p>
+    <p>
+      Mr. Paley's Letter. &ldquo;London Medical Gazette,&rdquo; 1839.
+    </p>
+    <p>
+      Remarks at the Medical and Chirurgical Society. &ldquo;Lancet,&rdquo; 1840.
+    </p>
+    <p>
+      Dr. Rigby's &ldquo;System of Midwifery.&rdquo; 1841.
+    </p>
+    <p>
+      &ldquo;Nunneley on Erysipelas,&rdquo;&mdash;a work which contains a large number of
+      references on the subject. 1841.
+    </p>
+    <p>
+      &ldquo;British and Foreign Quarterly Review,&rdquo; 1842.
+    </p>
+    <p>
+      Dr. S. Jackson of Northumberland, as already quoted from the Summary of
+      the College of Physicians, 1842.
+    </p>
+    <p>
+      And lastly, a startling series of cases by Mr. Storrs of Doncaster, to be
+      found in the &ldquo;American Journal of the Medical Sciences&rdquo; for January, 1843.
+    </p>
+    <p>
+      The relation of puerperal fever with other continued fevers would seem to
+      be remote and rarely obvious. Hey refers to two cases of synochus
+      occurring in the Royal Infirmary of Edinburgh, in women who had attended
+      upon puerperal patients. Dr. Collins refers to several instances in which
+      puerperal fever has appeared to originate from a continued proximity to
+      patients suffering with typhus.
+    </p>
+    <p>
+      Such occurrences as those just mentioned, though most important to be
+      remembered and guarded against, hardly attract our notice in the midst of
+      the gloomy facts by which they are surrounded. Of these facts, at the risk
+      of fatiguing repetitions, I have summoned a sufficient number, as I
+      believe, to convince the most incredulous that every attempt to disguise
+      the truth which underlies them all is useless.
+    </p>
+    <p>
+      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 to have found puerperal fever contagious. At the most they
+      give us mere negative facts, worthless against an extent of evidence which
+      now overlaps the widest range of doubt, and doubles upon itself in the
+      redundancy of superfluous demonstration. Examined in detail, this and much
+      of the show of testimony brought up to 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. Nor do I feel
+      the necessity of enforcing the conclusion which arises spontaneously from
+      the facts which have been enumerated, by formally citing the opinions of
+      those grave authorities who have for the last half-century been sounding
+      the unwelcome truth it has cost so many lives to establish.
+    </p>
+    <p>
+      &ldquo;It is to the British practitioner,&rdquo; says Dr. Rigby, &ldquo;that we are indebted
+      for strongly insisting upon this important and dangerous character of
+      puerperal fever.&rdquo;
+     </p>
+    <p>
+      The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
+      Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
+      Ingleby, Locock, Abercrombie, Alison, Travers, Rigby, and Watson, many of
+      whose writings I have already referred to, may have some influence with
+      those who prefer the weight of authorities to the simple deductions of
+      their own reason from the facts laid before them. A few Continental
+      writers have adopted similar conclusions. It gives me pleasure to
+      remember, that while the doctrine has been unceremoniously discredited in
+      one of the leading Journals, and made very light of by teachers in two of
+      the principal Medical Schools, of this country, Dr. Channing has for many
+      years inculcated, and enforced by examples, the danger to be apprehended
+      and the precautions to be taken in the disease under consideration.
+    </p>
+    <p>
+      I have no wish to express any harsh feeling with regard to the painful
+      subject which has come before us. If there are any so far excited by the
+      story of these dreadful events that they ask for some word of indignant
+      remonstrance to show that science does not turn the hearts of its
+      followers into ice or stone, let me remind them that such words have been
+      uttered by those who speak with an authority I could not claim. It is as a
+      lesson rather than as a reproach that I call up the memory of these
+      irreparable errors and wrongs. No tongue can tell the heart-breaking
+      calamity they have caused; they have closed the eyes just 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 the
+      stranger's arms, or bequeathed it, with less cruelty, the death of its
+      dying parent. There is no tone deep enough for regret, and no voice loud
+      enough for warning. The woman about to become a mother, or with her
+      new-born infant upon her bosom, should be the object of trembling care and
+      sympathy wherever she bears her tender burden, or stretches her aching
+      limbs. The very outcast of the streets has pity upon her sister in
+      degradation, when the seal of promised maternity is impressed upon her.
+      The remorseless vengeance of the law, brought down upon its victim by a
+      machinery as sure as destiny, is arrested in its fall at a word which
+      reveals her transient claim for mercy. The solemn prayer of the liturgy
+      singles out her sorrows from the multiplied trials of life, to plead for
+      her in the hour of peril. God forbid that any member of the profession to
+      which she trusts her life, doubly precious at that eventful period, should
+      hazard it negligently, unadvisedly, or selfishly!
+    </p>
+    <p>
+      There may be some among those whom I address who are disposed to ask the
+      question, What course are we to follow in relation to this matter? The
+      facts are before them, and the answer must be left to their own judgment
+      and conscience. If any should care to know my own conclusions, they are
+      the following; and in taking the liberty to state them very freely and
+      broadly, I would ask the inquirer to examine them as freely in the light
+      of the evidence which has been laid before him.
+    </p>
+    <p>
+      1. A physician holding himself in readiness to attend cases of midwifery
+      should never take any active part in the post-mortem examination of cases
+      of puerperal fever.
+    </p>
+    <p>
+      2. If a physician is present at such autopsies, he should use thorough
+      ablution, change every article of dress, and allow twenty-four hours or
+      more to elapse before attending to any case of midwifery. It may be well
+      to extend the same caution to cases of simple peritonitis.
+    </p>
+    <p>
+      3. Similar precautions should be taken after the autopsy or surgical
+      treatment of cases of erysipelas, if the physician is obliged to unite
+      such offices with his obstetrical duties, which is in the highest degree
+      inexpedient.
+    </p>
+    <p>
+      4. On the occurrence of a single case of puerperal fever in his practice,
+      the physician is bound to consider the next female he attends in labor,
+      unless some weeks at least have elapsed, as in danger of being infected by
+      him, and it is his duty to take every precaution to diminish her risk of
+      disease and death.
+    </p>
+    <p>
+      5. If within a short period two cases of puerperal fever happen close to
+      each other, in the practice of the same physician, the disease not
+      existing or prevailing in the neighborhood, he would do wisely to
+      relinquish his obstetrical practice for at least one month, and endeavor
+      to free himself by every available means from any noxious influence he may
+      carry about with him.
+    </p>
+    <p>
+      6. The occurrence of three or more closely connected cases, in the
+      practice of one individual, no others existing in the neighborhood, and no
+      other sufficient cause being alleged for the coincidence, is prima facie
+      evidence that he is the vehicle of contagion.
+    </p>
+    <p>
+      7. It is the duty of the physician to take every precaution that the
+      disease shall not be introduced by nurses or other assistants, by making
+      proper inquiries concerning them, and giving timely warning of every
+      suspected source of danger.
+    </p>
+    <p>
+      8. Whatever indulgence may be granted to those who have heretofore been
+      the ignorant causes of so much misery, the time has come when the
+      existence of a private pestilence in the sphere of a single physician
+      should be looked upon, not as a misfortune, but a crime; and in the
+      knowledge of such occurrences the duties of the practitioner to his
+      profession should give way to his paramount obligations to society.
+      ADDITIONAL REFERENCES AND CASES.
+    </p>
+    <p>
+      Fifth Annual Report of the Registrar-General of England.
+    </p>
+    <p>
+      1843. Appendix. Letter from William Farr, Esq.&mdash;Several new series of
+      cases are given in the Letter of Mr. Stows, contained in the Appendix to
+      this Report. Mr. Stows suggests precautions similar to those I have laid
+      down, and these precautions are strongly enforced by Mr. Farr, who is,
+      therefore, obnoxious to the same criticisms as myself.
+    </p>
+    <p>
+      Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.&mdash;Cases
+      of puerperal fever seeming to originate in erysipelas.
+    </p>
+    <p>
+      Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. Journ.
+      Med. Sc. for April, 1844.&mdash;Six cases in less than a fortnight,
+      seeming to originate in a case of erysipelas.
+    </p>
+    <p>
+      West's Reports, in Brit. and For. Med. Review for October, 1845, and
+      January, 1847.&mdash;Affection of the arm, resembling malignant pustule,
+      after removing the 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 Journal for February, 1846, as showing connection of
+      puerperal fever and erysipelas.
+    </p>
+    <p>
+      Kneeland.&mdash;Contagiousness of Puerperal Fever. Am. Jour. Med. Se.,
+      January, 1846. Also, Connection between Puerperal Fever and Epidemic
+      Erysipelas. Ibid., April, 1846.
+    </p>
+    <p>
+      Robert Storrs.&mdash;Contagious Effects of Puerperal Fever on the Male
+      Subject; or on Persons not Child-bearing. (From Provincial Med. and Surg.
+      Journal.) Am. Jour. Med. Sc., January, 1846. Numerous cases. See also Dr.
+      Reid's case in same Journal for April, 1846.
+    </p>
+    <p>
+      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.
+    </p>
+    <p>
+      Hill, of Leuchars.&mdash;A Series of Cases illustrating the Contagious
+      Nature of Erysipelas and of Puerperal Fever, and their Intimate
+      Pathological Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med.
+      Se., July, 1850.
+    </p>
+    <p>
+      Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from
+      inoculation with different morbid secretions.) Am. Jour. Med. Se.,
+      October, 1850.
+    </p>
+    <p>
+      Arneth. Paper read before the National Academy of Medicine. Annales
+      d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M.
+      &ldquo;Semmeliveis&rdquo; (Semmelweiss.) Lotions of chloride of lime and use of
+      nail-brush before admission to lying-in wards. Alleged sudden and great
+      decrease of mortality from puerperal fever. Cause of disease attributed to
+      inoculation with cadaveric matters.) See also Routh's paper, mentioned
+      above.
+    </p>
+    <p>
+      Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society.
+      Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all fatal.
+      Also to several instances of individual pupils having had a succession of
+      cases in various quarters of the town, while others, practising as
+      extensively in the same localities, had none. Also to several special
+      cases not mentioned elsewhere. Am. Jour. Med. Se. for October, 1851. (From
+      New Monthly Journal of Med. Science.)
+    </p>
+    <p>
+      Simpson.&mdash;Observations at a Meeting of the Edinburgh Obstetrical
+      Society. (An &ldquo;eminent gentleman,&rdquo; according to Dr. Meigs, whose &ldquo;name is
+      as well known in America as in (his) native land.&rdquo; Obstetrics. Phil. 1852,
+      pp. 368, 375.) The student is referred to this paper for a valuable resume
+      of many of the facts, and the necessary inferences, relating to 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 diseased parts. His next four
+      child-bed patients were affected with puerperal fever, and it was the
+      first time he had seen it in practice. As Dr. Simpson is a gentleman (Dr.
+      Meigs, as above), and as &ldquo;a gentleman's hands are clean&rdquo; (Dr. Meigs' Sixth
+      Letter), it follows that a gentleman with clean hands may carry the
+      disease. Am. Jour. Med. Sc., October, 1851.
+    </p>
+    <p>
+      Peddle.&mdash;The five or six cases of Dr. Sidey, followed by the four of
+      Dr. Simpson, did not end the series. A practitioner in Leith having
+      examined in Dr. Simpson's house, a portion of the uterus obtained from one
+      of the patients, had immediately afterwards three fatal cases of puerperal
+      fever. Dr. Veddie referred to two distinct series of consecutive cases in
+      his own practice. He had since taken precautions, and not met with any
+      such cases. Am. Jour. Med. Sc., October, 1851.
+    </p>
+    <p>
+      Copland. Considers it proved that puerperal fever maybe propagated by the
+      hands and the clothes, or either, of a third person, the bed-clothes or
+      body-clothes of a patient. Mentions a new series of cases, one of which he
+      saw, with the practitioner who had attended them. She was the sixth he had
+      had within a few days. All died. Dr. Copland insisted that contagion had
+      caused these cases; advised precautionary measures, and the practitioner
+      had no other cases for a considerable time. Considers it criminal, after
+      the evidence adduced,&mdash;which he could have quadrupled,&mdash;and the
+      weight of authority brought forward, for a practitioner to be the medium
+      of transmitting contagion and death to his patients. Dr. Copland lays down
+      rules similar to those suggested by myself, and is therefore entitled to
+      the same epithet for so doing. Medical Dictionary, New York, 1852.
+      Article, Puerperal States and Diseases.
+    </p>
+    <p>
+      If there is any appetite for facts so craving as to be yet unappeased,&mdash;Lesotho,
+      necdum satiata,&mdash;more can be obtained. Dr. Hodge remarks that &ldquo;the
+      frequency and importance of this singular circumstance (that the disease
+      is occasionally more prevalent with one practitioner than another) has
+      been exceedingly overrated.&rdquo; More than thirty strings of cases, more than
+      two hundred and fifty sufferers from puerperal fever, more than one
+      hundred and thirty deaths appear as the results of a sparing estimate of
+      such among the facts I have gleaned as could be numerically valued. These
+      facts constitute, we may take it for granted, but a small fraction of
+      those that have actually occurred. The number of them might be greater,
+      but &ldquo;'t is enough, 't will serve,&rdquo; in Mercutio's modest phrase, so far as
+      frequency is concerned. For a just estimate of the importance of the
+      singular circumstance, it might be proper to consult the languid
+      survivors, the widowed husbands, and the motherless children, as well as
+      &ldquo;the unfortunate accoucheur.&rdquo;
+     </p>
+    <p>
+      <a name="link2H_4_0006" id="link2H_4_0006">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+    </h2>
+    <p>
+      An Address delivered before the Massachusetts Medical Society, at the
+      Annual Meeting, May 30, 1860.
+    </p>
+<pre xml:space="preserve">
+        &ldquo;Facultate magis quam violentia.&rdquo;
+                   HIPPOCRATES.
+</pre>
+    <p>
+      Our Annual Meeting never fails to teach us at least one lesson. The art
+      whose province it is to heal and to save cannot protect its own ranks from
+      the inroads of disease and the waste of the Destroyer.
+    </p>
+    <p>
+      Seventeen of our associates have been taken from us since our last
+      Anniversary. Most of them followed their calling in the villages or towns
+      that lie among the hills or along the inland streams. Only those who have
+      lived the kindly, mutually dependent life of the country, can tell how
+      near the physician who is the main reliance in sickness of all the
+      families throughout a thinly settled region comes to the hearts of the
+      people among whom he labors, how they value him while living, how they
+      cherish his memory when dead. For these friends of ours who have gone
+      before, there is now no more toil; they start from their slumbers no more
+      at the cry of pain; they sally forth no more into the storms; they ride no
+      longer over the lonely roads that knew them so well; their wheels are
+      rusting on their axles or rolling with other burdens; their watchful eyes
+      are closed to all the sorrows they lived to soothe. Not one of these was
+      famous in the great world; some were almost unknown beyond their own
+      immediate circle. But they have left behind them that loving remembrance
+      which is better than fame, and if their epitaphs are chiselled briefly in
+      stone, they are written at full length on living tablets in a thousand
+      homes to which they carried their ever-welcome aid and sympathy.
+    </p>
+    <p>
+      One whom we have lost, very widely known and honored, was a leading
+      practitioner of this city. His image can hardly be dimmed in your
+      recollection, as he stood before you only three years ago, filling the
+      same place with which I am now honored. To speak of him at all worthily,
+      would be to write the history of professional success, won without special
+      aid at starting, by toil, patience, good sense, pure character, and
+      pleasing manners; won in a straight uphill ascent, without one
+      breathing-space until he sat down, not to rest, but to die. If prayers
+      could have shielded him from the stroke, if love could have drawn forth
+      the weapon, and skill could have healed the wound, this passing tribute
+      might have been left to other lips and to another generation.
+    </p>
+    <p>
+      Let us hope that our dead have at last found that rest which neither
+      summer nor winter, nor day nor night, had granted to their unending
+      earthly labors! And let us remember that our duties to our brethren do not
+      cease when they become unable to share our toils, or leave behind them in
+      want and woe those whom their labor had supported. It is honorable to the
+      Profession that it has organized an Association for the relief of its
+      suffering members and their families; it owes this tribute to the
+      ill-rewarded industry and sacrifices of its less fortunate brothers who
+      wear out health and life in the service of humanity. I have great pleasure
+      in referring to this excellent movement, which gives our liberal
+      profession a chance to 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.
+    </p>
+    <p>
+      A medical man, as he goes about his daily business after twenty years of
+      practice, is apt to suppose that he treats his patients according to the
+      teachings of his experience. No doubt this is true to some extent; to what
+      extent depending much on the qualities of the individual. But it is easy
+      to prove that the prescriptions of even wise physicians are very commonly
+      founded on something quite different from experience. Experience must be
+      based on the permanent facts of nature. But a glance at the prevalent
+      modes of treatment of any two successive generations will show that there
+      is a changeable as well as a permanent element in the art of healing; not
+      merely changeable as diseases vary, or as new remedies are introduced, but
+      changeable by the going out of fashion of special remedies, by the
+      decadence of a popular theory from which their fitness was deduced, or
+      other cause not more significant. There is no reason to suppose that the
+      present time is essentially different in this respect from any other.
+      Much, therefore, which is now very commonly considered to be the result of
+      experience, will be recognized in the next, or in some succeeding
+      generation, as no such result at all, but as a foregone conclusion, based
+      on some prevalent belief or fashion of the time.
+    </p>
+    <p>
+      There are, of course, in every calling, those who go about the work of the
+      day before them, doing it according to the rules of their craft, and
+      asking no questions of the past or of the future, or of the aim and end to
+      which their special labor is contributing. These often consider and call
+      themselves practical men. They pull the oars of society, and have no
+      leisure to watch the currents running this or that way; let theorists and
+      philosophers attend to them. In the mean time, however, these currents are
+      carrying the practical men, too, and all their work may be thrown away,
+      and worse than thrown away, if they do not take knowledge of them and get
+      out of the wrong ones and into the right ones as soon as they may. Sir
+      Edward Parry and his party were going straight towards the pole in one of
+      their arctic expeditions, travelling at the rate of ten miles a day. But
+      the ice over which they travelled was drifting straight towards the
+      equator, at the rate of twelve miles a day, and yet no man among them
+      would have known that he was travelling two miles a day backward unless he
+      had lifted his eyes from the track in which he was plodding. It is not
+      only going backward that the plain practical workman is liable to, if he
+      will not look up and look around; he may go forward to ends he little
+      dreams of. It is a simple business for a 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 Jewish artisan to fit two pieces of
+      timber together according to the legal pattern in the time of Pontius
+      Pilate; he asked no questions, perhaps, but we know what burden the cross
+      bore on the morrow! And so, with subtler tools than trowels or axes, the
+      statesman who works in policy without principle, the theologian who works
+      in forms without a soul, the physician who, calling himself a practical
+      man, refuses to recognize the larger laws which govern his changing
+      practice, may all find that they have been building truth into the wall,
+      and hanging humanity upon the cross.
+    </p>
+    <p>
+      The truth is, that medicine, professedly founded on observation, 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 straightforward inductive path,
+      without regard to changes of government or to fluctuations of public
+      opinion. But look a moment while I clash a few facts together, and see if
+      some sparks do not reveal by their light a closer relation between the
+      Medical Sciences and the conditions of Society and the general thought of
+      the time, than would at first be suspected.
+    </p>
+    <p>
+      Observe the coincidences between certain great political and intellectual
+      periods and the appearance of illustrious medical reformers and teachers.
+      It was in the age of Pericles, of Socrates, of Plato, of Phidias, that
+      Hippocrates gave to medical knowledge the form which it retained for
+      twenty centuries. With the world-conquering Alexander, the world-embracing
+      Aristotle, appropriating anatomy and physiology, among his manifold spoils
+      of study, marched abreast of his royal pupil to wider conquests. Under the
+      same Ptolemies who founded the Alexandrian Library and Museum, and ordered
+      the Septuagint version of the Hebrew Scriptures, the infallible Herophilus
+      [&ldquo;Contradicere Herophilo in anatomicis, est contradicere evangelium,&rdquo; was
+      a saying of Fallopius.] made those six hundred dissections of which
+      Tertullian accused him, and the sagacious Erasistratus introduced his mild
+      antiphlogistic treatment in opposition to the polypharmacy and antidotal
+      practice of his time. It is significant that the large-minded Galen should
+      have been the physician and friend of the imperial philosopher Marcus
+      Aurelius. The Arabs gave laws in various branches of knowledge to those
+      whom their arms had invaded, or the terror of their spreading dominion had
+      reached, and the point from which they started was, as Humboldt
+      acknowledges, &ldquo;the study of medicine, by which they long ruled the
+      Christian Schools,&rdquo; and to which they added the department of chemical
+      pharmacy.
+    </p>
+    <p>
+      Look at Vesalius, the contemporary of Luther. Who can fail to see one
+      common spirit in the radical ecclesiastic and the reforming
+      court-physician? Both still to some extent under the dominion of the
+      letter: Luther holding to the real presence; Vesalius actually causing to
+      be drawn and engraved two muscles which he knew were not found in the
+      human subject, because they had been described by Galen, from dissections
+      of the lower animals. Both breaking through old traditions in the search
+      of truth; one, knife in hand, at the risk of life and reputation, the
+      other at the risk of fire and fagot, with that mightier weapon which all
+      the devils could not silence, though they had been thicker than the tiles
+      on the house-tops. How much the physician of the Catholic Charles V. had
+      in common with the great religious destructive, may be guessed by the
+      relish with which he tells the story how certain Pavian students exhumed
+      the body of an &ldquo;elegans scortum,&rdquo; or lovely dame of ill repute, the
+      favorite of a monk of the order of St. Anthony, who does not seem to have
+      resisted temptation so well as the founder of his order. We have always
+      ranked the physician Rabelais among the early reformers, but I do not know
+      that Vesalius has ever been thanked for his hit at the morals of the
+      religious orders, or for turning to the good of science what was intended
+      for the &ldquo;benefit of clergy.&rdquo;
+     </p>
+    <p>
+      Our unfortunate medical brother, Michael Servetus, the spiritual patient
+      to whom the theological moxa was applied over the entire surface for the
+      cure of his heresy, came very near anticipating Harvey. The same quickened
+      thought of the time which led him to dispute the dogma of the Church,
+      opened his mind to the facts which contradicted the dogmas of the Faculty.
+    </p>
+    <p>
+      Harvey himself was but the posthumous child of the great Elizabethan
+      period. Bacon was at once his teacher and his patient. The founder of the
+      new inductive philosophy had only been dead two years when the treatise on
+      the Circulation, the first-fruit of the Restoration of Science, was given
+      to the world.
+    </p>
+    <p>
+      And is it to be looked at as a mere accidental coincidence, that while
+      Napoleon was modernizing the political world, Bichat was revolutionizing
+      the science of life and the art that is based upon it; that while the
+      young general was scaling the Alps, the young surgeon was climbing the
+      steeper summits of unexplored nature; that the same year read the
+      announcement of those admirable &ldquo;Researches on Life and Death,&rdquo; and the
+      bulletins of the battle of Marengo?
+    </p>
+    <p>
+      If we come to our own country, who can fail to recognize that Benjamin
+      Rush, the most conspicuous of American physicians, was the intellectual
+      offspring of the movement which produced the Revolution? &ldquo;The same hand,&rdquo;
+       says one of his biographers, &ldquo;which subscribed the declaration of the
+      political independence of these States, accomplished their emancipation
+      from medical systems formed in foreign countries, and wholly unsuitable to
+      the state of diseases in America.&rdquo;
+     </p>
+    <p>
+      Following this general course of remark, I propose to indicate in a few
+      words the direction of the main intellectual current of the time, and to
+      point out more particularly some of the eddies which tend to keep the
+      science and art of medicine from moving with it, or even to carry them
+      backwards.
+    </p>
+    <p>
+      The two dominant words of our time are law and average, both pointing to
+      the uniformity of the order of being in which we live. Statistics have
+      tabulated everything,&mdash;population, growth, wealth, crime, disease. We
+      have shaded maps showing the geographical distribution of larceny and
+      suicide. Analysis and classification have been at work upon all tangible
+      and visible objects. The Positive Philosophy of Comte has only given
+      expression to the observing and computing mind of the nineteenth century.
+    </p>
+    <p>
+      In the mean time, the great stronghold of intellectual conservatism,
+      traditional belief, has been assailed by facts which would have been
+      indicted as blasphemy but a few generations ago. Those new tables of the
+      law, placed in the hands of the geologist by the same living God who spoke
+      from Sinai to the Israelites of old, have remodelled the beliefs of half
+      the civilized world. The solemn scepticism of science has replaced the
+      sneering doubts of witty philosophers. The more positive knowledge we
+      gain, the more we incline to question all that has been received without
+      absolute proof.
+    </p>
+    <p>
+      As a matter of course, this movement has its partial reactions. The
+      province of faith is claimed as a port free of entry to unsupported
+      individual convictions. The tendency to question is met by the unanalyzing
+      instinct of reverence. The old church calls back its frightened truants.
+      Some who have lost their hereditary religious belief find a resource in
+      the revelations of Spiritualism. By a parallel movement, some of those who
+      have become medical infidels pass over to the mystic band of believers in
+      the fancied miracles of Homoeopathy.
+    </p>
+    <p>
+      Under these influences transmitted to, or at least shared by, the medical
+      profession, the old question between &ldquo;Nature,&rdquo; so called, and &ldquo;Art,&rdquo; or
+      professional tradition, has reappeared with new interest. I say the old
+      question, for Hippocrates stated the case on the side of &ldquo;Nature&rdquo; more
+      than two thousand years ago. Miss Florence Nightingale,&mdash;and if I
+      name her next to the august Father of the Healing Art, its noblest
+      daughter well deserves that place of honor,&mdash;Miss Florence
+      Nightingale begins her late volume with a paraphrase of his statement. But
+      from a very early time to this there has always been a strong party
+      against &ldquo;Nature.&rdquo; Themison called the practice of Hippocrates &ldquo;a
+      meditation upon death.&rdquo; Dr. Rush says: &ldquo;It is impossible to calculate the
+      mischief which Hippocrates has done, by first marking Nature with his
+      name and afterwards letting her loose upon sick people. Millions have
+      perished by her hands in all ages and countries.&rdquo; Sir John Forbes, whose
+      defence of &ldquo;Nature&rdquo; in disease you all know, and to the testimonial in
+      whose 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 years sooner, and the opinion that no man had done so much
+      to destroy the confidence of the public in the medical profession.
+    </p>
+    <p>
+      In this Society we have had the Hippocratic and the Themisonic side fairly
+      represented. The treatise of one of your early Presidents on the Mercurial
+      Treatment is familiar to my older listeners. Others who have held the same
+      office have been noted for the boldness of their practice, and even for
+      partiality to the use of complex medication.
+    </p>
+    <p>
+      On the side of &ldquo;Nature&rdquo; we have had, first of all, that remarkable
+      discourse on Self-Limited Diseases, [On Self-Limited Diseases. A Discourse
+      delivered before the Massachusetts Medical Society, at their Annual
+      Meeting, May 27, 1835 by Jacob Bigelow, M. D.] which has given the
+      key-note to the prevailing medical tendency of this neighborhood, at
+      least, for the quarter of a century since it was delivered. Nor have we
+      forgotten the address delivered at Springfield twenty 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. Worthington Hooker. [Rational
+      Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New Haven.
+      Boston. 1857.] We should not omit from the list the important address of
+      another of our colleagues, [On the Treatment of Compound and Complicated
+      Fractures. By William J. Walker, M. D. read at the Annual Meeting, May 29,
+      1845.] showing by numerous cases the power of Nature in healing compound
+      fractures to be much greater than is frequently supposed,&mdash;affording,
+      indeed, more striking illustrations than can be obtained from the history
+      of visceral disease, of the supreme wisdom, forethought, and adaptive
+      dexterity of that divine Architect, as shown in repairing the shattered
+      columns which support the living temple of the body.
+    </p>
+    <p>
+      We who are on the side of &ldquo;Nature&rdquo; please ourselves with the idea that we
+      are in the great current in which the true intelligence of the time is
+      moving. We believe that some who oppose, or fear, or denounce our movement
+      are themselves caught in various eddies that set back against the truth.
+      And we do most earnestly desire and most actively strive, that Medicine,
+      which, it is painful to remember, has been spoken of as &ldquo;the withered
+      branch of science&rdquo; at a meeting of the British Association, shall be at
+      length brought fully to share, if not to lead, the great wave of knowledge
+      which rolls with the tides that circle the globe.
+    </p>
+    <p>
+      If there is any State or city which might claim to be the American
+      headquarters of the nature-trusting heresy, provided it be one, that State
+      is Massachusetts, and that city is its capital. The effect which these
+      doctrines have upon the confidence reposed in the profession is a matter
+      of opinion. For myself, I do not believe this confidence can be impaired
+      by any investigations which tend to limit the application of troublesome,
+      painful, uncertain, or dangerous remedies. Nay, I will venture to say
+      this, that if every specific were to fail utterly, if the cinchona trees
+      all died out, and the arsenic mines were exhausted, and the sulphur
+      regions were burned up, if every drug from the vegetable, animal, and
+      mineral kingdom were to disappear from the market, a body of enlightened
+      men, organized as a distinct profession, would be required just as much as
+      now, and respected and trusted as now, whose province should be to guard
+      against the causes of disease, to eliminate them if possible when still
+      present, to order all the conditions of the patient so as to favor the
+      efforts of the system to right itself, and to give those predictions of
+      the course of disease which only experience can warrant, and which in so
+      many cases relieve the exaggerated fears of sufferers and their friends,
+      or warn them in season of impending danger. Great as the loss would be if
+      certain active remedies could no longer be obtained, it would leave the
+      medical profession the most essential part of its duties, and all, and
+      more than all, its present share of honors; for it would be the death-blow
+      to charlatanism, which depends for its success almost entirely on drugs,
+      or at least on a nomenclature that suggests them.
+    </p>
+    <p>
+      There is no offence, then, or danger in expressing the opinion, that,
+      after all which has been said, the community is still overdosed: The best
+      proof of it is, that &ldquo;no families take so little medicine as those of
+      doctors, except those of apothecaries, and that old practitioners are more
+      sparing of active medicines than younger ones.&rdquo; [Dr. James Jackson has
+      kindly permitted me to make the following extract from a letter just
+      received by him from Sir James Clark, and dated May 26, 1860: &ldquo;As a
+      physician advances in age, he generally, I think, places less confidence
+      in the ordinary medical treatment than he did, not only during his early,
+      but even his middle period of life.&rdquo;] The conclusion from these facts is
+      one which the least promising of Dr. Howe's pupils in the mental
+      department could hardly help drawing.
+    </p>
+    <p>
+      Part of the blame of over-medication must, I fear, rest with the
+      profession, for yielding to the tendency to self-delusion, which seems
+      inseparable from the practice of the art of healing. I need only touch on
+      the common modes of misunderstanding or misapplying the evidence of
+      nature.
+    </p>
+    <p>
+      First, there is the natural incapacity for sound observation, which is
+      like a faulty ear in music. We see this in many persons who know a good
+      deal about books, but who are not sharp-sighted enough to buy a horse or
+      deal with human diseases.
+    </p>
+    <p>
+      Secondly, there is in some persons a singular inability to weigh the value
+      of testimony; of which, I think, from a pretty careful examination of his
+      books, Hahnemann affords the best specimen outside the walls of Bedlam.
+    </p>
+    <p>
+      The inveterate logical errors to which physicians have always been subject
+      are chiefly these:
+    </p>
+    <p>
+      The mode of inference per enumerationem simplicem, in scholastic phrase;
+      that is, counting only their favorable cases. This is the old trick
+      illustrated in Lord Bacon's story of the gifts of the shipwrecked people,
+      hung up in the temple.&mdash;Behold! they vowed these gifts to the altar,
+      and the gods saved them. Ay, said a doubting bystander, but how many made
+      vows of gifts and were shipwrecked notwithstanding? The numerical system
+      is the best corrective of this and similar errors. The arguments commonly
+      brought against its application to all matters of medical observation,
+      treatment included, seem to apply rather to the tabulation of facts ill
+      observed, or improperly classified, than to the method itself.
+    </p>
+    <p>
+      The post hoc ergo propter hoc error: he got well after taking my medicine;
+      therefore in consequence of taking it.
+    </p>
+    <p>
+      The false induction from genuine facts of observation, leading to the
+      construction of theories which are then deductively applied in the face of
+      the results of direct observation. The school of Broussais has furnished
+      us with a good example of this error.
+    </p>
+    <p>
+      And lastly, the error which Sir Thomas Browne calls giving &ldquo;a reason of
+      the golden tooth;&rdquo; that is, assuming a falsehood as a fact, and giving
+      reasons for it, commonly fanciful ones, as is constantly done by that
+      class of incompetent observers who find their &ldquo;golden tooth&rdquo; in the
+      fabulous effects of the homoeopathie materia medica,&mdash;which consists
+      of sugar of milk and a nomenclature.
+    </p>
+    <p>
+      Another portion of the blame rests with the public itself, which insists
+      on being poisoned. Somebody buys all the quack medicines that build
+      palaces for the mushroom, say rather, the toadstool millionaires. Who is
+      it? These people have a constituency of millions. The popular belief is
+      all but universal that sick persons should feed on noxious substances. One
+      of our members was called not long since to a man with a terribly sore
+      mouth. On inquiry he found that the man had picked up a box of unknown
+      pills, in Howard Street, and had proceeded to take them, on general
+      principles, pills being good for people. They happened to contain mercury,
+      and hence the trouble for which he consulted our associate.
+    </p>
+    <p>
+      The outside pressure, therefore, is immense upon the physician, tending to
+      force him to active treatment of some kind. Certain old superstitions,
+      still lingering in the mind of the public, and not yet utterly expelled
+      from that of the profession, are at the bottom of this, or contribute to
+      it largely. One of the most ancient is, that disease is a malignant
+      agency, or entity, to be driven out of the body by offensive substances,
+      as the smoke of the fish's heart and liver drove the devil out of Tobit's
+      bridal chamber, according to the Apochrypha. Epileptics used to suck the
+      blood from the wounds of dying gladiators. [Plinii Hist. Mundi. lib.
+      xxviii. c. 4.] The Hon. Robert Boyle's little book was published some
+      twenty or thirty years before our late President, Dr. Holyoke, was born.
+      [A Collection of Choice and Safe Remedies. The Fifth Edition, corrected.
+      London, 1712. Dr. Holyoke was born in 1728.] In it he recommends, as
+      internal medicines, most of the substances commonly used as fertilizers of
+      the soil. His &ldquo;Album Graecum&rdquo; is best left untranslated, and his &ldquo;Zebethum
+      Occidentale&rdquo; is still more transcendentally unmentionable except in a
+      strange dialect. It sounds odiously to us to hear him recommend for
+      dysentery a powder made from &ldquo;the sole of an old shoe worn by some man
+      that walks much.&rdquo; Perhaps nobody here ever heard of tying a stocking,
+      which had been worn during the day, round the neck at night for a sore
+      throat. The same idea of virtue in unlovely secretions! [The idea is very
+      ancient. &ldquo;Sordes hominis&rdquo; &ldquo;Sudore et oleo medicinam facientibus.&rdquo;&mdash;Plin.
+      xxviii. 4.]
+    </p>
+    <p>
+      Even now the Homoeopathists have been introducing the venom of serpents,
+      under the learned title of Lachesis, and outraging human nature with
+      infusions of the pediculus capitis; that is, of course, as we understand
+      their dilutions, the names of these things; for if a fine-tooth-comb
+      insect were drowned in Lake Superior, we cannot agree with them in
+      thinking that every drop of its waters would be impregnated with all the
+      pedicular virtues they so highly value. They know what they are doing.
+      They are appealing to the detestable old superstitious presumption in
+      favor of whatever is nauseous and noxious as being good for the sick.
+    </p>
+    <p>
+      Again, we all occasionally meet persons stained with nitrate of silver,
+      given for epilepsy. Read what Dr. Martin says, about the way in which it
+      came to be used, in his excellent address before the Norfolk County
+      Medical Society, and the evidence I can show, but have not time for now,
+      and then say what you think of the practice which on such presumptions
+      turns a white man as blue as the double-tattooed King of the Cannibal
+      Islands! [Note A.]
+    </p>
+    <p>
+      If medical superstitions have fought their way down through all the
+      rationalism and scepticism of the nineteenth century, of course the
+      theories of the schools, supported by great names, adopted into the
+      popular belief and incorporated with the general mass of misapprehension
+      with reference to disease, must be expected to meet us at every turn in
+      the shape of bad practice founded on false doctrine. A French patient
+      complains that his blood heats him, and expects his doctor to bleed him.
+      An English or American one says he is bilious, and will not be easy
+      without a dose of calomel. A doctor looks at a patient's tongue, sees it
+      coated, and says the stomach is foul; his head full of the old saburral
+      notion which the extreme inflammation-doctrine of Broussais did so much to
+      root out, but which still leads, probably, to much needless and injurious
+      wrong of the stomach and bowels by evacuants, when all they want is to be
+      let alone. It is so hard to get anything out of the dead hand of medical
+      tradition! The mortmain of theorists extinct in science clings as close as
+      that of ecclesiastics defunct in law.
+    </p>
+    <p>
+      One practical hint may not be out of place here. It seems to be sometimes
+      forgotten, by those who must know the fact, that the tongue is very
+      different, anatomically and physiologically, from the stomach. Its
+      condition does not in the least imply a similar one of the stomach, which
+      is a very different structure, covered with a different kind of
+      epithelium, and furnished with entirely different secretions. A
+      silversmith will, for a dollar, make a small hoe, of solid silver, which
+      will last for centuries, and will give a patient more comfort, used for
+      the removal of the accumulated epithelium and fungous growths which
+      constitute the &ldquo;fur,&rdquo; than many a prescription with a split-footed Rx
+      before it, addressed to the parts out of reach.
+    </p>
+    <p>
+      I think more of this little implement on account of its agency in saving
+      the Colony at Plymouth in the year 1623. Edward Winslow heard that
+      Massasoit was sick and like to die. He found him with a houseful of people
+      about him, women rubbing his arms and legs, and friends &ldquo;making such a
+      hellish noise&rdquo; as they probably thought would scare away the devil of
+      sickness. Winslow gave him some conserve, washed his mouth, scraped his
+      tongue, which was in a horrid state, got down some drink, made him some
+      broth, dosed him with an infusion of strawberry leaves and sassafras root,
+      and had the satisfaction of seeing him rapidly recover. Massasoit, full of
+      gratitude, revealed the plot which had been formed to destroy the
+      colonists, whereupon the Governor ordered Captain Miles Standish to see to
+      them; who thereupon, as everybody remembers, stabbed Pecksuot with his own
+      knife, broke up the plot, saved the colony, and thus rendered
+      Massachusetts and the Massachusetts Medical Society a possibility, as they
+      now are a fact before us. So much for this parenthesis of the
+      tongue-scraper, which helped to save the young colony from a much more
+      serious scrape, and may save the Union yet, if a Presidential candidate
+      should happen to be taken sick as Massasoit was, and his tongue wanted
+      cleaning,&mdash;which process would not hurt a good many politicians, with
+      or without a typhoid fever.
+    </p>
+    <p>
+      Again, see how the &ldquo;bilious&rdquo; theory works in every-day life here and now,
+      illustrated by a case from actual life. A youthful practitioner, whose
+      last molars have not been a great while cut, meets an experienced and
+      noted physician in consultation. This is the case. A slender, lymphatic
+      young woman is suckling two lusty twins, the intervals of suction being
+      occupied on her part with palpitations, headaches, giddiness, throbbing in
+      the head, and various nervous symptoms, her cheeks meantime getting
+      bloodless, and her strength running away in company with her milk. The old
+      experienced physician, seeing the yellowish waxy look which is common in
+      anaemic patients, considers it a &ldquo;bilious&rdquo; case, and is for giving a
+      rousing emetic. Of course, he has to be wheedled out of this, a recipe is
+      written for beefsteaks and porter, the twins are ignominiously expelled
+      from the anaemic bosom, and forced to take prematurely to the bottle, and
+      this prolific mother is saved for future usefulness in the line of
+      maternity.
+    </p>
+    <p>
+      The practice of making a profit on the medicine ordered has been held up
+      to reprobation by one at least of the orators who have preceded me. That
+      the effect of this has been ruinous in English practice I cannot doubt,
+      and that in this country the standard of practice was in former
+      generations lowered through the same agency is not unlikely. I have seen
+      an old account-book in which the physician charged an extra price for
+      gilding his rich patients' pills. If all medicine were very costly, and
+      the expense of it always came out of the physician's fee, it would really
+      be a less objectionable arrangement than this other most pernicious one.
+      He would naturally think twice before he gave an emetic or cathartic which
+      evacuated his own pocket, and be sparing of the cholagogues that emptied
+      the biliary ducts of his own wallet, unless he were sure they were needed.
+      If there is any temptation, it should not be in favor of giving noxious
+      agents, as it clearly must be in the case of English druggists and
+      &ldquo;General Practitioners.&rdquo; The complaint against the other course is a very
+      old one. Pliny, inspired with as truly Roman horror of quackery as the
+      elder Cato,&mdash;who declared that the Greek doctors had sworn to
+      exterminate all barbarians, including the Romans, with their drugs, but is
+      said to have physicked his own wife to death, notwithstanding,&mdash;Pliny
+      says, in so many words, 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.
+    </p>
+    <p>
+      A pretty strong eddy, then, or rather many eddies, setting constantly back
+      from the current of sober observation of nature, in the direction of old
+      superstitions and fancies, of exploded theories, of old ways of making
+      money, which are very slow to pass out of fashion.
+    </p>
+    <p>
+      But there are other special American influences which we are bound to take
+      cognizance of. If I wished to show a student the difficulties of getting
+      at truth from medical experience, I would give him the history of epilepsy
+      to read. If I wished him to understand the tendencies of the American
+      medical mind, its sanguine enterprise, its self-confidence, its audacious
+      handling of Nature, its impatience with her old-fashioned ways of taking
+      time to get a sick man well, I would make him read the life and writings
+      of Benjamin Rush. Dr. Rush thought and said that there were twenty times
+      more intellect and a hundred times more knowledge in the country in 1799
+      than before the Revolution. His own mind was in a perpetual state of
+      exaltation produced by the stirring scenes in which he had taken a part,
+      and the quickened life of the time in which he lived. It was not the state
+      to favor sound, calm observation. He was impatient, and Nature is
+      profoundly imperturbable. We may adjust the beating of our hearts to her
+      pendulum if we will and can, but we may be very sure that she will not
+      change the pendulum's rate of going because our hearts are palpitating. He
+      thought he had mastered yellow-fever. &ldquo;Thank God,&rdquo; he said, &ldquo;out of one
+      hundred patients whom I have visited or prescribed for this day, I have
+      lost none.&rdquo; Where was all his legacy of knowledge when Norfolk was
+      decimated? Where was it when the blue flies were buzzing over the coffins
+      of the unburied dead piled up in the cemetery of New Orleans, at the edge
+      of the huge trenches yawning to receive them?
+    </p>
+    <p>
+      One such instance will do as well as twenty. Dr. Rush must have been a
+      charming teacher, as he was an admirable man. He was observing, rather
+      than a sound observer; eminently observing, curious, even, about all
+      manner of things. But he could not help feeling as if Nature had been a
+      good deal shaken by the Declaration of Independence, and that American art
+      was getting to be rather too much for her,&mdash;especially as illustrated
+      in his own practice. He taught thousands of American students, he gave a
+      direction to the medical mind of the country more than any other one man;
+      perhaps he typifies it better than any other. It has clearly tended to
+      extravagance in remedies and trust in remedies, as in everything else. How
+      could a people which has a revolution once in four years, which has
+      contrived the Bowie-knife and the revolver, which has chewed the juice out
+      of all the superlatives in the language in Fourth of July orations, and so
+      used up its epithets in the rhetoric of abuse that it takes two great
+      quarto dictionaries to supply the demand; which insists in sending out
+      yachts and horses and boys to out-sail, out-run, out-fight, and checkmate
+      all the rest of creation; how could such a people be content with any but
+      &ldquo;heroic&rdquo; practice? What wonder that the stars and stripes wave over doses
+      of ninety grains of sulphate of quinine, [More strictly, ninety-six grains
+      in two hours. Dunglison's Practice, 1842, vol. ii. p. 520. Eighty grains
+      in one dose. Ibid. p. 536. Ninety-six grains of sulphate of quinine are
+      equal to eight ounces of good bark.&mdash;Wood &amp; Bache.] and that the
+      American eagle screams with delight to see three drachms of calomel given
+      at a single mouthful?
+    </p>
+    <p>
+      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 which must find something to fill their columns, and so print all the
+      new plans of treatment and new remedies they can get hold of, as the
+      newspapers, from a similar necessity, print the shocking catastrophes and
+      terrible murders.
+    </p>
+    <p>
+      Besides all this, here are we, the great body of teachers in the
+      numberless medical schools of the Union, some of us lecturing to crowds
+      who clap and stamp in the cities, some of us wandering over the country,
+      like other professional fertilizers, to fecundate the minds of less
+      demonstrative audiences at various scientific stations; all of us talking
+      habitually to those supposed to know less than ourselves, and loving to
+      claim as much for our art as we can, not to say for our own schools, and
+      possibly indirectly for our own practical skill. Hence that annual crop of
+      introductory lectures; the useful blossoming into the ornamental, as the
+      cabbage becomes glorified in the cauliflower; that lecture-room literature
+      of adjectives, that declamatory exaggeration, that splendid show of
+      erudition borrowed from D'Israeli, and credited to Lord Bacon and the
+      rest, which have suggested to our friends of the Medical Journals an
+      occasional epigram at our expense. Hence the tendency in these
+      productions, and in medical lectures generally, to overstate the efficacy
+      of favorite methods of cure, and hence the premium offered for showy
+      talkers rather than sagacious observers, for the men of adjectives rather
+      than of nouns substantive in the more ambitious of these institutions.
+    </p>
+    <p>
+      Such are some of the eddies in which we are liable to become involved and
+      carried back out of the broad stream of philosophical, or, in other words,
+      truth-loving, investigations. The causes of disease, in the mean time,
+      have been less earnestly studied in the eagerness 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-house might
+      not be known, while the very men who were discussing the treatment of the
+      disease were stupidly conveying the infection from bed to bed, as
+      rat-killers carry their poisons from one household to another. Do not some
+      of you remember that I have had to fight this private-pestilence question
+      against a scepticism which sneered in the face of a mass of evidence such
+      as the calm statisticians of the Insurance office could not listen to
+      without horror and indignation? [&ldquo;The Contagiousness of Puerperal Fever.&rdquo;&mdash;N.
+      E. Quar. Jour. of Medicine and Surgery, April, 1843. Reprinted, with
+      Additions. Boston: Ticknor &amp; Fields. 1855.] Have we forgotten what is
+      told 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's lives in a single hospital? How long would it
+      have taken small doses of calomel and rhubarb to save as many children?
+      These may be useful in prudent hands, but how insignificant compared to
+      the great hygienic conditions! Causes, causes, and again causes,&mdash;more
+      and more we fall back on these as the chief objects of our attention. The
+      shortest system 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 it to the first mother when she saw her first-born child
+      putting some ugly pebble or lurid berry into its mouth. I know not in what
+      language it was spoken, but I know that in English it would sound thus:
+      Spit it out!
+    </p>
+    <p>
+      Art can do something more than say this. It can sometimes reach the pebble
+      or berry after it has been swallowed. But the great thing is to keep these
+      things out of children's mouths, and as soon as they are beyond our reach,
+      to be reasonable and patient with Nature, who means well, but does not
+      like to hurry, and who took nine calendar months, more or less, to every
+      mother's son among us, before she thought he was fit to be shown to the
+      public.
+    </p>
+    <p>
+      Suffer me now to lay down a few propositions, whether old or new it
+      matters little, not for your immediate acceptance, nor yet for your hasty
+      rejection, but for your calm consideration.
+    </p>
+    <p>
+      But first, there are a number of terms which we are in the habit of using
+      in a vague though not unintelligible way, and which it is as well now to
+      define. These terms are the tools with which we are to work, and the first
+      thing is to sharpen them. It is nothing to us that they have been
+      sharpened a thousand times before; they always get dull in the using, and
+      every new workman has a right to carry them to the grindstone and sharpen
+      them to suit himself.
+    </p>
+    <p>
+      Nature, in medical language, as opposed to Art, means trust in the
+      reactions of the living system against ordinary normal impressions.
+    </p>
+    <p>
+      Art, in the same language, as opposed to Nature, means an intentional
+      resort to extraordinary abnormal impressions for the relief of disease.
+    </p>
+    <p>
+      The reaction of the living system is the essence of both. Food is nothing,
+      if there is no digestive act to respond to it. We cannot raise a blister
+      on a dead man, or hope that a carminative forced between his lips will
+      produce its ordinary happy effect.
+    </p>
+    <p>
+      Disease, dis-ease,&mdash;disturbed quiet, uncomfortableness,&mdash;means
+      imperfect or abnormal reaction of the living system, and its more or less
+      permanent results.
+    </p>
+    <p>
+      Food, in its largest sense, is whatever helps to build up the normal
+      structures, or to maintain their natural actions.
+    </p>
+    <p>
+      Medicine, in distinction from food, is every unnatural or noxious agent
+      applied for the relief of disease.
+    </p>
+    <p>
+      Physic means properly the Natural art, and Physician is only the Greek
+      synonyme of Naturalist.
+    </p>
+    <p>
+      With these few explanations I proceed to unfold the propositions I have
+      mentioned.
+    </p>
+    <p>
+      Disease and death, if we may judge by the records of creation, are
+      inherently and essentially necessary in the present order of things. A
+      perfect intelligence, trained by a perfect education, could do no more
+      than keep the laws of the physical and spiritual universe. An imperfect
+      intelligence, imperfectly taught,&mdash;and this is the condition of our
+      finite humanity,&mdash;will certainly fail to keep all these laws
+      perfectly. Disease is one of the penalties of one of the forms of such
+      failure. It is prefigured in the perturbations of the planets, in the
+      disintegration of the elemental masses; it has left its traces in the
+      fossil organisms of extinct creations. [Professor Agassiz has kindly
+      handed me the following note: &ldquo;There are abnormal structures in animals of
+      all ages anterior to the creation of mankind. Malformed specimens of
+      Crinoids are known from the Triassic and Jurassic deposits. Malformed and
+      diseased bones of tertiary mammalia have been collected in the caverns of
+      Gailenreuth with traces of healing.&rdquo;]
+    </p>
+    <p>
+      But it is especially the prerogative, I had almost said 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 get rid of
+      those who will not mind or cannot be kept subject to these laws.
+    </p>
+    <p>
+      Disease, being always an effect, is always in exact proportion to the sum
+      of its causes, as much in the case of Spigelius, who dies of a scratch, as
+      in that of the man who recovers after an iron bar has been shot through
+      his brain. The one prevalent failing of the medical art is to neglect the
+      causes and quarrel with the effect.
+    </p>
+    <p>
+      There are certain general facts which include a good deal of what is
+      called and treated as disease. Thus, there are two opposite movements of
+      life to be seen in cities and elsewhere, belonging to races which, from
+      various persistent causes, are breeding down and tending to run out, and
+      to races which are breeding up, or accumulating vital capital,&mdash;a
+      descending and an ascending series. Let me give an example of each; and
+      that I may incidentally remove a common impression about this country as
+      compared with the Old World, an impression which got tipsy with conceit
+      and staggered into the attitude of a formal proposition in the work of Dr.
+      Robert Knox, I will illustrate the downward movement from English
+      experience, and the upward movement from a family history belonging to
+      this immediate neighborhood.
+    </p>
+    <p>
+      Miss Nightingale speaks of &ldquo;the fact so often seen of a great-grandmother,
+      who was a tower of physical vigor, descending into a grandmother perhaps a
+      little less vigorous, but still sound as a bell, and healthy to the core,
+      into a mother languid and confined to her carriage and house; and lastly
+      into a daughter sickly and confined to her bed.&rdquo; So much for the
+      descending English series; now for the ascending American series.
+    </p>
+    <p>
+      Something more than one hundred and thirty years ago there graduated at
+      Harvard College a delicate youth, who lived an invalid life and died at
+      the age of about fifty. His two children were both of moderate physical
+      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 of
+      its members. The fourth generation was of fair average endowment. The
+      fifth generation, great-great-grandchildren of the slender invalid, are
+      several of, them of extraordinary bodily and mental power; large in
+      stature, formidable alike with their brains and their arms, organized on a
+      more extensive scale than either of their parents.
+    </p>
+    <p>
+      This brief account illustrates incidentally the fallacy of the
+      universal-degeneration theory applied to American life; the same on which
+      one of our countrymen has lately brought some very forcible facts to bear
+      in a muscular discussion of which we have heard rather more than is good
+      for us. But the two series, American and English, ascending and
+      descending, were adduced with the main purpose of showing the immense
+      difference of vital endowments in different strains of blood; a difference
+      to which all ordinary medication is in all probability a matter of
+      comparatively trivial purport. Many affections which art has to strive
+      against might be easily shown to be vital to the well-being of society.
+      Hydrocephalus, tabes mesenterica, and other similar maladies, are natural
+      agencies which cut off the children of races that are sinking below the
+      decent minimum which nature has established as the condition of viability,
+      before they reach the age of reproduction. They are really not so much
+      diseases, as manifestations of congenital incapacity for life; the race
+      would be ruined if art could ever learn always to preserve the individuals
+      subject to them. We must do the best we can for them, but we ought also to
+      know what these &ldquo;diseases&rdquo; mean.
+    </p>
+    <p>
+      Again, invalidism is the normal state of many organizations. It can be
+      changed to disease, but never to absolute health by medicinal appliances.
+      There are many ladies, ancient and recent, who are perpetually taking
+      remedies for irremediable pains and aches. They ought to have headaches
+      and back-aches and stomach-aches; they are not well if they do not have
+      them. To expect them to live without frequent twinges is like expecting a
+      doctor's old chaise to go without creaking; if it did, we might be sure
+      the springs were broken. There is no doubt that the constant demand for
+      medicinal remedies from patients of this class leads to their over-use;
+      often in the case of cathartics, sometimes in that of opiates. I have been
+      told by an intelligent practitioner in a Western town, that the constant
+      prescription of opiates by certain physicians in his vicinity has rendered
+      the habitual use of that drug in all that region very prevalent; more
+      common, I should think, than alcoholic drunkenness in the most intemperate
+      localities of which I have known anything. A frightful endemic
+      demoralization betrays itself in the frequency with which the haggard
+      features and drooping shoulders of the opium-drunkards are met with in the
+      streets.
+    </p>
+    <p>
+      The next proposition I would ask you to consider is this: The presumption
+      always is that every noxious agent, including medicines proper, which
+      hurts a well man, hurts a sick one. [Note B.]
+    </p>
+    <p>
+      Let me illustrate this proposition before you decide upon it. If it were
+      known that a prize-fighter were to have a drastic purgative administered
+      two or three days before a contest, or a large blister applied to his
+      back, no one will question that it would affect the betting on his side
+      unfavorably; we will say to the amount of five per cent. Now the drain
+      upon the resources of the system produced in such a case must be at its
+      minimum, for the subject is a powerful man, in the prime of life, and in
+      admirable condition. If the drug or the blister takes five per cent. from
+      his force of resistance, it will take at least as large a fraction from
+      any invalid. But this invalid has to fight a champion who strikes hard but
+      cannot be hit in return, who will press him sharply for breath, but will
+      never pant himself while the wind can whistle through his fleshless ribs.
+      The suffering combatant is liable to want all his stamina, and five per
+      cent. may lose him the battle.
+    </p>
+    <p>
+      All noxious agents, all appliances which are not natural food 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 force produced
+      by any of them, that is, would exactly kill him, nothing less than kill
+      him, and nothing more. If this, or something like this, is true, then all
+      these medications are, prima facie, injurious.
+    </p>
+    <p>
+      In the game of Life-or-Death, Rouge et Noir, as played between the Doctor
+      and the Sexton, this five per cent., this certain small injury entering
+      into the chances is clearly the sexton's perquisite for keeping the green
+      table, over which the game is played, and where he hoards up his gains.
+      Suppose a blister to diminish a man's pain, effusion or dyspnoea to the
+      saving of twenty per cent. in vital force; his profit from it is fifteen,
+      in that case, for it always hurts him five to begin with, according to our
+      previous assumption.
+    </p>
+    <p>
+      Presumptions are of vast importance in medicine, as in law. A man is
+      presumed innocent until he is proved guilty. A medicine&mdash;that is, a
+      noxious agent, like a blister, a seton, an emetic, or a cathartic &mdash;should
+      always be presumed to be hurtful. It always is directly hurtful; it may
+      sometimes be indirectly beneficial. If this presumption were established,
+      and disease always assumed to be the innocent victim of circumstances, and
+      not punishable by medicines, that is, noxious agents, or poisons, until
+      the contrary was shown, we should not so frequently hear the remark
+      commonly, perhaps erroneously, attributed to Sir Astley Cooper, but often
+      repeated by sensible persons, that, on the whole, more harm than good is
+      done by medication. Throw out opium, which the Creator himself seems to
+      prescribe, for we often see the scarlet poppy growing in the cornfields,
+      as if it were foreseen that wherever there is hunger to be fed there must
+      also be pain to be soothed; throw out a few specifics which our art did
+      not discover, and is hardly needed to apply [ Note C.]; throw out wine,
+      which is a food, and the vapors which produce the miracle of anaesthesia,
+      and I firmly believe that if the whole materia medica, as now used, could
+      be sunk to the bottom of the sea, it would be all the better for mankind,&mdash;and
+      all the worse for the fishes.
+    </p>
+    <p>
+      But to justify this proposition, I must add that the injuries inflicted by
+      over-medication are to a great extent masked by disease. Dr. Hooker
+      believes that the typhus syncopatia of a preceding generation in New
+      England &ldquo;was often in fact a brandy and opium disease.&rdquo; How is a physician
+      to distinguish the irritation produced by his blister from that caused by
+      the inflammation it was meant to cure? How can he tell the exhaustion
+      produced by his evacuants from the collapse belonging to the disease they
+      were meant to remove?
+    </p>
+    <p>
+      Lastly, medication without insuring favorable hygienic conditions is like
+      amputation without ligatures. I had a chance to learn this well of old,
+      when physician to the Broad Street district of the Boston Dispensary.
+      There, there was no help for the utter want of wholesome conditions, and
+      if anybody got well under my care, it must have been in virtue of the
+      rough-and-tumble constitution which emerges from the struggle for life in
+      the street gutters, rather than by the aid of my prescriptions.
+    </p>
+    <p>
+      But if the materia medica were lost overboard, how much more pains would
+      be taken in ordering all the circumstances surrounding the patient (as can
+      be done everywhere out of the crowded pauper districts), than are taken
+      now by too many who think they do their duty and earn their money when
+      they write a recipe for a patient left in an atmosphere of domestic
+      malaria, or to the most negligent kind of nursing! I confess that I should
+      think my chance of recovery from illness less with Hippocrates for my
+      physician and Mrs. Gamp for my nurse, than if I were in the hands of
+      Hahnemann himself, with Florence Nightingale or good Rebecca Taylor to
+      care for me.
+    </p>
+    <p>
+      If I am right in maintaining that the presumption is always against the
+      use of noxious agents in disease, and if any whom I might influence should
+      adopt this as a principle of practice, they will often find themselves
+      embarrassed by the imperative demand of patients and their friends for
+      such agents where a case is not made out against this standing
+      presumption. I must be permitted to say, that I think the French, a not
+      wholly uncivilized people, are in advance of the English and ourselves in
+      the art of prescribing for the sick without hurting them. And I do confess
+      that I think their varied ptisans and syrups are as much preferable to the
+      mineral regimen of bug-poison and ratsbane, so long in favor on the other
+      side of the Channel, as their art of preparing food for the table to the
+      rude cookery of those hard-feeding and much-dosing islanders. We want a
+      reorganized cuisine of invalidism perhaps as much as the culinary, reform,
+      for which our lyceum lecturers, and others who live much at hotels and
+      taverns, are so urgent. Will you think I am disrespectful if I ask
+      whether, even in Massachusetts, a dose of calomel is not sometimes given
+      by a physician on the same principle as that upon which a landlord
+      occasionally prescribes bacon and eggs,&mdash;because he cannot think of
+      anything else quite so handy? I leave my suggestion of borrowing a hint
+      from French practice to your mature consideration.
+    </p>
+    <p>
+      I may, however, call your attention, briefly, to the singular fact, that
+      English and American practitioners are 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 &ldquo;decidedly less effective&rdquo; than that of his own
+      country. Mr. S. Cooper, again, defends the simple British practice of
+      procuring union by the first intention against the attacks of M. Roux and
+      Baron Larrey. [Cooper's Surg. Diet. art. &ldquo;Wounds.&rdquo; Yet Mr. John Bell gives
+      the French surgeons credit for introducing this doctrine of adhesion, and
+      accuses O'Halloran of &ldquo;rudeness and ignorance,&rdquo; and &ldquo;bold, uncivil
+      language,&rdquo; in disputing their teaching. Princ. of Surgery, vol. i. p. 42.
+      Mr. Hunter succeeded at last in naturalizing the doctrine and practice,
+      but even he had to struggle against the perpetual jealousy of rivals, and
+      died at length assassinated by an insult.] We have often heard similar
+      opinions maintained by our own countrymen. While Anglo-American criticism
+      blows hot or cold on the two departments of French practice, it is not, I
+      hope, indecent to question whether all the wisdom is necessarily with us
+      in both cases.
+    </p>
+    <p>
+      Our art has had two or three lessons which have a deep meaning to those
+      who are willing to read them honestly. The use of water-dressings in
+      surgery completed the series of reforms by which was abolished the &ldquo;coarse
+      and cruel practice&rdquo; of the older surgeons, who with their dressings and
+      acrid balsams, their tents and leaden tubes, &ldquo;absolutely delayed the
+      cure.&rdquo; The doctrine of Broussais, transient as was its empire, reversed
+      the practice of half of Christendom for a season, and taught its hasty
+      disciples to shun their old favorite remedies as mortal poisons. This was
+      not enough permanently to shift the presumption about drugs where it
+      belonged, and so at last, just as the sympathetic powder and the Unguentum
+      Armarium came in a superstitious age to kill out the abuses of external
+      over-medication, the solemn farce of Homoeopathy was enacted in the face
+      of our own too credulous civilization, that under shelter of its pretences
+      the &ldquo;inward bruises&rdquo; of over-drugged viscera might be allowed to heal by
+      the first intention. Its lesson we must accept, whether we will or not;
+      its follies we are tired of talking about. The security of the medical
+      profession against this and all similar fancies is in the average
+      constitution of the human mind with regard to the laws of evidence.
+    </p>
+    <p>
+      My friends and brothers in Art! There is nothing to be feared from the
+      utterance of any seeming heresy to which you may have listened. I cannot
+      compromise your collective wisdom. If I have strained the truth one hair's
+      breadth for the sake of an epigram or an antithesis, you are accustomed to
+      count the normal pulse-beats of sound judgment, and know full well how to
+      recognize the fever-throbs of conceit and the nervous palpitations of
+      rhetoric.
+    </p>
+    <p>
+      The freedom with which each of us speaks his thought in this presence,
+      belongs in part to the assured position of the Profession in our
+      Commonwealth, to the attitude of Science, which is always fearless, and to
+      the genius of the soil on which we stand, from which Nature withheld the
+      fatal gift of malaria only to fill it with exhalations that breed the
+      fever of inquiry in our blood and in our brain. But mainly we owe the
+      large license of speech we enjoy to those influences and privileges common
+      to us all as self-governing Americans.
+    </p>
+    <p>
+      This Republic is the chosen home of minorities, of the less power in the
+      presence of the greater. It is a common error to speak of our distinction
+      as consisting 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
+      death treading down the tenfold more numerous minorities. In the old
+      civilizations they root themselves like oaks in the soil; men must live in
+      their shadow or cut them down. With us the majority is only the flower of
+      the passing noon, and the minority is the bud which may open in the next
+      morning's sun. We must be tolerant, for the thought which stammers on a
+      single tongue today may organize itself in the growing consciousness of
+      the time, and come back to us like the voice of the multitudinous waves of
+      the ocean on the morrow.
+    </p>
+    <p>
+      Twenty-five years have passed since one of your honored Presidents spoke
+      to this Society of certain limitations to the power of our Art, now very
+      generally conceded. Some were troubled, some were almost angry, thinking
+      the Profession might suffer from such concessions. It has certainly not
+      suffered here; if, as some affirm, it has lost respect anywhere, it was
+      probably for other, and no doubt sufficient reasons.
+    </p>
+    <p>
+      Since that time the civilization of this planet has changed hands. Strike
+      out of existence at this moment every person who was breathing on that
+      day, May 27, 1835, and every institution of society, every art and every
+      science would remain intact and complete in the living that would be left.
+      Every idea the world then held has been since dissolved and
+      recrystallized.
+    </p>
+    <p>
+      We are repeating the same process. Not to make silver shrines for our old
+      divinities, even though by this craft we should have our wealth, was this
+      Society organized and carried on by the good men and true who went before
+      us. Not for this, but to melt the gold out of the past, though its dross
+      should fly in dust to all the winds of heaven, to save all our old
+      treasures of knowledge and mine deeply for new, to cultivate that mutual
+      respect of which outward courtesy is the sign, to work together, to feel
+      together, to take counsel together, and to stand together for the truth,
+      now, always, here, everywhere; for this our fathers instituted, and we
+      accept, the offices and duties of this time-honored Society.
+    </p>
+    <p>
+      <a name="link2H_4_0008" id="link2H_4_0008">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+    </h2>
+    <p>
+      An Introductory Lecture delivered before the Medical Class of Harvard
+      University, November 6, 1861.
+    </p>
+    <p>
+      [This Lecture appears as it would have been delivered had the time allowed
+      been less strictly, limited. Passages necessarily omitted have been
+      restored, and points briefly touched have been more fully considered. A
+      few notes have been added for the benefit of that limited class of
+      students who care to track an author through the highways and by-ways of
+      his reading. I owe my thanks to several of my professional brethren who
+      have communicated with me on subjects with which they are familiar;
+      especially to Dr. John Dean, for the opportunity of profiting by his
+      unpublished labors, and to Dr. Hasket Derby, for information and
+      references to recent authorities relating to the anatomy and physiology of
+      the eye.]
+    </p>
+    <p>
+      The entrance upon a new course of Lectures is always a period of interest
+      to instructors and pupils. As the birth of a child to a parent, so is the
+      advent of a new class to a teacher. As the light of the untried world to
+      the infant, so is the dawning of the light resting over the unexplored
+      realms of science to the student. In the name of the Faculty I welcome
+      you, Gentlemen of the Medical Class, new-born babes of science, or lustier
+      nurslings, to this morning of your medical life, and to the arms and the
+      bosom of this ancient University. Fourteen years ago I stood in this place
+      for the first time to address those who occupied these benches. As I
+      recall these past seasons of our joint labors, I feel that they have been
+      on the whole prosperous, and not undeserving of their prosperity.
+    </p>
+    <p>
+      For it has been my privilege to be associated with a body of true and
+      faithful workers; I cannot praise them freely to their faces, or I should
+      be proud to discourse of the harmonious diligence and the noble spirit in
+      which they have toiled together, not merely to teach their several
+      branches, but to elevate the whole standard of teaching.
+    </p>
+    <p>
+      I may speak with less restraint of those gentlemen who have aided me in
+      the most laborious part of my daily duties, the Demonstrators, to whom the
+      successive classes have owed so much of their instruction. They rise
+      before me, the dead and the living, in the midst of the most grateful
+      recollections. The fair, manly face and stately figure of my friend, Dr.
+      Samuel Parkman, himself fit for the highest offices of teaching, yet
+      willing to be my faithful assistant in the time of need, come back to me
+      with the long sigh of regret for his early loss to our earthly
+      companionship. Every year I speak the eulogy of Dr. Ainsworth's patient
+      toil as I show his elaborate preparations: When I take down my &ldquo;American
+      Cyclopaedia&rdquo; and borrow instruction from the learned articles of Dr.
+      Kneeland, I cease to regret that his indefatigable and intelligent
+      industry was turned into a broader channel. And what can I say too cordial
+      of my long associated companion and friend, Dr. Hodges, whose admirable
+      skill, working through the swiftest and surest fingers that ever held a
+      scalpel among us, has delighted class after class, and filled our Museum
+      with monuments which will convey his name to unborn generations?
+    </p>
+    <p>
+      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 their mysteries, or timid neophytes just entering
+      the portals of 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
+      alcoves remain in darkness.
+    </p>
+    <p>
+      SCIENCE is the topography of ignorance. From a few elevated points we
+      triangulate vast spaces, inclosing infinite unknown details. We cast the
+      lead, and draw up a little sand from abysses we may never reach with our
+      dredges.
+    </p>
+    <p>
+      The best part of our knowledge is that which teaches us where knowledge
+      leaves off and ignorance begins. Nothing more clearly separates a vulgar
+      from a superior mind, than the confusion in the first between the little
+      that it truly knows, on the one hand, and what it half knows and what it
+      thinks it knows on the other.
+    </p>
+    <p>
+      That which is true of every subject is especially true of the branch of
+      knowledge which deals with living beings. Their existence is a perpetual
+      death and 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.
+    </p>
+<pre xml:space="preserve">
+        &ldquo;Thou art not thyself;
+   For thou exist'st on many a thousand grains
+   That issue out of dust.&rdquo;
+ </pre>
+    <p>
+      If it is true that we understand ourselves but imperfectly in health, this
+      truth is more signally manifested in disease, where natural actions
+      imperfectly understood, disturbed in an obscure way by half-seen causes,
+      are creeping and winding along in the dark toward their destined issue,
+      sometimes using our remedies as safe stepping-stones, occasionally, it may
+      be, stumbling over them as obstacles.
+    </p>
+    <p>
+      I propose in this lecture to show you some points of contact between our
+      ignorance and our knowledge in several of the branches upon the study of
+      which you are entering. I may teach you a very little directly, but I hope
+      much more from the trains of thought I shall suggest. Do not expect too
+      much ground to be covered in this rapid survey. Our task is only that of
+      sending out a few pickets under the starry flag of science to the edge of
+      that dark domain where the ensigns of the obstinate rebel, Ignorance, are
+      flying undisputed. We are not making a reconnoissance in force, still less
+      advancing with the main column. But here are a few roads along which we
+      have to march together, and we wish to see clearly how far our lines
+      extend, and where the enemy's outposts begin.
+    </p>
+    <p>
+      Before touching the branches of knowledge that deal with organization and
+      vital functions, let us glance at that science which meets you at the
+      threshold of your study, and prepares you in some measure to deal with the
+      more complex problems of the living laboratory.
+    </p>
+    <p>
+      CHEMISTRY includes the art of separating and combining the elements of
+      matter, and the study of the changes produced by these operations. We can
+      hardly say too much of what it has contributed to our knowledge of the
+      universe and our power of dealing with its materials. It has given us a
+      catalogue raisonne of the substances found upon our planet, and shown how
+      everything living and dead is put together from them. It is accomplishing
+      wonders before us every day, such as Arabian story-tellers used to string
+      together in their fables. It spreads the sensitive film on the artificial
+      retina which looks upon us through the optician's lens for a few seconds,
+      and fixes an image that will outlive its original. It questions the light
+      of the sun, and detects the vaporized metals floating around the great
+      luminary,&mdash;iron, sodium, lithium, and the rest,&mdash;as if the
+      chemist of our remote planet could fill his bell-glasses from its fiery
+      atmosphere. It lends the power which flashes our messages in thrills that
+      leave the lazy chariot of day behind them. It seals up a few dark grains
+      in iron vases, and lo! at the touch of a single spark, rises in smoke and
+      flame a mighty Afrit with a voice like thunder and an arm that shatters
+      like an earthquake. The dreams of Oriental fancy have become the sober
+      facts of our every-day life, and the chemist is the magician to whom we
+      owe them.
+    </p>
+    <p>
+      To return to the colder scientific aspect of chemistry. It has shown us
+      how bodies stand affected to each other through an almost boundless range
+      of combinations. It has given us a most ingenious theory to account for
+      certain fixed relations in these combinations. It has successfully
+      eliminated a great number of proximate compounds, more or less stable,
+      from organic structures. It has invented others which form the basis of
+      long series of well-known composite substances. In fact, we are perhaps
+      becoming overburdened with our list of proximate principles, demonstrated
+      and hypothetical.
+    </p>
+    <p>
+      How much nearer have we come to the secret of force than Lully and Geber
+      and the whole crew of juggling alchemists? We have learned a great deal
+      about the how, what have we learned about the why?
+    </p>
+    <p>
+      Why does iron rust, while gold remains untarnished, and gold amalgamate,
+      while iron refuses the alliance of mercury?
+    </p>
+    <p>
+      The alchemists called gold Sol, the sun, and iron Mars, and pleased
+      themselves with fancied relations between these substances and the
+      heavenly bodies, by which they pretended to explain the facts they
+      observed. Some of their superstitions have lingered in practical medicine
+      to the present day, but chemistry has grown wise enough to confess the
+      fact of absolute ignorance.
+    </p>
+    <p>
+      What is it that makes common salt crystallize in the form of cubes, and
+      saltpetre in the shape of six-sided prisms? We see no reason why it should
+      not have been just the other way, salt in prisms and saltpetre in cubes,
+      or why either should take an exact geometrical outline, any more than
+      coagulating albumen.
+    </p>
+    <p>
+      But although we had given up attempting to explain the essential nature of
+      affinities and of crystalline types, we might have supposed that we had at
+      least fixed the identity of the substances with which we deal, and
+      determined the laws of their combination. All at once we find that a
+      simple substance changes face, puts off its characteristic qualities and
+      resumes them at will;&mdash;not merely when we liquefy or vaporize a
+      solid, or reverse the process; but that a solid is literally transformed
+      into another solid under our own eyes. We thought we knew phosphorus. We
+      warm a portion of it sealed in an empty tube, for about a week. It has
+      become a brown infusible substance, which does not shine in the dark nor
+      oxidate in the air. We heat it to 500 F., and it becomes common phosphorus
+      again. We transmute sulphur in the same singular way. Nature, you know,
+      gives us 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.
+    </p>
+    <p>
+      These facts of allotropism have some corollaries connected with them
+      rather startling to us of the nineteenth century. There may be other
+      transmutations possible besides those of phosphorus and sulphur. When Dr.
+      Prout, in 1840, talked about azote and carbon being &ldquo;formed&rdquo; in the living
+      system, it was looked upon as one of those freaks of fancy to which
+      philosophers, like other men, are subject. But when Professor Faraday, in
+      1851, says, at a meeting of the British Association, that &ldquo;his hopes are
+      in the direction of proving that bodies called simple were really
+      compounds, and may be formed artificially as soon as we are masters of the
+      laws influencing their combinations,&rdquo;&mdash;when he comes forward and says
+      that he has tried experiments at transmutation, and means, if his life is
+      spared, to try them again,&mdash;how can we be surprised at the popular
+      story of 1861, that Louis Napoleon has established a gold-factory and is
+      glutting the mints of Europe with bullion of his own making?
+    </p>
+    <p>
+      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 glass vessel, c, we do not expect the glass to change them, unless a or
+      b or the compound a b has the power of dissolving 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 signs of combustion and form
+      water, the third in the mean time undergoing no perceptible change. It has
+      played the part of the unwedded priest, who marries a pair without taking
+      a fee or having any further relation with the parties. We call this
+      catalysis, catalytic action, the action of presence, or by what learned
+      name we choose. Give what name to it we will, it is a manifestation of
+      power which crosses our established laws of combination at a very open
+      angle of intersection. I think we may find an analogy for it in electrical
+      induction, the disturbance of the equilibrium of the electricity of a body
+      by the approach of a charged body to it, without interchange of electrical
+      conditions between the two bodies. But an analogy is not an explanation,
+      and why a few drops of yeast should change a saccharine mixture to
+      carbonic acid and alcohol,&mdash;a little leaven leavening the whole lump,&mdash;not
+      by combining with it, but by setting a movement at work, we not only
+      cannot explain, but the fact is such an exception to the recognized laws
+      of combination that Liebig is unwilling to admit the new force at all to
+      which Berzelius had given the name so generally accepted.
+    </p>
+    <p>
+      The phenomena of isomerism, or identity of composition and proportions of
+      constituents with difference of qualities, and of isomorphism, or identity
+      of form in crystals which have one element substituted for another, were
+      equally surprises to science; and although the mechanism by which they are
+      brought about can be to a certain extent explained by a reference to the
+      hypothetical atoms of which the elements are constituted, yet this is only
+      turning the difficulty into a fraction with an infinitesimal denominator
+      and an infinite numerator.
+    </p>
+    <p>
+      So far we have studied the working of force and its seeming anomalies in
+      purely chemical phenomena. But we soon find that chemical force is
+      developed by various other physical agencies,&mdash;by heat, by light, by
+      electricity, by magnetism, by mechanical agencies; and, vice versa, that
+      chemical action develops heat, light, electricity, magnetism, mechanical
+      force, as we see in our matches, galvanic batteries, and explosive
+      compounds. Proceeding with our experiments, we find that every kind of
+      force is capable of producing all other kinds, or, in Mr. Faraday's
+      language, that &ldquo;the various forms under which the forces of matter are
+      made manifest have a common origin, or, in other words, are so directly
+      related and mutually dependent that they are convertible one into
+      another.&rdquo;
+     </p>
+    <p>
+      Out of this doctrine naturally springs that of the conservation of force,
+      so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. Faraday. This
+      idea is no novelty, though it seems so at first sight. It was maintained
+      and disputed among the giants of philosophy. Des Cartes and Leibnitz
+      denied that any new motion originated in nature, or that any ever ceased
+      to exist; all motion being in a circle, passing from one body to another,
+      one losing what the other gained. Newton, on the other hand, believed that
+      new motions were generated and existing ones destroyed. On the first
+      supposition, there is a fixed amount of force always circulating in the
+      universe. On the second, the total amount may be increasing or
+      diminishing. You will find in the &ldquo;Annual of Scientific Discovery&rdquo; for
+      1858 a very interesting lecture by Professor Helmholtz of Bonn, in which
+      it is maintained that a certain portion of force is lost in every natural
+      process, being converted into unchangeable heat, so that the universe will
+      come to a stand-still at last, all force passing into heat, and all heat
+      into a state of equilibrium.
+    </p>
+    <p>
+      The doctrines of the convertibility or specific equivalence of the various
+      forms of force, and of its conservation, which is its logical consequence,
+      are very generally accepted, as I believe, at the present time, among
+      physicists. We are naturally led to the question, What is the nature of
+      force? The three illustrious philosophers just referred to agree in
+      attributing the general movements of the universe to the immediate Divine
+      action. The doctrine of &ldquo;preestablished harmony&rdquo; was an especial
+      contrivance of Leibnitz to remove the Creator from unworthy association
+      with the less divine acts of living beings. Obsolete as this expression
+      sounds to our ears, the phrase laws of the universe, which we use so
+      constantly with a wider application, appears to me essentially identical
+      with it.
+    </p>
+    <p>
+      Force does not admit of explanation, nor of proper definition, any more
+      than the hypothetical substratum of matter. If we assume the Infinite as
+      omnipresent, omniscient, omnipotent, we cannot suppose Him excluded from
+      any part of His creation, except from rebellious souls which voluntarily
+      exclude Him by the exercise of their fatal prerogative of free-will.
+      Force, then, is the act of immanent Divinity. I find no meaning in
+      mechanical explanations. Newton's hypothesis of an ether filling the
+      heavenly spaces does 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 &ldquo;immaterial&rdquo; cause to the &ldquo;material&rdquo;
+       effect.
+    </p>
+    <p>
+      The problem of force meets us everywhere, and I prefer to encounter it in
+      the world of physical phenomena before reaching that of living actions. It
+      is only the name for the incomprehensible cause of certain changes known
+      to our consciousness, and assumed to be outside of it. For me it is the
+      Deity Himself in action.
+    </p>
+    <p>
+      I can therefore see a large significance in the somewhat bold language of
+      Burdach: &ldquo;There is for me but one miracle, that of infinite existence, and
+      but one mystery, the manner in which the finite proceeds from the
+      infinite. So soon as we recognize this incomprehensible act as the general
+      and primordial miracle, 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 by experience in this light, there is
+      for us no other impenetrable miracle or mystery.&rdquo;
+     </p>
+    <p>
+      Let us turn to a branch of knowledge which deals with certainties up to
+      the limit of the senses, and is involved in no speculations beyond them.
+      In certain points of view, HUMAN ANATOMY may be considered an almost
+      exhausted science. From time to time some small organ which had escaped
+      earlier observers has been pointed out,&mdash;such parts as the tensor
+      tarsi, the otic ganglion, or the Pacinian bodies; but some of our best
+      anatomical works are those which have been classic for many generations.
+      The plates of the bones in Vesalius, three centuries old, are still
+      masterpieces of accuracy, as of art. The magnificent work of Albinus on
+      the muscles, published in 1747, is still supreme in its department, as the
+      constant references of the most thorough recent treatise on the subject,
+      that of Theile, sufficiently show. More has been done in unravelling the
+      mysteries of the fasciae, but there has been a tendency to overdo this
+      kind of material analysis. Alexander Thomson split them up into cobwebs,
+      as you may see in the plates to Velpeau's Surgical Anatomy. I well
+      remember how he used to shake his head over the coarse work of Scarpa and
+      Astley Cooper,&mdash;as if Denner, who painted the separate hairs of the
+      beard and pores of the skin in his portraits, had spoken lightly of the
+      pictures of Rubens and Vandyk.
+    </p>
+    <p>
+      Not only has little been added to the catalogue of parts, but some things
+      long known had become half-forgotten. Louis and others confounded the
+      solitary glands of the lower part of the small intestine with those which
+      &ldquo;the great Brunner,&rdquo; as Haller calls him, described in 1687 as being found
+      in the duodenum. The display of the fibrous structure of the brain seemed
+      a novelty as shown by Spurzheim. One is startled to find the method
+      anticipated by Raymond Vieussens nearly two centuries ago. I can hardly
+      think Gordon had ever looked at his figures, though he names their author,
+      when he wrote the captious and sneering article which attracted so much
+      attention in the pages of the &ldquo;Edinburgh Review.&rdquo;
+     </p>
+    <p>
+      This is the place, if anywhere, to mention any observations I could
+      pretend to have made in the course of my teaching the structure of the
+      human body. I can make no better show than most of my predecessors in this
+      well-reaped field. The nucleated cells found connected with the
+      cancellated structure of the bones, which I first pointed out and had
+      figured in 1847, and have shown yearly from that time to the present, and
+      the fossa masseterica, a shallow concavity on the ramus of the lower jaw,
+      for the lodgment of the masseter muscle, which acquires significance when
+      examined by the side of the deep cavity on the corresponding part in some
+      carnivora to which it answers, may perhaps be claimed as deserving
+      attention. I have also pleased myself by making a special group of the six
+      radiating muscles which diverge from the spine of the axis, or second
+      cervical vertebra, and by giving to it the name stella musculosa nuchae.
+      But this scanty catalogue is only an evidence that one may teach long and
+      see little that has not been noted by those who have gone before him. Of
+      course I do not think it necessary to include rare, but already described
+      anomalies, such as the episternal bones, the rectus sternalis, and other
+      interesting exceptional formations I have encountered, which have shown a
+      curious tendency to present themselves several times in the same season,
+      perhaps because the first specimen found calls our attention to any we may
+      subsequently meet with.
+    </p>
+    <p>
+      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 human body has changed its old aspect, and become fertile in
+      new observations. This rejuvenescence was effected by means of two
+      principal agencies,&mdash;new methods and a new instrument.
+    </p>
+    <p>
+      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 as when Arrowsmith, who was born in 1750, published his admirable
+      maps. But in that same year was born Werner, who taught a new way of
+      studying the earth, since become familiar to us all under the name of
+      Geology.
+    </p>
+    <p>
+      What geology has done for our knowledge of the earth, has been done for
+      our knowledge of the body by that method of study to which is given the
+      name of General Anatomy. It studies, not the organs as such, but the
+      elements out of which the organs are constructed. It is the geology of the
+      body, as that is the general anatomy of the earth. The extraordinary
+      genius of Bichat, to whom more than any other we owe this new method of
+      study, does not require Mr. Buckle's testimony to impress the practitioner
+      with the importance of its achievements. I have heard a very wise
+      physician question whether any important result had accrued to practical
+      medicine from Harvey's discovery of the circulation. But Anatomy,
+      Physiology, and Pathology have received a new light from this novel method
+      of contemplating the living structures, which has had a vast influence in
+      enabling the practitioner at least to distinguish and predict the course
+      of disease. We know as well what differences to expect in the habits of a
+      mucous and of a serous membrane, as what mineral substances to look for in
+      the chalk or the coal measures. You have only to read Cullen's description
+      of inflammation of the lungs or of the bowels, and compare it with such as
+      you may find in Laennec or Watson, to see the immense gain which diagnosis
+      and prognosis have derived from general anatomy.
+    </p>
+    <p>
+      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 this century. It does not deal with organs, as did the earlier
+      anatomists, nor with tissues, after the manner of Bichat. It maps the
+      whole surface of the body into an arbitrary number of regions, and studies
+      each region successively from the surface to the bone, or beneath it. This
+      hardly deserves the name of a science, although Velpeau has dignified it
+      with that title, but it furnishes an admirable practical way for the
+      surgeon who has to operate on a particular region of the body to study
+      that region. If we are buying a farm, we are not content with the State
+      map 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 sometimes called,
+      surgical anatomy, does for the surgeon with reference to the part on which
+      his skill is to be exercised. It enables him to see with the mind's eye
+      through the opaque tissues down to the bone on which they lie, as if the
+      skin were transparent as the cornea, and the organs it covers translucent
+      as the gelatinous pulp of a medusa.
+    </p>
+    <p>
+      It is curious that the Japanese should have anticipated Europe in a kind
+      of rude regional anatomy. I have seen a manikin of Japanese make traced
+      all over with lines, and points marking their intersection. By this their
+      doctors are guided in the performance of acupuncture, marking the safe
+      places to thrust in needles, as we buoy out our ship-channels, and
+      doubtless indicating to learned eyes the spots where incautious meddling
+      had led to those little accidents of shipwreck to which patients are
+      unfortunately liable.
+    </p>
+    <p>
+      A change of method, then, has given us General and Regional Anatomy.
+      These, too, have been worked so thoroughly, that, if not exhausted, they
+      have at least become to a great extent fixed and positive branches of
+      knowledge. But the first of them, General Anatomy, would never have
+      reached this positive condition but for the introduction of that
+      instrument which I have mentioned as the second great aid to modern
+      progress.
+    </p>
+    <p>
+      This instrument is the achromatic microscope. For the history of the
+      successive steps by which it became the effective scientific implement we
+      now possess, I must refer you to the work of Mr. Quekett, to an excellent
+      article in the &ldquo;Penny Cyclopaedia,&rdquo; or to that of Sir David Brewster in
+      the &ldquo;Encyclopaedia Britannica.&rdquo; It is a most interesting piece of
+      scientific history, which shows how the problem which Biot in 1821
+      pronounced insolvable was in the course of a few years practically solved,
+      with a success equal to that which Dollond had long before obtained with
+      the telescope. It is enough for our purpose that we are now in possession
+      of an instrument freed from all confusions and illusions, which magnifies
+      a thousand diameters,&mdash;a million times in surface,&mdash;without
+      serious distortion or discoloration of its object.
+    </p>
+    <p>
+      A quarter of a century ago, or a little more, an instructor would not have
+      hesitated to put John Bell's &ldquo;Anatomy&rdquo; and Bostock's &ldquo;Physiology&rdquo; into a
+      student's hands, as good authority on their respective subjects. Let us
+      not be unjust to either of these authors. John Bell is the liveliest
+      medical writer that I can remember who has written since the days of
+      delightful old Ambroise Pare. His picturesque descriptions and bold
+      figures are as good now as they ever were, and his book can never become
+      obsolete. But listen to what John Bell says of the microscope:
+    </p>
+    <p>
+      &ldquo;Philosophers of the last age had been at infinite pains to find the
+      ultimate fibre of muscles, thinking to discover its properties in its
+      form; but they saw just in proportion to the glasses which they used, or
+      to their practice and skill in that art, which is now almost forsaken.&rdquo;
+     </p>
+    <p>
+      Dr. Bostock's work, neglected as it is, is one which I value very highly
+      as a really learned compilation, full of original references. But Dr.
+      Bostock says: &ldquo;Much as the naturalist has been indebted to the microscope,
+      by bringing into view many beings of which he could not otherwise have
+      ascertained the existence, the physiologist has not yet derived any great
+      benefit from the instrument.&rdquo;
+     </p>
+    <p>
+      These are only specimens of the manner in which the microscope and its
+      results were generally regarded by the generation just preceding our own.
+    </p>
+    <p>
+      I have referred you to the proper authorities for the account of those
+      improvements which about the year 1830 rendered the compound microscope an
+      efficient and trustworthy instrument. It was now for the first time that a
+      true general anatomy became possible. As early as 1816 Treviranus had
+      attempted to resolve the tissues, of which Bichat had admitted no less
+      than 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 all the tissues, the areolar, was not at all understood? All
+      that method could do had been accomplished by Bichat and his followers. It
+      was for the optician to take the next step. The future of anatomy and
+      physiology, as an enthusiastic micrologist of the time said, was in the
+      hands of Messrs. Schieck and Pistor, famous opticians of Berlin.
+    </p>
+    <p>
+      In those earlier days of which I am speaking, all the points of minute
+      anatomy were involved in obscurity. Some found globules everywhere, some
+      fibres. Students disputed whether the conjunctiva extended over the cornea
+      or not, and worried themselves over Gaultier de Claubry's stratified
+      layers of the skin, or Breschet's blennogenous and chromatogenous organs.
+      The dartos was a puzzle, the central spinal canal a myth, the decidua
+      clothed in fable as much as the golden fleece. The structure of bone, now
+      so beautifully made out,&mdash;even that of the teeth, in which old
+      Leeuwenhoek, peeping with his octogenarian eyes through the minute lenses
+      wrought with his own hands, had long ago seen the &ldquo;pipes,&rdquo; as he called
+      them,&mdash;was hardly known at all. The minute structure of the viscera
+      lay in the mists of an uncertain microscopic vision. The intimate recesses
+      of the animal system were to the students of anatomy what the anterior of
+      Africa long was to geographers, and the stories of microscopic explorers
+      were as much sneered at as those of Bruce or Du Chailly, and with better
+      reason.
+    </p>
+    <p>
+      Now what have we come to in our own day? In the first place, the minute
+      structure of all the organs has been made out in the most satisfactory
+      way. The special arrangements of the vessels and the ducts of all the
+      glands, of the air-tubes and vesicles of the lungs, of the parts which
+      make up the skin and other membranes, all the details of those complex
+      parenchymatous organs which had confounded investigation so long, have
+      been lifted out of the invisible into the sight of all observers. It is
+      fair to mention here, that we owe a great deal to the art of minute
+      injection, by which we are enabled to trace the smallest vessels in the
+      midst of the tissues where they are distributed. This is an old artifice
+      of anatomists. The famous Ruysch, who died a hundred and thirty years ago,
+      showed that each of the viscera has its terminal vessels arranged in its
+      own peculiar way; the same fact which you may see illustrated in Gerber's
+      figures 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 a very rich
+      collection of injected preparations sent him by Professor Hyrtl, formerly
+      of Prague, now of Vienna, for the proper exhibition of which I had a
+      number of microscopes made expressly, by Mr. Grunow, during the past
+      season. All this illustrates what has been done for the elucidation of the
+      intimate details of formation of the organs.
+    </p>
+    <p>
+      But the great triumph of the microscope as applied to anatomy has been in
+      the resolution of the organs and the tissues into their simple constituent
+      anatomical elements. It has taken up general anatomy where Bichat left it.
+      He had succeeded in reducing the structural language of nature to
+      syllables, if you will permit me to use so bold an image. The microscopic
+      observers who have come after him have analyzed these into letters, as we
+      may call them,&mdash;the simple elements by the combination of which
+      Nature spells 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, until she binds up in one living whole that
+      wondrous volume of power and wisdom which we call the human body.
+    </p>
+    <p>
+      The alphabet of the organization is so short and simple, that I will risk
+      fatiguing your attention by repeating it, according to the plan I have
+      long adopted.
+    </p>
+    <p>
+      A. Cells, either floating, as in the blood, or fixed, like those in the
+      cancellated structure of bone, already referred to. Very commonly they
+      have undergone a change of figure, most frequently a flattening which
+      reduces them to scales, as in the epidermis and the epithelium.
+    </p>
+    <p>
+      B. Simple, translucent, homogeneous solid, such as is found at the back of
+      the cornea, or forming the intercellular substance of cartilage.
+    </p>
+    <p>
+      C. The white fibrous element, consisting of very delicate, tenacious
+      threads. This is the long staple textile substance of the body. It is to
+      the organism what 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-work together. It furnishes the sinews, which are the 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 made of it.
+    </p>
+    <p>
+      D. The yellow elastic, fibrous element, the caoutchouc of the animal
+      mechanism, which pulls things back into place, as the India-rubber band
+      shuts the door we have opened.
+    </p>
+    <p>
+      E. The striped muscular fibre,&mdash;the red flesh, which shortens itself
+      in obedience to the will, and thus produces all voluntary active motion.
+    </p>
+    <p>
+      F. The unstriped muscular fibre, more properly the fusiform-cell fibre,
+      which carries on the involuntary internal movements.
+    </p>
+    <p>
+      G. The nerve-cylinder, a glassy tube, with a pith of some firmness, which
+      conveys sensation to the brain and the principle which induces motion from
+      it.
+    </p>
+    <p>
+      H. The nerve-corpuscle, the centre of nervous power.
+    </p>
+    <p>
+      I. The mucous tissue, as Virchow calls it, common in embryonic structures,
+      seen in the vitreous humor of the adult.
+    </p>
+    <p>
+      To these add X, granules, of indeterminate shape and size, Y, for
+      inorganic matters, such as the salts of bone and teeth, and Z, to stand as
+      a symbol of the fluids, and you have the letters of what I have ventured
+      to call the alphabet of the body.
+    </p>
+    <p>
+      But just as in language certain diphthongs and syllables are frequently
+      recurring, so we have in the body certain secondary and tertiary
+      combinations, which we meet more frequently than the solitary elements of
+      which they are composed.
+    </p>
+    <p>
+      Thus A B, or a collection of cells united by simple structureless solid,
+      is seen to be extensively employed in the body under the name of
+      cartilage. Out of this the surfaces of the articulations and the springs
+      of the breathing apparatus are formed. But when Nature came to the buffers
+      of the spinal column (intervertebral disks) and the washers of the joints
+      (semilunar fibrocartilages of the knee, etc.), she required more tenacity
+      than common cartilage possessed. What did she do? What does man do in a
+      similar case of need? I need hardly tell you. The mason lays his bricks in
+      simple mortar. But the plasterer works some hair into the mortar which he
+      is going to lay in large sheets on the walls. The children of Israel
+      complained that they had no straw to make their bricks with, though
+      portions of it may still be seen in the crumbling pyramid of Darshour,
+      which they are said to have built. I visited the old house on Witch Hill
+      in Salem a year or two ago, and there I found the walls coated with clay
+      in which straw was abundantly mingled;&mdash;the old Judaizing
+      witch-hangers copied the Israelites in a good many things. The Chinese and
+      the Corsicans blend the fibres of amianthus in their pottery to give it
+      tenacity. Now to return to Nature. To make her buffers and washers hold
+      together in the shocks to which they would be subjected, she took common
+      cartilage and mingled the white fibrous tissue with it, to serve the same
+      purpose as the hair in the mortar, the straw in the bricks and in the
+      plaster of the old wall, and the amianthus in the earthen vessels. Thus we
+      have the combination A B C, or fibro-cartilage. Again, the bones were once
+      only gristle or cartilage, A B. To give them solidity they were
+      infiltrated with stone, in the form of salts of lime, an inorganic
+      element, so that bone would be spelt out by the letters A, B, and Y.
+    </p>
+    <p>
+      If from these organic syllables we proceed to form organic words, we shall
+      find that Nature employs three principal forms; namely, Vessels,
+      Membranes, and Parenchyma, or visceral tissue. The most complex of them
+      can be resolved into a combination of these few simple anatomical
+      constituents.
+    </p>
+    <p>
+      Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find the
+      same elements in morbid growths that we have met with in normal
+      structures. The pus-corpuscle and the white blood-corpuscle can only be
+      distinguished by tracing them to their origin. A frequent form of
+      so-called malignant disease proves to 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,&mdash;the crowding together of the elements, the size of
+      the cell-nuclei, and similar variable characters.
+    </p>
+    <p>
+      Let us turn to PHYSIOLOGY. The microscope, which has made a new science of
+      the intimate structure of the organs, has at the same time cleared up many
+      uncertainties concerning the mechanism of the special functions. Up to the
+      time of the living generation of observers, Nature had kept over all her
+      inner workshops the forbidding inscription, No Admittance! If any prying
+      observer ventured to spy through his magnifying tubes into the mysteries
+      of her glands and canals and fluids, she covered up her work in blinding
+      mists and bewildering halos, as the deities of old concealed their favored
+      heroes in the moment of danger.
+    </p>
+    <p>
+      Science has at length sifted the turbid light of her lenses, and blanched
+      their delusive rainbows.
+    </p>
+    <p>
+      Anatomy studies the organism in space. Physiology studies it also in time.
+      After the study of form and composition follows close that of action, and
+      this leads us along back to the first moment of the germ, and forward to
+      the resolution of the living frame into its lifeless elements. In this way
+      Anatomy, or rather that branch of it which we call Histology, has become
+      inseparably blended with the study of function. The connection between the
+      science of life and that of intimate structure on the one hand, and
+      composition on the other, is illustrated in the titles of two recent works
+      of remarkable excellence,&mdash;&ldquo;the Physiological Anatomy&rdquo; of Todd and
+      Bowman, and the &ldquo;Physiological Chemistry&rdquo; of Lehmann.
+    </p>
+    <p>
+      Let me briefly recapitulate a few of our acquisitions in Physiology, due
+      in large measure to our new instruments and methods of research, and at
+      the same time indicate the limits which form the permanent or the
+      temporary boundaries of our knowledge. I will begin with the largest fact
+      and with the most absolute and universally encountered limitation.
+    </p>
+    <p>
+      The &ldquo;largest truth in Physiology&rdquo; Mr. Paget considers to be &ldquo;the
+      development of ova through multiplication and division of their cells.&rdquo; I
+      would state it more broadly as the agency of the cell in all living
+      processes. It seems at present necessary to abandon the original idea of
+      Schwann, that we can observe the building up of a cell from the simple
+      granules of a blastema, or formative fluid. The evidence points rather
+      towards the axiom, Omnis cellula a cellula; that is, the germ of a new
+      cell is always derived from a preexisting cell. The doctrine of Schwann,
+      as I remarked long ago (1844), runs parallel with the nebular theory in
+      astronomy, and they may yet stand or fall together.
+    </p>
+    <p>
+      As we have seen Nature anticipating the plasterer in fibro-cartilage, so
+      we see her beforehand with the 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 Nature shapes her hyaline vesicles and
+      modifies them to serve the needs of the part where they are found. The
+      artisan whirls his rod, and his glass bubble becomes a flattened disk,
+      with its bull's-eye for a nucleus. These lips of ours are all glazed with
+      microscopic tiles formed of flattened cells, each one of them with its
+      nucleus still as plain and relatively as prominent, to the eye of the
+      microscopist, as the bull's-eye in the old-fashioned windowpane.
+      Everywhere we find cells, modified or unchanged. They roll in
+      inconceivable multitudes (five millions and more to the cubic millimetre,
+      according to Vierordt) as blood-disks through our vessels. A close-fitting
+      mail of flattened cells coats our surface with a panoply of imbricated
+      scales (more than twelve thousand millions), as Harting has computed, as
+      true a defence against our enemies as the buckler of the armadillo or the
+      carapace of the tortoise against theirs. The same little protecting organs
+      pave all the great highways of the interior system. Cells, again, preside
+      over the chemical processes which elaborate the living fluids; they change
+      their form to become the agents of voluntary and involuntary motion; the
+      soul itself sits on a throne of nucleated cells, and flashes its mandates
+      through skeins of glassy filaments which once were simple chains of
+      vesicles. And, as if to reduce the problem of living force to its simplest
+      expression, we see the yolk of a transparent egg dividing itself in whole
+      or in part, and again dividing and subdividing, until it becomes a mass of
+      cells, out of which the harmonious diversity of the organs arranges
+      itself, worm or man, as God has willed from the beginning.
+    </p>
+    <p>
+      This differentiation having been effected, each several part assumes its
+      special office, having a life of its own adjusted to that of other parts
+      and the whole. &ldquo;Just as a tree constitutes a mass arranged in a definite
+      manner, in which, in every single part, in the leaves as in the root, in
+      the trunk as in the blossom, cells are discovered to be the ultimate
+      elements, so is it also with the forms of animal life. Every animal
+      presents itself as a sum of vital unities, every one of which manifests
+      all the characteristics of life.&rdquo;
+     </p>
+    <p>
+      The mechanism is as clear, as unquestionable, as absolutely settled and
+      universally accepted, as the order of movement of the heavenly bodies,
+      which we compute backward to the days of the observatories on the plains
+      of Shinar, and on the faith of which we regulate the movements of war and
+      trade by the predictions of our ephemeris.
+    </p>
+    <p>
+      The mechanism, and that is all. We see the workman and the tools, but the
+      skill that guides the work and the power that performs it are as invisible
+      as ever. I fear that not every listener took the significance of those
+      pregnant words in the passage I quoted from John Bell,&mdash;&ldquo;thinking to
+      discover its properties in its form.&rdquo; We have discovered the working bee
+      in this great hive of organization. We have detected the cell in the very
+      act of forming itself from a nucleus, of transforming itself into various
+      tissues, of selecting the elements of various secretions. But why one cell
+      becomes nerve and another muscle, why one selects bile and another fat, we
+      can no more pretend to tell, than why one grape sucks out of the soil the
+      generous juice which princes hoard in their cellars, and another the wine
+      which it takes three men to drink,&mdash;one to pour it down, another to
+      swallow it, and a third to hold him while it is going down. Certain
+      analogies between this selecting power and the phenomena of endosmosis in
+      the elective affinities of chemistry we can find, but the problem of force
+      remains here, as everywhere, unsolved and insolvable.
+    </p>
+    <p>
+      Do we gain anything by attempting to get rid of the idea of a special
+      vital force because we find certain mutually convertible relations between
+      forces in the body and out of it? I think not, any more than we should
+      gain by getting rid of the idea and expression Magnetism because of its
+      correlation with electricity. We may concede the unity of all forms of
+      force, but we cannot overlook the fixed differences of its manifestations
+      according to the conditions under which it acts. It is a mistake, however,
+      to think the mystery is greater in an organized body than in any other. We
+      see a stone fall or a crystal form, and there is nothing stranger left to
+      wonder at, for we have seen the Infinite in action.
+    </p>
+    <p>
+      Just so far as we can recognize the ordinary modes of operation of the
+      common forces of nature,&mdash;gravity, cohesion, elasticity,
+      transudation, chemical action, and the rest,&mdash;we see the so-called
+      vital acts in the light of a larger range of known facts and familiar
+      analogies. Matteuecci's well-remembered lectures contain many and striking
+      examples of the working of physical forces in physiological processes.
+      Wherever rigid experiment carries us, we are safe in following this lead;
+      but the moment we begin to theorize beyond our strict observation, we are
+      in danger of falling into those mechanical follies which true science has
+      long outgrown.
+    </p>
+    <p>
+      Recognizing the fact, then, that we have learned nothing but the machinery
+      of life, and are no nearer to its essence, what is it that we have gained
+      by this great discovery of the cell formation and function?
+    </p>
+    <p>
+      It would have been reward enough to learn the method Nature pursues for
+      its own sake. If the sovereign Artificer lets us into his own laboratories
+      and workshops, we need not ask more than the privilege of looking on at
+      his work. We do not know where we now stand in the hierarchy of created
+      intelligences. We were made a little lower than the angels. I speak it not
+      irreverently; as the lower animals surpass man in some of their
+      attributes, so it may be that not every angel's eye can see as broadly and
+      as deeply into the material works of God as man himself, looking at the
+      firmament through an equatorial of fifteen inches' aperture, and searching
+      into the tissues with a twelfth of an inch objective.
+    </p>
+    <p>
+      But there are other positive gains of a more practical character. Thus we
+      are no longer permitted to place the seat of the living actions in the
+      extreme vessels, which are only the carriers from which each part takes
+      what it wants by the divine right of the omnipotent nucleated cell. The
+      organism has become, in the words already borrowed from Virchow, &ldquo;a sum of
+      vital unities.&rdquo; The strictum and laxum, the increased and diminished
+      action of the vessels, out of which medical theories and methods of
+      treatment have grown up, have yielded to the doctrine of local
+      cell-communities, belonging to this or that vascular district, from which
+      they help themselves, as contractors are wont to do from the national
+      treasury.
+    </p>
+    <p>
+      I cannot promise to do more than to select a few of the points of contact
+      between our ignorance and our knowledge which present particular interest
+      in the existing state of our physiological acquisitions. Some of them
+      involve the microscopic discoveries of which I have been speaking, some
+      belong to the domain of chemistry, and some have relations with other
+      departments of physical science.
+    </p>
+    <p>
+      If we should begin with the digestive function, we should find that the
+      long-agitated question of the nature of the acid of the gastric juice is
+      becoming settled in favor of the lactic. But the whole solvent agency of
+      the digestive fluid enters into the category of that exceptional mode of
+      action already familiar to us in chemistry as catalysis. It is therefore
+      doubly difficult of explanation; first, as being, like all reactions, a
+      fact not to be accounted for except by the imaginative appeal to
+      &ldquo;affinity,&rdquo; and secondly, as being one of those peculiar reactions
+      provoked by an element which stands outside and looks on without
+      compromising itself.
+    </p>
+    <p>
+      The doctrine of Mulder, so widely diffused in popular and scientific
+      belief, of the existence of a common base of all albuminous substances,
+      the so-called protein, has not stood the test of rigorous analysis. The
+      division of food into azotized and non-azotized is no doubt important, but
+      the attempt to show that the first only is plastic or nutritive, while the
+      second is simply calorifacient, or heat-producing, fails entirely in the
+      face of the facts revealed by the study of man in different climates, and
+      of numerous experiments in the feeding of animals. I must return to this
+      subject in connection with the respiratory function.
+    </p>
+    <p>
+      The sugar-making faculty of the liver is another &ldquo;catalytic&rdquo; mystery, as
+      great as the rest of them, and no greater. Liver-tissue brings sugar out
+      of the blood, or out of its own substance;&mdash;why?
+    </p>
+<pre xml:space="preserve">
+     Quia est in eo
+     Virtus saccharitiva.
+</pre>
+    <p>
+      Just what becomes of the sugar beyond the fact of its disappearance before
+      it can get into the general circulation and sweeten our tempers, it is
+      hard to say.
+    </p>
+    <p>
+      The pancreatic fluid makes an emulsion of the fat contained in our food,
+      but just how the fatty particles get into the villi we must leave Brucke
+      and Kolliker to settle if they can.
+    </p>
+    <p>
+      No one has shown satisfactorily the process by which the blood-corpuscles
+      are formed out of the lymph-corpuscles, nor what becomes of them. These
+      two questions are like those famous household puzzles,&mdash;Where do the
+      flies come from? and, Where do the pins go to?
+    </p>
+    <p>
+      There is a series of organs in the body which has long puzzled
+      physiologists,&mdash;organs of glandular aspect, but having no ducts,&mdash;the
+      spleen, the thyroid and thymus bodies, and the suprarenal capsules. We
+      call them vascular glands, and we believe that they elaborate colored and
+      uncolored blood-cells; but just what changes they effect, and just how
+      they effect them, it has proved a very difficult matter to determine. So
+      of the noted glandules which form Peyer's patches, their precise office,
+      though seemingly like those of the lymphatic glands, cannot be positively
+      assigned, so far as I know, at the present time. It is of obvious interest
+      to learn it with reference to the pathology of typhoid fever. It will be
+      remarked that the coincidence of their changes in this disease with
+      enlargement of the spleen suggests the idea of a similarity of function in
+      these two organs.
+    </p>
+    <p>
+      The theories of the production of animal heat, from the times of Black,
+      Lavoisier, and Crawford to those of Liebig, are familiar to all who have
+      paid any attention to physiological studies. The simplicity of Liebig's
+      views, and the popular form in which they have been presented, have given
+      them wide currency, and incorporated them in the common belief and
+      language of our text-books. Direct oxidation or combustion of the carbon
+      and hydrogen contained in the food, or in the tissues themselves; the
+      division of alimentary substances into respiratory, or non-azotized, and
+      azotized,&mdash;these doctrines are 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 than with sulphur and azote. Such is the well-grounded
+      statement of Robin and Verdeil. &ldquo;It is very probable that animal heat is
+      entirely produced by the chemical actions which take place in the
+      organism, but the phenomenon is too complex to admit of our calculating it
+      according to the quality of oxygen consumed.&rdquo; These last are the words of
+      Regnault, as cited by Mr. Lewes, whose intelligent discussion of this and
+      many of the most interesting physiological problems I strongly recommend
+      to your attention.
+    </p>
+    <p>
+      This single illustration covers a wider ground than the special function
+      to which it belongs. We are learning that the chemistry of the body must
+      be studied, not simply by its ingesta and egesta, but that there is a long
+      intermediate series of changes which must be investigated in their own
+      light, under their own special conditions. The expression &ldquo;sum of vital
+      unities&rdquo; applies to the chemical actions, as well as to other actions
+      localized in special parts; and when the distinguished chemists whom I
+      have just cited entitle their work a treatise on the immediate principles
+      of the body, they only indicate the nature of that profound and subtile
+      analysis which must take the place of all hasty generalizations founded on
+      a comparison of the food with residual products.
+    </p>
+    <p>
+      I will only call your attention to the fact, that the exceptional
+      phenomenon of the laboratory is the prevailing law of the organism.
+      Nutrition itself is but one great catalytic process. As the blood travels
+      its rounds, each part selects its appropriate element and transforms it to
+      its own likeness. Whether the appropriating agent be cell or nucleus, or a
+      structureless solid like the intercellular substance of cartilage, the
+      fact of its presence determines the separation of its proper constituents
+      from the circulating fluid, so that even when we are wounded bone is
+      replaced by bone, skin by skin, and nerve by nerve.
+    </p>
+    <p>
+      It is hardly without a smile that we resuscitate the old question of the
+      'vis insita' of the muscular fibre, so famous in the discussions of Haller
+      and his contemporaries. Speaking generally, I think we may say that
+      Haller's doctrine is the one now commonly received; namely, that the
+      muscles contract in virtue of their own inherent endowments. It is true
+      that Kolliker says no perfectly decisive fact has been brought forward to
+      prove that the striated muscles contract without having been acted on by
+      nerves. Yet Mr. Bowman's observations on the contraction of isolated
+      fibres appear decisive enough (unless we consider them invalidated by Dr.
+      Lionel Beale's recent researches), tending to show that each elementary
+      fibre is supplied with nerves; and as to the smooth muscular fibres, we
+      have Virchow's statement respecting the contractility of those of the
+      umbilical cord, where there is not a trace of any nerves.
+    </p>
+    <p>
+      In the investigation of the nervous system, anatomy and physiology have
+      gone hand in hand. It is very singular that so important, and seemingly
+      simple, a fact as the connection of the nerve-tubes, at their origin or in
+      their course, with the nerve-cells, should have so long remained open to
+      doubt, as you may see that it did by referring to the very complete work
+      of Sharpey and Quain (edition of 1849), the histological portion of which
+      is cordially approved by Kolliker himself.
+    </p>
+    <p>
+      Several most interesting points of the minute anatomy of the nervous
+      centres have been laboriously and skilfully worked out by a recent
+      graduate of this Medical School, in a monograph worthy to stand in line
+      with those of Lockhart Clarke, Stilling, and Schroder van der Kolk. I have
+      had the privilege of examining and of showing some of you a number of Dr.
+      Dean's skilful preparations. I have no space to give even an abstract of
+      his conclusions. I can only refer to his proof of the fact, that a single
+      cell may send its processes into several different bundles of nerve-roots,
+      and to his demonstration of the curved ascending and descending fibres
+      from the posterior nerveroots, to reach what he has called the
+      longitudinal columns of the cornea. I must also mention Dr. Dean's
+      exquisite microscopic photographs from sections of the medulla oblongata,
+      which appear to me to promise a new development, if not a new epoch, in
+      anatomical art.
+    </p>
+    <p>
+      It having been settled that the nerve-tubes can very commonly be traced
+      directly to the nerve-cells, the object of all the observers in this
+      department of anatomy is to follow these tubes to their origin. We have an
+      infinite snarl of telegraph wires, and we may be reasonably sure, that, if
+      we can follow them up, we shall find each of them ends in a battery
+      somewhere. One of the most interesting problems is to find the ganglionic
+      origin of the great nerves of the medulla oblongata, and this is the end
+      to which, by the aid of the most delicate sections, colored so as to bring
+      out their details, mounted so as to be imperishable, magnified by the best
+      instruments, and now self-recorded in the light of the truth-telling
+      sunbeam, our fellow-student is making a steady progress in a labor which I
+      think bids fair to rank with the most valuable contributions to histology
+      that we have had from this side of the Atlantic.
+    </p>
+    <p>
+      It is interesting to see how old questions are incidentally settled in the
+      course of these new investigations. Thus, Mr. Clarke's dissections,
+      confirmed by preparations of Mr. Dean's which I have myself examined,
+      placed the fact of the decussation of the pyramids&mdash;denied by Haller,
+      by Morgagni, and even by Stilling&mdash;beyond doubt. So the spinal canal,
+      the existence of which, at least in the adult, has been so often disputed,
+      appears as a coarse and unequivocal anatomical fact in many of the
+      preparations referred to.
+    </p>
+    <p>
+      While these studies of the structure of the cord have been going on, the
+      ingenious and indefatigable Brown-Sequard has been investigating the
+      functions of its different parts with equal diligence. The microscopic
+      anatomists had shown that the ganglionic corpuscles of the gray matter of
+      the cord are connected with each other by their processes, as well as with
+      the nerve-roots. M. Brown-Sequard has proved by numerous experiments that
+      the gray substance transmits sensitive impressions and muscular
+      stimulation. The oblique ascending and descending fibres from the
+      posterior nerve-roots, joining the &ldquo;longitudinal columns of the cornua,&rdquo;
+       account for the results of Brown-Sequard's sections of the posterior
+      columns. The physiological experimenter has also made it evident that the
+      decussation of the conductors of sensitive impressions has its seat in the
+      spinal core, and not in the encephalon, as had been supposed. Not less
+      remarkable than these results are the facts, which I with others of my
+      audience have had the opportunity of observing, as shown by M.
+      Brown-Sequard, of the artificial production of epilepsy in animals by
+      injuring the spinal cord, and the induction of the paroxysm by pinching a
+      certain portion of the skin. I would also call the student's attention to
+      his account of the relations of the nervous centres to nutrition and
+      secretion, the last of which relations has been made the subject of an
+      extended essay by our fellow countryman, Dr. H. F. Campbell of Georgia.
+    </p>
+    <p>
+      The physiology of the spinal cord seems a simple matter as you study it in
+      Longet. The experiments of Brown-Sequard have shown the problem to be a
+      complex one, and raised almost as many doubts as they have solved
+      questions; at any rate, I believe all lecturers on physiology agree that
+      there is no part of their task they dread so much as the analysis of the
+      evidence relating to the special offices of the different portions of the
+      medulla spinalis. In the brain we are sure 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 crossed paralysis of sensation, and the
+      conducting agency of the gray substance, I am afraid we retain no cardinal
+      principles discovered since the development of the reflex function took
+      its place by Sir Charles Bell's great discovery.
+    </p>
+    <p>
+      By the manner in which I spoke of the brain, you will see that I am
+      obliged to leave phrenology sub Jove,&mdash;out in the cold,&mdash;as not
+      one of the household of science. I am not one of its haters; on the
+      contrary, I am grateful for the incidental good it has done. I love to
+      amuse myself in its plaster Golgothas, and listen to the glib professor,
+      as he discovers by his manipulations
+    </p>
+<pre xml:space="preserve">
+   &ldquo;All that disgraced my betters met in me.&rdquo;
+ </pre>
+    <p>
+      I loved of old to see square-headed, heavy-jawed Spurzheim make a brain
+      flower out into a corolla of marrowy filaments, as Vieussens had done
+      before him, and to hear the dry-fibred but human-hearted George Combe
+      teach good sense under the disguise of his equivocal system. But the
+      pseudo-sciences, phrenology and the rest, seem to me only appeals to weak
+      minds and the weak points of strong ones. There is a pica or false
+      appetite in many intelligences; they take to odd fancies in place of
+      wholesome truth, as girls gnaw at chalk and charcoal. Phrenology juggles
+      with nature. It is so adjusted as to soak up all evidence 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 boundary of our
+      ignorance, it seems to me, but is one of the will-o'-the-wisps of its
+      undisputed central domain of bog and quicksand. Yet I should not have
+      devoted so many words to it, did I not recognize the light it has thrown
+      on human actions by its study of congenital organic tendencies. Its maps
+      of the surface of the head are, I feel sure, founded on a delusion, but
+      its studies of individual character are always interesting and
+      instructive.
+    </p>
+    <p>
+      The &ldquo;snapping-turtle&rdquo; strikes after its natural fashion when it first
+      comes out of the egg. Children betray their tendencies in their way of
+      dealing with the breasts that nourish them; nay, lean venture to affirm,
+      that long before they are born they teach their mothers something of their
+      turbulent or quiet tempers.
+    </p>
+<pre xml:space="preserve">
+   &ldquo;Castor gaudet equis, ovo proanatus eodem
+     Pugnis.&rdquo;
+ </pre>
+    <p>
+      Strike out the false pretensions of phrenology; call it anthropology; let
+      it study man the individual in distinction from man the abstraction, the
+      metaphysical or theological lay-figure; and it becomes &ldquo;the proper study
+      of mankind,&rdquo; one of the noblest and most interesting of pursuits.
+    </p>
+    <p>
+      The whole physiology of the nervous system, from the simplest
+      manifestation of its power in an insect up to the supreme act of the human
+      intelligence working through the brain, is full of the most difficult yet
+      profoundly interesting questions. The singular relations between
+      electricity and nerve-force, relations which it has been attempted to
+      interpret as meaning identity, in the face of palpable differences,
+      require still more extended studies. You may be interested by Professor
+      Faraday's statement of his opinion on the matter. &ldquo;Though I am not
+      satisfied that the nervous fluid is only electricity, still I think that
+      the agent in the nervous system maybe an inorganic force; and if there be
+      reason for supposing that magnetism is a higher relation of force than
+      electricity, so it may well be imagined that the nervous power may be of a
+      still more exalted character, and yet within the reach of experiment.&rdquo;
+     </p>
+    <p>
+      In connection with this statement, it is interesting to refer to the
+      experiments of Helmholtz on the rapidity of transmission of the nervous
+      actions. The rate is given differently in Valentin's report of these
+      experiments and in that found in the &ldquo;Scientific Annual&rdquo; for 1858. One
+      hundred and eighty to three hundred feet per second is the rate of
+      movement assigned for sensation, but all such results must be very vaguely
+      approximative. Boxers, fencers, players at the Italian game of morn,
+      &ldquo;prestidigitators,&rdquo; and all who depend for their success on rapidity of
+      motion, know what differences there are in the personal equation of
+      movement.
+    </p>
+    <p>
+      Reflex action, the mechanical sympathy, if I may so call it, of distant
+      parts; Instinct, which is crystallized intelligence,&mdash;an absolute law
+      with its invariable planes and angles introduced into the sphere of
+      consciousness, as raphides are inclosed in the living cells of plants;
+      Intellect,&mdash;the operation of the thinking principle through material
+      organs, with an appreciable waste of tissue in every act of thought, so
+      that our clergymen's blood has more phosphates to get rid of on Monday
+      than on any other day of the week; Will,&mdash;theoretically the absolute
+      determining power, practically limited in different degrees by the varying
+      organization of races and individuals, annulled or perverted by different
+      ill-understood organic changes; on all these subjects our knowledge is in
+      its infancy, and from the study of some of them the interdict of the
+      Vatican is hardly yet removed.
+    </p>
+    <p>
+      I must allude to one or two points in the histology and physiology of the
+      organs of sense. The anterior continuation of the retina beyond the ora
+      serrata has been a subject of much discussion. If H. Muller and Kolliker
+      can be relied upon, this question is settled by recognizing that a layer
+      of cells, continued from the retina, passes over the surface of the zonula
+      Zinnii, but that no proper nervous element is so prolonged forward.
+    </p>
+    <p>
+      I observe that Kolliker calls the true nervous elements of the retina &ldquo;the
+      layer of gray cerebral substance.&rdquo; In fact, the ganglionic corpuscles of
+      each eye may be considered as constituting a little brain, connected with
+      the masses behind by the commissure, commonly called the optic nerve. We
+      are prepared, therefore, to find these two little brains in the most
+      intimate relations with each other, as we find the cerebral hemispheres.
+      We know that they are directly connected by fibres that arch round through
+      the chiasma.
+    </p>
+    <p>
+      I mention these anatomical facts to introduce a physiological observation
+      of my own, first announced in one of the lectures before the Medical
+      Class, subsequently communicated to the American Academy of Arts and
+      Sciences, and printed in its &ldquo;Transactions&rdquo; for February 14, 1860. I refer
+      to the apparent transfer of impressions from one retina to the other, to
+      which I have given the name reflex vision. The idea was suggested to me in
+      consequence of certain effects noticed in employing the stereoscope.
+      Professor William B. Rodgers has since called the attention of the
+      American Scientific Association to some facts bearing on the subject, and
+      to a very curious experiment of Leonardo da Vinci's, which enables the
+      observer to look through the palm of his hand (or seem to), as if it had a
+      hole bored through it. As he and others hesitated to accept my
+      explanation, I was not sorry to find recently the following words in the
+      &ldquo;Observations on Man&rdquo; of that acute observer and thinker, David Hartley.
+      &ldquo;An impression made on the right eye alone by a single object may
+      propagate itself into the left, and there raise up an image almost equal
+      in vividness to itself; and consequently when we see with one eye only, we
+      may, however, have pictures in both eyes.&rdquo; Hartley, in 1784, had
+      anticipated many of the doctrines which have since been systematized into
+      the theory of reflex actions, and with which I have attempted to associate
+      this act of reflex vision. My sixth experiment, however, in the
+      communication referred to, appears to me to be a crucial one, proving the
+      correctness of my explanation, and I am not aware that it has been before
+      instituted.
+    </p>
+    <p>
+      Another point of great interest connected with the physiology of vision,
+      and involved for a long time in great obscurity, is that of the adjustment
+      of the eye to different distances. Dr. Clay Wallace of New York, who
+      published a very ingenious little book on the eye about twenty years ago,
+      with vignettes reminding one of Bewick, was among the first, if not the
+      first, to describe the ciliary muscle, to which the power of adjustment is
+      generally ascribed. It is ascertained, by exact experiment with the
+      phacueidoscope, that accommodation depends on change of form of the
+      crystalline lens. Where the crystalline is wanting, as Mr. Ware long ago
+      taught, no power of accommodation remains. The ciliary muscle is generally
+      thought to effect the change of form of the crystalline. The power of
+      accommodation is lost after the application of atropine, in consequence,
+      as is supposed, of the paralysis of this muscle. This, I believe, is the
+      nearest approach to a demonstration we have on this point.
+    </p>
+    <p>
+      I have only time briefly to refer to Professor Draper's most ingenious
+      theory as to the photographic nature of vision, for an account of which I
+      must refer to his original and interesting Treatise on Physiology.
+    </p>
+    <p>
+      It were to be wished that the elaborate and very interesting researches of
+      the Marquis Corti, which have revealed such singular complexity of
+      structure in the cochlea of the ear, had done more to clear up its
+      doubtful physiology; but I am afraid we have nothing but hypotheses for
+      the special part it plays in the act of hearing, and that we must say the
+      same respecting the office of the semicircular canals.
+    </p>
+    <p>
+      The microscope has achieved some of its greatest triumphs in teaching us
+      the changes which occur in the development of the embryo. No more
+      interesting discovery stands recorded in the voluminous literature of this
+      subject than the one originally announced by Martin Barry, afterwards
+      discredited, and still later confirmed by Mr. Newport and others; namely
+      the fact that the fertilizing filament reaches the interior of the ovum in
+      various animals;&mdash;a striking parallel to the action of the
+      pollen-tube in the vegetable. But beyond the mechanical facts all is
+      mystery in the movements of organization, as profound as in the fall of a
+      stone or the formation of a crystal.
+    </p>
+    <p>
+      To the chemist and the microscopist the living body presents the same
+      difficulties, arising from the fact that everything is in perpetual change
+      in the organism. The fibrine of the blood puzzles the one as much as its
+      globules puzzle the other. The difference between the branches of science
+      which deal with space only, and those which deal with space and time, is
+      this: we have no glasses that can magnify time. The figure I here show you
+      a was photographed from an object (pleurosigma angulatum) magnified a
+      thousand diameters, or presenting a million times its natural surface.
+      This other figure of the same object, enlarged from the one just shown, is
+      magnified seven thousand diameters, or forty-nine million times in
+      surface. When we can make the forty-nine millionth of a second as long as
+      its integer, physiology and chemistry will approach nearer the
+      completeness of anatomy.
+    </p>
+    <p>
+      Our reverence becomes more worthy, or, if you will, less unworthy of its
+      Infinite Object in proportion as our intelligence is lifted and expanded
+      to a higher and broader understanding of the Divine methods of action. If
+      Galen called his heathen readers to admire, the power, the wisdom, the
+      providence, the goodness of the &ldquo;Framer of the animal body,&rdquo;&mdash;if Mr.
+      Boyle, the student of nature, as Addison and that friend of his who had
+      known him for forty years tell us, never uttered the name of the Supreme
+      Being without making a distinct pause in his speech, in token of his
+      devout recognition of its awful meaning,&mdash;surely we, who inherit the
+      accumulated wisdom of nearly two hundred 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 study to their great
+      Artificer. These wonderful discoveries which we owe to that mighty little
+      instrument, the telescope of the inner firmament with all its included
+      worlds; these simple formulae by which we condense the observations of a
+      generation in a single axiom; these logical analyses by which we fence out
+      the ignorance we cannot reclaim, and fix the limits of our knowledge,&mdash;all
+      lead us up to the inspiration of the Almighty, which gives understanding
+      to the world's great teachers. To fear science or knowledge, lest it
+      disturb our old beliefs, is to fear the influx of the Divine wisdom into
+      the souls of our fellow-men; for what is science but the piecemeal
+      revelation,&mdash;uncovering,&mdash;of the plan of creation, by the agency
+      of those chosen prophets of nature whom God has illuminated from the
+      central light of truth for that single purpose?
+    </p>
+    <p>
+      The studies which we have glanced at are preliminary in your education to
+      the practical arts which make use of them,&mdash;the arts of healing,&mdash;surgery
+      and medicine. The more you examine the structure of the organs and the
+      laws of life, the more you will find how resolutely each of the
+      cell-republics which make up the E pluribus unum of the body maintains its
+      independence. Guard it, feed it, air it, warm it, exercise or rest it
+      properly, and the working elements will do their best to keep well or to
+      get well. 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 side of the
+      fence looking in good health, while those on the other side were scraggy
+      and miserable. How do 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, and
+      supplying them with the right kind of food in fitting quantities.
+    </p>
+    <p>
+      Now a man is not a plant, or, at least, he is a very curious one, for he
+      carries his soil in his stomach, which is a kind&mdash;of portable
+      flower-pot, and he grows round it, instead of out of it. He has, besides,
+      a singularly complex nutritive apparatus and a nervous system. But
+      recollect the doctrine already enunciated in the language of Virchow, that
+      an animal, like a tree, is a sum of vital unities, of which the cell is
+      the ultimate element. Every healthy cell, whether in a vegetable or an
+      animal, necessarily performs its function properly so long as 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 normal
+      state. But if originally sound and subsequently diseased, there has
+      certainly been some excess, deficiency, or wrong quality in the materials
+      or stimuli applied to it. You remove this injurious influence and
+      substitute a normal one; remove the baked coal-ashes, for instance, from
+      the roots of a tree, and replace them with loam; take away the salt meat
+      from the patient's table, and replace it with fresh meat and vegetables,
+      and the cells of the tree or the man return to their duty.
+    </p>
+    <p>
+      I do not know that we ever apply to a plant any element which is not a
+      natural constituent of the vegetable structure, except perhaps externally,
+      for the accidental purpose of killing parasites. The whole art of
+      cultivation consists in learning the proper food and conditions of plants,
+      and supplying them. We give them water, earths, salts of various kinds
+      such as they are made of, with a chance to help themselves to air and
+      light. The farmer would be laughed at who undertook to manure his fields
+      or his trees with a salt of lead or of arsenic. These elements are not
+      constituents of healthy plants. The gardener uses the waste of the arsenic
+      furnaces to kill the weeds in his walks.
+    </p>
+    <p>
+      If the law of the animal cell, and of the animal organism, which is built
+      up of such cells, is like that of the vegetable, we might expect that we
+      should treat all morbid conditions of any of the vital unities belonging
+      to an animal in the same way, by increasing, diminishing, or changing its
+      natural food or stimuli.
+    </p>
+    <p>
+      That is an aliment which nourishes; whatever we find in the organism, as a
+      constant and integral element, either forming part of its structure, or
+      one of the conditions of vital processes, that and that only deserves the
+      name of aliment. I see no reason, therefore, why iron, phosphate of lime,
+      sulphur, should not be considered food for man, as much as guano or
+      poudrette for vegetables. Whether one or another of them is best in any
+      given case,&mdash;whether they shall be taken alone or in combination, in
+      large or small quantities, are separate questions. But they are elements
+      belonging to the body, and even in moderate excess will produce little
+      disturbance. There is no presumption against any of this class of
+      substances, any more than against water or salt, provided they are used in
+      fitting combinations, proportions, and forms.
+    </p>
+    <p>
+      But when it comes to substances alien to the healthy system, which never
+      belong to it as normal constituents, the case is very different. There is
+      a presumption against putting lead or arsenic into the human body, as
+      against putting them into plants, because they do 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 they get into the system we cannot always tell. But in
+      the case of silver, from the accident of its changing color under the
+      influence of light, we do know what happens. It is thrown out, in part at
+      least, under the epidermis, and there it remains to the patient's dying
+      day. This is a striking illustration of the difficulty which the system
+      finds in dealing with non-assimilable elements, and justifies in some
+      measure the vulgar prejudice against mineral poisons.
+    </p>
+    <p>
+      I trust the youngest student on these benches will not commit the childish
+      error of confounding a presumption against a particular class of agents
+      with a condemnation of them. Mercury, for instance, is alien to the
+      system, and eminently disturbing in its influence. Yet its efficacy in
+      certain forms of specific disease is acknowledged by all but the most
+      sceptical theorists. Even the esprit moqueur of Ricord, the Voltaire of
+      pelvic literature, submits to the time-honored constitutional authority of
+      this great panacea in the class of cases to which he has devoted his
+      brilliant intelligence. Still, there is no telling what evils have arisen
+      from the abuse of this mineral. Dr. Armstrong long ago pointed out some of
+      them, and they have become matters of common notoriety. I am pleased,
+      therefore, when I find so able and experienced a practitioner as Dr.
+      Williams of this city proving that iritis is best treated without mercury,
+      and Dr. Vanderpoel showing the same thing to be true for pericarditis.
+    </p>
+    <p>
+      Whatever elements nature does not introduce into vegetables, the natural
+      food of all animal life,&mdash;directly of herbivorous, indirectly of
+      carnivorous animals,&mdash;are to be regarded with suspicion.
+      Arsenic-eating may seem to improve the condition of horses for a time,&mdash;and
+      even of human beings, if Tschudi's stories can be trusted,&mdash;but it
+      soon appears that its alien qualities are at war with the animal
+      organization. So of copper, antimony, and other non-alimentary simple
+      substances; everyone of them is an intruder in the living system, as much
+      as a constable would be, quartered in our household. This does not mean
+      that they may not, any of them, be called in for a special need, as we
+      send for the constable when we have good reason to think we have a thief
+      under our roof; but a man's body is his castle, as well as his house, and
+      the presumption is that we are to keep our alimentary doors bolted against
+      these perturbing agents.
+    </p>
+    <p>
+      Now the feeling is very apt to be just contrary to this. The habit has
+      been very general with well-taught practitioners, to have recourse to the
+      introduction of these alien elements into the system on the occasion of
+      any slight disturbance. The tongue was a little coated, and mercury must
+      be given; the skin was a little dry, and the patient must take antimony.
+      It was like sending for the constable and the posse comitatus when there
+      is only a carpet to shake or a refuse-barrel to empty. [Dr. James Johnson
+      advises persons not ailing to take five grains of blue pill with one or
+      two of aloes twice a week for three or four months in the year, with half
+      a pint of compound decoction of sarsaparilla every day for the same
+      period, to preserve health and prolong life. Pract. Treatise on Dis. of
+      Liver, etc. p. 272.] The constitution bears slow poisoning a great deal
+      better than might be expected; yet the most intelligent men in the
+      profession have gradually got out of the habit of prescribing these
+      powerful alien substances in the old routine way. Mr. Metcalf will tell
+      you how much more sparingly they are given by our practitioners at the
+      present time, than when he first inaugurated the new era of pharmacy among
+      us. Still, the presumption in favor of poisoning out every spontaneous
+      reaction of outraged nature is not extinct in those who are trusted with
+      the lives of their fellow-citizens. &ldquo;On examining the file of
+      prescriptions at the hospital, I discovered that they were rudely written,
+      and indicated a treatment, as they consisted chiefly of tartar emetic,
+      ipecacuanha, and epsom salts, hardly favorable to the cure of the
+      prevailing diarrhoea and dysenteries.&rdquo; In a report of a poisoning case now
+      on trial, where we are told that arsenic enough was found in the stomach
+      to produce death in twenty-four hours, the patient is said to have been
+      treated by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
+      acid,&mdash;by a practitioner of what school it may be imagined.
+    </p>
+    <p>
+      The traditional idea of always poisoning out disease, as we smoke out
+      vermin, is now seeking its last refuge behind the wooden cannon and
+      painted port-holes of that unblushing system of false scientific pretences
+      which I do not care to name in a discourse addressed to an audience
+      devoted to the study of the laws of nature 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, has accustomed all who have sense
+      enough to see through its thin artifices to the idea that diseases get
+      well without being &ldquo;cured,&rdquo; should now be the main support of the
+      tottering poison-cure doctrine. It has unquestionably helped to teach wise
+      people that nature heals most diseases without help from pharmaceutic art,
+      but it continues to persuade fools that art can arrest them all with its
+      specifics.
+    </p>
+    <p>
+      It is worse than useless to attempt in any way to check the freest
+      expression of opinion as to the efficacy of any or all of the &ldquo;heroic&rdquo;
+       means of treatment employed by practitioners of different schools and
+      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 larger jurisdiction; that, namely, in which the laws of human belief
+      are summoned to the witness-box, and obliged to testify to the sources of
+      error which beset the medical practitioner. The verdict is as old as the
+      father of medicine, who announces it in the words, &ldquo;judgment is
+      difficult.&rdquo; Physicians differed so in his time, that some denied that
+      there was any such thing as an art of medicine.
+    </p>
+    <p>
+      One man's best remedies were held as mischievous by another. The art of
+      healing was like soothsaying, so the common people said; &ldquo;the same bird
+      was lucky or unlucky, according as he flew to the right or left.&rdquo;
+     </p>
+    <p>
+      The practice of medicine has undergone great changes within 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 Bellevue and the
+      Massachusetts General Hospitals, it is almost obsolete in these
+      institutions, at least in medical practice. The old Brunonian stimulating
+      treatment has come into vogue again in the practice of Dr. Todd and his
+      followers. The compounds of mercury have yielded their place as drugs of
+      all work, and specifics for that very frequent subjective complaint,
+      nescio quid faciam,&mdash;to compounds of iodine. [Sir Astley Cooper has
+      the boldness,&mdash;or honesty,&mdash;to speak of medicines which &ldquo;are
+      given as much to assist the medical man as his patient.&rdquo; Lectures (London,
+      1832), p. 14.] Opium is believed in, and quinine, and &ldquo;rum,&rdquo; using that
+      expressive 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.
+    </p>
+    <p>
+      I have been in relation successively with the English and American
+      evacuant and alterative practice, in which calomel and antimony figured so
+      largely that, as you may see in Dr. Jackson's last &ldquo;Letter,&rdquo; Dr. Holyoke,
+      a good representative of sterling old-fashioned medical art, counted them
+      with opium and Peruvian bark as his chief remedies; with the moderately
+      expectant practice of Louis; the blood-letting &ldquo;coup sur coup&rdquo; of
+      Bouillaud; the contra-stimulant method of Rasori and his followers; the
+      anti-irritant system of Broussais, with its leeching and gum-water; I have
+      heard from our own students of the simple opium practice of the renowned
+      German teacher, Oppolzer; and now I find the medical community brought
+      round by the revolving cycle of opinion to that same old plan of treatment
+      which John Brown taught in Edinburgh in the last quarter of the last
+      century, and Miner and Tully fiercely advocated among ourselves in the
+      early years of the present. The worthy physicians last mentioned, and
+      their antagonist Dr. Gallup, used stronger language than we of these
+      degenerate days permit ourselves. &ldquo;The lancet is a weapon which annually
+      slays more than the sword,&rdquo; says Dr. Tully. &ldquo;It is probable that, for
+      forty years past, opium and its preparations have done seven times the
+      injury they have rendered benefit, on the great scale of the world,&rdquo; says
+      Dr. Gallup.
+    </p>
+    <p>
+      What is the meaning of these perpetual changes and conflicts of medical
+      opinion and practice, from an early antiquity to our own time? Simply
+      this: all &ldquo;methods&rdquo; of treatment end in disappointment of those
+      extravagant expectations which men are wont to entertain of medical art.
+      The bills of mortality are more obviously affected by drainage, than by
+      this or that method of practice. The insurance companies do not commonly
+      charge a different percentage on the lives of the patients of this or that
+      physician. In the course of a generation, more or less, physicians
+      themselves are liable to get tired of a practice which has so little
+      effect upon the average movement of vital decomposition. Then they are
+      ready for a change, even if it were back again to a method which has
+      already been tried, and found wanting.
+    </p>
+    <p>
+      Our practitioners, or many of them, have got back to the ways of old Dr.
+      Samuel Danforth, who, as it is well known, had strong objections to the
+      use of the lancet. By and by a new reputation will be made by some
+      discontented practitioner, who, tired of seeing patients die with their
+      skins full of whiskey and their brains muddy with opium, returns to a bold
+      antiphlogistic treatment, and has the luck to see a few patients of note
+      get well under it. So of the remedies which have gone out of fashion and
+      been superseded by others. It can hardly be doubted that they will come
+      into vogue again, more or less extensively, under the influence of that
+      irresistible demand for change just referred to.
+    </p>
+    <p>
+      Then will come the usual talk about a change in the character of disease,
+      which has about as much meaning as that concerning &ldquo;old-fashioned
+      snow-storms.&rdquo; &ldquo;Epidemic constitutions&rdquo; of disease mean something, no
+      doubt; a great deal as applied to malarious affections; but that the whole
+      type of diseases undergoes such changes that the practice must be reversed
+      from depleting to stimulating, and vice versa, is much less likely than
+      that methods of treatment go out of fashion and come in again. If there is
+      any disease which claims its percentage with reasonable uniformity, it is
+      phthisis. Yet I remember that the reverend and venerable Dr. Prince of
+      Salem told me one Commencement day, as I was jogging along towards
+      Cambridge with him, that he recollected the time when that disease was
+      hardly known; and in confirmation of his statement mentioned a case
+      in which it was told as a great event, that somebody down on &ldquo;the Cape&rdquo;
+       had died of &ldquo;a consumption.&rdquo; This story does not sound probable to myself,
+      as I repeat it, yet I assure you it is true, and it shows how cautiously
+      we must receive all popular stories of great changes in the habits of
+      disease.
+    </p>
+    <p>
+      Is there no progress, then, but do we return to the same beliefs and
+      practices which our forefathers wore out and threw away? I trust and
+      believe that there 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 go back to the simple Brunonian pathology, since we
+      have learned too much of diseased action to accept its convenient dualism.
+      So of other doctrines, each new Avatar strips them of some of their old
+      pretensions, until they take their fitting place at last, if they have any
+      truth in them, or disappear, if they were mere phantasms of the
+      imagination.
+    </p>
+    <p>
+      In the mean time, while medical theories are coming in and going out,
+      there is a set of sensible men who are never run away with by them, but
+      practise their art sagaciously and faithfully in much the same way from
+      generation to generation. From the time of Hippocrates to that of our own
+      medical patriarch, there has been an apostolic succession of wise and good
+      practitioners. If you will look at the first aphorism of the ancient
+      Master you will see that before all remedies he places the proper conduct
+      of the patient and his attendants, and the fit ordering of all the
+      conditions surrounding him. The class of practitioners I have referred to
+      have always been the most faithful in attending to these points. No doubt
+      they have sometimes prescribed unwisely, in compliance with the prejudices
+      of their time, but they have grown wiser as they have grown older, and
+      learned to trust more in nature and less in their plans of interference. I
+      believe common opinion confirms Sir James Clark's observation to this
+      effect.
+    </p>
+    <p>
+      The experience of the profession must, I think, run parallel with that of
+      the wisest of its individual members. Each time a plan of treatment or a
+      particular remedy comes up for trial, it is submitted to a sharper
+      scrutiny. When Cullen wrote his Materia Medica, he had seriously to assail
+      the practice of giving burnt toad, which was still countenanced by at
+      least one medical authority of note. I have read recently in some medical
+      journal, that an American practitioner, whose name is known to the
+      country, is prescribing the hoof of a horse for epilepsy. It was doubtless
+      suggested by that old fancy of wearing a portion of elk's hoof hung round
+      the neck or in a ring, for this disease. But it is hard to persuade
+      reasonable people to swallow the abominations of a former period. The
+      evidence which satisfied Fernelius will not serve one of our hospital
+      physicians.
+    </p>
+    <p>
+      In this way those articles of the Materia Medica which had nothing but
+      loathsomeness to recommend them have been gradually dropped, and are not
+      like to obtain any 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 the utility of some of them, when properly employed.
+      Though I believe that at present, taking the world at large, and leaving
+      out a few powerful agents of such immense value that they rank next to
+      food in importance, the poisons prescribed for disease do more hurt than
+      good, I have no doubt, and never professed to have any, that they do much
+      good in prudent and instructed hands. But I am very willing to confess a
+      great jealousy of many agents, and I could almost wish to see the Materia
+      Medica so classed as to call suspicion upon certain ones among them.
+    </p>
+    <p>
+      Thus the alien elements, those which do not properly enter into the
+      composition of any living tissue, are the most to be suspected, &mdash;mercury,
+      lead, antimony, silver, and the rest, for the reasons I have before
+      mentioned. Even iodine, which, as it is found in certain plants, seems
+      less remote from the animal tissues, gives unequivocal proofs from time to
+      time that it is hostile to some portions of the glandular system.
+    </p>
+    <p>
+      There is, of course, less prima facie objection to those agents which
+      consist of assimilable elements, such as are found making a part of
+      healthy tissues. These are divisible into three classes,&mdash;foods,
+      poisons, and inert, mostly because insoluble, substances. The food of one
+      animal or of one human being is sometimes poison to another, and vice
+      versa; inert substances may act mechanically, so as to produce the effect
+      of poisons; but this division holds exactly enough for our purpose.
+    </p>
+    <p>
+      Strictly speaking, every poison consisting of assimilable elements 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's
+      action, or some other symptom for which the subject of it would consult
+      the physician, if it came on from any other cause than taking it under the
+      name of medicine. Yet portions of this unwholesome food which we call
+      medicine, we have reason to believe, are assimilated; thus, castor-oil
+      appears to be partially digested by infants, so that they require large
+      doses to affect them medicinally. Even that deadliest of poisons,
+      hydrocyanic acid, is probably assimilated, and helps to make living
+      tissue, if it do not kill the patient, for the assimilable elements which
+      it contains, given in the separate forms of amygdalin and emulsin, produce
+      no disturbance, unless, as in Bernard's experiments, they are suffered to
+      meet in the digestive organs. A medicine consisting of assimilable
+      substances being then simply unwholesome food, we understand what is meant
+      by those cumulative effects of such remedies often observed, as in the
+      case of digitalis and strychnia. They are precisely similar to the
+      cumulative effects of a salt diet in producing scurvy, or of spurred rye
+      in producing dry gangrene. As the effects of such substances are a
+      violence to the organs, we should exercise the same caution with regard to
+      their use that we would exercise about any other kind of poisonous food,&mdash;partridges
+      at certain seasons, for instance. Even where these poisonous kinds of food
+      seem to be useful, we should still regard them with great jealousy.
+      Digitalis lowers the pulse in febrile conditions. Veratrum viride does the
+      same thing. How do we know that a rapid pulse is not a normal adjustment
+      of nature to the condition it accompanies? Digitalis has gone out of
+      favor; how sure are we that Veratrum viride will not be found to 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 use of opium in delirium tremens (which you remember is
+      sometimes called delirium vigilans), where it seemed so obviously
+      indicated, since the publication of Dr. Ware's admirable essay. I respect
+      the evidence of my contemporaries, but I cannot forget the sayings of the
+      Father of medicine,&mdash;Ars longa, judicium difficile.
+    </p>
+    <p>
+      I am not presuming to express an opinion concerning Veratrum viride, which
+      was little heard of when I was still practising medicine. I am only
+      appealing to that higher court of experience which sits in judgment on all
+      decisions of the lower medical tribunals, and which requires more than one
+      generation for its final verdict.
+    </p>
+    <p>
+      Once change the habit of mind so long prevalent among practitioners of
+      medicine; once let it be everywhere understood that the presumption is in
+      favor of food, and not of alien substances, of innocuous, and not of
+      unwholesome food, for the sick; that this presumption requires very strong
+      evidence in each particular case to overcome it; but that, when such
+      evidence is afforded, the alien substance or the unwholesome food should
+      be given boldly, in sufficient quantities, in the same spirit as that with
+      which the surgeon lifts his knife against a patient,&mdash;that is, with
+      the same reluctance and the same determination,&mdash;and I think we shall
+      have and hear much less of charlatanism in and out of the profession. The
+      disgrace of medicine has been that colossal system of self-deception, in
+      obedience to which mines have been emptied of their cankering minerals,
+      the vegetable kingdom robbed of all its noxious growths, the entrails of
+      animals taxed for their impurities, the poison-bags of reptiles drained of
+      their venom, and all the inconceivable abominations thus obtained thrust
+      down the throats of human beings suffering from some fault of
+      organization, nourishment, or vital stimulation.
+    </p>
+    <p>
+      Much as we have gained, we have not yet thoroughly shaken off the notion
+      that poison is the natural food of disease, as wholesome aliment is the
+      support of health. Cowper's lines, in &ldquo;The Task,&rdquo; show the
+      matter-of-course practice of his time:
+    </p>
+<pre xml:space="preserve">
+  &ldquo;He does not scorn it, who has long endured
+   A fever's agonies, and fed on drugs.&rdquo;
+ </pre>
+    <p>
+      Dr. Kimball of Lowell, who has been in the habit of seeing a great deal
+      more of typhoid fever than most practitioners, and whose surgical exploits
+      show him not to be wanting in boldness or enterprise, can tell you whether
+      he finds it necessary to feed his patients on drugs or not. His experience
+      is, I believe, that of the most enlightened and advanced portion of the
+      profession; yet I think that even in typhoid fever, and certainly in many
+      other complaints, the effects of ancient habits and prejudices may still
+      be seen in the practice of some educated physicians.
+    </p>
+    <p>
+      To you, young men, it belongs to judge all that has gone before you. You
+      come nearer to the great fathers of modern medicine than some of you
+      imagine. Three of my own instructors attended Dr. Rush's Lectures. The
+      illustrious Haller mentions Rush's inaugural thesis in his &ldquo;Bibliotheca
+      Anatomica;&rdquo; and this same Haller, brought so close to us, tells us he
+      remembers Ruysch, then an old man, and used to carry letters between him
+      and Boerhaave. Look through the history of medicine from Boerhaave to this
+      present day. You will see at once that medical doctrine and practice have
+      undergone a long series of changes. You will see that the doctrine and
+      practice of our own time must probably change in their turn, and that, if
+      we can trust at all to the indications of their course, it will be in the
+      direction of an improved hygiene and a simplified treatment. Especially
+      will the old habit of violating the instincts of the sick give place to a
+      judicious study of these same instincts. It will be found that bodily,
+      like mental insanity, is best managed, for the most part, by natural
+      soothing agencies. Two centuries ago there was a prescription for scurvy
+      containing &ldquo;stercoris taurini et anserini par, quantitas trium magnarum
+      nucum,&rdquo; of the hell-broth containing which &ldquo;guoties-cumque sitit oeger,
+      large bibit.&rdquo; When I have recalled the humane common-sense of Captain Cook
+      in the matter of preventing this disease; when I have heard my friend, Mr.
+      Dana, describing the avidity with which the scurvy-stricken sailors
+      snuffed up the earthy fragrance of fresh raw potatoes, the food which was
+      to supply the elements wanting to their spongy tissues, I have recognized
+      that the perfection of art is often a return to nature, and seen in this
+      single instance the germ of innumerable beneficent future medical reforms.
+    </p>
+    <p>
+      I cannot help believing that medical curative treatment will by and by
+      resolve itself in great measure into modifications of the food, swallowed
+      and breathed, and of the natural stimuli, and that less will be expected
+      from specifics and noxious disturbing agents, either alien or assimilable.
+      The noted mineral-waters containing iron, sulphur, carbonic acid, supply
+      nutritious or stimulating materials to the body as much as phosphate of
+      lime and ammoniacal compounds do to the cereal plants. The effects of a
+      milk and vegetable diet, of gluten bread in diabetes, of cod-liver oil in
+      phthisis, even of such audacious innovations as the water-cure and the
+      grape-cure, are only hints of what will be accomplished when we have
+      learned to discover what organic elements are 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 his crops and
+      modifies the composition of his soil. In acute febrile diseases we have
+      long ago discovered that far above all drug-medication is the use of mild
+      liquid diet in the period of excitement, and of stimulant and nutritious
+      food in that of exhaustion. Hippocrates himself was as particular about
+      his barley-ptisan as any Florence Nightingale of our time could be.
+    </p>
+    <p>
+      The generation to which you, who are just entering the profession, belong,
+      will make a vast stride forward, as I believe, in the direction of
+      treatment by natural rather than violent agencies. What is it that makes
+      the reputation of Sydenham, as the chief of English physicians? His
+      prescriptions consisted principally of simples. An aperient or an opiate,
+      a &ldquo;cardiac&rdquo; or a tonic, may be commonly found in the midst of a somewhat
+      fantastic miscellany of garden herbs. It was not by his pharmaceutic
+      prescriptions that he gained his great name. It was by daring to order
+      fresh air for small-pox patients, and riding on horseback for
+      consumptives, in place of the smothering system, and the noxious and often
+      loathsome rubbish of the established schools. Of course Sydenham was much
+      abused by his contemporaries, as he frequently takes occasion to remind
+      his reader. &ldquo;I must needs conclude,&rdquo; he says, &ldquo;either that I am void of
+      merit, or that the candid and ingenuous part of mankind, who are formed
+      with so excellent a temper of mind as to be no strangers to gratitude,
+      make a very small part of the whole.&rdquo; If in the fearless pursuit of truth
+      you should find the world as ungracious in the nineteenth century as he
+      found it in the seventeenth, you may learn a lesson of self-reliance from
+      another utterance of the same illustrious physician: &ldquo;'T is none of 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 writings with temper.&rdquo;
+     </p>
+    <p>
+      The physician has learned a great deal from the surgeon, who is naturally
+      in advance of him, because he has a better opportunity of seeing the
+      effects of his remedies. Let me shorten one of Ambroise Pare's stories for
+      you. There had been a great victory at the pass of Susa, and they were
+      riding into the city. The wounded cried out as the horses trampled them
+      under their hoofs, which caused good Ambroise great pity, and made him
+      wish himself back in Paris. Going into a stable he saw four dead soldiers,
+      and three desperately wounded, placed with their backs against the wall.
+      An old campaigner came up.&mdash;&ldquo;Can these fellows get well?&rdquo; he said.
+      &ldquo;No!&rdquo; answered the surgeon. Thereupon, the old soldier walked 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. &ldquo;I hope
+      to God;&rdquo; he said, &ldquo;somebody will do as much for me if I ever get into such
+      a scrape&rdquo; (accoustre de telle facon). &ldquo;I was not much salted in those
+      days&rdquo; (bien doux de sel), says Ambroise, &ldquo;and little acquainted with the
+      treatment of wounds.&rdquo; However, as he tells us, he proceeded to apply
+      boiling oil of Sambuc (elder) after the approved fashion of the time,&mdash;with
+      what torture to the patient may be guessed. At last his precious oil gave
+      out, and he used instead an insignificant mixture of his own contrivance.
+      He could not sleep that night for fear his patients who had not been
+      scalded with the boiling oil would be poisoned by the gunpowder conveyed
+      into their wounds by the balls. To his surprise, he found them much better
+      than the others the next morning, and resolved never again to burn his
+      patients with hot oil for gun-shot wounds.
+    </p>
+    <p>
+      This was the beginning, as nearly as we can fix it, of that reform which
+      has introduced plain water-dressings in the place of the farrago of
+      external applications which had been a source of profit to apothecaries
+      and disgrace to art from, and before, the time when Pliny complained of
+      them. A young surgeon who was at Sudley Church, laboring among the wounded
+      of Bull Run, tells me they had nothing but water for dressing, and he
+      (being also doux de sel) was astonished to see how well the wounds did
+      under that simple treatment.
+    </p>
+    <p>
+      Let me here mention a fact or two which may be of use to some of you who
+      mean to enter the public service. You will, as it seems, have gun-shot
+      wounds almost exclusively to deal with. Three different surgeons, the one
+      just mentioned and two who saw the wounded of Big Bethel, assured me that
+      they found no sabre-cuts or bayonet wounds. It is the rifle-bullet from a
+      safe distance which pierces the breasts of our soldiers, and not the
+      gallant charge of broad platoons and sweeping squadrons, such as we have
+      been in the habit of considering the chosen mode of warfare of ancient and
+      modern chivalry. [Sir Charles James Napier had the same experience in
+      Virginia in 1813. &ldquo;Potomac. We have nasty sort of fighting here, amongst
+      creeks and bushes, and lose men without show.&rdquo; &ldquo;Yankee never shows
+      himself, he keeps in the thickest wood, fires and runs off.&rdquo;&mdash;&ldquo;These
+      five thousand in the open field might be attacked, but behind works it
+      would be throwing away lives.&rdquo; He calls it &ldquo;an inglorious warfare,&rdquo;&mdash;says
+      one of the leaders is &ldquo;a little deficient in gumption,&mdash;but&mdash;still
+      my opinion is, that if we tuck up our sleeves and lay our ears back we
+      might thrash them; that is, if we caught them out of their trees, so as to
+      slap at them with the bayonet.&rdquo;&mdash;Life, etc. vol. i. p. 218 et seq.]
+    </p>
+    <p>
+      Another fact parallels the story of the old campaigner, and may teach some
+      of you caution in selecting your assistants. A chaplain told it to two of
+      our officers personally known to myself. He overheard the examination of a
+      man who wished to drive one of the &ldquo;avalanche&rdquo; wagons, as they call them.
+      The man was asked if he knew how to deal with wounded men. &ldquo;Oh yes,&rdquo; he
+      answered; &ldquo;if they're hit here,&rdquo; pointing to the abdomen, &ldquo;knock 'em on
+      the head,&mdash;they can't get well.&rdquo;
+     </p>
+    <p>
+      In art and outside of it you will meet the same barbarisms that Ambroise
+      Pare met with,&mdash;for men differ less from century to century than we
+      are apt to suppose; you will encounter the same opposition, if you attack
+      any prevailing opinion, that Sydenham complained of. So far as possible,
+      let not such experiences breed in you a contempt for those who are the
+      subjects of folly or prejudice, or foster any love of dispute for its own
+      sake. Should you become authors, express your opinions freely; defend them
+      rarely. It is not often that an opinion is worth expressing, which cannot
+      take care of itself. Opposition is the best mordant to fix the color of
+      your thought in the general belief.
+    </p>
+    <p>
+      It is time to bring these crowded remarks to a close. The day has been
+      when at the beginning of a course of Lectures I should have thought it
+      fitting to exhort you to diligence and entire devotion to your tasks as
+      students. It is not so now. The young man who has not heard the
+      clarion-voices of honor and of duty now sounding throughout the land, will
+      heed 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 our own blood or stanching that of our wounded defenders,
+      students or teachers, whatever our calling and our ability, we belong, not
+      to ourselves, but to our imperilled country, whose danger is our calamity,
+      whose ruin would be our enslavement, whose rescue shall be our earthly
+      salvation!
+    </p>
+    <p>
+      <a name="link2H_4_0009" id="link2H_4_0009">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      SCHOLASTIC AND BEDSIDE TEACHING.
+    </h2>
+    <p>
+      An Introductory Lecture delivered before the Medical Class of Harvard
+      University, November 6, 1867.
+    </p>
+    <p>
+      The idea is entertained by some of our most sincere professional brethren,
+      that to lengthen and multiply our Winter Lectures will be of necessity to
+      advance the cause of medical education. It is a fair subject for
+      consideration whether they do not overrate the relative importance of that
+      particular mode of instruction which forms the larger part of these
+      courses.
+    </p>
+    <p>
+      As this School could only lengthen its lecture term at the expense of its
+      &ldquo;Summer Session,&rdquo; in which more direct, personal, and familiar teaching
+      takes the place of our academic discourses, and in which more time can be
+      given to hospitals, infirmaries, and practical instruction in various
+      important specialties, whatever might be gained, a good deal would
+      certainly be lost in our case by the exchange.
+    </p>
+    <p>
+      The most essential part of a student's instruction is 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 indelibly in the memory. Before
+      the student is aware of what he has acquired, he has learned the aspects
+      and course and probable issue of the diseases he has seen with his
+      teacher, and the proper mode of dealing with them, so far as his master
+      knows it. On the other hand, our ex cathedra prelections have a strong
+      tendency to run into details which, however interesting they may be to
+      ourselves and a few of our more curious listeners, have nothing in them
+      which will ever be of use to the student as a practitioner. It is a
+      perfectly fair question whether I and some other American Professors do
+      not teach quite enough that is useless already. Is it not well to remind
+      the student from time to time that a physician's business is to avert
+      disease, to heal the sick, to prolong life, and to diminish suffering? Is
+      it not true that the young man of average ability will find it as much as
+      he can do to fit himself for these simple duties? Is it not best to begin,
+      at any rate, by making sure of such knowledge as he will require in his
+      daily walk, by no means discouraging him from any study for which his
+      genius fits him when he once feels that he has become master of his chosen
+      art.
+    </p>
+    <p>
+      I know that many branches of science are of the greatest value as feeders
+      of our medical reservoirs. But the practising physician's office is to
+      draw the healing waters, and while he gives his time to this labor he can
+      hardly be expected to explore all the sources that spread themselves over
+      the wide domain of science. The traveller who would not drink of the Nile
+      until he had tracked it to its parent lakes, would be like to die of
+      thirst; and the medical practitioner who would not use the results of many
+      laborers in other departments without sharing their special toils, would
+      find life far too short and art immeasurably too long.
+    </p>
+    <p>
+      We owe much to Chemistry, one of the most captivating as well as important
+      of studies; but the medical man must as a general rule content himself
+      with a clear view of its principles and a limited acquaintance with its
+      facts; such especially as are pertinent to his pursuits. I am in little
+      danger of underrating Anatomy or Physiology; but as each of these branches
+      splits up into specialties, any one of which may take up a scientific
+      life-time, I would have them taught with a certain judgment and reserve,
+      so that they shall not crowd the more immediately practical branches. So
+      of all the other ancillary and auxiliary kinds of knowledge, I would have
+      them strictly subordinated to that particular kind of knowledge for which
+      the community looks to its medical advisers.
+    </p>
+    <p>
+      A medical school is not a scientific school, except just 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 is implied in
+      Hufeland's aphorism: &ldquo;The physician must generalize the disease and
+      individualize the patient.&rdquo;
+     </p>
+    <p>
+      The coordinated and classified results of empirical observation, in
+      distinction from scientific experiment, have furnished almost all we know
+      about food, the medicine of health, and medicine, the food of sickness. We
+      eat the root of the Solanum tuberosum and throw away its fruit; we eat the
+      fruit of the Solanum Lycopersicum and throw away its root. Nothing but
+      vulgar experience has taught us to reject the potato ball and cook the
+      tomato. So of most of our remedies. The subchloride of mercury, calomel,
+      is the great British specific; the protochloride of mercury, corrosive
+      sublimate, kills like arsenic, but no chemist could have told us it would
+      be so.
+    </p>
+    <p>
+      From observations like these we can obtain certain principles from which
+      we can argue deductively to facts of a like nature, but the process is
+      limited, and we are suspicious of all reasoning in that direction applied
+      to the processes of healthy and diseased life. We are continually
+      appealing to special facts. We are willing to give Liebig's artificial
+      milk when we cannot do better, but we watch the child anxiously whose
+      wet-nurse is a chemist's pipkin. A pair of substantial mammary glands has
+      the advantage over the two hemispheres of the most learned Professor's
+      brain, in the art of compounding a nutritious fluid for infants.
+    </p>
+    <p>
+      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 not directly useful to the future practitioner. But
+      the over ambitious and active student must not be led away by the
+      seduction of knowledge for its own sake from his principal pursuit. The
+      humble beginner, who is alarmed at the vast fields of knowledge opened to
+      him, may be encouraged by the assurance that with a very slender provision
+      of science, in distinction from practical skill, he may be a useful and
+      acceptable member of the profession to which the health of the community
+      is intrusted.
+    </p>
+    <p>
+      To those who are not to engage in practice, the various pursuits of
+      science hardly require to be commended. Only they must not be disappointed
+      if they find many subjects treated in our courses as a medical class
+      requires, rather than as a scientific class would expect, that is, with
+      special limitations and constant reference to practical ends. Fortunately
+      they are within easy reach of the highest scientific instruction. The
+      business of a school like this is to make useful working physicians, and
+      to succeed in this it is almost as important not to overcrowd the mind of
+      the pupil with merely curious knowledge as it is to store it with useful
+      information.
+    </p>
+    <p>
+      In this direction I have written my lecture, not to undervalue any form of
+      scientific labor in its place, an unworthy thought from which I hope I
+      need not defend myself,&mdash;but to discourage any undue inflation of the
+      scholastic programme, which even now asks more of the student than the
+      teacher is able to obtain from the great majority of those who present
+      themselves for examination. I wish to take a hint in education from the
+      Secretary of the Massachusetts Board of Agriculture, who regards the
+      cultivation of too much land as a great defect in our New England farming.
+      I hope that our Medical Institutions may never lay themselves open to the
+      kind of accusation Mr. Lowe brings against the English Universities, when
+      he says that their education is made up &ldquo;of words that few understand and
+      most will shortly forget; of arts that can never be used, if indeed they
+      can even be learnt; of histories inapplicable to our times; of languages
+      dead and even mouldy; of grammatical rules that never had living use and
+      are only post mortem examinations; and of statements fagoted with utter
+      disregard of their comparative value.&rdquo;
+     </p>
+    <p>
+      This general thought will be kept in view throughout my somewhat
+      discursive address, which will begin with an imaginary clinical lesson
+      from the lips of an historical personage, and close with the portrait from
+      real life of one who, both as teacher and practitioner, was long loved and
+      honored among us. If I somewhat overrun my hour, you must pardon me, for I
+      can say with Pascal that I have not had the time to make my lecture
+      shorter.
+    </p>
+    <p>
+      In the year 1647, that good man John Eliot, commonly called the Apostle
+      Eliot, writing to Mr. Thomas Shepherd, the pious minister of Cambridge,
+      referring to the great need of medical instruction for the Indians, used
+      these words:
+    </p>
+    <p>
+      &ldquo;I have thought in my heart that it were a singular good work, if the Lord
+      would stirre up the hearts of some or other of his people in England to
+      give some maintenance toward some Schoole or Collegiate exercise this way,
+      wherein there should be Anatomies and other instructions that way, and
+      where there might be some recompence given to any that should bring in any
+      vegetable or other thing that is vertuous in the way of Physick.
+    </p>
+    <p>
+      &ldquo;There is another reason which moves my thought and desires this way,
+      namely that our young students in Physick may be trained up better then
+      they yet bee, who have onely theoreticall knowledge, and are forced to
+      fall to practise before ever they saw an Anatomy 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, did make and read upon
+      very well, but no more of that now.&rdquo;
+     </p>
+    <p>
+      Since the time of the Apostle Eliot the Lord has stirred up the hearts of
+      our people to the building of many Schools and Colleges where medicine is
+      taught in all its branches. Mr. Giles Firmin's &ldquo;Anatomy&rdquo; may be considered
+      the first ancestor of a long line of skeletons which have been dangling
+      and rattling in our lecture-rooms for more than a century.
+    </p>
+    <p>
+      Teaching in New England in 1647 was a grave but simple matter. A single
+      person, combining in many cases, as in that of Mr. Giles Firmin, the
+      offices of physician and preacher, taught what he knew to a few disciples
+      whom he gathered about him. Of the making of that &ldquo;Anatomy&rdquo; on which my
+      first predecessor in the branch I teach &ldquo;did read very well&rdquo; we can know
+      nothing. The body of some poor wretch who had swung upon the gallows, was
+      probably conveyed by night to some lonely dwelling at the outskirts of the
+      village, and there by the light of flaring torches hastily dissected by
+      hands that trembled over the unwonted task. And ever and anon the master
+      turned to his book, as he laid bare the mysteries of the hidden organs; to
+      his precious Vesalius, it might be, or his figures repeated in the
+      multifarious volume of Ambroise Pare; to the Aldine octavo in which
+      Fallopius recorded his fresh observations; or that giant folio of
+      Spigelius just issued from the press of Amsterdam, in which lovely ladies
+      display their viscera with a coquettish grace implying that it is rather a
+      pleasure than otherwise to show the lace-like omentum, and hold up their
+      appendices epiploicae as if they were saying &ldquo;these are our jewels.&rdquo;
+     </p>
+    <p>
+      His teaching of medicine was no doubt chiefly clinical, and received with
+      the same kind of faith as that which accepted his words from the pulpit.
+      His notions of disease were based on what he had observed, seen always in
+      the light of the traditional doctrines in which he was bred. His discourse
+      savored of the weighty doctrines of Hippocrates, diluted by the subtle
+      speculations of Galen, reinforced by the curious comments of the Arabian
+      schoolmen as they were conveyed in the mellifluous language of Fernelius,
+      blended, it may be, with something of the lofty mysticism of Van Helmont,
+      and perhaps stealing a flavor of that earlier form of Homoeopathy which
+      had lately come to light in Sir Kenelm Digby's &ldquo;Discourse concerning the
+      Cure of Wounds by the Sympathetic Powder.&rdquo;
+     </p>
+    <p>
+      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 Licetus and saw figures of a
+      lion with the head of a woman, and a man with the head of an elephant. He
+      had offered to his gaze, as born of a human mother, the effigy of a winged
+      cherub, a pterocephalous specimen, which our Professor of Pathological
+      Anatomy would hardly know whether to treat with the reverence due to its
+      celestial aspect, or to imprison in one of his immortalizing jars of
+      alcohol.
+    </p>
+    <p>
+      His pharmacopoeia consisted mainly of simples, such as the venerable
+      &ldquo;Herball&rdquo; of Gerard describes and figures in abounding affluence. St.
+      John's wort and Clown's All-heal, with Spurge and Fennel, Saffron and
+      Parsley, Elder and Snake-root, with opium in some form, and roasted
+      rhubarb and the Four Great Cold Seeds, and the two Resins, of which it
+      used to be said that whatever the Tacamahaca has not cured, the Caranna
+      will, with the more familiar Scammony and Jalap and Black Hellebore, made
+      up a good part of his probable list of remedies. He would have ordered
+      Iron now and then, and possibly an occasional dose of Antimony. He would
+      perhaps have had a rheumatic patient wrapped in the skin of a wolf or a
+      wild cat, and in case of a malignant fever with &ldquo;purples&rdquo; or petechiae, or
+      of an obstinate king's evil, he might have prescribed a certain black
+      powder, which had been made by calcining toads in an earthen pot; a choice
+      remedy, taken internally, or applied to any outward grief.
+    </p>
+    <p>
+      Except for the toad-powder and the peremptory drastics, one might have
+      borne up against this herb doctoring as well as against some more modern
+      styles of medication. Barbeyrac and his scholar Sydenham had not yet
+      cleansed the Pharmacopoeia of its perilous stuff, but there is no doubt
+      that the more sensible physicians of that day knew well enough that a good
+      honest herb-tea which amused the patient and his nurses was all that was
+      required to carry him through all common disorders.
+    </p>
+    <p>
+      The student soon learned the physiognomy of disease by going about with
+      his master; fevers, pleurisies, asthmas, dropsies, fluxes, small-pox,
+      sore-throats, measles, consumptions. He saw what was done for them. 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 he
+      could give his whole attention to them. Chirurgery was a separate
+      specialty. Women in child-birth were cared for by midwives. There was no
+      chemistry deserving the name to require his study. He did not learn a
+      great deal, perhaps, but what he did learn was his business, namely, how
+      to take care of sick people.
+    </p>
+    <p>
+      Let me give you a picture of the old-fashioned way of instruction, by
+      carrying you with me in imagination in the company of worthy Master Giles
+      Firmin as he makes his round of visits among the good folk of Ipswich,
+      followed by his one student, who shall answer to the scriptural name of
+      Luke. It will not be for entertainment chiefly, but to illustrate the one
+      mode of teaching which can never be superseded, and which, I venture to
+      say, is more important than all the rest put together. The student is a
+      green hand, as you will perceive.
+    </p>
+    <p>
+      In the first dwelling they come to, a stout fellow is bellowing with
+      colic.
+    </p>
+    <p>
+      &ldquo;He will die, Master, of a surety, methinks,&rdquo; says the timid youth in a
+      whisper.
+    </p>
+    <p>
+      &ldquo;Nay, Luke,&rdquo; the Master answers, &ldquo;'t is but a dry belly-ache. Didst thou
+      not mark that he stayed his roaring when I did press hard over the lesser
+      bowels? Note that he hath not the pulse of them with fevers, and by what
+      Dorcas telleth me there hath been no long shutting up of the vice
+      naturales. We will steep certain comforting herbs which I will shew thee,
+      and put them in a bag and lay them on his belly. Likewise he shall have my
+      cordial julep with a portion of this confection which we do call Theriaca
+      Andromachi, which hath juice of poppy in it, and is a great stayer of
+      anguish. This fellow is at his prayers to-day, but I warrant thee he shall
+      be swearing with the best of them to-morrow.&rdquo;
+     </p>
+    <p>
+      They jog along the bridle-path on their horses until they come to another
+      lowly dwelling. They sit a while with a delicate looking girl in whom the
+      ingenuous youth naturally takes a special interest. The good physician
+      talks cheerfully with her, asks her a few questions. Then to her mother:
+      &ldquo;Good-wife, Margaret hath somewhat profited, as she telleth, by the goat's
+      milk she hath taken night and morning. Do thou pluck a maniple&mdash;that
+      is an handful&mdash;of the plant called Maidenhair, and make a syrup
+      therewith as I have shewed thee. Let her take a cup full of the same,
+      fasting, before she sleepeth, also before she riseth from her bed.&rdquo; And so
+      they leave the house.
+    </p>
+    <p>
+      &ldquo;What thinkest thou, Luke, of the maid we have been visiting?&rdquo; &ldquo;She
+      seemeth not much ailing, Master, according to my poor judgment. For she
+      did say she was better. And she had a red cheek and a bright eye, and she
+      spake of being soon able to walk unto the meeting, and did seem greatly
+      hopeful, but spare of flesh, methought, and her voice something 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?&rdquo;
+     </p>
+    <p>
+      &ldquo;Yea, Luke, I do think she shall be well, and mayhap speedily. But it is
+      not here with us she shall be well. For that redness of the cheek is but
+      the sign of the fever which, after the Grecians, we do call the hectical;
+      and that shining of the eyes is but a sickly glazing, and they which do
+      every day get better and likewise thinner and weaker shall find that way
+      leadeth to the church-yard gate. This is the malady which the ancients did
+      call tubes, or the wasting disease, and some do name the consumption. A
+      disease whereof most that fall ailing do perish. This Margaret is not long
+      for earth&mdash;but she knoweth it not, and still hopeth.&rdquo;
+     </p>
+    <p>
+      &ldquo;Why, then, Master, didst thou give her of thy medicine, seeing that her
+      ail is unto death?&rdquo;
+     </p>
+    <p>
+      &ldquo;Thou shalt learn, boy, that they which are sick must have somewhat
+      wherewith to busy their thoughts. There be some who do give these tabid or
+      consumptives a certain posset made with lime-water and anise and liquorice
+      and raisins of the sun, and there be other some who do give the juice of
+      craw-fishes boiled in barley-water with chicken-broth, but these be toys,
+      as I do think, and ye shall find as good virtue, nay better, in this syrup
+      of the simple called Maidenhair.&rdquo;
+     </p>
+    <p>
+      Something after this manner might Master Giles Firmin have delivered his
+      clinical instructions. Somewhat in this way, a century and a half later,
+      another New England physician, Dr. Edward Augustus Holyoke, taught a young
+      man who came to study with him, a very diligent and intelligent youth,
+      James Jackson by name, the same whose portrait in his advanced years hangs
+      upon this wall, long the honored Professor of Theory and Practice in this
+      Institution, of whom I shall say something in this Lecture. Our venerated
+      Teacher studied assiduously afterwards in the great London Hospitals, but
+      I think he used to quote his &ldquo;old Master&rdquo; ten times where he quoted Mr.
+      Cline or Dr. Woodville once.
+    </p>
+    <p>
+      When I compare this direct transfer of the practical experience of a wise
+      man into the mind of a student,&mdash;every fact one that he can use in
+      the battle of life and death,&mdash;with the far off, unserviceable
+      &ldquo;scientific&rdquo; truths that I and some others are in the habit of teaching, I
+      cannot help asking myself whether, if we concede that our forefathers
+      taught too little, there is not&mdash;a possibility that we may sometimes
+      attempt to teach too much. I almost blush when I think of myself as
+      describing the eight several facets on two slender processes of the palate
+      bone, or the seven little twigs that branch off from the minute tympanic
+      nerve, and I wonder whether my excellent colleague feels in the same way
+      when he pictures himself as giving the constitution of neurin, which as he
+      and I know very 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 students can be
+      expected to remember it, is C10 H4 N4 O6+ 2HO, NO5=C8 H4 N2
+      O10+2CO2+N2+NH4 O, NO5.
+    </p>
+    <p>
+      I can bear the voice of some rough iconoclast addressing the Anatomist and
+      the Chemist in tones of contemptuous indignation: &ldquo;What is this stuff with
+      which you are cramming the brains of young men who are to hold the lives
+      of the community in their hands? Here is a man fallen in a fit; you can
+      tell me all about the eight surfaces of the two processes of the palate
+      bone, but you have not had the sense to loosen that man's neck-cloth, and
+      the old women are all calling you a fool? Here is a fellow that has just
+      swallowed poison. I want something to turn his stomach inside out at the
+      shortest notice. Oh, you have forgotten the dose of the sulphate of zinc,
+      but you remember the formula for the production of alloxan!&rdquo;
+     </p>
+    <p>
+      &ldquo;Look you, Master Doctor,&mdash;if I go to a carpenter to come and stop a
+      leak in my roof that is flooding the house, do you suppose I care whether
+      he is a botanist or not? Cannot a man work in wood without knowing all
+      about endogens and exogens, or must he attend Professor Gray's Lectures
+      before he can be trusted to make a box-trap? If my horse casts a shoe, do
+      you think I will not trust a blacksmith to shoe him until I have made sure
+      that he is sound on the distinction between the sesquioxide and the
+      protosesquioxide of iron?&rdquo;
+     </p>
+    <p>
+      &mdash;But my scientific labor is to lead to useful results by and by, in
+      the next generation, or in some possible remote future.&mdash;
+    </p>
+    <p>
+      &ldquo;Diavolo!&rdquo; as your Dr. Rabelais has it,&mdash;answers the iconoclast,&mdash;&ldquo;what
+      is that to me and my colic, to me and my strangury? I pay the Captain of
+      the Cunard steamship to carry me quickly and safely to Liverpool, not to
+      make a chart of the Atlantic for after voyagers! If Professor Peirce
+      undertakes to pilot me into Boston Harbor and runs me on Cohasset rocks,
+      what answer is it to tell me that he is Superintendent of the Coast
+      Survey? No, Sir! I want a plain man in a pea-jacket and a sou'wester, who
+      knows the channel of Boston Harbor, and the rocks of Boston Harbor, and
+      the distinguished Professor is quite of my mind as to the matter, for I
+      took the pains to ask him before I ventured to use his name in the way of
+      illustration.&rdquo;
+     </p>
+    <p>
+      I do not know how the remarks of the image-breaker may strike others, but
+      I feel that they put me on my defence with regard to much of my teaching.
+      Some years ago I ventured to show in an introductory Lecture how very
+      small a proportion of the anatomical facts taught in a regular course, as
+      delivered by myself and others, had any practical bearing whatever on the
+      treatment of disease. How can I, how can any medical teacher justify
+      himself in teaching anything that is not like to be of practical use to a
+      class of young men who are to hold in their hands the balance in which
+      life and death, ease and anguish, happiness and wretchedness are to be
+      daily weighed?
+    </p>
+    <p>
+      I hope we are not all wrong. Oftentimes in finding how sadly ignorant of
+      really essential and vital facts and rules were some of those whom we had
+      been larding with the choicest scraps of science, I have doubted whether
+      the old one-man system of teaching, when the one man was of the right
+      sort, did not turn out better working physicians than our more elaborate
+      method. The best practitioner I ever knew was mainly shaped to excellence
+      in that way. I can understand perfectly the regrets of my friend Dr. John
+      Brown of Edinburgh, for the good that was lost with the old apprenticeship
+      system. I understand as well Dr. Latham's fear &ldquo;that many men of the best
+      abilities and good education will be deterred from prosecuting physic as a
+      profession, in consequence of the necessity indiscriminately laid upon all
+      for impossible attainments.&rdquo;
+     </p>
+    <p>
+      I feel therefore impelled to say a very few words in defence of that
+      system of teaching adopted in our Colleges, by which we wish to supplement
+      and complete the instruction given by private individuals or by what are
+      often called Summer Schools.
+    </p>
+    <p>
+      The reason why we teach so much that is not practical and in itself
+      useful, is because we find that the easiest way of teaching what is
+      practical and useful. If we could in any way eliminate all that would help
+      a man to deal successfully with disease, and teach it by itself so that it
+      should be as tenaciously rooted in the memory, as easily summoned when
+      wanted, as fertile in suggestion of related facts, as satisfactory to the
+      peremptory demands of the intelligence as if taught in its scientific
+      connections, I think it would be our duty so to teach the momentous truths
+      of medicine, and to regard all useless additions as an intrusion on the
+      time which should be otherwise occupied.
+    </p>
+    <p>
+      But we cannot successfully eliminate and teach by itself that which is
+      purely practical. The easiest and surest way of acquiring facts is to
+      learn them in groups, in systems, and systematized knowledge is science.
+      You can very often carry two facts fastened together more easily than one
+      by itself, as a housemaid can carry two pails of water with a hoop more
+      easily than one without it. You can remember a man's face, made up of many
+      features, better than you can his nose or his mouth or his eye-brow.
+      Scores of proverbs show you that you can remember two lines that rhyme
+      better than one without the jingle. The ancients, who knew the laws of
+      memory, grouped the seven cities that contended for the honor of being
+      Homer's birthplace in a line thus given by Aulus Gellius:
+    </p>
+    <p>
+      Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
+    </p>
+    <p>
+      I remember, in the earlier political days of Martin Van Buren, that
+      Colonel Stone, of the &ldquo;New York Commercial,&rdquo; or one of his correspondents,
+      said that six towns of New York would claim in the same way to have been
+      the birth-place of the &ldquo;Little Magician,&rdquo; as he was then called; and thus
+      he gave their names, any one of which I should long ago have forgotten,
+      but which as a group have stuck tight in my memory from that day to this;
+    </p>
+    <p>
+      Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
+    </p>
+    <p>
+      If the memory gains so much by mere rhythmical association, how much more
+      will it gain when isolated facts are brought together under laws and
+      principles, when organs are examined in their natural connections, when
+      structure is coupled with function, and healthy and diseased action are
+      studied as they pass one into the other! Systematic, or scientific study
+      is invaluable as supplying a natural kind of mnemonics, if for nothing
+      else. You cannot properly learn the facts you want from Anatomy and
+      Chemistry in any way so easily as by taking them in their regular order,
+      with other allied facts, only there must be common sense exercised in
+      leaving out a great deal which belongs to each of the two branches as pure
+      science. The dullest of teachers is the one who does not know what to
+      omit.
+    </p>
+    <p>
+      The larger aim of scientific training is to furnish you with principles to
+      which you will be able to refer isolated facts, and so bring these within
+      the range of recorded experience. See what the &ldquo;London Times&rdquo; said about
+      the three Germans who cracked open John Bull Chatwood's strong-box at the
+      Fair the other day, while the three Englishmen hammered away in vain at
+      Brother Jonathan Herring's. The Englishmen represented brute force. The
+      Germans had been trained to appreciate principle. The Englishman &ldquo;knows
+      his business by rote and rule of thumb&rdquo;&mdash;science, which would &ldquo;teach
+      him to do in an hour what has hitherto occupied him two hours,&rdquo; &ldquo;is in a
+      manner forbidden to him.&rdquo; To this cause the &ldquo;Times&rdquo; attributes the falling
+      off of English workmen in comparison with those of the Continent.
+    </p>
+    <p>
+      Granting all this, we must not expect too much from &ldquo;science&rdquo; as
+      distinguished from common experience. There are ten thousand experimenters
+      without special apparatus for every one in the laboratory. Accident is the
+      great chemist and toxicologist. Battle is the great vivisector. Hunger has
+      instituted researches on food such as no Liebig, no Academic Commission
+      has ever recorded.
+    </p>
+    <p>
+      Medicine, sometimes impertinently, often ignorantly, often carelessly
+      called &ldquo;allopathy,&rdquo; appropriates everything from every source that can be
+      of the slightest use to anybody who is ailing in any way, or like to be
+      ailing from any cause. It learned from a monk how to use antimony, from a
+      Jesuit how to cure agues, from a friar how to cut for stone, from a
+      soldier how 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 from an old market-woman how to catch the
+      itch-insect. It borrowed acupuncture and the moxa from the Japanese
+      heathen, and was taught the use of lobelia by the American savage. It
+      stands ready to-day to accept anything from any theorist, from any empiric
+      who can make out a good case for his discovery or his remedy. &ldquo;Science&rdquo; is
+      one of its benefactors, but only one, out of many. Ask the wisest
+      practising physician you know, what branches of science help him
+      habitually, and what amount of knowledge relating to each branch he
+      requires for his professional duties. He will tell you that scientific
+      training has a value independent of all the special knowledge acquired. He
+      will tell you that many facts are explained by studying them in the wider
+      range of related facts to which they belong. He will gratefully recognize
+      that the anatomist has furnished him with indispensable data, that the
+      physiologist has sometimes put him on the track of new modes of treatment,
+      that the chemist has isolated the active principles of his medicines, has
+      taught him how to combine them, has from time to time offered him new
+      remedial agencies, and so of others of his allies. But he will also tell
+      you, if I am not mistaken, that his own branch of knowledge is so
+      extensive and so perplexing that he must accept most of his facts ready
+      made at their hands. He will own to you that in the struggle for life
+      which goes on day and night in our thoughts as in the outside world of
+      nature, much that he learned under the name of science has died out, and
+      that simple homely experience has largely taken the place of that
+      scholastic knowledge to which he and perhaps some of his instructors once
+      attached a paramount importance.
+    </p>
+    <p>
+      This, then, is my view of scientific training as conducted in courses such
+      as you are entering on. Up to a certain point I believe in set Lectures as
+      excellent adjuncts to what is far more important, practical instruction at
+      the bedside, in the operating room, and under the eye of the Demonstrator.
+      But I am so far from wishing these courses extended, that I think some of
+      them&mdash;suppose I say my own&mdash;would almost bear curtailing. Do you
+      want me to describe more branches of the sciatic and crural nerves? I can
+      take Fischer's plates, and lecturing on that scale fill up my whole course
+      and not finish the nerves alone. We must stop somewhere, and for my own
+      part I think the scholastic exercises of our colleges have already claimed
+      their full share of the student's time without our seeking to extend them.
+    </p>
+    <p>
+      I trust I have vindicated the apparent inconsequence of teaching young
+      students a good deal that seems at first sight profitless, but which helps
+      them to learn and retain what is profitable. But this is an inquisitive
+      age, and if we insist on piling up beyond a certain height knowledge which
+      is in itself mere trash and lumber to a man whose life is to be one long
+      fight with death and disease, there will be some sharp questions asked by
+      and by, and our quick-witted people will perhaps find they can get along
+      as well without the professor's cap as without the bishop's mitre and the
+      monarch's crown.
+    </p>
+    <p>
+      I myself have nothing to do with clinical teaching. Yet I do not hesitate
+      to say it is more essential than all the rest put together, so far as the
+      ordinary practice of medicine is concerned; and this is by far the most
+      important thing to be learned, because it deals with so many more lives
+      than any other branch of the profession. So of personal instruction, such
+      as we give and others give in the interval of lectures, much of it at the
+      bedside, some of it in the laboratory, some in the microscope-room, some
+      in the recitation-room, I think it has many advantages of its own over the
+      winter course, and I do not wish to see it shortened for the sake of
+      prolonging what seems to me long enough already.
+    </p>
+    <p>
+      If I am jealous of the tendency to expand the time given to the
+      acquisition of curious knowledge, at the expense of the plain
+      old-fashioned bedside teachings, I only share the feeling which Sydenham
+      expressed two hundred years ago, using an image I have already borrowed.
+      &ldquo;He would be no honest and successful pilot who was to apply himself with
+      less industry to avoid rocks and sands and bring his vessel safely home,
+      than to search into the causes of the ebbing and flowing of the sea,
+      which, though very well for a philosopher, is foreign to him whose
+      business it is to secure the ship. So neither will a physician, whose
+      province it is to cure diseases, be able to do so, though he be a person
+      of great genius, who bestows less time on the hidden and intricate method
+      of nature, and adapting his means thereto, than on curious and subtle
+      speculation.&rdquo;
+     </p>
+    <p>
+      &ldquo;Medicine is my wife and Science is my mistress,&rdquo; said Dr. Rush. I do not
+      think that the breach of the seventh commandment can be shown to have been
+      of 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 studied under him, whether Dr. Rush had ever
+      learned the meaning of that saying of Lord Bacon, that man is the minister
+      and interpreter of Nature, or whether he did not speak habitually of
+      Nature as an intruder in the sick room, from which his art was to expel
+      her as an incompetent and a meddler.
+    </p>
+    <p>
+      All a man's powers are not too much for such a profession as Medicine. &ldquo;He
+      is a learned man,&rdquo; said old Parson Emmons of Franklin, &ldquo;who understands
+      one subject, and he is a very learned man who understands two subjects.&rdquo;
+       Schonbein says he has been studying oxygen for thirty years. Mitscherlich
+      said it took fourteen years to establish a new fact in chemistry. Aubrey
+      says of Harvey, the discoverer of the circulation, that &ldquo;though all his
+      profession would allow him to be an excellent anatomist, I have never
+      heard of any who admired his therapeutic way.&rdquo; My learned and excellent
+      friend before referred to, Dr. Brown of Edinburgh, from whose very lively
+      and sensible Essay, &ldquo;Locke and Sydenham,&rdquo; I have borrowed several of my
+      citations, contrasts Sir Charles Bell, the discoverer, the man of science,
+      with Dr. Abercrombie, the master in the diagnosis and treatment of
+      disease. It is through one of the rarest of combinations that we have in
+      our Faculty a teacher on whom the scientific mantle of Bell has fallen,
+      and who yet stands preeminent in the practical treatment of the class of
+      diseases which his inventive and ardent experimental genius has
+      illustrated. M. Brown-Sequard's example is as eloquent as his teaching in
+      proof of the advantages of well directed scientific investigation. But
+      those who emulate his success at once as a discoverer and a practitioner
+      must be content like him to limit their field of practice. The highest
+      genius cannot afford in our time to forget the ancient precept, Divide et
+      impera.
+    </p>
+    <p>
+      &ldquo;I suppose I must go and earn this guinea,&rdquo; said a medical man who was
+      sent for while he was dissecting an animal. I should not have cared to be
+      his patient. His dissection would do me no good, and his thoughts would be
+      too much upon it. I want a whole man for my doctor, not a half one. I
+      would have sent for a humbler practitioner, who would have given himself
+      entirely to me, and told the other&mdash;who was no less a man than John
+      Hunter&mdash;to go on and finish the dissection of his tiger.
+    </p>
+    <p>
+      Sydenham's &ldquo;Read Don Quixote&rdquo; should be addressed not to the student, but
+      to the Professor of today. Aimed at him it means, &ldquo;Do not be too learned.&rdquo;
+     </p>
+    <p>
+      Do not think you are going to lecture to picked young men who are training
+      themselves to be scientific discoverers. They are of fair average
+      capacity, and they are going to be working doctors.
+    </p>
+    <p>
+      These young men are to have some very serious vital facts to deal with. I
+      will mention a few of them.
+    </p>
+    <p>
+      Every other resident adult you meet in these streets is or will be more or
+      less tuberculous. This is not an extravagant estimate, as very nearly one
+      third of the deaths of adults in Boston last year were from phthisis. If
+      the relative number is less in our other northern cities, it is probably
+      in a great measure because they are more unhealthy; that is, they have as
+      much, or nearly as much, consumption, but they have more fevers or other
+      fatal diseases.
+    </p>
+    <p>
+      These heavy-eyed men with the alcoholized brains, these pallid youths with
+      the nicotized optic ganglia and thinking-marrows brown as their own
+      meerschaums, of whom you meet too many,&mdash;will ask all your wisdom to
+      deal with their poisoned nerves and their enfeebled wills.
+    </p>
+    <p>
+      Nearly seventeen hundred children under five years of age died last year
+      in this city. A poor human article, no doubt, in many cases, still, worth
+      an attempt to save them, especially when we remember the effect of Dr.
+      Clarke's suggestion at the Dublin Hospital, by which some twenty-five or
+      thirty thousand children's lives have probably been saved in a single
+      city.
+    </p>
+    <p>
+      Again, the complaint is often heard that the native population is not
+      increasing so rapidly as in former generations. The breeding and nursing
+      period of American women is one of peculiar delicacy and frequent
+      infirmity. Many of them must require a considerable interval between the
+      reproductive efforts, to repair damages and regain strength. This matter
+      is not to be decided by an appeal to unschooled nature. It is the same
+      question as that of the deformed pelvis,&mdash;one of degree. The facts of
+      mal-vitalization are as much to be attended to as those of mal-formation.
+      If the woman with a twisted pelvis is to be considered an exempt, the
+      woman with a defective organization should be recognized as belonging to
+      the invalid corps. We shudder to hear what is alleged as to the prevalence
+      of criminal practices; if back of these there can be shown organic
+      incapacity or overtaxing of too limited powers, the facts belong to the
+      province of the practical physician, as well as of the moralist and the
+      legislator, and require his gravest consideration.
+    </p>
+    <p>
+      Take the important question of bleeding. Is venesection done with forever?
+      Six years ago it was said here in an introductory Lecture that it would
+      doubtless come back again sooner or later. A fortnight ago I found myself
+      in the cars with one of the most sensible and esteemed practitioners in
+      New England. He took out his wallet and showed me two lancets, which he
+      carried with him; he had never given up their use. This is a point you
+      will have to consider.
+    </p>
+    <p>
+      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 does
+      harm. The caution with reference to it on this ground was long ago
+      recorded in the Lecture above referred to. See what Dr. John Hughes
+      Bennett says of it in the recent edition of his work on Medicine. Nothing
+      but the most careful clinical experience can settle this and such points
+      of treatment.
+    </p>
+    <p>
+      These are all practical questions&mdash;questions of life and death, and
+      every day will be full of just such questions. Take the problem of
+      climate. A patient comes to you with asthma and wants to know where he can
+      breathe; another comes to you with phthisis and wants to know where he can
+      live. What boy's play is nine tenths of all that is taught in many a
+      pretentious course of lectures, compared with what an accurate and
+      extensive knowledge of the advantages and disadvantages of different
+      residences in these and other complaints would be to a practising
+      physician.
+    </p>
+    <p>
+      I saw the other day a gentleman living in Canada, who had spent seven
+      successive winters in Egypt, with the entire relief of certain obscure
+      thoracic symptoms which troubled him while at home. I saw, two months ago,
+      another gentleman from Minnesota, an observer and a man of sense, who
+      considered that State as the great sanatorium for all pulmonary
+      complaints. If half our grown population are or will be more or less
+      tuberculous, the question of colonizing Florida assumes a new aspect. Even
+      within the borders of our own State, the very interesting researches of
+      Dr. Bowditch show that there is a great variation in the amount of
+      tuberculous disease in different towns, apparently connected with local
+      conditions. The hygienic map of a State is quite as valuable as its
+      geological map, and it is the business of every practising physician to
+      know it thoroughly. They understand this in England, and send a patient
+      with a dry irritating cough to Torquay or Penzance, while they send
+      another with relaxed bronchial membranes to Clifton or Brighton. Here is
+      another great field for practical study.
+    </p>
+    <p>
+      So as to the all-important question of diet. &ldquo;Of all the means of cure at
+      our command,&rdquo; says Dr. Bennett, &ldquo;a regulation of the quantity and quality
+      of the diet is by far the most powerful.&rdquo; Dr. MacCormac would perhaps
+      except the air we breathe, for he thinks that impure air, especially in
+      sleeping rooms, is the great cause of tubercle. It is sufficiently proved
+      that the American,&mdash;the New Englander,&mdash;the Bostonian, can breed
+      strong and sound children, generation after generation,&mdash;nay, I have
+      shown by the record of a particular family that vital losses may be
+      retrieved, and a feeble race grow to lusty vigor in this very climate and
+      locality. Is not the question why our young men and women so often break
+      down, and how they can be kept from breaking down, far more important for
+      physicians to settle than whether there is one cranial vertebra, or
+      whether there are four, or none?
+    </p>
+    <p>
+      &mdash;But I have a taste for the homologies, I want to go deeply into the
+      subject of embryology, I want to analyze the protonihilates precipitated
+      from pigeon's milk by the action of the lunar spectrum,&mdash;shall I not
+      follow my star,&mdash;shall I not obey my instinct,&mdash;shall I not give
+      myself to the lofty pursuits of science for its own sake?
+    </p>
+    <p>
+      Certainly you may, if you like. But take down your sign, or never put it
+      up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and Dr. Jeffries
+      Wyman, Dr. Gray and Dr. Charles T. Jackson settled the difficulty. We all
+      admire the achievements of 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 six hundred at Balaclava, &ldquo;C'est
+      magnifique, mais ce n'est pas la guerre,&rdquo;&mdash;it is very splendid, but
+      it is not a practising doctor's business. His patient has a right to the
+      cream of his life and not merely to the thin milk that is left after
+      &ldquo;science&rdquo; has skimmed it off. The best a physician can give is never too
+      good for the patient.
+    </p>
+    <p>
+      It is often a disadvantage to a young practitioner to be known for any
+      accomplishment outside of his profession. Haller lost his election as
+      Physician to the Hospital in his native city of Berne, principally on the
+      ground that he was a poet. In his later years the physician may venture
+      more boldly. Astruc was sixty-nine years old when he published his
+      &ldquo;Conjectures,&rdquo; the first attempt, we are told, to decide the authorship of
+      the Pentateuch showing anything like a discerning criticism. Sir Benjamin
+      Brodie was seventy years old before he left his physiological and surgical
+      studies to indulge in psychological speculations. The period of pupilage
+      will be busy enough in acquiring the knowledge needed, and the season of
+      active practice will leave little leisure for any but professional
+      studies.
+    </p>
+    <p>
+      Dr. Graves of Dublin, one of the first clinical teachers of our time,
+      always insisted on his students' beginning at once to visit the hospital.
+      At the bedside the student must learn to treat disease, and just as
+      certainly as we spin out and multiply our academic prelections we shall
+      work in more and more stuffing, more and more rubbish, more and more
+      irrelevant, useless detail which the student will get rid of just as soon
+      as he leaves us. Then the next thing will be a new organization, with an
+      examining board of first-rate practical men, who will ask the candidate
+      questions that mean business,&mdash;who will make him operate if he is to
+      be a surgeon, and try him at the bedside if he is to be a physician,&mdash;and
+      not puzzle him with scientific conundrums which not more than one of the
+      questioners could answer himself or ever heard of since he graduated.
+    </p>
+    <p>
+      Or these women who are hammering at the gates on which is written &ldquo;No
+      admittance for the mothers of mankind,&rdquo; will by and by organize an
+      institution, which starting from that skilful kind of nursing which
+      Florence Nightingale taught so well, will work backwards through anodynes,
+      palliatives, curatives, preventives, until with little show of science it
+      imparts most of what is most valuable in those branches of the healing art
+      it professes to teach. When that time comes, the fitness of women for
+      certain medical duties, which Hecquet advocated in 1708, which Douglas
+      maintained in 1736, which Dr. John Ware, long the honored Professor of
+      Theory and Practice in this Institution, upheld within our own
+      recollection in the face of his own recorded opinion to the contrary, will
+      very possibly be recognized.
+    </p>
+    <p>
+      My advice to every teacher less experienced than myself would be,
+      therefore: Do not fret over the details you have to omit; you probably
+      teach altogether too many as it is. Individuals may learn a thing with
+      once hearing it, but the only way of teaching a whole class is by enormous
+      repetition, representation, and illustration in all possible forms. Now
+      and then you will have a young man on your benches like the late Waldo
+      Burnett,&mdash;not very often, if you lecture half a century. You cannot
+      pretend to lecture chiefly for men like that,&mdash;a Mississippi raft
+      might as well take an ocean-steamer in tow. To meet his wants you would
+      have to leave the rest of your class behind and that you must not do.
+      President Allen of Jefferson College says that his instruction has been
+      successful in proportion as it has been elementary. It may be a
+      humiliating statement, but it is one which I have found true in my own
+      experience.
+    </p>
+    <p>
+      To the student I would say, that however plain and simple may be our
+      teaching, he must expect to forget much 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 voluntarily recall,&mdash;they are outside the limits of
+      the will. But they sway our conscious thought as the unseen planets
+      influence the movements of those within the sphere of vision. No man knows
+      how much he knows,&mdash;how many ideas he has,&mdash;any more than he
+      knows how many blood-globules roll in his veins. Sometimes accident brings
+      back here and there one, but the mind is full of irrevocable remembrances
+      and unthinkable thoughts, which take a part in all its judgments as
+      indestructible forces. Some of you must feel your scientific deficiencies
+      painfully after your best efforts. But every one can acquire what is most
+      essential. A man of very moderate ability may be a good physician, if he
+      devotes himself faithfully to the work. More than this, a positively dull
+      man, in the ordinary acceptation of the term, sometimes makes a safer
+      practitioner than one who has, we will say, five per cent. more brains
+      than his average neighbor, but who thinks it is fifty per cent. more.
+      Skulls belonging to this last variety of the human race are more common, I
+      may remark, than specimens like the Neanderthal cranium, a cast of which
+      you will find on the table in the Museum.
+    </p>
+    <p>
+      Whether the average talent be high or low, the Colleges of the land must
+      make the best commodity they can out of such material as the country and
+      the cities furnish them. The community must have Doctors as it must have
+      bread. It uses up its Doctors just as it wears out its shoes, and requires
+      new ones. All the bread need not be French rolls, all the shoes need not
+      be patent leather ones; but the bread must be something that can be eaten,
+      and the shoes must be something that can be worn. Life must somehow find
+      food for the two forces that rub everything to pieces, or burn it to
+      ashes,&mdash;friction and oxygen. Doctors are oxydable products, and the
+      schools must keep furnishing new ones as the old ones turn into oxyds;
+      some of first-rate quality that burn with 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.
+    </p>
+    <p>
+      The public will give every honest and reasonably competent worker in the
+      healing art a hearty welcome. It is on the whole very loyal to the Medical
+      Profession. Three successive years have borne witness to the feeling with
+      which this Institution, representing it in its educational aspect, is
+      regarded by those who are themselves most honored and esteemed. The great
+      Master of Natural Science bade the last year's class farewell in our
+      behalf, in those accents which delight every audience. The Head of our
+      ancient University honored us in the same way in the preceding season. And
+      how can we forget that other occasion when the Chief Magistrate of the
+      Commonwealth, that noble citizen whom we have just lost, large-souled,
+      sweet-natured, always ready for every kind office, came among us at our
+      bidding, and talked to us of our duties in words as full of wisdom as his
+      heart was of goodness?
+    </p>
+    <p>
+      You have not much to fear, I think, from the fancy practitioners. The
+      vulgar quackeries drop off, atrophied, one after another. Homoeopathy has
+      long been encysted, and is carried on the body medical as quietly as an
+      old wen. Every year gives you a more reasoning and reasonable people to
+      deal with. See how it is in Literature. The dynasty of British dogmatists,
+      after lasting a hundred years and more, is on its last legs. Thomas
+      Carlyle, third in the line of descent, finds an audience very different
+      from those which listened to the silver speech of Samuel Taylor Coleridge
+      and the sonorous phrases of Samuel Johnson. We read him, we smile at his
+      clotted English, his &ldquo;swarmery&rdquo; and other picturesque expressions, but we
+      lay down his tirade as we do one of Dr. Cumming's interpretations of
+      prophecy, which tells us that the world is coming to an end next week or
+      next month, if the weather permits,&mdash;not otherwise,&mdash;feeling
+      very sure that the weather will be unfavorable.
+    </p>
+    <p>
+      It is the same common-sense public you will appeal to. The less pretension
+      you make, the better they will like you in the long run. I hope we shall
+      make everything as plain and as simple to you as we can. I would never use
+      a long word, even, where a short one would answer the purpose. I know
+      there are professors in this country who &ldquo;ligate&rdquo; arteries. Other surgeons
+      only tie them, and it stops the bleeding just as well. It is the
+      familiarity and simplicity of bedside instruction which makes it so
+      pleasant as well as so profitable. A good clinical teacher is himself a
+      Medical School. We need not wonder that our young men are beginning to
+      announce themselves not only as graduates of this or that College, but
+      also as pupils of some one distinguished master.
+    </p>
+    <p>
+      I wish to close this Lecture, if you will allow me a few moments longer,
+      with a brief sketch of an instructor and practitioner whose character was
+      as nearly a model one in both capacities as I can find anywhere recorded.
+    </p>
+    <p>
+      Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine in
+      this University from 1812 to 1846, and whose name has been since retained
+      on our rolls as Professor Emeritus, died on the 27th of August 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 physicians
+      who have borne witness to their knowledge of the laws of life by living to
+      complete their hundredth year. I think the student took his Old Master, as
+      he always loved to call him, as his model; each was worthy of the other,
+      and both were bright examples to all who come after them.
+    </p>
+    <p>
+      I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke's
+      death, one of the points most insisted upon as characteristic of that wise
+      and good old man was the perfect balance of all his faculties. The same
+      harmonious adjustment of powers, the same symmetrical arrangement of life,
+      the same complete fulfilment of every day's duties, without haste and
+      without needless delay, which characterized the master, equally
+      distinguished the scholar. A glance at the life of our own Old Master, if
+      I can do any justice at all to his excellences, will give you something to
+      carry away from this hour's meeting not unworthy to be remembered.
+    </p>
+    <p>
+      From December, 1797, to October, 1799, he remained with Dr. Holyoke as a
+      student, a period which he has spoken of as a most interesting and most
+      gratifying part of his life. After this he passed eight months in London,
+      and on his return, in October, 1800, he began business in Boston.
+    </p>
+    <p>
+      He had followed Mr. Cline, as I have mentioned, and was competent to
+      practise Surgery. But he found Dr. John Collins Warren had already
+      occupied the ground which at that day hardly called for more than one
+      leading practitioner, and wisely chose the Medical branch of the
+      profession. He had only himself to rely upon, but he had confidence in his
+      prospects, conscious, doubtless, of his own powers, knowing his own
+      industry and determination, and being of an eminently cheerful and hopeful
+      disposition. No better proof of his spirit can be given than that, just a
+      year from the time when he began to practise as a physician, he took that
+      eventful step which in such a man implies that he sees his way clear to a
+      position; he married a lady blessed with many gifts, but not bringing him
+      a fortune to paralyze his industry.
+    </p>
+    <p>
+      He had not miscalculated his chances in life. He very soon rose into a
+      good practice, and began the founding of that reputation which grew with
+      his years, until he stood by general consent at the head of his chosen
+      branch of the profession, to say the least, in this city and in all this
+      region of country. His skill and wisdom were the last tribunal to which
+      the sick and suffering could appeal. The community trusted and loved him,
+      the profession recognized him as the noblest type of the physician. The
+      young men 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 older and began to think more of their ability to help
+      the sick than their power of talking about phenomena, they began to look
+      back to the teaching of Dr. Jackson, as he, after his London experience,
+      looked back to that of Dr. Holyoke. And so it came to be at last that the
+      bare mention of his name in any of our medical assemblies would call forth
+      such a tribute of affectionate regard as is only yielded to age when it
+      brings with it the record of a life spent in well doing.
+    </p>
+    <p>
+      No accident ever carries a man to eminence such as his in the medical
+      profession. He who looks for it must want it earnestly and work for it
+      vigorously; Nature must have qualified him in many ways, and education
+      must have equipped him with various knowledge, or his reputation will
+      evaporate before it reaches the noon-day blaze of fame. How did Dr.
+      Jackson gain the position which all conceded to him? In the answer to this
+      question some among you may find a key that shall unlock the gate opening
+      on that fair field of the future of which all dream but which not all will
+      ever reach.
+    </p>
+    <p>
+      First of all, he truly loved his profession. He had no intellectual
+      ambitions outside of it, literary, scientific or political. To him it was
+      occupation enough to apply at the bedside the best of all that he knew for
+      the good of his patient; to protect the community against the inroads of
+      pestilence; to teach the young all that he himself had been taught, with
+      all that his own experience had added; to leave on record some of the most
+      important results of his long observation.
+    </p>
+    <p>
+      With his patients he was so perfect at all points that it is hard to
+      overpraise him. I have seen many noted British and French and American
+      practitioners, but I never saw the man so altogether admirable at the
+      bedside of the sick as Dr. James Jackson. His smile was itself a remedy
+      better than the potable gold and the dissolved pearls that comforted the
+      praecordia of mediaeval monarchs. Did a patient, alarmed without cause,
+      need encouragement, it carried the sunshine of hope into his heart and put
+      all his whims to flight, as David's harp cleared the haunted chamber 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 heart
+      felt it. So gentle was he, so thoughtful, so calm, so absorbed in the case
+      before him, not to turn round and look for a tribute to his sagacity, not
+      to bolster himself in a favorite theory, but to find out all he could, and
+      to weigh gravely and cautiously all that he found, that to follow him in
+      his morning visit was 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 visit with Dr. Jackson was a medical education.
+    </p>
+    <p>
+      He was very firm, with all his kindness. He would have the truth about his
+      patients. The nurses found it out; and the shrewder ones never ventured to
+      tell him anything but a straight story. A clinical dialogue between Dr.
+      Jackson and Miss Rebecca Taylor, sometime nurse in the Massachusetts
+      General Hospital, a mistress in her calling, was as good questioning and
+      answering as one would be like to hear outside of the court-room.
+    </p>
+    <p>
+      Of his practice you can form an opinion from his book called &ldquo;Letters to a
+      Young Physician.&rdquo; Like all sensible men from the days of Hippocrates to
+      the present, he knew that diet and regimen were more important than any
+      drug or than all drugs put together. Witness his treatment of phthisis and
+      of epilepsy. He retained, however, more confidence in some remedial agents
+      than most of the younger generation would concede to them. Yet his materia
+      medica was a simple one.
+    </p>
+    <p>
+      &ldquo;When I first went to live with Dr. Holyoke,&rdquo; he says, &ldquo;in 1797, showing
+      me his shop, he said, 'There seems to you to be a great variety of
+      medicines here, and that it will take you long to get acquainted with
+      them, but most of them are unimportant. There are four which are equal to
+      all the rest, namely, Mercury, Antimony, Bark and Opium.'&rdquo; And Dr. Jackson
+      adds, &ldquo;I can only say of his practice, the longer I have lived, I have
+      thought better and better of it.&rdquo; When he thought it necessary to give
+      medicine, he gave it in earnest. He hated half-practice&mdash;giving a
+      little of this or that, so as to be able to say that one had done
+      something, in case a consultation was held, or a still more ominous event
+      occurred. He would give opium, for instance, as boldly as the late Dr.
+      Fisher of Beverly, but he followed the aphorism of the Father of Medicine,
+      and kept extreme remedies for extreme cases.
+    </p>
+    <p>
+      When it came to the &ldquo;non-naturals,&rdquo; as he would sometimes call them, after
+      the old physicians,&mdash;namely, air, meat and drink, sleep and watching,
+      motion and rest, the retentions and excretions, and the affections of the
+      mind,&mdash;he was, as I have said, of the school of sensible
+      practitioners, in distinction from that vast community of quacks, with or
+      without the diploma, who think the chief end of man is to support
+      apothecaries, and are never easy until they can get every patient upon a
+      regular course of something nasty or noxious. Nobody was so precise in his
+      directions about diet, air, and exercise, as Dr. Jackson. He had the same
+      dislike to the a peu pres, the about so much, about so often, about so
+      long, which I afterwards found among the punctilious adherents of the
+      numerical system at La Pitie.
+    </p>
+    <p>
+      He used to insist on one small point with a certain philological
+      precision, namely, the true meaning of the word &ldquo;cure.&rdquo; He would have it
+      that to cure a patient was simply to care for him. I refer to it as
+      showing what his idea was of the relation of the physician to the patient.
+      It was indeed to care for him, as if his life were bound up in him, to
+      watch his incomings and outgoings, to stand guard at every avenue that
+      disease might enter, to leave nothing to chance; not merely to throw a few
+      pills and powders into one pan of the scales of Fate, 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 human power
+      to do it. Such devotion as this is only to be looked for in the man who
+      gives himself wholly up to the business of healing, who considers Medicine
+      itself a Science, or if not a science, is willing to follow it as an art,&mdash;the
+      noblest of arts, which the gods and demigods of ancient religions did not
+      disdain to practise and to teach.
+    </p>
+    <p>
+      The same zeal made him always ready to listen to any new suggestion which
+      promised to be useful, at a period of life when many men find it hard to
+      learn new methods and accept new doctrines. Few of his generation became
+      so accomplished as he in the arts of direct exploration; coming straight
+      from the Parisian experts, I have examined many patients with him, and
+      have had frequent opportunities of observing his skill in percussion and
+      auscultation.
+    </p>
+    <p>
+      One element in his success, a trivial one compared with others, but not to
+      be despised, was his punctuality. He always carried two watches,&mdash;I
+      doubt if he told why, any more than Dr. Johnson told what he did with the
+      orange-peel,&mdash;but probably with reference to this virtue. He was as
+      much to be depended upon at the appointed time as the solstice or the
+      equinox. There was another point I have heard him speak of as an important
+      rule with him; to come at the hour when he was expected; if he had made
+      his visit for several days successively at ten o'clock, for instance, not
+      to put it off, if he could possibly help it, until eleven, and so keep a
+      nervous patient and an anxious family waiting for him through a long,
+      weary hour.
+    </p>
+    <p>
+      If I should attempt to characterize his teaching, I should say that while
+      it conveyed the best results of his sagacious and extended observation, it
+      was singularly modest, cautious, simple, sincere. Nothing was for show,
+      for self-love; there was no rhetoric, no declamation, no triumphant &ldquo;I
+      told you so,&rdquo; but the plain statement of a clear-headed honest man, who
+      knows that he is handling one of the gravest subjects that interest
+      humanity. His positive instructions were full of value, but the spirit in
+      which he taught inspired that loyal love of truth which lies at the bottom
+      of all real excellence.
+    </p>
+    <p>
+      I will not say that, during his long career, Dr. Jackson never made an
+      enemy. I have heard him tell how, in his very early days, old Dr. Danforth
+      got into a towering passion with him about some professional consultation,
+      and exploded a monosyllable or two of the more energetic kind on the
+      occasion. I remember that that somewhat peculiar personage, Dr.
+      Waterhouse, took it hardly when Dr. Jackson succeeded to his place as
+      Professor of Theory and Practice. A young man of Dr. Jackson's talent and
+      energy could hardly take the position that belonged to him without
+      crowding somebody in a profession where three in a bed is the common rule
+      of the household. But he was a peaceful man and a peace-maker all his
+      days. No man ever did more, if so much, to produce and maintain the spirit
+      of harmony for which we consider our medical community as somewhat
+      exceptionally distinguished.
+    </p>
+    <p>
+      If this harmony should ever be threatened, I could wish that every
+      impatient and irritable member of the profession would read that
+      beautiful, that noble Preface to the &ldquo;Letters,&rdquo; addressed to John Collins
+      Warren. I know nothing finer in the medical literature of all time than
+      this Prefatory Introduction. It is a golden prelude, fit to go with the
+      three great Prefaces which challenge the admiration of scholars,&mdash;Calvin's
+      to his Institutes, De Thou's to his History, and Casaubon's to his
+      Polybius,&mdash;not because of any learning or rhetoric, though it is
+      charmingly written, but for a spirit flowing through it to which learning
+      and rhetoric are but as the breath that is wasted on the air to the Mood
+      that warms the heart.
+    </p>
+    <p>
+      Of a similar character is this short extract which I am permitted to make
+      from a private letter of his to a dear young friend. He was eighty-three
+      years old at the time of writing it.
+    </p>
+    <p>
+      &ldquo;I have not loved everybody whom I have known, but I have striven to see
+      the good points in the characters of all men and women. At first I must
+      have done this from something in my own nature, for I was not aware of it,
+      and yet was doing it without any plan, when one day, sixty years ago, a
+      friend whom I loved and respected said this to me, 'Ah, James, I see that
+      you are destined to succeed in the world, and to make friends, because you
+      are so ready to see the good point in the characters of those you meet.'&rdquo;
+     </p>
+    <p>
+      I close this imperfect notice of some features in the character of this
+      most honored and beloved of physicians by applying to him the words which
+      were written of William Heberden, whose career was not unlike his own, and
+      who lived to the same patriarchal age.
+    </p>
+    <p>
+      &ldquo;From his early youth he had always entertained a deep sense of religion,
+      a consummate love of virtue, an ardent thirst after knowledge, and an
+      earnest desire to promote the welfare and happiness of all mankind. By
+      these qualities, accompanied with great sweetness of manners, he acquired
+      the love and esteem of all good men, in a degree which perhaps very few
+      have experienced; and after passing an active life with the uniform
+      testimony of a good conscience, he became an eminent example of its
+      influence, in the cheerfulness and serenity of his latest age.&rdquo;
+     </p>
+    <p>
+      Such was the man whom I offer to you as a model, young gentlemen, at the
+      outset of your medical career. I hope that many of you will recognize some
+      traits of your own special teachers scattered through various parts of the
+      land in the picture I have drawn. Let me assure you that whatever you may
+      learn in this or any other course of public lectures,&mdash;and I trust
+      you will learn a great deal,&mdash;the daily guidance, counsel, example,
+      of your medical father, for such the Oath of Hippocrates tells you to
+      consider your preceptor, will, if he is in any degree like him of whom I
+      have spoken, be the foundation on which all that we teach is reared, and
+      perhaps outlive most of our teachings, as in Dr. Jackson's memory the last
+      lessons that remained with him were those of his Old Master.
+    </p>
+    <p>
+      <a name="link2H_4_0010" id="link2H_4_0010">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      THE MEDICAL PROFESSION IN MASSACHUSETTS.
+    </h2>
+    <p>
+      A Lecture of a Course by members of the Massachusetts Historical Society,
+      delivered before the Lowell Institute, January 29, 1869.
+    </p>
+    <p>
+      The medical history of eight generations, told in an hour, must be in many
+      parts a mere outline. The details I shall give will relate chiefly to the
+      first century. I shall only indicate the leading occurrences, with the
+      more prominent names of the two centuries which follow, and add some
+      considerations suggested by the facts which have been passed in review.
+    </p>
+    <p>
+      A geographer who was asked to describe the tides of Massachusetts Bay,
+      would have to recognize the circumstance that they are a limited
+      manifestation of a great oceanic movement. To consider them apart from
+      this, would be to localize a planetary phenomenon, and to provincialize a
+      law of the universe. The art of healing in Massachusetts has shared more
+      or less fully and readily the movement which, with its periods of ebb and
+      flow, has been raising its level from age to age throughout the better
+      part of Christendom. Its practitioners brought with them much of the
+      knowledge and many of the errors of the Old World; they have always been
+      in communication with its wisdom and its folly; it is not without interest
+      to see how far the new conditions in which they found themselves have been
+      favorable or unfavorable to the growth of sound medical knowledge and
+      practice.
+    </p>
+    <p>
+      The state of medicine is an index of the civilization of an age and
+      country,&mdash;one of the best, perhaps, by which it can be judged.
+      Surgery invokes the aid of all the mechanical arts. From the rude
+      violences of the age of stone,&mdash;a relic of which we may find in the
+      practice of Zipporah, the wife of Moses,&mdash;to the delicate operations
+      of to-day upon patients lulled into temporary insensibility, is a progress
+      which presupposes a skill in metallurgy and in the labors of the workshop
+      and the laboratory it 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, can find their place in our pharmacies,
+      commerce must have perfected its machinery, and science must have refined
+      its processes, through periods only to be counted by the life of nations.
+      Before the means which nature and art have put in the hands of the medical
+      practitioner can be fairly brought into use, the prejudices of the vulgar
+      must be overcome, the intrusions of false philosophy must be fenced out,
+      and the partnership with the priesthood dissolved. All this implies that
+      freedom and activity of thought which belong only to the most advanced
+      conditions of society; and the progress towards this is by gradations as
+      significant of wide-spread changes, as are the varying states of the
+      barometer of far-extended conditions of the atmosphere.
+    </p>
+    <p>
+      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 trivial and almost unworthy of record. A medical entry in
+      Governor Winthrop's journal may seem at first sight a mere curiosity; but,
+      rightly interpreted, it is a key to his whole system of belief as to the
+      order of the universe and the relations between man and his Maker. Nothing
+      sheds such light on the superstitions of an age as the prevailing
+      interpretation and treatment of disease. When the touch of a profligate
+      monarch was a cure for one of the most inveterate of maladies, when the
+      common symptoms of hysteria were prayed over as marks of demoniacal
+      possession, we might well expect the spiritual realms of thought to be
+      peopled with still stranger delusions.
+    </p>
+    <p>
+      Let us go before the Pilgrims of the Mayflower, and look at the shores on
+      which they were soon to land. A wasting pestilence had so thinned the
+      savage tribes that it was sometimes piously interpreted as having
+      providentially prepared the way for the feeble band of exiles. Cotton
+      Mather, who, next to the witches, hated the &ldquo;tawnies,&rdquo; &ldquo;wild beasts,&rdquo;
+       &ldquo;blood-hounds,&rdquo; &ldquo;rattlesnakes,&rdquo; &ldquo;infidels,&rdquo; as in different places he
+      calls the unhappy Aborigines, describes the condition of things in his
+      lively way, thus: &ldquo;The Indians in these Parts had newly, even about a Year
+      or Two before, been visited with such a prodigious Pestilence; as carried
+      away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of Twenty)
+      among them so that the Woods were almost cleared of those pernicious
+      Creatures to make Room for a better Growth.&rdquo;
+     </p>
+    <p>
+      What this pestilence was has been much discussed. It is variously
+      mentioned by different early writers as &ldquo;the plague,&rdquo; &ldquo;a great and
+      grievous plague,&rdquo; &ldquo;a sore consumption,&rdquo; as attended with spots which left
+      unhealed places on those who recovered, as making the &ldquo;whole surface
+      yellow as with a garment.&rdquo; Perhaps no disease answers all these conditions
+      so well as smallpox. We know from different sources what frightful havoc
+      it made among the Indians in after years,&mdash;in 1631, for instance,
+      when it swept away the aboriginal inhabitants of &ldquo;whole towns,&rdquo; and in
+      1633. We have seen a whole tribe, the Mandans, extirpated by it in our own
+      day. The word &ldquo;plague&rdquo; was used very vaguely, as in the description of the
+      &ldquo;great sickness&rdquo; found among the Indians by the expedition of 1622. This
+      same great sickness could hardly have been yellow fever, as it occurred in
+      the month of November. I cannot think, therefore, that either the scourge
+      of the East or our Southern malarial pestilence was the disease that
+      wasted the Indians. As for the yellowness like a garment, that is too
+      familiar to the eyes of all who have ever looked on the hideous mask of
+      confluent variola.
+    </p>
+    <p>
+      Without the presence or the fear of these exotic maladies, the forlorn
+      voyagers of the Mayflower had sickness enough to contend with. At their
+      first landing at Cape Cod, gaunt and hungry and longing for fresh food,
+      they found upon the sandy shore &ldquo;great mussels, and very fat and full of
+      sea-pearl.&rdquo; Sailors and passengers indulged in the treacherous delicacy;
+      which seems to have been the sea-clam; and found that these mollusks, like
+      the shell the poet tells of, remembered their august abode, and treated
+      the way-worn adventurers to a gastric reminiscence of the heaving billows.
+      In the mean time it blew and snowed and froze. The water turned to ice on
+      their clothes, and made them many times like coats of iron. Edward Tilley
+      had like to have &ldquo;sounded&rdquo; with cold. The gunner, too, was sick unto
+      death, but &ldquo;hope of trucking&rdquo; kept him on his feet,&mdash;a Yankee, it
+      should seem, when he first touched the shore of New England. Most, if not
+      all, got colds and coughs, which afterwards turned to scurvy, whereof many
+      died.
+    </p>
+    <p>
+      How can we wonder that the crowded and tempest-tossed voyagers, many of
+      them already suffering, should have fallen before the trials of the first
+      winter in Plymouth? Their imperfect shelter, their insufficient supply of
+      bread, their salted food, now in unwholesome condition, account too well
+      for the diseases and the mortality that marked this first dreadful season;
+      weakness, swelling of the limbs, and other signs of scurvy, betrayed the
+      want of proper nourishment and protection from the elements. In December
+      six of their number died, in January eight, in February, seventeen, in
+      March thirteen. With the advance of spring the mortality diminished, the
+      sick and lame began to recover, and the colonists, saddened but not
+      disheartened, applied themselves to the labors of the opening year.
+    </p>
+    <p>
+      One of the most pressing needs of the early colonists must have been that
+      of physicians and surgeons. In Mr. Savage's remarkable Genealogical
+      Dictionary of the first settlers who came over before 1692 and their
+      descendants to the third generation, I find scattered through the four
+      crowded volumes the names of one hundred and thirty-four medical
+      practitioners. Of these, twelve, and probably many more, practised
+      surgery; three were barber-surgeons. A little incident throws a glimmer
+      from the dark lantern of memory upon William Direly, one of these
+      practitioners with the razor and the lancet. He was lost between Boston
+      and Roxbury in a violent tempest of wind and snow; ten days afterwards a
+      son was born to his widow, and with a touch of homely sentiment, I had
+      almost said poetry, they called the little creature &ldquo;Fathergone&rdquo; 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 into
+      the Connecticut River, and so ended. One was not only doctor, but also
+      schoolmaster and poet. One practised medicine and kept a tavern. One was 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,&mdash;Ann Moore,&mdash;was the precursor of that intrepid
+      sisterhood whose cause it has long been my pleasure and privilege to
+      advocate on all fitting occasions.
+    </p>
+    <p>
+      Outside of this list I must place the name of Thomas Wilkinson, who was
+      complained of, in 1676, for practising contrary to law.
+    </p>
+    <p>
+      Many names in the catalogue of these early physicians have been
+      associated, in later periods, with the practice of the profession, &mdash;among
+      them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver,
+      Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, Woodward.
+      Touton was a Huguenot, Burchsted a German from Silesia, Lunerus a German
+      or a Pole; &ldquo;Pighogg Churrergeon,&rdquo; I hope, for the honor of the profession,
+      was only Peacock disguised under this alias, which would not, I fear,
+      prove very attractive to patients.
+    </p>
+    <p>
+      What doctrines and practice were these colonists likely to bring, with
+      them?
+    </p>
+    <p>
+      Two principal schools of medical practice prevailed in the Old World
+      during the greater part of the seventeenth century. The first held to the
+      old methods of Galen: its theory was that the body, the microcosm, like
+      the macrocosm, was made up of the four elements&mdash;fire, air, water,
+      earth; having respectively the qualities hot, dry, moist, cold. The body
+      was to be preserved in health by keeping each of these qualities in its
+      natural proportion; heat, by the proper temperature; moisture, by the due
+      amount of fluid; and so as to the rest. Diseases which arose from excess
+      of heat were to be attacked by cooling remedies; those from excess of
+      cold, by heating ones; and so of the other derangements of balance. This
+      was truly the principle of contraries contrariis, which ill-informed
+      persons have attempted to make out to be the general doctrine of medicine,
+      whereas there is no general dogma other than this: disease is to be
+      treated by anything that is proved to cure it. The means the Galenist
+      employed were chiefly diet and vegetable remedies, with the use of the
+      lancet and other depleting agents. He attributed the four fundamental
+      qualities to different vegetables, in four different degrees; thus chicory
+      was cold in the fourth degree, pepper was hot in the fourth, endive was
+      cold and dry in the second, and bitter almonds were hot in the first and
+      dry in the second degree. When we say &ldquo;cool as a cucumber,&rdquo; we are talking
+      Galenism. The seeds of that vegetable ranked as one of &ldquo;the four greater
+      cold seeds&rdquo; of this system.
+    </p>
+    <p>
+      Galenism prevailed mostly in the south of Europe and France. The readers
+      of Moliere will have no difficulty in recalling some of its favorite modes
+      of treatment, and the abundant mirth he extracted from them.
+    </p>
+    <p>
+      These Galenists were what we should call &ldquo;herb-doctors&rdquo; to-day. Their
+      insignificant infusions lost credit after a time; their absurdly
+      complicated mixtures excited contempt, and their nauseous prescriptions
+      provoked loathing and disgust. A simpler and bolder practice found welcome
+      in Germany, depending chiefly on 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 limits we may assign to the use of these
+      long-trusted mineral drugs, there can be no doubt that the chemical
+      school, as it was called, did a great deal towards the expurgation of the
+      old, overloaded, and repulsive pharmacopoeia. We shall find evidence in
+      the practice of our New-England physicians of the first century, that they
+      often employed chemical remedies, and that, by the early part of the
+      following century, their chief trust was in the few simple, potent drugs
+      of Paracelsus.
+    </p>
+    <p>
+      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 existed from a very early period; from the Egyptian priest to
+      the Indian medicine-man, the alliance has been maintained in one form or
+      another. The partnership was very common among our British ancestors. Mr.
+      Ward, the Vicar of Stratford-on-Avon, himself a notable example of the
+      union of the two characters, writing about 1660, says,
+    </p>
+    <p>
+      &ldquo;The Saxons had their blood-letters, but under the Normans physicke,
+      begunne in England; 300 years agoe itt was not a distinct profession by
+      itself, but practised by men in orders, witness Nicholas de Ternham, the
+      chief English physician and Bishop of Durham; Hugh of Evesham, a physician
+      and cardinal; Grysant, physician and pope; John Chambers, Dr. of Physick,
+      was the first Bishop of Peterborough; Paul Bush, a bachelor of divinitie
+      in Oxford, was a man well read in physick as well as divinitie, he was the
+      first bishop of Bristol.&rdquo;
+     </p>
+    <p>
+      &ldquo;Again in King Richard the Second's time physicians and divines were not
+      distinct professions; for one Tydeman, Bishop of Landaph and Worcester,
+      was physician to King Richard the Second.&rdquo;
+     </p>
+    <p>
+      This alliance may have had its share in creating and keeping up the many
+      superstitions which have figured so largely in the history of medicine. It
+      is curious to see that a medical work left in manuscript by the Rev.
+      Cotton Mather and hereafter to be referred to, is running over with
+      follies and superstitious fancies; while his contemporary and
+      fellow-townsman, William Douglass, relied on the same few simple remedies
+      which, through Dr. Edward Holyoke and Dr. James Jackson, have come down to
+      our own time, as the most important articles of the materia medica.
+    </p>
+    <p>
+      Let us now take a general glance at some of the conditions of the early
+      settlers; and first, as to the healthfulness of the climate. The mortality
+      of the season that followed the landing of the Pilgrims at Plymouth has
+      been sufficiently accounted for. After this, the colonists seem to have
+      found the new country agreeing very well with their English constitutions.
+      Its clear air is the subject of eulogy. Its dainty springs of sweet water
+      are praised not only by Higginson and Wood, but even the mischievous
+      Morton says, that for its delicate waters &ldquo;Canaan came not near this
+      country.&rdquo; There is a tendency to dilate on these simple blessings, which
+      reminds one a little of the Marchioness in Dickens's story, with her
+      orange-peel-and-water beverage. Still more does one feel the warmth of
+      coloring,&mdash;such as we expect from converts to a new faith, and
+      settlers who want to entice others over to their clearings, when Winslow
+      speaks, in 1621, of &ldquo;abundance of roses, white, red, and damask; single,
+      but very sweet indeed;&rdquo; a most of all, however, when, in the same
+      connection, he says, &ldquo;Here are grapes white and red, and very sweet and
+      strong also.&rdquo; This of our wild grape, a little vegetable Indian, which
+      scalps a civilized man's mouth, as his animal representative scalps his
+      cranium. But there is something quite charming in Winslow's picture of the
+      luxury in which they are living. Lobsters, oysters, eels, mussels, fish
+      and fowl, delicious fruit, including the grapes aforesaid,&mdash;if they
+      only had &ldquo;kine, horses, and sheep,&rdquo; he makes no question but men would
+      live as contented here as in any part of the world. We cannot help
+      admiring the way in which they took their trials, and made the most of
+      their blessings.
+    </p>
+    <p>
+      &ldquo;And how Content they were,&rdquo; says Cotton Mather, &ldquo;when an Honest Man, as I
+      have heard, inviting his Friends to a Dish of Clams, at the Table gave
+      Thanks to Heaven, who had given them to suck the abundance of the Seas,
+      and of the Treasures Hid in the Sands!&rdquo;
+     </p>
+    <p>
+      Strangely enough, as it would seem, except for this buoyant determination
+      to make the best of everything, they hardly appear to recognize the
+      difference of the climate from that which they had left. After almost
+      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 a difference), is sharper
+      and longer; but yet he may be deceived by the want of the comforts he
+      enjoyed at home. He cannot conceive any climate to agree better with the
+      constitution of the English, not being oppressed with extremity of heats,
+      nor nipped by biting cold:
+    </p>
+    <p>
+      &ldquo;By which means, blessed be God, we enjoy our health, notwithstanding
+      those difficulties we have undergone, in such a measure as would have been
+      admired, if we had lived in England with the like means.&rdquo;
+     </p>
+    <p>
+      Edward Johnson, after mentioning the shifts to which they were put for
+      food, says,&mdash;
+    </p>
+    <p>
+      &ldquo;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 their fill of bread.&rdquo;
+     </p>
+    <p>
+      Higginson, himself a dyspeptic, &ldquo;continually in physic,&rdquo; as he says, and
+      accustomed to dress in thick clothing, and to comfort his stomach with
+      drink that was &ldquo;both strong and stale,&rdquo;&mdash;the &ldquo;jolly good ale and
+      old,&rdquo; I suppose, of free and easy Bishop Still's song,&mdash;found that he
+      both could and did oftentimes drink New England water very well,&mdash;which
+      he seems to look upon as a remarkable feat. He could go as lightclad as
+      any, too, with only a light stuff cassock upon his shirt, and stuff
+      breeches without linings. Two of his children were sickly: one,&mdash;little
+      misshapen Mary,&mdash;died on the passage, and, in her father's words,
+      &ldquo;was the first in our ship that was buried in the bowels of the great
+      Atlantic sea;&rdquo; the other, who had been &ldquo;most lamentably handled&rdquo; by
+      disease, recovered almost entirely &ldquo;by the very wholesomeness of the air,
+      altering, digesting, and drying up the cold and crude humors of the body.&rdquo;
+       Wherefore, he thinks it a wise course for all cold complexions to come to
+      take physic in New England, and ends with those often quoted words, that
+      &ldquo;a sup of New England's air is better than a whole draught of Old
+      England's ale.&rdquo; Mr. Higginson died, however, &ldquo;of a hectic fever,&rdquo; a little
+      more than a year after his arrival.
+    </p>
+    <p>
+      The medical records which I shall cite show that the colonists were not
+      exempt from the complaints of the Old World. Besides the common diseases
+      to which their descendants are subject, there were two others, to say
+      nothing of the dreaded small-pox, which later medical science has
+      disarmed,&mdash;little known among us at the present day, but frequent
+      among the first 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 into discontent, and lingered after their former
+      conditions in England; the poor homesick creatures in fact, whom we so
+      forget in our florid pictures of the early times of the little band in the
+      wilderness. Many who were suffering from scurvy got well when the Lyon
+      arrived from England, bringing store of juice of lemons. The Governor
+      speaks of another case in 1644; and it seems probable that the disease was
+      not of rare occurrence.
+    </p>
+    <p>
+      The other complaint from which they suffered, but which has nearly
+      disappeared from among us, was intermittent fever, or fever and ague. I
+      investigated the question as to the prevalence of this disease in New
+      England, in a dissertation, which was published in a 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 &ldquo;Old Men's Tears,&rdquo; dated
+      1691, speaks of &ldquo;shaking agues,&rdquo; as among the trials to which they had
+      been subjected. The outline map of New England, accompanying the
+      dissertation above referred to, indicates all the places where I had
+      evidence that the disease had originated. It was plain enough that it used
+      to be known in many localities where it has long ceased to be feared.
+      Still it was and is remarkable to see what a clean bill of health in this
+      particular respect our barren soil inherited with its sterility. There are
+      some malarious spots on the edge of Lake Champlain, and there have been
+      some temporary centres of malaria, within the memory of man, on one or
+      more of our Massachusetts rivers, but these are harmless enough, for the
+      most part, unless the millers dam them, when they are apt to retaliate
+      with a whiff from their meadows, that sets the whole neighborhood shaking
+      with fever and ague.
+    </p>
+    <p>
+      The Pilgrims of the Mayflower had with them a good physician, 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 and bad
+      food, and, probably enough, desperate homesickness in some of the feebler
+      sort, from doing their work. No detailed record remains of what they
+      suffered or what was attempted for their relief during the first sad
+      winter. The graves of those who died were levelled and sowed with grain
+      that the losses of the little band might not be suspected by the savage
+      tenants of the wilderness, and their story remains untold.
+    </p>
+    <p>
+      Of Dr. Fuller's practice, at a later period, we have an account in a
+      letter of his to Governor Bradford, dated June, 1630. &ldquo;I have been to
+      Matapan&rdquo; (now Dorchester), he says, &ldquo;and let some twenty of those people
+      blood.&rdquo; Such wholesale depletion as this, except with avowed homicidal
+      intent, is quite unknown in these days; though I once saw the noted French
+      surgeon, Lisfranc, in a fine phlebotomizing frenzy, order some ten or
+      fifteen patients, taken almost indiscriminately, to be bled in a single
+      morning.
+    </p>
+    <p>
+      Dr. Fuller's two visits to Salem, at the request of Governor Endicott,
+      seem to have been very satisfactory to that gentleman. Morton, the wild
+      fellow of Merry Mount, gives a rather questionable reason for the
+      Governor's being so well pleased with the physician's doings. The names
+      under which he mentions the two personages, it will be seen, are not
+      intended to be complimentary. &ldquo;Dr. Noddy did a great cure for Captain
+      Littleworth. He cured him of a disease called a wife.&rdquo; William Gager, who
+      came out with Winthrop, is spoken of as &ldquo;a right godly man and skilful
+      chyrurgeon, but died of a malignant fever not very long after his
+      arrival.&rdquo;
+     </p>
+    <p>
+      Two practitioners of the ancient town of Newbury are entitled to special
+      notice, for different reasons. The first is Dr. John Clark, who is said by
+      tradition to have been the first regularly educated physician who resided
+      in New England. His portrait, in close-fitting skull-cap, with long locks
+      and venerable flowing beard, is familiar to our eyes on the wall of our
+      Society's antechamber. His left hand rests upon a skull, his right hand
+      holds an instrument which deserves a passing comment. It is a trephine, a
+      surgical implement for cutting round pieces out of broken skulls, so as to
+      get at the fragments which have been driven in, and lift them up. It has a
+      handle like that of a gimlet, with a claw like a hammer, to lift with, I
+      suppose, which last contrivance I do not see figured in my books. But the
+      point I refer to is this: the old instrument, the trepan, had a handle
+      like a wimble, what we call a brace or bit-stock. The trephine is not
+      mentioned at all in Peter Lowe's book, London, 1634; nor in Wiseman's
+      great work on Surgery, London, 1676; nor in the translation of 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 of the last
+      century. As John Clark died in 1661, it is remarkable to see the last
+      fashion in the way of skull-sawing contrivances in his hands,&mdash;to say
+      nothing of the claw on the handle, and a Hey's saw, so called in England,
+      lying on the table by him, and painted there more than a hundred years
+      before Hey was born. This saw is an old invention, perhaps as old as
+      Hippocrates, and may be seen figured in the &ldquo;Armamentarium Chirurgicum&rdquo; of
+      Scultetus, or in the Works of Ambroise Pare.
+    </p>
+    <p>
+      Dr. Clark is said to have received a diploma before he 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 more or less traditional authority,
+      give us the feeling that the people of Newbury, and afterwards of Boston,
+      had a wise and skilful medical adviser and surgeon in Dr. John Clark.
+    </p>
+    <p>
+      The venerable town of Newbury had another physician who was less
+      fortunate. The following is a court record of 1652:
+    </p>
+    <p>
+      &ldquo;This is to certify whom it may concern, that we the subscribers, being
+      called upon to testify against doctor William Snelling for words by him
+      uttered, affirm that being in way of merry discourse, a health being drank
+      to all friends, he answered,
+    </p>
+<pre xml:space="preserve">
+  &ldquo;I'll pledge my friends,
+   And for my foes
+   A plague for their heels
+   And,'&mdash;&mdash;
+</pre>
+    <p>
+      [a similar malediction on the other extremity of their feet.]
+    </p>
+    <p>
+      &ldquo;Since when he hath affirmed that he only intended the proverb used in the
+      west country, nor do we believe he intended otherwise.
+    </p>
+    <p>
+      &ldquo;[Signed] WILLIAM THOMAS.
+    </p>
+    <p>
+      &ldquo;THOMAS MILWARD.&rdquo;
+     </p>
+    <p>
+      &ldquo;March 12th 1651, All which I acknowledge, and am sorry I did not expresse
+      my intent, or that I was so weak as to use so foolish a proverb.
+    </p>
+    <p>
+      &ldquo;[Signed] GULIELMUS SNELLING.&rdquo;
+     </p>
+    <p>
+      Notwithstanding this confession and apology, the record tells us that
+      &ldquo;William Snelling in his presentment for cursing is fined ten shillings
+      and the fees of court.&rdquo;
+     </p>
+    <p>
+      I will mention one other name among those of the Fathers of the medical
+      profession in New England. The &ldquo;apostle&rdquo; Eliot says, writing in 1647, &ldquo;We
+      never had but one anatomy in the country, which Mr. Giles Firman, now in
+      England, did make and read upon very well.&rdquo;
+     </p>
+    <p>
+      Giles Firmin, as the name is commonly spelled, practised physic in this
+      country for a time. He seems to have found it a poor business; for, in a
+      letter to Governor Winthrop, he says, &ldquo;I am strongly sett upon to studye
+      divinitie: my studyes else must be lost, for physick is but a meene
+      helpe.&rdquo;
+     </p>
+    <p>
+      Giles Firmin's Lectures on Anatomy were the first scientific teachings of
+      the New World. While the Fathers were enlightened enough to permit such
+      instructions, they were severe in dealing with quackery; for, in 1631, our
+      court records show that one Nicholas Knopp, or Knapp, was sentenced to be
+      fined or whipped &ldquo;for taking upon him to cure the scurvey by a water of
+      noe worth nor value, which he solde att a very deare rate.&rdquo; Empty purses
+      or sore backs would be common with us to-day if such a rule were enforced.
+    </p>
+    <p>
+      Besides the few worthies spoken of, and others whose names I have not
+      space to record, we must remember that there were many clergymen who took
+      charge of the bodies as well as the souls of their patients, among them
+      two Presidents of Harvard College, Charles Chauncy and Leonard Hoar,&mdash;and
+      Thomas Thacher, first minister of the &ldquo;Old South,&rdquo; author of the earliest
+      medical treatises printed in the country, [A Brief Rule to Guide the Common
+      People in Small pox and Measles. 1674.] whose epitaph in Latin and Greek,
+      said to have been written by Eleazer, an &ldquo;Indian Youth&rdquo; and a member of
+      the Senior Class of Harvard College, may be found in the &ldquo;Magnalia.&rdquo; I
+      miss this noble savage's name in our triennial catalogue; and as there is
+      many a slip between the cup and lip, one is tempted to guess that he may
+      have lost his degree by some display of his native instinct,&mdash;possibly
+      a flourish of the tomahawk or scalping-knife. However this may have been,
+      the good man he celebrated was a notable instance of the Angelical
+      Conjunction, as the author of the &ldquo;Magnalia&rdquo; calls it, of the offices of
+      clergyman and medical practitioner.
+    </p>
+    <p>
+      Michael Wigglesworth, author of the &ldquo;Day of Doom,&rdquo; attended the sick, &ldquo;not
+      only as a Pastor, but as a Physician too, and this, not only in his own
+      town, but also in all those of the vicinity.&rdquo; Mather says of the sons of
+      Charles Chauncy, &ldquo;All of these did, while they had Opportunity, Preach the
+      Gospel; and most, if not all of them, like their excellent Father before
+      them, had an eminent skill in physick added unto their other
+      accomplishments,&rdquo; etc. Roger Williams is said to have saved many in a kind
+      of pestilence which swept away many Indians.
+    </p>
+    <p>
+      To these names must be added, as sustaining a certain relation to the
+      healing art, that of the first Governor Winthrop, who is said by John
+      Cotton to have been &ldquo;Help for our Bodies by Physick [and] for our Estates
+      by Law,&rdquo; and that of his son, the Governor of Connecticut, who, as we
+      shall see, was as much physician as magistrate.
+    </p>
+    <p>
+      I had submitted to me for examination, in 1862, a manuscript found among
+      the Winthrop Papers, marked with the superscription, &ldquo;For my worthy friend
+      Mr. Wintrop,&rdquo; dated in 1643, London, signed Edward Stafford, and
+      containing medical directions and prescriptions. It may be remembered by
+      some present that I wrote a report on this paper, which was published in
+      the &ldquo;Proceedings&rdquo; of this Society. Whether the paper was written for
+      Governor John Winthrop of Massachusetts, or for his son, Governor John of
+      Connecticut, there is no positive evidence that I have been able to
+      obtain. It is very interesting, however, as giving short and simple
+      practical directions, such as would be most like to be wanted and most
+      useful, in the opinion of a physician in repute of that day.
+    </p>
+    <p>
+      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. The remedies are of three
+      kinds: simples, such as St. John's wort, Clown's all-heal, elder, parsley,
+      maidenhair, mineral drugs, such as lime, saltpetre, Armenian bole, crocus
+      metallorum, or sulphuret of antimony; and thaumaturgic or mystical, of
+      which the chief is, &ldquo;My black powder against the plague, small-pox;
+      purples, all sorts of feavers; Poyson; either, by Way of Prevention or
+      after Infection.&rdquo; This marvellous remedy was made by putting live toads
+      into an earthen pot so as to half fill it, and baking and burning them &ldquo;in
+      the open ayre, not in an house,&rdquo;&mdash;concerning which latter possibility
+      I suspect Madam Winthrop would have had something to say,&mdash;until they
+      could be reduced by pounding, first into a brown, and then into a black,
+      powder. Blood-letting in some inflammations, fasting in the early stage of
+      fevers, and some of those peremptory drugs with which most of us have been
+      well acquainted in our time, the infragrant memories of which I will not
+      pursue beyond this slight allusion, are among his remedies.
+    </p>
+    <p>
+      The Winthrops, to one of whom Dr. Stafford's directions were addressed,
+      were the medical as well as the political advisers of their
+      fellow-citizens for three or four successive generations. One of them,
+      Governor John of Connecticut, practised so extensively, that, but for his
+      more distinguished title in the State, he would have been remembered as
+      the Doctor. The fact that he practised in another colony, for the most
+      part, makes little difference in the value of the records we have of his
+      medical experience, which have fortunately been preserved, and give a very
+      fair idea, in all probability, of the way in which patients were treated
+      in Massachusetts, when they fell into intelligent and somewhat educated
+      hands, a little after the middle of the seventeenth century:
+    </p>
+    <p>
+      I have before me, while writing, a manuscript collection of the medical
+      cases treated by him, and recorded at the time in his own hand, which has
+      been intrusted to me by our President, his descendant.
+    </p>
+    <p>
+      They are generally marked Hartford, and extend from the year 1657 to 1669.
+      From these, manuscripts, and from the letters printed in the Winthrop
+      Papers published by our Society, I have endeavored to obtain some idea of
+      the practice of Governor John Winthrop, Junior. The learned eye of Mr.
+      Pulsifer would have helped me, no doubt, as it has done in other cases;
+      but I have ventured this time to attempt finding my own way among the
+      hieroglyphics of these old pages. By careful comparison of many
+      prescriptions, and by the aid of Schroder, Salmon, Culpeper, and other old
+      compilers, I have deciphered many of his difficult paragraphs with their
+      mysterious recipes.
+    </p>
+    <p>
+      The Governor employed a number of the simples dear to ancient women,
+      &mdash;elecampane and elder and wormwood and anise and the rest; but he
+      also employed certain mineral remedies, which he almost always indicates
+      by their ancient symbols, or by a name which should leave them a mystery
+      to the vulgar. I am now prepared to reveal the mystic secrets of the
+      Governor's beneficent art, which rendered so many good and great as well
+      as so many poor and dependent people his debtors,&mdash;at least, in their
+      simple belief,&mdash;for their health and their lives.
+    </p>
+    <p>
+      His great remedy, which he gave oftener than any other, was nitre; which
+      he ordered in doses of twenty or thirty grains to adults, and of three
+      grains to infants. Measles, colics, sciatica, headache, giddiness, and
+      many other ailments, all found themselves treated, and I trust bettered,
+      by nitre; a pretty safe medicine in moderate doses, and one not likely to
+      keep the good Governor awake at night, thinking whether it might not kill,
+      if it did not cure. We may say as much for spermaceti, which he seems to
+      have considered &ldquo;the sovereign'st thing on earth&rdquo; for inward bruises, and
+      often prescribes after falls and similar injuries.
+    </p>
+    <p>
+      One of the next remedies, in point of frequency, which he was in the habit
+      of giving, was (probably diaphoretic) antimony; a mild form of that very
+      active metal, and which, mild as it was, left his patients very commonly
+      with a pretty strong conviction that they had been taking 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 dose of
+      rhubarb or jalap; a taste of stinging horseradish, oftener of warming
+      guiacum; sometimes an anodyne, in the shape of mithridate,&mdash;the
+      famous old farrago, which owed its virtue to poppy juice; [This is the
+      remedy which a Boston divine tried to simplify. See Electuarium Novum
+      Alexipharmacum, by Rev. Thomas Harward, lecturer at the Royal Chappell.
+      Boston, 1732. This tract is in our Society's library.] very often, a
+      harmless powder of coral; less frequently, an inert prescription of
+      pleasing amber; and (let me say it softly within possible hearing of his
+      honored descendant), twice or oftener,&mdash;let us hope as a last resort,&mdash;an
+      electuary of millipedes,&mdash;sowbugs, if we must give them their homely
+      English name. One or two other prescriptions, of the many unmentionable
+      ones which disgraced the pharmacopoeia of the seventeenth century, are to
+      be found, but only in very rare instances, in the faded characters of the
+      manuscript.
+    </p>
+    <p>
+      The excellent Governor's accounts of diseases are so brief, that we get
+      only a very general notion of the complaints for which he prescribed.
+      Measles and their consequences are at first more prominent than any other
+      one affection, but the common infirmities of both sexes and of all ages
+      seem to have come under his healing hand. Fever and ague appears to have
+      been of frequent occurrence.
+    </p>
+    <p>
+      His published correspondence shows that many noted people were in
+      communication with him as his patients. Roger Williams wants a little of
+      his medicine for Mrs. Weekes's daughter; worshipful John Haynes is in
+      receipt of his powders; troublesome Captain Underhill wants &ldquo;a little
+      white vitterall&rdquo; for his wife, and something to cure his wife's friend's
+      neuralgia, (I think his wife's friend's husband had a little rather have
+      had it sent by the hands of Mrs. Underhill, than by those of the gallant
+      and discursive captain); and pious John Davenport says, his wife &ldquo;tooke
+      but one halfe of one of the papers&rdquo; (which probably contained the medicine
+      he called rubila), &ldquo;but could not beare the taste of it, and is
+      discouraged from taking any more;&rdquo; and honored William Leete asks for more
+      powders for his &ldquo;poore little daughter Graciana,&rdquo; though he found it &ldquo;hard
+      to make her take it,&rdquo; delicate, and of course sensitive, child as she was,
+      languishing and dying before her time, in spite of all the bitter things
+      she swallowed,&mdash;God help all little children in the hands of dosing
+      doctors and 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 relief he
+      has obtained from the Governor's prescriptions, wondering how &ldquo;a thing so
+      little in quantity, so little in sent, so little in taste, and so little
+      to sence in operation, should beget and bring forth such efects,&rdquo; that we
+      repent our hasty exclamation, and bless the memory of the good Governor,
+      who gave relief to the worn-out frame of our long-departed brother, the
+      sturdy old heretic of Rhode Island.
+    </p>
+    <p>
+      What was that medicine which so frequently occurs in the printed letters
+      under the name of &ldquo;rubila&rdquo;? It is evidently a secret remedy, and, so far
+      as I know, has not yet been made out. I had almost given it up in despair,
+      when I found what appears to be a key to the mystery. In the vast
+      multitude of prescriptions contained in the manuscripts, most of them
+      written in symbols, I find one which I thus interpret:
+    </p>
+    <p>
+      &ldquo;Four grains of (diaphoretic) antimony, with twenty grains of nitre, with
+      a little salt of tin, making rubila.&rdquo; Perhaps something was added to
+      redden the powder, as he constantly speaks of &ldquo;rubifying&rdquo; or &ldquo;viridating&rdquo;
+       his prescriptions; a very common practice of prescribers, when their
+      powders look a little too much like plain salt or sugar.
+    </p>
+    <p>
+      Waitstill Winthrop, the Governor's son, &ldquo;was a skilful physician,&rdquo; says
+      Mr. Sewall, in his funeral sermon; &ldquo;and generously gave, not only his
+      advice, but also his Medicines, for the healing of the Sick, which, by the
+      Blessing of God, were made successful for the recovery of many.&rdquo; &ldquo;His son
+      John, a member of the Royal Society, speaks of himself as 'Dr. Winthrop,'
+      and mentions one of his own prescriptions in a letter to Cotton Mather.&rdquo;
+       Our President tells me that there was an heirloom of the ancient skill in
+      his family, within his own remembrance, in the form of a certain precious
+      eye-water, to which the late President John Quincy Adams ascribed rare
+      virtue, and which he used to obtain from the possessor of the ancient
+      recipe.
+    </p>
+    <p>
+      These inherited prescriptions are often treasured in 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 Cambridgeport
+      schoolmates used to call the &ldquo;ager,&rdquo;&mdash;meaning thereby toothache or
+      face-ache,&mdash;I used to get relief from a certain plaster which never
+      went by any other name in the family than &ldquo;Dr. Oliver.&rdquo;
+     </p>
+    <p>
+      Dr. James Oliver was my great-great-grandfather, graduated in 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 particular medicine,
+      or other possession or secret, and physicians in old times used to keep
+      their choice recipes to themselves a good deal, as we have had occasion to
+      see.
+    </p>
+    <p>
+      Some years ago I found among my old books a small manuscript marked &ldquo;James
+      Oliver. This Book Begun Aug. 12, 1685.&rdquo; It is a rough sort of
+      account-book, containing among other things prescriptions for patients,
+      and charges for the same, with counter-charges for the purchase of
+      medicines and other matters. Dr. Oliver practised in Cambridge, where may
+      be seen his tomb with inscriptions, and with sculptured figures that look
+      more like Diana of the Ephesians, as given in Calmet's Dictionary, than
+      like any angels admitted into good society here or elsewhere.
+    </p>
+    <p>
+      I do not find any particular record of what his patients suffered from,
+      but I have carefully copied out the remedies he mentions, and find that
+      they form a very respectable catalogue. Besides the usual simples, elder,
+      parsley, fennel, saffron, snake-root, wormwood, I find the Elixir
+      Proprietatis, with other elixire and cordials, as if he rather fancied
+      warming medicines; but he called in the aid of some of the more energetic
+      remedies, including iron, and probably mercury, as he bought two pounds of
+      it at one time.
+    </p>
+    <p>
+      The most interesting item is his bill against the estate of Samuel Pason
+      of Roxbury, for services during his last illness. He attended this
+      gentleman,&mdash;for such he must have been, by the amount of physic which
+      he took, and which his heirs paid for,&mdash;from June 4th, 1696, to
+      September 3d of the same year, three months. I observe he charges for
+      visits as well as for medicines, which is not the case in most of his
+      bills. He opens the attack with a carminative appeal to the visceral
+      conscience, and follows it up with good hard-hitting remedies for dropsy,&mdash;as
+      I suppose the disease would have been called,&mdash;and finishes off with
+      a rallying dose of hartshorn and iron.
+    </p>
+    <p>
+      It is a source of honest pride to his descendant that his bill, which was
+      honestly paid, as it seems to have been honorably earned, amounted to the
+      handsome total of seven pounds and two shillings. Let me add that he
+      repeatedly prescribes plaster, one of which was very probably the &ldquo;Dr.
+      Oliver&rdquo; that soothed my infant griefs, and for which I blush to say that
+      my venerated ancestor received from Goodman Hancock the painfully exiguous
+      sum of no pounds, no shillings, and sixpence.
+    </p>
+    <p>
+      I have illustrated the practice of the first century, from the two
+      manuscripts I have examined, as giving an impartial idea of its every-day
+      methods. The Governor, Johannes Secundus, it is fair to remember, was an
+      amateur practitioner, while my ancestor was a professed physician.
+      Comparing their modes of treatment with the many scientific follies still
+      prevailing in the Old World, and still more with the extraordinary
+      theological superstitions of the community in which they lived, we shall
+      find reason, I think, to consider the art of healing as in a comparatively
+      creditable state during the first century of New England.
+    </p>
+    <p>
+      In addition to the evidence as to methods of treatment furnished by the
+      manuscripts I have cited, I subjoin the following document, to which my
+      attention was called by Dr. Shurtleff, our present Mayor. This is a letter
+      of which the original is to be found in vol. lxix. page 10 of the
+      &ldquo;Archives&rdquo; preserved at the State House in Boston. It will be seen that
+      what the surgeon wanted consisted chiefly of opiates, stimulants,
+      cathartics, plasters, and materials for bandages. The complex and varied
+      formulae have given place to simpler and often more effective forms of the
+      same remedies; but the list and the manner in which it is made out are
+      proofs of the good sense and 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 upon which he wrote, a great body of
+      Indians&mdash;supposed to be six or seven hundred&mdash;appeared before
+      Hatfield; and twenty-five resolute young men of Hadley, from which town he
+      wrote, crossed the river and drove them away.
+    </p>
+    <p>
+      HADLY May 30: 76
+    </p>
+    <p>
+      Mr RAWSON Sr
+    </p>
+    <p>
+      What we have recd by Tho: Houey the past month is not the chiefest of our
+      wants as you have love for poor wounded I pray let us not want for these
+      following medicines if you have not a speedy conveyance of them I pray
+      send on purpose they are those things mentioned in my former letter but to
+      prevent future mistakes I have wrote them att large wee have great want
+      with the greatest halt and speed let us be supplyed. Sr Yr Sert WILL
+      LOCHS.
+    </p>
+    <p>
+      (Endorsed)
+    </p>
+    <p>
+      Mr. Lockes Letter Recd from the Governor 13 Jane &amp; acquainted ye
+      Council with it but could not obtaine any thing to be sent in answer
+      thereto. 13 June 1676.
+    </p>
+    <p>
+      I have given some idea of the chief remedies used by our earlier
+      physicians, which were both Galenic and chemical; that is, vegetable and
+      mineral. They, of course, employed the usual perturbing medicines which
+      Montaigne says are the chief reliance of their craft. There were,
+      doubtless, individual practitioners who employed special remedies with
+      exceptional boldness and perhaps success. Mr. Eliot is spoken of, in a
+      letter of William Leete to Winthrop, Junior, as being under Mr.
+      Greenland's mercurial administrations. The latter was probably enough one
+      of these specialists.
+    </p>
+    <p>
+      There is another class of remedies which appears to have been employed
+      occasionally, but, on the whole, is so little prominent as to imply a good
+      deal of common sense among the medical practitioners, as compared with 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 incredible fact that they were
+      retained in the materia medica so late as when Rees's Cyclopaedia was
+      published, and we there find the directions formerly given by the College
+      of Edinburgh for their preparation. Once or twice we have found him
+      admitting still more objectionable articles into his materia medica; in
+      doing which, I am sorry to say that he could plead grave and learned
+      authority. But these instances are very rare exceptions in a medical
+      practice of many years, which is, on the whole, very respectable,
+      considering the time and circumstances.
+    </p>
+    <p>
+      Some remedies of questionable though not odious character appear
+      occasionally to have been employed by the early practitioners, but they
+      were such as still had the support of the medical profession. Governor
+      John Winthrop, the first, sends for East Indian bezoar, with other
+      commodities he is writing for. Governor Endicott sends him one he had of
+      Mr. Humfrey. I hope it was genuine, for they cheated infamously in the
+      matter of this concretion, which ought to come out of an animal's stomach,
+      but the real history of which resembles what is sometimes told of modern
+      sausages.
+    </p>
+    <p>
+      There is a famous law-case of James the First's time, in which a goldsmith
+      sold a hundred pounds' worth of what he called bezoar, which was proved to
+      be false, and the purchaser got a verdict against him. Governor Endicott
+      also sends Winthrop a unicorn's horn, which was the property of a certain
+      Mrs. Beggarly, who, in spite of her name, seems to have been rich in
+      medical knowledge and possessions. The famous Thomas Bartholinus wrote a
+      treatise on the virtues of this fabulous-sounding remedy, which was
+      published in 1641, and republished in 1678.
+    </p>
+    <p>
+      The &ldquo;antimonial cup,&rdquo; a drinking vessel made of that metal, which, like
+      our quassia-wood cups, might be filled and emptied in saecula saeculorum
+      without exhausting its virtues, is mentioned by Matthew Cradock, in a
+      letter to the elder Winthrop, but in a doubtful way, as it was thought, he
+      says, to have shortened the days of Sir Nathaniel Riche; and Winthrop
+      himself, as I think, refers to its use, calling it simply &ldquo;the cup.&rdquo; An
+      antimonial cup is included in the inventory of Samuel Seabury, who died
+      1680, and is valued at five shillings. There is a treatise entitled &ldquo;The
+      Universall Remedy, or the Vertues of the Antimoniall Cup, By John Evans,
+      Minister and Preacher of God's Word, London, 1634,&rdquo; in our own Society's
+      library.
+    </p>
+    <p>
+      One other special remedy deserves notice, because of native growth. I do
+      not know when Culver's root, Leptandra Virginica of our National
+      Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to John
+      Winthrop of New London, speaks of it as famous for the cure of
+      consumptions, and wishes to get some of it, through his mediation, for
+      Katharine, his eldest daughter. He gets it, and gives it to the &ldquo;poor
+      damsel,&rdquo; who is languishing, as he says, and who dies the next month,&mdash;all
+      the sooner, I have little doubt, for this uncertain and violent drug, with
+      which the meddlesome pedant tormented her in that spirit of well-meant but
+      restless quackery, which could touch nothing without making mischief, not
+      even a quotation, and yet proved at length the means of bringing a great
+      blessing to our community, as we shall see by and by; so does Providence
+      use our very vanities and infirmities for its wise purposes.
+    </p>
+    <p>
+      Externally, I find the practitioners on whom I have chiefly relied used
+      the plasters of Paracelsus, of melilot, diachylon, and probably
+      diaphoenicon, all well known to the old pharmacopoeias, and some of them
+      to the modern ones,&mdash;to say nothing of &ldquo;my yellow salve,&rdquo; of Governor
+      John, the second, for the composition of which we must apply to his
+      respected descendant.
+    </p>
+    <p>
+      The authors I find quoted are Barbette's Surgery, Camerarius on Gout, and
+      Wecherus, of all whom notices may be found in the pages of Haller and
+      Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's Practice of
+      Physic and Anatomy, the last as belonging to Samuel Seabury, chirurgeon,
+      before mentioned. Nicholas Culpeper was a shrewd charlatan, and as
+      impudent a varlet as ever prescribed for a colic; but knew very well what
+      he was about, and badgers the College with great vigor. A copy of
+      Spigelius's famous Anatomy, in the Boston Athenaeum, has the names of
+      Increase and Samuel Mather written in it, and was doubtless early
+      overhauled by the youthful Cotton, who refers to the great anatomist's
+      singular death, among his curious stories in the &ldquo;Magnalia,&rdquo; and quotes
+      him among nearly a hundred authors whom he cites in his manuscript &ldquo;The
+      Angel of Bethesda.&rdquo; Dr. John Clark's &ldquo;books and instruments, with several
+      chirurgery materials in the closet,&rdquo; were valued in his inventory at
+      sixty pounds; Dr. Matthew Fuller, who died in 1678, left a library valued
+      at ten pounds; and a surgeon's chest and drugs valued at sixteen pounds.'
+    </p>
+    <p>
+      Here we leave the first century and all attempts at any further detailed
+      accounts of medicine and its practitioners. It is necessary to show in a
+      brief glance what had been going on in Europe during the latter part of
+      that century, the first quarter of which had been made illustrious in the
+      history of medical science by the discovery of the circulation.
+    </p>
+    <p>
+      Charles Barbeyrac, a Protestant in his religion, was a 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, until it
+      becomes hard to tell the family of one from that of the other. Barbeyrac
+      threw overboard the old complex medical farragos of the pharmacopoeias, as
+      his church had disburdened itself of the popish ceremonies.
+    </p>
+    <p>
+      Among the students who followed his instructions were two Englishmen: one
+      of them, John Locke, afterwards author of an &ldquo;Essay on the Human
+      Understanding,&rdquo; three years younger than his teacher; the other, Thomas
+      Sydenham, five years older. Both returned to England. Locke, whose medical
+      knowledge is borne witness to by Sydenham, had the good fortune to form a
+      correct opinion on a disease from which the Earl of Shaftesbury was
+      suffering, which led to an operation that saved his life. Less felicitous
+      was his experience with a certain ancilla culinaria virgo,&mdash;which I
+      am afraid would in those days have been translated kitchen-wench, instead
+      of lady of the culinary department,&mdash;who turned him off after she had
+      got tired of him, and called 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, and took to other studies.
+    </p>
+    <p>
+      The name of Thomas Sydenham is as distinguished in the history of medicine
+      as that of John Locke in philosophy. As Barbeyrac was found in opposition
+      to the established religion, as Locke took the rational side against
+      orthodox Bishop Stillingfleet, so Sydenham went with Parliament against
+      Charles, and was never admitted a Fellow by the College of Physicians,
+      which, after he was dead, placed his bust in their hall by the side of
+      that of Harvey.
+    </p>
+    <p>
+      What Sydenham did for medicine was briefly this: he studied the course of
+      diseases carefully, and especially as affected by the particular season;
+      to patients with fever he gave air and cooling drinks, instead of
+      smothering and heating them, with the idea of sweating out their disease;
+      he ordered horseback exercise to consumptives; he, like his teacher, used
+      few and comparatively simple remedies; he did not give any drug at all, if
+      he thought none was needed, but let well enough alone. He was a sensible
+      man, in short, who applied his common sense to diseases which he had
+      studied with the best light of science that he could obtain.
+    </p>
+    <p>
+      The influence of the reform he introduced must have been more or less felt
+      in this country, but not much before the beginning of the eighteenth
+      century, as his great work was not published until 1675, and then in
+      Latin. I very strongly suspect that there was not so much to reform in the
+      simple practice of the physicians of the new community, as there was in
+      that of the learned big-wigs of the &ldquo;College,&rdquo; who valued their remedies
+      too much in proportion to their complexity, and the extravagant and
+      fantastic ingredients which went to their making.
+    </p>
+    <p>
+      During the memorable century which bred and bore the Revolution, the
+      medical profession gave great names to our history. But John Brooks
+      belonged to the State, and Joseph Warren belongs to the country and
+      mankind, and to speak of them would lead me beyond my limited subject.
+      There would be little pleasure in dwelling on the name of Benjamin Church;
+      and as for the medical politicians, like Elisha Cooke in the early part of
+      the century, or Charles Jarvis, the bald eagle of Boston, in its later
+      years, whether their practice was heroic or not, their patients were, for
+      he is a bold man who trusts one that is making speeches and coaxing
+      voters, to meddle with the internal politics of his corporeal republic.
+    </p>
+    <p>
+      One great event stands out in the medical history of this eighteenth
+      century; namely, the introduction of the practice of inoculation for
+      small-pox. Six epidemics of this complaint had visited Boston in the
+      course of a hundred years. Prayers had been asked in the churches for more
+      than a hundred sick in a single day, and this many times. About a thousand
+      persons had died in a twelvemonth, we are told, and, as we may infer,
+      chiefly from this cause.
+    </p>
+    <p>
+      In 1721, this disease, after a respite of nineteen years, again appeared
+      as an epidemic. In that year it was that Cotton Mather, browsing, as was
+      his wont, on all the printed fodder that came within reach of his
+      ever-grinding mandibles, came upon an account of inoculation as practised
+      in Turkey, contained in the &ldquo;Philosophical Transactions.&rdquo; He spoke of it
+      to several physicians, who paid little heed 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 &ldquo;Angel of Bethesda,&rdquo; and satiated with his
+      speculations on the Nishmath Chajim.
+    </p>
+    <p>
+      The Reverend Mather,&mdash;I use a mode of expression he often employed
+      when speaking of his honored brethren,&mdash;the Reverend Mather was right
+      this time, and the irreverent doctors who laughed at him were wrong. One
+      only of their number disputes his claim to giving the first impulse to the
+      practice in Boston. This is what that person says: &ldquo;The Small-Pox spread
+      in Boston, New England, 1721, and the Reverend Dr. Cotton Mather, having
+      had the use of these Communications from Dr. William Douglass (that is,
+      the writer of these words); surreptitiously, without the knowledge of his
+      Informer, that he might have the honour of a New fangled notion, sets an
+      Undaunted Operator to work, and in this Country about 290 were
+      inoculated.&rdquo;
+     </p>
+    <p>
+      All this has not deprived Cotton Mather of the credit of suggesting, and a
+      bold and intelligent physician of the honor of carrying out, the new
+      practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston of
+      Boston inoculated his only son for smallpox,&mdash;the first person ever
+      submitted to the operation in the New World. The story of the fierce
+      resistance to the introduction of the practice; of how Boylston was
+      mobbed, and Mather had a hand-grenade thrown in at his window; of how
+      William Douglass, the Scotchman, &ldquo;always positive, and sometimes
+      accurate,&rdquo; as was neatly said of him, at once depreciated the practice and
+      tried to get the credit of suggesting it, and how Lawrence Dalhonde, the
+      Frenchman, testified to its destructive consequences; of how Edmund
+      Massey, lecturer at St. Albans, preached against sinfully endeavoring to
+      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 his sermon, afterwards reprinted in Boston, many of our New
+      England clergy stood up boldly in defence of the practice,&mdash;all this
+      has been told so well and so often that I spare you its details. Set this
+      good hint of Cotton Mather against that letter of his to John Richards,
+      recommending the search after witch-marks, and the application of the
+      water-ordeal, which means throw your grandmother into the water, if she
+      has a mole on her arm;&mdash;if she swims, she is a witch and must be
+      hanged; if she sinks, the Lord have mercy on her soul!
+    </p>
+    <p>
+      Thus did America receive this great discovery, destined to save thousands
+      of lives, via Boston, from the hands of one of our own Massachusetts
+      physicians.
+    </p>
+    <p>
+      The year 1735 was rendered sadly memorable by the epidemic of the terrible
+      disease known as &ldquo;throat distemper,&rdquo; and regarded by many as the same as
+      our &ldquo;diphtheria.&rdquo; Dr. Holyoke thinks the more general use of mercurials in
+      inflammatory complaints dates from the time of their employment in this
+      disease, in which they were thought to have proved specially useful.
+    </p>
+    <p>
+      At some time in the course of this century medical practice had settled
+      down on four remedies as its chief reliance. I must repeat an incident
+      which I have related in another of these Essays. When Dr. Holyoke, nearly
+      seventy years ago, received young Mr. James Jackson as his student, he
+      showed him the formidable array of bottles, jars, and drawers around his
+      office, and then named the four remedies referred to as being of more
+      importance than all the rest put together. These were &ldquo;Mercury, Antimony,
+      Opium, and Peruvian Bark.&rdquo; I doubt if either of them remembered that,
+      nearly seventy years before, in 1730, Dr. William Douglass, the
+      disputatious Scotchman, mentioned those same four remedies, in the
+      dedication of his quarrelsome essay on inoculation, as the most important
+      ones in the hands of the physicians of his time.
+    </p>
+    <p>
+      In the &ldquo;Proceedings&rdquo; of this Society for the year 1863 is a very pleasant
+      paper by the late Dr. Ephraim Eliot, giving an account of the leading
+      physicians of Boston during the last quarter of the last century. The
+      names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth, John Warren,
+      Jeffries, are all famous in local history, and are commemorated in our
+      medical biographies. One of them, at least, appears to have been more
+      widely known, not only as one of the first aerial voyagers, but as an
+      explorer in the almost equally hazardous realm of medical theory. Dr. John
+      Jeffries, the first of that name, is considered by Broussais as a leader
+      of medical opinion in America, and so referred to in his famous &ldquo;Examen
+      des Doctrines Medicales.&rdquo;
+     </p>
+    <p>
+      Two great movements took place in this eighteenth century, the effect of
+      which has been chiefly felt in our own time; namely, the establishment of
+      the Massachusetts Medical Society, and the founding of the Medical School
+      of Harvard University.
+    </p>
+    <p>
+      The third century of our medical history began with the introduction of
+      the second great medical discovery of modern times,&mdash;of all time up
+      to that date, I may say,&mdash;once more via Boston, if we count the
+      University village as its suburb, and once more by one of our
+      Massachusetts physicians. In the month of July, 1800, Dr. Benjamin
+      Waterhouse of Cambridge submitted four of his own children to the new
+      process of vaccination,&mdash;the first persons vaccinated, as Dr. Zabdiel
+      Boylston's son had been the first person inoculated in the New World.
+    </p>
+    <p>
+      A little before the first half of this century was completed, in the
+      autumn of 1846, the great discovery went forth from the Massachusetts
+      General Hospital, which repaid the debt of America to the science of the
+      Old World, and gave immortality to the place of its origin in the memory
+      and the heart of mankind. The production of temporary insensibility at
+      will&mdash;tuto, cito, jucunde, safely, quickly, pleasantly&mdash;is one
+      of those triumphs over the infirmities of our mortal condition which
+      change the aspect of life ever afterwards. Rhetoric can add nothing to its
+      glory; gratitude, and the pride permitted to human weakness, that our
+      Bethlehem should have been chosen as the birthplace of this new embodiment
+      of the divine mercy, are all we can yet find room for.
+    </p>
+    <p>
+      The present century has seen the establishment of all those great
+      charitable institutions for the cure of diseases of the body and of the
+      mind, which our State and our city have a right to consider as among the
+      chief ornaments of their civilization.
+    </p>
+    <p>
+      The last century had very little to show, in our State, in the way of
+      medical literature. The worthies who took care of our grandfathers and
+      great-grandfathers, like the Revolutionary heroes, fought (with disease)
+      and bled (their patients) and died (in spite of their own remedies); but
+      their names, once familiar, are heard only at rare intervals. Honored in
+      their day, not unremembered by a few solitary students of the past, their
+      memories are going sweetly to sleep in the arms of the patient old
+      dry-nurse, whose &ldquo;blackdrop&rdquo; is the never-failing anodyne of the restless
+      generations of men. Except the lively controversy on inoculation, and
+      floating papers in journals, we have not much of value for that long
+      period, in the shape of medical records.
+    </p>
+    <p>
+      But while the trouble with the last century is to find authors to mention,
+      the trouble of this would be to name all that we find. Of these, a very
+      few claim unquestioned preeminence.
+    </p>
+    <p>
+      Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School of
+      our University, did a great work for the advancement of medicine and
+      surgery in New England, by his labors as teacher and author, greater, it
+      is claimed by some, than was ever done by any other man. The two Warrens,
+      of our time, each left a large and permanent record of a most extended
+      surgical practice. James Jackson not only educated a whole generation by
+      his lessons of wisdom, but bequeathed some of the most valuable results of
+      his experience to those who came after him, in a series of letters
+      singularly pleasant and kindly as well as instructive. John Ware, keen and
+      cautious, earnest and deliberate, wrote the two remarkable essays which
+      have identified his name, for all time, with two important diseases, on
+      which he has shed new light by his original observations.
+    </p>
+    <p>
+      I must do violence to the modesty of the living by referring to the many
+      important contributions to medical science by Dr. Jacob Bigelow, and
+      especially to his discourse on &ldquo;Self-limited Diseases,&rdquo; an address which
+      can be read in a single hour, but the influence of which will be felt for
+      a century.
+    </p>
+    <p>
+      Nor would the profession forgive me if I forgot to mention the admirable
+      museum of pathological anatomy, created almost entirely by the hands of
+      Dr. John Barnard Swett Jackson, and illustrated by his own printed
+      descriptive catalogue, justly spoken of by a distinguished professor in
+      the University of Pennsylvania as the most important contribution which
+      had ever been made in this country to the branch to which it relates.
+    </p>
+    <p>
+      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 Massachusetts or
+      placed at the head of her institutions for the treatment of the insane.
+    </p>
+    <p>
+      We have a right to claim also one who is known all over the civilized
+      world as a philanthropist, to us as a townsman and a graduate of our own
+      Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of a
+      great multitude who were born to a world of inward or of outward darkness.
+    </p>
+    <p>
+      I cannot pass over in silence the part taken by our own physicians in
+      those sanitary movements which are assuming every year greater importance.
+      Two diseases especially have attracted attention, above all others, with
+      reference to their causes and prevention; cholera, the &ldquo;black death&rdquo; of
+      the nineteenth century, and consumption, the white plague of the North,
+      both of which have been faithfully studied and reported on by physicians
+      of our own State and city. The cultivation of medical and surgical
+      specialties, which is fast becoming prevalent, is beginning to show its
+      effects in the literature of the profession, which is every year growing
+      richer in original observations and investigations.
+    </p>
+    <p>
+      To these benefactors who have labored for us in their peaceful vocation,
+      we must add the noble army of surgeons, who went with the soldiers who
+      fought the battles of their country, sharing many of their dangers, not
+      rarely falling victims to fatigue, disease, or the deadly volleys to which
+      they often exposed themselves in the discharge of their duties.
+    </p>
+    <p>
+      The pleasant biographies of the venerable Dr. Thacher, and the worthy and
+      kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, are
+      filled with the names of men who served their generation well, and rest
+      from their labors, followed by the blessing of those for whom they endured
+      the toils and fatigues inseparable from their calling. The hardworking,
+      intelligent country physician more especially deserves the gratitude of
+      his own generation, for he rarely leaves any permanent record in the
+      literature of his profession. Books are hard to obtain; hospitals, which
+      are always centres of intelligence, are remote; thoroughly educated and
+      superior men are separated by wide intervals; and long rides, though
+      favorable to reflection, take up much of the time which might otherwise 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 a great and
+      deserved reputation, become the oracles of large districts, and yet leave
+      nothing, or next to nothing, by which their names shall be preserved from
+      blank oblivion.
+    </p>
+    <p>
+      One or two other facts deserve mention, as showing the readiness of our
+      medical community to receive and adopt any important idea or discovery.
+      The new science of Histology, as it is now called, was first brought fully
+      before the profession of this country by the translation of Bichat's great
+      work, &ldquo;Anatomie Generale,&rdquo; by the late Dr. George Hayward.
+    </p>
+    <p>
+      The first work printed in this country on Auscultation,&mdash;that
+      wonderful art of discovering disease, which, as it were, puts a window in
+      the breast, through which the vital organs can be seen, to all intents and
+      purposes, was the manual published anonymously by &ldquo;A Member of the
+      Massachusetts Medical Society.&rdquo;
+     </p>
+    <p>
+      We are now in some slight measure prepared to weigh the record of the
+      medical profession in Massachusetts, and pass our judgment upon it. But
+      in order to do justice to the first generation of practitioners, we must
+      compare what we know of their treatment of disease with the state of the
+      art in England, and the superstitions which they saw all around them in
+      other departments of knowledge or belief.
+    </p>
+    <p>
+      English medical literature must have been at a pretty low ebb when
+      Sydenham recommended Don Quixote to Sir Richard Blackmore for professional
+      reading. The College Pharmacopoeia was loaded with the most absurd
+      compound mixtures, one of the most complex of which (the same which the
+      Reverend Mr. Harward, &ldquo;Lecturer at the Royal Chappel in Boston,&rdquo; tried to
+      simplify), was not dropped until the year 1801. Sir Kenelm Digby was
+      playing his fantastic tricks with the Sympathetic powder, and teaching
+      Governor Winthrop, the second, how to cure fever and ague, which some may
+      like to know. &ldquo;Pare the patient's nails; put the parings in a little bag,
+      and hang the bag round the neck of a live eel, and put him in a tub of
+      water. The eel will die, and the patient will recover.&rdquo;
+     </p>
+    <p>
+      Wiseman, the great surgeon, was discoursing eloquently on the efficacy of
+      the royal touch in scrofula. The founder of the Ashmolean Museum at
+      Oxford, consorting with alchemists and astrologers, was treasuring the
+      manuscripts of the late pious Dr. Richard Napier, in which certain letters
+      (Rx Ris) were understood to mean Responsum Raphaelis,&mdash;the answer of
+      the angel Raphael to the good man's medical questions. The illustrious
+      Robert Boyle was making his collection of choice and safe remedies,
+      including the sole of an old shoe, the thigh bone of a hanged man, and
+      things far worse than these, as articles of his materia medica. Dr.
+      Stafford, whose paper of directions to his &ldquo;friend, Mr. Wintrop,&rdquo; I cited,
+      was probably a man of standing in London; yet toad-powder was his
+      sovereign remedy.
+    </p>
+    <p>
+      See what was the state of belief in other matters among the most
+      intelligent persons of the colonies, magistrates and clergymen. Jonathan
+      Brewster, son of the church-elder, writes the wildest letters to John
+      Winthrop about alchemy,&mdash;&ldquo;mad for making gold as the Lynn rock-borers
+      are for finding it.&rdquo;
+     </p>
+    <p>
+      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 with an upper chamber of saints, and a tremendous opposition in
+      the lower house; the leader of which may have been equalled, but cannot
+      have been surpassed by any of our earth-born politicians. The demons were
+      prowling round the houses every night, as the foxes were sneaking about
+      the hen-roosts. The men of Gloucester fired whole flasks of gunpowder at
+      devils disguised as Indians and Frenchmen.
+    </p>
+    <p>
+      How deeply the notion of miraculous interference with the course of nature
+      was rooted, is shown by the tenacity of the superstition about
+      earthquakes. We can hardly believe that our Professor Winthrop, father of
+      the old judge and the &ldquo;squire,&rdquo; whom many of us Cambridge people remember
+      so well, had to defend himself against the learned and excellent Dr.
+      Prince, of the Old South Church, for discussing their phenomena as if they
+      belonged to the province of natural science.
+    </p>
+    <p>
+      Not for the sake of degrading the aspect of the noble men who founded our
+      State, do I refer to their idle beliefs and painful delusions, but to show
+      against what influences the common sense of the medical profession had to
+      assert itself.
+    </p>
+    <p>
+      Think, then, of the blazing stars, that shook their horrid hair in the
+      sky; the phantom ship, that brought its message direct from the other
+      world; the story of the mouse and the snake at Watertown; of the mice and
+      the prayer-book; of the snake in church; of the calf with two heads; and
+      of the cabbage in the perfect form of a cutlash,&mdash;all which innocent
+      occurrences were accepted or feared as alarming portents.
+    </p>
+    <p>
+      We can smile at these: but we cannot smile at the account of unhappy Mary
+      Dyer's malformed offspring; or of Mrs. Hutchinson's domestic misfortune of
+      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 fifteen alarming pages about an unfortunate young woman
+      suffering with hysteria. Or go a little deeper into tragedy, and see poor
+      Dorothy Talby, mad as Ophelia, first admonished, then whipped; at last,
+      taking her own little daughter's life; put on trial, and standing mute,
+      threatened to be pressed to death, confessing, sentenced, praying to be
+      beheaded; and none the less pitilessly swung from the fatal ladder.
+    </p>
+    <p>
+      The cooper's crazy wife&mdash;crazy in the belief that she has committed
+      the unpardonable sin&mdash;tries to drown her child, to save it from
+      misery; and the poor lunatic, who would be tenderly cared for to-day in a
+      quiet asylum, is judged to be acting under the instigation of Satan
+      himself. Yet, after all, what can we say, who put Bunyan's &ldquo;Pilgrim's
+      Progress,&rdquo; full of nightmare dreams of horror, into all our children's
+      hands; a story in which the awful image of the man in the cage might well
+      turn the nursery where it is read into a madhouse?
+    </p>
+    <p>
+      The miserable delusion of witchcraft illustrates, in a still more
+      impressive way, the false ideas which governed the supposed relation of
+      men with the spiritual world. I have no doubt many physicians shared in
+      these superstitions. Mr. Upham says they&mdash;that is, some of them&mdash;were
+      in the habit of attributing their want of success to the fact, that an
+      &ldquo;evil hand&rdquo; was on their patient. The temptation was strong, no doubt,
+      when magistrates and ministers and all that followed their lead were
+      contented with such an explanation. But how was it in Salem, according to
+      Mr. Upham's own statement? Dr. John Swinnerton was, he says, for many
+      years the principal physician of Salem. And he says, also, &ldquo;The Swinnerton
+      family were all along opposed to Mr. Parris, and kept remarkably clear
+      from the witchcraft delusion.&rdquo; Dr. John Swinnerton&mdash;the same, by the
+      way, whose memory is illuminated by a ray from the genius of Hawthorne&mdash;died
+      the very year before the great witchcraft explosion took place. But who
+      can doubt that it was from him that the family had learned to despise and
+      to resist the base superstition; or that Bridget Bishop, whose house he
+      rented, as Mr. Upham tells me, the first person hanged in the time of the
+      delusion, would have found an efficient protector in her tenant, had he
+      been living, to head the opposition of his family to the misguided
+      clergymen and magistrates?
+    </p>
+    <p>
+      I cannot doubt that our early physicians brought with them many Old-World
+      medical superstitions, and I have no question that they were more or less
+      involved in the prevailing errors of the community in which they lived.
+      But, on the whole, their record is a clean one, so far as we can get at
+      it; and where it is questionable we must remember that there must have
+      been many little-educated persons among them; and that all must have felt,
+      to some extent, the influence of those sincere and devoted but unsafe men,
+      the physic-practising clergymen, who often used spiritual means as a
+      substitute for temporal ones, who looked upon a hysteric patient as
+      possessed by the devil, and treated a fractured skull by prayers and
+      plasters, following the advice of a ruling elder in opposition to the
+      &ldquo;unanimous opinion of seven surgeons.&rdquo;
+     </p>
+    <p>
+      To what results the union of the two professions was liable to lead, may
+      be seen by the example of a learned and famous person, who has left on
+      record the product of his labors in the double capacity of clergyman and
+      physician.
+    </p>
+    <p>
+      I have had the privilege of examining a manuscript of Cotton Mather's
+      relating to medicine, by the kindness of the librarian of the American
+      Antiquarian Society, to which society it belongs. A brief notice of this
+      curious document may prove not uninteresting.
+    </p>
+    <p>
+      It is entitled &ldquo;The Angel of Bethesda: an Essay upon the Common Maladies
+      of Mankind, offering, first, the sentiments of Piety,&rdquo; etc., etc., and &ldquo;a
+      collection of plain but potent and Approved REMEDIES for the Maladies.&rdquo;
+       There are sixty-six &ldquo;Capsula's,&rdquo; as he calls them, or chapters, in his
+      table of contents; of which, five&mdash;from the fifteenth to the
+      nineteenth, inclusive&mdash;are missing. This is a most unfortunate loss,
+      as the eighteenth capsula treated of agues, and we could have learned from
+      it something of their degree of frequency in this part of New England.
+      There is no date to the manuscript; which, however, refers to a case
+      observed Nov. 14, 1724.
+    </p>
+    <p>
+      The divine takes precedence of the physician in this extraordinary
+      production. He begins by preaching a sermon at his unfortunate patient.
+      Having thrown him into a cold sweat by his spiritual sudorific, he attacks
+      him with his material remedies, which are often quite as unpalatable. The
+      simple and cleanly practice of Sydenham, with whose works he was
+      acquainted, seems to have been thrown away upon him. Everything he could
+      find mentioned in the seventy or eighty authors he cites, all that the old
+      women of both sexes had ever told him of, gets into his text, or squeezes
+      itself into his margin.
+    </p>
+    <p>
+      Evolving disease out of sin, he hates it, one would say, as he hates its
+      cause, and would drive it out of the body with all noisome appliances.
+      &ldquo;Sickness is in Fact Flagellum Dei pro peccatis mundi.&rdquo; So saying, he
+      encourages the young mother whose babe is wasting away upon her breast
+      with these reflections:
+    </p>
+    <p>
+      &ldquo;Think; oh the grievous Effects of Sin! This wretched Infant has not
+      arrived unto years of sense enough, to sin after the similitude of the
+      transgression committed by Adam. Nevertheless the Transgression of 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
+      infected Adam when he fell into his Transgression, by hearkening to the
+      Tempter, has corrupted all mankind, and is a seed unto such diseases as
+      this Infant is now laboring under. Lord, what are we, and what are our
+      children, but a Generation of Vipers?&rdquo;
+     </p>
+    <p>
+      Many of his remedies are at least harmless, but his pedantry and utter
+      want of judgment betray themselves everywhere. He piles his prescriptions
+      one upon another, without the least discrimination. He is run away with by
+      all sorts of fancies and superstitions. He prescribes euphrasia,
+      eye-bright, for disease of the eyes; appealing confidently to the strange
+      old doctrine of signatures, which inferred its use from the resemblance of
+      its flower to the organ of vision. For the scattering of wens, the
+      efficacy of a Dead Hand has been out of measure wonderful. But when he
+      once comes to the odious class of remedies, he revels in them like a
+      scarabeus. This allusion will bring us quite near enough to the
+      inconceivable abominations with which he proposed to outrage the sinful
+      stomachs of the unhappy confederates and accomplices of Adam.
+    </p>
+    <p>
+      It is well that the treatise was never printed, yet there are passages in
+      it worth preserving. He speaks of some remedies which have since become
+      more universally known:
+    </p>
+    <p>
+      &ldquo;Among the plants of our soyl, Sir William Temple singles out Five [Six]
+      as being of the greatest virtue and most friendly to health: and his
+      favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder.&rdquo;
+     </p>
+    <p>
+      &ldquo;But these Five [Six] plants may admitt of some competitors. The QUINQUINA&mdash;How
+      celebrated: Immoderately, Hyperbolically celebrated!&rdquo;
+     </p>
+    <p>
+      Of Ipecacuanha, he says,&mdash;&ldquo;This is now in its reign; the most
+      fashionable vomit.&rdquo;
+     </p>
+    <p>
+      &ldquo;I am not sorry that antimonial emetics begin to be disused.&rdquo;
+     </p>
+    <p>
+      He quotes &ldquo;Mr. Lock&rdquo; as recommending red poppy-water and abstinence from
+      flesh as often useful in children's diseases.
+    </p>
+    <p>
+      One of his &ldquo;Capsula's&rdquo; is devoted to the animalcular origin of diseases,
+      at the end of which he says, speaking of remedies for this supposed source
+      of our distempers:
+    </p>
+    <p>
+      &ldquo;Mercury we know thee: But we are afraid thou wilt kill us too, if we
+      employ thee to kill them that kill us.
+    </p>
+    <p>
+      &ldquo;And yett, for the cleansing of the small Blood Vessels, and making way
+      for the free circulation of the Blood and Lymph&mdash;there is nothing
+      like Mercurial Deobstruents.&rdquo;
+     </p>
+    <p>
+      From this we learn that mercury was already in common use, and the subject
+      of the same popular prejudice as in our own time.
+    </p>
+    <p>
+      His poetical turn shows itself here and there:
+    </p>
+    <p>
+      &ldquo;O Nightingale, with a Thorn at thy Breast; Under the trouble of a Cough,
+      what can be more proper than such thoughts as these?&rdquo;...
+    </p>
+    <p>
+      If there is pathos in this, there is bathos in his apostrophe to the
+      millipede, beginning &ldquo;Poor sowbug!&rdquo; and eulogizing the healing virtues of
+      that odious little beast; of which he tells us to take &ldquo;half a pound, putt
+      'em alive into a quart or two of wine,&rdquo; with saffron and other drugs, and
+      take two ounces twice a day.
+    </p>
+    <p>
+      The &ldquo;Capsula&rdquo; entitled &ldquo;Nishmath Chajim&rdquo; was printed in 1722, at New
+      London, and is in the possession of our own Society. He means, by these
+      words, something like the Archxus of Van Helmont, of which he discourses
+      in a style wonderfully resembling that of Mr. Jenkinson in the &ldquo;Vicar of
+      Wakefield.&rdquo; &ldquo;Many of the Ancients thought there was much of a Real History
+      in the Parable, and their Opinion was that there is, DIAPHORA KATA TAS
+      MORPHAS, A Distinction (and so a Resemblance) of men as to their Shapes
+      after Death.&rdquo; And so on, with Ireaeus, Tertullian, Thespesius, and &ldquo;the TA
+      TONE PSEUCONE CROMATA,&rdquo; in the place of &ldquo;Sanconiathon, Manetho, Berosus,&rdquo;
+       and &ldquo;Anarchon ara kai ateleutaion to pan.&rdquo;
+     </p>
+    <p>
+      One other passage deserves notice, as it relates to the single medical
+      suggestion which does honor to Cotton Mather's memory. It does not appear
+      that he availed himself of the information which he says he obtained from
+      his slave, for such I suppose he was.
+    </p>
+    <p>
+      In his appendix to &ldquo;Variolae Triumphatae,&rdquo; he says,&mdash;
+    </p>
+    <p>
+      &ldquo;There has been a wonderful practice lately used in several parts of the
+      world, which indeed is not yet become common in our nation.
+    </p>
+    <p>
+      &ldquo;I was first informed of it by a Garamantee servant of my own, long before
+      I knew that any Europeans or Asiaticks had the least acquaintance with it,
+      and some years before I was enriched with the communications of the
+      learned Foreigners, whose accounts I found agreeing with what I received
+      of my servant, when he 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.
+    </p>
+    <p>
+      &ldquo;I have since met with a considerable Number of these Africans, who all
+      agree in one story; That in their countrey grandy-many dy of the
+      small-pox: But now they learn this way: people take juice of smallpox and
+      cutty-skin and put in a Drop; then by'nd by a little sicky, sicky: then
+      very few little things like small-pox; and nobody dy of it; and nobody
+      have small-pox any more. Thus, in Africa, where the poor creatures dy of
+      the smallpox like Rotten Sheep, a merciful God has taught them an
+      Infallible preservative. 'T is a common practice, and is attended with a
+      constant success.&rdquo;
+     </p>
+    <p>
+      What has come down to us of the first century of medical practice, in the
+      hands of Winthrop and Oliver, is comparatively simple and reasonable. I
+      suspect that the conditions of rude, stern life, in which the colonists
+      found themselves in the wilderness, took the nonsense out of them, as the
+      exigencies of a campaign did out of our physicians and surgeons in the
+      late war. Good food and enough of it, pure air and water, cleanliness,
+      good attendance, an anaesthetic, an opiate, a stimulant, quinine, and two
+      or three common drugs, proved to be the marrow of medical treatment; and
+      the fopperies of the pharmacopoeia went the way of embroidered shirts and
+      white kid gloves and malacca joints, in their time of need. &ldquo;Good wine is
+      the best cordiall for her,&rdquo; said Governor John Winthrop, Junior, to Samuel
+      Symonds, speaking of that gentleman's wife,&mdash;just as Sydenham,
+      instead of physic, once ordered a roast chicken and a pint of canary for
+      his patient in male hysterics.
+    </p>
+    <p>
+      But the profession of medicine never could reach its full development
+      until it became entirely separated from that of divinity. The spiritual
+      guide, the consoler in affliction, the confessor who is admitted into the
+      secrets of our souls, has his own noble sphere of duties; but the healer
+      of men must confine himself solely to the revelations of God in nature, as
+      he sees their miracles with his own eyes. No doctrine of prayer or special
+      providence is to be his excuse for not looking straight at secondary
+      causes, and acting, exactly so far as experience justifies him, as if he
+      were himself the divine agent which antiquity fabled him to be. While
+      pious men were praying&mdash;humbly, sincerely, rightly, according to
+      their knowledge&mdash;over the endless succession of little children dying
+      of spasms in the great Dublin Hospital, a sagacious physician knocked some
+      holes in the walls of the ward, let God's blessed air in on the little
+      creatures, and so had already saved in that single hospital, as it was
+      soberly calculated thirty years ago, more than sixteen thousand lives of
+      these infant heirs of immortality. [Collins's Midwifery, p. 312. Published
+      by order of the Massachusetts Medical Society. Boston, 1841.]
+    </p>
+    <p>
+      Let it be, if you will, that the wise inspiration of the physician was
+      granted in virtue of the clergyman's supplications. Still, the habit of
+      dealing with things seen generates another kind of knowledge, and another
+      way of thought, from that of dealing with things unseen; which knowledge
+      and way of thought are special means granted by Providence, and to be
+      thankfully accepted.
+    </p>
+    <p>
+      The mediaeval ecclesiastics expressed a great truth in that saying, so
+      often quoted, as carrying a reproach with it: &ldquo;Ubi tres medici, duo
+      athei,&rdquo;&mdash;&ldquo;Where there are three physicians, there are two atheists.&rdquo;
+     </p>
+    <p>
+      It was true then, it is true to-day, that the physician very commonly, if
+      not very generally, denies and repudiates the deity of ecclesiastical
+      commerce. The Being whom Ambroise Pare meant when he spoke those memorable
+      words, which you may read over the professor's chair in the French School
+      of Medicine, &ldquo;Te le pensay, et Dieu le guarit,&rdquo; &ldquo;I dressed his wound, and
+      God healed it,&rdquo;&mdash;is a different being from the God that scholastic
+      theologians have projected from their consciousness, or shaped even from
+      the sacred pages which have proved so plastic in their hands. He is a God
+      who never leaves himself without witness, who repenteth him of the evil,
+      who never allows a disease or an injury, compatible with the enjoyment of
+      life, to take its course without establishing an effort, limited by
+      certain fixed conditions, it is true, but an effort, always, to restore
+      the broken body or the shattered mind. In the perpetual presence of this
+      great Healing Agent, who stays the bleeding of wounds, who knits the
+      fractured bone, who expels the splinter by a gentle natural process, who
+      walls in the inflammation that might involve the vital organs, who draws a
+      cordon to separate the dead part from the living, who sends his three
+      natural anaesthetics to the over-tasked frame in due order, according to
+      its need,&mdash;sleep, fainting, death; in this perpetual presence, it is
+      doubtless hard for the physician to realize the theological fact 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 has
+      abrogated the pardoning power, and mercy forgets its errand; where the
+      omnipotent is unfelt save in malignant agencies, and the omnipresent is
+      unseen and unrepresented; hard to accept the God of Dante's &ldquo;Inferno,&rdquo; and
+      of Bunyan's caged lunatic. If this is atheism, call three, instead of two
+      of the trio, atheists, and it will probably come nearer the truth.
+    </p>
+    <p>
+      I am not disposed to deny the occasional injurious effect of the
+      materializing influences to which the physician is subjected. A spiritual
+      guild is absolutely necessary to keep him, to keep us all, from becoming
+      the &ldquo;fingering slaves&rdquo; that Wordsworth treats with such shrivelling scorn.
+      But it is well that the two callings have been separated, and it is
+      fitting that they remain apart. In settling the affairs of the late
+      concern, I am afraid our good friends remain a little in our debt. We lent
+      them our physician Michael Servetus in fair condition, and they returned
+      him so damaged by fire as to be quite useless for our purposes. Their
+      Reverend Samuel Willard wrote us a not over-wise report of a case of
+      hysteria; and our Jean Astruc gave them (if we may trust Dr. Smith's
+      Dictionary of the Bible) the first discerning criticism on the authorship
+      of the Pentateuch. Our John Locke enlightened them with his letters
+      concerning toleration; and their Cotton Mather obscured our twilight with
+      his &ldquo;Nishmath Chajim.&rdquo;
+     </p>
+    <p>
+      Yet we must remember that the name of Basil Valentine, the monk, is
+      associated with whatever good and harm we can ascribe to antimony; and
+      that the most remarkable of our specifics long bore the name of &ldquo;Jesuit's
+      Bark,&rdquo; from an old legend connected with its introduction. &ldquo;Frere
+      Jacques,&rdquo; who taught the lithotomists of Paris, owes his ecclesiastical
+      title to courtesy, as he did not belong to a religious order.
+    </p>
+    <p>
+      Medical science, and especially the study of mental disease, is destined,
+      I believe, to react to much greater advantage on the theology of the
+      future than theology has acted on medicine in the past. The liberal spirit
+      very generally prevailing in both professions, and the good understanding
+      between their most enlightened members, promise well for the future of
+      both in a community which holds every point of human belief, every
+      institution in human hands, and every word written in a human dialect,
+      open to free discussion today, to-morrow, and to the end of time. Whether
+      the world at large will ever be cured of trusting to specifics as a
+      substitute for observing the laws of health, and to mechanical or
+      intellectual formula as a substitute for character, may admit of question.
+      Quackery and idolatry are all but immortal.
+    </p>
+    <p>
+      We can find most of the old beliefs alive amongst us to-day, only having
+      changed their dresses and the social spheres in which they thrive. We
+      think the quarrels of Galenists and chemists belong to the past,
+      forgetting that Thomsonism has its numerous apostles in our community;
+      that it is common to see remedies vaunted as purely vegetable, and that
+      the prejudice against &ldquo;mineral poisons,&rdquo; especially mercury, is as strong
+      in many quarters now as it was at the beginning of the seventeenth
+      century. Names are only air, and blow away with a change of wind; 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 for a very
+      moderate compensation. Nostradamus and Lilly seem impossible in our time;
+      but we have seen the advertisements of an astrologer in our Boston papers
+      year after year, which seems to imply that he found believers and patrons.
+      You smiled when I related Sir Kenelm Digby's prescription with the live
+      eel in it; but if each of you were to empty his or her pockets, would
+      there not roll out, from more than one of them, a horse-chestnut, carried
+      about as a cure for rheumatism? The brazen head of Roger Bacon is mute;
+      but is not &ldquo;Planchette&rdquo; uttering her responses in a hundred houses of this
+      city? We think of palmistry or chiromancy as belonging to the days of
+      Albertus Magnus, or, if existing in our time, as given over to the
+      gypsies; but a very distinguished person has recently shown me the line of
+      life, and the line of fortune, on the palm of his hand, with a seeming
+      confidence in the sanguine predictions of his career which had been drawn
+      from them. What shall we say of the plausible and well-dressed charlatans
+      of our own time, who trade in false pretences, like Nicholas Knapp of old,
+      but without any fear of being fined or whipped; or of the many follies and
+      inanities, imposing on the credulous part of the community, each of them
+      gaping with eager, open mouth for a gratuitous advertisement by the
+      mention of its foolish name in any respectable connection?
+    </p>
+    <p>
+      I turn from this less pleasing aspect of the common intelligence which
+      renders such follies possible, to close the honorable record of the
+      medical profession in this, our ancient Commonwealth.
+    </p>
+    <p>
+      We have seen it in the first century divided among clergymen, magistrates,
+      and regular practitioners; yet, on the whole, for the time, and under the
+      circumstances, respectable, except where it invoked supernatural agencies
+      to account for natural phenomena.
+    </p>
+    <p>
+      In the second century it simplified its practice, educated many
+      intelligent practitioners, and began the work of organizing for concerted
+      action, and for medical teaching.
+    </p>
+    <p>
+      In this, our own century, it has built hospitals, perfected and multiplied
+      its associations and educational institutions, enlarged and created
+      museums, and challenged a place in the world of science by its literature.
+    </p>
+    <p>
+      In reviewing the whole course of its history we read a long list of
+      honored names, and a precious record written in private memories, in
+      public charities, in permanent contributions to medical science, in
+      generous sacrifices for the country. We can point to our capital as the
+      port of entry for the New World of the great medical discoveries of two
+      successive centuries, and we can claim for it the triumph over the most
+      dreaded foe that assails the human body,&mdash;a triumph which the annals
+      of the race can hardly match in three thousand years of medical history.
+    </p>
+    <p>
+      <a name="link2H_4_0011" id="link2H_4_0011">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      THE YOUNG PRACTITIONER
+    </h2>
+    <p>
+      [A Valedictory Address delivered to the Graduating Class of the Bellevue
+      Hospital College, March 2, 1871.]
+    </p>
+    <p>
+      The occasion which calls us together reminds us not a little of that other
+      ceremony which unites a man and woman for life. The banns have already
+      been pronounced which have wedded our young friends to the profession of
+      their choice. It remains only to address to them some friendly words of
+      cheering counsel, and to bestow upon them the parting benediction.
+    </p>
+    <p>
+      This is not the time for rhetorical display or ambitious eloquence. We
+      must forget ourselves, and think only of them. To us it is an occasion; to
+      them it is an epoch. The spectators at the wedding look curiously at the
+      bride and bridegroom; at the bridal veil, the orange-flower garland, the
+      giving and receiving of the ring; they listen for the tremulous &ldquo;I will,&rdquo;
+       and wonder what are the mysterious syllables the clergyman whispers in the
+      ear of the married maiden. But to the newly-wedded pair what meaning in
+      those words, &ldquo;for better, for worse,&rdquo; &ldquo;in sickness and in health,&rdquo; &ldquo;till
+      death us do part!&rdquo; To the father, to the mother, who know too well how
+      often the deadly nightshade is interwoven with the wreath of
+      orange-blossoms, how empty the pageant, how momentous the reality!
+    </p>
+    <p>
+      You will not wonder that I address myself chiefly to those who are just
+      leaving academic life for the sterner struggle and the larger tasks of
+      matured and instructed manhood. The hour belongs to them; if others find
+      patience to listen, they will kindly remember that, after all, they are
+      but as the spectators at the wedding, and that the priest is thinking less
+      of them than of their friends who are kneeling at the altar.
+    </p>
+    <p>
+      I speak more directly to you, then, gentlemen of the graduating class. The
+      days of your education, as pupils of trained instructors, are over. Your
+      first harvest is all garnered. Henceforth you are to be sowers as well as
+      reapers, and your field is the world. How does your knowledge stand
+      to-day? What have you gained as a permanent possession? What must you
+      expect to forget? What remains for you yet to learn? These are questions
+      which it may interest you to consider.
+    </p>
+    <p>
+      There is another question which must force itself on the thoughts of many
+      among you: &ldquo;How am I to obtain patients and to keep their confidence?&rdquo; You
+      have chosen a laborious calling, and made many sacrifices to fit
+      yourselves for its successful pursuit. You wish to be employed that you
+      may be useful, and that you may receive the reward of your industry. I
+      would take advantage of these most receptive moments to give you some
+      hints which may help you to realize your hopes and expectations. Such is
+      the outline of the familiar talk I shall offer you.
+    </p>
+    <p>
+      Your acquaintance with some of the accessory branches is probably greater
+      now than it will be in a year from now,&mdash;much greater than it will be
+      ten years from now. The progress of knowledge, it may be feared, or hoped,
+      will have outrun the text-books in which you studied these branches.
+      Chemistry, for instance, is very apt to spoil on one's hands. &ldquo;Nous avons
+      change tout cela&rdquo; might serve as the standing motto of many of our
+      manuals. Science is a great traveller, and wears her shoes out pretty
+      fast, as might be expected.
+    </p>
+    <p>
+      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 large practice all around you would find a more potent
+      sudorific than any in the Pharmacopceia. These masters of the art of
+      healing were once as ready with their answers as you are now, but they
+      have got rid of a great deal of 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 trains off the fat of a
+      prize-fighter.
+    </p>
+    <p>
+      Yet, pause a moment before you infer that your teachers must have been in
+      fault when they furnished you with mental stores not directly convertible
+      to practical purposes, and likely in a few years to lose their place in
+      your memory. All systematic knowledge involves much that is not practical,
+      yet it is the only kind of knowledge which satisfies the mind, and
+      systematic study proves, in the long-run, the easiest way of acquiring 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 condition is
+      not the same as if you had never known what you now try in vain to recall.
+      There is a perpetual metempsychosis of thought, and the knowledge of
+      to-day finds a soil in the forgotten facts of yesterday. You cannot see
+      anything in the new season of the guano you placed last year about the
+      roots of your climbing plants, but it is blushing and breathing fragrance
+      in your trellised roses; it has scaled your porch in the bee-haunted
+      honey-suckle; it has found its way where the ivy is green; it is gone
+      where the woodbine expands its luxuriant foliage.
+    </p>
+    <p>
+      Your diploma seems very broad to-day with your list of accomplishments,
+      but it begins to shrink from this hour like the Peau de Chagrin of
+      Balzac's story. Do not worry about it, for all the while there will be
+      making out for you an ampler and fairer parchment, signed by old Father
+      Time himself as President of that great University in which experience is
+      the one perpetual and all-sufficient professor.
+    </p>
+    <p>
+      Your present plethora of acquirements will soon cure itself. Knowledge
+      that is not wanted dies out like the eyes of the fishes of the Mammoth
+      Cave. When you come to handle life and death as your daily business, your
+      memory will of itself bid good-by to such inmates as the well-known
+      foramina of the sphenoid bone and the familiar oxides of
+      methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known
+      them, and remember that even the learned ignorance of a nomenclature is
+      something to have mastered, and may furnish pegs to hang facts upon which
+      would otherwise have strewed the floor of memory in loose disorder.
+    </p>
+    <p>
+      But your education has, after all, been very largely practical. You have
+      studied medicine and surgery, not chiefly in books, but at the bedside and
+      in the operating amphitheatre. It is the special advantage of large cities
+      that they afford the opportunity of seeing a great deal of disease in a
+      short space of time, and of seeing many cases of the same kind of disease
+      brought together. Let us not be unjust to the claims of the schools remote
+      from the larger centres of population. Who among us has taught better than
+      Nathan Smith, better than Elisha Bartlett? who teaches better than some of
+      our living contemporaries who divide their time between city and country
+      schools? I am afraid we do not always do justice to our country brethren,
+      whose merits are less conspicuously exhibited than those of the great city
+      physicians and surgeons, such especially as have charge of large
+      hospitals. There are modest practitioners living in remote rural districts
+      who are gifted by nature with such sagacity and wisdom, trained so well in
+      what is most essential to the practice of their art, taught so thoroughly
+      by varied experience, forced to such manly self-reliance by their
+      comparative isolation, that, from converse with them alone, from riding
+      with them on their long rounds as they pass from village to village, from
+      talking over cases with them, putting up their prescriptions, watching
+      their expedients, listening to their cautions, marking the event of their
+      predictions, hearing them tell of their mistakes, and now and then glory a
+      little in the detection of another's blunder, a young man would find
+      himself better fitted for his real work than many who have followed long
+      courses of lectures and passed a showy examination. But the young man is
+      exceptionally fortunate who enjoys the intimacy of such a teacher. And it
+      must be confessed that the great hospitals, infirmaries, and dispensaries
+      of large cities, where men of well-sifted reputations are in constant
+      attendance, are the true centres of medical education. No students, I
+      believe, are more thoroughly aware of this than those who have graduated
+      at this institution. Here, as in all our larger city schools, the greatest
+      pains are taken to teach things as well as names. You have entered into
+      the inheritance of a vast amount of transmitted skill and wisdom, which
+      you have taken, warm, as it were, 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 many of those whose names we
+      hardly mention without a genuflection. I had rather be cared for in a
+      fever by the best-taught among you than by the renowned Fernelius or the
+      illustrious Boerhaave, could they come back to us from that better world
+      where there are no physicians needed, and, if the old adage can be
+      trusted, not many within call. I had rather have one of you exercise his
+      surgical skill upon me than find myself in the hands of a resuscitated
+      Fabricius Hildanus, or even of a wise Ambroise Pare, revisiting earth in
+      the light of the nineteenth century.
+    </p>
+    <p>
+      You will not accuse me of underrating your accomplishments. You know what
+      to do for a child in a fit, for an alderman in an apoplexy, for a girl
+      that has fainted, for a woman in hysterics, for a leg that is broken, for
+      an arm that is out of joint, for fevers of every color, for the sailor's
+      rheumatism, and the tailor's cachexy. In fact you do really know so much
+      at this very hour, that nothing but the searching test of time can fully
+      teach you the limitations of your knowledge.
+    </p>
+    <p>
+      Of some of these you will permit me to remind you. You will never have
+      outgrown the possibility of new acquisitions, for Nature is endless in her
+      variety. But even the knowledge which you may be said to possess will be a
+      different thing after long habit has made it a part of your existence. The
+      tactus eruditus extends 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 wise in 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 Shipman brought home with him from the sea&mdash;
+    </p>
+<pre xml:space="preserve">
+   &ldquo;In many a tempest had his berd be shake.&rdquo;
+ </pre>
+    <p>
+      This is the knowledge we place most confidence in, in the practical
+      affairs of life.
+    </p>
+    <p>
+      Our training has two stages. The first stage deals with our intelligence,
+      which takes the idea of what is to be done with the most charming ease and
+      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 glance
+      from that ball and hit that other ball, and to knock that ball with this
+      ball into a certain caecal sacculus or diverticulum which our professional
+      friend calls a pocket. Nothing can be clearer; it is as easy as &ldquo;playing
+      upon this pipe,&rdquo; for which Hamlet gives Guildenstern such lucid
+      directions. But this intelligent Me, who steps forward as the senior
+      partner in our dual personality, turns out to be a terrible bungler. He
+      misses those glancing hits which the hard-featured young professional
+      person calls &ldquo;carroms,&rdquo; and insists on pocketing his own ball instead of
+      the other one.
+    </p>
+    <p>
+      It is the unintelligent Me, stupid as an idiot, that has to try a thing a
+      thousand times before he can do it, and then never knows how he does it,
+      that at last does it well. We have to educate ourselves through the
+      pretentious claims of intellect, into the humble accuracy of instinct, and
+      we end at last by acquiring the dexterity, the perfection, the certainty,
+      which those masters of arts, the bee and the spider, inherit from Nature.
+    </p>
+    <p>
+      Book-knowledge, lecture-knowledge, examination-knowledge, are all in the
+      brain. But work-knowledge is not only in the brain, it is in the senses,
+      in the muscles, in the ganglia of the sympathetic nerves,&mdash;all over
+      the man, as one may say, as instinct seems diffused through every part of
+      those lower animals that have no such distinct organ as a brain. See a
+      skilful surgeon handle a broken limb; see a wise old physician smile away
+      a case that looks to a novice as if the sexton would soon be sent for;
+      mark what a large experience has 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.
+    </p>
+    <p>
+      May I venture to contrast youth and experience in medical practice,
+      something in the way the man painted the lion, that is, the lion under?
+    </p>
+    <p>
+      The young man knows the rules, but the old man knows the exceptions. The
+      young man knows his patient, but the old man knows also his patient's
+      family, dead and alive, up and down for generations. He can tell
+      beforehand what diseases their unborn children will be subject to, what
+      they will die of if they live long enough, and whether they had better
+      live at all, or remain unrealized possibilities, as belonging to a stock
+      not worth being perpetuated. The young man feels uneasy if he is not
+      continually doing something to stir up his patient's internal
+      arrangements. The old man takes things more quietly, and is much more
+      willing to let well enough alone: All these superiorities, if such they
+      are, you must wait for time to bring you. In the meanwhile (if we will let
+      the lion be uppermost for a moment), the young man's senses are quicker
+      than those of his older rival. His education in all the accessory branches
+      is more recent, and therefore nearer the existing condition of knowledge.
+      He finds it easier than his seniors to accept the improvements which every
+      year is bringing forward. New ideas build their nests in young men's
+      brains. &ldquo;Revolutions are not made by men in spectacles,&rdquo; as I once heard
+      it remarked, and the first whispers of a new truth are not caught by those
+      who begin to feel the need of an ear-trumpet. Granting all these
+      advantages to the young man, he ought, nevertheless, to go on improving,
+      on the whole, as a medical practitioner, with every year, until he has
+      ripened into a well-mellowed maturity. But, to improve, he must be good
+      for something at the start. If you ship a poor cask of wine to India and
+      back, if you keep it a half a century, it only grows thinner and sharper.
+    </p>
+    <p>
+      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 look to you as
+      its authorized champions in the struggle of life against its numerous
+      enemies?
+    </p>
+    <p>
+      In the first place, the persons who seek the aid of the physician are very
+      honest and sincere in their wish to get rid of their complaints, and,
+      generally speaking, to live as long as they can. However attractively the
+      future is painted to them, they are attached to the planet with which they
+      are already acquainted. They are addicted to the daily use of this
+      empirical and unchemical mixture which we call air; and would hold on to
+      it as a tippler does to his alcoholic drinks. There is nothing men will
+      not do, there is nothing they have not done, to recover their health and
+      save their lives. They have submitted to be half-drowned in water, and
+      half-choked with gases, to be buried up to their chins in earth, to be
+      seared with hot irons like galley-slaves, to be crimped with knives, like
+      cod-fish, to have needles thrust into their flesh, and bonfires kindled on
+      their skin, to swallow all sorts of abominations, and to pay for all this,
+      as if to be singed and scalded were a costly privilege, as if blisters
+      were a blessing, and leeches were a luxury. What more can be asked to
+      prove their honesty and sincerity?
+    </p>
+    <p>
+      This same community is very intelligent with respect to a great many
+      subjects&mdash;commerce, mechanics, manufactures, politics. But with regard to
+      medicine it is hopelessly ignorant and never finds it out. I do not know
+      that it is any worse in this country than in Great Britain, where Mr.
+      Huxley speaks very freely of &ldquo;the utter ignorance of the simplest laws of
+      their own animal life, which prevails among even the most highly educated
+      persons.&rdquo; And Cullen said before him &ldquo;Neither the acutest genius nor the
+      soundest judgment 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 sometimes with reasons, and I have found that any will pass, even
+      with able divines and acute lawyers; the same will pass with the husbands
+      as with the wives.&rdquo; If the community could only be made aware of its own
+      utter ignorance, and incompetence to form opinions on medical subjects,
+      difficult enough to those who give their lives to the study of them, the
+      practitioner would have an easier task. But it will form opinions of its
+      own, it cannot help it, and we cannot blame it, even though we know how
+      slight and deceptive are their foundations.
+    </p>
+    <p>
+      This is the way it happens: Every grown-up person has either been ill
+      himself or had a friend suffer from illness, from which he has recovered.
+      Every sick person has done something or other by somebody's advice, or of
+      his own accord, a little before getting better. There is an irresistible
+      tendency to associate the thing done, and the improvement which followed
+      it, as cause and effect. This is the great source of fallacy in medical
+      practice. But the physician has some chance of correcting his hasty
+      inference. He thinks his prescription cured a single case of a particular
+      complaint; he tries it in twenty similar cases without effect, and sets
+      down the first as probably nothing more than a coincidence. The
+      unprofessional experimenter or observer has no large experience to correct
+      his hasty generalization. He wants to believe that the means he employed
+      effected his cure. He feels grateful to the person who advised it, he
+      loves to praise the pill or potion which helped him, and he has a kind of
+      monumental pride in himself as a living testimony to its efficacy. So it
+      is that you will find the community in which you live, be it in town or
+      country, full of brands plucked from the burning, as they believe, by some
+      agency which, with your better training, you feel reasonably confident had
+      nothing to do with it. Their disease went out of itself, and the stream
+      from the medical fire-annihilator had never even touched it.
+    </p>
+    <p>
+      You cannot and need not expect to disturb the public in 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 ninth chapter of St. John's Gospel, and
+      you will find that the logic of a restored patient was very simple then,
+      as it is now, and very hard to deal with. My clerical friends will forgive
+      me for poaching on their sacred territory, in return for an occasional
+      raid upon the medical domain of which they have now and then been accused.
+    </p>
+    <p>
+      A blind man was said to have been restored to sight by a young person whom
+      the learned doctors of the Jewish law considered a sinner, and, as such,
+      very unlikely to have been endowed with a divine gift of healing. They
+      visited the patient repeatedly, and evidently teased him with their
+      questions about the treatment, and their insinuations about the young man,
+      until he lost his temper. At last he turned sharply upon them: &ldquo;Whether he
+      be a sinner or no, I know not: one thing I know, that, whereas I was
+      blind, now I see.&rdquo;
+     </p>
+    <p>
+      This is the answer that always has been and always will be given by most
+      persons when they find themselves getting well after doing anything, no
+      matter what,&mdash;recommended by anybody, no matter whom. Lord Bacon,
+      Robert Boyle, Bishop Berkeley, all put their faith in panaceas which we
+      should laugh to scorn. They had seen people get well after using them. Are
+      we any wiser than those great men? Two years ago, in a lecture before the
+      Massachusetts Historical Society, I mentioned this recipe of Sir Kenelm
+      Digby for fever and ague: Pare the patient's nails; put the parings in a
+      little bag, and hang the bag round the neck of a live eel, and place him
+      in a tub of water. The eel will die, and the patient will recover.
+    </p>
+    <p>
+      Referring to this prescription in the course of the same lecture, I said:
+      &ldquo;You smiled when I related Sir Kenehn Digby's prescription, with the live
+      eel in it; but if each of you were to empty his or her pockets, would
+      there not roll out, from more than one of them, a horse-chestnut, carried
+      about as a cure for rheumatism?&rdquo; Nobody saw fit to empty his or her
+      pockets, and my question brought no response. But two months ago I was in
+      a company of educated persons, college graduates every one of them, 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 his
+      breeches-pocket, and laid them on the table, telling us how, having
+      suffered from the complaint in question, he had, by the advice of a
+      friend, procured these two horse-chestnuts on a certain time a year or
+      more ago, and carried them about him ever since; from which very day he
+      had been entirely free from rheumatism.
+    </p>
+    <p>
+      This argument, from what looks like cause and effect, whether it be so or
+      not, is what you will have to meet wherever you go, and you need not think
+      you can answer it. In the natural course of things some thousands of
+      persons must be getting well or better of slight attacks of colds, of
+      rheumatic pains, every week, in this city alone. Hundreds of them do
+      something or other in the way of remedy, by medical or other advice, or of
+      their own motion, and the last thing they do gets the credit of the
+      recovery. Think what a crop of remedies this must furnish, if it were all
+      harvested!
+    </p>
+    <p>
+      Experience has taught, or will teach you, that most of the wonderful
+      stories patients and others tell of sudden and signal cures are like Owen
+      Glendower's story of the portents that announced his birth. The earth
+      shook at your nativity, did it? Very likely, and
+    </p>
+<pre xml:space="preserve">
+        &ldquo;So it would have done,
+   At the same season, if your mother's cat
+   Had kittened, though yourself had ne'er been born.&rdquo;
+ </pre>
+    <p>
+      You must listen more meekly than Hotspur did to the babbling Welshman, for
+      ignorance is a solemn and sacred fact, and, like infancy, which it
+      resembles, should be respected. Once in a while you will have a patient of
+      sense, born with the gift of observation, from whom you may learn
+      something. When you find yourself in the presence of one who is fertile of
+      medical opinions, and affluent in stories of marvellous cures,&mdash;of a
+      member of Congress whose name figures in certificates to the value of
+      patent medicines, of a voluble dame who discourses on the miracles she has
+      wrought or seen wrought with the little jokers of the sugar-of-milk
+      globule-box, take out your watch and count the pulse; also note the time
+      of day, and charge 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 dispensation into a double blessing, for this class
+      of patients loves dearly to talk, and it does them a deal of good, and you
+      feel as if you had earned your money by the dose you have taken, quite as
+      honestly as by any dose you may have ordered.
+    </p>
+    <p>
+      You must take the community just as it is, and make the best of it. You
+      wish to obtain its confidence; there is a short rule for doing this which
+      you will find useful,&mdash;deserve it. But, to deserve it in full
+      measure, you must unite many excellences, natural and acquired.
+    </p>
+    <p>
+      As the basis of all the rest, you must have all those traits of character
+      which fit you to enter into the most intimate and confidential relations
+      with the families of which you are the privileged friend and counsellor.
+      Medical Christianity, if I may use such a term, is of very early date. By
+      the oath of Hippocrates, the practitioner of ancient times bound himself
+      to enter his patient's house with the sole purpose of doing him good, and
+      so to conduct himself as to avoid the very appearance of evil. Let the
+      physician of to-day begin by coming up to this standard, and add to it all
+      the more recently discovered virtues and graces.
+    </p>
+    <p>
+      A certain amount of natural ability is requisite to make you a good
+      physician, but by no means that disproportionate development of some
+      special faculty which goes by the name of genius. A just balance of the
+      mental powers is a great deal more likely to be useful than any single
+      talent, even were it the power of observation, in excess. For a mere
+      observer is liable to be too fond of facts for their own sake, so that, if
+      he told the real truth, he would confess that he takes more pleasure in a
+      post-mortem examination which shows him what was the matter with a
+      patient, than in a case which insists on getting well and leaving him in
+      the dark as to its nature. Far more likely to interfere with the sound
+      practical balance of the mind is that speculative, theoretical tendency
+      which has made so many men noted in their day, whose fame has passed away
+      with their dissolving theories. Read Dr. Bartlett's comparison of the
+      famous Benjamin Rush with his modest fellow-townsman Dr. William Currie,
+      and see the dangers into which a passion for grandiose generalizations
+      betrayed a man of many admirable qualities.
+    </p>
+    <p>
+      I warn you against all ambitious aspirations outside of your profession.
+      Medicine is the most difficult of sciences and the most laborious of arts.
+      It will task all your powers of body and mind if you are faithful to it.
+      Do not dabble in the muddy sewer of politics, nor linger by the enchanted
+      streams of literature, nor dig in far-off fields for the hidden waters of
+      alien sciences. The great practitioners are generally those who
+      concentrate all their powers on their business. If there are here and
+      there brilliant exceptions, it is only in virtue of extraordinary gifts,
+      and industry to which very few are equal.
+    </p>
+    <p>
+      To get business a man must really want it; and do you suppose that when
+      you are in the middle of a heated caucus, or half-way through a delicate
+      analysis, or in the spasm of an unfinished ode, your eyes rolling in the
+      fine frenzy of poetical composition, you want to be called to a teething
+      infant, or an ancient person groaning under the griefs of a lumbago? I
+      think I have known more than one young man whose doctor's sign proclaimed
+      his readiness to serve mankind in that capacity, but who hated the sound
+      of a patient's knock, and as he sat with his book or his microscope, felt
+      exactly as the old party expressed himself in my friend Mr. Brownell's
+      poem&mdash;
+    </p>
+<pre xml:space="preserve">
+     &ldquo;All I axes is, let me alone.&rdquo;
+ </pre>
+    <p>
+      The community soon finds out whether you are in earnest, and really mean
+      business, or whether you are one of those diplomaed dilettanti who like
+      the amusement of quasi medical studies, but have no idea of wasting their
+      precious time in putting their knowledge in practice for the benefit of
+      their suffering fellow-creatures.
+    </p>
+    <p>
+      The public is a very incompetent judge of your skill and knowledge, but it
+      gives its confidence most readily to those who stand well with their
+      professional brethren, whom they call upon when they themselves or their
+      families 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 yet have defects which prevent his becoming a favorite
+      practitioner, but no popularity can be depended upon as permanent which is
+      not sanctioned by the judgment of professional experts, and with these you
+      will always stand on your substantial merits.
+    </p>
+    <p>
+      What shall I say of the personal habits you must form if you wish for
+      success? Temperance is first upon the list. Intemperance in a physician
+      partakes of the guilt of homicide, for the muddled brain may easily make a
+      fatal blunder in a prescription and the unsteady hand transfix an artery
+      in an operation. Tippling doctors have been too common in the history of
+      medicine. Paracelsus was a sot, Radcliffe was much too fond of his glass,
+      and Dr. James Hurlbut of Wethersfield, Connecticut, a famous man in his
+      time, used to drink a square bottle of rum a day, with a corresponding
+      allowance of opium to help steady his nerves. We commonly speak of a man
+      as being the worse for liquor, but I was asking an Irish laborer one day
+      about his doctor, who, as he said, was somewhat given to drink. &ldquo;I like
+      him best when he's a little that way,&rdquo; he said; &ldquo;then I can spake to him.&rdquo;
+       I pitied the poor patient who could not venture to allude to his colic or
+      his pleurisy until his physician was tipsy.
+    </p>
+    <p>
+      There are personal habits of less gravity than the one I have mentioned
+      which it is well to guard against, or, if they are formed, to relinquish.
+      A man who may be called at a moment's warning into the fragrant boudoir of
+      suffering loveliness should not unsweeten its atmosphere with
+      reminiscences of extinguished meerschaums. He should remember that the
+      sick are sensitive and fastidious, that they love the sweet odors and the
+      pure tints of flowers, and if his presence is not like the breath of the
+      rose, if his hands are not like the leaf of the lily, his visit may be
+      unwelcome, and if he looks behind him he may see a window thrown open
+      after he has left the sick-chamber. I remember too well the old doctor who
+      sometimes came to help me through those inward griefs to which childhood
+      is liable. &ldquo;Far off his coming &ldquo;&mdash;shall I say &ldquo;shone,&rdquo; and finish the
+      Miltonic phrase, or leave the verb to the happy conjectures of my
+      audience? Before him came a soul-subduing whiff of ipecacuanha, and after
+      him lingered a shuddering consciousness of rhubarb. He had lived so much
+      among his medicaments that he had at last become himself a drug, and to
+      have him pass through a sick-chamber was a stronger dose than a
+      conscientious disciple of Hahnemann would think it safe to administer.
+    </p>
+    <p>
+      Need I remind you of the importance of punctuality in your engagements,
+      and of the worry and distress to patients and their friends which the want
+      of it occasions? One of my old teachers always carried two watches, to
+      make quite sure of being exact, and not only kept his appointments with
+      the regularity of a chronometer, but took great pains to be at his
+      patient's house at the time when he had reason to believe he was expected,
+      even if no express appointment was made. It is a good rule; if you call
+      too early, my lady's hair may not be so smooth as could be wished, and, if
+      you keep her waiting too long, her hair may be smooth, but her temper
+      otherwise.
+    </p>
+    <p>
+      You will remember, of course, always to get the weather-gage of your
+      patient. I mean, to place him so that the light falls on his face and not
+      on yours. It is a kind of, ocular duel that is about to take place between
+      you; you are going to look through his features into his pulmonary and
+      hepatic and other internal machinery, and he is going to look into yours
+      quite as sharply to see what you think about his probabilities for time or
+      eternity.
+    </p>
+    <p>
+      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,
+      and serene 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 benevolent old hypocrite; she cheats the sick and the dying with
+      illusions better than any anodynes. If there are cogent reasons why a
+      patient should be undeceived, do it deliberately and advisedly, but do not
+      betray your apprehensions through your tell-tale features.
+    </p>
+    <p>
+      We had a physician in our city whose smile was commonly reckoned as being
+      worth five thousand dollars a year to him, in the days, too, of moderate
+      incomes. You cannot put on such a smile as that any more than you can get
+      sunshine without sun; there was a tranquil and kindly nature under it that
+      irradiated the pleasant face it made one happier to meet on his daily
+      rounds. But you can cultivate the disposition, and it will work its way
+      through to the surface, nay, more,&mdash;you can try to wear a quiet and
+      encouraging look, and it will react on your disposition and make you like
+      what you seem to be, or at least bring you nearer to its own likeness.
+    </p>
+    <p>
+      Your patient has no more right to all the truth you know than he has to
+      all the medicine in your saddlebags, if you carry that kind of
+      cartridge-box for the ammunition that slays disease. He should get only
+      just so much as is good for him. I have seen a physician examining a
+      patient's chest stop all at once, as he brought out a particular sound
+      with a tap on the collarbone, in the attitude of a pointer who has just
+      come on the scent or sight of a woodcock. You remember the Spartan boy,
+      who, with unmoved countenance, hid the fox that was tearing his vitals
+      beneath his mantle. What he could do in his own suffering you must learn
+      to do for others on whose vital organs disease has fastened its devouring
+      teeth. It is a terrible thing to take away hope, even earthly hope, from a
+      fellow-creature. Be very careful what names you let fall before your
+      patient. He knows what it means when you tell him he has tubercles or
+      Bright's disease, and, if he hears the word carcinoma, he will certainly
+      look it out in a medical dictionary, if he does not interpret its dread
+      significance on the instant. Tell him he has asthmatic symptoms, or a
+      tendency to the gouty diathesis, and he will at once think of all the
+      asthmatic and gouty old patriarchs he has ever heard of, and be comforted.
+      You need not be so cautious in speaking of the health of rich and remote
+      relatives, if he is in the line of succession.
+    </p>
+    <p>
+      Some shrewd old doctors have a few phrases always on hand for patients
+      that will insist on knowing the pathology of their complaints without the
+      slightest capacity of understanding the scientific explanation. I have
+      known the term &ldquo;spinal irritation&rdquo; serve well on such occasions, but I
+      think nothing on the whole has covered so much ground, and meant so
+      little, and given such profound satisfaction to all parties, as the
+      magnificent phrase &ldquo;congestion of the portal system.&rdquo;
+     </p>
+    <p>
+      Once more, let me recommend you, as far as possible, to keep your doubts
+      to yourself, and give the patient the benefit of your decision. Firmness,
+      gentle firmness, is absolutely necessary in this and certain other
+      relations. Mr. Rarey with Cruiser, Richard with Lady Ann, Pinel with his
+      crazy people, show what steady nerves can do with the most intractable of
+      animals, the most irresistible of despots, and the most unmanageable of
+      invalids.
+    </p>
+    <p>
+      If you cannot acquire and keep the confidence of your patient, it is time
+      for you to give place to some other practitioner who can. If you are wise
+      and diligent, you can establish relations with the best of them which they
+      will find it very hard to break. But, if they wish to employ another
+      person, who, as they think, knows more than you do, do not take it as a
+      personal wrong. A patient believes another man 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, it is a great
+      impertinence to think you have any property in him. Your estimate of your
+      own ability is not the question, it is what the patient thinks of it. All
+      your wisdom is to him like the lady's virtue in Raleigh's song:
+    </p>
+<pre xml:space="preserve">
+  &ldquo;If she seem not chaste to me,
+   What care I how chaste she be?&rdquo;
+ </pre>
+    <p>
+      What I call a good patient is one who, having found a good physician,
+      sticks to him till he dies. But there are many very good people who are
+      not what I call good patients. I was once requested to call 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-sixth member of the faculty into whose arms, professionally
+      speaking, she had successively thrown herself. Not being a believer in
+      such a rapid rotation of scientific crops, I gently deposited the burden,
+      commending it to the care of number twenty-seven, and, him, whoever he
+      might be, to the care of Heaven.
+    </p>
+    <p>
+      If there happened to be among my audience any person who wished to know on
+      what principles the patient should choose his physician, I should give him
+      these few precepts to think over:
+    </p>
+    <p>
+      Choose a man who is personally agreeable, for a daily visit from an
+      intelligent, amiable, pleasant, sympathetic person will cost you no more
+      than one from a sloven or a boor, and his presence will do more for you
+      than any prescription the other will order.
+    </p>
+    <p>
+      Let him be a man of recognized good sense in other matters, and the chance
+      is that he will be sensible as a practitioner.
+    </p>
+    <p>
+      Let him be a man who stands well with his professional brethren, whom they
+      approve as honest, able, courteous.
+    </p>
+    <p>
+      Let him be one whose patients are willing to die in his hands, not one
+      whom they go to for trifles, and leave as soon as they are in danger, and
+      who can say, therefore, that he never loses a patient.
+    </p>
+    <p>
+      Do not leave the ranks of what is called the regular profession, unless
+      you wish to go farther and fare worse, for you may be assured that its
+      members recognize no principle which hinders their accepting any remedial
+      agent proved to be useful, no matter from what quarter it 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 as an anesthetic, they will find no difficulty in procuring
+      its recognition.
+    </p>
+    <p>
+      Some of you will probably be more or less troubled by the pretensions of
+      that parody of mediaeval theology which finds its dogma of hereditary
+      depravity in the doctrine of psora, its miracle of transubstantiation in
+      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 to
+      accept these curious medical superstitions. The saturation-point of
+      individual minds with reference to evidence, and especially medical
+      evidence, differs, and must always continue to differ, very widely. There
+      are those whose minds are satisfied with the decillionth dilution of a
+      scientific proof. No wonder they believe in the efficacy of a similar
+      attenuation of bryony or pulsatilla. You have no fulcrum you can rest upon
+      to lift an error out of such minds as these, often highly endowed with
+      knowledge and talent, sometimes with genius, but commonly richer in the
+      imaginative than the observing and reasoning faculties.
+    </p>
+    <p>
+      Let me return once more to the young graduate. Your relations to your
+      professional brethren may be a source of lifelong happiness and growth in
+      knowledge and character, or they may make you wretched and end by leaving
+      you isolated from those who should be your friends and counsellors. The
+      life of a physician becomes ignoble when he suffers himself to feed on
+      petty jealousies and sours his temper in perpetual quarrels. You will be
+      liable to meet an uncomfortable man here and there in the profession,&mdash;one
+      who is so fond of being in hot water that it is a wonder all the albumen
+      in his body is not coagulated. There are common barrators among doctors as
+      there are among lawyers,&mdash;stirrers up of strife under one pretext and
+      another, but in reality because they like it. They are their own worst
+      enemies, and do themselves a mischief each time they assail their
+      neighbors. In my student days I remember a good deal of this
+      Donnybrook-Fair style of quarrelling, more especially in Paris, where some
+      of the noted surgeons were always at loggerheads, and in one of our lively
+      Western cities. Soon after I had set up an office, I had a trifling
+      experience which may serve to point a moral in this direction. I had
+      placed a lamp behind the glass in the entry to indicate to the passer-by
+      where relief from all curable infirmities was to be sought and found. Its
+      brilliancy attracted the attention of a devious youth, who dashed his fist
+      through the glass and upset my modest luminary. All he got by his
+      vivacious assault was that he left portions of integument from his
+      knuckles upon the glass, had a lame hand, was very easily identified, and
+      had to pay the glazier's bill. The moral is that, if the brilliancy of
+      another's reputation excites your belligerent instincts, it is not worth
+      your while to strike at it, without calculating which of you is likely to
+      suffer most, if you do.
+    </p>
+    <p>
+      You may be assured that when an ill-conditioned neighbor is always
+      complaining of a bad taste in his mouth and an evil atmosphere about him,
+      there is something wrong about his own secretions. In such cases there is
+      an alterative regimen of remarkable efficacy: it is a starvation-diet of
+      letting alone. The great majority of the profession are peacefully
+      inclined. Their pursuits are eminently humanizing, and they look with
+      disgust on the personalities which intrude themselves into the placid
+      domain of an art whose province it is to heal and not to wound.
+    </p>
+    <p>
+      The intercourse of teacher and student in a large school is necessarily
+      limited, but it should be, and, so far as my experience goes, it is,
+      eminently cordial and kindly. You will leave with regret, and hold in
+      tender remembrance, those who have taken you by the hand at your entrance
+      on your chosen path, and led you patiently and faithfully, until the great
+      gates at its end have swung upon their hinges, and the world lies open
+      before you. That venerable oath to which I have before referred bound the
+      student to regard his instructor in the light of a parent, to treat his
+      children like brothers, to succor him in his day of need. I trust the
+      spirit of the oath of Hippocrates is not dead in the hearts of the
+      students of to-day. They will remember with gratitude every earnest
+      effort, every encouraging word, which has helped them in their difficult
+      and laborious career of study. The names they read on their diplomas will
+      recall faces that are like family-portraits in their memory, and the echo
+      of voices they have listened to so long will linger in their memories far
+      into the still evening of their lives.
+    </p>
+    <p>
+      One voice will be heard no more which has been familiar to many among you.
+      It is not for me, a stranger to these scenes, to speak his eulogy. I have
+      no right to sadden this hour by dwelling on the deep regrets of
+      friendship, or to bid the bitter tears of sorrow flow afresh. Yet I cannot
+      help remembering what a void the death of such a practitioner as your late
+      instructor must leave in the wide circle of those who leaned upon his
+      counsel and assistance in their hour of need, in a community where he was
+      so widely known and esteemed, in a school where he bore so important a
+      part. There is no exemption from the common doom for him who holds the
+      shield to protect others. The student is called from his bench, the
+      professor from his chair, the practitioner in his busiest period hears a
+      knock more peremptory than any patient's midnight summons, and goes on
+      that unreturning visit which admits of no excuse, and suffers no delay.
+      The call of such a man away from us is the bereavement of a great family.
+      Nor can we help regretting the loss for him of a bright and cheerful
+      earthly future; for the old age of a physician is one of the happiest
+      periods of his life. He is loved and cherished for what he has been, and
+      even in the decline of his faculties there are occasions when his
+      experience is still appealed to, and his trembling hands are looked to
+      with renewing hope and trust, as being yet able to stay the arm of the
+      destroyer.
+    </p>
+    <p>
+      But if there is so much left for age, how beautiful, how inspiring is the
+      hope of youth! I see among those whom I count as listeners one by whose
+      side I have sat as a fellow-teacher, and by whose instructions I have felt
+      myself not too old to profit. As we borrowed him from your city, I must
+      take this opportunity of telling you that his zeal, intelligence, and
+      admirable faculty as an instructor were heartily and universally
+      recognized among us. We return him, as we trust, uninjured, to the
+      fellow-citizens who have the privilege of claiming him as their own.
+    </p>
+    <p>
+      And now, gentlemen of the graduating class, nothing remains but for me to
+      bid you, in the name of those for 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's accession are proclaimed by the same voice at the same moment. You
+      would hardly excuse me if I stooped to any meaner dialect than the
+      classical and familiar language of your prescriptions, the same in which
+      your title to the name of physician is, if, like our own institution, you
+      follow the ancient usage, engraved upon your diplomas.
+    </p>
+    <p>
+      Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, filii!
+    </p>
+    <p>
+      Salvete, VIRI, artis medicae magister; Salvete amici; salvete fratres!
+    </p>
+    <p>
+      <a name="link2H_4_0012" id="link2H_4_0012">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      MEDICAL LIBRARIES.
+    </h2>
+    <p>
+      [Dedicatory Address at the opening of the Medical Library in Boston,
+      December 3, 1878.]
+    </p>
+    <p>
+      It is my appointed task, my honorable privilege, this evening, to speak of
+      what has been done by others. No one can bring his tribute of words into
+      the presence of great deeds, or try with them to embellish the memory of
+      any inspiring achievement, without feeling and leaving with others a sense
+      of their insufficiency. So felt Alexander when he compared even his adored
+      Homer with the hero the poet had sung. So felt Webster when he contrasted
+      the phrases of rhetoric with the eloquence of patriotism and of
+      self-devotion. So felt Lincoln when on the field of Gettysburg he spoke
+      those immortal words which Pericles could not have bettered, which
+      Aristotle could not have criticised. So felt he who wrote the epitaph of
+      the builder of the dome which looks down on the crosses and weathercocks
+      that glitter over London.
+    </p>
+    <p>
+      We are not met upon a battle-field, except so far as every laborious
+      achievement means a victory over opposition, indifference, selfishness,
+      faintheartedness, and that great property of mind as well as matter,&mdash;inertia.
+      We are not met in a cathedral, except so far as every building whose walls
+      are lined with the products of useful and ennobling thought is a temple of
+      the Almighty, whose inspiration has given us understanding. But we have
+      gathered within walls which bear testimony to the self-sacrificing,
+      persevering efforts of a few young men, to whom we owe the origin and
+      development of all that excites our admiration in this completed
+      enterprise; and I might consider my task as finished if I contented myself
+      with borrowing the last word of the architect's epitaph and only saying,
+      Look around you!
+    </p>
+    <p>
+      The reports of the librarian have told or will tell you, in some detail,
+      what has been accomplished since the 21st of December, 1874, when six
+      gentlemen met at the house of Dr. Henry Ingersoll Bowditch to discuss
+      different projects for a medical library. In less than four years from
+      that time, by the liberality of associations and of individuals, this
+      collection of nearly ten thousand volumes, of five thousand pamphlets, and
+      of one hundred and twenty-five journals, regularly received,&mdash;all
+      worthily sheltered beneath this lofty roof,&mdash;has come into being
+      under our eyes. It has sprung up, as it were, in the night like a
+      mushroom; it stands before us in full daylight as lusty as an oak, and
+      promising to grow and flourish in the perennial freshness of an evergreen.
+    </p>
+    <p>
+      To whom does our profession owe this already large collection of books,
+      exceeded in numbers only by four or five of the most extensive medical
+      libraries in the country, and lodged in a building so well adapted to its
+      present needs? We will not point out individually all those younger
+      members of the profession who have accomplished what their fathers and
+      elder brethren had attempted and partially achieved. We need not write
+      their names on these walls, after the fashion of those civic dignitaries
+      who immortalize themselves on tablets of marble and gates of iron. But
+      their contemporaries know them well, and their descendants will not forget
+      them,&mdash;the men who first met together, the men who have given their
+      time and their money, the faithful workers, worthy associates of the
+      strenuous agitator who gave no sleep to his eyes, no slumber to his
+      eyelids, until he had gained his ends; the untiring, imperturbable,
+      tenacious, irrepressible, all-subduing agitator who neither rested nor let
+      others rest until the success of the project was assured. If, against his
+      injunctions, I name Dr. James Read Chadwick, it is only my revenge for his
+      having kept me awake so often and so long while he was urging on the
+      undertaking in which he has been preeminently active and triumphantly
+      successful.
+    </p>
+    <p>
+      We must not forget the various medical libraries which preceded this: that
+      of an earlier period, when Boston contained about seventy regular
+      practitioners, the collection afterwards transferred to the Boston
+      Athenaeum; the two collections belonging to the University; the Treadwell
+      Library at the Massachusetts General Hospital; the collections of the two
+      societies, that for Medical Improvement and that for Medical Observation;
+      and more especially the ten thousand volumes relating to medicine
+      belonging to our noble public city library,&mdash;too many blossoms on the
+      tree of knowledge, perhaps, for the best fruit to ripen. But the
+      Massachusetts Medical Society now numbers nearly four hundred members in
+      the city of Boston. The time had arrived for a new and larger movement.
+      There was needed a place to which every respectable member of the medical
+      profession could obtain easy access; where, under one roof, all might find
+      the special information they were seeking; where the latest medical
+      intelligence should be spread out daily as the shipping news is posted on
+      the bulletins of the exchange; where men engaged in a common pursuit could
+      meet, surrounded by the mute oracles of science and art; where the whole
+      atmosphere should be as full of professional knowledge as the apothecary's
+      shop is of the odor of his medicaments. This was what the old men longed
+      for,&mdash;the prophets and kings of the profession, who
+    </p>
+<pre xml:space="preserve">
+        &ldquo;Desired it long,
+   But died without the sight.&rdquo;
+ </pre>
+    <p>
+      This is what the young men and those who worked under their guidance
+      undertook to give us. And now such 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 profession of our city, and, let us
+      add, of all those neighboring places which it can reach with its iron
+      arms, is united as never before by the commune vinculum, the common bond
+      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 centralized
+      libraries; abreast of them, but not promising to be content with that
+      position. What glorifies a town like a cathedral? What dignifies a
+      province like a university? What illuminates a country like its
+      scholarship, and what is the nest that hatches scholars but a library?
+    </p>
+    <p>
+      The physician, some may say, is a practical man and has little use for all
+      this book-learning. Every student has heard Sydenham's reply to Sir
+      Richard Blackmore's question as to what books he should read,&mdash;meaning
+      medical books. &ldquo;Read Don Quixote,&rdquo; was his famous answer. But Sydenham
+      himself made medical books and may be presumed to have thought those at
+      least worth reading. Descartes was asked where was his library, and in
+      reply held up the dissected body of an animal. But Descartes made books,
+      great books, and a great many of them. A physician of common sense without
+      erudition is better than a learned one without common sense, but the
+      thorough master of his profession must have learning added to his natural
+      gifts.
+    </p>
+    <p>
+      It is not necessary to maintain the direct practical utility of all kinds
+      of learning. Our shelves contain many books which only a certain class of
+      medical scholars will be likely to consult. There is a dead 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 has no
+      living value for the student, will not teach him something by its autopsy.
+      But it is with the live literature of his profession that the medical
+      practitioner is first of all concerned.
+    </p>
+    <p>
+      Now there has come a great change in our time over the form in which
+      living thought presents itself. The first printed books,&mdash;the
+      incunabula,&mdash;were inclosed in boards of solid oak, with brazen clasps
+      and corners; the boards by and by were replaced by pasteboard covered with
+      calf or sheepskin; then cloth came in and took the place of leather; then
+      the pasteboard was covered with paper instead of cloth; and at this day
+      the quarterly, the monthly, the weekly periodical in its flimsy
+      unsupported dress of paper, and the daily journal, naked as it came from
+      the womb of the press, hold the larger part of the fresh reading we live
+      upon. We must have the latest thought in its latest expression; the page
+      must be newly turned like the morning bannock; the pamphlet must be newly
+      opened like the ante-prandial oyster.
+    </p>
+    <p>
+      Thus a library, to meet the need of our time, must take, and must spread
+      out in a convenient form, a great array of periodicals. Our active
+      practitioners read these by preference over almost everything else. Our
+      specialists, more particularly, depend on the month's product, on the
+      yearly crop of new facts, new suggestions, new contrivances, as much as
+      the farmer on the annual yield of his acres. One of the first wants, then,
+      of the profession is supplied by our library in its great array of
+      periodicals from many lands, in many languages. Such a number of medical
+      periodicals no private library would have room for, no private person
+      would pay for, or flood his tables with if they were sent him for nothing.
+      These, I think, with the reports of medical societies and the papers
+      contributed to them, will form the most attractive part of our accumulated
+      medical treasures. They will be also one of our chief expenses, for these
+      journals must be bound in volumes and they require a great amount of
+      shelf-room; all this, in addition to the cost of subscription for those
+      which are not furnished us gratuitously.
+    </p>
+    <p>
+      It is true that the value of old scientific periodicals is, other things
+      being equal, in the inverse ratio of their age, for the obvious reason
+      that what is most valuable in the earlier volumes of a series is drained
+      off into the standard works with which the intelligent practitioner is
+      supposed to be familiar. But no extended record of facts grows too old to
+      be useful, provided only that we have a ready and sure way of getting at
+      the particular fact or facts we are in search of.
+    </p>
+    <p>
+      And this leads me to speak of what I conceive to be one of the principal
+      tasks to be performed by the present and the coming generation of
+      scholars, not only in the medical, but in every department of knowledge. I
+      mean the formation of indexes, and more especially of indexes to
+      periodical literature.
+    </p>
+    <p>
+      This idea has long been working in the minds of scholars, and all who have
+      had occasion to follow out any special subject. I have a right to speak of
+      it, for I long ago attempted to supply the want of indexes in some small
+      measure for my own need. I had a very complete set of the &ldquo;American
+      Journal of the Medical Sciences;&rdquo; an entire set of the &ldquo;North American
+      Review,&rdquo; and many volumes of the reprints of the three leading British
+      quarterlies. Of what use were they to me without general indexes? I looked
+      them all through carefully and made classified lists of all the articles I
+      thought I should most care to read. But they soon outgrew my lists. The
+      &ldquo;North American Review&rdquo; kept filling up shelf after shelf, rich in
+      articles which I often wanted to consult, but what a labor to find them,
+      until the index of Mr. Gushing, published a few months since, made the
+      contents of these hundred and twenty volumes 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 lost its value
+      for me in later years. But where to look for what I wanted? I wished to
+      know, for instance, what Dr. Burney had to say about singing. Who would
+      have looked for it under the Italian word cantare? I was curious to learn
+      something of the etchings of Rembrandt, and where should I find it but
+      under the head &ldquo;Low Countries, Engravers of the,&rdquo;&mdash;an elaborate and
+      most valuable article of a hundred double-columned close-printed quarto
+      pages, to which no reference, even, is made under the title Rembrandt.
+    </p>
+    <p>
+      There was nothing to be done, if I wanted to know where that which I
+      specially cared for was to be found in my Rees's Cyclopaedia, but to look
+      over every page of its forty-one quarto volumes and make out a brief list
+      of matters of interest which I could not find by their titles, and this I
+      did, at no small expense of time and trouble.
+    </p>
+    <p>
+      Nothing, therefore, could be more pleasing to me than to see the attention
+      which has been given of late years to the great work of indexing. It is a
+      quarter of a century since Mr. Poole published his &ldquo;Index to Periodical
+      Literature,&rdquo; which it is much to be hoped is soon to appear in a new
+      edition, grown as it must be to formidable dimensions by the additions of
+      so long a period. The &ldquo;British and Foreign Medical Review,&rdquo; edited by the
+      late Sir John Forties, contributed to by Huxley, Carpenter, Laycock, and
+      others of the most distinguished scientific men of Great Britain, has an
+      index to its twenty-four volumes, and by its aid I find this valuable
+      series as manageable as a lexicon. The last edition of the &ldquo;Encyclopaedia
+      Britannica&rdquo; had a complete index in a separate volume, and the publishers
+      of Appletons' &ldquo;American Cyclopaedia&rdquo; have recently issued an index to
+      their useful work, which must greatly add to its value. I have already
+      referred to the index to the &ldquo;North American Review,&rdquo; which to an
+      American, and especially to a New Englander, is the most interesting and
+      most valuable addition of its kind to our literary apparatus since the
+      publication of Mr. Allibone's &ldquo;Dictionary of Authors.&rdquo; I might almost dare
+      to parody Mr. Webster's words in speaking of Hamilton, to describe what
+      Mr. Gushing did for the solemn rows of back volumes of our honored old
+      Review which had been long fossilizing on our shelves: &ldquo;He touched the
+      dead corpse of the 'North American,' and it sprang to its feet.&rdquo; A library
+      of the best thought of the best American scholars during the greater
+      portion of the century was brought to light by the work of the indexmaker
+      as truly as were the Assyrian tablets by the labors of Layard.
+    </p>
+    <p>
+      A great portion of the best writing and reading&mdash;literary, scientific,
+      professional, miscellaneous&mdash;comes to 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-binder puts a coat on his
+      back, and he joins the forlorn brotherhood of &ldquo;back volumes,&rdquo; than which,
+      so long as they are unindexed, nothing can be more exasperating. 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 a goldback
+      behind it?
+    </p>
+    <p>
+      I have referred chiefly to the medical journals, but I would include with
+      these the reports of medical associations, and those separate publications
+      which, coming in the form of pamphlets, heap themselves into chaotic piles
+      and bundles which are worse than useless, taking up a great deal of room,
+      and frightening everything away but mice and mousing antiquarians, or
+      possibly at long intervals some terebrating specialist.
+    </p>
+    <p>
+      Arranged, bound, indexed, all these at once become accessible and
+      valuable. I will take the first instance which happens to suggest itself.
+      How many who know all about osteoblasts and the experiments of Ollier, and
+      all that has grown out of them, know where to go for a paper by the late
+      Dr. A. L. Peirson of Salem, published in the year 1840, under the modest
+      title, Remarks on Fractures? And if any practitioner who has to deal with
+      broken bones does not know that most excellent and practical essay, it is
+      a great pity, for it answers very numerous questions which will be sure to
+      suggest themselves to the surgeon and the patient as no one of the recent
+      treatises, on my own shelves, at least, can do.
+    </p>
+    <p>
+      But if indexing is the special need of our time in medical literature, as
+      in every department of knowledge, it must be remembered that it is not
+      only an immense labor, but one that never ends. It requires, therefore,
+      the cooperation of a large number of individuals to do the work, and a
+      large amount of money to pay for making its results public through the
+      press. When it is remembered that the catalogue of the library of the
+      British Museum is contained in nearly three thousand large folios of
+      manuscript, and not all its books are yet included, the task of indexing
+      any considerable branch of science or literature looks as if it were well
+      nigh impossible. But many hands make light work. An &ldquo;Index Society&rdquo; has
+      been formed in England, already numbering about one hundred and seventy
+      members. It aims at &ldquo;supplying thorough indexes to valuable works and
+      collections which have hitherto lacked them; at issuing indexes to the
+      literature of special subjects; and at gathering materials for a general
+      reference index.&rdquo; This society has published a little treatise setting
+      forth the history and the art of indexing, which I trust is in the hands
+      of some of our members, if not upon our shelves.
+    </p>
+    <p>
+      Something has been done in the same direction by individuals in our own
+      country, as we have already seen. The need of it in the department of
+      medicine is beginning to be clearly felt. Our library has already an
+      admirable catalogue with cross references, the work of a number of its
+      younger members cooperating in the task. A very intelligent medical
+      student, Mr. William D. Chapin, whose excellent project is indorsed by
+      well-known New York physicians and professors, proposes to publish a
+      yearly index to original communications in the medical journals of the
+      United States, classified by authors and subjects. But it is from the
+      National Medical Library at Washington that we have the best promise and
+      the largest expectations. That great and growing collection of fifty
+      thousand volumes is under the eye and hand of a librarian who knows books
+      and how to manage them. For libraries are the standing armies of
+      civilization, and an army is but a mob without a general who can organize
+      and marshal it so as to make it effective. The &ldquo;Specimen Fasciculus of a
+      Catalogue of the National Medical Library,&rdquo; prepared under the direction
+      of Dr. Billings, the librarian, would have excited the admiration of
+      Haller, the master scholar in medical science of the last century, or
+      rather of the profession in all centuries, and if carried out as it is
+      begun will be to the nineteenth all and more than all that the three
+      Bibliothecae&mdash;Anatomica, Chirurgica, and Medicinae-Practicae&mdash;were
+      to the eighteenth century. I cannot forget the story that Agassiz was so
+      fond of telling of the king of Prussia and Fichte. It was after the
+      humiliation and spoliation of the kingdom by Napoleon that the monarch
+      asked the philosopher what could be done to regain the lost position of
+      the nation. &ldquo;Found a great university, Sire,&rdquo; was the answer, and so it
+      was that in the year 1810 the world-renowned University of Berlin came
+      into being. I believe that we in this country can do better than found a
+      national university, whose professors shall be nominated in caucuses, go
+      in and out, perhaps, like postmasters, with every change of
+      administration, and deal with science in the face of their constituency as
+      the courtier did with time when his sovereign asked him what o'clock it
+      was: &ldquo;Whatever hour your majesty pleases.&rdquo; But when we have a noble
+      library like that at Washington, and a librarian of exceptional
+      qualifications like the gentleman who now holds that office, I believe
+      that a liberal appropriation by Congress to carry out a conscientious work
+      for the advancement of sound knowledge and the bettering of human
+      conditions, like this which Dr. Billings has so well begun, would redound
+      greatly to the honor of the nation. It ought to be willing to be at some
+      charge to make its treasures useful to its citizens, and, for its own
+      sake, especially to that class which has charge of health, public and
+      private. This country abounds in what are called &ldquo;self-made men,&rdquo; and is
+      justly proud of many whom it thus designates. In one sense no man is
+      self-made who breathes the air of a civilized community. In another sense
+      every man who is anything other than a phonograph on legs is self-made.
+      But if we award his just praise to the man who has attained any kind of
+      excellence without having had the same advantages as others whom,
+      nevertheless, he has equalled or surpassed, let us not be betrayed into
+      undervaluing the mechanic's careful training to his business, the thorough
+      and laborious education of the scholar and the professional man.
+    </p>
+    <p>
+      Our American atmosphere is vocal with the flippant loquacity of half
+      knowledge. We must accept whatever good can be got out of it, and keep it
+      under as we do sorrel and mullein and witchgrass, by enriching the soil,
+      and sowing good seed in plenty; by good teaching and good books, rather
+      than by wasting our time in talking against it. Half knowledge dreads
+      nothing but whole knowledge.
+    </p>
+    <p>
+      I have spoken of the importance and the predominance of periodical
+      literature, and have attempted to do justice to its value. But the almost
+      exclusive reading of it is not without its dangers. The journals contain
+      much that is crude and unsound; the presumption, it might be maintained,
+      is against their novelties, unless they come from observers of established
+      credit. Yet I have known a practitioner,&mdash;perhaps more than one,&mdash;who
+      was as much under the dominant influence of the last article he had read
+      in his favorite medical journal as a milliner under the sway of the last
+      fashion-plate. The difference between green and seasoned knowledge is very
+      great, and such practitioners never hold long enough to any of their
+      knowledge to have it get seasoned.
+    </p>
+    <p>
+      It is needless to say, then, that all the substantial and permanent
+      literature of the profession should be represented upon our shelves. Much
+      of it is there already, and as one private library after another falls
+      into this by the natural law of gravitation, it will gradually acquire all
+      that is most valuable almost without effort. A scholar should not be in a
+      hurry to part with his books. They are probably more valuable to him than
+      they can be to any other individual. What Swedenborg called
+      &ldquo;correspondence&rdquo; has established itself between his intelligence and the
+      volumes which wall him within their sacred inclosure. Napoleon said that
+      his mind was as if furnished with drawers,&mdash;he drew out each as he
+      wanted its contents, and closed it at will when done with them. The
+      scholar's mind, to use a similar comparison, is furnished with shelves,
+      like his library. Each book knows its place in the brain as well as
+      against the wall or in the alcove. His consciousness is doubled by the
+      books which encircle him, as the trees that surround a lake repeat
+      themselves in its unruffled waters. Men talk of the nerve that runs to the
+      pocket, but one who loves his books, and has lived long with them, has a
+      nervous filament which runs 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 temple is to the worshipper who frequents it. There is the
+      altar sacred to his holiest experiences. There is the font where his
+      new-born thought was baptized and first had a name in his consciousness.
+      There is the monumental tablet of a dead belief, sacred still in the
+      memory of what it was while yet alive. No visitor can read all this on the
+      lettered backs of the books that have gathered around the scholar, but for
+      him, from the Aldus on the lowest shelf to the Elzevir on the highest,
+      every volume has a language which none but he can interpret. Be patient
+      with the book-collector who loves his companions too well to let them go.
+      Books are not buried with their owners, and the veriest book-miser that
+      ever lived was probably doing far more for his successors than his more
+      liberal neighbor who despised his learned or unlearned avarice. Let the
+      fruit fall with the leaves still clinging round it. Who would have
+      stripped Southey's walls of the books that filled them, when, his mind no
+      longer capable of taking in their meaning, he would still pat and fondle
+      them with the vague loving sense of what they had once been to him,&mdash;to
+      him, the great scholar, now like a little child among his playthings?
+    </p>
+    <p>
+      We need in this country not only the scholar, but the virtuoso, who hoards
+      the treasures which he loves, it may be chiefly for their rarity and
+      because others who know more than he does of their value set a high price
+      upon them. As the wine of old vintages is gently decanted out of its
+      cobwebbed bottles with their rotten corks into clean new receptacles, so
+      the wealth of the New World is quietly emptying many of the libraries and
+      galleries of the Old World into its 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 before the New Zealander takes
+      his stand on a broken arch of London Bridge to sketch the ruins of St.
+      Paul's in the midst of a vast solitude, the treasures of the British
+      Museum will have found a new shelter in the halls of New York or Boston.
+      No Catholic will think hardly of my saying that before the Coliseum falls,
+      and with it the imperial city, whose doom prophecy has linked with that of
+      the almost eternal amphitheatre, the marbles, the bronzes, the paintings,
+      the manuscripts of the Vatican will have left the shores of the Tiber for
+      those of the Potomac, the Hudson, the Mississippi, or the Sacramento. And
+      what a delight in the pursuit of the rarities which the eager book-hunter
+      follows with the scent of a beagle!
+    </p>
+    <p>
+      Shall I ever forget that rainy day in Lyons, that dingy bookshop, where I
+      found the Aetius, long missing from my Artis bledicae Principes, and where
+      I bought for a small pecuniary consideration, though it was marked rare,
+      and was really tres rare, the Aphorisms of Hippocrates, edited by and with
+      a preface from the hand of Francis Rabelais? And the vellum-bound Tulpius,
+      which I came upon in Venice, afterwards my only reading when imprisoned in
+      quarantine at Marseilles, so that the two hundred and twenty-eight cases
+      he has recorded are, many of them, to this day still fresh in my memory.
+      And the Schenckius,&mdash;the folio filled with casus rariores, which had
+      strayed in among the rubbish of the bookstall on the boulevard,&mdash;and
+      the noble old Vesalius with its grand frontispiece not unworthy of Titian,
+      and the fine old Ambroise Pare, long waited for even in Paris and long
+      ago, and the colossal Spigelius with his eviscerated beauties, and Dutch
+      Bidloo with its miracles of fine engraving and bad dissection, and Italian
+      Mascagni, the despair of all would-be imitators, and pre-Adamite John de
+      Ketam, and antediluvian Berengarius Carpensis,&mdash;but why multiply
+      names, every one of which brings back the accession of a book which was an
+      event almost like the birth of an infant?
+    </p>
+    <p>
+      A library like ours must exercise the largest hospitality. A great many
+      books may be found in every large collection which remind us of those
+      apostolic looking old men who figure on the platform at our political and
+      other assemblages. Some of them have spoken words of wisdom in their day,
+      but they have ceased to be oracles; some of them never had any
+      particularly important message for humanity, but they add dignity to the
+      meeting by their presence; they look wise, whether they are so or not, and
+      no one grudges them their places of honor. Venerable figure-heads, what
+      would our platforms be without you?
+    </p>
+    <p>
+      Just so with our libraries. Without their rows of folios in creamy vellum,
+      or showing their black backs with antique lettering of tarnished gold, our
+      shelves would look as insufficient and unbalanced as a column without its
+      base, as a statue without its pedestal. And do not think they are kept
+      only to be spanked and dusted during that dreadful period when their owner
+      is but too thankful to become an exile and a wanderer from the scene of
+      single combats between dead authors and living housemaids. Men were not
+      all cowards before Agamemnon or all fools before the days of Virchow and
+      Billroth. And apart from any practical use to be derived from the older
+      medical authors, is there not a true pleasure in reading the accounts of
+      great discoverers in their own words? I do not pretend to hoist up the
+      Bibliotheca Anatomica of Mangetus and spread it on my table every day. I
+      do not get out my great Albinus before every lecture on the muscles, nor
+      disturb the majestic repose of Vesalius every time I speak of the bones he
+      has so admirably described and figured. But it does please me to read the
+      first descriptions of parts to which the names of their discoverers or
+      those who have first described them have become so joined that not even
+      modern science can part them; to listen to the talk of my old volume as
+      Willis describes his circle and Fallopius his aqueduct and Varolius his
+      bridge and Eustachius his tube and Monro his foramen,&mdash;all so well
+      known to us in the human body; it does please me to know the very words in
+      which Winslow described the opening which bears his name, and Glisson his
+      capsule and De Graaf his vesicle; I am not content until I know in what
+      language Harvey announced his discovery of the circulation, and how
+      Spigelius made the liver his perpetual memorial, and Malpighi found a
+      monument more enduring than brass in the corpuscles of the spleen and the
+      kidney.
+    </p>
+    <p>
+      But after all, the readers who care most for the early records of medical
+      science and art are the specialists who are dividing up the practice of
+      medicine and surgery as 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 others is applicable the saying of D'Alembert that the
+      author kills himself in lengthening out what the reader kills himself in
+      trying to shorten.
+    </p>
+    <p>
+      There are practical books among these ancient volumes which can never grow
+      old. Would you know how to recognize &ldquo;male hysteria&rdquo; and to treat it, take
+      down your Sydenham; would you read the experience of a physician who was
+      himself the subject of asthma, and who, notwithstanding that, in the words
+      of Dr. Johnson, &ldquo;panted on till ninety,&rdquo; you will find it in the venerable
+      treatise of Sir John Floyer; would you listen to the story of the King's
+      Evil cured by the royal touch, as told by a famous chirurgeon who fully
+      believed in it, go to Wiseman; would you get at first hand the description
+      of the spinal disease which long bore his name, do not be startled if I
+      tell you to go to Pott,&mdash;to Percival Pott, the great surgeon of the
+      last century.
+    </p>
+    <p>
+      There comes a time for every book in a library when it is wanted by
+      somebody. It is but a few weeks since one of the most celebrated
+      physicians in the country wrote to me from a great centre of medical
+      education to know if I had the works of Sanctorius, which he had tried in
+      vain to find. I could have lent him the &ldquo;Medicina Statica,&rdquo; with its
+      frontispiece showing Sanctorius with his dinner on the table before him,
+      in his balanced chair which sunk with him below the level of his
+      banquet-board when he had swallowed a certain number of ounces,&mdash;an
+      early foreshadowing of Pettenkofer's chamber and quantitative physiology,&mdash;but
+      the &ldquo;Opera Omnia&rdquo; of Sanctorius I had never met with, and I fear he had to
+      do without it.
+    </p>
+    <p>
+      I would extend the hospitality of these shelves to a class of works which
+      we are in the habit of considering as being outside of the pale of medical
+      science, properly so called, and sometimes of coupling with a
+      disrespectful name. Such has always been my own practice. I have welcomed
+      Culpeper and Salmon to my bookcase as willingly as Dioscorides or Quincy,
+      or Paris or Wood and Bache. I have found a place for St. John Long, and
+      read the story of his trial for manslaughter with as much interest as the
+      laurel-water case in which John Hunter figured as a witness. I would give
+      Samuel Hahnemann a place by the side of Samuel Thomson. Am I not afraid
+      that some student of imaginative turn and not provided with the needful
+      cerebral strainers without which all the refuse of gimcrack intelligences
+      gets into the mental drains and chokes them up,&mdash;am I not afraid that
+      some such student will get hold of the &ldquo;Organon&rdquo; or the &ldquo;Maladies
+      Chroniques&rdquo; and be won over by their delusions, and so be lost to those
+      that love him as a man of common sense and a brother in their high
+      calling? Not in the least. If he showed any symptoms of infection I would
+      for once have recourse to the principle of similia similibus. To cure him
+      of Hahnemann I would prescribe my favorite homoeopathic antidote, Okie's
+      Bonninghausen. If that failed, I would order Grauvogl as a heroic remedy,
+      and if he survived that uncured, I would give him my blessing, if I
+      thought him honest, and bid him depart in peace. For me he is no longer an
+      individual. He belongs to a class of minds which we are bound to be
+      patient with if their Maker sees fit to indulge them with existence. We
+      must accept the conjuring ultra-ritualist, the dreamy second adventist,
+      the erratic spiritualist, the fantastic homoeopathist, as not unworthy of
+      philosophic study; not more unworthy of it than the squarers of the circle
+      and the inventors of perpetual motion, and the other whimsical visionaries
+      to whom De Morgan has devoted his most instructive and entertaining
+      &ldquo;Budget of Paradoxes.&rdquo; I hope, therefore, that our library will admit the
+      works of the so-called Eclectics, of the Thomsonians, if any are in
+      existence, of the Clairvoyants, if they have a literature, and especially
+      of the Homoeopathists. This country seems to be the place for such a
+      collection, which will by and by be curious and of more value than at
+      present, for Homoeopathy seems to be following the pathological law of
+      erysipelas, fading out where it originated as it spreads to new regions.
+      At least I judge so by the following translated extract from a criticism
+      of an American work in the &ldquo;Homoeopatische Rundschau&rdquo; of Leipzig for
+      October, 1878, which I find in the &ldquo;Homoeopathic Bulletin&rdquo; for the month
+      of November just passed: &ldquo;While we feel proud of the spread and rise of
+      Homoeopathy across the ocean, and while the Homoeopathic works reaching us
+      from there, and published in a style such as is unknown in Germany, bear
+      eloquent testimony to the eminent activity of our transatlantic
+      colleagues, we are overcome by sorrowful regrets at the position
+      Homoeopathy occupies in Germany. Such a work [as the American one referred
+      to] with us would be impossible; it would lack the necessary support.&rdquo;
+     </p>
+    <p>
+      By all means let our library secure a good representation of the
+      literature of Homoeopathy before it leaves us its &ldquo;sorrowful regrets&rdquo; and
+      migrates with its sugar of milk pellets, which have taken the place of the
+      old pilulae micae panis, to Alaska, to &ldquo;Nova Zembla, or the Lord knows
+      where.&rdquo;
+     </p>
+    <p>
+      What shall I say in this presence of the duties of a Librarian? Where have
+      they ever been better performed than in our own public city library, where
+      the late Mr. Jewett and the living Mr. Winsor have shown us what a
+      librarian ought to be,&mdash;the organizing head, the vigilant guardian,
+      the seeker's index, the scholar's counsellor? His work is not merely that
+      of administration, manifold and laborious as its duties are. He must have
+      a quick intelligence and a retentive memory. He is a public carrier of
+      knowledge in its germs. His office is like that which naturalists
+      attribute to the bumble-bee,&mdash;he lays up little honey for himself,
+      but he conveys the fertilizing pollen from flower to flower.
+    </p>
+    <p>
+      Our undertaking, just completed,&mdash;and just begun&mdash;has come at
+      the right time, not a day too soon. Our practitioners need a library like
+      this, for with all their skill and devotion there is too little genuine
+      erudition, such as a liberal profession ought to be able to claim for many
+      of its members. In reading the recent obituary notices of the late Dr.
+      Geddings of South Carolina, I recalled what our lamented friend Dr. Coale
+      used to tell me of his learning and accomplishments, and I could not help
+      reflecting how few such medical scholars we had to show in Boston or New
+      England. We must clear up this unilluminated atmosphere, and here,&mdash;here
+      is the true electric light which will irradiate its darkness.
+    </p>
+    <p>
+      The public will catch the rays reflected from the same source of light,
+      and it needs instruction on the great subjects of health and disease,&mdash;needs
+      it sadly. It is preyed upon by every kind of imposition almost without
+      hindrance. Its ignorance and prejudices react upon the profession to the
+      great injury of both. The jealous feeling, for instance, with regard to
+      such provisions for the study of anatomy as are sanctioned by the laws in
+      this State and carried out with strict regard to those laws, threatens the
+      welfare, if not the existence of institutions for medical instruction
+      wherever it is not held in check by enlightened intelligence. And on the
+      other hand the profession has just been startled by a verdict against a
+      physician, ruinous in its amount,&mdash;enough to drive many a
+      hard-working young practitioner out of house and home,&mdash;a verdict
+      which leads to the fear that suits for malpractice may take the place of
+      the panel game and child-stealing as a means of extorting money. If the
+      profession in this State, which claims a high standard of civilization, is
+      to be crushed and ground beneath the upper millstone of the dearth of
+      educational advantages and the lower millstone of ruinous penalties for
+      what the ignorant ignorantly shall decide to be ignorance, all I can say
+      is
+    </p>
+<pre xml:space="preserve">
+     God save the Commonhealth of Massachusetts!
+</pre>
+    <p>
+      Once more, we cannot fail to see that just as astrology has given place to
+      astronomy, so theology, the science of Him whom by searching no man can
+      find out, is fast being replaced by what we may not improperly call
+      theonomy, or the science of the laws according to which the Creator acts.
+      And since these laws find their fullest manifestations for us, at least,
+      in rational human natures, the study of anthropology is largely replacing
+      that of scholastic divinity. We must contemplate our Maker indirectly in
+      human attributes as we talk of Him in human parts of speech. And this
+      gives a sacredness to the study of man in his physical, mental, moral,
+      social, and religious nature which elevates the faithful students of
+      anthropology to the dignity of a priesthood, and sheds a holy light on the
+      recorded results of their labors, brought together as they are in such a
+      collection as this which is now spread out before us.
+    </p>
+    <p>
+      Thus, then, our library is a temple as truly as the dome-crowned cathedral
+      hallowed by the breath of prayer and praise, where the dead repose and the
+      living worship. May it, with all its treasures, be consecrated like that
+      to the glory of God, through the contributions it shall make to the
+      advancement of sound knowledge, to the relief of human suffering, to the
+      promotion of harmonious relations between the members of the two noble
+      professions which deal with the diseases of the soul and with those of the
+      body, and to the common cause in which all good men are working, the
+      furtherance of the well-being of their fellow-creatures!
+    </p>
+    <p>
+      NOTE.&mdash;As an illustration of the statement in the last paragraph but
+      one, I take the following notice from the &ldquo;Boston Daily Advertiser,&rdquo; of
+      December 4th, the day after the delivery of the address: &ldquo;Prince Lucien
+      Bonaparte is now living in London, and is devoting himself to the work of
+      collecting the creeds of all religions and sects, with a view to their
+      classification,&mdash;his object being simply scientific or
+      anthropological.&rdquo;
+     </p>
+    <p>
+      Since delivering the address, also, I find a leading article in the
+      &ldquo;Cincinnati Lancet and Clinic&rdquo; of November 30th, headed &ldquo;The Decadence of
+      Homoeopathy,&rdquo; abundantly illustrated by extracts from the &ldquo;Homoeopathic
+      Times,&rdquo; the leading American organ of that sect.
+    </p>
+    <p>
+      In the New York &ldquo;Medical Record&rdquo; of the same date, which I had not seen
+      before the delivery of my address, is an account of the action of the
+      Homoeopathic Medical Society of Northern New York, in which Hahnemann's
+      theory of &ldquo;dynamization&rdquo; is characterized in a formal resolve as &ldquo;unworthy
+      the confidence of the Homoeopathic profession.&rdquo;
+     </p>
+    <p>
+      It will be a disappointment to the German Homoeopathists to read in the
+      &ldquo;Homoeopathic Times&rdquo; such a statement as the following: &ldquo;Whatever the
+      influences have been which have checked the outward development of
+      Homoeopathy, it is plainly evident that the Homoeopathic school, as
+      regards the number of its openly avowed representatives, has attained its
+      majority, and has begun to decline both in this country and in England.&rdquo;
+     </p>
+    <p>
+      All which is an additional reason for making a collection of the
+      incredibly curious literature of Homoeopathy before that pseudological
+      inanity has faded out like so many other delusions.
+    </p>
+    <p>
+      <a name="link2H_4_0013" id="link2H_4_0013">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      SOME OF MY EARLY TEACHERS
+    </h2>
+    <p>
+      [A Farewell Address to the Medical School of Harvard University, November
+      28, 1882.]
+    </p>
+    <p>
+      I had intended that the recitation of Friday last should be followed by a
+      few parting words to my class and any friends who might happen to be in
+      the lecture-room. But I learned on the preceding evening that there was an
+      expectation, a desire, that my farewell should take a somewhat different
+      form; and not to disappoint the wishes of those whom I was anxious to
+      gratify, I made up my mind to appear before you with such hasty
+      preparation as the scanty time admitted.
+    </p>
+    <p>
+      There are three occasions upon which a human being has a right to consider
+      himself as a centre of interest to those about him: when he is christened,
+      when he is married, and when he is buried. Every one is the chief
+      personage, the hero, of his own baptism, his own wedding, and his own
+      funeral.
+    </p>
+    <p>
+      There are other occasions, less momentous, in which one may make more of
+      himself than under ordinary circumstances he would think it proper to do;
+      when he may talk about himself, and tell his own experiences, in fact,
+      indulge in a more or less egotistic monologue without fear or reproach.
+    </p>
+    <p>
+      I think I may claim that this is one of those occasions. I have delivered
+      my last anatomical lecture and heard my class recite for the last time.
+      They wish to hear from me again in a less scholastic mood than that in
+      which they have known me. Will you not indulge me in telling you something
+      of my own story?
+    </p>
+    <p>
+      This is the thirty-sixth Course of Lectures in which I have taken my place
+      and performed my duties as Professor of Anatomy. For more than half of my
+      term of office I gave instruction in Physiology, after the fashion of my
+      predecessors and in the manner then generally prevalent in our schools,
+      where the physiological laboratory was not a necessary part of the
+      apparatus of instruction. It was with my hearty approval that the teaching
+      of Physiology was constituted a separate department and made an
+      independent Professorship. Before my time, Dr. Warren had taught Anatomy,
+      Physiology, and Surgery in the same course of Lectures, lasting only three
+      or four months. As the boundaries of science are enlarged, new divisions
+      and subdivisions of its territories become necessary. In the place of six
+      Professors in 1847, when I first became a member of the Faculty, I count
+      twelve upon the Catalogue before me, and I find the whole number engaged
+      in the work of instruction in the Medical School amounts to no less than
+      fifty.
+    </p>
+    <p>
+      Since I began teaching in this school, the aspect of many branches of
+      science has undergone a very remarkable transformation. Chemistry and
+      Physiology are no longer what they were, as taught by the instructors of
+      that time. We are looking forward to the synthesis of new organic
+      compounds; our artificial madder is already in the market, and the
+      indigo-raisers are now fearing that their crop will be supplanted by the
+      manufactured article. In the living body we talk of fuel supplied and work
+      done, in movement, in heat, just as if we were dealing with a machine of
+      our own contrivance.
+    </p>
+    <p>
+      A physiological laboratory of to-day is equipped with instruments of
+      research of such ingenious contrivance, such elaborate construction, that
+      one might suppose himself in a workshop where some exquisite fabric was to
+      be wrought, such as Queens love to wear, and Kings do not always love to
+      pay for. They are, indeed, weaving a charmed web, for these are the looms
+      from which comes the knowledge that clothes the nakedness of the
+      intellect. Here are the mills that grind food for its hunger, and &ldquo;is not
+      the life more than meat, and the body than raiment?&rdquo;
+     </p>
+    <p>
+      But while many of the sciences have so changed that the teachers of the
+      past would hardly know them, it has not been so with the branch I teach,
+      or, rather, with that division of it which is chiefly taught in this
+      amphitheatre. General anatomy, or histology, on the other hand, is almost
+      all new; it has grown up, mainly, since I began my medical studies. I
+      never saw a compound microscope during my years of study in Paris.
+      Individuals had begun to use the instrument, but I never heard it alluded
+      to by either Professors or students. In descriptive anatomy I have found
+      little to unlearn, and not a great deal that was both new and important to
+      learn. Trifling additions are made from year to year, not to be despised
+      and not to be overvalued. Some of the older anatomical works are still
+      admirable, some of the newer ones very much the contrary. I have had
+      recent anatomical plates brought me for inspection, and I have actually
+      button-holed the book-agent, a being commonly as hard to get rid of as the
+      tar-baby in the negro legend, that I might put him to shame with the
+      imperial illustrations of the bones and muscles in the great folio of
+      Albinus, published in 1747, and the unapproached figures of the lymphatic
+      system of Mascagni, now within a very few years of a century old, and
+      still copied, or, rather, pretended to be copied, in the most recent works
+      on anatomy.
+    </p>
+    <p>
+      I am afraid that it is a good plan to get rid of old Professors, and I am
+      thankful to hear that there is a movement for making provision for those
+      who are left in need when they lose their offices and their salaries. I
+      remember one of our ancient Cambridge Doctors once asked me to get into
+      his rickety chaise, and said to me, half humorously, half sadly, that he
+      was like an old horse,&mdash;they had taken off his saddle and turned him
+      out to pasture. I fear the grass was pretty short where that old servant
+      of the public found himself grazing. If I myself needed an apology for
+      holding my office so long, I should find it in the fact that human anatomy
+      is much the same study that it was in the days of Vesalius and Fallopius,
+      and that the greater part of my teaching was of such a nature that it
+      could never become antiquated.
+    </p>
+    <p>
+      Let me begin with my first experience as a medical student. I had come
+      from the lessons of Judge Story and Mr. Ashmun in the Law School at
+      Cambridge. I had been busy, more or less, with the pages of Blackstone and
+      Chitty, and other text-books of the first year of legal study. More or
+      less, I say, but I am afraid it was less rather than more. For during that
+      year I first tasted the intoxicating pleasure of authorship. A college
+      periodical, conducted by friends of mine, still undergraduates, tempted me
+      into print, and there is no form of lead-poisoning which more rapidly and
+      thoroughly pervades the blood and bones and marrow than that which reaches
+      the young author through mental contact with type-metal. Qui a bu, boira,&mdash;he
+      who has once been a drinker will drink again, says the French proverb. So
+      the man or woman who has tasted type is sure to return 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 of it from that
+      day to this. But for that I might have applied myself more diligently to
+      my legal studies, and carried a green bag in place of a stethoscope and a
+      thermometer up to the present day.
+    </p>
+    <p>
+      What determined me to give up Law and apply myself to Medicine I can
+      hardly say, but I had from the first looked upon that year's study as an
+      experiment. At any rate, I made the change, and soon found myself
+      introduced to new scenes and new companionships.
+    </p>
+    <p>
+      I can scarcely credit my memory when I recall the first impressions
+      produced upon me by sights afterwards become so familiar that they could
+      no more disturb a 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 devoted to the students of the school I had joined,
+      just as the fleshless figure of Time, with the hour-glass and scythe, used
+      to glare upon me in my childhood from the &ldquo;New England Primer.&rdquo; The white
+      faces in the beds at the Hospital found their reflection in my own cheeks,
+      which lost their color as I looked upon them. All this had to pass away in
+      a little time; I had chosen my profession, and must meet its painful and
+      repulsive aspects until they lost their power over my sensibilities.
+    </p>
+    <p>
+      The private medical school which I had joined was one 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 either spoken
+      elsewhere or may find occasion to speak hereafter. The two younger members
+      of this association of teachers were both graduates of our University, one
+      of the year 1819, the other of 1818.
+    </p>
+    <p>
+      Dr. Lewis was a great favorite with students. He was a man of very lively
+      temperament, fond of old books and young people, open-hearted,
+      free-spoken, an enthusiast in teaching, and especially at home in that
+      apartment of the temple of science where nature is seen in undress, the
+      anthropotomic laboratory, known to common speech as the dissecting-room.
+      He had that quality which is the special gift of the man born for a
+      teacher,&mdash;the power of exciting an interest in that which he taught.
+      While he was present the apartment I speak of was the sunniest of studios
+      in spite of its mortuary spectacles. Of the students I met there I best
+      remember James Jackson, Junior, full of zeal and playful as a boy, a young
+      man whose early death was a calamity to the profession of which he
+      promised to be a chief ornament; the late Reverend J. S. C. Greene, who,
+      as the prefix to his name signifies, afterwards changed his profession,
+      but one of whose dissections I remember looking upon with admiration; and
+      my friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
+      entitled to be called, then, as now and always, a favorite with all about
+      him. He had come to us from the schools of Germany, and brought with him
+      recollections of the 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,&mdash;I will not
+      say as important as a good Professor in the teaching of Anatomy, because I
+      am not sure that he is not more important. He comes into direct personal
+      relations with the students,&mdash;he is one of them, in fact, as the
+      Professor cannot be from the nature of his duties. The Professor's chair
+      is an insulating stool, so to speak; his age, his knowledge, real or
+      supposed, his official station, are like the glass legs which support the
+      electrician's piece of furniture, and cut it off from the common currents
+      of the floor upon which it stands. Dr. Lewis enjoyed teaching and made his
+      students enjoy being taught. He delighted in those anatomical conundrums
+      to answer which keeps the student's eyes open and his wits awake. He was
+      happy as he dexterously performed the tour de maitre of the old
+      barber-surgeons, or applied the spica bandage and taught his scholars to
+      do it, so neatly and symmetrically that the aesthetic missionary from the
+      older centre of civilization would bend over it in blissful contemplation,
+      as if it were a sunflower. Dr. Lewis had many other tastes, and was a
+      favorite, not only with students, but in a wide circle, professional,
+      antiquarian, masonic, and social.
+    </p>
+    <p>
+      Dr. Otis was less widely known, but was a fluent and agreeable lecturer,
+      and esteemed as a good surgeon.
+    </p>
+    <p>
+      I must content myself with this glimpse at myself and a few of my
+      fellow-students in Boston. After attending two courses of Lectures in the
+      school of the University, I went to Europe to continue my studies.
+    </p>
+    <p>
+      You may like to hear something of the famous Professors of Paris in the
+      days when I was a student in the Ecole de Medicine, and following the
+      great Hospital teachers.
+    </p>
+    <p>
+      I can hardly believe my own memory when I recall the old practitioners and
+      Professors who were still going round the hospitals when I mingled with
+      the train of students that attended the morning visits. See that bent old
+      man who is groping his way through the wards of La Charity. That is the
+      famous Baron Boyer, author of the great work on surgery in nine volumes, a
+      writer whose clearness of style commends his treatise to general
+      admiration, and makes it a kind of classic. He slashes away at a terrible
+      rate, they say, when he gets hold of the subject of fistula in its most
+      frequent habitat,&mdash;but I never saw him do more than look as if he
+      wanted to cut a good dollop out of a patient he was examining. The short,
+      square, substantial man with iron-gray hair, ruddy face, and white apron
+      is Baron Larrey, Napoleon's favorite surgeon, the most honest man he ever
+      saw,&mdash;it is reputed that he called him. To go round the Hotel des
+      Invalides with Larrey was to live over the campaigns of Napoleon, to look
+      on the sun of Austerlitz, to hear the cannons of Marengo, to struggle
+      through the icy waters of the Beresina, to shiver in the snows of the
+      Russian retreat, and to gaze through the battle smoke upon the last charge
+      of the red lancers on the redder field of Waterloo. Larrey was still
+      strong and sturdy as I saw him, and few portraits remain printed in
+      livelier colors on the tablet of my memory.
+    </p>
+    <p>
+      Leave the little group of students which gathers about Larrey beneath the
+      gilded dome of the Invalides and follow me to the Hotel Dieu, where rules
+      and reigns the master-surgeon of his day, at least so far as Paris and
+      France are concerned,&mdash;the illustrious Baron Dupuytren. No man
+      disputed his reign, some envied his supremacy. Lisfranc shrugged his
+      shoulders as he spoke of &ldquo;ce grand homme de l'autre cote de la riviere,&rdquo;
+       that great man on the other side of the river, but the great man he
+      remained, until he bowed before the mandate which none may disobey. &ldquo;Three
+      times,&rdquo; said Bouillaud, &ldquo;did the apoplectic thunderbolt fall on that
+      robust brain,&rdquo;&mdash;it yielded at last as the old bald cliff that is
+      riven and crashes down into the valley. I saw him before the first
+      thunderbolt had descended: a square, solid man, with a high and full-domed
+      head, oracular in his utterances, indifferent to those around him,
+      sometimes, it was said, very rough with them. He spoke in low, even tones,
+      with quiet fluency, and was listened to with that hush of rapt attention
+      which I have hardly seen in any circle of listeners unless when such men
+      as ex-President John Quincy Adams or Daniel Webster were the speakers. I
+      do not think that Dupuytren has left a record which explains his
+      influence, but in point of fact he dominated those around him in a
+      remarkable manner. You must have all witnessed something of the same kind.
+      The personal presence of some men carries command with it, and their
+      accents silence the crowd around them, when the same words from other lips
+      might fall comparatively unheeded.
+    </p>
+    <p>
+      As for Lisfranc, I can say little more of him than that he was a great
+      drawer of blood and hewer of members. I remember his ordering a wholesale
+      bleeding of his patients, right and left, whatever might be the matter
+      with them, one morning when a phlebotomizing fit was on him. I recollect
+      his regretting the splendid guardsmen of the old Empire,&mdash;for what?
+      because they had such magnificent thighs to amputate. I got along about as
+      far as that with him, when I ceased to be a follower of M. Lisfranc.
+    </p>
+    <p>
+      The name of Velpeau must have reached many of you, for he died in 1867,
+      and his many works made his name widely known. Coming to Paris in wooden
+      shoes, starving, almost, at first, he raised himself to great eminence as
+      a surgeon and as an author, and at last obtained the Professorship to
+      which his talents and learning entitled him. His example may be an
+      encouragement to some of my younger hearers who are born, not with the
+      silver spoon in their mouths, but with the two-tined iron fork in their
+      hands. It is a poor thing to take up their milk porridge with in their
+      young days, but in after years it will often transfix the solid dumplings
+      that roll out of the silver spoon. So Velpeau found it. He had not what is
+      called genius, he was far from prepossessing in aspect, looking as if he
+      might have wielded the sledge-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 distinction and
+      prosperity, as some of you sitting on these benches and wondering
+      anxiously what is to become of you in the struggle for life will have done
+      before the twentieth century has got halfway through its first quarter. A
+      good sound head over a pair of wooden shoes is a great deal better than a
+      wooden head belonging to an owner who cases his feet in calf-skin, but a
+      good brain is not enough without a stout heart to fill the four great
+      conduits which carry at once fuel and fire to that mightiest of engines.
+    </p>
+    <p>
+      How many of you who are before me are familiarly acquainted with the name
+      of Broussais, or even with that of Andral? Both were lecturing at the
+      Ecole de Medicine, and I often heard them. Broussais was in those days
+      like an old volcano, which has pretty nearly used up its fire and
+      brimstone, but is still boiling and bubbling in its interior, and now and
+      then sends up a spirt of lava and a volley of pebbles. His theories of
+      gastro-enteritis, of irritation and inflammation as the cause of disease,
+      and the practice which sprang from them, ran over the fields of medicine
+      for a time like flame over the grass of the prairies. The way in which
+      that knotty-featured, savage old man would bring out the word irritation&mdash;with
+      rattling and rolling reduplication of the resonant letter r&mdash;might
+      have taught a lesson in articulation to Salvini. But Broussais's theory
+      was languishing and well-nigh become obsolete, and this, no doubt, added
+      vehemence to his defence of his cherished dogmas.
+    </p>
+    <p>
+      Old theories, and old men who cling to them, must take themselves out of
+      the way as the new generation with its fresh thoughts and altered habits
+      of mind comes forward to take the place of that which is dying out. This
+      was a truth which the fiery old theorist found it very hard to learn, and
+      harder to bear, as it was forced upon him. For the hour of his lecture was
+      succeeded by that of a younger and far more popular professor. As his
+      lecture drew towards its close, the benches, thinly sprinkled with
+      students, began to fill up; the doors creaked open and banged back oftener
+      and oftener, until at last the sound grew almost continuous, and the voice
+      of the lecturer became a leonine growl as he strove in vain to be heard
+      over the noise of doors and footsteps.
+    </p>
+    <p>
+      Broussais was now sixty-two years old. The new generation had outgrown his
+      doctrines, and the Professor for whose hour the benches had filled
+      themselves belonged to that new generation. Gabriel Andral was little more
+      than half the age of Broussais, in the full prime and vigor of manhood at
+      thirty-seven years. He was a rapid, fluent, fervid, and imaginative
+      speaker, pleasing in aspect and manner,&mdash;a strong contrast to the
+      harsh, vituperative old man who had just preceded him. His Clinique
+      Medicale is still valuable as a collection of cases, and his researches on
+      the blood, conducted in association with Gavarret, contributed new and
+      valuable facts to science. But I remember him chiefly as one of those
+      instructors whose natural eloquence made it delightful to listen to him. I
+      doubt if I or my fellow-students did full justice either to him or to the
+      famous physician of Hotel Dieu, Chomel. We had addicted ourselves almost
+      too closely to the words of another master, by whom we were ready to swear
+      as against all teachers that ever were or ever would be.
+    </p>
+    <p>
+      This object of our reverence, I might almost say idolatry, was one whose
+      name is well known to most of the young men before me, even to those who
+      may know comparatively little of his works and teachings. Pierre Charles
+      Alexandre Louis, at the age of forty-seven, as I recall him, was a tall,
+      rather spare, dignified personage, of serene and grave aspect, but with a
+      pleasant smile and kindly voice for the student with whom he came into
+      personal relations. If I summed up the lessons of Louis in two
+      expressions, they would be these; I do not hold him answerable for the
+      words, but I will condense them after my own fashion in French, and then
+      give them to you, expanded somewhat, in English:
+    </p>
+<pre xml:space="preserve">
+     Formez toujours des idees nettes.
+     Fuyez toujours les a peu pres.
+</pre>
+    <p>
+      Always make sure that you form a distinct and clear idea of the matter you
+      are considering.
+    </p>
+    <p>
+      Always avoid vague approximations where exact estimates are possible;
+      about so many,&mdash;about so much, instead of the precise number and
+      quantity.
+    </p>
+    <p>
+      Now, if there is anything on which the biological sciences have prided
+      themselves in these latter years it is the substitution of quantitative
+      for qualitative formulae. The &ldquo;numerical system,&rdquo; of which Louis was the
+      great advocate, if not the absolute originator, was an attempt to
+      substitute series of carefully recorded facts, rigidly counted and closely
+      compared, for those never-ending records of vague, unverifiable
+      conclusions with which the classics of the healing art were overloaded.
+      The history of practical medicine had been like the story of the Danaides.
+      &ldquo;Experience&rdquo; had been, from time immemorial, pouring its flowing treasures
+      into buckets full of holes. At the existing rate of supply and leakage
+      they would never be filled; nothing would ever be settled in medicine. But
+      cases thoroughly recorded and mathematically analyzed would always be
+      available for future use, and when accumulated in sufficient number would
+      lead to results which would be trustworthy, and belong to science.
+    </p>
+    <p>
+      You young men who are following the hospitals hardly know how much you are
+      indebted to Louis. I say nothing of his Researches on Phthisis or his
+      great work on Typhoid Fever. But I consider his modest and brief Essay on
+      Bleeding in some Inflammatory Diseases, based on cases carefully observed
+      and numerically analyzed, one of the most important written contributions
+      to practical medicine, to the treatment of internal disease, of this
+      century, if not since the days of Sydenham. The lancet was the magician's
+      wand of the dark ages of medicine. The old physicians not only believed in
+      its general efficacy as a wonder-worker in disease, but they believed that
+      each malady could be successfully attacked from some special part of the
+      body,&mdash;the strategic point which commanded the seat of the morbid
+      affection. On a figure given in the curious old work of John de Ketam, no
+      less than thirty-eight separate places are marked as the 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 suffering from
+      headache should be bled in the foot, in preference to any other part.
+    </p>
+    <p>
+      But what Louis did was this: he showed by a strict analysis of numerous
+      cases that bleeding did not strangle,&mdash;jugulate was the word then
+      used,&mdash;acute diseases, more especially pneumonia. This was not a
+      reform,&mdash;it was a revolution. It was followed up in this country by
+      the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited Diseases,
+      which has, I believe, done more than any other work or essay in our own
+      language to rescue the practice of medicine from the slavery to the
+      drugging system which was a part of the inheritance of the profession.
+    </p>
+    <p>
+      Yes, I say, as I look back on the long hours of the many days I spent in
+      the wards and in the autopsy room of La Pitie, where Louis was one of the
+      attending physicians,&mdash;yes, Louis did a great work for practical
+      medicine. Modest in the presence of nature, fearless in the face of
+      authority, unwearying in the pursuit of truth, he was a man whom any
+      student might be happy and proud to claim as his teacher and his friend,
+      and yet, as I look back on the days when I followed his teachings, I feel
+      that I gave myself up too exclusively to his methods of thought and study.
+    </p>
+    <p>
+      There is one part of their business which certain medical practitioners
+      are too apt to forget; namely, that what they should most of all try to do
+      is to ward off disease, to alleviate suffering, to preserve life, or at
+      least to prolong it if possible. It is not of the slightest interest to
+      the patient to know whether three or three and a quarter cubic inches of
+      his lung are hepatized. His mind is not occupied with thinking of the
+      curious problems which are to be solved by his own autopsy,&mdash;whether
+      this or that strand of the spinal marrow is the seat of this or that form
+      of degeneration. He wants something to relieve his pain, to mitigate the
+      anguish of dyspnea, to bring back motion and sensibility to the dead limb,
+      to still the tortures of neuralgia. What is it to him that you can
+      localize and name by some uncouth term the disease which you could not
+      prevent and which you cannot cure? An old woman who knows how to make a
+      poultice and how to put it on, and does it tuto, eito, jucunde, just when
+      and where it is wanted, is better,&mdash;a thousand times better in many
+      cases,&mdash;than a staring pathologist, who explores and thumps and
+      doubts and guesses, and tells his patient he will be better tomorrow, and
+      so goes home to tumble his books over and make out a diagnosis.
+    </p>
+    <p>
+      But in those days, I, like most of my fellow students, was thinking much
+      more of &ldquo;science&rdquo; than of practical medicine, and I believe if we had not
+      clung so closely to the skirts of Louis and had followed some of the
+      courses of men like Trousseau,&mdash;therapeutists, who gave special
+      attention to curative methods, and not chiefly to diagnosis,&mdash;it
+      would have been better for me and others. One thing, at any rate, we did
+      learn in the wards of Louis. We learned that a very large proportion of
+      diseases get well of themselves, without any special medication,&mdash;the
+      great fact formulated, enforced, and popularized by Dr. Jacob Bigelow in
+      the Discourse referred to. We unlearned the habit of drugging for its own
+      sake. This detestable practice, which I was almost proscribed for
+      condemning somewhat too epigrammatically a little more than twenty years
+      ago, came to us, I suspect, in a considerable measure from the English
+      &ldquo;general practitioners,&rdquo; a sort of prescribing apothecaries. You remember
+      how, when the city was besieged, each artisan who was called upon in
+      council to suggest the best means of defence recommended the articles he
+      dealt in: the carpenter, wood; the blacksmith, iron; the mason, brick;
+      until it came to be a puzzle to know which to adopt. Then the shoemaker
+      said, &ldquo;Hang your walls with new boots,&rdquo; and gave good reasons why these
+      should be the best of all possible defences. Now the &ldquo;general
+      practitioner&rdquo; charged, as I understand, for his medicine, and in that way
+      got paid for his visit. Wherever this is the practice, medicine is sure to
+      become a trade, and the people learn to expect drugging, and to consider
+      it necessary, because drugs are so universally given to the patients of
+      the man who gets his living by them.
+    </p>
+    <p>
+      It was something to have unlearned the pernicious habit of constantly
+      giving poisons to a patient, as if they were good in themselves, of
+      drawing off the blood 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 draught and mixtures,&mdash;only because
+      he was sick and something must be done. But there were positive as well as
+      negative facts to be learned, and some of us, I fear, came home rich in
+      the negatives of the expectant practice, poor in the resources which many
+      a plain country practitioner had ready in abundance for the relief and the
+      cure of disease. No one instructor can be expected to do all for a student
+      which he requires. Louis taught us who followed him the love of truth, the
+      habit of passionless listening to the teachings of nature, the most
+      careful and searching methods of observation, and the sure means of
+      getting at the results to be obtained from them in the constant employment
+      of accurate tabulation. He was not a showy, or eloquent, or, I should say,
+      a very generally popular man, though the favorite, almost the idol, of
+      many students, especially Genevese and Bostonians. But he was a man of
+      lofty and admirable scientific character, and his work will endure in its
+      influences long after his name is lost sight of save to the faded eyes of
+      the student of medical literature.
+    </p>
+    <p>
+      Many other names of men more or less famous in their day, and who were
+      teaching while I was in Paris, come up before me. They are but empty
+      sounds for the most part in the ears of persons of not more than middle
+      age. Who of you knows anything of Richerand, author of a very popular work
+      on Physiology, commonly put into the student's hands when I first began to
+      ask for medical text-books? I heard him lecture once, and have had his
+      image with me ever since as that of an old, worn-out man,&mdash;a
+      venerable but dilapidated relic of an effete antiquity. To verify this
+      impression I have just looked out the dates of his birth and death, and
+      find that he was eighteen years younger than the speaker who is now
+      addressing you. There is a terrible parallax between the period before
+      thirty and that after threescore and ten, as two men of those ages look,
+      one with naked eyes, one through his spectacles, at the man of fifty and
+      thereabout. Magendie, I doubt not you have all heard of. I attended but
+      one of his lectures. I question if one here, unless some contemporary of
+      my own has strayed into the amphitheatre,&mdash;knows anything about
+      Marjolin. I remember two things about his lectures on surgery, the deep
+      tones of his voice as he referred to his oracle,&mdash;the earlier writer,
+      Jean Louis Petit,&mdash;and his formidable snuffbox. What he taught me
+      lies far down, 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 now is the fame of Bouillaud, Professor and Deputy, the
+      Sangrado of his time? Where is the renown of Piorry, percussionist and
+      poet, expert alike in the resonances of the thoracic cavity and those of
+      the rhyming vocabulary?&mdash;I think life has not yet done with the
+      vivacious Ricord, whom I remember calling the Voltaire of pelvic
+      literature,&mdash;a sceptic as to the morality of the race in general, who
+      would have submitted Diana to treatment with his mineral specifics, and
+      ordered a course of blue pills for the vestal virgins.
+    </p>
+    <p>
+      Ricord was born at the beginning of the century, and Piorry some years
+      earlier. Cruveilhier, who died in 1874, is still remembered by his great
+      work on pathological anatomy; his work on descriptive anatomy has some
+      things which I look in vain for elsewhere. But where is Civiale,&mdash;where
+      are Orfila, Gendrin, Rostan, Biett, Alibert,&mdash;jolly old Baron
+      Alibert, whom I remember so well in his broad-brimmed hat, worn a little
+      jauntily on one side, calling out to the students in the court-yard of the
+      Hospital St. Louis, &ldquo;Enfans de la methode naturelle, etes-vous tous ici?&rdquo;
+       &ldquo;Children of the natural method [his own method of classification of skin
+      diseases,] are you all here?&rdquo; All here, then, perhaps; all where, now?
+    </p>
+    <p>
+      My show of ghosts is over. It is always the same story that old men tell
+      to younger ones, some few of whom will in their turn repeat the tale, only
+      with altered names, to their children's children.
+    </p>
+<pre xml:space="preserve">
+   Like phantoms painted on the magic slide,
+   Forth from the darkness of the past we glide,
+   As living shadows for a moment seen
+   In airy pageant on the eternal screen,
+   Traced by a ray from one unchanging flame,
+   Then seek the dust and stillness whence we came.
+</pre>
+    <p>
+      Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
+      where he had written his Latin graduating thesis, talking of the learned
+      Gaubius and the late illustrious Boerhaave and other dead Dutchmen, of
+      whom you know as much, most of you, as you do of Noah's apothecary and the
+      family physician of Methuselah, whose prescriptions seem to have been lost
+      to posterity. Dr. Lloyd came back to Boston full of the teachings of
+      Cheselden and Sharpe, William Hunter, Smellie, and Warner; Dr. James
+      Jackson loved to tell of Mr. Cline and to talk of Mr. John Hunter; Dr.
+      Reynolds would give you his recollections of Sir Astley Cooper and Mr.
+      Abernethy; I have named the famous Frenchmen of my student days; Leyden,
+      Edinburgh, London, Paris, were each in turn the Mecca of medical students,
+      just as at the present day Vienna and Berlin are the centres where our
+      young men crowd for instruction. These also must sooner or later yield
+      their precedence and pass the torch they hold to other hands. Where shall
+      it next flame at the head of the long procession? Shall it find its old
+      place on the shores of the Gulf of Salerno, or shall it mingle its rays
+      with the northern aurora up among the fiords of Norway,&mdash;or shall it
+      be borne across the Atlantic and reach the banks of the Charles, where
+      Agassiz and Wyman have taught, where Hagen still teaches, glowing like his
+      own Lampyris splendidula, with enthusiasm, where the first of American
+      botanists and the ablest of American surgeons are still counted in the
+      roll of honor of our great University?
+    </p>
+    <p>
+      Let me add a few words which shall not be other than cheerful, as I bid
+      farewell to this edifice which I have known so long. I am grateful to the
+      roof which has sheltered me, to the floors which have sustained me, though
+      I have thought it safest always to abstain from anything like eloquence,
+      lest a burst of too emphatic applause might land my class and myself in
+      the cellar of the collapsing structure, and bury us in the fate of Korah,
+      Dathan, and Abiram. I have helped to wear these stairs into hollows,&mdash;stairs
+      which I trod when they were smooth and level, fresh from the plane. There
+      are just thirty-two of them, as there were five and thirty years ago, but
+      they are steeper and harder to climb, it seems to me, than they were then.
+      I remember that in the early 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's room, that some day or other a whole class would
+      go heels over head down this graded precipice, like the herd told of in
+      Scripture story. This has never happened as yet; I trust it never will. I
+      have never 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, and I resign it, with a wish that it were more worthy of
+      regret, into the hands of my successor, with my parting benediction.
+      Within its twilight precincts I have often prayed for light, like Ajax,
+      for the daylight found scanty entrance, and the gaslight never illuminated
+      its dark recesses. May it prove to him who comes after me like the cave of
+      the Sibyl, out of the gloomy depths of which came the oracles which shone
+      with the rays of truth and wisdom!
+    </p>
+    <p>
+      This temple of learning is not surrounded by the mansions of the great and
+      the wealthy. No stately avenues lead up to its facades and porticoes. I
+      have sometimes felt, when convoying a distinguished stranger through its
+      precincts to its door, that he might question whether star-eyed Science
+      had not missed her way when she found herself in this not too attractive
+      locality. I cannot regret that we&mdash;you, I should say&mdash;are soon
+      to migrate to a more favored region, and carry on your work as teachers
+      and as learners in ampler halls and under far more favorable conditions.
+    </p>
+    <p>
+      I hope that I may have the privilege of meeting you there, possibly may be
+      allowed to add my words of welcome to those of my former colleagues, and
+      in that pleasing anticipation I bid good-by to this scene of my long
+      labors, and, for the present at least, to the friends with whom I have
+      been associated.
+    </p>
+    <p>
+      <a name="link2H_4_0014" id="link2H_4_0014">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      APPENDUM
+    </h2>
+    <p>
+      <a name="link2H_NOTE" id="link2H_NOTE">
+      <!--  H2 anchor --> </a>
+    </p>
+    <div style="height: 4em;">
+      <br /><br /><br /><br />
+    </div>
+    <h2>
+      NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE.
+    </h2>
+    <p>
+      Some passages contained in the original manuscript of the Address, and
+      omitted in the delivery on account of its length, are restored in the text
+      or incorporated with these Notes.
+    </p>
+    <p>
+      NOTE A.&mdash;
+    </p>
+    <p>
+      There is good reason to doubt whether the nitrate of silver has any real
+      efficacy in epilepsy. It has seemed to cure many cases, but epilepsy is a
+      very uncertain disease, and there is hardly anything which has not been
+      supposed to cure it. Dr. Copland cites many authorities in its favor, most
+      especially Lombard's cases. But De la Berge and Monneret (Comp. de Med.
+      Paris), 1839, analyze these same cases, eleven in number, and can only
+      draw the inference of a very questionable value in the supposed remedy.
+      Dr. James Jackson says that relief of epilepsy is not to 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, Professor at
+      the Royal College, Author of the Antimonial Martyrology, a wit and a man
+      of sense and learning, who died almost two hundred years ago, had come to
+      the same conclusion, though the chemists of his time boasted of their
+      remedies. &ldquo;Did, you ever see a case of epilepsy cured by nitrate of
+      silver?&rdquo; I said to one of the oldest and most experienced surgeons in this
+      country. &ldquo;Never,&rdquo; was his instant reply. Dr. Twitchell's experience was
+      very similar. How, then, did nitrate of silver come to be given for
+      epilepsy? Because, as Dr. Martin has so well reminded us, lunatics were
+      considered formerly to be under the special influence of Luna, the moon
+      (which Esquirol, be it observed, utterly denies), and lunar caustic, or
+      nitrate of silver, is a salt of that metal which was called luna from its
+      whiteness, and of course must be in the closest relations with the moon.
+      It follows beyond all reasonable question that the moon's metal, silver,
+      and its preparations, must be the specific remedy for moonblasted maniacs
+      and epileptics!
+    </p>
+    <p>
+      Yet the practitioner who prescribes the nitrate of silver supposes he is
+      guided by the solemn experience of the past, instead of by its idle
+      fancies. He laughs at those old physicians who placed such confidence in
+      the right hind hoof of an elk as a remedy for the same disease, and leaves
+      the record of his own belief in a treatment quite as fanciful and far more
+      objectionable, written in indelible ink upon a living tablet where he who
+      runs may read it for a whole generation, if nature spares his walking
+      advertisement so long.
+    </p>
+    <p>
+      NOTE B.&mdash;
+    </p>
+    <p>
+      The presumption that a man is innocent until he is proved guilty, does not
+      mean that there are no rogues, but lays the onus probandi on the party to
+      which it properly belongs. So with this proposition. A noxious agent
+      should never be employed in sickness unless there is ample evidence in the
+      particular case to overcome the general presumption against all such
+      agents, and the evidence is very apt to be defective.
+    </p>
+    <p>
+      The miserable delusion of Homoeopathy builds itself upon an axiom directly
+      the opposite of this; namely, that the sick are to be cured by poisons.
+      Similia similibus curantur means exactly this. It is simply a theory of
+      universal poisoning, nullified in practice by the infinitesimal
+      contrivance. The only way to kill it and all similar fancies, and to throw
+      every quack nostrum into discredit, is to root out completely the suckers
+      of the old rotten superstition that whatever is odious or noxious is
+      likely to be good for disease. The current of sound practice with
+      ourselves is, I believe, setting fast in the direction I have indicated in
+      the above proposition. To uphold the exhibition of noxious agents in
+      disease, as the rule, instead of admitting them cautiously and reluctantly
+      as the exception, is, as I think, an eddy of opinion in the direction of
+      the barbarism out of which we believe our art is escaping. It is only
+      through the enlightened sentiment and action of the Medical Profession
+      that the community can be brought to acknowledge that drugs should always
+      be regarded as evils.
+    </p>
+    <p>
+      It is true that some suppose, and our scientific and thoughtful associate,
+      Dr. Gould, has half countenanced the opinion, that there may yet be
+      discovered a specific for every disease. Let us not despair of the future,
+      but let us be moderate in our expectations. When an oil is discovered that
+      will make a bad watch keep good time; when a recipe is given which will
+      turn an acephalous foetus into a promising child; when a man can enter the
+      second time into his mother's womb and give her back the infirmities which
+      twenty generations have stirred into her blood, and infused into his own
+      through hers, we may be prepared to enlarge the National Pharmacopoeia
+      with a list of specifies for everything but old age,&mdash;and possibly
+      for that also.
+    </p>
+    <p>
+      NOTE C.&mdash;
+    </p>
+    <p>
+      The term specific is used here in its ordinary sense, without raising the
+      question of the propriety of its application to these or other remedies.
+    </p>
+    <p>
+      The credit of introducing Cinchona rests between the Jesuits, the Countess
+      of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, who employed it
+      as a secret remedy. (Pereira.) Mercury as an internal specific remedy was
+      brought into use by that impudent and presumptuous quack, as he was
+      considered, Paracelsus. (Encyc. Brit. art. &ldquo;Paracelsus.&rdquo;) Arsenic was
+      introduced into England as a remedy for intermittents by Dr. Fowler, in
+      consequence of the success of a patent medicine, the Tasteless Ague Drops,
+      which were supposed, &ldquo;probably with reason,&rdquo; to be a preparation of that
+      mineral. (Rees's Cyc. art. &ldquo;Arsenic.&rdquo;) Colchicum came into notice in a
+      similar way, from the success of the Eau Medicinale of M. Husson, a French
+      military officer. (Pereira.) Iodine was discovered by a saltpetre
+      manufacturer, but applied by a physician in place of the old remedy, burnt
+      sponge, which seems to owe its efficacy to it. (Dunglison, New Remedies.)
+      As for Sulphur, &ldquo;the common people have long used it as an ointment&rdquo; for
+      scabies. (Rees's Cyc. art. &ldquo;Scabies.&rdquo;) The modern cantiscorbutic regimen
+      is credited to Captain Cook. &ldquo;To his sagacity we are indebted for the
+      first impulse to those regulations by which scorbutus is so successfully
+      prevented in our navy.&rdquo; (Lond. Cyc. Prac. Med. art. &ldquo;Scorbutus.&rdquo;) Iron and
+      various salts which enter into the normal composition of the human body do
+      not belong to the materia medica by our definition, but to the materia
+      alimentaria.
+    </p>
+    <p>
+      For the first introduction of iron as a remedy, see Pereira, who gives a
+      very curious old story.
+    </p>
+    <p>
+      The statement in the text concerning a portion of the materia medica
+      stands exactly as delivered, and is meant exactly as it stands. No
+      denunciation of drugs, as sparingly employed by a wise physician, was or
+      is intended. If, however, as Dr. Gould stated in his &ldquo;valuable and
+      practical discourse&rdquo; to which the Massachusetts Medical Society &ldquo;listened
+      with profit as well as interest,&rdquo; &ldquo;Drugs, in themselves considered, may
+      always be regarded as evils,&rdquo;&mdash;any one who chooses may question
+      whether the evils from their abuse are, on the whole, greater or less than
+      the undoubted benefits obtained from their proper use. The large exception
+      of opium, wine, specifics, and anaesthetics, made in the text, takes off
+      enough from the useful side, as I fully believe, to turn the balance; so
+      that a vessel containing none of these, but loaded with antimony,
+      strychnine, acetate of lead, aloes, aconite, lobelia, lapis infernalis,
+      stercus diaboli, tormentilla, and other approved, and, in skilful hands,
+      really useful remedies, brings, on the whole, more harm than good to the
+      port it enters.
+    </p>
+    <p>
+      It is a very narrow and unjust view of the practice of medicine, to
+      suppose it to consist altogether in the use of powerful drugs, or of drugs
+      of any kind. Far from it. &ldquo;The physician may do very much for the welfare
+      of the sick, more than others can do, although he does not, even in the
+      major part of cases, undertake to control and overcome the disease by art.
+      It was with these views that I never reported any patient cured at our
+      hospital. Those who recovered their health were reported as well; not
+      implying that they were made so by the active treatment they had received
+      there. But it was to be understood that all patients received in that
+      house were to be cured, that is, taken care of.&rdquo; (Letters to a Young
+      Physician, by James Jackson, M. D., Boston, 1855.)
+    </p>
+    <p>
+      &ldquo;Hygienic rules, properly enforced, fresh air, change of air, travel,
+      attention to diet, good and appropriate food judiciously regulated,
+      together with the administration of our tonics, porter, ale, wine, iron,
+      etc., supply the diseased or impoverished system with what Mr. Gull, of
+      St. Bartholomew's Hospital, aptly calls the 'raw material of the blood;'
+      and we believe that if any real improvement has taken place in medical
+      practice, independently of those truly valuable contributions we have
+      before described, it is in the substitution of tonics, stimulants, and
+      general management, for drastic cathartics, for bleeding, depressing
+      agents, including mercury, tartar emetics, etc., so much in vogue during
+      the early part even of this century.&rdquo; (F. P. Porcher, in Charleston Med.
+      Journal and Review for January, 1860.)
+    </p>
+    <p>
+      <br /> <br />
+    </p>
+    <hr />
+    <p>
+      <br /> <br />
+    </p>
+<pre xml:space="preserve">
+
+
+
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+
+
+MEDICAL ESSAYS
+
+BY OLIVER WENDELL HOLMES
+
+
+
+
+1842-1882
+
+
+CONTENTS:
+
+I.   HOMEOPATHY AND ITS KINDRED DELUSIONS
+
+II.  THE CONTAGIOUSNESS OF PUERPERAL FEVER
+
+III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+IV.  BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE
+
+V.   SCHOLASTIC AND BEDSIDE TEACHING
+
+VI.  THE MEDICAL PROFESSION IN MASSACHUSETTS
+
+VII. THE YOUNG PRACTITIONER
+
+VIII. MEDICAL LIBRARIES
+
+IX.  SOME OF MY EARLY TEACHERS
+
+
+
+
+
+
+PREFACE.
+
+The character of the opposition which some of these papers have met
+with suggests the inference that they contain really important, but
+unwelcome truths.  Negatives multiplied into each other change their
+sign and become positives.  Hostile criticisms meeting together are
+often equivalent to praise, and the square of fault-finding turns out
+to be the same thing as eulogy.
+
+But a writer has rarely so many enemies as it pleases him to believe.
+Self-love leads us to overrate the numbers of our negative
+constituency.  The larger portion of my limited circle of readers
+must be quite indifferent to, if not ignorant of, the adverse
+opinions which have been expressed or recorded concerning any of
+these Addresses or Essays now submitted to their own judgment.  It is
+proper, however, to inform them, that some of the positions
+maintained in these pages have been unsparingly attacked, with
+various degrees of ability, scholarship, and good-breeding.  The tone
+of criticism naturally changes with local conditions in different
+parts of a country extended like our own, so that it is one of the
+most convenient gauges of the partial movements in the direction of
+civilization.  It is satisfactory to add, that the views assailed
+have also been unflinchingly defended by unsought champions, among
+the ablest of whom it is pleasant to mention, at this moment of
+political alienation, the Editor of the Charleston Medical Journal.
+
+"Currents and Counter-Currents" was written and delivered as an
+Oration, a florid rhetorical composition, expressly intended to
+secure the attention of an audience not easy to hold as listeners.
+It succeeded in doing this, and also in being as curiously
+misunderstood and misrepresented as if it had been a political
+harangue.  This gave it more local notoriety than it might otherwise
+have attained, so that, as I learn, one ingenious person made use of
+its title as an advertisement to a production of his own.
+
+The commonest mode of misrepresentation was this: qualified
+propositions, the whole meaning of which depended on the
+qualifications, were stripped of these and taken as absolute.  Thus,
+the attempt to establish a presumption against giving poisons to sick
+persons was considered as equivalent to condemning the use of these
+substances.  The only important inference the writer has been able to
+draw from the greater number of the refutations of his opinions which
+have been kindly sent him, is that the preliminary education of the
+Medical Profession is not always what it ought to be.
+
+One concession he is willing to make, whatever sacrifice of pride it
+may involve.  The story of Massasoit, which has furnished a coral, as
+it were, for some teething critics, when subjected to a powerful
+logical analysis, though correct in its essentials, proves to have
+been told with exceptionable breadth of statement, and therefore (to
+resume the metaphor) has been slightly rounded off at its edges, so
+as to be smoother for any who may wish to bite upon it hereafter.  In
+other respects the Discourse has hardly been touched.  It is only an
+individual's expression, in his own way, of opinions entertained by
+hundreds of the Medical Profession in every civilized country, and
+has nothing in it which on revision the writer sees cause to retract
+or modify.  The superstitions it attacks lie at the very foundation
+of Homoeopathy, and of almost every form of medical charlatanism.
+Still the mere routinists and unthinking artisans in most callings
+dislike whatever shakes the dust out of their traditions, and it may
+be unreasonable to expect that Medicine will always prove an
+exception to the rule.  One half the opposition which the numerical
+system of Louis has met with, as applied to the results of treatment,
+has been owing to the fact that it showed the movements of disease to
+be far more independent of the kind of practice pursued than was
+agreeable to the pride of those whose self-confidence it abated.
+
+The statement, that medicines are more sparingly used in physicians'
+families than in most others, admits of a very natural explanation,
+without putting a harsh construction upon it, which it was not
+intended to admit.  Outside pressure is less felt in the physician'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 who
+have more confidence in drugging than his own family commonly has,
+the learned Professor Dunglison is hereby requested to apologize for
+his definition of the word Placebo, or to expunge it from his Medical
+Dictionary.
+
+One thing is certain.  A loud outcry on a slight touch reveals the
+weak spot in a profession, as well as in a patient.  It is a doubtful
+policy to oppose the freest speech in those of our own number who are
+trying to show us where they honestly believe our weakness lies.
+Vast as are the advances of our Science and Art, may it not possibly
+prove on examination that we retain other old barbarisms beside the
+use of the astrological sign of Jupiter, with which we endeavor to
+insure good luck to our prescriptions?  Is it the act of a friend or
+a foe to try to point them out to our brethren when asked to address
+them, and is the speaker to subdue the constitutional habit of his
+style to a given standard, under penalty of giving offence to a grave
+assembly?
+
+Homoeopathy and its Kindred Delusions " was published nearly twenty
+years ago, and has been long out of print, so that the author tried
+in vain to procure a copy until the kindness of a friend supplied him
+with the only one he has had for years.  A foolish story reached his
+ears that he was attempting to buy up stray copies for the sake of
+suppressing it.  This edition was in the press at that very time.
+
+Many of the arguments contained in the Lectures have lost whatever
+novelty they may have possessed.  All its predictions have been
+submitted to the formidable test of time.  They appear to have stood
+it, so far, about as well as most uninspired prophecies; indeed, some
+of them require much less accommodation than certain grave
+commentators employ in their readings of the ancient Prophets.
+
+If some statistics recently published are correct, Homoeopathy has
+made very slow progress in Europe.
+
+In all England, as it appears, there are hardly a fifth more
+Homoeopathic practitioners than there are students attending Lectures
+at the Massachusetts Medical College at the present time.  In America
+it has undoubtedly proved more popular and lucrative, yet how loose a
+hold it has on the public confidence is shown by the fact that, when
+a specially valued life, which has been played with by one of its
+agents, is seriously threatened, the first thing we expect to hear is
+that a regular practitioner is by the patient's bed, and the
+Homoeopathic counsellor overruled or discarded.  Again, how many of
+the ardent and capricious persons who embraced Homoeopathy have run
+the whole round of pretentious novelties;--have been boarded at
+water-cure establishments, closeted with uterine and other
+specialists, and finally wandered over seas to put themselves in
+charge of foreign celebrities, who dosed them as lustily as they were
+ever dosed before they took to globules!  It will surprise many to
+learn to what a shadow of a shade Homoeopathy has dwindled in the
+hands of many of its noted practitioners.  The itch-doctrine is
+treated with contempt.  Infinitesimal doses are replaced by full ones
+whenever the fancy-practitioner chooses.  Good Homoeopathic reasons
+can be found for employing anything that anybody wants to employ.
+Homoeopathy 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 cases where we would thankfully sacrifice all
+our prejudices and give the world to have them true to their
+promises.
+
+Homoeopathy has not died out so rapidly as Tractoration.  Perhaps it
+was well that it should not, for it has taught us a lesson of the
+healing faculty of Nature which was needed, and for which many of us
+have made proper acknowledgments.  But it probably does more harm
+than good to medical science at the present time, by keeping up the
+delusion of treating everything by specifics,--the old barbarous
+notion that sick people should feed on poisons [Lachesis, arrow-
+poison, obtained from a serpent (Pulte).  Crotalus horridus,
+rattlesnake's venom (Neidhard).  The less dangerous Pediculus capilis
+is the favorite remedy of Dr. Mure, the English 'Apostle of
+Homoeopathy."  These are examples of the retrograde current setting
+towards barbarism] against which a part of the Discourse at the
+beginning of this volume is directed.
+
+The infinitesimal globules have not become a curiosity as yet, like
+Perkins's Tractors.  But time is a very elastic element in Geology
+and Prophecy.  If Daniel's seventy weeks mean four hundred and ninety
+years, as the learned Prideaux and others have settled it that they
+do, the "not many years" of my prediction may be stretched out a
+generation or two beyond our time, if necessary, when the prophecy
+will no doubt prove true.
+
+It might be fitting to add a few words with regard to the Essay on
+the Contagiousness of Puerperal Fever.  But the whole question I
+consider to be now transferred from the domain of medical inquiry to
+the consideration of Life Insurance agencies and Grand Juries.  For
+the justification of this somewhat sharply accented language I must
+refer the reader to the paper itself for details which I regret to
+have been forced to place on permanent record.
+
+BOSTON, January, 1861.
+
+
+
+
+A SECOND PREFACE.
+
+These Lectures and Essays are arranged in the order corresponding to
+the date of their delivery or publication.  They must, of course, be
+read with a constant reference to these dates, by such as care to
+read them.  I have not attempted to modernize their aspect or
+character in presenting them, in this somewhat altered connection, to
+the public.  Several of them were contained in a former volume which
+received its name from the Address called "Currents and Counter-
+Currents."  Some of those contained in the former volume have been
+replaced by others.  The Essay called "Mechanism of Vital Actions"
+has been transferred to a distinct collection of Miscellaneous
+essays, forming a separate volume.
+
+I had some intention of including with these papers an Essay on
+Intermittent Fever in New England, which received one of the Boylston
+prizes in 1837, and was published in the following year.  But as this
+was upon a subject of local interest, chiefly, and would have taken
+up a good deal of room, I thought it best to leave it out, trusting
+that the stray copies to be met with in musty book-shops would
+sufficiently supply the not very extensive or urgent demand for a
+paper almost half a century old.
+
+Some of these papers created a little stir when they first fell from
+the press into the pool of public consciousness.  They will slide in
+very quietly now in this new edition, and find out for themselves
+whether the waters are those of Lethe, or whether they are to live
+for a time as not wholly unvalued reminiscences.
+
+March 21, 1883.
+
+
+
+
+PREFACE TO THE NEW EDITION.
+
+These Essays are old enough now to go alone without staff or crutch
+in the shape of Prefaces.  A very few words may be a convenience to
+the reader who takes up the book and wishes to know what he is likely
+to find in it.
+
+
+               HOMOEOPATHY AND ITS KINDRED DELUSIONS.
+
+Homoeopathy has proved lucrative, and so long as it continues to be
+so will surely exist,--as surely as astrology, palmistry, and other
+methods of getting a living out of the weakness and credulity of
+mankind and womankind.  Though it has no pretensions to be considered
+as belonging among the sciences, it may be looked upon by a
+scientific man as a curious object 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 studied it in the Essay before
+the reader, under the aspect of an extravagant and purely imaginative
+creation of its founder.  Since that first essay was written, nearly
+half a century ago, we have all had a chance to witness its practical
+working.  Two opposite inferences 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 by a much larger number of persons.  As they see
+that patients are very commonly getting well under treatment by
+infinitesimal drugging, which they consider equivalent to no
+medication at all, they come to disbelieve in every form of drugging
+and put their whole trust in "nature."  Thus experience,
+
+          "From seeming evil still educing good,"
+
+has shown that the dealers in this preposterous system of pseudo-
+therapeutics have cooperated with the wiser class of practitioners in
+breaking up the system of over-dosing and over-drugging which has
+been one of the standing reproaches of medical practice.  While.
+keeping up the miserable delusion that diseases were all to be
+"cured" by drugging, Homoeopathy has been unintentionally showing
+that they would very generally get well without any drugging at all.
+In the mean time the newer doctrines of the "mind cure," the "faith
+cure," and the rest are encroaching on the territory so long
+monopolized by that most ingenious of the pseudo-sciences.  It would
+not be surprising if its whole ground should be taken possession of
+by these new claimants with their flattering appeals to the
+imaginative class of persons open to such attacks.  Similia similabus
+may prove fatally true for once, if Homoeopathy is killed out by its
+new-born rivals.
+
+It takes a very moderate amount of erudition to unearth a charlatan
+like the supposed father of the infinitesimal dosing system.  The
+real inventor of that specious trickery was an Irishman by the name
+of Butler.  The whole story is to be found in the "Ortus Medicinm" of
+Van Helmont.  I have given some account of his chapter "Butler" in
+different articles, but I would refer the students of our
+Homoeopathic educational institutions to the original, which they
+will find very interesting and curious.
+
+
+                    CURRENTS AND COUNTER-CURRENTS
+
+My attack on over-drugging brought out some hostile comments and
+treatment.  Thirty years ago I expressed myself with more vivacity
+than I should show if I were writing on the same subjects today.
+Some of my more lively remarks called out very sharp animadversion.
+Thus my illustration of prevention as often better than treatment in
+the mother's words to her child which had got a poisonous berry in
+its mouth,--"Spit it out!" gave mortal offence to a well-known New
+York practitioner and writer, who advised the Massachusetts Medical
+Society to spit out the offending speaker.  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 and in excess, as then used "could be
+sunk to the bottom of the sea, it would be all the better for mankind
+and all the worse for the fishes."  This was too bad.  The sentence
+was misquoted, quoted without its qualifying conditions, and
+frightened some of my worthy professional brethren as much as if I
+had told them to throw all physic to the dogs.  But for the
+epigrammatic sting the sentiment would have been unnoticed as a
+harmless overstatement at the very worst.
+
+Since this lecture was delivered a great and, as I think, beneficial
+change has taken place in the practice of medicine.  The habit of the
+English "general practitioner" of making his profit out of the pills
+and potions he administered was ruinous to professional advancement
+and the dignity of the physician.  When a half-starving medical man
+felt that he must give his patient draught and boluses for which he
+could charge him, he was in a pitiable position and too likely to
+persuade himself that his drugs were useful to 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 the
+errors I combated.
+
+
+               THE CONTAGIOUSNESS 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 but a single year.  It naturally attracted less attention than
+it would have done if published in such a periodical as the "American
+Journal of Medical Sciences."  Still it had its effect, as I have
+every reason to believe.  I cannot doubt that it has saved the lives
+of many young mothers by calling attention to the existence and
+propagation of "Puerperal Fever as a Private Pestilence," and laying
+down rules for taking the necessary precautions against it.  The case
+has long been decided in favor of the views I advocated, but, at the
+time when I wrote two of the most celebrated professors of Obstetrics
+in this country opposed my conclusions with all the weight of their
+experience and position.
+
+This paper was written in a great heat and with passionate
+indignation.  If I touched it at all I might trim its rhetorical
+exuberance, but I prefer to leave it all its original strength of
+expression.  I could not, if I had tried, have disguised the feelings
+with which I regarded the attempt to put out of sight the frightful
+facts which I brought forward and the necessary conclusions to which
+they led.  Of course the whole matter has been looked at in a new
+point of view since the microbe as a vehicle of contagion has been
+brought into light, and explained the mechanism of that which was
+plain enough as a fact to all who were not blind or who did not shut
+their eyes.
+
+O.  W.  H.
+
+BEVERLY Farms, Mass., August 3, 1891
+
+
+
+
+
+
+HOMOEOPATHY AND ITS KINDRED DELUSIONS
+[Two lectures delivered before the Boston Society for the Diffusion
+of Useful Knowledge.  1842.]
+
+
+[When a physician attempts to convince a person, who has fallen into
+the Homoeopathic delusion, of the emptiness of its pretensions, he is
+often answered by a statement of cases in which its practitioners are
+thought to have effected wonderful cures.  The main object of the
+first of these Lectures is to show, by abundant facts, that such
+statements, made by persons unacquainted with the fluctuations of
+disease and the fallacies of observation, are to be considered in
+general as of little or no value in establishing the truth of a
+medical doctrine or the utility of a method of practice.
+
+Those kind friends who suggest to a person suffering from a tedious
+complaint, that he "Had better try Homoeopathy," are apt to enforce
+their suggestion by 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 community to encourage ignorance, error,
+or deception in a profession which deals with the life and health of
+our fellow-creatures.  Whether or not those who countenance
+Homoeopathy are guilty of this injustice towards others, the second
+of these Lectures may afford them some means of determining.
+
+To deny that good effects may happen from the observance of diet and
+regimen when prescribed by Homoeopathists as well as by others, would
+be very unfair to them.  But to suppose that men with minds so
+constituted as to accept such statements and embrace such doctrines
+as make up the so-called science of Homoeopathy are more competent
+than others to regulate the circumstances which influence the human
+body in health and disease, would be judging very harshly the average
+capacity of ordinary practitioners.
+
+To deny that some patients may have been actually benefited through
+the influence exerted upon their imaginations, would be to refuse to
+Homoeopathy what all are willing to concede to every one of those
+numerous modes of practice known to all intelligent persons by an
+opprobrious title.
+
+So long as the body is affected through the mind, no audacious
+device, even of the most manifestly dishonest character, can fail of
+producing occasional good to those who yield it an implicit or even a
+partial faith.  The argument founded on this occasional good would be
+as applicable in justifying the counterfeiter and giving circulation
+to his base coin, on the ground that a spurious dollar had often
+relieved a poor man's necessities.
+
+Homoeopathy has come before our public at a period when the growing
+spirit of eclecticism has prepared many ingenious and honest minds to
+listen to all new doctrines with a candor liable to degenerate into
+weakness.  It is not impossible that the pretended evolution of great
+and mysterious virtues from infinitely attenuated atoms may have
+enticed a few over-refining philosophers, who have slid into a vague
+belief that matter subdivided grows less material, and approaches
+nearer to a spiritual nature as it requires a more powerful
+microscope for its detection.
+
+However this may be, some persons seem disposed to take the ground of
+Menzel that the Laity must pass formal judgment between the Physician
+and the Homoeopathist, 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 in these Lectures upon
+this shadowy system; which, in the calm and serious judgment of many
+of the wisest members of the medical profession, is not entitled by
+anything it has ever said or done to the notoriety of a public
+rebuke, still less to the honors of critical martyrdom.]
+
+
+I
+
+I have selected four topics for this lecture, the first three of
+which I shall touch but slightly, the last more fully.  They are
+
+1.  The Royal cure of the King's Evil, or Scrofula.
+
+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 numerous facts are
+accumulated to prove the most fanciful and senseless extravagances.
+
+The third exhibits the entire insufficiency of exalted wisdom,
+immaculate honesty, and vast general acquirements to make a good
+physician of a great bishop.
+
+The fourth shows us the intimate machinery of an extinct delusion,
+which flourished only forty years ago; drawn in all its details, as
+being a rich and comparatively recent illustration of the
+pretensions, the arguments, the patronage, by means of which windy
+errors have long been, and will long continue to be, swollen into
+transient consequence.  All display in superfluous abundance the
+boundless credulity and excitability of mankind upon subjects
+connected with medicine.
+
+>From the time of Edward the Confessor to Queen Anne, the monarchs of
+England were in the habit of touching those who were brought to them
+suffering with the scrofula, for the cure of that distemper.  William
+the Third had good sense enough to discontinue the practice, but Anne
+resumed it, and, among her other patients, performed the royal
+operation upon a child, who, in spite of his, disease, grew up at
+last into Samuel Johnson.  After laying his hand upon the sufferers,
+it was customary for the monarch to hang a gold piece around the neck
+of each patient.  Very strict precautions were adopted to prevent
+those who thought more of the golden angel hung round the neck by a
+white ribbon, than of relief of their bodily infirmities, from making
+too many calls, as they sometimes attempted to do.  According to the
+statement of the advocates and contemporaries of this remedy, none
+ever failed of receiving benefit unless their little faith and
+credulity starved their merits.  Some are said to have been cured
+immediately on the very touch, 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 for several weeks,
+and months, and obliged even to be led to Whitehall, yet recovered
+their sight immediately upon being touched, so as to walk away
+without any guide."  So widely, at one period, was the belief
+diffused, that, in the course of twelve years, nearly a hundred
+thousand persons were touched by Charles the Second.  Catholic
+divines; in disputes upon the orthodoxy of their church, did not deny
+that the power had descended to protestant princes;--Dr. Harpsfield,
+in his " Ecclesiastical History of England," admitted it, and in
+Wiseman's words, "when Bishop Tooker would make use of this Argument
+to prove the Truth of our Church, Smitheus doth not thereupon go
+about to deny the Matter of fact; nay, both he and Cope acknowledge
+it."  "I myself," says Wiseman, the best English surgical writer of
+his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.]
+--"I my self have been a frequent Eye-witness of many hundred of
+Cures performed by his Majesties Touch alone, without any assistance
+of Chirurgery; and those, many of them such as had tired out the
+endeavours of able Chirurgeons before they came hither.  It were
+endless to recite what I myself have seen, and what I have received
+acknowledgments of by Letter, not only from the severall parts of
+this Nation, but also from Ireland, Scotland, Jersey, Garnsey.  It is
+needless also to remember what Miracles of this nature were performed
+by the very Bloud of his late Majesty of Blessed memory, after whose
+decollation by the inhuman Barbarity of the Regicides, the reliques
+of that were gathered on Chips and in Handkerchieffs by the pious
+Devotes, who could not but think so great a suffering in so
+honourable and pious a Cause, would be attended by an extraordinary
+assistance 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, accounted for these
+cures in three ways: by the journey and change of air the patients
+obtained in coming to London; by the influence of imagination; and
+the wearing of gold.
+
+To these objections he answers, 1st.  That many of those cured were
+inhabitants of the city.  2d.  That the subjects of treatment were
+frequently infants.  3d.  That sometimes silver was given, and
+sometimes nothing, yet the patients were cured.
+
+A superstition resembling this probably exists at the present time in
+some ignorant districts of England and this country.  A writer in a
+Medical Journal in the year 1807, speaks of a farmer in Devonshire,
+who, being a ninth son of a ninth son, is thought endowed with
+healing powers like those of ancient royalty, and who is accustomed
+one day in every week to strike for the evil.
+
+I remember that one of my schoolmates told me, when a boy, of a
+seventh son of a seventh son, somewhere in Essex County, who touched
+for the scrofula, and who used to hang a silver fourpence halfpenny
+about the neck of those who came to him, which fourpence halfpenny it
+was solemnly affirmed became of a remarkably black color after having
+been some time worn, and that his own brother had been subjected to
+this extraordinary treatment; but I must add that my schoolmate drew
+a bow of remarkable length, strength, and toughness for his tender
+years.
+
+One of the most curious examples of the fallacy of popular belief and
+the uncertainty of asserted facts in medical experience is to be
+found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
+
+Fabricius Hildanus, whose name is familiar to every surgical
+scholar, and Lord Bacon, who frequently dipped a little into
+medicine, are my principal authorities for the few circumstances I
+shall mention regarding it.  The Weapon Ointment was a preparation
+used for the healing of wounds, but instead of its being applied to
+them, the injured part was washed and bandaged, and the weapon with
+which the wound was inflicted was carefully anointed with the
+unguent.  Empirics, ignorant barbers, and men of that sort, are said
+to have especially employed it.  Still there were not wanting some
+among the more respectable members of 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, rather
+than the wound or weapon, entered into all.  Such were portions of
+mummy, of human blood, and of moss from the skull of a thief hung in
+chains.
+
+Hildanus was a wise and learned man, one of the best surgeons of his
+time.  He was fully aware that a part of the real secret of the
+Unguentum Armarium consisted in the washing and bandaging the wound
+and then letting it alone.  But he could not resist the solemn
+assertions respecting its efficacy; he gave way before the outcry of
+facts, and therefore, instead of denying all their pretensions, he
+admitted and tried to account for them upon supernatural grounds.  As
+the virtue of those applications, he says, which are made to the
+weapon cannot reach the wound, and as they can produce no effect
+without contact, it follows, of necessity, that the Devil must have a
+hand in the business; and as he is by far the most long headed and
+experienced of practitioners, he cannot find this a matter of any
+great difficulty.  Hildanus himself reports, in detail, the case of a
+lady who had received a moderate wound, for which the Unguentum
+Armarium was employed without the slightest use.  Yet instead of
+receiving this flat case of failure as any evidence against the
+remedy, he accounts for its not succeeding by the devout character of
+the lady, and her freedom from that superstitious and over-
+imaginative tendency which the Devil requires in those who are to be
+benefited by his devices.
+
+Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
+having in its favor the testimony of men of credit, though, in his
+own language, he himself "as yet is not fully inclined to believe
+it."  His remarks upon the asserted facts respecting it show a
+mixture of wise suspicion and partial belief.  He does not like the
+precise directions given as to the circumstances under which the
+animals from which some of the materials were obtained were to be
+killed; for he thought it looked like a provision for an excuse in
+case of failure, by laying the fault to the omission of some of these
+circumstances.  But he likes well that "they do not observe the
+confecting of the Ointment under any certain constellation; which is
+commonly the excuse of magical medicines, when they fail, that they
+were not made under a fit figure of heaven." [This was a mistake,
+however, since the two recipes given by Hildanus are both very
+explicit as to the aspect of the heavens required for different
+stages of the process.]  "It was pretended that if the offending
+weapon could not be had, it would serve the purpose to anoint a
+wooden one made like it.  "This," says Bacon, "I should doubt to be a
+device to keep this strange form of cure in request and use; because
+many times you cannot come by the weapon itself."  And in closing his
+remarks on the statements of the advocates of the ointment, he says,
+"Lastly, it will cure a beast as well as a man, which I like best of
+all the rest, because it subjecteth the matter to an easy trial."  It
+is worth remembering, that more than two hundred years ago, when an
+absurd and fantastic remedy was asserted to possess wonderful power,
+and when sensible persons ascribed its pretended influence to
+imagination, it was boldly answered that the cure took place when the
+wounded party did not know of the application made to the weapon, and
+even when a brute animal was the subject of the experiment, and that
+this assertion, he as we all know it was, came in such a shape as to
+shake the incredulity of the keenest thinker of his time.  The very
+same assertion has been since repeated in favor of Perkinism, and,
+since that, of Homoeopathy.
+
+The same essential idea as that of the Weapon Ointment reproduced
+itself in the still more famous SYMPATHETIC POWDER.  This Powder was
+said to have the faculty, if applied to the blood-stained garments of
+a wounded person, to cure his injuries, even though he were at a
+great distance at the time.  A friar, returning from the East,
+brought the recipe to Europe somewhat before the middle of the
+seventeenth century.  The Grand Duke of Florence, in which city the
+friar was residing, heard of his cures, and tried, but without
+success, to obtain his secret.  Sir Kenehn Digby, an Englishman well
+known to fame, was fortunate enough to do him a favor, which wrought
+upon his feelings and induced him to impart to his benefactor the
+composition of his extraordinary Powder.  This English knight was at
+different periods of his life an admiral, a theologian, a critic, a
+metaphysician, a politician, and a disciple of Alchemy.  As is not
+unfrequent with versatile and inflammable people, he caught fire at
+the first spark of a new medical discovery, and no sooner got home to
+England than he began to spread the conflagration.
+
+An opportunity soon offered itself to try the powers of the famous
+powder.  Mr. J. Howell, having been wounded in endeavoring to part
+two of his friends who were fighting a duel, submitted himself to a
+trial of the Sympathetic Powder.  Four days after he received 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 were
+very painful, grew easy, although the patient, who was 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
+hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent
+his servant in a great hurry to tell him that his wounds were paining
+him horribly; the garter was therefore replaced in the solution of
+the Powder, and the patient got well after five or six days of its
+continued immersion."
+
+King James First, his son Charles the First, the Duke of Buckingham,
+then prime minister, and all the principal personages of the time,
+were cognizant of this fact; and James himself, being curious to know
+the secret of this remedy, asked it of Sir Kenelm, who revealed it to
+him, and his Majesty had the opportunity of making several trials of
+its efficacy, which all succeeded in a surprising manner." [Dict.
+des Sciences Medieales.]
+
+The king's physician, Dr. Mayerne, was made master of the secret,
+which he carried to France and communicated to the Duke of Mayenne,
+who performed many cures by means of it, and taught it to his
+surgeon, who, after the Duke's death, sold it to many distinguished
+persons, by whose agency it soon ceased to be a secret.  What was
+this wonderful substance which so astonished kings, princes, dukes,
+knights, and doctors?  Nothing but powdered blue vitriol.  But it was
+made to undergo several processes that conferred on it extraordinary
+virtues.  Twice or thrice it was to be dissolved, filtered, and
+crystallized.  The crystals were to be laid in the sun during the
+months of June, July, and August, taking care to turn them carefully
+that all should be exposed.  Then they were to be powdered,
+triturated, and again exposed to the sun, again reduced to a very
+fine powder, and secured in a vessel, while hot, from the sunshine.
+If there seem anything remarkable in the fact of such astonishing
+properties being developed by this process, it must be from our
+short-sightedness, for common salt and charcoal develop powers quite
+as marvellous after a certain number of thumps, stirs, and shakes,
+from the hands of modern workers of miracles.  In fact the Unguentum
+Armarium and Sympathetic Powder resemble some more recent
+prescriptions; the latter consisting in an infinite dilution of the
+common dose in which remedies are given, and the two former in an
+infinite dilution of the common distance at which they are applied.
+
+Whether philosophers, and more especially metaphysicians, have any
+peculiar tendency to dabble in drugs and dose themselves with physic,
+is a question which might suggest itself to the reader of their
+biographies.
+
+When Bishop Berkeley visited the illustrious Malebranche at Paris, he
+found him in his cell, cooking in a small pipkin a medicine for an
+inflammation of the lungs, from which he was suffering; and the
+disease, being unfortunately aggravated by the vehemence of their
+discussion, or the contents of the pipkin, carried him off in the
+course of a few days.  Berkeley himself afforded a remarkable
+illustration of a truth which has long been known to the members of
+one of the learned professions, namely, that no amount of talent, or
+of acquirements in other departments, can rescue from lamentable
+folly those who, without something of the requisite preparation,
+undertake to experiment with nostrums upon themselves and their
+neighbors.  The exalted character of Berkeley is thus drawn by Sir
+James Mackintosh: Ancient learning, exact science, polished society,
+modern literature, and the fine arts, contributed to adorn and enrich
+the mind of this accomplished man.  All his contemporaries agreed
+with the satirist in ascribing
+
+     "'To Berkeley every virtue under heaven.'
+
+"Even the discerning, fastidious, and turbulent Atterbury said, after
+an interview with him, 'So much understanding, so much knowledge, so
+much innocence, and such humility, I did not think had been the
+portion of any but angels, till I saw this gentleman.'"
+
+But among the writings of this great and good man is an Essay of the
+most curious character, illustrating his weakness upon the point in
+question, and entitled, "Siris, a Chain of Philosophical Reflections
+and Inquiries concerning the Virtues of TAR WATER, and divers other
+Subjects,"--an essay which begins with a recipe for his favorite
+fluid, and slides by gentle gradations into an examination of the
+sublimest doctrines of Plato.  To show how far a man of honesty and
+benevolence, and with a mind of singular acuteness and depth, may be
+run away with by a favorite notion on a subject which his habits and
+education do not fit him to investigate, I shall give a short account
+of this Essay, merely stating that as all the supposed virtues of Tar
+Water, made public in successive editions of his treatise by so
+illustrious an author, have not saved it from neglect and disgrace,
+it may be fairly assumed that they were mainly imaginary.
+
+The bishop, as is usual in such cases, speaks of himself as
+indispensably obliged, by the duty he owes to mankind, to make his
+experience public.  Now this was by no means evident, nor does it
+follow in general, that because a man has formed a favorable opinion
+of a person or a thing he has not the proper means of thoroughly
+understanding, he shall be bound to print it, and thus give currency
+to his impressions, which may be erroneous, and therefore injurious.
+He would have done much better to have laid his impressions before
+some experienced physicians and surgeons, such as Dr. Mead and Mr.
+Cheselden, to have asked them to try his experiment over again, and
+have been guided by their answers.  But the good bishop got excited;
+he pleased himself with the thought that he had discovered a great
+panacea; and having once tasted the bewitching cup of self-quackery,
+like many before and since his time, he was so infatuated with the
+draught that he would insist on pouring it down the throats of his
+neighbors and all mankind.
+
+The precious fluid was made by stirring a gallon of water with a
+quart of tar, leaving it forty-eight hours, and pouring off the clear
+water.  Such was the specific which the great metaphysician
+recommended for averting and curing all manner of diseases.  It was,
+if he might be believed, a preventive of the small-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 gout and fevers, and was an
+excellent preservative of the teeth and gums; answered all the
+purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and
+mineral waters; was particularly to be recommended to sea-faring
+persons, ladies, and men of studious and sedentary lives; could never
+be taken too long, but, on the contrary, produced advantages which
+sometimes did not begin to show themselves for two or three months.
+
+"From my representing Tar Water as good for so many things," says
+Berkeley, "some perhaps may conclude it is good for nothing.  But
+charity obligeth me to say what I know, and what I think, however it
+may be taken.  Men may censure and object as they please, but I
+appeal to time and experiment.  Effects misimputed, cases wrong told,
+circumstances overlooked, perhaps, too, prejudices and partialities
+against truth, may for a time prevail and keep her at the bottom of
+her well, from whence nevertheless she emergeth sooner or later, and
+strikes the eyes of all who do not keep them shut."  I cannot resist
+the temptation of illustrating the bishop's belief in the wonderful
+powers of his remedy, by a few sentences from different parts of his
+essay.  "The hardness of stubbed vulgar constitutions renders them
+insensible of a thousand things that fret and gall those delicate
+people, who, as if their skin was peeled off, feel to the quick
+everything that touches them.  The tender nerves and low spirits of
+such poor creatures would be much relieved by the use of Tar Water,
+which might prolong and cheer their lives."  "It [the Tar Water] may
+be made stronger for brute beasts, as horses, in whose disorders I
+have found it very useful."  " This same water will also give
+charitable relief to the ladies, who often want it more than the
+parish poor; being many of them never able to make a good meal, and
+sitting pale, puny, and forbidden, like ghosts, at their own table,
+victims of vapors and indigestion."  It does not appear among the
+virtues of Tar Water that "children cried for it," as for some of our
+modern remedies, but the bishop says, "I have known children take it
+for above six months together with great benefit, and without any
+inconvenience; and after long and repeated experience I do esteem it
+a most excellent diet drink, fitted to all seasons and ages."  After
+mentioning its usefulness in febrile complaints, he says: "I have had
+all this confirmed by my own experience in the late sickly season of
+the year one thousand seven hundred and forty-one, having had twenty-
+five fevers in my own family cured by this medicinal water, drunk
+copiously."  And to finish these extracts with a most important
+suggestion for the improvement of the British nation: "It is much to
+be lamented that our Insulars who act and think so much for
+themselves, should yet, from grossness of air and diet, grow stupid
+or doat sooner than other people, who, by virtue of elastic air,
+water-drinking, and light food, preserve their faculties to extreme
+old 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 might have lived
+longer, but his fatal illness was so sudden that there was not time
+enough to stir up a quart of the panacea.  He was an illustrious man,
+but he held two very odd opinions; that tar water was everything, and
+that the whole material universe was nothing.
+
+                    ---------------------------
+
+Most of those present have at some time in their lives heard mention
+made of the METALLIC TRACTORS, invented by one Dr. Perkins, an
+American, and formerly enjoying great repute for the cure of various
+diseases.  Many have seen or heard of a satirical poem, written by
+one of our own countrymen also, about forty years since, and called
+"Terrible Tractoration."  The Metallic Tractors are now so utterly
+abandoned that I have only by good fortune fallen upon a single one
+of a pair, to show for the sake of illustration.  For more than
+thirty years this great discovery, which was to banish at least half
+the evils which afflict humanity, has been sleeping undisturbed in
+the grave of 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, its brilliant promises are all
+covered with the dust of silent neglect; and of the generation which
+has sprung up since the period when it flourished, very few know
+anything of its history, and hardly even the title which in its palmy
+days it bore of PERKINISM.  Taking it as settled, then, as no one
+appears to answer for 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 absolutely defunct, I select it
+for anatomical examination.  If this pretended discovery was made
+public; if it was long kept before the public; if it was addressed to
+the people of different countries; if it was formally investigated by
+scientific men, and systematically adopted by benevolent persons, who
+did everything in their power to diffuse the knowledge and practice
+of it; if various collateral motives, such as interest and vanity,
+were embarked in its cause; if, notwithstanding all these things, it
+gradually sickened and died, then the conclusion seems a fair one,
+that it did not 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 historically shown 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 and by what means a
+considerable part of the community may be led into the belief of that
+which is to be eventually considered' as an idle folly.  If there is
+any existing folly, fraudulent or innocent in its origin, which
+appeals to certain arguments for its support; provided that the very
+same arguments can be shown to have been used for Perkinism with as
+good reason, they will at once fall to the ground.  Still more, if it
+shall appear that the general course of any existing delusion bears a
+strong resemblance to that of Perkinism, that the former is most
+frequently advocated by the same class of persons who were
+conspicuous in behalf of the latter, and treated with contempt or
+opposed by the same kind of persons who thus treated Perkinism; if
+the facts in favor of both have a similar aspect; if the motives of
+their originators and propagators may be presumed to have been
+similar; then there is every reason to suppose that the existing
+folly will follow in the footsteps of the past, and after displaying
+a given amount of cunning and credulity in those deceiving and
+deceived, will drop from the public view like a fruit which has
+ripened into spontaneous rottenness, and be succeeded by the fresh
+bloom of some other delusion required by the same excitable portion
+of the community.
+
+Dr. Elisha Perkins was born at Norwich, Connecticut, in the year
+1740.  He had practised his profession with a good local reputation
+for many years, when he fell upon a course of experiments, as it is
+related, which led to his great discovery.  He conceived the idea
+that metallic substances might have the effect of removing diseases,
+if applied in a certain manner; a notion probably suggested by the
+then recent experiments of Galvani, in which muscular contractions
+were found to be produced by the contact of two metals with the
+living fibre.  It was in 1796 that his discovery was promulgated in
+the shape of the Metallic Tractors, two pieces of metal, one
+apparently iron and the other brass, about three inches long, blunt
+at one end and pointed at the other.  These instruments were applied
+for the cure of different complaints, such as rheumatism, local
+pains, inflammations, and even tumors, by drawing them over the
+affected part very lightly for about twenty minutes.  Dr. Perkins
+took out a patent for his discovery, and travelled about the country
+to diffuse the new practice.  He soon found numerous advocates of his
+discovery, many of them of high standing and influence.  In the year
+1798 the tractors had crossed the Atlantic, and were publicly
+employed in the Royal Hospital at Copenhagen.  About the same time
+the son of the inventor, Mr. Benjamin Douglass Perkins, carried them
+to London, where they soon attracted attention.  The Danish
+physicians published an account of their cases, containing numerous
+instances of alleged success, in a respectable octavo volume.  In the
+year 1804 an establishment, honored with the name of the Perkinean
+Institution, was founded in London.  The transactions of this
+institution were published in pamphlets, the Perkinean Society had
+public dinners at the Crown and Anchor, and a poet celebrated their
+medical triumph in strains like these :
+
+    "See, pointed metals, blest with power t' appease
+     The ruthless rage of merciless disease,
+     O'er the frail part a subtle fluid pour,
+     Drenched with invisible Galvanic shower,
+     Till the arthritic staff and crutch forego,
+     And leap exulting like the bounding roe!"
+
+While all these things were going on, Mr. Benjamin Douglass Perkins
+was calmly pocketing money, so that after some half a dozen years he
+left the country with more than ten thousand pounds, which had been
+paid him by the believers in Great Britain.  But in spite of all this
+success, and the number of those interested and committed in its
+behalf, Perkinism soon began to decline, and in 1811 the Tractors are
+spoken of by an intelligent writer as being almost forgotten.  Such
+was the origin and duration of this doctrine and practice, into the
+history of which we will now look a little more narrowly.
+
+Let us see, then, by whose agency this delusion was established and
+kept up; whether it was principally by 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 learned
+bodies usually supposed to take an interest in scientific
+discoveries, or only of individuals whose claims to distinction were
+founded upon their position in society, or political station, or
+literary eminence; whether the judicious or excitable classes entered
+most deeply into it; whether, in short, the scientific men of that
+time were deceived, or only intruded upon, and shouted down for the
+moment by persons who had no particular call to invade their
+precincts.
+
+Not much, perhaps, was to be expected of the Medical Profession in
+the way of encouragement.  One Dr. Fuller, who wrote in England,
+himself a Perkinist, thus expressed his opinion: "It must be an
+extraordinary exertion of virtue and humanity for a medical man,
+whose livelihood depends either on the sale of drugs, or on receiving
+a guinea for writing a prescription, which must relate to those
+drugs, to say to his patient, 'You had better purchase a set of
+Tractors to keep in your family; they will cure you without the
+expense of my attendance, or the danger of the common medical
+practice.'  For very obvious reasons medical men must never be
+expected to recommend the use of Perkinism.  The Tractors must trust
+for their patronage to the enlightened and philanthropic out of the
+profession, or to medical men retired from practice, and who know of
+no other interest than the luxury of relieving the distressed.  And I
+do not despair of seeing the day when but very few of this
+description as well as private families will be without them."
+
+Whether the motives assigned by this medical man to his professional
+brethren existed or not, it is true that Dr. Perkins did not gain a
+great deal at their hands.  The Connecticut Medical Society expelled
+him in 1797 for violating their law against the use of nostrums, or
+secret remedies.  The leading English physicians appear to have
+looked on with singular apathy or contempt at the miracles which it
+was pretended were enacting in the hands of the apostles of the new
+practice.  In looking over the reviews of the time, I have found
+little beyond brief occasional notices of their pretensions; the
+columns of these journals being occupied with subjects of more
+permanent interest.  The state of things in London is best learned,
+however, from the satirical poem to which I have already alluded as
+having been written at the period referred to.  This was entitled,
+"Terrible Tractoration!!  A Poetical Petition against Galvanizing
+Trumpery and the Perkinistic Institution.  Most respectfully
+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 learned
+Societies."  Two editions of this work were published in London in
+the years 1803 and 1804, and one or two have been published in this
+country.
+
+"Terrible Tractoration" is supposed, by those who never read it, to
+be a satire upon the follies of Perkins and his followers.  It is, on
+the contrary, a most zealous defence of Perkinism, and a fierce
+attack upon its opponents, most especially upon such of the medical
+profession as treated the subject with neglect or ridicule.  The
+Royal College of Physicians was the more peculiar object of the
+attack, but with this body, the editors of some of the leading
+periodicals, and several physicians distinguished at that time, and
+even now remembered for their services to science and humanity, were
+involved in unsparing denunciations.  The work is by no means of the
+simply humorous character it might be supposed, but is overloaded
+with notes of the most seriously polemical nature.  Much of the
+history of the subject, indeed, is to be looked for in this volume.
+
+It appears from this work that the principal members of 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 it is now evident that, though they were much abused
+for so doing, they knew very well what they had to deal with, and
+were altogether in the right.  The delusion at last attracted such an
+amount of attention as to induce Dr. Haygarth and some others of
+respectable standing to institute some experiments which I shall
+mention in their proper place, the result of which might have seemed
+sufficient to show the emptiness of the whole contrivance.
+
+The Royal Society, that learned body which for ages has constituted
+the best tribunal to which Britain can appeal in questions of
+science, accepted Mr. Perkins's Tractors and the book written about
+them, passed the customary vote of thanks, and never thought of
+troubling itself further in the investigation of pretensions of such
+an aspect.  It is not to be denied that a considerable number of
+physicians did avow themselves advocates of the new practice; but out
+of the whole catalogue of those who were publicly proclaimed as such,
+no one has ever been known, so far as I am aware, to the scientific
+world, except in connection with the short-lived notoriety of
+Perkinism.  Who were the people, then, to whose activity, influence,
+or standing with the community was owing all the temporary excitement
+produced by the Metallic Tractors?
+
+First, those persons who had been induced to purchase a pair of
+Tractors.  These little bits of brass and 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
+whistle is 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 metropolis to concur in the establishment of a
+public institution for the use of these instruments upon the poor,
+"it was found that only five out of above a hundred objected to
+subscribe, on account of their want of confidence in the efficacy of
+the practice; and these," the committee observes, "there is reason to
+believe, never gave them a fair trial, probably never used them in
+more than one case, and that perhaps a case in which the Tractors had
+never been recommended as serviceable."  "Purchasers of the
+Tractors," said one of their ardent advocates, "would be among the
+last to approve of them if they had reason to suppose themselves
+defrauded of five guineas."  He forgot poor Moses, with his "gross of
+green spectacles, with silver rims and shagreen cases."  "Dear
+mother," cried the boy, "why won't you listen to reason?  I had them
+a dead bargain, or I should not have bought them.  The silver rims
+alone will sell for double the money."
+
+But it is an undeniable fact, that many persons of considerable
+standing, and in some instances holding the most elevated positions
+in society, openly patronized the new practice.  In a translation of
+a work entitled "Experiments with the Metallic Tractors," originally
+published in Danish, thence rendered successively into German and
+English, Mr. Benjamin Perkins, who edited the English edition, has
+given a copious enumeration of the distinguished individuals, both in
+America and Europe, whose patronage he enjoyed.  He goes so far as to
+signify that ROYALTY itself was to be included among the number.
+When the Perkinean Institution was founded, no less a person than
+Lord Rivers was elected President, and eleven other individuals of
+distinction, among them Governor Franklin, son of Dr. Franklin,
+figured as Vice-Presidents.  Lord Henniker, a member of the Royal
+Society, who is spoken of as a man of judgment and talents,
+condescended to patronize the astonishing discovery, and at different
+times bought three pairs of Tractors.  When the Tractors were
+introduced into Europe, a large number of testimonials accompanied
+them from various distinguished characters in America, the list of
+whom is given in the translation of the Danish work referred to as
+follows:
+
+"Those who have individually stated cases, or who have presented
+their names to the public as men who approved of this remedy, and
+acknowledged themselves instrumental in circulating the Tractors, are
+fifty-six in number; thirty-four of whom are physicians and surgeons,
+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, one professor of natural philosophy in a college, etc.,
+etc."  It seemed to be taken rather hardly by Mr. Perkins that the
+translators of the work which he edited, in citing the names of the
+advocates of the Metallic Practice, frequently omitted the honorary
+titles which should have been annexed.  The testimonials were
+obtained by the Danish writer, from a pamphlet published in America,
+in which these titles were given in full.  Thus one of these
+testimonials is from " John Tyler, Esq., a magistrate in the county
+of New London, and late Brigadier-General of the militia in that
+State."  The "omission of the General's title" is the subject of
+complaint, as if this title were sufficient evidence of the
+commanding powers of one of the patrons of tractoration.  A similar
+complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney
+at Law, and a member of the Legislature of the State of Connecticut,"
+is mentioned without his titular honors, and even on account of the
+omission of the proper official titles belonging to "Nathan Pierce,
+Esq., Governor and Manager of the Almshouse of Newburyport."  These
+instances show the great importance to be attached to civil and
+military dignities, in qualifying their holders to judge of
+scientific subjects, a truth which has not been overlooked by the
+legitimate successors of the Perkinists.  In Great Britain, the
+Tractors were not less honored than in America, by the learned and
+the illustrious.  The "Perkinistic Committee" made this statement in
+their report: "Mr. Perkins has annually laid before the public a
+large collection of new cases communicated to him for that purpose by
+disinterested and intelligent characters, from almost every quarter
+of Great Britain.  In regard to the competency of these vouchers, it
+will be sufficient simply to state that, amongst others whose 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 that the number of
+clergymen both in America and Great Britain who thrust forward their
+evidence on this medical topic was singularly large in proportion to
+that of the members of the medical profession.  Whole pages are
+contributed by such worthies as the Rev. Dr. Trotter of Hans Place,
+the Rear.  Waring Willett, Chaplain to the Earl of Dunmore, the Rev.
+Dr. Clarke, Chaplain to the Prince of Wales.  The style of these
+theologico-medical communications may be seen in the following from a
+divine who was also professor in one of the colleges of New England.
+"I have used the Tractors with success in several other cases in my
+own family, and although, like Naaman the Syrian, I cannot tell why
+the waters of Jordan should be better than Abana and Pharpar, rivers
+of Damascus; yet since experience has proved them so, no reasoning
+can change the opinion.  Indeed, the causes of all common facts are,
+we think, perfectly well known to us; and it is very probable, fifty
+or a hundred years hence, we shall as well know why the Metallic
+Tractors should in a few minutes remove violent pains, as we now know
+why cantharides and opium will produce opposite effects, namely, we
+shall know very little about either excepting facts."  Fifty or a
+hundred years hence! if he could have looked forward forty years, he
+would have seen the descendants of the "Perkinistic" philosophers
+swallowing infinitesimal globules, and knowing and caring as much
+about the Tractors as the people at Saratoga Springs do about the
+waters of Abana and Pharpar.
+
+I trust it will not be thought in any degree disrespectful to a
+profession which we all honor, that I have mentioned the great zeal
+of many clergymen in the cause of Perkinism.  I hope, too, that I may
+without offence suggest the causes which have often led them out of
+their own province into one to which their education has no special
+reference.  The members of that profession ought to 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
+them are suffering from bodily illness.  It is natural enough that a
+strong desire should be excited to alleviate sufferings which may
+have defied the efforts of professional skill; as natural that any
+remedy which recommends itself to the belief or the fancy of the
+spiritual physician 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 him to take the most flattering view
+of its effects upon the patient; his own sagacity and judgment being
+staked upon the success of the trial.  The inventor of the Tractors
+was aware of these truths.  He therefore sent the Tractors
+gratuitously to many clergymen, accompanied with a formal certificate
+that the holder had become entitled to their possession by the
+payment of five guineas.  This was practised in our own neighborhood,
+and I remember finding one of these certificates, so presented, which
+proved that amongst the risks of infancy I had to encounter Perkins's
+Tractors.  Two clergymen of Boston and the vicinity, both well known
+to local fame, gave in their testimony to the value of the
+instruments thus presented to them; an unusually moderate proportion,
+when it is remembered that to the common motives of which I have
+spoken was added the seduction of a gift for which the profane public
+was expected to pay so largely.
+
+It was remarkable, also, that Perkinism, which had so little success
+with the medical and scientific part of the community, found great
+favor in the eyes of its more lovely and less obstinate portion.
+"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,--
+"having been lately in America, had seen and heard much of the great
+effects of Perkinism.  Influenced by a most benevolent disposition,
+she brought these Tractors and the pamphlet with her to Europe, with
+a laudable desire of extending their utility to her suffering
+countrymen."  Such was the channel by which the Tractors were
+conveyed to Denmark, where they soon became the ruling passion.
+The workmen, says a French writer, could not manufacture them fast
+enough.  Women carried them about their persons, and delighted in
+bringing them into general use.  To what extent the Tractors were
+favored with the patronage of English and American ladies, it is of
+course not easy to say, except on general principles, as their names
+were not brought before the public.  But one of Dr. Haygarth's
+stories may lead us to conjecture that there was a class of female
+practitioners who went about doing good with the Tractors in England
+as well as in Denmark.  A certain lady had the misfortune to have a
+spot as big as a silver penny at the corner of her eye, caused by a
+bruise, or some such injury.  Another lady, who was a friend of hers,
+and a strong believer in Perkinism, was very anxious to try the
+effects of tractoration upon this unfortunate blemish.  The patient
+consented; the lady "produced the instruments, and, after drawing
+them four or five times over the spot, declared that it changed to a
+paler color, and on repeating the use of them a few minutes longer,
+that it had almost vanished, and was scarcely visible, and departed
+in high triumph at her success."  The lady who underwent the
+operation assured the narrator "that she looked in the glass
+immediately after, and that not the least visible alteration had
+taken place."
+
+It would be a very interesting question, what was the intellectual
+character of those persons most conspicuous in behalf of the
+Perkinistic delusion?  Such an inquiry might bring to light some
+principles which we could hereafter apply to the study of other
+popular errors.  But the obscurity into which nearly all these
+enthusiasts have subsided renders the question easier to ask than to
+answer.  I believe it would have been found that most of these
+persons were of ardent temperament and of considerable imagination,
+and that their history would show that Perkinism was not the first
+nor the last hobby-horse they rode furiously.  Many of them may very
+probably have been persons of more than common talent, of active and
+ingenious minds, of versatile powers and various acquirements.  Such,
+for instance, was the estimable man to whom I have repeatedly
+referred as a warm defender of tractoration, and a bitter assailant
+of its enemies.  The story tells itself in the biographical preface
+to his poem.  He went to London with the view of introducing a
+hydraulic machine, which he and his Vermont friends regarded as a
+very important invention.  He found, however, that the machine was
+already in common use in that metropolis.  A brother Yankee, then in
+London, had started the project of a mill, which was to be carried by
+the water of the Thames.  He was sanguine enough to purchase one
+fifth of this concern, which also proved a failure.  At about the
+same period he wrote the work which proved the great excitement of
+his mind upon the subject of the transient folly then before the
+public.  Originally a lawyer, he was in succession a mechanician, a
+poet, and an editor, meeting with far less success in each of these
+departments than usually attends men of less varied gifts, but of
+more tranquil and phlegmatic composition.  But who is ignorant that
+there is a class of minds characterized by qualities like those I
+have mentioned; minds with many bright and even beautiful traits; but
+aimless and fickle as the butterfly; that settle upon every gayly-
+colored illusion as it opens into flower, and flutter away to another
+when the first has dropped its leaves, and stands naked in the icy
+air of truth!
+
+Let us now look at the general tenor of the arguments addressed by
+believers to sceptics and opponents.  Foremost of all, emblazoned at
+the head of every column, loudest shouted by every triumphant
+disputant, held up as paramount to all other considerations,
+stretched like an impenetrable shield to protect the weakest advocate
+of the great cause against the weapons of the adversary, was that
+omnipotent monosyllable which has been the patrimony of cheats and
+the currency of dupes from time immemorial,--Facts! Facts ! Facts!
+First came the published cases of the American clergymen, brigadier-
+generals, almshouse governors, representatives, attorneys, and
+esquires.  Then came the published cases of the surgeons of
+Copenhagen.  Then followed reports of about one hundred and fifty
+cases published in England, "demonstrating the efficacy of the
+metallic practice in a variety of complaints both upon the human body
+and on horses, etc."  But the progress of facts in Great Britain did
+not stop here.  Let those who rely upon the numbers of their
+testimonials, as being alone sufficient to prove the soundness and
+stability of a medical novelty, digest the following from the report
+of the Perkinistic Committee.  "The cases published [in Great
+Britain] amounted, in March last, the date of Mr. Perkins's last
+publication, to about five thousand.  Supposing that not more than
+one cure in three hundred which the Tractors have performed has been
+published, and the proportion is probably much greater, it will be
+seen that the number, to March last, will have exceeded one million
+five hundred thousand!"
+
+Next in order after the appeal to what were called facts, came a
+series of arguments, which have been so long bruised and battered
+round in the cause of every doctrine or pretension, new, monstrous,
+or deliriously impossible, that each of them is as odiously familiar
+to the scientific scholar as the faces of so many old acquaintances,
+among the less reputable classes, to the officers of police.
+
+No doubt many of my hearers will recognize, in the following
+passages, arguments they may have heard brought forward with
+triumphant confidence in behalf of some doctrine not yet extinct.  No
+doubt some may have honestly thought they proved something; may have
+used them with the purpose of convincing their friends, or of
+silencing the opponents of their favorite doctrine, whatever that
+might be.  But any train of arguments which was contrived for
+Perkinism, which was just as applicable to it as to any other new
+doctrine in the same branch of science, and which was fully employed
+against its adversaries forty years since, might, in common charity,
+be suffered to slumber in the grave of Perkinism.  Whether or not the
+following sentences, taken literally from the work of Mr. Perkins,
+were the originals of some of the idle propositions we hear bandied
+about from time to time, let those who listen judge.
+
+The following is the test assumed for the new practice : "If diseases
+are really removed, as those persons who have practised extensively
+with the Tractors declare, it should seem there would be but little
+doubt of their being generally adopted; but if the numerous reports
+of 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 judging and uncandid
+class of individuals who buy their dinners without tasting all the
+food there is in the market.  "On all discoveries there are persons
+who, without descending to any inquiry into the truth, pretend to
+know, as it were by intuition, that newly asserted facts are founded
+in the grossest errors.  These were those who knew that Harvey's
+report of the circulation of the blood was a preposterous and
+ridiculous suggestion, and in latter later days there were others who
+knew that Franklin deserved reproach for declaring that points were
+preferable to balls for protecting buildings from lightning."
+
+Again: "This unwarrantable mode of offering assertion for proof, so
+unauthorized and even unprecedented except in the condemnation of a
+Galileo, the persecution of a Copernicus, and a few other acts of
+inquisitorial authority, 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 Materia Medica act on principles
+of which we are totally ignorant.  None have ever yet been able to
+explain how opium produces sleep, or how bark cures intermittent
+fevers; and yet few, it is hoped, will be so absurd as to desist from
+the use of these important articles because they know nothing of the
+principle of their operations."  Or if the argument is preferred, in
+the eloquent language of the Perkinistic poet:
+
+    "What though the CAUSES may not be explained,
+     Since these EFFECTS are duly ascertained,
+     Let not self-interest, prejudice, or pride,
+     Induce mankind to set the means aside;
+     Means which, though simple, are by
+     Heaven designed to alleviate the woes of human kind."
+
+This course of argument is so often employed, that it deserves to be
+expanded a little, so that its length and breadth may be fairly seen.
+A series of what are called facts is brought forward to prove some
+very improbable doctrine.  It is objected by judicious people, or
+such as have devoted themselves to analogous subjects, that these
+assumed facts are in direct opposition to all that is known of the
+course of nature, that the universal experience of the past affords a
+powerful presumption against their truth, and that in proportion to
+the gravity of these objections, should be the number and competence
+of the witnesses.  The answer is a ready one.  What do we know of the
+mysteries of Nature?  Do we understand the intricate machinery of the
+Universe?  When to this is added the never-failing quotation,
+
+    "There are more things in heaven and 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.  It is in itself strange
+and incredible that the relations of the heavenly bodies to each
+other at a given moment of time, perhaps half a century ago, should
+have anything to do with my success or misfortune in any undertaking
+of to-day.  But what right have I to say it cannot be so?  Can I bind
+the sweet influences of Pleiades, or loose the bands of Orion?  I do
+not know by what mighty magic the planets roll in their fluid paths,
+confined to circles as unchanging as if they were rings of steel, nor
+why the great wave of ocean follows in a sleepless round upon the
+skirts of moonlight; nor cam I say from any certain knowledge that
+the phases of the heavenly bodies, or even the falling of the leaves
+of the forest, or the manner in which the sands lie upon the sea-
+shore, may not be knit up by invisible threads with the web of human
+destiny.  There is a class of minds much more ready to believe that
+which is at first sight incredible, and because it is incredible,
+than what is generally thought reasonable.  Credo quia impossibile
+est,--"I believe, because it is impossible,"--is an old paradoxical
+expression which might be literally applied to this tribe of persons.
+And they always succeed in finding something marvellous, to call out
+the exercise of their robust faith.  The old Cabalistic teachers
+maintained that there was not a verse, line, word, or even letter in
+the Bible which had not a special efficacy either to defend the
+person who rightly employed it, or to injure his enemies; always
+provided the original Hebrew was made use of.  In the hands of modern
+Cabalists every substance, no matter how inert, acquires wonderful
+medicinal virtues, provided it be used in a proper state of purity
+and subdivision.
+
+I have already mentioned the motives attributed by the Perkinists to
+the Medical Profession, as preventing its members from receiving the
+new but unwelcome truths.  This accusation is repeated in different
+forms and places, as, for instance, in the following passage:
+"Will the medical man who has spent much money and labor in the
+pursuit of the arcana of Physic, and on the exercise of which depends
+his support in life, proclaim the inefficacy of his art, and
+recommend a remedy to his patient which the most unlettered in
+society can employ as advantageously as himself? and a remedy, too,
+which, unlike the drops, the pills, the powders, etc., of the Materia
+Medica, is inconsumable, and ever in readiness to be employed in
+successive diseases?"
+
+As usual with these people, much indignation was expressed at any
+parallel between their particular doctrine and practice and those of
+their exploded predecessors.  "The motives," says the disinterested
+Mr. Perkins, "which must have impelled to this attempt at classing
+the METALLIC PRACTICE with the most paltry of empyrical projects, are
+but too thinly veiled to escape detection."
+
+To all these arguments was added, as a matter of course, an appeal to
+the feelings of the benevolent in behalf of suffering humanity, in
+the shape of a notice that the poor would be treated gratis.  It is
+pretty well understood that this gratuitous treatment of the poor
+does not necessarily imply an excess of benevolence, any more than
+the gratuitous distribution of a trader's shop-bills is an evidence
+of remarkable generosity; in short, that it is one of those things
+which honest men often do from the best motives, but which rogues and
+impostors never fail to announce as one of their special
+recommendations.  It is astonishing to see how these things brighten
+up at the touch of Mr. Perkins's poet:
+
+    "Ye worthy, honored, philanthropic few,
+     The muse shall weave her brightest wreaths for you,
+     Who in Humanity's bland cause unite,
+     Nor heed the shaft by interest aimed or spite;
+     Like the great Pattern of Benevolence,
+     Hygeia's blessings to the poor dispense;
+     And though opposed by folly's servile brood,
+     ENJOY THE LUXURY OF DOING GOOD."
+
+Having thus sketched the history of Perkinism in its days of
+prosperity; having seen how it sprung into being, and by what means
+it maintained its influence, it only remains to tell the brief story
+of its discomfiture and final downfall.  The vast majority of the
+sensible part of the medical profession were contented, so far as we
+can judge, to let it die out of itself.  It was in vain that the
+advocates of this invaluable discovery exclaimed over their perverse
+and interested obstinacy,--in vain that they called up the injured
+ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving
+generation; the Baillies and the Heberdens,--men whose names have
+come down to us as synonymous with honor and wisdom,--bore their
+reproaches in meek silence, and left them unanswered to 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
+would be broken by an open trial of its virtue, as compared with that
+of some less hallowed formula.  It must be remembered that a peculiar
+value was attached to the Metallic Tractors, as made and patented by
+Mr. Perkins.  Dr. Haygarth, of Bath, performed various experiments
+upon patients afflicted with different complaints,--the patients
+supposing that the real five-guinea Tractors were employed.  Strange
+to relate, he obtained equally wonderful effects with Tractors of
+lead and of wood; with nails, pieces of bone, slate pencil, and
+tobacco-pipe.  Dr. Alderson employed sham Tractors made of wood, and
+produced such effects upon five patients that they returned solemn
+thanks in church for their cures.  A single specimen of these cases
+may stand for all of them.  Ann Hill had suffered for some months
+from pain in the right arm and shoulder.  The Tractors (wooden ones)
+were applied, and in the space of five minutes she expressed herself
+relieved in the following apostrophe: "Bless me! why, who could have
+thought it, that them little things could pull the pain from one.
+Well, to be sure, the longer one lives, the more one sees; ah, dear!"
+
+These experiments did not result in the immediate extinction of
+Perkinism.  Doubtless they were a great comfort to many obstinate
+unbelievers, and helped to settle some sceptical minds; but for the
+real Perkinistic enthusiasts, it may be questioned whether they would
+at that time have changed their opinion though one had risen from the
+dead to assure them that it was an error.  It perished without
+violence, by an easy and natural process.  Like the famous toy of
+Mongolfier, it rose by means of heated air,--the fevered breath of
+enthusiastic ignorance,--and when this grew cool, as it always does
+in a little while, it collapsed and fell.
+
+And now, on reviewing the whole subject, how shall we account for the
+extraordinary prevalence of the belief in Perkinism among a portion
+of what is supposed to be the thinking part of the community?
+
+Could the cures have been real ones, produced by the principle of
+ANIMAL MAGNETISM?  To this it may be answered that the Perkinists
+ridiculed the idea of approximating Mesmer and the founder of their
+own doctrine, that nothing like the somnambulic condition seems to
+have followed the use of the Tractors, and that neither the exertion
+of the will nor the powers of the individual who operated seem to
+have been considered of any consequence.  Besides, the absolute
+neglect into which the Tractors soon declined is good evidence that
+they were incapable of affording any considerable and permanent
+relief in the complaints for the cure of which they were applied.
+
+Of course a large number of apparent cures were due solely to nature;
+which is true under every form of treatment, orthodox or empirical.
+Of course many persons experienced at least temporary relief from the
+strong impression made upon their minds by this novel and marvellous
+method of treatment.
+
+Many, again, influenced by the sanguine hopes of those about them,
+like dying people, who often say sincerely, from day to day, that
+they are getting better, cheated themselves into a false and short-
+lived belief that they were cured; and as happens in such cases, the
+public never knew more than the first half of the story.
+
+When it was said to the Perkinists, that whatever effects they
+produced were merely through the imagination, they declared (like the
+advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM that this
+explanation was sufficiently disproved by the fact of numerous and
+successful cures which had been witnessed in infants and brute
+animals.  Dr. Haygarth replied to this, that "in these cases it is
+not the Patient, but the Observer, who is deceived by his own
+imagination," and that such may be the fact, we have seen in the case
+of the good lady who thought she had conjured away the spot from her
+friend's countenance, when it remained just as before.
+
+As to the motives of the inventor and vender of the Tractors, 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 that they are a peculiar compound, when they are artfully
+associated with a new and brilliant discovery (which then happened to
+be Galvanism), when they are sold at many hundred times their value,
+and the seller prints his 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 practise on each other,"
+one cannot but suspect that they were contrived in the neighborhood
+of a wooden nutmeg factory; that legs of ham in that region are not
+made of the best mahogany; and that such as buy their cucumber seed
+in that vicinity have to wait for the fruit as long as the Indians
+for their crop of gunpowder.
+
+
+                    ---------------------------
+
+The succeeding lecture will be devoted to an examination of 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, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy,
+and the claims of which are considered by some as infinitely
+important, and by many as immeasurably ridiculous.
+
+I wish to state, for the sake of any who may be interested in the
+subject, that I shall treat it, not by ridicule, but by argument;
+perhaps with great freedom, but with good temper and in peaceable
+language; with very little hope of reclaiming converts, with no
+desire of making enemies, but with a firm belief that its pretensions
+and assertions cannot stand before a single hour of calm
+investigation.
+
+
+
+
+II.
+
+It may be thought that a direct attack upon the pretensions of
+HOMOEOPATHY is an uncalled-for aggression upon an unoffending
+doctrine and its peaceful advocates.
+
+But a little inquiry will show that it has long assumed so hostile a
+position with respect to the Medical Profession, that any trouble I,
+or any other member of that profession, may choose to bestow upon it
+may be considered merely as a matter of self-defence.  It began with
+an attempt to show the insignificance of all existing medical
+knowledge.  It not only laid claim to wonderful powers of its own,
+but it declared the common practice to be attended with the most
+positively injurious effects, that by it acute diseases are
+aggravated, and chronic diseases rendered incurable.  It has at
+various times brought forward collections of figures having the air
+of statistical documents, pretending to show a great proportional
+mortality among the patients of the Medical Profession, as compared
+with those treated according to its own rules.  Not contented with
+choosing a name of classical origin for itself, it invented one for
+the whole community of innocent physicians, assuring them, to their
+great surprise, that they were all ALLOPATHISTS, whether they knew it
+or not, and including all the illustrious masters of the past, from
+Hippocrates down to Hunter, under the same gratuitous title.  The
+line, then, has been drawn by the champions of the new doctrine; they
+have lifted the lance, they have sounded the charge, and are
+responsible for any little skirmishing which may happen.
+
+But, independently of any such grounds of active resistance, the
+subject involves interests so disproportioned to its intrinsic
+claims, that it is no more than an act 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, and acquires
+the same degree of influence that we have often seen obtained by
+other illusions, there is not one of my audience who may not have
+occasion to deplore the fatal credulity which listened to its
+promises.
+
+I shall therefore undertake a sober examination of its principles,
+its facts, and some points of its history.  The limited time at my
+disposal requires me to condense as much as possible what I have to
+say, but I shall endeavor to be plain and direct in expressing it.
+Not one statement shall be made which cannot be supported by
+unimpeachable reference: not one word shall be uttered which I am not
+as willing to print as to speak.  I have no quibbles to utter, and I
+shall stoop to answer none; but, with full faith in the sufficiency
+of a plain statement of facts and reasons, I submit the subject to
+the discernment of my audience.
+
+
+The question may be asked in the outset,--Have you submitted the
+doctrines you are professing to examine 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, from what
+has often happened, that it would be of no manner of use for me to
+allege the results of any experiments I might have instituted.  Again
+and again have the most explicit statements been made by the most
+competent persons of the utter failure of all their trials, and there
+were the same abundant explanations offered as used to be for the
+Unguentum Armarium arid the Metallic Tractors.  I could by no
+possibility perform any experiments the result of which could not be
+easily explained away so as to be of no conclusive significance.
+Besides, as arguments in favor of Homoeopathy are constantly
+addressed to the public in journals, pamphlets, and even lectures, by
+inexperienced dilettanti, the same channel must be open to all its
+opponents.
+
+It is necessary, for the sake of those to whom the whole subject may
+be new, to give in the smallest possible compass the substance of the
+Homoeopathic Doctrine.  Samuel Hahnemann, its founder, is a German
+physician, now living in Paris," [Hahnemann died in 1843.] at the age
+of eighty-seven years.  In 1796 he published the first paper
+containing his peculiar notions; in 1805 his first work on the
+subject; in 1810 his somewhat famous "Organon of the Healing Art;"
+the next year what he called the "Pure Materia Medica;" and in 1828
+his last work, the "Treatise on Chronic Diseases."  He has therefore
+been writing at intervals on his favorite subject for nearly half a
+century.
+
+The one great doctrine which constitutes the basis of Homoeopathy as
+a system is expressed by the Latin aphorism,
+
+               "SIMILIA SIBIILIBUS CURANTUR,"
+
+or like cures like, that is, diseases are cured by agents capable of
+producing symptoms resembling those found in the disease under
+treatment.  A disease for Hahnemann consists essentially in a group
+of symptoms.  The proper medicine for any disease is the one which is
+capable of producing a similar group of symptoms when given to a
+healthy person.
+
+It is of course necessary to know what are the trains of symptoms
+excited by different substances, when administered to persons in
+health, if any such can be shown to exist.  Hahnemann and his
+disciples give catalogues of the symptoms which they affirm were
+produced upon themselves or others by a large number of drugs which
+they submitted to experiment.
+
+The second great fact which Hahnemann professes to have established
+is the efficacy of medicinal substances reduced to a wonderful degree
+of minuteness or dilution.  The following account of his mode of
+preparing his medicines is from his work on Chronic Diseases, which
+has not, I believe, yet been translated into English.  A grain of the
+substance, if it is solid, a drop if it is liquid, is to be added to
+about a third part of one hundred grains of sugar of milk in an
+unglazed porcelain capsule which has had the polish removed from the
+lower part of its cavity by rubbing it with wet sand; they are to be
+mingled for an instant with a bone or horn spatula, and then rubbed
+together for six minutes; then the mass is to be scraped together
+from 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 the powder into a heap, and the second third of the hundred
+grains of sugar of milk to be added.  Then they are to be stirred an
+instant and rubbed six minutes,--again to be scraped together four
+minutes and forcibly rubbed six; once more scraped together for four
+minutes, when the last third of the hundred grains of sugar of milk
+is to be added and mingled by stirring with the spatula; six minutes
+of forcible rubbing, four of scraping together, and six more
+(positively the last six) of rubbing, finish this part of the
+process.
+
+Every grain of this powder contains the hundredth of a grain of the
+medicinal substance mingled with the sugar of milk.  If, therefore, a
+grain of the powder just prepared is mingled with another hundred
+grains of sugar of milk, and the process just described repeated, we
+shall have a powder of which every grain contains the hundredth of
+the hundredth, or the ten thousandth part of a grain of the medicinal
+substance.  Repeat the same process with the same quantity of fresh
+sugar of milk, and every grain of your powder will contain the
+millionth of a grain of the medicinal substance.  When the powder is
+of this strength, it is ready to employ in the further solutions and
+dilutions to be made use of in practice.
+
+A grain of the powder is to be taken, a hundred drops of alcohol are
+to be poured on it, the vial is to be slowly turned for a few
+minutes, until the powder is 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 observations upon the sick lead me
+within the last few years to prefer giving only two shakes to
+medicinal liquids, whereas I formerly used to give ten."  The process
+of dilution is carried on in the same way as the attenuation of the
+powder was done; each successive dilution with alcohol reducing the
+medicine to a hundredth part of the quantity of that which preceded
+it.  In this way the dilution of the original millionth of a grain of
+medicine contained in the grain of powder operated on is carried
+successively to the billionth, trillionth, quadrillionth,
+quintillionth, and very often much higher fractional divisions.  A
+dose of any of these medicines is a minute fraction of a drop,
+obtained by moistening with them one or more little globules of
+sugar, of which Hahnemann says it takes about two hundred to weigh a
+grain.
+
+As an instance of the strength of the medicines prescribed by
+Hahnemann, I will mention carbonate of lime.  He does not employ
+common chalk, but prefers a little portion 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 mentioned can convey is a
+common dose.  But for persons of very delicate nerves it is proper
+that the dilution should be carried to the decillionth degree.  That
+is, an important medicinal effect is to be expected from the two
+hundredth or hundredth part of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of a
+grain of oyster-shell.  This is only the tenth degree of potency, but
+some of his disciples profess to have obtained palpable effects from
+much higher dilutions."
+
+The third great doctrine of Hahnemann is the following.  Seven
+eighths at least of all chronic diseases are produced by the
+existence in the system of that infectious disorder known in the
+language of science by the appellation of PSORA, but to the less
+refined portion of the community by the name of ITCH.  In the words
+of Hahnemann's "Organon,"  "This Psora is the sole true and
+fundamental cause that produces 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 the bones, or rickets, scoliosis
+and cyphosis, caries, cancer, fungua haematodes, gout,--yellow
+jaundice and cyanosis, dropsy,--
+
+["The degrees of DILUTION must not be confounded with those of
+POTENCY.  Their relations may be seen by this table:
+
+lst dilution,--One hundredth of a drop or grain.
+
+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.,--and so on indefinitely.
+
+
+The large figures denote the degrees of POTENCY.]
+
+
+
+gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the
+lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of
+sense, pains of every kind, etc., appear in our pathology as so many
+peculiar, distinct, and independent diseases."
+
+For the last three centuries, if the same authority may be trusted,
+under the influence of the more refined personal habits which have
+prevailed, and the application of various external remedies which
+repel the affection from the skin; Psora has revealed itself in these
+numerous forms of internal disease, instead of appearing, as in
+former periods, under the aspect of an external malady.
+
+These are the three cardinal doctrines of Hahnemann, as laid down in
+those standard works of Homoeopathy, the "Organon" and the "Treatise
+on Chronic Diseases."
+
+Several other principles may be added, upon all of which he insists
+with great force, and which are very generally received by his
+disciples.
+
+1.  Very little power is allowed to the curative efforts of nature.
+Hahnemann goes so far as to say that no one has ever seen the simple
+efforts of nature effect the durable recovery of a patient from a
+chronic disease.  In general, the Homoeopathist calls every recovery
+which happens under his treatment a cure.
+
+2.  Every medicinal substance must be administered in a state of the
+most perfect purity, and uncombined with any other.  The union of
+several remedies in a single prescription destroys its utility, and,
+according to the "Organon," frequently adds a new disease.
+
+3.  A large number of substances commonly thought to be inert develop
+great medicinal powers when prepared in the manner already described;
+and a great proportion of them are ascertained to have specific
+antidotes in 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 collections of symptoms, each of which differs from every
+other collection.
+
+5.  The symptoms of any complaint must be described with the most
+minute exactness, and so far as possible in the patient's own words.
+To illustrate the kind of circumstances the patient is expected to
+record, I will mention one or two from the 313th page of the
+"Treatise on Chronic Diseases,"--being the first one at which I
+opened accidentally.
+
+"After dinner, disposition to sleep; the patient winks."
+
+"After dinner, prostration and feeling of weakness (nine days after
+taking the remedy)."
+
+This remedy was that same oyster-shell which is to be prescribed
+"fractions of the sextillionth or decillionth degree.  According to
+Hahnemann, the action of a single dose of the size mentioned does not
+fully display itself in some cases until twenty-four or even thirty
+days after it is taken, and in such instances has not exhausted its
+good effects until towards the fortieth or fiftieth day,--before
+which time it would be absurd and injurious to administer a new
+remedy.
+
+So much for the doctrines of Hahnemann, which have been stated
+without comment, or exaggeration of any of their features, very much
+as any adherent of his opinions might have stated them, if obliged to
+compress them into so narrow a space.
+
+Does Hahnemann himself represent Homoeopathy as it now exists?  He
+certainly ought to be its best representative, after having created
+it, and devoted his life to it for half a century.  He is spoken of
+as the great physician of the time, in most, if not all Homoeopathic
+works.  If he is not authority on the subject of his own doctrines,
+who is?  So far as I am aware, not one tangible discovery in the
+so-called science has ever been ascribed to any other observer; at
+least, no general principle or law, of consequence enough to claim
+any prominence in Homoeopathic works, has ever been pretended to have
+originated with any of his illustrious disciples.  He is one of the
+only two Homoeopathic writers with whom, as I shall mention, the
+Paris publisher will have anything to do upon his own account.  The
+other is Jahr, whose Manual is little more than a catalogue of
+symptoms and remedies.  If any persons choose to reject Hahnemann as
+not in the main representing Homoeopathy, if they strike at his
+authority, if they wink out of sight his deliberate and formally
+announced results, it is an act of suicidal rashness; for upon his
+sagacity and powers of observation, and experience, as embodied in
+his works, and especially in his Materia Medica, repose the
+foundations of Homoeopathy as a practical system.
+
+So far as I can learn from the conflicting statements made upon the
+subject, the following is the present condition of belief.
+
+1.  All of any note agree that the law Similia similibus is the only
+fundamental principle in medicine.  Of course if any man does not
+agree to this the name Homoeopathist can no longer be applied to him
+with propriety.
+
+2.  The belief in and employment of the infinitesimal doses is
+general, and in some places universal, among the advocates of
+Homoeopathy; but a distinct movement has been made in Germany to get
+rid of any restriction to the use of these doses, and to employ
+medicines with the same license as other practitioners.
+
+3.  The doctrine of the origin of most chronic diseases in Psora,
+notwithstanding Hahnemann says it cost him twelve years of study and
+research to establish the fact and its practical consequences, has
+met with great neglect and even opposition from very many of his own
+disciples.
+
+It is true, notwithstanding, that, throughout most of their writings
+which I have seen, there runs a prevailing tone of great deference to
+Hahnemann's opinions, a constant reference to his authority, a
+general 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's Translation of Jahr's Manual may observe
+how little comparative space is given to remedies resting upon 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 consider it vastly more probable that any
+observer in so fallacious and difficult a field of inquiry as
+medicine had been led into error, or walked into it of his own
+accord, than that such numerous and extraordinary facts had really
+just come to light.  They would feel a right to exercise the same
+obduracy towards them as the French Institute is in the habit of
+displaying when memoirs or models are offered to it relating to 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
+philosophers must have felt when, some half a dozen years ago, an
+unknown man came forward, and asked for an opportunity to demonstrate
+to Arago and his colleagues that the moon and planets were at a
+distance of a little more than a hundred miles from the earth.  And
+so they would not even look into Homoeopathy, though all its
+advocates should exclaim in the words of Mr. Benjamin Douglass
+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 newly asserted
+facts are founded in the grossest errors."  And they would lay their
+heads upon their pillows with a perfectly clear conscience, although
+they were assured that they were behaving in the same way that people
+of 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 these assertions is
+not sufficient to deter many, from examining their claims to belief.
+I therefore lean but very slightly on the extravagance and extreme
+apparent singularity of their pretensions.  I might have omitted
+them, but on the whole it seemed more just to the claims of my
+argument to suggest the vast complication of improbabilities involved
+in the statements enumerated.  Every one must of course judge for
+himself as to the weight of these objections, which are by no means
+brought forward as a proof of the extravagance of Homoeopathy, but
+simply as entitled to a brief consideration before the facts of the
+case are submitted to our scrutiny.
+
+The three great asserted discoveries of Hahnemann are entirely
+unconnected with and independent of each other.  Were there any
+natural relation between them it would seem probable enough that the
+discovery of the first would have led to that of the others.  But
+assuming it to be a fact that diseases are cured by remedies capable
+of producing symptoms like their own, no manifest relation exists
+between this fact and the next assertion, namely, the power of the
+infinitesimal doses.  And allowing both these to be true, neither has
+the remotest affinity to the third new doctrine, that which declares
+seven eighths of all chronic diseases to be owing to Psora.
+
+This want of any obvious relation between Hahnemann's three cardinal
+doctrines appears to be self-evident upon inspection.  But if, as is
+often true with his disciples, they prefer the authority of one of
+their own number, I will refer them to Dr. Trinks's paper on the
+present state of Homoeopathy in Europe, with which, of course, they
+are familiar, as his name is mentioned as one of the most prominent
+champions of 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 three such unconnected and astonishing
+discoveries, each of them a complete revolution of all that ages of
+the most varied experience had been taught to believe, should spring
+full formed from the brain of a single individual.
+
+Let us look a moment at the first of his doctrines.  Improbable
+though it may seem to some, there is no essential absurdity involved
+in the proposition that diseases yield to remedies capable of
+producing like symptoms.  There are, on the other hand, some
+analogies which lend a degree of plausibility to the statement.
+There are well-ascertained facts, known from the earliest periods of
+medicine, showing that, under certain circumstances, the very
+medicine which, from its known effects, one would expect to aggravate
+the disease, may contribute to its relief.  I may be permitted to
+allude, in the most general way, to the case in which the spontaneous
+efforts of an overtasked stomach are quieted by the agency of a drug
+which that organ refuses to entertain upon any terms.  But that every
+cure ever performed by medicine should have been founded upon this
+principle, although without the knowledge of a physician; that the
+Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature
+in therapeutics," a law of which nothing more than a transient
+glimpse ever presented itself to the innumerable host of medical
+observers, is a dogma of such sweeping extent, and pregnant novelty,
+that it demands a corresponding breadth and depth of unquestionable
+facts to cover its vast pretensions.
+
+So much ridicule has been thrown upon the pretended powers of the
+minute doses that I shall only touch upon this point for the purpose
+of conveying, by illustrations, some shadow of ideas far transcending
+the powers of the imagination to realize.  It must be remembered that
+these comparisons are not matters susceptible of dispute, being
+founded on simple arithmetical computations, level to the capacity of
+any intelligent schoolboy.  A person who once wrote a very small
+pamphlet made some show of objecting to calculations of thus kind, on
+the ground that the highest dilutions could easily be made with a few
+ounces of alcohol.  But he should have remembered that at every
+successive dilution he lays aside or throws away ninety-nine
+hundredths of the fluid on which he is operating, and that, although
+he begins with a drop, he only prepares a millionth, billionth,
+trillionth, and similar fractions of it, all of which, added
+together, would constitute but a vastly minute portion of the drop
+with which he began.  But now let us suppose we take one single drop
+of the Tincture of Camomile, and that the whole of this were to be
+carried through the common series of dilutions.
+
+A calculation nearly like the following was made by Dr. Panvini, and
+may be readily followed in its essential particulars by any one who
+chooses.
+
+For the first dilution it would take 100 drops of alcohol.
+
+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 ninth dilution, which would take ten
+billion gallons, which he computed would fill the basin of Lake
+Agnano, a body of water two miles in circumference.  The twelfth
+dilution would of course fill a million such lakes.  By the time the
+seventeenth degree of dilution should be reached, the alcohol
+required would equal in quantity the waters of ten thousand Adriatic
+seas.  Trifling errors must be expected, but they are as likely to be
+on one side as the other, and any little matter like Lake Superior or
+the Caspian would be but a drop in the bucket.
+
+Swallowers of globules, one of your little pellets, moistened in the
+mingled waves of one million lakes of alcohol, each two miles in
+circumference, with which had been blended that one drop of Tincture
+of Camomile, would be of precisely the strength recommended for that
+medicine in your favorite Jahr's Manual, against the most sudden,
+frightful, and fatal diseases!" [In the French edition of 1834, the
+proper doses of the medicines are mentioned, and Camomile is marked
+IV.  Why are the doses omitted in Hull's Translation, except in three
+instances out of the whole two hundred remedies, notwithstanding the
+promise in the preface that "some remarks upon the doses used may be
+found at the head of each medicine"?  Possibly because it makes no
+difference whether they are employed in one Homoeopathic dose or
+another; but then it is very singular that such precise directions
+were formerly given in the same work, and that Hahnemann's
+"experience" should have led him to draw the nice distinctions we
+have seen in a former part of this Lecture (p. 44).]
+
+And proceeding on the common data, I have just made a calculation
+which shows that this single drop of Tincture of Camomile, given in
+the quantity ordered by Jahr's Manual, would have supplied every
+individual of the whole human family, past and present, with more
+than five billion doses each, the action of each dose lasting about
+four days.
+
+Yet this is given only at the quadrillionth, or fourth degree of
+potency, and various substances are frequently administered at the
+decillionth or tenth degree, and occasionally at still higher
+attenuations with professed medicinal results.  Is there not in this
+as great an exception to all the hitherto received laws of nature as
+in the miracle of the loaves and fishes?  Ask this question of a
+Homoeopathist, and he will answer by referring to the effects
+produced by a very minute portion of vaccine matter, or the
+extraordinary diffusion of odors.  But the vaccine matter is one of
+those substances called morbid poisons, of which it is a peculiar
+character to multiply themselves, when introduced into the system, as
+a seed does in the soil.  Therefore the hundredth part of a grain of
+the vaccine matter, if no more than this is employed, soon increases
+in quantity, until, in the course of about a week, it is a grain or
+more, and can be removed in considerable drops.  And what is a very
+curious illustration of Homoeopathy, it does not produce its most.
+characteristic effects until it is already in sufficient quantity not
+merely to be visible, but to be collected for further use.  The
+thoughtlessness which can allow an inference to be extended from a
+product of disease possessing this susceptibility of multiplication
+when conveyed into the living body, to substances of inorganic
+origin, such as silex or sulphur, would be capable of arguing that a
+pebble may produce a mountain, because an acorn can become a forest.
+
+As to the analogy to be found between the alleged action of the
+infinitely attenuated doses, and the effects of some odorous
+substances which possess the extraordinary power of diffusing their
+imponderable emanations through a very wide space, however it may be
+abused in argument, and rapidly as it evaporates on examination, it
+is not like that just mentioned, wholly without meaning.  The fact of
+the vast diffusion of some odors, as that of musk or the rose, for
+instance, has long been cited as the most remarkable illustration of
+the divisibility of matter, and the nicety of the senses.  And if
+this were compared with the effects of a very minute dose of morphia
+on the whole system, or the sudden and fatal impression of a single
+drop of prussic acid, or, with what comes still nearer, the poisonous
+influence of an atmosphere impregnated with invisible malaria, we
+should find in each of these examples an evidence of the degree to
+which nature, in some few instances, concentrates powerful qualities
+in minute or subtile forms of matter.  But if a man comes to me with
+a pestle and mortar in his hand, and tells me that he will take a
+little speck of some substance which nobody ever thought to have any
+smell at all, as, for instance, a grain of chalk or of charcoal, and
+that he will, after an hour or two of rubbing and scraping, develop
+in a portion of it an odor which, if the whole grain were used, would
+be capable of pervading an apartment, a house, a village, a province,
+an empire, nay, the entire atmosphere of this broad planet upon which
+we tread; and that from each of fifty or sixty substances he can in
+this way develop a distinct and hitherto unknown odor: and if he
+tries to show that all this is rendered quite reasonable by the
+analogy of musk and roses, I shall certainly be justified in
+considering him incapable of reasoning, and beyond the reach of my
+argument.  What if, instead of this, he professes to develop new and
+wonderful medicinal powers from the same speck of chalk or charcoal,
+in such proportions as would impregnate every pond, lake, river, sea,
+and ocean of our globe, and appeals to the same analogy in favor of
+the probability of his assertion.
+
+All this may be true, notwithstanding these considerations.  But so
+extraordinary would be the fact, that a single atom of substances
+which a child might swallow without harm by the teaspoonful could, by
+an easy mechanical process, be made to develop such inconceivable
+powers, that nothing but the strictest agreement of the most cautious
+experimenters, secured by every guaranty that they were honest and
+faithful, appealing to repeated experiments in public, with every
+precaution to guard against error, and with the most plain and
+peremptory results, should induce us to lend any credence to such
+pretensions.
+
+The third doctrine, that Psora, the other name of which you remember,
+is the cause of the great majority of chronic diseases, is a
+startling one, to say the least.  That an affection always recognized
+as a very unpleasant personal companion, but generally regarded as a
+mere temporary incommodity, readily yielding to treatment in those
+unfortunate enough to suffer from it, and hardly known among the
+better classes of society, should be all at once found out by a
+German physician to be the great scourge of mankind, the cause of
+their severest bodily and mental calamities, cancer and consumption,
+idiocy and madness, must excite our unqualified surprise.  And when
+the originator of this singular truth ascribes, as in the page now
+open before me, the declining health of a disgraced courtier, the
+chronic malady of a bereaved mother, even the melancholy of the love-
+sick and slighted maiden, to nothing more nor less than the
+insignificant, unseemly, and almost unmentionable ITCH, does it not
+seem as if the very soil upon which we stand were dissolving into
+chaos, over the earthquake-heaving of discovery?
+
+And when one man claims to have established these three independent
+truths, which are about as remote from each other as the discovery of
+the law of gravitation, the invention of printing, and that of the
+mariner's compass, unless the facts in their favor are overwhelming
+and unanimous, the question naturally arises, Is not this man
+deceiving himself, or trying to deceive others?
+
+I proceed to examine the proofs of the leading ideas of Hahnemann and
+his school.
+
+
+In order to show the axiom, similia similibus curantur (or like is
+cured by like), to be the basis of the healing art,--"the sole law of
+nature in therapeutics,"--it is necessary,
+
+1.  That the symptoms produced by drugs in healthy persons should be
+faithfully studied and recorded.
+
+2.  That drugs should be shown to be always capable of curing those
+diseases most like their own symptoms.
+
+3.  That remedies should be shown not to cure diseases when they do
+not produce symptoms resembling those presented in these diseases.
+
+
+1.  The effects of drugs upon healthy persons have 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
+experimentation appears to have been, to take the substance on trial,
+either in common or minute doses, and then to set down every little
+sensation, every little movement of mind or body, which occurred
+within many succeeding hours or days, as being produced solely by the
+substance employed.  When I have enumerated some of the symptoms
+attributed to the power of the drugs taken, you will be able to judge
+how much value is to be ascribed to the assertions of such observers.
+
+The following list was taken literally from the Materia Medica of
+Hahnemann, by my friend M.  Vernois, for whose 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 of the
+work.  I shall be very brief in my citations.
+
+"After stooping some time, sense of painful weight about the head
+upon resuming the erect posture."
+
+"An itching, tickling sensation at the outer edge of the palm of the
+left hand, which obliges the person to scratch."  The medicine was
+acetate of lime, and as the action of the globule taken is said to
+last twenty-eight days, you may judge how many such symptoms as the
+last might be supposed to happen.
+
+Among the symptoms attributed to muriatic acid are these: a catarrh,
+sighing, pimples; "after having written a long time with the back a
+little bent over, violent pain in the back and shoulder-blades, as if
+from a strain,"--"dreams which are not remembered,--disposition to
+mental dejection,--wakefulness before and after midnight."
+
+I might extend this catalogue almost indefinitely.  I have not cited
+these specimens with any view to exciting a sense of the ridiculous,
+which many others of those mentioned would not fail to do, but to
+show that the common accidents of sensation, the little bodily
+inconveniences to which all of us are subject, are seriously and
+systematically ascribed to whatever medicine may have been exhibited,
+even in the minute doses 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 hereafter illustrate, to be
+produced by the substance in question.
+
+The effects of sixty-four medicinal substances, ascertained by one or
+both of these methods, are enumerated in the Materia Medica of
+Hahnemann, which may be considered as the basis of practical
+Homoeopathy.  In the Manual of Jahr, which is the common guide, so
+far as I know, of those who practise Homoeopathy in these regions,
+two hundred remedies are enumerated, many of which, however, have
+never been employed in practice.  In at least one edition there were
+no means of distinguishing those which had been tried upon the sick
+from the others.  It is true that marks have been added in the
+edition employed here, which serve to distinguish them; but what are
+we to think of a standard practical author on Materia Medica, who at
+one time omits to designate the proper doses of his remedies, and at
+another to let us have any means of knowing whether a remedy has ever
+been tried or not, while he is recommending its employment in the
+most critical and threatening diseases?
+
+I think that, from what I have shown of the character of Hahnemann's
+experiments, it would be a satisfaction to any candid inquirer to
+know whether other persons, to whose assertions he could look with
+confidence, confirm these pretended facts.  Now there are many
+individuals, long and well known to the scientific world, who have
+tried these experiments upon healthy subjects, and utterly deny that
+their effects have at 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 experiments in his hospital as to
+the result of his own trials.  This distinguished physician is
+Professor of Medicine in the School of Paris, and one of the most
+widely known and valued authors upon practical and theoretical
+subjects the profession can claim in any country.  He is a man of
+great kindness of character, a most liberal eclectic by nature and
+habit, of unquestioned integrity, and is called, in the leading
+article of the first number of the "Homoepathic 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
+extolled remedies.  His experiments lasted a year, and he stated
+publicly to the Academy of Medicine that they never produced the
+slightest appearance of the symptoms attributed to them.  The results
+of a man like this, so extensively known as one of the most
+philosophical and candid, as well as brilliant of instructors, and
+whose admirable abilities and signal liberality are generally
+conceded, ought to be of great weight in deciding the question.
+
+M. Double, a well-known medical writer and a physician of high
+standing in Paris, had occasion so long ago as 1801, before he had
+heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian
+bark.  He and several others took the drug in every kind of dose for
+four months, and the fever it is pretended by Hahnemann to excite
+never was produced.
+
+M. Bonnet, President of the Royal Society of Medicine of Bordeaux,
+had occasion to observe many soldiers during the Peninsular War, who
+made use of Cinchona as a preservative against different diseases,
+but he never 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 of the Homoeopathic substances, which
+were given to healthy persons with every precaution as to diet and
+regimen, by M. Louis Fleury, without being followed by the slightest
+of the pretended consequences.  And let me mention as a curious fact,
+that the same quantity of arsenic given to one animal in the common
+form of the unprepared powder, and to another after having been
+rubbed up into six hundred globules, offered no particular difference
+of activity in the two cases.
+
+This is a strange contradiction to the doctrine of the development of
+what they call dynamic power, by means of friction and subdivision.
+
+In 1835 a public challenge was offered to the best known Homoeopathic
+physician in Paris to select any ten substances asserted to produce
+the most striking effects; to prepare them himself; to choose one by
+lot without knowing which of them he had taken, and try it upon
+himself or any intelligent and devoted Homoeopatbist, and, waiting
+his own time, to come forward and tell what substance had been
+employed.  The challenge was at first accepted, but the acceptance
+retracted before the time of trial arrived.
+
+>From all this I think it fair to conclude that the catalogues of
+symptoms attributed in Homoeopathic works to the influence of various
+drugs upon healthy persons are not entitled to any confidence.
+
+
+2.  It is necessary to show, in the next place, that medicinal
+substances are always capable of curing diseases most like their own
+symptoms.  For facts relating to this question we must look to two
+sources; the recorded experience of the medical profession in
+general, and the results of trials made according to Homoeopathic
+principles, and capable of testing the truth of the doctrine.
+
+No person, that I am aware of, has ever denied that in some cases
+there exists a resemblance between the effects of a remedy and the
+symptoms of diseases in which 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 true of only a very
+small proportion of useful remedies.  Nor has it ever been considered
+as an established truth that the efficacy of even these few remedies
+was in any definite ratio to their power of producing symptoms more
+or less like those they cured.
+
+Such was the state of opinion when Hahnemann came forward with the
+proposition that all the cases of successful treatment found in the
+works of all preceding medical writers were to be ascribed solely to
+the operation of the Homoeopathic principle, which had effected the
+cure, although without the physician's knowledge that this was the
+real secret.  And strange as it may seem, he was enabled to give such
+a degree of plausibility to this assertion, that any person not
+acquainted somewhat with medical literature, not quite familiar, I
+should rather say, with the relative value of medical evidence,
+according to the sources whence it is derived, would be almost
+frightened into the belief, at seeing the pages upon pages of Latin
+names he has summoned as his witnesses.
+
+It has hitherto been customary, when examining the writings of
+authors of preceding ages, upon subjects as to which they were less
+enlightened than ourselves, and which they were very liable to
+misrepresent, to exercise some little discretion; to discriminate, in
+some measure, between writers deserving confidence and those not
+entitled to it.  But there is not the least appearance of any such
+delicacy on the part of Hahnemann.  A large majority of the names of
+old authors he cites are wholly unknown to science.  With some of
+them I have been long acquainted, and I know that their accounts of
+diseases are no more to be trusted than their contemporary Ambroise
+Pare's stories of mermen, and similar absurdities.  But if my
+judgment is rejected, as being a prejudiced one, I can refer to
+Cullen, who mentioned three of Hahnemann's authors in one sentence,
+as being "not necessarily bad authorities; but certainly such when
+they delivered very improbable events;" and as this was said more
+than half a century ago, it could not have had any reference to
+Hahnemann.  But although not the slightest sign of discrimination is
+visible in his quotations,--although for him a handful of chaff from
+Schenck is all the same thing as a measure of wheat from Morgagni,--
+there is a formidable display of authorities, and an abundant proof
+of ingenious researches to be found in each of the great works of
+Hahnemann with which I am familiar."[Some painful surmises might
+arise as to the erudition of Hahnemann's English Translator, who
+makes two individuals of "Zacutus, Lucitanus," as well as respecting
+that of the conductors of an American Homoeopathic periodical, who
+suffer the name of the world-renowned Cardanus to be spelt Cardamus
+in at least three places, were not this gross ignorance of course
+attributable only to the printer.]
+
+It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
+proved many of Hahnemann's quotations from old authors to be
+adulterate and false.  What particular instances he has pointed out I
+have no means of learning.  And it is probably wholly impossible on
+this side of the Atlantic, and even in most of the public libraries
+of Europe, to find anything more than a small fraction of the
+innumerable obscure publications which the neglect of grocers and
+trunkmakers has spared to be ransacked by the all-devouring genius of
+Homoeopathy.  I have endeavored to verify such passages as my own
+library afforded me the means of doing.  For some I have looked in
+vain, for want, as I am willing to believe, of more exact references.
+But this I am able to affirm, that, out of the very small number
+which I have been able, to trace back to their original authors, I
+have found two to be wrongly quoted, one of them being a gross
+misrepresentation.
+
+The first is from the ancient Roman author, Caelius Aurelianus; the
+second from the venerable folio of Forestus.  Hahnemann uses the
+following expressions,--if he is not misrepresented in the English
+Translation of the "Organon ": "Asclepiades on one occasion cured an
+inflammation of the brain by 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 treatment employed by Asclepiades, into both of
+which the use of wine entered, as being in the highest degree
+irrational 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 says that Forestus
+observed violent colic caused by its administration.  But, as the
+author tells the story, a young man took, by the counsel of a
+surgeon, an acrid and virulent medicine, the name of which is not
+given, which brought on a most cruel fit of the gripes and colic.
+After this another surgeon was called, who gave him oil of anise-seed
+and wine, which increased his suffering." [Observ. et Curat.  Med.
+lib.  XXZ obs.  xiii.  Frankfort, 1614.]  Now if this was the
+Homoeopathic remedy, as Hahnemann pretends, it might be a fair
+question why the young man was not cured by it.  But it is a much
+graver question why a man who has shrewdness and learning enough to
+go so far after his facts, should think it right to treat them with
+such astonishing negligence or such artful unfairness.
+
+Even if every word he had pretended to take from his old authorities
+were to be found in them, even if the authority of every one of these
+authors were beyond question, the looseness with which they are used
+to prove whatever Hahnemann chooses is beyond the bounds of
+credibility.  Let me give one instance to illustrate the character of
+this man's mind.  Hahnemann asserts, in a note annexed to the 110th
+paragraph of the "Organon," that the smell of the rose will cause
+certain persons to faint.  And he says in the text that substances
+which produce peculiar effects of this nature on particular
+constitutions cure the same symptoms in people in general.  Then in
+another note to the same paragraph he quotes the following fact from
+one of the last sources one would have looked to for medical
+information, the Byzantine Historians.
+
+"It was by these means" (i.e. Homoeopathically) that the Princess
+Eudosia with rose-water restored a person who had fainted!"
+
+Is it possible that a man who is guilty of such pedantic folly as
+this,--a man who can see a confirmation of his doctrine in such a
+recovery as this,--a recovery which is happening every day, from a
+breath of 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 a man, of whose pages, not here and
+there one, but hundreds upon hundreds are loaded with such
+trivialities, is the Newton, the Columbus, the Harvey of the
+nineteenth century!
+
+The whole process of demonstration he employs is this.  An experiment
+is instituted with some drug upon one or more healthy persons.
+Everything that happens for a number of days or weeks is, as we have
+seen, set down as an effect of the medicine.  Old volumes are then
+ransacked promiscuously, and every morbid sensation or change that
+anybody ever said was produced by the drug in question is added to
+the list of symptoms.  By one or both of these methods, each of the
+sixty-four substances enumerated by Hahnemann is shown to produce a
+very large number of symptoms, the lowest in his scale being ninety-
+seven, and the highest fourteen hundred and ninety-one.  And having
+made out this list respecting any drug, a catalogue which, as you may
+observe in any Homoeopathic manual, contains various symptoms
+belonging to every organ of the body, what can be easier than to find
+alleged cures in every medical author which can at once be attributed
+to the Homoeopathic principle; still more if the grave of
+extinguished credulity is called upon to give up its dead bones as
+living witnesses; and worst of all, if the monuments of the past are
+to be mutilated in favor of "the sole law of Nature in therapeutics"?
+
+There are a few familiar facts of which great use has been made as an
+entering wedge for the Homoeopathic doctrine.  They have been
+suffered to pass current so long that it is time they should be
+nailed to the counter, a little operation which I undertake, with
+perfect cheerfulness, to perform for them.
+
+The first is a supposed illustration of the Homoeopathic law found in
+the precept given for the treatment of parts which have been frozen,
+by friction with snow or similar means.  But we deceive ourselves by
+names, if we suppose the frozen part to be treated by cold, and not
+by heat.  The snow may even be actually 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 to a frozen
+part, except as a mode of regulating the application of what? of
+heat.  But the heat must be applied gradually, just as food must be
+given a little at a time to those perishing with hunger.  If the
+patient were brought into a warm room, heat would be applied very
+rapidly, were not something interposed to prevent this, and allow its
+gradual admission.  Snow or iced water is exactly what is wanted; it
+is not cold to the part; it is very possibly warm, on the contrary,
+for these terms are relative, and if it does not melt and let the
+heat in, or is not taken away, the part will remain frozen up until
+doomsday.  Now the treatment of a frozen limb by heat, in large or
+small quantities, is not Homoeopathy.
+
+The next supposed illustration of the Homoeopathic law is the alleged
+successful management of burns, by holding them to the fire.  This is
+a popular mode of treating those burns which are of too little
+consequence to require any more efficacious remedy, and would
+inevitably get well of themselves, without any trouble being bestowed
+upon them.  It produces a most acute pain in the part, which is
+followed by some loss of sensibility, as happens with the eye after
+exposure to strong light, and the ear after being subjected to very
+intense sounds.  This is all it is capable of doing, and all further
+notions of its efficacy must be attributed merely to the vulgar love
+of paradox.  If this example affords any comfort to the
+Homoeopathist, it seems as cruel to deprive him of it as it would be
+to convince the mistress of the smoke-jack or the flatiron that the
+fire does not literally "draw the fire out," which is her hypothesis.
+
+But if it were true that frost-bites were cured by cold and burns by
+heat, it would be subversive, so far as it went, of the great
+principle of Homoeopathy.
+
+For you will remember that this principle is that Like cures Like,
+and not that Same cures Same; that there is resemblance and not
+identity between the symptoms of the disease and those produced by
+the drug which cures it, and none have been readier to insist upon
+this distinction than the Homoeopathists themselves.  For if Same
+cures Same, then every poison must be its own antidote,--which is
+neither a part of their theory nor their so-called experience.  They
+have been asked often enough, why it was that arsenic could not cure
+the mischief which arsenic had caused, and why the infectious cause
+of small-pox did not remedy the disease it had produced, and then
+the; were ready enough to see the distinction I have pointed out.  O
+no!  it was not the hair of the same dog, but only of one very much
+like him!
+
+A third instance in proof of the Homoeopathic law is sought for in
+the acknowledged efficacy of vaccination.  And how does the law apply
+to this?  It is granted by the advocates of Homoeopathy that there is
+a resemblance between the effects of the vaccine virus on a person in
+health and the symptoms of small-pox.  Therefore, according to the
+rule, the vaccine virus will cure the small-pox, which, as everybody
+knows, is entirely untrue.  But it prevents small-pox, say the
+Homoeopathists.  Yes, and so does small-pox prevent itself from ever
+happening again, and we know just as much of the principle involved
+in the one case as in the other.  For this is only one of a series of
+facts which we are wholly unable to explain.  Small-pox, measles,
+scarlet-fever, hooping-cough, protect those who have them once from
+future attacks; but nettle-rash and catarrh and lung fever, each of
+which is just as Homoeopathic to itself as any one of the others,
+have no such preservative power.  We are obliged to accept the fact,
+unexplained, and we can do no more for vaccination than for the rest.
+
+
+I come now to the most directly practical point connected with the
+subject, namely,--
+
+What is the state of the evidence as to the efficacy of the proper
+Homoeopathic treatment in the cure of diseases.
+
+As the treatment adopted by the Homoeopathists has been almost
+universally by means of the infinitesimal doses, the question of
+their efficacy is thrown open, in common with that of the truth of
+their fundamental axiom, as both are tested in practice.
+
+We must look for facts as to the actual working of Homoeopathy to
+three sources.
+
+1.  The statements of the unprofessional public.
+
+2.  The assertions of Homoeopathic practitioners.
+
+3.  The results of trials by competent and honest physicians, not
+pledged to the system.
+
+I think, after what we have seen of medical facts, as they are
+represented by incompetent persons, we are disposed to attribute
+little value to all statements of wonderful cures, coming from those
+who have never been accustomed to watch the caprices of disease, and
+have not cooled down their young enthusiasm by the habit of tranquil
+observation.  Those who know nothing of the natural progress of a
+malady, of its ordinary duration, of its various modes of
+terminating, of its liability to accidental complications, of the
+signs which mark its insignificance or severity, of what is to be
+expected of it when left to itself, of how much or how little is to
+be anticipated from remedies, those who know nothing or next to
+nothing of all these things, and who are in a great state of
+excitement from benevolence, sympathy, or zeal for a new medical
+discovery, can hardly be expected to be sound judges of facts which
+have misled so many sagacious men, who have spent their lives in the
+daily study and observation of them.  I believe that, after having
+drawn the portrait of defunct Perkinism, with its five thousand
+printed cures, and its million and a half computed ones, its miracles
+blazoned about through America, Denmark, and England; after relating
+that forty years ago women carried the Tractors about in their
+pockets, and workmen could not make them fast enough 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 lucky
+accident, so utterly lost is the memory of all their wonderful
+achievements; I believe, after all this, I need not waste time in
+showing that medical accuracy is not to be looked for in the florid
+reports of benevolent associations, the assertions of illustrious
+patrons, the lax effusions of daily journals, or the effervescent
+gossip of the tea-table.
+
+Dr. Hering, whose name is somewhat familiar to the champions of
+Homoeopathy, has said that "the new healing art is not to be judged
+by its success in isolated cases only, but according to its success
+in general, its innate truth, and the incontrovertible nature of its
+innate principles."
+
+We have seen something of "the incontrovertible nature of its innate
+principles," and it seems probable, on the whole, that its success in
+general must be made up of its success in isolated cases.  Some
+attempts have been made, however, to finish the whole matter by
+sweeping statistical documents, which are intended to prove its
+triumphant success over the common practice.
+
+It is well known to those who have had the good fortune to see the
+"Homoeopathic Examiner," that this journal led off, in its first
+number, with a grand display of everything the newly imported
+doctrine had to show for itself.  It is well remarked, on the twenty-
+third page of this article, that "the comparison of bills of
+mortality among an equal number of sick, treated by divers methods,
+is a most poor and lame way to get at conclusions touching principles
+of the healing art."  In confirmation of which, the author proceeds
+upon the twenty-fifth page to prove the superiority of the
+Homoeopathic treatment of cholera, by precisely these very bills of
+mortality.  Now, every intelligent physician is aware that the poison
+of cholera differed so much in its activity at different times and,
+places, that it was next to impossible to form any opinion as to the
+results of treatment, unless every precaution was taken to secure the
+most perfectly corresponding conditions in the patients treated, and
+hardly even then.  Of course, then, a Russian Admiral, by the name of
+Mordvinov, backed by a number of so-called physicians practising in
+Russian villages, is singularly competent to the task of settling the
+whole question of the utility of this or that kind of treatment; to
+prove that, if not more than eight and a half per cent. of those
+attacked with the disease perished, the rest owed their immunity to
+Hahnemann.  I can remember when more than a hundred patients in a
+public institution were attacked with what, I doubt not, many
+Homoeopathic physicians (to say nothing of Homoeopathic admirals)
+would have called cholera, and not one of them died, though treated
+in the common way, and it is my firm belief that, if such a result
+had followed the administration of the omnipotent globules, it would
+have been in the mouth of every adept in Europe, from Quin of London
+to Spohr of Gandersheim.  No longer ago than yesterday, in one of the
+most widely circulated papers of this city, there was published an
+assertion that the mortality in several Homoeopathic Hospitals was
+not quite five in a hundred, whereas, in what are called by the
+writer Allopathic Hospitals, it is said to be eleven in a hundred.
+An honest man should be ashamed of such an argumentum ad ignorantiam.
+The mortality of a hospital depends not merely on the treatment of
+the patients, but on the class of diseases it is in the habit of
+receiving, on the place where it is, on the season, and many other
+circumstances.  For instance, there are many hospitals in the great
+cities of Europe that receive few diseases of a nature to endanger
+life, and, on the other hand, there are others where dangerous
+diseases are accumulated out of the common proportion.  Thus, in the
+wards of Louis, at the Hospital of La Pitie, a vast number of
+patients in the last stages of consumption were constantly entering,
+to swell the mortality of that hospital.  It was because he was known
+to pay particular attention to the diseases of the chest that
+patients laboring under those fatal affections to an incurable extent
+were so constantly coming in upon him.  It is always a miserable
+appeal to the thoughtlessness of the vulgar, to allege the naked fact
+of the less comparative mortality in the practice of one hospital or
+of one physician than another, as an evidence of the superiority of
+their treatment.  Other things being equal, it must always be
+expected that those institutions and individuals enjoying to the
+highest degree the confidence of the community will lose the largest
+proportion of their patients; for the simple reason that they will
+naturally be looked to by those suffering from the gravest class of
+diseases; that many, who know that they are affected with mortal
+disease, will choose to die under their care or shelter, while the
+subjects of trifling maladies, and merely troublesome symptoms, amuse
+themselves to any extent among the fancy practitioners.  When,
+therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner,"
+and quoted in yesterday's "Daily Advertiser," asserts that the
+mortality among his patients is only one per cent. since he has
+practised Homoeopathy, whereas it was six per cent. when he employed
+the common mode of practice, I am convinced by this, his own
+statement, that the citizens of Brunswick, whenever they are
+seriously 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 detailed examination of the very numerous
+cases reported in the Homoeopathic Treatises and Journals.  Having
+been in the habit of receiving the French "Archives of Homoeopathic
+Medicine" until the premature decease of that Journal, I have had the
+opportunity of becoming acquainted somewhat with the style of these
+documents, and experiencing whatever degree of conviction they were
+calculated to produce.  Although of course I do not wish any value to
+be assumed for my opinion, such as it is, I consider that you are
+entitled to hear it.  So far, then, as I am acquainted with the
+general character of the cases reported by the Homoeopathic
+physicians, they would for the most part be considered as wholly
+undeserving a place in any English, French, or American periodical of
+high standing, if, instead of favoring the doctrine they were
+intended to support, they were brought forward to prove the efficacy
+of any common remedy administered by any common practitioner.  There
+are occasional exceptions to this remark; but the general truth of it
+is rendered probable by the fact that these cases are always, or
+almost always, written with the single object of showing the efficacy
+of the medicine used, or the skill of the practitioner, and it is
+recognized as a general rule that such cases deserve very little
+confidence.  Yet they may sound well enough, one at a time, to those
+who are not fully aware of the fallacies of medical evidence.  Let me
+state a case in illustration.  Nobody doubts that some patients
+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 as a physician is called to in daily practice, would
+recover, sooner or later, with more or less difficulty, provided
+nothing were done to interfere seriously with the efforts of nature.
+
+Suppose, then, a physician who has a hundred patients prescribes to
+each of them pills made of some entirely inert substance, as starch,
+for instance.  Ninety of them get well, or if he chooses to use such
+language, he cures ninety of them.  It is evident, according to the
+doctrine of chances, that there must be a considerable number of
+coincidences between the relief of the patient and the administration
+of the remedy.  It is altogether probable that there will happen two
+or three very striking coincidences out of the whole ninety cases, in
+which it would seem evident that the medicine produced the relief,
+though it had, as we assumed, nothing to do with it.  Now suppose
+that the physician publishes these cases, will they not have a
+plausible appearance of proving that which, as we granted at the
+outset, was entirely false?  Suppose that instead of pills of starch
+he employs microscopic sugarplums, with the five' million billion
+trillionth part of a suspicion of aconite or pulsatilla, and then
+publishes his successful cases, through the leaden lips of the press,
+or the living ones of his female acquaintances,--does that make the
+impression a less erroneous one?  But so it is that in Homoeopathic
+works and journals and gossip one can never, or next to never, find
+anything but successful cases, which might do very well as a proof of
+superior skill, did it not prove as much for the swindling
+advertisers whose certificates disgrace so many of our newspapers.
+How long will it take mankind to learn that while they listen to "the
+speaking hundreds and units, who make the world ring "with the
+pretended triumphs they have witnessed, the "dumb millions" of
+deluded and injured victims are paying the daily forfeit of their
+misplaced confidence!
+
+I am sorry to see, also, that a degree of ignorance as to the natural
+course of diseases is often shown in these published cases, which,
+although it may not be detected by the unprofessional reader, conveys
+an unpleasant impression to those who are acquainted with the
+subject.  Thus a young woman affected with jaundice is mentioned in
+the German "Annals of Clinical Homoeopathy" as having been cured in
+twenty-nine days by pulsatilla and nux vomica.  Rummel, a well-known
+writer of the same school, speaks of curing a case of jaundice in
+thirty-four days by Homoeopathic doses of pulsatilla, aconite, and
+cinchona.  I happened to have a case in my own household, a few weeks
+since, which lasted about ten days, and this was longer than I have
+repeatedly seen it in hospital practice, so that it was nothing to
+boast of.
+
+Dr. Munneche of Lichtenburg in Saxony is called to a patient with
+sprained ankle who had been a fortnight under the common treatment.
+The patient gets well by the use of arnica in a little more than a
+month longer, and this extraordinary fact is published in the French
+"Archives of Homoeopathic Medicine."
+
+In the same Journal is recorded the case of a patient who with
+nothing more, so far as any proof goes, than inluenza, gets down to
+her shop upon the sixth day.
+
+And again, the cool way in which everything favorable in a case is
+set down by these people entirely to their treatment, may be seen in
+a case of croup reported in the "Homoeopathic 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 of some Homoeopathic fluid.
+
+I need not multiply these quotations, which illustrate the grounds of
+an opinion which the time does not allow me to justify more at
+length; other such cases are lying open before me; there is no end to
+them if more were wanted; for nothing is necessary but to look into
+any of the numerous broken-down Journals of Homoeopathy, the volumes
+of which may be found on the shelves of those curious in such
+matters.
+
+A number of public trials of Homoeopathy have been made in different
+parts of the world.  Six of these are mentioned in the Manifesto of
+the "Homoeopathic Examiner."  Now to suppose that any trial can
+absolutely silence people, would be to forget the whole experience of
+the past.  Dr. Haygarth and Dr. Alderson could not stop the sale of
+the five-guinea Tractors, although they proved that they could work
+the same miracles with pieces of wood and tobacco-pipe.  It takes
+time for truth to operate as well as Homoeopathic globules.  Many
+persons thought the results of these trials were decisive enough of
+the nullity of the treatment; those who wish to see the kind of
+special pleading and evasion by which it is attempted to cover
+results which, stated by the "Homoeopathic 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 trials at all, having abundant other evidence on the point.
+But I think it best, on the whole, to mention two of them in a few
+words,--that instituted at Naples and that of Andral.
+
+There have been few names in the medical profession, for the last
+half century, so widely known throughout the world of science as that
+of M. Esquirol, whose life was devoted to the treatment of insanity,
+and who was without a rival in that department of practical medicine.
+It is from an analysis communicated by him to the "Gazette Medicale
+de Paris" that I derive my acquaintance with the account of the trial
+at Naples by Dr. Panvini, physician to the Hospital della Pace.  This
+account seems to be entirely deserving of credit.  Ten patients were
+set apart, and not allowed to take any medicine at all,--much against
+the wish of the Homoeopathic physician.  All of them got well, and of
+course all of them would have been claimed as triumphs if they had
+been submitted to the treatment.  Six other slight cases (each of
+which is specified) got well under the Homoeopathic treatment, none
+of its asserted specific effects being manifested.
+
+All the rest were cases of grave disease; and so far as the trial,
+which was interrupted about the fortieth day, extended, the patients
+grew worse, or received no benefit.  A case is reported on the page
+before me of a soldier affected with acute inflammation in the chest,
+who took successively aconite, bryonia, nux vomica, and pulsatilla,
+and after thirty-eight days of treatment remained without any
+important change in his disease.  The Homoeopathic physician who
+treated these patients was M. de Horatiis, who had the previous year
+been announcing his wonderful cures.  And M. Esquirol asserted to the
+Academy of Medicine in 1835, that this M. de Horatiis, who is one of
+the prominent personages in the "Examiner's" Manifesto published in
+1840, had subsequently renounced Homoeopathy.  I may remark, by the
+way, that this same periodical, which is so very easy in explaining
+away the results of these trials, makes a mistake of only six years
+or a little more as to the time when this at Naples was instituted.
+
+M. Andral, the "eminent and very enlightened allopathist " of the
+"Homoeopathic Examiner," made the following statement in March, 1835,
+to the Academy of Medicine: "I have submitted this doctrine to
+experiment; I can reckon at this time from one hundred and thirty to
+one hundred and forty cases, recorded with perfect fairness, in a
+great hospital, under the eye of numerous witnesses; to avoid every
+objection--I obtained my remedies of M.  Guibourt, who keeps a
+Homoeopathic pharmacy, and whose strict exactness is well known; the
+regimen has been scrupulously observed, and I obtained from the
+sisters attached to the hospital a special regimen, such as Hahnemann
+orders.  I was told, however, some months since, that I had not been
+faithful to all the rules of the doctrine.  I therefore took the
+trouble to begin again; I have studied the practice of the Parisian
+Homoeopathists, as I had studied their books, and I became convinced
+that they treated their patients as I had treated mine, and I affirm
+that I have been as rigorously exact in the treatment as any other
+person."
+
+And he expressly asserts the entire nullity of the influence of all
+the Homoeopathic remedies tried by him in modifying, so far as he
+could observe, the progress or termination of diseases.  It deserves
+notice that he experimented with the most boasted substances,--
+cinchona, aconite, mercury, bryonia, belladonna.  Aconite, for
+instance, he says he administered in more than forty cases of that
+collection of feverish symptoms in which it exerts so much power,
+according to Hahnemann, and in not one of them did it have the
+slightest influence, the pulse and heat remaining as before.
+
+These statements look pretty honest, and would seem hard to be
+explained away, but it is calmly said that he "did not know enough of
+the method to select the remedies with any tolerable precision."
+["Homoeopathic Examiner, vol.  i.  p.  22.
+"Nothing is left to the caprice of the physician.  (In a word,
+instead of being dependent upon blind chance, that there is an
+infallible law, guided by which; the physician MUST select the proper
+remedies.') "Ibid., in a notice of Menzel's paper.]  Who are they
+that practice Homoeopathy, and say this of a man with the Materia
+Medica of Hahnemann lying before him?  Who are they that send these
+same globules, on which he experimented, accompanied by a little
+book, into families, whose members are thought competent to employ
+them, when they deny any such capacity to a man whose life has been
+passed at the bedside of patients, the most prominent teacher in the
+first Medical Faculty in the world, the consulting physician of the
+King of France, and one of the most renowned practical writers, not
+merely of his nation, but of his age?  I leave the quibbles by which
+such persons would try to creep out from under the crushing weight of
+these conclusions to the unfortunates who suppose that a reply is
+equivalent to an answer.
+
+Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
+invited two Homoeopathic practitioners to experiment in his wards.
+One of these was Curie, now of London, whose works are on the
+counters of some of our bookstores, and probably in the hands of some
+of my audience.  This gentleman, whom Dr. Baillie declares to be an
+enlightened man, and perfectly sincere in his convictions, brought
+his own medicines from the pharmacy which furnished Hahnemann
+himself, and employed them for four or five months upon patients in
+his ward, and with results equally unsatisfactory, as appears from
+Dr. Baillie's statement at a meeting of the Academy of Medicine.  And
+a similar experiment was permitted by the Clinical Professor of the
+Hotel Dieu of Lyons, with the same complete failure.
+
+But these are old and prejudiced practitioners.  Very well, then take
+the statement of Dr. Fleury, a most intelligent young physician, who
+treated homoeopathically more than fifty patients, suffering from
+diseases which it was not dangerous to treat in this way, taking
+every kind of precaution as to regimen, removal of disturbing
+influences, and the state of the atmosphere, insisted upon by the
+most vigorous partisans of the doctrine, and found not the slightest
+effect produced by the medicines.  And more than this, read nine of
+these cases, 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 are pretended to exert such palpable, such
+obvious, such astonishing influences.  In the view of these
+statements, it is impossible not to realize the entire futility of
+attempting to silence this asserted science by the flattest and most
+peremptory results of experiment.  Were all the hospital physicians
+of Europe and America to devote themselves, for the requisite period,
+to this sole pursuit, and were their results to be unanimous as to
+the total worthlessness of the whole system in practice, this
+slippery delusion would slide through their fingers without the
+slightest discomposure, when, as they supposed, they had crushed
+every joint in its tortuous and trailing body.
+
+
+3.  I have said, that to show the truth of the Homoeopathic doctrine,
+as announced by Hahnemann, it would be necessary to show, in the
+third place, that remedies never cure diseases when they are not
+capable of producing similar symptoms!  The burden of this somewhat
+comprehensive demonstration lying entirely upon the advocates of this
+doctrine, it may be left to their mature reflections.
+
+
+It entered into my original plan to treat of the doctrine relating to
+Psora, or itch,--an almost insane conception, which I am glad to get
+rid of, for this is a subject one does not care to handle without
+gloves.  I am saved this trouble, however, by finding that many of
+the disciples of Hahnemann, those disciples the very gospel of whose
+faith stands upon his word, make very light of his authority on this
+point, although he himself says, "It has cost me twelve years of
+study and research to trace out the source of this incredible number
+of chronic affections, to discover this great truth, which remained
+concealed from all my predecessors and contemporaries, to establish
+the basis of its demonstration, and find out, at the same time, the
+curative medicines that were fit to combat this hydra in all its
+different forms."
+
+But, in the face of all this, the following remarks are made by
+Wolff, of Dresden, whose essays, according to the editor of the
+"Homoeopathic Examiner," "represent the opinions of a large majority
+of Homoeopathists in Europe."
+
+"It cannot be unknown to any one at all familiar with Homoeopathic
+literature, that Hahnemann's idea of tracing the large majority of
+chronic diseases to actual itch has met with the greatest opposition
+from Homoeopathic physicians themselves."  And again, "If the Psoric
+theory has led to no proper schism, the reason is to be found in the
+fact that it is almost without any influence in practice."
+
+We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke
+of Baden," and a "distinguished" Homoeopathist, actually asked
+Hahnemann for the proof that chronic diseases, such as dropsy, for
+instance, never arise from any other cause than itch; and that,
+according to common report, the venerable sage was highly incensed
+(fort courrouce) with Dr. Hartmann, of Leipsic, another
+"distinguished" Homoeopathist, for maintaining that they certainly
+did arise from other causes.
+
+And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after
+saying, in a good-natured way, that Psora is the Devil in medicine,
+and that physicians are 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 Hahnemann who may honor me with his
+presence, by not attacking a doctrine on which some of the disciples
+of his creed would be very happy to have its adversaries waste their
+time and strength.  I will not meddle with this excrescence, which,
+though often used in time of 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 heavily to my
+sickle, that I should blunt it upon straw and stubble.
+
+I will close the subject with a brief examination of some of the
+statements made in Homoeopathic works, and more particularly in the
+brilliant Manifesto of the "Examiner," before referred to.  And
+first, it is there stated under the head of "Homoeopathic
+Literature," that "SEVEN HUNDRED volumes have been issued from the
+press developing the peculiarities of the system, and many of them
+possessed of a scientific character that savans know well how to
+respect."  If my assertion were proper evidence in the case, I should
+declare, that, having seen a good many of these publications, from
+the year 1834, when I bought the work of the Rev. Thomas Everest,"
+[Dr. Curie speaks of this silly pamphlet as having been published in
+1835.] to within a few weeks, when I received my last importation of
+Homaeopathic literature, I have found that all, with a very few
+exceptions, were stitched pamphlets varying from twenty or thirty
+pages to somewhat less than a hundred, and generally resembling each
+other as much as so many spelling-books.
+
+But not being evidence in the case, I will give you the testimony of
+Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the
+same Manifesto as one of the most distinguished among the
+Homoeopathists of Europe.  I translate the sentence literally from
+the "Archives de la Medecine Homoeopathique."
+
+"The literature of Homoeopathy, if that honorable name must be
+applied to all kinds of book-making, has been degraded to the
+condition of the humblest servitude.  Productions without talent,
+without spirit, without discrimination, flat and pitiful eulogies,
+exaggerations surpassing the limits of the most robust faith,
+invectives against such as dared to doubt the dogmas which had been
+proclaimed, or catalogues of remedies; of such materials is it
+composed!  From distance to distance only, have appeared some memoirs
+useful to science or practice, which appear as so many green oases in
+the midst of this literary desert."
+
+It is a very natural as well as a curious question to ask, What has
+been the success of Homoeopathy in the different countries of Europe,
+and what is its present condition?
+
+The greatest reliance of the advocates of Homoeopathy is of course on
+Germany.  We know very little of its medical schools, its medical
+doctrines, or its medical men, compared with those of England and
+France.  And, therefore, when an intelligent traveller gives a direct
+account from personal inspection of the miserable condition of the
+Homoeopathic hospital at Leipsic, the first established in Europe,
+and the first on the list of the ever-memorable Manifesto, it is easy
+enough answer or elude the fact by citing various hard names of
+"distinguished " practitioners, which sound just as well to the
+uninformed public as if they were Meckel, or Tiedemann, or
+Langenbeck.  Dr. Leo-Wolf, who, to be sure, is opposed to
+Homoeopathy, but who is a scholar, and ought to know something of his
+own countrymen, assures us that "Dr. Kopp is the only German
+Homoeopathist, if we can call him so, who has been distinguished as
+an author and practitioner before he examined this method."  And Dr.
+Lee, the same gentleman in whose travels the paragraph relating to
+the Leipsic Hospital is to be found, says the same thing.  And I will
+cheerfully expose myself to any impertinent remark which it might
+suggest, to assure my audience that I never heard or saw one
+authentic Homoeopathic name of any country in Europe, which I had
+ever heard mentioned before as connected with medical science by a
+single word or deed sufficient to make it in any degree familiar to
+my ears, unless Arnold of Heidelberg is the anatomist who discovered
+a little nervous centre, called the otic ganglion.  But you need ask
+no better proof of who and what the German adherents of this doctrine
+must be, than the testimony of a German Homoeopathist as to the
+wretched character of the works they manufacture to enforce its
+claims.
+
+As for the act of this or that government tolerating or encouraging
+Homoeopathy, every person of common intelligence knows that it is a
+mere form granted or denied according to the general principles of
+policy adopted in different states, or the degree of influence which
+some few persons who have adopted it may happen to have at court.
+What may be the value of certain pompous titles with which many of
+the advocates of Homoeopathy are honored, it might be disrespectful
+to question.  But in the mean time the judicious inquirer may ponder
+over an extract which I translate from a paper relating to a
+personage well known to the community as Williams the Oculist, with
+whom I had the honor of crossing the Atlantic some years since, and
+who himself handed me two copies of the paper in question.
+
+"To say that he was oculist of Louis XVIII.  and of Charles X., and
+that he now enjoys the same title with respect to His Majesty, Louis
+Philippe, and the King of the Belgians, is unquestionably to say a
+great deal; and yet it is one of the least of his titles to public
+confidence.  His reputation rests upon a basis more substantial even
+than the numerous diplomas with which he is provided, than the
+membership of the different medical societies which have chosen him
+as their associate," etc., etc.
+
+And as to one more point, it is time that the public should fully
+understand that the common method of supporting barefaced imposture
+at the present day, both in Europe and in this country, consists in
+trumping up "Dispensaries," " Colleges of Health," and other
+advertising charitable clap-traps, which use the poor as decoy-ducks
+for the rich, and the proprietors of which have a strong predilection
+for the title of "Professor."  These names, therefore, have come to
+be of little or no value as evidence of the good character, still
+less of the high pretensions of those who invoke their authority.
+Nor does it follow, even when a chair is founded in connection with a
+well-known institution, that it has either a salary or an occupant;
+so that it may be, and probably is, a mere harmless piece of
+toleration on the part of the government if a Professorship of
+Homoeopathy is really in existence at Jena or Heidelberg.  And
+finally, in order to correct the error of any who might suppose that
+the whole Medical Profession of Germany has long since fallen into
+the delusions of Hahnemann, I will quote two lines which a celebrated
+anatomist and surgeon (whose name will occur again in this lecture in
+connection with a very pleasing letter) addressed to the French
+Academy of Medicine in 1835.  "I happened to be in Germany some
+months since, at a meeting of nearly six hundred physicians; one of
+them wished to bring up the question of Homoeopathy; they would not
+even listen to him."  This may have been very impolite and bigoted,
+but that is not precisely the point in reference to which I mention
+the circumstance.
+
+But if we cannot easily get at Germany, we can very easily obtain
+exact information from France and England.  I took the trouble to
+write some months ago to two friends in Paris, in whom I could place
+confidence, for information upon the subject.  One of them answered
+briefly to the effect that nothing was said about it.  When the late
+Curator of the Lowell Institute, at his request, asked about the
+works upon the subject, he was told that they had remained a long
+time on the shelves quite unsalable, and never spoken of.
+
+The other gentleman, ["Dr. Henry T.  Bigelow, now Professor of
+Surgery in Harvard University.] whose name is well known to my
+audience, and who needs no commendation of mine, had the kindness to
+procure for me many publications upon the subject, and some
+information which sets the whole matter at rest, so far as Paris is
+concerned.  He went directly to the Baillieres, the principal and
+almost the only publishers of all the Homoeopathic books and journals
+in that city.  The following facts were taken by him from the
+account-books of this publishing firm.  Four Homoeopathic Journals
+have been published in Paris; three of them by the Baillieres.
+
+The reception they met with may be judged of by showing the number of
+subscribers to each on the books of the publishing firm.
+
+A Review published by some other house, which lasted one year, and
+had about fifty subscribers, appeared in 1834, 1835.
+
+There were only four Journals of Homoeopathy ever published in Paris.
+The Baillieres informed my correspondent that the sale of
+Homoeopathic books was much less than formerly, and that consequently
+they should undertake to publish no new books upon the subject,
+except those of Jahr or Hahnemann.  "This man," says my
+correspondent,--referring to one of the brothers,--"the publisher and
+headquarters of Homoeopathy in Paris, informs me that it is going
+down in England and Germany as well as in Paris."  For all the facts
+he had stated he pledged himself as responsible.
+
+Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
+since then has been going down.
+
+Louis told my correspondent that no person of distinction in Paris
+had embraced Homoeopathy, and that it was declining.  If you ask who
+Louis is, I refer you to the well-known Homoeopathist, Peschier of
+Geneva, who says, addressing him, "I respect no one more than
+yourself; the feeling which guides your researches, your labors, and
+your pen, is so honorable and rare, that I could not but bow down
+before it; and I own, if there were any allopathist who inspired me
+with higher veneration, it would be him and not yourself whom I
+should address."
+
+Among the names of "Distinguished Homoeopathists," however, displayed
+in imposing columns, in the index of the "Homoeopathic Examiner," are
+those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the
+world of science, and the last of them identified with some of the
+most valuable contributions which anatomical knowledge has received
+since the commencement of the present century.  One Dr. Chrysaora,
+who stands sponsor for many facts in that Journal, makes the
+following statement among the rest: "Professors, who are esteemed
+among the most distinguished of the Faculty (Faculty de Medicine),
+both as to knowledge and reputation, have openly confessed the power
+of Homoeopathia in forms of disease where the ordinary method of
+practice proved totally insufficient.  It affords me the highest
+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 Homoeopathists to my correspondent:--
+
+"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
+
+"You have had the kindness to inform me in your letter that a new
+American Journal, the 'New World,'  has made use of my name in
+support of the pretended Homoeopathic doctrines, and that I am
+represented as one of the warmest partisans of Homoeopathy in France.
+
+"I am vastly surprised at the reputation manufactured for me upon the
+new continent; but I am obliged, in deference to truth, to reject it
+with my whole energy.  I spurn far from me everything which relates
+to that charlatanism called Homoeopathy, for these pretended
+doctrines cannot endure the scrutiny of wise and enlightened persons,
+who are guided by honorable sentiments in the practice of the noblest
+of arts.
+
+"PARIS, 3d November, 1841:"
+
+I am, etc., etc.,
+
+"G. BRESCHET,
+
+"Professor in the Faculty of Medicine, Member of the Institute,
+Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc.
+
+I first saw M.  Breschet's name mentioned in that Journal
+
+Concerning Amussat, my correspondent writes, that he was informed by
+Madame Hahnemann, who converses in French more readily than her
+husband, and therefore often speaks for him, that "he was not a
+physician, neither Homoeopathist nor Allopathist, but that he was the
+surgeon of their own establishment; that is, performed as a surgeon
+all the operations they had occasion for in their practice."
+
+I regret not having made any inquiries as to Marjolin, who, I doubt
+not, would strike his ponderous snuff-box until it resounded like the
+Grecian horse, at hearing such a doctrine associated with his
+respectable name.  I was not aware, when writing to Paris, that this
+worthy Professor, whose lectures I long attended, was included in
+these audacious claims; but after the specimens I have given of the
+accuracy of the foreign correspondence of the "Homoeopathic
+Examiner," any further information I might obtain would seem so
+superfluous as hardly to be worth the postage.
+
+Homoeopathy may be said, then, to be in a sufficiently miserable
+condition in Paris.  Yet there lives, and there has lived for years,
+the illustrious Samuel Hahnemann, who himself assured my
+correspondent that no 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. Curie in October,
+1839, about eight years after its introduction into the country, that
+there were eighteen Homoeopathic physicians in the United Kingdom, of
+whom only three were to be found out of London, and that many of
+these practised Homoeopathy in secret.
+
+It will be seen, therefore, that, according to the recent statement
+of one of its leading English advocates, Homoeopathy had obtained not
+quite half as many practical disciples in England as Perkinism could
+show for itself in a somewhat less period from the time of its first
+promulgation 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, Homoeopathy is commencing to make an inroad into
+England by the way of Ireland.  At Dublin, distinguished physicians
+have already embraced the new system, and a great part of the
+nobility and gentry of that city have emancipated themselves from the
+English fashion and professional authority."
+
+But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
+Homoeopathy; the Queen Dowager Adelaide has been treated by a
+Homoeopathic 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 than two Lords, and
+if the Dowager of Royalty is better than Royalty itself, all of which
+illustrious dignities were claimed in behalf of Benjamin Douglass
+Perkins?
+
+But if the balance is thought too evenly suspended in this case,
+another instance can be given in which the evidence of British
+noblemen and their ladies is shown to be as valuable in establishing
+the character of a medical man or doctrine, as would be the testimony
+of the Marquis of Waterford concerning the present condition and
+prospects of missionary enterprise.  I have before me an octavo
+volume of more than four hundred pages, in which, among much similar
+matter, I find highly commendatory letters from the Marchioness of
+Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the
+Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis
+of Sligo,--all addressed to "John St. John Long, Esq," a wretched
+charlatan, twice tried for, and once convicted of, manslaughter at
+the Old Bailey.
+
+This poor creature, too, like all of his tribe, speaks of the medical
+profession as a great confederation of bigoted monopolists.  He, too,
+says that "If an innovator should appear, holding out hope to those
+in despair, and curing disorders which the faculty have recorded as
+irremediable, he is at once, and without inquiry, denounced as an
+empiric and an impostor."  He, too, cites the inevitable names of
+Galileo and Harvey, and refers to the feelings excited by the great
+discovery of Jenner.  From the treatment of the great astronomer who
+was visited with the punishment of other heretics by the
+ecclesiastical authorities of a Catholic country some centuries
+since, there is no very direct inference to be drawn to the medical
+profession of the present time.  His name should be babbled no
+longer, after having been placarded for the hundredth time in the
+pages of St. John Long.  But if we are doomed to see constant
+reference to the names of Harvey and Jenner in every worthless
+pamphlet containing the prospectus of some new trick upon the public,
+let us, once for all, stare the facts in the face, and see how the
+discoveries of these great men were actually received by the medical
+profession.
+
+In 1628, Harvey published his first work upon the circulation.  His
+doctrines were a complete revolution of the prevailing opinions of
+all antiquity.  They immediately found both champions and opponents;
+of which last, one only, Riolanus, seemed to Harvey worthy of an
+answer, on account of his "rank, fame, and learning."  Controversy in
+science, as in religion, was not, in those days, carried on with all
+the courtesy which our present habits demand, and it is possible that
+some hard words may have been applied to Harvey, as it is very
+certain that he used the 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 hearing it both well and ill spoken of; some attack it
+with great hostility, others defend it with high encomiums; one party
+believe that I have abundantly proved the truth of the doctrine
+against all the weight of opposing arguments, by experiments,
+observations, and dissections; others think it not yet sufficiently
+cleared up, and free from objections."  Two really eminent
+Professors, 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, dissolved away, gradually, but certainly,
+before the demonstrations of Harvey.  Twenty-four years after the
+publication of his first work, and six years before his death, his
+bust in marble was placed in the Hall of the College of Physicians,
+with a suitable inscription recording his discoveries.
+
+Two years after this he was unanimously invited to accept the
+Presidency of that body; and he lived to see his doctrine
+established, and all reputable opposition withdrawn.
+
+There were many circumstances connected with the discovery of Dr.
+Jenner which were of a nature to excite repugnance and opposition.
+The practice of inoculation for the small-pox had already disarmed
+that disease of many of its terrors.  The introduction of a
+contagious disease from a brute creature into the human system
+naturally struck the public mind with a sensation of disgust and
+apprehension, and a part of the medical public may have shared these
+feelings.  I find that Jenner's discovery of vaccination was made
+public in June, 1798.  In July of the same year the celebrated
+surgeon, Mr. Cline, vaccinated a child with virus received from Dr.
+Jenner, and in communicating the 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 published his "Inquiry," containing the
+testimony of numerous practitioners in different parts of the
+kingdom, to the efficacy of the practice.  Dr. HAYGARTH, who was so
+conspicuous in exposing the follies of Perkinism, was among the very
+earliest to express his opinion in favor of vaccination.  In 1801,
+Dr. Lettsom mentions the circumstance "as being to the honor of the
+medical professors, that they have very generally encouraged this
+salutary practice, although it is certainly calculated to lessen
+their pecuniary advantages by its tendency to extirpate a fertile
+source of professional practice."
+
+In the same year the Medical Committee of Paris spoke of vaccination
+in a public letter, as "the most brilliant and most important
+discovery of the eighteenth century."  The Directors of a Society for
+the Extermination of the Small-Pox, in a Report dated October 1st,
+1807, "congratulate the public on the very favorable opinion which
+the Royal College of Physicians of London, after a most minute and
+laborious investigation 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 of which the sum of twenty thousand pounds was voted
+to 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 up against the
+Medical Profession, are only one mode in which is manifested a spirit
+of opposition not merely to medical science, but to all science, and
+to all sound knowledge.  It is a spirit which neither understands
+itself nor the object at which it is aiming.  It gropes among the
+loose records of 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 have passed their lives in the study
+of a branch of knowledge the very essence of which must always
+consist in long and accurate observation, are less competent to judge
+of new doctrines in their own department than the rest of the
+community.  It belongs to the clown in society, the destructive in
+politics, and the rogue in practice.
+
+The name of Harvey, whose great discovery was the legitimate result
+of his severe training and patient study, should be mentioned only to
+check the pretensions of presumptuous ignorance.  The example of
+Jenner, who gave his inestimable secret, the result of twenty-two
+years of experiment and researches, unpurchased, to the public,--
+when, as was said in Parliament, he might have made a hundred
+thousand pounds by it as well as any smaller sum,--should be referred
+to only to rebuke the selfish venders of secret remedies, among whom
+his early history obliges us reluctantly to record Samuel Hahnemann.
+Those who speak of the great body of physicians as if they were
+united in a league to support the superannuated notions of the past
+against the progress of improvement, have read 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 ambitious
+and plausible innovators.  If at the present time ten years of public
+notoriety have passed over any doctrine professing to be of
+importance in medical science, and if it has not succeeded in raising
+up a powerful body of able, learned, and ingenious advocates for its
+claims, the fault must be in the doctrine and not in the medical
+profession.
+
+Homoeopathy has had a still more extended period of trial than this,
+and we have seen with what results.  It only remains to throw out a
+few conjectures as to the particular manner in which it is to break
+up and disappear.
+
+1.  The confidence of the few believers in this delusion will never
+survive the loss of friends who may die of any acute disease, under a
+treatment such as that prescribed by Homoeopathy.  It is doubtful how
+far cases of this kind will be trusted to its tender mercies, but
+wherever it acquires any considerable foothold, such cases must come,
+and with them the ruin of those who practise it, should any highly
+valued life be thus sacrificed.
+
+2.  After its novelty has worn out, the ardent and capricious
+individuals who constitute the most prominent class of its patrons
+will return to visible doses, were it only for the sake of a change.
+
+3.  The Semi-Homoeopathic practitioner will gradually withdraw from
+the rotten half of his business and try to make the public forget his
+connection with it.
+
+4.  The ultra Homoeopathist will either recant and try to rejoin the
+medical profession; or he will embrace some newer and if possible
+equally extravagant doctrine; or he will stick to his colors and go
+down with his sinking doctrine.  Very few will pursue the course last
+mentioned.
+
+A single fact may serve to point out in what direction there will
+probably be a movement of the dissolving atoms of Homoeopathy.  On
+the 13th page of the too frequently cited Manifesto of the "Examiner"
+I read the following stately paragraph:
+
+"Bigelius, M. D., physician to the Emperor of Russia, whose elevated
+reputation is well known in Europe, has been an acknowledged advocate
+of Hahnemann's doctrines for several years.  He abandoned Allopathia
+for Homoeopathia."  The date of this statement is January, 1840.  I
+find on looking at the booksellers' catalogues that one Bigel, or
+Bigelius, to speak more classically, has been at various times
+publishing Homoeopathic books for some years.
+
+Again, on looking into the " Encyclographie des Sciences Medicales "
+for April, 1840, I find a work entitled " Manual of HYDROSUDOPATHY,
+or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel,
+Physician of the School of Strasburg, Member of the Medico-
+Chirurgical Institute of Naples, of the Academy of St.  Petersburg,--
+Assessor of the College of the Empire of Russia, Physician of 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
+sprung up in Germany since Homoeopathy, which it bids fair to drive
+out of the market, if, as Dr. Bigel says, fourteen physicians
+afflicted with diseases which defied themselves and their colleagues
+came to Graefenberg, in the year 1836 alone, and were cured.  Now Dr.
+Bigel, "whose elevated reputation is well known in Europe," writes as
+follows: "The reader will not fail to see in this defence of the
+curative method of Graefenberg a profession of medical faith, and he
+will be correct in so doing."  And his work closes with the following
+sentence, worthy of so distinguished an individual: "We believe, with
+religion, that the water of baptism purifies the soul from its
+original sin; let us believe also, with experience, that it is for
+our corporeal sins the redeemer of the human body."  If Bigel,
+Physician to the late Grand Duke Constantine, is identical with Bigel
+whom the "Examiner" calls Physician to the Emperor of Russia, it
+appears that he is now actively engaged in throwing cold water at
+once upon his patients and the future prospects of Homoeopathy.
+
+If, as must be admitted, no one of Hahnemann's doctrines is received
+with tolerable unanimity among his disciples, except the central
+axiom, Similia similibus curantur; if this axiom itself relies mainly
+for its support upon the folly and trickery of Hahnemann, what can we
+think of those who announce themselves ready to relinquish all the
+accumulated treasures of our art, to trifle with life upon the
+strength of these fantastic theories?  What shall we think of
+professed practitioners of medicine, if, in the words of Jahr, "from
+ignorance, for their personal convenience, or through charlatanism,
+they treat their patients one day Homoeopathically and the next
+Allopathically; " if they parade their pretended new science before
+the unguarded portion of the community; if they suffer their names to
+be coupled with it wherever it may gain a credulous patient; and deny
+all responsibility for its character, refuse all argument for its
+doctrines, allege no palliation for the ignorance and deception
+interwoven with every thread of its flimsy tissue, when they are
+questioned by those competent to judge and entitled to an answer?
+
+Such is the pretended science of Homoeopathy, to which you are asked
+to trust your lives and the lives of those dearest to you.  A mingled
+mass of perverse ingenuity, of tinsel erudition, of imbecile
+credulity, and of artful misrepresentation, too often mingled in
+practice, if we may trust the authority of its founder, with
+heartless and shameless imposition.  Because it is suffered so often
+to appeal unanswered to the public, because it has its journals, its
+patrons, its apostles, some are weak enough to suppose it can escape
+the inevitable doom of utter disgrace and oblivion.  Not many years
+can pass away before the same curiosity excited by one of Perkins's
+Tractors will be awakened at the sight of one of the Infinitesimal
+Globules.  If it should claim a longer existence, it can only be by
+falling into the hands of the sordid wretches who wring their bread
+from the cold grasp of disease and death in the hovels of ignorant
+poverty.
+
+As one humble member of a profession which for more than two thousand
+years has devoted itself to the pursuit of the best earthly interests
+of mankind, always assailed and insulted from without by such as are
+ignorant of its infinite perplexities and labors, always striving in
+unequal contest with the hundred-armed giant who walks in the
+noonday, and sleeps not in the midnight, yet still toiling, not
+merely for itself and 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 noble science 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 so far contagious as to be
+frequently carried from patient to patient by physicians and nurses."
+O. W. Holmes, 1843.
+
+
+THE NEGATIVE.
+
+"The result of the whole discussion will, I trust, serve, not only to
+exalt your views of the value and dignity of our profession, but to
+divest your minds of the overpowering dread that you can ever become,
+especially to woman, under the extremely interesting circumstances of
+gestation and parturition, the minister of evil; that you can ever
+convey, in any possible manner, a horrible virus, so destructive in
+its effects, and so mysterious in its operations as that attributed
+to puerperal fever." --Professor Hodge,
+1852.
+
+"I prefer to attribute them to accident, or Providence, of which I
+can form a conception, rather than to a contagion of which I cannot
+form any clear idea, at least as to this particular malady."--
+Professor Meigs, 1852.
+
+" .  .  .  in the propagation of which they have no more to do, than
+with the propagation of cholera from Jessore to San Francisco, and
+from Mauritius to St. Petersburg."--Professor Meigs, 1854.
+
+                    ---------------------
+
+"I arrived at that certainty in the matter, that I could venture to
+foretell what women would be affected with the disease, upon hearing
+by what midwife they were to be delivered, or by what nurse they 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 every year by the contagion of
+puerperal fever, communicated by the nurses and medical attendants."
+Farr, in Fifth Annual Report of Registrar-General of England, 1843.
+
+".  .  .  boards of health, if such exist, or, without them, the
+medical institutions of a country, should have the power of coercing,
+or of inflicting some kind of punishment on those who recklessly go
+from cases of puerperal fevers to parturient or puerperal females,
+without using due precaution; and who, having been shown the risk,
+criminally encounter it, and convey pestilence and death to the
+persons they are employed to aid in the most interesting and
+suffering period of female existence." --Copland's Medical
+Dictionary, Art.  Puerperal States and Diseases, 1852.
+
+"We conceive it unnecessary to go into detail to prove the contagious
+nature of this disease, as there are few, if any, American
+practitioners who do not believe in this doctrine." --Dr. Lee, in
+Additions to Article last cited.
+
+                    -----------------------
+
+[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
+arose in a Medical Society of which I was a member, involving the
+subject of a certain supposed cause of disease, about which something
+was known, a good deal suspected, and not a little feared.  The
+discussion was suggested by a case, reported at the preceding
+meeting, of a physician who made an examination of the body of a
+patient who had died with puerperal fever, and who himself died in
+less than a week, apparently in consequence of a wound received at
+the examination, having attended several women in confinement in the
+mean time, all of whom, as it was alleged, were attacked with
+puerperal fever.
+
+Whatever apprehensions and beliefs were entertained, it was plain
+that a fuller knowledge of the facts relating to the subject would be
+acceptable to all present.  I therefore felt that it would be doing a
+good service to look into the best records I could find, and inquire
+of the most trustworthy practitioners I knew, to learn what
+experience had to teach in the matter, and arrived at the results
+contained in the following pages.
+
+The Essay was read before the Boston Society for Medical Improvement,
+and, at the request of the Society, printed in the "New England
+Quarterly Journal of Medicine and Surgery" for April, 1843.  As this
+Journal never obtained a large circulation, and ceased to be
+published after a year's existence, and as the few copies I had
+struck off separately were soon lost sight of among the friends to
+whom they were sent, the Essay can hardly be said to have been fully
+brought before the Profession.
+
+The subject of this Paper has the same profound interest for me at
+the present moment as it had when I was first collecting the terrible
+evidence out of which, as it seems to me, the commonest exercise of
+reason could not help shaping the truth it involved.  It is not
+merely on account of the bearing of the question,--if there is a
+question,--on all that is most sacred in human life and happiness,
+that the subject cannot lose its interest.  It is because it seems
+evident that a fair statement of the facts must produce its proper
+influence on a very large proportion of well-constituted and
+unprejudiced minds.  Individuals may, here and there, resist the
+practical bearing of the evidence on their own feelings or interests;
+some may fail to see its meaning, as some persons may be found who
+cannot tell red from green; but I cannot doubt that most readers will
+be satisfied and convinced, to loathing, long before they have
+finished the dark obituary calendar laid before them.
+
+I do not know that I shall ever again have so good an opportunity of
+being useful as was granted me by the raising of the question which
+produced this Essay.  For I have abundant evidence that it has made
+many practitioners more cautious in their relations with puerperal
+females, and I have no doubt it will do so still, if it has a chance
+of being read, though it should call out a hundred counterblasts,
+proving to the satisfaction of their authors that it proved nothing.
+And for my part, I had rather rescue one mother from being poisoned
+by her attendant, than claim to have saved forty out of fifty
+patients to whom I had carried the disease.  Thus, I am willing to
+avail myself of any hint coming from without to offer this paper once
+more to the press.  The occasion has presented itself, as will be
+seen, in a convenient if 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 eliminates those secondary questions which cannot be entertained
+for a moment until the one great point of fact is peremptorily
+settled.  In its very statement of the doctrine maintained it avoids
+all discussion of the nature of the disease "known as puerperal
+fever," and all the somewhat stale philology of the word contagion.
+It mentions, fairly enough, the names of sceptics, or unbelievers as
+to the reality of personal transmission; of Dewees, of Tonnelle, of
+Duges, of Baudelocque, and others; of course, not including those
+whose works were then unwritten or unpublished; nor enumerating all
+the Continental writers who, in ignorance of the great mass of
+evidence accumulated by British practitioners, could hardly be called
+well informed on this subject.  It meets all the array of negative
+cases,--those in which disease did not follow exposure,--by the
+striking example of small-pox, which, although one of the most
+contagious of diseases, is subject to the most remarkable
+irregularities and seeming caprices in its transmission.  It makes
+full allowance for other causes besides personal transmission,
+especially for epidemic influences.  It allows for the possibility of
+different modes of conveyance of the destructive principle.  It
+recognizes and supports the belief that a series of cases may
+originate from a single primitive source which affects each new
+patient in turn; and especially from cases of Erysipelas.  It does
+not undertake to discuss the theoretical aspect of the subject; that
+is a secondary matter of consideration.  Where facts are numerous,
+and unquestionable, and unequivocal in their significance, theory
+must follow them as it best may, keeping time with their step, and
+not go before them, marching to the sound of its own drum and
+trumpet.  Having thus narrowed its area to a limited practical
+platform of discussion, a matter of life and death, and not of
+phrases or theories, it covers every inch of it with a mass of
+evidence which I conceive a Committee of Husbands, who can count
+coincidences and draw conclusions as well as a Synod of Accoucheurs,
+would justly consider as affording ample reasons for an unceremonious
+dismissal of a practitioner (if it is conceivable that such a step
+could be waited for), after five or six funerals had marked the path
+of his daily visits, while other practitioners 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 hands this Essay may fall, some
+words of introduction may be appropriate, and perhaps, to a small
+number of them, necessary.  There are some among them who, from
+youth, or want of training, are easily bewildered and confused in any
+conflict of opinions into which their studies lead them.  They are
+liable to lose sight of the main question in collateral issues, and
+to be run away with by suggestive speculations.  They confound belief
+with evidence, often trusting the first because it is expressed with
+energy, and slighting the latter because it is calm and
+unimpassioned.  They are not satisfied with proof; they cannot
+believe a point is settled so long as everybody is not silenced.
+They have not learned that error is got out of the minds that cherish
+it, as the taenia is removed from the body, one joint, or a few
+joints at a time, for the most part, rarely the whole evil at once.
+They naturally have faith in their instructors, turning to them for
+truth, and taking what they may choose to give them; babes in
+knowledge, not yet able to tell the breast from the bottle, pumping
+away for the milk of truth at all that offers, were it nothing better
+than a Professor's shrivelled forefinger.
+
+In the earliest and embryonic stage of professional development, any
+violent impression on the instructor's mind is apt to be followed by
+some lasting effect on that of the pupil.  No mother's mark is more
+permanent than the mental naevi and moles, and excrescences, and
+mutilations, that students carry with them out of the lecture-room,
+if once the teeming intellect which nourishes theirs has been scared
+from its propriety by any misshapen fantasy.  Even an impatient or
+petulant expression, which to a philosopher would be a mere index of
+the low state of amiability of the speaker at the moment of its
+utterance, may pass into the young mind as an element of its future
+constitution, to injure its temper or corrupt its judgment.  It is a
+duty, therefore, which we owe to this younger class of students, to
+clear any important truth which may have been rendered questionable
+in their minds by such language, or any truth-teller against whom
+they may have been prejudiced by hasty epithets, 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 this prejudice is local or personal, and
+not an acknowledged conviction with the public at large.  It may be
+necessary to break through our usual habits of reserve to do this,
+but this is the fault of the position in which others have placed us.
+
+Two widely-known and highly-esteemed practitioners, Professors in two
+of the largest Medical Schools of the Union, teaching the branch of
+art which includes the Diseases of Women, and therefore speaking with
+authority; addressing in their lectures and printed publications
+large numbers of young men, many of them in the tenderest immaturity
+of knowledge, have recently taken ground in a formal way against the
+doctrine maintained 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 of his Class.  By Charles D.
+Meigs, M.  D., Professor of Midwifery and the Diseases of Women and
+Children in Jefferson Medical College, Philadelphia, etc., etc.
+Philadelphia, 1854.  Letter VI.
+
+
+The first of the two publications, Dr. Hodge's Lecture, while its
+theoretical considerations and negative experiences do not seem to me
+to require any further notice than such as lay ready for them in my
+Essay written long before, is, I am pleased to say, unobjectionable
+in tone and language, and may be read without offence.
+
+This can hardly be said of the chapter of Dr. Meigs's volume which
+treats of Contagion in Childbed Fever.  There are expressions used in
+it which might well put a stop to all scientific discussions, were
+they to form the current coin in our exchange of opinions.  I leave
+the "very young gentlemen," whose careful expositions of the results
+of practice in more than six thousand cases are characterized as "the
+jejune and fizenless dreamings of sophomore writers," to the
+sympathies of those "dear young friends," and "dear young gentlemen,"
+who will judge how much to value their instructor's counsel to think
+for themselves, knowing what they are to expect if they happen not to
+think as he does.
+
+One unpalatable expression I suppose the laws of construction oblige
+me to appropriate to myself, as my reward for a certain amount of
+labor bestowed on the investigation of a very important question of
+evidence, and a statement of my own practical conclusions.  I take no
+offence, and attempt no retort.  No man makes a quarrel with me over
+the counterpane that covers a mother, with her new-born infant at her
+breast.  There is no epithet in the vocabulary of slight and sarcasm
+that can reach my personal sensibilities in such a controversy.  Only
+just so far as a disrespectful phrase may turn the student aside from
+the examination of the evidence, by discrediting or dishonoring the
+witness, does it call for any word of notice.
+
+I appeal from the disparaging language by which the Professor in the
+Jefferson School of Philadelphia world dispose of my claims to be
+listened to.  I appeal, not to the vote of the Society for Medical
+Improvement, although this was an unusual evidence of interest in the
+paper in question, for it was a vote passed among my own townsmen;
+nor to the opinion of any American, for none know better than the
+Professors in the great Schools of Philadelphia how cheaply the
+praise of native contemporary criticism is obtained.  I appeal to the
+recorded opinions of those whom I do 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 spoken of my Essay in
+phrases to which the pamphlets of American "scribblers" are seldom
+used from European authorities; to Ramsbotham, whose compendious
+eulogy is all that self-love could ask; to the "Fifth Annual Report"
+of the Registrar-General of England, in which the second-hand
+abstract of my Essay figures largely, and not without favorable
+comment, in an important appended paper.  These testimonies, half
+forgotten until this circumstance recalled them, are dragged into the
+light, not in a paroxysm of vanity, but to show that there may be
+food for thought in the small pamphlet which the Philadelphia Teacher
+treats so lightly.  They were at least unsought for, and would never
+have been proclaimed but for the sake of securing the privilege of a
+decent and unprejudiced hearing.
+
+I will take it for granted that they have so far counterpoised the
+depreciating language of my fellow-countryman and fellow-teacher as
+to gain me a reader here and there among the youthful class of
+students I am now addressing.  It is only for their sake that I think
+it 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 for beginners; and as I do not expect the
+practitioner, or even the more mature student, to take the trouble to
+follow me through an Introduction which I consider wholly unnecessary
+and superfluous for them, I shall not hesitate to stoop to the most
+elementary simplicity for the benefit of the younger student.  I do
+this more willingly because it affords a good opportunity, as it
+seems to me, of exercising the untrained mind in that medical logic
+which does not seem to have been either taught or practised in our
+schools of late, to the extent that might be desired.
+
+I will now exhibit, in a series of propositions reduced to their
+simplest expression, the same essential statements and conclusions as
+are contained in the Essay, with such commentaries and explanations
+as may be profitable to the inexperienced class of readers addressed.
+
+
+I.  It has been long believed, by many competent observers, that
+Puerperal Fever (so called) is sometimes carried from patient to
+patient by medical assistants.
+
+II.  The express object of this Essay is to prove that it is so
+carried.
+
+III.  In order to prove this point, it is not necessary to consult
+any medical theorist as to whether or not it is consistent with his
+preconceived notions that such a mode of transfer should exist.
+
+IV.  If the medical theorist insists on being consulted, and we see
+fit to indulge him, he cannot be allowed to assume that the alleged
+laws of contagion, deduced from observation in other diseases, shall
+be cited to disprove the alleged laws deduced from observation in
+this.  Science would never make progress under such conditions.
+Neither the long incubation of hydrophobia, nor the protecting power
+of vaccination, would ever have been admitted, if the results of
+observation in these affections had been rejected as contradictory to
+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 which I have examined.
+
+VI.  When an unusually large number of cases of this disease occur
+about the same time, it is inferred, therefore, that there exists
+some special cause for this increased frequency.  If the disease
+prevails extensively over a wide region of country, it is attributed
+without dispute to an epidemic influence.  If it prevails in a single
+locality, as in a hospital, and not elsewhere, this is considered
+proof that some local cause is there active in its production.
+
+VII.  When a large number of cases of this disease occur in rapid
+succession, in one individual's ordinary practice, and few or none
+elsewhere, these cases appearing in scattered localities, in patients
+of the same average condition as those who escape under the care of
+others, there is the same reason for connecting the cause of the
+disease with the person in this instance, as with the place in that
+last mentioned.
+
+VIII.  Many series of cases, answering to these conditions, are given
+in this Essay, and many others will be referred to which have
+occurred since it was written.
+
+IX.  The alleged results of observation may be set aside; first,
+because the so-called facts are in their own nature equivocal;
+secondly, because they stand on insufficient authority; thirdly,
+because they are not sufficiently numerous.  But, in this case, the
+disease is one of striking and well-marked character; the witnesses
+are experts, interested in denying and disbelieving the facts; the
+number of consecutive cases in many instances frightful, and the
+number of series of cases such that I have no room for many of them
+except 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 effect of chance.  I have had the chances
+calculated by a competent person, that a given practitioner, A.,
+shall have sixteen fatal cases in a month, on the following data:
+A. to average attendance upon two hundred and fifty births in a year;
+three deaths in one thousand births to be assumed as the average from
+puerperal fever; no epidemic to be at the time prevailing.  It
+follows, from the answer given me, that if we suppose every one of
+the five hundred thousand annual births of England to have been
+recorded during the last half-century, there would not be one chance
+in a million million million millions that one such series should be
+noted.  No possible fractional error in this calculation can render
+the chance a working probability.  Applied to dozens of series of
+various lengths, it is obviously an absurdity.  Chance, therefore, is
+out of the question as an explanation of the admitted coincidences.
+
+XI.  There is, therefore, some relation of cause and effect between
+the physician's presence and the patient's disease.
+
+XII.  Until it is proved to what removable condition attaching to the
+attendant the disease is owing, he is bound to stay away from his
+patients so soon as he finds himself singled out to be tracked by the
+disease.  How long, and with what other precautions, I have
+suggested, without dictating, at the close of my Essay.  If the
+physician does not at once act on any reasonable suspicion of his
+being the medium of transfer, the families where he is engaged, if
+they are allowed to know the facts, should decline his services for
+the time.  His feelings on the occasion, however interesting to
+himself, should not be even named in this connection.  A physician
+who talks about ceremony and gratitude, and services rendered, and
+the treatment he got, surely forgets himself; it is impossible that
+he should seriously think of these small matters where there is even
+a question 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 mode in which he may
+relieve his mind of any confusion, or possibly, if very young, any
+doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised
+in his mind.
+
+The most prominent ideas of the Letter are, first, that the
+transmissible nature of puerperal fever appears improbable, and,
+secondly, that it would be very inconvenient to the writer.
+Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in
+London, found it improbable, and exceedingly inconvenient to himself,
+that cow pox should prevent small-pox; but Dr. Jenner took the
+liberty to prove the fact, notwithstanding.
+
+I will first call the young student's attention to the show of
+negative facts (exposure without subsequent disease), of which much
+seems to be thought.  And I may at the same time refer him to Dr.
+Hodge's Lecture, where he will find the same kind of facts and
+reasoning.  Let him now take up Watson's Lectures, the good sense and
+spirit of which have made his book a universal favorite, and open to
+the chapter on Continued Fever.  He will find a paragraph containing
+the following sentence: "A man might say, 'I was in the battle of
+Waterloo, and saw many men around me fall down and die, and it was
+said that they were struck down by musket-balls; but I know better
+than that, for I was there all the time, and so were many of my
+friends, and we were never hit by any musket-balls.  Musket-balls,
+therefore, could not have been the cause of the deaths we witnessed.'
+And if, like contagion, they were not palpable to the senses, such a
+person might go on to affirm that no proof existed of there being any
+such thing as musket-balls."  Now let the student turn back to the
+chapter on Hydrophobia in the same volume.  He will find that John
+Hunter knew a case in which, of twenty-one persons bitten, only one
+died of the disease.  He will find that one dog at Charenton was
+bitten at different times by 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 rabid animal, because so many escape?  Or let
+him look at "Underwood on Diseases of Children,"[Philadelphia, 1842,
+p.  244, note.] and he will find the case of a young woman who was
+inoculated eight times in thirty days, at the same time attending
+several children with smallpox, and yet was not infected.  But seven
+weeks afterwards she took the disease and died.
+
+It would seem as if the force of this argument could hardly fail to
+be seen, if it were granted that every one of these series of cases
+were so reported as to prove that there could have been no transfer
+of disease.  There is not one of them so reported, in the Lecture or
+the Letter, as to prove that the disease may not have been carried by
+the practitioner.  I strongly suspect that it was so carried in some
+of these cases, but from the character of the very imperfect evidence
+the question can never be settled without further disclosures.
+
+Although the Letter is, as I have implied, principally taken 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
+touch some of these questions briefly, as an illustration of its
+logical character.
+
+The first thing to be done, as I thought when I wrote my Essay, was
+to throw out all discussions of the word contagion, and this I did
+effectually by the careful wording of my statement of the subject to
+be discussed.  My object was not to settle the etymology or
+definition of a word, but to show that women had often died in
+childbed, poisoned in some way by their medical attendants.  On the
+other point, I, at least, have no controversy with anybody, and I
+think the student will do well to avoid it in this connection.  If I
+must define my position, however, as well as the term in question, I
+am contented with Worcester's definition; provided always this avowal
+do not open another 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 the laws of the
+eruptive fevers must necessarily hold true of this peculiar disease
+of puerperal women.  If there were any such propriety, the laws of
+the eruptive fevers must at least be stated correctly.  It is not
+true, for instance, as Dr. Meigs states, that contagion is "no
+respecter of persons;" that "it attacks all individuals alike."  To
+give one example: Dr. Gregory, of the Small-Pox Hospital, who ought
+to know, says that persons pass through life apparently insensible to
+or unsusceptible of the small-pox virus, and that the same persons do
+not take the vaccine disease.
+
+As to the short time of incubation, of which so much is made, we have
+no right to decide beforehand whether it shall be long or short, in
+the cases we are considering.  A dissection wound may produce
+symptoms of poisoning in six hours; the bite of a rabid animal may
+take as many months.
+
+After the student has read the case in Dr. Meigs's 136th paragraph,
+and the following one, in which he exclaims against the idea of
+contagion, because the patient, delivered on the 26th of December,
+was attacked in twenty-four hours, and died on the third day, let him
+read what happened at the "Black Assizes" of 1577 and 1750.  In the
+first case, six hundred persons sickened the same night of the
+exposure, and three hundred more in three days. [Elliotson's
+Practice, p.  298.]  Of those attacked in the latter year, the
+exposure being on the 11th of May, Alderman Lambert died on the 13th,
+Under-Sheriff Cox on the 14th, and many of note before the
+20th.  But these are old stories.  Let the student listen then to Dr.
+Gerhard, whose reputation as a cautious observer he may be supposed
+to know.  "The nurse was shaving a man, who died in a few hours after
+his entrance; he inhaled his breath, which had a nauseous taste, and
+in an hour afterwards was taken with nausea, cephalalgia, and singing
+of the ears.  From that moment the attack began, and assumed a severe
+character.  The assistant was supporting another patient, who died
+soon afterwards; he felt the pungent heat upon his skin, and was
+taken immediately with the symptoms of typhus."[Am.  Jour.  Med.
+Sciences, Feb.  1837, p.  299.]   It is by notes of cases, rather
+than notes of admiration, that we must be guided, when we study the
+Revised Statutes of Nature, as laid down from the curule chairs of
+Medicine.
+
+Let the student read Dr. Meigs's 140th paragraph soberly, and then
+remember, that not only does he infer, suspect, and surmise, but he
+actually asserts (page 154, "there was poison in the house," because
+three out of five patients admitted into a ward had puerperal fever
+and died.  Have I not as much right to draw a positive inference from
+"Dr. A.'s " seventy exclusive cases as he from the 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 know
+that the patients he bled in puerperal fever would not have all got
+well if he had not bled them?
+
+"You see a man discharge a gun at another; you see the flash, you
+hear the report, you see the person fall a lifeless corpse; and you
+infer, from all these circumstances, that there was a ball discharged
+from the gun, which entered his body and caused his death, because
+such is the usual and natural cause of such an effect.  But you did
+not see the ball leave the gun, pass through the air, and enter the
+body of the slain; and your testimony to the fact of killing is,
+therefore, only inferential,--in other words, circumstantial.  It is
+possible that no ball was in the gun; and we infer that there was,
+only because 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: Is the circumstance of
+intercourse with the sick followed by the appearance of the disease
+in a proportion of cases so much greater than any other circumstance
+common to any portion of the inhabitants of the place under
+observation, as to make it inconceivable that the succession of cases
+occurring in persons having that intercourse should have been the
+result of chance?  If so, the inference is unavoidable, that that
+intercourse must have acted as a cause of the disease.  All
+observations which do not bear strictly on that point are irrelevant,
+and, in the case of an epidemic first appearing in a town or
+district, a succession of two cases is sometimes sufficient to
+furnish evidence which, on the principle I have stated, is nearly
+irresistible."
+
+Possibly an inexperienced youth may be awe-struck by the quotation
+from Cuvier.  These words, or their equivalent, are certainly to be
+found in his Introduction.  So are the words "top not come down"!
+to be found in the Bible, and they were as much meant for the ladies'
+head-dresses as the words of Cuvier were meant to make clinical
+observation wait for a permit from anybody to look with its eyes and
+count on its fingers.  Let the inquiring youth read the whole
+Introduction, and he will see what they mean.
+
+I intend no breach of courtesy, but this is a proper place to warn
+the student against skimming the prefaces and introductions of works
+for mottoes and embellishments to his thesis.  He cannot learn
+anatomy by thrusting an exploring needle into the body.  He will be
+very liable to misquote his author's meaning while he is picking off
+his outside sentences.  He may make as great a blunder as that simple
+prince who praised the conductor of his orchestra for the piece just
+before the overture; the musician was too good a courtier to tell him
+that it was only the tuning of the instruments.
+
+To the six propositions in the 142d paragraph, and the remarks about
+"specific" diseases, the answer, if any is necessary, seems very
+simple.  An inflammation of a serous membrane may give rise to
+secretions which act as a poison, whether that be a "specific" poison
+or not, as Dr. Homer has told his young readers, and as dissectors
+know too well; and that poison may produce its symptoms in a few
+hours after the system has received it, as any may see in Druitt's
+"Surgery," if they care to look.  Puerperal peritonitis may produce
+such a poison, and puerperal women may be very sensible to its
+influences, conveyed by contact or exhalation.  Whether this is so or
+not, facts alone can determine, and to facts we have had recourse to
+settle it.
+
+The following statement is made by Dr. Meigs in his 142d paragraph,
+and developed more at length, with rhetorical amplifications, in the
+134th.  "No human being, save a pregnant or parturient woman, is
+susceptible to the poison."  This statement is wholly incorrect, as I
+am sorry to have to point out to a Teacher in Dr. Meigs's position.
+I do not object to the erudition which quotes Willis and Fernelius,
+the last of whom was pleasantly said to have "preserved the dregs of
+the Arabs in the honey of his Latinity."  But I could wish that more
+modern authorities had not been overlooked.  On this point, for
+instance, among the numerous facts disproving the statement, the
+"American Journal of Medical Sciences," published not far from his
+lecture-room, would have presented him with a respectable catalog of
+such cases.  Thus he might refer to Mr. Storrs's paper "On the
+Contagious Effects of Puerperal Fever on the Male Subject; or on
+Persons not Childbearing"(Jan.  1846), or to Dr. Reid's case (April,
+1846), or to Dr. Barron's statement of the children's dying of
+peritonitis in an epidemic of puerperal fever at the Philadelphia
+Hospital (Oct.  1842), or to various instances cited in Dr.
+Kneeland's article (April, 186).  Or, if he would have referred to
+the "New York Journal," he might have seen Prof. Austin Flint's
+cases.  Or, if he had honored my Essay so far, he might have found
+striking instances of the same kind in the first of the new series of
+cases there reported and elsewhere.  I do not see the bearing of his
+proposition, if it were true.  But it is one of those assertions that
+fall in a moment before a slight examination of the facts; and I
+confess my surprise, that a professor who lectures on the Diseases of
+Women should have ventured to make it.
+
+Nearly seven pages are devoted to showing that I was wrong in saying
+I would not be "understood to imply that there exists a doubt in the
+mind of any well-informed member of the medical profession as to the
+fact that puerperal fever is sometimes communicated from one person
+to another, both directly and indirectly."  I will devote seven lines
+to these seven pages, which seven 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. --Believes the disease is sometimes communicable by
+contagion.  Tonnelle, Baudelocque.  Both cited by me.  Jacquemier.
+--Published three years after my Essay.  Kiwisch.  Behindhand in
+knowledge of Puerperal Fever." [B. & F.  Med.  Rev.  Jan.  1842.]
+Paul Dubois. --Scanzoni.
+
+These Continental writers not well informed on this point.[See Dr.
+Simpson's Remarks at Meeting of Edin.  Med.  Chir.  Soc.  (Am.  Jour.
+Oct.  1851.)]
+
+The story of Von Busch is of interest and value, but there is nothing
+in it which need perplex the student.  It is not pretended that the
+disease is always, or even, it may be, in the majority of cases,
+carried about by attendants; only that it is so carried in certain
+cases.  That it may have local and epidemic causes, as well as that
+depending on personal transmission, is not disputed.  Remember how
+small-pox often disappears from a community in spite of its
+contagious character, and the necessary exposure of many persons to
+those suffering from it; in both diseases contagion is 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 puerperal fever 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 by Dr.
+Condie, as given in my Essay, and say whether or not a man should
+allow his wife to be attended by a practitioner in whose hands
+"scarcely a female that has been delivered for weeks past has escaped
+an attack,"  "while no instance of the disease has occurred in the
+patients of any other accoucheur practising in the same district."
+If I understand Dr. Meigs and Dr. Hodge, they would not warn the
+physician or spare the patient under such circumstances.  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 respectfully ask them to state what they do
+mean, to their next classes, in the name of humanity, if not of
+science!
+
+I might repeat the question asked concerning Dr. Rutter's cases, with
+reference to those reported by Dr. Roberton.  Perhaps, however, the
+student would like to know the opinion of a person in the habit of
+working at matters of this kind in a practical point of view.  To
+satisfy him on this ground, I addressed the following question to the
+President of one of our principal Insurance Companies, leaving Dr.
+Meigs's book and my Essay in his hands at the same time.
+
+Question.  "If such facts as Roberton's cases were before you, and
+the attendant had had ten, or even five fatal cases, or three, or two
+even, would you, or would you not, if insuring the life of the next
+patient to be taken care of by that attendant, expect an extra
+premium over that of an average case of childbirth?"
+
+Answer.  " Of course I should require a very large extra premium, if
+I would take take risk at all."
+
+But I do not choose to add the expressions of indignation which the
+examination of the facts before him called out.  I was satisfied from
+the effect they produced on him, that if all the hideous catalogues
+of cases now accumulated were fully brought to the knowledge of the
+public, nothing, since the days of Burke and Hare, has raised such a
+cry of horror as would be shrieked 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 through the agency of
+secondary causes, as in other diseases, or not.  If through such
+causes, let us find out what 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 of bringing them!  But if Providence does
+not act through secondary causes in this particular sphere of
+etiology, then why does Dr. Meigs take such pains to reason so
+extensively about the laws of contagion, which, on that supposition,
+have no more to do with this case than with the plague which
+destroyed the people after David had numbered them?  Above all, what
+becomes of the theological aspect of the question, when he asserts
+that a practitioner was "only unlucky in meeting with the epidemic
+cases?" ( Op.  cit.  p.  633.) We do not deny that the God of battles
+decides the fate of nations; but we like to have the biggest
+squadrons on our side, and we are particular that our soldiers should
+not only say their prayers, but also keep their powder dry.  We do
+not deny the agency of Providence in the disaster at Norwalk, but we
+turn off the engineer, and charge the Company five thousand dollars
+apiece for every life that is sacrificed.
+
+Why a grand jury should not bring in a bill against a physician who
+switches off a score of women one after the other along his private
+track, when he knows that there is a black gulf at the end of it,
+down which they are to plunge, while the great highway is clear, is
+more than I can answer.  It is not by laying the open draw to
+Providence that he is to escape the charge of manslaughter.
+
+To finish with all these lesser matters of question, I am unable to
+see why a female must necessarily be unattended in her confinement,
+because she declines the services of a particular practitioner.  In
+all the series of cases mentioned, the death-carrying attendant was
+surrounded by others not tracked by disease and its consequences.
+Which, I would ask, is worse,--to call in another, even a rival
+practitioner, or to submit an unsuspecting female to a risk which an
+Insurance Company would have nothing to do with?
+
+I do not expect ever to return to this subject.  There is a point of
+mental saturation, beyond which argument cannot be forced without
+breeding impatient, if not harsh, feelings towards those who refuse
+to be convinced.  If I have so far manifested neither, it is well to
+stop here, and leave the rest to those younger friends who may have
+more stomach for the dregs of a stale argument.
+
+The extent of my prefatory remarks may lead some to think that I
+attach too much importance to my own Essay.  Others may wonder that I
+should expend so many words upon the two productions referred to, the
+Letter and the Lecture.  I do consider my Essay of much importance so
+long as the doctrine it maintains is treated as a question, and so
+long as any important part of the defence of that doctrine is thought
+to rest on its evidence or arguments.  I cannot treat as
+insignificant any opinions bearing on life, and interests dearer than
+life, proclaimed yearly to hundreds of young men, who will carry them
+to their legitimate results in practice.
+
+The teachings of the two Professors in the great schools of
+Philadelphia are sure to be listened to, not only by their immediate
+pupils, but by the Profession at large.  I am too much in earnest for
+either humility or vanity, but I do entreat those who hold the keys
+of life and death to listen to me also for this once.  I ask no
+personal favor; but I beg to be heard in behalf of the women whose
+lives are at stake, until some stronger voice shall plead for them.
+
+I trust that I have made the issue perfectly distinct and
+intelligible.  And let it be remembered that this is no subject to be
+smoothed over by nicely adjusted phrases of half-assent and half-
+censure divided between the parties.  The balance must be struck
+boldly and the result declared plainly.  If I have been hasty,
+presumptuous, ill-informed, illogical; if my array of facts means
+nothing; if there is no reason for any caution in the view of these
+facts; let me be told so on such authority that I must believe it,
+and I will be silent henceforth, recognizing that my mind is in a
+state of disorganization.  If the doctrine I have maintained is a
+mournful truth; if to 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 carry it, into confiding
+families, let it be proclaimed as plainly what is to be thought of
+the teachings of those who sneer at the alleged dangers, and scout
+the very idea of precaution.  Let it be remembered that persons are
+nothing in this matter; better that twenty pamphleteers should be
+silenced, or as many professors unseated, than that one mother's life
+should be taken.  There is no quarrel here between men, but there is
+deadly incompatibility and exterminating warfare between doctrines.
+Coincidences, meaning nothing, though a man have a monopoly of the
+disease for weeks or months; or cause and effect, the cause being in
+some way connected with the person; this is the question.  If I am
+wrong, let me be put down by such a rebuke as no rash declaimer has
+received since there has been a public opinion in the medical
+profession of America; if I am right, let doctrines which lead to
+professional homicide be no longer taught from the chairs of those
+two great Institutions.  Indifference will not do here; our
+Journalists and Committees have no right to take up their pages with
+minute anatomy and tediously detailed cases, while it is a question
+whether or not the "blackdeath" of child-bed is to be scattered
+broadcast by the agency of the mother's friend and adviser.  Let the
+men who mould opinions look to it; if there is any voluntary
+blindness, any interested oversight, any culpable negligence, even,
+in such a matter, and the facts shall reach the public ear; the
+pestilence-carrier of the lying-in chamber must look to God for
+pardon, for man will never forgive him.
+
+
+               THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+In collecting, enforcing, and adding to the evidence accumulated upon
+this most serious subject, I would not be understood to imply that
+there exists a doubt in the mind of any well-informed member of the
+medical profession as to the fact that puerperal fever is sometimes
+communicated from one person to another, both directly and
+indirectly.  In the present state of our knowledge upon this point I
+should consider such doubts merely as a proof that the sceptic had
+either not examined the evidence, or, having examined it, refused to
+accept its plain and unavoidable consequences.  I should be sorry to
+think, with Dr. Rigby, that it was a case of "oblique vision;" I
+should be unwilling to force home the argumentum ad hominem of Dr.
+Blundell, but I would not consent to make a question of a momentous
+fact which is no longer to be considered as a subject for trivial
+discussions, but to be acted upon with silent promptitude.  It
+signifies nothing that wise and experienced practitioners have
+sometimes doubted the reality of the danger in question; no man has
+the right to doubt it any longer.  No negative facts, no opposing
+opinions, be they what they may, or whose they may, can form any
+answer to the series of cases now within the reach of all who choose
+to explore the records of medical science.
+
+If there are some who conceive that any important end would be
+answered by recording such opinions, or by collecting the history of
+all the cases they could find in which no evidence of the influence
+of contagion existed, I believe they are in error.  Suppose a few
+writers of authority can be found to profess a disbelief in
+contagion,--and they are very few compared with those who think
+differently,--is it quite clear that they formed their opinions on a
+view of all the facts, or is it not apparent that they relied mostly
+on their own solitary experience?  Still further, of those whose
+names are quoted, is it not true that scarcely a single one could by
+any possibility have known the half or the tenth of the facts bearing
+on the subject which have reached such a frightful amount within the
+last few years?  Again, as to the utility of negative facts, as we
+may briefly call them,--instances, namely, in which exposure has not
+been followed by disease,--although, like other truths, they may be
+worth knowing, I do not see that they are like to shed any important
+light upon the subject before us.  Every such instance requires a
+good deal of circumstantial explanation before it can be accepted.
+It is not enough that a practitioner should have had a single case of
+puerperal fever not followed by others.  It must be known whether he
+attended others while this case was in progress, whether he went
+directly from one chamber to others, whether he took any, and what
+precautions.  It is important to know that several women were exposed
+to infection derived from the patient, so that allowance may be made
+for want of predisposition.  Now if of negative facts so sifted there
+could be accumulated a hundred for every one plain instance of
+communication here recorded, I trust it need not be said that we are
+bound to guard and watch over the hundredth tenant of our fold,
+though the ninety and nine may be sure of escaping the wolf at its
+entrance.  If any one is disposed, then, to take a hundred instances
+of lives endangered or sacrificed out of those I have mentioned, and
+make it reasonably clear that within a similar time and compass ten
+thousand escaped the same exposure, I shall thank him for his
+industry, but I must be permitted to hold to my own practical
+conclusions, and beg him to adopt or at least to examine them also.
+Children that walk in calico before open fires are not always burned
+to death; the instances to the contrary may be worth recording; but
+by no means if they are to be used as arguments against woollen
+frocks and high fenders.
+
+I am not sure that this paper will escape another remark which it
+might be wished were founded in justice.  It may be said that the
+facts are too generally known and acknowledged to require any formal
+argument or exposition, that there is nothing new in the positions
+advanced, and no need of laying additional statements before the
+Profession.  But on turning to two works, one almost universally, and
+the other extensively appealed to as authority in this country, I see
+ample reason to overlook this objection.  In the last edition of
+Dewees's Treatise on the "Diseases of Females," it is expressly said,
+"In this country, under no circumstance that puerperal fever has
+appeared hitherto, does it afford the slightest ground for the belief
+that it is contagious."  In the "Philadelphia Practice of Midwifery"
+not one word can be found in the chapter devoted to this disease
+which would lead the reader to suspect that the idea of contagion had
+ever been entertained.  It seems proper, therefore, to remind those
+who are in the habit of referring to these works for guidance, that
+there may possibly be some sources of danger they have slighted or
+omitted, quite as important as a trifling irregularity of diet, or a
+confined state of the bowels, and that whatever confidence a
+physician may have in his own mode of treatment, his services are of
+questionable value whenever he carries the bane as 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 contagious as to be
+frequently carried from patient to patient by physicians and nurses.
+
+
+Let me begin by throwing out certain incidental questions, which,
+without being absolutely essential, would render the subject more
+complicated, and by making such concessions and assumptions as may be
+fairly supposed to be without the pale of discussion.
+
+1.  It is granted that all the forms of what is called puerperal
+fever may not be, and probably are not, equally contagious or
+infectious.  I do not enter into the distinctions which have been
+drawn by authors, because the facts do not appear to me sufficient to
+establish any absolute line of demarcation between such forms as may
+be propagated by contagion and those which are never so propagated.
+This general result I shall only support by the authority of Dr.
+Ramsbotham, who gives, as the result of his experience, that the same
+symptoms belong to what he calls the infectious and the sporadic
+forms of the disease, and the opinion of Armstrong in his original
+Essay.  If others can show any such distinction, I leave it to them
+to do it.  But there are cases enough that show the prevalence of the
+disease among the patients of a single practitioner when it was in no
+degree epidemic, in the proper sense of the term. I may refer to
+those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as
+examples.
+
+2.  I shall not enter into any dispute about the particular mode of
+infection, whether it be by the atmosphere the physician carries
+about him into the sick-chamber, or by the direct application of the
+virus to the absorbing surfaces with which his hand comes in contact.
+Many facts and opinions are in favor of each of these modes of
+transmission.  But it is obvious that in the majority of cases it
+must be impossible to decide by which of these channels the disease
+is conveyed, from the nature of the intercourse between the physician
+and the patient.
+
+3.  It is not pretended that the contagion of puerperal fever must
+always be followed by the disease.  It is true of all contagious
+diseases, that they frequently spare those who appear to be fully
+submitted to their influence.  Even the vaccine virus, fresh from the
+subject, fails every day to produce its legitimate effect, though
+every precaution is taken to insure its action.  This is still more
+remarkably the case with scarlet fever and some other diseases.
+
+4.  It is granted that the disease may be produced and 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 a great extent by contagion, yet it goes through the same periods
+of periodical increase and diminution which have been remarked in
+puerperal fever.  If the question is asked how we are to reconcile
+the great variations in the mortality of puerperal fever in different
+seasons and places with the supposition of contagion, I will answer
+it by another question from Mr. Farr's letter to the Registrar-
+General.  He makes the statement that "five die weekly of small-pox
+in the metropolis when the disease is not epidemic,"--and adds, "The
+problem for solution is,-- Why do the five deaths become 10, 15, 20,
+31, 58, 88, weekly, and then progressively fall through the same
+measured steps?"
+
+5.  I take it for granted, that if it can be shown that great numbers
+of lives have been and are sacrificed to ignorance or blindness on
+this point, no other error of which physicians or nurses may be
+occasionally suspected will be alleged in palliation of this; but
+that whenever and wherever they can be shown to carry disease and
+death instead of health and safety, the common instincts of humanity
+will silence every attempt to explain away their responsibility.
+
+
+The treatise of Dr. Gordon of Aberdeen was published in the year
+1795, being among the earlier special works upon the disease.  Apart
+of his testimony has been occasionally copied into other works, but
+his expressions are so clear, his experience is given with such manly
+distinctness and disinterested honesty, that it may be quoted as a
+model which might have been often followed with advantage.
+
+"This disease seized such women only as were visited, or delivered by
+a practitioner, or taken care of by a nurse, who had previously
+attended patients affected with the disease."
+
+"I had evident proofs of its infectious nature, and that the
+infection was as readily communicated as that of the small-pox or
+measles, and operated more speedily than any other infection with
+which I am acquainted."
+
+"I had evident proofs that every person who had been with a patient
+in the puerperal fever became charged with an atmosphere of
+infection, which was communicated to every pregnant woman who
+happened to come within its sphere.  This is not an assertion, but a
+fact, admitting of demonstration, as may be seen by a perusal of the
+foregoing table,"--referring to a table of seventy-seven cases, in
+many of which the channel of propagation was evident.
+
+He adds, "It is a disagreeable declaration for me to mention, that I
+myself was the means of carrying the infection to a great number of
+women."  He then enumerates a number of instances in which the
+disease was conveyed by midwives and others to the neighboring
+villages, and declares that "these facts fully prove that the cause
+of the puerperal fever, of which I treat, was a specific contagion,
+or infection, altogether unconnected with a noxious constitution 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 FORETELL WHAT
+WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT
+MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE
+ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY
+PREDICTION WAS VERIFIED."
+
+Even previously to Gordon, Mr. White of Manchester had said, "I am
+acquainted with two gentlemen in another town, where the whole
+business of midwifery is divided betwixt them, and it is very
+remarkable that one of them loses several patients every year of the
+puerperal fever, and the other never so much as meets with the
+disorder,"--a difference which he seems to attribute to their various
+modes of treatment. [On the Management of Lying-in Women, p.  120.]
+
+Dr. Armstrong has given a number of instances in his Essay on
+Puerperal Fever, of the prevalence of the disease among the patients
+of a single practitioner.  At Sunderland, "in all, forty-three cases
+occurred from the 1st of January to the 1st of October, when the
+disease ceased; and of this number forty were witnessed by Mr.
+Gregson and his assistant, Mr. Gregory, the remainder having been
+separately seen by three accoucheurs."  There is appended to the
+London edition of this Essay, a letter from Mr. Gregson, in which
+that gentleman says, in reference to the great number of cases
+occurring in his practice, "The cause of this I cannot pretend fully
+to explain, but I should be wanting in common liberality if I were to
+make any hesitation in asserting, that the disease which appeared in
+my practice was highly contagious, and communicable from one
+puerperal woman to another."  "It is customary among the lower and
+middle ranks of people to make frequent personal visits to puerperal
+women resident in the same neighborhood, and I have ample evidence
+for affirming that the infection of the disease was often carried
+about in that manner; and, however painful to my feelings, I must in
+candor declare, that it is very probable the contagion was conveyed,
+in some instances, by myself, though I took every possible care to
+prevent such a thing from happening, the moment that I ascertained
+that the distemper was infectious."  Dr. Armstrong goes on to mention
+six other instances within his knowledge, in which the disease had at
+different times and places been limited, in the same singular manner,
+to the practice of individuals, while it existed scarcely if at all
+among the patients of others around them.  Two of the gentlemen
+became so convinced of their conveying the contagion, that they
+withdrew for a time from practice.
+
+I find a brief notice, in an American Journal, of another series of
+cases, first mentioned by Mr. Davies, in the "Medical Repository."
+This gentleman stated his conviction that the disease is contagious.
+
+"In the autumn of 1822 he met with twelve cases, while his medical
+friends in the neighborhood did not meet with any, ' or at least very
+few.'  He could attribute this circumstance to no other cause than
+his having been present at the examination, after death, of two
+cases, some time previous, and of his having imparted the disease to
+his patients, notwithstanding every precaution.'"
+
+Dr. Gooch says, "It is not uncommon for the greater number of cases
+to occur in the practice of one man, whilst the other practitioners
+of the neighborhood, who are not more skilful or more busy, meet with
+few or none.  A practitioner opened the body of a woman who had died
+of puerperal fever, and continued to wear the same clothes.  A lady
+whom he delivered a few days afterwards was attacked with and died of
+a similar disease; two more of his lying-in patients, in rapid
+succession, met with the same fate; struck by the thought, that he
+might have carried contagion in his clothes, he instantly changed
+them, and met with no more cases of the kind.'  A woman in the
+country, who was employed as washerwoman and nurse, washed the linen
+of one who had died of puerperal fever; the next lying-in patient she
+nursed died of the same disease; a third nursed by her met with the
+same fate, till the neighborhood, getting afraid of her, ceased to
+employ her."
+
+In the winter of the year 1824, "Several instances occurred of its
+prevalence among the patients of particular practitioners, whilst
+others who were equally busy met with few or none.  One instance of
+this kind was very remarkable.  A general practitioner, in large
+midwifery practice, lost so many patients from puerperal fever, that
+he determined to deliver no more for some time, but that his partner
+should attend in his place.  This plan was pursued for one month,
+during which not a case of the disease occurred in their practice.
+The elder practitioner, being then sufficiently recovered, returned
+to his practice, but the first patient he attended was attacked by
+the disease and died.  A physician, who met him in consultation soon
+afterwards, about a case of a different kind, and who knew nothing of
+his misfortune, asked him whether puerperal fever was at all
+prevalent in his neighborhood, on which he burst into tears, and
+related the above circumstances.
+
+"Among the cases which I saw this season in consultation, four
+occurred in one month in the practice of one medical man, and all of
+them terminated fatally." [Lond.  Med.  Gaz.  May 2, 1835.]
+
+Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he
+had known the disease spread through a particular district, or be
+confined to the practice of a particular person, almost every patient
+being attacked with it, while others had not a single case.  It
+seemed capable, he thought, of conveyance, not only by common modes;
+but through the dress of the attendants upon the patient.
+
+In a letter to be found in the "London Medical Gazette"for January,
+1840, Mr. Roberton of Manchester makes the statement which I here
+give in a somewhat condensed form.
+
+A midwife delivered a woman on the 4th of December, 1830, who died
+soon after with the symptoms of puerperal fever.  In one month from
+this date the same midwife delivered thirty women, residing in
+different parts of an extensive suburb, of which number sixteen
+caught the disease and all died.  These were the only cases which had
+occurred for a considerable time in Manchester.  The other midwives
+connected with the same charitable institution as the woman already
+mentioned are twenty-five in number, and deliver, on an average,
+ninety women a week, or about three hundred and eighty a month.  None
+of these women had a case of puerperal fever.  "Yet all this time
+this woman was crossing the other midwives in every direction, scores
+of the patients of the charity being delivered by them in the very
+same quarters where her cases of fever were happening."
+
+Mr. Roberton remarks, that little more than half the women she
+delivered during this month took the fever; that on some days all
+escaped, on others only one or more out of three or four; a
+circumstance similar to what is seen in other infectious maladies.
+
+Dr. Blundell says, "Those who have never made the experiment can have
+but a faint conception how difficult it is to obtain the exact truth
+respecting any occurrence in which feelings and interests are
+concerned.  Omitting particulars, then, I content myself with
+remarking, generally, that from more than one district I have
+received accounts of the prevalence of puerperal fever in the
+practice of some individuals, while its occurrence in that of others,
+in the same neighborhood, was not observed.  Some, as I have been
+told, have lost ten, twelve, or a greater number of patients, in
+scarcely broken succession; like their evil genius, the puerperal
+fever has seemed to stalk behind them wherever they went.  Some have
+deemed it prudent to retire for a time from practice.  In fine, that
+this fever may occur spontaneously, I admit; that its infectious
+nature may be plausibly disputed, I do not deny; but I add,
+considerately, that in my own family I had rather that those I
+esteemed the most should be delivered, unaided, in a stable, by the
+manger-side, than that they should receive the best help, in the
+fairest apartment, but exposed to the vapors of this pitiless
+disease.  Gossiping friends, wet-nurses, monthly nurses, the
+practitioner himself, these are the channels by which, as I suspect,
+the infection is principally conveyed."
+
+At a meeting of the Royal Medical and Chirurgical Society, Dr. King
+mentioned that some years since a practitioner at Woolwich lost
+sixteen patients from puerperal fever in the same year.  He was
+compelled to give up practice for one or two years, his business
+being divided among the neighboring practitioners.  No case of
+puerperal fever occurred afterwards, neither had any of the
+neighboring surgeons any cases of this disease.
+
+At the same meeting Mr. Hutchinson mentioned the occurrence of three
+consecutive cases of puerperal fever, followed subsequently by two
+others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]
+
+Dr. Lee makes the following statement: "In the last two weeks of
+September, 1827, five fatal cases of uterine inflammation came under
+our observation.  All the individuals so attacked had been attended
+in labor by the same midwife, and no example of a febrile or
+inflammatory disease of a serious nature occurred during that period
+among the other patients of the Westminster General Dispensary, who
+had been attended by the other midwives belonging to that
+institution."
+
+The recurrence of long series of cases like those I have cited,
+reported by those most interested to disbelieve in contagion,
+scattered along through an interval of half a century, might have
+been thought sufficient to satisfy the minds of all inquirers that
+here was something more than a singular coincidence.  But if, on a
+more extended observation, it should be found that the same ominous
+groups of cases clustering about individual practitioners were
+observed in a remote country, at different times, and in widely
+separated regions, it would seem incredible that any should be found
+too prejudiced or indolent to accept the solemn truth knelled into
+their ears by the funeral bells from both sides of the ocean,--the
+plain conclusion that the physician and the disease entered, hand in
+hand, into the chamber of the unsuspecting patient.
+
+That such series of cases have been observed in this country, and in
+this neighborhood, I proceed to show.
+
+In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited
+from Dr. Hosack, in which he refers to certain puerperal cases which
+proved fatal to several lying-in women, and in some of which the
+disease was supposed to be conveyed by the accoucheurs themselves.
+
+A writer in the "New York Medical and Physical Journal" for October,
+1829, in speaking of the occurrence of puerperal fever, confined to
+one man's practice, remarks, "We have known cases of this kind occur,
+though rarely, in New York."
+
+I mention these little hints about the occurrence of such cases,
+partly because they are the first I have met with in American medical
+literature, but more especially because they serve to remind us that
+behind the fearful array of published facts there lies a dark list of
+similar events, unwritten in the records of science, but long
+remembered by many a desolated fireside.
+
+Certainly nothing can be more open and explicit than the account
+given by Dr. Peirson of Salem, of the cases seen by him.  In the
+first nineteen days of January, 1829, he had five consecutive cases
+of puerperal fever, every patient he attended being attacked, and the
+three first cases proving fatal.  In March of 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, "I am not
+informed that a single case had occurred in the practice of any other
+physician.  Since that period I have had no fatal case in my
+practice, although I have had several dangerous cases.  I have
+attended in all twenty cases of this disease, of which four have been
+fatal.  I am not aware that there has been any other case in the town
+of distinct puerperal peritonitis, although I am willing to admit my
+information may be very defective on this point.  I have been told of
+some I 'mixed cases,' and 'morbid affections after delivery.'"
+
+In the "Quarterly Summary of the Transactions of the College of
+Physicians of Philadelphia" may be found some most extraordinary
+developments respecting a series of cases occurring in the practice
+of a member of that body.
+
+Dr. Condie called the attention of the Society to the prevalence, at
+the present time, of puerperal fever of a peculiarly insidious and
+malignant character.  "In the practice of one gentleman extensively
+engaged as an obstetrician, nearly every female he has attended in
+confinement, during several weeks past, within the above limits" (the
+southern sections and neighboring districts), "had been attacked by
+the fever."
+
+"An important query presents itself, the Doctor observed, in
+reference to the particular form of fever now prevalent.  Is it,
+namely, capable of being propagated by contagion, and is a physician
+who has been in attendance upon a case of the disease warranted in
+continuing, without interruption, his practice as an obstetrician?
+Dr. C., although not a believer in the contagious character of many
+of those affections generally supposed to be propagated in this
+manner, has nevertheless become convinced by the facts that have
+fallen under his notice, that the puerperal fever now prevailing is
+capable of being communicated by contagion.  How otherwise can be
+explained the very curious circumstance of the disease in one
+district being exclusively confined to the practice of a single
+physician, a Fellow of this College, extensively engaged in
+obstetrical practice,--while no instance of the disease has occurred
+in the patients under the care of any other accoucheur practising
+within the same district; scarcely a female that has been delivered
+for weeks past has escaped an attack?"
+
+Dr. Rutter, the practitioner referred to, "observed that, after the
+occurrence of a number of cases of the disease in his practice, he
+had left the city and remained absent for a week, but on returning,
+no article of clothing he then wore having been used by him before,
+one of the very first cases of parturition he attended was followed
+by an attack of the fever, and terminated fatally; he cannot,
+readily, therefore, believe in the transmission of the disease from
+female to female, in the person or clothes of the physician."
+
+The meeting at which these remarks were made was held on the 3d of
+May, 1842.  In a letter dated December 20, 1842, addressed to Dr.
+Meigs, and to be found in the "Medical Examiner,"  he speaks of
+"those horrible cases of puerperal fever, some of which you did me
+the favor to see with me during the past summer," and talks of his
+experience in the disease, "now numbering nearly seventy cases, all
+of which have occurred within less than a twelvemonth past."
+
+And Dr. Meigs asserts, on the same page, "Indeed, I believe that his
+practice in that department of the profession was greater than that
+of any other gentleman, which was probably the cause of his seeing a
+greater number of the cases."  This from a professor of midwifery,
+who some time ago assured a gentleman whom he met in consultation,
+that the night on which they met was the eighteenth in succession
+that he himself had been summoned from his repose, seems hardly
+satisfactory.
+
+I must call the attention of the inquirer most particularly to the
+(Quarterly Report above referred to, and the letters of Dr. Meigs and
+Dr. Rutter, to be found in the "Medical Examiner."  Whatever
+impression they may produce upon his mind, I trust they will at least
+convince him that there is some reason for looking into this
+apparently uninviting subject.
+
+At a meeting of the College of Physicians just mentioned, Dr.
+Warrington stated, that a few days after assisting at an autopsy of
+puerperal peritonitis, in which he laded out the contents of the
+abdominal cavity with his hands, he was called upon to deliver three
+women in rapid succession.  All of these women were attacked with
+different forms of what is commonly called puerperal fever.  Soon
+after these he saw two other patients, both on the same day, with the
+same disease.  Of these five patients two died.
+
+At the same meeting, Dr. West mentioned a fact related to him by Dr.
+Samuel Jackson of Northumberland.  Seven females, delivered by Dr.
+Jackson in rapid succession, while practising in Northumberland
+County, were all attacked with puerperal fever, and five of them
+died.  "Women," he said, "who had expected me to attend upon them,
+now becoming alarmed, removed out of my reach, and others sent for a
+physician residing several miles distant.  These women, as well as
+those attended by midwives; all did well; nor did we hear of any
+deaths in child-bed within a radius of fifty miles, excepting two,
+and these I afterwards ascertained to have been caused by other
+diseases."  He underwent, as he thought, a thorough purification, and
+still his next patient was attacked with the disease and died.  He
+was led to suspect that the contagion might have been carried in the
+gloves which he had worn in attendance upon the previous cases.  Two
+months or more after this he had two other cases.  He could find
+nothing to account for these, unless it were the instruments for
+giving enemata, which had been used in two of the former cases, and
+were employed by these patients.  When the first case occurred, he
+was attending and dressing a limb extensively mortified from
+erysipelas, and went immediately to the accouchement with his clothes
+and gloves most thoroughly imbued with its efluvia.  And here I may
+mention, that this very Dr. Samuel Jackson of Northumberland is one
+of Dr. Dewees's authorities against contagion.
+
+The three following statements are now for the first time given to
+the public.  All of the cases referred to occurred within this State,
+and two of the three series in Boston and its immediate vicinity.
+
+I.  The first is a series of cases which took place during the last
+spring in a town at some distance from 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 physician during the
+period referred to.  "They were all attended by him until their
+termination, with the exception of the patient No.  6, who fell into
+the hands 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-named periods, none of which, however,
+presented any peculiar symptoms of the disease.
+
+About the 1st of July he attended another patient in a neighboring
+village, who died two or three days after delivery.
+
+The first patient, it is stated, was delivered on the 20th of March.
+"On the 19th, Dr. C. made the autopsy of a man who died suddenly,
+sick only forty-eight hours; had oedema of the thigh, and gangrene
+extending from a little above the ankle into the cavity of the
+abdomen."  Dr. C. wounded himself, very slightly, in the right hand
+during the autopsy.  The hand was quite painful the night following,
+during his attendance on the patient No. 1.  He did not see this
+patient after the 20th, being confined to the house, and very sick
+from the wound just mentioned, from this time until the 3d of April.
+
+Several cases of erysipelas occurred in the house where the autopsy
+mentioned above took place, soon after the examination.  There were
+also many cases of erysipelas in town at the time of the fatal
+puerperal cases 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 sore throat and erysipelas, and died in
+ten days from the first attack.
+
+The nurse who laid out the body of the patient No. 4 was taken on the
+day following with symptoms like those of this patient, and died in a
+week, without any external marks of erysipelas.
+
+"No other cases of similar character with those of Dr. C. occurred in
+the practice of any of the physicians in the town or vicinity at the
+time.  Deaths following confinement have occurred in the practice of
+other physicians during the past year, but they were not cases of
+puerperal fever.  No post-mortem examinations were held in any of
+these puerperal cases."
+
+Some additional statements in this letter are deserving of insertion.
+
+"A physician attended a woman in the immediate neighborhood 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 doubtful
+whether this should be considered a case of puerperal fever.  She had
+suffered from canker, indigestion, and diarrhoea for a year previous
+to her delivery.  Her complaints were much aggravated for two or
+three months previous to delivery; she had become greatly emaciated,
+and weakened to such an extent that it had not been expected that she
+would long survive her confinement, if indeed she reached that
+period.  Her labor was easy enough; she flowed a good deal, seemed
+exceedingly prostrated, had ringing in the ears, and other symptoms
+of exhaustion; the pulse was quick and small.  On the second and
+third day there was some tenderness and tumefaction of the abdomen,
+which increased somewhat on the fourth and fifth.  He had cases in
+midwifery before and after this, which presented nothing peculiar."
+
+It is also mentioned in the same letter, that another physician had a
+case during the last summer and another last fall, both of which
+recovered.
+
+Another gentleman reports a case last December, a second case five
+weeks, and another three weeks since.  All these recovered.  A case
+also occurred very recently in the practice of a physician in the
+village where the eighth patient of Dr. C. resides, which proved
+fatal.  "This patient had some patches of erysipelas on the legs and
+arms.  The same physician has delivered three cases since, which have
+all done well.  There have been no other cases in this town or its
+vicinity recently.  There have been some few cases of erysipelas."
+It deserves notice that the partner of Dr. C., who attended the
+autopsy of the man above mentioned and took an active part in it; who
+also suffered very slightly from a prick under the thumb-nail
+received during the examination, had twelve cases of midwifery
+between March 26th and April 12th, all of which did well, and
+presented no peculiar symptoms.  It should also be stated, that
+during these seventeen days he was in attendance on all the cases of
+erysipelas in the house where the autopsy had been performed.
+
+I owe these facts to the prompt kindness of a gentleman whose
+intelligence and character are sufficient guaranty for their
+accuracy.
+
+The two following letters were addressed to my friend Dr. Scorer, by
+the gentleman in whose practice the cases of puerperal fever
+occurred.  His name renders it unnecessary to refer more particularly
+to these gentlemen, who on their part have manifested the most
+perfect freedom and courtesy in affording these accounts of their
+painful experience.
+
+
+"January 28, 1843.
+
+II.  .  .  .  "The time to which you allude was in 1830.  The first
+case was in February, during a very cold time.  She was confined the
+4th, and died the 12th.  Between the 10th and 28th of this month, I
+attended six women in labor, all of whom did well except the last, as
+also two who were confined March 1st and 5th.  Mrs. E., confined
+February 28th, sickened, and died March 8th.  The next day, 9th, I
+inspected the body, and the night after attended a lady, Mrs. B., who
+sickened, and died 16th.  The 10th, I attended another, Mrs. G., who
+sickened, but recovered.  March 16th, I went from Mrs. G.'s room to
+attend a Mrs. H., who sickened, and died 21st.  The 17th, I inspected
+Mrs. B.  On the 19th, I went directly from Mrs. H.'s room to 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
+attended another woman, who was not sick.  Up to 20th of this month I
+wore the same clothes.  I now refused to 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.  The others were from two to three miles apart, and nearly
+that distance from my residence.  There were no other cases in their
+immediate vicinity which came to my knowledge.  The general health of
+all the women was pretty good, and all the labors as good as common,
+except the first.  This woman, in consequence of my not arriving in
+season, and the child being half-born at some time before I arrived,
+was very much exposed to the cold at the time of confinement, and
+afterwards, 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 had puerperal fever, one
+very badly, the other not so badly.  Both recovered.  One other had
+swelled leg, or phlegmasia dolens, and one or two others did not
+recover as well as usual.
+
+"In the summer of 1835 another disastrous period occurred in my
+practice.  July 1st, I attended a lady in labor, who was afterwards
+quite ill and feverish; but at the time I did not consider her case a
+decided puerperal fever.  On the 8th, I attended one who did well.
+On the 12th, one who was seriously sick.  This was also an equivocal
+case, apparently arising from constipation and irritation of the
+rectum.  These women were ten miles apart and five from my residence.
+On 15th and 20th, two who did well.  On 25th, I attended another.
+This was a severe labor, and followed by unequivocal puerperal fever,
+or peritonitis.  She recovered.  August 2d and 3d, in about twenty-
+four hours I attended four persons.  Two of them did very well; one
+was attacked with some of the common symptoms, which however subsided
+in a day or two, and the other had decided puerperal fever, but
+recovered.  This woman resided five miles from me.  Up to this time I
+wore the same coat.  All my other clothes had frequently been
+changed.  On 6th, I attended two women, one of whom was not sick at
+all; but the other, Mrs. L., was afterwards taken ill.  On 10th, I
+attended a lady, who did very well.  I had previously changed all my
+clothes, and had no garment on which had been in a puerperal room.
+On 12th, I was called to Mrs. S., in labor.  While she was ill, I
+left her to visit Mrs. L., one of the ladies who was confined on 6th.
+Mrs. L.  had been more unwell than usual, but I had not considered
+her case anything more than common till this visit.  I had on a
+surtout at this visit, which, on my return to Mrs.  S., I left in
+another room.  Mrs. S.  was delivered on 13th with forceps.  These
+women both died of decided puerperal fever.
+
+"While I attended these women in their fevers, I changed my clothes,
+and washed my hands in a solution of chloride of lime after each
+visit.  I attended seven women in labor during this period, all of
+whom recovered without sickness.
+
+"In my practice I have had several single cases of puerperal fever,
+some of whom have died and some have recovered.  Until the year 1830
+I had no suspicion that the disease could be communicated from one
+patient to another by a nurse or midwife; but I now think the
+foregoing facts strongly favor that idea.  I was so much convinced of
+this fact, that I adopted the plan before related.
+
+"I believe my own health was as good as usual at each of the above
+periods.  I have no recollections to the contrary.
+
+"I believe I have answered all your questions.  I have been more
+particular on some points perhaps than necessary; but I thought you
+could form your own opinion better than to take mine.  In 1830 I
+wrote to Dr. Charming a more particular statement of my cases.  If I
+have not answered your questions sufficiently, perhaps Dr. C.  may
+have my letter to him, and you can find your answer there." [In a
+letter to myself, this gentleman also stated, "I do not recollect
+that there was any erysipelas or any other disease particularly
+prevalent at the time."]
+
+
+"BOSTON, February 3, 1843.
+
+III.  "MY DEAR SIR,--I received a note from you last evening,
+requesting me to answer certain questions therein proposed, touching
+the cases of puerperal fever which came under my observation the past
+summer.  It gives me pleasure to comply with your request, so far as
+it is in my power so to do, but, owing to the hurry in preparing for
+a journey, the notes of the cases I had then taken were lost or
+mislaid.  The principal facts, however, are too vivid upon my
+recollection to be soon forgotten.  I think, therefore, that I shall
+be able to give you all the information you may require.
+
+"All the cases that occurred in my practice took place between the
+7th of May and the 17th of June 1842.
+
+"They were not confined to any particular part of the city.  The
+first two cases were patients residing at the South End, the next was
+at the extreme North End, one living in Sea Street and the other in
+Roxbury.  The following is the order in which they 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 the circumstances.  She died on the 10th.
+
+"Case 2.  Mrs._____  was confined on the 10th of June (four weeks
+after Mrs.  C.), at 11 A. M., after a natural, but somewhat severe
+labor of five 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
+until the 18th, when symptoms of puerperal fever were manifest.  She
+died on the 20th.
+
+"Case 4.  Mrs._____ , confined June 17th, at 5 o'clock, A.  M., was
+doing well 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 of
+June, at 6 o'clock in the evening.  This patient had been attacked
+with puerperal fever, at three of her previous confinements, but the
+disease yielded to depletion and other remedies without difficulty.
+This time, I regret to say, I was not so fortunate.  She was not
+attacked, as were the other 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 she died in great distress on the
+22d of the same month.  Owing to the extreme heat of the season, and
+my own indisposition, none of the subjects were examined after death.
+Dr. Channing, who was in attendance with me on the three last cases,
+proposed to have a post-mortem examination of the subject of case No.
+5, but from some cause which I do not now recollect it was not
+obtained.
+
+"You wish to know whether I wore the same clothes when attending the
+different cases.  I cannot positively say, but I should think I did
+not, as the weather became warmer after the first two cases; I
+therefore think it probable that I made a change of at least a part
+of my dress.  I have had no other case of puerperal fever in my own
+practice for three years, save those above related, and I do not
+remember to have lost a patient before with this disease.  While
+absent, last July, I visited two patients sick with puerperal fever,
+with a friend of mine in the country.  Both of them recovered.
+
+"The cases that I have recorded were not confined to any particular
+constitution or temperament, but it seized upon the strong and the
+weak, the old and the young,--one being over forty years, and the
+youngest under eighteen years of age .  .  .  .  If the disease is of
+an erysipelatous nature, as many suppose, contagionists may perhaps
+find some ground for their belief in the fact, that, for two weeks
+previous to my first case of puerperal fever, I had been attending a
+severe case of erysipelas, and the infection may have been conveyed
+through me to the patient; but, on the other hand, why is not this
+the case with other physicians, or with the same physician at all
+times, for since my return from the country I have had a more
+inveterate case of erysipelas than ever before, and no difficulty
+whatever has attended any of my midwifery cases?"
+
+
+I am assured, on unquestionable authority, that "About three years
+since, a gentleman in extensive midwifery business, in a neighboring
+State, lost in the course of a few weeks eight patients in child-bed,
+seven of them being undoubted cases of puerperal fever.  No other
+physician of the town lost a single patient of this disease during
+the same period."  And from what I have heard in conversation with
+some of our most experienced practitioners, I am inclined to think
+many cases of the kind might be brought to light by extensive
+inquiry.
+
+
+This long catalogue of melancholy histories assumes a still darker
+aspect when we remember how kindly nature deals with the parturient
+female, when she is not immersed in the virulent atmosphere of an
+impure lying-in hospital, or poisoned in her chamber by the
+unsuspected breath of contagion.  From all causes together, not more
+than four deaths in a thousand births and miscarriages happened in
+England and Wales during the period embraced by the first Report of
+the Registrar-General."  In the second Report the mortality was shown
+to be about five in one 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 from this disease in 278 cases, or between
+three and four to the thousand a yet during this period the disease
+was endemic in the hospital, and might have gone on to 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 cases that are to be
+ascribed to the self-acting system of propagation, it would seem that
+the disease must be far from common.  Mr. White of Manchester says,
+"Out of the whole number of lying-in patients whom I have delivered
+(and I may safely call it a great one), I have never lost one, nor to
+the best of my recollection has one been greatly endangered, by the
+puerperal, miliary, low nervous, putrid malignant, or milk fever."
+Dr. Joseph Clarke informed Dr. Collins, that in the course of forty-
+five years' most extensive practice he lost but four patients from
+this disease.  One of the most eminent practitioners of Glasgow, who
+has been engaged in very extensive practice for upwards of a quarter
+of a century, testifies that he never saw more than twelve cases of
+real puerperal fever.[Lancet, May 4, 1833]
+
+I have myself been told by two gentlemen practising in this city, and
+having for many years a large midwifery business, that they had
+neither of them lost a patient from this disease, and by one of them
+that he had only seen it in consultation with other physicians.  In
+five hundred cases of midwifery, of which Dr. Storer has given an
+abstract in the first number of this Journal, there was only one
+instance of fatal puerperal peritonitis.
+
+In the view of these facts, it does appear a singular coincidence,
+that one man or woman should have ten, twenty, thirty, or seventy
+cases of this rare disease following his or her footsteps with the
+keenness of a beagle, through the streets and lanes of a crowded
+city, while the scores that cross the same paths on the same errands
+know it only by name.  It is a series of similar coincidences which
+has led us to consider the dagger, the musket, and certain innocent-
+looking white powders as having some little claim to be regarded as
+dangerous.  It is the practical inattention to similar coincidences
+which has given rise to the unpleasant but often necessary documents
+called indictments, which has sharpened a form of the cephalotome
+sometimes employed in the case of adults, and adjusted that
+modification of the fillet which delivers the world of those who
+happen to be too much in the way while such striking coincidences are
+taking place.
+
+I shall now mention a few instances in which the disease appears to
+have been conveyed by the process of direct inoculation.
+
+Dr. Campbell of Edinburgh states that in October, 1821, he assisted
+at the post-mortem examination of a patient who died with puerperal
+fever.  He carried the pelvic viscera in his pocket to the class-
+room.  The same evening he attended a woman in labor without
+previously 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 with the disease within a few weeks, three
+shared the same fate in succession.
+
+In June, 1823, he assisted some of his pupils at the autopsy of a
+case of puerperal fever.  He was unable to wash his hands with proper
+care, for want of the necessary accommodations.  On getting home he
+found that two patients required his assistance.  He went without
+further ablution, or changing his clothes; both these patients died
+with puerperal fever.  This same Dr. Campbell is one of Dr.
+Churchill's authorities against contagion.
+
+Mr. Roberton says that in one instance within his knowledge a
+practitioner passed the catheter for a patient with puerperal fever
+late in the evening; the same night he attended a lady who had the
+symptoms of the disease on the second day.  In another instance a
+surgeon was called while in the act of inspecting the body of a woman
+who had died of this fever, to attend a labor; within forty-eight
+hours this patient was seized with the fever.'
+
+On the 16th of March, 1831, a medical practitioner examined the body
+of a woman who had died a few days after delivery, from puerperal
+peritonitis.  On the evening of the 17th he delivered a patient, who
+was seized with puerperal fever on the 19th, and died on the 24th.
+Between this period and the 6th of April, the same practitioner
+attended two other patients, both of whom were attacked with the same
+disease and died.
+
+In the autumn of 1829 a physician was present at the examination of a
+case of puerperal fever, dissected out the organs, and assisted in
+sewing up the body.  He had scarcely reached home when he was
+summoned to attend a young lady in labor.  In sixteen hours she was
+attacked with the symptoms of puerperal fever, and narrowly escaped
+with her life.
+
+In December, 1830, a midwife, who had attended two fatal cases of
+puerperal fever at the British Lying-in Hospital, examined a patient
+who had just been admitted, to ascertain if labor had commenced.
+This patient remained two days in the expectation that labor would
+come on, when she returned home and was then suddenly taken in labor
+and delivered before she could set out for the hospital.  She went on
+favorably for two days, and was then taken with puerperal fever and
+died in thirty-six hours.
+
+"A young practitioner, contrary to advice, examined the body of a
+patient who had died from puerperal fever; there was no epidemic at
+the time; the case appeared to be purely sporadic.  He delivered
+three other women shortly afterwards; they all died with puerperal
+fever, the symptoms of which broke out very soon after labor.  The
+patients of his colleague did well, except one, where he assisted to
+remove some coagula from the uterus; she was attacked in the same
+manner as those whom he had attended, and died also."  The writer in
+the "British and Foreign Medical Review," from whom I quote this
+statement,--and who is no other than Dr. Rigby, adds, "We trust that
+this fact alone will forever silence such doubts, and stamp the well-
+merited epithet of 'criminal,' as above quoted, upon such attempts."
+[Brit.  and For.  Medical Review for Jan.  1842, p.  112.]
+
+>From the cases given by Mr. Ingleby, I select the following.  Two
+gentlemen, after having been engaged in conducting the post-mortem
+examination of a case of puerperal fever, went in the same dress,
+each respectively, to a case of midwifery.  "The one patient was
+seized  with the rigor about thirty hours afterwards.  The other
+patient was seized with a rigor the third morning after delivery.
+One recovered, one died." [Edin.  Med.  and Surg.  Journal, April,
+1838.]
+
+One of these same gentlemen attended another woman in the same
+clothes two days after the autopsy referred to.  "The rigor did not
+take place until the evening of the fifth day from the first visit.
+Result fatal."  These cases belonged to a series of seven, the first
+of which was thought to have originated in a case of erysipelas.
+"Several cases of a mild character followed the foregoing seven, and
+their nature being now most unequivocal, my friend declined visiting
+all midwifery cases for a time, and there was no recurrence of the
+disease."  These cases occurred in 1833.  Five of them proved fatal.
+Mr. Ingleby gives another series of seven eases which occurred to a
+practitioner in 1836, the first of which was also attributed to his
+having opened several erysipelatous abscesses a short time
+previously.
+
+I need not refer to the case lately read before this Society, in
+which a physician went, soon after performing an autopsy of a case of
+puerperal fever, to a woman in labor, who was seized with the same
+disease and perished.  The forfeit of that error has been already
+paid.
+
+At a meeting of the Medical and Chirurgical Society before referred
+to, Dr. Merriman related an instance occurring in his own practice,
+which excites a reasonable suspicion that two lives were sacrificed
+to a still less dangerous experiment.  He was at the examination of a
+case of puerperal fever at two o'clock in the afternoon.  He took
+care not to touch the body.  At nine o'clock the same evening he
+attended a woman in labor; she was so nearly delivered that he had
+scarcely anything to do.  The next morning she had severe rigors, and
+in forty-eight hours she was a corpse.  Her infant had erysipelas and
+died 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 often fatal effects which have
+followed from wounds received in the post-mortem examination of
+patients who have died of puerperal fever.  The fact that such wounds
+are attended with peculiar risk has been long noticed.  I find that
+Chaussier was in the habit of cautioning his students against the
+danger to which they were exposed in these dissections. [Stein, L'Art
+d'Accoucher, 1794; Dict. des Sciences Medicales, art.  "Puerperal."]
+The head pharmacien of the Hotel Dieu, in his analysis of the fluid
+effused in puerperal peritonitis, says that practitioners are
+convinced of its deleterious qualities, and that it is very dangerous
+to apply it to the denuded skin. [Journal de Pharmacie, January,
+1836.]  Sir Benjamin Brodie speaks of it as being well known that the
+inoculation of lymph or pus from the peritoneum of a puerperal
+patient is often attended with dangerous and even fatal symptoms.
+Three cases in confirmation of this statement, two of them fatal,
+have been reported to this Society within a few months.
+
+Of about fifty cases of injuries of this kind, of various degrees of
+severity, which I have collected from different sources, at least
+twelve were instances of infection from puerperal peritonitis.  Some
+of the others are so stated as to render it probable that they may
+have been of the same nature.  Five other cases were of peritoneal
+inflammation; three in males.  Three were what was called enteritis,
+in one instance complicated with erysipelas; but it is well known
+that this term has been often used to signify inflammation of the
+peritoneum covering the intestines.  On the other hand, no case of
+typhus or typhoid fever is mentioned as giving rise to dangerous
+consequences, with the exception of the single instance of an
+undertaker mentioned by Mr. Travers, who seems to have been poisoned
+by a fluid which exuded from the body.  The other accidents were
+produced by dissection, or some other mode of contact with bodies of
+patients who had died of various affections.  They also differed much
+in severity, the cases of puerperal origin being among the most
+formidable and fatal.  Now a moment's reflection will show that the
+number of cases of serious consequences ensuing from the dissection
+of the bodies of those who had perished of puerperal fever is so
+vastly disproportioned to the relatively small number of autopsies
+made in this complaint as compared with typhus or pneumonia (from
+which last disease not one case of poisoning happened), and still
+more from all diseases put together, that the conclusion is
+irresistible that a most fearful morbid poison is often generated in
+the course of this 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 following statement of Dr.
+Rigby.  "That the discharges from a patient under puerperal fever are
+in the highest degree contagious we have abundant evidence in the
+history of lying-in hospitals.  The puerperal abscesses are also
+contagious, and may be communicated to healthy lying-in women by
+washing with the same sponge; this fact has been repeatedly proved in
+the Vienna Hospital; but they are equally communicable to women not
+pregnant; on more than one occasion the women engaged in washing the
+soiled bed-linen of the General Lying-in Hospital have been attacked
+with abscess in the fingers or hands, attended with rapidly spreading
+inflammation of the cellular tissue."
+
+Now add to all this the undisputed fact, that within the walls of
+lying-in hospitals there is often generated a miasm, palpable as the
+chlorine used to destroy it, tenacious so as in some cases almost to
+defy extirpation, deadly in some institutions as the plague; which
+has killed women in a private hospital of London so fast that they
+were buried two in one coffin to conceal its horrors; which enabled
+Tonnelle to record two hundred and twenty-two autopsies at the
+Maternite of Paris; which has led Dr. Lee to express his deliberate
+conviction that the loss of life occasioned by these institutions
+completely defeats the objects of their founders; and out of this
+train of cumulative evidence, the multiplied groups of cases
+clustering about individuals, the deadly results of autopsies, the
+inoculation by fluids from the living patient, the murderous poison
+of hospitals, -does there not result a conclusion that laughs all
+sophistry to scorn, and renders all argument an insult?
+
+I have had occasion to mention some instances in which there was an
+apparent relation between puerperal fever and erysipelas.  The length
+to which this paper has extended does not allow me to enter into the
+consideration of this most important subject.  I will only say, that
+the evidence appears to me altogether satisfactory that some most
+fatal series of puerperal fever have been produced by an infection
+originating in the matter or effluvia of erysipelas.  In evidence of
+some connection between the two diseases, I need not go back to the
+older authors, as Pouteau or Gordon, but will content myself with
+giving the following references, with their dates; from which it will
+be seen that the testimony has been constantly coming before the
+profession for the last few years.
+
+"London Cyclopaedia of Practical Medicine," article Puerperal Fever,
+1833.
+
+Mr. Ceeley's Account of the Puerperal Fever at Aylesbury.  "Lancet,"
+1835.
+
+Dr. Ramsbotham's Lecture.  "London Medical Gazette," 1835.
+
+Mr. Yates Ackerly's Letter in the same Journal, 1838.
+
+Mr. Ingleby on Epidemic Puerperal Fever.  "Edinburgh Medical and
+Surgical Journal," 1838.
+
+Mr. Paley's Letter.  "London Medical Gazette," 1839.
+
+Remarks at the Medical and Chirurgical Society. "Lancet," 1840.
+
+Dr. Rigby's "System of Midwifery."  1841.
+
+"Nunneley on Erysipelas,"--a work which contains a large number of
+references on the subject.  1841.
+
+"British and Foreign Quarterly Review," 1842.
+
+Dr. S.  Jackson of Northumberland, as already quoted from the Summary
+of the College of Physicians, 1842.
+
+And lastly, a startling series of cases by Mr. Storrs of Doncaster,
+to be, found in the "American Journal of the Medical Sciences" for
+January, 1843.
+
+The relation of puerperal fever with other continued fevers would
+seem to be remote and rarely obvious.  Hey refers to two cases of
+synochus occurring in the Royal Infirmary of Edinburgh, in women who
+had attended upon puerperal patients.  Dr. Collins refers to several
+instances in which puerperal fever has appeared to originate from a
+continued proximity to patients suffering with typhus.
+
+Such occurrences as those just mentioned, though most important to be
+remembered and guarded against, hardly attract our notice in the
+midst of the gloomy facts by which they are surrounded.  Of these
+facts, at the risk of fatiguing repetitions, I have summoned a
+sufficient number, as I believe, to convince the most incredulous
+that every attempt to disguise the truth 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 to have found puerperal fever contagious.  At
+the most they give us mere negative facts, worthless against an
+extent of evidence which now overlaps the widest range of doubt, and
+doubles upon itself in the redundancy of superfluous demonstration.
+Examined in detail, this and much of the show of testimony brought up
+to 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.  Nor do I feel the necessity of enforcing
+the conclusion which arises spontaneously from the facts which have
+been enumerated, by formally citing the opinions of those grave
+authorities who have for the last half-century been sounding the
+unwelcome truth it has cost so many lives to establish.
+
+"It is to the British practitioner," says Dr. Rigby, "that we are
+indebted for strongly insisting upon this important and dangerous
+character of puerperal fever."
+
+The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
+Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
+Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson,
+many of whose writings I have already referred to, may have some
+influence with those who prefer the weight of authorities to the
+simple deductions of their own reason from the facts laid before
+them.  A few Continental writers have adopted similar conclusions. It
+gives me pleasure to remember, that while the doctrine has been
+unceremoniously discredited in one of the leading Journals, and made
+very light of by teachers in two of the principal Medical Schools, of
+this country, Dr. Channing has for many years inculcated, and
+enforced by examples, the danger to be apprehended and the
+precautions to be taken in the disease under consideration.
+
+I have no wish to express any harsh feeling with regard to the
+painful subject which has come before us.  If there are any so far
+excited by the story of these dreadful events that they ask for some
+word of indignant remonstrance to show that science does not turn the
+hearts of its followers into ice or stone, let me remind them that
+such words have been uttered by those who speak with an authority I
+could not claim.  It is as a lesson rather than as a reproach that I
+call up the memory of these irreparable errors and wrongs.  No tongue
+can tell the heart-breaking calamity they have caused; they have
+closed the eyes just 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 the stranger's arms, or bequeathed
+it, with less cruelty, the death of its dying parent.  There is no
+tone deep enough for regret, and no voice loud enough for warning.
+The woman about to become a mother, or with her new-born infant upon
+her bosom, should be the object of trembling care and sympathy
+wherever she bears her tender burden, or stretches her aching limbs.
+The very outcast of the streets has pity upon her sister in
+degradation, when the seal of promised maternity is impressed upon
+her.  The remorseless vengeance of the law, brought down upon its
+victim by a machinery as sure as destiny, is arrested in its fall at
+a word which reveals her transient claim for mercy.  The solemn
+prayer of the liturgy singles out her sorrows from the multiplied
+trials of life, to plead for her in the hour of peril.  God forbid
+that any member of the profession to which she trusts her life,
+doubly precious at that eventful period, should hazard it
+negligently, unadvisedly, or selfishly!
+
+There may be some among those whom I address who are disposed to ask
+the question, What course are we to follow in relation to this
+matter?  The facts are before them, and the answer must be left to
+their own judgment and conscience.  If any should care to know my own
+conclusions, they are the following; and in taking the liberty to
+state them very freely and broadly, I would ask the inquirer to
+examine them as freely in the light of the evidence which has been
+laid before him.
+
+1.  A physician holding himself in readiness to attend cases of
+midwifery should never take any active part in the post-mortem
+examination of cases of puerperal fever.
+
+2.  If a physician is present at such autopsies, he should use
+thorough ablution, change every article of dress, and allow twenty-
+four hours or more to elapse before attending to any case of
+midwifery.  It may be well to extend the same caution to cases of
+simple peritonitis.
+
+3.  Similar precautions should be taken after the autopsy or surgical
+treatment of cases of erysipelas, if the physician is obliged to
+unite such offices with his obstetrical duties, which is in the
+highest degree inexpedient.
+
+4.  On the occurrence of a single case of puerperal fever in his
+practice, the physician is bound to consider the next female he
+attends in labor, unless some weeks at least have elapsed, as in
+danger of being infected by him, and it is his duty to take every
+precaution to diminish her risk of disease and death.
+
+5.  If within a short period two cases of puerperal fever happen
+close to each other, in the practice of the same physician, the
+disease not existing or prevailing in the neighborhood, he would do
+wisely to relinquish his obstetrical practice for at least one month,
+and endeavor to free himself by every available means from any
+noxious influence he may carry about with him.
+
+6.  The occurrence of three or more closely connected cases, in the
+practice of one individual, no others existing in the neighborhood,
+and no other sufficient cause being alleged for the coincidence, is
+prima facie evidence that he is the vehicle of contagion.
+
+7.  It is the duty of the physician to take every precaution that the
+disease shall not be introduced by nurses or other assistants, by
+making proper inquiries concerning them, and giving timely warning of
+every suspected source of danger.
+
+8.  Whatever indulgence may be granted to those who have heretofore
+been the ignorant causes of so much misery, the time has come when
+the existence of a private pestilence in the sphere of a single
+physician should be looked upon, not as a misfortune, but a crime;
+and in the knowledge of such occurrences the duties of the
+practitioner to his profession should give way 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 given in the Letter of Mr. Stows, contained in the
+Appendix to this Report.  Mr. Stows suggests precautions similar to
+those I have laid down, and these precautions are 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 puerperal fever 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 than a
+fortnight, seeming to originate in a case of erysipelas.
+
+West's Reports, in Brit.  and For.  Med.  Review for October, 1845,
+and January, 1847.--Affection of the arm, resembling malignant
+pustule, after removing the 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 Journal for
+February, 1846, as showing connection of puerperal fever and
+erysipelas.
+
+Kneeland. --Contagiousness of Puerperal Fever.  Am.  Jour.  Med.
+Se., January, 1846.  Also, Connection between Puerperal Fever and
+Epidemic Erysipelas.  Ibid., April, 1846.
+
+Robert Storrs. --Contagious Effects of Puerperal Fever on the Male
+Subject; or on Persons not Child-bearing.  (From Provincial Med.  and
+Surg.  Journal.) Am.  Jour.  Med.  Sc., January, 184,6.  Numerous
+cases.  See also Dr. Reid's case in same Journal 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 illustrating the Contagious
+Nature of Erysipelas and of Puerperal Fever, and their Intimate
+Pathological Connection.  (From Monthly Journal of Med.  Sc.) Am.
+Jour.  Med.  Se., July, 1850.
+
+Skoda on the Causes of Puerperal Fever.  (Peritonitis in rabbits,
+from inoculation with different morbid secretions.) Am.  Jour.  Med.
+Se., October, 1850.
+
+Arneth.  Paper read before the National Academy of Medicine.  Annales
+d'Hygiene, Tome LXV.  2e Partie.  (Means of Disinfection proposed by
+M.  "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use
+of nail-brush before admission to lying-in wards.  Alleged sudden and
+great decrease of mortality from puerperal fever.  Cause of disease
+attributed to inoculation with cadaveric matters.) See also Routh's
+paper, mentioned above.
+
+Moir.  Remarks at a meeting of the Edinburgh Medico-Chirurgical
+Society.  Refers to cases of Dr. Kellie, of Leith.  Sixteen in
+succession, all fatal.  Also to several instances of individual
+pupils having had a succession of cases in various quarters of the
+town, while others, practising as extensively in the same localities,
+had none.  Also to several special cases not mentioned elsewhere.
+Am.  Jour.  Med.  Se.  for October, 1851.  (From New Monthly Journal
+of Med.  Science.)
+
+Simpson. --Observations at a Meeting of the Edinburgh Obstetrical
+Society.  (An "eminent gentleman," according to Dr.  Meigs, whose
+"name is as well known in America as in (his) native land."
+Obstetrics.  Phil.  1852, pp.  368, 375.) The student is referred to
+this paper for a valuable resume of many of the facts, and the
+necessary inferences, relating to 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 diseased parts.  His next four child-bed patients
+were affected with puerperal fever, and it was the first time he had
+seen it in practice.  As Dr. Simpson is a gentleman (Dr. Meigs, as
+above), and as "a gentleman's hands are clean " (Dr. Meigs' Sixth
+Letter), it follows that a gentleman with clean hands 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 the series.  A practitioner in Leith having
+examined in Dr. Simpson's house, a portion of the uterus obtained
+from one of the patients, had immediately afterwards three fatal
+cases of puerperal fever.  Dr.  Veddie referred to two distinct
+series of consecutive cases in his own practice.  He had since taken
+precautions, and not met with any such cases.  Am.  Jour.  Med.  Sc.,
+October, 1851.
+
+Copland.  Considers it proved that puerperal fever maybe propagated
+by the hands and the clothes, or either, of a third person, the bed-
+clothes or body-clothes of a patient.  Mentions a new series of
+cases, one of which he saw, with the practitioner who had attended
+them.  She was the sixth he had had within a few days.  All died.
+Dr. Copland insisted that contagion had caused these cases; advised
+precautionary measures, and the practitioner had no other cases for a
+considerable time.  Considers it criminal, after the evidence
+adduced,--which he could have quadrupled,--and the weight of
+authority brought forward, for a practitioner to be the medium of
+transmitting contagion and death to his patients.  Dr. Copland lays
+down rules similar to those suggested by myself, and is therefore
+entitled to the same epithet for so doing.  Medical Dictionary, New
+York, 1852.  Article, Puerperal States and Diseases.
+
+If there is any appetite for facts so craving as to be yet
+unappeased,--Lesotho, necdum satiata,--more can be obtained.
+Dr.  Hodge remarks that "the frequency and importance of this
+singular circumstance (that the disease is occasionally more
+prevalent with one practitioner than another) has been exceedingly
+overrated."  More than thirty strings of cases, more than two hundred
+and fifty sufferers from puerperal fever, more than one hundred and
+thirty deaths appear as the results of a sparing estimate of such
+among the facts I have gleaned as could be numerically valued.  These
+facts constitute, we may take it for granted, but a small fraction of
+those that have actually occurred.  The number of them might be
+greater, but "'t is enough, 't will serve," in Mercutio's modest
+phrase, so far as frequency is concerned.  For a just estimate of the
+importance of the singular circumstance, it might 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 Medical Society, at the
+Annual Meeting, May 30, 1860.
+
+               "Facultate magis quam violentia.
+                                   HIPPOCRATES.
+
+Our Annual Meeting never fails to teach us at least one lesson.  The
+art whose province it is to heal and to save cannot protect its own
+ranks from the inroads of disease and the waste of the Destroyer.
+
+Seventeen of our associates have been taken from us since our last
+Anniversary.  Most of them followed their calling in the villages or
+towns that lie among the hills or along the inland streams.  Only
+those who have lived the kindly, mutually dependent life of the
+country, can tell how near the physician who is the main reliance in
+sickness of all the families throughout a thinly settled region comes
+to the hearts of the people among whom he labors, how they value him
+while living, how they cherish his memory when dead.  For these
+friends of ours who have gone before, there is now no more toil; they
+start from their slumbers no more at the cry of pain; they sally
+forth no more into the storms; they ride no longer over the lonely
+roads that knew them so well; their wheels are rusting on their axles
+or rolling with other burdens; their watchful eyes are closed to all
+the sorrows they lived to soothe.  Not one of these was famous in the
+great world; some were almost unknown beyond their own immediate
+circle.  But they have left behind them that loving remembrance which
+is better than fame, and if their epitaphs are chiselled briefly in
+stone, they are written at full length on living tablets in a
+thousand homes to which they carried their ever-welcome aid and
+sympathy.
+
+One whom we have lost, very widely known and honored, was a leading
+practitioner of this city.  His image can hardly be dimmed in your
+recollection, as he stood before you only three years ago, filling
+the same place with which I am now honored.  To speak of him at all
+worthily, would be to write the history of professional success, won
+without special aid at starting, by toil, patience, good sense, pure
+character, and pleasing manners; won in a straight uphill ascent,
+without one breathing-space until he sat down, not to rest, but to
+die.  If prayers could have shielded him from the stroke, if love
+could have drawn forth the weapon, and skill could have healed the
+wound, this passing tribute might have been left to other lips and to
+another generation.
+
+Let us hope that our dead have at last found that rest which neither
+summer nor winter, nor day nor night, had granted to their unending
+earthly labors!  And let us remember that our duties to our brethren
+do not cease when they become unable to share our toils, or leave
+behind them in want and woe those whom their labor had supported.  It
+is honorable to the Profession that it has organized an Association a
+for the relief of its suffering members and their families; it owes
+this tribute to the ill-rewarded industry and sacrifices of its less
+fortunate brothers who wear out health and life in the service of
+humanity.  I have great pleasure in referring to this excellent
+movement, which gives our liberal profession a chance to 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 business after twenty years
+of practice, is apt to suppose that he treats his patients according
+to the teachings of his experience.  No doubt this is true to some
+extent; to what extent depending much on the qualities of the
+individual.  But it is easy to prove that the prescriptions of even
+wise physicians are very commonly founded on something quite
+different from experience.  Experience must be based on the permanent
+facts of nature.  But a glance at the prevalent modes of treatment of
+any two successive generations will show that there is a changeable
+as well as a permanent element in the art of healing; not merely
+changeable as diseases vary, or as new remedies are introduced, but
+changeable by the going out of fashion of special remedies, by the
+decadence of a popular theory from which their fitness was deduced,
+or other cause not more significant.  There is no reason to suppose
+that the present time is essentially different in this respect from
+any other.  Much, therefore, which is now very commonly considered to
+be the result of experience, will be recognized in the next, or in
+some succeeding generation, as no such result at all, but as a
+foregone conclusion, based on some prevalent belief or fashion of the
+time.
+
+There are, of course, in every calling, those who go about the work
+of the day before them, doing it according to the rules of their
+craft, and asking no questions of the past or of the future, or of
+the aim and end to which their special labor is contributing.  These
+often consider and call themselves practical men.  They pull the oars
+of society, and have no leisure to watch the currents running this or
+that way; let theorists and philosophers attend to them.  In the mean
+time, however, these currents are carrying the practical men, too,
+and all their work may be thrown away, and worse than thrown away, if
+they do not take knowledge of them and get out of the wrong ones and
+into the right ones as soon as they may.  Sir Edward Parry and his
+party were going straight towards the pole in one of their arctic
+expeditions, travelling at the rate of ten miles a day.  But the ice
+over which they travelled was drifting straight towards the equator,
+at the rate of twelve miles a day, and yet no man among them would
+have known that he was travelling two miles a day backward unless he
+had lifted his eyes from the track in which he was plodding.  It is
+not only going backward that the plain practical workman is liable
+to, if he will not look up and look around; he may go forward to ends
+he little dreams of.  It is a simple business for a 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 Jewish
+artisan to fit two pieces of timber together according to the legal
+pattern in the time of Pontius Pilate; he asked no questions,
+perhaps, but we know what burden the cross bore on the morrow!  And
+so, with subtler tools than trowels or axes, the statesman who works
+in policy without principle, the theologian who works in forms
+without a soul, the physician who, calling himself a practical man,
+refuses to recognize the larger laws which govern his changing
+practice, may all find that they have been building truth into the
+wall, and hanging humanity upon the cross.
+
+The truth is, that medicine, professedly founded on observation, 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
+straightforward inductive path, without regard to changes of
+government or to fluctuations of public opinion.  But look a moment
+while I clash a few facts together, and see if some sparks do not
+reveal by their light a closer relation between the Medical Sciences
+and the conditions of Society and the general thought of the time,
+than would at first be suspected.
+
+Observe the coincidences between certain great political and
+intellectual periods and the appearance of illustrious medical
+reformers and teachers.  It was in the age of Pericles, of Socrates,
+of Plato, of Phidias, that Hippocrates gave to medical knowledge the
+form which it retained for twenty centuries.  With the world-
+conquering Alexander, the world-embracing Aristotle, appropriating
+anatomy and physiology, among his manifold spoils of study, marched
+abreast of his royal pupil to wider conquests.  Under the same
+Ptolemies who founded the Alexandrian Library and Museum, and ordered
+the Septuagint version of the Hebrew Scriptures, the infallible
+Herophilus ["Contradicere Herophilo in anatomicis, est contradicere
+evangelium," was a saying of Fallopius.] made those six hundred
+dissections of which Tertullian accused him, and the sagacious
+Erasistratus introduced his mild antiphlogistic treatment in
+opposition to the polypharmacy and antidotal practice of his time.
+It is significant that the large-minded Galen should have been the
+physician and friend of the imperial philosopher Marcus Aurelius.
+The Arabs gave laws in various branches of knowledge to those whom
+their arms had invaded, or the terror of their spreading dominion had
+reached, and the point from which they started was, as Humboldt
+acknowledges, "the study of medicine, by which they long ruled the
+Christian Schools," and to which they added the department of
+chemical pharmacy.
+
+Look at Vesalius, the contemporary of Luther.  Who can fail to see
+one common spirit in the radical ecclesiastic and the reforming
+court-physician?  Both still to some extent under the dominion of the
+letter: Luther holding to the real presence; Vesalius actually
+causing to be drawn and engraved two muscles which he knew were not
+found in the human subject, because they had been described by Galen,
+from dissections of the lower animals.  Both breaking through old
+traditions in the search of truth; one, knife in hand, at the risk of
+life and reputation, the other at the risk of fire and fagot, with
+that mightier weapon which all the devils could not silence, though
+they had been thicker than the tiles on the house-tops.  How much the
+physician of the Catholic Charles V. had in common with the great
+religious destructive, may be 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 ill repute, the favorite of a
+monk of the order of St. Anthony, who does not seem to have resisted
+temptation so well as the founder of his order.  We have always
+ranked the physician Rabelais among the early reformers, but I do not
+know that Vesalius has ever been thanked for his hit at the morals of
+the religious orders, or for turning to the good of science what was
+intended for the "benefit of clergy."
+
+Our unfortunate medical brother, Michael Servetus, the spiritual
+patient to whom the theological moxa was applied over the entire
+surface for the cure of his heresy, came very near anticipating
+Harvey.  The same quickened thought of the time which led him to
+dispute the dogma of the Church, opened his mind to the facts which
+contradicted the dogmas of the Faculty.
+
+Harvey himself was but the posthumous child of the great Elizabethan
+period.  Bacon was at once his teacher and his patient.  The founder
+of the new inductive philosophy had only been dead two years when the
+treatise on the Circulation, the first-fruit of the 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 political world, Bichat was
+revolutionizing the science of life and the art that is based upon
+it; that while the young general was scaling the Alps, the young
+surgeon was climbing the steeper summits of unexplored nature; that
+the same year read the announcement of those admirable "Researches on
+Life and Death," and the bulletins of the battle of Marengo?
+
+If we come to our own country, who can fail to recognize that
+Benjamin Rush, the most conspicuous of American physicians, was the
+intellectual offspring of the movement which produced the Revolution?
+"The same hand," says one of his biographers," which subscribed the
+declaration of the political independence of these States,
+accomplished their emancipation from medical systems formed in
+foreign countries, and wholly unsuitable to the state of diseases in
+America."
+
+Following this general course of remark, I propose to indicate in a
+few words the direction of the main intellectual current of the time,
+and to point out more particularly some of the eddies which tend to
+keep the science and art of medicine from moving with it, 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 being in which we live.  Statistics
+have tabulated everything,--population, growth, wealth, crime,
+disease.  We have shaded maps showing the geographical distribution
+of larceny and suicide.  Analysis and classification have been at
+work upon all tangible and visible objects.  The Positive Philosophy
+of Comte has only given expression to the observing and computing
+mind of the nineteenth century.
+
+In the mean time, the great stronghold of intellectual conservatism,
+traditional belief, has been assailed by facts which would have been
+indicted as blasphemy but a few generations ago.  Those new tables of
+the law, placed in the hands of the geologist by the same living God
+who spoke from Sinai to the Israelites of old, have remodelled the
+beliefs of half the civilized world.  The solemn scepticism of
+science has replaced the sneering doubts of witty philosophers.  The
+more positive knowledge we gain, the more we incline to question all
+that has been received without absolute proof.
+
+As a matter of course, this movement has its partial reactions.  The
+province of faith is claimed as a port free of entry to unsupported
+individual convictions.  The tendency to question is met by the
+unanalyzing instinct of reverence.  The old church calls back its
+frightened truants.  Some who have lost their hereditary religious
+belief find a resource in the revelations of Spiritualism.  By a
+parallel movement, some of those who have become medical infidels
+pass over to the mystic band of believers in the fancied miracles of
+Homoeopathy.
+
+Under these influences transmitted to, or at least shared by, the
+medical profession, the old question between "Nature," so called, and
+"Art," or professional tradition, has reappeared with new interest.
+I say the old question, for Hippocrates stated the case on the side
+of "Nature" more than two thousand years ago.  Miss Florence
+Nightingale,--and if I name her next to the august Father of the
+Healing Art, its noblest daughter well deserves that place of honor,
+--Miss Florence Nightingale begins her late volume with a paraphrase
+of his statement.  But from a very early time to this there has
+always been a strong party against "Nature."  Themison called the
+practice of Hippocrates "a meditation upon death."  Dr. Rush says:
+"It is impossible to calculate the mischief which Hippocrates, has
+done, by first marking Nature with his name and afterwards letting
+her loose upon sick people.  Millions have perished by her hands in
+all ages and countries."  Sir John Forbes, whose defence of "Nature"
+in disease you all know, and to the testimonial in whose 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 years sooner, and the opinion that no man had done so
+much to destroy the confidence of the public in the medical
+profession.
+
+In this Society we have had the Hippocratic and the Themisonic side
+fairly represented.  The treatise of one of your early Presidents on
+the Mercurial Treatment is familiar to my older listeners.  Others
+who have held the same office have been noted for the boldness of
+their practice, and even for partiality to the use of complex
+medication.
+
+On the side of "Nature" we have had, first of all, that remarkable
+discourse on Self-Limited Diseases, [On Self-Limited Diseases.  A
+Discourse delivered before the Massachusetts Medical Society, at
+their Annual Meeting, May 27, 1835.  By Jacob Bigelow, M. D.] which
+has given the key-note to the prevailing medical tendency of this
+neighborhood, at least, for the quarter of a century since it was
+delivered.  Nor have we forgotten the address delivered at
+Springfield twenty 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. Worthington Hooker. [Rational Therapeutics.  A
+Prize Essay.  By Worthington Hooker, M.  D., of New Haven.  Boston.
+1857.] We should not omit from the list the important address of
+another of our colleagues, [On the Treatment of Compound and
+Complicated Fractures. By William J.  Walker, M.  D.  Read at the
+Annual Meeting, May 29, 1845.] showing by numerous cases the power of
+Nature in healing compound fractures to be much greater than is
+frequently supposed,--affording, indeed, more striking illustrations
+than can be obtained from the history of visceral disease, of the
+supreme wisdom, forethought, and adaptive dexterity of that divine
+Architect, as shown in repairing the shattered columns which support
+the living temple of the body.
+
+We who are on the side of "Nature" please ourselves with the idea
+that we are in the great current in which the true intelligence of
+the time is moving.  We believe that some who oppose, or fear, or
+denounce our movement are themselves caught in various eddies that
+set back against the truth.  And we do most earnestly desire and most
+actively strive, that Medicine, which, it is painful to remember, has
+been spoken of as "the withered branch of science" at a meeting of
+the British Association, shall be at length brought fully to share,
+if not to lead, the great wave of knowledge which rolls with the
+tides that circle the globe.
+
+If there is any State or city which might claim to be the American
+headquarters of the nature-trusting heresy, provided it be one, that
+State is Massachusetts, and that city is its capital.  The effect
+which these doctrines have upon the confidence reposed in the
+profession is a matter of opinion.  For myself, I do not believe this
+confidence can be impaired by any investigations which tend to limit
+the application of troublesome, painful, uncertain, or dangerous
+remedies.  Nay, I will venture to say this, that if every specific
+were to fail utterly, if the cinchona trees all died out, and the
+arsenic mines were exhausted, and the sulphur regions were burned up,
+if every drug from the vegetable, animal, and mineral kingdom were to
+disappear from the market, a body of enlightened men, organized as a
+distinct profession, would be required just as much as now, and
+respected and trusted as now, whose province should be to guard
+against the causes of disease, to eliminate them if possible when
+still present, to order all the conditions of the patient so as to
+favor the efforts of the system to right itself, and to give those
+predictions of the course of disease which only experience can
+warrant, and which in so many cases relieve the exaggerated fears of
+sufferers and their friends, or warn them in season of impending
+danger.  Great as the loss would be if certain active remedies could
+no longer be obtained, it would leave the medical profession the most
+essential part of it's duties, and all, and more than all, its
+present share of honors; for it would be the death-blow to
+charlatanism, which depends for its success almost entirely on drugs,
+or at least on a nomenclature that suggests them.
+
+There is no offence, then, or danger in expressing the opinion, that,
+after all which has been said, the community is still overdosed: The
+best proof of it is, that no families take so little medicine as
+those of doctors, except those of apothecaries, and that old
+practitioners are more sparing of active medicines than younger
+ones." [Dr. James Jackson has kindly permitted me to make the
+following extract from a letter just received by him from Sir James
+Clark, and dated May 26, 1860:  "As a physician advances in age, he
+generally, I think, places less confidence in the ordinary medical
+treatment than he did, not only during his early, but even his middle
+period of life."]  The conclusion from these facts is one which the
+least promising of Dr. Howe's pupils in the mental department could
+hardly help drawing.
+
+Part of the blame of over-medication must, I fear, rest with the
+profession, for yielding to the tendency to self-delusion, which
+seems inseparable from the practice of the art of healing.  I need
+only touch on the common modes of misunderstanding or misapplying the
+evidence of nature.
+
+First, there is the natural incapacity for sound observation, which
+is like a faulty ear in music.  We see this in many persons who know
+a good deal about books, but who are not sharp-sighted enough to buy
+a horse or deal with human diseases.
+
+Secondly, there is in some persons a singular inability to weigh the
+value of testimony; of which, I think, from a pretty careful
+examination of his books, Hahnemann affords the best specimen outside
+the walls of Bedlam.
+
+The inveterate logical errors to which physicians have always been
+subject are chiefly these:
+
+The mode of inference per enumerationem simplicem, in scholastic
+phrase; that is, counting only their favorable cases.  This is the
+old trick illustrated in Lord Bacon's story of the gifts of the
+shipwrecked people, hung up in the temple. --Behold! they vowed these
+gifts to the altar, and the gods saved them.  Ay, said a doubting
+bystander, but how many made vows of gifts and were shipwrecked
+notwithstanding?  The numerical system is the best corrective of this
+and similar errors.  The arguments commonly brought against its
+application to all matters of medical observation, treatment
+included, seem to apply rather to the tabulation of facts ill
+observed, or improperly classified, than to the method itself.
+
+The post hoc ergo propter hoc error: he got well after taking my
+medicine; therefore in consequence of taking it.
+
+The false induction from genuine facts of observation, leading to the
+construction of theories which are then deductively applied in the
+face of the results of direct observation.  The school of Broussais
+has furnished us with a good example of this error.
+
+And lastly, the error which Sir Thomas Browne calls giving "a reason
+of the golden tooth;" that is, assuming a falsehood as a fact, and
+giving reasons for it, commonly fanciful ones, as is constantly done
+by that class of incompetent observers who find their "golden tooth"
+in the fabulous effects of the homoeopathie materia medica,--which
+consists of sugar of milk and a nomenclature.
+
+Another portion of the blame rests with the public itself, which
+insists on being poisoned.  Somebody buys all the quack medicines
+that build palaces for the mushroom, say rather, the toadstool
+millionaires.  Who is it?  These people have a constituency of
+millions.  The popular belief is all but universal that sick persons
+should feed on noxious substances.  One of our members was called not
+long since to a man with a terribly sore mouth.  On inquiry he found
+that the man had picked up a box of unknown pills, in Howard Street,
+and had proceeded to take them, on general principles, pills being
+good for people.  They happened to contain mercury, and hence the
+trouble for which he consulted our associate.
+
+The outside pressure, therefore, is immense upon the physician,
+tending to force him to active treatment of some kind.  Certain old
+superstitions, still lingering in the mind of the public, and not yet
+utterly expelled from that of the profession, are at the bottom of
+this, or contribute to it largely.  One of the most ancient is, that
+disease is a malignant agency, or entity, to be driven out of the
+body by offensive substances, as the smoke of the fish's heart and
+liver drove the devil out of Tobit's bridal chamber, according to the
+Apochrypha.  Epileptics used to suck the blood from the wounds of
+dying gladiators. [Plinii Hist.  Mundi.  lib.  xxviii.  c.  4.] The
+Hon. Robert Boyle's little book was published some twenty or thirty
+years before our late President, Dr. Holyoke, was born. [A Collection
+of Choice and Safe Remedies.  The Fifth Edition, corrected.  London,
+1712.  Dr. Holyoke was born in 1728.] In it he recommends, as
+internal medicines, most of the substances commonly used as
+fertilizers of the soil.  His "Album Graecum" is best left
+untranslated, and his "Zebethum Occidentale" is still more
+transcendentally unmentionable except in a strange dialect.  It
+sounds odiously to us to hear him recommend for dysentery a powder
+made from "the sole 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 neck at night for a sore throat.  The
+same idea of virtue in unlovely secretions! [The idea is very
+ancient.  "Sordes hominis" "Sudore et oleo medicinam facientibus."
+--Plin.  xxviii.  4.]
+
+Even now the Homoeopathists have been introducing the venom of
+serpents, under the learned title of Lachesis, and outraging human
+nature with infusions of the pediculus capitis; that is, of course,
+as we understand their dilutions, the names of these things; for if a
+fine-tooth-comb insect were drowned in Lake Superior, we cannot agree
+with them in thinking that every drop of its waters would be
+impregnated with all the pedicular virtues they so highly value.
+They know what they are doing.  They are appealing to the detestable
+old superstitious presumption in favor of whatever is nauseous and
+noxious as being good for the sick.
+
+Again, we all occasionally meet persons stained with nitrate of
+silver, given for epilepsy.  Read what Dr. Martin says, about the way
+in which it came to be used, in his excellent address before the
+Norfolk County Medical Society, and the evidence I can show, but have
+not time for now, and then say what you think of the practice which
+on such presumptions turns a white man as blue as the double-tattooed
+King of the Cannibal Islands!  [Note A.]
+
+If medical superstitions have fought their way down through all the
+rationalism and scepticism of the nineteenth century, of course the
+theories of the schools, supported by great names, adopted into the
+popular belief and incorporated with the general mass of
+misapprehension with reference to disease, must be expected to meet
+us at every turn in the shape of bad practice founded on false
+doctrine.  A French patient complains that his blood heats him, and
+expects his doctor to bleed him.  An English or American one says he
+is bilious, and will not be easy without a dose of calomel.  A doctor
+looks at a patient's tongue, sees it coated, and says the stomach is
+foul; his head full of the old saburral notion which the extreme
+inflammation-doctrine of Broussais did so much to root out, but which
+still leads, probably, to much needless and injurious wrong of the
+stomach and bowels by evacuants, when all they want is to be let
+alone.  It is so hard to get anything out of the dead hand of medical
+tradition!  The mortmain of theorists extinct in science clings as
+close as that of ecclesiastics defunct in law.
+
+One practical hint may not be out of place here.  It seems to be
+sometimes forgotten, by those who must know the fact, that the tongue
+is very different, anatomically and physiologically, from the
+stomach.  Its condition does not in the least imply a similar one of
+the stomach, which is a very different structure, covered with a
+different kind of epithelium, and furnished with entirely different
+secretions.  A silversmith will, for a dollar, make a small hoe, of
+solid silver, which will last for centuries, and will give a patient
+more comfort, used for the removal of the accumulated epithelium and
+fungous growths which constitute the "fur," than many a prescription
+with a split-footed Rx before it, addressed to the parts out of
+reach.
+
+I think more of this little implement on account of its agency in
+saving the Colony at Plymouth in the year 1623.  Edward Winslow heard
+that Massasoit was sick and like to die.  He found him with a
+houseful of people about him, women rubbing his arms and legs, and
+friends "making such a hellish noise" as they probably thought would
+scare away the devil of sickness.  Winslow gave him some conserve,
+washed his mouth, scraped his tongue, which was in a horrid state,
+got down some drink, made him some broth, dosed him with an infusion
+of strawberry leaves and sassafras root, and had the satisfaction of
+seeing him rapidly recover.  Massasoit, full of gratitude, revealed
+the plot which had been formed to destroy the colonists, whereupon
+the Governor ordered Captain Miles Standish to see to them; who
+thereupon, as everybody remembers, stabbed Pecksuot with his own
+knife, broke up the plot, saved the colony, and thus rendered
+Massachusetts and the Massachusetts Medical Society a possibility, as
+they now are a fact before us.  So much for this parenthesis of the
+tongue-scraper, which helped to save the young colony from a much
+more serious scrape, and may save the Union yet, if a Presidential
+candidate should happen to be taken sick as Massasoit was, and his
+tongue wanted cleaning,--which process would not hurt a good many
+politicians, with or without a typhoid fever.
+
+Again, see how the "bilious" theory works in every-day life here and
+now, illustrated by a case from actual life.  A youthful
+practitioner, whose last molars have not been a great while cut,
+meets an experienced and noted physician in consultation.  This is
+the case.  A slender, lymphatic young woman is suckling two lusty
+twins, the intervals of suction being occupied on her part with
+palpitations, headaches, giddiness, throbbing in the head, and
+various nervous symptoms, her cheeks meantime getting bloodless, and
+her strength running away in company with her milk.  The old
+experienced physician, seeing the yellowish waxy look which is common
+in anaemic patients, considers it a "bilious" case, and is for giving
+a rousing emetic.  Of course, he has to be wheedled out of this, a
+recipe is written for beefsteaks and porter, the twins are
+ignominiously expelled from the anaemic bosom, and forced to take
+prematurely to the bottle, and this prolific mother is saved for
+future usefulness in the line of maternity.
+
+The practice of making a profit on the medicine ordered has been held
+up to reprobation by one at least of the orators who have preceded
+me.  That the effect of this has been ruinous in English practice I
+cannot doubt, and that in this country the standard of practice was
+in former generations lowered through the same agency is not
+unlikely.  I have seen an old account-book in which the physician
+charged an extra price for gilding his rich patients' pills.  If all
+medicine were very costly, and the expense of it always came out of
+the physician's fee, it would really be a less objectionable
+arrangement than this other most pernicious one.  He would naturally
+think twice before he gave an emetic or cathartic which evacuated his
+own pocket, and be sparing of the cholagogues that emptied the
+biliary ducts of his own wallet, unless he were sure they were
+needed.  If there is any temptation, it should not be in favor of
+giving noxious agents, as it clearly must be in the case of English
+druggists and "General Practitioners."  The complaint against the
+other course is a very old one.  Pliny, inspired with as truly Roman
+horror of quackery as the elder Cato,--who declared that the Greek
+doctors had sworn to exterminate all barbarians, including the
+Romans, with their drugs, but is said to have physicked his own wife
+to death, notwithstanding,--Pliny says, in so many words, 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 sober observation of nature, in the
+direction of old superstitions and fancies, of exploded theories, of
+old ways of making money, which are very slow to pass out of fashion
+
+But there are other special American influences which we are bound to
+take cognizance of.  If I wished to show a student the difficulties
+of getting at truth from medical experience, I would give him the
+history of epilepsy to read.  If I wished him to understand the
+tendencies of the American medical mind, its sanguine enterprise, its
+self-confidence, its audacious handling of Nature, its impatience
+with her old-fashioned ways of taking time to get a sick man well, I
+would make him read the life and writings of Benjamin Rush.  Dr. Rush
+thought and said that there were twenty times more intellect and a
+hundred times more knowledge in the country in 1799 than before the
+Revolution.  His own mind was in a perpetual state of exaltation
+produced by the stirring scenes in which he had taken a part, and the
+quickened life of the time in which he lived.  It was not the state
+to favor sound, calm observation.  He was impatient, and Nature is
+profoundly imperturbable.  We may adjust the beating of our hearts to
+her pendulum if we will and can, but we may be very sure that she
+will not change the pendulum's rate of going because our hearts are
+palpitating.  He thought he had mastered yellow-fever.  "Thank God,"
+he said, "out of one hundred patients whom I have visited or
+prescribed for this day, I have lost none."  Where was all his legacy
+of knowledge when Norfolk was decimated?  Where was it when the blue
+flies were buzzing over the coffins of the unburied dead piled up in
+the cemetery of New Orleans, at the edge of the huge trenches yawning
+to receive them?
+
+One such instance will do as well as twenty.  Dr. Rush must have been
+a charming teacher, as he was an admirable man.  He was observing,
+rather than a sound observer; eminently observing, curious, even,
+about all manner of things.  But he could not help feeling as if
+Nature had been a good deal shaken by the Declaration of
+Independence, and that American art was getting to be rather too much
+for her,--especially as illustrated in his own practice.  He taught
+thousands of American students, he gave a direction to the medical
+mind of the country more than any other one man; perhaps he typifies
+it better than any other.  It has clearly tended to extravagance in
+remedies and trust in remedies, as in everything else.  How could a
+people which has a revolution once in four years, which has contrived
+the Bowie-knife and the revolver, which has chewed the juice out of
+all the superlatives in the language in Fourth of July orations, and
+so used up its epithets in the rhetoric of abuse that it takes two
+great quarto dictionaries to supply the demand; which insists in
+sending out yachts and horses and boys to out-sail, out-run, out-
+fight, and checkmate all the rest of creation; how could such a
+people be content with any but "heroic" practice"?  What wonder that
+the stars and stripes wave over doses of ninety grains of sulphate of
+quinine, [More strictly, ninety-six grains in two hours. Dunglison's
+Practice, 1842, vol.  ii.  p.  520.  Eighty grains in one dose.
+Ibid.  p.  536.  Ninety-six grains of sulphate of quinine are equal
+to eight ounces of good bark. --Wood & Bache.] and that the American
+eagle screams with delight to see three drachms of calomel given at a
+single 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 which must find something to fill their columns, and
+so print all the new plans of treatment and new remedies they can get
+hold of, as the newspapers, from a similar necessity, print the
+shocking catastrophes and terrible murders.
+
+Besides all this, here are we, the great body of teachers in the
+numberless medical schools of the Union, some of us lecturing to
+crowds who clap and stamp in the cities, some of us wandering over
+the country, like other professional fertilizers, to fecundate the
+minds of less demonstrative audiences at various scientific stations;
+all of us talking habitually to those supposed to know less than
+ourselves, and loving to claim as much for our art as we can, not to
+say for our own schools, and possibly indirectly for our own
+practical skill.  Hence that annual crop of introductory lectures;
+the useful blossoming into the ornamental, as the cabbage becomes
+glorified in the cauliflower; that lecture-room literature of
+adjectives, that declamatory exaggeration, that splendid show of
+erudition borrowed from D'Israeli, and credited to Lord Bacon and the
+rest, which have suggested to our friends of the Medical Journals an
+occasional epigram at our expense.  Hence the tendency in these
+productions, and in medical lectures generally, to overstate the
+efficacy of favorite methods of cure, and hence the premium offered
+for showy talkers rather than sagacious observers, for the men of
+adjectives rather than of nouns substantive in the more ambitious of
+these institutions.
+
+Such are some of the eddies in which we are liable to become involved
+and carried back out of the broad stream of philosophical, or, in
+other words, truth-loving, investigations.  The causes of disease, in
+the mean time, have been less earnestly studied in the eagerness 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-house might not be known, while the very men who were
+discussing the treatment of the disease were stupidly conveying the
+infection from bed to bed, as rat-killers carry their poisons from
+one household to another.  Do not some of you remember that I have
+had to fight this private-pestilence question against a scepticism
+which sneered in the face of a mass of evidence such as the calm
+statisticians of the Insurance office could not listen to without
+horror and indignation? [The Contagiousness of Puerperal Fever."-N.
+E.  Quan Jour.  of Medicine and Surgery, April, 1843.  Reprinted,
+with Additions.  Boston: Ticknor & Fields.  1855.] Have we forgotten
+what is told 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's lives in a single
+hospital?  How long would it have taken small doses of calomel and
+rhubarb to save as many children?  These may be useful in prudent
+hands, but how insignificant compared to the great hygienic
+conditions!  Causes, causes, and again causes,--more and more we fall
+back on these as the chief objects of our attention.  The shortest
+system 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 it to the first mother when she saw her first-born
+child putting some ugly pebble or lurid berry into its mouth.  I know
+not in what language it was spoken, but I know that in English it
+would sound thus: Spit it out!
+
+Art can do something more than say this.  It can sometimes reach the
+pebble or berry after it has been swallowed.  But the great thing is
+to keep these things out of children's mouths, and as soon as they
+are beyond our reach, to be reasonable and patient with Nature, who
+means well, but does not like to hurry, and who took nine calendar
+months, more or less, to every mother's son among us, before she
+thought he was fit to he shown to the public.
+
+Suffer me now to lay down a few propositions, whether old or new it
+matters little, not for your immediate acceptance, nor yet for your
+hasty rejection, but for your calm consideration.
+
+But first, there are a number of terms which we are in the habit of
+using in a vague though not unintelligible way, and which it is as
+well now to define.  These terms are the tools with which we are to
+work, and the first thing is to sharpen them.  It is nothing to us
+that they have been sharpened a thousand times before; they always
+get dull in the using, and every new workman has a right to carry
+them to the grindstone and sharpen them to suit himself.
+
+Nature, in medical language, as opposed to Art, means trust in the
+reactions of the living system against, ordinary normal impressions.
+
+Art, in the same language, as opposed to Nature, means an intentional
+resort to extraordinary abnormal impressions for the relief of
+disease.
+
+The reaction of the living system is the essence of both.  Food is
+nothing, if there is no digestive act to respond to it.  We cannot
+raise a blister on a dead man, or hope that a carminative forced
+between his lips will produce its ordinary happy effect.
+
+Disease, dis-ease,--disturbed quiet, uncomfortableness,--means
+imperfect or abnormal reaction of the living system, and its more or
+less permanent results.
+
+Food, in its largest sense, is whatever helps to build up the normal
+structures, or to maintain their natural actions.
+
+Medicine, in distinction from food, is every unnatural or noxious
+agent applied for the relief of disease.
+
+Physic means properly the Natural art, and Physician is only the
+Greek synonyme of Naturalist.
+
+With these few explanations I proceed to unfold the propositions I
+have mentioned.
+
+Disease and death, if we may judge by the records of creation, are
+inherently and essentially necessary in the present order of things.
+A perfect intelligence, trained by a perfect education, could do no
+more than keep the laws of the physical and spiritual universe.  An
+imperfect intelligence, imperfectly taught,--and this is the
+condition of our finite humanity,--will certainly fail to keep all
+these laws perfectly.  Disease is one of the penalties of one of the
+forms of such failure.  It is prefigured in the perturbations of the
+planets, in the disintegration of the elemental masses; it has left
+its traces in the fossil organisms of extinct creations. [Professor
+Agassiz has kindly handed me the following note: "There are abnormal
+structures in animals of all ages anterior to the creation of
+mankind.  Malformed specimens of Crinoids are known from the Triassic
+and Jurassic deposits.  Malformed and diseased bones of tertiary
+mammalia have been collected in the caverns of Gailenreuth with
+traces of healing."]
+
+But it is especially the prerogative, I had almost said 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 get rid of those who will not mind or cannot be kept subject to
+these laws.
+
+Disease, being always an effect, is always in exact proportion to the
+sum of its causes, as much in the case of Spigelius, who dies of a
+scratch, as in that of the man who recovers after an iron bar has
+been shot through his brain.  The one prevalent failing of the
+medical art is to neglect the causes and quarrel with the effect.
+
+There are certain general facts which include a good deal of what is
+called and treated as disease.  Thus, there are two opposite
+movements of life to be seen in cities and elsewhere, belonging to
+races which, from various persistent causes, are breeding down and
+tending to run out, and to races which are breeding up, or
+accumulating vital capital,--a descending and an ascending series.
+Let me give an example of each; and that I may incidentally remove a
+common impression about this country as compared with the Old World,
+an impression which got tipsy with conceit and staggered into the
+attitude of a formal proposition in the work of Dr. Robert Knox, I
+will illustrate the downward movement from English experience, and
+the upward movement from a family history belonging to this immediate
+neighborhood.
+
+Miss Nightingale speaks of "the fact so often seen of a
+great-grandmother, who was a tower of physical vigor, descending into
+a grandmother perhaps a little less vigorous, but still sound as a
+bell, and healthy to the core, into a mother languid and confined to
+her carriage and house; and lastly into a daughter sickly and
+confined to her bed." So much for the descending English series; now
+for the ascending American series.
+
+Something more than one hundred and thirty years ago there graduated
+at Harvard College a delicate youth, who lived an invalid life and
+died at the age of about fifty.  His two children were both of
+moderate physical 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 of its members.  The fourth generation
+was of fair average endowment.  The fifth generation, great-great-
+grandchildren of the slender invalid, are several of, them of
+extraordinary bodily and mental power; large in stature, formidable
+alike with their brains and their arms, organized on a more extensive
+scale than either of their parents.
+
+This brief account illustrates incidentally the fallacy of the
+universal-degeneration theory applied to American life; the same on
+which one of our countrymen has lately brought some very forcible
+facts to bear in a muscular discussion of which we have heard rather
+more than is good for us. But the two series, American and English,
+ascending and descending, were adduced with the main purpose of
+showing the immense difference of vital endowments in different
+strains of blood; a difference to which all ordinary medication is in
+all probability a matter of comparatively trivial purport.  Many
+affections which art has to strive against might be easily shown to
+be vital to the well-being of society.  Hydrocephalus, tabes
+mesenterica, and other similar maladies, are natural agencies which
+cut off the children of races that are sinking below the decent
+minimum which nature has established as the condition of viability,
+before they reach the age of reproduction.  They are really not so
+much diseases, as manifestations of congenital incapacity for life;
+the race would be ruined if art could ever learn always to preserve
+the individuals subject to them.  We must do the best we can for
+them, but we 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 absolute health by medicinal
+appliances.  There are many ladies, ancient and recent, who are
+perpetually taking remedies for irremediable pains and aches.  They
+ought to have headaches and back-aches and stomach-aches; they are
+not well if they do not have them.  To expect them to live without
+frequent twinges is like expecting a doctor's old chaise to go
+without creaking; if it did, we might be sure the springs were
+broken.  There is no doubt that the constant demand for medicinal
+remedies from patients of this class leads to their over-use; often
+in the case of cathartics, sometimes in that of opiates.  I have been
+told by an intelligent practitioner in a Western town, that the
+constant prescription of opiates by certain physicians in his
+vicinity has rendered the habitual use of that drug in all that
+region very prevalent; more common, I should think, than alcoholic
+drunkenness in the most intemperate localities of which I have known
+anything.  A frightful endemic demoralization betrays itself in the
+frequency with which the haggard features and drooping shoulders of
+the opium-drunkards are met with in the streets.
+
+The next proposition I would ask you to consider is this:
+The presumption always is that every noxious agent, including
+medicines proper, which hurts a well man, hurts a sick one.
+[ Note B.]
+
+Let me illustrate this proposition before you decide upon it.  If it
+were known that a prize-fighter were to have a drastic purgative
+administered two or three days before a contest, or a large blister
+applied to his back, no one will question that it would affect the
+betting on his side unfavorably; we will say to the amount of five
+per cent.  Now the drain upon the resources of the system produced in
+such a case must be at its minimum, for the subject is a powerful
+man, in the prime of life, and in admirable condition.  If the drug
+or the blister takes five per cent. from his force of resistance, it
+will take at least as large a fraction from any invalid.  But this
+invalid has to fight a champion who strikes hard but cannot be hit in
+return, who will press him sharply for breath, but will never pant
+himself while the wind can whistle through his fleshless ribs.  The
+suffering combatant is liable to want all his stamina, and five per
+cent. may lose him the battle.
+
+All noxious agents, all appliances which are not natural food 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 force produced by any of them, that is, would exactly kill him,
+nothing less than kill him, and nothing more.  If this, or something
+like this, is true, then all these medications are, prima facie,
+injurious.
+
+In the game of Life-or-Death, Rouge et Noir, as played between the
+Doctor and the Sexton, this five per cent., this certain small injury
+entering into the chances is clearly the sexton's perquisite for
+keeping the green table, over which the game is played, and where he
+hoards up his gains.  Suppose a blister to diminish a man's pain,
+effusion or dyspnoea to the saving of twenty per cent. in vital
+force; his profit from it is fifteen, in that case, for it always
+hurts him five to begin with, according to our previous assumption.
+
+Presumptions are of vast importance in medicine, as in law.  A man is
+presumed innocent until he is proved guilty.  A medicine--that is, a
+noxious agent, like a blister, a seton, an emetic, or a cathartic--
+should always be presumed to be hurtful.  It always is directly
+hurtful; it may sometimes be indirectly beneficial.  If this
+presumption were established, and disease always assumed to be the
+innocent victim of circumstances, and not punishable by medicines,
+that is, noxious agents, or poisons, until the contrary was shown, we
+should not so frequently hear the remark commonly, perhaps
+erroneously, attributed to Sir Astley Cooper, but often repeated by
+sensible persons, that, on the whole, more harm than good is done by
+medication.  Throw out opium, which the Creator himself seems to
+prescribe, for we often see the scarlet poppy growing in the
+cornfields, as if it were foreseen that wherever there is hunger to
+be fed there must also be pain to be soothed; throw out a few
+specifics which our art did not discover, and is hardly needed to
+apply [ Note C.]; throw out wine, which is a food, and the vapors
+which produce the miracle of anaesthesia, and I firmly believe that
+if the whole materia medica, as now used, could be sunk to the bottom
+of the sea, it would be all the better for mankind,--and all the
+worse for the fishes.
+
+But to justify this proposition, I must add that the injuries
+inflicted by over-medication are to a great extent masked by disease.
+Dr. Hooker believes that the typhus syncopatia of a preceding
+generation in New England "was often in fact a brandy and opium
+disease."  How is a physician to distinguish the irritation produced
+by his blister from that caused by the inflammation it was meant to
+cure?  How can he tell the exhaustion produced by his evacuants from
+the collapse belonging to the disease they were meant to remove?
+
+Lastly, medication without insuring favorable hygienic conditions is
+like amputation without ligatures.  I had a chance to learn this well
+of old, when physician to the Broad Street district of the Boston
+Dispensary.  There, there was no help for the utter want of wholesome
+conditions, and if anybody got well under my care, it must have been
+in virtue of the rough-and-tumble constitution which emerges from the
+struggle for life in the street gutters, rather than by the aid of my
+prescriptions.
+
+But if the materia medica were lost overboard, how much more pains
+would be taken in ordering all the circumstances surrounding the
+patient (as can be done everywhere out of the crowded pauper
+districts), than are taken now by too many who think they do their
+duty and earn their money when they write a recipe for a patient left
+in an atmosphere of domestic malaria, or to the most negligent kind
+of nursing!  I confess that I should think my chance of recovery from
+illness less with Hippocrates for my physician and Mrs. Gamp for my
+nurse, than if I were in the hands of Hahnemann himself, with
+Florence Nightingale or good Rebecca Taylor to care for me.
+
+If I am right in maintaining that the presumption is always against
+the use of noxious agents in disease, and if any whom I might
+influence should adopt this as a principle of practice, they will
+often find themselves embarrassed by the imperative demand of
+patients and their friends for such agents where a case is not made
+out against this standing presumption.  I must be permitted to say,
+that I think the French, a not wholly uncivilized people, are in
+advance of the English and ourselves in the art of prescribing for
+the sick without hurting them.  And I do confess that I think their
+varied ptisans and syrups are as much preferable to the mineral
+regimen of bug-poison and ratsbane, so long in favor on the other
+side of the Channel, as their art of preparing food for the table to
+the rude cookery of those hard-feeding and much-dosing islanders.
+We want a reorganized cuisine of invalidism perhaps as much as the
+culinary, reform, for which our lyceum lecturers, and others who live
+much at hotels and taverns, are so urgent.  Will you think I am
+disrespectful if I ask whether, even in Massachusetts, a dose of
+calomel is not sometimes given by a physician on the same principle
+as that upon which a landlord occasionally prescribes bacon and
+eggs,--because he cannot think of anything else quite so handy?  I
+leave my suggestion of borrowing a hint from French practice to your
+mature consideration.
+
+I may, however, call your attention, briefly, to the singular fact,
+that English and American practitioners are 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 less effective"
+than that of his own country."  Mr. S. Cooper, again, defends the
+simple British practice of procuring union by the first intention
+against the attacks of M. Roux and Baron Larrey. [Cooper's Surg.
+Diet.  art.  "Wounds."  Yet Mr. John Bell gives the French surgeons
+credit for introducing this doctrine of adhesion, and accuses
+O'Halloran of "rudeness and ignorance," and "bold, uncivil language,"
+in disputing their teaching.  Princ.  of Surgery, vol.  i.  p.  42.
+Mr. Hunter succeeded at last in naturalizing the doctrine and
+practice, but even he had to struggle against the perpetual jealousy
+of rivals, and died at length assassinated by an insult.]  We have
+often heard similar opinions maintained by our own countrymen.  While
+Anglo-American criticism blows hot or cold on the two departments of
+French practice, it is not, I hope, indecent to question whether all
+the wisdom is necessarily with us in both cases.
+
+Our art has had two or three lessons which have a deep meaning to
+those who are willing to read them honestly.  The use of water-
+dressings in surgery completed the series of reforms by which was
+abolished the "coarse and cruel practice" of the older surgeons, who
+with their dressings and acrid balsams, their tents and leaden tubes,
+"absolutely delayed the cure."  The doctrine of Broussais, transient
+as was its empire, reversed the practice of half of Christendom for a
+season, and taught its hasty disciples to shun their old favorite
+remedies as mortal poisons.  This was not enough permanently to shift
+the presumption about drugs where it belonged, and so at last, just
+as the sympathetic powder and the Unguentum Armarium came in a
+superstitious age to kill out the abuses of external over-medication,
+the solemn farce of Homoeopathy was enacted in the face of our own
+too credulous civilization, that under shelter of its pretences the
+"inward bruises" of over-drugged viscera might be allowed to heal by
+the first intention.  Its lesson we must accept, whether we will or
+not; its follies we are tired of talking about.  The security of the
+medical profession against this and all similar fancies is in the
+average constitution of the human.  mind with regard to the laws of
+evidence.
+
+My friends and brothers in Art!  There is nothing to be feared from
+the utterance of any seeming heresy to which you may have listened.
+I cannot compromise your collective wisdom.  If I have strained the
+truth one hair's breadth for the sake of an epigram or an antithesis,
+you are accustomed to count the normal pulse-beats of sound judgment,
+and know full well how to recognize the fever-throbs of conceit and
+the nervous palpitations of rhetoric.
+
+The freedom with which each of us speaks his thought in this
+presence, belongs in part to the assured position of the Profession
+in our Commonwealth, to the attitude of Science, which is always
+fearless, and to the genius of the soil on which we stand, from which
+Nature withheld the fatal gift of malaria only to fill it with
+exhalations that breed the fever of inquiry in our blood and in our
+brain.  But mainly we owe the large license of speech we enjoy to
+those influences and privileges common to us all as self-governing
+Americans.
+
+This Republic is the chosen home of minorities, of the less power in
+the presence of the greater.  It is a common error to speak of our
+distinction as consisting 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 death treading down the tenfold more
+numerous minorities.  In the old civilizations they root themselves
+like oaks in the soil; men must live in their shadow or cut them
+down.  With us the majority is only the flower of the passing noon,
+and the minority is the bud which may open in the next morning's sun.
+We must be tolerant, for the thought which stammers on a single
+tongue today may organize itself in the growing consciousness of the
+time, and come back to us like the voice of the multitudinous waves
+of the ocean on the morrow.
+
+Twenty-five years have passed since one of your honored Presidents
+spoke to this Society of certain limitations to the power of our Art,
+now very generally conceded.  Some were troubled, some were almost
+angry, thinking the Profession might suffer from such concessions.
+It has certainly not suffered here; if, as some affirm, it has lost
+respect anywhere, it was probably for other, and no doubt sufficient
+reasons.
+
+Since that time the civilization of this planet has changed hands.
+Strike out of existence at this moment every person who was breathing
+on that day, May 27, 1835, and every institution of society, every
+art and every science would remain intact and complete in the living
+that would be left.  Every idea the world then held has been since
+dissolved and recrystallized.
+
+We are repeating the same process.  Not to make silver shrines for
+our old divinities, even though by this craft we should have our
+wealth, was this Society organized and carried on by the good men and
+true who went before us.  Not for this, but to melt the gold out of
+the past, though its dross should fly in dust to all the winds of
+heaven, to save all our old treasures of knowledge and mine deeply
+for new, to cultivate that mutual respect of which outward courtesy
+is the sign, to work together, to feel together, to take counsel
+together, and to stand together for the truth, now, always, here,
+everywhere; for this our fathers instituted, and we accept, the
+offices and duties of this time-honored Society.
+
+
+
+
+
+
+
+BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+
+An Introductory Lecture delivered before the Medical Class
+of Harvard University, November 6, 1861.
+
+
+[This Lecture appears as it would have been delivered had the time
+allowed been less strictly, limited.  Passages necessarily omitted
+have been restored, and points briefly touched have been more fully
+considered.  A few notes have been added for the benefit of that
+limited class of students who care to track an author through the
+highways and by-ways of his reading.  I owe my thanks to several of
+my professional brethren who have communicated with me on subjects
+with which they are familiar; especially to Dr. John Dean, for the
+opportunity of profiting by his unpublished labors, and to Dr. Hasket
+Derby, for information and references to recent authorities relating
+to the anatomy and physiology of the eye.]
+
+
+The entrance upon a new course of Lectures is always a period of
+interest to instructors and pupils.  As the birth of a child to a
+parent, so is the advent of a new class to a teacher.  As the light
+of the untried world to the infant, so is the dawning of the light
+resting over the unexplored realms of science to the student.  In the
+name of the Faculty I welcome you, Gentlemen of the Medical Class,
+new-born babes of science, or lustier nurslings, to this morning of
+your medical life, and to the arms and the bosom of this ancient
+University.  Fourteen years ago I stood in this place for the first
+time to address those who occupied these benches.  As I recall these
+past seasons of our joint labors, I feel that they have been on the
+whole prosperous, and not undeserving of their prosperity.
+
+For it has been my privilege to be associated with a body of true and
+faithful workers; I cannot praise them freely to their faces, or I
+should be proud to discourse of the harmonious diligence and the
+noble spirit in which they have toiled together, not merely to teach
+their several branches, but to elevate the whole standard of
+teaching.
+
+I may speak with less restraint of those gentlemen who have aided me
+in the most laborious part of my daily duties, the Demonstrators, to
+whom the successive classes have owed so much of their instruction.
+They rise before me, the dead and the living, in the midst of the
+most grateful recollections.  The fair, manly face and stately figure
+of my friend, Dr. Samuel Parkman, himself fit for the highest offices
+of teaching, yet willing to be my faithful assistant in the time of
+need, come back to me with the long sigh of regret for his early loss
+to our earthly companionship.  Every year I speak the eulogy of Dr.
+Ainsworth's patient toil as I show his elaborate preparations: When I
+take down my "American Cyclopaedia" and borrow instruction from the
+learned articles of Dr. Kneeland, I cease to regret that his
+indefatigable and intelligent industry was turned into a broader
+channel.  And what can I say too cordial of my long associated
+companion and friend, Dr. Hodges, whose admirable skill, working
+through the swiftest and surest fingers that ever held a scalpel
+among us, has delighted class after class, and filled our Museum with
+monuments which 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 their mysteries, or timid neophytes just
+entering the portals of 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 alcoves remain in darkness.
+
+
+SCIENCE is the topography of ignorance.  From a few elevated points
+we triangulate vast spaces, inclosing infinite unknown details.  We
+cast the lead, and draw up a little sand from abysses we may never
+reach with our dredges.
+
+The best part of our knowledge is that which teaches us where
+knowledge leaves off and ignorance begins.  Nothing more clearly
+separates a vulgar from a superior mind, than the confusion in the
+first between the little that it truly knows, on the one hand, and
+what it half knows and what it thinks it knows on the other.
+
+That which is true of every subject is especially true of the branch
+of knowledge which deals with living beings.  Their existence is a
+perpetual death and 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.
+
+               "Thou art not thyself;
+     For thou exist'st on many a thousand grains
+     That issue out of dust."
+
+If it is true that we understand ourselves but imperfectly in health,
+this truth is more signally manifested in disease, where natural
+actions imperfectly understood, disturbed in an obscure way by half-
+seen causes, are creeping and winding along in the dark toward their
+destined issue, sometimes using our remedies as safe stepping-stones,
+occasionally, it may be, stumbling over them as obstacles.
+
+I propose in this lecture to show you some points of contact between
+our ignorance and our knowledge in several of the branches upon the
+study of which you are entering.  I may teach you a very little
+directly, but I hope much more from the trains of thought I shall
+suggest.  Do not expect too much ground to be covered in this rapid
+survey.  Our task is only that of sending out a few pickets under the
+starry flag of science to the edge of that dark domain where the
+ensigns of the obstinate rebel, Ignorance, are flying undisputed.  We
+are not making a reconnoissance in force, still less advancing with
+the main column.  But here are a few roads along which we have to
+march together, and we wish to see clearly how far our lines extend,
+and where the enemy's outposts begin.
+
+Before touching the branches of knowledge that deal with organization
+and vital functions, let us glance at that science which meets you at
+the threshold of your study, and prepares you in some measure to deal
+with the more complex problems of the living laboratory.
+
+
+CHEMISTRY.  includes the art of separating and combining the elements
+of matter, and the study of the changes produced by these operations.
+We can hardly say too much of what it has contributed to our
+knowledge of the universe and our power of dealing with its
+materials.  It has given us a catalogue raisonne of the substances
+found upon our planet, and shown how everything living and dead is
+put together from them.  It is accomplishing wonders before us every
+day, such as Arabian story-tellers used to string together in their
+fables.  It spreads the, sensitive film on the artificial retina
+which looks upon us through the optician's lens for a few seconds,
+and fixes an image that will outlive its original.  It questions the
+light of the sun, and detects the vaporized metals floating around
+the great luminary,--iron, sodium, lithium, and the rest,--as if the
+chemist of our remote planet could fill his bell-glasses from its
+fiery atmosphere.  It lends the power which flashes our messages in
+thrills that leave the lazy chariot of day behind them.  It seals up
+a few dark grains in iron vases, and lo! at the touch of a single
+spark, rises in smoke and flame a mighty Afrit with a voice like
+thunder and an arm that shatters like an earthquake.  The dreams of
+Oriental fancy have 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 each other through an almost
+boundless range of combinations.  It has given us a most ingenious
+theory to account for certain fixed relations in these combinations.
+It has successfully eliminated a great number of proximate compounds,
+more or less stable, from organic structures.  It has invented others
+which form the basis of long series of well-known composite
+substances.  In fact, we are perhaps becoming overburdened with our
+list of proximate principles, demonstrated and hypothetical.
+
+How much nearer have we come to the secret of force than Lully and
+Geber and the whole crew of juggling alchemists?  We have learned a
+great deal about the how, what have we learned about the why?
+
+Why does iron rust, while gold remains untarnished, and gold
+amalgamate, while iron refuses the alliance of mercury?
+
+The alchemists called gold Sol, the sun, and iron Mars, and pleased
+themselves with fancied relations between these substances and the
+heavenly bodies, by which they pretended to explain the facts they
+observed.  Some of their superstitions have lingered in practical
+medicine to the present day, but chemistry has grown wise enough to
+confess the fact of absolute ignorance.
+
+What is it that makes common salt crystallize in the form of cubes,
+and saltpetre in the shape of six-sided prisms?  We see no reason why
+it should not have been just the other way, salt in prisms and
+saltpetre in cubes, or why either should take an exact geometrical
+outline, any more than coagulating albumen.
+
+But although we had given up attempting to explain the essential
+nature of affinities and of crystalline types, we might have supposed
+that we had at least fixed the identity of the substances with which
+we deal, and determined the laws of their combination.  All at once
+we find that a simple substance changes face, puts off its
+characteristic qualities and resumes them at will;--not merely when
+we liquefy or vaporize a solid, or reverse the process; but that a
+solid is literally transformed into another solid under our own eyes.
+We thought we knew phosphorus.  We warm a portion of it sealed in an
+empty tube, for about a week.  It has become a brown infusible
+substance, which does not shine in the dark nor oxidate in the air.
+We heat it to 500 F., and it becomes common phosphorus again.  We
+transmute sulphur in the same singular way.  Nature, you know, gives
+us 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 connected with them
+rather startling to us of the nineteenth century.  There may be other
+transmutations possible besides those of phosphorus and sulphur.
+When Dr. Prout, in 1840, talked about azote and carbon being "formed"
+in the living system, it was looked upon as one of those freaks of
+fancy to which philosophers, like other men, are subject.  But when
+Professor Faraday, in 1851, says, at a meeting of the British
+Association, that "his hopes are in the direction of proving that
+bodies called simple were really compounds, and may be formed
+artificially as soon as we are masters of the laws influencing their
+combinations,"--when he comes forward and says that he has tried
+experiments at transmutation, and means, if his life is spared, to
+try them again,--how can we be surprised at the popular story of
+1861, that Louis Napoleon has established a gold-factory and is
+glutting the mints of Europe with bullion of his 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 glass vessel, c, we do not expect the glass to change
+them, unless a or b or the compound a b has the power of dissolving
+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 signs of combustion and form water, the third in the mean time
+undergoing no perceptible change.  It has played the part of the
+unwedded priest, who marries a pair without taking a fee or having
+any further relation with the parties.  We call this catalysis,
+catalytic action, the action of presence, or by what learned name we
+choose.  Give what name to it we will, it is a manifestation of power
+which crosses our established laws of combination at a very open
+angle of intersection.  I think we may find an analogy for it in
+electrical induction, the disturbance of the equilibrium of the
+electricity of a body by the approach of a charged body to it,
+without interchange of electrical conditions between the two bodies.
+But an analogy is not an explanation, and why a few drops of yeast
+should change a saccharine mixture to carbonic acid and alcohol,--a
+little leaven leavening the whole lump,--not by combining with it,
+but by setting a movement at work, we not only cannot explain, but
+the fact is such an exception to the recognized laws of combination
+that Liebig is unwilling to admit the new force at all to which
+Berzelius had given the name so generally accepted.
+
+The phenomena of isomerism, or identity of composition and
+proportions of constituents with difference of qualities, and of
+isomorphism, or identity of form in crystals which have one element
+substituted for another, were equally surprises to science; and
+although the mechanism by which they are brought about can be to a
+certain extent explained by a reference to the hypothetical atoms of
+which the elements are constituted, yet this is only turning the
+difficulty into a fraction with an infinitesimal denominator and an
+infinite numerator.
+
+So far we have studied the working of force and its seeming anomalies
+in purely chemical phenomena.  But we soon find that chemical force
+is developed by various other physical agencies,--by heat, by light,
+by electricity, by magnetism, by mechanical agencies; and, vice
+versa, that chemical action develops heat, light, electricity,
+magnetism, mechanical force, as we see in our matches, galvanic
+batteries, and explosive compounds.  Proceeding with our experiments,
+we find that every kind of force is capable of producing all other
+kinds, or, in Mr. Faraday's language, that "the various forms under
+which the forces of matter are made manifest have a common origin,
+or, in other words, are so directly related and mutually dependent
+that they are convertible one into another."
+
+Out of this doctrine naturally springs that of the conservation of
+force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr.
+Faraday.  This idea is no novelty, though it seems so at first sight.
+It was maintained and disputed among the giants of philosophy.
+Des Cartes and Leibnitz denied that any new motion originated in
+nature, or that any ever ceased to exist; all motion being in a
+circle, passing from one body to another, one losing what the other
+gained.  Newton, on the other hand, believed that new motions were
+generated and existing ones destroyed.  On the first supposition,
+there is a fixed amount of force always circulating in the universe.
+On the second, the total amount may be increasing or diminishing.
+You will find in the "Annual of Scientific Discovery" for 1858 a very
+interesting lecture by Professor Helmholtz of Bonn, in which it is
+maintained that a certain portion of force is lost in every natural
+process, being converted into unchangeable heat, so that the universe
+will come to a stand-still at last, all force passing into heat, and
+all heat into a state of equilibrium.
+
+The doctrines of the convertibility or specific equivalence of the
+various forms of force, and of its conservation, which is its logical
+consequence, are very generally accepted, as I believe, at the
+present time, among physicists.  We are naturally led to the
+question, What is the nature of force?  The three illustrious
+philosophers just referred to agree in attributing the general
+movements of the universe to the immediate Divine action.  The
+doctrine of "preestablished harmony" was an especial contrivance of
+Leibnitz to remove the Creator from unworthy association with the
+less divine acts of living beings.  Obsolete as this expression
+sounds to our ears, the phrase laws of the universe, which we use so
+constantly with a wider application, appears to me essentially
+identical with it.
+
+Force does not admit of explanation, nor of proper definition, any
+more than the hypothetical substratum of matter.  If we assume the
+Infinite as omnipresent, omniscient, omnipotent, we cannot suppose
+Him excluded from any part of His creation, except from rebellious
+souls which voluntarily exclude Him by the exercise of their fatal
+prerogative of free-will.  Force, then, is the act of immanent
+Divinity.  I find no meaning in mechanical explanations.  Newton's
+hypothesis of an ether filling the heavenly spaces does 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 prefer to encounter
+it in the world of physical phenomena before reaching that of living
+actions.  It is only the name for the incomprehensible cause of
+certain changes known to our consciousness, and assumed to be outside
+of it.  For me it is the Deity Himself in action.
+
+I can therefore see a large significance in the somewhat bold
+language of Burdach : "There is for me but one miracle, that of
+infinite existence, and but one mystery, the manner in which the
+finite proceeds from the infinite.  So soon as we recognize this
+incomprehensible act as the general and primordial miracle, 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 by experience in this light, there is for us no other
+impenetrable miracle or mystery."
+
+Let us turn to a branch of knowledge which deals with certainties up
+to the limit of the senses, and is involved in no speculations beyond
+them.  In certain points of view, HUMAN ANATOMY may be considered an
+almost exhausted science.  From time to time some small organ which
+had escaped earlier observers has been pointed out,--such parts as
+the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some
+of our best anatomical works are those which have been classic for
+many generations. The plates of the bones in Vesalius, three
+centuries old, are still masterpieces of accuracy, as of art.  The
+magnificent work of Albinus on the muscles, published in 1747, is
+still supreme in its department, as the constant references of the
+most thorough recent treatise on the subject, that of Theile,
+sufficiently show.  More has been done in unravelling the mysteries
+of the fasciae, but there has been a tendency to overdo this kind of
+material analysis.  Alexander Thomson split them up into cobwebs, as
+you may see in the plates to Velpeau's Surgical Anatomy.  I well
+remember how he used to shake his head over the coarse work of Scarpa
+and Astley Cooper,--as if Denner, who painted the separate hairs of
+the beard and pores of the skin in his portraits, had spoken lightly
+of the pictures of Rubens and Vandyk.
+
+Not only has little been added to the catalogue of parts, but some
+things long known had become half-forgotten. Louis and others
+confounded the solitary glands of the 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 brain seemed a novelty as shown by
+Spurzheim.  One is startled to find the method anticipated by Raymond
+Vieussens nearly two centuries ago.  I can hardly think Gordon had
+ever looked at his figures, though he names their author, when he
+wrote the captious and sneering article which attracted so much
+attention in the pages of the "Edinburgh Review."
+
+This is the place, if anywhere, to mention any observations I could
+pretend to have made in the course of my teaching the structure of
+the human body.  I can make no better show than most of my
+predecessors in this well-reaped field.  The nucleated cells found
+connected with the cancellated structure of the bones, which I first
+pointed out and had figured in 1847, and have shown yearly from that
+time to the present, and the fossa masseterica, a shallow concavity
+on the ramus of the lower jaw, for the lodgment of the masseter
+muscle, which acquires significance when examined by the side of the
+deep cavity on the corresponding part in some carnivora to which it
+answers, may perhaps be claimed as deserving attention.  I have also
+pleased myself by making a special group of the six radiating muscles
+which diverge from the spine of the axis, or second cervical
+vertebra, and by giving to it the name stella musculosa nuchaee.  But
+this scanty catalogue is only an evidence that one may teach long and
+see little that has not been noted by those who have gone before him.
+Of course I do not think it necessary to include rare, but already
+described anomalies, such as the episternal bones, the rectus
+sternalis, and other interesting exceptional formations I have
+encountered, which have shown a curious tendency to present
+themselves several times in the same season, perhaps because the
+first specimen found calls our attention 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 human body has changed its old aspect, and become
+fertile in new observations.  This rejuvenescence was effected by
+means of two principal agencies,--new methods 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 as when Arrowsmith, who was born in 1750, published his
+admirable maps.  But in that same year was born Werner, who taught a
+new way of studying the earth, since become familiar to us all under
+the name of Geology.
+
+What geology has done for our knowledge of the earth, has been done
+for our knowledge of the body by that method of study to which is
+given the name of General Anatomy.  It studies, not the organs as
+such, but the elements out of which the organs are constructed.  It
+is the geology of the body, as that is the general anatomy of the
+earth.  The extraordinary genius of Bichat, to whom more than any
+other we owe this new method of study, does not require Mr. Buckle's
+testimony to impress the practitioner with the importance of its
+achievements.  I have heard a very wise physician question whether
+any important result had accrued to practical medicine from Harvey's
+discovery of the circulation.  But Anatomy, Physiology, and Pathology
+have received a new light from this novel method of contemplating the
+living structures, which has had a vast influence in enabling the
+practitioner at least to distinguish and predict the course of
+disease.  We know as well what differences to expect in the habits of
+a mucous and of a serous membrane, as what mineral substances to look
+for in the chalk or the coal measures.  You have only to read
+Cullen's description of inflammation of the lungs or of the bowels,
+and compare it with such as you may find in Laennec or Watson, to see
+the immense gain which diagnosis and 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 this century.  It does not deal with organs, as
+did the earlier anatomists, nor with tissues, after the manner of
+Bichat.  It maps the whole surface of the body into an arbitrary
+number of regions, and studies each region successively from the
+surface to the bone, or beneath it.  This hardly deserves the name of
+a science, although Velpeau has dignified it with that title, but it
+furnishes an admirable practical way for the surgeon who has to
+operate on a particular region of the body to study that region.  If
+we are buying a farm, we are not content with the State map 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 sometimes
+called, surgical anatomy, does for the surgeon with reference to the
+part on which his skill is to be exercised.  It enables him to see
+with the mind's eye through the opaque tissues down to the bone on
+which they lie, as if the skin were transparent as the cornea, and
+the organs it covers translucent as the gelatinous pulp of a medusa.
+
+It is curious that the Japanese should have anticipated Europe in a
+kind of rude regional anatomy.  I have seen a manikin of Japanese
+make traced all over with lines, and points marking their
+intersection.  By this their doctors are guided in the performance of
+acupuncture, marking the safe places to thrust in needles, as we buoy
+out our ship-channels, and doubtless indicating to learned eyes the
+spots where incautious meddling had led to those little accidents of
+shipwreck to which patients are unfortunately liable.
+
+A change of method, then, has given us General and Regional Anatomy.
+These, too, have been worked so thoroughly, that, if not exhausted,
+they have at least become to a great extent fixed and positive
+branches of knowledge.  But the first of them, General Anatomy, would
+never, have reached this positive condition but for the introduction
+of that, instrument which I have mentioned as the second great aid to
+modern progress.
+
+This instrument is the achromatic microscope.  For the history of the
+successive steps by which it became the effective scientific
+implement we now possess, I must refer you to the work of Mr.
+Quekett, to an excellent article in the "Penny Cyclopaedia," or to
+that of Sir David Brewster in the "Encyclopaedia Britannica."  It is
+a most interesting piece of scientific history, which shows how the
+problem which Biot in 1821 pronounced insolvable was in the course of
+a few years practically solved, with a success equal to that which
+Dollond had long before obtained with the telescope.  It is enough
+for our purpose that we are now in possession of an instrument freed
+from all confusions and illusions, which magnifies a thousand
+diameters,--a million times in surface,--without serious distortion
+or discoloration of its object.
+
+A quarter of a century ago, or a little more, an instructor would not
+have hesitated to put John Bell's "Anatomy" and Bostock's
+"Physiology" into a student's hands, as good authority on their
+respective subjects.  Let us not be unjust to either of these
+authors.  John Bell is the liveliest medical writer that I can
+remember who has written since the days of delightful old Ambroise
+Pare.  His picturesque descriptions and bold figures are as good now
+as they ever were, and his book can never become obsolete.  But
+listen to what John Bell says of the microscope :
+
+"Philosophers of the last age had been at infinite pains to find the
+ultimate fibre of muscles, thinking to discover its properties in its
+form; but they saw just in proportion to the glasses which they used,
+or to their practice and skill in that art, which is now almost
+forsaken."
+
+Dr. Bostock's work, neglected as it is, is one which I value very
+highly as a really learned compilation, full of original references.
+But Dr. Bostock says: "Much as the naturalist has been indebted to
+the microscope, by bringing into view many beings of which he could
+not otherwise have ascertained the existence, the physiologist has
+not yet derived any great benefit from the instrument."
+
+These are only specimens of the manner in which the microscope and
+its results were generally regarded by the generation just preceding
+our own.
+
+I have referred you to the proper authorities for the account of
+those improvements which about the year 1830 rendered the compound
+microscope an efficient and trustworthy instrument.  It was now for
+the first time that a true general anatomy became possible.  As early
+as 1816 Treviranus had attempted to resolve the tissues, of which
+Bichat had admitted no less than 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 all the
+tissues, the areolar, was not at all understood?  All that method
+could do had been accomplished by Bichat and his followers.  It was
+for the optician to take the next step.  The future of anatomy and
+physiology, as an enthusiastic micrologist of the time said, was in
+the hands of Messrs.  Schieck and Pistor, famous opticians of Berlin.
+
+In those earlier days of which I am speaking, all the points of
+minute anatomy were involved in obscurity.  Some found globules
+everywhere, some fibres.  Students disputed whether the conjunctiva
+extended over the cornea or not, and worried themselves over Gaultier
+de Claubry's stratified layers of the skin, or Breschet's
+blennogenous and chromatogenous organs.  The dartos was a puzzle, the
+central spinal canal a myth, the decidua clothed in fable as much as
+the golden fleece.  The structure of bone, now so beautifully made
+out,--even that of the teeth, in which old Leeuwenhoek, peeping with
+his octogenarian eyes through the minute lenses wrought with 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 mists
+of an uncertain microscopic vision.  The intimate recesses of the
+animal system were to the students of anatomy what the anterior of
+Africa long was to geographers, and the stories of microscopic
+explorers were 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 the first place, the
+minute structure of all the organs has been made out in the most
+satisfactory way.  The special arrangements of the vessels and the
+ducts of all the glands, of the air-tubes and vesicles of the lungs,
+of the parts which make up the skin and other membranes, all the
+details of those complex parenchymatous organs which had confounded
+investigation so long, have been lifted out of the invisible into the
+sight of all observers.  It is fair to mention here, that we owe a
+great deal to the art of minute injection, by which we are enabled to
+trace the smallest vessels in the midst of the tissues where they are
+distributed.  This is an old artifice of anatomists.  The famous
+Ruysch, who died a hundred and thirty years ago, showed that each of
+the viscera has its terminal vessels arranged in its own peculiar
+way; the same fact which you may see illustrated in Gerber's figures
+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 a
+very rich collection of injected preparations sent him by Professor
+Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
+of which I had a number of microscopes made expressly, by Mr. Grunow,
+during the past season.  All this illustrates what has been done for
+the elucidation of the intimate details of formation of the organs.
+
+But the great triumph of the microscope as applied to anatomy has
+been in the resolution of the organs and the tissues into their
+simple constituent anatomical elements.  It has taken up general
+anatomy where Bichat left it.  He had succeeded in reducing the
+structural language of nature to syllables, if you will permit me to
+use so bold an image.  The microscopic observers who have come after
+him have analyzed these into letters, as we may call them,--the
+simple elements by the combination of which Nature spells 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, until she binds up in one living whole that wondrous
+volume of 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 repeating it, 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, already referred to.  Very
+commonly they have undergone a change of figure, most frequently a
+flattening which reduces them to scales, as in the epidermis and the
+epithelium.
+
+B.  Simple, translucent, homogeneous solid, such as is found at the
+back of the cornea, or forming the intercellular substance of
+cartilage.
+
+C.  The white fibrous element, consisting of very delicate, tenacious
+threads.  This is the long staple textile substance of the body.  It
+is to the organism what 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-work together.  It furnishes the
+sinews, which are the 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 made of it.
+
+D.  The yellow elastic, fibrous element, the caoutchouc of the animal
+mechanism, which pulls things back into place, as the India-rubber
+band shuts the door we have opened.
+
+E.  The striped muscular fibre,--the red flesh, which shortens itself
+in obedience to the will, and thus produces all voluntary active
+motion.
+
+F.  The unstriped muscular fibre, more properly the fusiform-cell
+fibre, which carries on the involuntary internal movements.
+
+G.  The nerve-cylinder, a glassy tube, with a pith of some firmness,
+which conveys sensation to the brain and the principle which induces
+motion from it.
+
+H.  The nerve-corpuscle, the centre of nervous power.
+
+I.  The mucous tissue, as Virchow calls it, common in embryonic
+structures, seen in the vitreous humor of the adult.
+
+To these add X, granules, of indeterminate shape and size, Y, for
+inorganic matters, such as the salts of bone and teeth, and Z, to
+stand as a symbol of the fluids, and you have the letters of what I
+have ventured to call the alphabet of the body.
+
+But just as in language certain diphthongs and syllables are
+frequently recurring, so we have in the body certain secondary and
+tertiary combinations, which we meet more frequently than the
+solitary elements of which they are composed.
+
+Thus A B, or a collection of cells united by simple structureless
+solid, is seen to be extensively employed in the body under the name
+of cartilage.  Out of this the surfaces of the articulations and the
+springs of the breathing apparatus are formed.  But when Nature came
+to the buffers of the spinal column (intervertebral disks) and the
+washers of the joints (semilunar fibrocartilages of the knee, etc.),
+she required more tenacity than common cartilage possessed.  What did
+she do?  What does man do in a similar case of need?  I need hardly
+tell you.  The mason lays his bricks in simple mortar.  But the
+plasterer works some hair into the mortar which he is going to lay in
+large sheets on the walls.  The children of Israel complained that
+they had no straw to make their bricks with, though portions of it
+may still be seen in the crumbling pyramid of Darshour, which they
+are said to have built.  I visited the old house on Witch Hill in
+Salem a year or two ago, and there I found the walls coated with clay
+in which straw was abundantly mingled;--the old Judaizing witch-
+hangers copied the Israelites in a good many things.  The Chinese and
+the Corsicans blend the fibres of amianthus in their pottery to give
+it tenacity.  Now to return to Nature.  To make her buffers and
+washers hold together in the shocks to which they would be subjected,
+she took common cartilage and mingled the white fibrous tissue with
+it, to serve the same purpose as the hair in the mortar, the straw in
+the bricks and in the plaster of the old wall, and the amianthus in
+the earthen vessels.  Thus we have the combination A B C, or fibro-
+cartilage.  Again, the bones were once only gristle or cartilage, A
+B.  To give them solidity they were infiltrated with stone, in the
+form of salts of lime, an inorganic element, so that bone would be
+spelt out by the letters A, B, and Y.
+
+If from these organic syllables we proceed to form organic words, we
+shall find that Nature employs three principal forms; namely,
+Vessels, Membranes, and Parenchyma, or visceral tissue.  The most
+complex of them can be resolved into a combination of these few
+simple anatomical constituents.
+
+
+Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
+the same elements in morbid growths that we have met with in normal
+structures.  The pus-corpuscle and the white blood-corpuscle can only
+be distinguished by tracing them to their origin.  A frequent form of
+so-called malignant disease proves to 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,--the crowding together of the
+elements, the size of the cell-nuclei, and similar variable
+characters.
+
+Let us turn to PHYSIOLOGY.  The microscope, which has made a new
+science of the intimate structure of the organs, has at the same time
+cleared up many uncertainties concerning the mechanism of the special
+functions.  Up to the time of the living generation of observers,
+Nature had kept over all her inner workshops the forbidding
+inscription, No Admittance!  If any prying observer ventured to spy
+through his magnifying tubes into the mysteries of her glands and
+canals and fluids, she covered up her work in blinding mists and
+bewildering halos, as the deities of old concealed their favored
+heroes in the moment of danger.
+
+Science has at length sifted the turbid light of her lenses, and
+blanched their delusive rainbows.
+
+Anatomy studies the organism in space.  Physiology studies it also in
+time.  After the study of form and composition follows close that of
+action, and this leads us along back to the first moment of the germ,
+and forward to the resolution of the living frame into its lifeless
+elements.  In this way Anatomy, or rather that branch of it which we
+call Histology, has become inseparably blended with the study of
+function.  The connection between the science of life and that of
+intimate structure on the one hand, and composition on the other, is
+illustrated in the titles of two recent works of remarkable
+excellence,--"the Physiological Anatomy" of Todd and Bowman, and the
+"Physiological Chemistry" of Lehmann.
+
+Let me briefly recapitulate a few of our acquisitions in Physiology,
+due in large measure to our new instruments and methods of research,
+and at the same time indicate the limits which form the permanent or
+the temporary boundaries of our knowledge.  I will begin with the
+largest fact and with the most absolute and universally encountered
+limitation.
+
+The "largest truth in Physiology" Mr. Paget considers to be "the
+development of ova through multiplication and division of their
+cells."  I would state it more broadly as the agency of the cell in
+all living processes.  It seems at present necessary to abandon the
+original idea of Schwann, that we can observe the building up of a
+cell from the simple granules of a blastema, or formative fluid.  The
+evidence points rather towards the axiom, Omnis cellula a cellula;
+that is, the germ of a new cell is always derived from a preexisting
+cell.  The doctrine 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 plasterer in fibro-cartilage,
+so we see her beforehand with the 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 Nature shapes her hyaline
+vesicles and modifies them to serve the needs of the part where they
+are found.  The artisan whirls his rod, and his glass bubble becomes
+a flattened disk, with its bull's-eye for a nucleus.  These lips of
+ours are all glazed with microscopic tiles formed of flattened cells,
+each one of them with its nucleus still as plain and relatively as
+prominent, to the eye of the microscopist, as the bull's-eye in the
+old-fashioned windowpane.  Everywhere we find cells, modified or
+unchanged.  They roll in inconceivable multitudes (five millions and
+more to the cubic millimetre, according to Vierordt) as blood-disks
+through our vessels.  A close-fitting mail of flattened cells coats
+our surface with a panoply of imbricated scales (more than twelve
+thousand millions, as Harting has computed, as true a defence against
+our enemies as the buckler of the armadillo or the carapace of the
+tortoise against theirs.  The same little protecting organs pave all
+the great highways of the interior system.  Cells, again, preside
+over the chemical processes which elaborate the living fluids; they
+change their form to become the agents of voluntary and involuntary
+motion; the soul itself sits on a throne of nucleated cells, and
+flashes its mandates through skeins of glassy filaments which once
+were simple chains of vesicles.  And, as if to reduce the problem of
+living force to its simplest expression, we see the yolk of a
+transparent egg dividing itself in whole or in part, and again
+dividing and subdividing, until it becomes a mass of cells, out of
+which the harmonious diversity of the organs arranges itself, worm or
+man, as God has willed from the beginning.
+
+This differentiation having been effected, each several part assumes
+its special office, having a life of its own adjusted to that of
+other parts and the whole.  "Just as a tree constitutes a mass
+arranged in a definite manner, in which, in every single part, in the
+leaves as in the root, in the trunk as in the blossom, cells are
+discovered to be the ultimate elements, so is it also with the forms
+of animal life.  Every animal presents itself as a sum of vital
+unities, every one of which manifests all the characteristics of
+life."
+
+The mechanism is as clear, as unquestionable, as absolutely settled
+and universally accepted, as the order of movement of the heavenly
+bodies, which we compute backward to the days of the observatories on
+the plains of Shinar, and on the faith of which we regulate the
+movements of war and trade by the predictions of our ephemeris.
+
+The mechanism, and that is all.  We see the workman and the tools,
+but the skill that guides the work and the power that performs it are
+as invisible as ever.  I fear that not every listener took the
+significance of those pregnant words in the passage I quoted from
+John Bell,--"thinking to discover its properties in its form."  We
+have discovered the working bee in this great hive of organization.
+We have detected the cell in the very act of forming itself from a
+nucleus, of transforming itself into various tissues, of selecting
+the elements of various secretions.  But why one cell becomes nerve
+and another muscle, why one selects bile and another fat, we can no
+more pretend to tell, than why one grape sucks out of the soil the
+generous juice which princes hoard in their cellars, and another the
+wine which it takes three men to drink,--one to pour it down, another
+to swallow it, and a third to hold him while it is going down.
+Certain analogies between this selecting power and the phenomena of
+endosmosis in the elective affinities of chemistry we can find, but
+the problem of force remains here, as everywhere, unsolved and
+insolvable.
+
+Do we gain anything by attempting to get rid of the idea of a special
+vital force because we find certain mutually convertible relations
+between forces in the body and out of it?  I think not, any more than
+we should gain by getting rid of the idea and expression Magnetism
+because of its correlation with electricity.  We may concede the
+unity of all forms of force, but we cannot overlook the fixed
+differences of its manifestations according to the conditions under
+which it acts.  It is a mistake, however, to think the mystery is
+greater in an organized body than in any other.  We see a stone fall
+or a crystal form, and there is nothing stranger left to wonder at,
+for we have seen the Infinite in action.
+
+Just so far as we can recognize the ordinary modes of operation of
+the common forces of nature,--gravity, cohesion, elasticity,
+transudation, chemical action, and the rest,--we see the so-called
+vital acts in the light of a larger range of known facts and familiar
+analogies.  Matteuecci's well-remembered lectures contain many and
+striking examples of the working of physical forces in physiological
+processes.  Wherever rigid experiment carries us, we are safe in
+following this lead; but the moment we begin to theorize beyond our
+strict observation, we are in danger of falling into those mechanical
+follies which true science has long outgrown.
+
+Recognizing the fact, then, that we have learned nothing but the
+machinery of life, and are no nearer to its essence, what is it that
+we have gained by this great discovery of the cell formation and
+function?
+
+It would have been reward enough to learn the method Nature pursues
+for its own sake.  If the sovereign Artificer lets us into his own
+laboratories and workshops, we need not ask more than the privilege
+of looking on at his work.  We do not know where we now stand in the
+hierarchy of created intelligences.  We were made a little lower than
+the angels.  I speak it not irreverently; as the lower animals
+surpass man in some of their attributes, so it may be that not every
+angel's eye can see as broadly and as deeply into the material works
+of God as man himself, looking at the firmament through an equatorial
+of fifteen inches' aperture, and searching into the tissues with a
+twelfth of an inch objective.
+
+But there are other positive gains of a more practical character.
+Thus we are no longer permitted to place the seat of the living
+actions in the extreme vessels, which are only the carriers from
+which each part takes what it wants by the divine right of the
+omnipotent nucleated cell.  The organism has become, in the words
+already borrowed from Virchow, "a sum of vital unities."  The
+strictum and laxum, the increased and diminished action of the
+vessels, out of which medical theories and methods of treatment have
+grown up, have yielded to the doctrine of local cell-communities,
+belonging to this or that vascular 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 of the points of
+contact between our ignorance and our knowledge which present
+particular interest in the existing state of our physiological
+acquisitions.  Some of them involve the microscopic discoveries of
+which I have been speaking, some belong to the domain of chemistry,
+and some have relations with other departments of physical science.
+
+If we should begin with the digestive function, we should find that
+the long-agitated question of the nature of the acid of the gastric
+juice is becoming settled in favor of the lactic.  But the whole
+solvent agency of the digestive fluid enters into the category of
+that exceptional mode of action already familiar to us in chemistry
+as catalysis.  It is therefore doubly difficult of explanation;
+first, as being, like all reactions, a fact not to be accounted for
+except by the imaginative appeal to "affinity," and secondly, as
+being one of those peculiar reactions provoked by an element which
+stands outside and looks on without compromising itself.
+
+The doctrine of Mulder, so widely diffused in popular and scientific
+belief, of the existence of a common base of all albuminous
+substances, the so-called protein, has not stood the test of rigorous
+analysis.  The division of food into azotized and non-azotized is no
+doubt important, but the attempt to show that the first only is
+plastic or nutritive, while the second is simply calorifacient, or
+heat-producing, fails entirely in the face of the facts revealed by
+the study of man in different climates, and of numerous experiments
+in the feeding of animals.  I must return to this subject 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 out of its own substance;--why?
+
+          Quia est in eo
+          Virtus saccharitiva.
+
+Just what becomes of the sugar beyond the fact of its disappearance
+before it can get into the general circulation and sweeten our
+tempers, it is hard to say.
+
+The pancreatic fluid makes an emulsion of the fat contained in our
+food, but just how the fatty particles get into the villi we must
+leave Brucke and Kolliker to settle if they can.
+
+No one has shown satisfactorily the process by which the blood-
+corpuscles are formed out of the lymph-corpuscles, nor what becomes
+of them.  These two questions are like those famous household
+puzzles,--Where do the flies come from?  and, Where do the pins go
+to?
+
+There is a series of organs in the body which has long puzzled
+physiologists,--organs of glandular aspect, but having no ducts,--the
+spleen, the thyroid and thymus bodies, and the suprarenal capsules.
+We call them vascular glands, and we believe that they elaborate
+colored and uncolored blood-cells; but just what changes they effect,
+and just how they effect them, it has proved a very difficult matter
+to determine.  So of the noted glandules which form Peyer's patches,
+their precise office, though seemingly like those of the lymphatic
+glands, cannot be positively assigned, so far as I know, at the
+present time.  It is of obvious interest to learn it with reference
+to the pathology of typhoid fever.  It will be remarked that the
+coincidence of their changes in this disease with enlargement of the
+spleen suggests the idea of a similarity of function in these two
+organs.
+
+The theories of the production of animal heat, from the times of
+Black, Lavoisier, and Crawford to those of Liebig, are familiar to
+all who have paid any attention to physiological studies.  The
+simplicity of Liebig's views, and the popular form in which they have
+been presented, have given them wide currency, and incorporated them
+in the common belief and language of our text-books.  Direct
+oxidation or combustion of the carbon and hydrogen contained in the
+food, or in the tissues themselves; the division of alimentary
+substances into respiratory, or non-azotized, and azotized,--these
+doctrines are 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 than with sulphur and azote.  Such is the well-
+grounded statement of Robin and Verdeil.  "It is very probable that
+animal heat is entirely produced by the chemical actions which take
+place in the organism, but the phenomenon is too complex to admit of
+our calculating it according to the quality of oxygen consumed."
+These last are the words of Regnault, as cited by Mr. Lewes, whose
+intelligent discussion of this and many of the most interesting
+physiological problems I strongly recommend to your attention.
+
+This single illustration covers a wider ground than the special
+function to which it belongs.  We are learning that the chemistry of
+the body must be studied, not simply by its ingesta and egesta, but
+that there is a long intermediate series of changes which must be
+investigated in their own light, under their own special conditions.
+The expression "sum of 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 just cited entitle their
+work a treatise on the immediate principles of the body, they only
+indicate the nature of that profound and subtile analysis which must
+take the place of all hasty generalizations founded on a comparison
+of the food with residual products.
+
+I will only call your attention to the fact, that the exceptional
+phenomenon of the laboratory is the prevailing law of the organism.
+Nutrition itself is but one great catalytic process.  As the blood
+travels its rounds, each part selects its appropriate element and
+transforms it to its own likeness.  Whether the appropriating agent
+be cell or nucleus, or a structureless solid like the intercellular
+substance of cartilage, the fact of its presence determines the
+separation of its proper constituents from the circulating fluid, so
+that even when we are wounded bone is replaced by bone, skin by skin,
+and nerve by nerve.
+
+It is hardly without a smile that we resuscitate the old question of
+the vis insita of the muscular fibre, so famous in the discussions of
+Haller and his contemporaries.  Speaking generally, I think we may
+say that Haller's doctrine is the one now commonly received; namely,
+that the muscles contract in virtue of their own inherent endowments.
+It is true that Kolliker says no perfectly decisive fact has been
+brought forward to prove that the striated muscles contract with.
+out having been acted on by nerves.  Yet Mr. Bowman's observations on
+the contraction of isolated fibres appear decisive enough (unless we
+consider them invalidated by Dr. Lionel Beale's recent researches,
+tending to show that each elementary fibre is supplied with nerves;
+and as to the smooth muscular fibres, we have Virchow's statement
+respecting the contractility of those of the umbilical cord, where
+there is not a trace of any nerves.
+
+In the investigation of the nervous system, anatomy and physiology
+have gone hand in hand.  It is very singular that so important, and
+seemingly simple, a fact as the connection of the nerve-tubes, at
+their origin or in their course, with the nerve-cells, should have so
+long remained open to doubt, as you may see that it did by referring
+to the very complete work of Sharpey and Quain (edition of 1849), the
+histological portion of which is cordially approved by Kolliker
+himself.
+
+Several most interesting points of the minute anatomy of the nervous
+centres have been laboriously and skilfully worked out by a recent
+graduate of this Medical School, in a monograph worthy to stand in
+line with those of Lockhart Clarke, Stilling, and Schroder van der
+Kolk. I have had the privilege of examining and of showing some of
+you a number of Dr. Dean's skilful preparations.  I have no space to
+give even an abstract of his conclusions.  I can only refer to his
+proof of the fact, that a single cell may send its processes into
+several different bundles of nerve-roots, and to his demonstration of
+the curved ascending and descending fibres from the posterior
+nerveroots, to reach what he has called the longitudinal columns of
+the cornea.  I must also mention Dr. Dean's exquisite microscopic
+photographs from sections of the medulla oblongata, which appear to
+me to promise a new development, if not a new epoch, in anatomical
+art.
+
+It having been settled that the nerve-tubes can very commonly be
+traced directly to the nerve-cells, the object of all the observers
+in this department of anatomy is to follow these tubes to their
+origin.  We have an infinite snarl of telegraph wires, and we may be
+reasonably sure, that, if we can follow them up, we shall find each
+of them ends in a battery somewhere.  One of the most interesting
+problems is to find the ganglionic origin of the great nerves of the
+medulla oblongata, and this is the end to which, by the aid of the
+most delicate sections, colored so as to bring out their details,
+mounted so as to be imperishable, magnified by the best instruments,
+and now self-recorded in the light of the truth-telling sunbeam, our
+fellow-student is making a steady progress in a labor which I think
+bids fair to rank with the most valuable contributions to histology
+that we have had from this side of the Atlantic.
+
+It is interesting to see how old questions are incidentally settled
+in the course of these new investigations.  Thus, Mr. Clarke's
+dissections, confirmed by preparations of Mr. Dean's which I have
+myself examined, placed the fact of the decussation of the pyramids--
+denied by Haller, by Morgagni, and even by Stilling--beyond doubt.
+So the spinal canal, the existence of which, at least in the adult,
+has been so often disputed, appears as a coarse and unequivocal
+anatomical fact in many of the preparations referred to.
+
+While these studies of the structure of the cord have been going on,
+the ingenious and indefatigable Brown-Sequard has been investigating
+the functions of its different parts with equal diligence.  The
+microscopic anatomists had shown that the ganglionic corpuscles of
+the gray matter of the cord are connected with each other by their
+processes, as well as with the nerve-roots.  M.  Brown-Sequard has
+proved by numerous experiments that the gray substance transmits
+sensitive impressions and muscular stimulation.  The oblique
+ascending and descending fibres from the posterior nerve-roots,
+joining the "longitudinal columns of the cornua," account for the
+results of Brown-Sequard's sections of the posterior columns.  The
+physiological experimenter has also made it evident that the
+decussation of the conductors of sensitive impressions has its seat
+in the spinal core, and not in the encephalon, as had been supposed.
+Not less remarkable than these results are the facts, which I with
+others of my audience have had the opportunity of observing, as shown
+by M. Brown-S6quard, of the artificial production of epilepsy in
+animals by injuring the spinal cord, and the induction of the
+paroxysm by pinching a certain portion of the skin.  I would also
+call the student's attention to his account of the relations of the
+nervous centres to nutrition and secretion, the last of which
+relations has been made the subject of an extended essay by our
+fellow countryman, Dr. H. F. Campbell of Georgia.
+
+The physiology of the spinal cord seems a simple matter as you study
+it in Longet.  The experiments of Brown-Sequard have shown the
+problem to be a complex one, and raised almost as many doubts as they
+have solved questions; at any rate, I believe all lecturers on
+physiology agree that there is no part of their task they dread so
+much as the analysis of the evidence relating to the special offices
+of the different portions of the medulla spinalis.  In the brain we
+are sure 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 crossed paralysis of sensation, and the conducting agency of
+the gray substance, I am afraid we retain no cardinal principles
+discovered since the development of the reflex function took its
+place by Sir Charles Bell's great discovery.
+
+By the manner in which I spoke of the brain, you will see that I am
+obliged to leave phrenology sub Jove,--out in the cold,--as not one
+of the household of science.  I am not one of its haters; on the
+contrary, I am grateful for the incidental good it has done.  I love
+to amuse myself in its plaster Golgothas, and listen to the glib
+professor, as he discovers by his manipulations
+
+     "All that disgraced my betters met in me."
+
+I loved of old to see square-headed, heavy-jawed Spurzheim make a
+brain flower out into a corolla of marrowy filaments, as Vieussens
+had done before him, and to hear the dry-fibred but human-hearted
+George Combe teach good sense under the disguise of his equivocal
+system.  But the pseudo-sciences, phrenology and the rest, seem to me
+only appeals to weak minds and the weak points of strong ones.  There
+is a pica or false appetite in many intelligences; they take to odd
+fancies in place of wholesome truth, as girls gnaw at chalk and
+charcoal.  Phrenology juggles with nature.  It is so adjusted as to
+soak up all evidence 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 boundary of our ignorance, it seems to me,
+but is one of the will-o'-the-wisps of its undisputed central domain
+of bog and quicksand.  Yet I should not have devoted so many words to
+it, did I not recognize the light it has thrown on human actions by
+its study of congenital organic tendencies.  Its maps of the.
+surface of the head are, I feel sure, founded on a delusion, but its
+studies of individual character are always interesting and
+instructive.
+
+The "snapping-turtle" strikes after its natural fashion when it first
+comes out of the egg.  Children betray their tendencies in their way
+of dealing with the breasts that nourish them; nay, lean venture to
+affirm, that long before they are born they teach their mothers
+something of their turbulent or quiet tempers.
+
+     "Castor gaudet equis, ovo proanatus eodem
+          Pugnis."
+
+Strike out the false pretensions of phrenology; call it anthropology;
+let it study man the individual in distinction from man the
+abstraction, the metaphysical or theological lay-figure; and it
+becomes "the proper study of mankind," one of the noblest and most
+interesting of pursuits.
+
+The whole physiology of the nervous system, from the simplest
+manifestation of its power in an insect up to the supreme act of the
+human intelligence working through the brain, is full of the most
+difficult yet profoundly interesting questions.  The singular
+relations between electricity and nerve-force, relations which it has
+been attempted to interpret as meaning identity, in the face of
+palpable differences, require still more extended studies.  You may
+be interested by Professor Faraday's statement of his opinion on the
+matter.  "Though I am not satisfied that the nervous fluid is only
+electricity, still I think that the agent in the nervous system maybe
+an inorganic force; and if there be reason for supposing that
+magnetism is a higher relation of force than electricity, so it may
+well be imagined that the nervous power may be of a still more
+exalted character, and yet within the reach of experiment."
+
+In connection with this statement, it is interesting to refer to the
+experiments of Helmholtz on the rapidity of transmission of the
+nervous actions.  The rate is given differently in Valentin's report
+of these experiments and in that found in the "Scientific Annual" for
+1858.  One hundred and eighty to three hundred feet per second is the
+rate of movement assigned for sensation, but all such results must be
+very vaguely approximative.  Boxers, fencers, players at the Italian
+game of morn, "prestidigitators," and all who depend for their
+success on rapidity of motion, know what differences there are in the
+personal equation of movement.
+
+Reflex action, the mechanical sympathy, if I may so call it, of
+distant parts; Instinct, which is crystallized intelligence,--an
+absolute law with its invariable planes and angles introduced into
+the sphere of consciousness, as raphides are inclosed in the living
+cells of plants; Intellect,--the operation of the thinking principle
+through material organs, with an appreciable waste of tissue in every
+act of thought, so that our clergymen's blood has more phosphates to
+get rid of on Monday than on any other day of the week; Will,--
+theoretically the absolute determining power, practically limited in
+different degrees by the varying organization of races and
+individuals, annulled or perverted by different ill-understood
+organic changes; on all these subjects our knowledge is in its
+infancy, and from the study of some of them the interdict of the
+Vatican is hardly yet removed.
+
+I must allude to one or two points in the histology and physiology of
+the organs of sense.  The anterior continuation of the retina beyond
+the ora serrata has been a subject of much discussion.  If H. Muller
+and Kolliker can be relied upon, this question is settled by
+recognizing that a layer of cells, continued from the retina, passes
+over the surface of the zonula Zinnii, but that no proper nervous
+element is so prolonged forward.
+
+I observe that Kolliker calls the true nervous elements of the retina
+"the layer of gray cerebral substance."  In fact, the ganglionic
+corpuscles of each eye may be considered as constituting a little
+brain, connected with the masses behind by the commissure, commonly
+called the optic nerve.  We are prepared, therefore, to find these
+two little brains in the most intimate relations with each other, as
+we find the cerebral hemispheres.  We know that they are directly
+connected by fibres that arch round through the chiasma.
+
+I mention these anatomical facts to introduce a physiological
+observation of my own, first announced in one of the lectures before
+the Medical Class, subsequently communicated to the American Academy
+of Arts and Sciences, and printed in its "Transactions" for February
+14, 1860.  I refer to the apparent transfer of impressions from one
+retina to the other, to which I have given the name reflex vision.
+The idea was suggested to me in consequence of certain effects
+noticed in employing the stereoscope.  Professor William B. Rodgers
+has since called the attention of the American Scientific Association
+to some facts bearing on the subject, and to a very curious
+experiment of Leonardo da Vinci's, which enables the observer to look
+through the palm of his hand (or seem to), as if it had a hole bored
+through it.  As he and others hesitated to accept my explanation, I
+was not sorry to find recently the following words in the
+"Observations on Man" of that acute observer and thinker, David
+Hartley.  "An impression made on the right eye alone by a single
+object may propagate itself into the left, and there raise up an
+image almost equal in vividness to itself; and consequently when we
+see with one eye only, we may, however, have pictures in both eyes."
+Hartley, in 1784, had anticipated many of the doctrines which have
+since been systematized into the theory of reflex actions, and with
+which I have attempted to associate this act of reflex vision.  My
+sixth experiment, however, in the communication referred to, appears
+to me to be a crucial one, proving the correctness of my explanation,
+and I am not aware that it has been before instituted.
+
+Another point of great interest connected with the physiology of
+vision, and involved for a long time in great obscurity, is that of
+the adjustment of the eye to different distances.  Dr. Clay Wallace
+of New York, who published a very ingenious little book on the eye
+about twenty years ago, with vignettes reminding one of Bewick, was
+among the first, if not the first, to describe the ciliary muscle, to
+which the power of adjustment is generally ascribed.  It is
+ascertained, by exact experiment with the phacueidoscope, that
+accommodation depends on change of form of the crystalline lens.
+Where the crystalline is wanting, as Mr. Ware long ago taught, no
+power of accommodation remains.  The ciliary muscle is generally
+thought to effect the change of form of the crystalline.  The power
+of accommodation is lost after the application of atropine, in
+consequence, as is supposed, of the paralysis of this muscle.  This,
+I believe, is the nearest approach to a demonstration we have on this
+point.
+
+I have only time briefly to refer to Professor Draper's most
+ingenious theory as to the photographic nature of vision, for an
+account of which I must refer to his original and interesting
+Treatise on Physiology.
+
+It were to be wished that the elaborate and very interesting
+researches of the Marquis Corti, which have revealed such singular
+complexity of structure in the cochlea of the ear, had done more to
+clear up its doubtful physiology; but I am afraid we have nothing but
+hypotheses for the special part it plays in the act of hearing, and
+that we must say the same respecting the office of the semicircular
+canals.
+
+The microscope has achieved some of its greatest triumphs in teaching
+us the changes which occur in the development of the embryo.  No more
+interesting discovery stands recorded in the voluminous literature of
+this subject than the one originally announced by Martin Barry,
+afterwards discredited, and still later confirmed by Mr. Newport and
+others; namely the fact that the fertilizing filament reaches the
+interior of the ovum in various animals;--a striking parallel to the
+action of the pollen-tube in the vegetable.  But beyond the
+mechanical facts all is mystery in the movements of organization, as
+profound as in the fall of a stone or the formation of a crystal.
+
+To the chemist and the microscopist the living body presents the same
+difficulties, arising from the fact that everything is in perpetual
+change in the organism.  The fibrine of the blood puzzles the one as
+much as its globules puzzle the other.  The difference between the
+branches of science which deal with space only, and those which deal
+with space and time, is this: we have no glasses that can magnify
+time.  The figure I here show you a was photographed from an object
+(pleurosigma angulatum) magnified a thousand diameters, or presenting
+a million times its natural surface.  This other figure of the same
+object, enlarged from the one just shown, is magnified seven thousand
+diameters, or forty-nine million times in surface.  When we can make
+the forty-nine millionth of a second as long as its integer,
+physiology and chemistry will approach nearer the completeness of
+anatomy.
+
+Our reverence becomes more worthy, or, if you will, less unworthy of
+its Infinite Object in proportion as our intelligence is lifted and
+expanded to a higher and broader understanding of the Divine methods
+of action.  If Galen called his heathen readers to admire, the power,
+the wisdom, the providence, the goodness of the Framer of the animal
+body,"--if Mr. Boyle, the student of nature, as Addison and that
+friend of his who had known him for forty years tell us, never
+uttered the name of the Supreme Being without making a distinct pause
+in his speech, in token of his devout recognition of its awful
+meaning,--surely we, who inherit the accumulated wisdom of nearly two
+hundred 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 study to their great Artificer.  These
+wonderful discoveries which we owe to that mighty little instrument,
+the telescope of the inner firmament with all its included worlds;
+these simple formulae by which we condense the observations of a
+generation in a single axiom; these logical analyses by which we
+fence out the ignorance we cannot reclaim, and fix the limits of our
+knowledge,--all lead us up to the inspiration of the Almighty, which
+gives understanding to the world's great teachers.  To fear science
+or knowledge, lest it disturb our old beliefs, is to fear the influx
+of the Divine wisdom into the souls of our fellow-men; for what is
+science but the piecemeal revelation,--uncovering,--of the plan of
+creation, by the agency of those chosen prophets of nature whom God
+has illuminated from the central light of truth for that single
+purpose?
+
+The studies which we have glanced at are preliminary in your
+education to the practical arts which make use of them,--the arts of
+healing,--surgery and medicine.  The more you examine the structure
+of the organs and the laws of life, the more you will find how
+resolutely each of the cell-republics which make up the E pluribus
+unum of the body maintains its independence.  Guard it, feed it, air
+it, warm it, exercise or rest it properly, and the working elements
+will do their best to keep well or to get well.  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 side of the fence looking in
+good health, while those on the other side were scraggy and
+miserable.  How do 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,
+and supplying them with the right kind of food in fitting quantities.
+
+Now a man is not a plant, or, at least, he is a very curious 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.  He has,
+besides, a singularly complex nutritive apparatus and a nervous
+system.  But recollect the doctrine already enunciated in the
+language of Virchow, that an animal, like a tree, is a sum of vital
+unities, of which the cell is the ultimate element.  Every healthy
+cell, whether in a vegetable or an animal, necessarily performs its
+function properly so long as 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 normal state.  But if
+originally sound and subsequently diseased, there has certainly been
+some excess, deficiency, or wrong quality in the materials or stimuli
+applied to it.  You remove this injurious influence and substitute a
+normal one; remove the baked coal-ashes, for instance, from the roots
+of a tree, and replace them with loam; take away the salt meat from
+the patient's table, and replace it with fresh meat and vegetables,
+and the cells of the tree or the man return to their duty.
+
+I do not know that we ever apply to a plant any element which is not
+a natural constituent of the vegetable structure, except perhaps
+externally, for the accidental purpose of killing parasites.  The
+whole art of cultivation consists in learning the proper food and
+conditions of plants, and supplying them.  We give them water,
+earths, salts of various kinds such as they are made of, with a
+chance to help themselves to air and light.  The farmer would be
+laughed at who undertook to manure his fields or his trees with a
+salt of lead or of arsenic.  These elements are not constituents of
+healthy plants.  The gardener uses the waste of the arsenic furnaces
+to kill the weeds 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 the vegetable, we might
+expect that we should treat all morbid conditions of any of the vital
+unities belonging to an animal in the same way, by increasing,
+diminishing, or changing its natural food or stimuli.
+
+"That is an aliment which nourishes; whatever we find in the
+organism, as a constant and integral element, either forming part of
+its structure, or one of the conditions of vital processes, that and
+that only deserves the name of aliment."  " I see no reason,
+therefore, why iron, phosphate of lime, sulphur, should not be
+considered food for man, as much as guano or poudrette for
+vegetables.  Whether one or another of them is best in any given
+case,--whether they shall be taken alone or in combination, in large
+or small quantities, are separate questions.  But they are elements
+belonging to the body, and even in moderate excess will produce
+little disturbance.  There is no presumption against any of this
+class of substances, any more than against water or salt, provided
+they are used in fitting combinations, proportions, and forms.
+
+But when it comes to substances alien to the healthy system, which
+never belong to it as normal constituents, the case is very
+different.  There is a presumption against putting lead or arsenic
+into the human body, as against putting them into plants, because
+they do 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
+they get into the system we cannot always tell.  But in the case of
+silver, from the accident of its changing color under the influence
+of light, we do know what happens.  It is thrown out, in part at
+least, under the epidermis, and there it remains to the patient's
+dying day.  This is a striking illustration of the difficulty which
+the system finds in dealing with non-assimilable elements, and
+justifies in some measure the vulgar prejudice against mineral
+poisons."
+
+I trust the youngest student on these benches will not commit the
+childish error of confounding a presumption against a particular
+class of agents with a condemnation of them.  Mercury, for instance,
+is alien to the system, and eminently disturbing in its influence.
+Yet its efficacy in certain forms of specific disease is acknowledged
+by all but the most sceptical theorists.  Even the esprit moqueur of
+Ricord, the Voltaire of pelvic literature, submits to the time-
+honored constitutional authority of this great panacea in the class
+of cases to which he has devoted his brilliant intelligence.  Still,
+there is no telling what evils have arisen from the abuse of this
+mineral.  Dr. Armstrong long ago pointed out some of them, and they
+have become matters of common notoriety.  I am pleased, therefore,
+when I find so able and experienced a practitioner as Dr. Williams of
+this city proving that iritis is best treated without mercury, and
+Dr. Vanderpoel showing the same thing to be true for pericarditis.
+
+Whatever elements nature does not introduce into vegetables, the
+natural food of all animal life,--directly of herbivorous, indirectly
+of carnivorous animals,--are to be regarded with suspicion.  Arsenic-
+eating may seem to improve the condition of horses for a time,--and
+even of human beings, if Tschudi's stories can be trusted,--but it
+soon appears that its alien qualities are at war with the animal
+organization.  So of copper, antimony, and other non-alimentary
+simple substances; everyone of them is an intruder in the living
+system, as much as a constable would be, quartered in our household.
+This does not mean that they may not, any of them, be called in for a
+special need, as we send for the constable when we have good reason
+to think we have a thief under our roof; but a man's body is his
+castle, as well as his house, and the presumption is that we are to
+keep our alimentary doors bolted against these perturbing agents.
+
+Now the feeling is very apt to be just contrary to this.  The habit
+has been very general with well-taught practitioners, to have
+recourse to the introduction of these alien elements into the system
+on the occasion of any slight disturbance.  The tongue was a little
+coated, and mercury must be given; the skin was a little dry, and the
+patient must take antimony.  It was like sending for the constable
+and the posse comitatus when there is only a carpet to shake or a
+refuse-barrel to empty. [Dr. James Johnson advises persons not ailing
+to take ,five grains of blue pill with one or two of aloes twice a
+week for three or four months in the year, with half a pint of
+compound decoction of sarsaparilla every day for the same period, to
+preserve health and prolong life.  Pract.  Treatise on Dis.  of
+Liver, etc.  p.  272.] The constitution bears slow poisoning a great
+deal better than might be expected; yet the most intelligent men in
+the profession have gradually got out of the habit of prescribing
+these powerful alien substances in the old routine way.  Mr. Metcalf
+will tell you how much more sparingly they are given by our
+practitioners at the present time, than when he first inaugurated the
+new era of pharmacy among us.  Still, the presumption in favor of
+poisoning out every spontaneous reaction of outraged nature is not
+extinct in those who are trusted with the lives of their fellow-
+citizens.  "On examining the file of prescriptions at the hospital, I
+discovered that they were rudely written, and indicated a treatment,
+as they consisted chiefly of tartar emetic, ipecacuanha, and epsom
+salts, hardly favorable to the cure of the prevailing diarrhoea and
+dysenteries."   In a report of a poisoning case now on trial, where
+we are told that arsenic enough was found in the stomach to produce
+death in twenty-four hours, the patient is said to have been treated
+by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
+acid,--by a practitioner of what school it may be imagined.
+
+The traditional idea of always poisoning out disease, as we smoke out
+vermin, is now seeking its last refuge behind the wooden cannon and
+painted port-holes of that unblushing system of false scientific
+pretences which I do not care to name in a discourse addressed to an
+audience devoted to the study of the laws of nature 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, has accustomed
+all who have sense enough to see through its thin artifices to the
+idea that diseases get well without being "cured," should now be the
+main support of the tottering poison-cure doctrine.  It has
+unquestionably helped to teach wise people that nature heals most
+diseases without help from pharmaceutic art, but it continues to
+persuade fools that art can arrest them all with its specifics.
+
+It is worse than useless to attempt in any way to check the freest
+expression of opinion as to the efficacy of any or all of the
+"heroic" means of treatment employed by practitioners of different
+schools and 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 larger jurisdiction; that, namely, in
+which the laws of human belief are summoned to the witness-box, and
+obliged to testify to the sources of error which beset the medical
+practitioner.  The verdict is as old as the father of medicine, who
+announces it in the words, "judgment is difficult."  Physicians
+differed so in his time, that some denied that there was any such
+thing as an art of medicine.
+
+One man's best remedies were held as mischievous by another.  The art
+of healing was like soothsaying, so the common people said; the same
+bird was lucky or unlucky, according as he flew to the right or
+left."
+
+The practice of medicine has undergone great changes within 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
+Bellevue and the Massachusetts General Hospitals, it is almost
+obsolete in these institutions, at least in medical practice.  The
+old Brunonian stimulating treatment has come into vogue again in the
+practice of Dr. Todd and his followers.  The compounds of mercury
+have yielded their place as drugs of all work, and specifics for that
+very frequent subjective complaint, nescio quid faciam,--to compounds
+of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to
+speak of medicines which "are given as much to assist the medical man
+as his patient."  Lectures (London, 1832), p.  14.] Opium is believed
+in, and quinine, and "rum," using that expressive 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 English and American
+evacuant and alterative practice, in which 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-
+fashioned medical art, counted them with opium and Peruvian bark as
+his chief remedies; with the moderately expectant practice of Louis;
+the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant
+method of Rasori and his followers; the anti-irritant system of
+Broussais, with its leeching and gum-water; I have heard from our own
+students of the simple opium practice of the renowned German teacher,
+Oppolzer; and now I find the medical community brought round by the
+revolving cycle of opinion to that same old plan of treatment which
+John Brown taught in Edinburgh in the last quarter of the last
+century, and Miner and Tully fiercely advocated among ourselves in
+the early years of the present.  The worthy physicians last
+mentioned, and their antagonist Dr. Gallup, used stronger language
+than we of these degenerate days permit ourselves.  "The lancet is a
+weapon which annually slays more than the sword," says Dr. Tully.
+"It is probable that, for forty years past, opium and its
+preparations have done seven times the injury they have rendered
+benefit, on the great scale of the world," says Dr. Gallup.
+
+What is the meaning of these perpetual changes and conflicts of
+medical opinion and practice, from an early antiquity to our own
+time?  Simply this: all "methods" of treatment end in disappointment
+of those extravagant expectations which men are wont to entertain of
+medical art.  The bills of mortality are more obviously affected by
+drainage, than by this or that method of practice.  The insurance
+companies do not commonly charge a different percentage on the lives
+of the patients of this or that physician.  In the course of a
+generation, more or less, physicians themselves are liable to get
+tired of a practice which has so little effect upon the average
+movement of vital decomposition.  Then they are ready for a change,
+even if it were back again to a method which has already been tried,
+and found wanting.
+
+Our practitioners, or many of them, have got back to the ways of old
+Dr. Samuel Danforth, who, as it is well known, had strong objections
+to the use of the lancet.  By and by a new reputation will be made by
+some discontented practitioner, who, tired of seeing patients die
+with their skins full of whiskey and their brains muddy with opium,
+returns to a bold antiphlogistic treatment, and has the luck to see a
+few patients of note get well under it.  So of the remedies which
+have gone out of fashion and been superseded by others.  It can
+hardly be doubted that they will come into vogue again, more or less
+extensively, under the influence of that irresistible demand for
+change just referred to.
+
+Then will come the usual talk about a change in the character of
+disease, which has about as much meaning as that concerning
+"old-fashioned snow-storms."  "Epidemic constitutions" of disease
+mean something, no doubt; a great deal as applied to malarious
+affections; but that the whole type of diseases undergoes such
+changes that the practice must be reversed from depleting to
+stimulating, and vice versa, is much less likely than that methods of
+treatment go out of fashion and come in again.  If there is any
+disease which claims its percentage with reasonable uniformity, it is
+phthisis.  Yet I remember that the reverend and venerable Dr. Prince
+of Salem told me one Commencement day, as I was jogging along towards
+Cambridge with him, that he recollected the time when that disease
+was hardly hardly known; and in confirmation of his statement
+mentioned a case in which it was told as a great event, that somebody
+down on "the Cape" had died of "a consumption."  This story does not
+sound probable to myself, as I repeat it, yet I assure you it is
+true, and it shows how cautiously we must receive all popular stories
+of great changes in the habits of disease.
+
+Is there no progress, then, but do we return to the same beliefs and
+practices which our forefathers wore out and threw away?  I trust and
+believe that there 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 go back to the simple Brunonian
+pathology, since we have learned too much of diseased action to
+accept its convenient dualism.  So of other doctrines, each new
+Avatar strips them of some of their old pretensions, until they take
+their fitting place at last, if they have any truth in them, or
+disappear, if they were mere phantasms of the imagination.
+
+In the mean time, while medical theories are coming in and going out,
+there is a set of sensible men who are never run away with by them,
+but practise their art sagaciously and faithfully in much the same
+way from generation to generation.  From the time of Hippocrates to
+that of our own medical patriarch, there has been an apostolic
+succession of wise and good practitioners.  If you will look at the
+first aphorism of the ancient Master you will see that before all
+remedies he places the proper conduct of the patient and his
+attendants, and the fit ordering of all the conditions surrounding
+him.  The class of practitioners I have referred to have always been
+the most faithful in attending to these points.  No doubt they have
+sometimes prescribed unwisely, in compliance with the prejudices of
+their time, but they have grown wiser as they have grown older, and
+learned to trust more in nature and less in their plans of
+interference.  I believe common opinion confirms Sir James Clark's
+observation to this effect.
+
+The experience of the profession must, I think, run parallel with
+that of the wisest of its individual members.  Each time a plan of
+treatment or a particular remedy comes up for trial, it is submitted
+to a sharper scrutiny.  When Cullen wrote his Materia Medica, he had
+seriously to assail the practice of giving burnt toad, which was
+still countenanced by at least one medical authority of note.  I have
+read recently in some medical journal, that an American practitioner,
+whose name is known to the country, is prescribing the hoof of a
+horse for epilepsy.  It was doubtless suggested by that old fancy of
+wearing a portion of elk's hoof hung round the neck or in a ring, for
+this disease.  But it is hard to persuade reasonable people to
+swallow the abominations of a former period.  The evidence which
+satisfied Fernelius will not serve one of our hospital physicians.
+
+In this way those articles of the Materia Medica which had nothing
+but loathsomeness to recommend them have been gradually dropped, and
+are not like to obtain any 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 the utility of some of them,
+when properly employed.  Though I believe that at present, taking the
+world at large, and leaving out a few powerful agents of such immense
+value that they rank next to food in importance, the poisons
+prescribed for disease do more hurt than good, I have no doubt, and
+never professed to have any, that they do much good in prudent and
+instructed hands.  But I am very willing to confess a great jealousy
+of many agents, and I could almost wish to see the Materia Medica so
+classed as to call suspicion upon certain ones among them.
+
+Thus the alien elements, those which do not properly enter into the
+composition of any living tissue, are the most to be suspected,--
+mercury, lead, antimony, silver, and the rest, for the reasons I have
+before mentioned.  Even iodine, which, as it is found in certain
+plants, seems less remote from the animal tissues, gives unequivocal
+proofs from time to time that it is hostile to some portions of the
+glandular system.
+
+There is, of course, less prima facie objection to those 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 sometimes poison to another,
+and vice versa; inert substances may act mechanically, so as to
+produce the effect of poisons; but this division holds exactly enough
+for our purpose.
+
+Strictly speaking, every poison consisting of assimilable elements
+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's action, or some other symptom for which
+the subject of it would consult the physician, if it came on from any
+other cause than taking it under the name of medicine.  Yet portions
+of this unwholesome food which we call medicine, we have reason to
+believe, are assimilated; thus, castor-oil appears to be partially
+digested by infants, so that they require large doses to affect them
+medicinally.  Even that deadliest of poisons, hydrocyanic acid, is
+probably assimilated, and helps to make living tissue, if it do not
+kill the patient, for the assimilable elements which it contains,
+given in the separate forms of amygdalin and emulsin, produce no
+disturbance, unless, as in Bernard's experiments, they are suffered
+to meet in the digestive organs.  A medicine consisting of
+assimilable substances being then simply unwholesome food, we
+understand what is meant by those cumulative effects of such remedies
+often observed, as in the case of digitalis and strychnia.  They are
+precisely similar to the cumulative effects of a salt diet in
+producing scurvy, or of spurred rye in producing dry gangrene.  As
+the effects of such substances are a violence to the organs, we
+should exercise the same caution with regard to their use that we
+would exercise about any other kind of poisonous food,--partridges at
+certain seasons, for instance.  Even where these poisonous kinds of
+food seem to be useful, we should still regard them with great
+jealousy.  Digitalis lowers the pulse in febrile conditions.
+Veratrum viride does the same thing.  How do we know that a rapid
+pulse is not a normal adjustment of nature to the condition it
+accompanies?  Digitalis has gone out of favor; how sure are we that
+Veratrum viride will not be found to 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 use
+of opium in delirium tremens (which you remember is sometimes called
+delirium vigilans), where it seemed so obviously indicated, since the
+publication of Dr. Ware's admirable essay.  I respect the evidence of
+my contemporaries, but I cannot forget the sayings of the Father of
+medicine,--Ars longa, judicium diffcile.
+
+I am not presuming to express an opinion concerning Veratrum viride,
+which was little heard of when I was still practising medicine.  I am
+only appealing to that higher court of experience which sits in
+judgment on all decisions of the lower medical tribunals, and which
+requires more than one generation for its final verdict.
+
+Once change the habit of mind so long prevalent among practitioners
+of medicine; once let it be everywhere understood that the
+presumption is in favor of food, and not of alien substances, of
+innocuous, and not of unwholesome food, for the sick; that this
+presumption requires very strong evidence in each particular case to
+overcome it; but that, when such evidence is afforded, the alien
+substance or the unwholesome food should be given boldly, in
+sufficient quantities, in the same spirit as that with which the
+surgeon lifts his knife against a patient,--that is, with the same
+reluctance and the same determination,--and I think we shall have and
+hear much less of charlatanism in and out of the profession.  The
+disgrace of medicine has been that colossal system of self-deception,
+in obedience to which mines have been emptied of their cankering
+minerals, the vegetable kingdom robbed of all its noxious growths,
+the entrails of animals taxed for their impurities, the poison-bags
+of reptiles drained of their venom, and all the inconceivable
+abominations thus obtained thrust down the throats of human beings
+suffering from some fault of organization, nourishment, or vital
+stimulation.
+
+Much as we have gained, we have not yet thoroughly shaken off the
+notion that poison is the natural food of disease, as wholesome
+aliment is the support of health.  Cowper's lines, in "The Task,"
+show the matter-of-course practice of his time:
+
+    "He does not scorn it, who has long endured
+     A fever's agonies, and fed on drugs."
+
+Dr. Kimball of Lowell, who has been in the habit of seeing a great
+deal more of typhoid fever than most practitioners, and whose
+surgical exploits show him not to be wanting in boldness or
+enterprise, can tell you whether he finds it necessary to feed his
+patients on drugs or not.  His experience is, I believe, that of the
+most enlightened and advanced portion of the profession; yet I think
+that even in typhoid fever, and certainly in many other complaints,
+the effects of ancient habits and prejudices may still be seen in the
+practice of some educated physicians.
+
+To you, young men, it belongs to judge all that has gone before you.
+You come nearer to the great fathers of modern medicine than some of
+you imagine.  Three of my own instructors attended Dr. Rush's
+Lectures.  The illustrious Haller mentions Rush's inaugural thesis in
+his "Bibliotheca Anatomica;" and this same Haller, brought so close
+to us, tells us he remembers Ruysch, then an old man, and used to
+carry letters between him and Boerhaave.  Look through the history of
+medicine from Boerhaave to this present day.  You will see at once
+that medical doctrine and practice have undergone a long series of
+changes.  You will see that the doctrine and practice of our own time
+must probably change in their turn, and that, if we can trust at all
+to the indications of their course, it will be in the direction of an
+improved hygiene and a simplified treatment.  Especially will the old
+habit of violating the instincts of the sick give place to a
+judicious study of these same instincts.  It will be found that
+bodily, like mental insanity, is best managed, for the most part, by
+natural soothing agencies.  Two centuries ago there was a
+prescription for scurvy containing "stercoris taurini et anserini
+par, quantitas trium magnarum nucum," of the hell-broth containing
+which "guoties-cumque sitit oeger, large bibit."   When I have
+recalled the humane common-sense of Captain Cook in the matter of
+preventing this disease; when I have heard my friend, Mr. Dana,
+describing the avidity with which the scurvy-stricken sailors snuffed
+up the earthy fragrance of fresh raw potatoes, the food which was to
+supply the elements wanting to their spongy tissues, I have
+recognized that the perfection of art is often a return to nature,
+and seen in this single instance the germ of innumerable beneficent
+future medical reforms.
+
+I cannot help believing that medical curative treatment will by and
+by resolve itself in great measure into modifications of the food,
+swallowed and breathed, and of the natural stimuli, and that less
+will be expected from specifics and noxious disturbing agents, either
+alien or assimilable.  The noted mineral-waters containing iron,
+sulphur, carbonic acid, supply nutritious or stimulating materials to
+the body as much as phosphate of lime and ammoniacal compounds do to
+the cereal plants.  The effects of a milk and vegetable diet, of
+gluten bread in diabetes, of cod-liver oil in phthisis, even of such
+audacious innovations as the water-cure and the grape-cure, are only
+hints of what will be accomplished when we have learned to discover
+what organic elements are 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 his crops and modifies
+the composition of his soil.  In acute febrile diseases we have long
+ago discovered that far above all drug-medication is the use of mild
+liquid diet in the period of excitement, and of stimulant and
+nutritious food in that of exhaustion.  Hippocrates himself was as
+particular about his barley-ptisan as any Florence Nightingale of our
+time could be.
+
+The generation to which you, who are just entering the profession,
+belong, will make a vast stride forward, as I believe, in the
+direction of treatment by natural rather than violent agencies.  What
+is it that makes the reputation of Sydenham, as the chief of English
+physicians?  His prescriptions consisted principally of simples.  An
+aperient or an opiate, a "cardiac" or a tonic, may be commonly found
+in the midst of a somewhat fantastic miscellany of garden herbs.  It
+was not by his pharmaceutic prescriptions that he gained his great
+name.  It was by daring to order fresh air for small-pox patients,
+and riding on horseback for consumptives, in place of the smothering
+system, and the noxious and often loathsome rubbish of the
+established schools.  Of course Sydenham was much abused by his
+contemporaries, as he frequently takes occasion to remind his reader.
+"I must needs conclude," he says, "either that I am void of merit, or
+that the candid and ingenuous part of mankind, who are formed with so
+excellent a temper of mind as to be no strangers to gratitude, make a
+very small part of the whole."  If in the fearless pursuit of truth
+you should find the world as ungracious in the nineteenth century as
+he found it in the seventeenth, you may learn a lesson of self-
+reliance from another utterance of the same illustrious physician:
+"'T is none of 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 writings with temper."
+
+The physician has learned a great deal from the surgeon, who is
+naturally in advance of him, because he has a better opportunity of
+seeing the effects of his remedies.  Let me shorten one of Ambroise
+Pare's stories for you.  There had been a great victory at the pass
+of Susa, and they were riding into the city.  The wounded cried out
+as the horses trampled them under their hoofs, which caused good
+Ambroise great pity, and made him wish himself back in Paris.  Going
+into a stable he saw four dead soldiers, and three desperately
+wounded, placed with their backs against the wall.  An old campaigner
+came up. --"Can these fellows get well?" he said.  "No!" answered the
+surgeon.  Thereupon, the old soldier walked 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, "somebody will do as much for me if I ever
+get into such a scrape" (accoustre de telle facon).  "I was not much
+salted in those days" (bien doux de sel), says Ambroise, "and little
+acquainted with the treatment of wounds."  However, as he tells us,
+he proceeded to apply boiling oil of Sambuc (elder) after the
+approved fashion of the time,--with what torture to the patient may
+be guessed.  At last his precious oil gave out, and he used instead
+an insignificant mixture of his own contrivance.  He could not sleep
+that night for fear his patients who had not been scalded with the
+boiling oil would be poisoned by the gunpowder conveyed into their
+wounds by the balls.  To his surprise, he found them much better than
+the others the next morning, and resolved never again to burn his
+patients with hot oil for gun-shot wounds.
+
+This was the beginning, as nearly as we can fix it, of that reform
+which has introduced plain water-dressings in the place of the
+farrago of external applications which had been a source of profit to
+apothecaries and disgrace to art from, and before, the time when
+Pliny complained of them.  A young surgeon who was at Sudley Church,
+laboring among the wounded of Bull Run, tells me they had nothing but
+water for dressing, and he (being also doux de sel) was astonished to
+see how well the wounds did under that simple treatment.
+
+Let me here mention a fact or two which may be of use to some of you
+who mean to enter the public service.  You will, as it seems, have
+gun-shot wounds almost exclusively to deal with.  Three different
+surgeons, the one just mentioned and two who saw the wounded of Big
+Bethel, assured me that they found no sabre-cuts or bayonet wounds.
+It is the rifle-bullet from a safe distance which pierces the breasts
+of our soldiers, and not the gallant charge of broad platoons and
+sweeping squadrons, such as we have been in the habit of considering
+the chosen mode of warfare of ancient and modern chivalry. [Sir
+Charles James Napier had the same experience in Virginia in 1813.
+"Potomac.  We have nasty sort of fighting here, amongst creeks and
+bushes, and lose men without show."  "Yankee never shows himself, he
+keeps in the thickest wood, fires and runs off." --These five
+thousand in the open field might be attacked, but behind works it
+would be throwing away lives."  He calls it "an inglorious warfare,"
+--says one of the leaders is "a little deficient in gumption,"--but
+--still my opinion is, that if we tuck up our sleeves and lay our
+ears back we might thrash them; that is, if we caught them out of
+their trees, so as to slap at them with 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 your assistants.  A chaplain told it
+to two of our officers personally known to myself.  He overheard the
+examination of a man who wished to drive one of the "avalanche"
+wagons, as they call them.  The man was asked if he knew how to deal
+with wounded men.  "Oh yes," he answered; "if they're hit here,"
+pointing to the abdomen, "knock 'em on the head,--they can't get
+well."
+
+In art and outside of it you will meet the same barbarisms that
+Ambroise Pare met with,--for men differ less from century to century
+than we are apt to suppose; you will encounter the same opposition,
+if you attack any prevailing opinion, that Sydenham complained of.
+So far as possible, let not such experiences breed in you a contempt
+for those who are the subjects of folly or prejudice, or foster any
+love of dispute for its own sake.  Should you become authors, express
+your opinions freely; defend them rarely.  It is not often that an
+opinion is worth expressing, which cannot take care of itself.
+Opposition is the best mordant to fix the color of your thought in
+the general belief.
+
+It is time to bring these crowded remarks to a close.  The day has
+been when at the beginning of a course of Lectures I should have
+thought it fitting to exhort you to diligence and entire devotion to
+your tasks as students.  It is not so now.  The young man who has not
+heard the clarion-voices of honor and of duty now sounding throughout
+the land, will heed 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 our own blood or stanching that of our
+wounded defenders, students or teachers, whatever our calling and our
+ability, we belong, not to ourselves, but to our imperilled country,
+whose danger is our calamity, whose ruin would be our enslavement,
+whose rescue shall be our earthly salvation!
+
+
+
+
+
+
+SCHOLASTIC AND BEDSIDE TEACHING.
+
+An Introductory Lecture delivered before the Medical Class of Harvard
+University, November 6, 1867.
+
+The idea is entertained by some of our most sincere professional
+brethren, that to lengthen and multiply our Winter Lectures will be
+of necessity to advance the cause of medical education.  It is a fair
+subject for consideration whether they do not overrate the relative
+importance of that particular mode of instruction which forms the
+larger part of these courses.
+
+As this School could only lengthen its lecture term at the expense of
+its "Summer Session," in which more direct, personal, and familiar
+teaching takes the place of our academic discourses, and in which
+more time can be given to hospitals, infirmaries, and practical
+instruction in various important specialties, whatever might be
+gained, a good deal would certainly be lost in our case by the
+exchange.
+
+The most essential part of a student's instruction is 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 indelibly in
+the memory.  Before the student is aware of what he has acquired, he
+has learned the aspects and course and probable issue of the diseases
+he has seen with his teacher, and the proper mode of dealing with
+them, so far as his master knows it.  On the other hand, our ex
+cathedra prelections have a strong tendency to run into details
+which, however interesting they may be to ourselves and a few of our
+more curious listeners, have nothing in them which will ever be of
+use to the student as a practitioner.  It is a perfectly fair
+question whether I and some other American Professors do not teach
+quite enough that is useless already.  Is it not well to remind the
+student from time to time that a physician's business is to avert
+disease, to heal the sick, to prolong life, and to diminish
+suffering?  Is it not true that the young man of average ability will
+find it as much as he can do to fit himself for these simple duties?
+Is it not best to begin, at any rate, by making sure of such
+knowledge as he will require in his daily walk, by no means
+discouraging him from any study for which his genius fits him when he
+once feels that he has become master of his chosen art.
+
+I know that many branches of science are of the greatest value as
+feeders of our medical reservoirs.  But the practising physician's
+office is to draw the healing waters, and while he gives his time to
+this labor he can hardly be expected to explore all the sources that
+spread themselves over the wide domain of science.  The traveller who
+would not drink of the Nile until he had tracked it to its parent
+lakes, would be like to die of thirst; and the medical practitioner
+who would not use the results of many laborers in other departments
+without sharing their special toils, would find life far too short
+and art immeasurably too long.
+
+We owe much to Chemistry, one of the most captivating as well as
+important of studies; but the medical man must as a general rule
+content himself with a clear view of its principles and a limited
+acquaintance with its facts; such especially as are pertinent to his
+pursuits.  I am in little danger of underrating Anatomy or
+Physiology; but as each of these branches splits up into specialties,
+any one of which may take up a scientific life-time, I would have
+them taught with a certain judgment and reserve, so that they shall
+not crowd the more immediately practical branches.  So of all the
+other ancillary and auxiliary kinds of knowledge, I would have them
+strictly subordinated to that particular kind of knowledge for which
+the community looks to its medical advisers.
+
+A medical school is not a scientific school, except just 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 is implied
+in Hufeland's aphorism: "The physician must generalize the disease
+and individualize the patient."
+
+The coordinated and classified results of empirical observation, in
+distinction from scientific experiment, have furnished almost all we
+know about food, the medicine of health, and medicine, the food of
+sickness.  We eat the root of the Solanum tuberosum and throw away
+its fruit; we eat the fruit of the Solanum Lycopersicum and throw
+away its root.  Nothing but vulgar experience has taught us to reject
+the potato ball and cook the tomato.  So of most of our remedies.
+The subchloride of mercury, calomel, is the great British specific;
+the protochloride of mercury, corrosive sublimate, kills like
+arsenic, but no chemist could have told us it would be so.
+
+>From observations like these we can obtain certain principles from
+which we can argue deductively to facts of a like nature, but the
+process is limited, and we are suspicious of all reasoning in that
+direction applied to the processes of healthy and diseased life.  We
+are continually appealing to special facts.  We are willing to give
+Liebig's artificial milk when we cannot do better, but we watch the
+child anxiously whose wet-nurse is a chemist's pipkin.  A pair of
+substantial mammary glands has the advantage over the two hemispheres
+of the most learned Professor's brain, in the art of compounding a
+nutritious fluid for 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 not directly useful to the future
+practitioner.  But the over ambitious and active student must not be
+led away by the seduction of knowledge for its own sake from his
+principal pursuit.  The humble beginner, who is alarmed at the vast
+fields of knowledge opened to him, may be encouraged by the assurance
+that with a very slender provision of science, in distinction from
+practical skill, he may be a useful and acceptable member of the
+profession to which the health of the community is intrusted.
+
+To those who are not to engage in practice, the various pursuits of
+science hardly require to be commended.  Only they must not be
+disappointed if they find many subjects treated in our courses as a
+medical class requires, rather than as a scientific class would
+expect, that is, with special limitations and constant reference to
+practical ends.  Fortunately they are within easy reach of the
+highest scientific instruction.  The business of a school like this
+is to make useful working physicians, and to succeed in this it is
+almost as important not to overcrowd the mind of the pupil with
+merely curious knowledge as it is to store it with useful
+information.
+
+In this direction I have written my lecture, not to undervalue any
+form of scientific labor in its place, an unworthy thought from which
+I hope I need not defend myself,--but to discourage any undue
+inflation of the scholastic programme, which even now asks more of
+the student than the teacher is able to obtain from the great
+majority of those who present themselves for examination.  I wish to
+take a hint in education from the Secretary of the Massachusetts
+Board of Agriculture, who regards the cultivation of too much land as
+a great defect in our New England farming.  I hope that our Medical
+Institutions may never lay themselves open to the kind of accusation
+Mr. Lowe brings against the English Universities, when he says that
+their education is made up "of words that few understand and most
+will shortly forget; of arts that can never be used, if indeed they
+can even be learnt; of histories inapplicable to our times; of
+languages dead and even mouldy; of grammatical rules that never had
+living use and are only post mortem examinations; and of statements
+fagoted with utter disregard of their comparative value."
+
+This general thought will be kept in view throughout my somewhat
+discursive address, which will begin with an imaginary clinical
+lesson from the lips of an historical personage, and close with the
+portrait from real life of one who, both as teacher and practitioner,
+was long loved and honored among us.  If I somewhat overrun my hour,
+you must pardon me, for I can say with Pascal that I have not had the
+time to make my lecture shorter.
+
+
+In the year 1647, that good man John Eliot, commonly called the
+Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of
+Cambridge, referring to the great need of medical instruction for the
+Indians, used these words:
+
+"I have thought in my heart that it were a singular good work, if the
+Lord would stirre up the hearts of some or other of his people in
+England to give some maintenance toward some Schoole or Collegiate
+exercise this way, wherein there should be Anatomies and other
+instructions that way, and where there might be some recompence given
+to any that should bring in any vegetable or other thing that is
+vertuous in the way of Physick.
+
+"There is another reason which moves my thought and desires this way,
+namely that our young students in Physick may be trained up better
+then they yet bee, who have onely theoreticall knowledge, and are
+forced to fall to practise before ever they saw an Anatomy 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, did make and read upon very well, but no more of that now."
+
+Since the time of the Apostle Eliot the Lord has stirred up the
+hearts of our people to the building of many Schools and Colleges
+where medicine is taught in all its branches.  Mr. Giles Firmin's
+"Anatomy " may be considered the first ancestor of a long line of
+skeletons which have been dangling and rattling in our lecture-rooms
+for more than a century.
+
+Teaching in New England in 1647 was a grave but simple matter.  A
+single person, combining in many cases, as in that of Mr. Giles
+Firmin, the offices of physician and preacher, taught what he knew to
+a few disciples whom he gathered about him.  Of the making of that
+"Anatomy" on which my first predecessor in the branch I teach" did
+read very well" we can know nothing.  The body of some poor wretch
+who had swung upon the gallows, was probably conveyed by night to
+some lonely dwelling at the outskirts of the village, and there by
+the light of flaring torches hastily dissected by hands that trembled
+over the unwonted task.  And ever and anon the master turned to his
+book, as he laid bare the mysteries of the hidden organs; to his
+precious Vesalius, it might be, or his figures repeated in the
+multifarious volume of Ambroise Pare; to the Aldine octavo in which
+Fallopius recorded his fresh observations; or that giant folio of
+Spigelius just issued from the press of Amsterdam, in which lovely
+ladies display their viscera with a coquettish grace implying that it
+is rather a pleasure than otherwise to show the lace-like omentum,
+and hold up their appendices epiploicae as if they were saying "these
+are our jewels."
+
+His teaching of medicine was no doubt chiefly clinical, and received
+with the same kind of faith as that which accepted his words from the
+pulpit.  His notions of disease were based on what he had observed,
+seen always in the light of the traditional doctrines in which he was
+bred.  His discourse savored of the weighty doctrines of Hippocrates,
+diluted by the subtle speculations of Galen, reinforced by the
+curious comments of the Arabian schoolmen as they were conveyed in
+the mellifluous language of Fernelius, blended, it may be, with
+something of the lofty mysticism of Van Helmont, and perhaps stealing
+a flavor of that earlier form of Homoeopathy which had lately come to
+light in Sir Kenelm Digby's "Discourse concerning the 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 Licetus
+and saw figures of a lion with the head of a woman, and a man with
+the head of an elephant.  He had offered to his gaze, as born of a
+human mother, the effigy of a winged cherub, a pterocephalous
+specimen, which our Professor of Pathological Anatomy would hardly
+know whether to treat with the reverence due to its celestial aspect,
+or to imprison in one of his immortalizing jars of alcohol.
+
+His pharmacopoeia consisted mainly of simples, such as the venerable
+"Herball" of Gerard describes and figures in abounding affluence.
+St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron
+and Parsley, Elder and Snake-root, with opium in some form, and
+roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of
+which it used to be said that whatever the Tacamahaca has not cured,
+the Caranna will, with the more familiar Scammony and Jalap and Black
+Hellebore, made up a good part of his probable list of remedies.  He
+would have ordered Iron now and then, and possibly an occasional dose
+of Antimony.  He would perhaps have had a rheumatic patient wrapped
+in the skin of a wolf or a wild cat, and in case of a malignant fever
+with "purples" or petechiae, or of an obstinate king's evil, he might
+have prescribed a certain black powder, which had been made by
+calcining toads in 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 doctoring as well as against some
+more modern styles of medication.  Barbeyrac and his scholar Sydenham
+had not yet cleansed the Pharmacopoeia of its perilous stuff, but
+there is no doubt that the more sensible physicians of that day knew
+well enough that a good honest herb-tea which amused the patient and
+his nurses was all that was required to carry him through all common
+disorders.
+
+The student soon learned the physiognomy of disease by going about
+with his master; fevers, pleurisies, asthmas, dropsies, fluxes,
+small-pox, sore-throats, measles, consumptions.  He saw what was done
+for them.  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 he could give his whole attention to
+them.  Chirurgery was a separate specialty.  Women in child-birth
+were cared for by midwives.  There was no chemistry deserving the
+name to require his study.  He did not learn a great deal, perhaps,
+but what he did learn was his business, namely, how to take care of
+sick people.
+
+Let me give you a picture of the old=fashioned way of instruction, by
+carrying you with me in imagination in the company of worthy Master
+Giles Firmin as he makes his round of visits among the good folk of
+Ipswich, followed by his one student, who shall answer to the
+scriptural name of Luke.  It will not be for entertainment chiefly,
+but to illustrate the one mode of teaching which can never be
+superseded, and which, I venture to 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 fellow is bellowing with
+colic.
+
+"He will die, Master, of a surety, methinks," says the timid youth in
+a whisper.
+
+"Nay, Luke," the Master answers, "'t is but a dry belly-ache.  Didst
+thou not mark that he stayed his roaring when I did press hard over
+the lesser bowels?  Note that he hath not the pulse of them with
+fevers, and by what Dorcas telleth me there hath been no long
+shutting up of the vice naturales.  We will steep certain comforting
+herbs which I will shew thee, and put them in a bag and lay them on
+his belly.  Likewise he shall have my cordial julep with a portion of
+this confection which we do call Theriaca Andromachi, which hath
+juice of poppy in it, and is a great stayer of anguish.  This fellow
+is at his prayers to-day, but I warrant thee he shall be swearing
+with the best of them to-morrow."
+
+They jog along the bridle-path on their horses until they come to
+another lowly dwelling.  They sit a while with a delicate looking
+girl in whom the ingenuous youth naturally takes a special interest.
+The good physician talks cheerfully with her, asks her a few
+questions.  Then to her mother: "Good-wife, Margaret hath somewhat
+profited, as she telleth, by the goat's milk she hath taken night and
+morning.  Do thou pluck a maniple--that is an handful--of the plant
+called Maidenhair, and make a syrup therewith as I have shewed thee.
+Let her take a cup full of the same, fasting, before she sleepeth,
+also before she riseth from her bed."  And so they leave the house.
+
+"What thinkest thou, Luke, of the maid we have been visiting?"  "She
+seemeth not much ailing, Master, according to my poor judgment.  For
+she did say she was better.  And she had a red cheek and a bright
+eye, and she spake of being soon able to walk unto the meeting, and
+did seem greatly hopeful, but spare of flesh, methought, and her
+voice something 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, and mayhap speedily.  But
+it is not here with us she shall be well.  For that redness of the
+cheek is but the sign of the fever which, after the Grecians, we do
+call the hectical; and that shining of the eyes is but a sickly
+glazing, and they which do every day get better and likewise thinner
+and weaker shall find that way leadeth to the church-yard gate.  This
+is the malady which the ancients did call tubes, or the wasting
+disease, and some do name the consumption.  A disease whereof most
+that fall ailing do perish.  This Margaret is not long for earth--but
+she knoweth it not, and still hopeth."
+
+"Why, then, Master, didst thou give her of thy medicine, seeing that
+her ail is unto death?"
+
+"Thou shalt learn, boy, that they which are sick must have somewhat
+wherewith to busy their thoughts.  There be some who do give these
+tabid or consumptives a certain posset made with lime-water and anise
+and liquorice and raisins of the sun, and there be other some who do
+give the juice of craw-fishes boiled in barley-water with chicken-
+broth, but these be toys, as I do think, and ye shall find as good
+virtue, nay better, in this syrup of the simple called Maidenhair."
+
+Something after this manner might Master Giles Firmin have delivered
+his clinical instructions.  Somewhat in this way, a century and a
+half later, another New England physician, Dr. Edward Augustus
+Holyoke, taught a young man who came to study with him, a very
+diligent and intelligent youth, James Jackson by name, the same whose
+portrait in his advanced years hangs upon this wall, long the honored
+Professor of Theory and Practice in this Institution, of whom I shall
+say something in this Lecture.  Our venerated Teacher studied
+assiduously 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. Woodville once.
+
+When I compare this direct transfer of the practical experience of a
+wise man into the mind of a student,--every fact one that he can use
+in the battle of life and death,--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 concede that our
+forefathers taught too little, there is not--a possibility that we
+may sometimes attempt to teach too much.  I almost blush when I think
+of myself as describing the eight several facets on two slender
+processes of the palate bone, or the seven little twigs that branch
+off from the minute tympanic nerve, and I wonder whether my excellent
+colleague feels in the same way when he pictures himself as giving
+the constitution of neurin, which as he and I know very 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 students can 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 addressing the
+Anatomist and the Chemist in tones of contemptuous indignation: "What
+is this stuff with which you are cramming the brains of young men who
+are to hold the lives of the community in their hands?  Here is a man
+fallen in a fit; you can tell me all about the eight surfaces of the
+two processes of the palate bone, but you have not had the sense to
+loosen that man's neck-cloth, and the old women are all calling you a
+fool?  Here is a fellow that has just swallowed poison.  I want
+something to turn his stomach inside out at the shortest notice.  Oh,
+you have forgotten the dose of the sulphate of zinc, but you remember
+the formula for the production of alloxan!"
+
+"Look you, Master Doctor,--if I go to a carpenter to come and stop a
+leak in my roof that is flooding the house, do you suppose I care
+whether he is a botanist or not?  Cannot a man work in wood without
+knowing all about endogens and exogens, or must he attend Professor
+Gray's Lectures before he can be trusted to make a box-trap?  If my
+horse casts a shoe, do you think I will not trust a blacksmith to
+shoe him until I have made sure that he is sound on the distinction
+between the sesquioxide and the protosesquioxide of iron?"
+
+--But my scientific labor is to lead to useful results by and by, in
+the next generation, or in some possible remote future.--
+
+"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,--
+"what is that to me and my colic, to me and my strangury?  I pay the
+Captain of the Cunard steamship to carry me quickly and safely to
+Liverpool, not to make a chart of the Atlantic for after voyagers!
+If Professor Peirce undertakes to pilot me into Boston Harbor and
+runs me on Cohasset rocks, what answer is it to tell me that he is
+Superintendent of the Coast Survey?  No, Sir!  I want a plain man in
+a pea-jacket and a sou'wester, who knows the channel of Boston
+Harbor, and the rocks of Boston Harbor, and the distinguished
+Professor is quite of my mind as to the matter, for I took the pains
+to ask him before I ventured to use his name in the way of
+illustration."
+
+
+I do not know how the remarks of the image-breaker may strike others,
+but I feel that they put me on my defence with regard to much of my
+teaching.  Some years ago I ventured to show in an introductory
+Lecture how very small a proportion of the anatomical facts taught in
+a regular course, as delivered by myself and others, had any
+practical bearing whatever on the treatment of disease.  How can I,
+how can any medical teacher justify himself in teaching anything that
+is not like to be of practical use to a class of young men who are to
+hold in their hands the balance in which life and death, ease and
+anguish, happiness and wretchedness are to be daily weighed?
+
+I hope we are not all wrong.  Oftentimes in finding how sadly
+ignorant of really essential and vital facts and rules were some of
+those whom we had been larding with the choicest scraps of science, I
+have doubted whether the old one-man system of teaching, when the one
+man was of the right sort, did not turn out better working physicians
+than our more elaborate method.  The best practitioner I ever knew
+was mainly shaped to excellence in that way.  I can understand
+perfectly the regrets of my friend Dr. John Brown of Edinburgh, for
+the good that was lost with the old apprenticeship system.  I
+understand as well Dr. Latham's fear "that many men of the best
+abilities and good education will be deterred from prosecuting physic
+as a profession, in consequence of the necessity indiscriminately
+laid upon all for impossible attainments."
+
+I feel therefore impelled to say a very few words in defence of that
+system of teaching adopted in our Colleges, by which we wish to
+supplement and complete the instruction given by private individuals
+or by what are often called Summer Schools.
+
+The reason why we teach so much that is not practical and in itself
+useful, is because we find that the easiest way of teaching what is
+practical and useful.  If we could in any way eliminate all that
+would help a man to deal successfully with disease, and teach it by
+itself so that it should be as tenaciously rooted in the memory, as
+easily summoned when wanted, as fertile in suggestion of related
+facts, as satisfactory to the peremptory demands of the intelligence
+as if taught in its scientific connections, I think it would be our
+duty so to teach the momentous truths of medicine, and to regard all
+useless additions as an intrusion on the time which should be
+otherwise occupied.
+
+But we cannot successfully eliminate and teach by itself that which
+is purely practical.  The easiest and surest why of acquiring facts
+is to learn them in groups, in systems, and systematized knowledge is
+science.  You can very often carry two facts fastened together more
+easily than one by itself, as a housemaid can carry two pails of
+water with a hoop more easily than one without it.  You can remember
+a man's face, made up of many features, better than you can his nose
+or his mouth or his eye-brow.  Scores of proverbs show you that you
+can remember two lines that rhyme better than one without the jingle.
+The ancients, who knew the laws of memory, grouped the seven cities
+that contended for the honor of being Homer's birthplace in a line
+thus given by Aulus Gellius :
+
+Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
+
+I remember, in the earlier political days of Martin Van Buren, that
+Colonel Stone, of the "New York Commercial," or one of his
+correspondents, said that six towns of New York would claim in the
+same way to have been the birth-place of the "Little Magician," as he
+was then called; and thus he gave their names, any one of which I
+should long ago have forgotten, but which as a group have stuck tight
+in my memory from that day to this;
+
+Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
+
+If the memory gains so much by mere rhythmical association, how much
+more will it gain when isolated facts are brought together under laws
+and principles, when organs are examined in their natural
+connections, when structure is coupled with function, and healthy and
+diseased action are studied as they pass one into the other!
+Systematic, or scientific study is invaluable as supplying a natural
+kind of mnemonics, if for nothing else.  You cannot properly learn
+the facts you want from Anatomy and Chemistry in any way so easily as
+by taking them in their regular order, with other allied facts, only
+there must be common sense exercised in leaving out a great deal
+which belongs to each of the two branches as pure science.  The
+dullest of teachers is the one who does not know what to omit.
+
+The larger aim of scientific training is to furnish you with
+principles to which you will be able to refer isolated facts, and so
+bring these within the range of recorded experience.  See what the
+"London Times" said about the three Germans who cracked open John
+Bull Chatwood's strong-box at the Fair the other day, while the three
+Englishmen hammered away in vain at Brother Jonathan Herring's.  The
+Englishmen represented brute force.  The Germans had been trained to
+appreciate principle.  The Englishman "knows his business by rote and
+rule of thumb"--science, which would "teach him to do in an hour what
+has hitherto occupied him two hours," "is in a manner forbidden to
+him."  To this cause the "Times" attributes the falling off of
+English workmen in comparison with those of the Continent.
+
+Granting all this, we must not expect too much from "science" as
+distinguished from common experience.  There are ten thousand
+experimenters without special apparatus for every one in the
+laboratory.  Accident is the great chemist and toxicologist.  Battle
+is the great vivisector.  Hunger has instituted researches on food
+such as no Liebig, no Academic Commission has ever recorded.
+
+Medicine, sometimes impertinently, often ignorantly, often carelessly
+called "allopathy," appropriates everything from every source that
+can be of the slightest use to anybody who is ailing in any way, or
+like to be ailing from any cause.  It learned from a monk how to use
+antimony, from a Jesuit how to cure agues, from a friar how to cut
+for stone, from a soldier how 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 from an old market-
+woman how to catch the itch-insect.  It borrowed acupuncture and the
+moxa from the Japanese heathen, and was taught the use of lobelia by
+the American savage.  It stands ready to-day to accept anything from
+any theorist, from any empiric who can make out a good case for his
+discovery or his remedy.  "Science" is one of its benefactors, but
+only one, out of many.  Ask the wisest practising physician you know,
+what branches of science help him habitually, and what amount of
+knowledge relating to each branch he requires for his professional
+duties.  He will tell you that scientific training has a value
+independent of all the special knowledge acquired.  He will tell you
+that many facts are explained by studying them in the wider range of
+related facts to which they belong.  He will gratefully recognize
+that the anatomist has furnished him with indispensable data, that
+the physiologist has sometimes put him on the track of new modes of
+treatment, that the chemist has isolated the active principles of his
+medicines, has taught him how to combine them, has from time to time
+offered him new remedial agencies, and so of others of his allies.
+But he will also tell you, if I am not mistaken, that his own branch
+of knowledge is so extensive and so perplexing that he must accept
+most of his facts ready made at their hands.  He will own to you that
+in the struggle for life which goes on day and night in our thoughts
+as in the outside world of nature, much that he learned under the
+name of science has died out, and that simple homely experience has
+largely taken the place of that scholastic knowledge to which he and
+perhaps some of his instructors once attached a paremount importance.
+
+This, then, is my view of scientific training as conducted in courses
+such as you are entering on.  Up to a certain point I believe in set
+Lectures as excellent adjuncts to what is far more important,
+practical instruction at the bedside, in the operating room, and
+under the eye of the Demonstrator.  But I am so far from wishing
+these courses extended, that I think some of them--suppose I say my
+own--would almost bear curtailing.  Do you want me to describe more
+branches of the sciatic and crural nerves?  I can take Fischer's
+plates, and lecturing on that scale fill up my whole course and not
+finish the nerves alone.  We must stop somewhere, and for my own part
+I think the scholastic exercises of our colleges have already claimed
+their full share of the student's time without our seeking to extend
+them.
+
+I trust I have vindicated the apparent inconsequence of teaching
+young students a good deal that seems at first sight profitless, but
+which helps them to learn and retain what is profitable.  But this is
+an inquisitive age, and if we insist on piling up beyond a certain
+height knowledge which is in itself mere trash and lumber to a man
+whose life is to be one long fight with death and disease, there will
+be some sharp questions asked by and by, and our quick-witted people
+will perhaps find they can get along as well without the professor's
+cap as without the bishop's mitre and the monarch's crown.
+
+I myself have nothing to do with clinical teaching.  Yet I do not
+hesitate to say it is more essential than all the rest put together,
+so far as the ordinary practice of medicine is concerned; and this is
+by far the most important thing to be learned, because it deals with
+so many more lives than any other branch of the profession.  So of
+personal instruction, such as we give and others give in the interval
+of lectures, much of it at the bedside, some of it in the laboratory,
+some in the microscope-room, some in the recitation-room, I think it
+has many advantages of its own over the winter course, and I do not
+wish to see it shortened for the sake of prolonging what seems to me
+long enough already.
+
+If I am jealous of the tendency to expand the time given to the
+acquisition of curious knowledge, at the expense of the plain old-
+fashioned bedside teachings, I only share the feeling which Sydenham
+expressed two hundred years ago, using an image I have already
+borrowed.  "He would be no honest and successful pilot who was to
+apply himself with less industry to avoid rocks and sands and bring
+his vessel safely home, than to search into the causes of the ebbing
+and flowing of the sea, which, though very well for a philosopher, is
+foreign to him whose business it is to secure the ship.  So neither
+will a physician, whose province it is to cure diseases, be able to
+do so, though he be a person of great genius, who bestows less time
+on the hidden and intricate method of nature, and adapting his means
+thereto, than on curious and subtle speculation."
+
+"Medicine is my wife and Science is my mistress," said Dr. Rush.  I
+do not think that the breach of the seventh commandment can be shown
+to have been of 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 studied under him, whether
+Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
+that man is the minister and interpreter of Nature, or whether he did
+not speak habitually of Nature as an intruder in the sick room, from
+which his art was to expel her as an incompetent and a meddler.
+
+All a man's powers are not too much for such a profession as
+Medicine.  "He is a learned man," said old Parson Emmons of Franklin,
+"who understands one subject, and he is a very learned man who
+understands two subjects."  Schonbein says he has been studying
+oxygen for thirty years.  Mitscherlich said it took fourteen years to
+establish a new fact in chemistry.  Aubrey says of Harvey, the
+discoverer of the circulation, that "though all his profession would
+allow him to be an excellent anatomist, I have never heard of any who
+admired his therapeutic way."  My learned and excellent friend before
+referred to, Dr. Brown of Edinburgh, from whose very lively and
+sensible Essay, "Locke and Sydenham," I have borrowed several of my
+citations, contrasts Sir Charles Bell, the discoverer, the man of
+science, with Dr. Abercrombie, the master in the diagnosis and
+treatment of disease.  It is through one of the rarest of
+combinations that we have in our Faculty a teacher on whom the
+scientific mantle of Bell has fallen, and who yet stands preeminent
+in the practical treatment of the class of diseases which his
+inventive and ardent experimental genius has illustrated.  M. Brown-
+Sequard's example is as, eloquent as his teaching in proof of the
+advantages of well directed scientific investigation.  But those who
+emulate his success at once as a discoverer and a practitioner must
+be content like him to limit their field of practice.  The highest
+genius cannot afford 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 dissecting an animal.  I should not have
+cared to be his patient.  His dissection would do me no good, and his
+thoughts would be too much upon it.  I want a whole man for my
+doctor, not a half one.  I would have sent for a humbler
+practitioner, who would have given himself entirely to me, and told
+the other--who was no less a man than John Hunter--to go on and
+finish the dissection of his tiger.
+
+Sydenham's "Read Don Quixote" should be addressed not to the student,
+but to the Professor of today.  Aimed at him it means, "Do not be too
+learned.
+
+Do not think you are going to lecture to picked young men who are
+training themselves to be scientific discoverers.  They are of fair
+average capacity, and they are going to be working doctors.
+
+These young men are to have some very serious vital facts to deal
+with.  I will mention a few of them.
+
+Every other resident adult you meet in these streets is or will be
+more or less tuberculous.  This is not an extravagant estimate, as
+very nearly one third of the deaths of adults in Boston last year
+were from phthisis.  If the relative number is less in our other
+northern cities, it is probably in a great measure because they are
+more unhealthy; that is, 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 ganglia and thinking-marrows brown as their
+own meerschaums, of whom you meet too many,--will ask all your wisdom
+to deal with their poisoned nerves and their enfeebled wills.
+
+Nearly seventeen hundred children under five years of age died last
+year in this city.  A poor human article, no doubt, in many cases,
+still, worth an attempt to save them, especially when we remember the
+effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
+some twenty-five or thirty thousand children's lives have probably
+been saved in a single city.
+
+Again, the complaint is often heard that the native population is not
+increasing so rapidly as in former generations.  The breeding and
+nursing period of American women is one of peculiar delicacy and
+frequent infirmity.  Many of them must require a considerable
+interval between the reproductive efforts, to repair damages arid
+regain strength.  This matter is not to be decided by an appeal to
+unschooled nature.  It is the same question as that of the deformed
+pelvis,--one of degree.  The facts of mal-vitalization are as much to
+be attended to as those of mal-formation.  If the woman with a
+twisted pelvis is to be considered an exempt, the woman with a
+defective organization should be recognized as belonging to the
+invalid corps.  We shudder to hear what is alleged as to the
+prevalence of criminal practices; if back of these there can be shown
+organic incapacity or overtaxing of too limited powers, the facts
+belong to the province of the practical physician, as well as of the
+moralist and the legislator, and require his gravest consideration.
+
+Take the important question of bleeding.  Is venesection done with
+forever?  Six years ago it was said here in an introductory Lecture
+that it would doubtless come back again sooner or later.  A fortnight
+ago I found myself in the cars with one of the most sensible and
+esteemed practitioners in New England.  He took out his wallet and
+showed me two lancets, which he 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 does harm.  The caution with reference to it on this ground
+was long ago recorded in the Lecture above referred to.  See what Dr.
+John Hughes Bennett says of it in the recent edition of his work on
+Medicine.  Nothing but the most careful clinical experience can
+settle this and such points of treatment.
+
+These are all practical questions--questions of life and death, and
+every day will be full of just such questions.  Take the problem of
+climate.  A patient comes to you with asthma and wants to know where
+he can breathe; another comes to you with phthisis and wants to know
+where he can live.  What boy's play is nine tenths of all that is
+taught in many a pretentious course of lectures, compared with what
+an accurate and extensive knowledge of the advantages and
+disadvantages of different residences in these and 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, with the entire relief of certain
+obscure thoracic symptoms which troubled him while at home.  I saw,
+two months ago, another gentleman from Minnesota, an observer and a
+man of sense, who considered that State as the great sanatorium for
+all pulmonary complaints.  If half our grown population are or will
+be more or less tuberculous, the question of colonizing Florida
+assumes a new aspect.  Even within the borders of our own State, the
+very interesting researches of Dr. Bowditch show that there is a
+great variation in the amount of tuberculous disease in different
+towns, apparently connected with local conditions.  The hygienic map
+of a State is quite as valuable as its geological map, and it is the
+business of every practising physician to know it thoroughly.  They
+understand this in England, and send a patient with a dry irritating
+cough to Torquay or Penzance, while they send another with relaxed
+bronchial membranes to Clifton or Brighton.  Here is another great
+field 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 quantity
+and 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 sleeping rooms, is the great cause of tubercle.
+It is sufficiently proved that the American,--the New Englander,--the
+Bostonian, can breed strong and sound children, generation after
+generation,--nay, I have shown by the record of a particular family
+that vital losses may be retrieved, and a feeble race grow to lusty
+vigor in this very climate and locality.  Is not the question why our
+young men and women so often break down, and how they can be kept
+from breaking down, far more important for physicians to settle than
+whether there is one cranial vertebra, or whether there are four, or
+none?
+
+--But I have a taste for the homologies, I want to go deeply into the
+subject of embryology, I want to analyze the protonihilates
+precipitated from pigeon's milk by the action of the lunar spectrum,-
+shall I not follow my star,--shall I not obey my instinct,--shall I
+not give myself to the lofty pursuits of science for its own sake?
+
+Certainly you may, if you like.  But take down your sign, or never
+put it up.  That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
+Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
+difficulty.  We all admire the achievements of 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 six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
+guerre,"--it is very splendid, but it is not a practising doctor's
+business.  His patient has a right to the cream of his life and not
+merely to the thin milk that is left after "science " has skimmed it
+off.  The best a physician can give is never too good for the
+patient.
+
+It is often a disadvantage to a young practitioner to be known for
+any accomplishment outside of his profession.  Haller lost his
+election as Physician to the Hospital in his native city of Berne,
+principally on the ground that he was a poet.  In his later years the
+physician may venture more boldly.  Astruc was sixty-nine years old
+when he published his "Conjectures," the first attempt, we are told,
+to decide the authorship of the Pentateuch showing anything like a
+discerning criticism.  Sir Benjamin Brodie was seventy years old
+before he left his physiological and surgical studies to indulge in
+psychological speculations.  The period of pupilage will be busy
+enough in acquiring the knowledge needed, and the season of active
+practice will leave little leisure for any but professional studies.
+
+Dr. Graves of Dublin, one of the first clinical teachers of our time,
+always insisted on his students' beginning at once to visit the
+hospital.  At the bedside the student must learn to treat disease,
+and just as certainly as we spin out and multiply our academic
+prelections we shall work in more and more stuffing, more and more
+rubbish, more and more irrelevant, useless detail which the student
+will get rid of just as soon as he leaves us.  Then the next thing
+will be a new organization, with an examining board of first-rate
+practical men, who will ask the candidate questions that mean
+business,--who will make him operate if he is to be a surgeon, and
+try him at the bedside if he is to be a physician,--and not puzzle
+him with scientific conundrums which not more than one of the
+questioners could answer himself or ever heard of since he graduated.
+
+Or these women who are hammering at the gates on which is written "No
+admittance for the mothers of mankind," will by and by organize an
+institution, which starting from that skilful kind of nursing which
+Florence Nightingale taught so well, will work backwards through
+anodynes, palliatives, curatives, preventives, until with little show
+of science it imparts most of what is most valuable in those branches
+of the healing art it professes to teach.  When that time comes, the
+fitness of women for certain medical duties, which Hecquet advocated
+in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
+the honored Professor of Theory and Practice in this Institution,
+upheld within our own recollection in the face of his own recorded
+opinion to the contrary, will very possibly be recognized.
+
+My advice to every teacher less experienced than myself would be,
+therefore: Do not fret over the details you have to omit; you
+probably teach altogether too many as it is.  Individuals may learn a
+thing with once hearing it, but the only way of teaching a whole
+class is by enormous repetition, representation, and illustration in
+all possible forms.  Now and then you will have a young man on your
+benches like the late Waldo Burnett,--not very often, if you lecture
+half a century.  You cannot pretend to lecture chiefly for men like
+that,--a Mississippi raft might as well take an ocean-steamer in tow.
+To meet his wants you would have to leave the rest of your class
+behind and that you must not do.  President Allen of Jefferson
+College says that his instruction has been successful in proportion
+as it has been elementary.  It may be a humiliating statement, but it
+is one which I have found true in my own experience.
+
+To the student I would say, that however plain and simple may be our
+teaching, he must expect to forget much 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 voluntarily recall,--
+they are outside the limits of the will.  But they sway our conscious
+thought as the unseen planets influence the movements of those within
+the sphere of vision.  No man knows how much he knows,--how many
+ideas he has,--any more than he knows how many blood-globules roll in
+his veins.  Sometimes accident brings back here and there one, but
+the mind is full of irrevocable remembrances and unthinkable
+thoughts, which take a part in all its judgments as indestructible
+forces.  Some of you must feel your scientific deficiencies painfully
+after your best efforts.  But every one can acquire what is most
+essential.  A man of very moderate ability may be a good physician,
+if he devotes himself faithfully to the work.  More than this, a
+positively dull man, in the ordinary acceptation of the term,
+sometimes makes a safer practitioner than one who has, we will say,
+five per cent. more brains than his average neighbor, but who thinks
+it is fifty per cent. more.  Skulls belonging to this last variety of
+the human race are more common, I may remark, than specimens like the
+Neanderthal cranium, a cast of which you will find on the table in
+the Museum.
+
+Whether the average talent be high or low, the Colleges of the land
+must make the best commodity they can out of such material as the
+country and the cities furnish them.  The community must have Doctors
+as it must have bread.  It uses up its Doctors just as it wears out
+its shoes, and requires new ones.  All the bread need not be French
+rolls, all the shoes need not be patent leather ones; but the bread
+must be something that can be eaten, and the shoes must be something
+that can be worn.  Life must somehow find food for the two forces
+that rub everything to pieces, or burn it to ashes,--friction and
+oxygen.  Doctors are oxydable products, and the schools must keep
+furnishing new ones as the old ones turn into oxyds; some of first-
+rate quality that burn with 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 competent worker in
+the healing art a hearty welcome.  It is on the whole very loyal to
+the Medical Profession.  Three successive years have borne witness to
+the feeling with which this Institution, representing it in its
+educational aspect, is regarded by those who are themselves most
+honored and esteemed.  The great Master of Natural Science bade the
+last year's class farewell in our behalf, in those accents which
+delight every audience.  The Head of our ancient University honored
+us in the same way in the preceding season.  And how can we forget
+that other occasion when the Chief Magistrate of the Commonwealth,
+that noble citizen whom we have just lost, large-souled, sweet-
+natured, always ready for every kind office, came among us at our
+bidding, and talked to us of our duties in words as full of wisdom as
+his heart was of goodness?
+
+You have not much to fear, I think, from the fancy practitioners.
+The vulgar quackeries drop off, atrophied, one after another.
+Homoeopathy has long been encysted, and is carried on the body
+medical as quietly as an old wen.  Every year gives you a more
+reasoning and reasonable people to deal with.  See how it is in
+Literature.  The dynasty of British dogmatists, after lasting a
+hundred years and more, is on its last legs.  Thomas Carlyle, third
+in the line of descent, finds an audience very different from those
+which listened to the silver speech of Samuel Taylor Coleridge and
+the sonorous phrases of Samuel Johnson.  We read him, we smile at his
+clotted English, his "swarmery" and other picturesque expressions,
+but we lay down his tirade as we do one of Dr. Cumming's
+interpretations of prophecy, which tells us that the world is coming
+to an end next week or next month, if the weather permits,--not
+otherwise,--feeling very sure that the weather will be unfavorable.
+
+It is the same common-sense public you will appeal to.  The less
+pretension you make, the better they will like you in the long run.
+I hope we shall make everything as plain and as simple to you as we
+can.  I would never use a long word, even, where a short one would
+answer the purpose.  I know there are professors in this country who
+"ligate" arteries.  Other surgeons only tie them, and it stops the
+bleeding just as well.  It is the familiarity and simplicity of
+bedside instruction which makes it so pleasant as well as so
+profitable.  A good clinical teacher is himself a Medical School.  We
+need not wonder that our young men are beginning to announce
+themselves not only as graduates of this or that College, but also as
+pupils of some one distinguished master.
+
+I wish to close this Lecture, if you will allow me a few moments
+longer, with a brief sketch of an instructor and practitioner whose
+character was as nearly a model one in both capacities as I can find
+anywhere recorded.
+
+Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
+in this University from 1812 to 1846, and whose name has been since
+retained on our rolls as Professor Emeritus, died on the 27th of
+August 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 physicians who have borne witness to their knowledge
+of the laws of life by living to complete their hundredth year.  I
+think the student took his Old Master, as he always loved to call
+him, as his model; each was worthy of the other, and both were bright
+examples to all who come after them.
+
+I remember that in the sermon preached by Dr. Grazer after Dr.
+Holyoke's death, one of the points most insisted upon as
+characteristic of that wise and good old man was the perfect balance
+of all his faculties.  The same harmonious adjustment of powers, the
+same symmetrical arrangement of life, the same complete fulfilment of
+every day's duties, without haste and without needless delay, which
+characterized the master, equally distinguished the scholar.  A
+glance at the life of our own Old Master, if I can do any justice at
+all to his excellences, will give you something to carry away from
+this hour's meeting not unworthy to be remembered.
+
+>From December, 1797, to October, 1799, he remained with Dr. Holyoke
+as a student, a period which he has spoken of as a most interesting
+and most gratifying part of his life.  After this he passed eight
+months in London, and on his return, in October, 1800, he began
+business in Boston.
+
+He had followed Mr. Cline, as I have mentioned, and was competent to
+practise Surgery.  But he found Dr. John Collins Warren had already
+occupied the ground which at that day hardly called for more than one
+leading practitioner, and wisely chose the Medical branch of the
+profession.  He had only himself to rely upon, but he had confidence
+in his prospects, conscious, doubtless, of his own powers, knowing
+his own industry and determination, and being of an eminently
+cheerful and hopeful disposition.  No better proof of his spirit can
+be given than that, just a year from the time when he began to
+practise as a physician, he took that eventful step which in such a
+man implies that he sees his way clear to a position; he married a
+lady blessed with many gifts, but not bringing him a fortune to
+paralyze his industry.
+
+He had not miscalculated his chances in life.  He very soon rose into
+a good practice, and began the founding of that reputation which grew
+with his years, until he stood by general consent at the head of his
+chosen branch of the profession, to say the least, in this city and
+in all this region of country.  His skill and wisdom were the last
+tribunal to which the sick and suffering could appeal.  The community
+trusted and loved him, the profession recognized him as the noblest
+type of the physician.  The young men 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 older and
+began to think more of their ability to help the sick than their
+power of talking about phenomena, they began to look back to the
+teaching of Dr. Jackson, as he, after his London experience, looked
+back to that of Dr. Holyoke.  And so it came to be at last that the
+bare mention of his name in any of our medical assemblies would call
+forth such a tribute of affectionate regard as is only yielded to age
+when it brings with it the record of a life spent in well doing.
+
+No accident ever carries a man to eminence such as his in the medical
+profession.  He who looks for it must want it earnestly and work for
+it vigorously; Nature must have qualified him in many ways, and
+education must have equipped him with various knowledge, or his
+reputation will evaporate before it reaches the noon-day blaze of
+fame.  How did Dr. Jackson gain the position which all conceded to
+him?  In the answer to this question some among you may find a key
+that shall unlock the gate opening on that fair field of the future
+of 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 occupation enough to apply at the bedside the best of all that
+he knew for the good of his patient; to protect the community against
+the inroads of pestilence; to teach the young all that he himself had
+been taught, with all that his own experience had added; to leave on
+record some of the most important results of his long observation.
+
+With his patients he was so perfect at all points that it is hard to
+overpraise him.  I have seen many noted British and French and
+American practitioners, but I never saw the man so altogether
+admirable at the bedside of the sick as Dr. James Jackson.  His smile
+was itself a remedy better than the potable gold and the dissolved
+pearls that comforted the praecordia of mediaeval monarchs.  Did a
+patient, alarmed without cause, need encouragement, it carried the
+sunshine of hope into his heart and put all his whims to flight, as
+David's harp cleared the haunted chamber 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 heart felt it.  So
+gentle was he, so thoughtful, so calm, so absorbed in the case before
+him, not to turn round and look for a tribute to his sagacity, not to
+bolster himself in a favorite theory, but to find out all he could,
+and to weigh gravely and cautiously all that he found, that to follow
+him in his morning visit was 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 visit with Dr. Jackson was a
+medical education.
+
+He was very firm, with all his kindness.  He would have the truth
+about his patients.  The nurses found it out; and the shrewder ones
+never ventured to tell him anything but a straight story.  A clinical
+dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
+in the Massachusetts General Hospital, a mistress in her calling, was
+as good questioning and answering as one would be like to hear
+outside of the court-room.
+
+Of his practice you can form an opinion from his book called "Letters
+to a Young Physician."  Like all sensible men from the days of
+Hippocrates to the present, he knew that diet and regimen were more
+important than any drug or than all drugs put together.  Witness his
+treatment of phthisis and of epilepsy.  He retained, however, more
+confidence in some remedial agents than most of the younger
+generation would concede to them.  Yet his materia medica was 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 of medicines here, and that it will take you long to get
+acquainted with them, but most of them are unimportant.  There are
+four which are equal to all the rest, namely, Mercury, Antimony, Bark
+and Opium.'"  And Dr. Jackson adds, "I can only say of his practice,
+the longer I have lived, I have thought better and better of it."
+When he thought it necessary to give medicine, he gave it in earnest.
+He hated half-practice--giving a little of this or that, so as to be
+able to say that one had done something, in case a consultation was
+held, or a still more ominous event occurred.  He would give opium,
+for instance, as boldly as the late Dr. Fisher of Beverly, but he
+followed the aphorism of the Father of Medicine, and kept extreme
+remedies for extreme cases.
+
+When it came to the "non-naturals," as he would sometimes call them,
+after the old physicians,--namely, air, meat and drink, sleep and
+watching, motion and rest, the retentions and excretions, and the
+affections of the mind,--he was, as I have said, of the school of
+sensible practitioners, in distinction from that vast community of
+quacks, with or without the diploma, who think the chief end of man
+is to support apothecaries, and are never easy until they can get
+every patient upon a regular course of something nasty or noxious.
+Nobody was so precise in his directions about diet, air, and
+exercise, as Dr. Jackson.  He had the same dislike to the a peu pres,
+the about so much, about so often, about so long, which I afterwards
+found among the punctilious adherents of the numerical system at La
+Pitie.
+
+He used to insist on one small point with a certain philological
+precision, namely, the true meaning of the word "cure."  He would
+have it that to cure a patient was simply to care for him.  I refer
+to it as showing what his idea was of the relation of the physician
+to the patient.  It was indeed to care for him, as if his life were
+bound up in him, to watch his incomings and outgoings, to stand guard
+at every avenue that disease might enter, to leave nothing to chance;
+not merely to throw a few pills and powders into one pan of the
+scales of Fate, 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 human power to do it.  Such
+devotion as this is only to be looked for in the man who gives
+himself wholly up to the business of healing, who considers Medicine
+itself a Science, or if not a science, is willing to follow it as an
+art,--the noblest of arts, which the gods and demigods of ancient
+religions did not disdain to practise and to teach.
+
+The same zeal made him always ready to listen to any new suggestion
+which promised to be useful, at a period of life when many men find
+it hard to learn new methods and accept new doctrines.  Few of his
+generation became so accomplished as he in the arts of direct
+exploration; coming straight from the Parisian experts, I have
+examined many patients with him, and have had frequent opportunities
+of observing his skill in percussion and auscultation.
+
+One element in his success, a trivial one compared with others, but
+not to be despised, was his punctuality.  He always carried two
+watches,--I doubt if he told why, any more than Dr. Johnson told what
+he did with the orange-peel,--but probably with reference to this
+virtue.  He was as much to be depended upon at the appointed time as
+the solstice or the equinox.  There was another point I have heard
+him speak of as an important rule with him; to come at the hour when
+he was expected; if he had made his visit for several days
+successively at ten o'clock, for instance, not to put it off, if be
+could possibly help it, until eleven, and so keep a nervous patient
+and an anxious family waiting for him through a long, weary hour.
+
+If I should attempt to characterize his teaching, I should say that
+while it conveyed the best results of his sagacious and extended
+observation, it was singularly modest, cautious, simple, sincere.
+Nothing was for show, for self-love; there was no rhetoric, no
+declamation, no triumphant "I told you so," but the plain statement
+of a clear-headed honest man, who knows that he is handling one of
+the gravest subjects that interest humanity.  His positive
+instructions were full of value, but the spirit in which he taught
+inspired that loyal love of truth which lies at the bottom of all
+real excellence.
+
+I will not say that, during his long career, Dr. Jackson never made
+an enemy.  I have heard him tell how, in his very early days, old Dr.
+Danforth got into a towering passion with him about some professional
+consultation, and exploded a monosyllable or two of the more
+energetic kind on the occasion.  I remember that that somewhat
+peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
+succeeded to his place as Professor of Theory and Practice.  A young
+man of Dr. Jackson's talent and energy could hardly take the position
+that belonged to him without crowding somebody in a profession where
+three in a bed is the common rule of the household.  But he was a
+peaceful man and a peace-maker all his days.  No man ever did more,
+if so much, to produce and maintain the spirit of harmony for which
+we consider our medical community as somewhat exceptionally
+distinguished.
+
+If this harmony should ever be threatened, I could wish that every
+impatient and irritable member of the profession would read that
+beautiful, that noble Preface to the "Letters," addressed to John
+Collins Warren.  I know nothing finer in the medical literature of
+all time than this Prefatory Introduction.  It is a golden prelude,
+fit to go with the three great Prefaces which challenge the
+admiration of scholars,--Calvin's to his Institutes, De Thou's to his
+History, and Casaubon's to his Polybius,--not because of any learning
+or rhetoric, though it is charmingly written, but for a spirit
+flowing through it to which learning and rhetoric are but as the
+breath that is wasted on the air to the Mood that warms the heart.
+
+Of a similar character is this short extract which I am permitted to
+make from a private letter of his to a dear young friend.  He was
+eighty-three years old 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 characters of all men and women.  At first
+I must have done this from something in my own nature, for I was not
+aware of it, and yet was doing it without any plan, when one day,
+sixty years ago, a friend whom I loved and respected said this to me,
+'Ah, James, I see that you are destined to succeed in the world, and
+to make friends, because you are so ready to see the good point in
+the characters of those you meet.'"
+
+I close this imperfect notice of some features in the character of
+this most honored and beloved of physicians by applying to him the
+words which were written of William Heberden, whose career was not
+unlike his own, and who lived to the same patriarchal age.
+
+"From his early youth he had always entertained a deep sense of
+religion, a consummate love of virtue, an ardent thirst after
+knowledge, and an earnest desire to promote the welfare and happiness
+of all mankind.  By these qualities, accompanied with great sweetness
+of manners, he acquired the love and esteem of all good men, in a
+degree which perhaps very few have experienced; and after passing an
+active life with the uniform testimony of a good conscience, he
+became an eminent example of its influence, in the cheerfulness and
+serenity of his latest age."
+
+Such was the man whom I offer to you as a model, young gentlemen, at
+the outset of your medical career.  I hope that many of you will
+recognize some traits of your own special teachers scattered through
+various parts of the land in the picture I have drawn.  Let me assure
+you that whatever you may learn in this or any other course of public
+lectures,--and I trust you will learn a great deal,--the daily
+guidance, counsel, example, of your medical father, for such the Oath
+of Hippocrates tells you to consider your preceptor, will, if he is
+in any degree like him of whom I have spoken, be the foundation on
+which all that we teach is reared, and perhaps outlive most of our
+teachings, as in Dr. Jackson's memory the last lessons that remained
+with him were those of his Old Master.
+
+
+
+
+
+
+THE MEDICAL PROFESSION IN MASSACHUSETTS.
+
+A Lecture of a Course by members of the Massachusetts Historical
+Society, delivered before the Lowell Institute, January 29, 1869.
+
+The medical history of eight generations, told in an hour, must be in
+many parts a mere outline.  The details I shall give will relate
+chiefly to the first century.  I shall only indicate the leading
+occurrences, with the more prominent names of the two centuries which
+follow, and add some considerations suggested by the facts which have
+been passed in review.
+
+A geographer who was asked to describe the tides of Massachusetts
+Bay, would have to recognize the circumstance that they are a limited
+manifestation of a great oceanic movement.  To consider them apart
+from this, would be to localize a planetary phenomenon, and to
+provincialize a law of the universe.  The art of healing in
+Massachusetts has shared more or less fully and readily the movement
+which, with its periods of ebb and flow, has been raising its level
+from age to age throughout the better part of Christendom.  Its
+practitioners brought with them much of the knowledge and many of the
+errors of the Old World; they have always been in communication with
+its wisdom and its folly; it is not without interest to see how far
+the new conditions in which they found themselves have been favorable
+or unfavorable to the growth of sound medical knowledge and practice.
+
+The state of medicine is an index of the civilization of an age and
+country,--one of the best, perhaps, by which it can be judged.
+Surgery invokes the aid of all the mechanical arts.  From the rude
+violences of the age of stone,--a relic of which we may find in the
+practice of Zipporah, the wife of Moses,--to the delicate operations
+of to-day upon patients lulled into temporary insensibility, is a
+progress which presupposes a skill in metallurgy and in the labors of
+the workshop and the laboratory it 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, can find their place
+in our pharmacies, commerce must have perfected its machinery, and
+science must have refined its processes, through periods only to be
+counted by the life of nations.  Before the means which nature and
+art have put in the hands of the medical practitioner can be fairly
+brought into use, the prejudices of the vulgar must be overcome, the
+intrusions of false philosophy must be fenced out, and the
+partnership with the priesthood dissolved.  All this implies that
+freedom and activity of thought which belong only to the most
+advanced conditions of society; and the progress towards this is by
+gradations as significant of wide-spread changes, as are the varying
+states of the barometer of far-extended conditions of 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 trivial and almost unworthy of record.  A
+medical entry in Governor Winthrop's journal may seem at first sight
+a mere curiosity; but, rightly interpreted, it is a key to his whole
+system of belief as to the order of the universe and the relations
+between man and his Maker.  Nothing sheds such light on the
+superstitions of an age as the prevailing interpretation and
+treatment of disease.  When the touch of a profligate monarch was a
+cure for one of the most inveterate of maladies, when the common
+symptoms of hysteria were prayed over as marks of demoniacal
+possession, we might well expect the spiritual realms of thought to
+be peopled with still stranger delusions.
+
+Let us go before the Pilgrims of the Mayflower, and look at the
+shores on which they were soon to land.  A wasting pestilence had so
+thinned the savage tribes that it was sometimes piously interpreted
+as having providentially prepared the way for the feeble band of
+exiles.  Cotton Mather, who, next to the witches, hated the
+"tawnies," " wild beasts," "blood-hounds," "rattlesnakes,"
+"infidels," as in different places he calls the unhappy Aborigines,
+describes the condition of things in his lively way, thus:
+"The Indians in these Parts had newly, even about a Year or Two
+before, been visited with such a prodigious Pestilence; as carried
+away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
+Twenty) among them so that the Woods were almost cleared of those
+pernicious Creatures to make Room for a better Growth."
+
+What this pestilence was has been much discussed.  It is variously
+mentioned by different early writers as "the plague," "a great and
+grievous plague," "a sore consumption," as attended with spots which
+left unhealed places on those who recovered, as making the "whole
+surface yellow as with a garment."  Perhaps no disease answers all
+these conditions so well as smallpox.  We know from different sources
+what frightful havoc it made among the Indians in after years,--in
+1631, for instance, when it swept away the aboriginal inhabitants of
+whole towns," and in 1633.  We have seen a whole tribe, the Mandans,
+extirpated by it in our own day.  The word "plague" was used very
+vaguely, as in the description of the "great sickness" found among
+the Indians by the expedition of 1622.  This same great sickness
+could hardly have been yellow fever, as it occurred in the month of
+November.  I cannot think, therefore, that either the scourge of the
+East or our Southern malarial pestilence was the disease that wasted
+the Indians.  As for the yellowness like a garment, that is too
+familiar to the eyes of all who have ever looked on the hideous mask
+of confluent variola.
+
+Without the presence or the fear of these exotic maladies, the
+forlorn voyagers of the Mayflower had sickness enough to contend
+with.  At their first landing at Cape Cod, gaunt and hungry and
+longing for fresh food, they found upon the sandy shore "great
+mussel's, and very fat and full of sea-pearl."  Sailors and
+passengers indulged in the treacherous delicacy; which seems to have
+been the sea-clam; and found that these mollusks, like the shell the
+poet tells of, remembered their august abode, and treated the way-
+worn adventurers to a gastric reminiscence of the heaving billows.
+In the mean time it blew and snowed and froze.  The water turned to
+ice on their clothes, and made them many times like coats of iron.
+Edward Tilley had like to have "sounded" with cold.  The gunner, too,
+was sick unto death, but "hope of trucking" kept him on his feet,--a
+Yankee, it should seem, when he first touched the shore of New
+England.  Most, if not all, got colds and coughs, which afterwards
+turned to scurvy, whereof many died.
+
+How can we wonder that the crowded and tempest-tossed voyagers, many
+of them already suffering, should have fallen before the trials of
+the first winter in Plymouth?  Their imperfect shelter, their
+insufficient supply of bread, their salted food, now in unwholesome
+condition, account too well for the diseases and the mortality that
+marked this first dreadful season; weakness, swelling of the limbs,
+and other signs of scurvy, betrayed the want of proper nourishment
+and protection from the elements.  In December six of their number
+died, in January eight, in February, seventeen, in March thirteen.
+With the advance of spring the mortality 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 colonists must have been
+that of physicians and surgeons.  In Mr. Savage's remarkable
+Genealogical Dictionary of the first settlers who came over before
+1692 and their descendants to the third generation, I find scattered
+through the four crowded volumes the names of one hundred and thirty-
+four medical practitioners.  Of these, twelve, and probably many
+more, practised surgery; three were barber-surgeons.  A little
+incident throws a glimmer from the dark lantern of memory upon
+William Direly, one of these practitioners with the razor and the
+lancet.  He was lost between Boston and Roxbury in a violent tempest
+of wind and snow; ten days afterwards a son was born to his widow,
+and with a touch of homely sentiment, I had almost said 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 into the
+Connecticut River, and so ended.  One was not only doctor, but also
+schoolmaster and poet.  One practised medicine and kept a tavern.
+One was 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,--Ann Moore,--was the precursor
+of that intrepid sisterhood whose cause it has long been my pleasure
+and privilege to advocate on all fitting occasions.
+
+Outside of this list I must place the name of Thomas Wilkinson, who
+was complained of, is 1676, for practising contrary to law.
+
+Many names in the catalogue of these early physicians have been
+associated, in later periods, with the practice of the profession,--
+among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
+Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
+Woodward.  Touton was a Huguenot, Burchsted a German from Silesia,
+Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
+honor of the profession, was only Peacock disguised under this alias,
+which would not, I fear, prove very attractive to patients.
+
+What doctrines and practice were these colonists likely to bring,
+with them?
+
+Two principal schools of medical practice prevailed in the Old World
+during the greater part of the seventeenth century.  The first held
+to the old methods of Galen: 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 qualities hot, dry,
+moist, cold.  The body was to be preserved in health by keeping each
+of these qualities in its natural proportion; heat, by the proper
+temperature; moisture, by the due amount of fluid; and so as to the
+rest.  Diseases which arose from excess of heat were to be attacked
+by cooling remedies; those from excess of cold, by heating ones; and
+so of the other derangements of balance.  This was truly the
+principle of contraries contrariis, which ill-informed persons have
+attempted to make out to be the general doctrine of medicine, whereas
+there is no general dogma other than this: disease is to be treated
+by anything that is proved to cure it.  The means the Galenist
+employed were chiefly diet and vegetable remedies, with the use of
+the lancet and other depleting agents.  He attributed the four
+fundamental qualities to different vegetables, in four different
+degrees; thus chicory was cold in the fourth degree, pepper was hot
+in the fourth, endive was cold and dry in the second, and bitter
+almonds were hot in the first and dry in the second degree.  When we
+say "cool as a cucumber," we are talking Galenism.  The seeds of that
+vegetable ranked as one of "the four greater cold seeds" of this
+system.
+
+Galenism prevailed mostly in the south of Europe and France.  The
+readers of Moliere will have no difficulty in 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 credit after a time; their
+absurdly complicated mixtures excited contempt, and their nauseous
+prescriptions provoked loathing and disgust.  A simpler and bolder
+practice found welcome in Germany, depending chiefly on 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 limits we
+may assign to the use of these long-trusted mineral drugs, there can
+be no doubt that the chemical school, as it was called, did a great
+deal towards the expurgation of the old, overloaded, and repulsive
+pharmacopoeia.  We shall find evidence in the practice of our New-
+England physicians of the first century, that they often employed
+chemical remedies, and that, by the early part of the following
+century, their chief trust was in the few 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 existed from a very early period; from the
+Egyptian priest to the Indian medicine-man, the alliance has been
+maintained in one form or another.  The partnership was very common
+among our British ancestors.  Mr. Ward, the Vicar of Stratford-on-
+Avon, himself a notable example of the union of the two characters,
+writing about 1660, says,
+
+"The Saxons had their blood-letters, but under the Normans physicke,
+begunne in England; 300 years agoe itt was not a distinct profession
+by itself, but practised by men in orders, witness Nicholas de
+Ternham, the chief English physician and Bishop of Durham; Hugh of
+Evesham, a physician and cardinal; Grysant, physician and pope; John
+Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
+Bush, a bachelor of divinitie in Oxford, was a man well read in
+physick as well as divinitie, he was the first bishop of Bristol."
+
+"Again in King Richard the Second's time physicians 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 and keeping up the
+many superstitions which have figured so largely in the history of
+medicine.  It is curious to see that a medical work left in
+manuscript by the Rev. Cotton Mather and hereafter to be referred to,
+is running over with follies and superstitious fancies; while his
+contemporary and fellow-townsman, William Douglass, relied on the
+same few simple remedies which, through Dr. Edward Holyoke and Dr.
+James Jackson, have come down to our own time, as the most important
+articles of the materia medica.
+
+Let us now take a general glance at some of the conditions of the
+early settlers; and first, as to the healthfulness of the climate.
+The mortality of the season that followed the landing of the Pilgrims
+at Plymouth has been sufficiently accounted for.  After this, the
+colonists seem to have found the new country agreeing very well with
+their English constitutions.  Its clear air is the subject of eulogy.
+Its dainty springs of sweet water are praised not only by Higginson
+and Wood, but even the mischievous Morton says, that for its delicate
+waters Canaan came not near this country."  There is a tendency to
+dilate on these simple blessings, which reminds one a little of the
+Marchioness in Dickens's story, with her orange-peel-and-water
+beverage.  Still more does one feel the warmth of coloring,--such as
+we expect from converts to a new faith, and settlers who want to
+entice others over to their clearings, when Winslow speaks, in 1621,
+of "abundance of roses, white, red, and damask; single, but very
+sweet indeed;" a most of all, however, when, in the same connection,
+he says, "Here are grapes white and red, and very sweet and strong
+also."  This of our wild grape, a little vegetable Indian, which
+scalps a civilized man's mouth, as his animal representative scalps
+his cranium.  But there is something quite charming in Winslow's
+picture of the luxury in which they are living.  Lobsters, oysters,
+eels, mussels, fish and fowl, delicious fruit, including the grapes
+aforesaid,--if they only had "kine, horses, and sheep," he makes no
+question but men would live as contented here as in any part of the
+world.  We cannot help admiring the way in which they took their
+trials, and made the most of their blessings.
+
+"And how Content they were," says Cotton Mather, "when an Honest Man,
+as I have heard, inviting his Friends to a Dish of Clams, at the
+Table gave Thanks to Heaven, who had given them to suck the abundance
+of the Seas, and of the Treasures Aid in the Sands!"
+
+Strangely enough, as it would seem, except for this buoyant
+determination to make the best of everything, they hardly appear to
+recognize the difference of the climate from that which they had
+left.  After almost 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 a difference), is sharper and longer; but yet he may be
+deceived by the want of the comforts he enjoyed at home.  He cannot
+conceive any climate to agree better with the constitution of the
+English, not being oppressed with extremity of heats, nor nipped by
+biting cold :
+
+"By which means, blessed be God, we enjoy our health, notwithstanding
+those difficulties we have undergone, 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 which they 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 their fill of bread."
+
+Higginson, himself a dyspeptic, "continually in physic," as he says,
+and accustomed to dress in thick clothing, and to comfort his stomach
+with drink that was "both strong and stale,"--the "jolly good ale and
+old," I suppose, of free and easy Bishop Still's song,--found that he
+both could and did oftentimes drink New England water very well,
+--which he seems to look upon as a remarkable feat.  He could go as
+lightclad as any, too, with only a light stuff cassock upon his
+shirt, and stuff breeches without linings.  Two of his children were
+sickly: one,--little misshapen Mary,--died on the passage, and, in
+her father's words, "was the first in our ship that was buried in the
+bowels of the great Atlantic sea;" the other, who had been "most
+lamentably handled" by disease, recovered almost entirely "by the
+very wholesomeness of the air, altering, digesting, and drying up the
+cold and crude humors of the body."  Wherefore, he thinks it a wise
+course for all cold complexions to come to take physic in New
+England, and ends with those often quoted words, that "a sup of New
+England's air is better than a whole draught of Old England's ale."
+Mr. Higginson died, however, "of a hectic fever," a little more than
+a year after his arrival.
+
+The medical records which I shall cite show that the colonists were
+not exempt from the complaints of the Old World.  Besides the common
+diseases to which their descendants are subject, there were two
+others, to say nothing of the dreaded small-pox, which later medical
+science has disarmed,--little known among us at the present day, but
+frequent among the first 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 into discontent, and lingered
+after their former conditions in England; the poor homesick creatures
+in fact, whom we so forget in our florid pictures of the early times
+of the little band in the wilderness.  Many who were suffering from
+scurvy got well when the Lyon arrived from England, bringing store of
+juice of lemons.  The Governor speaks of another case in 1644; and it
+seems probable that the disease was not of rare occurrence.
+
+The other complaint from which they suffered, but which has nearly
+disappeared from among us, was intermittent fever, or fever and ague.
+I investigated the question as to the prevalence of this disease in
+New England, in a dissertation, which was published in a 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 "Old
+Men's Tears," dated 1691, speaks of "shaking agues," as among the
+trials to which they had been subjected.  The outline map of New
+England, accompanying the dissertation above referred to, indicates
+all the places where I had evidence that the disease had originated.
+It was plain enough that it used to be known in many localities where
+it has long ceased to be feared.  Still it was and is remarkable to
+see what a clean bill of health in this particular respect our barren
+soil inherited with its sterility.  There are some malarious spots on
+the edge of Lake Champlain, arid there have been some temporary
+centres of malaria, within the memory of man, on one or more of our
+Massachusetts rivers, but these are harmless enough, for the most
+part, unless the millers dam them, when they are apt to retaliate
+with a whiff from their meadows, that sets the whole neighborhood
+shaking with fever and ague.
+
+
+The Pilgrims of the Mayflower had with them a good physician, 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 and bad food, and, probably enough, desperate homesickness in
+some of the feebler sort, from doing their work.  No detailed record
+remains of what they suffered or what was attempted for their relief
+during the first sad winter.  The graves of those who died were
+levelled and sowed with grain that the losses of the little band
+might not be suspected by the savage tenants of 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 Governor Bradford, dated June, 1630.  "I have been
+to Matapan" (now Dorchester), he says, "and let some twenty of those
+people blood."  Such wholesale depletion as this, except with avowed
+homicidal intent, is quite unknown in these days; though I once saw
+the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
+order some ten or fifteen patients, taken almost indiscriminately, to
+be bled in a single morning.
+
+Dr. Fuller's two visits to Salem, at the request of Governor
+Endicott, seem to have been very satisfactory to that gentleman.
+Morton, the wild fellow of Merry Mount, gives a rather questionable
+reason for the Governor's being so well pleased with the physician's
+doings.  The names under which he mentions the two personages, it
+will be seen, are not 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 spoken of as
+"a right godly man and skilful chyrurgeon," but died of a malignant
+fever not very long after his arrival."
+
+Two practitioners of the ancient town of Newbury are entitled to
+special notice, for different reasons.  The first is Dr. John Clark,
+who is said by tradition to have been the first regularly educated
+physician who resided in New England.  His portrait, in close-fitting
+skull-cap, with long locks and venerable flowing beard, is familiar
+to our eyes on the wall of our Society's antechamber.  His left hand
+rests upon a skull, his right hand holds an instrument which deserves
+a passing comment.  It is a trephine, a surgical implement for
+cutting round pieces out of broken skulls, so as to get at the
+fragments which have been driven in, and lift them up.  It has a
+handle like that of a gimlet, with a claw like a hammer, to lift
+with, I suppose, which last contrivance I do not see figured in my
+books.  But the point I refer to is this: the old instrument, the
+trepan, had a handle like a wimble, what we call a brace or bit-
+stock.  The trephine is not mentioned at all in Peter Lowe's book,
+London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
+nor in the translation of 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 of the last century.  As John Clark
+died in 1661, it is remarkable to see the last fashion in the way of
+skull-sawing contrivances in his hands,--to say nothing of the claw
+on the handle, and a Hey's saw, so called in England, lying on the
+table by him, and painted there more than a hundred years before Hey
+was born.  This saw is an old invention, perhaps as 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 before be 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 more or less
+traditional authority, give us the feeling that the people of
+Newbury, and afterwards of Boston, had a wise and skilful medical
+adviser and surgeon in Dr. John Clark.
+
+The venerable town of Newbury had another physician who was less
+fortunate.  The following is a court record of 1652:
+
+"This is to certify whom it may concern, that we the subscribers,
+being called upon to testify against doctor William Snelling for
+words by him uttered, affirm that being in way of merry discourse, a
+health being 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 their feet.]
+
+"Since when he hath affirmed that he only intended the proverb used
+in the west country, nor do we believe he intended otherwise.
+
+[Signed]
+WILLIAM THOMAS.
+THOMAS MILWARD.
+
+"March 12th 1651, All which I acknowledge, and am sorry I did not
+expresse my intent, or that I was so weak as to use so foolish a
+proverb.
+
+[Signed]
+GULIELMUS SNELLING."
+
+
+Notwithstanding this confession and apology, the record tells us that
+"William Snelling in his presentment for cursing is fined ten
+shillings and the fees of court."
+
+I will mention one other name among those of the Fathers of 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 and read upon very well."
+
+Giles Firmin, as the name is commonly spelled, practised physic in
+this country for a time.  He seems to have found it a poor business;
+for, in a letter to Governor Winthrop, he says, "I am strongly sett
+upon to studye divinitie: my studyes else must be lost, for physick
+is but a meene helpe."
+
+Giles Firmin's Lectures on Anatomy were the first scientific
+teachings of the New World.  While the Fathers were enlightened
+enough to permit such instructions, they were severe in dealing with
+quackery; for, in 1631, our court records show that one Nicholas
+Knopp, or Knapp, was sentenced to be fined or whipped "for taking
+upon him to cure the scurvey by a water of noe worth nor value, which
+he solde att a very deare rate."  Empty purses or sore backs would be
+common with us to-day if such a rule were enforced.
+
+Besides the few worthies spoken of, and others whose names I have not
+space to record, we must remember that there were many clergymen who
+took charge of the bodies as well as the souls of their patients,
+among them two Presidents of Harvard College, Charles Chauncy and
+Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
+author of the earliest medical treatises printed in the country,[A
+Brief Rule to Guide the Common People in Small pox and
+Measles.  1674.] whose epitaph in Latin and Greek, said to have been
+written by Eleazer, an "Indian Youth" and a member of the Senior
+Class of Harvard College, may be found in the "Magnalia."  I miss
+this noble savage's name in our triennial catalogue; and as there is
+many a slip between the cup and lip, one is tempted to guess that he
+may have lost his degree by some display of his native instinct,--
+possibly a flourish of the tomahawk or scalping-knife.  However this
+may have been, the good man he celebrated was a notable instance of
+the Angelical Conjunction, as the author of the "Magnalia" calls it,
+of the offices of clergyman and medical practitioner.
+
+Michael Wigglesworth, author of the "Day of Doom," attended the sick,
+"not only as a Pastor, but as a Physician too, and this, not only in
+his own town, but also in all those of the vicinity."  Mather says of
+the sons of Charles Chauncy, " All of these did, while they had
+Opportunity, Preach the Gospel; and most, if not all of them, like
+their excellent Father before them, had an eminent skill in physick
+added unto their other accomplishments," etc.  Roger Williams is said
+to have saved many in a kind of pestilence which swept away many
+Indians.
+
+To these names must be added, as sustaining a certain relation to the
+healing art, that of the first Governor Winthrop, who is said by John
+Cotton to have been "Help for our Bodies by Physick [and] for our
+Estates by Law," and that of his son, the Governor of Connecticut,
+who, as we shall see, was as much physician as magistrate.
+
+I had submitted to me for examination, in 1862, a manuscript found
+among the Winthrop Papers, marked with the superscription, "For my
+worthy friend Mr. Wintrop," dated in 1643, London, signed Edward
+Stafford, and containing medical directions and prescriptions.  It
+may be remembered by some present that I wrote a report on this
+paper, which was published in the "Proceedings" of this Society.
+Whether the paper was written for Governor John Winthrop of
+Massachusetts, or for his son, Governor John of Connecticut, there is
+no positive evidence that I have been able to obtain.  It is very
+interesting, however, as giving short and simple practical
+directions, such as 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.  The remedies
+are of three kinds: simples, such as St. John's wort, Clown's all-
+heal, elder, parsley, maidenhair, mineral drugs, such as lime,
+saltpetre, Armenian bole, crocus metallorum, or sulphuret of
+antimony; and thaumaturgic or mystical, of which the chief 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 toads into an earthen
+pot so as to half fill it, and baking and burning them "in the open
+ayre, not in an house,"--concerning which latter possibility I
+suspect Madam Winthrop would have had something to say,--until they
+could be reduced by pounding, first into a brown, and then into a
+black, powder.  Blood-letting in some inflammations, fasting in the
+early stage of fevers, and some of those peremptory drugs with which
+most of us have been well acquainted in our time, the infragrant
+memories of which I will not pursue beyond this slight allusion, are
+among his remedies.
+
+The Winthrops, to one of whom Dr. Stafford's directions were
+addressed, were the medical as well as the political advisers of
+their fellow-citizens for three or four successive generations.  One
+of them, Governor John of Connecticut, practised so extensively,
+that, but for his more distinguished title in the State, he would
+have been remembered as the Doctor.  The fact that he practised in
+another colony, for the most part, makes little difference in the
+value of the records we have of his medical experience, which have
+fortunately been preserved, and give a very fair idea, in all
+probability, of the way in which patients were treated in
+Massachusetts, when they fell into intelligent and somewhat educated
+hands, a little after the middle of the seventeenth century:
+
+I have before me, while writing, a manuscript collection of the
+medical cases treated by him, and recorded at the time in his own
+hand, which has been intrusted to me by our President, his
+descendant.
+
+They are generally marked Hartford, and extend from the year 1657 to
+1669.  From these, manuscripts, and from the letters printed in the
+Winthrop Papers published by our Society, I have endeavored to obtain
+some idea of the practice of Governor John Winthrop, Junior.  The
+learned eye of Mr. Pulsifer would have helped me, no doubt, as it has
+done in other cases; but I have ventured this time to attempt finding
+my own way among the hieroglyphics of these old pages.  By careful
+comparison of many prescriptions, and by the aid of Schroder, Salmon,
+Culpeper, and other old compilers, I have deciphered many of his
+difficult paragraphs with their mysterious recipes.
+
+The Governor employed a number of the simples dear to ancient women,
+--elecampane and elder and wormwood and anise and the rest; but he
+also employed certain mineral remedies, which he almost always
+indicates by their ancient symbols, or by a name which should leave
+them a mystery to the vulgar.  I am now prepared to reveal the mystic
+secrets of the Governor's beneficent art, which rendered so many good
+and great as well as so many poor and dependent people his debtors,-
+at least, in their simple belief,--for their health and their lives.
+
+His great remedy, which he gave oftener than any other, was nitre;
+which he ordered in doses of twenty or thirty grains to adults, and
+of three grains to infants.  Measles, colics, sciatica, headache,
+giddiness, and many other ailments, all found themselves treated, and
+I trust bettered, by nitre; a pretty safe medicine in moderate doses,
+and one not likely to keep the good Governor awake at night, thinking
+whether it might not kill, if it did not cure.  We may say as much
+for spermaceti, which he seems to have considered "the sovereign'st
+thing on earth" for inward bruises, and often prescribes after falls
+and similar injuries.
+
+One of the next remedies, in point of frequency, which he was in the
+habit of giving, was (probably diaphoretic) antimony; a mild form of
+that very active metal, and which, mild as it was, left his patients
+very commonly with a pretty strong conviction that they had been
+taking 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 dose of rhubarb or jalap; a taste of
+stinging horseradish, oftener of warming guiacum; sometimes an
+anodyne, in the shape of mithridate,--the famous old farrago, which
+owed its virtue to poppy juice; [This is the remedy which a Boston
+divine tried to simplify.  See Electuarium Novum Alexipharmacum, by
+Rev.  Thomas Harward, lecturer at the Royal Chappell.  Boston, 1732.
+This tract is in our Society's library.] very often, a harmless
+powder of coral; less frequently, an inert prescription of pleasing
+amber; and (let me say it softly within possible hearing of his
+honored descendant), twice or oftener,--let us hope as a last
+resort,--an electuary of millipedes,--sowbugs, if we must give them
+their homely English name.  One or two other prescriptions, of the
+many unmentionable ones which disgraced the pharmacopoeia of the
+seventeenth century, are to be found, but only in very rare
+instances, in the faded characters of the manuscript.
+
+The excellent Governor's accounts of diseases are so brief, that we
+get only a very general notion of the complaints for which he
+prescribed.  Measles and their consequences are at first more
+prominent than any other one affection, but the common infirmities of
+both sexes and of all ages seem to have come under his healing hand.
+Fever and ague appears to have been of frequent occurrence.
+
+His published correspondence shows that many noted people were in
+communication with him as his patients.  Roger Williams wants a
+little of his medicine for Mrs. Weekes's daughter; worshipful John
+Haynes is in receipt of his powders; troublesome Captain Underhill
+wants "a little white vitterall" for his wife, and something to cure
+his wife's friend's neuralgia, (I think his wife's friend's husband
+had a little rather have had it sent by the hands of Mrs. Underhill,
+than by those of the gallant and discursive captain); and pious John
+Davenport says, his wife "tooke but one halfe of one of the papers"
+(which probably contained the medicine he called rubila), "but could
+not beare the taste of it, and is discouraged from taking any more;"
+and honored William Leete asks for more 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 of all the bitter things she
+swallowed,--God help all little children in the hands of dosing
+doctors and 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
+relief he 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 little to sence in operation, should beget and bring
+forth such efects," that we repent our hasty exclamation, and bless
+the memory of the good Governor, who gave relief to the worn-out
+frame of our long-departed brother, the sturdy old heretic of Rhode
+Island.
+
+What was that medicine which so frequently occurs in the printed
+letters under the name of "rubila"?  It is evidently a secret remedy,
+and, so far as I know, has not yet been made out.  I had almost given
+it up in despair, when I found what appears to be a key to the
+mystery.  In the vast multitude of prescriptions contained in the
+manuscripts, most of them written in symbols, I find one which I thus
+interpret:
+
+"Four grains of (diaphoretic) antimony, with twenty grains of nitre,
+with a little salt of tin, making rubila."  Perhaps something was
+added to redden the powder, as he constantly speaks of "rubifying "
+or "viridating" his prescriptions; a very common practice of
+prescribers, when their powders look a little too much like plain
+salt or sugar.
+
+
+Waitstill Winthrop, the Governor's son, "was a skilful physician,"
+says Mr. Sewall, in his funeral sermon; "and generously gave, not
+only his advice, but also his Medicines, for the healing of the Sick,
+which, by the Blessing of God, were made successful for the recovery
+of many."  "His son John, a member of the Royal Society, speaks of
+himself as "Dr. Winthrop," and mentions one of his own prescriptions
+in a letter to Cotton Mather.  Our President tells me that there was
+an heirloom of the ancient skill in his family, within his own
+remembrance, in the form of a certain precious eye-water, to which
+the late President John Quincy Adams ascribed rare virtue, and which
+he used to obtain from the possessor of the ancient recipe.
+
+These inherited prescriptions are often treasured in 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
+Cambridgeport schoolmates used to call the "ager,"--meaning thereby
+toothache or face-ache,--I used to get relief from a certain plaster
+which never went by any other name in the family than "Dr. Oliver."
+
+Dr. James Oliver was my great-great-grandfather, graduated in 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
+particular medicine, or other possession or secret, and physicians in
+old times used to keep their choice recipes to themselves a good
+deal, as we have had occasion to see.
+
+Some years ago I found among my old books a small manuscript marked
+"James Oliver.  This Book Begun Aug. 12, 1685."  It is a rough sort
+of account-book, containing among other things prescriptions for
+patients, and charges for the same, with counter-charges for the
+purchase of medicines and other matters.  Dr. Oliver practised in
+Cambridge, where may be seen his tomb with inscriptions, and with
+sculptured figures that look more like Diana of the Ephesians, as
+given in Calmet's Dictionary, than like any angels admitted into good
+society here or elsewhere.
+
+I do not find any particular record of what his patients suffered
+from, but I have carefully copied out the remedies he mentions, and
+find that they form a very respectable catalogue.  Besides the usual
+simples, elder, parsley, fennel, saffron, snake-root, wormwood, I
+find the Elixir Proprietatis, with other elixire and cordials, as if
+he rather fancied warming medicines; but he called in the aid of some
+of the more energetic remedies, including iron, and probably mercury,
+as he bought two pounds of it at one time.
+
+The most interesting item is his bill against the estate of Samuel
+Pason of Roxbury, for services during his last illness.  He attended
+this gentleman,--for such he must have been, by the amount of physic
+which he took, and which his heirs paid for,--from June 4th, 1696, to
+September 3d of the same year, three months.  I observe he charges
+for visits as well as for medicines, which is not the case in most of
+his bills.  He opens the attack with a carminative appeal to the
+visceral conscience, and follows it up with good hard-hitting
+remedies for dropsy,--as I suppose the disease would have been
+called,--and finishes off with a rallying dose of hartshorn and iron.
+
+It is a source of honest pride to his descendant that his bill, which
+was honestly paid, as it seems to have been honorably earned,
+amounted to the handsome total of seven pounds and two shillings.
+Let me add that he repeatedly prescribes plaster, one of which was
+very probably the "Dr. Oliver" that soothed my infant griefs, and for
+which I blush to say that my venerated ancestor received from Goodman
+Hancock the painfully exiguous sum of no pounds, no shillings, and
+sixpence.
+
+I have illustrated the practice of the first century, from the two
+manuscripts I have examined, as giving an impartial idea of its
+every-day methods.  The Governor, Johannes Secundus, it is fair to
+remember, was an amateur practitioner, while my ancestor was a
+professed physician.  Comparing their modes of treatment with the
+many scientific follies still prevailing in the Old World, and still
+more with the extraordinary theological superstitions of the
+community in which they lived, we shall find reason, I think, to
+consider the art of healing as in a comparatively creditable state
+during the first century of New England.
+
+In addition to the evidence as to methods of treatment furnished by
+the manuscripts I have cited, I subjoin the following document, to
+which my attention was called by Dr. Shurtleff, our present Mayor.
+This is a letter of which the original is to be found in vol.  lxix.
+page 10 of the "Archives" preserved at the State House in Boston.  It
+will be seen that what the surgeon wanted consisted chiefly of
+opiates, stimulants, cathartics, plasters, and materials for
+bandages.  The complex and varied formulae have given place to
+simpler and often more effective forms of the same remedies; but the
+list and the manner in which it is made out are proofs of the good
+sense and 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 upon which he wrote, a great body of Indians--
+supposed to be six or seven hundred--appeared before Hatfield; and
+twenty-five resolute young men of Hadley, from which town he wrote,
+crossed the river and drove them away.
+
+
+HADLY May 30: 76
+
+Mr RAWSON Sr
+
+What we have recd by Tho: Houey the past month is not the cheifest of
+our wants as you have love for poor wounded I pray let us not want
+for these following medicines if you have not a speedy conveyance of
+them I pray send on purpose they are those things mentioned in my
+former letter but to prevent future mistakes I have wrote them att
+large wee have great want 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 obtaine any thing to be sent in answer
+thereto 13 June 1676
+
+
+I have given some idea of the chief remedies used by our earlier
+physicians, which were both Galenic and chemical; that is, vegetable
+and mineral.  They, of course, employed the usual perturbing
+medicines which Montaigne says are the chief reliance of their craft.
+There were, doubtless, individual practitioners who employed special
+remedies with exceptional boldness and perhaps success.  Mr. Eliot is
+spoken of, in a letter of William Leete to Winthrop, Junior, as being
+under Mr. Greenland's mercurial administrations.  The latter was
+probably enough one of these specialists.
+
+There is another class of remedies which appears to have been
+employed occasionally, but, on the whole, is so little prominent as
+to imply a good deal of common sense among the medical practitioners,
+as compared with 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
+incredible fact that they were retained in the materia medica so late
+as when Rees's Cyclopaedia was published, and we there find the
+directions formerly given by the College of Edinburgh for their
+preparation.  Once or twice we have found him admitting still more
+objectionable articles into his materia medica; in doing which, I am
+sorry to say that he could plead grave and learned authority.  But
+these instances are very rare exceptions in a medical practice of
+many years, which is, on the whole, very respectable, considering the
+time and circumstances.
+
+Some remedies of questionable though not odious character appear
+occasionally to have been employed by the early practitioners, but
+they were such as still had the support of the medical profession.
+Governor John Winthrop, the first, sends for East Indian bezoar, with
+other commodities he is writing for.  Governor Endicott sends him one
+he had of Mr. Humfrey.  I hope it was genuine, for they cheated
+infamously in the matter of this concretion, which ought to come out
+of an animal's stomach, but the real history of which resembles what
+is sometimes told of modern sausages.
+
+There is a famous law-case of James the First's time, in which a
+goldsmith sold a hundred pounds' worth of what he called bezoar,
+which was proved to be false, and the purchaser got a verdict against
+him.  Governor Endicott also sends Winthrop a unicorn's horn, which
+was the property of a certain Mrs. Beggarly, who, in spite of her
+name, seems to have been rich in medical knowledge and possessions.
+The famous Thomas Bartholinus wrote a treatise on the virtues of this
+fabulous-sounding remedy, which was published in 1641, and
+republished in 1678.
+
+The "antimonial cup," a drinking vessel made of that metal, which,
+like our quassia-wood cups, might be filled and emptied in saecula
+saeculorum without exhausting its virtues, is mentioned by Matthew
+Cradock, in a letter to the elder Winthrop, but in a doubtful way, as
+it was thought, he says, to have shortened the days of Sir Nathaniel
+Riche; and Winthrop himself, as I think, refers to its use, calling
+it simply "the cup."   An antimonial cup is included in the inventory
+of Samuel Seabury, who died 1680, and is valued at five shillings.�
+There is a treatise entitled "The Universall Remedy, or the Vertues
+of the Antimoniall Cup, By John Evans, Minister and Preacher of God's
+Word, London, 1634," in our own Society's library.
+
+One other special remedy deserves notice, because of native growth.
+I do not know when Culver's root, Leptandra Virginica of our National
+Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
+John Winthrop of New London, speaks of it as famous for the cure of
+consumptions, and wishes to get some of it, through his mediation,
+for Katharine, his eldest daughter.  He gets it, and gives it to the
+"poor damsel," who is languishing, as he says, and who dies the next
+month,--all the sooner, I have little doubt, for this uncertain and
+violent drug, with which the meddlesome pedant tormented her in that
+spirit of well-meant but restless quackery, which could touch nothing
+without making mischief, not even a quotation, and yet proved at
+length the means of bringing a great blessing to our community, as we
+shall see by and by; so does Providence use our very vanities and
+infirmities for its wise purposes.
+
+Externally, I find the practitioners on whom I have chiefly relied
+used the plasters of Paracelsus, of melilot, diachylon, and probably
+diaphoenicon, all well known to the old pharmacopoeias, and some of
+them to the modern ones,--to say nothing of "my yellow salve," of
+Governor John, the second, for the composition of which we must apply
+to his respected descendant.
+
+The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
+and Wecherus, of all whom notices may be found in the pages of Haller
+and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
+Practice of Physic and Anatomy, the last as belonging to Samuel
+Seabury, chirurgeon, before mentioned.  Nicholas Culpeper was a
+shrewd charlatan, and as impudent a varlet as ever prescribed for a
+colic; but knew very well what he was about, and badgers the College
+with great vigor.  A copy of Spigelius's famous Anatomy, in the
+Boston Athenaeum, has the names of Increase and Samuel Mather written
+in it, and was doubtless early overhauled by the youthful Cotton, who
+refers to the great anatomist's singular death, among his curious
+stories in the "Magnalia," and quotes him among nearly a hundred
+authors whom he 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 valued
+at ten pounds; and a surgeon's chest and drugs valued at sixteen
+pounds.'
+
+
+Here we leave the first century and all attempts at any further
+detailed accounts of medicine and its practitioners.  It is necessary
+to show in a brief glance what had been going on in Europe during the
+latter part of that century, the first quarter of which had been made
+illustrious in the history of medical science by the discovery of the
+circulation.
+
+Charles Barbeyrac, a Protestant in his religion, was a 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,
+until it becomes hard to tell the family of one from that of the
+other.  Barbeyrac threw overboard the old complex medical farragos of
+the pharmacopoeias, as his church had disburdened itself of the
+popish ceremonies.
+
+Among the students who followed his instructions were two Englishmen:
+one of them, John Locke, afterwards author of an "Essay on the Human
+Understanding," three years younger than his teacher; the other,
+Thomas Sydenham, five years older.  Both returned to England.  Locke,
+whose medical knowledge is borne witness to by Sydenham, had the good
+fortune to form a correct opinion on a disease from which the Earl of
+Shaftesbury was suffering, which led to an operation that saved his
+life.  Less felicitous was his experience with a certain ancilla
+culinaria virgo,--which I am afraid would in those days have been
+translated kitchen-wench, instead of lady of the culinary
+department,--who turned him off after she had got tired of him, and
+called 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, and took to other
+studies.
+
+The name of Thomas Sydenham is as distinguished in the history of
+medicine as that of John Locke in philosophy.  As Barbeyrac was found
+in opposition to the established religion, as Locke took the rational
+side against orthodox Bishop Stillingfleet, so Sydenham went with
+Parliament against Charles, and was never admitted a Fellow by the
+College of Physicians, which, after he was dead, placed his bust in
+their hall by the side of that of Harvey.
+
+What Sydenham did for medicine was briefly this he studied the course
+of diseases carefully, and especially as affected by the particular
+season; to patients with fever he gave air and cooling drinks,
+instead of smothering and heating them, with the idea of sweating out
+their disease; he ordered horseback exercise to consumptives; he,
+like his teacher, used few and comparatively simple remedies; he did
+not give any drug at all, if he thought none was needed, but let well
+enough alone.  He was a sensible man, in short, who applied his
+common sense to diseases which he had studied with the best light of
+science that he could obtain.
+
+The influence of the reform he introduced must have been more or less
+felt in this country, but not much before the beginning of the
+eighteenth century, as his great work was not published until 1675,
+and then in Latin.  I very strongly suspect that there was not so
+much to reform in the simple practice of the physicians of the new
+community, as there was in that of the learned big-wigs of the
+"College," who valued their remedies too much in proportion to their
+complexity, and the extravagant and fantastic ingredients which went
+to their making.
+
+During the memorable century which bred and bore the Revolution, the
+medical profession gave great names to our history.  But John Brooks
+belonged to the State, and Joseph Warren belongs to the country and
+mankind, and to speak of them would lead me beyond my limited--
+subject.  There would be little pleasure in dwelling on the name of
+Benjamin Church; and as for the medical politicians, like Elisha
+Cooke in the early part of the century, or Charles Jarvis, the bald
+eagle of Boston, in its later years, whether their practice was
+heroic or not, their patients were, for he is a bold man who trusts
+one that is making speeches and coaxing voters, to meddle with the
+internal politics of his corporeal republic.
+
+One great event stands out in the medical history of this eighteenth
+century; namely, the introduction of the practice of inoculation for
+small-pox.  Six epidemics of this complaint had visited Boston in the
+course of a hundred years."  Prayers had been asked in the churches
+for more than a hundred sick in a single day, and this many times.
+About a thousand persons had died in a twelvemonth, we are told, and,
+as we may infer, chiefly from this cause.
+
+In 1721, this disease, after a respite of nineteen years, again
+appeared as an epidemic.  In that year it was that Cotton Mather,
+browsing, as was his wont, on all the printed fodder that came within
+reach of his ever-grinding mandibles, came upon an account of
+inoculation as practised in Turkey, contained in the "Philosophical
+Transactions."  He spoke of it to several physicians, who paid little
+heed 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 of Bethesda," and satiated with his speculations on the
+Nishmath Chajim.
+
+The Reverend Mather,--I use a mode of expression he often employed
+when speaking of his honored brethren,--the Reverend Mather was right
+this time, and the irreverent doctors who laughed at him were wrong.
+One only of their number disputes his claim to giving the first
+impulse to the practice, in Boston.  This is what that person says:
+"The Small-Pox spread in Boston, New England, A.1721, and the
+Reverend Dr. Cotton Mather, having had the use of these
+Communications from Dr. William Douglass " (that is, the writer of
+these words); surreptitiously, without the knowledge of his Informer,
+that he might have the honour of a New fangled notion, sets an
+Undaunted Operator to work, and in this Country about 290 were
+inoculated."
+
+All this has not deprived Cotton Mather of the credit of suggesting,
+and a bold and intelligent physician of the honor of carrying out,
+the new practice.  On the twenty-seventh day of June, 1721, Zabdiel
+Boylston of Boston inoculated his only son for smallpox,--the first
+person ever submitted to the operation in the New World.  The story
+of the fierce resistance to the introduction of the practice; of how
+Boylston was mobbed, and Mather had a hand-grenade thrown in at his
+window; of how William Douglass, the Scotchman, "always positive, and
+sometimes accurate," as was neatly said of him, at once depreciated
+the practice and tried to get the credit of suggesting it, and how
+Lawrence Dalhonde, the Frenchman, testified to its destructive
+consequences; of how Edmund Massey, lecturer at St.  Albans, preached
+against sinfully endeavoring to 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 his
+sermon, afterwards reprinted in Boston, many of our New England
+clergy stood up boldly in defence of the practice,--all this has been
+told so well and so often that I spare you its details.  Set this
+good hint of Cotton Mather against that letter of his to John
+Richards, recommending the search after witch-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, the Lord have mercy on her
+soul!
+
+Thus did America receive this great discovery, destined to save
+thousands of lives, via Boston, from the hands of one of our own
+Massachusetts physicians.
+
+The year 1735 was rendered sadly memorable by the epidemic of the
+terrible disease known as "throat distemper," and regarded by many as
+the same as our "diphtheria."  Dr. Holyoke thinks the more general
+use of mercurials in inflammatory complaints dates from the time of
+their employment in this disease, in which they were thought to have
+proved specially useful.
+
+At some time in the course of this century medical practice had
+settled down on four remedies as its chief reliance.  I must repeat
+an incident which I have related in another of these Essays.  When
+Dr. Holyoke, nearly seventy years ago, received young Mr. James
+Jackson as his student, he showed him the formidable array of
+bottles, jars, and drawers around his office, and then named the four
+remedies referred to as being of more importance than all the rest
+put together.  These were Mercury, Antimony, Opium, and Peruvian
+Bark."  I doubt if either of them remembered that, nearly seventy
+years before, in 1730, Dr. William Douglass, the disputatious
+Scotchman, mentioned those same four remedies, in the dedication of
+his quarrelsome essay on inoculation, as the most important ones in
+the hands of the physicians of his time.
+
+In the "Proceedings" of this Society for the year 1863 is a very
+pleasant paper by the late Dr. Ephraim Eliot, giving an account of
+the leading physicians of Boston during the last quarter of the last
+century.  The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch,
+Danforth, John Warren, Jeffries, are all famous in local history, and
+are commemorated in our medical biographies.  One of them, at least,
+appears to have been more widely known, not only as one of the first
+aerial voyagers, but as an explorer in the almost equally hazardous
+realm of medical theory.  Dr. John Jeffries, the first of that name,
+is considered by Broussais as a leader of medical opinion in America,
+and so referred to in his famous "Examen des Doctrines Medicales."
+
+Two great movements took place in this eighteenth century, the effect
+of which has been chiefly felt in our own time; namely, the
+establishment of the Massachusetts Medical Society, and the founding
+of the Medical School of Harvard University.
+
+
+The third century of our medical history began with the introduction
+of the second great medical discovery of modern times,--of all time
+up to that date, I may say,--once more via Boston, if we count the
+University village as its suburb, and once more by one of our
+Massachusetts physicians.  In the month of July, 1800, Dr. Benjamin
+Waterhouse of Cambridge submitted four of his own children to the new
+process of vaccination,--the first persons vaccinated, as Dr. Zabdiel
+Boylston's son had been the first person inoculated in the New World.
+
+A little before the first half of this century was completed, in the
+autumn of 1846, the great discovery went forth from the Massachusetts
+General Hospital, which repaid the debt of America to the science of
+the Old World, and gave immortality to the place of its origin in the
+memory and the heart of mankind.  The production of temporary
+insensibility at will--tuto, cito, jucunde, safely, quickly,
+pleasantly--is one of those triumphs over the infirmities of our
+mortal condition which change the aspect of life ever afterwards.
+Rhetoric can add nothing to its glory; gratitude, and the pride
+permitted to human weakness, that our Bethlehem should have been
+chosen as the birthplace of this new embodiment of the divine mercy,
+are all we can yet find room for.
+
+The present century has seen the establishment of all those great
+charitable institutions for the cure of diseases of the body and of
+the mind, which our State and our city have a right to consider as
+among the chief ornaments of their civilization.
+
+The last century had very little to show, in our State, in the way of
+medical literature.  The worthies who took care of our grandfathers
+and great-grandfathers, like the Revolutionary heroes, fought (with
+disease) and bled (their patients) and died (in spite of their own
+remedies); but their names, once familiar, are heard only at rare
+intervals.  Honored in their day, not unremembered by a few solitary
+students of the past, their memories are going sweetly to sleep in
+the arms of the patient old dry-nurse, whose "blackdrop" is the
+never-failing anodyne of the restless generations of men.  Except the
+lively controversy on inoculation, and floating papers in journals,
+we have not much of value for that long period, in the shape of
+medical records.
+
+But while the trouble with the last century is to find authors to
+mention, the trouble of this would be to name all that we find.  Of
+these, a very few claim unquestioned preeminence.
+
+Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical
+School of our University, did a great work for the advancement of
+medicine and surgery in New England, by his labors as teacher and
+author, greater, it is claimed by some, than was ever done by any
+other man.  The two Warrens, of our time, each left a large and
+permanent record of a most extended surgical practice.  James Jackson
+not only educated a whole generation by his lessons of wisdom, but
+bequeathed some of the most valuable results of his experience to
+those who came after him, in a series of letters singularly pleasant
+and kindly as well as instructive.  John Ware, keen and cautious,
+earnest and deliberate, wrote the two remarkable essays which have
+identified his 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 by referring to the
+many important contributions to medical science by Dr. Jacob Bigelow,
+and especially to his discourse on "Self-limited Diseases," an
+address which can be read in a single hour, but the influence of
+which will be felt for a century.
+
+Nor would the profession forgive me if I forgot to mention the
+admirable museum of pathological anatomy, created almost entirely by
+the hands of Dr. John Barnard Swett Jackson, and illustrated by his
+own printed descriptive catalogue, justly spoken of by a
+distinguished professor in the University of Pennsylvania as the most
+important contribution which had ever been made in 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 Massachusetts
+or placed at the head of her institutions for the treatment of the
+insane.
+
+We have a right to claim also one who is known all over the civilized
+world as a philanthropist, to us as a townsman and a graduate of our
+own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor
+of a great multitude who were born to a world of inward or of outward
+darkness.
+
+I cannot pass over in silence the part taken by our own physicians in
+those sanitary movements which are assuming every year greater
+importance.  Two diseases especially 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, both of which have been faithfully studied
+and reported on by physicians of our own State and city.  The
+cultivation of medical and surgical specialties, which is fast
+becoming prevalent, is beginning to show its effects in the
+literature of the profession, which is every year growing richer in
+original observations and investigations.
+
+To these benefactors who have labored for us in their peaceful
+vocation, we must add the noble army of surgeons, who went with the
+soldiers who fought the battles of their country, sharing many of
+their dangers, not rarely falling victims to fatigue, disease, or the
+deadly volleys to which they often exposed themselves in the
+discharge of their duties.
+
+The pleasant biographies of the venerable Dr. Thacher, and the worthy
+and kind-hearted gleaner, Dr. Stephen W.  Williams, who came after
+him, are filled with the names of men who served their generation
+well, and rest from their labors, followed by the blessing of those
+for whom they endured the toils and fatigues inseparable from their
+calling.  The hardworking, intelligent country physician more
+especially deserves the gratitude of his own generation, for he
+rarely leaves any permanent record in the literature of his
+profession.  Books are hard to obtain; hospitals, which are always
+centres of intelligence, are remote; thoroughly educated and superior
+men are separated by wide intervals; and long rides, though favorable
+to reflection, take up much of the time which might otherwise 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 a
+great and deserved reputation, become the oracles of large districts,
+and yet leave nothing, or next to nothing, by which their names shall
+be preserved from blank oblivion.
+
+One or two other facts deserve mention, as showing the readiness of
+our medical community to receive and adopt any important idea or
+discovery.  The new science of Histology, as it is now called, was
+first brought fully before the profession of this country by the
+translation of Bichat's great work, "Anatomie Generale," by the late
+Dr. George Hayward.
+
+The first work printed in this country on Auscultation,--that
+wonderful art of discovering disease, which, as it were, puts a
+window in the breast, through which the vital organs can be seen, to
+all intents and purposes, was the manual published anonymously by
+"A Member of the Massachusetts Medical Society."
+
+
+We are now in some slight measure prepared to weigh the record of the
+medical profession in Massachusetts, and pass our judgment upon it.
+But in-order to do justice to the first generation of practitioners,
+we must compare what we know of their treatment of disease with the
+state of the art in England, and the superstitions which they saw all
+around them in other departments of knowledge or belief.
+
+English medical literature must have been at a pretty low ebb when
+Sydenham recommended Don Quixote to Sir Richard Blackmore for
+professional reading.  The College Pharmacopoeia was loaded with the
+most absurd compound mixtures, one of the most complex of which (the
+same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel
+in Boston," tried to simplify, was not dropped until the year 1801.
+Sir Kenelm Digby was playing his fantastic tricks with the
+Sympathetic powder, and teaching Governor Winthrop, the second, how
+to cure fever and ague, which some may like to know.  "Pare the
+patient's nails; put the parings in a little bag, and hang the bag
+round the 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 eloquently on the
+efficacy of the royal touch in scrofula.  The founder of the
+Ashmolean Museum at Oxford, consorting with alchemists and
+astrologers, was treasuring the manuscripts of the late pious Dr.
+Richard Napier, in which certain letters (Rx Ris) were understood to
+mean Responsum Raphaelis,--the answer of the angel Raphael to the
+good man's medical questions.  The illustrious Robert Boyle was
+making his collection of choice and safe remedies, including the sole
+of an old shoe,  the thigh bone of a hanged man, and things far 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 of standing in London; yet toad-powder was his
+sovereign remedy.
+
+See what was the state of belief in other matters among the most
+intelligent persons of the colonies, magistrates and clergymen.
+Jonathan Brewster, son of the church-elder, writes the wildest
+letters to John Winthrop about alchemy,--mad for making gold as the
+Lynn rock-borers are for finding it."
+
+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 with an upper chamber of saints, and a tremendous
+opposition in the lower house; the leader of which may have been
+equalled, but cannot have been surpassed by any of our earth-born
+politicians.  The demons were prowling round the houses every night,
+as the foxes were sneaking about the hen-roosts.  The men of
+Gloucester fired whole flasks of gunpowder at devils disguised as
+Indians and Frenchmen.
+
+How deeply the notion of miraculous interference with the course of
+nature was rooted, is shown by the tenacity of the superstition about
+earthquakes.  We can hardly believe that our Professor Winthrop,
+father of the old judge and the "squire," whom many of us Cambridge
+people remember so well, had to defend himself against the learned
+and excellent Dr. Prince, of the Old South Church, for discussing
+their phenomena as if they belonged to the province of natural
+science:
+
+Not for the sake of degrading the aspect of the noble men who founded
+our State, do I refer to their idle beliefs and painful delusions,
+but to show against what influences the common sense of the medical
+profession had to assert itself.
+
+Think, then, of the blazing stars, that shook their horrid hair in
+the sky; the phantom ship, that brought its message direct from the
+other world; the story of the mouse and the snake at Watertown;  of
+the mice and the prayer-book;  of the snake in church; of the calf
+with two heads; and of the cabbage in the perfect form of a cutlash,
+--all which innocent occurrences were accepted or feared as alarming
+portents.
+
+We can smile at these: but we cannot smile at the account of unhappy
+Mary Dyer's malformed offspring;  or of Mrs.  Hutchinson's domestic
+misfortune of 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 fifteen alarming pages about an
+unfortunate young woman suffering with hysteria.  Or go a little
+deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia,
+first admonished, then whipped; at last, taking her own little
+daughter's life; put on trial, and standing mute, threatened to be
+pressed to death, confessing, sentenced, praying to be beheaded; and
+none the less pitilessly swung from the fatal ladder.
+
+The cooper's crazy wife--crazy in the belief that she has committed
+the unpardonable sin--tries to drown her child, to save it from
+misery; and the poor lunatic, who would be tenderly cared for to-day
+in a quiet asylum, is judged to be acting under the instigation of
+Satan himself."  Yet, after all, what can we say, who put Bunyan's
+"Pilgrim's Progress," full of nightmare dreams of horror, into all
+our children's hands; a story in which the awful image of the man in
+the cage might well turn the nursery where it is read into a
+madhouse?
+
+The miserable delusion of witchcraft illustrates, in a still more
+impressive way, the false ideas which governed the supposed relation
+of men with the spiritual world.  I have no doubt many physicians
+shared in these superstitions.  Mr. Upham says they--that is, some of
+them--were in the habit of attributing their want of success to the
+fact, that an "evil hand" was on their patient.  The temptation was
+strong, no doubt, when magistrates and ministers and all that
+followed their lead were contented with such an explanation.  But how
+was it in Salem, according to Mr. Upham's own statement?  Dr. John
+Swinnerton was, he says, for many years the principal physician of
+Salem.  And he says, also, "The Swinnerton family were all along
+opposed to Mr. Parris, and kept remarkably clear from the witchcraft
+delusion."   Dr. John Swinnerton--the same, by the way, whose memory
+is illuminated by a ray from the genius of Hawthorne--died the very
+year before the great witchcraft explosion took place.  But who can
+doubt that it was from him that the family had learned to despise and
+to resist the base superstition; or that Bridget Bishop, whose house
+he rented, as Mr. Upham tells me, the first person hanged in the time
+of the delusion, would have found an efficient protector in her
+tenant, had he been living, to head the opposition of his family to
+the misguided clergymen and magistrates?
+
+I cannot doubt that our early physicians brought with them many Old-
+World medical superstitions, and I have no question that they were
+more or less involved in the prevailing errors of the community in
+which they lived.  But, on the whole, their record is a clean one, so
+far as we can get at it; and where it is questionable we must
+remember that there must have been many little-educated persons among
+them; and that all must have felt, to some extent, the influence of
+those sincere and devoted but unsafe men, the physic-practising
+clergymen, who often used spiritual means as a substitute for
+temporal ones, who looked upon a hysteric patient as possessed by the
+devil, and treated a fractured skull by prayers and plasters,
+following the advice of a ruling elder in opposition to the unanimous
+opinion of seven surgeons."
+
+To what results the union of the two professions was liable to lead,
+may be seen by the example of a learned and famous person, who has
+left on record the product of his labors in the double capacity of
+clergyman and physician.
+
+I have had the privilege of examining a manuscript of Cotton Mather's
+relating to medicine, by the kindness of the librarian of the
+American Antiquarian Society, to which society it belongs.  A brief
+notice 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 Approved REMEDIES for
+the Maladies."  There are sixty-six "Capsula's," as he calls them, or
+chapters, in his table of contents; of which, five--from the
+fifteenth to the nineteenth, inclusive--are missing.  This is a most
+unfortunate loss, as the eighteenth capsula treated of agues, and we
+could have learned from it something of their degree of frequency in
+this part of New England.  There is no date to the manuscript; which,
+however, refers to a case observed Nov. 14, 1724.
+
+The divine takes precedence of the physician in this extraordinary
+production.  He begins by preaching a sermon at his unfortunate
+patient.  Having thrown him into a cold sweat by his spiritual
+sudorific, he attacks him with his material remedies, which are often
+quite as unpalatable.  The simple and cleanly practice of Sydenham,
+with whose works he was acquainted, seems to have been thrown away
+upon him.  Everything he could find mentioned in the seventy or
+eighty authors he cites, all that the old women of both sexes had
+ever told him of, gets into his text, or squeezes itself into his
+margin.
+
+Evolving disease out of sin, he hates it, one would say, as he hates
+its cause, and would drive it out of the body with all noisome
+appliances.  "Sickness is in Fact Flagellum Dei pro peccatis mundi."
+So saying, he encourages the young mother whose babe is wasting away
+upon her breast with these reflections:
+
+"Think; oh the grievous Effects of Sin!  This wretched Infant has not
+arrived unto years of sense enough, to sin after the similitude of
+the transgression committed by Adam.  Nevertheless the Transgression
+of 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 infected Adam when he fell into his Transgression, by
+hearkening to the Tempter, has corrupted all mankind, and is a seed
+unto such diseases as this Infant is now laboring under.  Lord, what
+are we, and what are our children, but a Generation of Vipers?"
+
+Many of his remedies are at least harmless, but his pedantry and
+utter want of judgment betray themselves everywhere.  He piles his
+prescriptions one upon another, without the least discrimination.  He
+is run away with by all sorts of fancies and superstitions.  He
+prescribes euphrasia, eye-bright, for disease of the eyes; appealing
+confidently to the strange old doctrine of signatures, which inferred
+its use from the resemblance of its flower to the organ of vision.
+For the scattering of wens,  the efficacy of a Dead Hand has been out
+of measure wonderful.  But when he once comes to the odious class of
+remedies, he revels in them like a scarabeus.  This allusion will
+bring us quite near enough to the inconceivable abominations with
+which he proposed to outrage the sinful stomachs of the unhappy
+confederates and accomplices of Adam.
+
+It is well that the treatise was never printed, yet there are
+passages in it worth preserving.  He speaks of some remedies which
+have since become more universally known:
+
+"Among the plants of our soyl, Sir William Temple singles out Five
+[Six] as being of the greatest virtue and most friendly to health:
+and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and
+Elder."
+
+"But these Five [Six] plants may admitt of some competitors.  The
+QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"
+
+Of Ipecacuanha, he says,--
+"This is now in its reign; the most fashionable vomit."
+
+"I am not sorry that antimonial emetics begin to be disused."
+
+He quotes "Mr. Lock" as recommending red poppy-water and abstinence
+from flesh as often useful in children's diseases.
+
+One of his "Capsula's" is devoted to the animalcular origin of
+diseases, at the end of which he says, speaking of remedies for this
+supposed source of our distempers:
+
+"Mercury we know thee: But we are afraid thou wilt kill us too, if we
+employ thee to kill them that kill us.
+
+"And yett, for the cleansing of the small Blood Vessels, and making
+way for the free circulation of the Blood and Lymph--there is nothing
+like Mercurial Deobstruents."
+
+>From this we learn that mercury was already in common use, and the
+subject of the same popular prejudice as 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 proper than such thoughts as these?"...
+
+If there is pathos in this, there is bathos in his apostrophe to the
+millipede, beginning "Poor sowbug!" and eulogizing the healing
+virtues of that odious little beast; of which he tells us to take
+"half a pound, putt 'em alive into a quart or two of wine," with
+saffron and other drugs, and take two ounces twice a day.
+
+The "Capsula " entitled "Nishmath Chajim " was printed in 1722, at
+New London, and is in the possession of our own Society.  He means,
+by these words, something like the Archxus of Van Helmont, of which
+he discourses in a style wonderfully resembling that of Mr. Jenkinson
+in the "Vicar of Wakefield."  "Many of the Ancients thought there was
+much of a Real History in the Parable, and their Opinion was that
+there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a
+Resemblance) of men as to their Shapes after Death."  And so on, with
+Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA,"
+in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara
+kai ateleutaion to pan."
+
+One other passage deserves notice, as it relates to the single
+medical suggestion which does honor to Cotton Mather's memory.  It
+does not appear that he availed himself of the information which he
+says, he obtained from his slave, for such I suppose he was.
+
+In his appendix to " Variolae Triumphatae," he says,--
+
+"There has been a wonderful practice lately used in several parts of
+the world, which indeed is not yet become common in our nation.
+
+"I was first informed of it by a Garamantee servant of my own, long
+before I knew that any Europeans or Asiaticks had the least
+acquaintance with it, and some years before I was enriched with the
+communications of the learned Foreigners, whose accounts I found
+agreeing with what I received of my servant, when he 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 Number of these Africans, who
+all agree in one story; That in their countrey grandy-many dy of the
+small-pox: But now they learn this way: people take juice of smallpox
+and cutty-skin and put in a Drop; then by'nd by a little sicky,
+sicky: then very few little things like small-pox; and nobody dy of
+it; and nobody have small-pox any more.  Thus, in Africa, where the
+poor creatures dy of the smallpox like Rotten Sheep, a merciful God
+has taught them an Infallible preservative.  'T is a common practice,
+and is attended with a constant success."
+
+What has come down to us of the first century of medical practice, in
+the hands of Winthrop and Oliver, is comparatively simple and
+reasonable.  I suspect that the conditions of rude, stern life, in
+which the colonists found themselves in the wilderness, took the
+nonsense out of them, as the exigencies of a campaign did out of our
+physicians and surgeons in the late war.  Good food and enough of it,
+pure air and water, cleanliness, good attendance, an anaesthetic, an
+opiate, a stimulant, quinine, and two or three common drugs, proved
+to be the marrow of medical treatment; and the fopperies of the
+pharmacopoeia went the way of embroidered shirts and white kid gloves
+and malacca joints, in their time of need.  "Good wine is the best
+cordiall for her," said Governor John Winthrop, Junior, to Samuel
+Symonds, speaking of that gentleman's wife,--just as Sydenham,
+instead of physic, once ordered a roast chicken and a pint of canary
+for his patient in male hysterics.
+
+But the profession of medicine never could reach its full development
+until it became entirely separated from that of divinity.  The
+spiritual guide, the consoler in afliction, the confessor who is
+admitted into the secrets of our souls, has his own noble sphere of
+duties; but the healer of men must confine himself solely to the
+revelations of God in nature, as he sees their miracles with his own
+eyes.  No doctrine of prayer or special providence is to be his
+excuse for not looking straight at secondary causes, and acting,
+exactly so far as experience justifies him, as if he were himself the
+divine agent which antiquity fabled him to be.  While pious men were
+praying--humbly, sincerely, rightly, according to their knowledge--
+over the endless succession of little children dying of spasms in the
+great Dublin Hospital, a sagacious physician knocked some holes in
+the walls of the ward, let God's blessed air in on the little
+creatures, and so had already saved in that single hospital, as it
+was soberly calculated thirty years ago, more than sixteen thousand
+lives of these infant heirs of immortality. [Collins's Midwifery, p.
+312.  Published by order of the Massachusetts Medical Society.
+Boston, 1841.]
+
+Let it be, if you will, that the wise inspiration of the physician
+was granted in virtue of the clergyman's supplications.  Still, the
+habit of dealing with things seen generates another kind of
+knowledge, and another way of thought, from that of dealing with
+things unseen; which knowledge and way of thought are special means
+granted by Providence, and to be thankfully accepted.
+
+The mediaeval ecclesiastics expressed a great truth in that saying,
+so often quoted, as carrying a reproach with it: "Ubi tres medici,
+duo athei,"--"Where there are three physicians, there are two
+atheists."
+
+It was true then, it is true to-day, that the physician very
+commonly, if not very generally, denies and repudiates the deity of
+ecclesiastical commerce.  The Being whom Ambroise Pare meant when he
+spoke those memorable words, which you may read over the professor's
+chair in the French School of Medicine, "Te le pensay, et Dieu le
+guarit," "I dressed his wound, and God healed it,"--is a different
+being from the God that scholastic theologians have projected from
+their consciousness, or shaped even from the sacred pages which have
+proved so plastic in their hands.  He is a God who never leaves
+himself without witness, who repenteth him of the evil, who never
+allows a disease or an injury, compatible with the enjoyment of life,
+to take its course without establishing an effort, limited by certain
+fixed conditions, it is true, but an effort, always, to restore the
+broken body or the shattered mind.  In the perpetual presence of this
+great Healing Agent, who stays the bleeding of wounds, who knits the
+fractured bone, who expels the splinter by a gentle natural process,
+who walls in the inflammation that might involve the vital organs,
+who draws a cordon to separate the dead part from the living, who
+sends his three natural anaesthetics to the over-tasked frame in due
+order, according to its need,--sleep, fainting, death; in this
+perpetual presence, it is doubtless hard for the physician to realize
+the theological fact 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 has abrogated the pardoning power,
+and mercy forgets its errand; where the omnipotent is unfelt save in
+malignant agencies, and the omnipresent is unseen and unrepresented;
+hard to accept the God of Dante's "Inferno," and of Bunyan's caged
+lunatic.  If this is atheism, 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 injurious effect of the
+materializing influences to which the physician is subjected.
+A spiritual guild is absolutely necessary to keep him, to keep us
+all, from becoming the "fingering slaves" that Wordsworth treats with
+such shrivelling scorn.  But it is well that the two callings have
+been separated, and it is fitting that they remain apart.  In
+settling the affairs of the late concern, I am afraid our good
+friends remain a little in our debt.  We lent them our physician
+Michael Servetus in fair condition, and they returned him so damaged
+by fire as to be quite useless for our purposes.  Their Reverend
+Samuel Willard wrote us a not over-wise report of a case of hysteria;
+and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary
+of the Bible) the first discerning criticism on the authorship of the
+Pentateuch.  Our John Locke enlightened them with his letters
+concerning toleration; and their Cotton Mather obscured our twilight
+with his "Nishmath Chajim."
+
+Yet we must remember that the name of Basil Valentine, the monk, is
+associated with whatever good and harm we can ascribe to antimony;
+and that the most remarkable of our specifics long bore the name of
+"Jesuit's Bark," from an old legend connected with its introduction.
+"Frere Jacques," who taught the lithotomists of Paris, owes his
+ecclesiastical title to courtesy, as he did not belong to a religious
+order.
+
+Medical science, and especially the study of mental disease, is
+destined, I believe, to react to much greater advantage on the
+theology of the future than theology has acted on medicine in the
+past.  The liberal spirit very generally prevailing in both
+professions, and the good understanding between their most
+enlightened members, promise well for the future of both in a
+community which holds every point of human belief, every institution
+in human hands, and every word written in a human dialect, open to
+free discussion today, to-morrow, and to the end of time.  Whether
+the world at large will ever be cured of trusting to specifics as a
+substitute for observing the laws of health, and to mechanical or
+intellectual formula as a substitute for character, may admit of
+question.  Quackery and idolatry are all but immortal.
+
+We can find most of the old beliefs alive amongst us to-day, only
+having changed their dresses and the social spheres in which they
+thrive.  We think the quarrels of Galenists and chemists belong to
+the past, forgetting that Thomsonism has its numerous apostles in our
+community; that it is common to see remedies vaunted as purely
+vegetable, and that the prejudice against "mineral poisons,"
+especially mercury, is as strong in many quarters now as it was at
+the beginning of the seventeenth century.  Names are only air, and
+blow away with a change of wind; 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 for a very moderate compensation.
+Nostradamus and Lilly seem impossible in our time; but we have seen
+the advertisements of an astrologer in our Boston papers year after
+year, which seems to imply that he found believers and patrons.  You
+smiled when I related Sir Kenelm Digby's prescription with the live
+eel in it; but if each of you were to empty his or her pockets, would
+there not roll out, from more than one of them, a horse-chestnut,
+carried about as a cure for rheumatism?  The brazen head of Roger
+Bacon is mute; but is not "Planchette" uttering her responses in a
+hundred houses of this city?  We think of palmistry or chiromancy as
+belonging to the days of Albertus Magnus, or, if existing in our
+time, as given over to the gypsies; but a very distinguished person
+has recently shown me the line of life, and the line of fortune, on
+the palm of his hand, with a seeming confidence in the sanguine
+predictions of his career which had been drawn from them.  What shall
+we say of the plausible and well-dressed charlatans of our own time,
+who trade in false pretences, like Nicholas Knapp of old, but without
+any fear of being fined or whipped; or of the many follies and
+inanities, imposing on the credulous part of the community, each of
+them gaping with eager, open mouth for a gratuitous advertisement by
+the mention of its foolish name in any respectable connection?
+
+I turn from this less pleasing aspect of the common intelligence
+which renders such follies possible, to close the honorable record of
+the medical profession in this, our ancient Commonwealth.
+
+We have seen it in the first century divided among clergymen,
+magistrates, and regular practitioners; yet, on the whole, for the
+time, and under the circumstances, respectable, except where it
+invoked supernatural agencies to account for natural phenomena.
+
+In the second century it simplified its practice, educated many
+intelligent practitioners, and began the work of organizing for
+concerted action, and for medical teaching.
+
+In this, our own century, it has built hospitals, perfected and
+multiplied its associations and educational institutions, enlarged
+and created museums, and challenged a place in the world of science
+by its literature.
+
+In reviewing the whole course of its history we read a long list of
+honored names, and a precious record written in private memories, in
+public charities, in permanent contributions to medical science, in
+generous sacrifices for the country.  We can point to our capital as
+the port of entry for the New World of the great medical discoveries
+of two successive centuries, and we can claim for it the triumph over
+the most dreaded foe that assails the human body,--a triumph which
+the annals of the race can hardly match in three thousand years of
+medical history.
+
+
+
+
+
+
+THE YOUNG PRACTITIONER
+
+[A Valedictory Address delivered to the Graduating Class of the
+Bellevue Hospital College, March 2, 1871.]
+
+
+The occasion which calls us together reminds us not a little of that
+other ceremony which unites a man and woman for life.  The banns have
+already been pronounced which have wedded our young friends to the
+profession of their choice.  It remains only to address 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 ambitious eloquence.
+We must forget ourselves, and think only of them.  To us it is an
+occasion; to them it is an epoch.  The spectators at the wedding look
+curiously at the bride and bridegroom; at the bridal veil, the
+orange-flower garland, the giving and receiving of the ring; they
+listen for the tremulous "I will," and wonder what are the mysterious
+syllables the clergyman whispers in the ear of the married maiden.
+But to the newly-wedded pair what meaning in those words, "for
+better, for worse," "in sickness and in health," "till death us do
+part!"  To the father, to the mother, who know too well how often the
+deadly nightshade is interwoven with the wreath of orange-blossoms,
+how empty the pageant, how momentous the reality!
+
+You will not wonder that I address myself chiefly to those who are
+just leaving academic life for the sterner struggle and the larger
+tasks of matured and instructed manhood.  The hour belongs to them;
+if others find patience to listen, they will kindly remember that,
+after all, they are but as the spectators at the wedding, and that
+the priest is thinking less of them than of their friends who are
+kneeling at the altar.
+
+I speak more directly to you, then, gentlemen of the graduating
+class.  The days of your education, as pupils of trained instructors,
+are over.  Your first harvest is all garnered.  Henceforth you are to
+be sowers as well as reapers, and your field is the world.  How does
+your knowledge stand to-day?  What have you gained as a permanent
+possession?  What must you expect to forget?  What remains for you
+yet to learn?  These are questions which it may interest you to
+consider.
+
+There is another question which must force itself on the thoughts of
+many among you: "How am I to obtain patients and to keep their
+confidence?  "You have chosen a laborious calling, and made many
+sacrifices to fit yourselves for its successful pursuit.  You wish to
+be employed that you may be useful, and that you may receive the
+reward of your industry.  I would take advantage of these most
+receptive moments to give you some hints which may help you to
+realize your hopes and expectations.  Such is the outline of the
+familiar talk I shall offer you.
+
+Your acquaintance with some of the accessory branches is probably
+greater now than it will be in a year from now,--much greater than it
+will by ten years from now.  The progress of knowledge, it may be
+feared, or hoped, will have outrun the text-books in which you
+studied these branches.  Chemistry, for instance, is very apt to
+spoil on one's hands.  "Nous avons change tout cela" might serve as
+the standing motto of many of our manuals.  Science is a great
+traveller, and wears her shoes out pretty 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 large practice all around you would find a
+more potent sudorific than any in the Pharmacopceia.  These masters
+of the art of healing were once as ready with their answers as you
+are now, but they have got rid of a great deal of 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 trains off the fat of a prize-fighter.
+
+Yet, pause a moment before you infer that your teachers must have
+been in fault when they furnished you with mental stores not directly
+convertible to practical purposes, and likely in a few years to lose
+their place in your memory.  All systematic knowledge involves much
+that is not practical, yet it is the only kind of knowledge which
+satisfies the mind, and systematic study proves, in the long-run, the
+easiest way of acquiring 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 condition is not the same as if you had
+never known what you now try in vain to recall.  There is a perpetual
+metempsychosis of thought, and the knowledge of to-day finds a soil
+in the forgotten facts of yesterday.  You cannot see anything in the
+new season of the guano you placed last year about the roots of your
+climbing plants, but it is blushing and breathing fragrance in your
+trellised roses; it has scaled your porch in the bee-haunted honey-
+suckle; it has found its way where the ivy is green; it is gone where
+the woodbine expands its luxuriant foliage.
+
+Your diploma seems very broad to-day with your list of
+accomplishments, but it begins to shrink from this hour like the Peau
+de Chagrin of Balzac's story.  Do not worry about it, for all the
+while there will be making out for you an ampler and fairer
+parchment, signed by old Father Time himself as President of that
+great University in which experience is the one perpetual and all-
+sufficient professor.
+
+Your present plethora of acquirements will soon cure itself.
+Knowledge that is not wanted dies out like the eyes of the fishes of
+the Mammoth Cave.  When you come to handle life and death as your
+daily business, your memory will of itself bid good-by to such
+inmates as the well-known foramina of the sphenoid bone and the
+familiar oxides of methyl-ethylamyl-phenyl-ammonium.  Be thankful
+that you have once known them, and remember that even the learned
+ignorance of a nomenclature is something to have mastered, and may
+furnish pegs to hang facts upon which would otherwise have strewed
+the floor of memory in loose disorder.
+
+But your education has, after all, been very largely practical.  You
+have studied medicine and surgery, not chiefly in books, but at the
+bedside and in the operating amphitheatre.  It is the special
+advantage of large cities that they afford the opportunity of seeing
+a great deal of disease in a short space of time, and of seeing many
+cases of the same kind of disease brought together.  Let us not be
+unjust to the claims of the schools remote from the larger centres of
+population.  Who among us has taught better than Nathan Smith, better
+than Elisha Bartlett? who teaches better than some of our living
+contemporaries who divide their time between city and country
+schools?  I am afraid we do not always do justice to our country
+brethren, whose merits are less conspicuously exhibited than those of
+the great city physicians and surgeons, such especially as have
+charge of large hospitals.  There are modest practitioners living in
+remote rural districts who are gifted by nature with such sagacity
+and wisdom, trained so well in what is most essential to the practice
+of their art, taught so thoroughly by varied experience, forced to
+such manly self-reliance by their comparative isolation, that, from
+converse with them alone, from riding with them on their long rounds
+as they pass from village to village, from talking over cases with
+them, putting up their prescriptions, watching their expedients,
+listening to their cautions, marking the event of their predictions,
+hearing them tell of their mistakes, and now and then glory a little
+in the detection of another's blunder, a young man would find himself
+better fitted for his real work than many who have followed long
+courses of lectures and passed a showy examination.  But the young
+man is exceptionally fortunate who enjoys the intimacy of such a
+teacher.  And it must be confessed that the great hospitals,
+infirmaries, and dispensaries of large cities, where men of well-
+sifted reputations are in constant attendance, are the true centres
+of medical education.  No students, I believe, are more thoroughly
+aware of this than those who have graduated at this institution.
+Here, as in all our larger city schools, the greatest pains are taken
+to teach things as well as names.  You have entered into the
+inheritance of a vast amount of transmitted skill and wisdom, which
+you have taken, warm, as it were, 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 many of those whose
+names we hardly mention without a genuflection.  I had rather be
+cared for in a fever by the best-taught among you than by the
+renowned Fernelius or the illustrious Boerhaave, could they come back
+to us from that better world where there are no physicians needed,
+and, if the old adage can be trusted, not many within call.  I had
+rather have one of you exercise his surgical skill upon me than find
+myself in the hands of a resuscitated Fabricius 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 alderman in an apoplexy, for
+a girl that has fainted, for a woman in hysterics, for a leg that is
+broken, for an arm that is out of joint, for fevers of every color,
+for the sailor's rheumatism, and the tailor's cachexy.  In fact you
+do really know so much at this very hour, that nothing but the
+searching test of time can fully teach you the limitations of your
+knowledge.
+
+Of some of these you will permit me to remind you.  You will never
+have outgrown the possibility of new acquisitions, for Nature is
+endless in her variety.  But even the knowledge which you may be said
+to possess will be a different thing after long habit has made it a
+part of your existence.  The tactus eruditus extends 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 wise in 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 Shipman
+brought home with him from the sea a
+
+     "In many a tempest had his berd be shake."
+
+This is the knowledge we place most confidence in, in the practical
+affairs of life.
+
+Our training has two stages.  The first stage deals with our
+intelligence, which takes the idea of what is to be done with the
+most charming ease and 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 glance from that ball and hit that other
+ball, and to knock that ball with this ball into a certain caecal
+sacculus or diverticulum which our professional friend calls a
+pocket.  Nothing can be clearer; it is as easy as "playing upon this
+pipe," for which Hamlet gives Guildenstern such lucid directions.
+But this intelligent Me, who steps forward as the senior partner in
+our dual personality, turns out to be a terrible bungler.  He misses
+those glancing hits which the hard-featured young professional person
+calls "carroms," and insists on pocketing his own ball instead of the
+other one.
+
+It is the unintelligent Me, stupid as an idiot, that has to try a
+thing a thousand times before he can do it, and then never knows how
+he does it, that at last does it well.  We have to educate ourselves
+through the pretentious claims of intellect, into the humble accuracy
+of instinct, and we end at last by 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 not only in the brain, it is in the
+senses, in the muscles, in the ganglia of the sympathetic nerves,--
+all over the man, as one may say, as instinct seems diffused through
+every part of those lower animals that have no such distinct organ as
+a brain.  See a skilful surgeon handle a broken limb; see a wise old
+physician smile away a case that looks to a novice as if the sexton
+would soon be sent for; mark what a large experience has 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 in medical practice,
+something in the way the man painted the lion, that is, the lion
+under?
+
+The young man knows the rules, but the old man knows-the exceptions.
+The young man knows his patient, but the old man knows also his
+patient's family, dead and alive, up and down for generations.  He
+can tell beforehand what diseases their unborn children will be
+subject to, what they will die of if they live long enough, and
+whether they had better live at all, or remain unrealized
+possibilities, as belonging to a stock not worth being perpetuated.
+The young man feels uneasy if he is not continually doing something
+to stir up his patient's internal arrangements.  The old man takes
+things more quietly, and is much more willing to let well enough
+alone: All these superiorities, if such they are,'you must wait for
+time to bring you.  In the meanwhile (if we will let the lion be
+uppermost for a moment), the young man's senses are quicker than
+those of his older rival.  His education in all the accessory
+branches is more recent, and therefore nearer the existing condition
+of knowledge.  He finds it easier than his seniors to accept the
+improvements which every year is bringing forward.  New ideas build
+their nests in young men's brains.  "Revolutions are not made by men
+in spectacles," as I once heard it remarked, and the first whispers
+of a new truth are not caught by those who begin to feel the need of
+an ear-trumpet.  Granting all these advantages to the young man, he
+ought, nevertheless, to go on improving, on the whole, as a medical
+practitioner, with every year, until he has ripened into a well-
+mellowed maturity.  But, to improve, he must be good for something at
+the start.  If you ship a poor cask of wine to India and back, if you
+keep it a half a century, 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 look to you as its authorized champions in the struggle of life
+against its numerous enemies?
+
+In the first place, the persons who seek the aid of the physician are
+very honest and sincere in their wish to get rid of their complaints,
+and, generally speaking, to live as long as they can.  However
+attractively the future is painted to them, they are attached to the
+planet with which they are already acquainted.  They are addicted to
+the daily use of this empirical and unchemical mixture which we call
+air; and would hold on to it as a tippler does to his alcoholic
+drinks.  There is nothing men will not do, there is nothing they have
+not done, to recover their health and save their lives.  They have
+submitted to be half-drowned in water, and half-choked with gases, to
+be buried up to their chins in earth, to be seared with hot irons
+like galley-slaves, to be crimped with knives, like cod-fish, to have
+needles thrust into their flesh, and bonfires kindled on their skin,
+to swallow all sorts of abominations, and to pay for all this, as if
+to be singed and scalded were a costly privilege, as if blisters were
+a blessing, and leeches were a luxury.  What more can be asked to
+prove their honesty and sincerity?
+
+This same community is very intelligent with respect to a great many
+subjects-commerce, mechanics, manufactures, politics.  But with
+regard to medicine it is hopelessly ignorant and never finds it out.
+I do not know that it is any worse in this country than in Great
+Britain, where Mr. Huxley speaks very freely of "the utter ignorance
+of the simplest laws of their own animal life, which prevails among
+even the most highly educated persons."  And Cullen said before him
+"Neither the acutest genius nor the soundest judgment 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 sometimes
+with reasons, and I have found that any will pass, even with able
+divines and acute lawyers; the same will pass with the husbands as
+with the wives."  If the community could only be made aware of its
+own utter ignorance, and incompetence to form opinions on medical
+subjects, difficult enough to those who give their lives to the study
+of them, the practitioner would have an easier task.  But it will
+form opinions of its own, it cannot help it, and we cannot blame it,
+even though we know how slight and deceptive are their foundations.
+
+This is the way it happens: Every grown-up person has either been ill
+himself or had a friend suffer from illness, from which he has
+recovered.  Every sick person has done something or other by
+somebody's advice, or of his own accord, a little before getting
+better.  There is an irresistible tendency to associate the thing
+done, and the improvement which followed it, as cause and effect.
+This is the great source of fallacy in medical practice.  But the
+physician has some chance of correcting his hasty inference.  He
+thinks his prescription cured a single case of a particular
+complaint; he tries it in twenty similar cases without effect, and
+sets down the first as probably nothing more than a coincidence.  The
+unprofessional experimenter or observer has no large experience to
+correct his hasty generalization.  He wants to believe that the means
+he employed effected his cure.  He feels grateful to the person who
+advised it, he loves to praise the pill or potion which helped him,
+and he has a kind of monumental pride in himself as a living
+testimony to its efficacy.  So it is that you will find the community
+in which you live, be it in town or country, full of brands plucked
+from the burning, as they believe, by some agency which, with your
+better training, you feel reasonably confident had nothing to do with
+it.  Their disease went out of itself, and the stream from the
+medical fire-annihilator had never even touched it.
+
+You cannot and need not expect to disturb the public in 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 ninth
+chapter of St. John's Gospel, and you will find that the logic of a
+restored patient was very simple then, as it is now, and very hard to
+deal with.  My clerical friends will forgive me for poaching on their
+sacred territory, in return for an occasional raid upon the medical
+domain of which they have now and then been accused.
+
+A blind man was said to have been restored to sight by a young person
+whom the learned doctors of the Jewish law considered a sinner, and,
+as such, very unlikely to have been endowed with a divine gift of
+healing.  They visited the patient repeatedly, and evidently teased
+him with their questions about the treatment, and their insinuations
+about the young man, until he lost his temper.  At last he turned
+sharply upon them:  "Whether he be a sinner or no, I know not: one
+thing I know, that, whereas I was blind, now I see."
+
+This is the answer that always has been and always will be given by
+most persons when they find themselves getting well after doing
+anything, no matter what,--recommended by anybody, no matter whom.
+Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in
+panaceas which we should laugh to scorn.  They had seen people get
+well after using them.  Are we any wiser than those great men?  Two
+years ago, in a lecture before the Massachusetts Historical Society,
+I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare
+the patient's nails; put the parings in a little bag, and hang the
+bag round the neck of a live eel, and place him in a tub of water.
+The eel will die, and the patient will recover.
+
+Referring to this prescription in the course of the same lecture, I
+said: "You smiled when I related Sir Kenehn Digby's prescription,
+with the live eel in it; but if each of you were to empty his or her
+pockets, would there not roll out, from more than one of them, a
+horse-chestnut, carried about as a cure for rheumatism?  Nobody saw
+fit to empty his or her pockets, and my question brought no response.
+But two months ago I was in a company of educated persons, college
+graduates every one of them, 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 his breeches-pocket, and laid them on the
+table, telling us how, having suffered from the complaint in
+question, he had, by the advice of a friend, procured these two
+horse-chestnuts on a certain time a year or more ago, and carried
+them about him ever since; from which very 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 to meet wherever you go, and you
+need not think you can answer it.  In the natural course of things
+some thousands of persons must be getting well or better of slight
+attacks of colds, of rheumatic pains, every week, in this city alone.
+Hundreds of them do something or other in the way of remedy, by
+medical or other advice, or of their own motion, and the last thing
+they do gets the credit of the recovery.  Think what a crop of
+remedies this must furnish, if it were all harvested!
+
+Experience has taught, or will teach you, that most of the wonderful
+stories patients and others tell of sudden and signal cures are like
+Owen Glendower's story of the portents that announced his birth.  The
+earth shook at your nativity, did it?  Very likely, and
+
+               "So it would have done,
+     At the same season, if your mother's cat
+     Had kittened, though yourself had ne'er been born."
+
+You must listen more meekly than Hotspur did to the babbling
+Welshman, for ignorance is a solemn and sacred fact, and, like
+infancy, which it resembles, should be respected.  Once in a while
+you will have a patient of sense, born with the gift of observation,
+from whom you may learn something.  When you find yourself in the
+presence of one who is fertile of medical opinions, and affluent in
+stories of marvellous cures,--of a member of Congress whose name
+figures in certificates to the value of patent medicines, of a
+voluble dame who discourses on the miracles she has wrought or seen
+wrought with the little jokers of the sugar-of-milk globule-box, take
+out your watch and count the pulse; also note the time of day, and
+charge 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 dispensation into a double blessing, for this class
+of patients loves dearly to talk, and it does them a deal of good,
+and you feel as if you had earned your money by the dose you have
+taken, quite as honestly as by any dose you may have ordered.
+
+You must take the community just as it is, and make the best of it.
+You wish to obtain its confidence; there is a short rule for doing
+this which you will find useful,--deserve it.  But, to deserve it in
+full measure, you must unite many excellences, natural and acquired.
+
+As the basis of all the rest, you must have all those traits of
+character which fit you to enter into the most intimate and
+confidential relations with the families of which you are the
+privileged friend and counsellor.  Medical Christianity, if I may use
+such a term, is of very early date.  By the oath of Hippocrates, the
+practitioner of ancient times bound himself to enter his patient's
+house with the sole purpose of doing him good, and so to conduct
+himself as to avoid the very appearance of evil.  Let the physician
+of to-day begin by coming up to this standard, and add to it all the
+more recently discovered virtues and graces.
+
+A certain amount of natural ability is requisite to make you a good
+physician, but by no means that disproportionate development of some
+special faculty which goes by the name of genius.  A just balance of
+the mental powers is a great deal more likely to be useful than any
+single talent, even were it the power of observation; in excess.  For
+a mere observer is liable to be too fond of facts for their own sake,
+so that, if he told the real truth, he would confess that he takes
+more pleasure in a post-mortem examination which shows him what was
+the matter with a patient, than in a case which insists on getting
+well and leaving him in the dark as to its nature.  Far more likely
+to interfere with the sound practical balance of the mind is that
+speculative, theoretical tendency which has made so many men noted in
+their day, whose fame has passed away with their dissolving theories.
+Read Dr. Bartlett's comparison of the famous Benjamin Rush with his
+modest fellow-townsman Dr. William Currie, and see the dangers into
+which a passion for grandiose generalizations betrayed a man of many
+admirable qualities.
+
+I warn you against all ambitious aspirations outside of your
+profession.  Medicine is the most difficult of sciences and the most
+laborious of arts.  It will task all your powers of body and mind if
+you are faithful to it.  Do not dabble in the muddy sewer of
+politics, nor linger by the enchanted streams of literature, nor dig
+in far-off fields for the hidden waters of alien sciences.  The great
+practitioners are generally those who concentrate all their powers on
+their business.  If there are here and there brilliant exceptions, it
+is only in virtue of extraordinary gifts, and industry to which very
+few are equal.
+
+To get business a man mast really want it; and do you suppose that
+when you are in the middle of a heated caucus, or half-way through a
+delicate analysis, or in the spasm of an unfinished ode, your eyes
+rolling in the fine frenzy of poetical composition, you want to be
+called to a teething infant, or an ancient person groaning under the
+griefs of a lumbago?  I think I have known more than one young man
+whose doctor's sign proclaimed his readiness to serve mankind in that
+capacity, but who hated the sound of a patient's knock, and as he sat
+with his book or his microscope, felt exactly as the old party
+expressed himself in my 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 of those diplomaed dilettanti
+who like the amusement of quasi medical studies, but have no idea of
+wasting their precious time in putting their knowledge in practice
+for the benefit of their suffering fellow-creatures.
+
+The public is a very incompetent judge of your skill and knowledge,
+but it gives its confidence most readily to those who stand well with
+their professional brethren, whom they call upon when they themselves
+or their families 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 yet have defects which prevent his
+becoming a favorite practitioner, but no popularity can be depended
+upon as permanent which is not sanctioned by the judgment of
+professional experts, and with these you will always stand on your
+substantial merits.
+
+What shall I say of the personal habits you must form if you wish for
+success?  Temperance is first upon the list.  Intemperance in a
+physician partakes of the guilt of homicide, for the muddled brain
+may easily make a fatal blunder in a prescription and the unsteady
+hand transfix an artery in an operation.  Tippling doctors have been
+too common in the history of medicine.  Paracelsus was a sot,
+Radcliffe was much too fond of his glass, and Dr. James Hurlbut of
+Wethersfield, Connecticut, a famous man in his time, used to drink a
+square bottle of rum a day, with a corresponding allowance of opium
+to help steady his nerves.  We commonly speak of a man as being the
+worse for liquor, but I was asking an Irish laborer one day about his
+doctor, who, as he said, was somewhat given to drink.  "I like him
+best when he's a little that way," he said; "then I can spake to
+him."  I pitied the poor patient who could not venture to allude to
+his colic or his pleurisy until his physician was tipsy.
+
+There are personal habits of less gravity than the one I have
+mentioned which it is well to guard against, or, if they are formed,
+to relinquish.  A man who may be called at a moment's warning into
+the fragrant boudoir of suffering loveliness should not unsweeten its
+atmosphere with reminiscences of extinguished meerschaums.  He should
+remember that the sick are sensitive and fastidious, that they love
+the sweet odors and the pure tints of flowers, and if his presence is
+not like the breath of the rose, if his hands are not like the leaf
+of the lily, his visit may be unwelcome, and if he looks behind him
+he may see a window thrown open after he has left the sick-chamber.
+I remember too well the old doctor who sometimes came to help me
+through those inward griefs to which childhood is liable.  "Far off
+his coming "--shall I say "shone," and finish the Miltonic phrase, or
+leave the verb to the happy conjectures of my audience?  Before him
+came a soul-subduing whiff of ipecacuanha, and after him lingered a
+shuddering consciousness of rhubarb.  He had lived so much among his
+medicaments that he had at last become himself a drug, and to have
+him pass through a sick-chamber was a stronger dose than a
+conscientious disciple of Hahnemann would think it safe to
+administer.
+
+Need I remind yon of the importance of punctuality in your
+engagements, and of the worry and distress to patients and their
+friends which the want of it occasions?  One of my old teachers
+always carried two watches, to make quite sure of being exact, and
+not only kept his appointments with the regularity of a chronometer,
+but took great pains to be at his patient's house at the time when he
+had reason to believe he was expected, even if no express appointment
+was made.  It is a good rule; if you call too early, my lady's hair
+may not be so smooth as could be wished, and, if you keep her waiting
+too long, her hair may be smooth, but her temper otherwise.
+
+You will remember, of course, always to get the weather-gage of your
+patient.  I mean, to place him so that the light falls on his face
+and not on yours.  It is a kind of, ocular duel that is about to take
+place between you; you are going to look through his features into
+his pulmonary and hepatic and other internal machinery, and he is
+going to look into yours quite as sharply to see what you think about
+his probabilities for 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, and serene 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 benevolent old hypocrite; she
+cheats the sick and the dying with illusions better than any
+anodynes.  If there are cogent reasons why a patient should be
+undeceived, do it deliberately and advisedly, but do not betray your
+apprehensions through your tell-tale features.
+
+We had a physician in our city whose smile was commonly reckoned as
+being worth five thousand dollars a year to him, in the days, too, of
+moderate incomes.  You cannot put on such a smile as that any more
+than you can get sunshine without sun; there was a tranquil and
+kindly nature under it that irradiated the pleasant face it made one
+happier to meet on his daily rounds.  But you can cultivate the
+disposition, and it will work its way through to the surface, nay,
+more,--you can try to wear a quiet and encouraging look, and it will
+react on your disposition and make you like what you seem to be, or
+at least bring you nearer to its own likeness.
+
+Your patient has no more right to all the truth you know than he has
+to all the medicine in your saddlebags, if you carry that kind of
+cartridge-box for the ammunition that slays disease.  He should get
+only just so much as is good for him.  I have seen a physician
+examining a patient's chest stop all at once, as he brought out a
+particular sound with a tap on the collarbone, in the attitude of a
+pointer who has just come on the scent or sight of a woodcock.  You
+remember the Spartan boy, who, with unmoved countenance, hid the fox
+that was tearing his vitals beneath his mantle.  What he could do in
+his own suffering you must learn to do for others on whose vital
+organs disease has fastened its devouring teeth.  It is a terrible
+thing to take away hope, even earthly hope, from a fellow-creature.
+Be very careful what names you let fall before your patient.  He
+knows what it means when you tell him he has tubercles or Bright's
+disease, and, if he hears the word carcinoma, he will certainly look
+it out in a medical dictionary, if he does not interpret its dread
+significance on the instant.  Tell him he has asthmatic symptoms, or
+a tendency to the gouty diathesis, and he will at once think of all
+the asthmatic and gouty old patriarchs he has ever heard of, and be
+comforted.  You need not be so cautious in speaking of the health of
+rich and remote relatives, if he is in the line of succession.
+
+Some shrewd old doctors have a few phrases always on hand for
+patients that will insist on knowing the pathology of their
+complaints without the slightest capacity of understanding the
+scientific explanation.  I have known the term "spinal irritation "
+serve well on such occasions, but I think nothing on the whole has
+covered so much ground, and meant so little, and given such profound
+satisfaction to all parties, as the magnificent phrase "congestion of
+the portal system."
+
+Once more, let me recommend you, as far as possible, to keep your
+doubts to yourself, and give the patient the benefit of your
+decision.  Firmness, gentle firmness, is absolutely necessary in this
+and certain other relations.  Mr. Rarey with Cruiser, Richard with
+Lady Ann, Pinel with his crazy people, show what steady nerves can do
+with the most intractable of animals, the most irresistible of
+despots, and the most unmanageable of invalids.
+
+If you cannot acquire and keep the confidence of your patient, it is
+time for you to give place to some other practitioner who can.  If
+you are wise and diligent, you can establish relations with the best
+of them which they will find it very hard to break.  But, if they
+wish to employ another person, who, as they think, knows more than
+you do, do not take it as a personal wrong.  A patient believes
+another man 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, it is a great impertinence to think you
+have any property in him.  Your estimate of your own ability is not
+the question, it is what the patient thinks of it.  All your wisdom
+is to him like the lady's virtue 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 found a good physician,
+sticks to him till he dies.  But there are many very good people who
+are not what I call good patients.  I was once requested to call 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-sixth member of the faculty into whose arms,
+professionally speaking, she had successively thrown herself.  Not
+being a believer in such a rapid rotation of scientific crops, I
+gently deposited the burden, commending it to the care of number
+twenty-seven, and, him, whoever he might be, to the care of Heaven.
+
+If there happened to be among my audience any person who wished to
+know on what principles the patient should choose his physician, I
+should give him these few precepts to think over:
+
+Choose a man who is personally agreeable, for a daily visit from an
+intelligent, amiable, pleasant, sympathetic person will cost you no
+more than one from a sloven or a boor, and his presence will do more
+for you than any prescription the other will order.
+
+Let him be a man of recognized good sense in other matters, and the
+chance is that he will be sensible as a practitioner.
+
+Let him be a man who stands well with his professional brethren, whom
+they approve as honest, able, courteous.
+
+Let him be one whose patients are willing to die in his hands, not
+one whom they go to for trifles, and leave 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 regular profession,
+unless you wish to go farther and fare worse, for you may be assured
+that its members recognize no principle which hinders their accepting
+any remedial agent proved to be useful, no matter from what quarter
+it 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 as an anesthetic, they
+will find no difficulty in procuring its recognition.
+
+Some of you will probably be more or less troubled by the pretensions
+of that parody of mediaeval theology which finds its dogma of
+hereditary depravity in the doctrine of psora, its miracle of
+transubstantiation in 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 to accept these curious medical
+superstitions.  The saturation-point of individual minds with
+reference to evidence, and especially medical evidence, differs, and
+must always continue to differ, very widely.  There are those whose
+minds are satisfied with the decillionth dilution of a scientific
+proof.  No wonder they believe in the efficacy of a similar
+attenuation of bryony or pulsatilla.  You have no fulcrum you can
+rest upon to lift an error out of such minds as these, often highly
+endowed with knowledge and talent, sometimes with genius, but
+commonly richer in the imaginative than the observing and reasoning
+faculties.
+
+Let me return once more to the young graduate.  Your relations to
+your professional brethren may be a source of lifelong happiness and
+growth in knowledge and character, or they may make you wretched and
+end by leaving you isolated from those who should be your friends and
+counsellors.  The life of a physician becomes ignoble when he suffers
+himself to feed on petty jealousies and sours his temper in perpetual
+quarrels.  You will be liable to meet an uncomfortable man here and
+there in the profession,--one who is so fond of being in hot water
+that it is a wonder all the albumen in his body is not coagulated.
+There are common barrators among doctors as there are among lawyers,
+--stirrers up of strife under one pretext and another, but in reality
+because they like it.  They are their own worst enemies, and do
+themselves a mischief each time they assail their neighbors.  In my
+student days I remember a good deal of this Donnybrook-Fair style of
+quarrelling, more especially in Paris, where some of the noted
+surgeons were always at loggerheads, and in one of our lively Western
+cities.  Soon after I had set up an office, I had a trifling
+experience which may serve to point a moral in this direction.  I had
+placed a lamp behind the glass in the entry to indicate to the
+passer-by where relief from all curable infirmities was to be sought
+and found.  Its brilliancy attracted the attention of a devious
+youth, who dashed his fist through the glass and upset my modest
+luminary.  All he got by his vivacious assault was that he left
+portions of integument from his knuckles upon the glass, had a lame
+hand, was very easily identified, and had to pay the glazier's bill.
+The moral is that, if the brilliancy of another's reputation excites
+your belligerent instincts, it is not worth your while to strike at
+it, without calculating which of you is likely to suffer most, if you
+do.
+
+You may be assured that when an ill-conditioned neighbor is always
+complaining of a bad taste in his mouth and an evil atmosphere about
+him, there is something wrong about his own secretions.  In such
+cases there is an alterative regimen of remarkable efficacy: it is a
+starvation-diet of letting alone.  The great majority of the
+profession are peacefully inclined.  Their pursuits are eminently
+humanizing, and they look with disgust on the personalities which
+intrude themselves into the placid domain of an art whose province it
+is to heal and not to wound.
+
+The intercourse of teacher and student in a large school is
+necessarily limited, but it should be, and, so far as my experience
+goes, it is, eminently cordial and kindly.  You will leave with
+regret, and hold in tender remembrance, those who have taken you by
+the hand at your entrance on your chosen path, and led you patiently
+and faithfully, until the great gates at its end have swung upon
+their hinges, and the world lies open before you.  That venerable
+oath to which I have before referred bound the student to regard his
+instructor in the light of a parent, to treat his children like
+brothers, to succor him in his day of need.  I trust the spirit of
+the oath of Hippocrates is not dead in the hearts of the students of
+to-day.  They will remember with gratitude every earnest effort,
+every encouraging word, which has helped them in their difficult and
+laborious career of study.  The names they read on their diplomas
+will recall faces that are like family-portraits in their memory, and
+the echo of voices they have listened to so long will linger in their
+memories far into the still evening of their lives.
+
+One voice will be heard no more which has been familiar to many among
+you.  It is not for me, a stranger to these scenes, to speak his
+eulogy.  I have no right to sadden this hour by dwelling on the deep
+regrets of friendship, or to bid the bitter tears of sorrow flow
+afresh.  Yet I cannot help remembering what a void the death of such
+a practitioner as your late instructor must leave in the wide circle
+of those who leaned upon his counsel and assistance in their hour of
+need, in a community where he was so widely known and esteemed, in a
+school where he bore so important a part.  There is no exemption from
+the common doom for him who holds the shield to protect others.  The
+student is called from his bench, the professor from his chair, the
+practitioner in his busiest period hears a knock more peremptory than
+any patient's midnight summons, and goes on that unreturning visit
+which admits of no excuse, and suffers no delay.  The call of such a
+man away from us is the bereavement of a great family.  Nor can we
+help regretting the loss for him of a bright and cheerful earthly
+future; for the old age of a physician is one of the happiest periods
+of his life.  He is loved and cherished for what he has been, and
+even in the decline of his faculties there are occasions when his
+experience is still appealed to, and his trembling hands are looked
+to with renewing hope and trust, as being yet able to 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 among those whom I count as listeners one
+by whose side I have sat as a fellow-teacher, and by whose
+instructions I have felt myself not too old to profit.  As we
+borrowed him from your city, I must take this opportunity of telling
+you that his zeal, intelligence, and admirable faculty as an
+instructor were heartily and universally recognized among us.  We
+return him, as we trust, uninjured, to the fellow-citizens who have
+the privilege of claiming him as their own.
+
+And now, gentlemen of the graduating class, nothing remains but for
+me to bid you, in the name of those for 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's accession are proclaimed
+by the same voice at the same moment.  You would hardly excuse me if
+I stooped to any meaner dialect than the classical and familiar
+language of your prescriptions, the same in which your title to the
+name of physician is, if, like our own institution, you follow the
+ancient usage, engraved upon 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 Medical Library in Boston,
+December 3, 1878.]
+
+It is my appointed task, my honorable privilege, this evening, to
+speak of what has been done by others.  No one can bring his tribute
+of words into the presence of great deeds, or try with them to
+embellish the memory of any inspiring achievement, without feeling
+and leaving with others a sense of their insufficiency.  So felt
+Alexander when he compared even his adored Homer with the hero the
+poet had sung.  So felt Webster when he contrasted the phrases of
+rhetoric with the eloquence of patriotism and of self-devotion.  So
+felt Lincoln when on the field of Gettysburg he spoke those immortal
+words which Pericles could not nave bettered, which Aristotle could
+not have criticised.  So felt he who wrote the epitaph of the builder
+of the dome which looks down on the crosses and weathercocks that
+glitter over London.
+
+We are not met upon a battle-field, except so far as every laborious
+achievement means a victory over opposition, 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 every building whose walls are lined with the products of
+useful and ennobling thought is a temple of the Almighty, whose
+inspiration has given us understanding.  But we have gathered within
+walls which bear testimony to the self-sacrificing, persevering
+efforts of a few young men, to whom we owe the origin and development
+of all that excites our admiration in this completed enterprise; and
+I might consider my task as finished if I contented myself with
+borrowing the last word of the architect's epitaph and only saying,
+Look around you!
+
+The reports of the librarian have told or will tell you, in some
+detail, what has been accomplished since the 21st of December, 1874,
+when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch
+to discuss different projects for a medical library.  In less than
+four years from that time, by the liberality of associations and of
+individuals, this collection of nearly ten thousand volumes, of five
+thousand pamphlets, and of one hundred and twenty-five journals,
+regularly received,--all worthily sheltered beneath this lofty roof,
+--has come into being under our eyes.  It has sprung up, as it were;
+in the night like a mushroom; it stands before us in full daylight as
+lusty as an oak, and promising to grow and flourish in the perennial
+freshness of an evergreen.
+
+To whom does our profession owe this already large collection of
+books, exceeded in numbers only by four or five of the most extensive
+medical libraries in the country, and lodged in a building so well
+adapted to its present needs?  We will not point out individually all
+those younger members of the profession who have accomplished what
+their fathers and elder brethren had attempted and partially
+achieved.  We need not write their names on these walls, after the
+fashion of those civic dignitaries who immortalize themselves on
+tablets of marble and gates of iron.  But their contemporaries know
+them well, and their descendants will not forget them,--the men who
+first met together, the men who have given their time and their
+money, the faithful workers, worthy associates of the strenuous
+agitator who gave no sleep to his eyes, no slumber to his eyelids,
+until he had gained his ends; the untiring, imperturbable, tenacious,
+irrepressible, all-subduing agitator who neither rested nor let
+others rest until the success of the project was assured.  If,
+against his injunctions, I name Dr. James Read Chadwick, it is only
+my revenge for his having kept me awake so often and so long while he
+was urging on the undertaking in which he has been preeminently
+active and triumphantly successful.
+
+We must not forget the various medical libraries which preceded this:
+that of an earlier period, when Boston contained about seventy
+regular practitioners, the collection afterwards transferred to the
+Boston Athenaeum; the two collections belonging to the University;
+the Treadwell Library at the Massachusetts General Hospital; the
+collections of the two societies, that for Medical Improvement and
+that for Medical Observation; and more especially the ten thousand
+volumes relating to medicine belonging to our noble public city
+library,--too many blossoms on the tree of knowledge, perhaps, for
+the best fruit to ripen.  But the Massachusetts Medical Society now
+numbers nearly four hundred members in the city of Boston.  The time
+had arrived for a new and larger movement.  There was needed a place
+to which every respectable member of the medical profession could
+obtain easy access; where, under one roof, all might find the special
+information they were seeking; where the latest medical intelligence
+should be spread out daily as the shipping news is posted on the
+bulletins of the exchange; where men engaged in a common pursuit
+could meet, surrounded by the mute oracles of science and art; where
+the whole atmosphere should be as full of professional knowledge as
+the apothecary's shop is of the odor of his medicaments.  This was
+what the old men longed for,--the prophets and kings of the
+profession, who
+
+               "Desired it long,
+     But died without the sight."
+
+This is what the young men and those who worked under their guidance
+undertook to give us.  And now such a library, such a reading-room,
+such an exchange, such an intellectual and social meeting place, we
+be hold a fact, plain before us.  The medical profession of our city,
+and, let us add, of all those neighboring places which it can reach
+with its iron arms, is united as never before by the commune
+vinculum, the common bond 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 centralized libraries; abreast of them,
+but not promising to be content with that position.  What glorifies a
+town like a cathedral?  What dignifies a province like a university?
+What illuminates a country like its scholarship, and what is the nest
+that hatches scholars but a library?
+
+The physician, some may say, is a practical man and has little use
+for all this book-learning.  Every student has heard Sydenham's reply
+to Sir Richard Blackmore's question as to what books he should read,
+--meaning medical books.  "Read Don Quixote," was his famous answer.
+But Sydenham himself made medical books and may be presumed to have
+thought those at least worth reading.  Descartes was asked where was
+his library, and in reply held up the dissected body of an animal.
+But Descartes made books, great books, and a great many of them.  A
+physician of common sense without erudition is better than a learned
+one without common sense, but the thorough master of his profession
+must have learning added to his natural gifts.
+
+It is not necessary to maintain the direct practical utility of all
+kinds of learning.  Our shelves contain many books which only a
+certain class of medical scholars will be likely to consult.  There
+is a dead 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 has no living value for the student, will
+not teach him something by its autopsy.  But it is with the live
+literature of his profession that the medical practitioner is first
+of all concerned.
+
+Now there has come a great change in our time over the form in which
+living thought presents itself.  The first printed books,--the
+incunabula,--were inclosed in boards of solid oak, with brazen clasps
+and corners; the boards by and by were replaced by pasteboard covered
+with calf or sheepskin; then cloth came in and took the place of
+leather; then the pasteboard was covered with paper instead of cloth;
+and at this day the quarterly, the monthly, the weekly periodical in
+its flimsy unsupported dress of paper, and the daily journal, naked
+as it came from the womb of the press, hold the larger part of the
+fresh reading we live upon.  We must have the latest thought in its
+latest expression; the page must be newly turned like the morning
+bannock; the pamphlet must be newly opened like the ante-prandial
+oyster.
+
+Thus a library, to meet the need of our time, must take, and must
+spread out in a convenient form, a great array of periodicals.  Our
+active practitioners read these by preference over almost everything
+else.  Our specialists, more particularly, depend on the month's
+product, on the yearly crop of new facts, new suggestions, new
+contrivances, as much as the farmer on the annual yield of his acres.
+One of the first wants, then, of the profession is supplied by our
+library in its great array of periodicals from many lands, in many
+languages.  Such a number of medical periodicals no private library
+would have room for, no private person would pay for, or flood his
+tables with if they were sent him for nothing.  These, I think, with
+the reports of medical societies and the papers contributed to them,
+will form the most attractive part of our accumulated medical
+treasures.  They will be also one of our chief expenses, for these
+journals must be bound in volumes and they require a great amount of
+shelf-room; all this, in addition to the cost of subscription for
+those which are not furnished us gratuitously.
+
+It is true that the value of old scientific periodicals is, other
+things being equal, in the inverse ratio of their age, for the
+obvious reason that what is most valuable in the earlier volumes of a
+series is drained off into the standard works with which the
+intelligent practitioner is supposed to be familiar.  But no extended
+record of facts grows too old to be useful, provided only that we
+have a ready and sure way of getting at the particular fact or facts
+we are in search of.
+
+And this leads me to speak of what I conceive to be one of the
+principal tasks to be performed by the present and the coming
+generation of scholars, not only in the medical, but in every
+department of knowledge.  I mean the formation of indexes, and more
+especially of 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 special subject.  I have a right
+to speak of it, for I long ago attempted to supply the want of
+indexes in some small measure for my own need.  I had a very complete
+set of the "American Journal of the Medical Sciences;" an entire set
+of the "North American Review," and many volumes of the reprints of
+the three leading British quarterlies.  Of what use were they to me
+without general indexes?  I looked them all through carefully and
+made classified lists of all the articles I thought I should most
+care to read.  But they soon outgrew my lists.  The "North American
+Review " kept filling up shelf after shelf, rich in articles which I
+often wanted to consult, but what a labor to find them, until the
+index of Mr. Gushing, published a few months since, made the contents
+of these hundred and twenty volumes 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 lost its
+value for me in later years.  But where to look for what I wanted?  I
+wished to know, for instance, what Dr. Burney had to say about
+singing.  Who would have looked for it under the Italian word
+cantare?  I was curious to learn something of the etchings of
+Rembrandt, and where should I find it but under the head "Low
+Countries, Engravers of the,"--an elaborate and most valuable article
+of a hundred double-columned close-printed quarto pages, to which no
+reference, even, is made under the title Rembrandt.
+
+There was nothing to be done, if I wanted to know where that which I
+specially cared for was to be found in my Rees's Cyclopaedia, but to
+look over every page of its forty-one quarto volumes and make out a
+brief list of matters of interest which I could not find by their
+titles, and this I did, at no small expense of time and trouble.
+
+Nothing, therefore, could be more pleasing to me than to see the
+attention which has been given of late years to the great work of
+indexing.  It is a quarter of a century since Mr. Poole published his
+"Index to Periodical Literature," which it is much to be hoped is
+soon to appear in a new edition, grown as it must be to formidable
+dimensions by the additions of so long a period.  The "British and
+Foreign Medical Review," edited by the late Sir John Forties,
+contributed to by Huxley, Carpenter, Laycock, and others of the most
+distinguished scientific men of Great Britain, has an index to its
+twenty-four volumes, and by its aid I find this valuable series as
+manageable as a lexicon.  The last edition of the "Encyclopaedia
+Britannica" had a complete index in a separate volume, and the
+publishers of Appletons' "American Cyclopaedia" have recently issued
+an index to their useful work, which must greatly add to its value.
+I have already referred to the index to the "North American Review,"
+which to an American, and especially to a New Englander, is the most
+interesting and most valuable addition of its kind to our literary
+apparatus since the publication of Mr. Allibone's "Dictionary of
+Authors."  I might almost dare to parody Mr. Webster's words in
+speaking of Hamilton, to describe what Mr. Gushing did for the solemn
+rows of back volumes of our honored old Review which had been long
+fossilizing on our shelves: "He touched the dead corpse of the 'North
+American,'" and it sprang to its feet."  A library of the best
+thought of the best American scholars during the greater portion of
+the century was brought to light by the work of the indexmaker as
+truly as were the Assyrian tablets by the labors of Layard.
+
+A great portion of the best writing and reading literary, scientific,
+professional, miscellaneous--comes to 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-binder puts a coat
+on his back, and he joins the forlorn brotherhood of "back volumes,"
+than which, so long as they are unindexed, nothing can be more
+exasperating.  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 a goldback behind it?
+
+I have referred chiefly to the medical journals, but I would include
+with these the reports of medical associations, and those separate
+publications which, coming in the form of pamphlets, heap themselves
+into chaotic piles and bundles which are worse than useless, taking
+up a great deal of room, and frightening everything away but mice and
+mousing antiquarians, or possibly at long intervals some terebrating
+specialist.
+
+Arranged, bound, indexed, all these at once become accessible and
+valuable.  I will take the first instance which happens to suggest
+itself.  How many who know all about osteoblasts and the experiments
+of Ollier, and all that has grown out of them, know where to go for a
+paper by the late Dr. A. L. Peirson of Salem, published in the year
+1840, under the modest title, Remarks on Fractures?  And if any
+practitioner who has to deal with broken bones does not know that
+most excellent and practical essay, it is a great pity, for it
+answers very numerous questions which will be sure to suggest
+themselves to the surgeon and the patient as no one of the recent
+treatises, on my own shelves, at least, can do.
+
+But if indexing is the special need of our time in medical
+literature, as in every department of knowledge, it must be
+remembered that it is not only an immense labor, but one that never
+ends.  It requires, therefore, the cooperation of a large number of
+individuals to do the work, and a large amount of money to pay for
+making its results public through the press.  When it is remembered
+that the catalogue of the library of the British Museum is contained
+in nearly three thousand large folios of manuscript, and not all its
+books are yet included, the task of indexing any considerable branch
+of science or literature looks as if it were well nigh impossible.
+But many hands make light work.  An "Index Society" has been formed
+in England, already numbering about one hundred and seventy members.
+It aims at "supplying thorough indexes to valuable works and
+collections which have hitherto lacked them; at issuing indexes to
+the literature of special subjects; and at gathering materials for a
+general reference index."  This society has published a little
+treatise setting forth the history and the art of indexing, which I
+trust is in the hands of some of our members, if not upon our
+shelves.
+
+Something has been done in the same direction by individuals in our
+own country, as we have already seen.  The need of it in the
+department of medicine is beginning to be clearly felt.  Our library
+has already an admirable catalogue with cross references, the work of
+a number of its younger members cooperating in the task.  A very
+intelligent medical student, Mr. William D. Chapin, whose excellent
+project is indorsed by well-known New York physicians and professors,
+proposes to publish a yearly index to original communications in the
+medical journals of the United States, classified by authors and
+subjects.  But it is from the National Medical Library at Washington
+that we have the best promise and the largest expectations.  That
+great and growing collection of fifty thousand volumes is under the
+eye and hand of a librarian who knows books and how to manage them.
+For libraries are the standing armies of civilization, and an army is
+but a mob without a general who can organize and marshal it so as to
+make it effective.  The "Specimen Fasciculus of a Catalogue of the
+National Medical Library," prepared under the direction of Dr.
+Billings, the librarian, would have excited the admiration of Haller,
+the master scholar in medical science of the last century, or rather
+of the profession in all centuries, and if carried out as it is begun
+will be to the nineteenth all and more than all that the three
+Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to
+the eighteenth century.  I cannot forget the story that Agassiz was
+so fond of telling of the king of Prussia and Fichte.  It was after
+the humiliation and spoliation of the kingdom by Napoleon that the
+monarch asked the philosopher what could be done to regain the lost
+position of the nation.  "Found a great university, Sire," was the
+answer, and so it was that in the year 1810 the world-renowned
+University of Berlin came into being.  I believe that we in this
+country can do better than found a national university, whose
+professors shall be nominated in caucuses, go in and out, perhaps,
+like postmasters, with every change of administration, and deal with
+science in the face of their constituency as the courtier did with
+time when his sovereign asked him what o'clock it was: "Whatever hour
+your majesty pleases."  But when we have a noble library like that at
+Washington, and a librarian of exceptional qualifications like the
+gentleman who now holds that office, I believe that a liberal
+appropriation by Congress to carry out a conscientious work for the
+advancement of sound knowledge and the bettering of human conditions,
+like this which Dr. Billings has so well begun, would redound greatly
+to the honor of the nation.  It ought to be willing to be at some
+charge to make its treasures useful to its citizens, and, for its own
+sake, especially to that class which has charge of health, public and
+private.  This country abounds in what are called "self-made men,"
+and is justly proud of many whom it thus designates.  In one sense no
+man is self-made who breathes the air of a civilized community.  In
+another sense every man who is anything other than a phonograph on
+legs is self-made.  But if we award his just praise to the man who
+has attained any kind of excellence without having had the same
+advantages as others whom, nevertheless, he has equalled or
+surpassed, let us not be betrayed into undervaluing the mechanic's
+careful training to his business, the thorough and laborious
+education of the scholar and the professional man.
+
+Our American atmosphere is vocal with the flippant loquacity of half
+knowledge.  We must accept whatever good can be got out of it, and
+keep it under as we do sorrel and mullein and witchgrass, by
+enriching the soil, and sowing good seed in plenty; by good teaching
+and good books, rather than by wasting our time in talking against
+it.  Half knowledge dreads nothing but whole knowledge.
+
+I have spoken of the importance and the predominance of periodical
+literature, and have attempted to do justice to its value.  But the
+almost exclusive reading of it is not without its dangers.  The
+journals contain much that is crude and unsound; the presumption; it
+might be maintained, is against their novelties, unless they come
+from observers of established credit.  Yet I have known a
+practitioner,--perhaps more than one,--who was as much under the
+dominant influence of the last article he had read in his favorite
+medical journal as a milliner under the sway of the last fashion-
+plate.  The difference between green and seasoned knowledge is very
+great, and such practitioners never hold long enough to any of their
+knowledge to have it get seasoned.
+
+It is needless to say, then, that all the substantial and permanent
+literature of the profession should be represented upon our shelves.
+Much of it is there already, and as one private library after another
+falls into this by the natural law of gravitation, it will gradually
+acquire all that is most valuable almost without effort.  A scholar
+should not be in a hurry to part with his books.  They are probably
+more valuable to him than they can be to any other individual.  What
+Swedenborg called "correspondence" has established itself between his
+intelligence and the volumes which wall him within their sacred
+inclosure.  Napoleon said that his mind was as if furnished with
+drawers,--he drew out each as he wanted its contents, and closed it
+at will when done with them.  The scholar's mind, to use a similar
+comparison, is furnished with shelves, like his library.  Each book
+knows its place in the brain as well as against the wall or in the
+alcove.  His consciousness is doubled by the books which encircle
+him, as the trees that surround a lake repeat themselves in its
+unruffled waters.  Men talk of the nerve that runs to the pocket, but
+one who loves his books, and has lived long with them, has a nervous
+filament which runs 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 temple is to the worshipper who frequents it.  There is
+the altar sacred to his holiest experiences.  There is the font where
+his new-born thought was baptized and first had a name in his
+consciousness.  There is the monumental tablet of a dead belief,
+sacred still in the memory of what it was while yet alive.  No
+visitor can read all this on the lettered backs of the books that
+have gathered around the scholar, but for him, from the Aldus on the
+lowest shelf to the Elzevir on the highest, every volume has a
+language which none but be can interpret.  Be patient with the book-
+collector who loves his companions too well to let them go.  Books
+are not buried with their owners, and the veriest book-miser that
+ever lived was probably doing far more for his successors than his
+more liberal neighbor who despised his learned or unlearned avarice.
+Let the fruit fall with the leaves still clinging round it.  Who
+would have stripped Southey's walls of the books that filled them,
+when, his mind no longer capable of taking in their meaning, he would
+still pat and fondle them with the vague loving sense of what they
+had once been to him,--to him, the great scholar, now like a little
+child among his playthings?
+
+We need in this country not only the scholar, but the virtuoso, who
+hoards the treasures which he loves, it may be chiefly for their
+rarity and because others who know more than he does of their value
+set a high price upon them.  As the wine of old vintages is gently
+decanted out of its cobwebbed bottles with their rotten corks into
+clean new receptacles, so the wealth of the New World is quietly
+emptying many of the libraries and galleries of the Old World into
+its 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 before the New Zealander takes his stand on a
+broken arch of London Bridge to sketch the ruins of St. Paul's in the
+midst of a vast solitude, the treasures of the British Museum will
+have found a new shelter in the halls of New York or Boston.  No
+Catholic will think hardly of my saying that before the Coliseum
+falls, and with it the imperial city, whose doom prophecy has linked
+with that of the almost eternal amphitheatre, the marbles, the
+bronzes, the paintings, the manuscripts of the Vatican will have left
+the shores of the Tiber for those of the Potomac, the Hudson, the
+Mississippi, or the Sacramento.  And what a delight in the pursuit of
+the rarities which the eager book-hunter follows with the scent of a
+beagle!
+
+Shall I ever forget that rainy day in Lyons, that dingy bookshop,
+where I found the Aetius, long missing from my Artis bledicae
+Principes, and where I bought for a small pecuniary consideration,
+though it was marked rare, and was really tres rare, the Aphorisms of
+Hippocrates, edited by and with a preface from the hand of Francis
+Rabelais?  And the vellum-bound Tulpius, which I came upon in Venice,
+afterwards my only reading when imprisoned in quarantine at
+Marseilles, so that the two hundred and twenty-eight cases he has
+recorded are, many of them, to this day still fresh in my memory.
+And the Schenckius,--the folio filled with casus rariores, which had
+strayed in among the rubbish of the bookstall on the boulevard,--and
+the noble old Vesalius with its grand frontispiece not unworthy of
+Titian, and the fine old Ambroise Pare, long waited for even in Paris
+and long ago, and the colossal Spigelius with his eviscerated
+beauties, and Dutch Bidloo with its miracles of fine engraving and
+bad dissection, and Italian Mascagni, the despair of all would-be
+imitators, and pre-Adamite John de Ketam, and antediluvian
+Berengarius Carpensis,--but why multiply names, every one of which
+brings back the accession of a book which was an event almost like
+the birth of an infant?
+
+A library like ours must exercise the largest hospitality.  A great
+many books may be found in every large collection which remind us of
+those apostolic looking old men who figure on the platform at our
+political and other assemblages.  Some of them have spoken words of
+wisdom in their day, but they have ceased to be oracles; some of them
+never had any particularly important message for humanity, but they
+add dignity to the meeting by their presence; they look wise, whether
+they are so or not, and no one grudges them their places of honor.
+Venerable figure-heads, what would our platforms be without you?
+
+Just so with our libraries.  Without their rows of folios in creamy
+vellum, or showing their black backs with antique lettering of
+tarnished gold, our shelves would look as insufficient and unbalanced
+as a column without its base, as a statue without its pedestal.  And
+do not think they are kept only to be spanked and dusted during that
+dreadful period when their owner is but too thankful to become an
+exile and a wanderer from the scene of single combats between dead
+authors and living housemaids.  Men were not all cowards before
+Agamemnon or all fools before the days of Virchow and Billroth.  And
+apart from any practical use to be derived from the older medical
+authors, is there not a true pleasure in reading the accounts of
+great discoverers in their own words?  I do not pretend to hoist up
+the Bibliotheca Anatomica of Mangetus and spread it on my table every
+day.  I do not get out my great Albinus before every lecture on the
+muscles, nor disturb the majestic repose of Vesalius every time I
+speak of the bones he has so admirably described and figured.  But it
+does please me to read the first descriptions of parts to which the
+names of their discoverers or those who have first described them
+have become so joined that not even modern science can part them; to
+listen to the talk of my old volume as Willis describes his circle
+and Fallopius his aqueduct and Varolius his bridge and Eustachius his
+tube and Monro his foramen,--all so well known to us in the human
+body; it does please me to know the very words in which Winslow
+described the opening which bears his name, and Glisson his capsule
+and De Graaf his vesicle; I am not content until I know in what
+language Harvey announced his discovery of the circulation, and how
+Spigelius made the liver his perpetual memorial, and Malpighi found a
+monument more enduring than brass in the corpuscles of the spleen and
+the kidney.
+
+But after all, the readers who care most for the early records of
+medical science and art are the specialists who are dividing up the
+practice of medicine and surgery as 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 ail others is
+applicable the saying of D'Alembert that the author kills himself in
+lengthening out what the reader kills himself in trying to shorten.
+
+There are practical books among these ancient volumes which can never
+grow old.  Would you know how to recognize "male hysteria" and to
+treat it, take down your Sydenham; would you read the experience of a
+physician who was himself the subject of asthma, and who,
+notwithstanding that, in the words of Dr. Johnson, "panted on till
+ninety," you will find it in the venerable treatise of Sir John
+Floyer; would you listen to the story of the King's Evil cured by the
+royal touch, as told by a famous chirurgeon who fully believed in it,
+go to Wiseman; would you get at first hand the description of the
+spinal disease which long bore his name, do not be startled if I tell
+you to go to Pott,--to Percival Pott, the great surgeon of the last
+century.
+
+There comes a time for every book in a library when it is wanted by
+somebody.  It is but a few weeks since one of the most celebrated
+physicians in the country wrote to me from a great centre of medical
+education to know if I had the works of Sanctorius, which he had
+tried in vain to find.  I could have lent him the "Medicina Statica,"
+with its frontispiece showing Sanctorius with his dinner on the table
+before him, in his balanced chair which sunk with him below the level
+of his banquet-board when he had swallowed a certain number of
+ounces,--an early foreshadowing of Pettenkofer's chamber and
+quantitative physiology,--but the "Opera Omnia" of Sanctorius I had
+never met with, and I fear he had to do without it.
+
+I would extend the hospitality of these shelves to a class of works
+which we are in the habit of considering as being outside of the pale
+of medical science, properly so called, and sometimes of coupling
+with a disrespectful name.  Such has always been my own practice.  I
+have welcomed Culpeper and Salmon to my bookcase as willingly as
+Dioscorides or Quincy, or Paris or Wood and Bache.  I have found a
+place for St. John Long, and read the story of his trial for
+manslaughter with as much interest as the laurel-water case in which
+John Hunter figured as a witness.  I would give Samuel Hahnemann a
+place by the side of Samuel Thomson.  Am I not afraid that some
+student of imaginative turn and not provided with the needful
+cerebral strainers without which all the refuse of gimcrack
+intelligences gets into the mental drains and chokes them up,--am I
+not afraid that some such student will get hold of the "Organon" or
+the "Maladies Chroniques" and be won over by their delusions, and so
+be lost to those that love him as a man of common sense and a brother
+in their high calling?  Not in the least.  If he showed any symptoms
+of infection I would for once have recourse to the principle of
+similia similibus.  To cure him of Hahnemann I would prescribe my
+favorite homoeopathic antidote, Okie's Bonninghausen.  If that
+failed, I would order Grauvogl as a heroic remedy, and if he survived
+that uncured, I would give him my blessing, if I thought him honest,
+and bid him depart in peace.  For me he is no longer an individual.
+He belongs to a class of minds which we are bound to be patient with
+if their Maker sees fit to indulge them with existence.  We must
+accept the conjuring ultra-ritualist, the dreamy second adventist,
+the erratic spiritualist, the fantastic homoeopathist, as not
+unworthy of philosophic study; not more unworthy of it than the
+squarers of the circle and the inventors of perpetual motion, and the
+other whimsical visionaries to whom De Morgan has devoted his most
+instructive and entertaining "Budget of Paradoxes."  I hope,
+therefore, that our library will admit the works of the so-called
+Eclectics, of the Thomsonians, if any are in existence, of the
+Clairvoyants, if they have a literature, and especially of the
+Homoeopathists.  This country seems to be the place for such a
+collection, which will by and by be curious and of more value than at
+present, for Homoeopathy seems to be following the pathological law
+of erysipelas, fading out where it originated as it spreads to new
+regions.  At least I judge so by the following translated extract
+from a criticism of an American work in the "Homoeopatische
+Rundschau" of Leipzig for October, 1878, which I find in the
+"Homoeopathic Bulletin" for the month of November just passed:
+"While we feel proud of the spread and rise of Homoeopathy across the
+ocean, and while the Homoeopathic works reaching us from there, and
+published in a style such as is unknown in Germany, bear eloquent
+testimony to the eminent activity of our transatlantic colleagues, we
+are overcome by sorrowful regrets at the position Homoeopathy
+occupies in Germany.  Such a work [as the American one referred to]
+with us would be impossible; it would lack the necessary support."
+
+By all means let our library secure a good representation of the
+literature of Homoeopathy before it leaves us its "sorrowful regrets"
+and migrates with its sugar of milk pellets, which have taken the
+place 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 of a Librarian?
+Where have they ever been better performed than in our own public
+city library, where the late Mr. Jewett and the living Mr. Winsor
+have shown us what a librarian ought to be,--the organizing head, the
+vigilant guardian, the seeker's index, the scholar's counsellor?  His
+work is not merely that of administration, manifold and laborious as
+its duties are.  He must have a quick intelligence and a retentive
+memory.  He is a public carrier of knowledge in its germs.  His
+office is like that which naturalists attribute to the bumble-bee,--
+he lays up little honey for himself, but he conveys the fertilizing
+pollen from flower to flower.
+
+Our undertaking, just completed,--and just begun--has come at the
+right time, not a day too soon.  Our practitioners need a library
+like this, for with all their skill and devotion there is too little
+genuine erudition, such as a liberal profession ought to be able to
+claim for many of its members.  In reading the recent obituary
+notices of the late Dr. Geddings of South Carolina, I recalled what
+our lamented friend Dr. Coale used to tell me of his learning and
+accomplishments, and I could not help reflecting how few such medical
+scholars we had to show in Boston or New England.  We must clear up
+this unilluminated atmosphere, and here,--here is the true electric
+light which will irradiate its darkness.
+
+The public will catch the rays reflected from the same source of
+light, and it needs instruction on the great subjects of health and
+disease,--needs it sadly.  It is preyed upon by every kind of
+imposition almost without hindrance.  Its ignorance and prejudices
+react upon the profession to the great injury of both.  The jealous
+feeling, for instance, with regard to such provisions for the study
+of anatomy as are sanctioned by the laws in this State and carried
+out with strict regard to those laws, threatens the welfare, if not
+the existence of institutions for medical instruction wherever it is
+not held in check by enlightened intelligence.  And on the other hand
+the profession has just been startled by a verdict against a
+physician, ruinous in its amount,--enough to drive many a hard-
+working young practitioner out of house and home,--a verdict which
+leads to the fear that suits for malpractice may take the place of
+the panel game and child-stealing as a means of extorting money.  If
+the profession in this State, which claims a high standard of
+civilization, is to be crushed and ground beneath the upper millstone
+of the dearth of educational advantages and the lower millstone of
+ruinous penalties for what the ignorant ignorantly shall decide to be
+ignorance, all I can say is
+
+God save the Commonhealth of Massachusetts!
+
+Once more, we cannot fail to see that just as astrology has given
+place to astronomy, so theology, the science of Him whom by searching
+no man can find out, is fast being replaced by what we may not
+improperly call theonomy, or the science of the laws according to
+which the Creator acts.  And since these laws find their fullest
+manifestations for us, at least, in rational human natures, the study
+of anthropology is largely replacing that of scholastic divinity.  We
+must contemplate our Maker indirectly in human attributes as we talk
+of Him in human parts of speech.  And this gives a sacredness to the
+study of man in his physical, mental, moral, social, and religious
+nature which elevates the faithful students of anthropology to the
+dignity of a priesthood, and sheds a holy light on the recorded
+results of their labors, brought together as they are in such a
+collection as this which is now spread out before us.
+
+Thus, then, our library is a temple as truly as the dome-crowned
+cathedral hallowed by the breath of prayer and praise, where the dead
+repose and the living worship.  May it, with all its treasures, be
+consecrated like that to the glory of God, through the contributions
+it shall make to the advancement of sound knowledge, to the relief of
+human suffering, to the promotion of harmonious relations between the
+members of the two noble professions which deal with the diseases of
+the soul and with those of the body, and to the common cause in which
+all good men are working, the furtherance of the well-being of their
+fellow-creatures!
+
+NOTE.--As an illustration of the statement in the last paragraph but
+one, I take the following notice from the "Boston Daily Advertiser,"
+of December 4th, the day after the delivery of the address:
+"Prince Lucien Bonaparte is now living in London, and is devoting
+himself to the work of collecting the creeds of all religions and
+sects, with a view to their classification,--his object being simply
+scientific or anthropological."
+
+Since delivering the address, also, I find a leading article in the
+"Cincinnati Lancet and Clinic" of November 30th, headed "The
+Decadence of Homoeopathy," abundantly illustrated by extracts from
+the "Homoeopathic Times," the leading American organ of that sect.
+
+In the New York "Medical Record" of the same date, which I had not
+seen before the delivery of my address, is an account of the action
+of the Homoeopathic Medical Society of Northern New York, in which
+Hahnemann's theory of "dynamization" is characterized in a formal
+resolve as "unworthy the confidence of the Homoeopathic profession."
+
+It will be a disappointment to the German Homoeopathists to read in
+the "Homoeopathic Times" such a statement as the following:
+"Whatever the influences have been which have checked the outward
+development of Homoeopathy, it is plainly evident that the
+Homoeopathic school, as regards the number of its openly avowed
+representatives, has attained its majority, and has begun to decline
+both in this country and in England."
+
+All which is an additional reason for making a collection of the
+incredibly curious literature of Homoeopathy before that
+pseudological inanity has faded out like so many other delusions.
+
+
+
+
+
+
+SOME OF MY EARLY TEACHERS
+
+[A Farewell Address to the Medical School of Harvard University,
+November 28, 1882.]
+
+I had intended that the recitation of Friday last should be followed
+by a few parting words to my class and any friends who might happen
+to be in the lecture-room.  But I learned on the preceding evening
+that there was an expectation, a desire, that my farewell should take
+a somewhat different form; and not to disappoint the wishes of those
+whom I was anxious to gratify, I made up my mind to appear before you
+with such hasty preparation as the scanty time admitted.
+
+There are three occasions upon which a human being has a right to
+consider himself as a centre of interest to those about him: when he
+is christened, when he is married, and when he is buried.  Every one
+is the chief personage, the hero, of his own baptism, his own
+wedding, and his own funeral.
+
+There are other occasions, less momentous, in which one may make more
+of himself than under ordinary circumstances he would think it proper
+to do; when he may talk about himself, and tell his own experiences,
+in fact, indulge in a more or less egotistic monologue without fear
+or reproach.
+
+I think I may claim that this is one of those occasions.  I have
+delivered my last anatomical lecture and heard my class recite for
+the last time.  They wish to hear from me again in a less scholastic
+mood than that in which they have known me.  Will you not indulge me
+in telling you something of my own story?
+
+This is the thirty-sixth Course of Lectures in which I have taken my
+place and performed my duties as Professor of Anatomy.  For more than
+half of my term of office I gave instruction in Physiology, after the
+fashion of my predecessors and in the manner then generally prevalent
+in our schools, where the physiological laboratory was not a
+necessary part of the apparatus of instruction.  It was with my
+hearty approval that the teaching of Physiology was constituted a
+separate department and made an independent Professorship.  Before my
+time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the
+same course of Lectures, lasting only three or four months.  As the
+boundaries of science are enlarged, new divisions and subdivisions of
+its territories become necessary.  In the place of six Professors in
+1847, when I first became a member of the Faculty, I count twelve
+upon the Catalogue before me, and I find the whole number engaged in
+the work of instruction in the Medical School amounts to no less than
+fifty.
+
+Since I began teaching in this school, the aspect of many branches of
+science has undergone a very remarkable transformation.  Chemistry
+and Physiology are no longer what they were, as taught by the
+instructors of that time.  We are looking forward to the synthesis of
+new organic compounds; our artificial madder is already in the
+market, and the indigo-raisers are now fearing that their crop will
+be supplanted by the manufactured article.  In the living body we
+talk of fuel supplied and work done, in movement, in heat, just as if
+we were dealing with a machine of our own contrivance.
+
+A physiological laboratory of to-day is equipped with instruments of
+research of such ingenious contrivance, such elaborate construction,
+that one might suppose himself in a workshop where some exquisite
+fabric was to be wrought, such as Queens love to wear, and Kings do
+not always love to pay for.  They are, indeed, weaving a charmed web,
+for these are the looms from which comes the knowledge that clothes
+the nakedness of the intellect.  Here are the mills that grind food
+for its hunger, and "is not the life more than meat, and the body
+than raiment?"
+
+But while many of the sciences have so changed that the teachers of
+the past would hardly know them, it has not been so with the branch I
+teach, or, rather, with that division of it which is chiefly taught
+in this amphitheatre.  General anatomy, or histology, on the other
+hand, is almost all new; it has grown up, mainly, since I began my
+medical studies.  I never saw a compound microscope during my years
+of study in Paris.  Individuals had begun to use the instrument, but
+I never heard it alluded to by either Professors or students.  In
+descriptive anatomy I have found little to unlearn, and not a great
+deal that was both new and important to learn.  Trifling additions
+are made from year to year, not to be despised and not to be
+overvalued.  Some of the older anatomical works are still admirable,
+some of the newer ones very much the contrary.  I have had recent
+anatomical plates brought me for inspection, and I have actually
+button-holed the book-agent, a being commonly as hard to get rid of
+as the tar-baby in the negro legend, that I might put him to shame
+with the imperial illustrations of the bones and muscles in the great
+folio of Albinus, published in 1747, and the unapproached figures of
+the lymphatic system of Mascagni, now within a very few years of a
+century old, and still copied, or, rather, pretended to be copied, in
+the most recent works on anatomy.
+
+I am afraid that it is a good plan to get rid of old Professors, and
+I am thankful to hear that there is a movement for making provision
+for those who are left in need when they lose their offices and their
+salaries.  I remember one of our ancient Cambridge Doctors once asked
+me to get into his rickety chaise, and said to me, half humorously,
+half sadly, that he was like an old horse,--they had taken off his
+saddle and turned him out to pasture.  I fear the grass was pretty
+short where that old servant of the public found himself grazing.  If
+I myself needed an apology for holding my office so long, I should
+find it in the fact that human anatomy is much the same study that it
+was in the days of Vesalius and Fallopius, and that the greater part
+of my teaching was of such a nature that it could never become
+antiquated.
+
+Let me begin with my first experience as a medical student.  I had
+come from the lessons of Judge Story and Mr. Ashmun in the Law School
+at Cambridge.  I had been busy, more or less, with the pages of
+Blackstone and Chitty, and other text-books of the first year of
+legal study.  More or less, I say, but I am afraid it was less rather
+than more.  For during that year I first tasted the intoxicating
+pleasure of authorship.  A college periodical, conducted by friends
+of mine, still undergraduates, tempted me into print, and there is no
+form of lead-poisoning which more rapidly and thoroughly pervades the
+blood and bones and marrow than that which reaches the young author
+through mental contact with type-metal.  Qui a bu, boira,--he who has
+once been a drinker will drink again, says the French proverb.  So
+the man or woman who has tasted type is sure to return 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 of it from
+that day to this.  But for that I might have applied myself more
+diligently to my legal studies, and carried a green bag in place of a
+stethoscope and a thermometer up to the present day.
+
+What determined me to give up Law and apply myself to Medicine I can
+hardly say, but I had from the first looked upon that year's study as
+an experiment.  At any rate, I made the change, and soon found myself
+introduced to new scenes and new companionships.
+
+I can scarcely credit my memory when I recall the first impressions
+produced upon me by sights afterwards become so familiar that they
+could no more disturb a 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 devoted to the students of
+the school I had joined, just as the fleshless figure of Time, with
+the hour-glass and scythe, used to glare upon me in my childhood from
+the "New England Primer."  The white faces in the beds at the
+Hospital found their reflection in my own cheeks, which lost their
+color as I looked upon them.  All this had to pass away in a little
+time; I had chosen my profession, and must meet its painful and
+repulsive aspects until they lost their power over my sensibilities.
+
+The private medical school which I had joined was one 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
+either spoken elsewhere or may find occasion to speak hereafter.  The
+two younger members of this association of teachers were both
+graduates of our University, one of the year 1819, the other of 1818.
+
+Dr. Lewis was a great favorite with students.  He was a man of very
+lively temperament, fond of old books and young people, open-hearted,
+free-spoken, an enthusiast in teaching, and especially at home in
+that apartment of the temple of science where nature is seen in
+undress, the anthropotomic laboratory, known to common speech as the
+dissecting-room.  He had that quality which is the special gift of
+the man born for a teacher,--the power of exciting an interest in
+that which he taught.  While he was present the apartment I speak of
+was the sunniest of studios in spite of its mortuary spectacles.  Of
+the students I met there I best remember James Jackson, Junior, full
+of zeal and playful as a boy, a young man whose early death was a
+calamity to the profession of which he promised to be a chief
+ornament; the late Reverend J. S. C. Greene, who, as the prefix to
+his name signifies, afterwards changed his profession, but one of
+whose dissections I remember looking upon with admiration; and my
+friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
+entitled to be called, then, as now and always, a favorite with all
+about him.  He had come to us from the schools of Germany, and
+brought with him recollections of the 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 say as important as a good Professor in
+the teaching of Anatomy, because I am not sure that he is not more
+important.  He comes into direct personal relations with the
+students,--he is one of them, in fact, as the Professor cannot be
+from the nature of his duties.  The Professor's chair is an
+insulating stool, so to speak; his age, his knowledge, real or
+supposed, his official station, are like the glass legs which support
+the electrician's piece of furniture, and cut it off from the common
+currents of the floor upon which it stands.  Dr. Lewis enjoyed
+teaching and made his students enjoy being taught.  He delighted in
+those anatomical conundrums to answer which keeps the student's eyes
+open and his wits awake.  He was happy as he dexterously performed
+the tour de maitre of the old barber-surgeons, or applied the spica
+bandage and taught his scholars to do it, so neatly and symmetrically
+that the aesthetic missionary from the older centre of civilization
+would bend over it in blissful contemplation, as if it were a
+sunflower.  Dr. Lewis had many other tastes, and was a favorite, not
+only with students, but in a wide circle, professional, antiquarian,
+masonic, and social.
+
+Dr. Otis was less widely known, but was a fluent and agreeable
+lecturer, and esteemed as a good surgeon.
+
+I must content myself with this glimpse at myself and a few of my
+fellow-students in Boston.  After attending two courses of Lectures
+in the school of the University, I went to Europe to continue my
+studies.
+
+You may like to hear something of the famous Professors of Paris in
+the days when I was a student in the Ecole de Medicine, and following
+the great Hospital teachers.
+
+I can hardly believe my own memory when I recall the old
+practitioners and Professors who were still going round the hospitals
+when I mingled with the train of students that attended the morning
+visits.  See that bent old man who is groping his way through the
+wards of La Charity.  That is the famous Baron Boyer, author of the
+great work on surgery in nine volumes, a writer whose clearness of
+style commends his treatise to general admiration, and makes it a
+kind of classic.  He slashes away at a terrible rate, they say, when
+he gets hold of the subject of fistula in its most frequent habitat,
+--but I never saw him do more than look as if he wanted to cut a good
+dollop out of a patient he was examining.  The short, square,
+substantial man with iron-gray hair, ruddy face, and white apron is
+Baron Larrey, Napoleon's favorite surgeon, the most honest man he
+ever saw,--it is reputed that he called him.  To go round the Hotel
+des Invalides with Larrey was to live over the campaigns of Napoleon,
+to look on the sun of Austerlitz, to hear the cannons of Marengo, to
+struggle through the icy waters of the Beresina, to shiver in the
+snows of the Russian retreat, and to gaze through the battle smoke
+upon the last charge of the red lancers on the redder field of
+Waterloo.  Larrey was still strong and sturdy as I saw him, and few
+portraits remain printed in livelier colors on the tablet of my
+memory.
+
+Leave the little group of students which gathers about Larrey beneath
+the gilded dome of the Invalides and follow me to the Hotel Dieu,
+where rules and reigns the master-surgeon of his day, at least so far
+as Paris and France are concerned,--the illustrious Baron Dupuytren.
+No man disputed his reign, some envied his supremacy.  Lisfranc
+shrugged his shoulders as he spoke of "ce grand homme de 1'autre cots
+de la riviere," that great man on the other side of the river, but
+the great man he remained, until he bowed before the mandate which
+none may disobey.  "Three times," said Bouillaud, "did the apoplectic
+thunderbolt fall on that robust brain,"--it yielded at last as the
+old bald cliff that is riven and crashes down into the valley.  I saw
+him before the first thunderbolt had descended: a square, solid man,
+with a high and full-domed head, oracular in his utterances,
+indifferent to those around him, sometimes, it was said, very rough
+with them.  He spoke in low, even tones, with quiet fluency, and was
+listened to with that hush of rapt attention which I have hardly seen
+in any circle of listeners unless when such men as ex-President John
+Quincy Adams or Daniel Webster were the speakers.  I do not think
+that Dupuytren has left a record which explains his influence, but in
+point of fact he dominated those around him in a remarkable manner.
+You must have all witnessed something of the same kind.  The personal
+presence of some men carries command with it, and their accents
+silence the crowd around them, when the same words from other lips
+might fall comparatively unheeded.
+
+As for Lisfranc, I can say little more of him than that he was a
+great drawer of blood and hewer of members.  I remember his ordering
+a wholesale bleeding of his patients, right and left, whatever might
+be the matter with them, one morning when a phlebotomizing fit was on
+him.  I recollect his regretting the splendid guardsmen 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 I ceased
+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 name widely known.  Coming to Paris
+in wooden shoes, starving, almost, at first, he raised himself to
+great eminence as a surgeon and as an author, and at last obtained
+the Professorship to which his talents and learning entitled him.
+His example may be an encouragement to some of my younger hearers who
+are born, not with the silver spoon in their mouths, but with the
+two-tined iron fork in their hands.  It is a poor thing to take up
+their milk porridge with in their young days, but in after years it
+will often transfix the solid dumplings that roll out of the silver
+spoon.  So Velpeau found it.  He had not what is called genius, he
+was far from prepossessing in aspect, looking as if he might have
+wielded the sledge-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 distinction and
+prosperity, as some of you sitting on these benches and wondering
+anxiously what is to become of you in the struggle for life will have
+done before the twentieth century has got halfway through its first
+quarter.  A good sound head over a pair of wooden shoes is a great
+deal better than a wooden head belonging to an owner who cases his
+feet in calf-skin, but a good brain is not enough without a stout
+heart to fill the four great conduits which carry at once fuel and
+fire to that mightiest of engines.
+
+How many of you who are before me are familiarly acquainted with the
+name of Broussais, or even with that of Andral?  Both were lecturing
+at the Ecole de Medicine, and I often heard them.  Broussais was in
+those days like an old volcano, which has pretty nearly used up its
+fire and brimstone, but is still boiling and bubbling in its
+interior, and now and then sends up a spirt of lava and a volley of
+pebbles.  His theories of gastro-enteritis, of irritation and
+inflammation as the cause of disease, and the practice which sprang
+from them, ran over the fields of medicine for a time like flame over
+the grass of the prairies.  The way in which that knotty-featured,
+savage old man would bring out the word irritation--with rattling and
+rolling reduplication of the resonant letter r--might have taught a
+lesson in articulation to Salvini.  But Broussais's theory was
+languishing and well-nigh become obsolete, and this, no doubt, added
+vehemence to his defence of his cherished dogmas.
+
+Old theories, and old men who cling to them, must take themselves out
+of the way as the new generation with its fresh thoughts and altered
+habits of mind comes forward to take the place of that which is dying
+out. This was a truth which the fiery old theorist found it very hard
+to learn, and harder to bear, as it was forced upon him.  For the
+hour of his lecture was succeeded by that of a younger and far more
+popular professor.  As his lecture drew towards its close, the
+benches, thinly sprinkled with students, began to fill up; the doors
+creaked open and banged back oftener and oftener, until at last the
+sound grew almost continuous, and the voice of the lecturer became a
+leonine growl as he strove in vain to be heard over the noise of
+doors and footsteps.
+
+Broussais was now sixty-two years old.  The new generation had
+outgrown his doctrines, and the Professor for whose hour the benches
+had filled themselves belonged to that new generation.  Gabriel
+Andral was little more than half the age of Broussais, in the full
+prime and vigor of manhood at thirty-seven years.  He was a rapid,
+fluent, fervid, and imaginative speaker, pleasing in aspect and
+manner,--a strong contrast to the harsh, vituperative old man who had
+just preceded him.  His Clinique Medicale is still valuable as a
+collection of cases, and his researches on the blood, conducted in
+association with Gavarret, contributed new and valuable facts to
+science.  But I remember him chiefly as one of those instructors
+whose natural eloquence made it delightful to listen to him.  I doubt
+if I or my fellow-students did full justice either to him or to the
+famous physician of Hotel Dieu, Chomel.  We had addicted ourselves
+almost too closely to the words of another master, by whom we were
+ready to swear as against all teachers that 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 young men before me, even to
+those who may know comparatively little of his works and teachings.
+Pierre Charles Alexandre Louis, at the age of forty-seven, as I
+recall him, was a tall, rather spare, dignified personage, of serene
+and grave aspect, but with a pleasant smile and kindly voice for the
+student with whom he came into personal relations.  If I summed up
+the lessons of Louis in two expressions, they would be these; I do
+not hold him answerable for the words, but I will condense them after
+my own fashion in French, and then give them to you, expanded
+somewhat, in English:
+
+          Formez toujours des idees nettes.
+          Fuyez toujours les a peu pres.
+
+Always make sure that you form a distinct and clear idea of the
+matter you are considering.
+
+Always avoid vague approximations where exact estimates are possible;
+about so many,--about so much, instead of the precise number and
+quantity.
+
+Now, if there is anything on which the biological sciences have
+prided themselves in these latter years it is the substitution of
+quantitative for qualitative formulae.  The "numerical system," of
+which Louis was the great advocate, if not the absolute originator,
+was an attempt to substitute series of carefully recorded facts,
+rigidly counted and closely compared, for those never-ending records
+of vague, unverifiable conclusions with which the classics of the
+healing art were overloaded.  The history of practical medicine had
+been like the story of the Danaides.  "Experience " had been, from
+time immemorial, pouring its flowing treasures into buckets full of
+holes.  At the existing rate of supply and leakage they would never
+be filled; nothing would ever be settled in medicine.  But cases
+thoroughly recorded and mathematically analyzed would always be
+available for future use, and when accumulated in sufficient number
+would lead to results which would be trustworthy, and belong to
+science.
+
+You young men who are following the hospitals hardly know how much
+you are indebted to Louis.  I say nothing of his Researches on
+Phthisis or his great work on Typhoid Fever.  But I consider his
+modest and brief Essay on Bleeding in some Inflammatory Diseases,
+based on cases carefully observed and numerically analyzed, one of
+the most important written contributions to practical medicine, to
+the treatment of internal disease, of this century, if not since the
+days of Sydenham.  The lancet was the magician's wand of the dark
+ages of medicine.  The old physicians not only believed in its
+general efficacy as a wonder-worker in disease, but they believed
+that each malady could be successfully attacked from some special
+part of the body,--the strategic point which commanded the seat of
+the morbid affection.  On a figure given in the curious old work of
+John de Ketam, no less than thirty-eight separate places are marked
+as the 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 suffering from headache should be bled in the foot, in
+preference to any other part.
+
+But what Louis did was this: he showed by a strict analysis of
+numerous cases that bleeding did not strangle,--jugulate was the word
+then used,--acute diseases, more especially pneumonia.  This was not
+a reform,--it was a revolution.  It was followed up in this country
+by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited
+Diseases, which has, I believe, done more than any other work or
+essay in our own language to rescue the practice of medicine from the
+slavery to the drugging system which was a part of the inheritance of
+the profession.
+
+Yes, I say, as I look back on the long hours of the many days I spent
+in the wards and in the autopsy room of La Pitie, where Louis was one
+of the attending physicians,--yes, Louis did a great work for
+practical medicine.  Modest in the presence of nature, fearless in
+the face of authority, unwearying in the pursuit of truth, he was a
+man whom any student might be happy and proud to claim as his teacher
+and his friend, and yet, as I look back on the days when I followed
+his teachings, I feel that I gave myself up too exclusively to his
+methods of thought and study.
+
+There is one part of their business which certain medical
+practitioners are too apt to forget; namely, that what they should
+most of all try to do is to ward off disease, to alleviate suffering,
+to preserve life, or at least to prolong it if possible.  It is not
+of the slightest interest to the patient to know whether three or
+three and a quarter cubic inches of his lung are hepatized.  His mind
+is not occupied with thinking of the curious problems which are to be
+solved by his own autopsy,--whether this or that strand of the spinal
+marrow is the seat of this or that form of degeneration.  He wants
+something to relieve his pain, to mitigate the anguish of dyspnea, to
+bring back motion and sensibility to the dead limb, to still the
+tortures of neuralgia.  What is it to him that you can localize and
+name by some uncouth term the disease which you could not prevent and
+which you cannot cure?  An old woman who knows how to make a poultice
+and how to put it on, and does it tuto, eito, jucunde, just when and
+where it is wanted, is better,--a thousand times better in many
+cases,--than a staring pathologist, who explores and thumps and
+doubts and guesses, and tells his patient be will be better tomorrow,
+and so goes home to tumble his books over and make out a diagnosis.
+
+But in those days, I, like most of my fellow students, was thinking
+much more of "science" than of practical medicine, and I believe if
+we had not clung so closely to the skirts of Louis and had followed
+some of the courses of men like Trousseau,--therapeutists, who gave
+special attention to curative methods, and not chiefly to diagnosis,
+--it would have been better for me and others.  One thing, at any
+rate, we did learn in the wards of Louis.  We learned that a very
+large proportion of diseases get well of themselves, without any
+special medication,--the great fact formulated, enforced, and
+popularized by Dr. Jacob Bigelow in the Discourse referred to.  We
+unlearned the habit of drugging for its own sake.  This detestable
+practice, which I was almost proscribed for condemning somewhat too
+epigrammatically a little more than twenty years ago, came to us, I
+suspect, in a considerable measure from the English "general
+practitioners," a sort of prescribing apothecaries.  You remember
+how, when the city was besieged, each artisan who was called upon in
+council to suggest the best means of defence recommended the articles
+he dealt in: the carpenter, wood; the blacksmith, iron; the mason,
+brick; until it came to be a puzzle to know which to adopt. Then the
+shoemaker said, "Hang your walls with new boots,"  and gave good
+reasons why these should be the best of all possible defences.  Now
+the "general practitioner"  charged, as I understand, for his
+medicine, and in that way got paid for his visit.  Wherever this is
+the practice, medicine is sure to become a trade, and the people
+learn to expect drugging, and to consider it necessary, because drugs
+are so universally given to the patients of the man who gets his
+living by them.
+
+It was something to have unlearned the pernicious habit of constantly
+giving poisons to a patient, as if they were good in themselves, of
+drawing off the blood 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 draught and mixtures,
+--only because he was sick and something must be done.  But there
+were positive as well as negative facts to be learned, and some of
+us, I fear, came home rich in the negatives of the expectant
+practice, poor in the resources which many a plain country
+practitioner had ready in abundance for the relief and the cure of
+disease.  No one instructor can be expected to do all for a student
+which he requires.  Louis taught us who followed him the love of
+truth, the habit of passionless listening to the teachings of nature,
+the most careful and searching methods of observation, and the sure
+means of getting at the results to be obtained from them in the
+constant employment of accurate tabulation.  He was not a showy, or
+eloquent, or, I should say, a very generally popular man, though the
+favorite, almost the idol, of many students, especially Genevese and
+Bostonians.  But he was a man of lofty and admirable scientific
+character, and his work will endure in its influences long after his
+name is lost sight of save to the faded eyes of the student of
+medical literature.
+
+Many other names of men more or less famous in their day, and who
+were teaching while I was in Paris, come up before me.  They are but
+empty sounds for the most part in the ears of persons of not more
+than middle age.  Who of you knows anything of Richerand, author of a
+very popular work on Physiology, commonly put into the student's
+hands when I first began to ask for medical text-books?  I heard him
+lecture once, and have had his image with me ever since as that of an
+old, worn-out man,--a venerable but dilapidated relic of an effete
+antiquity.  To verify this impression I have just looked out the
+dates of his birth and death, and find that he was eighteen years
+younger than the speaker who is now addressing you.  There is a
+terrible parallax between the period before thirty and that after
+threescore and ten, as two men of those ages look, one with naked
+eyes, one through his spectacles, at the man of fifty and thereabout.
+Magendie, I doubt not you have all heard of.  I attended but one of
+his lectures.  I question if one here, unless some contemporary of my
+own has strayed into the amphitheatre,--knows anything about
+Marjolin.  I remember two things about his lectures on surgery, the
+deep tones of his voice as he referred to his oracle,--the earlier
+writer, Jean Louis Petit,--and his formidable snuffbox.  What he
+taught me lies far down, 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 now is the fame of
+Bouillaud, Professor and Deputy, the Sangrado of his time?  Where is
+the renown of Piorry, percussionist and poet, expert alike in the
+resonances of the thoracic cavity and those of the rhyming
+vocabulary? --I think life has not yet done with the vivacious
+Ricord, whom I remember calling the Voltaire of pelvic literature,--a
+sceptic as to the morality of the race in general, who would have
+submitted Diana to treatment with his mineral specifics, and ordered
+a course of blue pills for the vestal virgins.
+
+Ricord was born at the beginning of the century, and Piorry some
+years earlier.  Cruveilhier, who died in 1874, is still remembered by
+his great work on pathological anatomy; his work on descriptive
+anatomy has some things which I look in vain for elsewhere.  But
+where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,
+--jolly old Baron Alibert, whom I remember so well in his broad-
+brimmed hat, worn a little jauntily on one side, calling out to the
+students in the court-yard of the Hospital St.  Louis, "Enfans de la
+methode naturelle, etes-vous tous ici?" "Children of the natural
+method [his own method of classification of skin diseases,] are you
+all here?  "All here, then, perhaps; all where, now?
+
+My show of ghosts is over.  It is always the same story that old men
+tell to younger ones, some few of whom will in their turn repeat the
+tale, only with altered names, to their children's children.
+
+     Like phantoms painted on the magic slide,
+     Forth from the darkness of the past we glide,
+     As living shadows for a moment seen
+     In airy pageant on the eternal screen,
+     Traced by a ray from one unchanging flame,
+     Then seek the dust and stillness whence we came.
+
+Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
+where he had written his Latin graduating thesis, talking of the
+learned Gaubius and the late illustrious Boerhaave and other dead
+Dutchmen, of whom you know as much, most of you, as you do of Noah's
+apothecary and the family physician of Methuselah, whose
+prescriptions seem to have been lost to posterity.  Dr. Lloyd came
+back to Boston full of the teachings of Cheselden and Sharpe, William
+Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr.
+Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his
+recollections of Sir Astley Cooper and Mr. Abernethy; I have named
+the famous Frenchmen of my student days; Leyden, Edinburgh, London,
+Paris, were each in turn the Mecca of medical students, just as at
+the present day Vienna and Berlin are the centres where our young men
+crowd for instruction.  These also must sooner or later yield their
+precedence and pass the torch they hold to other hands.  Where shall
+it next flame at the head of the long procession?  Shall it find its
+old place on the shores of the Gulf of Salerno, or shall it mingle
+its rays with the northern aurora up among the fiords of Norway,--or
+shall it be borne across the Atlantic and reach the banks of the
+Charles, where Agassiz and Wyman have taught, where Hagen still
+teaches, glowing like his own Lampyris splendidula, with enthusiasm,
+where the first of American botanists and the ablest of American
+surgeons are still counted in the roll of honor of our great
+University?
+
+Let me add a few words which shall not be other than cheerful, as I
+bid farewell to this edifice which I have known so long.  I am
+grateful to the roof which has sheltered me, to the floors which have
+sustained me, though I have thought it safest always to abstain from
+anything like eloquence, lest a burst of too emphatic applause might
+land my class and myself in the cellar of the collapsing structure,
+and bury us in the fate of Korah, Dathan, and Abiram.  I have helped
+to wear these stairs into hollows,--stairs which I trod when they
+were smooth and level, fresh from the plane.  There are just thirty-
+two of them, as there were five and thirty years ago, but they are
+steeper and harder to climb, it seems to me, than they were then.  I
+remember that in the early 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's room, that some day or other a
+whole class would go heels over head down this graded precipice, like
+the herd told of in Scripture story.  This has never happened as yet;
+I trust it never will.  I have never 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, and I resign it,
+with a wish that it were more worthy of regret, into the hands of my
+successor, with my parting benediction.  Within its twilight
+precincts I have often prayed for light, like Ajax, for the daylight
+found scanty entrance, and the gaslight never illuminated its dark
+recesses.  May it prove to him who comes after me like the cave of
+the Sibyl, out of the gloomy depths of which came the oracles which
+shone with the rays of truth and wisdom!
+
+This temple of learning is not surrounded by the mansions of the
+great and the wealthy.  No stately avenues lead up to its facades and
+porticoes.  I have sometimes felt, when convoying a distinguished
+stranger through its precincts to its door, that he might question
+whether star-eyed Science had not missed her way when she found
+herself in this not too attractive locality.  I cannot regret that
+we--you, I should say--are soon to migrate to a more favored region,
+and carry on your work as teachers and as learners in ampler halls
+and under far more favorable conditions.
+
+I hope that I may have the privilege of meeting you there, possibly
+may be allowed to add my words of welcome to those of my former
+colleagues, and in that pleasing anticipation I bid good-by to this
+scene of my long labors, and, for the present at least, to the
+friends with whom I have been associated.
+
+
+
+
+
+
+APPENDUM
+
+NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
+CURRENTS IN MEDICAL SCIENCE.
+
+Some passages contained in the original manuscript of the Address,
+and omitted in the delivery on account of its length, are restored in
+the text or incorporated with these Notes.
+
+NOTE A. --
+
+There is good reason to doubt whether the nitrate of silver has any
+real efficacy in epilepsy.  It has seemed to cure many cases, but
+epilepsy is a very uncertain disease, and there is hardly anything
+which has not been supposed to cure it.  Dr. Copland cites many
+authorities in its favor, most especially Lombard's cases.  But De la
+Berge and Monneret (Comp.  de Med.  Paris), 1839, analyze these same
+cases, eleven in number, and can only draw the inference of a very
+questionable value in the supposed remedy.  Dr. James Jackson says
+that relief of epilepsy is not to 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, Professor at the
+Royal College, Author of the Antimonial Martyrology, a wit and a man
+of sense and learning, who died almost two 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 cured by
+nitrate of silver?"  I said to one of the oldest and 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 given for epilepsy?  Because, as Dr. Martin has so
+well reminded us, lunatics were considered formerly to be under the
+special influence of Luna, the moon (which Esquirol, be it observed,
+utterly denies), and lunar caustic, or nitrate of silver, is a salt
+of that metal which was called luna from its whiteness, and of course
+must be in the closest relations with the moon.  It follows beyond
+all reasonable question that the moon's metal, silver, and its
+preparations, must be the specific remedy for moonblasted maniacs and
+epileptics!
+
+Yet the practitioner who prescribes the nitrate of silver supposes he
+is guided by the solemn experience of the past, instead of by its
+idle fancies.  He laughs at those old physicians who placed such
+confidence in the right hind hoof of an elk as a remedy for the same
+disease, and leaves the record of his own belief in a treatment quite
+as fanciful and far more objectionable, written in indelible ink upon
+a living tablet where he who runs may read it for a whole generation,
+if nature spares his walking advertisement so long.
+
+
+
+NOTE B. --
+
+The presumption that a man is innocent until he is proved guilty,
+does not mean that there are no rogues, but lays the onus probandi on
+the party to which it properly belongs.  So with this proposition.
+A noxious agent should never be employed in sickness unless there is
+ample evidence in the particular case to overcome the general
+presumption against all such agents, and the evidence is very apt to
+be defective.
+
+The miserable delusion of Homoeopathy builds itself upon an axiom
+directly the opposite of this; namely, that the sick are to be cured
+by poisons.  Similia similibus curantur means exactly this.  It is
+simply a theory of universal poisoning, nullified in practice by the
+infinitesimal contrivance.  The only way to kill it and all similar
+fancies, and to throw every quack nostrum into discredit, is to root
+out completely the suckers of the old rotten superstition that
+whatever is odious or noxious is likely to be good for disease.  The
+current of sound practice with ourselves is, I believe, setting fast
+in the direction I have indicated in the above proposition.  To
+uphold the exhibition of noxious agents in disease, as the rule,
+instead of admitting them cautiously and reluctantly as the
+exception, is, as I think, an eddy of opinion in the direction of the
+barbarism out of which we believe our art is escaping.  It is only
+through the enlightened sentiment and action of the Medical
+Profession that the community can be brought to acknowledge that
+drugs should always be regarded as evils.
+
+It is true that some suppose, and our scientific and thoughtful
+associate, Dr.  Gould, has half countenanced the opinion, that there
+may yet be discovered a specific for every disease.  Let us not
+despair of the future, but let us be moderate in our expectations.
+When an oil is discovered that will make a bad watch keep good time;
+when a recipe is given which will turn an acephalous foetus into a
+promising child; when a man can enter the second time into his
+mother's womb and give her back the infirmities which twenty
+generations have stirred into her blood, and infused into his own
+through hers, we may be prepared to enlarge the National
+Pharmacopoeia with a list of specifies for everything but old age,
+--and possibly for that also.
+
+
+
+NOTE C. --
+
+The term specific is used here in its ordinary sense, without raising
+the question of the propriety of its application to these or other
+remedies.
+
+The credit of introducing Cinchona rests between the Jesuits, the
+Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
+who employed it as a secret remedy.  (Pereira.) Mercury as an
+internal specific remedy was brought into use by that impudent and
+presumptuous quack, as he was considered, Paracelsus.  (Encyc.  Brit.
+art.  "Paracelsus.") Arsenic was introduced into England as a remedy
+for intermittents by Dr. Fowler, in consequence of the success of a
+patent medicine, the Tasteless Ague Drops, which were supposed,
+"probably with reason," to be a preparation of that mineral.  (Rees's
+Cyc.  art.  "Arsenic.")  Colchicum came into notice in a similar way,
+from the success of the Eau Medicinale of M. Husson, a French
+military officer.  (Pereira.) Iodine was discovered by a saltpetre
+manufacturer, but applied by a physician in place of the old remedy,
+burnt sponge, which seems to owe its efficacy to it.  (Dunglison, New
+Remedies.) As for Sulphur, "the common people have long used it as an
+ointment" for scabies.  (Rees's Cyc.  art.  "Scabies.") The modern
+cantiscorbutic regimen is credited to Captain Cook.  "To his sagacity
+we are indebted for the first impulse to those regulations by which
+scorbutus is so successfully prevented in our navy."  (Lond.  Cyc.
+Prac.  Med.  art.  "Scorbutus.") Iron and various salts which enter
+into the normal composition of the human body do not belong to the
+materia medica by our definition, but to the materia alimentaria.
+
+For the first introduction of iron as a remedy, see Pereira, who
+gives a very curious old story.
+
+The statement in the text concerning a portion of the materia medica
+stands exactly as delivered, and is meant exactly as it stands.  No
+denunciation of drugs, as sparingly employed by a wise physician, was
+or is intended.  If, however, as Dr.  Gould stated in his "valuable
+and practical discourse" to which the Massachusetts Medical Society
+"listened with profit as well as interest,"  "Drugs, in themselves
+considered, may always be regarded as evils,"--any one who chooses
+may question whether the evils from their abuse are, on the whole,
+greater or less than the undoubted benefits obtained from their
+proper use.  The large exception of opium, wine, specifics, and
+anaesthetics, made in the text, takes off enough from the useful
+side, as I fully believe, to turn the balance; so that a vessel
+containing none of these, but loaded with antimony, strychnine,
+acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus
+diaboli, tormentilla, and other approved, and, in skilful hands,
+really useful remedies, brings, on the whole, more harm than good to
+the port it enters.
+
+It is a very narrow and unjust view of the practice of medicine, to
+suppose it to consist altogether in the use of powerful drugs, or of
+drugs of any kind.  Far from it.  "The physician may do very much for
+the welfare of the sick, more than others can do, although he does
+not, even in the major part of cases, undertake to control and
+overcome the disease by art.  It was with these views that I never
+reported any patient cured at our hospital.  Those who recovered
+their health were reported as well; not implying that they were made
+so by the active treatment they had received there.  But it was to be
+understood that all patients received in that house were to be cured,
+that is, taken care of."  (Letters to a Young Physician, by James
+Jackson, M.  D., Boston, 1855.)
+
+"Hygienic rules, properly enforced, fresh air, change of air, travel,
+attention to diet, good and appropriate food judiciously regulated,
+together with the administration of our tonics, porter, ale, wine,
+iron, etc., supply the diseased or impoverished system with what Mr.
+Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of
+the blood;' and we believe that if any real improvement has taken
+place in medical practice, independently of those truly valuable
+contributions we have before described, it is in the substitution of
+tonics, stimulants, and general management, for drastic cathartics,
+for bleeding, depressing agents, including mercury, tartar emetics,
+etc., so much in vogue during the early part even of this century."
+(F. P. Porcher, in Charleston Med. Journal and Review for January,
+1860.)
+
+
+
+
+
+End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes
+
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+The Project Gutenberg Etext of Medical Essays, by O. W. Holmes, Sr.
+#9 in our series by Oliver Wendell Holmes, Sr. (The Physician and Poet)
+
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+Title: Medical Essays
+
+Author: Oliver Wendell Holmes, Sr. (The Physician and Poet)
+(Not the Jurist O. W. Holmes, Jr.)
+
+Release Date: July, 2001 [Etext #2700]
+[Yes, we are more than one year ahead of schedule]
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+The Project Gutenberg Etext of Medical Essays, by Oliver W. Holmes
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+
+MEDICAL ESSAYS
+
+By Oliver Wendell Holmes
+
+
+
+
+1842-1882
+
+
+CONTENTS:
+
+I.   HOMEOPATHY AND ITS KINDRED DELUSIONS
+
+II.  THE CONTAGIOUSNESS OF PUERPERAL FEVER
+
+III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+IV.  BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE
+
+V.   SCHOLASTIC AND BEDSIDE TEACHING
+
+VI.  THE MEDICAL PROFESSION IN MASSACHUSETTS
+
+VII. THE YOUNG PRACTITIONER
+
+VIII. MEDICAL LIBRARIES
+
+IX.  SOME OF MY EARLY TEACHERS
+
+
+
+
+
+
+PREFACE.
+
+The character of the opposition which some of these papers have met
+with suggests the inference that they contain really important, but
+unwelcome truths.  Negatives multiplied into each other change their
+sign and become positives.  Hostile criticisms meeting together are
+often equivalent to praise, and the square of fault-finding turns out
+to be the same thing as eulogy.
+
+But a writer has rarely so many enemies as it pleases him to believe.
+Self-love leads us to overrate the numbers of our negative
+constituency.  The larger portion of my limited circle of readers
+must be quite indifferent to, if not ignorant of, the adverse
+opinions which have been expressed or recorded concerning any of
+these Addresses or Essays now submitted to their own judgment.  It is
+proper, however, to inform them, that some of the positions
+maintained in these pages have been unsparingly attacked, with
+various degrees of ability, scholarship, and good-breeding.  The tone
+of criticism naturally changes with local conditions in different
+parts of a country extended like our own, so that it is one of the
+most convenient gauges of the partial movements in the direction of
+civilization.  It is satisfactory to add, that the views assailed
+have also been unflinchingly defended by unsought champions, among
+the ablest of whom it is pleasant to mention, at this moment of
+political alienation, the Editor of the Charleston Medical Journal.
+
+"Currents and Counter-Currents" was written and delivered as an
+Oration, a florid rhetorical composition, expressly intended to
+secure the attention of an audience not easy to hold as listeners.
+It succeeded in doing this, and also in being as curiously
+misunderstood and misrepresented as if it had been a political
+harangue.  This gave it more local notoriety than it might otherwise
+have attained, so that, as I learn, one ingenious person made use of
+its title as an advertisement to a production of his own.
+
+The commonest mode of misrepresentation was this: qualified
+propositions, the whole meaning of which depended on the
+qualifications, were stripped of these and taken as absolute.  Thus,
+the attempt to establish a presumption against giving poisons to sick
+persons was considered as equivalent to condemning the use of these
+substances.  The only important inference the writer has been able to
+draw from the greater number of the refutations of his opinions which
+have been kindly sent him, is that the preliminary education of the
+Medical Profession is not always what it ought to be.
+
+One concession he is willing to make, whatever sacrifice of pride it
+may involve.  The story of Massasoit, which has furnished a coral, as
+it were, for some teething critics, when subjected to a powerful
+logical analysis, though correct in its essentials, proves to have
+been told with exceptionable breadth of statement, and therefore (to
+resume the metaphor) has been slightly rounded off at its edges, so
+as to be smoother for any who may wish to bite upon it hereafter.  In
+other respects the Discourse has hardly been touched.  It is only an
+individual's expression, in his own way, of opinions entertained by
+hundreds of the Medical Profession in every civilized country, and
+has nothing in it which on revision the writer sees cause to retract
+or modify.  The superstitions it attacks lie at the very foundation
+of Homoeopathy, and of almost every form of medical charlatanism.
+Still the mere routinists and unthinking artisans in most callings
+dislike whatever shakes the dust out of their traditions, and it may
+be unreasonable to expect that Medicine will always prove an
+exception to the rule.  One half the opposition which the numerical
+system of Louis has met with, as applied to the results of treatment,
+has been owing to the fact that it showed the movements of disease to
+be far more independent of the kind of practice pursued than was
+agreeable to the pride of those whose self-confidence it abated.
+
+The statement, that medicines are more sparingly used in physicians'
+families than in most others, admits of a very natural explanation,
+without putting a harsh construction upon it, which it was not
+intended to admit.  Outside pressure is less felt in the physician'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 who
+have more confidence in drugging than his own family commonly has,
+the learned Professor Dunglison is hereby requested to apologize for
+his definition of the word Placebo, or to expunge it from his Medical
+Dictionary.
+
+One thing is certain.  A loud outcry on a slight touch reveals the
+weak spot in a profession, as well as in a patient.  It is a doubtful
+policy to oppose the freest speech in those of our own number who are
+trying to show us where they honestly believe our weakness lies.
+Vast as are the advances of our Science and Art, may it not possibly
+prove on examination that we retain other old barbarisms beside the
+use of the astrological sign of Jupiter, with which we endeavor to
+insure good luck to our prescriptions?  Is it the act of a friend or
+a foe to try to point them out to our brethren when asked to address
+them, and is the speaker to subdue the constitutional habit of his
+style to a given standard, under penalty of giving offence to a grave
+assembly?
+
+"Homoeopathy and its Kindred Delusions" was published nearly twenty
+years ago, and has been long out of print, so that the author tried
+in vain to procure a copy until the kindness of a friend supplied him
+with the only one he has had for years.  A foolish story reached his
+ears that he was attempting to buy up stray copies for the sake of
+suppressing it.  This edition was in the press at that very time.
+
+Many of the arguments contained in the Lectures have lost whatever
+novelty they may have possessed.  All its predictions have been
+submitted to the formidable test of time.  They appear to have stood
+it, so far, about as well as most uninspired prophecies; indeed, some
+of them require much less accommodation than certain grave
+commentators employ in their readings of the ancient Prophets.
+
+If some statistics recently published are correct, Homoeopathy has
+made very slow progress in Europe.
+
+In all England, as it appears, there are hardly a fifth more
+Homoeopathic practitioners than there are students attending Lectures
+at the Massachusetts Medical College at the present time.  In America
+it has undoubtedly proved more popular and lucrative, yet how loose a
+hold it has on the public confidence is shown by the fact that, when
+a specially valued life, which has been played with by one of its
+agents, is seriously threatened, the first thing we expect to hear is
+that a regular practitioner is by the patient's bed, and the
+Homoeopathic counsellor overruled or discarded.  Again, how many of
+the ardent and capricious persons who embraced Homoeopathy have run
+the whole round of pretentious novelties;--have been boarded at
+water-cure establishments, closeted with uterine and other
+specialists, and finally wandered over seas to put themselves in
+charge of foreign celebrities, who dosed them as lustily as they were
+ever dosed before they took to globules!  It will surprise many to
+learn to what a shadow of a shade Homoeopathy has dwindled in the
+hands of many of its noted practitioners.  The itch-doctrine is
+treated with contempt.  Infinitesimal doses are replaced by full ones
+whenever the fancy-practitioner chooses.  Good Homoeopathic reasons
+can be found for employing anything that anybody wants to employ.
+Homoeopathy 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 cases where we would thankfully sacrifice all
+our prejudices and give the world to have them true to their
+promises.
+
+Homoeopathy has not died out so rapidly as Tractoration.  Perhaps it
+was well that it should not, for it has taught us a lesson of the
+healing faculty of Nature which was needed, and for which many of us
+have made proper acknowledgments.  But it probably does more harm
+than good to medical science at the present time, by keeping up the
+delusion of treating everything by specifics,--the old barbarous
+notion that sick people should feed on poisons [Lachesis, arrow-
+poison, obtained from a serpent (Pulte).  Crotalus horridus,
+rattlesnake's venom (Neidhard).  The less dangerous Pediculus capitis
+is the favorite remedy of Dr. Mure, the English "Apostle of
+Homoeopathy."  These are examples of the retrograde current setting
+towards barbarism] against which a part of the Discourse at the
+beginning of this volume is directed.
+
+The infinitesimal globules have not become a curiosity as yet, like
+Perkins's Tractors.  But time is a very elastic element in Geology
+and Prophecy.  If Daniel's seventy weeks mean four hundred and ninety
+years, as the learned Prideaux and others have settled it that they
+do, the "not many years" of my prediction may be stretched out a
+generation or two beyond our time, if necessary, when the prophecy
+will no doubt prove true.
+
+It might be fitting to add a few words with regard to the Essay on
+the Contagiousness of Puerperal Fever.  But the whole question I
+consider to be now transferred from the domain of medical inquiry to
+the consideration of Life Insurance agencies and Grand Juries.  For
+the justification of this somewhat sharply accented language I must
+refer the reader to the paper itself for details which I regret to
+have been forced to place on permanent record.
+
+BOSTON, January, 1861.
+
+
+
+
+A SECOND PREFACE.
+
+These Lectures and Essays are arranged in the order corresponding to
+the date of their delivery or publication.  They must, of course, be
+read with a constant reference to these dates, by such as care to
+read them.  I have not attempted to modernize their aspect or
+character in presenting them, in this somewhat altered connection, to
+the public.  Several of them were contained in a former volume which
+received its name from the Address called "Currents and Counter-
+Currents."  Some of those contained in the former volume have been
+replaced by others.  The Essay called "Mechanism of Vital Actions"
+has been transferred to a distinct collection of Miscellaneous
+essays, forming a separate volume.
+
+I had some intention of including with these papers an Essay on
+Intermittent Fever in New England, which received one of the Boylston
+prizes in 1837, and was published in the following year.  But as this
+was upon a subject of local interest, chiefly, and would have taken
+up a good deal of room, I thought it best to leave it out, trusting
+that the stray copies to be met with in musty book-shops would
+sufficiently supply the not very extensive or urgent demand for a
+paper almost half a century old.
+
+Some of these papers created a little stir when they first fell from
+the press into the pool of public consciousness.  They will slide in
+very quietly now in this new edition, and find out for themselves
+whether the waters are those of Lethe, or whether they are to live
+for a time as not wholly unvalued reminiscences.
+
+March 21, 1883.
+
+
+
+
+PREFACE TO THE NEW EDITION.
+
+These Essays are old enough now to go alone without staff or crutch
+in the shape of Prefaces.  A very few words may be a convenience to
+the reader who takes up the book and wishes to know what he is likely
+to find in it.
+
+
+               HOMOEOPATHY AND ITS KINDRED DELUSIONS.
+
+Homoeopathy has proved lucrative, and so long as it continues to be
+so will surely exist,--as surely as astrology, palmistry, and other
+methods of getting a living out of the weakness and credulity of
+mankind and womankind.  Though it has no pretensions to be considered
+as belonging among the sciences, it may be looked upon by a
+scientific man as a curious object 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 studied it in the Essay before
+the reader, under the aspect of an extravagant and purely imaginative
+creation of its founder.  Since that first essay was written, nearly
+half a century ago, we have all had a chance to witness its practical
+working.  Two opposite inferences 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 by a much larger number of persons.  As they see
+that patients are very commonly getting well under treatment by
+infinitesimal drugging, which they consider equivalent to no
+medication at all, they come to disbelieve in every form of drugging
+and put their whole trust in "nature."  Thus experience,
+
+          "From seeming evil still educing good,"
+
+has shown that the dealers in this preposterous system of pseudo-
+therapeutics have cooperated with the wiser class of practitioners in
+breaking up the system of over-dosing and over-drugging which has
+been one of the standing reproaches of medical practice.  While.
+keeping up the miserable delusion that diseases were all to be
+"cured" by drugging, Homoeopathy has been unintentionally showing
+that they would very generally get well without any drugging at all.
+In the mean time the newer doctrines of the "mind cure," the "faith
+cure," and the rest are encroaching on the territory so long
+monopolized by that most ingenious of the pseudo-sciences.  It would
+not be surprising if its whole ground should be taken possession of
+by these new claimants with their flattering appeals to the
+imaginative class of persons open to such attacks.  Similia similabus
+may prove fatally true for once, if Homoeopathy is killed out by its
+new-born rivals.
+
+It takes a very moderate amount of erudition to unearth a charlatan
+like the supposed father of the infinitesimal dosing system.  The
+real inventor of that specious trickery was an Irishman by the name
+of Butler.  The whole story is to be found in the "Ortus Medicinm" of
+Van Helmont.  I have given some account of his chapter "Butler" in
+different articles, but I would refer the students of our
+Homoeopathic educational institutions to the original, which they
+will find very interesting and curious.
+
+
+                    CURRENTS AND COUNTER-CURRENTS
+
+My attack on over-drugging brought out some hostile comments and
+treatment.  Thirty years ago I expressed myself with more vivacity
+than I should show if I were writing on the same subjects today.
+Some of my more lively remarks called out very sharp animadversion.
+Thus my illustration of prevention as often better than treatment in
+the mother's words to her child which had got a poisonous berry in
+its mouth,--"Spit it out!" gave mortal offence to a well-known New
+York practitioner and writer, who advised the Massachusetts Medical
+Society to spit out the offending speaker.  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 and in excess, as then used "could be
+sunk to the bottom of the sea, it would be all the better for mankind
+and all the worse for the fishes."  This was too bad.  The sentence
+was misquoted, quoted without its qualifying conditions, and
+frightened some of my worthy professional brethren as much as if I
+had told them to throw all physic to the dogs.  But for the
+epigrammatic sting the sentiment would have been unnoticed as a
+harmless overstatement at the very worst.
+
+Since this lecture was delivered a great and, as I think, beneficial
+change has taken place in the practice of medicine.  The habit of the
+English "general practitioner" of making his profit out of the pills
+and potions he administered was ruinous to professional advancement
+and the dignity of the physician.  When a half-starving medical man
+felt that he must give his patient draught and boluses for which he
+could charge him, he was in a pitiable position and too likely to
+persuade himself that his drugs were useful to 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 the
+errors I combated.
+
+
+               THE CONTAGIOUSNESS 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 but a single year.  It naturally attracted less attention than
+it would have done if published in such a periodical as the "American
+Journal of Medical Sciences."  Still it had its effect, as I have
+every reason to believe.  I cannot doubt that it has saved the lives
+of many young mothers by calling attention to the existence and
+propagation of "Puerperal Fever as a Private Pestilence," and laying
+down rules for taking the necessary precautions against it.  The case
+has long been decided in favor of the views I advocated, but, at the
+time when I wrote two of the most celebrated professors of Obstetrics
+in this country opposed my conclusions with all the weight of their
+experience and position.
+
+This paper was written in a great heat and with passionate
+indignation.  If I touched it at all I might trim its rhetorical
+exuberance, but I prefer to leave it all its original strength of
+expression.  I could not, if I had tried, have disguised the feelings
+with which I regarded the attempt to put out of sight the frightful
+facts which I brought forward and the necessary conclusions to which
+they led.  Of course the whole matter has been looked at in a new
+point of view since the microbe as a vehicle of contagion has been
+brought into light, and explained the mechanism of that which was
+plain enough as a fact to all who were not blind or who did not shut
+their eyes.
+
+O.  W.  H.
+
+BEVERLY Farms, Mass., August 3, 1891
+
+
+
+
+
+
+HOMOEOPATHY AND ITS KINDRED DELUSIONS
+[Two lectures delivered before the Boston Society for the Diffusion
+of Useful Knowledge.  1842.]
+
+
+[When a physician attempts to convince a person, who has fallen into
+the Homoeopathic delusion, of the emptiness of its pretensions, he is
+often answered by a statement of cases in which its practitioners are
+thought to have effected wonderful cures.  The main object of the
+first of these Lectures is to show, by abundant facts, that such
+statements, made by persons unacquainted with the fluctuations of
+disease and the fallacies of observation, are to be considered in
+general as of little or no value in establishing the truth of a
+medical doctrine or the utility of a method of practice.
+
+Those kind friends who suggest to a person suffering from a tedious
+complaint, that he "Had better try Homoeopathy," are apt to enforce
+their suggestion by 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 community to encourage ignorance, error,
+or deception in a profession which deals with the life and health of
+our fellow-creatures.  Whether or not those who countenance
+Homoeopathy are guilty of this injustice towards others, the second
+of these Lectures may afford them some means of determining.
+
+To deny that good effects may happen from the observance of diet and
+regimen when prescribed by Homoeopathists as well as by others, would
+be very unfair to them.  But to suppose that men with minds so
+constituted as to accept such statements and embrace such doctrines
+as make up the so-called science of Homoeopathy are more competent
+than others to regulate the circumstances which influence the human
+body in health and disease, would be judging very harshly the average
+capacity of ordinary practitioners.
+
+To deny that some patients may have been actually benefited through
+the influence exerted upon their imaginations, would be to refuse to
+Homoeopathy what all are willing to concede to every one of those
+numerous modes of practice known to all intelligent persons by an
+opprobrious title.
+
+So long as the body is affected through the mind, no audacious
+device, even of the most manifestly dishonest character, can fail of
+producing occasional good to those who yield it an implicit or even a
+partial faith.  The argument founded on this occasional good would be
+as applicable in justifying the counterfeiter and giving circulation
+to his base coin, on the ground that a spurious dollar had often
+relieved a poor man's necessities.
+
+Homoeopathy has come before our public at a period when the growing
+spirit of eclecticism has prepared many ingenious and honest minds to
+listen to all new doctrines with a candor liable to degenerate into
+weakness.  It is not impossible that the pretended evolution of great
+and mysterious virtues from infinitely attenuated atoms may have
+enticed a few over-refining philosophers, who have slid into a vague
+belief that matter subdivided grows less material, and approaches
+nearer to a spiritual nature as it requires a more powerful
+microscope for its detection.
+
+However this may be, some persons seem disposed to take the ground of
+Menzel that the Laity must pass formal judgment between the Physician
+and the Homoeopathist, 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 in these Lectures upon
+this shadowy system; which, in the calm and serious judgment of many
+of the wisest members of the medical profession, is not entitled by
+anything it has ever said or done to the notoriety of a public
+rebuke, still less to the honors of critical martyrdom.]
+
+
+I
+
+I have selected four topics for this lecture, the first three of
+which I shall touch but slightly, the last more fully.  They are
+
+1.  The Royal cure of the King's Evil, or Scrofula.
+
+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 numerous facts are
+accumulated to prove the most fanciful and senseless extravagances.
+
+The third exhibits the entire insufficiency of exalted wisdom,
+immaculate honesty, and vast general acquirements to make a good
+physician of a great bishop.
+
+The fourth shows us the intimate machinery of an extinct delusion,
+which flourished only forty years ago; drawn in all its details, as
+being a rich and comparatively recent illustration of the
+pretensions, the arguments, the patronage, by means of which windy
+errors have long been, and will long continue to be, swollen into
+transient consequence.  All display in superfluous abundance the
+boundless credulity and excitability of mankind upon subjects
+connected with medicine.
+
+From the time of Edward the Confessor to Queen Anne, the monarchs of
+England were in the habit of touching those who were brought to them
+suffering with the scrofula, for the cure of that distemper.  William
+the Third had good sense enough to discontinue the practice, but Anne
+resumed it, and, among her other patients, performed the royal
+operation upon a child, who, in spite of his, disease, grew up at
+last into Samuel Johnson.  After laying his hand upon the sufferers,
+it was customary for the monarch to hang a gold piece around the neck
+of each patient.  Very strict precautions were adopted to prevent
+those who thought more of the golden angel hung round the neck by a
+white ribbon, than of relief of their bodily infirmities, from making
+too many calls, as they sometimes attempted to do.  According to the
+statement of the advocates and contemporaries of this remedy, none
+ever failed of receiving benefit unless their little faith and
+credulity starved their merits.  Some are said to have been cured
+immediately on the very touch, 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 for several weeks,
+and months, and obliged even to be led to Whitehall, yet recovered
+their sight immediately upon being touched, so as to walk away
+without any guide."  So widely, at one period, was the belief
+diffused, that, in the course of twelve years, nearly a hundred
+thousand persons were touched by Charles the Second.  Catholic
+divines; in disputes upon the orthodoxy of their church, did not deny
+that the power had descended to protestant princes;--Dr. Harpsfield,
+in his "Ecclesiastical History of England," admitted it, and in
+Wiseman's words, "when Bishop Tooker would make use of this Argument
+to prove the Truth of our Church, Smitheus doth not thereupon go
+about to deny the Matter of fact; nay, both he and Cope acknowledge
+it."  "I myself," says Wiseman, the best English surgical writer of
+his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.]
+--"I my self have been a frequent Eye-witness of many hundred of
+Cures performed by his Majesties Touch alone, without any assistance
+of Chirurgery; and those, many of them such as had tired out the
+endeavours of able Chirurgeons before they came hither.  It were
+endless to recite what I myself have seen, and what I have received
+acknowledgments of by Letter, not only from the severall parts of
+this Nation, but also from Ireland, Scotland, Jersey, Garnsey.  It is
+needless also to remember what Miracles of this nature were performed
+by the very Bloud of his late Majesty of Blessed memory, after whose
+decollation by the inhuman Barbarity of the Regicides, the reliques
+of that were gathered on Chips and in Handkerchieffs by the pious
+Devotes, who could not but think so great a suffering in so
+honourable and pious a Cause, would be attended by an extraordinary
+assistance 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, accounted for these
+cures in three ways: by the journey and change of air the patients
+obtained in coming to London; by the influence of imagination; and
+the wearing of gold.
+
+To these objections he answers, 1st.  That many of those cured were
+inhabitants of the city.  2d.  That the subjects of treatment were
+frequently infants.  3d.  That sometimes silver was given, and
+sometimes nothing, yet the patients were cured.
+
+A superstition resembling this probably exists at the present time in
+some ignorant districts of England and this country.  A writer in a
+Medical Journal in the year 1807, speaks of a farmer in Devonshire,
+who, being a ninth son of a ninth son, is thought endowed with
+healing powers like those of ancient royalty, and who is accustomed
+one day in every week to strike for the evil.
+
+I remember that one of my schoolmates told me, when a boy, of a
+seventh son of a seventh son, somewhere in Essex County, who touched
+for the scrofula, and who used to hang a silver fourpence halfpenny
+about the neck of those who came to him, which fourpence halfpenny it
+was solemnly affirmed became of a remarkably black color after having
+been some time worn, and that his own brother had been subjected to
+this extraordinary treatment; but I must add that my schoolmate drew
+a bow of remarkable length, strength, and toughness for his tender
+years.
+
+One of the most curious examples of the fallacy of popular belief and
+the uncertainty of asserted facts in medical experience is to be
+found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
+
+Fabricius Hildanus, whose name is familiar to every surgical
+scholar, and Lord Bacon, who frequently dipped a little into
+medicine, are my principal authorities for the few circumstances I
+shall mention regarding it.  The Weapon Ointment was a preparation
+used for the healing of wounds, but instead of its being applied to
+them, the injured part was washed and bandaged, and the weapon with
+which the wound was inflicted was carefully anointed with the
+unguent.  Empirics, ignorant barbers, and men of that sort, are said
+to have especially employed it.  Still there were not wanting some
+among the more respectable members of 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, rather
+than the wound or weapon, entered into all.  Such were portions of
+mummy, of human blood, and of moss from the skull of a thief hung in
+chains.
+
+Hildanus was a wise and learned man, one of the best surgeons of his
+time.  He was fully aware that a part of the real secret of the
+Unguentum Armarium consisted in the washing and bandaging the wound
+and then letting it alone.  But he could not resist the solemn
+assertions respecting its efficacy; he gave way before the outcry of
+facts, and therefore, instead of denying all their pretensions, he
+admitted and tried to account for them upon supernatural grounds.  As
+the virtue of those applications, he says, which are made to the
+weapon cannot reach the wound, and as they can produce no effect
+without contact, it follows, of necessity, that the Devil must have a
+hand in the business; and as he is by far the most long headed and
+experienced of practitioners, he cannot find this a matter of any
+great difficulty.  Hildanus himself reports, in detail, the case of a
+lady who had received a moderate wound, for which the Unguentum
+Armarium was employed without the slightest use.  Yet instead of
+receiving this flat case of failure as any evidence against the
+remedy, he accounts for its not succeeding by the devout character of
+the lady, and her freedom from that superstitious and over-
+imaginative tendency which the Devil requires in those who are to be
+benefited by his devices.
+
+Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
+having in its favor the testimony of men of credit, though, in his
+own language, he himself "as yet is not fully inclined to believe
+it."  His remarks upon the asserted facts respecting it show a
+mixture of wise suspicion and partial belief.  He does not like the
+precise directions given as to the circumstances under which the
+animals from which some of the materials were obtained were to be
+killed; for he thought it looked like a provision for an excuse in
+case of failure, by laying the fault to the omission of some of these
+circumstances.  But he likes well that "they do not observe the
+confecting of the Ointment under any certain constellation; which is
+commonly the excuse of magical medicines, when they fail, that they
+were not made under a fit figure of heaven."  [This was a mistake,
+however, since the two recipes given by Hildanus are both very
+explicit as to the aspect of the heavens required for different
+stages of the process.]  "It was pretended that if the offending
+weapon could not be had, it would serve the purpose to anoint a
+wooden one made like it."  "This," says Bacon, "I should doubt to be a
+device to keep this strange form of cure in request and use; because
+many times you cannot come by the weapon itself."  And in closing his
+remarks on the statements of the advocates of the ointment, he says,
+"Lastly, it will cure a beast as well as a man, which I like best of
+all the rest, because it subjecteth the matter to an easy trial."  It
+is worth remembering, that more than two hundred years ago, when an
+absurd and fantastic remedy was asserted to possess wonderful power,
+and when sensible persons ascribed its pretended influence to
+imagination, it was boldly answered that the cure took place when the
+wounded party did not know of the application made to the weapon, and
+even when a brute animal was the subject of the experiment, and that
+this assertion, as we all know it was, came in such a shape as to
+shake the incredulity of the keenest thinker of his time.  The very
+same assertion has been since repeated in favor of Perkinism, and,
+since that, of Homoeopathy.
+
+The same essential idea as that of the Weapon Ointment reproduced
+itself in the still more famous SYMPATHETIC POWDER.  This Powder was
+said to have the faculty, if applied to the blood-stained garments of
+a wounded person, to cure his injuries, even though he were at a
+great distance at the time.  A friar, returning from the East,
+brought the recipe to Europe somewhat before the middle of the
+seventeenth century.  The Grand Duke of Florence, in which city the
+friar was residing, heard of his cures, and tried, but without
+success, to obtain his secret.  Sir Kenehn Digby, an Englishman well
+known to fame, was fortunate enough to do him a favor, which wrought
+upon his feelings and induced him to impart to his benefactor the
+composition of his extraordinary Powder.  This English knight was at
+different periods of his life an admiral, a theologian, a critic, a
+metaphysician, a politician, and a disciple of Alchemy.  As is not
+unfrequent with versatile and inflammable people, he caught fire at
+the first spark of a new medical discovery, and no sooner got home to
+England than he began to spread the conflagration.
+
+An opportunity soon offered itself to try the powers of the famous
+powder.  Mr. J. Howell, having been wounded in endeavoring to part
+two of his friends who were fighting a duel, submitted himself to a
+trial of the Sympathetic Powder.  Four days after he received 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 were
+very painful, grew easy, although the patient, who was 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
+hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent
+his servant in a great hurry to tell him that his wounds were paining
+him horribly; the garter was therefore replaced in the solution of
+the Powder, "and the patient got well after five or six days of its
+continued immersion."
+
+King James First, his son Charles the First, the Duke of Buckingham,
+then prime minister, and all the principal personages of the time,
+were cognizant of this fact; and James himself, being curious to know
+the secret of this remedy, asked it of Sir Kenelm, who revealed it to
+him, and his Majesty had the opportunity of making several trials of
+its efficacy, "which all succeeded in a surprising manner." [Dict.
+des Sciences Medieales.]
+
+The king's physician, Dr. Mayerne, was made master of the secret,
+which he carried to France and communicated to the Duke of Mayenne,
+who performed many cures by means of it, and taught it to his
+surgeon, who, after the Duke's death, sold it to many distinguished
+persons, by whose agency it soon ceased to be a secret.  What was
+this wonderful substance which so astonished kings, princes, dukes,
+knights, and doctors?  Nothing but powdered blue vitriol.  But it was
+made to undergo several processes that conferred on it extraordinary
+virtues.  Twice or thrice it was to be dissolved, filtered, and
+crystallized.  The crystals were to be laid in the sun during the
+months of June, July, and August, taking care to turn them carefully
+that all should be exposed.  Then they were to be powdered,
+triturated, and again exposed to the sun, again reduced to a very
+fine powder, and secured in a vessel, while hot, from the sunshine.
+If there seem anything remarkable in the fact of such astonishing
+properties being developed by this process, it must be from our
+short-sightedness, for common salt and charcoal develop powers quite
+as marvellous after a certain number of thumps, stirs, and shakes,
+from the hands of modern workers of miracles.  In fact the Unguentum
+Armarium and Sympathetic Powder resemble some more recent
+prescriptions; the latter consisting in an infinite dilution of the
+common dose in which remedies are given, and the two former in an
+infinite dilution of the common distance at which they are applied.
+
+Whether philosophers, and more especially metaphysicians, have any
+peculiar tendency to dabble in drugs and dose themselves with physic,
+is a question which might suggest itself to the reader of their
+biographies.
+
+When Bishop Berkeley visited the illustrious Malebranche at Paris, he
+found him in his cell, cooking in a small pipkin a medicine for an
+inflammation of the lungs, from which he was suffering; and the
+disease, being unfortunately aggravated by the vehemence of their
+discussion, or the contents of the pipkin, carried him off in the
+course of a few days.  Berkeley himself afforded a remarkable
+illustration of a truth which has long been known to the members of
+one of the learned professions, namely, that no amount of talent, or
+of acquirements in other departments, can rescue from lamentable
+folly those who, without something of the requisite preparation,
+undertake to experiment with nostrums upon themselves and their
+neighbors.  The exalted character of Berkeley is thus drawn by Sir
+James Mackintosh: Ancient learning, exact science, polished society,
+modern literature, and the fine arts, contributed to adorn and enrich
+the mind of this accomplished man.  All his contemporaries agreed
+with the satirist in ascribing
+
+     "'To Berkeley every virtue under heaven.'
+
+"Even the discerning, fastidious, and turbulent Atterbury said, after
+an interview with him, 'So much understanding, so much knowledge, so
+much innocence, and such humility, I did not think had been the
+portion of any but angels, till I saw this gentleman.'"
+
+But among the writings of this great and good man is an Essay of the
+most curious character, illustrating his weakness upon the point in
+question, and entitled, "Siris, a Chain of Philosophical Reflections
+and Inquiries concerning the Virtues of TAR WATER, and divers other
+Subjects,"--an essay which begins with a recipe for his favorite
+fluid, and slides by gentle gradations into an examination of the
+sublimest doctrines of Plato.  To show how far a man of honesty and
+benevolence, and with a mind of singular acuteness and depth, may be
+run away with by a favorite notion on a subject which his habits and
+education do not fit him to investigate, I shall give a short account
+of this Essay, merely stating that as all the supposed virtues of Tar
+Water, made public in successive editions of his treatise by so
+illustrious an author, have not saved it from neglect and disgrace,
+it may be fairly assumed that they were mainly imaginary.
+
+The bishop, as is usual in such cases, speaks of himself as
+indispensably obliged, by the duty he owes to mankind, to make his
+experience public.  Now this was by no means evident, nor does it
+follow in general, that because a man has formed a favorable opinion
+of a person or a thing he has not the proper means of thoroughly
+understanding, he shall be bound to print it, and thus give currency
+to his impressions, which may be erroneous, and therefore injurious.
+He would have done much better to have laid his impressions before
+some experienced physicians and surgeons, such as Dr. Mead and Mr.
+Cheselden, to have asked them to try his experiment over again, and
+have been guided by their answers.  But the good bishop got excited;
+he pleased himself with the thought that he had discovered a great
+panacea; and having once tasted the bewitching cup of self-quackery,
+like many before and since his time, he was so infatuated with the
+draught that he would insist on pouring it down the throats of his
+neighbors and all mankind.
+
+The precious fluid was made by stirring a gallon of water with a
+quart of tar, leaving it forty-eight hours, and pouring off the clear
+water.  Such was the specific which the great metaphysician
+recommended for averting and curing all manner of diseases.  It was,
+if he might be believed, a preventive of the small-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 gout and fevers, and was an
+excellent preservative of the teeth and gums; answered all the
+purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and
+mineral waters; was particularly to be recommended to sea-faring
+persons, ladies, and men of studious and sedentary lives; could never
+be taken too long, but, on the contrary, produced advantages which
+sometimes did not begin to show themselves for two or three months.
+
+"From my representing Tar Water as good for so many things," says
+Berkeley, "some perhaps may conclude it is good for nothing.  But
+charity obligeth me to say what I know, and what I think, however it
+may be taken.  Men may censure and object as they please, but I
+appeal to time and experiment.  Effects misimputed, cases wrong told,
+circumstances overlooked, perhaps, too, prejudices and partialities
+against truth, may for a time prevail and keep her at the bottom of
+her well, from whence nevertheless she emergeth sooner or later, and
+strikes the eyes of all who do not keep them shut."  I cannot resist
+the temptation of illustrating the bishop's belief in the wonderful
+powers of his remedy, by a few sentences from different parts of his
+essay.  "The hardness of stubbed vulgar constitutions renders them
+insensible of a thousand things that fret and gall those delicate
+people, who, as if their skin was peeled off, feel to the quick
+everything that touches them.  The tender nerves and low spirits of
+such poor creatures would be much relieved by the use of Tar Water,
+which might prolong and cheer their lives."  "It [the Tar Water] may
+be made stronger for brute beasts, as horses, in whose disorders I
+have found it very useful."  "This same water will also give
+charitable relief to the ladies, who often want it more than the
+parish poor; being many of them never able to make a good meal, and
+sitting pale, puny, and forbidden, like ghosts, at their own table,
+victims of vapors and indigestion."  It does not appear among the
+virtues of Tar Water that "children cried for it," as for some of our
+modern remedies, but the bishop says, "I have known children take it
+for above six months together with great benefit, and without any
+inconvenience; and after long and repeated experience I do esteem it
+a most excellent diet drink, fitted to all seasons and ages."  After
+mentioning its usefulness in febrile complaints, he says: "I have had
+all this confirmed by my own experience in the late sickly season of
+the year one thousand seven hundred and forty-one, having had twenty-
+five fevers in my own family cured by this medicinal water, drunk
+copiously."  And to finish these extracts with a most important
+suggestion for the improvement of the British nation: "It is much to
+be lamented that our Insulars who act and think so much for
+themselves, should yet, from grossness of air and diet, grow stupid
+or doat sooner than other people, who, by virtue of elastic air,
+water-drinking, and light food, preserve their faculties to extreme
+old 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 might have lived
+longer, but his fatal illness was so sudden that there was not time
+enough to stir up a quart of the panacea.  He was an illustrious man,
+but he held two very odd opinions; that tar water was everything, and
+that the whole material universe was nothing.
+
+                   ---------------------------
+
+Most of those present have at some time in their lives heard mention
+made of the METALLIC TRACTORS, invented by one Dr. Perkins, an
+American, and formerly enjoying great repute for the cure of various
+diseases.  Many have seen or heard of a satirical poem, written by
+one of our own countrymen also, about forty years since, and called
+"Terrible Tractoration."  The Metallic Tractors are now so utterly
+abandoned that I have only by good fortune fallen upon a single one
+of a pair, to show for the sake of illustration.  For more than
+thirty years this great discovery, which was to banish at least half
+the evils which afflict humanity, has been sleeping undisturbed in
+the grave of 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, its brilliant promises are all
+covered with the dust of silent neglect; and of the generation which
+has sprung up since the period when it flourished, very few know
+anything of its history, and hardly even the title which in its palmy
+days it bore of PERKINISM.  Taking it as settled, then, as no one
+appears to answer for 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 absolutely defunct, I select it
+for anatomical examination.  If this pretended discovery was made
+public; if it was long kept before the public; if it was addressed to
+the people of different countries; if it was formally investigated by
+scientific men, and systematically adopted by benevolent persons, who
+did everything in their power to diffuse the knowledge and practice
+of it; if various collateral motives, such as interest and vanity,
+were embarked in its cause; if, notwithstanding all these things, it
+gradually sickened and died, then the conclusion seems a fair one,
+that it did not 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 historically shown 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 and by what means a
+considerable part of the community may be led into the belief of that
+which is to be eventually considered' as an idle folly.  If there is
+any existing folly, fraudulent or innocent in its origin, which
+appeals to certain arguments for its support; provided that the very
+same arguments can be shown to have been used for Perkinism with as
+good reason, they will at once fall to the ground.  Still more, if it
+shall appear that the general course of any existing delusion bears a
+strong resemblance to that of Perkinism, that the former is most
+frequently advocated by the same class of persons who were
+conspicuous in behalf of the latter, and treated with contempt or
+opposed by the same kind of persons who thus treated Perkinism; if
+the facts in favor of both have a similar aspect; if the motives of
+their originators and propagators may be presumed to have been
+similar; then there is every reason to suppose that the existing
+folly will follow in the footsteps of the past, and after displaying
+a given amount of cunning and credulity in those deceiving and
+deceived, will drop from the public view like a fruit which has
+ripened into spontaneous rottenness, and be succeeded by the fresh
+bloom of some other delusion required by the same excitable portion
+of the community.
+
+Dr. Elisha Perkins was born at Norwich, Connecticut, in the year
+1740.  He had practised his profession with a good local reputation
+for many years, when he fell upon a course of experiments, as it is
+related, which led to his great discovery.  He conceived the idea
+that metallic substances might have the effect of removing diseases,
+if applied in a certain manner; a notion probably suggested by the
+then recent experiments of Galvani, in which muscular contractions
+were found to be produced by the contact of two metals with the
+living fibre.  It was in 1796 that his discovery was promulgated in
+the shape of the Metallic Tractors, two pieces of metal, one
+apparently iron and the other brass, about three inches long, blunt
+at one end and pointed at the other.  These instruments were applied
+for the cure of different complaints, such as rheumatism, local
+pains, inflammations, and even tumors, by drawing them over the
+affected part very lightly for about twenty minutes.  Dr. Perkins
+took out a patent for his discovery, and travelled about the country
+to diffuse the new practice.  He soon found numerous advocates of his
+discovery, many of them of high standing and influence.  In the year
+1798 the tractors had crossed the Atlantic, and were publicly
+employed in the Royal Hospital at Copenhagen.  About the same time
+the son of the inventor, Mr. Benjamin Douglass Perkins, carried them
+to London, where they soon attracted attention.  The Danish
+physicians published an account of their cases, containing numerous
+instances of alleged success, in a respectable octavo volume.  In the
+year 1804 an establishment, honored with the name of the Perkinean
+Institution, was founded in London.  The transactions of this
+institution were published in pamphlets, the Perkinean Society had
+public dinners at the Crown and Anchor, and a poet celebrated their
+medical triumph in strains like these:
+
+    "See, pointed metals, blest with power t' appease
+     The ruthless rage of merciless disease,
+     O'er the frail part a subtle fluid pour,
+     Drenched with invisible Galvanic shower,
+     Till the arthritic staff and crutch forego,
+     And leap exulting like the bounding roe!"
+
+While all these things were going on, Mr. Benjamin Douglass Perkins
+was calmly pocketing money, so that after some half a dozen years he
+left the country with more than ten thousand pounds, which had been
+paid him by the believers in Great Britain.  But in spite of all this
+success, and the number of those interested and committed in its
+behalf, Perkinism soon began to decline, and in 1811 the Tractors are
+spoken of by an intelligent writer as being almost forgotten.  Such
+was the origin and duration of this doctrine and practice, into the
+history of which we will now look a little more narrowly.
+
+Let us see, then, by whose agency this delusion was established and
+kept up; whether it was principally by 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 learned
+bodies usually supposed to take an interest in scientific
+discoveries, or only of individuals whose claims to distinction were
+founded upon their position in society, or political station, or
+literary eminence; whether the judicious or excitable classes entered
+most deeply into it; whether, in short, the scientific men of that
+time were deceived, or only intruded upon, and shouted down for the
+moment by persons who had no particular call to invade their
+precincts.
+
+Not much, perhaps, was to be expected of the Medical Profession in
+the way of encouragement.  One Dr. Fuller, who wrote in England,
+himself a Perkinist, thus expressed his opinion: "It must be an
+extraordinary exertion of virtue and humanity for a medical man,
+whose livelihood depends either on the sale of drugs, or on receiving
+a guinea for writing a prescription, which must relate to those
+drugs, to say to his patient, 'You had better purchase a set of
+Tractors to keep in your family; they will cure you without the
+expense of my attendance, or the danger of the common medical
+practice.'  For very obvious reasons medical men must never be
+expected to recommend the use of Perkinism.  The Tractors must trust
+for their patronage to the enlightened and philanthropic out of the
+profession, or to medical men retired from practice, and who know of
+no other interest than the luxury of relieving the distressed.  And I
+do not despair of seeing the day when but very few of this
+description as well as private families will be without them."
+
+Whether the motives assigned by this medical man to his professional
+brethren existed or not, it is true that Dr. Perkins did not gain a
+great deal at their hands.  The Connecticut Medical Society expelled
+him in 1797 for violating their law against the use of nostrums, or
+secret remedies.  The leading English physicians appear to have
+looked on with singular apathy or contempt at the miracles which it
+was pretended were enacting in the hands of the apostles of the new
+practice.  In looking over the reviews of the time, I have found
+little beyond brief occasional notices of their pretensions; the
+columns of these journals being occupied with subjects of more
+permanent interest.  The state of things in London is best learned,
+however, from the satirical poem to which I have already alluded as
+having been written at the period referred to.  This was entitled,
+"Terrible Tractoration!!  A Poetical Petition against Galvanizing
+Trumpery and the Perkinistic Institution.  Most respectfully
+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 learned
+Societies."  Two editions of this work were published in London in
+the years 1803 and 1804, and one or two have been published in this
+country.
+
+"Terrible Tractoration" is supposed, by those who never read it, to
+be a satire upon the follies of Perkins and his followers.  It is, on
+the contrary, a most zealous defence of Perkinism, and a fierce
+attack upon its opponents, most especially upon such of the medical
+profession as treated the subject with neglect or ridicule.  The
+Royal College of Physicians was the more peculiar object of the
+attack, but with this body, the editors of some of the leading
+periodicals, and several physicians distinguished at that time, and
+even now remembered for their services to science and humanity, were
+involved in unsparing denunciations.  The work is by no means of the
+simply humorous character it might be supposed, but is overloaded
+with notes of the most seriously polemical nature.  Much of the
+history of the subject, indeed, is to be looked for in this volume.
+
+It appears from this work that the principal members of 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 it is now evident that, though they were much abused
+for so doing, they knew very well what they had to deal with, and
+were altogether in the right.  The delusion at last attracted such an
+amount of attention as to induce Dr. Haygarth and some others of
+respectable standing to institute some experiments which I shall
+mention in their proper place, the result of which might have seemed
+sufficient to show the emptiness of the whole contrivance.
+
+The Royal Society, that learned body which for ages has constituted
+the best tribunal to which Britain can appeal in questions of
+science, accepted Mr. Perkins's Tractors and the book written about
+them, passed the customary vote of thanks, and never thought of
+troubling itself further in the investigation of pretensions of such
+an aspect.  It is not to be denied that a considerable number of
+physicians did avow themselves advocates of the new practice; but out
+of the whole catalogue of those who were publicly proclaimed as such,
+no one has ever been known, so far as I am aware, to the scientific
+world, except in connection with the short-lived notoriety of
+Perkinism.  Who were the people, then, to whose activity, influence,
+or standing with the community was owing all the temporary excitement
+produced by the Metallic Tractors?
+
+First, those persons who had been induced to purchase a pair of
+Tractors.  These little bits of brass and 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
+whistle is 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 metropolis to concur in the establishment of a
+public institution for the use of these instruments upon the poor,
+"it was found that only five out of above a hundred objected to
+subscribe, on account of their want of confidence in the efficacy of
+the practice; and these," the committee observes, "there is reason to
+believe, never gave them a fair trial, probably never used them in
+more than one case, and that perhaps a case in which the Tractors had
+never been recommended as serviceable."  "Purchasers of the
+Tractors," said one of their ardent advocates, "would be among the
+last to approve of them if they had reason to suppose themselves
+defrauded of five guineas."  He forgot poor Moses, with his "gross of
+green spectacles, with silver rims and shagreen cases."  "Dear
+mother," cried the boy, "why won't you listen to reason?  I had them
+a dead bargain, or I should not have bought them.  The silver rims
+alone will sell for double the money."
+
+But it is an undeniable fact, that many persons of considerable
+standing, and in some instances holding the most elevated positions
+in society, openly patronized the new practice.  In a translation of
+a work entitled "Experiments with the Metallic Tractors," originally
+published in Danish, thence rendered successively into German and
+English, Mr. Benjamin Perkins, who edited the English edition, has
+given a copious enumeration of the distinguished individuals, both in
+America and Europe, whose patronage he enjoyed.  He goes so far as to
+signify that ROYALTY itself was to be included among the number.
+When the Perkinean Institution was founded, no less a person than
+Lord Rivers was elected President, and eleven other individuals of
+distinction, among them Governor Franklin, son of Dr. Franklin,
+figured as Vice-Presidents.  Lord Henniker, a member of the Royal
+Society, who is spoken of as a man of judgment and talents,
+condescended to patronize the astonishing discovery, and at different
+times bought three pairs of Tractors.  When the Tractors were
+introduced into Europe, a large number of testimonials accompanied
+them from various distinguished characters in America, the list of
+whom is given in the translation of the Danish work referred to as
+follows:
+
+"Those who have individually stated cases, or who have presented
+their names to the public as men who approved of this remedy, and
+acknowledged themselves instrumental in circulating the Tractors, are
+fifty-six in number; thirty-four of whom are physicians and surgeons,
+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, one professor of natural philosophy in a college, etc.,
+etc."  It seemed to be taken rather hardly by Mr. Perkins that the
+translators of the work which he edited, in citing the names of the
+advocates of the Metallic Practice, frequently omitted the honorary
+titles which should have been annexed.  The testimonials were
+obtained by the Danish writer, from a pamphlet published in America,
+in which these titles were given in full.  Thus one of these
+testimonials is from "John Tyler, Esq., a magistrate in the county
+of New London, and late Brigadier-General of the militia in that
+State."  The "omission of the General's title" is the subject of
+complaint, as if this title were sufficient evidence of the
+commanding powers of one of the patrons of tractoration.  A similar
+complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney
+at Law, and a member of the Legislature of the State of Connecticut,"
+is mentioned without his titular honors, and even on account of the
+omission of the proper official titles belonging to "Nathan Pierce,
+Esq., Governor and Manager of the Almshouse of Newburyport."  These
+instances show the great importance to be attached to civil and
+military dignities, in qualifying their holders to judge of
+scientific subjects, a truth which has not been overlooked by the
+legitimate successors of the Perkinists.  In Great Britain, the
+Tractors were not less honored than in America, by the learned and
+the illustrious.  The "Perkinistic Committee" made this statement in
+their report: "Mr. Perkins has annually laid before the public a
+large collection of new cases communicated to him for that purpose by
+disinterested and intelligent characters, from almost every quarter
+of Great Britain.  In regard to the competency of these vouchers, it
+will be sufficient simply to state that, amongst others whose 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 that the number of
+clergymen both in America and Great Britain who thrust forward their
+evidence on this medical topic was singularly large in proportion to
+that of the members of the medical profession.  Whole pages are
+contributed by such worthies as the Rev. Dr. Trotter of Hans Place,
+the Rear.  Waring Willett, Chaplain to the Earl of Dunmore, the Rev.
+Dr. Clarke, Chaplain to the Prince of Wales.  The style of these
+theologico-medical communications may be seen in the following from a
+divine who was also professor in one of the colleges of New England.
+"I have used the Tractors with success in several other cases in my
+own family, and although, like Naaman the Syrian, I cannot tell why
+the waters of Jordan should be better than Abana and Pharpar, rivers
+of Damascus; yet since experience has proved them so, no reasoning
+can change the opinion.  Indeed, the causes of all common facts are,
+we think, perfectly well known to us; and it is very probable, fifty
+or a hundred years hence, we shall as well know why the Metallic
+Tractors should in a few minutes remove violent pains, as we now know
+why cantharides and opium will produce opposite effects, namely, we
+shall know very little about either excepting facts."  Fifty or a
+hundred years hence! if he could have looked forward forty years, he
+would have seen the descendants of the "Perkinistic" philosophers
+swallowing infinitesimal globules, and knowing and caring as much
+about the Tractors as the people at Saratoga Springs do about the
+waters of Abana and Pharpar.
+
+I trust it will not be thought in any degree disrespectful to a
+profession which we all honor, that I have mentioned the great zeal
+of many clergymen in the cause of Perkinism.  I hope, too, that I may
+without offence suggest the causes which have often led them out of
+their own province into one to which their education has no special
+reference.  The members of that profession ought to 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
+them are suffering from bodily illness.  It is natural enough that a
+strong desire should be excited to alleviate sufferings which may
+have defied the efforts of professional skill; as natural that any
+remedy which recommends itself to the belief or the fancy of the
+spiritual physician 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 him to take the most flattering view
+of its effects upon the patient; his own sagacity and judgment being
+staked upon the success of the trial.  The inventor of the Tractors
+was aware of these truths.  He therefore sent the Tractors
+gratuitously to many clergymen, accompanied with a formal certificate
+that the holder had become entitled to their possession by the
+payment of five guineas.  This was practised in our own neighborhood,
+and I remember finding one of these certificates, so presented, which
+proved that amongst the risks of infancy I had to encounter Perkins's
+Tractors.  Two clergymen of Boston and the vicinity, both well known
+to local fame, gave in their testimony to the value of the
+instruments thus presented to them; an unusually moderate proportion,
+when it is remembered that to the common motives of which I have
+spoken was added the seduction of a gift for which the profane public
+was expected to pay so largely.
+
+It was remarkable, also, that Perkinism, which had so little success
+with the medical and scientific part of the community, found great
+favor in the eyes of its more lovely and less obstinate portion.
+"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,--
+"having been lately in America, had seen and heard much of the great
+effects of Perkinism.  Influenced by a most benevolent disposition,
+she brought these Tractors and the pamphlet with her to Europe, with
+a laudable desire of extending their utility to her suffering
+countrymen."  Such was the channel by which the Tractors were
+conveyed to Denmark, where they soon became the ruling passion.
+The workmen, says a French writer, could not manufacture them fast
+enough.  Women carried them about their persons, and delighted in
+bringing them into general use.  To what extent the Tractors were
+favored with the patronage of English and American ladies, it is of
+course not easy to say, except on general principles, as their names
+were not brought before the public.  But one of Dr. Haygarth's
+stories may lead us to conjecture that there was a class of female
+practitioners who went about doing good with the Tractors in England
+as well as in Denmark.  A certain lady had the misfortune to have a
+spot as big as a silver penny at the corner of her eye, caused by a
+bruise, or some such injury.  Another lady, who was a friend of hers,
+and a strong believer in Perkinism, was very anxious to try the
+effects of tractoration upon this unfortunate blemish.  The patient
+consented; the lady "produced the instruments, and, after drawing
+them four or five times over the spot, declared that it changed to a
+paler color, and on repeating the use of them a few minutes longer,
+that it had almost vanished, and was scarcely visible, and departed
+in high triumph at her success."  The lady who underwent the
+operation assured the narrator "that she looked in the glass
+immediately after, and that not the least visible alteration had
+taken place."
+
+It would be a very interesting question, what was the intellectual
+character of those persons most conspicuous in behalf of the
+Perkinistic delusion?  Such an inquiry might bring to light some
+principles which we could hereafter apply to the study of other
+popular errors.  But the obscurity into which nearly all these
+enthusiasts have subsided renders the question easier to ask than to
+answer.  I believe it would have been found that most of these
+persons were of ardent temperament and of considerable imagination,
+and that their history would show that Perkinism was not the first
+nor the last hobby-horse they rode furiously.  Many of them may very
+probably have been persons of more than common talent, of active and
+ingenious minds, of versatile powers and various acquirements.  Such,
+for instance, was the estimable man to whom I have repeatedly
+referred as a warm defender of tractoration, and a bitter assailant
+of its enemies.  The story tells itself in the biographical preface
+to his poem.  He went to London with the view of introducing a
+hydraulic machine, which he and his Vermont friends regarded as a
+very important invention.  He found, however, that the machine was
+already in common use in that metropolis.  A brother Yankee, then in
+London, had started the project of a mill, which was to be carried by
+the water of the Thames.  He was sanguine enough to purchase one
+fifth of this concern, which also proved a failure.  At about the
+same period he wrote the work which proved the great excitement of
+his mind upon the subject of the transient folly then before the
+public.  Originally a lawyer, he was in succession a mechanician, a
+poet, and an editor, meeting with far less success in each of these
+departments than usually attends men of less varied gifts, but of
+more tranquil and phlegmatic composition.  But who is ignorant that
+there is a class of minds characterized by qualities like those I
+have mentioned; minds with many bright and even beautiful traits; but
+aimless and fickle as the butterfly; that settle upon every gayly-
+colored illusion as it opens into flower, and flutter away to another
+when the first has dropped its leaves, and stands naked in the icy
+air of truth!
+
+Let us now look at the general tenor of the arguments addressed by
+believers to sceptics and opponents.  Foremost of all, emblazoned at
+the head of every column, loudest shouted by every triumphant
+disputant, held up as paramount to all other considerations,
+stretched like an impenetrable shield to protect the weakest advocate
+of the great cause against the weapons of the adversary, was that
+omnipotent monosyllable which has been the patrimony of cheats and
+the currency of dupes from time immemorial,--Facts! Facts! Facts!
+First came the published cases of the American clergymen, brigadier-
+generals, almshouse governors, representatives, attorneys, and
+esquires.  Then came the published cases of the surgeons of
+Copenhagen.  Then followed reports of about one hundred and fifty
+cases published in England, "demonstrating the efficacy of the
+metallic practice in a variety of complaints both upon the human body
+and on horses, etc."  But the progress of facts in Great Britain did
+not stop here.  Let those who rely upon the numbers of their
+testimonials, as being alone sufficient to prove the soundness and
+stability of a medical novelty, digest the following from the report
+of the Perkinistic Committee.  "The cases published [in Great
+Britain] amounted, in March last, the date of Mr. Perkins's last
+publication, to about five thousand.  Supposing that not more than
+one cure in three hundred which the Tractors have performed has been
+published, and the proportion is probably much greater, it will be
+seen that the number, to March last, will have exceeded one million
+five hundred thousand!"
+
+Next in order after the appeal to what were called facts, came a
+series of arguments, which have been so long bruised and battered
+round in the cause of every doctrine or pretension, new, monstrous,
+or deliriously impossible, that each of them is as odiously familiar
+to the scientific scholar as the faces of so many old acquaintances,
+among the less reputable classes, to the officers of police.
+
+No doubt many of my hearers will recognize, in the following
+passages, arguments they may have heard brought forward with
+triumphant confidence in behalf of some doctrine not yet extinct.  No
+doubt some may have honestly thought they proved something; may have
+used them with the purpose of convincing their friends, or of
+silencing the opponents of their favorite doctrine, whatever that
+might be.  But any train of arguments which was contrived for
+Perkinism, which was just as applicable to it as to any other new
+doctrine in the same branch of science, and which was fully employed
+against its adversaries forty years since, might, in common charity,
+be suffered to slumber in the grave of Perkinism.  Whether or not the
+following sentences, taken literally from the work of Mr. Perkins,
+were the originals of some of the idle propositions we hear bandied
+about from time to time, let those who listen judge.
+
+The following is the test assumed for the new practice: "If diseases
+are really removed, as those persons who have practised extensively
+with the Tractors declare, it should seem there would be but little
+doubt of their being generally adopted; but if the numerous reports
+of 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 judging and uncandid
+class of individuals who buy their dinners without tasting all the
+food there is in the market.  "On all discoveries there are persons
+who, without descending to any inquiry into the truth, pretend to
+know, as it were by intuition, that newly asserted facts are founded
+in the grossest errors.  These were those who knew that Harvey's
+report of the circulation of the blood was a preposterous and
+ridiculous suggestion, and in latter later days there were others who
+knew that Franklin deserved reproach for declaring that points were
+preferable to balls for protecting buildings from lightning."
+
+Again: "This unwarrantable mode of offering assertion for proof, so
+unauthorized and even unprecedented except in the condemnation of a
+Galileo, the persecution of a Copernicus, and a few other acts of
+inquisitorial authority, 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 Materia Medica act on principles
+of which we are totally ignorant.  None have ever yet been able to
+explain how opium produces sleep, or how bark cures intermittent
+fevers; and yet few, it is hoped, will be so absurd as to desist from
+the use of these important articles because they know nothing of the
+principle of their operations."  Or if the argument is preferred, in
+the eloquent language of the Perkinistic poet:
+
+    "What though the CAUSES may not be explained,
+     Since these EFFECTS are duly ascertained,
+     Let not self-interest, prejudice, or pride,
+     Induce mankind to set the means aside;
+     Means which, though simple, are by
+     Heaven designed to alleviate the woes of human kind."
+
+This course of argument is so often employed, that it deserves to be
+expanded a little, so that its length and breadth may be fairly seen.
+A series of what are called facts is brought forward to prove some
+very improbable doctrine.  It is objected by judicious people, or
+such as have devoted themselves to analogous subjects, that these
+assumed facts are in direct opposition to all that is known of the
+course of nature, that the universal experience of the past affords a
+powerful presumption against their truth, and that in proportion to
+the gravity of these objections, should be the number and competence
+of the witnesses.  The answer is a ready one.  What do we know of the
+mysteries of Nature?  Do we understand the intricate machinery of the
+Universe?  When to this is added the never-failing quotation,
+
+    "There are more things in heaven and 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.  It is in itself strange
+and incredible that the relations of the heavenly bodies to each
+other at a given moment of time, perhaps half a century ago, should
+have anything to do with my success or misfortune in any undertaking
+of to-day.  But what right have I to say it cannot be so?  Can I bind
+the sweet influences of Pleiades, or loose the bands of Orion?  I do
+not know by what mighty magic the planets roll in their fluid paths,
+confined to circles as unchanging as if they were rings of steel, nor
+why the great wave of ocean follows in a sleepless round upon the
+skirts of moonlight; nor cam I say from any certain knowledge that
+the phases of the heavenly bodies, or even the falling of the leaves
+of the forest, or the manner in which the sands lie upon the sea-
+shore, may not be knit up by invisible threads with the web of human
+destiny.  There is a class of minds much more ready to believe that
+which is at first sight incredible, and because it is incredible,
+than what is generally thought reasonable.  Credo quia impossibile
+est,--"I believe, because it is impossible,"--is an old paradoxical
+expression which might be literally applied to this tribe of persons.
+And they always succeed in finding something marvellous, to call out
+the exercise of their robust faith.  The old Cabalistic teachers
+maintained that there was not a verse, line, word, or even letter in
+the Bible which had not a special efficacy either to defend the
+person who rightly employed it, or to injure his enemies; always
+provided the original Hebrew was made use of.  In the hands of modern
+Cabalists every substance, no matter how inert, acquires wonderful
+medicinal virtues, provided it be used in a proper state of purity
+and subdivision.
+
+I have already mentioned the motives attributed by the Perkinists to
+the Medical Profession, as preventing its members from receiving the
+new but unwelcome truths.  This accusation is repeated in different
+forms and places, as, for instance, in the following passage:
+"Will the medical man who has spent much money and labor in the
+pursuit of the arcana of Physic, and on the exercise of which depends
+his support in life, proclaim the inefficacy of his art, and
+recommend a remedy to his patient which the most unlettered in
+society can employ as advantageously as himself? and a remedy, too,
+which, unlike the drops, the pills, the powders, etc., of the Materia
+Medica, is inconsumable, and ever in readiness to be employed in
+successive diseases?"
+
+As usual with these people, much indignation was expressed at any
+parallel between their particular doctrine and practice and those of
+their exploded predecessors.  "The motives," says the disinterested
+Mr. Perkins, "which must have impelled to this attempt at classing
+the METALLIC PRACTICE with the most paltry of empyrical projects, are
+but too thinly veiled to escape detection."
+
+To all these arguments was added, as a matter of course, an appeal to
+the feelings of the benevolent in behalf of suffering humanity, in
+the shape of a notice that the poor would be treated gratis.  It is
+pretty well understood that this gratuitous treatment of the poor
+does not necessarily imply an excess of benevolence, any more than
+the gratuitous distribution of a trader's shop-bills is an evidence
+of remarkable generosity; in short, that it is one of those things
+which honest men often do from the best motives, but which rogues and
+impostors never fail to announce as one of their special
+recommendations.  It is astonishing to see how these things brighten
+up at the touch of Mr. Perkins's poet:
+
+    "Ye worthy, honored, philanthropic few,
+     The muse shall weave her brightest wreaths for you,
+     Who in Humanity's bland cause unite,
+     Nor heed the shaft by interest aimed or spite;
+     Like the great Pattern of Benevolence,
+     Hygeia's blessings to the poor dispense;
+     And though opposed by folly's servile brood,
+     ENJOY THE LUXURY OF DOING GOOD."
+
+Having thus sketched the history of Perkinism in its days of
+prosperity; having seen how it sprung into being, and by what means
+it maintained its influence, it only remains to tell the brief story
+of its discomfiture and final downfall.  The vast majority of the
+sensible part of the medical profession were contented, so far as we
+can judge, to let it die out of itself.  It was in vain that the
+advocates of this invaluable discovery exclaimed over their perverse
+and interested obstinacy,--in vain that they called up the injured
+ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving
+generation; the Baillies and the Heberdens,--men whose names have
+come down to us as synonymous with honor and wisdom,--bore their
+reproaches in meek silence, and left them unanswered to 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
+would be broken by an open trial of its virtue, as compared with that
+of some less hallowed formula.  It must be remembered that a peculiar
+value was attached to the Metallic Tractors, as made and patented by
+Mr. Perkins.  Dr. Haygarth, of Bath, performed various experiments
+upon patients afflicted with different complaints,--the patients
+supposing that the real five-guinea Tractors were employed.  Strange
+to relate, he obtained equally wonderful effects with Tractors of
+lead and of wood; with nails, pieces of bone, slate pencil, and
+tobacco-pipe.  Dr. Alderson employed sham Tractors made of wood, and
+produced such effects upon five patients that they returned solemn
+thanks in church for their cures.  A single specimen of these cases
+may stand for all of them.  Ann Hill had suffered for some months
+from pain in the right arm and shoulder.  The Tractors (wooden ones)
+were applied, and in the space of five minutes she expressed herself
+relieved in the following apostrophe: "Bless me! why, who could have
+thought it, that them little things could pull the pain from one.
+Well, to be sure, the longer one lives, the more one sees; ah, dear!"
+
+These experiments did not result in the immediate extinction of
+Perkinism.  Doubtless they were a great comfort to many obstinate
+unbelievers, and helped to settle some sceptical minds; but for the
+real Perkinistic enthusiasts, it may be questioned whether they would
+at that time have changed their opinion though one had risen from the
+dead to assure them that it was an error.  It perished without
+violence, by an easy and natural process.  Like the famous toy of
+Mongolfier, it rose by means of heated air,--the fevered breath of
+enthusiastic ignorance,--and when this grew cool, as it always does
+in a little while, it collapsed and fell.
+
+And now, on reviewing the whole subject, how shall we account for the
+extraordinary prevalence of the belief in Perkinism among a portion
+of what is supposed to be the thinking part of the community?
+
+Could the cures have been real ones, produced by the principle of
+ANIMAL MAGNETISM?  To this it may be answered that the Perkinists
+ridiculed the idea of approximating Mesmer and the founder of their
+own doctrine, that nothing like the somnambulic condition seems to
+have followed the use of the Tractors, and that neither the exertion
+of the will nor the powers of the individual who operated seem to
+have been considered of any consequence.  Besides, the absolute
+neglect into which the Tractors soon declined is good evidence that
+they were incapable of affording any considerable and permanent
+relief in the complaints for the cure of which they were applied.
+
+Of course a large number of apparent cures were due solely to nature;
+which is true under every form of treatment, orthodox or empirical.
+Of course many persons experienced at least temporary relief from the
+strong impression made upon their minds by this novel and marvellous
+method of treatment.
+
+Many, again, influenced by the sanguine hopes of those about them,
+like dying people, who often say sincerely, from day to day, that
+they are getting better, cheated themselves into a false and short-
+lived belief that they were cured; and as happens in such cases, the
+public never knew more than the first half of the story.
+
+When it was said to the Perkinists, that whatever effects they
+produced were merely through the imagination, they declared (like the
+advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this
+explanation was sufficiently disproved by the fact of numerous and
+successful cures which had been witnessed in infants and brute
+animals.  Dr. Haygarth replied to this, that "in these cases it is
+not the Patient, but the Observer, who is deceived by his own
+imagination," and that such may be the fact, we have seen in the case
+of the good lady who thought she had conjured away the spot from her
+friend's countenance, when it remained just as before.
+
+As to the motives of the inventor and vender of the Tractors, 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 that they are a peculiar compound, when they are artfully
+associated with a new and brilliant discovery (which then happened to
+be Galvanism), when they are sold at many hundred times their value,
+and the seller prints his 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 practise on each other,"
+one cannot but suspect that they were contrived in the neighborhood
+of a wooden nutmeg factory; that legs of ham in that region are not
+made of the best mahogany; and that such as buy their cucumber seed
+in that vicinity have to wait for the fruit as long as the Indians
+for their crop of gunpowder.
+
+
+                   ---------------------------
+
+The succeeding lecture will be devoted to an examination of 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, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy,
+and the claims of which are considered by some as infinitely
+important, and by many as immeasurably ridiculous.
+
+I wish to state, for the sake of any who may be interested in the
+subject, that I shall treat it, not by ridicule, but by argument;
+perhaps with great freedom, but with good temper and in peaceable
+language; with very little hope of reclaiming converts, with no
+desire of making enemies, but with a firm belief that its pretensions
+and assertions cannot stand before a single hour of calm
+investigation.
+
+
+
+
+II.
+
+It may be thought that a direct attack upon the pretensions of
+HOMOEOPATHY is an uncalled-for aggression upon an unoffending
+doctrine and its peaceful advocates.
+
+But a little inquiry will show that it has long assumed so hostile a
+position with respect to the Medical Profession, that any trouble I,
+or any other member of that profession, may choose to bestow upon it
+may be considered merely as a matter of self-defence.  It began with
+an attempt to show the insignificance of all existing medical
+knowledge.  It not only laid claim to wonderful powers of its own,
+but it declared the common practice to be attended with the most
+positively injurious effects, that by it acute diseases are
+aggravated, and chronic diseases rendered incurable.  It has at
+various times brought forward collections of figures having the air
+of statistical documents, pretending to show a great proportional
+mortality among the patients of the Medical Profession, as compared
+with those treated according to its own rules.  Not contented with
+choosing a name of classical origin for itself, it invented one for
+the whole community of innocent physicians, assuring them, to their
+great surprise, that they were all ALLOPATHISTS, whether they knew it
+or not, and including all the illustrious masters of the past, from
+Hippocrates down to Hunter, under the same gratuitous title.  The
+line, then, has been drawn by the champions of the new doctrine; they
+have lifted the lance, they have sounded the charge, and are
+responsible for any little skirmishing which may happen.
+
+But, independently of any such grounds of active resistance, the
+subject involves interests so disproportioned to its intrinsic
+claims, that it is no more than an act 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, and acquires
+the same degree of influence that we have often seen obtained by
+other illusions, there is not one of my audience who may not have
+occasion to deplore the fatal credulity which listened to its
+promises.
+
+I shall therefore undertake a sober examination of its principles,
+its facts, and some points of its history.  The limited time at my
+disposal requires me to condense as much as possible what I have to
+say, but I shall endeavor to be plain and direct in expressing it.
+Not one statement shall be made which cannot be supported by
+unimpeachable reference: not one word shall be uttered which I am not
+as willing to print as to speak.  I have no quibbles to utter, and I
+shall stoop to answer none; but, with full faith in the sufficiency
+of a plain statement of facts and reasons, I submit the subject to
+the discernment of my audience.
+
+
+The question may be asked in the outset,--Have you submitted the
+doctrines you are professing to examine 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, from what
+has often happened, that it would be of no manner of use for me to
+allege the results of any experiments I might have instituted.  Again
+and again have the most explicit statements been made by the most
+competent persons of the utter failure of all their trials, and there
+were the same abundant explanations offered as used to be for the
+Unguentum Armarium arid the Metallic Tractors.  I could by no
+possibility perform any experiments the result of which could not be
+easily explained away so as to be of no conclusive significance.
+Besides, as arguments in favor of Homoeopathy are constantly
+addressed to the public in journals, pamphlets, and even lectures, by
+inexperienced dilettanti, the same channel must be open to all its
+opponents.
+
+It is necessary, for the sake of those to whom the whole subject may
+be new, to give in the smallest possible compass the substance of the
+Homoeopathic Doctrine.  Samuel Hahnemann, its founder, is a German
+physician, now living in Paris, [Hahnemann died in 1843.] at the age
+of eighty-seven years.  In 1796 he published the first paper
+containing his peculiar notions; in 1805 his first work on the
+subject; in 1810 his somewhat famous "Organon of the Healing Art;"
+the next year what he called the "Pure Materia Medica;" and in 1828
+his last work, the "Treatise on Chronic Diseases."  He has therefore
+been writing at intervals on his favorite subject for nearly half a
+century.
+
+The one great doctrine which constitutes the basis of Homoeopathy as
+a system is expressed by the Latin aphorism,
+
+               "SIMILIA SIBILIBUS CURANTUR,"
+
+or like cures like, that is, diseases are cured by agents capable of
+producing symptoms resembling those found in the disease under
+treatment.  A disease for Hahnemann consists essentially in a group
+of symptoms.  The proper medicine for any disease is the one which is
+capable of producing a similar group of symptoms when given to a
+healthy person.
+
+It is of course necessary to know what are the trains of symptoms
+excited by different substances, when administered to persons in
+health, if any such can be shown to exist.  Hahnemann and his
+disciples give catalogues of the symptoms which they affirm were
+produced upon themselves or others by a large number of drugs which
+they submitted to experiment.
+
+The second great fact which Hahnemann professes to have established
+is the efficacy of medicinal substances reduced to a wonderful degree
+of minuteness or dilution.  The following account of his mode of
+preparing his medicines is from his work on Chronic Diseases, which
+has not, I believe, yet been translated into English.  A grain of the
+substance, if it is solid, a drop if it is liquid, is to be added to
+about a third part of one hundred grains of sugar of milk in an
+unglazed porcelain capsule which has had the polish removed from the
+lower part of its cavity by rubbing it with wet sand; they are to be
+mingled for an instant with a bone or horn spatula, and then rubbed
+together for six minutes; then the mass is to be scraped together
+from 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 the powder into a heap, and the second third of the hundred
+grains of sugar of milk to be added.  Then they are to be stirred an
+instant and rubbed six minutes,--again to be scraped together four
+minutes and forcibly rubbed six; once more scraped together for four
+minutes, when the last third of the hundred grains of sugar of milk
+is to be added and mingled by stirring with the spatula; six minutes
+of forcible rubbing, four of scraping together, and six more
+(positively the last six) of rubbing, finish this part of the
+process.
+
+Every grain of this powder contains the hundredth of a grain of the
+medicinal substance mingled with the sugar of milk.  If, therefore, a
+grain of the powder just prepared is mingled with another hundred
+grains of sugar of milk, and the process just described repeated, we
+shall have a powder of which every grain contains the hundredth of
+the hundredth, or the ten thousandth part of a grain of the medicinal
+substance.  Repeat the same process with the same quantity of fresh
+sugar of milk, and every grain of your powder will contain the
+millionth of a grain of the medicinal substance.  When the powder is
+of this strength, it is ready to employ in the further solutions and
+dilutions to be made use of in practice.
+
+A grain of the powder is to be taken, a hundred drops of alcohol are
+to be poured on it, the vial is to be slowly turned for a few
+minutes, until the powder is 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 observations upon the sick lead me
+within the last few years to prefer giving only two shakes to
+medicinal liquids, whereas I formerly used to give ten."  The process
+of dilution is carried on in the same way as the attenuation of the
+powder was done; each successive dilution with alcohol reducing the
+medicine to a hundredth part of the quantity of that which preceded
+it.  In this way the dilution of the original millionth of a grain of
+medicine contained in the grain of powder operated on is carried
+successively to the billionth, trillionth, quadrillionth,
+quintillionth, and very often much higher fractional divisions.  A
+dose of any of these medicines is a minute fraction of a drop,
+obtained by moistening with them one or more little globules of
+sugar, of which Hahnemann says it takes about two hundred to weigh a
+grain.
+
+As an instance of the strength of the medicines prescribed by
+Hahnemann, I will mention carbonate of lime.  He does not employ
+common chalk, but prefers a little portion 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 mentioned can convey is a
+common dose.  But for persons of very delicate nerves it is proper
+that the dilution should be carried to the decillionth degree.  That
+is, an important medicinal effect is to be expected from the two
+hundredth or hundredth part of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of a
+grain of oyster-shell.  This is only the tenth degree of potency, but
+some of his disciples profess to have obtained palpable effects from
+"much higher dilutions."
+
+The third great doctrine of Hahnemann is the following.  Seven
+eighths at least of all chronic diseases are produced by the
+existence in the system of that infectious disorder known in the
+language of science by the appellation of PSORA, but to the less
+refined portion of the community by the name of ITCH.  In the words
+of Hahnemann's "Organon,"  "This Psora is the sole true and
+fundamental cause that produces 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 the bones, or rickets, scoliosis
+and cyphosis, caries, cancer, fungua haematodes, gout,--yellow
+jaundice and cyanosis, dropsy,--"
+
+["The degrees of DILUTION must not be confounded with those of
+POTENCY.  Their relations may be seen by this table:
+
+lst dilution,--One hundredth of a drop or grain.
+
+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.,--and so on indefinitely.
+
+
+The large figures denote the degrees of POTENCY.]
+
+
+"gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the
+lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of
+sense, pains of every kind, etc., appear in our pathology as so many
+peculiar, distinct, and independent diseases."
+
+For the last three centuries, if the same authority may be trusted,
+under the influence of the more refined personal habits which have
+prevailed, and the application of various external remedies which
+repel the affection from the skin; Psora has revealed itself in these
+numerous forms of internal disease, instead of appearing, as in
+former periods, under the aspect of an external malady.
+
+These are the three cardinal doctrines of Hahnemann, as laid down in
+those standard works of Homoeopathy, the "Organon" and the "Treatise
+on Chronic Diseases."
+
+Several other principles may be added, upon all of which he insists
+with great force, and which are very generally received by his
+disciples.
+
+1.  Very little power is allowed to the curative efforts of nature.
+Hahnemann goes so far as to say that no one has ever seen the simple
+efforts of nature effect the durable recovery of a patient from a
+chronic disease.  In general, the Homoeopathist calls every recovery
+which happens under his treatment a cure.
+
+2.  Every medicinal substance must be administered in a state of the
+most perfect purity, and uncombined with any other.  The union of
+several remedies in a single prescription destroys its utility, and,
+according to the "Organon," frequently adds a new disease.
+
+3.  A large number of substances commonly thought to be inert develop
+great medicinal powers when prepared in the manner already described;
+and a great proportion of them are ascertained to have specific
+antidotes in 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 collections of symptoms, each of which differs from every
+other collection.
+
+5.  The symptoms of any complaint must be described with the most
+minute exactness, and so far as possible in the patient's own words.
+To illustrate the kind of circumstances the patient is expected to
+record, I will mention one or two from the 313th page of the
+"Treatise on Chronic Diseases,"--being the first one at which I
+opened accidentally.
+
+"After dinner, disposition to sleep; the patient winks."
+
+"After dinner, prostration and feeling of weakness (nine days after
+taking the remedy)."
+
+This remedy was that same oyster-shell which is to be prescribed
+"fractions of the sextillionth or decillionth degree."  According to
+Hahnemann, the action of a single dose of the size mentioned does not
+fully display itself in some cases until twenty-four or even thirty
+days after it is taken, and in such instances has not exhausted its
+good effects until towards the fortieth or fiftieth day,--before
+which time it would be absurd and injurious to administer a new
+remedy.
+
+So much for the doctrines of Hahnemann, which have been stated
+without comment, or exaggeration of any of their features, very much
+as any adherent of his opinions might have stated them, if obliged to
+compress them into so narrow a space.
+
+Does Hahnemann himself represent Homoeopathy as it now exists?  He
+certainly ought to be its best representative, after having created
+it, and devoted his life to it for half a century.  He is spoken of
+as the great physician of the time, in most, if not all Homoeopathic
+works.  If he is not authority on the subject of his own doctrines,
+who is?  So far as I am aware, not one tangible discovery in the
+so-called science has ever been ascribed to any other observer; at
+least, no general principle or law, of consequence enough to claim
+any prominence in Homoeopathic works, has ever been pretended to have
+originated with any of his illustrious disciples.  He is one of the
+only two Homoeopathic writers with whom, as I shall mention, the
+Paris publisher will have anything to do upon his own account.  The
+other is Jahr, whose Manual is little more than a catalogue of
+symptoms and remedies.  If any persons choose to reject Hahnemann as
+not in the main representing Homoeopathy, if they strike at his
+authority, if they wink out of sight his deliberate and formally
+announced results, it is an act of suicidal rashness; for upon his
+sagacity and powers of observation, and experience, as embodied in
+his works, and especially in his Materia Medica, repose the
+foundations of Homoeopathy as a practical system.
+
+So far as I can learn from the conflicting statements made upon the
+subject, the following is the present condition of belief.
+
+1.  All of any note agree that the law Similia similibus is the only
+fundamental principle in medicine.  Of course if any man does not
+agree to this the name Homoeopathist can no longer be applied to him
+with propriety.
+
+2.  The belief in and employment of the infinitesimal doses is
+general, and in some places universal, among the advocates of
+Homoeopathy; but a distinct movement has been made in Germany to get
+rid of any restriction to the use of these doses, and to employ
+medicines with the same license as other practitioners.
+
+3.  The doctrine of the origin of most chronic diseases in Psora,
+notwithstanding Hahnemann says it cost him twelve years of study and
+research to establish the fact and its practical consequences, has
+met with great neglect and even opposition from very many of his own
+disciples.
+
+It is true, notwithstanding, that, throughout most of their writings
+which I have seen, there runs a prevailing tone of great deference to
+Hahnemann's opinions, a constant reference to his authority, a
+general 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's Translation of Jahr's Manual may observe
+how little comparative space is given to remedies resting upon 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 consider it vastly more probable that any
+observer in so fallacious and difficult a field of inquiry as
+medicine had been led into error, or walked into it of his own
+accord, than that such numerous and extraordinary facts had really
+just come to light.  They would feel a right to exercise the same
+obduracy towards them as the French Institute is in the habit of
+displaying when memoirs or models are offered to it relating to 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
+philosophers must have felt when, some half a dozen years ago, an
+unknown man came forward, and asked for an opportunity to demonstrate
+to Arago and his colleagues that the moon and planets were at a
+distance of a little more than a hundred miles from the earth.  And
+so they would not even look into Homoeopathy, though all its
+advocates should exclaim in the words of Mr. Benjamin Douglass
+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 newly asserted
+facts are founded in the grossest errors."  And they would lay their
+heads upon their pillows with a perfectly clear conscience, although
+they were assured that they were behaving in the same way that people
+of 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 these assertions is
+not sufficient to deter many, from examining their claims to belief.
+I therefore lean but very slightly on the extravagance and extreme
+apparent singularity of their pretensions.  I might have omitted
+them, but on the whole it seemed more just to the claims of my
+argument to suggest the vast complication of improbabilities involved
+in the statements enumerated.  Every one must of course judge for
+himself as to the weight of these objections, which are by no means
+brought forward as a proof of the extravagance of Homoeopathy, but
+simply as entitled to a brief consideration before the facts of the
+case are submitted to our scrutiny.
+
+The three great asserted discoveries of Hahnemann are entirely
+unconnected with and independent of each other.  Were there any
+natural relation between them it would seem probable enough that the
+discovery of the first would have led to that of the others.  But
+assuming it to be a fact that diseases are cured by remedies capable
+of producing symptoms like their own, no manifest relation exists
+between this fact and the next assertion, namely, the power of the
+infinitesimal doses.  And allowing both these to be true, neither has
+the remotest affinity to the third new doctrine, that which declares
+seven eighths of all chronic diseases to be owing to Psora.
+
+This want of any obvious relation between Hahnemann's three cardinal
+doctrines appears to be self-evident upon inspection.  But if, as is
+often true with his disciples, they prefer the authority of one of
+their own number, I will refer them to Dr. Trinks's paper on the
+present state of Homoeopathy in Europe, with which, of course, they
+are familiar, as his name is mentioned as one of the most prominent
+champions of 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 three such unconnected and astonishing
+discoveries, each of them a complete revolution of all that ages of
+the most varied experience had been taught to believe, should spring
+full formed from the brain of a single individual.
+
+Let us look a moment at the first of his doctrines.  Improbable
+though it may seem to some, there is no essential absurdity involved
+in the proposition that diseases yield to remedies capable of
+producing like symptoms.  There are, on the other hand, some
+analogies which lend a degree of plausibility to the statement.
+There are well-ascertained facts, known from the earliest periods of
+medicine, showing that, under certain circumstances, the very
+medicine which, from its known effects, one would expect to aggravate
+the disease, may contribute to its relief.  I may be permitted to
+allude, in the most general way, to the case in which the spontaneous
+efforts of an overtasked stomach are quieted by the agency of a drug
+which that organ refuses to entertain upon any terms.  But that every
+cure ever performed by medicine should have been founded upon this
+principle, although without the knowledge of a physician; that the
+Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature
+in therapeutics," a law of which nothing more than a transient
+glimpse ever presented itself to the innumerable host of medical
+observers, is a dogma of such sweeping extent, and pregnant novelty,
+that it demands a corresponding breadth and depth of unquestionable
+facts to cover its vast pretensions.
+
+So much ridicule has been thrown upon the pretended powers of the
+minute doses that I shall only touch upon this point for the purpose
+of conveying, by illustrations, some shadow of ideas far transcending
+the powers of the imagination to realize.  It must be remembered that
+these comparisons are not matters susceptible of dispute, being
+founded on simple arithmetical computations, level to the capacity of
+any intelligent schoolboy.  A person who once wrote a very small
+pamphlet made some show of objecting to calculations of thus kind, on
+the ground that the highest dilutions could easily be made with a few
+ounces of alcohol.  But he should have remembered that at every
+successive dilution he lays aside or throws away ninety-nine
+hundredths of the fluid on which he is operating, and that, although
+he begins with a drop, he only prepares a millionth, billionth,
+trillionth, and similar fractions of it, all of which, added
+together, would constitute but a vastly minute portion of the drop
+with which he began.  But now let us suppose we take one single drop
+of the Tincture of Camomile, and that the whole of this were to be
+carried through the common series of dilutions.
+
+A calculation nearly like the following was made by Dr. Panvini, and
+may be readily followed in its essential particulars by any one who
+chooses.
+
+For the first dilution it would take 100 drops of alcohol.
+
+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 ninth dilution, which would take ten
+billion gallons, which he computed would fill the basin of Lake
+Agnano, a body of water two miles in circumference.  The twelfth
+dilution would of course fill a million such lakes.  By the time the
+seventeenth degree of dilution should be reached, the alcohol
+required would equal in quantity the waters of ten thousand Adriatic
+seas.  Trifling errors must be expected, but they are as likely to be
+on one side as the other, and any little matter like Lake Superior or
+the Caspian would be but a drop in the bucket.
+
+Swallowers of globules, one of your little pellets, moistened in the
+mingled waves of one million lakes of alcohol, each two miles in
+circumference, with which had been blended that one drop of Tincture
+of Camomile, would be of precisely the strength recommended for that
+medicine in your favorite Jahr's Manual, "against the most sudden,
+frightful, and fatal diseases!"  [In the French edition of 1834, the
+proper doses of the medicines are mentioned, and Camomile is marked
+IV.  Why are the doses omitted in Hull's Translation, except in three
+instances out of the whole two hundred remedies, notwithstanding the
+promise in the preface that "some remarks upon the doses used may be
+found at the head of each medicine"?  Possibly because it makes no
+difference whether they are employed in one Homoeopathic dose or
+another; but then it is very singular that such precise directions
+were formerly given in the same work, and that Hahnemann's
+"experience" should have led him to draw the nice distinctions we
+have seen in a former part of this Lecture (p. 44).]
+
+And proceeding on the common data, I have just made a calculation
+which shows that this single drop of Tincture of Camomile, given in
+the quantity ordered by Jahr's Manual, would have supplied every
+individual of the whole human family, past and present, with more
+than five billion doses each, the action of each dose lasting about
+four days.
+
+Yet this is given only at the quadrillionth, or fourth degree of
+potency, and various substances are frequently administered at the
+decillionth or tenth degree, and occasionally at still higher
+attenuations with professed medicinal results.  Is there not in this
+as great an exception to all the hitherto received laws of nature as
+in the miracle of the loaves and fishes?  Ask this question of a
+Homoeopathist, and he will answer by referring to the effects
+produced by a very minute portion of vaccine matter, or the
+extraordinary diffusion of odors.  But the vaccine matter is one of
+those substances called morbid poisons, of which it is a peculiar
+character to multiply themselves, when introduced into the system, as
+a seed does in the soil.  Therefore the hundredth part of a grain of
+the vaccine matter, if no more than this is employed, soon increases
+in quantity, until, in the course of about a week, it is a grain or
+more, and can be removed in considerable drops.  And what is a very
+curious illustration of Homoeopathy, it does not produce its most.
+characteristic effects until it is already in sufficient quantity not
+merely to be visible, but to be collected for further use.  The
+thoughtlessness which can allow an inference to be extended from a
+product of disease possessing this susceptibility of multiplication
+when conveyed into the living body, to substances of inorganic
+origin, such as silex or sulphur, would be capable of arguing that a
+pebble may produce a mountain, because an acorn can become a forest.
+
+As to the analogy to be found between the alleged action of the
+infinitely attenuated doses, and the effects of some odorous
+substances which possess the extraordinary power of diffusing their
+imponderable emanations through a very wide space, however it may be
+abused in argument, and rapidly as it evaporates on examination, it
+is not like that just mentioned, wholly without meaning.  The fact of
+the vast diffusion of some odors, as that of musk or the rose, for
+instance, has long been cited as the most remarkable illustration of
+the divisibility of matter, and the nicety of the senses.  And if
+this were compared with the effects of a very minute dose of morphia
+on the whole system, or the sudden and fatal impression of a single
+drop of prussic acid, or, with what comes still nearer, the poisonous
+influence of an atmosphere impregnated with invisible malaria, we
+should find in each of these examples an evidence of the degree to
+which nature, in some few instances, concentrates powerful qualities
+in minute or subtile forms of matter.  But if a man comes to me with
+a pestle and mortar in his hand, and tells me that he will take a
+little speck of some substance which nobody ever thought to have any
+smell at all, as, for instance, a grain of chalk or of charcoal, and
+that he will, after an hour or two of rubbing and scraping, develop
+in a portion of it an odor which, if the whole grain were used, would
+be capable of pervading an apartment, a house, a village, a province,
+an empire, nay, the entire atmosphere of this broad planet upon which
+we tread; and that from each of fifty or sixty substances he can in
+this way develop a distinct and hitherto unknown odor: and if he
+tries to show that all this is rendered quite reasonable by the
+analogy of musk and roses, I shall certainly be justified in
+considering him incapable of reasoning, and beyond the reach of my
+argument.  What if, instead of this, he professes to develop new and
+wonderful medicinal powers from the same speck of chalk or charcoal,
+in such proportions as would impregnate every pond, lake, river, sea,
+and ocean of our globe, and appeals to the same analogy in favor of
+the probability of his assertion.
+
+All this may be true, notwithstanding these considerations.  But so
+extraordinary would be the fact, that a single atom of substances
+which a child might swallow without harm by the teaspoonful could, by
+an easy mechanical process, be made to develop such inconceivable
+powers, that nothing but the strictest agreement of the most cautious
+experimenters, secured by every guaranty that they were honest and
+faithful, appealing to repeated experiments in public, with every
+precaution to guard against error, and with the most plain and
+peremptory results, should induce us to lend any credence to such
+pretensions.
+
+The third doctrine, that Psora, the other name of which you remember,
+is the cause of the great majority of chronic diseases, is a
+startling one, to say the least.  That an affection always recognized
+as a very unpleasant personal companion, but generally regarded as a
+mere temporary incommodity, readily yielding to treatment in those
+unfortunate enough to suffer from it, and hardly known among the
+better classes of society, should be all at once found out by a
+German physician to be the great scourge of mankind, the cause of
+their severest bodily and mental calamities, cancer and consumption,
+idiocy and madness, must excite our unqualified surprise.  And when
+the originator of this singular truth ascribes, as in the page now
+open before me, the declining health of a disgraced courtier, the
+chronic malady of a bereaved mother, even the melancholy of the love-
+sick and slighted maiden, to nothing more nor less than the
+insignificant, unseemly, and almost unmentionable ITCH, does it not
+seem as if the very soil upon which we stand were dissolving into
+chaos, over the earthquake-heaving of discovery?
+
+And when one man claims to have established these three independent
+truths, which are about as remote from each other as the discovery of
+the law of gravitation, the invention of printing, and that of the
+mariner's compass, unless the facts in their favor are overwhelming
+and unanimous, the question naturally arises, Is not this man
+deceiving himself, or trying to deceive others?
+
+I proceed to examine the proofs of the leading ideas of Hahnemann and
+his school.
+
+
+In order to show the axiom, similia similibus curantur (or like is
+cured by like), to be the basis of the healing art,--"the sole law of
+nature in therapeutics,"--it is necessary,
+
+1.  That the symptoms produced by drugs in healthy persons should be
+faithfully studied and recorded.
+
+2.  That drugs should be shown to be always capable of curing those
+diseases most like their own symptoms.
+
+3.  That remedies should be shown not to cure diseases when they do
+not produce symptoms resembling those presented in these diseases.
+
+
+1.  The effects of drugs upon healthy persons have 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
+experimentation appears to have been, to take the substance on trial,
+either in common or minute doses, and then to set down every little
+sensation, every little movement of mind or body, which occurred
+within many succeeding hours or days, as being produced solely by the
+substance employed.  When I have enumerated some of the symptoms
+attributed to the power of the drugs taken, you will be able to judge
+how much value is to be ascribed to the assertions of such observers.
+
+The following list was taken literally from the Materia Medica of
+Hahnemann, by my friend M.  Vernois, for whose 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 of the
+work.  I shall be very brief in my citations.
+
+"After stooping some time, sense of painful weight about the head
+upon resuming the erect posture."
+
+"An itching, tickling sensation at the outer edge of the palm of the
+left hand, which obliges the person to scratch."  The medicine was
+acetate of lime, and as the action of the globule taken is said to
+last twenty-eight days, you may judge how many such symptoms as the
+last might be supposed to happen.
+
+Among the symptoms attributed to muriatic acid are these: a catarrh,
+sighing, pimples; "after having written a long time with the back a
+little bent over, violent pain in the back and shoulder-blades, as if
+from a strain,"--"dreams which are not remembered,--disposition to
+mental dejection,--wakefulness before and after midnight."
+
+I might extend this catalogue almost indefinitely.  I have not cited
+these specimens with any view to exciting a sense of the ridiculous,
+which many others of those mentioned would not fail to do, but to
+show that the common accidents of sensation, the little bodily
+inconveniences to which all of us are subject, are seriously and
+systematically ascribed to whatever medicine may have been exhibited,
+even in the minute doses 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 hereafter illustrate, to be
+produced by the substance in question.
+
+The effects of sixty-four medicinal substances, ascertained by one or
+both of these methods, are enumerated in the Materia Medica of
+Hahnemann, which may be considered as the basis of practical
+Homoeopathy.  In the Manual of Jahr, which is the common guide, so
+far as I know, of those who practise Homoeopathy in these regions,
+two hundred remedies are enumerated, many of which, however, have
+never been employed in practice.  In at least one edition there were
+no means of distinguishing those which had been tried upon the sick
+from the others.  It is true that marks have been added in the
+edition employed here, which serve to distinguish them; but what are
+we to think of a standard practical author on Materia Medica, who at
+one time omits to designate the proper doses of his remedies, and at
+another to let us have any means of knowing whether a remedy has ever
+been tried or not, while he is recommending its employment in the
+most critical and threatening diseases?
+
+I think that, from what I have shown of the character of Hahnemann's
+experiments, it would be a satisfaction to any candid inquirer to
+know whether other persons, to whose assertions he could look with
+confidence, confirm these pretended facts.  Now there are many
+individuals, long and well known to the scientific world, who have
+tried these experiments upon healthy subjects, and utterly deny that
+their effects have at 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 experiments in his hospital) as
+to the result of his own trials.  This distinguished physician is
+Professor of Medicine in the School of Paris, and one of the most
+widely known and valued authors upon practical and theoretical
+subjects the profession can claim in any country.  He is a man of
+great kindness of character, a most liberal eclectic by nature and
+habit, of unquestioned integrity, and is called, in the leading
+article of the first number of the "Homoepathic 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
+extolled remedies.  His experiments lasted a year, and he stated
+publicly to the Academy of Medicine that they never produced the
+slightest appearance of the symptoms attributed to them.  The results
+of a man like this, so extensively known as one of the most
+philosophical and candid, as well as brilliant of instructors, and
+whose admirable abilities and signal liberality are generally
+conceded, ought to be of great weight in deciding the question.
+
+M. Double, a well-known medical writer and a physician of high
+standing in Paris, had occasion so long ago as 1801, before he had
+heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian
+bark.  He and several others took the drug in every kind of dose for
+four months, and the fever it is pretended by Hahnemann to excite
+never was produced.
+
+M. Bonnet, President of the Royal Society of Medicine of Bordeaux,
+had occasion to observe many soldiers during the Peninsular War, who
+made use of Cinchona as a preservative against different diseases,
+but he never 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 of the Homoeopathic substances, which
+were given to healthy persons with every precaution as to diet and
+regimen, by M. Louis Fleury, without being followed by the slightest
+of the pretended consequences.  And let me mention as a curious fact,
+that the same quantity of arsenic given to one animal in the common
+form of the unprepared powder, and to another after having been
+rubbed up into six hundred globules, offered no particular difference
+of activity in the two cases.
+
+This is a strange contradiction to the doctrine of the development of
+what they call dynamic power, by means of friction and subdivision.
+
+In 1835 a public challenge was offered to the best known Homoeopathic
+physician in Paris to select any ten substances asserted to produce
+the most striking effects; to prepare them himself; to choose one by
+lot without knowing which of them he had taken, and try it upon
+himself or any intelligent and devoted Homoeopatbist, and, waiting
+his own time, to come forward and tell what substance had been
+employed.  The challenge was at first accepted, but the acceptance
+retracted before the time of trial arrived.
+
+From all this I think it fair to conclude that the catalogues of
+symptoms attributed in Homoeopathic works to the influence of various
+drugs upon healthy persons are not entitled to any confidence.
+
+
+2.  It is necessary to show, in the next place, that medicinal
+substances are always capable of curing diseases most like their own
+symptoms.  For facts relating to this question we must look to two
+sources; the recorded experience of the medical profession in
+general, and the results of trials made according to Homoeopathic
+principles, and capable of testing the truth of the doctrine.
+
+No person, that I am aware of, has ever denied that in some cases
+there exists a resemblance between the effects of a remedy and the
+symptoms of diseases in which 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 true of only a very
+small proportion of useful remedies.  Nor has it ever been considered
+as an established truth that the efficacy of even these few remedies
+was in any definite ratio to their power of producing symptoms more
+or less like those they cured.
+
+Such was the state of opinion when Hahnemann came forward with the
+proposition that all the cases of successful treatment found in the
+works of all preceding medical writers were to be ascribed solely to
+the operation of the Homoeopathic principle, which had effected the
+cure, although without the physician's knowledge that this was the
+real secret.  And strange as it may seem, he was enabled to give such
+a degree of plausibility to this assertion, that any person not
+acquainted somewhat with medical literature, not quite familiar, I
+should rather say, with the relative value of medical evidence,
+according to the sources whence it is derived, would be almost
+frightened into the belief, at seeing the pages upon pages of Latin
+names he has summoned as his witnesses.
+
+It has hitherto been customary, when examining the writings of
+authors of preceding ages, upon subjects as to which they were less
+enlightened than ourselves, and which they were very liable to
+misrepresent, to exercise some little discretion; to discriminate, in
+some measure, between writers deserving confidence and those not
+entitled to it.  But there is not the least appearance of any such
+delicacy on the part of Hahnemann.  A large majority of the names of
+old authors he cites are wholly unknown to science.  With some of
+them I have been long acquainted, and I know that their accounts of
+diseases are no more to be trusted than their contemporary Ambroise
+Pare's stories of mermen, and similar absurdities.  But if my
+judgment is rejected, as being a prejudiced one, I can refer to
+Cullen, who mentioned three of Hahnemann's authors in one sentence,
+as being "not necessarily bad authorities; but certainly such when
+they delivered very improbable events;" and as this was said more
+than half a century ago, it could not have had any reference to
+Hahnemann.  But although not the slightest sign of discrimination is
+visible in his quotations,--although for him a handful of chaff from
+Schenck is all the same thing as a measure of wheat from Morgagni,--
+there is a formidable display of authorities, and an abundant proof
+of ingenious researches to be found in each of the great works of
+Hahnemann with which I am familiar.  [Some painful surmises might
+arise as to the erudition of Hahnemann's English Translator, who
+makes two individuals of "Zacutus, Lucitanus," as well as respecting
+that of the conductors of an American Homoeopathic periodical, who
+suffer the name of the world-renowned Cardanus to be spelt Cardamus
+in at least three places, were not this gross ignorance of course
+attributable only to the printer.]
+
+It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
+proved many of Hahnemann's quotations from old authors to be
+adulterate and false.  What particular instances he has pointed out I
+have no means of learning.  And it is probably wholly impossible on
+this side of the Atlantic, and even in most of the public libraries
+of Europe, to find anything more than a small fraction of the
+innumerable obscure publications which the neglect of grocers and
+trunkmakers has spared to be ransacked by the all-devouring genius of
+Homoeopathy.  I have endeavored to verify such passages as my own
+library afforded me the means of doing.  For some I have looked in
+vain, for want, as I am willing to believe, of more exact references.
+But this I am able to affirm, that, out of the very small number
+which I have been able, to trace back to their original authors, I
+have found two to be wrongly quoted, one of them being a gross
+misrepresentation.
+
+The first is from the ancient Roman author, Caelius Aurelianus; the
+second from the venerable folio of Forestus.  Hahnemann uses the
+following expressions,--if he is not misrepresented in the English
+Translation of the 'Organon': "Asclepiades on one occasion cured an
+inflammation of the brain by 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 treatment employed by Asclepiades, into both of
+which the use of wine entered, as being "in the highest degree
+irrational 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 says that Forestus
+observed violent colic caused by its administration.  But, as the
+author tells the story, a young man took, by the counsel of a
+surgeon, an acrid and virulent medicine, the name of which is not
+given, which brought on a most cruel fit of the gripes and colic.
+After this another surgeon was 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
+Homoeopathic remedy, as Hahnemann pretends, it might be a fair
+question why the young man was not cured by it.  But it is a much
+graver question why a man who has shrewdness and learning enough to
+go so far after his facts, should think it right to treat them with
+such astonishing negligence or such artful unfairness.
+
+Even if every word he had pretended to take from his old authorities
+were to be found in them, even if the authority of every one of these
+authors were beyond question, the looseness with which they are used
+to prove whatever Hahnemann chooses is beyond the bounds of
+credibility.  Let me give one instance to illustrate the character of
+this man's mind.  Hahnemann asserts, in a note annexed to the 110th
+paragraph of the "Organon," that the smell of the rose will cause
+certain persons to faint.  And he says in the text that substances
+which produce peculiar effects of this nature on particular
+constitutions cure the same symptoms in people in general.  Then in
+another note to the same paragraph he quotes the following fact from
+one of the last sources one would have looked to for medical
+information, the Byzantine Historians.
+
+"It was by these means (i.e. Homoeopathically) that the Princess
+Eudosia with rose-water restored a person who had fainted!"
+
+Is it possible that a man who is guilty of such pedantic folly as
+this,--a man who can see a confirmation of his doctrine in such a
+recovery as this,--a recovery which is happening every day, from a
+breath of 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 a man, of whose pages, not here and
+there one, but hundreds upon hundreds are loaded with such
+trivialities, is the Newton, the Columbus, the Harvey of the
+nineteenth century!
+
+The whole process of demonstration he employs is this.  An experiment
+is instituted with some drug upon one or more healthy persons.
+Everything that happens for a number of days or weeks is, as we have
+seen, set down as an effect of the medicine.  Old volumes are then
+ransacked promiscuously, and every morbid sensation or change that
+anybody ever said was produced by the drug in question is added to
+the list of symptoms.  By one or both of these methods, each of the
+sixty-four substances enumerated by Hahnemann is shown to produce a
+very large number of symptoms, the lowest in his scale being ninety-
+seven, and the highest fourteen hundred and ninety-one.  And having
+made out this list respecting any drug, a catalogue which, as you may
+observe in any Homoeopathic manual, contains various symptoms
+belonging to every organ of the body, what can be easier than to find
+alleged cures in every medical author which can at once be attributed
+to the Homoeopathic principle; still more if the grave of
+extinguished credulity is called upon to give up its dead bones as
+living witnesses; and worst of all, if the monuments of the past are
+to be mutilated in favor of "the sole law of Nature in therapeutics"?
+
+There are a few familiar facts of which great use has been made as an
+entering wedge for the Homoeopathic doctrine.  They have been
+suffered to pass current so long that it is time they should be
+nailed to the counter, a little operation which I undertake, with
+perfect cheerfulness, to perform for them.
+
+The first is a supposed illustration of the Homoeopathic law found in
+the precept given for the treatment of parts which have been frozen,
+by friction with snow or similar means.  But we deceive ourselves by
+names, if we suppose the frozen part to be treated by cold, and not
+by heat.  The snow may even be actually 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 to a frozen
+part, except as a mode of regulating the application of what? of
+heat.  But the heat must be applied gradually, just as food must be
+given a little at a time to those perishing with hunger.  If the
+patient were brought into a warm room, heat would be applied very
+rapidly, were not something interposed to prevent this, and allow its
+gradual admission.  Snow or iced water is exactly what is wanted; it
+is not cold to the part; it is very possibly warm, on the contrary,
+for these terms are relative, and if it does not melt and let the
+heat in, or is not taken away, the part will remain frozen up until
+doomsday.  Now the treatment of a frozen limb by heat, in large or
+small quantities, is not Homoeopathy.
+
+The next supposed illustration of the Homoeopathic law is the alleged
+successful management of burns, by holding them to the fire.  This is
+a popular mode of treating those burns which are of too little
+consequence to require any more efficacious remedy, and would
+inevitably get well of themselves, without any trouble being bestowed
+upon them.  It produces a most acute pain in the part, which is
+followed by some loss of sensibility, as happens with the eye after
+exposure to strong light, and the ear after being subjected to very
+intense sounds.  This is all it is capable of doing, and all further
+notions of its efficacy must be attributed merely to the vulgar love
+of paradox.  If this example affords any comfort to the
+Homoeopathist, it seems as cruel to deprive him of it as it would be
+to convince the mistress of the smoke-jack or the flatiron that the
+fire does not literally "draw the fire out," which is her hypothesis.
+
+But if it were true that frost-bites were cured by cold and burns by
+heat, it would be subversive, so far as it went, of the great
+principle of Homoeopathy.
+
+For you will remember that this principle is that Like cures Like,
+and not that Same cures Same; that there is resemblance and not
+identity between the symptoms of the disease and those produced by
+the drug which cures it, and none have been readier to insist upon
+this distinction than the Homoeopathists themselves.  For if Same
+cures Same, then every poison must be its own antidote,--which is
+neither a part of their theory nor their so-called experience.  They
+have been asked often enough, why it was that arsenic could not cure
+the mischief which arsenic had caused, and why the infectious cause
+of small-pox did not remedy the disease it had produced, and then
+the; were ready enough to see the distinction I have pointed out.  O
+no!  it was not the hair of the same dog, but only of one very much
+like him!
+
+A third instance in proof of the Homoeopathic law is sought for in
+the acknowledged efficacy of vaccination.  And how does the law apply
+to this?  It is granted by the advocates of Homoeopathy that there is
+a resemblance between the effects of the vaccine virus on a person in
+health and the symptoms of small-pox.  Therefore, according to the
+rule, the vaccine virus will cure the small-pox, which, as everybody
+knows, is entirely untrue.  But it prevents small-pox, say the
+Homoeopathists.  Yes, and so does small-pox prevent itself from ever
+happening again, and we know just as much of the principle involved
+in the one case as in the other.  For this is only one of a series of
+facts which we are wholly unable to explain.  Small-pox, measles,
+scarlet-fever, hooping-cough, protect those who have them once from
+future attacks; but nettle-rash and catarrh and lung fever, each of
+which is just as Homoeopathic to itself as any one of the others,
+have no such preservative power.  We are obliged to accept the fact,
+unexplained, and we can do no more for vaccination than for the rest.
+
+
+I come now to the most directly practical point connected with the
+subject, namely,--
+
+What is the state of the evidence as to the efficacy of the proper
+Homoeopathic treatment in the cure of diseases.
+
+As the treatment adopted by the Homoeopathists has been almost
+universally by means of the infinitesimal doses, the question of
+their efficacy is thrown open, in common with that of the truth of
+their fundamental axiom, as both are tested in practice.
+
+We must look for facts as to the actual working of Homoeopathy to
+three sources.
+
+1.  The statements of the unprofessional public.
+
+2.  The assertions of Homoeopathic practitioners.
+
+3.  The results of trials by competent and honest physicians, not
+pledged to the system.
+
+I think, after what we have seen of medical facts, as they are
+represented by incompetent persons, we are disposed to attribute
+little value to all statements of wonderful cures, coming from those
+who have never been accustomed to watch the caprices of disease, and
+have not cooled down their young enthusiasm by the habit of tranquil
+observation.  Those who know nothing of the natural progress of a
+malady, of its ordinary duration, of its various modes of
+terminating, of its liability to accidental complications, of the
+signs which mark its insignificance or severity, of what is to be
+expected of it when left to itself, of how much or how little is to
+be anticipated from remedies, those who know nothing or next to
+nothing of all these things, and who are in a great state of
+excitement from benevolence, sympathy, or zeal for a new medical
+discovery, can hardly be expected to be sound judges of facts which
+have misled so many sagacious men, who have spent their lives in the
+daily study and observation of them.  I believe that, after having
+drawn the portrait of defunct Perkinism, with its five thousand
+printed cures, and its million and a half computed ones, its miracles
+blazoned about through America, Denmark, and England; after relating
+that forty years ago women carried the Tractors about in their
+pockets, and workmen could not make them fast enough 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 lucky
+accident, so utterly lost is the memory of all their wonderful
+achievements; I believe, after all this, I need not waste time in
+showing that medical accuracy is not to be looked for in the florid
+reports of benevolent associations, the assertions of illustrious
+patrons, the lax effusions of daily journals, or the effervescent
+gossip of the tea-table.
+
+Dr. Hering, whose name is somewhat familiar to the champions of
+Homoeopathy, has said that "the new healing art is not to be judged
+by its success in isolated cases only, but according to its success
+in general, its innate truth, and the incontrovertible nature of its
+innate principles."
+
+We have seen something of "the incontrovertible nature of its innate
+principles," and it seems probable, on the whole, that its success in
+general must be made up of its success in isolated cases.  Some
+attempts have been made, however, to finish the whole matter by
+sweeping statistical documents, which are intended to prove its
+triumphant success over the common practice.
+
+It is well known to those who have had the good fortune to see the
+"Homoeopathic Examiner," that this journal led off, in its first
+number, with a grand display of everything the newly imported
+doctrine had to show for itself.  It is well remarked, on the twenty-
+third page of this article, that "the comparison of bills of
+mortality among an equal number of sick, treated by divers methods,
+is a most poor and lame way to get at conclusions touching principles
+of the healing art."  In confirmation of which, the author proceeds
+upon the twenty-fifth page to prove the superiority of the
+Homoeopathic treatment of cholera, by precisely these very bills of
+mortality.  Now, every intelligent physician is aware that the poison
+of cholera differed so much in its activity at different times and,
+places, that it was next to impossible to form any opinion as to the
+results of treatment, unless every precaution was taken to secure the
+most perfectly corresponding conditions in the patients treated, and
+hardly even then.  Of course, then, a Russian Admiral, by the name of
+Mordvinov, backed by a number of so-called physicians practising in
+Russian villages, is singularly competent to the task of settling the
+whole question of the utility of this or that kind of treatment; to
+prove that, if not more than eight and a half per cent. of those
+attacked with the disease perished, the rest owed their immunity to
+Hahnemann.  I can remember when more than a hundred patients in a
+public institution were attacked with what, I doubt not, many
+Homoeopathic physicians (to say nothing of Homoeopathic admirals)
+would have called cholera, and not one of them died, though treated
+in the common way, and it is my firm belief that, if such a result
+had followed the administration of the omnipotent globules, it would
+have been in the mouth of every adept in Europe, from Quin of London
+to Spohr of Gandersheim.  No longer ago than yesterday, in one of the
+most widely circulated papers of this city, there was published an
+assertion that the mortality in several Homoeopathic Hospitals was
+not quite five in a hundred, whereas, in what are called by the
+writer Allopathic Hospitals, it is said to be eleven in a hundred.
+An honest man should be ashamed of such an argumentum ad ignorantiam.
+The mortality of a hospital depends not merely on the treatment of
+the patients, but on the class of diseases it is in the habit of
+receiving, on the place where it is, on the season, and many other
+circumstances.  For instance, there are many hospitals in the great
+cities of Europe that receive few diseases of a nature to endanger
+life, and, on the other hand, there are others where dangerous
+diseases are accumulated out of the common proportion.  Thus, in the
+wards of Louis, at the Hospital of La Pitie, a vast number of
+patients in the last stages of consumption were constantly entering,
+to swell the mortality of that hospital.  It was because he was known
+to pay particular attention to the diseases of the chest that
+patients laboring under those fatal affections to an incurable extent
+were so constantly coming in upon him.  It is always a miserable
+appeal to the thoughtlessness of the vulgar, to allege the naked fact
+of the less comparative mortality in the practice of one hospital or
+of one physician than another, as an evidence of the superiority of
+their treatment.  Other things being equal, it must always be
+expected that those institutions and individuals enjoying to the
+highest degree the confidence of the community will lose the largest
+proportion of their patients; for the simple reason that they will
+naturally be looked to by those suffering from the gravest class of
+diseases; that many, who know that they are affected with mortal
+disease, will choose to die under their care or shelter, while the
+subjects of trifling maladies, and merely troublesome symptoms, amuse
+themselves to any extent among the fancy practitioners.  When,
+therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner,"
+and quoted in yesterday's "Daily Advertiser," asserts that the
+mortality among his patients is only one per cent. since he has
+practised Homoeopathy, whereas it was six per cent. when he employed
+the common mode of practice, I am convinced by this, his own
+statement, that the citizens of Brunswick, whenever they are
+seriously 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 detailed examination of the very numerous
+cases reported in the Homoeopathic Treatises and Journals.  Having
+been in the habit of receiving the French "Archives of Homoeopathic
+Medicine" until the premature decease of that Journal, I have had the
+opportunity of becoming acquainted somewhat with the style of these
+documents, and experiencing whatever degree of conviction they were
+calculated to produce.  Although of course I do not wish any value to
+be assumed for my opinion, such as it is, I consider that you are
+entitled to hear it.  So far, then, as I am acquainted with the
+general character of the cases reported by the Homoeopathic
+physicians, they would for the most part be considered as wholly
+undeserving a place in any English, French, or American periodical of
+high standing, if, instead of favoring the doctrine they were
+intended to support, they were brought forward to prove the efficacy
+of any common remedy administered by any common practitioner.  There
+are occasional exceptions to this remark; but the general truth of it
+is rendered probable by the fact that these cases are always, or
+almost always, written with the single object of showing the efficacy
+of the medicine used, or the skill of the practitioner, and it is
+recognized as a general rule that such cases deserve very little
+confidence.  Yet they may sound well enough, one at a time, to those
+who are not fully aware of the fallacies of medical evidence.  Let me
+state a case in illustration.  Nobody doubts that some patients
+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 as a physician is called to in daily practice, would
+recover, sooner or later, with more or less difficulty, provided
+nothing were done to interfere seriously with the efforts of nature.
+
+Suppose, then, a physician who has a hundred patients prescribes to
+each of them pills made of some entirely inert substance, as starch,
+for instance.  Ninety of them get well, or if he chooses to use such
+language, he cures ninety of them.  It is evident, according to the
+doctrine of chances, that there must be a considerable number of
+coincidences between the relief of the patient and the administration
+of the remedy.  It is altogether probable that there will happen two
+or three very striking coincidences out of the whole ninety cases, in
+which it would seem evident that the medicine produced the relief,
+though it had, as we assumed, nothing to do with it.  Now suppose
+that the physician publishes these cases, will they not have a
+plausible appearance of proving that which, as we granted at the
+outset, was entirely false?  Suppose that instead of pills of starch
+he employs microscopic sugarplums, with the five' million billion
+trillionth part of a suspicion of aconite or pulsatilla, and then
+publishes his successful cases, through the leaden lips of the press,
+or the living ones of his female acquaintances,--does that make the
+impression a less erroneous one?  But so it is that in Homoeopathic
+works and journals and gossip one can never, or next to never, find
+anything but successful cases, which might do very well as a proof of
+superior skill, did it not prove as much for the swindling
+advertisers whose certificates disgrace so many of our newspapers.
+How long will it take mankind to learn that while they listen to "the
+speaking hundreds and units, who make the world ring "with the
+pretended triumphs they have witnessed, the "dumb millions" of
+deluded and injured victims are paying the daily forfeit of their
+misplaced confidence!
+
+I am sorry to see, also, that a degree of ignorance as to the natural
+course of diseases is often shown in these published cases, which,
+although it may not be detected by the unprofessional reader, conveys
+an unpleasant impression to those who are acquainted with the
+subject.  Thus a young woman affected with jaundice is mentioned in
+the German "Annals of Clinical Homoeopathy" as having been cured in
+twenty-nine days by pulsatilla and nux vomica.  Rummel, a well-known
+writer of the same school, speaks of curing a case of jaundice in
+thirty-four days by Homoeopathic doses of pulsatilla, aconite, and
+cinchona.  I happened to have a case in my own household, a few weeks
+since, which lasted about ten days, and this was longer than I have
+repeatedly seen it in hospital practice, so that it was nothing to
+boast of.
+
+Dr. Munneche of Lichtenburg in Saxony is called to a patient with
+sprained ankle who had been a fortnight under the common treatment.
+The patient gets well by the use of arnica in a little more than a
+month longer, and this extraordinary fact is published in the French
+"Archives of Homoeopathic Medicine."
+
+In the same Journal is recorded the case of a patient who with
+nothing more, so far as any proof goes, than inluenza, gets down to
+her shop upon the sixth day.
+
+And again, the cool way in which everything favorable in a case is
+set down by these people entirely to their treatment, may be seen in
+a case of croup reported in the "Homoeopathic 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 of some Homoeopathic fluid.
+
+I need not multiply these quotations, which illustrate the grounds of
+an opinion which the time does not allow me to justify more at
+length; other such cases are lying open before me; there is no end to
+them if more were wanted; for nothing is necessary but to look into
+any of the numerous broken-down Journals of Homoeopathy, the volumes
+of which may be found on the shelves of those curious in such
+matters.
+
+A number of public trials of Homoeopathy have been made in different
+parts of the world.  Six of these are mentioned in the Manifesto of
+the "Homoeopathic Examiner."  Now to suppose that any trial can
+absolutely silence people, would be to forget the whole experience of
+the past.  Dr. Haygarth and Dr. Alderson could not stop the sale of
+the five-guinea Tractors, although they proved that they could work
+the same miracles with pieces of wood and tobacco-pipe.  It takes
+time for truth to operate as well as Homoeopathic globules.  Many
+persons thought the results of these trials were decisive enough of
+the nullity of the treatment; those who wish to see the kind of
+special pleading and evasion by which it is attempted to cover
+results which, stated by the "Homoeopathic 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 trials at all, having abundant other evidence on the point.
+But I think it best, on the whole, to mention two of them in a few
+words,--that instituted at Naples and that of Andral.
+
+There have been few names in the medical profession, for the last
+half century, so widely known throughout the world of science as that
+of M. Esquirol, whose life was devoted to the treatment of insanity,
+and who was without a rival in that department of practical medicine.
+It is from an analysis communicated by him to the "Gazette Medicale
+de Paris" that I derive my acquaintance with the account of the trial
+at Naples by Dr. Panvini, physician to the Hospital della Pace.  This
+account seems to be entirely deserving of credit.  Ten patients were
+set apart, and not allowed to take any medicine at all,--much against
+the wish of the Homoeopathic physician.  All of them got well, and of
+course all of them would have been claimed as triumphs if they had
+been submitted to the treatment.  Six other slight cases (each of
+which is specified) got well under the Homoeopathic treatment, none
+of its asserted specific effects being manifested.
+
+All the rest were cases of grave disease; and so far as the trial,
+which was interrupted about the fortieth day, extended, the patients
+grew worse, or received no benefit.  A case is reported on the page
+before me of a soldier affected with acute inflammation in the chest,
+who took successively aconite, bryonia, nux vomica, and pulsatilla,
+and after thirty-eight days of treatment remained without any
+important change in his disease.  The Homoeopathic physician who
+treated these patients was M. de Horatiis, who had the previous year
+been announcing his wonderful cures.  And M. Esquirol asserted to the
+Academy of Medicine in 1835, that this M. de Horatiis, who is one of
+the prominent personages in the "Examiner's" Manifesto published in
+1840, had subsequently renounced Homoeopathy.  I may remark, by the
+way, that this same periodical, which is so very easy in explaining
+away the results of these trials, makes a mistake of only six years
+or a little more as to the time when this at Naples was instituted.
+
+M. Andral, the "eminent and very enlightened allopathist" of the
+"Homoeopathic Examiner," made the following statement in March, 1835,
+to the Academy of Medicine: "I have submitted this doctrine to
+experiment; I can reckon at this time from one hundred and thirty to
+one hundred and forty cases, recorded with perfect fairness, in a
+great hospital, under the eye of numerous witnesses; to avoid every
+objection--I obtained my remedies of M. Guibourt, who keeps a
+Homoeopathic pharmacy, and whose strict exactness is well known; the
+regimen has been scrupulously observed, and I obtained from the
+sisters attached to the hospital a special regimen, such as Hahnemann
+orders.  I was told, however, some months since, that I had not been
+faithful to all the rules of the doctrine.  I therefore took the
+trouble to begin again; I have studied the practice of the Parisian
+Homoeopathists, as I had studied their books, and I became convinced
+that they treated their patients as I had treated mine, and I affirm
+that I have been as rigorously exact in the treatment as any other
+person."
+
+And he expressly asserts the entire nullity of the influence of all
+the Homoeopathic remedies tried by him in modifying, so far as he
+could observe, the progress or termination of diseases.  It deserves
+notice that he experimented with the most boasted substances,--
+cinchona, aconite, mercury, bryonia, belladonna.  Aconite, for
+instance, he says he administered in more than forty cases of that
+collection of feverish symptoms in which it exerts so much power,
+according to Hahnemann, and in not one of them did it have the
+slightest influence, the pulse and heat remaining as before.
+
+These statements look pretty honest, and would seem hard to be
+explained away, but it is calmly said that he "did not know enough of
+the method to select the remedies with any tolerable precision."
+["Homoeopathic Examiner, vol. i.  p. 22.]
+
+"Nothing is left to the caprice of the physician."  (In a word,
+instead of being dependent upon blind chance, that there is an
+infallible law, guided by which; the physician MUST select the proper
+remedies.') ['Ibid.,' in a notice of Menzel's paper.]  Who are they
+that practice Homoeopathy, and say this of a man with the Materia
+Medica of Hahnemann lying before him?  Who are they that send these
+same globules, on which he experimented, accompanied by a little
+book, into families, whose members are thought competent to employ
+them, when they deny any such capacity to a man whose life has been
+passed at the bedside of patients, the most prominent teacher in the
+first Medical Faculty in the world, the consulting physician of the
+King of France, and one of the most renowned practical writers, not
+merely of his nation, but of his age?  I leave the quibbles by which
+such persons would try to creep out from under the crushing weight of
+these conclusions to the unfortunates who suppose that a reply is
+equivalent to an answer.
+
+Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
+invited two Homoeopathic practitioners to experiment in his wards.
+One of these was Curie, now of London, whose works are on the
+counters of some of our bookstores, and probably in the hands of some
+of my audience.  This gentleman, whom Dr. Baillie declares to be an
+enlightened man, and perfectly sincere in his convictions, brought
+his own medicines from the pharmacy which furnished Hahnemann
+himself, and employed them for four or five months upon patients in
+his ward, and with results equally unsatisfactory, as appears from
+Dr. Baillie's statement at a meeting of the Academy of Medicine.  And
+a similar experiment was permitted by the Clinical Professor of the
+Hotel Dieu of Lyons, with the same complete failure.
+
+But these are old and prejudiced practitioners.  Very well, then take
+the statement of Dr. Fleury, a most intelligent young physician, who
+treated homoeopathically more than fifty patients, suffering from
+diseases which it was not dangerous to treat in this way, taking
+every kind of precaution as to regimen, removal of disturbing
+influences, and the state of the atmosphere, insisted upon by the
+most vigorous partisans of the doctrine, and found not the slightest
+effect produced by the medicines.  And more than this, read nine of
+these cases, 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 are pretended to exert such palpable, such
+obvious, such astonishing influences.  In the view of these
+statements, it is impossible not to realize the entire futility of
+attempting to silence this asserted science by the flattest and most
+peremptory results of experiment.  Were all the hospital physicians
+of Europe and America to devote themselves, for the requisite period,
+to this sole pursuit, and were their results to be unanimous as to
+the total worthlessness of the whole system in practice, this
+slippery delusion would slide through their fingers without the
+slightest discomposure, when, as they supposed, they had crushed
+every joint in its tortuous and trailing body.
+
+
+3.  I have said, that to show the truth of the Homoeopathic doctrine,
+as announced by Hahnemann, it would be necessary to show, in the
+third place, that remedies never cure diseases when they are not
+capable of producing similar symptoms!  The burden of this somewhat
+comprehensive demonstration lying entirely upon the advocates of this
+doctrine, it may be left to their mature reflections.
+
+
+It entered into my original plan to treat of the doctrine relating to
+Psora, or itch,--an almost insane conception, which I am glad to get
+rid of, for this is a subject one does not care to handle without
+gloves.  I am saved this trouble, however, by finding that many of
+the disciples of Hahnemann, those disciples the very gospel of whose
+faith stands upon his word, make very light of his authority on this
+point, although he himself says, "It has cost me twelve years of
+study and research to trace out the source of this incredible number
+of chronic affections, to discover this great truth, which remained
+concealed from all my predecessors and contemporaries, to establish
+the basis of its demonstration, and find out, at the same time, the
+curative medicines that were fit to combat this hydra in all its
+different forms."
+
+But, in the face of all this, the following remarks are made by
+Wolff, of Dresden, whose essays, according to the editor of the
+"Homoeopathic Examiner," "represent the opinions of a large majority
+of Homoeopathists in Europe."
+
+"It cannot be unknown to any one at all familiar with Homoeopathic
+literature, that Hahnemann's idea of tracing the large majority of
+chronic diseases to actual itch has met with the greatest opposition
+from Homoeopathic physicians themselves."  And again, "If the Psoric
+theory has led to no proper schism, the reason is to be found in the
+fact that it is almost without any influence in practice."
+
+We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke
+of Baden," and a "distinguished" Homoeopathist, actually asked
+Hahnemann for the proof that chronic diseases, such as dropsy, for
+instance, never arise from any other cause than itch; and that,
+according to common report, the venerable sage was highly incensed
+(fort courrouce) with Dr. Hartmann, of Leipsic, another
+"distinguished" Homoeopathist, for maintaining that they certainly
+did arise from other causes.
+
+And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after
+saying, in a good-natured way, that Psora is the Devil in medicine,
+and that physicians are 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 Hahnemann who may honor me with his
+presence, by not attacking a doctrine on which some of the disciples
+of his creed would be very happy to have its adversaries waste their
+time and strength.  I will not meddle with this excrescence, which,
+though often used in time of 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 heavily to my
+sickle, that I should blunt it upon straw and stubble.
+
+I will close the subject with a brief examination of some of the
+statements made in Homoeopathic works, and more particularly in the
+brilliant Manifesto of the "Examiner," before referred to.  And
+first, it is there stated under the head of "Homoeopathic
+Literature," that "SEVEN HUNDRED volumes have been issued from the
+press developing the peculiarities of the system, and many of them
+possessed of a scientific character that savans know well how to
+respect."  If my assertion were proper evidence in the case, I should
+declare, that, having seen a good many of these publications, from
+the year 1834, when I bought the work of the Rev. Thomas Everest,"
+[Dr. Curie speaks of this silly pamphlet as having been published in
+1835.] to within a few weeks, when I received my last importation of
+Homaeopathic literature, I have found that all, with a very few
+exceptions, were stitched pamphlets varying from twenty or thirty
+pages to somewhat less than a hundred, and generally resembling each
+other as much as so many spelling-books.
+
+But not being evidence in the case, I will give you the testimony of
+Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the
+same Manifesto as one of the most distinguished among the
+Homoeopathists of Europe.  I translate the sentence literally from
+the "Archives de la Medecine Homoeopathique."
+
+"The literature of Homoeopathy, if that honorable name must be
+applied to all kinds of book-making, has been degraded to the
+condition of the humblest servitude.  Productions without talent,
+without spirit, without discrimination, flat and pitiful eulogies,
+exaggerations surpassing the limits of the most robust faith,
+invectives against such as dared to doubt the dogmas which had been
+proclaimed, or catalogues of remedies; of such materials is it
+composed!  From distance to distance only, have appeared some memoirs
+useful to science or practice, which appear as so many green oases in
+the midst of this literary desert."
+
+It is a very natural as well as a curious question to ask, What has
+been the success of Homoeopathy in the different countries of Europe,
+and what is its present condition?
+
+The greatest reliance of the advocates of Homoeopathy is of course on
+Germany.  We know very little of its medical schools, its medical
+doctrines, or its medical men, compared with those of England and
+France.  And, therefore, when an intelligent traveller gives a direct
+account from personal inspection of the miserable condition of the
+Homoeopathic hospital at Leipsic, the first established in Europe,
+and the first on the list of the ever-memorable Manifesto, it is easy
+enough answer or elude the fact by citing various hard names of
+"distinguished" practitioners, which sound just as well to the
+uninformed public as if they were Meckel, or Tiedemann, or
+Langenbeck.  Dr. Leo-Wolf, who, to be sure, is opposed to
+Homoeopathy, but who is a scholar, and ought to know something
+of his own countrymen, assures us that "Dr. Kopp is the only German
+Homoeopathist, if we can call him so, who has been distinguished as
+an author and practitioner before he examined this method."  And Dr.
+Lee, the same gentleman in whose travels the paragraph relating to
+the Leipsic Hospital is to be found, says the same thing.  And I will
+cheerfully expose myself to any impertinent remark which it might
+suggest, to assure my audience that I never heard or saw one
+authentic Homoeopathic name of any country in Europe, which I had
+ever heard mentioned before as connected with medical science by a
+single word or deed sufficient to make it in any degree familiar to
+my ears, unless Arnold of Heidelberg is the anatomist who discovered
+a little nervous centre, called the otic ganglion.  But you need ask
+no better proof of who and what the German adherents of this doctrine
+must be, than the testimony of a German Homoeopathist as to the
+wretched character of the works they manufacture to enforce its
+claims.
+
+As for the act of this or that government tolerating or encouraging
+Homoeopathy, every person of common intelligence knows that it is a
+mere form granted or denied according to the general principles of
+policy adopted in different states, or the degree of influence which
+some few persons who have adopted it may happen to have at court.
+What may be the value of certain pompous titles with which many of
+the advocates of Homoeopathy are honored, it might be disrespectful
+to question.  But in the mean time the judicious inquirer may ponder
+over an extract which I translate from a paper relating to a
+personage well known to the community as Williams the Oculist, with
+whom I had the honor of crossing the Atlantic some years since, and
+who himself handed me two copies of the paper in question.
+
+"To say that he was oculist of Louis XVIII.  and of Charles X., and
+that he now enjoys the same title with respect to His Majesty, Louis
+Philippe, and the King of the Belgians, is unquestionably to say a
+great deal; and yet it is one of the least of his titles to public
+confidence.  His reputation rests upon a basis more substantial even
+than the numerous diplomas with which he is provided, than the
+membership of the different medical societies which have chosen him
+as their associate," etc., etc.
+
+And as to one more point, it is time that the public should fully
+understand that the common method of supporting barefaced imposture
+at the present day, both in Europe and in this country, consists in
+trumping up "Dispensaries," "Colleges of Health," and other
+advertising charitable clap-traps, which use the poor as decoy-ducks
+for the rich, and the proprietors of which have a strong predilection
+for the title of "Professor."  These names, therefore, have come to
+be of little or no value as evidence of the good character, still
+less of the high pretensions of those who invoke their authority.
+Nor does it follow, even when a chair is founded in connection with a
+well-known institution, that it has either a salary or an occupant;
+so that it may be, and probably is, a mere harmless piece of
+toleration on the part of the government if a Professorship of
+Homoeopathy is really in existence at Jena or Heidelberg.  And
+finally, in order to correct the error of any who might suppose that
+the whole Medical Profession of Germany has long since fallen into
+the delusions of Hahnemann, I will quote two lines which a celebrated
+anatomist and surgeon (whose name will occur again in this lecture in
+connection with a very pleasing letter) addressed to the French
+Academy of Medicine in 1835.  "I happened to be in Germany some
+months since, at a meeting of nearly six hundred physicians; one of
+them wished to bring up the question of Homoeopathy; they would not
+even listen to him."  This may have been very impolite and bigoted,
+but that is not precisely the point in reference to which I mention
+the circumstance.
+
+But if we cannot easily get at Germany, we can very easily obtain
+exact information from France and England.  I took the trouble to
+write some months ago to two friends in Paris, in whom I could place
+confidence, for information upon the subject.  One of them answered
+briefly to the effect that nothing was said about it.  When the late
+Curator of the Lowell Institute, at his request, asked about the
+works upon the subject, he was told that they had remained a long
+time on the shelves quite unsalable, and never spoken of.
+
+The other gentleman, [Dr. Henry T. Bigelow, now Professor of
+Surgery in Harvard University] whose name is well known to my
+audience, and who needs no commendation of mine, had the kindness to
+procure for me many publications upon the subject, and some
+information which sets the whole matter at rest, so far as Paris is
+concerned.  He went directly to the Baillieres, the principal and
+almost the only publishers of all the Homoeopathic books and journals
+in that city.  The following facts were taken by him from the
+account-books of this publishing firm.  Four Homoeopathic Journals
+have been published in Paris; three of them by the Baillieres.
+
+The reception they met with may be judged of by showing the number of
+subscribers to each on the books of the publishing firm.
+
+A Review published by some other house, which lasted one year, and
+had about fifty subscribers, appeared in 1834, 1835.
+
+There were only four Journals of Homoeopathy ever published in Paris.
+The Baillieres informed my correspondent that the sale of
+Homoeopathic books was much less than formerly, and that consequently
+they should undertake to publish no new books upon the subject,
+except those of Jahr or Hahnemann.  "This man," says my
+correspondent,--referring to one of the brothers,--"the publisher and
+headquarters of Homoeopathy in Paris, informs me that it is going
+down in England and Germany as well as in Paris."  For all the facts
+he had stated he pledged himself as responsible.
+
+Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
+since then has been going down.
+
+Louis told my correspondent that no person of distinction in Paris
+had embraced Homoeopathy, and that it was declining.  If you ask who
+Louis is, I refer you to the well-known Homoeopathist, Peschier of
+Geneva, who says, addressing him, "I respect no one more than
+yourself; the feeling which guides your researches, your labors, and
+your pen, is so honorable and rare, that I could not but bow down
+before it; and I own, if there were any allopathist who inspired me
+with higher veneration, it would be him and not yourself whom I
+should address."
+
+Among the names of "Distinguished Homoeopathists," however, displayed
+in imposing columns, in the index of the "Homoeopathic Examiner," are
+those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the
+world of science, and the last of them identified with some of the
+most valuable contributions which anatomical knowledge has received
+since the commencement of the present century.  One Dr. Chrysaora,
+who stands sponsor for many facts in that Journal, makes the
+following statement among the rest: "Professors, who are esteemed
+among the most distinguished of the Faculty (Faculty de Medicine),
+both as to knowledge and reputation, have openly confessed the power
+of Homoeopathia in forms of disease where the ordinary method of
+practice proved totally insufficient.  It affords me the highest
+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 Homoeopathists to my correspondent:--
+
+"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
+
+"You have had the kindness to inform me in your letter that a new
+American Journal, the 'New World,'  has made use of my name in
+support of the pretended Homoeopathic doctrines, and that I am
+represented as one of the warmest partisans of Homoeopathy in France.
+
+"I am vastly surprised at the reputation manufactured for me upon the
+new continent; but I am obliged, in deference to truth, to reject it
+with my whole energy.  I spurn far from me everything which relates
+to that charlatanism called Homoeopathy, for these pretended
+doctrines cannot endure the scrutiny of wise and enlightened persons,
+who are guided by honorable sentiments in the practice of the noblest
+of arts.
+
+"PARIS, 3d November, 1841
+
+"I am, etc., etc.,
+
+"G. BRESCHET,
+
+"Professor in the Faculty of Medicine, Member of the Institute,
+Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc."
+[I first saw M.  Breschet's name mentioned in that Journal]
+
+Concerning Amussat, my correspondent writes, that he was informed by
+Madame Hahnemann, who converses in French more readily than her
+husband, and therefore often speaks for him, that "he was not a
+physician, neither Homoeopathist nor Allopathist, but that he was the
+surgeon of their own establishment; that is, performed as a surgeon
+all the operations they had occasion for in their practice."
+
+I regret not having made any inquiries as to Marjolin, who, I doubt
+not, would strike his ponderous snuff-box until it resounded like the
+Grecian horse, at hearing such a doctrine associated with his
+respectable name.  I was not aware, when writing to Paris, that this
+worthy Professor, whose lectures I long attended, was included in
+these audacious claims; but after the specimens I have given of the
+accuracy of the foreign correspondence of the "Homoeopathic
+Examiner," any further information I might obtain would seem so
+superfluous as hardly to be worth the postage.
+
+Homoeopathy may be said, then, to be in a sufficiently miserable
+condition in Paris.  Yet there lives, and there has lived for years,
+the illustrious Samuel Hahnemann, who himself assured my
+correspondent that no 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. Curie in October,
+1839, about eight years after its introduction into the country, that
+there were eighteen Homoeopathic physicians in the United Kingdom, of
+whom only three were to be found out of London, and that many of
+these practised Homoeopathy in secret.
+
+It will be seen, therefore, that, according to the recent statement
+of one of its leading English advocates, Homoeopathy had obtained not
+quite half as many practical disciples in England as Perkinism could
+show for itself in a somewhat less period from the time of its first
+promulgation 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, Homoeopathy is commencing to make an inroad into
+England by the way of Ireland.  At Dublin, distinguished physicians
+have already embraced the new system, and a great part of the
+nobility and gentry of that city have emancipated themselves from the
+English fashion and professional authority."
+
+But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
+Homoeopathy; the Queen Dowager Adelaide has been treated by a
+Homoeopathic 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 than two Lords, and
+if the Dowager of Royalty is better than Royalty itself, all of which
+illustrious dignities were claimed in behalf of Benjamin Douglass
+Perkins?
+
+But if the balance is thought too evenly suspended in this case,
+another instance can be given in which the evidence of British
+noblemen and their ladies is shown to be as valuable in establishing
+the character of a medical man or doctrine, as would be the testimony
+of the Marquis of Waterford concerning the present condition and
+prospects of missionary enterprise.  I have before me an octavo
+volume of more than four hundred pages, in which, among much similar
+matter, I find highly commendatory letters from the Marchioness of
+Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the
+Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis
+of Sligo,--all addressed to "John St. John Long, Esq," a wretched
+charlatan, twice tried for, and once convicted of, manslaughter at
+the Old Bailey.
+
+This poor creature, too, like all of his tribe, speaks of the medical
+profession as a great confederation of bigoted monopolists.  He, too,
+says that "If an innovator should appear, holding out hope to those
+in despair, and curing disorders which the faculty have recorded as
+irremediable, he is at once, and without inquiry, denounced as an
+empiric and an impostor."  He, too, cites the inevitable names of
+Galileo and Harvey, and refers to the feelings excited by the great
+discovery of Jenner.  From the treatment of the great astronomer who
+was visited with the punishment of other heretics by the
+ecclesiastical authorities of a Catholic country some centuries
+since, there is no very direct inference to be drawn to the medical
+profession of the present time.  His name should be babbled no
+longer, after having been placarded for the hundredth time in the
+pages of St. John Long.  But if we are doomed to see constant
+reference to the names of Harvey and Jenner in every worthless
+pamphlet containing the prospectus of some new trick upon the public,
+let us, once for all, stare the facts in the face, and see how the
+discoveries of these great men were actually received by the medical
+profession.
+
+In 1628, Harvey published his first work upon the circulation.  His
+doctrines were a complete revolution of the prevailing opinions of
+all antiquity.  They immediately found both champions and opponents;
+of which last, one only, Riolanus, seemed to Harvey worthy of an
+answer, on account of his "rank, fame, and learning."  Controversy in
+science, as in religion, was not, in those days, carried on with all
+the courtesy which our present habits demand, and it is possible that
+some hard words may have been applied to Harvey, as it is very
+certain that he used the 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 hearing it both well and ill spoken of; some attack it
+with great hostility, others defend it with high encomiums; one party
+believe that I have abundantly proved the truth of the doctrine
+against all the weight of opposing arguments, by experiments,
+observations, and dissections; others think it not yet sufficiently
+cleared up, and free from objections."  Two really eminent
+Professors, 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, dissolved away, gradually, but certainly,
+before the demonstrations of Harvey.  Twenty-four years after the
+publication of his first work, and six years before his death, his
+bust in marble was placed in the Hall of the College of Physicians,
+with a suitable inscription recording his discoveries.
+
+Two years after this he was unanimously invited to accept the
+Presidency of that body; and he lived to see his doctrine
+established, and all reputable opposition withdrawn.
+
+There were many circumstances connected with the discovery of Dr.
+Jenner which were of a nature to excite repugnance and opposition.
+The practice of inoculation for the small-pox had already disarmed
+that disease of many of its terrors.  The introduction of a
+contagious disease from a brute creature into the human system
+naturally struck the public mind with a sensation of disgust and
+apprehension, and a part of the medical public may have shared these
+feelings.  I find that Jenner's discovery of vaccination was made
+public in June, 1798.  In July of the same year the celebrated
+surgeon, Mr. Cline, vaccinated a child with virus received from Dr.
+Jenner, and in communicating the 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 published his "Inquiry," containing the
+testimony of numerous practitioners in different parts of the
+kingdom, to the efficacy of the practice.  Dr. HAYGARTH, who was so
+conspicuous in exposing the follies of Perkinism, was among the very
+earliest to express his opinion in favor of vaccination.  In 1801,
+Dr. Lettsom mentions the circumstance "as being to the honor of the
+medical professors, that they have very generally encouraged this
+salutary practice, although it is certainly calculated to lessen
+their pecuniary advantages by its tendency to extirpate a fertile
+source of professional practice."
+
+In the same year the Medical Committee of Paris spoke of vaccination
+in a public letter, as "the most brilliant and most important
+discovery of the eighteenth century."  The Directors of a Society for
+the Extermination of the Small-Pox, in a Report dated October 1st,
+1807, "congratulate the public on the very favorable opinion which
+the Royal College of Physicians of London, after a most minute and
+laborious investigation 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 of which the sum of twenty thousand pounds was voted
+to 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 up against the
+Medical Profession, are only one mode in which is manifested a spirit
+of opposition not merely to medical science, but to all science, and
+to all sound knowledge.  It is a spirit which neither understands
+itself nor the object at which it is aiming.  It gropes among the
+loose records of 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 have passed their lives in the study
+of a branch of knowledge the very essence of which must always
+consist in long and accurate observation, are less competent to judge
+of new doctrines in their own department than the rest of the
+community.  It belongs to the clown in society, the destructive in
+politics, and the rogue in practice.
+
+The name of Harvey, whose great discovery was the legitimate result
+of his severe training and patient study, should be mentioned only to
+check the pretensions of presumptuous ignorance.  The example of
+Jenner, who gave his inestimable secret, the result of twenty-two
+years of experiment and researches, unpurchased, to the public,--
+when, as was said in Parliament, he might have made a hundred
+thousand pounds by it as well as any smaller sum,--should be referred
+to only to rebuke the selfish venders of secret remedies, among whom
+his early history obliges us reluctantly to record Samuel Hahnemann.
+Those who speak of the great body of physicians as if they were
+united in a league to support the superannuated notions of the past
+against the progress of improvement, have read 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 ambitious
+and plausible innovators.  If at the present time ten years of public
+notoriety have passed over any doctrine professing to be of
+importance in medical science, and if it has not succeeded in raising
+up a powerful body of able, learned, and ingenious advocates for its
+claims, the fault must be in the doctrine and not in the medical
+profession.
+
+Homoeopathy has had a still more extended period of trial than this,
+and we have seen with what results.  It only remains to throw out a
+few conjectures as to the particular manner in which it is to break
+up and disappear.
+
+1.  The confidence of the few believers in this delusion will never
+survive the loss of friends who may die of any acute disease, under a
+treatment such as that prescribed by Homoeopathy.  It is doubtful how
+far cases of this kind will be trusted to its tender mercies, but
+wherever it acquires any considerable foothold, such cases must come,
+and with them the ruin of those who practise it, should any highly
+valued life be thus sacrificed.
+
+2.  After its novelty has worn out, the ardent and capricious
+individuals who constitute the most prominent class of its patrons
+will return to visible doses, were it only for the sake of a change.
+
+3.  The Semi-Homoeopathic practitioner will gradually withdraw from
+the rotten half of his business and try to make the public forget his
+connection with it.
+
+4.  The ultra Homoeopathist will either recant and try to rejoin the
+medical profession; or he will embrace some newer and if possible
+equally extravagant doctrine; or he will stick to his colors and go
+down with his sinking doctrine.  Very few will pursue the course last
+mentioned.
+
+A single fact may serve to point out in what direction there will
+probably be a movement of the dissolving atoms of Homoeopathy.  On
+the 13th page of the too frequently cited Manifesto of the "Examiner"
+I read the following stately paragraph:
+
+"Bigelius, M. D., physician to the Emperor of Russia, whose elevated
+reputation is well known in Europe, has been an acknowledged advocate
+of Hahnemann's doctrines for several years.  He abandoned Allopathia
+for Homoeopathia."  The date of this statement is January, 1840.  I
+find on looking at the booksellers' catalogues that one Bigel, or
+Bigelius, to speak more classically, has been at various times
+publishing Homoeopathic books for some years.
+
+Again, on looking into the "Encyclographie des Sciences Medicales"
+for April, 1840, I find a work entitled "Manual of HYDROSUDOPATHY,
+or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel,
+Physician of the School of Strasburg, Member of the Medico-
+Chirurgical Institute of Naples, of the Academy of St.  Petersburg,--
+Assessor of the College of the Empire of Russia, Physician of 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
+sprung up in Germany since Homoeopathy, which it bids fair to drive
+out of the market, if, as Dr. Bigel says, fourteen physicians
+afflicted with diseases which defied themselves and their colleagues
+came to Graefenberg, in the year 1836 alone, and were cured.  Now Dr.
+Bigel, "whose elevated reputation is well known in Europe," writes as
+follows: "The reader will not fail to see in this defence of the
+curative method of Graefenberg a profession of medical faith, and he
+will be correct in so doing."  And his work closes with the following
+sentence, worthy of so distinguished an individual: "We believe, with
+religion, that the water of baptism purifies the soul from its
+original sin; let us believe also, with experience, that it is for
+our corporeal sins the redeemer of the human body."  If Bigel,
+Physician to the late Grand Duke Constantine, is identical with Bigel
+whom the "Examiner" calls Physician to the Emperor of Russia, it
+appears that he is now actively engaged in throwing cold water at
+once upon his patients and the future prospects of Homoeopathy.
+
+If, as must be admitted, no one of Hahnemann's doctrines is received
+with tolerable unanimity among his disciples, except the central
+axiom, Similia similibus curantur; if this axiom itself relies mainly
+for its support upon the folly and trickery of Hahnemann, what can we
+think of those who announce themselves ready to relinquish all the
+accumulated treasures of our art, to trifle with life upon the
+strength of these fantastic theories?  What shall we think of
+professed practitioners of medicine, if, in the words of Jahr, "from
+ignorance, for their personal convenience, or through charlatanism,
+they treat their patients one day Homoeopathically and the next
+Allopathically;" if they parade their pretended new science before
+the unguarded portion of the community; if they suffer their names to
+be coupled with it wherever it may gain a credulous patient; and deny
+all responsibility for its character, refuse all argument for its
+doctrines, allege no palliation for the ignorance and deception
+interwoven with every thread of its flimsy tissue, when they are
+questioned by those competent to judge and entitled to an answer?
+
+Such is the pretended science of Homoeopathy, to which you are asked
+to trust your lives and the lives of those dearest to you.  A mingled
+mass of perverse ingenuity, of tinsel erudition, of imbecile
+credulity, and of artful misrepresentation, too often mingled in
+practice, if we may trust the authority of its founder, with
+heartless and shameless imposition.  Because it is suffered so often
+to appeal unanswered to the public, because it has its journals, its
+patrons, its apostles, some are weak enough to suppose it can escape
+the inevitable doom of utter disgrace and oblivion.  Not many years
+can pass away before the same curiosity excited by one of Perkins's
+Tractors will be awakened at the sight of one of the Infinitesimal
+Globules.  If it should claim a longer existence, it can only be by
+falling into the hands of the sordid wretches who wring their bread
+from the cold grasp of disease and death in the hovels of ignorant
+poverty.
+
+As one humble member of a profession which for more than two thousand
+years has devoted itself to the pursuit of the best earthly interests
+of mankind, always assailed and insulted from without by such as are
+ignorant of its infinite perplexities and labors, always striving in
+unequal contest with the hundred-armed giant who walks in the
+noonday, and sleeps not in the midnight, yet still toiling, not
+merely for itself and 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 noble science 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 so far contagious as to be
+frequently carried from patient to patient by physicians and nurses."
+O. W. Holmes, 1843.
+
+
+THE NEGATIVE.
+
+"The result of the whole discussion will, I trust, serve, not only to
+exalt your views of the value and dignity of our profession, but to
+divest your minds of the overpowering dread that you can ever become,
+especially to woman, under the extremely interesting circumstances of
+gestation and parturition, the minister of evil; that you can ever
+convey, in any possible manner, a horrible virus, so destructive in
+its effects, and so mysterious in its operations as that attributed
+to puerperal fever."--Professor Hodge,
+1852.
+
+"I prefer to attribute them to accident, or Providence, of which I
+can form a conception, rather than to a contagion of which I cannot
+form any clear idea, at least as to this particular malady."--
+Professor Meigs, 1852.
+
+" .  .  .  in the propagation of which they have no more to do, than
+with the propagation of cholera from Jessore to San Francisco, and
+from Mauritius to St. Petersburg."--Professor Meigs, 1854.
+
+                    ---------------------
+
+"I arrived at that certainty in the matter, that I could venture to
+foretell what women would be affected with the disease, upon hearing
+by what midwife they were to be delivered, or by what nurse they 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 every year by the contagion of
+puerperal fever, communicated by the nurses and medical attendants."
+Farr, in Fifth Annual Report of Registrar-General of England, 1843.
+
+".  .  .  boards of health, if such exist, or, without them, the
+medical institutions of a country, should have the power of coercing,
+or of inflicting some kind of punishment on those who recklessly go
+from cases of puerperal fevers to parturient or puerperal females,
+without using due precaution; and who, having been shown the risk,
+criminally encounter it, and convey pestilence and death to the
+persons they are employed to aid in the most interesting and
+suffering period of female existence."--Copland's Medical
+Dictionary, Art.  Puerperal States and Diseases, 1852.
+
+"We conceive it unnecessary to go into detail to prove the contagious
+nature of this disease, as there are few, if any, American
+practitioners who do not believe in this doctrine."--Dr. Lee, in
+Additions to Article last cited.
+
+                   -----------------------
+
+[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
+arose in a Medical Society of which I was a member, involving the
+subject of a certain supposed cause of disease, about which something
+was known, a good deal suspected, and not a little feared.  The
+discussion was suggested by a case, reported at the preceding
+meeting, of a physician who made an examination of the body of a
+patient who had died with puerperal fever, and who himself died in
+less than a week, apparently in consequence of a wound received at
+the examination, having attended several women in confinement in the
+mean time, all of whom, as it was alleged, were attacked with
+puerperal fever.
+
+Whatever apprehensions and beliefs were entertained, it was plain
+that a fuller knowledge of the facts relating to the subject would be
+acceptable to all present.  I therefore felt that it would be doing a
+good service to look into the best records I could find, and inquire
+of the most trustworthy practitioners I knew, to learn what
+experience had to teach in the matter, and arrived at the results
+contained in the following pages.
+
+The Essay was read before the Boston Society for Medical Improvement,
+and, at the request of the Society, printed in the "New England
+Quarterly Journal of Medicine and Surgery" for April, 1843.  As this
+Journal never obtained a large circulation, and ceased to be
+published after a year's existence, and as the few copies I had
+struck off separately were soon lost sight of among the friends to
+whom they were sent, the Essay can hardly be said to have been fully
+brought before the Profession.
+
+The subject of this Paper has the same profound interest for me at
+the present moment as it had when I was first collecting the terrible
+evidence out of which, as it seems to me, the commonest exercise of
+reason could not help shaping the truth it involved.  It is not
+merely on account of the bearing of the question,--if there is a
+question,--on all that is most sacred in human life and happiness,
+that the subject cannot lose its interest.  It is because it seems
+evident that a fair statement of the facts must produce its proper
+influence on a very large proportion of well-constituted and
+unprejudiced minds.  Individuals may, here and there, resist the
+practical bearing of the evidence on their own feelings or interests;
+some may fail to see its meaning, as some persons may be found who
+cannot tell red from green; but I cannot doubt that most readers will
+be satisfied and convinced, to loathing, long before they have
+finished the dark obituary calendar laid before them.
+
+I do not know that I shall ever again have so good an opportunity of
+being useful as was granted me by the raising of the question which
+produced this Essay.  For I have abundant evidence that it has made
+many practitioners more cautious in their relations with puerperal
+females, and I have no doubt it will do so still, if it has a chance
+of being read, though it should call out a hundred counterblasts,
+proving to the satisfaction of their authors that it proved nothing.
+And for my part, I had rather rescue one mother from being poisoned
+by her attendant, than claim to have saved forty out of fifty
+patients to whom I had carried the disease.  Thus, I am willing to
+avail myself of any hint coming from without to offer this paper once
+more to the press.  The occasion has presented itself, as will be
+seen, in a convenient if 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 eliminates those secondary questions which cannot be entertained
+for a moment until the one great point of fact is peremptorily
+settled.  In its very statement of the doctrine maintained it avoids
+all discussion of the nature of the disease "known as puerperal
+fever," and all the somewhat stale philology of the word contagion.
+It mentions, fairly enough, the names of sceptics, or unbelievers as
+to the reality of personal transmission; of Dewees, of Tonnelle, of
+Duges, of Baudelocque, and others; of course, not including those
+whose works were then unwritten or unpublished; nor enumerating all
+the Continental writers who, in ignorance of the great mass of
+evidence accumulated by British practitioners, could hardly be called
+well informed on this subject.  It meets all the array of negative
+cases,--those in which disease did not follow exposure,--by the
+striking example of small-pox, which, although one of the most
+contagious of diseases, is subject to the most remarkable
+irregularities and seeming caprices in its transmission.  It makes
+full allowance for other causes besides personal transmission,
+especially for epidemic influences.  It allows for the possibility of
+different modes of conveyance of the destructive principle.  It
+recognizes and supports the belief that a series of cases may
+originate from a single primitive source which affects each new
+patient in turn; and especially from cases of Erysipelas.  It does
+not undertake to discuss the theoretical aspect of the subject; that
+is a secondary matter of consideration.  Where facts are numerous,
+and unquestionable, and unequivocal in their significance, theory
+must follow them as it best may, keeping time with their step, and
+not go before them, marching to the sound of its own drum and
+trumpet.  Having thus narrowed its area to a limited practical
+platform of discussion, a matter of life and death, and not of
+phrases or theories, it covers every inch of it with a mass of
+evidence which I conceive a Committee of Husbands, who can count
+coincidences and draw conclusions as well as a Synod of Accoucheurs,
+would justly consider as affording ample reasons for an unceremonious
+dismissal of a practitioner (if it is conceivable that such a step
+could be waited for), after five or six funerals had marked the path
+of his daily visits, while other practitioners 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 hands this Essay may fall, some
+words of introduction may be appropriate, and perhaps, to a small
+number of them, necessary.  There are some among them who, from
+youth, or want of training, are easily bewildered and confused in any
+conflict of opinions into which their studies lead them.  They are
+liable to lose sight of the main question in collateral issues, and
+to be run away with by suggestive speculations.  They confound belief
+with evidence, often trusting the first because it is expressed with
+energy, and slighting the latter because it is calm and
+unimpassioned.  They are not satisfied with proof; they cannot
+believe a point is settled so long as everybody is not silenced.
+They have not learned that error is got out of the minds that cherish
+it, as the taenia is removed from the body, one joint, or a few
+joints at a time, for the most part, rarely the whole evil at once.
+They naturally have faith in their instructors, turning to them for
+truth, and taking what they may choose to give them; babes in
+knowledge, not yet able to tell the breast from the bottle, pumping
+away for the milk of truth at all that offers, were it nothing better
+than a Professor's shrivelled forefinger.
+
+In the earliest and embryonic stage of professional development, any
+violent impression on the instructor's mind is apt to be followed by
+some lasting effect on that of the pupil.  No mother's mark is more
+permanent than the mental naevi and moles, and excrescences, and
+mutilations, that students carry with them out of the lecture-room,
+if once the teeming intellect which nourishes theirs has been scared
+from its propriety by any misshapen fantasy.  Even an impatient or
+petulant expression, which to a philosopher would be a mere index of
+the low state of amiability of the speaker at the moment of its
+utterance, may pass into the young mind as an element of its future
+constitution, to injure its temper or corrupt its judgment.  It is a
+duty, therefore, which we owe to this younger class of students, to
+clear any important truth which may have been rendered questionable
+in their minds by such language, or any truth-teller against whom
+they may have been prejudiced by hasty epithets, 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 this prejudice is local or personal, and
+not an acknowledged conviction with the public at large.  It may be
+necessary to break through our usual habits of reserve to do this,
+but this is the fault of the position in which others have placed us.
+
+Two widely-known and highly-esteemed practitioners, Professors in two
+of the largest Medical Schools of the Union, teaching the branch of
+art which includes the Diseases of Women, and therefore speaking with
+authority; addressing in their lectures and printed publications
+large numbers of young men, many of them in the tenderest immaturity
+of knowledge, have recently taken ground in a formal way against the
+doctrine maintained 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 of his Class.  By Charles D.
+Meigs, M.  D., Professor of Midwifery and the Diseases of Women and
+Children in Jefferson Medical College, Philadelphia, etc., etc.
+Philadelphia, 1854.  Letter VI.
+
+
+The first of the two publications, Dr. Hodge's Lecture, while its
+theoretical considerations and negative experiences do not seem to me
+to require any further notice than such as lay ready for them in my
+Essay written long before, is, I am pleased to say, unobjectionable
+in tone and language, and may be read without offence.
+
+This can hardly be said of the chapter of Dr. Meigs's volume which
+treats of Contagion in Childbed Fever.  There are expressions used in
+it which might well put a stop to all scientific discussions, were
+they to form the current coin in our exchange of opinions.  I leave
+the "very young gentlemen," whose careful expositions of the results
+of practice in more than six thousand cases are characterized as "the
+jejune and fizenless dreamings of sophomore writers," to the
+sympathies of those "dear young friends," and "dear young gentlemen,"
+who will judge how much to value their instructor's counsel to think
+for themselves, knowing what they are to expect if they happen not to
+think as he does.
+
+One unpalatable expression I suppose the laws of construction oblige
+me to appropriate to myself, as my reward for a certain amount of
+labor bestowed on the investigation of a very important question of
+evidence, and a statement of my own practical conclusions.  I take no
+offence, and attempt no retort.  No man makes a quarrel with me over
+the counterpane that covers a mother, with her new-born infant at her
+breast.  There is no epithet in the vocabulary of slight and sarcasm
+that can reach my personal sensibilities in such a controversy.  Only
+just so far as a disrespectful phrase may turn the student aside from
+the examination of the evidence, by discrediting or dishonoring the
+witness, does it call for any word of notice.
+
+I appeal from the disparaging language by which the Professor in the
+Jefferson School of Philadelphia world dispose of my claims to be
+listened to.  I appeal, not to the vote of the Society for Medical
+Improvement, although this was an unusual evidence of interest in the
+paper in question, for it was a vote passed among my own townsmen;
+nor to the opinion of any American, for none know better than the
+Professors in the great Schools of Philadelphia how cheaply the
+praise of native contemporary criticism is obtained.  I appeal to the
+recorded opinions of those whom I do 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 spoken of my Essay in
+phrases to which the pamphlets of American "scribblers" are seldom
+used from European authorities; to Ramsbotham, whose compendious
+eulogy is all that self-love could ask; to the "Fifth Annual Report"
+of the Registrar-General of England, in which the second-hand
+abstract of my Essay figures largely, and not without favorable
+comment, in an important appended paper.  These testimonies, half
+forgotten until this circumstance recalled them, are dragged into the
+light, not in a paroxysm of vanity, but to show that there may be
+food for thought in the small pamphlet which the Philadelphia Teacher
+treats so lightly.  They were at least unsought for, and would never
+have been proclaimed but for the sake of securing the privilege of a
+decent and unprejudiced hearing.
+
+I will take it for granted that they have so far counterpoised the
+depreciating language of my fellow-countryman and fellow-teacher as
+to gain me a reader here and there among the youthful class of
+students I am now addressing.  It is only for their sake that I think
+it 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 for beginners; and as I do not expect the
+practitioner, or even the more mature student, to take the trouble to
+follow me through an Introduction which I consider wholly unnecessary
+and superfluous for them, I shall not hesitate to stoop to the most
+elementary simplicity for the benefit of the younger student.  I do
+this more willingly because it affords a good opportunity, as it
+seems to me, of exercising the untrained mind in that medical logic
+which does not seem to have been either taught or practised in our
+schools of late, to the extent that might be desired.
+
+I will now exhibit, in a series of propositions reduced to their
+simplest expression, the same essential statements and conclusions as
+are contained in the Essay, with such commentaries and explanations
+as may be profitable to the inexperienced class of readers addressed.
+
+
+I.  It has been long believed, by many competent observers, that
+Puerperal Fever (so called) is sometimes carried from patient to
+patient by medical assistants.
+
+II.  The express object of this Essay is to prove that it is so
+carried.
+
+III.  In order to prove this point, it is not necessary to consult
+any medical theorist as to whether or not it is consistent with his
+preconceived notions that such a mode of transfer should exist.
+
+IV.  If the medical theorist insists on being consulted, and we see
+fit to indulge him, he cannot be allowed to assume that the alleged
+laws of contagion, deduced from observation in other diseases, shall
+be cited to disprove the alleged laws deduced from observation in
+this.  Science would never make progress under such conditions.
+Neither the long incubation of hydrophobia, nor the protecting power
+of vaccination, would ever have been admitted, if the results of
+observation in these affections had been rejected as contradictory to
+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 which I have examined.
+
+VI.  When an unusually large number of cases of this disease occur
+about the same time, it is inferred, therefore, that there exists
+some special cause for this increased frequency.  If the disease
+prevails extensively over a wide region of country, it is attributed
+without dispute to an epidemic influence.  If it prevails in a single
+locality, as in a hospital, and not elsewhere, this is considered
+proof that some local cause is there active in its production.
+
+VII.  When a large number of cases of this disease occur in rapid
+succession, in one individual's ordinary practice, and few or none
+elsewhere, these cases appearing in scattered localities, in patients
+of the same average condition as those who escape under the care of
+others, there is the same reason for connecting the cause of the
+disease with the person in this instance, as with the place in that
+last mentioned.
+
+VIII.  Many series of cases, answering to these conditions, are given
+in this Essay, and many others will be referred to which have
+occurred since it was written.
+
+IX.  The alleged results of observation may be set aside; first,
+because the so-called facts are in their own nature equivocal;
+secondly, because they stand on insufficient authority; thirdly,
+because they are not sufficiently numerous.  But, in this case, the
+disease is one of striking and well-marked character; the witnesses
+are experts, interested in denying and disbelieving the facts; the
+number of consecutive cases in many instances frightful, and the
+number of series of cases such that I have no room for many of them
+except 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 effect of chance.  I have had the chances
+calculated by a competent person, that a given practitioner, A.,
+shall have sixteen fatal cases in a month, on the following data:
+A. to average attendance upon two hundred and fifty births in a year;
+three deaths in one thousand births to be assumed as the average from
+puerperal fever; no epidemic to be at the time prevailing.  It
+follows, from the answer given me, that if we suppose every one of
+the five hundred thousand annual births of England to have been
+recorded during the last half-century, there would not be one chance
+in a million million million millions that one such series should be
+noted.  No possible fractional error in this calculation can render
+the chance a working probability.  Applied to dozens of series of
+various lengths, it is obviously an absurdity.  Chance, therefore, is
+out of the question as an explanation of the admitted coincidences.
+
+XI.  There is, therefore, some relation of cause and effect between
+the physician's presence and the patient's disease.
+
+XII.  Until it is proved to what removable condition attaching to the
+attendant the disease is owing, he is bound to stay away from his
+patients so soon as he finds himself singled out to be tracked by the
+disease.  How long, and with what other precautions, I have
+suggested, without dictating, at the close of my Essay.  If the
+physician does not at once act on any reasonable suspicion of his
+being the medium of transfer, the families where he is engaged, if
+they are allowed to know the facts, should decline his services for
+the time.  His feelings on the occasion, however interesting to
+himself, should not be even named in this connection.  A physician
+who talks about ceremony and gratitude, and services rendered, and
+the treatment he got, surely forgets himself; it is impossible that
+he should seriously think of these small matters where there is even
+a question 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 mode in which he may
+relieve his mind of any confusion, or possibly, if very young, any
+doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised
+in his mind.
+
+The most prominent ideas of the Letter are, first, that the
+transmissible nature of puerperal fever appears improbable, and,
+secondly, that it would be very inconvenient to the writer.
+Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in
+London, found it improbable, and exceedingly inconvenient to himself,
+that cow pox should prevent small-pox; but Dr. Jenner took the
+liberty to prove the fact, notwithstanding.
+
+I will first call the young student's attention to the show of
+negative facts (exposure without subsequent disease), of which much
+seems to be thought.  And I may at the same time refer him to Dr.
+Hodge's Lecture, where he will find the same kind of facts and
+reasoning.  Let him now take up Watson's Lectures, the good sense and
+spirit of which have made his book a universal favorite, and open to
+the chapter on Continued Fever.  He will find a paragraph containing
+the following sentence: "A man might say, 'I was in the battle of
+Waterloo, and saw many men around me fall down and die, and it was
+said that they were struck down by musket-balls; but I know better
+than that, for I was there all the time, and so were many of my
+friends, and we were never hit by any musket-balls.  Musket-balls,
+therefore, could not have been the cause of the deaths we witnessed.'
+And if, like contagion, they were not palpable to the senses, such a
+person might go on to affirm that no proof existed of there being any
+such thing as musket-balls."  Now let the student turn back to the
+chapter on Hydrophobia in the same volume.  He will find that John
+Hunter knew a case in which, of twenty-one persons bitten, only one
+died of the disease.  He will find that one dog at Charenton was
+bitten at different times by 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 rabid animal, because so many escape?  Or let
+him look at "Underwood on Diseases of Children,"[Philadelphia, 1842,
+p.  244, note.] and he will find the case of a young woman who was
+inoculated eight times in thirty days, at the same time attending
+several children with smallpox, and yet was not infected.  But seven
+weeks afterwards she took the disease and died.
+
+It would seem as if the force of this argument could hardly fail to
+be seen, if it were granted that every one of these series of cases
+were so reported as to prove that there could have been no transfer
+of disease.  There is not one of them so reported, in the Lecture or
+the Letter, as to prove that the disease may not have been carried by
+the practitioner.  I strongly suspect that it was so carried in some
+of these cases, but from the character of the very imperfect evidence
+the question can never be settled without further disclosures.
+
+Although the Letter is, as I have implied, principally taken 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
+touch some of these questions briefly, as an illustration of its
+logical character.
+
+The first thing to be done, as I thought when I wrote my Essay, was
+to throw out all discussions of the word contagion, and this I did
+effectually by the careful wording of my statement of the subject to
+be discussed.  My object was not to settle the etymology or
+definition of a word, but to show that women had often died in
+childbed, poisoned in some way by their medical attendants.  On the
+other point, I, at least, have no controversy with anybody, and I
+think the student will do well to avoid it in this connection.  If I
+must define my position, however, as well as the term in question, I
+am contented with Worcester's definition; provided always this avowal
+do not open another 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 the laws of the
+eruptive fevers must necessarily hold true of this peculiar disease
+of puerperal women.  If there were any such propriety, the laws of
+the eruptive fevers must at least be stated correctly.  It is not
+true, for instance, as Dr. Meigs states, that contagion is "no
+respecter of persons;" that "it attacks all individuals alike."  To
+give one example: Dr. Gregory, of the Small-Pox Hospital, who ought
+to know, says that persons pass through life apparently insensible to
+or unsusceptible of the small-pox virus, and that the same persons do
+not take the vaccine disease.
+
+As to the short time of incubation, of which so much is made, we have
+no right to decide beforehand whether it shall be long or short, in
+the cases we are considering.  A dissection wound may produce
+symptoms of poisoning in six hours; the bite of a rabid animal may
+take as many months.
+
+After the student has read the case in Dr. Meigs's 136th paragraph,
+and the following one, in which he exclaims against the idea of
+contagion, because the patient, delivered on the 26th of December,
+was attacked in twenty-four hours, and died on the third day, let him
+read what happened at the "Black Assizes" of 1577 and 1750.  In the
+first case, six hundred persons sickened the same night of the
+exposure, and three hundred more in three days. [Elliotson's
+Practice, p.  298.]  Of those attacked in the latter year, the
+exposure being on the 11th of May, Alderman Lambert died on the 13th,
+Under-Sheriff Cox on the 14th, and many of note before the
+20th.  But these are old stories.  Let the student listen then to Dr.
+Gerhard, whose reputation as a cautious observer he may be supposed
+to know.  "The nurse was shaving a man, who died in a few hours after
+his entrance; he inhaled his breath, which had a nauseous taste, and
+in an hour afterwards was taken with nausea, cephalalgia, and singing
+of the ears.  From that moment the attack began, and assumed a severe
+character.  The assistant was supporting another patient, who died
+soon afterwards; he felt the pungent heat upon his skin, and was
+taken immediately with the symptoms of typhus."[Am.  Jour.  Med.
+Sciences, Feb.  1837, p.  299.]   It is by notes of cases, rather
+than notes of admiration, that we must be guided, when we study the
+Revised Statutes of Nature, as laid down from the curule chairs of
+Medicine.
+
+Let the student read Dr. Meigs's 140th paragraph soberly, and then
+remember, that not only does he infer, suspect, and surmise, but he
+actually asserts (page 154), "there was poison in the house," because
+three out of five patients admitted into a ward had puerperal fever
+and died.  Have I not as much right to draw a positive inference from
+"Dr. A.'s" seventy exclusive cases as he from the 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 know
+that the patients he bled in puerperal fever would not have all got
+well if he had not bled them?
+
+"You see a man discharge a gun at another; you see the flash, you
+hear the report, you see the person fall a lifeless corpse; and you
+infer, from all these circumstances, that there was a ball discharged
+from the gun, which entered his body and caused his death, because
+such is the usual and natural cause of such an effect.  But you did
+not see the ball leave the gun, pass through the air, and enter the
+body of the slain; and your testimony to the fact of killing is,
+therefore, only inferential,--in other words, circumstantial.  It is
+possible that no ball was in the gun; and we infer that there was,
+only because 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: Is the circumstance of
+intercourse with the sick followed by the appearance of the disease
+in a proportion of cases so much greater than any other circumstance
+common to any portion of the inhabitants of the place under
+observation, as to make it inconceivable that the succession of cases
+occurring in persons having that intercourse should have been the
+result of chance?  If so, the inference is unavoidable, that that
+intercourse must have acted as a cause of the disease.  All
+observations which do not bear strictly on that point are irrelevant,
+and, in the case of an epidemic first appearing in a town or
+district, a succession of two cases is sometimes sufficient to
+furnish evidence which, on the principle I have stated, is nearly
+irresistible."
+
+Possibly an inexperienced youth may be awe-struck by the quotation
+from Cuvier.  These words, or their equivalent, are certainly to be
+found in his Introduction.  So are the words "top not come down"!
+to be found in the Bible, and they were as much meant for the ladies'
+head-dresses as the words of Cuvier were meant to make clinical
+observation wait for a permit from anybody to look with its eyes and
+count on its fingers.  Let the inquiring youth read the whole
+Introduction, and he will see what they mean.
+
+I intend no breach of courtesy, but this is a proper place to warn
+the student against skimming the prefaces and introductions of works
+for mottoes and embellishments to his thesis.  He cannot learn
+anatomy by thrusting an exploring needle into the body.  He will be
+very liable to misquote his author's meaning while he is picking off
+his outside sentences.  He may make as great a blunder as that simple
+prince who praised the conductor of his orchestra for the piece just
+before the overture; the musician was too good a courtier to tell him
+that it was only the tuning of the instruments.
+
+To the six propositions in the 142d paragraph, and the remarks about
+"specific" diseases, the answer, if any is necessary, seems very
+simple.  An inflammation of a serous membrane may give rise to
+secretions which act as a poison, whether that be a "specific" poison
+or not, as Dr. Homer has told his young readers, and as dissectors
+know too well; and that poison may produce its symptoms in a few
+hours after the system has received it, as any may see in Druitt's
+"Surgery," if they care to look.  Puerperal peritonitis may produce
+such a poison, and puerperal women may be very sensible to its
+influences, conveyed by contact or exhalation.  Whether this is so or
+not, facts alone can determine, and to facts we have had recourse to
+settle it.
+
+The following statement is made by Dr. Meigs in his 142d paragraph,
+and developed more at length, with rhetorical amplifications, in the
+134th.  "No human being, save a pregnant or parturient woman, is
+susceptible to the poison."  This statement is wholly incorrect, as I
+am sorry to have to point out to a Teacher in Dr. Meigs's position.
+I do not object to the erudition which quotes Willis and Fernelius,
+the last of whom was pleasantly said to have "preserved the dregs of
+the Arabs in the honey of his Latinity."  But I could wish that more
+modern authorities had not been overlooked.  On this point, for
+instance, among the numerous facts disproving the statement, the
+"American Journal of Medical Sciences," published not far from his
+lecture-room, would have presented him with a respectable catalog of
+such cases.  Thus he might refer to Mr. Storrs's paper "On the
+Contagious Effects of Puerperal Fever on the Male Subject; or on
+Persons not Childbearing"(Jan.  1846), or to Dr. Reid's case (April,
+1846), or to Dr. Barron's statement of the children's dying of
+peritonitis in an epidemic of puerperal fever at the Philadelphia
+Hospital (Oct.  1842), or to various instances cited in Dr.
+Kneeland's article (April, 186).  Or, if he would have referred to
+the "New York Journal," he might have seen Prof. Austin Flint's
+cases.  Or, if he had honored my Essay so far, he might have found
+striking instances of the same kind in the first of the new series of
+cases there reported and elsewhere.  I do not see the bearing of his
+proposition, if it were true.  But it is one of those assertions that
+fall in a moment before a slight examination of the facts; and I
+confess my surprise, that a professor who lectures on the Diseases of
+Women should have ventured to make it.
+
+Nearly seven pages are devoted to showing that I was wrong in saying
+I would not be "understood to imply that there exists a doubt in the
+mind of any well-informed member of the medical profession as to the
+fact that puerperal fever is sometimes communicated from one person
+to another, both directly and indirectly."  I will devote seven lines
+to these seven pages, which seven 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.--Believes the disease is sometimes communicable by
+contagion.  Tonnelle, Baudelocque.  Both cited by me.  Jacquemier.
+--Published three years after my Essay.  Kiwisch.  Behindhand in
+knowledge of Puerperal Fever." [B. & F.  Med.  Rev.  Jan.  1842.]
+Paul Dubois.--Scanzoni.
+
+These Continental writers not well informed on this point.[See Dr.
+Simpson's Remarks at Meeting of Edin.  Med.  Chir.  Soc.  (Am.  Jour.
+Oct.  1851.)]
+
+The story of Von Busch is of interest and value, but there is nothing
+in it which need perplex the student.  It is not pretended that the
+disease is always, or even, it may be, in the majority of cases,
+carried about by attendants; only that it is so carried in certain
+cases.  That it may have local and epidemic causes, as well as that
+depending on personal transmission, is not disputed.  Remember how
+small-pox often disappears from a community in spite of its
+contagious character, and the necessary exposure of many persons to
+those suffering from it; in both diseases contagion is 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 puerperal fever 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 by Dr.
+Condie, as given in my Essay, and say whether or not a man should
+allow his wife to be attended by a practitioner in whose hands
+"scarcely a female that has been delivered for weeks past has escaped
+an attack,"  "while no instance of the disease has occurred in the
+patients of any other accoucheur practising in the same district."
+If I understand Dr. Meigs and Dr. Hodge, they would not warn the
+physician or spare the patient under such circumstances.  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 respectfully ask them to state what they do
+mean, to their next classes, in the name of humanity, if not of
+science!
+
+I might repeat the question asked concerning Dr. Rutter's cases, with
+reference to those reported by Dr. Roberton.  Perhaps, however, the
+student would like to know the opinion of a person in the habit of
+working at matters of this kind in a practical point of view.  To
+satisfy him on this ground, I addressed the following question to the
+President of one of our principal Insurance Companies, leaving Dr.
+Meigs's book and my Essay in his hands at the same time.
+
+Question.  "If such facts as Roberton's cases were before you, and
+the attendant had had ten, or even five fatal cases, or three, or two
+even, would you, or would you not, if insuring the life of the next
+patient to be taken care of by that attendant, expect an extra
+premium over that of an average case of childbirth?"
+
+Answer.  "Of course I should require a very large extra premium, if
+I would take take risk at all."
+
+But I do not choose to add the expressions of indignation which the
+examination of the facts before him called out.  I was satisfied from
+the effect they produced on him, that if all the hideous catalogues
+of cases now accumulated were fully brought to the knowledge of the
+public, nothing, since the days of Burke and Hare, has raised such a
+cry of horror as would be shrieked 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 through the agency of
+secondary causes, as in other diseases, or not.  If through such
+causes, let us find out what 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 of bringing them!  But if Providence does
+not act through secondary causes in this particular sphere of
+etiology, then why does Dr. Meigs take such pains to reason so
+extensively about the laws of contagion, which, on that supposition,
+have no more to do with this case than with the plague which
+destroyed the people after David had numbered them?  Above all, what
+becomes of the theological aspect of the question, when he asserts
+that a practitioner was "only unlucky in meeting with the epidemic
+cases?" (Op. cit.  p. 633.) We do not deny that the God of battles
+decides the fate of nations; but we like to have the biggest
+squadrons on our side, and we are particular that our soldiers should
+not only say their prayers, but also keep their powder dry.  We do
+not deny the agency of Providence in the disaster at Norwalk, but we
+turn off the engineer, and charge the Company five thousand dollars
+apiece for every life that is sacrificed.
+
+Why a grand jury should not bring in a bill against a physician who
+switches off a score of women one after the other along his private
+track, when he knows that there is a black gulf at the end of it,
+down which they are to plunge, while the great highway is clear, is
+more than I can answer.  It is not by laying the open draw to
+Providence that he is to escape the charge of manslaughter.
+
+To finish with all these lesser matters of question, I am unable to
+see why a female must necessarily be unattended in her confinement,
+because she declines the services of a particular practitioner.  In
+all the series of cases mentioned, the death-carrying attendant was
+surrounded by others not tracked by disease and its consequences.
+Which, I would ask, is worse,--to call in another, even a rival
+practitioner, or to submit an unsuspecting female to a risk which an
+Insurance Company would have nothing to do with?
+
+I do not expect ever to return to this subject.  There is a point of
+mental saturation, beyond which argument cannot be forced without
+breeding impatient, if not harsh, feelings towards those who refuse
+to be convinced.  If I have so far manifested neither, it is well to
+stop here, and leave the rest to those younger friends who may have
+more stomach for the dregs of a stale argument.
+
+The extent of my prefatory remarks may lead some to think that I
+attach too much importance to my own Essay.  Others may wonder that I
+should expend so many words upon the two productions referred to, the
+Letter and the Lecture.  I do consider my Essay of much importance so
+long as the doctrine it maintains is treated as a question, and so
+long as any important part of the defence of that doctrine is thought
+to rest on its evidence or arguments.  I cannot treat as
+insignificant any opinions bearing on life, and interests dearer than
+life, proclaimed yearly to hundreds of young men, who will carry them
+to their legitimate results in practice.
+
+The teachings of the two Professors in the great schools of
+Philadelphia are sure to be listened to, not only by their immediate
+pupils, but by the Profession at large.  I am too much in earnest for
+either humility or vanity, but I do entreat those who hold the keys
+of life and death to listen to me also for this once.  I ask no
+personal favor; but I beg to be heard in behalf of the women whose
+lives are at stake, until some stronger voice shall plead for them.
+
+I trust that I have made the issue perfectly distinct and
+intelligible.  And let it be remembered that this is no subject to be
+smoothed over by nicely adjusted phrases of half-assent and half-
+censure divided between the parties.  The balance must be struck
+boldly and the result declared plainly.  If I have been hasty,
+presumptuous, ill-informed, illogical; if my array of facts means
+nothing; if there is no reason for any caution in the view of these
+facts; let me be told so on such authority that I must believe it,
+and I will be silent henceforth, recognizing that my mind is in a
+state of disorganization.  If the doctrine I have maintained is a
+mournful truth; if to 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 carry it, into confiding
+families, let it be proclaimed as plainly what is to be thought of
+the teachings of those who sneer at the alleged dangers, and scout
+the very idea of precaution.  Let it be remembered that persons are
+nothing in this matter; better that twenty pamphleteers should be
+silenced, or as many professors unseated, than that one mother's life
+should be taken.  There is no quarrel here between men, but there is
+deadly incompatibility and exterminating warfare between doctrines.
+Coincidences, meaning nothing, though a man have a monopoly of the
+disease for weeks or months; or cause and effect, the cause being in
+some way connected with the person; this is the question.  If I am
+wrong, let me be put down by such a rebuke as no rash declaimer has
+received since there has been a public opinion in the medical
+profession of America; if I am right, let doctrines which lead to
+professional homicide be no longer taught from the chairs of those
+two great Institutions.  Indifference will not do here; our
+Journalists and Committees have no right to take up their pages with
+minute anatomy and tediously detailed cases, while it is a question
+whether or not the "blackdeath" of child-bed is to be scattered
+broadcast by the agency of the mother's friend and adviser.  Let the
+men who mould opinions look to it; if there is any voluntary
+blindness, any interested oversight, any culpable negligence, even,
+in such a matter, and the facts shall reach the public ear; the
+pestilence-carrier of the lying-in chamber must look to God for
+pardon, for man will never forgive him.
+
+
+               THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+In collecting, enforcing, and adding to the evidence accumulated upon
+this most serious subject, I would not be understood to imply that
+there exists a doubt in the mind of any well-informed member of the
+medical profession as to the fact that puerperal fever is sometimes
+communicated from one person to another, both directly and
+indirectly.  In the present state of our knowledge upon this point I
+should consider such doubts merely as a proof that the sceptic had
+either not examined the evidence, or, having examined it, refused to
+accept its plain and unavoidable consequences.  I should be sorry to
+think, with Dr. Rigby, that it was a case of "oblique vision;" I
+should be unwilling to force home the argumentum ad hominem of Dr.
+Blundell, but I would not consent to make a question of a momentous
+fact which is no longer to be considered as a subject for trivial
+discussions, but to be acted upon with silent promptitude.  It
+signifies nothing that wise and experienced practitioners have
+sometimes doubted the reality of the danger in question; no man has
+the right to doubt it any longer.  No negative facts, no opposing
+opinions, be they what they may, or whose they may, can form any
+answer to the series of cases now within the reach of all who choose
+to explore the records of medical science.
+
+If there are some who conceive that any important end would be
+answered by recording such opinions, or by collecting the history of
+all the cases they could find in which no evidence of the influence
+of contagion existed, I believe they are in error.  Suppose a few
+writers of authority can be found to profess a disbelief in
+contagion,--and they are very few compared with those who think
+differently,--is it quite clear that they formed their opinions on a
+view of all the facts, or is it not apparent that they relied mostly
+on their own solitary experience?  Still further, of those whose
+names are quoted, is it not true that scarcely a single one could by
+any possibility have known the half or the tenth of the facts bearing
+on the subject which have reached such a frightful amount within the
+last few years?  Again, as to the utility of negative facts, as we
+may briefly call them,--instances, namely, in which exposure has not
+been followed by disease,--although, like other truths, they may be
+worth knowing, I do not see that they are like to shed any important
+light upon the subject before us.  Every such instance requires a
+good deal of circumstantial explanation before it can be accepted.
+It is not enough that a practitioner should have had a single case of
+puerperal fever not followed by others.  It must be known whether he
+attended others while this case was in progress, whether he went
+directly from one chamber to others, whether he took any, and what
+precautions.  It is important to know that several women were exposed
+to infection derived from the patient, so that allowance may be made
+for want of predisposition.  Now if of negative facts so sifted there
+could be accumulated a hundred for every one plain instance of
+communication here recorded, I trust it need not be said that we are
+bound to guard and watch over the hundredth tenant of our fold,
+though the ninety and nine may be sure of escaping the wolf at its
+entrance.  If any one is disposed, then, to take a hundred instances
+of lives endangered or sacrificed out of those I have mentioned, and
+make it reasonably clear that within a similar time and compass ten
+thousand escaped the same exposure, I shall thank him for his
+industry, but I must be permitted to hold to my own practical
+conclusions, and beg him to adopt or at least to examine them also.
+Children that walk in calico before open fires are not always burned
+to death; the instances to the contrary may be worth recording; but
+by no means if they are to be used as arguments against woollen
+frocks and high fenders.
+
+I am not sure that this paper will escape another remark which it
+might be wished were founded in justice.  It may be said that the
+facts are too generally known and acknowledged to require any formal
+argument or exposition, that there is nothing new in the positions
+advanced, and no need of laying additional statements before the
+Profession.  But on turning to two works, one almost universally, and
+the other extensively appealed to as authority in this country, I see
+ample reason to overlook this objection.  In the last edition of
+Dewees's Treatise on the "Diseases of Females," it is expressly said,
+"In this country, under no circumstance that puerperal fever has
+appeared hitherto, does it afford the slightest ground for the belief
+that it is contagious."  In the "Philadelphia Practice of Midwifery"
+not one word can be found in the chapter devoted to this disease
+which would lead the reader to suspect that the idea of contagion had
+ever been entertained.  It seems proper, therefore, to remind those
+who are in the habit of referring to these works for guidance, that
+there may possibly be some sources of danger they have slighted or
+omitted, quite as important as a trifling irregularity of diet, or a
+confined state of the bowels, and that whatever confidence a
+physician may have in his own mode of treatment, his services are of
+questionable value whenever he carries the bane as 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 contagious as to be
+frequently carried from patient to patient by physicians and nurses.
+
+
+Let me begin by throwing out certain incidental questions, which,
+without being absolutely essential, would render the subject more
+complicated, and by making such concessions and assumptions as may be
+fairly supposed to be without the pale of discussion.
+
+1.  It is granted that all the forms of what is called puerperal
+fever may not be, and probably are not, equally contagious or
+infectious.  I do not enter into the distinctions which have been
+drawn by authors, because the facts do not appear to me sufficient to
+establish any absolute line of demarcation between such forms as may
+be propagated by contagion and those which are never so propagated.
+This general result I shall only support by the authority of Dr.
+Ramsbotham, who gives, as the result of his experience, that the same
+symptoms belong to what he calls the infectious and the sporadic
+forms of the disease, and the opinion of Armstrong in his original
+Essay.  If others can show any such distinction, I leave it to them
+to do it.  But there are cases enough that show the prevalence of the
+disease among the patients of a single practitioner when it was in no
+degree epidemic, in the proper sense of the term. I may refer to
+those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as
+examples.
+
+2.  I shall not enter into any dispute about the particular mode of
+infection, whether it be by the atmosphere the physician carries
+about him into the sick-chamber, or by the direct application of the
+virus to the absorbing surfaces with which his hand comes in contact.
+Many facts and opinions are in favor of each of these modes of
+transmission.  But it is obvious that in the majority of cases it
+must be impossible to decide by which of these channels the disease
+is conveyed, from the nature of the intercourse between the physician
+and the patient.
+
+3.  It is not pretended that the contagion of puerperal fever must
+always be followed by the disease.  It is true of all contagious
+diseases, that they frequently spare those who appear to be fully
+submitted to their influence.  Even the vaccine virus, fresh from the
+subject, fails every day to produce its legitimate effect, though
+every precaution is taken to insure its action.  This is still more
+remarkably the case with scarlet fever and some other diseases.
+
+4.  It is granted that the disease may be produced and 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 a great extent by contagion, yet it goes through the same periods
+of periodical increase and diminution which have been remarked in
+puerperal fever.  If the question is asked how we are to reconcile
+the great variations in the mortality of puerperal fever in different
+seasons and places with the supposition of contagion, I will answer
+it by another question from Mr. Farr's letter to the Registrar-
+General.  He makes the statement that "five die weekly of small-pox
+in the metropolis when the disease is not epidemic,"--and adds, "The
+problem for solution is,--Why do the five deaths become 10, 15, 20,
+31, 58, 88, weekly, and then progressively fall through the same
+measured steps?"
+
+5.  I take it for granted, that if it can be shown that great numbers
+of lives have been and are sacrificed to ignorance or blindness on
+this point, no other error of which physicians or nurses may be
+occasionally suspected will be alleged in palliation of this; but
+that whenever and wherever they can be shown to carry disease and
+death instead of health and safety, the common instincts of humanity
+will silence every attempt to explain away their responsibility.
+
+
+The treatise of Dr. Gordon of Aberdeen was published in the year
+1795, being among the earlier special works upon the disease.  Apart
+of his testimony has been occasionally copied into other works, but
+his expressions are so clear, his experience is given with such manly
+distinctness and disinterested honesty, that it may be quoted as a
+model which might have been often followed with advantage.
+
+"This disease seized such women only as were visited, or delivered by
+a practitioner, or taken care of by a nurse, who had previously
+attended patients affected with the disease."
+
+"I had evident proofs of its infectious nature, and that the
+infection was as readily communicated as that of the small-pox or
+measles, and operated more speedily than any other infection with
+which I am acquainted."
+
+"I had evident proofs that every person who had been with a patient
+in the puerperal fever became charged with an atmosphere of
+infection, which was communicated to every pregnant woman who
+happened to come within its sphere.  This is not an assertion, but a
+fact, admitting of demonstration, as may be seen by a perusal of the
+foregoing table,"--referring to a table of seventy-seven cases, in
+many of which the channel of propagation was evident.
+
+He adds, "It is a disagreeable declaration for me to mention, that I
+myself was the means of carrying the infection to a great number of
+women."  He then enumerates a number of instances in which the
+disease was conveyed by midwives and others to the neighboring
+villages, and declares that "these facts fully prove that the cause
+of the puerperal fever, of which I treat, was a specific contagion,
+or infection, altogether unconnected with a noxious constitution 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 FORETELL WHAT
+WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT
+MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE
+ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY
+PREDICTION WAS VERIFIED."
+
+Even previously to Gordon, Mr. White of Manchester had said, "I am
+acquainted with two gentlemen in another town, where the whole
+business of midwifery is divided betwixt them, and it is very
+remarkable that one of them loses several patients every year of the
+puerperal fever, and the other never so much as meets with the
+disorder,"--a difference which he seems to attribute to their various
+modes of treatment. [On the Management of Lying-in Women, p.  120.]
+
+Dr. Armstrong has given a number of instances in his Essay on
+Puerperal Fever, of the prevalence of the disease among the patients
+of a single practitioner.  At Sunderland, "in all, forty-three cases
+occurred from the 1st of January to the 1st of October, when the
+disease ceased; and of this number forty were witnessed by Mr.
+Gregson and his assistant, Mr. Gregory, the remainder having been
+separately seen by three accoucheurs."  There is appended to the
+London edition of this Essay, a letter from Mr. Gregson, in which
+that gentleman says, in reference to the great number of cases
+occurring in his practice, "The cause of this I cannot pretend fully
+to explain, but I should be wanting in common liberality if I were to
+make any hesitation in asserting, that the disease which appeared in
+my practice was highly contagious, and communicable from one
+puerperal woman to another."  "It is customary among the lower and
+middle ranks of people to make frequent personal visits to puerperal
+women resident in the same neighborhood, and I have ample evidence
+for affirming that the infection of the disease was often carried
+about in that manner; and, however painful to my feelings, I must in
+candor declare, that it is very probable the contagion was conveyed,
+in some instances, by myself, though I took every possible care to
+prevent such a thing from happening, the moment that I ascertained
+that the distemper was infectious."  Dr. Armstrong goes on to mention
+six other instances within his knowledge, in which the disease had at
+different times and places been limited, in the same singular manner,
+to the practice of individuals, while it existed scarcely if at all
+among the patients of others around them.  Two of the gentlemen
+became so convinced of their conveying the contagion, that they
+withdrew for a time from practice.
+
+I find a brief notice, in an American Journal, of another series of
+cases, first mentioned by Mr. Davies, in the "Medical Repository."
+This gentleman stated his conviction that the disease is contagious.
+
+"In the autumn of 1822 he met with twelve cases, while his medical
+friends in the neighborhood did not meet with any, 'or at least very
+few.'  He could attribute this circumstance to no other cause than
+his having been present at the examination, after death, of two
+cases, some time previous, and of his having imparted the disease to
+his patients, notwithstanding every precaution."
+
+Dr. Gooch says, "It is not uncommon for the greater number of cases
+to occur in the practice of one man, whilst the other practitioners
+of the neighborhood, who are not more skilful or more busy, meet with
+few or none.  A practitioner opened the body of a woman who had died
+of puerperal fever, and continued to wear the same clothes.  A lady
+whom he delivered a few days afterwards was attacked with and died of
+a similar disease; two more of his lying-in patients, in rapid
+succession, met with the same fate; struck by the thought, that he
+might have carried contagion in his clothes, he instantly changed
+them, and 'met with no more cases of the kind.'  A woman in the
+country, who was employed as washerwoman and nurse, washed the linen
+of one who had died of puerperal fever; the next lying-in patient she
+nursed died of the same disease; a third nursed by her met with the
+same fate, till the neighborhood, getting afraid of her, ceased to
+employ her."
+
+In the winter of the year 1824, "Several instances occurred of its
+prevalence among the patients of particular practitioners, whilst
+others who were equally busy met with few or none.  One instance of
+this kind was very remarkable.  A general practitioner, in large
+midwifery practice, lost so many patients from puerperal fever, that
+he determined to deliver no more for some time, but that his partner
+should attend in his place.  This plan was pursued for one month,
+during which not a case of the disease occurred in their practice.
+The elder practitioner, being then sufficiently recovered, returned
+to his practice, but the first patient he attended was attacked by
+the disease and died.  A physician, who met him in consultation soon
+afterwards, about a case of a different kind, and who knew nothing of
+his misfortune, asked him whether puerperal fever was at all
+prevalent in his neighborhood, on which he burst into tears, and
+related the above circumstances.
+
+"Among the cases which I saw this season in consultation, four
+occurred in one month in the practice of one medical man, and all of
+them terminated fatally." [Lond.  Med.  Gaz.  May 2, 1835.]
+
+Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he
+had known the disease spread through a particular district, or be
+confined to the practice of a particular person, almost every patient
+being attacked with it, while others had not a single case.  It
+seemed capable, he thought, of conveyance, not only by common modes;
+but through the dress of the attendants upon the patient.
+
+In a letter to be found in the "London Medical Gazette" for January,
+1840, Mr. Roberton of Manchester makes the statement which I here
+give in a somewhat condensed form.
+
+A midwife delivered a woman on the 4th of December, 1830, who died
+soon after with the symptoms of puerperal fever.  In one month from
+this date the same midwife delivered thirty women, residing in
+different parts of an extensive suburb, of which number sixteen
+caught the disease and all died.  These were the only cases which had
+occurred for a considerable time in Manchester.  The other midwives
+connected with the same charitable institution as the woman already
+mentioned are twenty-five in number, and deliver, on an average,
+ninety women a week, or about three hundred and eighty a month.  None
+of these women had a case of puerperal fever.  "Yet all this time
+this woman was crossing the other midwives in every direction, scores
+of the patients of the charity being delivered by them in the very
+same quarters where her cases of fever were happening."
+
+Mr. Roberton remarks, that little more than half the women she
+delivered during this month took the fever; that on some days all
+escaped, on others only one or more out of three or four; a
+circumstance similar to what is seen in other infectious maladies.
+
+Dr. Blundell says, "Those who have never made the experiment can have
+but a faint conception how difficult it is to obtain the exact truth
+respecting any occurrence in which feelings and interests are
+concerned.  Omitting particulars, then, I content myself with
+remarking, generally, that from more than one district I have
+received accounts of the prevalence of puerperal fever in the
+practice of some individuals, while its occurrence in that of others,
+in the same neighborhood, was not observed.  Some, as I have been
+told, have lost ten, twelve, or a greater number of patients, in
+scarcely broken succession; like their evil genius, the puerperal
+fever has seemed to stalk behind them wherever they went.  Some have
+deemed it prudent to retire for a time from practice.  In fine, that
+this fever may occur spontaneously, I admit; that its infectious
+nature may be plausibly disputed, I do not deny; but I add,
+considerately, that in my own family I had rather that those I
+esteemed the most should be delivered, unaided, in a stable, by the
+manger-side, than that they should receive the best help, in the
+fairest apartment, but exposed to the vapors of this pitiless
+disease.  Gossiping friends, wet-nurses, monthly nurses, the
+practitioner himself, these are the channels by which, as I suspect,
+the infection is principally conveyed."
+
+At a meeting of the Royal Medical and Chirurgical Society, Dr. King
+mentioned that some years since a practitioner at Woolwich lost
+sixteen patients from puerperal fever in the same year.  He was
+compelled to give up practice for one or two years, his business
+being divided among the neighboring practitioners.  No case of
+puerperal fever occurred afterwards, neither had any of the
+neighboring surgeons any cases of this disease.
+
+At the same meeting Mr. Hutchinson mentioned the occurrence of three
+consecutive cases of puerperal fever, followed subsequently by two
+others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]
+
+Dr. Lee makes the following statement: "In the last two weeks of
+September, 1827, five fatal cases of uterine inflammation came under
+our observation.  All the individuals so attacked had been attended
+in labor by the same midwife, and no example of a febrile or
+inflammatory disease of a serious nature occurred during that period
+among the other patients of the Westminster General Dispensary, who
+had been attended by the other midwives belonging to that
+institution."
+
+The recurrence of long series of cases like those I have cited,
+reported by those most interested to disbelieve in contagion,
+scattered along through an interval of half a century, might have
+been thought sufficient to satisfy the minds of all inquirers that
+here was something more than a singular coincidence.  But if, on a
+more extended observation, it should be found that the same ominous
+groups of cases clustering about individual practitioners were
+observed in a remote country, at different times, and in widely
+separated regions, it would seem incredible that any should be found
+too prejudiced or indolent to accept the solemn truth knelled into
+their ears by the funeral bells from both sides of the ocean,--the
+plain conclusion that the physician and the disease entered, hand in
+hand, into the chamber of the unsuspecting patient.
+
+That such series of cases have been observed in this country, and in
+this neighborhood, I proceed to show.
+
+In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited
+from Dr. Hosack, in which he refers to certain puerperal cases which
+proved fatal to several lying-in women, and in some of which the
+disease was supposed to be conveyed by the accoucheurs themselves.
+
+A writer in the "New York Medical and Physical Journal" for October,
+1829, in speaking of the occurrence of puerperal fever, confined to
+one man's practice, remarks, "We have known cases of this kind occur,
+though rarely, in New York."
+
+I mention these little hints about the occurrence of such cases,
+partly because they are the first I have met with in American medical
+literature, but more especially because they serve to remind us that
+behind the fearful array of published facts there lies a dark list of
+similar events, unwritten in the records of science, but long
+remembered by many a desolated fireside.
+
+Certainly nothing can be more open and explicit than the account
+given by Dr. Peirson of Salem, of the cases seen by him.  In the
+first nineteen days of January, 1829, he had five consecutive cases
+of puerperal fever, every patient he attended being attacked, and the
+three first cases proving fatal.  In March of 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, "I am not
+informed that a single case had occurred in the practice of any other
+physician.  Since that period I have had no fatal case in my
+practice, although I have had several dangerous cases.  I have
+attended in all twenty cases of this disease, of which four have been
+fatal.  I am not aware that there has been any other case in the town
+of distinct puerperal peritonitis, although I am willing to admit my
+information may be very defective on this point.  I have been told of
+some I 'mixed cases,' and 'morbid affections after delivery.'"
+
+In the "Quarterly Summary of the Transactions of the College of
+Physicians of Philadelphia" may be found some most extraordinary
+developments respecting a series of cases occurring in the practice
+of a member of that body.
+
+Dr. Condie called the attention of the Society to the prevalence, at
+the present time, of puerperal fever of a peculiarly insidious and
+malignant character.  "In the practice of one gentleman extensively
+engaged as an obstetrician, nearly every female he has attended in
+confinement, during several weeks past, within the above limits" (the
+southern sections and neighboring districts), "had been attacked by
+the fever."
+
+"An important query presents itself, the Doctor observed, in
+reference to the particular form of fever now prevalent.  Is it,
+namely, capable of being propagated by contagion, and is a physician
+who has been in attendance upon a case of the disease warranted in
+continuing, without interruption, his practice as an obstetrician?
+Dr. C., although not a believer in the contagious character of many
+of those affections generally supposed to be propagated in this
+manner, has nevertheless become convinced by the facts that have
+fallen under his notice, that the puerperal fever now prevailing is
+capable of being communicated by contagion.  How otherwise can be
+explained the very curious circumstance of the disease in one
+district being exclusively confined to the practice of a single
+physician, a Fellow of this College, extensively engaged in
+obstetrical practice,--while no instance of the disease has occurred
+in the patients under the care of any other accoucheur practising
+within the same district; scarcely a female that has been delivered
+for weeks past has escaped an attack?"
+
+Dr. Rutter, the practitioner referred to, "observed that, after the
+occurrence of a number of cases of the disease in his practice, he
+had left the city and remained absent for a week, but on returning,
+no article of clothing he then wore having been used by him before,
+one of the very first cases of parturition he attended was followed
+by an attack of the fever, and terminated fatally; he cannot,
+readily, therefore, believe in the transmission of the disease from
+female to female, in the person or clothes of the physician."
+
+The meeting at which these remarks were made was held on the 3d of
+May, 1842.  In a letter dated December 20, 1842, addressed to Dr.
+Meigs, and to be found in the "Medical Examiner,"  he speaks of
+"those horrible cases of puerperal fever, some of which you did me
+the favor to see with me during the past summer," and talks of his
+experience in the disease, "now numbering nearly seventy cases, all
+of which have occurred within less than a twelvemonth past."
+
+And Dr. Meigs asserts, on the same page, "Indeed, I believe that his
+practice in that department of the profession was greater than that
+of any other gentleman, which was probably the cause of his seeing a
+greater number of the cases."  This from a professor of midwifery,
+who some time ago assured a gentleman whom he met in consultation,
+that the night on which they met was the eighteenth in succession
+that he himself had been summoned from his repose, seems hardly
+satisfactory.
+
+I must call the attention of the inquirer most particularly to the
+Quarterly Report above referred to, and the letters of Dr. Meigs and
+Dr. Rutter, to be found in the "Medical Examiner."  Whatever
+impression they may produce upon his mind, I trust they will at least
+convince him that there is some reason for looking into this
+apparently uninviting subject.
+
+At a meeting of the College of Physicians just mentioned, Dr.
+Warrington stated, that a few days after assisting at an autopsy of
+puerperal peritonitis, in which he laded out the contents of the
+abdominal cavity with his hands, he was called upon to deliver three
+women in rapid succession.  All of these women were attacked with
+different forms of what is commonly called puerperal fever.  Soon
+after these he saw two other patients, both on the same day, with the
+same disease.  Of these five patients two died.
+
+At the same meeting, Dr. West mentioned a fact related to him by Dr.
+Samuel Jackson of Northumberland.  Seven females, delivered by Dr.
+Jackson in rapid succession, while practising in Northumberland
+County, were all attacked with puerperal fever, and five of them
+died.  "Women," he said, "who had expected me to attend upon them,
+now becoming alarmed, removed out of my reach, and others sent for a
+physician residing several miles distant.  These women, as well as
+those attended by midwives; all did well; nor did we hear of any
+deaths in child-bed within a radius of fifty miles, excepting two,
+and these I afterwards ascertained to have been caused by other
+diseases."  He underwent, as he thought, a thorough purification, and
+still his next patient was attacked with the disease and died.  He
+was led to suspect that the contagion might have been carried in the
+gloves which he had worn in attendance upon the previous cases.  Two
+months or more after this he had two other cases.  He could find
+nothing to account for these, unless it were the instruments for
+giving enemata, which had been used in two of the former cases, and
+were employed by these patients.  When the first case occurred, he
+was attending and dressing a limb extensively mortified from
+erysipelas, and went immediately to the accouchement with his clothes
+and gloves most thoroughly imbued with its efluvia.  And here I may
+mention, that this very Dr. Samuel Jackson of Northumberland is one
+of Dr. Dewees's authorities against contagion.
+
+The three following statements are now for the first time given to
+the public.  All of the cases referred to occurred within this State,
+and two of the three series in Boston and its immediate vicinity.
+
+I.  The first is a series of cases which took place during the last
+spring in a town at some distance from 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 physician during the
+period referred to.  "They were all attended by him until their
+termination, with the exception of the patient No. 6, who fell into
+the hands 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-named periods, none of which, however,
+presented any peculiar symptoms of the disease."
+
+About the 1st of July he attended another patient in a neighboring
+village, who died two or three days after delivery.
+
+The first patient, it is stated, was delivered on the 20th of March.
+"On the 19th, Dr. C. made the autopsy of a man who died suddenly,
+sick only forty-eight hours; had oedema of the thigh, and gangrene
+extending from a little above the ankle into the cavity of the
+abdomen."  Dr. C. wounded himself, very slightly, in the right hand
+during the autopsy.  The hand was quite painful the night following,
+during his attendance on the patient No. 1.  He did not see this
+patient after the 20th, being confined to the house, and very sick
+from the wound just mentioned, from this time until the 3d of April.
+
+Several cases of erysipelas occurred in the house where the autopsy
+mentioned above took place, soon after the examination.  There were
+also many cases of erysipelas in town at the time of the fatal
+puerperal cases 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 sore throat and erysipelas, and died in
+ten days from the first attack.
+
+The nurse who laid out the body of the patient No. 4 was taken on the
+day following with symptoms like those of this patient, and died in a
+week, without any external marks of erysipelas.
+
+"No other cases of similar character with those of Dr. C. occurred in
+the practice of any of the physicians in the town or vicinity at the
+time.  Deaths following confinement have occurred in the practice of
+other physicians during the past year, but they were not cases of
+puerperal fever.  No post-mortem examinations were held in any of
+these puerperal cases."
+
+Some additional statements in this letter are deserving of insertion.
+
+"A physician attended a woman in the immediate neighborhood 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 doubtful
+whether this should be considered a case of puerperal fever.  She had
+suffered from canker, indigestion, and diarrhoea for a year previous
+to her delivery.  Her complaints were much aggravated for two or
+three months previous to delivery; she had become greatly emaciated,
+and weakened to such an extent that it had not been expected that she
+would long survive her confinement, if indeed she reached that
+period.  Her labor was easy enough; she flowed a good deal, seemed
+exceedingly prostrated, had ringing in the ears, and other symptoms
+of exhaustion; the pulse was quick and small.  On the second and
+third day there was some tenderness and tumefaction of the abdomen,
+which increased somewhat on the fourth and fifth.  He had cases in
+midwifery before and after this, which presented nothing peculiar."
+
+It is also mentioned in the same letter, that another physician had a
+case during the last summer and another last fall, both of which
+recovered.
+
+Another gentleman reports a case last December, a second case five
+weeks, and another three weeks since.  All these recovered.  A case
+also occurred very recently in the practice of a physician in the
+village where the eighth patient of Dr. C. resides, which proved
+fatal.  "This patient had some patches of erysipelas on the legs and
+arms.  The same physician has delivered three cases since, which have
+all done well.  There have been no other cases in this town or its
+vicinity recently.  There have been some few cases of erysipelas."
+It deserves notice that the partner of Dr. C., who attended the
+autopsy of the man above mentioned and took an active part in it; who
+also suffered very slightly from a prick under the thumb-nail
+received during the examination, had twelve cases of midwifery
+between March 26th and April 12th, all of which did well, and
+presented no peculiar symptoms.  It should also be stated, that
+during these seventeen days he was in attendance on all the cases of
+erysipelas in the house where the autopsy had been performed.
+
+I owe these facts to the prompt kindness of a gentleman whose
+intelligence and character are sufficient guaranty for their
+accuracy.
+
+The two following letters were addressed to my friend Dr. Scorer, by
+the gentleman in whose practice the cases of puerperal fever
+occurred.  His name renders it unnecessary to refer more particularly
+to these gentlemen, who on their part have manifested the most
+perfect freedom and courtesy in affording these accounts of their
+painful experience.
+
+
+"January 28, 1843.
+
+II.  .  .  .  "The time to which you allude was in 1830.  The first
+case was in February, during a very cold time.  She was confined the
+4th, and died the 12th.  Between the 10th and 28th of this month, I
+attended six women in labor, all of whom did well except the last, as
+also two who were confined March 1st and 5th.  Mrs. E., confined
+February 28th, sickened, and died March 8th.  The next day, 9th, I
+inspected the body, and the night after attended a lady, Mrs. B., who
+sickened, and died 16th.  The 10th, I attended another, Mrs. G., who
+sickened, but recovered.  March 16th, I went from Mrs. G.'s room to
+attend a Mrs. H., who sickened, and died 21st.  The 17th, I inspected
+Mrs. B.  On the 19th, I went directly from Mrs. H.'s room to 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
+attended another woman, who was not sick.  Up to 20th of this month I
+wore the same clothes.  I now refused to 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.  The others were from two to three miles apart, and nearly
+that distance from my residence.  There were no other cases in their
+immediate vicinity which came to my knowledge.  The general health of
+all the women was pretty good, and all the labors as good as common,
+except the first.  This woman, in consequence of my not arriving in
+season, and the child being half-born at some time before I arrived,
+was very much exposed to the cold at the time of confinement, and
+afterwards, 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 had puerperal fever, one
+very badly, the other not so badly.  Both recovered.  One other had
+swelled leg, or phlegmasia dolens, and one or two others did not
+recover as well as usual.
+
+"In the summer of 1835 another disastrous period occurred in my
+practice.  July 1st, I attended a lady in labor, who was afterwards
+quite ill and feverish; but at the time I did not consider her case a
+decided puerperal fever.  On the 8th, I attended one who did well.
+On the 12th, one who was seriously sick.  This was also an equivocal
+case, apparently arising from constipation and irritation of the
+rectum.  These women were ten miles apart and five from my residence.
+On 15th and 20th, two who did well.  On 25th, I attended another.
+This was a severe labor, and followed by unequivocal puerperal fever,
+or peritonitis.  She recovered.  August 2d and 3d, in about twenty-
+four hours I attended four persons.  Two of them did very well; one
+was attacked with some of the common symptoms, which however subsided
+in a day or two, and the other had decided puerperal fever, but
+recovered.  This woman resided five miles from me.  Up to this time I
+wore the same coat.  All my other clothes had frequently been
+changed.  On 6th, I attended two women, one of whom was not sick at
+all; but the other, Mrs. L., was afterwards taken ill.  On 10th, I
+attended a lady, who did very well.  I had previously changed all my
+clothes, and had no garment on which had been in a puerperal room.
+On 12th, I was called to Mrs. S., in labor.  While she was ill, I
+left her to visit Mrs. L., one of the ladies who was confined on 6th.
+Mrs. L.  had been more unwell than usual, but I had not considered
+her case anything more than common till this visit.  I had on a
+surtout at this visit, which, on my return to Mrs.  S., I left in
+another room.  Mrs. S.  was delivered on 13th with forceps.  These
+women both died of decided puerperal fever.
+
+"While I attended these women in their fevers, I changed my clothes,
+and washed my hands in a solution of chloride of lime after each
+visit.  I attended seven women in labor during this period, all of
+whom recovered without sickness.
+
+"In my practice I have had several single cases of puerperal fever,
+some of whom have died and some have recovered.  Until the year 1830
+I had no suspicion that the disease could be communicated from one
+patient to another by a nurse or midwife; but I now think the
+foregoing facts strongly favor that idea.  I was so much convinced of
+this fact, that I adopted the plan before related.
+
+"I believe my own health was as good as usual at each of the above
+periods.  I have no recollections to the contrary.
+
+"I believe I have answered all your questions.  I have been more
+particular on some points perhaps than necessary; but I thought you
+could form your own opinion better than to take mine.  In 1830 I
+wrote to Dr. Charming a more particular statement of my cases.  If I
+have not answered your questions sufficiently, perhaps Dr. C.  may
+have my letter to him, and you can find your answer there." [In a
+letter to myself, this gentleman also stated, "I do not recollect
+that there was any erysipelas or any other disease particularly
+prevalent at the time."]
+
+
+
+"BOSTON, February 3, 1843.
+
+III.  "MY DEAR SIR,--I received a note from you last evening,
+requesting me to answer certain questions therein proposed, touching
+the cases of puerperal fever which came under my observation the past
+summer.  It gives me pleasure to comply with your request, so far as
+it is in my power so to do, but, owing to the hurry in preparing for
+a journey, the notes of the cases I had then taken were lost or
+mislaid.  The principal facts, however, are too vivid upon my
+recollection to be soon forgotten.  I think, therefore, that I shall
+be able to give you all the information you may require.
+
+"All the cases that occurred in my practice took place between the
+7th of May and the 17th of June 1842.
+
+"They were not confined to any particular part of the city.  The
+first two cases were patients residing at the South End, the next was
+at the extreme North End, one living in Sea Street and the other in
+Roxbury.  The following is the order in which they 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 the circumstances.  She died on the 10th.
+
+"Case 2.  Mrs._____  was confined on the 10th of June (four weeks
+after Mrs.  C.), at 11 A. M., after a natural, but somewhat severe
+labor of five 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
+until the 18th, when symptoms of puerperal fever were manifest.  She
+died on the 20th.
+
+"Case 4.  Mrs._____ , confined June 17th, at 5 o'clock, A.  M., was
+doing well 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 of
+June, at 6 o'clock in the evening.  This patient had been attacked
+with puerperal fever, at three of her previous confinements, but the
+disease yielded to depletion and other remedies without difficulty.
+This time, I regret to say, I was not so fortunate.  She was not
+attacked, as were the other 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 she died in great distress on the
+22d of the same month.  Owing to the extreme heat of the season, and
+my own indisposition, none of the subjects were examined after death.
+Dr. Channing, who was in attendance with me on the three last cases,
+proposed to have a post-mortem examination of the subject of case No.
+5, but from some cause which I do not now recollect it was not
+obtained.
+
+"You wish to know whether I wore the same clothes when attending the
+different cases.  I cannot positively say, but I should think I did
+not, as the weather became warmer after the first two cases; I
+therefore think it probable that I made a change of at least a part
+of my dress.  I have had no other case of puerperal fever in my own
+practice for three years, save those above related, and I do not
+remember to have lost a patient before with this disease.  While
+absent, last July, I visited two patients sick with puerperal fever,
+with a friend of mine in the country.  Both of them recovered.
+
+"The cases that I have recorded were not confined to any particular
+constitution or temperament, but it seized upon the strong and the
+weak, the old and the young,--one being over forty years, and the
+youngest under eighteen years of age .  .  .  .  If the disease is of
+an erysipelatous nature, as many suppose, contagionists may perhaps
+find some ground for their belief in the fact, that, for two weeks
+previous to my first case of puerperal fever, I had been attending a
+severe case of erysipelas, and the infection may have been conveyed
+through me to the patient; but, on the other hand, why is not this
+the case with other physicians, or with the same physician at all
+times, for since my return from the country I have had a more
+inveterate case of erysipelas than ever before, and no difficulty
+whatever has attended any of my midwifery cases?"
+
+
+I am assured, on unquestionable authority, that "About three years
+since, a gentleman in extensive midwifery business, in a neighboring
+State, lost in the course of a few weeks eight patients in child-bed,
+seven of them being undoubted cases of puerperal fever.  No other
+physician of the town lost a single patient of this disease during
+the same period."  And from what I have heard in conversation with
+some of our most experienced practitioners, I am inclined to think
+many cases of the kind might be brought to light by extensive
+inquiry.
+
+
+This long catalogue of melancholy histories assumes a still darker
+aspect when we remember how kindly nature deals with the parturient
+female, when she is not immersed in the virulent atmosphere of an
+impure lying-in hospital, or poisoned in her chamber by the
+unsuspected breath of contagion.  From all causes together, not more
+than four deaths in a thousand births and miscarriages happened in
+England and Wales during the period embraced by the first "Report of
+the Registrar-General."  In the second Report the mortality was shown
+to be about five in one 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 from this disease in 278 cases, or between
+three and four to the thousand a yet during this period the disease
+was endemic in the hospital, and might have gone on to 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 cases that are to be
+ascribed to the self-acting system of propagation, it would seem that
+the disease must be far from common.  Mr. White of Manchester says,
+"Out of the whole number of lying-in patients whom I have delivered
+(and I may safely call it a great one), I have never lost one, nor to
+the best of my recollection has one been greatly endangered, by the
+puerperal, miliary, low nervous, putrid malignant, or milk fever."
+Dr. Joseph Clarke informed Dr. Collins, that in the course of forty-
+five years' most extensive practice he lost but four patients from
+this disease.  One of the most eminent practitioners of Glasgow, who
+has been engaged in very extensive practice for upwards of a quarter
+of a century, testifies that he never saw more than twelve cases of
+real puerperal fever.[Lancet, May 4, 1833]
+
+I have myself been told by two gentlemen practising in this city, and
+having for many years a large midwifery business, that they had
+neither of them lost a patient from this disease, and by one of them
+that he had only seen it in consultation with other physicians.  In
+five hundred cases of midwifery, of which Dr. Storer has given an
+abstract in the first number of this Journal, there was only one
+instance of fatal puerperal peritonitis.
+
+In the view of these facts, it does appear a singular coincidence,
+that one man or woman should have ten, twenty, thirty, or seventy
+cases of this rare disease following his or her footsteps with the
+keenness of a beagle, through the streets and lanes of a crowded
+city, while the scores that cross the same paths on the same errands
+know it only by name.  It is a series of similar coincidences which
+has led us to consider the dagger, the musket, and certain innocent-
+looking white powders as having some little claim to be regarded as
+dangerous.  It is the practical inattention to similar coincidences
+which has given rise to the unpleasant but often necessary documents
+called indictments, which has sharpened a form of the cephalotome
+sometimes employed in the case of adults, and adjusted that
+modification of the fillet which delivers the world of those who
+happen to be too much in the way while such striking coincidences are
+taking place.
+
+I shall now mention a few instances in which the disease appears to
+have been conveyed by the process of direct inoculation.
+
+Dr. Campbell of Edinburgh states that in October, 1821, he assisted
+at the post-mortem examination of a patient who died with puerperal
+fever.  He carried the pelvic viscera in his pocket to the class-
+room.  The same evening he attended a woman in labor without
+previously 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 with the disease within a few weeks, three
+shared the same fate in succession.
+
+In June, 1823, he assisted some of his pupils at the autopsy of a
+case of puerperal fever.  He was unable to wash his hands with proper
+care, for want of the necessary accommodations.  On getting home he
+found that two patients required his assistance.  He went without
+further ablution, or changing his clothes; both these patients died
+with puerperal fever.  This same Dr. Campbell is one of Dr.
+Churchill's authorities against contagion.
+
+Mr. Roberton says that in one instance within his knowledge a
+practitioner passed the catheter for a patient with puerperal fever
+late in the evening; the same night he attended a lady who had the
+symptoms of the disease on the second day.  In another instance a
+surgeon was called while in the act of inspecting the body of a woman
+who had died of this fever, to attend a labor; within forty-eight
+hours this patient was seized with the fever.'
+
+On the 16th of March, 1831, a medical practitioner examined the body
+of a woman who had died a few days after delivery, from puerperal
+peritonitis.  On the evening of the 17th he delivered a patient, who
+was seized with puerperal fever on the 19th, and died on the 24th.
+Between this period and the 6th of April, the same practitioner
+attended two other patients, both of whom were attacked with the same
+disease and died.
+
+In the autumn of 1829 a physician was present at the examination of a
+case of puerperal fever, dissected out the organs, and assisted in
+sewing up the body.  He had scarcely reached home when he was
+summoned to attend a young lady in labor.  In sixteen hours she was
+attacked with the symptoms of puerperal fever, and narrowly escaped
+with her life.
+
+In December, 1830, a midwife, who had attended two fatal cases of
+puerperal fever at the British Lying-in Hospital, examined a patient
+who had just been admitted, to ascertain if labor had commenced.
+This patient remained two days in the expectation that labor would
+come on, when she returned home and was then suddenly taken in labor
+and delivered before she could set out for the hospital.  She went on
+favorably for two days, and was then taken with puerperal fever and
+died in thirty-six hours.
+
+"A young practitioner, contrary to advice, examined the body of a
+patient who had died from puerperal fever; there was no epidemic at
+the time; the case appeared to be purely sporadic.  He delivered
+three other women shortly afterwards; they all died with puerperal
+fever, the symptoms of which broke out very soon after labor.  The
+patients of his colleague did well, except one, where he assisted to
+remove some coagula from the uterus; she was attacked in the same
+manner as those whom he had attended, and died also."  The writer in
+the "British and Foreign Medical Review," from whom I quote this
+statement,--and who is no other than Dr. Rigby, adds, "We trust that
+this fact alone will forever silence such doubts, and stamp the well-
+merited epithet of 'criminal,' as above quoted, upon such attempts."
+[Brit.  and For.  Medical Review for Jan.  1842, p.  112.]
+
+From the cases given by Mr. Ingleby, I select the following.  Two
+gentlemen, after having been engaged in conducting the post-mortem
+examination of a case of puerperal fever, went in the same dress,
+each respectively, to a case of midwifery.  "The one patient was
+seized  with the rigor about thirty hours afterwards.  The other
+patient was seized with a rigor the third morning after delivery.
+One recovered, one died." [Edin.  Med.  and Surg.  Journal, April,
+1838.]
+
+One of these same gentlemen attended another woman in the same
+clothes two days after the autopsy referred to.  "The rigor did not
+take place until the evening of the fifth day from the first visit.
+Result fatal."  These cases belonged to a series of seven, the first
+of which was thought to have originated in a case of erysipelas.
+"Several cases of a mild character followed the foregoing seven, and
+their nature being now most unequivocal, my friend declined visiting
+all midwifery cases for a time, and there was no recurrence of the
+disease."  These cases occurred in 1833.  Five of them proved fatal.
+Mr. Ingleby gives another series of seven eases which occurred to a
+practitioner in 1836, the first of which was also attributed to his
+having opened several erysipelatous abscesses a short time
+previously.
+
+I need not refer to the case lately read before this Society, in
+which a physician went, soon after performing an autopsy of a case of
+puerperal fever, to a woman in labor, who was seized with the same
+disease and perished.  The forfeit of that error has been already
+paid.
+
+At a meeting of the Medical and Chirurgical Society before referred
+to, Dr. Merriman related an instance occurring in his own practice,
+which excites a reasonable suspicion that two lives were sacrificed
+to a still less dangerous experiment.  He was at the examination of a
+case of puerperal fever at two o'clock in the afternoon.  He took
+care not to touch the body.  At nine o'clock the same evening he
+attended a woman in labor; she was so nearly delivered that he had
+scarcely anything to do.  The next morning she had severe rigors, and
+in forty-eight hours she was a corpse.  Her infant had erysipelas and
+died 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 often fatal effects which have
+followed from wounds received in the post-mortem examination of
+patients who have died of puerperal fever.  The fact that such wounds
+are attended with peculiar risk has been long noticed.  I find that
+Chaussier was in the habit of cautioning his students against the
+danger to which they were exposed in these dissections. [Stein, L'Art
+d'Accoucher, 1794; Dict. des Sciences Medicales, art.  "Puerperal."]
+The head pharmacien of the Hotel Dieu, in his analysis of the fluid
+effused in puerperal peritonitis, says that practitioners are
+convinced of its deleterious qualities, and that it is very dangerous
+to apply it to the denuded skin. [Journal de Pharmacie, January,
+1836.]  Sir Benjamin Brodie speaks of it as being well known that the
+inoculation of lymph or pus from the peritoneum of a puerperal
+patient is often attended with dangerous and even fatal symptoms.
+Three cases in confirmation of this statement, two of them fatal,
+have been reported to this Society within a few months.
+
+Of about fifty cases of injuries of this kind, of various degrees of
+severity, which I have collected from different sources, at least
+twelve were instances of infection from puerperal peritonitis.  Some
+of the others are so stated as to render it probable that they may
+have been of the same nature.  Five other cases were of peritoneal
+inflammation; three in males.  Three were what was called enteritis,
+in one instance complicated with erysipelas; but it is well known
+that this term has been often used to signify inflammation of the
+peritoneum covering the intestines.  On the other hand, no case of
+typhus or typhoid fever is mentioned as giving rise to dangerous
+consequences, with the exception of the single instance of an
+undertaker mentioned by Mr. Travers, who seems to have been poisoned
+by a fluid which exuded from the body.  The other accidents were
+produced by dissection, or some other mode of contact with bodies of
+patients who had died of various affections.  They also differed much
+in severity, the cases of puerperal origin being among the most
+formidable and fatal.  Now a moment's reflection will show that the
+number of cases of serious consequences ensuing from the dissection
+of the bodies of those who had perished of puerperal fever is so
+vastly disproportioned to the relatively small number of autopsies
+made in this complaint as compared with typhus or pneumonia (from
+which last disease not one case of poisoning happened), and still
+more from all diseases put together, that the conclusion is
+irresistible that a most fearful morbid poison is often generated in
+the course of this 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 following statement of Dr.
+Rigby.  "That the discharges from a patient under puerperal fever are
+in the highest degree contagious we have abundant evidence in the
+history of lying-in hospitals.  The puerperal abscesses are also
+contagious, and may be communicated to healthy lying-in women by
+washing with the same sponge; this fact has been repeatedly proved in
+the Vienna Hospital; but they are equally communicable to women not
+pregnant; on more than one occasion the women engaged in washing the
+soiled bed-linen of the General Lying-in Hospital have been attacked
+with abscess in the fingers or hands, attended with rapidly spreading
+inflammation of the cellular tissue."
+
+Now add to all this the undisputed fact, that within the walls of
+lying-in hospitals there is often generated a miasm, palpable as the
+chlorine used to destroy it, tenacious so as in some cases almost to
+defy extirpation, deadly in some institutions as the plague; which
+has killed women in a private hospital of London so fast that they
+were buried two in one coffin to conceal its horrors; which enabled
+Tonnelle to record two hundred and twenty-two autopsies at the
+Maternite of Paris; which has led Dr. Lee to express his deliberate
+conviction that the loss of life occasioned by these institutions
+completely defeats the objects of their founders; and out of this
+train of cumulative evidence, the multiplied groups of cases
+clustering about individuals, the deadly results of autopsies, the
+inoculation by fluids from the living patient, the murderous poison
+of hospitals,--does there not result a conclusion that laughs all
+sophistry to scorn, and renders all argument an insult?
+
+I have had occasion to mention some instances in which there was an
+apparent relation between puerperal fever and erysipelas.  The length
+to which this paper has extended does not allow me to enter into the
+consideration of this most important subject.  I will only say, that
+the evidence appears to me altogether satisfactory that some most
+fatal series of puerperal fever have been produced by an infection
+originating in the matter or effluvia of erysipelas.  In evidence of
+some connection between the two diseases, I need not go back to the
+older authors, as Pouteau or Gordon, but will content myself with
+giving the following references, with their dates; from which it will
+be seen that the testimony has been constantly coming before the
+profession for the last few years.
+
+"London Cyclopaedia of Practical Medicine," article Puerperal Fever,
+1833.
+
+Mr. Ceeley's Account of the Puerperal Fever at Aylesbury.  "Lancet,"
+1835.
+
+Dr. Ramsbotham's Lecture.  "London Medical Gazette," 1835.
+
+Mr. Yates Ackerly's Letter in the same Journal, 1838.
+
+Mr. Ingleby on Epidemic Puerperal Fever.  "Edinburgh Medical and
+Surgical Journal," 1838.
+
+Mr. Paley's Letter.  "London Medical Gazette," 1839.
+
+Remarks at the Medical and Chirurgical Society. "Lancet," 1840.
+
+Dr. Rigby's "System of Midwifery."  1841.
+
+"Nunneley on Erysipelas,"--a work which contains a large number of
+references on the subject.  1841.
+
+"British and Foreign Quarterly Review," 1842.
+
+Dr. S.  Jackson of Northumberland, as already quoted from the Summary
+of the College of Physicians, 1842.
+
+And lastly, a startling series of cases by Mr. Storrs of Doncaster,
+to be, found in the "American Journal of the Medical Sciences" for
+January, 1843.
+
+The relation of puerperal fever with other continued fevers would
+seem to be remote and rarely obvious.  Hey refers to two cases of
+synochus occurring in the Royal Infirmary of Edinburgh, in women who
+had attended upon puerperal patients.  Dr. Collins refers to several
+instances in which puerperal fever has appeared to originate from a
+continued proximity to patients suffering with typhus.
+
+Such occurrences as those just mentioned, though most important to be
+remembered and guarded against, hardly attract our notice in the
+midst of the gloomy facts by which they are surrounded.  Of these
+facts, at the risk of fatiguing repetitions, I have summoned a
+sufficient number, as I believe, to convince the most incredulous
+that every attempt to disguise the truth 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 to have found puerperal fever contagious.  At
+the most they give us mere negative facts, worthless against an
+extent of evidence which now overlaps the widest range of doubt, and
+doubles upon itself in the redundancy of superfluous demonstration.
+Examined in detail, this and much of the show of testimony brought up
+to 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.  Nor do I feel the necessity of enforcing
+the conclusion which arises spontaneously from the facts which have
+been enumerated, by formally citing the opinions of those grave
+authorities who have for the last half-century been sounding the
+unwelcome truth it has cost so many lives to establish.
+
+"It is to the British practitioner," says Dr. Rigby, "that we are
+indebted for strongly insisting upon this important and dangerous
+character of puerperal fever."
+
+The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
+Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
+Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson,
+many of whose writings I have already referred to, may have some
+influence with those who prefer the weight of authorities to the
+simple deductions of their own reason from the facts laid before
+them.  A few Continental writers have adopted similar conclusions. It
+gives me pleasure to remember, that while the doctrine has been
+unceremoniously discredited in one of the leading Journals, and made
+very light of by teachers in two of the principal Medical Schools, of
+this country, Dr. Channing has for many years inculcated, and
+enforced by examples, the danger to be apprehended and the
+precautions to be taken in the disease under consideration.
+
+I have no wish to express any harsh feeling with regard to the
+painful subject which has come before us.  If there are any so far
+excited by the story of these dreadful events that they ask for some
+word of indignant remonstrance to show that science does not turn the
+hearts of its followers into ice or stone, let me remind them that
+such words have been uttered by those who speak with an authority I
+could not claim.  It is as a lesson rather than as a reproach that I
+call up the memory of these irreparable errors and wrongs.  No tongue
+can tell the heart-breaking calamity they have caused; they have
+closed the eyes just 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 the stranger's arms, or bequeathed
+it, with less cruelty, the death of its dying parent.  There is no
+tone deep enough for regret, and no voice loud enough for warning.
+The woman about to become a mother, or with her new-born infant upon
+her bosom, should be the object of trembling care and sympathy
+wherever she bears her tender burden, or stretches her aching limbs.
+The very outcast of the streets has pity upon her sister in
+degradation, when the seal of promised maternity is impressed upon
+her.  The remorseless vengeance of the law, brought down upon its
+victim by a machinery as sure as destiny, is arrested in its fall at
+a word which reveals her transient claim for mercy.  The solemn
+prayer of the liturgy singles out her sorrows from the multiplied
+trials of life, to plead for her in the hour of peril.  God forbid
+that any member of the profession to which she trusts her life,
+doubly precious at that eventful period, should hazard it
+negligently, unadvisedly, or selfishly!
+
+There may be some among those whom I address who are disposed to ask
+the question, What course are we to follow in relation to this
+matter?  The facts are before them, and the answer must be left to
+their own judgment and conscience.  If any should care to know my own
+conclusions, they are the following; and in taking the liberty to
+state them very freely and broadly, I would ask the inquirer to
+examine them as freely in the light of the evidence which has been
+laid before him.
+
+1.  A physician holding himself in readiness to attend cases of
+midwifery should never take any active part in the post-mortem
+examination of cases of puerperal fever.
+
+2.  If a physician is present at such autopsies, he should use
+thorough ablution, change every article of dress, and allow twenty-
+four hours or more to elapse before attending to any case of
+midwifery.  It may be well to extend the same caution to cases of
+simple peritonitis.
+
+3.  Similar precautions should be taken after the autopsy or surgical
+treatment of cases of erysipelas, if the physician is obliged to
+unite such offices with his obstetrical duties, which is in the
+highest degree inexpedient.
+
+4.  On the occurrence of a single case of puerperal fever in his
+practice, the physician is bound to consider the next female he
+attends in labor, unless some weeks at least have elapsed, as in
+danger of being infected by him, and it is his duty to take every
+precaution to diminish her risk of disease and death.
+
+5.  If within a short period two cases of puerperal fever happen
+close to each other, in the practice of the same physician, the
+disease not existing or prevailing in the neighborhood, he would do
+wisely to relinquish his obstetrical practice for at least one month,
+and endeavor to free himself by every available means from any
+noxious influence he may carry about with him.
+
+6.  The occurrence of three or more closely connected cases, in the
+practice of one individual, no others existing in the neighborhood,
+and no other sufficient cause being alleged for the coincidence, is
+prima facie evidence that he is the vehicle of contagion.
+
+7.  It is the duty of the physician to take every precaution that the
+disease shall not be introduced by nurses or other assistants, by
+making proper inquiries concerning them, and giving timely warning of
+every suspected source of danger.
+
+8.  Whatever indulgence may be granted to those who have heretofore
+been the ignorant causes of so much misery, the time has come when
+the existence of a private pestilence in the sphere of a single
+physician should be looked upon, not as a misfortune, but a crime;
+and in the knowledge of such occurrences the duties of the
+practitioner to his profession should give way 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 given in the Letter of Mr. Stows, contained in the
+Appendix to this Report.  Mr. Stows suggests precautions similar to
+those I have laid down, and these precautions are 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 puerperal fever 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 than a
+fortnight, seeming to originate in a case of erysipelas.
+
+West's Reports, in Brit.  and For.  Med.  Review for October, 1845,
+and January, 1847.--Affection of the arm, resembling malignant
+pustule, after removing the 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 Journal for
+February, 1846, as showing connection of puerperal fever and
+erysipelas.
+
+Kneeland.--Contagiousness of Puerperal Fever.  Am.  Jour.  Med.
+Se., January, 1846.  Also, Connection between Puerperal Fever and
+Epidemic Erysipelas.  Ibid., April, 1846.
+
+Robert Storrs.--Contagious Effects of Puerperal Fever on the Male
+Subject; or on Persons not Child-bearing.  (From Provincial Med.  and
+Surg.  Journal.) Am.  Jour.  Med.  Sc., January, 184,6.  Numerous
+cases.  See also Dr. Reid's case in same Journal 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 illustrating the Contagious
+Nature of Erysipelas and of Puerperal Fever, and their Intimate
+Pathological Connection.  (From Monthly Journal of Med.  Sc.) Am.
+Jour.  Med.  Se., July, 1850.
+
+Skoda on the Causes of Puerperal Fever.  (Peritonitis in rabbits,
+from inoculation with different morbid secretions.) Am.  Jour.  Med.
+Se., October, 1850.
+
+Arneth.  Paper read before the National Academy of Medicine.  Annales
+d'Hygiene, Tome LXV.  2e Partie.  (Means of Disinfection proposed by
+M.  "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use
+of nail-brush before admission to lying-in wards.  Alleged sudden and
+great decrease of mortality from puerperal fever.  Cause of disease
+attributed to inoculation with cadaveric matters.) See also Routh's
+paper, mentioned above.
+
+Moir.  Remarks at a meeting of the Edinburgh Medico-Chirurgical
+Society.  Refers to cases of Dr. Kellie, of Leith.  Sixteen in
+succession, all fatal.  Also to several instances of individual
+pupils having had a succession of cases in various quarters of the
+town, while others, practising as extensively in the same localities,
+had none.  Also to several special cases not mentioned elsewhere.
+Am.  Jour.  Med.  Se.  for October, 1851.  (From New Monthly Journal
+of Med.  Science.)
+
+Simpson.--Observations at a Meeting of the Edinburgh Obstetrical
+Society.  (An "eminent gentleman," according to Dr.  Meigs, whose
+"name is as well known in America as in (his) native land."
+Obstetrics.  Phil.  1852, pp.  368, 375.) The student is referred to
+this paper for a valuable resume of many of the facts, and the
+necessary inferences, relating to 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 diseased parts.  His next four child-bed patients
+were affected with puerperal fever, and it was the first time he had
+seen it in practice.  As Dr. Simpson is a gentleman (Dr. Meigs, as
+above), and as "a gentleman's hands are clean" (Dr. Meigs' Sixth
+Letter), it follows that a gentleman with clean hands 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 the series.  A practitioner in Leith having
+examined in Dr. Simpson's house, a portion of the uterus obtained
+from one of the patients, had immediately afterwards three fatal
+cases of puerperal fever.  Dr.  Veddie referred to two distinct
+series of consecutive cases in his own practice.  He had since taken
+precautions, and not met with any such cases.  Am.  Jour.  Med.  Sc.,
+October, 1851.
+
+Copland.  Considers it proved that puerperal fever maybe propagated
+by the hands and the clothes, or either, of a third person, the bed-
+clothes or body-clothes of a patient.  Mentions a new series of
+cases, one of which he saw, with the practitioner who had attended
+them.  She was the sixth he had had within a few days.  All died.
+Dr. Copland insisted that contagion had caused these cases; advised
+precautionary measures, and the practitioner had no other cases for a
+considerable time.  Considers it criminal, after the evidence
+adduced,--which he could have quadrupled,--and the weight of
+authority brought forward, for a practitioner to be the medium of
+transmitting contagion and death to his patients.  Dr. Copland lays
+down rules similar to those suggested by myself, and is therefore
+entitled to the same epithet for so doing.  Medical Dictionary, New
+York, 1852.  Article, Puerperal States and Diseases.
+
+If there is any appetite for facts so craving as to be yet
+unappeased,--Lesotho, necdum satiata,--more can be obtained.
+Dr.  Hodge remarks that "the frequency and importance of this
+singular circumstance (that the disease is occasionally more
+prevalent with one practitioner than another) has been exceedingly
+overrated."  More than thirty strings of cases, more than two hundred
+and fifty sufferers from puerperal fever, more than one hundred and
+thirty deaths appear as the results of a sparing estimate of such
+among the facts I have gleaned as could be numerically valued.  These
+facts constitute, we may take it for granted, but a small fraction of
+those that have actually occurred.  The number of them might be
+greater, but "'t is enough, 't will serve," in Mercutio's modest
+phrase, so far as frequency is concerned.  For a just estimate of the
+importance of the singular circumstance, it might 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 Medical Society, at the
+Annual Meeting, May 30, 1860.
+
+               "Facultate magis quam violentia."
+                                   HIPPOCRATES.
+
+Our Annual Meeting never fails to teach us at least one lesson.  The
+art whose province it is to heal and to save cannot protect its own
+ranks from the inroads of disease and the waste of the Destroyer.
+
+Seventeen of our associates have been taken from us since our last
+Anniversary.  Most of them followed their calling in the villages or
+towns that lie among the hills or along the inland streams.  Only
+those who have lived the kindly, mutually dependent life of the
+country, can tell how near the physician who is the main reliance in
+sickness of all the families throughout a thinly settled region comes
+to the hearts of the people among whom he labors, how they value him
+while living, how they cherish his memory when dead.  For these
+friends of ours who have gone before, there is now no more toil; they
+start from their slumbers no more at the cry of pain; they sally
+forth no more into the storms; they ride no longer over the lonely
+roads that knew them so well; their wheels are rusting on their axles
+or rolling with other burdens; their watchful eyes are closed to all
+the sorrows they lived to soothe.  Not one of these was famous in the
+great world; some were almost unknown beyond their own immediate
+circle.  But they have left behind them that loving remembrance which
+is better than fame, and if their epitaphs are chiselled briefly in
+stone, they are written at full length on living tablets in a
+thousand homes to which they carried their ever-welcome aid and
+sympathy.
+
+One whom we have lost, very widely known and honored, was a leading
+practitioner of this city.  His image can hardly be dimmed in your
+recollection, as he stood before you only three years ago, filling
+the same place with which I am now honored.  To speak of him at all
+worthily, would be to write the history of professional success, won
+without special aid at starting, by toil, patience, good sense, pure
+character, and pleasing manners; won in a straight uphill ascent,
+without one breathing-space until he sat down, not to rest, but to
+die.  If prayers could have shielded him from the stroke, if love
+could have drawn forth the weapon, and skill could have healed the
+wound, this passing tribute might have been left to other lips and to
+another generation.
+
+Let us hope that our dead have at last found that rest which neither
+summer nor winter, nor day nor night, had granted to their unending
+earthly labors!  And let us remember that our duties to our brethren
+do not cease when they become unable to share our toils, or leave
+behind them in want and woe those whom their labor had supported.  It
+is honorable to the Profession that it has organized an Association a
+for the relief of its suffering members and their families; it owes
+this tribute to the ill-rewarded industry and sacrifices of its less
+fortunate brothers who wear out health and life in the service of
+humanity.  I have great pleasure in referring to this excellent
+movement, which gives our liberal profession a chance to 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 business after twenty years
+of practice, is apt to suppose that he treats his patients according
+to the teachings of his experience.  No doubt this is true to some
+extent; to what extent depending much on the qualities of the
+individual.  But it is easy to prove that the prescriptions of even
+wise physicians are very commonly founded on something quite
+different from experience.  Experience must be based on the permanent
+facts of nature.  But a glance at the prevalent modes of treatment of
+any two successive generations will show that there is a changeable
+as well as a permanent element in the art of healing; not merely
+changeable as diseases vary, or as new remedies are introduced, but
+changeable by the going out of fashion of special remedies, by the
+decadence of a popular theory from which their fitness was deduced,
+or other cause not more significant.  There is no reason to suppose
+that the present time is essentially different in this respect from
+any other.  Much, therefore, which is now very commonly considered to
+be the result of experience, will be recognized in the next, or in
+some succeeding generation, as no such result at all, but as a
+foregone conclusion, based on some prevalent belief or fashion of the
+time.
+
+There are, of course, in every calling, those who go about the work
+of the day before them, doing it according to the rules of their
+craft, and asking no questions of the past or of the future, or of
+the aim and end to which their special labor is contributing.  These
+often consider and call themselves practical men.  They pull the oars
+of society, and have no leisure to watch the currents running this or
+that way; let theorists and philosophers attend to them.  In the mean
+time, however, these currents are carrying the practical men, too,
+and all their work may be thrown away, and worse than thrown away, if
+they do not take knowledge of them and get out of the wrong ones and
+into the right ones as soon as they may.  Sir Edward Parry and his
+party were going straight towards the pole in one of their arctic
+expeditions, travelling at the rate of ten miles a day.  But the ice
+over which they travelled was drifting straight towards the equator,
+at the rate of twelve miles a day, and yet no man among them would
+have known that he was travelling two miles a day backward unless he
+had lifted his eyes from the track in which he was plodding.  It is
+not only going backward that the plain practical workman is liable
+to, if he will not look up and look around; he may go forward to ends
+he little dreams of.  It is a simple business for a 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 Jewish
+artisan to fit two pieces of timber together according to the legal
+pattern in the time of Pontius Pilate; he asked no questions,
+perhaps, but we know what burden the cross bore on the morrow!  And
+so, with subtler tools than trowels or axes, the statesman who works
+in policy without principle, the theologian who works in forms
+without a soul, the physician who, calling himself a practical man,
+refuses to recognize the larger laws which govern his changing
+practice, may all find that they have been building truth into the
+wall, and hanging humanity upon the cross.
+
+The truth is, that medicine, professedly founded on observation, 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
+straightforward inductive path, without regard to changes of
+government or to fluctuations of public opinion.  But look a moment
+while I clash a few facts together, and see if some sparks do not
+reveal by their light a closer relation between the Medical Sciences
+and the conditions of Society and the general thought of the time,
+than would at first be suspected.
+
+Observe the coincidences between certain great political and
+intellectual periods and the appearance of illustrious medical
+reformers and teachers.  It was in the age of Pericles, of Socrates,
+of Plato, of Phidias, that Hippocrates gave to medical knowledge the
+form which it retained for twenty centuries.  With the world-
+conquering Alexander, the world-embracing Aristotle, appropriating
+anatomy and physiology, among his manifold spoils of study, marched
+abreast of his royal pupil to wider conquests.  Under the same
+Ptolemies who founded the Alexandrian Library and Museum, and ordered
+the Septuagint version of the Hebrew Scriptures, the infallible
+Herophilus ["Contradicere Herophilo in anatomicis, est contradicere
+evangelium," was a saying of Fallopius.] made those six hundred
+dissections of which Tertullian accused him, and the sagacious
+Erasistratus introduced his mild antiphlogistic treatment in
+opposition to the polypharmacy and antidotal practice of his time.
+It is significant that the large-minded Galen should have been the
+physician and friend of the imperial philosopher Marcus Aurelius.
+The Arabs gave laws in various branches of knowledge to those whom
+their arms had invaded, or the terror of their spreading dominion had
+reached, and the point from which they started was, as Humboldt
+acknowledges, "the study of medicine, by which they long ruled the
+Christian Schools," and to which they added the department of
+chemical pharmacy.
+
+Look at Vesalius, the contemporary of Luther.  Who can fail to see
+one common spirit in the radical ecclesiastic and the reforming
+court-physician?  Both still to some extent under the dominion of the
+letter: Luther holding to the real presence; Vesalius actually
+causing to be drawn and engraved two muscles which he knew were not
+found in the human subject, because they had been described by Galen,
+from dissections of the lower animals.  Both breaking through old
+traditions in the search of truth; one, knife in hand, at the risk of
+life and reputation, the other at the risk of fire and fagot, with
+that mightier weapon which all the devils could not silence, though
+they had been thicker than the tiles on the house-tops.  How much the
+physician of the Catholic Charles V. had in common with the great
+religious destructive, may be 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 ill repute, the favorite of a
+monk of the order of St. Anthony, who does not seem to have resisted
+temptation so well as the founder of his order.  We have always
+ranked the physician Rabelais among the early reformers, but I do not
+know that Vesalius has ever been thanked for his hit at the morals of
+the religious orders, or for turning to the good of science what was
+intended for the "benefit of clergy."
+
+Our unfortunate medical brother, Michael Servetus, the spiritual
+patient to whom the theological moxa was applied over the entire
+surface for the cure of his heresy, came very near anticipating
+Harvey.  The same quickened thought of the time which led him to
+dispute the dogma of the Church, opened his mind to the facts which
+contradicted the dogmas of the Faculty.
+
+Harvey himself was but the posthumous child of the great Elizabethan
+period.  Bacon was at once his teacher and his patient.  The founder
+of the new inductive philosophy had only been dead two years when the
+treatise on the Circulation, the first-fruit of the 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 political world, Bichat was
+revolutionizing the science of life and the art that is based upon
+it; that while the young general was scaling the Alps, the young
+surgeon was climbing the steeper summits of unexplored nature; that
+the same year read the announcement of those admirable "Researches on
+Life and Death," and the bulletins of the battle of Marengo?
+
+If we come to our own country, who can fail to recognize that
+Benjamin Rush, the most conspicuous of American physicians, was the
+intellectual offspring of the movement which produced the Revolution?
+"The same hand," says one of his biographers," which subscribed the
+declaration of the political independence of these States,
+accomplished their emancipation from medical systems formed in
+foreign countries, and wholly unsuitable to the state of diseases in
+America."
+
+Following this general course of remark, I propose to indicate in a
+few words the direction of the main intellectual current of the time,
+and to point out more particularly some of the eddies which tend to
+keep the science and art of medicine from moving with it, 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 being in which we live.  Statistics
+have tabulated everything,--population, growth, wealth, crime,
+disease.  We have shaded maps showing the geographical distribution
+of larceny and suicide.  Analysis and classification have been at
+work upon all tangible and visible objects.  The Positive Philosophy
+of Comte has only given expression to the observing and computing
+mind of the nineteenth century.
+
+In the mean time, the great stronghold of intellectual conservatism,
+traditional belief, has been assailed by facts which would have been
+indicted as blasphemy but a few generations ago.  Those new tables of
+the law, placed in the hands of the geologist by the same living God
+who spoke from Sinai to the Israelites of old, have remodelled the
+beliefs of half the civilized world.  The solemn scepticism of
+science has replaced the sneering doubts of witty philosophers.  The
+more positive knowledge we gain, the more we incline to question all
+that has been received without absolute proof.
+
+As a matter of course, this movement has its partial reactions.  The
+province of faith is claimed as a port free of entry to unsupported
+individual convictions.  The tendency to question is met by the
+unanalyzing instinct of reverence.  The old church calls back its
+frightened truants.  Some who have lost their hereditary religious
+belief find a resource in the revelations of Spiritualism.  By a
+parallel movement, some of those who have become medical infidels
+pass over to the mystic band of believers in the fancied miracles of
+Homoeopathy.
+
+Under these influences transmitted to, or at least shared by, the
+medical profession, the old question between "Nature," so called, and
+"Art," or professional tradition, has reappeared with new interest.
+I say the old question, for Hippocrates stated the case on the side
+of "Nature" more than two thousand years ago.  Miss Florence
+Nightingale,--and if I name her next to the august Father of the
+Healing Art, its noblest daughter well deserves that place of honor,
+--Miss Florence Nightingale begins her late volume with a paraphrase
+of his statement.  But from a very early time to this there has
+always been a strong party against "Nature."  Themison called the
+practice of Hippocrates "a meditation upon death."  Dr. Rush says:
+"It is impossible to calculate the mischief which Hippocrates, has
+done, by first marking Nature with his name and afterwards letting
+her loose upon sick people.  Millions have perished by her hands in
+all ages and countries."  Sir John Forbes, whose defence of "Nature"
+in disease you all know, and to the testimonial in whose 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 years sooner, and the opinion that no man had done so
+much to destroy the confidence of the public in the medical
+profession.
+
+In this Society we have had the Hippocratic and the Themisonic side
+fairly represented.  The treatise of one of your early Presidents on
+the Mercurial Treatment is familiar to my older listeners.  Others
+who have held the same office have been noted for the boldness of
+their practice, and even for partiality to the use of complex
+medication.
+
+On the side of "Nature" we have had, first of all, that remarkable
+discourse on Self-Limited Diseases, [On Self-Limited Diseases.  A
+Discourse delivered before the Massachusetts Medical Society, at
+their Annual Meeting, May 27, 1835.  By Jacob Bigelow, M. D.] which
+has given the key-note to the prevailing medical tendency of this
+neighborhood, at least, for the quarter of a century since it was
+delivered.  Nor have we forgotten the address delivered at
+Springfield twenty 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. Worthington Hooker. [Rational Therapeutics.  A
+Prize Essay.  By Worthington Hooker, M.  D., of New Haven.  Boston.
+1857.] We should not omit from the list the important address of
+another of our colleagues, [On the Treatment of Compound and
+Complicated Fractures. By William J.  Walker, M.  D.  Read at the
+Annual Meeting, May 29, 1845.] showing by numerous cases the power of
+Nature in healing compound fractures to be much greater than is
+frequently supposed,--affording, indeed, more striking illustrations
+than can be obtained from the history of visceral disease, of the
+supreme wisdom, forethought, and adaptive dexterity of that divine
+Architect, as shown in repairing the shattered columns which support
+the living temple of the body.
+
+We who are on the side of "Nature" please ourselves with the idea
+that we are in the great current in which the true intelligence of
+the time is moving.  We believe that some who oppose, or fear, or
+denounce our movement are themselves caught in various eddies that
+set back against the truth.  And we do most earnestly desire and most
+actively strive, that Medicine, which, it is painful to remember, has
+been spoken of as "the withered branch of science" at a meeting of
+the British Association, shall be at length brought fully to share,
+if not to lead, the great wave of knowledge which rolls with the
+tides that circle the globe.
+
+If there is any State or city which might claim to be the American
+headquarters of the nature-trusting heresy, provided it be one, that
+State is Massachusetts, and that city is its capital.  The effect
+which these doctrines have upon the confidence reposed in the
+profession is a matter of opinion.  For myself, I do not believe this
+confidence can be impaired by any investigations which tend to limit
+the application of troublesome, painful, uncertain, or dangerous
+remedies.  Nay, I will venture to say this, that if every specific
+were to fail utterly, if the cinchona trees all died out, and the
+arsenic mines were exhausted, and the sulphur regions were burned up,
+if every drug from the vegetable, animal, and mineral kingdom were to
+disappear from the market, a body of enlightened men, organized as a
+distinct profession, would be required just as much as now, and
+respected and trusted as now, whose province should be to guard
+against the causes of disease, to eliminate them if possible when
+still present, to order all the conditions of the patient so as to
+favor the efforts of the system to right itself, and to give those
+predictions of the course of disease which only experience can
+warrant, and which in so many cases relieve the exaggerated fears of
+sufferers and their friends, or warn them in season of impending
+danger.  Great as the loss would be if certain active remedies could
+no longer be obtained, it would leave the medical profession the most
+essential part of it's duties, and all, and more than all, its
+present share of honors; for it would be the death-blow to
+charlatanism, which depends for its success almost entirely on drugs,
+or at least on a nomenclature that suggests them.
+
+There is no offence, then, or danger in expressing the opinion, that,
+after all which has been said, the community is still overdosed: The
+best proof of it is, that "no families take so little medicine as
+those of doctors, except those of apothecaries, and that old
+practitioners are more sparing of active medicines than younger
+ones." [Dr. James Jackson has kindly permitted me to make the
+following extract from a letter just received by him from Sir James
+Clark, and dated May 26, 1860:  "As a physician advances in age, he
+generally, I think, places less confidence in the ordinary medical
+treatment than he did, not only during his early, but even his middle
+period of life."]  The conclusion from these facts is one which the
+least promising of Dr. Howe's pupils in the mental department could
+hardly help drawing.
+
+Part of the blame of over-medication must, I fear, rest with the
+profession, for yielding to the tendency to self-delusion, which
+seems inseparable from the practice of the art of healing.  I need
+only touch on the common modes of misunderstanding or misapplying the
+evidence of nature.
+
+First, there is the natural incapacity for sound observation, which
+is like a faulty ear in music.  We see this in many persons who know
+a good deal about books, but who are not sharp-sighted enough to buy
+a horse or deal with human diseases.
+
+Secondly, there is in some persons a singular inability to weigh the
+value of testimony; of which, I think, from a pretty careful
+examination of his books, Hahnemann affords the best specimen outside
+the walls of Bedlam.
+
+The inveterate logical errors to which physicians have always been
+subject are chiefly these:
+
+The mode of inference per enumerationem simplicem, in scholastic
+phrase; that is, counting only their favorable cases.  This is the
+old trick illustrated in Lord Bacon's story of the gifts of the
+shipwrecked people, hung up in the temple.--Behold! they vowed these
+gifts to the altar, and the gods saved them.  Ay, said a doubting
+bystander, but how many made vows of gifts and were shipwrecked
+notwithstanding?  The numerical system is the best corrective of this
+and similar errors.  The arguments commonly brought against its
+application to all matters of medical observation, treatment
+included, seem to apply rather to the tabulation of facts ill
+observed, or improperly classified, than to the method itself.
+
+The post hoc ergo propter hoc error: he got well after taking my
+medicine; therefore in consequence of taking it.
+
+The false induction from genuine facts of observation, leading to the
+construction of theories which are then deductively applied in the
+face of the results of direct observation.  The school of Broussais
+has furnished us with a good example of this error.
+
+And lastly, the error which Sir Thomas Browne calls giving "a reason
+of the golden tooth;" that is, assuming a falsehood as a fact, and
+giving reasons for it, commonly fanciful ones, as is constantly done
+by that class of incompetent observers who find their "golden tooth"
+in the fabulous effects of the homoeopathie materia medica,--which
+consists of sugar of milk and a nomenclature.
+
+Another portion of the blame rests with the public itself, which
+insists on being poisoned.  Somebody buys all the quack medicines
+that build palaces for the mushroom, say rather, the toadstool
+millionaires.  Who is it?  These people have a constituency of
+millions.  The popular belief is all but universal that sick persons
+should feed on noxious substances.  One of our members was called not
+long since to a man with a terribly sore mouth.  On inquiry he found
+that the man had picked up a box of unknown pills, in Howard Street,
+and had proceeded to take them, on general principles, pills being
+good for people.  They happened to contain mercury, and hence the
+trouble for which he consulted our associate.
+
+The outside pressure, therefore, is immense upon the physician,
+tending to force him to active treatment of some kind.  Certain old
+superstitions, still lingering in the mind of the public, and not yet
+utterly expelled from that of the profession, are at the bottom of
+this, or contribute to it largely.  One of the most ancient is, that
+disease is a malignant agency, or entity, to be driven out of the
+body by offensive substances, as the smoke of the fish's heart and
+liver drove the devil out of Tobit's bridal chamber, according to the
+Apochrypha.  Epileptics used to suck the blood from the wounds of
+dying gladiators. [Plinii Hist.  Mundi.  lib.  xxviii.  c.  4.] The
+Hon. Robert Boyle's little book was published some twenty or thirty
+years before our late President, Dr. Holyoke, was born. [A Collection
+of Choice and Safe Remedies.  The Fifth Edition, corrected.  London,
+1712.  Dr. Holyoke was born in 1728.] In it he recommends, as
+internal medicines, most of the substances commonly used as
+fertilizers of the soil.  His "Album Graecum" is best left
+untranslated, and his "Zebethum Occidentale" is still more
+transcendentally unmentionable except in a strange dialect.  It
+sounds odiously to us to hear him recommend for dysentery a powder
+made from "the sole 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 neck at night for a sore throat.  The
+same idea of virtue in unlovely secretions! [The idea is very
+ancient.  "Sordes hominis" "Sudore et oleo medicinam facientibus."
+--Plin.  xxviii.  4.]
+
+Even now the Homoeopathists have been introducing the venom of
+serpents, under the learned title of Lachesis, and outraging human
+nature with infusions of the pediculus capitis; that is, of course,
+as we understand their dilutions, the names of these things; for if a
+fine-tooth-comb insect were drowned in Lake Superior, we cannot agree
+with them in thinking that every drop of its waters would be
+impregnated with all the pedicular virtues they so highly value.
+They know what they are doing.  They are appealing to the detestable
+old superstitious presumption in favor of whatever is nauseous and
+noxious as being good for the sick.
+
+Again, we all occasionally meet persons stained with nitrate of
+silver, given for epilepsy.  Read what Dr. Martin says, about the way
+in which it came to be used, in his excellent address before the
+Norfolk County Medical Society, and the evidence I can show, but have
+not time for now, and then say what you think of the practice which
+on such presumptions turns a white man as blue as the double-tattooed
+King of the Cannibal Islands!  [Note A.]
+
+If medical superstitions have fought their way down through all the
+rationalism and scepticism of the nineteenth century, of course the
+theories of the schools, supported by great names, adopted into the
+popular belief and incorporated with the general mass of
+misapprehension with reference to disease, must be expected to meet
+us at every turn in the shape of bad practice founded on false
+doctrine.  A French patient complains that his blood heats him, and
+expects his doctor to bleed him.  An English or American one says he
+is bilious, and will not be easy without a dose of calomel.  A doctor
+looks at a patient's tongue, sees it coated, and says the stomach is
+foul; his head full of the old saburral notion which the extreme
+inflammation-doctrine of Broussais did so much to root out, but which
+still leads, probably, to much needless and injurious wrong of the
+stomach and bowels by evacuants, when all they want is to be let
+alone.  It is so hard to get anything out of the dead hand of medical
+tradition!  The mortmain of theorists extinct in science clings as
+close as that of ecclesiastics defunct in law.
+
+One practical hint may not be out of place here.  It seems to be
+sometimes forgotten, by those who must know the fact, that the tongue
+is very different, anatomically and physiologically, from the
+stomach.  Its condition does not in the least imply a similar one of
+the stomach, which is a very different structure, covered with a
+different kind of epithelium, and furnished with entirely different
+secretions.  A silversmith will, for a dollar, make a small hoe, of
+solid silver, which will last for centuries, and will give a patient
+more comfort, used for the removal of the accumulated epithelium and
+fungous growths which constitute the "fur," than many a prescription
+with a split-footed Rx before it, addressed to the parts out of
+reach.
+
+I think more of this little implement on account of its agency in
+saving the Colony at Plymouth in the year 1623.  Edward Winslow heard
+that Massasoit was sick and like to die.  He found him with a
+houseful of people about him, women rubbing his arms and legs, and
+friends "making such a hellish noise" as they probably thought would
+scare away the devil of sickness.  Winslow gave him some conserve,
+washed his mouth, scraped his tongue, which was in a horrid state,
+got down some drink, made him some broth, dosed him with an infusion
+of strawberry leaves and sassafras root, and had the satisfaction of
+seeing him rapidly recover.  Massasoit, full of gratitude, revealed
+the plot which had been formed to destroy the colonists, whereupon
+the Governor ordered Captain Miles Standish to see to them; who
+thereupon, as everybody remembers, stabbed Pecksuot with his own
+knife, broke up the plot, saved the colony, and thus rendered
+Massachusetts and the Massachusetts Medical Society a possibility, as
+they now are a fact before us.  So much for this parenthesis of the
+tongue-scraper, which helped to save the young colony from a much
+more serious scrape, and may save the Union yet, if a Presidential
+candidate should happen to be taken sick as Massasoit was, and his
+tongue wanted cleaning,--which process would not hurt a good many
+politicians, with or without a typhoid fever.
+
+Again, see how the "bilious" theory works in every-day life here and
+now, illustrated by a case from actual life.  A youthful
+practitioner, whose last molars have not been a great while cut,
+meets an experienced and noted physician in consultation.  This is
+the case.  A slender, lymphatic young woman is suckling two lusty
+twins, the intervals of suction being occupied on her part with
+palpitations, headaches, giddiness, throbbing in the head, and
+various nervous symptoms, her cheeks meantime getting bloodless, and
+her strength running away in company with her milk.  The old
+experienced physician, seeing the yellowish waxy look which is common
+in anaemic patients, considers it a "bilious" case, and is for giving
+a rousing emetic.  Of course, he has to be wheedled out of this, a
+recipe is written for beefsteaks and porter, the twins are
+ignominiously expelled from the anaemic bosom, and forced to take
+prematurely to the bottle, and this prolific mother is saved for
+future usefulness in the line of maternity.
+
+The practice of making a profit on the medicine ordered has been held
+up to reprobation by one at least of the orators who have preceded
+me.  That the effect of this has been ruinous in English practice I
+cannot doubt, and that in this country the standard of practice was
+in former generations lowered through the same agency is not
+unlikely.  I have seen an old account-book in which the physician
+charged an extra price for gilding his rich patients' pills.  If all
+medicine were very costly, and the expense of it always came out of
+the physician's fee, it would really be a less objectionable
+arrangement than this other most pernicious one.  He would naturally
+think twice before he gave an emetic or cathartic which evacuated his
+own pocket, and be sparing of the cholagogues that emptied the
+biliary ducts of his own wallet, unless he were sure they were
+needed.  If there is any temptation, it should not be in favor of
+giving noxious agents, as it clearly must be in the case of English
+druggists and "General Practitioners."  The complaint against the
+other course is a very old one.  Pliny, inspired with as truly Roman
+horror of quackery as the elder Cato,--who declared that the Greek
+doctors had sworn to exterminate all barbarians, including the
+Romans, with their drugs, but is said to have physicked his own wife
+to death, notwithstanding,--Pliny says, in so many words, 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 sober observation of nature, in the
+direction of old superstitions and fancies, of exploded theories, of
+old ways of making money, which are very slow to pass out of fashion
+
+But there are other special American influences which we are bound to
+take cognizance of.  If I wished to show a student the difficulties
+of getting at truth from medical experience, I would give him the
+history of epilepsy to read.  If I wished him to understand the
+tendencies of the American medical mind, its sanguine enterprise, its
+self-confidence, its audacious handling of Nature, its impatience
+with her old-fashioned ways of taking time to get a sick man well, I
+would make him read the life and writings of Benjamin Rush.  Dr. Rush
+thought and said that there were twenty times more intellect and a
+hundred times more knowledge in the country in 1799 than before the
+Revolution.  His own mind was in a perpetual state of exaltation
+produced by the stirring scenes in which he had taken a part, and the
+quickened life of the time in which he lived.  It was not the state
+to favor sound, calm observation.  He was impatient, and Nature is
+profoundly imperturbable.  We may adjust the beating of our hearts to
+her pendulum if we will and can, but we may be very sure that she
+will not change the pendulum's rate of going because our hearts are
+palpitating.  He thought he had mastered yellow-fever.  "Thank God,"
+he said, "out of one hundred patients whom I have visited or
+prescribed for this day, I have lost none."  Where was all his legacy
+of knowledge when Norfolk was decimated?  Where was it when the blue
+flies were buzzing over the coffins of the unburied dead piled up in
+the cemetery of New Orleans, at the edge of the huge trenches yawning
+to receive them?
+
+One such instance will do as well as twenty.  Dr. Rush must have been
+a charming teacher, as he was an admirable man.  He was observing,
+rather than a sound observer; eminently observing, curious, even,
+about all manner of things.  But he could not help feeling as if
+Nature had been a good deal shaken by the Declaration of
+Independence, and that American art was getting to be rather too much
+for her,--especially as illustrated in his own practice.  He taught
+thousands of American students, he gave a direction to the medical
+mind of the country more than any other one man; perhaps he typifies
+it better than any other.  It has clearly tended to extravagance in
+remedies and trust in remedies, as in everything else.  How could a
+people which has a revolution once in four years, which has contrived
+the Bowie-knife and the revolver, which has chewed the juice out of
+all the superlatives in the language in Fourth of July orations, and
+so used up its epithets in the rhetoric of abuse that it takes two
+great quarto dictionaries to supply the demand; which insists in
+sending out yachts and horses and boys to out-sail, out-run, out-
+fight, and checkmate all the rest of creation; how could such a
+people be content with any but "heroic" practice?  What wonder that
+the stars and stripes wave over doses of ninety grains of sulphate of
+quinine, [More strictly, ninety-six grains in two hours. Dunglison's
+Practice, 1842, vol. ii.  p. 520.  Eighty grains in one dose.
+Ibid.  p. 536.  Ninety-six grains of sulphate of quinine are equal
+to eight ounces of good bark.--Wood & Bache.] and that the American
+eagle screams with delight to see three drachms of calomel given at a
+single 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 which must find something to fill their columns, and
+so print all the new plans of treatment and new remedies they can get
+hold of, as the newspapers, from a similar necessity, print the
+shocking catastrophes and terrible murders.
+
+Besides all this, here are we, the great body of teachers in the
+numberless medical schools of the Union, some of us lecturing to
+crowds who clap and stamp in the cities, some of us wandering over
+the country, like other professional fertilizers, to fecundate the
+minds of less demonstrative audiences at various scientific stations;
+all of us talking habitually to those supposed to know less than
+ourselves, and loving to claim as much for our art as we can, not to
+say for our own schools, and possibly indirectly for our own
+practical skill.  Hence that annual crop of introductory lectures;
+the useful blossoming into the ornamental, as the cabbage becomes
+glorified in the cauliflower; that lecture-room literature of
+adjectives, that declamatory exaggeration, that splendid show of
+erudition borrowed from D'Israeli, and credited to Lord Bacon and the
+rest, which have suggested to our friends of the Medical Journals an
+occasional epigram at our expense.  Hence the tendency in these
+productions, and in medical lectures generally, to overstate the
+efficacy of favorite methods of cure, and hence the premium offered
+for showy talkers rather than sagacious observers, for the men of
+adjectives rather than of nouns substantive in the more ambitious of
+these institutions.
+
+Such are some of the eddies in which we are liable to become involved
+and carried back out of the broad stream of philosophical, or, in
+other words, truth-loving, investigations.  The causes of disease, in
+the mean time, have been less earnestly studied in the eagerness 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-house might not be known, while the very men who were
+discussing the treatment of the disease were stupidly conveying the
+infection from bed to bed, as rat-killers carry their poisons from
+one household to another.  Do not some of you remember that I have
+had to fight this private-pestilence question against a scepticism
+which sneered in the face of a mass of evidence such as the calm
+statisticians of the Insurance office could not listen to without
+horror and indignation? ["The Contagiousness of Puerperal Fever."--
+N. E. Quar. Jour. of Medicine and Surgery, April, 1843.  Reprinted,
+with Additions.  Boston: Ticknor & Fields.  1855.] Have we forgotten
+what is told 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's lives in a single
+hospital?  How long would it have taken small doses of calomel and
+rhubarb to save as many children?  These may be useful in prudent
+hands, but how insignificant compared to the great hygienic
+conditions!  Causes, causes, and again causes,--more and more we fall
+back on these as the chief objects of our attention.  The shortest
+system 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 it to the first mother when she saw her first-born
+child putting some ugly pebble or lurid berry into its mouth.  I know
+not in what language it was spoken, but I know that in English it
+would sound thus: Spit it out!
+
+Art can do something more than say this.  It can sometimes reach the
+pebble or berry after it has been swallowed.  But the great thing is
+to keep these things out of children's mouths, and as soon as they
+are beyond our reach, to be reasonable and patient with Nature, who
+means well, but does not like to hurry, and who took nine calendar
+months, more or less, to every mother's son among us, before she
+thought he was fit to be shown to the public.
+
+Suffer me now to lay down a few propositions, whether old or new it
+matters little, not for your immediate acceptance, nor yet for your
+hasty rejection, but for your calm consideration.
+
+But first, there are a number of terms which we are in the habit of
+using in a vague though not unintelligible way, and which it is as
+well now to define.  These terms are the tools with which we are to
+work, and the first thing is to sharpen them.  It is nothing to us
+that they have been sharpened a thousand times before; they always
+get dull in the using, and every new workman has a right to carry
+them to the grindstone and sharpen them to suit himself.
+
+Nature, in medical language, as opposed to Art, means trust in the
+reactions of the living system against, ordinary normal impressions.
+
+Art, in the same language, as opposed to Nature, means an intentional
+resort to extraordinary abnormal impressions for the relief of
+disease.
+
+The reaction of the living system is the essence of both.  Food is
+nothing, if there is no digestive act to respond to it.  We cannot
+raise a blister on a dead man, or hope that a carminative forced
+between his lips will produce its ordinary happy effect.
+
+Disease, dis-ease,--disturbed quiet, uncomfortableness,--means
+imperfect or abnormal reaction of the living system, and its more or
+less permanent results.
+
+Food, in its largest sense, is whatever helps to build up the normal
+structures, or to maintain their natural actions.
+
+Medicine, in distinction from food, is every unnatural or noxious
+agent applied for the relief of disease.
+
+Physic means properly the Natural art, and Physician is only the
+Greek synonyme of Naturalist.
+
+With these few explanations I proceed to unfold the propositions I
+have mentioned.
+
+Disease and death, if we may judge by the records of creation, are
+inherently and essentially necessary in the present order of things.
+A perfect intelligence, trained by a perfect education, could do no
+more than keep the laws of the physical and spiritual universe.  An
+imperfect intelligence, imperfectly taught,--and this is the
+condition of our finite humanity,--will certainly fail to keep all
+these laws perfectly.  Disease is one of the penalties of one of the
+forms of such failure.  It is prefigured in the perturbations of the
+planets, in the disintegration of the elemental masses; it has left
+its traces in the fossil organisms of extinct creations. [Professor
+Agassiz has kindly handed me the following note: "There are abnormal
+structures in animals of all ages anterior to the creation of
+mankind.  Malformed specimens of Crinoids are known from the Triassic
+and Jurassic deposits.  Malformed and diseased bones of tertiary
+mammalia have been collected in the caverns of Gailenreuth with
+traces of healing."]
+
+But it is especially the prerogative, I had almost said 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 get rid of those who will not mind or cannot be kept subject to
+these laws.
+
+Disease, being always an effect, is always in exact proportion to the
+sum of its causes, as much in the case of Spigelius, who dies of a
+scratch, as in that of the man who recovers after an iron bar has
+been shot through his brain.  The one prevalent failing of the
+medical art is to neglect the causes and quarrel with the effect.
+
+There are certain general facts which include a good deal of what is
+called and treated as disease.  Thus, there are two opposite
+movements of life to be seen in cities and elsewhere, belonging to
+races which, from various persistent causes, are breeding down and
+tending to run out, and to races which are breeding up, or
+accumulating vital capital,--a descending and an ascending series.
+Let me give an example of each; and that I may incidentally remove a
+common impression about this country as compared with the Old World,
+an impression which got tipsy with conceit and staggered into the
+attitude of a formal proposition in the work of Dr. Robert Knox, I
+will illustrate the downward movement from English experience, and
+the upward movement from a family history belonging to this immediate
+neighborhood.
+
+Miss Nightingale speaks of "the fact so often seen of a
+great-grandmother, who was a tower of physical vigor, descending into
+a grandmother perhaps a little less vigorous, but still sound as a
+bell, and healthy to the core, into a mother languid and confined to
+her carriage and house; and lastly into a daughter sickly and
+confined to her bed." So much for the descending English series; now
+for the ascending American series.
+
+Something more than one hundred and thirty years ago there graduated
+at Harvard College a delicate youth, who lived an invalid life and
+died at the age of about fifty.  His two children were both of
+moderate physical 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 of its members.  The fourth generation
+was of fair average endowment.  The fifth generation, great-great-
+grandchildren of the slender invalid, are several of, them of
+extraordinary bodily and mental power; large in stature, formidable
+alike with their brains and their arms, organized on a more extensive
+scale than either of their parents.
+
+This brief account illustrates incidentally the fallacy of the
+universal-degeneration theory applied to American life; the same on
+which one of our countrymen has lately brought some very forcible
+facts to bear in a muscular discussion of which we have heard rather
+more than is good for us. But the two series, American and English,
+ascending and descending, were adduced with the main purpose of
+showing the immense difference of vital endowments in different
+strains of blood; a difference to which all ordinary medication is in
+all probability a matter of comparatively trivial purport.  Many
+affections which art has to strive against might be easily shown to
+be vital to the well-being of society.  Hydrocephalus, tabes
+mesenterica, and other similar maladies, are natural agencies which
+cut off the children of races that are sinking below the decent
+minimum which nature has established as the condition of viability,
+before they reach the age of reproduction.  They are really not so
+much diseases, as manifestations of congenital incapacity for life;
+the race would be ruined if art could ever learn always to preserve
+the individuals subject to them.  We must do the best we can for
+them, but we 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 absolute health by medicinal
+appliances.  There are many ladies, ancient and recent, who are
+perpetually taking remedies for irremediable pains and aches.  They
+ought to have headaches and back-aches and stomach-aches; they are
+not well if they do not have them.  To expect them to live without
+frequent twinges is like expecting a doctor's old chaise to go
+without creaking; if it did, we might be sure the springs were
+broken.  There is no doubt that the constant demand for medicinal
+remedies from patients of this class leads to their over-use; often
+in the case of cathartics, sometimes in that of opiates.  I have been
+told by an intelligent practitioner in a Western town, that the
+constant prescription of opiates by certain physicians in his
+vicinity has rendered the habitual use of that drug in all that
+region very prevalent; more common, I should think, than alcoholic
+drunkenness in the most intemperate localities of which I have known
+anything.  A frightful endemic demoralization betrays itself in the
+frequency with which the haggard features and drooping shoulders of
+the opium-drunkards are met with in the streets.
+
+The next proposition I would ask you to consider is this:
+The presumption always is that every noxious agent, including
+medicines proper, which hurts a well man, hurts a sick one.
+[ Note B.]
+
+Let me illustrate this proposition before you decide upon it.  If it
+were known that a prize-fighter were to have a drastic purgative
+administered two or three days before a contest, or a large blister
+applied to his back, no one will question that it would affect the
+betting on his side unfavorably; we will say to the amount of five
+per cent.  Now the drain upon the resources of the system produced in
+such a case must be at its minimum, for the subject is a powerful
+man, in the prime of life, and in admirable condition.  If the drug
+or the blister takes five per cent. from his force of resistance, it
+will take at least as large a fraction from any invalid.  But this
+invalid has to fight a champion who strikes hard but cannot be hit in
+return, who will press him sharply for breath, but will never pant
+himself while the wind can whistle through his fleshless ribs.  The
+suffering combatant is liable to want all his stamina, and five per
+cent. may lose him the battle.
+
+All noxious agents, all appliances which are not natural food 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 force produced by any of them, that is, would exactly kill him,
+nothing less than kill him, and nothing more.  If this, or something
+like this, is true, then all these medications are, prima facie,
+injurious.
+
+In the game of Life-or-Death, Rouge et Noir, as played between the
+Doctor and the Sexton, this five per cent., this certain small injury
+entering into the chances is clearly the sexton's perquisite for
+keeping the green table, over which the game is played, and where he
+hoards up his gains.  Suppose a blister to diminish a man's pain,
+effusion or dyspnoea to the saving of twenty per cent. in vital
+force; his profit from it is fifteen, in that case, for it always
+hurts him five to begin with, according to our previous assumption.
+
+Presumptions are of vast importance in medicine, as in law.  A man is
+presumed innocent until he is proved guilty.  A medicine--that is, a
+noxious agent, like a blister, a seton, an emetic, or a cathartic--
+should always be presumed to be hurtful.  It always is directly
+hurtful; it may sometimes be indirectly beneficial.  If this
+presumption were established, and disease always assumed to be the
+innocent victim of circumstances, and not punishable by medicines,
+that is, noxious agents, or poisons, until the contrary was shown, we
+should not so frequently hear the remark commonly, perhaps
+erroneously, attributed to Sir Astley Cooper, but often repeated by
+sensible persons, that, on the whole, more harm than good is done by
+medication.  Throw out opium, which the Creator himself seems to
+prescribe, for we often see the scarlet poppy growing in the
+cornfields, as if it were foreseen that wherever there is hunger to
+be fed there must also be pain to be soothed; throw out a few
+specifics which our art did not discover, and is hardly needed to
+apply [ Note C.]; throw out wine, which is a food, and the vapors
+which produce the miracle of anaesthesia, and I firmly believe that
+if the whole materia medica, as now used, could be sunk to the bottom
+of the sea, it would be all the better for mankind,--and all the
+worse for the fishes.
+
+But to justify this proposition, I must add that the injuries
+inflicted by over-medication are to a great extent masked by disease.
+Dr. Hooker believes that the typhus syncopatia of a preceding
+generation in New England "was often in fact a brandy and opium
+disease."  How is a physician to distinguish the irritation produced
+by his blister from that caused by the inflammation it was meant to
+cure?  How can he tell the exhaustion produced by his evacuants from
+the collapse belonging to the disease they were meant to remove?
+
+Lastly, medication without insuring favorable hygienic conditions is
+like amputation without ligatures.  I had a chance to learn this well
+of old, when physician to the Broad Street district of the Boston
+Dispensary.  There, there was no help for the utter want of wholesome
+conditions, and if anybody got well under my care, it must have been
+in virtue of the rough-and-tumble constitution which emerges from the
+struggle for life in the street gutters, rather than by the aid of my
+prescriptions.
+
+But if the materia medica were lost overboard, how much more pains
+would be taken in ordering all the circumstances surrounding the
+patient (as can be done everywhere out of the crowded pauper
+districts), than are taken now by too many who think they do their
+duty and earn their money when they write a recipe for a patient left
+in an atmosphere of domestic malaria, or to the most negligent kind
+of nursing!  I confess that I should think my chance of recovery from
+illness less with Hippocrates for my physician and Mrs. Gamp for my
+nurse, than if I were in the hands of Hahnemann himself, with
+Florence Nightingale or good Rebecca Taylor to care for me.
+
+If I am right in maintaining that the presumption is always against
+the use of noxious agents in disease, and if any whom I might
+influence should adopt this as a principle of practice, they will
+often find themselves embarrassed by the imperative demand of
+patients and their friends for such agents where a case is not made
+out against this standing presumption.  I must be permitted to say,
+that I think the French, a not wholly uncivilized people, are in
+advance of the English and ourselves in the art of prescribing for
+the sick without hurting them.  And I do confess that I think their
+varied ptisans and syrups are as much preferable to the mineral
+regimen of bug-poison and ratsbane, so long in favor on the other
+side of the Channel, as their art of preparing food for the table to
+the rude cookery of those hard-feeding and much-dosing islanders.
+We want a reorganized cuisine of invalidism perhaps as much as the
+culinary, reform, for which our lyceum lecturers, and others who live
+much at hotels and taverns, are so urgent.  Will you think I am
+disrespectful if I ask whether, even in Massachusetts, a dose of
+calomel is not sometimes given by a physician on the same principle
+as that upon which a landlord occasionally prescribes bacon and
+eggs,--because he cannot think of anything else quite so handy?  I
+leave my suggestion of borrowing a hint from French practice to your
+mature consideration.
+
+I may, however, call your attention, briefly, to the singular fact,
+that English and American practitioners are 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 less effective"
+than that of his own country.   Mr. S. Cooper, again, defends the
+simple British practice of procuring union by the first intention
+against the attacks of M. Roux and Baron Larrey. [Cooper's Surg.
+Diet.  art.  "Wounds."  Yet Mr. John Bell gives the French surgeons
+credit for introducing this doctrine of adhesion, and accuses
+O'Halloran of "rudeness and ignorance," and "bold, uncivil language,"
+in disputing their teaching.  Princ.  of Surgery, vol. i.  p. 42.
+Mr. Hunter succeeded at last in naturalizing the doctrine and
+practice, but even he had to struggle against the perpetual jealousy
+of rivals, and died at length assassinated by an insult.]  We have
+often heard similar opinions maintained by our own countrymen.  While
+Anglo-American criticism blows hot or cold on the two departments of
+French practice, it is not, I hope, indecent to question whether all
+the wisdom is necessarily with us in both cases.
+
+Our art has had two or three lessons which have a deep meaning to
+those who are willing to read them honestly.  The use of water-
+dressings in surgery completed the series of reforms by which was
+abolished the "coarse and cruel practice" of the older surgeons, who
+with their dressings and acrid balsams, their tents and leaden tubes,
+"absolutely delayed the cure."  The doctrine of Broussais, transient
+as was its empire, reversed the practice of half of Christendom for a
+season, and taught its hasty disciples to shun their old favorite
+remedies as mortal poisons.  This was not enough permanently to shift
+the presumption about drugs where it belonged, and so at last, just
+as the sympathetic powder and the Unguentum Armarium came in a
+superstitious age to kill out the abuses of external over-medication,
+the solemn farce of Homoeopathy was enacted in the face of our own
+too credulous civilization, that under shelter of its pretences the
+"inward bruises" of over-drugged viscera might be allowed to heal by
+the first intention.  Its lesson we must accept, whether we will or
+not; its follies we are tired of talking about.  The security of the
+medical profession against this and all similar fancies is in the
+average constitution of the human.  mind with regard to the laws of
+evidence.
+
+My friends and brothers in Art!  There is nothing to be feared from
+the utterance of any seeming heresy to which you may have listened.
+I cannot compromise your collective wisdom.  If I have strained the
+truth one hair's breadth for the sake of an epigram or an antithesis,
+you are accustomed to count the normal pulse-beats of sound judgment,
+and know full well how to recognize the fever-throbs of conceit and
+the nervous palpitations of rhetoric.
+
+The freedom with which each of us speaks his thought in this
+presence, belongs in part to the assured position of the Profession
+in our Commonwealth, to the attitude of Science, which is always
+fearless, and to the genius of the soil on which we stand, from which
+Nature withheld the fatal gift of malaria only to fill it with
+exhalations that breed the fever of inquiry in our blood and in our
+brain.  But mainly we owe the large license of speech we enjoy to
+those influences and privileges common to us all as self-governing
+Americans.
+
+This Republic is the chosen home of minorities, of the less power in
+the presence of the greater.  It is a common error to speak of our
+distinction as consisting 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 death treading down the tenfold more
+numerous minorities.  In the old civilizations they root themselves
+like oaks in the soil; men must live in their shadow or cut them
+down.  With us the majority is only the flower of the passing noon,
+and the minority is the bud which may open in the next morning's sun.
+We must be tolerant, for the thought which stammers on a single
+tongue today may organize itself in the growing consciousness of the
+time, and come back to us like the voice of the multitudinous waves
+of the ocean on the morrow.
+
+Twenty-five years have passed since one of your honored Presidents
+spoke to this Society of certain limitations to the power of our Art,
+now very generally conceded.  Some were troubled, some were almost
+angry, thinking the Profession might suffer from such concessions.
+It has certainly not suffered here; if, as some affirm, it has lost
+respect anywhere, it was probably for other, and no doubt sufficient
+reasons.
+
+Since that time the civilization of this planet has changed hands.
+Strike out of existence at this moment every person who was breathing
+on that day, May 27, 1835, and every institution of society, every
+art and every science would remain intact and complete in the living
+that would be left.  Every idea the world then held has been since
+dissolved and recrystallized.
+
+We are repeating the same process.  Not to make silver shrines for
+our old divinities, even though by this craft we should have our
+wealth, was this Society organized and carried on by the good men and
+true who went before us.  Not for this, but to melt the gold out of
+the past, though its dross should fly in dust to all the winds of
+heaven, to save all our old treasures of knowledge and mine deeply
+for new, to cultivate that mutual respect of which outward courtesy
+is the sign, to work together, to feel together, to take counsel
+together, and to stand together for the truth, now, always, here,
+everywhere; for this our fathers instituted, and we accept, the
+offices and duties of this time-honored Society.
+
+
+
+
+
+
+
+BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+
+An Introductory Lecture delivered before the Medical Class
+of Harvard University, November 6, 1861.
+
+
+[This Lecture appears as it would have been delivered had the time
+allowed been less strictly, limited.  Passages necessarily omitted
+have been restored, and points briefly touched have been more fully
+considered.  A few notes have been added for the benefit of that
+limited class of students who care to track an author through the
+highways and by-ways of his reading.  I owe my thanks to several of
+my professional brethren who have communicated with me on subjects
+with which they are familiar; especially to Dr. John Dean, for the
+opportunity of profiting by his unpublished labors, and to Dr. Hasket
+Derby, for information and references to recent authorities relating
+to the anatomy and physiology of the eye.]
+
+
+The entrance upon a new course of Lectures is always a period of
+interest to instructors and pupils.  As the birth of a child to a
+parent, so is the advent of a new class to a teacher.  As the light
+of the untried world to the infant, so is the dawning of the light
+resting over the unexplored realms of science to the student.  In the
+name of the Faculty I welcome you, Gentlemen of the Medical Class,
+new-born babes of science, or lustier nurslings, to this morning of
+your medical life, and to the arms and the bosom of this ancient
+University.  Fourteen years ago I stood in this place for the first
+time to address those who occupied these benches.  As I recall these
+past seasons of our joint labors, I feel that they have been on the
+whole prosperous, and not undeserving of their prosperity.
+
+For it has been my privilege to be associated with a body of true and
+faithful workers; I cannot praise them freely to their faces, or I
+should be proud to discourse of the harmonious diligence and the
+noble spirit in which they have toiled together, not merely to teach
+their several branches, but to elevate the whole standard of
+teaching.
+
+I may speak with less restraint of those gentlemen who have aided me
+in the most laborious part of my daily duties, the Demonstrators, to
+whom the successive classes have owed so much of their instruction.
+They rise before me, the dead and the living, in the midst of the
+most grateful recollections.  The fair, manly face and stately figure
+of my friend, Dr. Samuel Parkman, himself fit for the highest offices
+of teaching, yet willing to be my faithful assistant in the time of
+need, come back to me with the long sigh of regret for his early loss
+to our earthly companionship.  Every year I speak the eulogy of Dr.
+Ainsworth's patient toil as I show his elaborate preparations: When I
+take down my "American Cyclopaedia" and borrow instruction from the
+learned articles of Dr. Kneeland, I cease to regret that his
+indefatigable and intelligent industry was turned into a broader
+channel.  And what can I say too cordial of my long associated
+companion and friend, Dr. Hodges, whose admirable skill, working
+through the swiftest and surest fingers that ever held a scalpel
+among us, has delighted class after class, and filled our Museum with
+monuments which 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 their mysteries, or timid neophytes just
+entering the portals of 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 alcoves remain in darkness.
+
+
+SCIENCE is the topography of ignorance.  From a few elevated points
+we triangulate vast spaces, inclosing infinite unknown details.  We
+cast the lead, and draw up a little sand from abysses we may never
+reach with our dredges.
+
+The best part of our knowledge is that which teaches us where
+knowledge leaves off and ignorance begins.  Nothing more clearly
+separates a vulgar from a superior mind, than the confusion in the
+first between the little that it truly knows, on the one hand, and
+what it half knows and what it thinks it knows on the other.
+
+That which is true of every subject is especially true of the branch
+of knowledge which deals with living beings.  Their existence is a
+perpetual death and 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.
+
+               "Thou art not thyself;
+     For thou exist'st on many a thousand grains
+     That issue out of dust."
+
+If it is true that we understand ourselves but imperfectly in health,
+this truth is more signally manifested in disease, where natural
+actions imperfectly understood, disturbed in an obscure way by half-
+seen causes, are creeping and winding along in the dark toward their
+destined issue, sometimes using our remedies as safe stepping-stones,
+occasionally, it may be, stumbling over them as obstacles.
+
+I propose in this lecture to show you some points of contact between
+our ignorance and our knowledge in several of the branches upon the
+study of which you are entering.  I may teach you a very little
+directly, but I hope much more from the trains of thought I shall
+suggest.  Do not expect too much ground to be covered in this rapid
+survey.  Our task is only that of sending out a few pickets under the
+starry flag of science to the edge of that dark domain where the
+ensigns of the obstinate rebel, Ignorance, are flying undisputed.  We
+are not making a reconnoissance in force, still less advancing with
+the main column.  But here are a few roads along which we have to
+march together, and we wish to see clearly how far our lines extend,
+and where the enemy's outposts begin.
+
+Before touching the branches of knowledge that deal with organization
+and vital functions, let us glance at that science which meets you at
+the threshold of your study, and prepares you in some measure to deal
+with the more complex problems of the living laboratory.
+
+
+CHEMISTRY.  includes the art of separating and combining the elements
+of matter, and the study of the changes produced by these operations.
+We can hardly say too much of what it has contributed to our
+knowledge of the universe and our power of dealing with its
+materials.  It has given us a catalogue raisonne of the substances
+found upon our planet, and shown how everything living and dead is
+put together from them.  It is accomplishing wonders before us every
+day, such as Arabian story-tellers used to string together in their
+fables.  It spreads the, sensitive film on the artificial retina
+which looks upon us through the optician's lens for a few seconds,
+and fixes an image that will outlive its original.  It questions the
+light of the sun, and detects the vaporized metals floating around
+the great luminary,--iron, sodium, lithium, and the rest,--as if the
+chemist of our remote planet could fill his bell-glasses from its
+fiery atmosphere.  It lends the power which flashes our messages in
+thrills that leave the lazy chariot of day behind them.  It seals up
+a few dark grains in iron vases, and lo! at the touch of a single
+spark, rises in smoke and flame a mighty Afrit with a voice like
+thunder and an arm that shatters like an earthquake.  The dreams of
+Oriental fancy have 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 each other through an almost
+boundless range of combinations.  It has given us a most ingenious
+theory to account for certain fixed relations in these combinations.
+It has successfully eliminated a great number of proximate compounds,
+more or less stable, from organic structures.  It has invented others
+which form the basis of long series of well-known composite
+substances.  In fact, we are perhaps becoming overburdened with our
+list of proximate principles, demonstrated and hypothetical.
+
+How much nearer have we come to the secret of force than Lully and
+Geber and the whole crew of juggling alchemists?  We have learned a
+great deal about the how, what have we learned about the why?
+
+Why does iron rust, while gold remains untarnished, and gold
+amalgamate, while iron refuses the alliance of mercury?
+
+The alchemists called gold Sol, the sun, and iron Mars, and pleased
+themselves with fancied relations between these substances and the
+heavenly bodies, by which they pretended to explain the facts they
+observed.  Some of their superstitions have lingered in practical
+medicine to the present day, but chemistry has grown wise enough to
+confess the fact of absolute ignorance.
+
+What is it that makes common salt crystallize in the form of cubes,
+and saltpetre in the shape of six-sided prisms?  We see no reason why
+it should not have been just the other way, salt in prisms and
+saltpetre in cubes, or why either should take an exact geometrical
+outline, any more than coagulating albumen.
+
+But although we had given up attempting to explain the essential
+nature of affinities and of crystalline types, we might have supposed
+that we had at least fixed the identity of the substances with which
+we deal, and determined the laws of their combination.  All at once
+we find that a simple substance changes face, puts off its
+characteristic qualities and resumes them at will;--not merely when
+we liquefy or vaporize a solid, or reverse the process; but that a
+solid is literally transformed into another solid under our own eyes.
+We thought we knew phosphorus.  We warm a portion of it sealed in an
+empty tube, for about a week.  It has become a brown infusible
+substance, which does not shine in the dark nor oxidate in the air.
+We heat it to 500 F., and it becomes common phosphorus again.  We
+transmute sulphur in the same singular way.  Nature, you know, gives
+us 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 connected with them
+rather startling to us of the nineteenth century.  There may be other
+transmutations possible besides those of phosphorus and sulphur.
+When Dr. Prout, in 1840, talked about azote and carbon being "formed"
+in the living system, it was looked upon as one of those freaks of
+fancy to which philosophers, like other men, are subject.  But when
+Professor Faraday, in 1851, says, at a meeting of the British
+Association, that "his hopes are in the direction of proving that
+bodies called simple were really compounds, and may be formed
+artificially as soon as we are masters of the laws influencing their
+combinations,"--when he comes forward and says that he has tried
+experiments at transmutation, and means, if his life is spared, to
+try them again,--how can we be surprised at the popular story of
+1861, that Louis Napoleon has established a gold-factory and is
+glutting the mints of Europe with bullion of his 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 glass vessel, c, we do not expect the glass to change
+them, unless a or b or the compound a b has the power of dissolving
+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 signs of combustion and form water, the third in the mean time
+undergoing no perceptible change.  It has played the part of the
+unwedded priest, who marries a pair without taking a fee or having
+any further relation with the parties.  We call this catalysis,
+catalytic action, the action of presence, or by what learned name we
+choose.  Give what name to it we will, it is a manifestation of power
+which crosses our established laws of combination at a very open
+angle of intersection.  I think we may find an analogy for it in
+electrical induction, the disturbance of the equilibrium of the
+electricity of a body by the approach of a charged body to it,
+without interchange of electrical conditions between the two bodies.
+But an analogy is not an explanation, and why a few drops of yeast
+should change a saccharine mixture to carbonic acid and alcohol,--a
+little leaven leavening the whole lump,--not by combining with it,
+but by setting a movement at work, we not only cannot explain, but
+the fact is such an exception to the recognized laws of combination
+that Liebig is unwilling to admit the new force at all to which
+Berzelius had given the name so generally accepted.
+
+The phenomena of isomerism, or identity of composition and
+proportions of constituents with difference of qualities, and of
+isomorphism, or identity of form in crystals which have one element
+substituted for another, were equally surprises to science; and
+although the mechanism by which they are brought about can be to a
+certain extent explained by a reference to the hypothetical atoms of
+which the elements are constituted, yet this is only turning the
+difficulty into a fraction with an infinitesimal denominator and an
+infinite numerator.
+
+So far we have studied the working of force and its seeming anomalies
+in purely chemical phenomena.  But we soon find that chemical force
+is developed by various other physical agencies,--by heat, by light,
+by electricity, by magnetism, by mechanical agencies; and, vice
+versa, that chemical action develops heat, light, electricity,
+magnetism, mechanical force, as we see in our matches, galvanic
+batteries, and explosive compounds.  Proceeding with our experiments,
+we find that every kind of force is capable of producing all other
+kinds, or, in Mr. Faraday's language, that "the various forms under
+which the forces of matter are made manifest have a common origin,
+or, in other words, are so directly related and mutually dependent
+that they are convertible one into another."
+
+Out of this doctrine naturally springs that of the conservation of
+force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr.
+Faraday.  This idea is no novelty, though it seems so at first sight.
+It was maintained and disputed among the giants of philosophy.
+Des Cartes and Leibnitz denied that any new motion originated in
+nature, or that any ever ceased to exist; all motion being in a
+circle, passing from one body to another, one losing what the other
+gained.  Newton, on the other hand, believed that new motions were
+generated and existing ones destroyed.  On the first supposition,
+there is a fixed amount of force always circulating in the universe.
+On the second, the total amount may be increasing or diminishing.
+You will find in the "Annual of Scientific Discovery" for 1858 a very
+interesting lecture by Professor Helmholtz of Bonn, in which it is
+maintained that a certain portion of force is lost in every natural
+process, being converted into unchangeable heat, so that the universe
+will come to a stand-still at last, all force passing into heat, and
+all heat into a state of equilibrium.
+
+The doctrines of the convertibility or specific equivalence of the
+various forms of force, and of its conservation, which is its logical
+consequence, are very generally accepted, as I believe, at the
+present time, among physicists.  We are naturally led to the
+question, What is the nature of force?  The three illustrious
+philosophers just referred to agree in attributing the general
+movements of the universe to the immediate Divine action.  The
+doctrine of "preestablished harmony" was an especial contrivance of
+Leibnitz to remove the Creator from unworthy association with the
+less divine acts of living beings.  Obsolete as this expression
+sounds to our ears, the phrase laws of the universe, which we use so
+constantly with a wider application, appears to me essentially
+identical with it.
+
+Force does not admit of explanation, nor of proper definition, any
+more than the hypothetical substratum of matter.  If we assume the
+Infinite as omnipresent, omniscient, omnipotent, we cannot suppose
+Him excluded from any part of His creation, except from rebellious
+souls which voluntarily exclude Him by the exercise of their fatal
+prerogative of free-will.  Force, then, is the act of immanent
+Divinity.  I find no meaning in mechanical explanations.  Newton's
+hypothesis of an ether filling the heavenly spaces does 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 prefer to encounter
+it in the world of physical phenomena before reaching that of living
+actions.  It is only the name for the incomprehensible cause of
+certain changes known to our consciousness, and assumed to be outside
+of it.  For me it is the Deity Himself in action.
+
+I can therefore see a large significance in the somewhat bold
+language of Burdach: "There is for me but one miracle, that of
+infinite existence, and but one mystery, the manner in which the
+finite proceeds from the infinite.  So soon as we recognize this
+incomprehensible act as the general and primordial miracle, 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 by experience in this light, there is for us no other
+impenetrable miracle or mystery."
+
+Let us turn to a branch of knowledge which deals with certainties up
+to the limit of the senses, and is involved in no speculations beyond
+them.  In certain points of view, HUMAN ANATOMY may be considered an
+almost exhausted science.  From time to time some small organ which
+had escaped earlier observers has been pointed out,--such parts as
+the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some
+of our best anatomical works are those which have been classic for
+many generations. The plates of the bones in Vesalius, three
+centuries old, are still masterpieces of accuracy, as of art.  The
+magnificent work of Albinus on the muscles, published in 1747, is
+still supreme in its department, as the constant references of the
+most thorough recent treatise on the subject, that of Theile,
+sufficiently show.  More has been done in unravelling the mysteries
+of the fasciae, but there has been a tendency to overdo this kind of
+material analysis.  Alexander Thomson split them up into cobwebs, as
+you may see in the plates to Velpeau's Surgical Anatomy.  I well
+remember how he used to shake his head over the coarse work of Scarpa
+and Astley Cooper,--as if Denner, who painted the separate hairs of
+the beard and pores of the skin in his portraits, had spoken lightly
+of the pictures of Rubens and Vandyk.
+
+Not only has little been added to the catalogue of parts, but some
+things long known had become half-forgotten. Louis and others
+confounded the solitary glands of the 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 brain seemed a novelty as shown by
+Spurzheim.  One is startled to find the method anticipated by Raymond
+Vieussens nearly two centuries ago.  I can hardly think Gordon had
+ever looked at his figures, though he names their author, when he
+wrote the captious and sneering article which attracted so much
+attention in the pages of the "Edinburgh Review."
+
+This is the place, if anywhere, to mention any observations I could
+pretend to have made in the course of my teaching the structure of
+the human body.  I can make no better show than most of my
+predecessors in this well-reaped field.  The nucleated cells found
+connected with the cancellated structure of the bones, which I first
+pointed out and had figured in 1847, and have shown yearly from that
+time to the present, and the fossa masseterica, a shallow concavity
+on the ramus of the lower jaw, for the lodgment of the masseter
+muscle, which acquires significance when examined by the side of the
+deep cavity on the corresponding part in some carnivora to which it
+answers, may perhaps be claimed as deserving attention.  I have also
+pleased myself by making a special group of the six radiating muscles
+which diverge from the spine of the axis, or second cervical
+vertebra, and by giving to it the name stella musculosa nuchaee.  But
+this scanty catalogue is only an evidence that one may teach long and
+see little that has not been noted by those who have gone before him.
+Of course I do not think it necessary to include rare, but already
+described anomalies, such as the episternal bones, the rectus
+sternalis, and other interesting exceptional formations I have
+encountered, which have shown a curious tendency to present
+themselves several times in the same season, perhaps because the
+first specimen found calls our attention 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 human body has changed its old aspect, and become
+fertile in new observations.  This rejuvenescence was effected by
+means of two principal agencies,--new methods 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 as when Arrowsmith, who was born in 1750, published his
+admirable maps.  But in that same year was born Werner, who taught a
+new way of studying the earth, since become familiar to us all under
+the name of Geology.
+
+What geology has done for our knowledge of the earth, has been done
+for our knowledge of the body by that method of study to which is
+given the name of General Anatomy.  It studies, not the organs as
+such, but the elements out of which the organs are constructed.  It
+is the geology of the body, as that is the general anatomy of the
+earth.  The extraordinary genius of Bichat, to whom more than any
+other we owe this new method of study, does not require Mr. Buckle's
+testimony to impress the practitioner with the importance of its
+achievements.  I have heard a very wise physician question whether
+any important result had accrued to practical medicine from Harvey's
+discovery of the circulation.  But Anatomy, Physiology, and Pathology
+have received a new light from this novel method of contemplating the
+living structures, which has had a vast influence in enabling the
+practitioner at least to distinguish and predict the course of
+disease.  We know as well what differences to expect in the habits of
+a mucous and of a serous membrane, as what mineral substances to look
+for in the chalk or the coal measures.  You have only to read
+Cullen's description of inflammation of the lungs or of the bowels,
+and compare it with such as you may find in Laennec or Watson, to see
+the immense gain which diagnosis and 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 this century.  It does not deal with organs, as
+did the earlier anatomists, nor with tissues, after the manner of
+Bichat.  It maps the whole surface of the body into an arbitrary
+number of regions, and studies each region successively from the
+surface to the bone, or beneath it.  This hardly deserves the name of
+a science, although Velpeau has dignified it with that title, but it
+furnishes an admirable practical way for the surgeon who has to
+operate on a particular region of the body to study that region.  If
+we are buying a farm, we are not content with the State map 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 sometimes
+called, surgical anatomy, does for the surgeon with reference to the
+part on which his skill is to be exercised.  It enables him to see
+with the mind's eye through the opaque tissues down to the bone on
+which they lie, as if the skin were transparent as the cornea, and
+the organs it covers translucent as the gelatinous pulp of a medusa.
+
+It is curious that the Japanese should have anticipated Europe in a
+kind of rude regional anatomy.  I have seen a manikin of Japanese
+make traced all over with lines, and points marking their
+intersection.  By this their doctors are guided in the performance of
+acupuncture, marking the safe places to thrust in needles, as we buoy
+out our ship-channels, and doubtless indicating to learned eyes the
+spots where incautious meddling had led to those little accidents of
+shipwreck to which patients are unfortunately liable.
+
+A change of method, then, has given us General and Regional Anatomy.
+These, too, have been worked so thoroughly, that, if not exhausted,
+they have at least become to a great extent fixed and positive
+branches of knowledge.  But the first of them, General Anatomy, would
+never, have reached this positive condition but for the introduction
+of that, instrument which I have mentioned as the second great aid to
+modern progress.
+
+This instrument is the achromatic microscope.  For the history of the
+successive steps by which it became the effective scientific
+implement we now possess, I must refer you to the work of Mr.
+Quekett, to an excellent article in the "Penny Cyclopaedia," or to
+that of Sir David Brewster in the "Encyclopaedia Britannica."  It is
+a most interesting piece of scientific history, which shows how the
+problem which Biot in 1821 pronounced insolvable was in the course of
+a few years practically solved, with a success equal to that which
+Dollond had long before obtained with the telescope.  It is enough
+for our purpose that we are now in possession of an instrument freed
+from all confusions and illusions, which magnifies a thousand
+diameters,--a million times in surface,--without serious distortion
+or discoloration of its object.
+
+A quarter of a century ago, or a little more, an instructor would not
+have hesitated to put John Bell's "Anatomy" and Bostock's
+"Physiology" into a student's hands, as good authority on their
+respective subjects.  Let us not be unjust to either of these
+authors.  John Bell is the liveliest medical writer that I can
+remember who has written since the days of delightful old Ambroise
+Pare.  His picturesque descriptions and bold figures are as good now
+as they ever were, and his book can never become obsolete.  But
+listen to what John Bell says of the microscope:
+
+"Philosophers of the last age had been at infinite pains to find the
+ultimate fibre of muscles, thinking to discover its properties in its
+form; but they saw just in proportion to the glasses which they used,
+or to their practice and skill in that art, which is now almost
+forsaken."
+
+Dr. Bostock's work, neglected as it is, is one which I value very
+highly as a really learned compilation, full of original references.
+But Dr. Bostock says: "Much as the naturalist has been indebted to
+the microscope, by bringing into view many beings of which he could
+not otherwise have ascertained the existence, the physiologist has
+not yet derived any great benefit from the instrument."
+
+These are only specimens of the manner in which the microscope and
+its results were generally regarded by the generation just preceding
+our own.
+
+I have referred you to the proper authorities for the account of
+those improvements which about the year 1830 rendered the compound
+microscope an efficient and trustworthy instrument.  It was now for
+the first time that a true general anatomy became possible.  As early
+as 1816 Treviranus had attempted to resolve the tissues, of which
+Bichat had admitted no less than 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 all the
+tissues, the areolar, was not at all understood?  All that method
+could do had been accomplished by Bichat and his followers.  It was
+for the optician to take the next step.  The future of anatomy and
+physiology, as an enthusiastic micrologist of the time said, was in
+the hands of Messrs.  Schieck and Pistor, famous opticians of Berlin.
+
+In those earlier days of which I am speaking, all the points of
+minute anatomy were involved in obscurity.  Some found globules
+everywhere, some fibres.  Students disputed whether the conjunctiva
+extended over the cornea or not, and worried themselves over Gaultier
+de Claubry's stratified layers of the skin, or Breschet's
+blennogenous and chromatogenous organs.  The dartos was a puzzle, the
+central spinal canal a myth, the decidua clothed in fable as much as
+the golden fleece.  The structure of bone, now so beautifully made
+out,--even that of the teeth, in which old Leeuwenhoek, peeping with
+his octogenarian eyes through the minute lenses wrought with 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 mists
+of an uncertain microscopic vision.  The intimate recesses of the
+animal system were to the students of anatomy what the anterior of
+Africa long was to geographers, and the stories of microscopic
+explorers were 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 the first place, the
+minute structure of all the organs has been made out in the most
+satisfactory way.  The special arrangements of the vessels and the
+ducts of all the glands, of the air-tubes and vesicles of the lungs,
+of the parts which make up the skin and other membranes, all the
+details of those complex parenchymatous organs which had confounded
+investigation so long, have been lifted out of the invisible into the
+sight of all observers.  It is fair to mention here, that we owe a
+great deal to the art of minute injection, by which we are enabled to
+trace the smallest vessels in the midst of the tissues where they are
+distributed.  This is an old artifice of anatomists.  The famous
+Ruysch, who died a hundred and thirty years ago, showed that each of
+the viscera has its terminal vessels arranged in its own peculiar
+way; the same fact which you may see illustrated in Gerber's figures
+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 a
+very rich collection of injected preparations sent him by Professor
+Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
+of which I had a number of microscopes made expressly, by Mr. Grunow,
+during the past season.  All this illustrates what has been done for
+the elucidation of the intimate details of formation of the organs.
+
+But the great triumph of the microscope as applied to anatomy has
+been in the resolution of the organs and the tissues into their
+simple constituent anatomical elements.  It has taken up general
+anatomy where Bichat left it.  He had succeeded in reducing the
+structural language of nature to syllables, if you will permit me to
+use so bold an image.  The microscopic observers who have come after
+him have analyzed these into letters, as we may call them,--the
+simple elements by the combination of which Nature spells 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, until she binds up in one living whole that wondrous
+volume of 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 repeating it, 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, already referred to.  Very
+commonly they have undergone a change of figure, most frequently a
+flattening which reduces them to scales, as in the epidermis and the
+epithelium.
+
+B.  Simple, translucent, homogeneous solid, such as is found at the
+back of the cornea, or forming the intercellular substance of
+cartilage.
+
+C.  The white fibrous element, consisting of very delicate, tenacious
+threads.  This is the long staple textile substance of the body.  It
+is to the organism what 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-work together.  It furnishes the
+sinews, which are the 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 made of it.
+
+D.  The yellow elastic, fibrous element, the caoutchouc of the animal
+mechanism, which pulls things back into place, as the India-rubber
+band shuts the door we have opened.
+
+E.  The striped muscular fibre,--the red flesh, which shortens itself
+in obedience to the will, and thus produces all voluntary active
+motion.
+
+F.  The unstriped muscular fibre, more properly the fusiform-cell
+fibre, which carries on the involuntary internal movements.
+
+G.  The nerve-cylinder, a glassy tube, with a pith of some firmness,
+which conveys sensation to the brain and the principle which induces
+motion from it.
+
+H.  The nerve-corpuscle, the centre of nervous power.
+
+I.  The mucous tissue, as Virchow calls it, common in embryonic
+structures, seen in the vitreous humor of the adult.
+
+To these add X, granules, of indeterminate shape and size, Y, for
+inorganic matters, such as the salts of bone and teeth, and Z, to
+stand as a symbol of the fluids, and you have the letters of what I
+have ventured to call the alphabet of the body.
+
+But just as in language certain diphthongs and syllables are
+frequently recurring, so we have in the body certain secondary and
+tertiary combinations, which we meet more frequently than the
+solitary elements of which they are composed.
+
+Thus A B, or a collection of cells united by simple structureless
+solid, is seen to be extensively employed in the body under the name
+of cartilage.  Out of this the surfaces of the articulations and the
+springs of the breathing apparatus are formed.  But when Nature came
+to the buffers of the spinal column (intervertebral disks) and the
+washers of the joints (semilunar fibrocartilages of the knee, etc.),
+she required more tenacity than common cartilage possessed.  What did
+she do?  What does man do in a similar case of need?  I need hardly
+tell you.  The mason lays his bricks in simple mortar.  But the
+plasterer works some hair into the mortar which he is going to lay in
+large sheets on the walls.  The children of Israel complained that
+they had no straw to make their bricks with, though portions of it
+may still be seen in the crumbling pyramid of Darshour, which they
+are said to have built.  I visited the old house on Witch Hill in
+Salem a year or two ago, and there I found the walls coated with clay
+in which straw was abundantly mingled;--the old Judaizing witch-
+hangers copied the Israelites in a good many things.  The Chinese and
+the Corsicans blend the fibres of amianthus in their pottery to give
+it tenacity.  Now to return to Nature.  To make her buffers and
+washers hold together in the shocks to which they would be subjected,
+she took common cartilage and mingled the white fibrous tissue with
+it, to serve the same purpose as the hair in the mortar, the straw in
+the bricks and in the plaster of the old wall, and the amianthus in
+the earthen vessels.  Thus we have the combination A B C, or fibro-
+cartilage.  Again, the bones were once only gristle or cartilage, A
+B.  To give them solidity they were infiltrated with stone, in the
+form of salts of lime, an inorganic element, so that bone would be
+spelt out by the letters A, B, and Y.
+
+If from these organic syllables we proceed to form organic words, we
+shall find that Nature employs three principal forms; namely,
+Vessels, Membranes, and Parenchyma, or visceral tissue.  The most
+complex of them can be resolved into a combination of these few
+simple anatomical constituents.
+
+
+Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
+the same elements in morbid growths that we have met with in normal
+structures.  The pus-corpuscle and the white blood-corpuscle can only
+be distinguished by tracing them to their origin.  A frequent form of
+so-called malignant disease proves to 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,--the crowding together of the
+elements, the size of the cell-nuclei, and similar variable
+characters.
+
+Let us turn to PHYSIOLOGY.  The microscope, which has made a new
+science of the intimate structure of the organs, has at the same time
+cleared up many uncertainties concerning the mechanism of the special
+functions.  Up to the time of the living generation of observers,
+Nature had kept over all her inner workshops the forbidding
+inscription, No Admittance!  If any prying observer ventured to spy
+through his magnifying tubes into the mysteries of her glands and
+canals and fluids, she covered up her work in blinding mists and
+bewildering halos, as the deities of old concealed their favored
+heroes in the moment of danger.
+
+Science has at length sifted the turbid light of her lenses, and
+blanched their delusive rainbows.
+
+Anatomy studies the organism in space.  Physiology studies it also in
+time.  After the study of form and composition follows close that of
+action, and this leads us along back to the first moment of the germ,
+and forward to the resolution of the living frame into its lifeless
+elements.  In this way Anatomy, or rather that branch of it which we
+call Histology, has become inseparably blended with the study of
+function.  The connection between the science of life and that of
+intimate structure on the one hand, and composition on the other, is
+illustrated in the titles of two recent works of remarkable
+excellence,--"the Physiological Anatomy" of Todd and Bowman, and the
+"Physiological Chemistry" of Lehmann.
+
+Let me briefly recapitulate a few of our acquisitions in Physiology,
+due in large measure to our new instruments and methods of research,
+and at the same time indicate the limits which form the permanent or
+the temporary boundaries of our knowledge.  I will begin with the
+largest fact and with the most absolute and universally encountered
+limitation.
+
+The "largest truth in Physiology" Mr. Paget considers to be "the
+development of ova through multiplication and division of their
+cells."  I would state it more broadly as the agency of the cell in
+all living processes.  It seems at present necessary to abandon the
+original idea of Schwann, that we can observe the building up of a
+cell from the simple granules of a blastema, or formative fluid.  The
+evidence points rather towards the axiom, Omnis cellula a cellula;
+that is, the germ of a new cell is always derived from a preexisting
+cell.  The doctrine 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 plasterer in fibro-cartilage,
+so we see her beforehand with the 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 Nature shapes her hyaline
+vesicles and modifies them to serve the needs of the part where they
+are found.  The artisan whirls his rod, and his glass bubble becomes
+a flattened disk, with its bull's-eye for a nucleus.  These lips of
+ours are all glazed with microscopic tiles formed of flattened cells,
+each one of them with its nucleus still as plain and relatively as
+prominent, to the eye of the microscopist, as the bull's-eye in the
+old-fashioned windowpane.  Everywhere we find cells, modified or
+unchanged.  They roll in inconceivable multitudes (five millions and
+more to the cubic millimetre, according to Vierordt) as blood-disks
+through our vessels.  A close-fitting mail of flattened cells coats
+our surface with a panoply of imbricated scales (more than twelve
+thousand millions), as Harting has computed, as true a defence against
+our enemies as the buckler of the armadillo or the carapace of the
+tortoise against theirs.  The same little protecting organs pave all
+the great highways of the interior system.  Cells, again, preside
+over the chemical processes which elaborate the living fluids; they
+change their form to become the agents of voluntary and involuntary
+motion; the soul itself sits on a throne of nucleated cells, and
+flashes its mandates through skeins of glassy filaments which once
+were simple chains of vesicles.  And, as if to reduce the problem of
+living force to its simplest expression, we see the yolk of a
+transparent egg dividing itself in whole or in part, and again
+dividing and subdividing, until it becomes a mass of cells, out of
+which the harmonious diversity of the organs arranges itself, worm or
+man, as God has willed from the beginning.
+
+This differentiation having been effected, each several part assumes
+its special office, having a life of its own adjusted to that of
+other parts and the whole.  "Just as a tree constitutes a mass
+arranged in a definite manner, in which, in every single part, in the
+leaves as in the root, in the trunk as in the blossom, cells are
+discovered to be the ultimate elements, so is it also with the forms
+of animal life.  Every animal presents itself as a sum of vital
+unities, every one of which manifests all the characteristics of
+life."
+
+The mechanism is as clear, as unquestionable, as absolutely settled
+and universally accepted, as the order of movement of the heavenly
+bodies, which we compute backward to the days of the observatories on
+the plains of Shinar, and on the faith of which we regulate the
+movements of war and trade by the predictions of our ephemeris.
+
+The mechanism, and that is all.  We see the workman and the tools,
+but the skill that guides the work and the power that performs it are
+as invisible as ever.  I fear that not every listener took the
+significance of those pregnant words in the passage I quoted from
+John Bell,--"thinking to discover its properties in its form."  We
+have discovered the working bee in this great hive of organization.
+We have detected the cell in the very act of forming itself from a
+nucleus, of transforming itself into various tissues, of selecting
+the elements of various secretions.  But why one cell becomes nerve
+and another muscle, why one selects bile and another fat, we can no
+more pretend to tell, than why one grape sucks out of the soil the
+generous juice which princes hoard in their cellars, and another the
+wine which it takes three men to drink,--one to pour it down, another
+to swallow it, and a third to hold him while it is going down.
+Certain analogies between this selecting power and the phenomena of
+endosmosis in the elective affinities of chemistry we can find, but
+the problem of force remains here, as everywhere, unsolved and
+insolvable.
+
+Do we gain anything by attempting to get rid of the idea of a special
+vital force because we find certain mutually convertible relations
+between forces in the body and out of it?  I think not, any more than
+we should gain by getting rid of the idea and expression Magnetism
+because of its correlation with electricity.  We may concede the
+unity of all forms of force, but we cannot overlook the fixed
+differences of its manifestations according to the conditions under
+which it acts.  It is a mistake, however, to think the mystery is
+greater in an organized body than in any other.  We see a stone fall
+or a crystal form, and there is nothing stranger left to wonder at,
+for we have seen the Infinite in action.
+
+Just so far as we can recognize the ordinary modes of operation of
+the common forces of nature,--gravity, cohesion, elasticity,
+transudation, chemical action, and the rest,--we see the so-called
+vital acts in the light of a larger range of known facts and familiar
+analogies.  Matteuecci's well-remembered lectures contain many and
+striking examples of the working of physical forces in physiological
+processes.  Wherever rigid experiment carries us, we are safe in
+following this lead; but the moment we begin to theorize beyond our
+strict observation, we are in danger of falling into those mechanical
+follies which true science has long outgrown.
+
+Recognizing the fact, then, that we have learned nothing but the
+machinery of life, and are no nearer to its essence, what is it that
+we have gained by this great discovery of the cell formation and
+function?
+
+It would have been reward enough to learn the method Nature pursues
+for its own sake.  If the sovereign Artificer lets us into his own
+laboratories and workshops, we need not ask more than the privilege
+of looking on at his work.  We do not know where we now stand in the
+hierarchy of created intelligences.  We were made a little lower than
+the angels.  I speak it not irreverently; as the lower animals
+surpass man in some of their attributes, so it may be that not every
+angel's eye can see as broadly and as deeply into the material works
+of God as man himself, looking at the firmament through an equatorial
+of fifteen inches' aperture, and searching into the tissues with a
+twelfth of an inch objective.
+
+But there are other positive gains of a more practical character.
+Thus we are no longer permitted to place the seat of the living
+actions in the extreme vessels, which are only the carriers from
+which each part takes what it wants by the divine right of the
+omnipotent nucleated cell.  The organism has become, in the words
+already borrowed from Virchow, "a sum of vital unities."  The
+strictum and laxum, the increased and diminished action of the
+vessels, out of which medical theories and methods of treatment have
+grown up, have yielded to the doctrine of local cell-communities,
+belonging to this or that vascular 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 of the points of
+contact between our ignorance and our knowledge which present
+particular interest in the existing state of our physiological
+acquisitions.  Some of them involve the microscopic discoveries of
+which I have been speaking, some belong to the domain of chemistry,
+and some have relations with other departments of physical science.
+
+If we should begin with the digestive function, we should find that
+the long-agitated question of the nature of the acid of the gastric
+juice is becoming settled in favor of the lactic.  But the whole
+solvent agency of the digestive fluid enters into the category of
+that exceptional mode of action already familiar to us in chemistry
+as catalysis.  It is therefore doubly difficult of explanation;
+first, as being, like all reactions, a fact not to be accounted for
+except by the imaginative appeal to "affinity," and secondly, as
+being one of those peculiar reactions provoked by an element which
+stands outside and looks on without compromising itself.
+
+The doctrine of Mulder, so widely diffused in popular and scientific
+belief, of the existence of a common base of all albuminous
+substances, the so-called protein, has not stood the test of rigorous
+analysis.  The division of food into azotized and non-azotized is no
+doubt important, but the attempt to show that the first only is
+plastic or nutritive, while the second is simply calorifacient, or
+heat-producing, fails entirely in the face of the facts revealed by
+the study of man in different climates, and of numerous experiments
+in the feeding of animals.  I must return to this subject 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 out of its own substance;--why?
+
+          Quia est in eo
+          Virtus saccharitiva.
+
+Just what becomes of the sugar beyond the fact of its disappearance
+before it can get into the general circulation and sweeten our
+tempers, it is hard to say.
+
+The pancreatic fluid makes an emulsion of the fat contained in our
+food, but just how the fatty particles get into the villi we must
+leave Brucke and Kolliker to settle if they can.
+
+No one has shown satisfactorily the process by which the blood-
+corpuscles are formed out of the lymph-corpuscles, nor what becomes
+of them.  These two questions are like those famous household
+puzzles,--Where do the flies come from?  and, Where do the pins go
+to?
+
+There is a series of organs in the body which has long puzzled
+physiologists,--organs of glandular aspect, but having no ducts,--the
+spleen, the thyroid and thymus bodies, and the suprarenal capsules.
+We call them vascular glands, and we believe that they elaborate
+colored and uncolored blood-cells; but just what changes they effect,
+and just how they effect them, it has proved a very difficult matter
+to determine.  So of the noted glandules which form Peyer's patches,
+their precise office, though seemingly like those of the lymphatic
+glands, cannot be positively assigned, so far as I know, at the
+present time.  It is of obvious interest to learn it with reference
+to the pathology of typhoid fever.  It will be remarked that the
+coincidence of their changes in this disease with enlargement of the
+spleen suggests the idea of a similarity of function in these two
+organs.
+
+The theories of the production of animal heat, from the times of
+Black, Lavoisier, and Crawford to those of Liebig, are familiar to
+all who have paid any attention to physiological studies.  The
+simplicity of Liebig's views, and the popular form in which they have
+been presented, have given them wide currency, and incorporated them
+in the common belief and language of our text-books.  Direct
+oxidation or combustion of the carbon and hydrogen contained in the
+food, or in the tissues themselves; the division of alimentary
+substances into respiratory, or non-azotized, and azotized,--these
+doctrines are 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 than with sulphur and azote.  Such is the well-
+grounded statement of Robin and Verdeil.  "It is very probable that
+animal heat is entirely produced by the chemical actions which take
+place in the organism, but the phenomenon is too complex to admit of
+our calculating it according to the quality of oxygen consumed."
+These last are the words of Regnault, as cited by Mr. Lewes, whose
+intelligent discussion of this and many of the most interesting
+physiological problems I strongly recommend to your attention.
+
+This single illustration covers a wider ground than the special
+function to which it belongs.  We are learning that the chemistry of
+the body must be studied, not simply by its ingesta and egesta, but
+that there is a long intermediate series of changes which must be
+investigated in their own light, under their own special conditions.
+The expression "sum of 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 just cited entitle their
+work a treatise on the immediate principles of the body, they only
+indicate the nature of that profound and subtile analysis which must
+take the place of all hasty generalizations founded on a comparison
+of the food with residual products.
+
+I will only call your attention to the fact, that the exceptional
+phenomenon of the laboratory is the prevailing law of the organism.
+Nutrition itself is but one great catalytic process.  As the blood
+travels its rounds, each part selects its appropriate element and
+transforms it to its own likeness.  Whether the appropriating agent
+be cell or nucleus, or a structureless solid like the intercellular
+substance of cartilage, the fact of its presence determines the
+separation of its proper constituents from the circulating fluid, so
+that even when we are wounded bone is replaced by bone, skin by skin,
+and nerve by nerve.
+
+It is hardly without a smile that we resuscitate the old question of
+the 'vis insita' of the muscular fibre, so famous in the discussions of
+Haller and his contemporaries.  Speaking generally, I think we may
+say that Haller's doctrine is the one now commonly received; namely,
+that the muscles contract in virtue of their own inherent endowments.
+It is true that Kolliker says no perfectly decisive fact has been
+brought forward to prove that the striated muscles contract with.
+out having been acted on by nerves.  Yet Mr. Bowman's observations on
+the contraction of isolated fibres appear decisive enough (unless we
+consider them invalidated by Dr. Lionel Beale's recent researches),
+tending to show that each elementary fibre is supplied with nerves;
+and as to the smooth muscular fibres, we have Virchow's statement
+respecting the contractility of those of the umbilical cord, where
+there is not a trace of any nerves.
+
+In the investigation of the nervous system, anatomy and physiology
+have gone hand in hand.  It is very singular that so important, and
+seemingly simple, a fact as the connection of the nerve-tubes, at
+their origin or in their course, with the nerve-cells, should have so
+long remained open to doubt, as you may see that it did by referring
+to the very complete work of Sharpey and Quain (edition of 1849), the
+histological portion of which is cordially approved by Kolliker
+himself.
+
+Several most interesting points of the minute anatomy of the nervous
+centres have been laboriously and skilfully worked out by a recent
+graduate of this Medical School, in a monograph worthy to stand in
+line with those of Lockhart Clarke, Stilling, and Schroder van der
+Kolk. I have had the privilege of examining and of showing some of
+you a number of Dr. Dean's skilful preparations.  I have no space to
+give even an abstract of his conclusions.  I can only refer to his
+proof of the fact, that a single cell may send its processes into
+several different bundles of nerve-roots, and to his demonstration of
+the curved ascending and descending fibres from the posterior
+nerveroots, to reach what he has called the longitudinal columns of
+the cornea.  I must also mention Dr. Dean's exquisite microscopic
+photographs from sections of the medulla oblongata, which appear to
+me to promise a new development, if not a new epoch, in anatomical
+art.
+
+It having been settled that the nerve-tubes can very commonly be
+traced directly to the nerve-cells, the object of all the observers
+in this department of anatomy is to follow these tubes to their
+origin.  We have an infinite snarl of telegraph wires, and we may be
+reasonably sure, that, if we can follow them up, we shall find each
+of them ends in a battery somewhere.  One of the most interesting
+problems is to find the ganglionic origin of the great nerves of the
+medulla oblongata, and this is the end to which, by the aid of the
+most delicate sections, colored so as to bring out their details,
+mounted so as to be imperishable, magnified by the best instruments,
+and now self-recorded in the light of the truth-telling sunbeam, our
+fellow-student is making a steady progress in a labor which I think
+bids fair to rank with the most valuable contributions to histology
+that we have had from this side of the Atlantic.
+
+It is interesting to see how old questions are incidentally settled
+in the course of these new investigations.  Thus, Mr. Clarke's
+dissections, confirmed by preparations of Mr. Dean's which I have
+myself examined, placed the fact of the decussation of the pyramids--
+denied by Haller, by Morgagni, and even by Stilling--beyond doubt.
+So the spinal canal, the existence of which, at least in the adult,
+has been so often disputed, appears as a coarse and unequivocal
+anatomical fact in many of the preparations referred to.
+
+While these studies of the structure of the cord have been going on,
+the ingenious and indefatigable Brown-Sequard has been investigating
+the functions of its different parts with equal diligence.  The
+microscopic anatomists had shown that the ganglionic corpuscles of
+the gray matter of the cord are connected with each other by their
+processes, as well as with the nerve-roots.  M.  Brown-Sequard has
+proved by numerous experiments that the gray substance transmits
+sensitive impressions and muscular stimulation.  The oblique
+ascending and descending fibres from the posterior nerve-roots,
+joining the "longitudinal columns of the cornua," account for the
+results of Brown-Sequard's sections of the posterior columns.  The
+physiological experimenter has also made it evident that the
+decussation of the conductors of sensitive impressions has its seat
+in the spinal core, and not in the encephalon, as had been supposed.
+Not less remarkable than these results are the facts, which I with
+others of my audience have had the opportunity of observing, as shown
+by M. Brown-Sequard, of the artificial production of epilepsy in
+animals by injuring the spinal cord, and the induction of the
+paroxysm by pinching a certain portion of the skin.  I would also
+call the student's attention to his account of the relations of the
+nervous centres to nutrition and secretion, the last of which
+relations has been made the subject of an extended essay by our
+fellow countryman, Dr. H. F. Campbell of Georgia.
+
+The physiology of the spinal cord seems a simple matter as you study
+it in Longet.  The experiments of Brown-Sequard have shown the
+problem to be a complex one, and raised almost as many doubts as they
+have solved questions; at any rate, I believe all lecturers on
+physiology agree that there is no part of their task they dread so
+much as the analysis of the evidence relating to the special offices
+of the different portions of the medulla spinalis.  In the brain we
+are sure 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 crossed paralysis of sensation, and the conducting agency of
+the gray substance, I am afraid we retain no cardinal principles
+discovered since the development of the reflex function took its
+place by Sir Charles Bell's great discovery.
+
+By the manner in which I spoke of the brain, you will see that I am
+obliged to leave phrenology sub Jove,--out in the cold,--as not one
+of the household of science.  I am not one of its haters; on the
+contrary, I am grateful for the incidental good it has done.  I love
+to amuse myself in its plaster Golgothas, and listen to the glib
+professor, as he discovers by his manipulations
+
+     "All that disgraced my betters met in me."
+
+I loved of old to see square-headed, heavy-jawed Spurzheim make a
+brain flower out into a corolla of marrowy filaments, as Vieussens
+had done before him, and to hear the dry-fibred but human-hearted
+George Combe teach good sense under the disguise of his equivocal
+system.  But the pseudo-sciences, phrenology and the rest, seem to me
+only appeals to weak minds and the weak points of strong ones.  There
+is a pica or false appetite in many intelligences; they take to odd
+fancies in place of wholesome truth, as girls gnaw at chalk and
+charcoal.  Phrenology juggles with nature.  It is so adjusted as to
+soak up all evidence 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 boundary of our ignorance, it seems to me,
+but is one of the will-o'-the-wisps of its undisputed central domain
+of bog and quicksand.  Yet I should not have devoted so many words to
+it, did I not recognize the light it has thrown on human actions by
+its study of congenital organic tendencies.  Its maps of the.
+surface of the head are, I feel sure, founded on a delusion, but its
+studies of individual character are always interesting and
+instructive.
+
+The "snapping-turtle" strikes after its natural fashion when it first
+comes out of the egg.  Children betray their tendencies in their way
+of dealing with the breasts that nourish them; nay, lean venture to
+affirm, that long before they are born they teach their mothers
+something of their turbulent or quiet tempers.
+
+     "Castor gaudet equis, ovo proanatus eodem
+          Pugnis."
+
+Strike out the false pretensions of phrenology; call it anthropology;
+let it study man the individual in distinction from man the
+abstraction, the metaphysical or theological lay-figure; and it
+becomes "the proper study of mankind," one of the noblest and most
+interesting of pursuits.
+
+The whole physiology of the nervous system, from the simplest
+manifestation of its power in an insect up to the supreme act of the
+human intelligence working through the brain, is full of the most
+difficult yet profoundly interesting questions.  The singular
+relations between electricity and nerve-force, relations which it has
+been attempted to interpret as meaning identity, in the face of
+palpable differences, require still more extended studies.  You may
+be interested by Professor Faraday's statement of his opinion on the
+matter.  "Though I am not satisfied that the nervous fluid is only
+electricity, still I think that the agent in the nervous system maybe
+an inorganic force; and if there be reason for supposing that
+magnetism is a higher relation of force than electricity, so it may
+well be imagined that the nervous power may be of a still more
+exalted character, and yet within the reach of experiment."
+
+In connection with this statement, it is interesting to refer to the
+experiments of Helmholtz on the rapidity of transmission of the
+nervous actions.  The rate is given differently in Valentin's report
+of these experiments and in that found in the "Scientific Annual" for
+1858.  One hundred and eighty to three hundred feet per second is the
+rate of movement assigned for sensation, but all such results must be
+very vaguely approximative.  Boxers, fencers, players at the Italian
+game of morn, "prestidigitators," and all who depend for their
+success on rapidity of motion, know what differences there are in the
+personal equation of movement.
+
+Reflex action, the mechanical sympathy, if I may so call it, of
+distant parts; Instinct, which is crystallized intelligence,--an
+absolute law with its invariable planes and angles introduced into
+the sphere of consciousness, as raphides are inclosed in the living
+cells of plants; Intellect,--the operation of the thinking principle
+through material organs, with an appreciable waste of tissue in every
+act of thought, so that our clergymen's blood has more phosphates to
+get rid of on Monday than on any other day of the week; Will,--
+theoretically the absolute determining power, practically limited in
+different degrees by the varying organization of races and
+individuals, annulled or perverted by different ill-understood
+organic changes; on all these subjects our knowledge is in its
+infancy, and from the study of some of them the interdict of the
+Vatican is hardly yet removed.
+
+I must allude to one or two points in the histology and physiology of
+the organs of sense.  The anterior continuation of the retina beyond
+the ora serrata has been a subject of much discussion.  If H. Muller
+and Kolliker can be relied upon, this question is settled by
+recognizing that a layer of cells, continued from the retina, passes
+over the surface of the zonula Zinnii, but that no proper nervous
+element is so prolonged forward.
+
+I observe that Kolliker calls the true nervous elements of the retina
+"the layer of gray cerebral substance."  In fact, the ganglionic
+corpuscles of each eye may be considered as constituting a little
+brain, connected with the masses behind by the commissure, commonly
+called the optic nerve.  We are prepared, therefore, to find these
+two little brains in the most intimate relations with each other, as
+we find the cerebral hemispheres.  We know that they are directly
+connected by fibres that arch round through the chiasma.
+
+I mention these anatomical facts to introduce a physiological
+observation of my own, first announced in one of the lectures before
+the Medical Class, subsequently communicated to the American Academy
+of Arts and Sciences, and printed in its "Transactions" for February
+14, 1860.  I refer to the apparent transfer of impressions from one
+retina to the other, to which I have given the name reflex vision.
+The idea was suggested to me in consequence of certain effects
+noticed in employing the stereoscope.  Professor William B. Rodgers
+has since called the attention of the American Scientific Association
+to some facts bearing on the subject, and to a very curious
+experiment of Leonardo da Vinci's, which enables the observer to look
+through the palm of his hand (or seem to), as if it had a hole bored
+through it.  As he and others hesitated to accept my explanation, I
+was not sorry to find recently the following words in the
+"Observations on Man" of that acute observer and thinker, David
+Hartley.  "An impression made on the right eye alone by a single
+object may propagate itself into the left, and there raise up an
+image almost equal in vividness to itself; and consequently when we
+see with one eye only, we may, however, have pictures in both eyes."
+Hartley, in 1784, had anticipated many of the doctrines which have
+since been systematized into the theory of reflex actions, and with
+which I have attempted to associate this act of reflex vision.  My
+sixth experiment, however, in the communication referred to, appears
+to me to be a crucial one, proving the correctness of my explanation,
+and I am not aware that it has been before instituted.
+
+Another point of great interest connected with the physiology of
+vision, and involved for a long time in great obscurity, is that of
+the adjustment of the eye to different distances.  Dr. Clay Wallace
+of New York, who published a very ingenious little book on the eye
+about twenty years ago, with vignettes reminding one of Bewick, was
+among the first, if not the first, to describe the ciliary muscle, to
+which the power of adjustment is generally ascribed.  It is
+ascertained, by exact experiment with the phacueidoscope, that
+accommodation depends on change of form of the crystalline lens.
+Where the crystalline is wanting, as Mr. Ware long ago taught, no
+power of accommodation remains.  The ciliary muscle is generally
+thought to effect the change of form of the crystalline.  The power
+of accommodation is lost after the application of atropine, in
+consequence, as is supposed, of the paralysis of this muscle.  This,
+I believe, is the nearest approach to a demonstration we have on this
+point.
+
+I have only time briefly to refer to Professor Draper's most
+ingenious theory as to the photographic nature of vision, for an
+account of which I must refer to his original and interesting
+Treatise on Physiology.
+
+It were to be wished that the elaborate and very interesting
+researches of the Marquis Corti, which have revealed such singular
+complexity of structure in the cochlea of the ear, had done more to
+clear up its doubtful physiology; but I am afraid we have nothing but
+hypotheses for the special part it plays in the act of hearing, and
+that we must say the same respecting the office of the semicircular
+canals.
+
+The microscope has achieved some of its greatest triumphs in teaching
+us the changes which occur in the development of the embryo.  No more
+interesting discovery stands recorded in the voluminous literature of
+this subject than the one originally announced by Martin Barry,
+afterwards discredited, and still later confirmed by Mr. Newport and
+others; namely the fact that the fertilizing filament reaches the
+interior of the ovum in various animals;--a striking parallel to the
+action of the pollen-tube in the vegetable.  But beyond the
+mechanical facts all is mystery in the movements of organization, as
+profound as in the fall of a stone or the formation of a crystal.
+
+To the chemist and the microscopist the living body presents the same
+difficulties, arising from the fact that everything is in perpetual
+change in the organism.  The fibrine of the blood puzzles the one as
+much as its globules puzzle the other.  The difference between the
+branches of science which deal with space only, and those which deal
+with space and time, is this: we have no glasses that can magnify
+time.  The figure I here show you a was photographed from an object
+(pleurosigma angulatum) magnified a thousand diameters, or presenting
+a million times its natural surface.  This other figure of the same
+object, enlarged from the one just shown, is magnified seven thousand
+diameters, or forty-nine million times in surface.  When we can make
+the forty-nine millionth of a second as long as its integer,
+physiology and chemistry will approach nearer the completeness of
+anatomy.
+
+Our reverence becomes more worthy, or, if you will, less unworthy of
+its Infinite Object in proportion as our intelligence is lifted and
+expanded to a higher and broader understanding of the Divine methods
+of action.  If Galen called his heathen readers to admire, the power,
+the wisdom, the providence, the goodness of the "Framer of the animal
+body,"--if Mr. Boyle, the student of nature, as Addison and that
+friend of his who had known him for forty years tell us, never
+uttered the name of the Supreme Being without making a distinct pause
+in his speech, in token of his devout recognition of its awful
+meaning,--surely we, who inherit the accumulated wisdom of nearly two
+hundred 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 study to their great Artificer.  These
+wonderful discoveries which we owe to that mighty little instrument,
+the telescope of the inner firmament with all its included worlds;
+these simple formulae by which we condense the observations of a
+generation in a single axiom; these logical analyses by which we
+fence out the ignorance we cannot reclaim, and fix the limits of our
+knowledge,--all lead us up to the inspiration of the Almighty, which
+gives understanding to the world's great teachers.  To fear science
+or knowledge, lest it disturb our old beliefs, is to fear the influx
+of the Divine wisdom into the souls of our fellow-men; for what is
+science but the piecemeal revelation,--uncovering,--of the plan of
+creation, by the agency of those chosen prophets of nature whom God
+has illuminated from the central light of truth for that single
+purpose?
+
+The studies which we have glanced at are preliminary in your
+education to the practical arts which make use of them,--the arts of
+healing,--surgery and medicine.  The more you examine the structure
+of the organs and the laws of life, the more you will find how
+resolutely each of the cell-republics which make up the E pluribus
+unum of the body maintains its independence.  Guard it, feed it, air
+it, warm it, exercise or rest it properly, and the working elements
+will do their best to keep well or to get well.  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 side of the fence looking in
+good health, while those on the other side were scraggy and
+miserable.  How do 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,
+and supplying them with the right kind of food in fitting quantities.
+
+Now a man is not a plant, or, at least, he is a very curious 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.  He has,
+besides, a singularly complex nutritive apparatus and a nervous
+system.  But recollect the doctrine already enunciated in the
+language of Virchow, that an animal, like a tree, is a sum of vital
+unities, of which the cell is the ultimate element.  Every healthy
+cell, whether in a vegetable or an animal, necessarily performs its
+function properly so long as 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 normal state.  But if
+originally sound and subsequently diseased, there has certainly been
+some excess, deficiency, or wrong quality in the materials or stimuli
+applied to it.  You remove this injurious influence and substitute a
+normal one; remove the baked coal-ashes, for instance, from the roots
+of a tree, and replace them with loam; take away the salt meat from
+the patient's table, and replace it with fresh meat and vegetables,
+and the cells of the tree or the man return to their duty.
+
+I do not know that we ever apply to a plant any element which is not
+a natural constituent of the vegetable structure, except perhaps
+externally, for the accidental purpose of killing parasites.  The
+whole art of cultivation consists in learning the proper food and
+conditions of plants, and supplying them.  We give them water,
+earths, salts of various kinds such as they are made of, with a
+chance to help themselves to air and light.  The farmer would be
+laughed at who undertook to manure his fields or his trees with a
+salt of lead or of arsenic.  These elements are not constituents of
+healthy plants.  The gardener uses the waste of the arsenic furnaces
+to kill the weeds 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 the vegetable, we might
+expect that we should treat all morbid conditions of any of the vital
+unities belonging to an animal in the same way, by increasing,
+diminishing, or changing its natural food or stimuli.
+
+That is an aliment which nourishes; whatever we find in the
+organism, as a constant and integral element, either forming part of
+its structure, or one of the conditions of vital processes, that and
+that only deserves the name of aliment.  I see no reason,
+therefore, why iron, phosphate of lime, sulphur, should not be
+considered food for man, as much as guano or poudrette for
+vegetables.  Whether one or another of them is best in any given
+case,--whether they shall be taken alone or in combination, in large
+or small quantities, are separate questions.  But they are elements
+belonging to the body, and even in moderate excess will produce
+little disturbance.  There is no presumption against any of this
+class of substances, any more than against water or salt, provided
+they are used in fitting combinations, proportions, and forms.
+
+But when it comes to substances alien to the healthy system, which
+never belong to it as normal constituents, the case is very
+different.  There is a presumption against putting lead or arsenic
+into the human body, as against putting them into plants, because
+they do 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
+they get into the system we cannot always tell.  But in the case of
+silver, from the accident of its changing color under the influence
+of light, we do know what happens.  It is thrown out, in part at
+least, under the epidermis, and there it remains to the patient's
+dying day.  This is a striking illustration of the difficulty which
+the system finds in dealing with non-assimilable elements, and
+justifies in some measure the vulgar prejudice against mineral
+poisons.
+
+I trust the youngest student on these benches will not commit the
+childish error of confounding a presumption against a particular
+class of agents with a condemnation of them.  Mercury, for instance,
+is alien to the system, and eminently disturbing in its influence.
+Yet its efficacy in certain forms of specific disease is acknowledged
+by all but the most sceptical theorists.  Even the esprit moqueur of
+Ricord, the Voltaire of pelvic literature, submits to the time-
+honored constitutional authority of this great panacea in the class
+of cases to which he has devoted his brilliant intelligence.  Still,
+there is no telling what evils have arisen from the abuse of this
+mineral.  Dr. Armstrong long ago pointed out some of them, and they
+have become matters of common notoriety.  I am pleased, therefore,
+when I find so able and experienced a practitioner as Dr. Williams of
+this city proving that iritis is best treated without mercury, and
+Dr. Vanderpoel showing the same thing to be true for pericarditis.
+
+Whatever elements nature does not introduce into vegetables, the
+natural food of all animal life,--directly of herbivorous, indirectly
+of carnivorous animals,--are to be regarded with suspicion.  Arsenic-
+eating may seem to improve the condition of horses for a time,--and
+even of human beings, if Tschudi's stories can be trusted,--but it
+soon appears that its alien qualities are at war with the animal
+organization.  So of copper, antimony, and other non-alimentary
+simple substances; everyone of them is an intruder in the living
+system, as much as a constable would be, quartered in our household.
+This does not mean that they may not, any of them, be called in for a
+special need, as we send for the constable when we have good reason
+to think we have a thief under our roof; but a man's body is his
+castle, as well as his house, and the presumption is that we are to
+keep our alimentary doors bolted against these perturbing agents.
+
+Now the feeling is very apt to be just contrary to this.  The habit
+has been very general with well-taught practitioners, to have
+recourse to the introduction of these alien elements into the system
+on the occasion of any slight disturbance.  The tongue was a little
+coated, and mercury must be given; the skin was a little dry, and the
+patient must take antimony.  It was like sending for the constable
+and the posse comitatus when there is only a carpet to shake or a
+refuse-barrel to empty. [Dr. James Johnson advises persons not ailing
+to take five grains of blue pill with one or two of aloes twice a
+week for three or four months in the year, with half a pint of
+compound decoction of sarsaparilla every day for the same period, to
+preserve health and prolong life.  Pract.  Treatise on Dis.  of
+Liver, etc.  p. 272.]  The constitution bears slow poisoning a great
+deal better than might be expected; yet the most intelligent men in
+the profession have gradually got out of the habit of prescribing
+these powerful alien substances in the old routine way.  Mr. Metcalf
+will tell you how much more sparingly they are given by our
+practitioners at the present time, than when he first inaugurated the
+new era of pharmacy among us.  Still, the presumption in favor of
+poisoning out every spontaneous reaction of outraged nature is not
+extinct in those who are trusted with the lives of their fellow-
+citizens.  "On examining the file of prescriptions at the hospital, I
+discovered that they were rudely written, and indicated a treatment,
+as they consisted chiefly of tartar emetic, ipecacuanha, and epsom
+salts, hardly favorable to the cure of the prevailing diarrhoea and
+dysenteries."   In a report of a poisoning case now on trial, where
+we are told that arsenic enough was found in the stomach to produce
+death in twenty-four hours, the patient is said to have been treated
+by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
+acid,--by a practitioner of what school it may be imagined.
+
+The traditional idea of always poisoning out disease, as we smoke out
+vermin, is now seeking its last refuge behind the wooden cannon and
+painted port-holes of that unblushing system of false scientific
+pretences which I do not care to name in a discourse addressed to an
+audience devoted to the study of the laws of nature 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, has accustomed
+all who have sense enough to see through its thin artifices to the
+idea that diseases get well without being "cured," should now be the
+main support of the tottering poison-cure doctrine.  It has
+unquestionably helped to teach wise people that nature heals most
+diseases without help from pharmaceutic art, but it continues to
+persuade fools that art can arrest them all with its specifics.
+
+It is worse than useless to attempt in any way to check the freest
+expression of opinion as to the efficacy of any or all of the
+"heroic" means of treatment employed by practitioners of different
+schools and 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 larger jurisdiction; that, namely, in
+which the laws of human belief are summoned to the witness-box, and
+obliged to testify to the sources of error which beset the medical
+practitioner.  The verdict is as old as the father of medicine, who
+announces it in the words, "judgment is difficult."  Physicians
+differed so in his time, that some denied that there was any such
+thing as an art of medicine.
+
+One man's best remedies were held as mischievous by another.  The art
+of healing was like soothsaying, so the common people said; "the same
+bird was lucky or unlucky, according as he flew to the right or
+left."
+
+The practice of medicine has undergone great changes within 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
+Bellevue and the Massachusetts General Hospitals, it is almost
+obsolete in these institutions, at least in medical practice.  The
+old Brunonian stimulating treatment has come into vogue again in the
+practice of Dr. Todd and his followers.  The compounds of mercury
+have yielded their place as drugs of all work, and specifics for that
+very frequent subjective complaint, nescio quid faciam,--to compounds
+of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to
+speak of medicines which "are given as much to assist the medical man
+as his patient."  Lectures (London, 1832), p.  14.] Opium is believed
+in, and quinine, and "rum," using that expressive 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 English and American
+evacuant and alterative practice, in which 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-
+fashioned medical art, counted them with opium and Peruvian bark as
+his chief remedies; with the moderately expectant practice of Louis;
+the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant
+method of Rasori and his followers; the anti-irritant system of
+Broussais, with its leeching and gum-water; I have heard from our own
+students of the simple opium practice of the renowned German teacher,
+Oppolzer; and now I find the medical community brought round by the
+revolving cycle of opinion to that same old plan of treatment which
+John Brown taught in Edinburgh in the last quarter of the last
+century, and Miner and Tully fiercely advocated among ourselves in
+the early years of the present.  The worthy physicians last
+mentioned, and their antagonist Dr. Gallup, used stronger language
+than we of these degenerate days permit ourselves.  "The lancet is a
+weapon which annually slays more than the sword," says Dr. Tully.
+"It is probable that, for forty years past, opium and its
+preparations have done seven times the injury they have rendered
+benefit, on the great scale of the world," says Dr. Gallup.
+
+What is the meaning of these perpetual changes and conflicts of
+medical opinion and practice, from an early antiquity to our own
+time?  Simply this: all "methods" of treatment end in disappointment
+of those extravagant expectations which men are wont to entertain of
+medical art.  The bills of mortality are more obviously affected by
+drainage, than by this or that method of practice.  The insurance
+companies do not commonly charge a different percentage on the lives
+of the patients of this or that physician.  In the course of a
+generation, more or less, physicians themselves are liable to get
+tired of a practice which has so little effect upon the average
+movement of vital decomposition.  Then they are ready for a change,
+even if it were back again to a method which has already been tried,
+and found wanting.
+
+Our practitioners, or many of them, have got back to the ways of old
+Dr. Samuel Danforth, who, as it is well known, had strong objections
+to the use of the lancet.  By and by a new reputation will be made by
+some discontented practitioner, who, tired of seeing patients die
+with their skins full of whiskey and their brains muddy with opium,
+returns to a bold antiphlogistic treatment, and has the luck to see a
+few patients of note get well under it.  So of the remedies which
+have gone out of fashion and been superseded by others.  It can
+hardly be doubted that they will come into vogue again, more or less
+extensively, under the influence of that irresistible demand for
+change just referred to.
+
+Then will come the usual talk about a change in the character of
+disease, which has about as much meaning as that concerning
+"old-fashioned snow-storms."  "Epidemic constitutions" of disease
+mean something, no doubt; a great deal as applied to malarious
+affections; but that the whole type of diseases undergoes such
+changes that the practice must be reversed from depleting to
+stimulating, and vice versa, is much less likely than that methods of
+treatment go out of fashion and come in again.  If there is any
+disease which claims its percentage with reasonable uniformity, it is
+phthisis.  Yet I remember that the reverend and venerable Dr. Prince
+of Salem told me one Commencement day, as I was jogging along towards
+Cambridge with him, that he recollected the time when that disease
+was hardly hardly known; and in confirmation of his statement
+mentioned a case in which it was told as a great event, that somebody
+down on "the Cape" had died of "a consumption."  This story does not
+sound probable to myself, as I repeat it, yet I assure you it is
+true, and it shows how cautiously we must receive all popular stories
+of great changes in the habits of disease.
+
+Is there no progress, then, but do we return to the same beliefs and
+practices which our forefathers wore out and threw away?  I trust and
+believe that there 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 go back to the simple Brunonian
+pathology, since we have learned too much of diseased action to
+accept its convenient dualism.  So of other doctrines, each new
+Avatar strips them of some of their old pretensions, until they take
+their fitting place at last, if they have any truth in them, or
+disappear, if they were mere phantasms of the imagination.
+
+In the mean time, while medical theories are coming in and going out,
+there is a set of sensible men who are never run away with by them,
+but practise their art sagaciously and faithfully in much the same
+way from generation to generation.  From the time of Hippocrates to
+that of our own medical patriarch, there has been an apostolic
+succession of wise and good practitioners.  If you will look at the
+first aphorism of the ancient Master you will see that before all
+remedies he places the proper conduct of the patient and his
+attendants, and the fit ordering of all the conditions surrounding
+him.  The class of practitioners I have referred to have always been
+the most faithful in attending to these points.  No doubt they have
+sometimes prescribed unwisely, in compliance with the prejudices of
+their time, but they have grown wiser as they have grown older, and
+learned to trust more in nature and less in their plans of
+interference.  I believe common opinion confirms Sir James Clark's
+observation to this effect.
+
+The experience of the profession must, I think, run parallel with
+that of the wisest of its individual members.  Each time a plan of
+treatment or a particular remedy comes up for trial, it is submitted
+to a sharper scrutiny.  When Cullen wrote his Materia Medica, he had
+seriously to assail the practice of giving burnt toad, which was
+still countenanced by at least one medical authority of note.  I have
+read recently in some medical journal, that an American practitioner,
+whose name is known to the country, is prescribing the hoof of a
+horse for epilepsy.  It was doubtless suggested by that old fancy of
+wearing a portion of elk's hoof hung round the neck or in a ring, for
+this disease.  But it is hard to persuade reasonable people to
+swallow the abominations of a former period.  The evidence which
+satisfied Fernelius will not serve one of our hospital physicians.
+
+In this way those articles of the Materia Medica which had nothing
+but loathsomeness to recommend them have been gradually dropped, and
+are not like to obtain any 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 the utility of some of them,
+when properly employed.  Though I believe that at present, taking the
+world at large, and leaving out a few powerful agents of such immense
+value that they rank next to food in importance, the poisons
+prescribed for disease do more hurt than good, I have no doubt, and
+never professed to have any, that they do much good in prudent and
+instructed hands.  But I am very willing to confess a great jealousy
+of many agents, and I could almost wish to see the Materia Medica so
+classed as to call suspicion upon certain ones among them.
+
+Thus the alien elements, those which do not properly enter into the
+composition of any living tissue, are the most to be suspected,--
+mercury, lead, antimony, silver, and the rest, for the reasons I have
+before mentioned.  Even iodine, which, as it is found in certain
+plants, seems less remote from the animal tissues, gives unequivocal
+proofs from time to time that it is hostile to some portions of the
+glandular system.
+
+There is, of course, less prima facie objection to those 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 sometimes poison to another,
+and vice versa; inert substances may act mechanically, so as to
+produce the effect of poisons; but this division holds exactly enough
+for our purpose.
+
+Strictly speaking, every poison consisting of assimilable elements
+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's action, or some other symptom for which
+the subject of it would consult the physician, if it came on from any
+other cause than taking it under the name of medicine.  Yet portions
+of this unwholesome food which we call medicine, we have reason to
+believe, are assimilated; thus, castor-oil appears to be partially
+digested by infants, so that they require large doses to affect them
+medicinally.  Even that deadliest of poisons, hydrocyanic acid, is
+probably assimilated, and helps to make living tissue, if it do not
+kill the patient, for the assimilable elements which it contains,
+given in the separate forms of amygdalin and emulsin, produce no
+disturbance, unless, as in Bernard's experiments, they are suffered
+to meet in the digestive organs.  A medicine consisting of
+assimilable substances being then simply unwholesome food, we
+understand what is meant by those cumulative effects of such remedies
+often observed, as in the case of digitalis and strychnia.  They are
+precisely similar to the cumulative effects of a salt diet in
+producing scurvy, or of spurred rye in producing dry gangrene.  As
+the effects of such substances are a violence to the organs, we
+should exercise the same caution with regard to their use that we
+would exercise about any other kind of poisonous food,--partridges at
+certain seasons, for instance.  Even where these poisonous kinds of
+food seem to be useful, we should still regard them with great
+jealousy.  Digitalis lowers the pulse in febrile conditions.
+Veratrum viride does the same thing.  How do we know that a rapid
+pulse is not a normal adjustment of nature to the condition it
+accompanies?  Digitalis has gone out of favor; how sure are we that
+Veratrum viride will not be found to 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 use
+of opium in delirium tremens (which you remember is sometimes called
+delirium vigilans), where it seemed so obviously indicated, since the
+publication of Dr. Ware's admirable essay.  I respect the evidence of
+my contemporaries, but I cannot forget the sayings of the Father of
+medicine,--Ars longa, judicium diffcile.
+
+I am not presuming to express an opinion concerning Veratrum viride,
+which was little heard of when I was still practising medicine.  I am
+only appealing to that higher court of experience which sits in
+judgment on all decisions of the lower medical tribunals, and which
+requires more than one generation for its final verdict.
+
+Once change the habit of mind so long prevalent among practitioners
+of medicine; once let it be everywhere understood that the
+presumption is in favor of food, and not of alien substances, of
+innocuous, and not of unwholesome food, for the sick; that this
+presumption requires very strong evidence in each particular case to
+overcome it; but that, when such evidence is afforded, the alien
+substance or the unwholesome food should be given boldly, in
+sufficient quantities, in the same spirit as that with which the
+surgeon lifts his knife against a patient,--that is, with the same
+reluctance and the same determination,--and I think we shall have and
+hear much less of charlatanism in and out of the profession.  The
+disgrace of medicine has been that colossal system of self-deception,
+in obedience to which mines have been emptied of their cankering
+minerals, the vegetable kingdom robbed of all its noxious growths,
+the entrails of animals taxed for their impurities, the poison-bags
+of reptiles drained of their venom, and all the inconceivable
+abominations thus obtained thrust down the throats of human beings
+suffering from some fault of organization, nourishment, or vital
+stimulation.
+
+Much as we have gained, we have not yet thoroughly shaken off the
+notion that poison is the natural food of disease, as wholesome
+aliment is the support of health.  Cowper's lines, in "The Task,"
+show the matter-of-course practice of his time:
+
+    "He does not scorn it, who has long endured
+     A fever's agonies, and fed on drugs."
+
+Dr. Kimball of Lowell, who has been in the habit of seeing a great
+deal more of typhoid fever than most practitioners, and whose
+surgical exploits show him not to be wanting in boldness or
+enterprise, can tell you whether he finds it necessary to feed his
+patients on drugs or not.  His experience is, I believe, that of the
+most enlightened and advanced portion of the profession; yet I think
+that even in typhoid fever, and certainly in many other complaints,
+the effects of ancient habits and prejudices may still be seen in the
+practice of some educated physicians.
+
+To you, young men, it belongs to judge all that has gone before you.
+You come nearer to the great fathers of modern medicine than some of
+you imagine.  Three of my own instructors attended Dr. Rush's
+Lectures.  The illustrious Haller mentions Rush's inaugural thesis in
+his "Bibliotheca Anatomica;" and this same Haller, brought so close
+to us, tells us he remembers Ruysch, then an old man, and used to
+carry letters between him and Boerhaave.  Look through the history of
+medicine from Boerhaave to this present day.  You will see at once
+that medical doctrine and practice have undergone a long series of
+changes.  You will see that the doctrine and practice of our own time
+must probably change in their turn, and that, if we can trust at all
+to the indications of their course, it will be in the direction of an
+improved hygiene and a simplified treatment.  Especially will the old
+habit of violating the instincts of the sick give place to a
+judicious study of these same instincts.  It will be found that
+bodily, like mental insanity, is best managed, for the most part, by
+natural soothing agencies.  Two centuries ago there was a
+prescription for scurvy containing "stercoris taurini et anserini
+par, quantitas trium magnarum nucum," of the hell-broth containing
+which "guoties-cumque sitit oeger, large bibit."   When I have
+recalled the humane common-sense of Captain Cook in the matter of
+preventing this disease; when I have heard my friend, Mr. Dana,
+describing the avidity with which the scurvy-stricken sailors snuffed
+up the earthy fragrance of fresh raw potatoes, the food which was to
+supply the elements wanting to their spongy tissues, I have
+recognized that the perfection of art is often a return to nature,
+and seen in this single instance the germ of innumerable beneficent
+future medical reforms.
+
+I cannot help believing that medical curative treatment will by and
+by resolve itself in great measure into modifications of the food,
+swallowed and breathed, and of the natural stimuli, and that less
+will be expected from specifics and noxious disturbing agents, either
+alien or assimilable.  The noted mineral-waters containing iron,
+sulphur, carbonic acid, supply nutritious or stimulating materials to
+the body as much as phosphate of lime and ammoniacal compounds do to
+the cereal plants.  The effects of a milk and vegetable diet, of
+gluten bread in diabetes, of cod-liver oil in phthisis, even of such
+audacious innovations as the water-cure and the grape-cure, are only
+hints of what will be accomplished when we have learned to discover
+what organic elements are 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 his crops and modifies
+the composition of his soil.  In acute febrile diseases we have long
+ago discovered that far above all drug-medication is the use of mild
+liquid diet in the period of excitement, and of stimulant and
+nutritious food in that of exhaustion.  Hippocrates himself was as
+particular about his barley-ptisan as any Florence Nightingale of our
+time could be.
+
+The generation to which you, who are just entering the profession,
+belong, will make a vast stride forward, as I believe, in the
+direction of treatment by natural rather than violent agencies.  What
+is it that makes the reputation of Sydenham, as the chief of English
+physicians?  His prescriptions consisted principally of simples.  An
+aperient or an opiate, a "cardiac" or a tonic, may be commonly found
+in the midst of a somewhat fantastic miscellany of garden herbs.  It
+was not by his pharmaceutic prescriptions that he gained his great
+name.  It was by daring to order fresh air for small-pox patients,
+and riding on horseback for consumptives, in place of the smothering
+system, and the noxious and often loathsome rubbish of the
+established schools.  Of course Sydenham was much abused by his
+contemporaries, as he frequently takes occasion to remind his reader.
+"I must needs conclude," he says, "either that I am void of merit, or
+that the candid and ingenuous part of mankind, who are formed with so
+excellent a temper of mind as to be no strangers to gratitude, make a
+very small part of the whole."  If in the fearless pursuit of truth
+you should find the world as ungracious in the nineteenth century as
+he found it in the seventeenth, you may learn a lesson of self-
+reliance from another utterance of the same illustrious physician:
+"'T is none of 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 writings with temper."
+
+The physician has learned a great deal from the surgeon, who is
+naturally in advance of him, because he has a better opportunity of
+seeing the effects of his remedies.  Let me shorten one of Ambroise
+Pare's stories for you.  There had been a great victory at the pass
+of Susa, and they were riding into the city.  The wounded cried out
+as the horses trampled them under their hoofs, which caused good
+Ambroise great pity, and made him wish himself back in Paris.  Going
+into a stable he saw four dead soldiers, and three desperately
+wounded, placed with their backs against the wall.  An old campaigner
+came up.--"Can these fellows get well?" he said.  "No!" answered the
+surgeon.  Thereupon, the old soldier walked 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, "somebody will do as much for me if I ever
+get into such a scrape" (accoustre de telle facon).  "I was not much
+salted in those days" (bien doux de sel), says Ambroise, "and little
+acquainted with the treatment of wounds."  However, as he tells us,
+he proceeded to apply boiling oil of Sambuc (elder) after the
+approved fashion of the time,--with what torture to the patient may
+be guessed.  At last his precious oil gave out, and he used instead
+an insignificant mixture of his own contrivance.  He could not sleep
+that night for fear his patients who had not been scalded with the
+boiling oil would be poisoned by the gunpowder conveyed into their
+wounds by the balls.  To his surprise, he found them much better than
+the others the next morning, and resolved never again to burn his
+patients with hot oil for gun-shot wounds.
+
+This was the beginning, as nearly as we can fix it, of that reform
+which has introduced plain water-dressings in the place of the
+farrago of external applications which had been a source of profit to
+apothecaries and disgrace to art from, and before, the time when
+Pliny complained of them.  A young surgeon who was at Sudley Church,
+laboring among the wounded of Bull Run, tells me they had nothing but
+water for dressing, and he (being also doux de sel) was astonished to
+see how well the wounds did under that simple treatment.
+
+Let me here mention a fact or two which may be of use to some of you
+who mean to enter the public service.  You will, as it seems, have
+gun-shot wounds almost exclusively to deal with.  Three different
+surgeons, the one just mentioned and two who saw the wounded of Big
+Bethel, assured me that they found no sabre-cuts or bayonet wounds.
+It is the rifle-bullet from a safe distance which pierces the breasts
+of our soldiers, and not the gallant charge of broad platoons and
+sweeping squadrons, such as we have been in the habit of considering
+the chosen mode of warfare of ancient and modern chivalry. [Sir
+Charles James Napier had the same experience in Virginia in 1813.
+"Potomac.  We have nasty sort of fighting here, amongst creeks and
+bushes, and lose men without show."  "Yankee never shows himself, he
+keeps in the thickest wood, fires and runs off."--These five
+thousand in the open field might be attacked, but behind works it
+would be throwing away lives."  He calls it "an inglorious warfare,"
+--says one of the leaders is "a little deficient in gumption,"--but
+--still my opinion is, that if we tuck up our sleeves and lay our
+ears back we might thrash them; that is, if we caught them out of
+their trees, so as to slap at them with 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 your assistants.  A chaplain told it
+to two of our officers personally known to myself.  He overheard the
+examination of a man who wished to drive one of the "avalanche"
+wagons, as they call them.  The man was asked if he knew how to deal
+with wounded men.  "Oh yes," he answered; "if they're hit here,"
+pointing to the abdomen, "knock 'em on the head,--they can't get
+well."
+
+In art and outside of it you will meet the same barbarisms that
+Ambroise Pare met with,--for men differ less from century to century
+than we are apt to suppose; you will encounter the same opposition,
+if you attack any prevailing opinion, that Sydenham complained of.
+So far as possible, let not such experiences breed in you a contempt
+for those who are the subjects of folly or prejudice, or foster any
+love of dispute for its own sake.  Should you become authors, express
+your opinions freely; defend them rarely.  It is not often that an
+opinion is worth expressing, which cannot take care of itself.
+Opposition is the best mordant to fix the color of your thought in
+the general belief.
+
+It is time to bring these crowded remarks to a close.  The day has
+been when at the beginning of a course of Lectures I should have
+thought it fitting to exhort you to diligence and entire devotion to
+your tasks as students.  It is not so now.  The young man who has not
+heard the clarion-voices of honor and of duty now sounding throughout
+the land, will heed 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 our own blood or stanching that of our
+wounded defenders, students or teachers, whatever our calling and our
+ability, we belong, not to ourselves, but to our imperilled country,
+whose danger is our calamity, whose ruin would be our enslavement,
+whose rescue shall be our earthly salvation!
+
+
+
+
+
+
+SCHOLASTIC AND BEDSIDE TEACHING.
+
+An Introductory Lecture delivered before the Medical Class of Harvard
+University, November 6, 1867.
+
+The idea is entertained by some of our most sincere professional
+brethren, that to lengthen and multiply our Winter Lectures will be
+of necessity to advance the cause of medical education.  It is a fair
+subject for consideration whether they do not overrate the relative
+importance of that particular mode of instruction which forms the
+larger part of these courses.
+
+As this School could only lengthen its lecture term at the expense of
+its "Summer Session," in which more direct, personal, and familiar
+teaching takes the place of our academic discourses, and in which
+more time can be given to hospitals, infirmaries, and practical
+instruction in various important specialties, whatever might be
+gained, a good deal would certainly be lost in our case by the
+exchange.
+
+The most essential part of a student's instruction is 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 indelibly in
+the memory.  Before the student is aware of what he has acquired, he
+has learned the aspects and course and probable issue of the diseases
+he has seen with his teacher, and the proper mode of dealing with
+them, so far as his master knows it.  On the other hand, our ex
+cathedra prelections have a strong tendency to run into details
+which, however interesting they may be to ourselves and a few of our
+more curious listeners, have nothing in them which will ever be of
+use to the student as a practitioner.  It is a perfectly fair
+question whether I and some other American Professors do not teach
+quite enough that is useless already.  Is it not well to remind the
+student from time to time that a physician's business is to avert
+disease, to heal the sick, to prolong life, and to diminish
+suffering?  Is it not true that the young man of average ability will
+find it as much as he can do to fit himself for these simple duties?
+Is it not best to begin, at any rate, by making sure of such
+knowledge as he will require in his daily walk, by no means
+discouraging him from any study for which his genius fits him when he
+once feels that he has become master of his chosen art.
+
+I know that many branches of science are of the greatest value as
+feeders of our medical reservoirs.  But the practising physician's
+office is to draw the healing waters, and while he gives his time to
+this labor he can hardly be expected to explore all the sources that
+spread themselves over the wide domain of science.  The traveller who
+would not drink of the Nile until he had tracked it to its parent
+lakes, would be like to die of thirst; and the medical practitioner
+who would not use the results of many laborers in other departments
+without sharing their special toils, would find life far too short
+and art immeasurably too long.
+
+We owe much to Chemistry, one of the most captivating as well as
+important of studies; but the medical man must as a general rule
+content himself with a clear view of its principles and a limited
+acquaintance with its facts; such especially as are pertinent to his
+pursuits.  I am in little danger of underrating Anatomy or
+Physiology; but as each of these branches splits up into specialties,
+any one of which may take up a scientific life-time, I would have
+them taught with a certain judgment and reserve, so that they shall
+not crowd the more immediately practical branches.  So of all the
+other ancillary and auxiliary kinds of knowledge, I would have them
+strictly subordinated to that particular kind of knowledge for which
+the community looks to its medical advisers.
+
+A medical school is not a scientific school, except just 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 is implied
+in Hufeland's aphorism: "The physician must generalize the disease
+and individualize the patient."
+
+The coordinated and classified results of empirical observation, in
+distinction from scientific experiment, have furnished almost all we
+know about food, the medicine of health, and medicine, the food of
+sickness.  We eat the root of the Solanum tuberosum and throw away
+its fruit; we eat the fruit of the Solanum Lycopersicum and throw
+away its root.  Nothing but vulgar experience has taught us to reject
+the potato ball and cook the tomato.  So of most of our remedies.
+The subchloride of mercury, calomel, is the great British specific;
+the protochloride of mercury, corrosive sublimate, kills like
+arsenic, but no chemist could have told us it would be so.
+
+From observations like these we can obtain certain principles from
+which we can argue deductively to facts of a like nature, but the
+process is limited, and we are suspicious of all reasoning in that
+direction applied to the processes of healthy and diseased life.  We
+are continually appealing to special facts.  We are willing to give
+Liebig's artificial milk when we cannot do better, but we watch the
+child anxiously whose wet-nurse is a chemist's pipkin.  A pair of
+substantial mammary glands has the advantage over the two hemispheres
+of the most learned Professor's brain, in the art of compounding a
+nutritious fluid for 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 not directly useful to the future
+practitioner.  But the over ambitious and active student must not be
+led away by the seduction of knowledge for its own sake from his
+principal pursuit.  The humble beginner, who is alarmed at the vast
+fields of knowledge opened to him, may be encouraged by the assurance
+that with a very slender provision of science, in distinction from
+practical skill, he may be a useful and acceptable member of the
+profession to which the health of the community is intrusted.
+
+To those who are not to engage in practice, the various pursuits of
+science hardly require to be commended.  Only they must not be
+disappointed if they find many subjects treated in our courses as a
+medical class requires, rather than as a scientific class would
+expect, that is, with special limitations and constant reference to
+practical ends.  Fortunately they are within easy reach of the
+highest scientific instruction.  The business of a school like this
+is to make useful working physicians, and to succeed in this it is
+almost as important not to overcrowd the mind of the pupil with
+merely curious knowledge as it is to store it with useful
+information.
+
+In this direction I have written my lecture, not to undervalue any
+form of scientific labor in its place, an unworthy thought from which
+I hope I need not defend myself,--but to discourage any undue
+inflation of the scholastic programme, which even now asks more of
+the student than the teacher is able to obtain from the great
+majority of those who present themselves for examination.  I wish to
+take a hint in education from the Secretary of the Massachusetts
+Board of Agriculture, who regards the cultivation of too much land as
+a great defect in our New England farming.  I hope that our Medical
+Institutions may never lay themselves open to the kind of accusation
+Mr. Lowe brings against the English Universities, when he says that
+their education is made up "of words that few understand and most
+will shortly forget; of arts that can never be used, if indeed they
+can even be learnt; of histories inapplicable to our times; of
+languages dead and even mouldy; of grammatical rules that never had
+living use and are only post mortem examinations; and of statements
+fagoted with utter disregard of their comparative value."
+
+This general thought will be kept in view throughout my somewhat
+discursive address, which will begin with an imaginary clinical
+lesson from the lips of an historical personage, and close with the
+portrait from real life of one who, both as teacher and practitioner,
+was long loved and honored among us.  If I somewhat overrun my hour,
+you must pardon me, for I can say with Pascal that I have not had the
+time to make my lecture shorter.
+
+
+In the year 1647, that good man John Eliot, commonly called the
+Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of
+Cambridge, referring to the great need of medical instruction for the
+Indians, used these words:
+
+"I have thought in my heart that it were a singular good work, if the
+Lord would stirre up the hearts of some or other of his people in
+England to give some maintenance toward some Schoole or Collegiate
+exercise this way, wherein there should be Anatomies and other
+instructions that way, and where there might be some recompence given
+to any that should bring in any vegetable or other thing that is
+vertuous in the way of Physick.
+
+"There is another reason which moves my thought and desires this way,
+namely that our young students in Physick may be trained up better
+then they yet bee, who have onely theoreticall knowledge, and are
+forced to fall to practise before ever they saw an Anatomy 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, did make and read upon very well, but no more of that now."
+
+Since the time of the Apostle Eliot the Lord has stirred up the
+hearts of our people to the building of many Schools and Colleges
+where medicine is taught in all its branches.  Mr. Giles Firmin's
+"Anatomy" may be considered the first ancestor of a long line of
+skeletons which have been dangling and rattling in our lecture-rooms
+for more than a century.
+
+Teaching in New England in 1647 was a grave but simple matter.  A
+single person, combining in many cases, as in that of Mr. Giles
+Firmin, the offices of physician and preacher, taught what he knew to
+a few disciples whom he gathered about him.  Of the making of that
+"Anatomy" on which my first predecessor in the branch I teach" did
+read very well" we can know nothing.  The body of some poor wretch
+who had swung upon the gallows, was probably conveyed by night to
+some lonely dwelling at the outskirts of the village, and there by
+the light of flaring torches hastily dissected by hands that trembled
+over the unwonted task.  And ever and anon the master turned to his
+book, as he laid bare the mysteries of the hidden organs; to his
+precious Vesalius, it might be, or his figures repeated in the
+multifarious volume of Ambroise Pare; to the Aldine octavo in which
+Fallopius recorded his fresh observations; or that giant folio of
+Spigelius just issued from the press of Amsterdam, in which lovely
+ladies display their viscera with a coquettish grace implying that it
+is rather a pleasure than otherwise to show the lace-like omentum,
+and hold up their appendices epiploicae as if they were saying "these
+are our jewels."
+
+His teaching of medicine was no doubt chiefly clinical, and received
+with the same kind of faith as that which accepted his words from the
+pulpit.  His notions of disease were based on what he had observed,
+seen always in the light of the traditional doctrines in which he was
+bred.  His discourse savored of the weighty doctrines of Hippocrates,
+diluted by the subtle speculations of Galen, reinforced by the
+curious comments of the Arabian schoolmen as they were conveyed in
+the mellifluous language of Fernelius, blended, it may be, with
+something of the lofty mysticism of Van Helmont, and perhaps stealing
+a flavor of that earlier form of Homoeopathy which had lately come to
+light in Sir Kenelm Digby's "Discourse concerning the 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 Licetus
+and saw figures of a lion with the head of a woman, and a man with
+the head of an elephant.  He had offered to his gaze, as born of a
+human mother, the effigy of a winged cherub, a pterocephalous
+specimen, which our Professor of Pathological Anatomy would hardly
+know whether to treat with the reverence due to its celestial aspect,
+or to imprison in one of his immortalizing jars of alcohol.
+
+His pharmacopoeia consisted mainly of simples, such as the venerable
+"Herball" of Gerard describes and figures in abounding affluence.
+St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron
+and Parsley, Elder and Snake-root, with opium in some form, and
+roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of
+which it used to be said that whatever the Tacamahaca has not cured,
+the Caranna will, with the more familiar Scammony and Jalap and Black
+Hellebore, made up a good part of his probable list of remedies.  He
+would have ordered Iron now and then, and possibly an occasional dose
+of Antimony.  He would perhaps have had a rheumatic patient wrapped
+in the skin of a wolf or a wild cat, and in case of a malignant fever
+with "purples" or petechiae, or of an obstinate king's evil, he might
+have prescribed a certain black powder, which had been made by
+calcining toads in 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 doctoring as well as against some
+more modern styles of medication.  Barbeyrac and his scholar Sydenham
+had not yet cleansed the Pharmacopoeia of its perilous stuff, but
+there is no doubt that the more sensible physicians of that day knew
+well enough that a good honest herb-tea which amused the patient and
+his nurses was all that was required to carry him through all common
+disorders.
+
+The student soon learned the physiognomy of disease by going about
+with his master; fevers, pleurisies, asthmas, dropsies, fluxes,
+small-pox, sore-throats, measles, consumptions.  He saw what was done
+for them.  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 he could give his whole attention to
+them.  Chirurgery was a separate specialty.  Women in child-birth
+were cared for by midwives.  There was no chemistry deserving the
+name to require his study.  He did not learn a great deal, perhaps,
+but what he did learn was his business, namely, how to take care of
+sick people.
+
+Let me give you a picture of the old=fashioned way of instruction, by
+carrying you with me in imagination in the company of worthy Master
+Giles Firmin as he makes his round of visits among the good folk of
+Ipswich, followed by his one student, who shall answer to the
+scriptural name of Luke.  It will not be for entertainment chiefly,
+but to illustrate the one mode of teaching which can never be
+superseded, and which, I venture to 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 fellow is bellowing with
+colic.
+
+"He will die, Master, of a surety, methinks," says the timid youth in
+a whisper.
+
+"Nay, Luke," the Master answers, "'t is but a dry belly-ache.  Didst
+thou not mark that he stayed his roaring when I did press hard over
+the lesser bowels?  Note that he hath not the pulse of them with
+fevers, and by what Dorcas telleth me there hath been no long
+shutting up of the vice naturales.  We will steep certain comforting
+herbs which I will shew thee, and put them in a bag and lay them on
+his belly.  Likewise he shall have my cordial julep with a portion of
+this confection which we do call Theriaca Andromachi, which hath
+juice of poppy in it, and is a great stayer of anguish.  This fellow
+is at his prayers to-day, but I warrant thee he shall be swearing
+with the best of them to-morrow."
+
+They jog along the bridle-path on their horses until they come to
+another lowly dwelling.  They sit a while with a delicate looking
+girl in whom the ingenuous youth naturally takes a special interest.
+The good physician talks cheerfully with her, asks her a few
+questions.  Then to her mother: "Good-wife, Margaret hath somewhat
+profited, as she telleth, by the goat's milk she hath taken night and
+morning.  Do thou pluck a maniple--that is an handful--of the plant
+called Maidenhair, and make a syrup therewith as I have shewed thee.
+Let her take a cup full of the same, fasting, before she sleepeth,
+also before she riseth from her bed."  And so they leave the house.
+
+"What thinkest thou, Luke, of the maid we have been visiting?"  "She
+seemeth not much ailing, Master, according to my poor judgment.  For
+she did say she was better.  And she had a red cheek and a bright
+eye, and she spake of being soon able to walk unto the meeting, and
+did seem greatly hopeful, but spare of flesh, methought, and her
+voice something 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, and mayhap speedily.  But
+it is not here with us she shall be well.  For that redness of the
+cheek is but the sign of the fever which, after the Grecians, we do
+call the hectical; and that shining of the eyes is but a sickly
+glazing, and they which do every day get better and likewise thinner
+and weaker shall find that way leadeth to the church-yard gate.  This
+is the malady which the ancients did call tubes, or the wasting
+disease, and some do name the consumption.  A disease whereof most
+that fall ailing do perish.  This Margaret is not long for earth--but
+she knoweth it not, and still hopeth."
+
+"Why, then, Master, didst thou give her of thy medicine, seeing that
+her ail is unto death?"
+
+"Thou shalt learn, boy, that they which are sick must have somewhat
+wherewith to busy their thoughts.  There be some who do give these
+tabid or consumptives a certain posset made with lime-water and anise
+and liquorice and raisins of the sun, and there be other some who do
+give the juice of craw-fishes boiled in barley-water with chicken-
+broth, but these be toys, as I do think, and ye shall find as good
+virtue, nay better, in this syrup of the simple called Maidenhair."
+
+Something after this manner might Master Giles Firmin have delivered
+his clinical instructions.  Somewhat in this way, a century and a
+half later, another New England physician, Dr. Edward Augustus
+Holyoke, taught a young man who came to study with him, a very
+diligent and intelligent youth, James Jackson by name, the same whose
+portrait in his advanced years hangs upon this wall, long the honored
+Professor of Theory and Practice in this Institution, of whom I shall
+say something in this Lecture.  Our venerated Teacher studied
+assiduously 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. Woodville once.
+
+When I compare this direct transfer of the practical experience of a
+wise man into the mind of a student,--every fact one that he can use
+in the battle of life and death,--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 concede that our
+forefathers taught too little, there is not--a possibility that we
+may sometimes attempt to teach too much.  I almost blush when I think
+of myself as describing the eight several facets on two slender
+processes of the palate bone, or the seven little twigs that branch
+off from the minute tympanic nerve, and I wonder whether my excellent
+colleague feels in the same way when he pictures himself as giving
+the constitution of neurin, which as he and I know very 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 students can 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 addressing the
+Anatomist and the Chemist in tones of contemptuous indignation: "What
+is this stuff with which you are cramming the brains of young men who
+are to hold the lives of the community in their hands?  Here is a man
+fallen in a fit; you can tell me all about the eight surfaces of the
+two processes of the palate bone, but you have not had the sense to
+loosen that man's neck-cloth, and the old women are all calling you a
+fool?  Here is a fellow that has just swallowed poison.  I want
+something to turn his stomach inside out at the shortest notice.  Oh,
+you have forgotten the dose of the sulphate of zinc, but you remember
+the formula for the production of alloxan!"
+
+"Look you, Master Doctor,--if I go to a carpenter to come and stop a
+leak in my roof that is flooding the house, do you suppose I care
+whether he is a botanist or not?  Cannot a man work in wood without
+knowing all about endogens and exogens, or must he attend Professor
+Gray's Lectures before he can be trusted to make a box-trap?  If my
+horse casts a shoe, do you think I will not trust a blacksmith to
+shoe him until I have made sure that he is sound on the distinction
+between the sesquioxide and the protosesquioxide of iron?"
+
+--But my scientific labor is to lead to useful results by and by, in
+the next generation, or in some possible remote future.--
+
+"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,--
+"what is that to me and my colic, to me and my strangury?  I pay the
+Captain of the Cunard steamship to carry me quickly and safely to
+Liverpool, not to make a chart of the Atlantic for after voyagers!
+If Professor Peirce undertakes to pilot me into Boston Harbor and
+runs me on Cohasset rocks, what answer is it to tell me that he is
+Superintendent of the Coast Survey?  No, Sir!  I want a plain man in
+a pea-jacket and a sou'wester, who knows the channel of Boston
+Harbor, and the rocks of Boston Harbor, and the distinguished
+Professor is quite of my mind as to the matter, for I took the pains
+to ask him before I ventured to use his name in the way of
+illustration."
+
+
+I do not know how the remarks of the image-breaker may strike others,
+but I feel that they put me on my defence with regard to much of my
+teaching.  Some years ago I ventured to show in an introductory
+Lecture how very small a proportion of the anatomical facts taught in
+a regular course, as delivered by myself and others, had any
+practical bearing whatever on the treatment of disease.  How can I,
+how can any medical teacher justify himself in teaching anything that
+is not like to be of practical use to a class of young men who are to
+hold in their hands the balance in which life and death, ease and
+anguish, happiness and wretchedness are to be daily weighed?
+
+I hope we are not all wrong.  Oftentimes in finding how sadly
+ignorant of really essential and vital facts and rules were some of
+those whom we had been larding with the choicest scraps of science, I
+have doubted whether the old one-man system of teaching, when the one
+man was of the right sort, did not turn out better working physicians
+than our more elaborate method.  The best practitioner I ever knew
+was mainly shaped to excellence in that way.  I can understand
+perfectly the regrets of my friend Dr. John Brown of Edinburgh, for
+the good that was lost with the old apprenticeship system.  I
+understand as well Dr. Latham's fear "that many men of the best
+abilities and good education will be deterred from prosecuting physic
+as a profession, in consequence of the necessity indiscriminately
+laid upon all for impossible attainments."
+
+I feel therefore impelled to say a very few words in defence of that
+system of teaching adopted in our Colleges, by which we wish to
+supplement and complete the instruction given by private individuals
+or by what are often called Summer Schools.
+
+The reason why we teach so much that is not practical and in itself
+useful, is because we find that the easiest way of teaching what is
+practical and useful.  If we could in any way eliminate all that
+would help a man to deal successfully with disease, and teach it by
+itself so that it should be as tenaciously rooted in the memory, as
+easily summoned when wanted, as fertile in suggestion of related
+facts, as satisfactory to the peremptory demands of the intelligence
+as if taught in its scientific connections, I think it would be our
+duty so to teach the momentous truths of medicine, and to regard all
+useless additions as an intrusion on the time which should be
+otherwise occupied.
+
+But we cannot successfully eliminate and teach by itself that which
+is purely practical.  The easiest and surest why of acquiring facts
+is to learn them in groups, in systems, and systematized knowledge is
+science.  You can very often carry two facts fastened together more
+easily than one by itself, as a housemaid can carry two pails of
+water with a hoop more easily than one without it.  You can remember
+a man's face, made up of many features, better than you can his nose
+or his mouth or his eye-brow.  Scores of proverbs show you that you
+can remember two lines that rhyme better than one without the jingle.
+The ancients, who knew the laws of memory, grouped the seven cities
+that contended for the honor of being Homer's birthplace in a line
+thus given by Aulus Gellius:
+
+Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
+
+I remember, in the earlier political days of Martin Van Buren, that
+Colonel Stone, of the "New York Commercial," or one of his
+correspondents, said that six towns of New York would claim in the
+same way to have been the birth-place of the "Little Magician," as he
+was then called; and thus he gave their names, any one of which I
+should long ago have forgotten, but which as a group have stuck tight
+in my memory from that day to this;
+
+Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
+
+If the memory gains so much by mere rhythmical association, how much
+more will it gain when isolated facts are brought together under laws
+and principles, when organs are examined in their natural
+connections, when structure is coupled with function, and healthy and
+diseased action are studied as they pass one into the other!
+Systematic, or scientific study is invaluable as supplying a natural
+kind of mnemonics, if for nothing else.  You cannot properly learn
+the facts you want from Anatomy and Chemistry in any way so easily as
+by taking them in their regular order, with other allied facts, only
+there must be common sense exercised in leaving out a great deal
+which belongs to each of the two branches as pure science.  The
+dullest of teachers is the one who does not know what to omit.
+
+The larger aim of scientific training is to furnish you with
+principles to which you will be able to refer isolated facts, and so
+bring these within the range of recorded experience.  See what the
+"London Times" said about the three Germans who cracked open John
+Bull Chatwood's strong-box at the Fair the other day, while the three
+Englishmen hammered away in vain at Brother Jonathan Herring's.  The
+Englishmen represented brute force.  The Germans had been trained to
+appreciate principle.  The Englishman "knows his business by rote and
+rule of thumb"--science, which would "teach him to do in an hour what
+has hitherto occupied him two hours," "is in a manner forbidden to
+him."  To this cause the "Times" attributes the falling off of
+English workmen in comparison with those of the Continent.
+
+Granting all this, we must not expect too much from "science" as
+distinguished from common experience.  There are ten thousand
+experimenters without special apparatus for every one in the
+laboratory.  Accident is the great chemist and toxicologist.  Battle
+is the great vivisector.  Hunger has instituted researches on food
+such as no Liebig, no Academic Commission has ever recorded.
+
+Medicine, sometimes impertinently, often ignorantly, often carelessly
+called "allopathy," appropriates everything from every source that
+can be of the slightest use to anybody who is ailing in any way, or
+like to be ailing from any cause.  It learned from a monk how to use
+antimony, from a Jesuit how to cure agues, from a friar how to cut
+for stone, from a soldier how 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 from an old market-
+woman how to catch the itch-insect.  It borrowed acupuncture and the
+moxa from the Japanese heathen, and was taught the use of lobelia by
+the American savage.  It stands ready to-day to accept anything from
+any theorist, from any empiric who can make out a good case for his
+discovery or his remedy.  "Science" is one of its benefactors, but
+only one, out of many.  Ask the wisest practising physician you know,
+what branches of science help him habitually, and what amount of
+knowledge relating to each branch he requires for his professional
+duties.  He will tell you that scientific training has a value
+independent of all the special knowledge acquired.  He will tell you
+that many facts are explained by studying them in the wider range of
+related facts to which they belong.  He will gratefully recognize
+that the anatomist has furnished him with indispensable data, that
+the physiologist has sometimes put him on the track of new modes of
+treatment, that the chemist has isolated the active principles of his
+medicines, has taught him how to combine them, has from time to time
+offered him new remedial agencies, and so of others of his allies.
+But he will also tell you, if I am not mistaken, that his own branch
+of knowledge is so extensive and so perplexing that he must accept
+most of his facts ready made at their hands.  He will own to you that
+in the struggle for life which goes on day and night in our thoughts
+as in the outside world of nature, much that he learned under the
+name of science has died out, and that simple homely experience has
+largely taken the place of that scholastic knowledge to which he and
+perhaps some of his instructors once attached a paremount importance.
+
+This, then, is my view of scientific training as conducted in courses
+such as you are entering on.  Up to a certain point I believe in set
+Lectures as excellent adjuncts to what is far more important,
+practical instruction at the bedside, in the operating room, and
+under the eye of the Demonstrator.  But I am so far from wishing
+these courses extended, that I think some of them--suppose I say my
+own--would almost bear curtailing.  Do you want me to describe more
+branches of the sciatic and crural nerves?  I can take Fischer's
+plates, and lecturing on that scale fill up my whole course and not
+finish the nerves alone.  We must stop somewhere, and for my own part
+I think the scholastic exercises of our colleges have already claimed
+their full share of the student's time without our seeking to extend
+them.
+
+I trust I have vindicated the apparent inconsequence of teaching
+young students a good deal that seems at first sight profitless, but
+which helps them to learn and retain what is profitable.  But this is
+an inquisitive age, and if we insist on piling up beyond a certain
+height knowledge which is in itself mere trash and lumber to a man
+whose life is to be one long fight with death and disease, there will
+be some sharp questions asked by and by, and our quick-witted people
+will perhaps find they can get along as well without the professor's
+cap as without the bishop's mitre and the monarch's crown.
+
+I myself have nothing to do with clinical teaching.  Yet I do not
+hesitate to say it is more essential than all the rest put together,
+so far as the ordinary practice of medicine is concerned; and this is
+by far the most important thing to be learned, because it deals with
+so many more lives than any other branch of the profession.  So of
+personal instruction, such as we give and others give in the interval
+of lectures, much of it at the bedside, some of it in the laboratory,
+some in the microscope-room, some in the recitation-room, I think it
+has many advantages of its own over the winter course, and I do not
+wish to see it shortened for the sake of prolonging what seems to me
+long enough already.
+
+If I am jealous of the tendency to expand the time given to the
+acquisition of curious knowledge, at the expense of the plain old-
+fashioned bedside teachings, I only share the feeling which Sydenham
+expressed two hundred years ago, using an image I have already
+borrowed.  "He would be no honest and successful pilot who was to
+apply himself with less industry to avoid rocks and sands and bring
+his vessel safely home, than to search into the causes of the ebbing
+and flowing of the sea, which, though very well for a philosopher, is
+foreign to him whose business it is to secure the ship.  So neither
+will a physician, whose province it is to cure diseases, be able to
+do so, though he be a person of great genius, who bestows less time
+on the hidden and intricate method of nature, and adapting his means
+thereto, than on curious and subtle speculation."
+
+"Medicine is my wife and Science is my mistress," said Dr. Rush.  I
+do not think that the breach of the seventh commandment can be shown
+to have been of 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 studied under him, whether
+Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
+that man is the minister and interpreter of Nature, or whether he did
+not speak habitually of Nature as an intruder in the sick room, from
+which his art was to expel her as an incompetent and a meddler.
+
+All a man's powers are not too much for such a profession as
+Medicine.  "He is a learned man," said old Parson Emmons of Franklin,
+"who understands one subject, and he is a very learned man who
+understands two subjects."  Schonbein says he has been studying
+oxygen for thirty years.  Mitscherlich said it took fourteen years to
+establish a new fact in chemistry.  Aubrey says of Harvey, the
+discoverer of the circulation, that "though all his profession would
+allow him to be an excellent anatomist, I have never heard of any who
+admired his therapeutic way."  My learned and excellent friend before
+referred to, Dr. Brown of Edinburgh, from whose very lively and
+sensible Essay, "Locke and Sydenham," I have borrowed several of my
+citations, contrasts Sir Charles Bell, the discoverer, the man of
+science, with Dr. Abercrombie, the master in the diagnosis and
+treatment of disease.  It is through one of the rarest of
+combinations that we have in our Faculty a teacher on whom the
+scientific mantle of Bell has fallen, and who yet stands preeminent
+in the practical treatment of the class of diseases which his
+inventive and ardent experimental genius has illustrated.  M. Brown-
+Sequard's example is as, eloquent as his teaching in proof of the
+advantages of well directed scientific investigation.  But those who
+emulate his success at once as a discoverer and a practitioner must
+be content like him to limit their field of practice.  The highest
+genius cannot afford 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 dissecting an animal.  I should not have
+cared to be his patient.  His dissection would do me no good, and his
+thoughts would be too much upon it.  I want a whole man for my
+doctor, not a half one.  I would have sent for a humbler
+practitioner, who would have given himself entirely to me, and told
+the other--who was no less a man than John Hunter--to go on and
+finish the dissection of his tiger.
+
+Sydenham's "Read Don Quixote" should be addressed not to the student,
+but to the Professor of today.  Aimed at him it means, "Do not be too
+learned."
+
+Do not think you are going to lecture to picked young men who are
+training themselves to be scientific discoverers.  They are of fair
+average capacity, and they are going to be working doctors.
+
+These young men are to have some very serious vital facts to deal
+with.  I will mention a few of them.
+
+Every other resident adult you meet in these streets is or will be
+more or less tuberculous.  This is not an extravagant estimate, as
+very nearly one third of the deaths of adults in Boston last year
+were from phthisis.  If the relative number is less in our other
+northern cities, it is probably in a great measure because they are
+more unhealthy; that is, 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 ganglia and thinking-marrows brown as their
+own meerschaums, of whom you meet too many,--will ask all your wisdom
+to deal with their poisoned nerves and their enfeebled wills.
+
+Nearly seventeen hundred children under five years of age died last
+year in this city.  A poor human article, no doubt, in many cases,
+still, worth an attempt to save them, especially when we remember the
+effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
+some twenty-five or thirty thousand children's lives have probably
+been saved in a single city.
+
+Again, the complaint is often heard that the native population is not
+increasing so rapidly as in former generations.  The breeding and
+nursing period of American women is one of peculiar delicacy and
+frequent infirmity.  Many of them must require a considerable
+interval between the reproductive efforts, to repair damages arid
+regain strength.  This matter is not to be decided by an appeal to
+unschooled nature.  It is the same question as that of the deformed
+pelvis,--one of degree.  The facts of mal-vitalization are as much to
+be attended to as those of mal-formation.  If the woman with a
+twisted pelvis is to be considered an exempt, the woman with a
+defective organization should be recognized as belonging to the
+invalid corps.  We shudder to hear what is alleged as to the
+prevalence of criminal practices; if back of these there can be shown
+organic incapacity or overtaxing of too limited powers, the facts
+belong to the province of the practical physician, as well as of the
+moralist and the legislator, and require his gravest consideration.
+
+Take the important question of bleeding.  Is venesection done with
+forever?  Six years ago it was said here in an introductory Lecture
+that it would doubtless come back again sooner or later.  A fortnight
+ago I found myself in the cars with one of the most sensible and
+esteemed practitioners in New England.  He took out his wallet and
+showed me two lancets, which he 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 does harm.  The caution with reference to it on this ground
+was long ago recorded in the Lecture above referred to.  See what Dr.
+John Hughes Bennett says of it in the recent edition of his work on
+Medicine.  Nothing but the most careful clinical experience can
+settle this and such points of treatment.
+
+These are all practical questions--questions of life and death, and
+every day will be full of just such questions.  Take the problem of
+climate.  A patient comes to you with asthma and wants to know where
+he can breathe; another comes to you with phthisis and wants to know
+where he can live.  What boy's play is nine tenths of all that is
+taught in many a pretentious course of lectures, compared with what
+an accurate and extensive knowledge of the advantages and
+disadvantages of different residences in these and 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, with the entire relief of certain
+obscure thoracic symptoms which troubled him while at home.  I saw,
+two months ago, another gentleman from Minnesota, an observer and a
+man of sense, who considered that State as the great sanatorium for
+all pulmonary complaints.  If half our grown population are or will
+be more or less tuberculous, the question of colonizing Florida
+assumes a new aspect.  Even within the borders of our own State, the
+very interesting researches of Dr. Bowditch show that there is a
+great variation in the amount of tuberculous disease in different
+towns, apparently connected with local conditions.  The hygienic map
+of a State is quite as valuable as its geological map, and it is the
+business of every practising physician to know it thoroughly.  They
+understand this in England, and send a patient with a dry irritating
+cough to Torquay or Penzance, while they send another with relaxed
+bronchial membranes to Clifton or Brighton.  Here is another great
+field 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 quantity
+and 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 sleeping rooms, is the great cause of tubercle.
+It is sufficiently proved that the American,--the New Englander,--the
+Bostonian, can breed strong and sound children, generation after
+generation,--nay, I have shown by the record of a particular family
+that vital losses may be retrieved, and a feeble race grow to lusty
+vigor in this very climate and locality.  Is not the question why our
+young men and women so often break down, and how they can be kept
+from breaking down, far more important for physicians to settle than
+whether there is one cranial vertebra, or whether there are four, or
+none?
+
+--But I have a taste for the homologies, I want to go deeply into the
+subject of embryology, I want to analyze the protonihilates
+precipitated from pigeon's milk by the action of the lunar spectrum,-
+shall I not follow my star,--shall I not obey my instinct,--shall I
+not give myself to the lofty pursuits of science for its own sake?
+
+Certainly you may, if you like.  But take down your sign, or never
+put it up.  That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
+Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
+difficulty.  We all admire the achievements of 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 six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
+guerre,"--it is very splendid, but it is not a practising doctor's
+business.  His patient has a right to the cream of his life and not
+merely to the thin milk that is left after "science" has skimmed it
+off.  The best a physician can give is never too good for the
+patient.
+
+It is often a disadvantage to a young practitioner to be known for
+any accomplishment outside of his profession.  Haller lost his
+election as Physician to the Hospital in his native city of Berne,
+principally on the ground that he was a poet.  In his later years the
+physician may venture more boldly.  Astruc was sixty-nine years old
+when he published his "Conjectures," the first attempt, we are told,
+to decide the authorship of the Pentateuch showing anything like a
+discerning criticism.  Sir Benjamin Brodie was seventy years old
+before he left his physiological and surgical studies to indulge in
+psychological speculations.  The period of pupilage will be busy
+enough in acquiring the knowledge needed, and the season of active
+practice will leave little leisure for any but professional studies.
+
+Dr. Graves of Dublin, one of the first clinical teachers of our time,
+always insisted on his students' beginning at once to visit the
+hospital.  At the bedside the student must learn to treat disease,
+and just as certainly as we spin out and multiply our academic
+prelections we shall work in more and more stuffing, more and more
+rubbish, more and more irrelevant, useless detail which the student
+will get rid of just as soon as he leaves us.  Then the next thing
+will be a new organization, with an examining board of first-rate
+practical men, who will ask the candidate questions that mean
+business,--who will make him operate if he is to be a surgeon, and
+try him at the bedside if he is to be a physician,--and not puzzle
+him with scientific conundrums which not more than one of the
+questioners could answer himself or ever heard of since he graduated.
+
+Or these women who are hammering at the gates on which is written "No
+admittance for the mothers of mankind," will by and by organize an
+institution, which starting from that skilful kind of nursing which
+Florence Nightingale taught so well, will work backwards through
+anodynes, palliatives, curatives, preventives, until with little show
+of science it imparts most of what is most valuable in those branches
+of the healing art it professes to teach.  When that time comes, the
+fitness of women for certain medical duties, which Hecquet advocated
+in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
+the honored Professor of Theory and Practice in this Institution,
+upheld within our own recollection in the face of his own recorded
+opinion to the contrary, will very possibly be recognized.
+
+My advice to every teacher less experienced than myself would be,
+therefore: Do not fret over the details you have to omit; you
+probably teach altogether too many as it is.  Individuals may learn a
+thing with once hearing it, but the only way of teaching a whole
+class is by enormous repetition, representation, and illustration in
+all possible forms.  Now and then you will have a young man on your
+benches like the late Waldo Burnett,--not very often, if you lecture
+half a century.  You cannot pretend to lecture chiefly for men like
+that,--a Mississippi raft might as well take an ocean-steamer in tow.
+To meet his wants you would have to leave the rest of your class
+behind and that you must not do.  President Allen of Jefferson
+College says that his instruction has been successful in proportion
+as it has been elementary.  It may be a humiliating statement, but it
+is one which I have found true in my own experience.
+
+To the student I would say, that however plain and simple may be our
+teaching, he must expect to forget much 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 voluntarily recall,--
+they are outside the limits of the will.  But they sway our conscious
+thought as the unseen planets influence the movements of those within
+the sphere of vision.  No man knows how much he knows,--how many
+ideas he has,--any more than he knows how many blood-globules roll in
+his veins.  Sometimes accident brings back here and there one, but
+the mind is full of irrevocable remembrances and unthinkable
+thoughts, which take a part in all its judgments as indestructible
+forces.  Some of you must feel your scientific deficiencies painfully
+after your best efforts.  But every one can acquire what is most
+essential.  A man of very moderate ability may be a good physician,
+if he devotes himself faithfully to the work.  More than this, a
+positively dull man, in the ordinary acceptation of the term,
+sometimes makes a safer practitioner than one who has, we will say,
+five per cent. more brains than his average neighbor, but who thinks
+it is fifty per cent. more.  Skulls belonging to this last variety of
+the human race are more common, I may remark, than specimens like the
+Neanderthal cranium, a cast of which you will find on the table in
+the Museum.
+
+Whether the average talent be high or low, the Colleges of the land
+must make the best commodity they can out of such material as the
+country and the cities furnish them.  The community must have Doctors
+as it must have bread.  It uses up its Doctors just as it wears out
+its shoes, and requires new ones.  All the bread need not be French
+rolls, all the shoes need not be patent leather ones; but the bread
+must be something that can be eaten, and the shoes must be something
+that can be worn.  Life must somehow find food for the two forces
+that rub everything to pieces, or burn it to ashes,--friction and
+oxygen.  Doctors are oxydable products, and the schools must keep
+furnishing new ones as the old ones turn into oxyds; some of first-
+rate quality that burn with 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 competent worker in
+the healing art a hearty welcome.  It is on the whole very loyal to
+the Medical Profession.  Three successive years have borne witness to
+the feeling with which this Institution, representing it in its
+educational aspect, is regarded by those who are themselves most
+honored and esteemed.  The great Master of Natural Science bade the
+last year's class farewell in our behalf, in those accents which
+delight every audience.  The Head of our ancient University honored
+us in the same way in the preceding season.  And how can we forget
+that other occasion when the Chief Magistrate of the Commonwealth,
+that noble citizen whom we have just lost, large-souled, sweet-
+natured, always ready for every kind office, came among us at our
+bidding, and talked to us of our duties in words as full of wisdom as
+his heart was of goodness?
+
+You have not much to fear, I think, from the fancy practitioners.
+The vulgar quackeries drop off, atrophied, one after another.
+Homoeopathy has long been encysted, and is carried on the body
+medical as quietly as an old wen.  Every year gives you a more
+reasoning and reasonable people to deal with.  See how it is in
+Literature.  The dynasty of British dogmatists, after lasting a
+hundred years and more, is on its last legs.  Thomas Carlyle, third
+in the line of descent, finds an audience very different from those
+which listened to the silver speech of Samuel Taylor Coleridge and
+the sonorous phrases of Samuel Johnson.  We read him, we smile at his
+clotted English, his "swarmery" and other picturesque expressions,
+but we lay down his tirade as we do one of Dr. Cumming's
+interpretations of prophecy, which tells us that the world is coming
+to an end next week or next month, if the weather permits,--not
+otherwise,--feeling very sure that the weather will be unfavorable.
+
+It is the same common-sense public you will appeal to.  The less
+pretension you make, the better they will like you in the long run.
+I hope we shall make everything as plain and as simple to you as we
+can.  I would never use a long word, even, where a short one would
+answer the purpose.  I know there are professors in this country who
+"ligate" arteries.  Other surgeons only tie them, and it stops the
+bleeding just as well.  It is the familiarity and simplicity of
+bedside instruction which makes it so pleasant as well as so
+profitable.  A good clinical teacher is himself a Medical School.  We
+need not wonder that our young men are beginning to announce
+themselves not only as graduates of this or that College, but also as
+pupils of some one distinguished master.
+
+I wish to close this Lecture, if you will allow me a few moments
+longer, with a brief sketch of an instructor and practitioner whose
+character was as nearly a model one in both capacities as I can find
+anywhere recorded.
+
+Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
+in this University from 1812 to 1846, and whose name has been since
+retained on our rolls as Professor Emeritus, died on the 27th of
+August 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 physicians who have borne witness to their knowledge
+of the laws of life by living to complete their hundredth year.  I
+think the student took his Old Master, as he always loved to call
+him, as his model; each was worthy of the other, and both were bright
+examples to all who come after them.
+
+I remember that in the sermon preached by Dr. Grazer after Dr.
+Holyoke's death, one of the points most insisted upon as
+characteristic of that wise and good old man was the perfect balance
+of all his faculties.  The same harmonious adjustment of powers, the
+same symmetrical arrangement of life, the same complete fulfilment of
+every day's duties, without haste and without needless delay, which
+characterized the master, equally distinguished the scholar.  A
+glance at the life of our own Old Master, if I can do any justice at
+all to his excellences, will give you something to carry away from
+this hour's meeting not unworthy to be remembered.
+
+From December, 1797, to October, 1799, he remained with Dr. Holyoke
+as a student, a period which he has spoken of as a most interesting
+and most gratifying part of his life.  After this he passed eight
+months in London, and on his return, in October, 1800, he began
+business in Boston.
+
+He had followed Mr. Cline, as I have mentioned, and was competent to
+practise Surgery.  But he found Dr. John Collins Warren had already
+occupied the ground which at that day hardly called for more than one
+leading practitioner, and wisely chose the Medical branch of the
+profession.  He had only himself to rely upon, but he had confidence
+in his prospects, conscious, doubtless, of his own powers, knowing
+his own industry and determination, and being of an eminently
+cheerful and hopeful disposition.  No better proof of his spirit can
+be given than that, just a year from the time when he began to
+practise as a physician, he took that eventful step which in such a
+man implies that he sees his way clear to a position; he married a
+lady blessed with many gifts, but not bringing him a fortune to
+paralyze his industry.
+
+He had not miscalculated his chances in life.  He very soon rose into
+a good practice, and began the founding of that reputation which grew
+with his years, until he stood by general consent at the head of his
+chosen branch of the profession, to say the least, in this city and
+in all this region of country.  His skill and wisdom were the last
+tribunal to which the sick and suffering could appeal.  The community
+trusted and loved him, the profession recognized him as the noblest
+type of the physician.  The young men 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 older and
+began to think more of their ability to help the sick than their
+power of talking about phenomena, they began to look back to the
+teaching of Dr. Jackson, as he, after his London experience, looked
+back to that of Dr. Holyoke.  And so it came to be at last that the
+bare mention of his name in any of our medical assemblies would call
+forth such a tribute of affectionate regard as is only yielded to age
+when it brings with it the record of a life spent in well doing.
+
+No accident ever carries a man to eminence such as his in the medical
+profession.  He who looks for it must want it earnestly and work for
+it vigorously; Nature must have qualified him in many ways, and
+education must have equipped him with various knowledge, or his
+reputation will evaporate before it reaches the noon-day blaze of
+fame.  How did Dr. Jackson gain the position which all conceded to
+him?  In the answer to this question some among you may find a key
+that shall unlock the gate opening on that fair field of the future
+of 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 occupation enough to apply at the bedside the best of all that
+he knew for the good of his patient; to protect the community against
+the inroads of pestilence; to teach the young all that he himself had
+been taught, with all that his own experience had added; to leave on
+record some of the most important results of his long observation.
+
+With his patients he was so perfect at all points that it is hard to
+overpraise him.  I have seen many noted British and French and
+American practitioners, but I never saw the man so altogether
+admirable at the bedside of the sick as Dr. James Jackson.  His smile
+was itself a remedy better than the potable gold and the dissolved
+pearls that comforted the praecordia of mediaeval monarchs.  Did a
+patient, alarmed without cause, need encouragement, it carried the
+sunshine of hope into his heart and put all his whims to flight, as
+David's harp cleared the haunted chamber 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 heart felt it.  So
+gentle was he, so thoughtful, so calm, so absorbed in the case before
+him, not to turn round and look for a tribute to his sagacity, not to
+bolster himself in a favorite theory, but to find out all he could,
+and to weigh gravely and cautiously all that he found, that to follow
+him in his morning visit was 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 visit with Dr. Jackson was a
+medical education.
+
+He was very firm, with all his kindness.  He would have the truth
+about his patients.  The nurses found it out; and the shrewder ones
+never ventured to tell him anything but a straight story.  A clinical
+dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
+in the Massachusetts General Hospital, a mistress in her calling, was
+as good questioning and answering as one would be like to hear
+outside of the court-room.
+
+Of his practice you can form an opinion from his book called "Letters
+to a Young Physician."  Like all sensible men from the days of
+Hippocrates to the present, he knew that diet and regimen were more
+important than any drug or than all drugs put together.  Witness his
+treatment of phthisis and of epilepsy.  He retained, however, more
+confidence in some remedial agents than most of the younger
+generation would concede to them.  Yet his materia medica was 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 of medicines here, and that it will take you long to get
+acquainted with them, but most of them are unimportant.  There are
+four which are equal to all the rest, namely, Mercury, Antimony, Bark
+and Opium.'"  And Dr. Jackson adds, "I can only say of his practice,
+the longer I have lived, I have thought better and better of it."
+When he thought it necessary to give medicine, he gave it in earnest.
+He hated half-practice--giving a little of this or that, so as to be
+able to say that one had done something, in case a consultation was
+held, or a still more ominous event occurred.  He would give opium,
+for instance, as boldly as the late Dr. Fisher of Beverly, but he
+followed the aphorism of the Father of Medicine, and kept extreme
+remedies for extreme cases.
+
+When it came to the "non-naturals," as he would sometimes call them,
+after the old physicians,--namely, air, meat and drink, sleep and
+watching, motion and rest, the retentions and excretions, and the
+affections of the mind,--he was, as I have said, of the school of
+sensible practitioners, in distinction from that vast community of
+quacks, with or without the diploma, who think the chief end of man
+is to support apothecaries, and are never easy until they can get
+every patient upon a regular course of something nasty or noxious.
+Nobody was so precise in his directions about diet, air, and
+exercise, as Dr. Jackson.  He had the same dislike to the a peu pres,
+the about so much, about so often, about so long, which I afterwards
+found among the punctilious adherents of the numerical system at La
+Pitie.
+
+He used to insist on one small point with a certain philological
+precision, namely, the true meaning of the word "cure."  He would
+have it that to cure a patient was simply to care for him.  I refer
+to it as showing what his idea was of the relation of the physician
+to the patient.  It was indeed to care for him, as if his life were
+bound up in him, to watch his incomings and outgoings, to stand guard
+at every avenue that disease might enter, to leave nothing to chance;
+not merely to throw a few pills and powders into one pan of the
+scales of Fate, 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 human power to do it.  Such
+devotion as this is only to be looked for in the man who gives
+himself wholly up to the business of healing, who considers Medicine
+itself a Science, or if not a science, is willing to follow it as an
+art,--the noblest of arts, which the gods and demigods of ancient
+religions did not disdain to practise and to teach.
+
+The same zeal made him always ready to listen to any new suggestion
+which promised to be useful, at a period of life when many men find
+it hard to learn new methods and accept new doctrines.  Few of his
+generation became so accomplished as he in the arts of direct
+exploration; coming straight from the Parisian experts, I have
+examined many patients with him, and have had frequent opportunities
+of observing his skill in percussion and auscultation.
+
+One element in his success, a trivial one compared with others, but
+not to be despised, was his punctuality.  He always carried two
+watches,--I doubt if he told why, any more than Dr. Johnson told what
+he did with the orange-peel,--but probably with reference to this
+virtue.  He was as much to be depended upon at the appointed time as
+the solstice or the equinox.  There was another point I have heard
+him speak of as an important rule with him; to come at the hour when
+he was expected; if he had made his visit for several days
+successively at ten o'clock, for instance, not to put it off, if be
+could possibly help it, until eleven, and so keep a nervous patient
+and an anxious family waiting for him through a long, weary hour.
+
+If I should attempt to characterize his teaching, I should say that
+while it conveyed the best results of his sagacious and extended
+observation, it was singularly modest, cautious, simple, sincere.
+Nothing was for show, for self-love; there was no rhetoric, no
+declamation, no triumphant "I told you so," but the plain statement
+of a clear-headed honest man, who knows that he is handling one of
+the gravest subjects that interest humanity.  His positive
+instructions were full of value, but the spirit in which he taught
+inspired that loyal love of truth which lies at the bottom of all
+real excellence.
+
+I will not say that, during his long career, Dr. Jackson never made
+an enemy.  I have heard him tell how, in his very early days, old Dr.
+Danforth got into a towering passion with him about some professional
+consultation, and exploded a monosyllable or two of the more
+energetic kind on the occasion.  I remember that that somewhat
+peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
+succeeded to his place as Professor of Theory and Practice.  A young
+man of Dr. Jackson's talent and energy could hardly take the position
+that belonged to him without crowding somebody in a profession where
+three in a bed is the common rule of the household.  But he was a
+peaceful man and a peace-maker all his days.  No man ever did more,
+if so much, to produce and maintain the spirit of harmony for which
+we consider our medical community as somewhat exceptionally
+distinguished.
+
+If this harmony should ever be threatened, I could wish that every
+impatient and irritable member of the profession would read that
+beautiful, that noble Preface to the "Letters," addressed to John
+Collins Warren.  I know nothing finer in the medical literature of
+all time than this Prefatory Introduction.  It is a golden prelude,
+fit to go with the three great Prefaces which challenge the
+admiration of scholars,--Calvin's to his Institutes, De Thou's to his
+History, and Casaubon's to his Polybius,--not because of any learning
+or rhetoric, though it is charmingly written, but for a spirit
+flowing through it to which learning and rhetoric are but as the
+breath that is wasted on the air to the Mood that warms the heart.
+
+Of a similar character is this short extract which I am permitted to
+make from a private letter of his to a dear young friend.  He was
+eighty-three years old 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 characters of all men and women.  At first
+I must have done this from something in my own nature, for I was not
+aware of it, and yet was doing it without any plan, when one day,
+sixty years ago, a friend whom I loved and respected said this to me,
+'Ah, James, I see that you are destined to succeed in the world, and
+to make friends, because you are so ready to see the good point in
+the characters of those you meet.'"
+
+I close this imperfect notice of some features in the character of
+this most honored and beloved of physicians by applying to him the
+words which were written of William Heberden, whose career was not
+unlike his own, and who lived to the same patriarchal age.
+
+"From his early youth he had always entertained a deep sense of
+religion, a consummate love of virtue, an ardent thirst after
+knowledge, and an earnest desire to promote the welfare and happiness
+of all mankind.  By these qualities, accompanied with great sweetness
+of manners, he acquired the love and esteem of all good men, in a
+degree which perhaps very few have experienced; and after passing an
+active life with the uniform testimony of a good conscience, he
+became an eminent example of its influence, in the cheerfulness and
+serenity of his latest age."
+
+Such was the man whom I offer to you as a model, young gentlemen, at
+the outset of your medical career.  I hope that many of you will
+recognize some traits of your own special teachers scattered through
+various parts of the land in the picture I have drawn.  Let me assure
+you that whatever you may learn in this or any other course of public
+lectures,--and I trust you will learn a great deal,--the daily
+guidance, counsel, example, of your medical father, for such the Oath
+of Hippocrates tells you to consider your preceptor, will, if he is
+in any degree like him of whom I have spoken, be the foundation on
+which all that we teach is reared, and perhaps outlive most of our
+teachings, as in Dr. Jackson's memory the last lessons that remained
+with him were those of his Old Master.
+
+
+
+
+
+
+THE MEDICAL PROFESSION IN MASSACHUSETTS.
+
+A Lecture of a Course by members of the Massachusetts Historical
+Society, delivered before the Lowell Institute, January 29, 1869.
+
+The medical history of eight generations, told in an hour, must be in
+many parts a mere outline.  The details I shall give will relate
+chiefly to the first century.  I shall only indicate the leading
+occurrences, with the more prominent names of the two centuries which
+follow, and add some considerations suggested by the facts which have
+been passed in review.
+
+A geographer who was asked to describe the tides of Massachusetts
+Bay, would have to recognize the circumstance that they are a limited
+manifestation of a great oceanic movement.  To consider them apart
+from this, would be to localize a planetary phenomenon, and to
+provincialize a law of the universe.  The art of healing in
+Massachusetts has shared more or less fully and readily the movement
+which, with its periods of ebb and flow, has been raising its level
+from age to age throughout the better part of Christendom.  Its
+practitioners brought with them much of the knowledge and many of the
+errors of the Old World; they have always been in communication with
+its wisdom and its folly; it is not without interest to see how far
+the new conditions in which they found themselves have been favorable
+or unfavorable to the growth of sound medical knowledge and practice.
+
+The state of medicine is an index of the civilization of an age and
+country,--one of the best, perhaps, by which it can be judged.
+Surgery invokes the aid of all the mechanical arts.  From the rude
+violences of the age of stone,--a relic of which we may find in the
+practice of Zipporah, the wife of Moses,--to the delicate operations
+of to-day upon patients lulled into temporary insensibility, is a
+progress which presupposes a skill in metallurgy and in the labors of
+the workshop and the laboratory it 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, can find their place
+in our pharmacies, commerce must have perfected its machinery, and
+science must have refined its processes, through periods only to be
+counted by the life of nations.  Before the means which nature and
+art have put in the hands of the medical practitioner can be fairly
+brought into use, the prejudices of the vulgar must be overcome, the
+intrusions of false philosophy must be fenced out, and the
+partnership with the priesthood dissolved.  All this implies that
+freedom and activity of thought which belong only to the most
+advanced conditions of society; and the progress towards this is by
+gradations as significant of wide-spread changes, as are the varying
+states of the barometer of far-extended conditions of 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 trivial and almost unworthy of record.  A
+medical entry in Governor Winthrop's journal may seem at first sight
+a mere curiosity; but, rightly interpreted, it is a key to his whole
+system of belief as to the order of the universe and the relations
+between man and his Maker.  Nothing sheds such light on the
+superstitions of an age as the prevailing interpretation and
+treatment of disease.  When the touch of a profligate monarch was a
+cure for one of the most inveterate of maladies, when the common
+symptoms of hysteria were prayed over as marks of demoniacal
+possession, we might well expect the spiritual realms of thought to
+be peopled with still stranger delusions.
+
+Let us go before the Pilgrims of the Mayflower, and look at the
+shores on which they were soon to land.  A wasting pestilence had so
+thinned the savage tribes that it was sometimes piously interpreted
+as having providentially prepared the way for the feeble band of
+exiles.  Cotton Mather, who, next to the witches, hated the
+"tawnies," "wild beasts," "blood-hounds," "rattlesnakes,"
+"infidels," as in different places he calls the unhappy Aborigines,
+describes the condition of things in his lively way, thus:
+"The Indians in these Parts had newly, even about a Year or Two
+before, been visited with such a prodigious Pestilence; as carried
+away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
+Twenty) among them so that the Woods were almost cleared of those
+pernicious Creatures to make Room for a better Growth."
+
+What this pestilence was has been much discussed.  It is variously
+mentioned by different early writers as "the plague," "a great and
+grievous plague," "a sore consumption," as attended with spots which
+left unhealed places on those who recovered, as making the "whole
+surface yellow as with a garment."  Perhaps no disease answers all
+these conditions so well as smallpox.  We know from different sources
+what frightful havoc it made among the Indians in after years,--in
+1631, for instance, when it swept away the aboriginal inhabitants of
+"whole towns," and in 1633.  We have seen a whole tribe, the Mandans,
+extirpated by it in our own day.  The word "plague" was used very
+vaguely, as in the description of the "great sickness" found among
+the Indians by the expedition of 1622.  This same great sickness
+could hardly have been yellow fever, as it occurred in the month of
+November.  I cannot think, therefore, that either the scourge of the
+East or our Southern malarial pestilence was the disease that wasted
+the Indians.  As for the yellowness like a garment, that is too
+familiar to the eyes of all who have ever looked on the hideous mask
+of confluent variola.
+
+Without the presence or the fear of these exotic maladies, the
+forlorn voyagers of the Mayflower had sickness enough to contend
+with.  At their first landing at Cape Cod, gaunt and hungry and
+longing for fresh food, they found upon the sandy shore "great
+mussel's, and very fat and full of sea-pearl."  Sailors and
+passengers indulged in the treacherous delicacy; which seems to have
+been the sea-clam; and found that these mollusks, like the shell the
+poet tells of, remembered their august abode, and treated the way-
+worn adventurers to a gastric reminiscence of the heaving billows.
+In the mean time it blew and snowed and froze.  The water turned to
+ice on their clothes, and made them many times like coats of iron.
+Edward Tilley had like to have "sounded" with cold.  The gunner, too,
+was sick unto death, but "hope of trucking" kept him on his feet,--a
+Yankee, it should seem, when he first touched the shore of New
+England.  Most, if not all, got colds and coughs, which afterwards
+turned to scurvy, whereof many died.
+
+How can we wonder that the crowded and tempest-tossed voyagers, many
+of them already suffering, should have fallen before the trials of
+the first winter in Plymouth?  Their imperfect shelter, their
+insufficient supply of bread, their salted food, now in unwholesome
+condition, account too well for the diseases and the mortality that
+marked this first dreadful season; weakness, swelling of the limbs,
+and other signs of scurvy, betrayed the want of proper nourishment
+and protection from the elements.  In December six of their number
+died, in January eight, in February, seventeen, in March thirteen.
+With the advance of spring the mortality 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 colonists must have been
+that of physicians and surgeons.  In Mr. Savage's remarkable
+Genealogical Dictionary of the first settlers who came over before
+1692 and their descendants to the third generation, I find scattered
+through the four crowded volumes the names of one hundred and thirty-
+four medical practitioners.  Of these, twelve, and probably many
+more, practised surgery; three were barber-surgeons.  A little
+incident throws a glimmer from the dark lantern of memory upon
+William Direly, one of these practitioners with the razor and the
+lancet.  He was lost between Boston and Roxbury in a violent tempest
+of wind and snow; ten days afterwards a son was born to his widow,
+and with a touch of homely sentiment, I had almost said 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 into the
+Connecticut River, and so ended.  One was not only doctor, but also
+schoolmaster and poet.  One practised medicine and kept a tavern.
+One was 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,--Ann Moore,--was the precursor
+of that intrepid sisterhood whose cause it has long been my pleasure
+and privilege to advocate on all fitting occasions.
+
+Outside of this list I must place the name of Thomas Wilkinson, who
+was complained of, is 1676, for practising contrary to law.
+
+Many names in the catalogue of these early physicians have been
+associated, in later periods, with the practice of the profession,--
+among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
+Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
+Woodward.  Touton was a Huguenot, Burchsted a German from Silesia,
+Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
+honor of the profession, was only Peacock disguised under this alias,
+which would not, I fear, prove very attractive to patients.
+
+What doctrines and practice were these colonists likely to bring,
+with them?
+
+Two principal schools of medical practice prevailed in the Old World
+during the greater part of the seventeenth century.  The first held
+to the old methods of Galen: 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 qualities hot, dry,
+moist, cold.  The body was to be preserved in health by keeping each
+of these qualities in its natural proportion; heat, by the proper
+temperature; moisture, by the due amount of fluid; and so as to the
+rest.  Diseases which arose from excess of heat were to be attacked
+by cooling remedies; those from excess of cold, by heating ones; and
+so of the other derangements of balance.  This was truly the
+principle of contraries contrariis, which ill-informed persons have
+attempted to make out to be the general doctrine of medicine, whereas
+there is no general dogma other than this: disease is to be treated
+by anything that is proved to cure it.  The means the Galenist
+employed were chiefly diet and vegetable remedies, with the use of
+the lancet and other depleting agents.  He attributed the four
+fundamental qualities to different vegetables, in four different
+degrees; thus chicory was cold in the fourth degree, pepper was hot
+in the fourth, endive was cold and dry in the second, and bitter
+almonds were hot in the first and dry in the second degree.  When we
+say "cool as a cucumber," we are talking Galenism.  The seeds of that
+vegetable ranked as one of "the four greater cold seeds" of this
+system.
+
+Galenism prevailed mostly in the south of Europe and France.  The
+readers of Moliere will have no difficulty in 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 credit after a time; their
+absurdly complicated mixtures excited contempt, and their nauseous
+prescriptions provoked loathing and disgust.  A simpler and bolder
+practice found welcome in Germany, depending chiefly on 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 limits we
+may assign to the use of these long-trusted mineral drugs, there can
+be no doubt that the chemical school, as it was called, did a great
+deal towards the expurgation of the old, overloaded, and repulsive
+pharmacopoeia.  We shall find evidence in the practice of our New-
+England physicians of the first century, that they often employed
+chemical remedies, and that, by the early part of the following
+century, their chief trust was in the few 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 existed from a very early period; from the
+Egyptian priest to the Indian medicine-man, the alliance has been
+maintained in one form or another.  The partnership was very common
+among our British ancestors.  Mr. Ward, the Vicar of Stratford-on-
+Avon, himself a notable example of the union of the two characters,
+writing about 1660, says,
+
+"The Saxons had their blood-letters, but under the Normans physicke,
+begunne in England; 300 years agoe itt was not a distinct profession
+by itself, but practised by men in orders, witness Nicholas de
+Ternham, the chief English physician and Bishop of Durham; Hugh of
+Evesham, a physician and cardinal; Grysant, physician and pope; John
+Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
+Bush, a bachelor of divinitie in Oxford, was a man well read in
+physick as well as divinitie, he was the first bishop of Bristol."
+
+"Again in King Richard the Second's time physicians 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 and keeping up the
+many superstitions which have figured so largely in the history of
+medicine.  It is curious to see that a medical work left in
+manuscript by the Rev. Cotton Mather and hereafter to be referred to,
+is running over with follies and superstitious fancies; while his
+contemporary and fellow-townsman, William Douglass, relied on the
+same few simple remedies which, through Dr. Edward Holyoke and Dr.
+James Jackson, have come down to our own time, as the most important
+articles of the materia medica.
+
+Let us now take a general glance at some of the conditions of the
+early settlers; and first, as to the healthfulness of the climate.
+The mortality of the season that followed the landing of the Pilgrims
+at Plymouth has been sufficiently accounted for.  After this, the
+colonists seem to have found the new country agreeing very well with
+their English constitutions.  Its clear air is the subject of eulogy.
+Its dainty springs of sweet water are praised not only by Higginson
+and Wood, but even the mischievous Morton says, that for its delicate
+waters Canaan came not near this country."  There is a tendency to
+dilate on these simple blessings, which reminds one a little of the
+Marchioness in Dickens's story, with her orange-peel-and-water
+beverage.  Still more does one feel the warmth of coloring,--such as
+we expect from converts to a new faith, and settlers who want to
+entice others over to their clearings, when Winslow speaks, in 1621,
+of "abundance of roses, white, red, and damask; single, but very
+sweet indeed;" a most of all, however, when, in the same connection,
+he says, "Here are grapes white and red, and very sweet and strong
+also."  This of our wild grape, a little vegetable Indian, which
+scalps a civilized man's mouth, as his animal representative scalps
+his cranium.  But there is something quite charming in Winslow's
+picture of the luxury in which they are living.  Lobsters, oysters,
+eels, mussels, fish and fowl, delicious fruit, including the grapes
+aforesaid,--if they only had "kine, horses, and sheep," he makes no
+question but men would live as contented here as in any part of the
+world.  We cannot help admiring the way in which they took their
+trials, and made the most of their blessings.
+
+"And how Content they were," says Cotton Mather, "when an Honest Man,
+as I have heard, inviting his Friends to a Dish of Clams, at the
+Table gave Thanks to Heaven, who had given them to suck the abundance
+of the Seas, and of the Treasures Aid in the Sands!"
+
+Strangely enough, as it would seem, except for this buoyant
+determination to make the best of everything, they hardly appear to
+recognize the difference of the climate from that which they had
+left.  After almost 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 a difference), is sharper and longer; but yet he may be
+deceived by the want of the comforts he enjoyed at home.  He cannot
+conceive any climate to agree better with the constitution of the
+English, not being oppressed with extremity of heats, nor nipped by
+biting cold:
+
+"By which means, blessed be God, we enjoy our health, notwithstanding
+those difficulties we have undergone, 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 which they 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 their fill of bread."
+
+Higginson, himself a dyspeptic, "continually in physic," as he says,
+and accustomed to dress in thick clothing, and to comfort his stomach
+with drink that was "both strong and stale,"--the "jolly good ale and
+old," I suppose, of free and easy Bishop Still's song,--found that he
+both could and did oftentimes drink New England water very well,
+--which he seems to look upon as a remarkable feat.  He could go as
+lightclad as any, too, with only a light stuff cassock upon his
+shirt, and stuff breeches without linings.  Two of his children were
+sickly: one,--little misshapen Mary,--died on the passage, and, in
+her father's words, "was the first in our ship that was buried in the
+bowels of the great Atlantic sea;" the other, who had been "most
+lamentably handled" by disease, recovered almost entirely "by the
+very wholesomeness of the air, altering, digesting, and drying up the
+cold and crude humors of the body."  Wherefore, he thinks it a wise
+course for all cold complexions to come to take physic in New
+England, and ends with those often quoted words, that "a sup of New
+England's air is better than a whole draught of Old England's ale."
+Mr. Higginson died, however, "of a hectic fever," a little more than
+a year after his arrival.
+
+The medical records which I shall cite show that the colonists were
+not exempt from the complaints of the Old World.  Besides the common
+diseases to which their descendants are subject, there were two
+others, to say nothing of the dreaded small-pox, which later medical
+science has disarmed,--little known among us at the present day, but
+frequent among the first 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 into discontent, and lingered
+after their former conditions in England; the poor homesick creatures
+in fact, whom we so forget in our florid pictures of the early times
+of the little band in the wilderness.  Many who were suffering from
+scurvy got well when the Lyon arrived from England, bringing store of
+juice of lemons.  The Governor speaks of another case in 1644; and it
+seems probable that the disease was not of rare occurrence.
+
+The other complaint from which they suffered, but which has nearly
+disappeared from among us, was intermittent fever, or fever and ague.
+I investigated the question as to the prevalence of this disease in
+New England, in a dissertation, which was published in a 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 "Old
+Men's Tears," dated 1691, speaks of "shaking agues," as among the
+trials to which they had been subjected.  The outline map of New
+England, accompanying the dissertation above referred to, indicates
+all the places where I had evidence that the disease had originated.
+It was plain enough that it used to be known in many localities where
+it has long ceased to be feared.  Still it was and is remarkable to
+see what a clean bill of health in this particular respect our barren
+soil inherited with its sterility.  There are some malarious spots on
+the edge of Lake Champlain, arid there have been some temporary
+centres of malaria, within the memory of man, on one or more of our
+Massachusetts rivers, but these are harmless enough, for the most
+part, unless the millers dam them, when they are apt to retaliate
+with a whiff from their meadows, that sets the whole neighborhood
+shaking with fever and ague.
+
+
+The Pilgrims of the Mayflower had with them a good physician, 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 and bad food, and, probably enough, desperate homesickness in
+some of the feebler sort, from doing their work.  No detailed record
+remains of what they suffered or what was attempted for their relief
+during the first sad winter.  The graves of those who died were
+levelled and sowed with grain that the losses of the little band
+might not be suspected by the savage tenants of 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 Governor Bradford, dated June, 1630.  "I have been
+to Matapan" (now Dorchester), he says, "and let some twenty of those
+people blood."  Such wholesale depletion as this, except with avowed
+homicidal intent, is quite unknown in these days; though I once saw
+the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
+order some ten or fifteen patients, taken almost indiscriminately, to
+be bled in a single morning.
+
+Dr. Fuller's two visits to Salem, at the request of Governor
+Endicott, seem to have been very satisfactory to that gentleman.
+Morton, the wild fellow of Merry Mount, gives a rather questionable
+reason for the Governor's being so well pleased with the physician's
+doings.  The names under which he mentions the two personages, it
+will be seen, are not 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 spoken of as
+"a right godly man and skilful chyrurgeon, but died of a malignant
+fever not very long after his arrival."
+
+Two practitioners of the ancient town of Newbury are entitled to
+special notice, for different reasons.  The first is Dr. John Clark,
+who is said by tradition to have been the first regularly educated
+physician who resided in New England.  His portrait, in close-fitting
+skull-cap, with long locks and venerable flowing beard, is familiar
+to our eyes on the wall of our Society's antechamber.  His left hand
+rests upon a skull, his right hand holds an instrument which deserves
+a passing comment.  It is a trephine, a surgical implement for
+cutting round pieces out of broken skulls, so as to get at the
+fragments which have been driven in, and lift them up.  It has a
+handle like that of a gimlet, with a claw like a hammer, to lift
+with, I suppose, which last contrivance I do not see figured in my
+books.  But the point I refer to is this: the old instrument, the
+trepan, had a handle like a wimble, what we call a brace or bit-
+stock.  The trephine is not mentioned at all in Peter Lowe's book,
+London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
+nor in the translation of 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 of the last century.  As John Clark
+died in 1661, it is remarkable to see the last fashion in the way of
+skull-sawing contrivances in his hands,--to say nothing of the claw
+on the handle, and a Hey's saw, so called in England, lying on the
+table by him, and painted there more than a hundred years before Hey
+was born.  This saw is an old invention, perhaps as 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 before be 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 more or less
+traditional authority, give us the feeling that the people of
+Newbury, and afterwards of Boston, had a wise and skilful medical
+adviser and surgeon in Dr. John Clark.
+
+The venerable town of Newbury had another physician who was less
+fortunate.  The following is a court record of 1652:
+
+"This is to certify whom it may concern, that we the subscribers,
+being called upon to testify against doctor William Snelling for
+words by him uttered, affirm that being in way of merry discourse, a
+health being 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 their feet.]
+
+"Since when he hath affirmed that he only intended the proverb used
+in the west country, nor do we believe he intended otherwise.
+
+"[Signed]
+"WILLIAM THOMAS.
+"THOMAS MILWARD.
+
+"March 12th 1651, All which I acknowledge, and am sorry I did not
+expresse my intent, or that I was so weak as to use so foolish a
+proverb.
+
+"[Signed]
+"GULIELMUS SNELLING."
+
+
+Notwithstanding this confession and apology, the record tells us that
+"William Snelling in his presentment for cursing is fined ten
+shillings and the fees of court."
+
+I will mention one other name among those of the Fathers of 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 and read upon very well."
+
+Giles Firmin, as the name is commonly spelled, practised physic in
+this country for a time.  He seems to have found it a poor business;
+for, in a letter to Governor Winthrop, he says, "I am strongly sett
+upon to studye divinitie: my studyes else must be lost, for physick
+is but a meene helpe."
+
+Giles Firmin's Lectures on Anatomy were the first scientific
+teachings of the New World.  While the Fathers were enlightened
+enough to permit such instructions, they were severe in dealing with
+quackery; for, in 1631, our court records show that one Nicholas
+Knopp, or Knapp, was sentenced to be fined or whipped "for taking
+upon him to cure the scurvey by a water of noe worth nor value, which
+he solde att a very deare rate."  Empty purses or sore backs would be
+common with us to-day if such a rule were enforced.
+
+Besides the few worthies spoken of, and others whose names I have not
+space to record, we must remember that there were many clergymen who
+took charge of the bodies as well as the souls of their patients,
+among them two Presidents of Harvard College, Charles Chauncy and
+Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
+author of the earliest medical treatises printed in the country,[A
+Brief Rule to Guide the Common People in Small pox and
+Measles.  1674.] whose epitaph in Latin and Greek, said to have been
+written by Eleazer, an "Indian Youth" and a member of the Senior
+Class of Harvard College, may be found in the "Magnalia."  I miss
+this noble savage's name in our triennial catalogue; and as there is
+many a slip between the cup and lip, one is tempted to guess that he
+may have lost his degree by some display of his native instinct,--
+possibly a flourish of the tomahawk or scalping-knife.  However this
+may have been, the good man he celebrated was a notable instance of
+the Angelical Conjunction, as the author of the "Magnalia" calls it,
+of the offices of clergyman and medical practitioner.
+
+Michael Wigglesworth, author of the "Day of Doom," attended the sick,
+"not only as a Pastor, but as a Physician too, and this, not only in
+his own town, but also in all those of the vicinity."  Mather says of
+the sons of Charles Chauncy, "All of these did, while they had
+Opportunity, Preach the Gospel; and most, if not all of them, like
+their excellent Father before them, had an eminent skill in physick
+added unto their other accomplishments," etc.  Roger Williams is said
+to have saved many in a kind of pestilence which swept away many
+Indians.
+
+To these names must be added, as sustaining a certain relation to the
+healing art, that of the first Governor Winthrop, who is said by John
+Cotton to have been "Help for our Bodies by Physick [and] for our
+Estates by Law," and that of his son, the Governor of Connecticut,
+who, as we shall see, was as much physician as magistrate.
+
+I had submitted to me for examination, in 1862, a manuscript found
+among the Winthrop Papers, marked with the superscription, "For my
+worthy friend Mr. Wintrop," dated in 1643, London, signed Edward
+Stafford, and containing medical directions and prescriptions.  It
+may be remembered by some present that I wrote a report on this
+paper, which was published in the "Proceedings" of this Society.
+Whether the paper was written for Governor John Winthrop of
+Massachusetts, or for his son, Governor John of Connecticut, there is
+no positive evidence that I have been able to obtain.  It is very
+interesting, however, as giving short and simple practical
+directions, such as 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.  The remedies
+are of three kinds: simples, such as St. John's wort, Clown's all-
+heal, elder, parsley, maidenhair, mineral drugs, such as lime,
+saltpetre, Armenian bole, crocus metallorum, or sulphuret of
+antimony; and thaumaturgic or mystical, of which the chief 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 toads into an earthen
+pot so as to half fill it, and baking and burning them "in the open
+ayre, not in an house,"--concerning which latter possibility I
+suspect Madam Winthrop would have had something to say,--until they
+could be reduced by pounding, first into a brown, and then into a
+black, powder.  Blood-letting in some inflammations, fasting in the
+early stage of fevers, and some of those peremptory drugs with which
+most of us have been well acquainted in our time, the infragrant
+memories of which I will not pursue beyond this slight allusion, are
+among his remedies.
+
+The Winthrops, to one of whom Dr. Stafford's directions were
+addressed, were the medical as well as the political advisers of
+their fellow-citizens for three or four successive generations.  One
+of them, Governor John of Connecticut, practised so extensively,
+that, but for his more distinguished title in the State, he would
+have been remembered as the Doctor.  The fact that he practised in
+another colony, for the most part, makes little difference in the
+value of the records we have of his medical experience, which have
+fortunately been preserved, and give a very fair idea, in all
+probability, of the way in which patients were treated in
+Massachusetts, when they fell into intelligent and somewhat educated
+hands, a little after the middle of the seventeenth century:
+
+I have before me, while writing, a manuscript collection of the
+medical cases treated by him, and recorded at the time in his own
+hand, which has been intrusted to me by our President, his
+descendant.
+
+They are generally marked Hartford, and extend from the year 1657 to
+1669.  From these, manuscripts, and from the letters printed in the
+Winthrop Papers published by our Society, I have endeavored to obtain
+some idea of the practice of Governor John Winthrop, Junior.  The
+learned eye of Mr. Pulsifer would have helped me, no doubt, as it has
+done in other cases; but I have ventured this time to attempt finding
+my own way among the hieroglyphics of these old pages.  By careful
+comparison of many prescriptions, and by the aid of Schroder, Salmon,
+Culpeper, and other old compilers, I have deciphered many of his
+difficult paragraphs with their mysterious recipes.
+
+The Governor employed a number of the simples dear to ancient women,
+--elecampane and elder and wormwood and anise and the rest; but he
+also employed certain mineral remedies, which he almost always
+indicates by their ancient symbols, or by a name which should leave
+them a mystery to the vulgar.  I am now prepared to reveal the mystic
+secrets of the Governor's beneficent art, which rendered so many good
+and great as well as so many poor and dependent people his debtors,-
+at least, in their simple belief,--for their health and their lives.
+
+His great remedy, which he gave oftener than any other, was nitre;
+which he ordered in doses of twenty or thirty grains to adults, and
+of three grains to infants.  Measles, colics, sciatica, headache,
+giddiness, and many other ailments, all found themselves treated, and
+I trust bettered, by nitre; a pretty safe medicine in moderate doses,
+and one not likely to keep the good Governor awake at night, thinking
+whether it might not kill, if it did not cure.  We may say as much
+for spermaceti, which he seems to have considered "the sovereign'st
+thing on earth" for inward bruises, and often prescribes after falls
+and similar injuries.
+
+One of the next remedies, in point of frequency, which he was in the
+habit of giving, was (probably diaphoretic) antimony; a mild form of
+that very active metal, and which, mild as it was, left his patients
+very commonly with a pretty strong conviction that they had been
+taking 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 dose of rhubarb or jalap; a taste of
+stinging horseradish, oftener of warming guiacum; sometimes an
+anodyne, in the shape of mithridate,--the famous old farrago, which
+owed its virtue to poppy juice; [This is the remedy which a Boston
+divine tried to simplify.  See Electuarium Novum Alexipharmacum, by
+Rev.  Thomas Harward, lecturer at the Royal Chappell.  Boston, 1732.
+This tract is in our Society's library.] very often, a harmless
+powder of coral; less frequently, an inert prescription of pleasing
+amber; and (let me say it softly within possible hearing of his
+honored descendant), twice or oftener,--let us hope as a last
+resort,--an electuary of millipedes,--sowbugs, if we must give them
+their homely English name.  One or two other prescriptions, of the
+many unmentionable ones which disgraced the pharmacopoeia of the
+seventeenth century, are to be found, but only in very rare
+instances, in the faded characters of the manuscript.
+
+The excellent Governor's accounts of diseases are so brief, that we
+get only a very general notion of the complaints for which he
+prescribed.  Measles and their consequences are at first more
+prominent than any other one affection, but the common infirmities of
+both sexes and of all ages seem to have come under his healing hand.
+Fever and ague appears to have been of frequent occurrence.
+
+His published correspondence shows that many noted people were in
+communication with him as his patients.  Roger Williams wants a
+little of his medicine for Mrs. Weekes's daughter; worshipful John
+Haynes is in receipt of his powders; troublesome Captain Underhill
+wants "a little white vitterall" for his wife, and something to cure
+his wife's friend's neuralgia, (I think his wife's friend's husband
+had a little rather have had it sent by the hands of Mrs. Underhill,
+than by those of the gallant and discursive captain); and pious John
+Davenport says, his wife "tooke but one halfe of one of the papers"
+(which probably contained the medicine he called rubila), "but could
+not beare the taste of it, and is discouraged from taking any more;"
+and honored William Leete asks for more 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 of all the bitter things she
+swallowed,--God help all little children in the hands of dosing
+doctors and 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
+relief he 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 little to sence in operation, should beget and bring
+forth such efects," that we repent our hasty exclamation, and bless
+the memory of the good Governor, who gave relief to the worn-out
+frame of our long-departed brother, the sturdy old heretic of Rhode
+Island.
+
+What was that medicine which so frequently occurs in the printed
+letters under the name of "rubila"?  It is evidently a secret remedy,
+and, so far as I know, has not yet been made out.  I had almost given
+it up in despair, when I found what appears to be a key to the
+mystery.  In the vast multitude of prescriptions contained in the
+manuscripts, most of them written in symbols, I find one which I thus
+interpret:
+
+"Four grains of (diaphoretic) antimony, with twenty grains of nitre,
+with a little salt of tin, making rubila."  Perhaps something was
+added to redden the powder, as he constantly speaks of "rubifying"
+or "viridating" his prescriptions; a very common practice of
+prescribers, when their powders look a little too much like plain
+salt or sugar.
+
+
+Waitstill Winthrop, the Governor's son, "was a skilful physician,"
+says Mr. Sewall, in his funeral sermon; "and generously gave, not
+only his advice, but also his Medicines, for the healing of the Sick,
+which, by the Blessing of God, were made successful for the recovery
+of many."  "His son John, a member of the Royal Society, speaks of
+himself as 'Dr. Winthrop,' and mentions one of his own prescriptions
+in a letter to Cotton Mather."  Our President tells me that there was
+an heirloom of the ancient skill in his family, within his own
+remembrance, in the form of a certain precious eye-water, to which
+the late President John Quincy Adams ascribed rare virtue, and which
+he used to obtain from the possessor of the ancient recipe.
+
+These inherited prescriptions are often treasured in 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
+Cambridgeport schoolmates used to call the "ager,"--meaning thereby
+toothache or face-ache,--I used to get relief from a certain plaster
+which never went by any other name in the family than "Dr. Oliver."
+
+Dr. James Oliver was my great-great-grandfather, graduated in 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
+particular medicine, or other possession or secret, and physicians in
+old times used to keep their choice recipes to themselves a good
+deal, as we have had occasion to see.
+
+Some years ago I found among my old books a small manuscript marked
+"James Oliver.  This Book Begun Aug. 12, 1685."  It is a rough sort
+of account-book, containing among other things prescriptions for
+patients, and charges for the same, with counter-charges for the
+purchase of medicines and other matters.  Dr. Oliver practised in
+Cambridge, where may be seen his tomb with inscriptions, and with
+sculptured figures that look more like Diana of the Ephesians, as
+given in Calmet's Dictionary, than like any angels admitted into good
+society here or elsewhere.
+
+I do not find any particular record of what his patients suffered
+from, but I have carefully copied out the remedies he mentions, and
+find that they form a very respectable catalogue.  Besides the usual
+simples, elder, parsley, fennel, saffron, snake-root, wormwood, I
+find the Elixir Proprietatis, with other elixire and cordials, as if
+he rather fancied warming medicines; but he called in the aid of some
+of the more energetic remedies, including iron, and probably mercury,
+as he bought two pounds of it at one time.
+
+The most interesting item is his bill against the estate of Samuel
+Pason of Roxbury, for services during his last illness.  He attended
+this gentleman,--for such he must have been, by the amount of physic
+which he took, and which his heirs paid for,--from June 4th, 1696, to
+September 3d of the same year, three months.  I observe he charges
+for visits as well as for medicines, which is not the case in most of
+his bills.  He opens the attack with a carminative appeal to the
+visceral conscience, and follows it up with good hard-hitting
+remedies for dropsy,--as I suppose the disease would have been
+called,--and finishes off with a rallying dose of hartshorn and iron.
+
+It is a source of honest pride to his descendant that his bill, which
+was honestly paid, as it seems to have been honorably earned,
+amounted to the handsome total of seven pounds and two shillings.
+Let me add that he repeatedly prescribes plaster, one of which was
+very probably the "Dr. Oliver" that soothed my infant griefs, and for
+which I blush to say that my venerated ancestor received from Goodman
+Hancock the painfully exiguous sum of no pounds, no shillings, and
+sixpence.
+
+I have illustrated the practice of the first century, from the two
+manuscripts I have examined, as giving an impartial idea of its
+every-day methods.  The Governor, Johannes Secundus, it is fair to
+remember, was an amateur practitioner, while my ancestor was a
+professed physician.  Comparing their modes of treatment with the
+many scientific follies still prevailing in the Old World, and still
+more with the extraordinary theological superstitions of the
+community in which they lived, we shall find reason, I think, to
+consider the art of healing as in a comparatively creditable state
+during the first century of New England.
+
+In addition to the evidence as to methods of treatment furnished by
+the manuscripts I have cited, I subjoin the following document, to
+which my attention was called by Dr. Shurtleff, our present Mayor.
+This is a letter of which the original is to be found in vol.  lxix.
+page 10 of the "Archives" preserved at the State House in Boston.  It
+will be seen that what the surgeon wanted consisted chiefly of
+opiates, stimulants, cathartics, plasters, and materials for
+bandages.  The complex and varied formulae have given place to
+simpler and often more effective forms of the same remedies; but the
+list and the manner in which it is made out are proofs of the good
+sense and 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 upon which he wrote, a great body of Indians--
+supposed to be six or seven hundred--appeared before Hatfield; and
+twenty-five resolute young men of Hadley, from which town he wrote,
+crossed the river and drove them away.
+
+
+HADLY May 30: 76
+
+Mr RAWSON Sr
+
+What we have recd by Tho: Houey the past month is not the cheifest of
+our wants as you have love for poor wounded I pray let us not want
+for these following medicines if you have not a speedy conveyance of
+them I pray send on purpose they are those things mentioned in my
+former letter but to prevent future mistakes I have wrote them att
+large wee have great want 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 obtaine any thing to be sent in answer
+thereto 13 June 1676
+
+
+I have given some idea of the chief remedies used by our earlier
+physicians, which were both Galenic and chemical; that is, vegetable
+and mineral.  They, of course, employed the usual perturbing
+medicines which Montaigne says are the chief reliance of their craft.
+There were, doubtless, individual practitioners who employed special
+remedies with exceptional boldness and perhaps success.  Mr. Eliot is
+spoken of, in a letter of William Leete to Winthrop, Junior, as being
+under Mr. Greenland's mercurial administrations.  The latter was
+probably enough one of these specialists.
+
+There is another class of remedies which appears to have been
+employed occasionally, but, on the whole, is so little prominent as
+to imply a good deal of common sense among the medical practitioners,
+as compared with 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
+incredible fact that they were retained in the materia medica so late
+as when Rees's Cyclopaedia was published, and we there find the
+directions formerly given by the College of Edinburgh for their
+preparation.  Once or twice we have found him admitting still more
+objectionable articles into his materia medica; in doing which, I am
+sorry to say that he could plead grave and learned authority.  But
+these instances are very rare exceptions in a medical practice of
+many years, which is, on the whole, very respectable, considering the
+time and circumstances.
+
+Some remedies of questionable though not odious character appear
+occasionally to have been employed by the early practitioners, but
+they were such as still had the support of the medical profession.
+Governor John Winthrop, the first, sends for East Indian bezoar, with
+other commodities he is writing for.  Governor Endicott sends him one
+he had of Mr. Humfrey.  I hope it was genuine, for they cheated
+infamously in the matter of this concretion, which ought to come out
+of an animal's stomach, but the real history of which resembles what
+is sometimes told of modern sausages.
+
+There is a famous law-case of James the First's time, in which a
+goldsmith sold a hundred pounds' worth of what he called bezoar,
+which was proved to be false, and the purchaser got a verdict against
+him.  Governor Endicott also sends Winthrop a unicorn's horn, which
+was the property of a certain Mrs. Beggarly, who, in spite of her
+name, seems to have been rich in medical knowledge and possessions.
+The famous Thomas Bartholinus wrote a treatise on the virtues of this
+fabulous-sounding remedy, which was published in 1641, and
+republished in 1678.
+
+The "antimonial cup," a drinking vessel made of that metal, which,
+like our quassia-wood cups, might be filled and emptied in saecula
+saeculorum without exhausting its virtues, is mentioned by Matthew
+Cradock, in a letter to the elder Winthrop, but in a doubtful way, as
+it was thought, he says, to have shortened the days of Sir Nathaniel
+Riche; and Winthrop himself, as I think, refers to its use, calling
+it simply "the cup."   An antimonial cup is included in the inventory
+of Samuel Seabury, who died 1680, and is valued at five shillings.
+There is a treatise entitled "The Universall Remedy, or the Vertues
+of the Antimoniall Cup, By John Evans, Minister and Preacher of God's
+Word, London, 1634," in our own Society's library.
+
+One other special remedy deserves notice, because of native growth.
+I do not know when Culver's root, Leptandra Virginica of our National
+Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
+John Winthrop of New London, speaks of it as famous for the cure of
+consumptions, and wishes to get some of it, through his mediation,
+for Katharine, his eldest daughter.  He gets it, and gives it to the
+"poor damsel," who is languishing, as he says, and who dies the next
+month,--all the sooner, I have little doubt, for this uncertain and
+violent drug, with which the meddlesome pedant tormented her in that
+spirit of well-meant but restless quackery, which could touch nothing
+without making mischief, not even a quotation, and yet proved at
+length the means of bringing a great blessing to our community, as we
+shall see by and by; so does Providence use our very vanities and
+infirmities for its wise purposes.
+
+Externally, I find the practitioners on whom I have chiefly relied
+used the plasters of Paracelsus, of melilot, diachylon, and probably
+diaphoenicon, all well known to the old pharmacopoeias, and some of
+them to the modern ones,--to say nothing of "my yellow salve," of
+Governor John, the second, for the composition of which we must apply
+to his respected descendant.
+
+The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
+and Wecherus, of all whom notices may be found in the pages of Haller
+and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
+Practice of Physic and Anatomy, the last as belonging to Samuel
+Seabury, chirurgeon, before mentioned.  Nicholas Culpeper was a
+shrewd charlatan, and as impudent a varlet as ever prescribed for a
+colic; but knew very well what he was about, and badgers the College
+with great vigor.  A copy of Spigelius's famous Anatomy, in the
+Boston Athenaeum, has the names of Increase and Samuel Mather written
+in it, and was doubtless early overhauled by the youthful Cotton, who
+refers to the great anatomist's singular death, among his curious
+stories in the "Magnalia," and quotes him among nearly a hundred
+authors whom he 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 valued
+at ten pounds; and a surgeon's chest and drugs valued at sixteen
+pounds.'
+
+
+Here we leave the first century and all attempts at any further
+detailed accounts of medicine and its practitioners.  It is necessary
+to show in a brief glance what had been going on in Europe during the
+latter part of that century, the first quarter of which had been made
+illustrious in the history of medical science by the discovery of the
+circulation.
+
+Charles Barbeyrac, a Protestant in his religion, was a 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,
+until it becomes hard to tell the family of one from that of the
+other.  Barbeyrac threw overboard the old complex medical farragos of
+the pharmacopoeias, as his church had disburdened itself of the
+popish ceremonies.
+
+Among the students who followed his instructions were two Englishmen:
+one of them, John Locke, afterwards author of an "Essay on the Human
+Understanding," three years younger than his teacher; the other,
+Thomas Sydenham, five years older.  Both returned to England.  Locke,
+whose medical knowledge is borne witness to by Sydenham, had the good
+fortune to form a correct opinion on a disease from which the Earl of
+Shaftesbury was suffering, which led to an operation that saved his
+life.  Less felicitous was his experience with a certain ancilla
+culinaria virgo,--which I am afraid would in those days have been
+translated kitchen-wench, instead of lady of the culinary
+department,--who turned him off after she had got tired of him, and
+called 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, and took to other
+studies.
+
+The name of Thomas Sydenham is as distinguished in the history of
+medicine as that of John Locke in philosophy.  As Barbeyrac was found
+in opposition to the established religion, as Locke took the rational
+side against orthodox Bishop Stillingfleet, so Sydenham went with
+Parliament against Charles, and was never admitted a Fellow by the
+College of Physicians, which, after he was dead, placed his bust in
+their hall by the side of that of Harvey.
+
+What Sydenham did for medicine was briefly this he studied the course
+of diseases carefully, and especially as affected by the particular
+season; to patients with fever he gave air and cooling drinks,
+instead of smothering and heating them, with the idea of sweating out
+their disease; he ordered horseback exercise to consumptives; he,
+like his teacher, used few and comparatively simple remedies; he did
+not give any drug at all, if he thought none was needed, but let well
+enough alone.  He was a sensible man, in short, who applied his
+common sense to diseases which he had studied with the best light of
+science that he could obtain.
+
+The influence of the reform he introduced must have been more or less
+felt in this country, but not much before the beginning of the
+eighteenth century, as his great work was not published until 1675,
+and then in Latin.  I very strongly suspect that there was not so
+much to reform in the simple practice of the physicians of the new
+community, as there was in that of the learned big-wigs of the
+"College," who valued their remedies too much in proportion to their
+complexity, and the extravagant and fantastic ingredients which went
+to their making.
+
+During the memorable century which bred and bore the Revolution, the
+medical profession gave great names to our history.  But John Brooks
+belonged to the State, and Joseph Warren belongs to the country and
+mankind, and to speak of them would lead me beyond my limited--
+subject.  There would be little pleasure in dwelling on the name of
+Benjamin Church; and as for the medical politicians, like Elisha
+Cooke in the early part of the century, or Charles Jarvis, the bald
+eagle of Boston, in its later years, whether their practice was
+heroic or not, their patients were, for he is a bold man who trusts
+one that is making speeches and coaxing voters, to meddle with the
+internal politics of his corporeal republic.
+
+One great event stands out in the medical history of this eighteenth
+century; namely, the introduction of the practice of inoculation for
+small-pox.  Six epidemics of this complaint had visited Boston in the
+course of a hundred years.  Prayers had been asked in the churches
+for more than a hundred sick in a single day, and this many times.
+About a thousand persons had died in a twelvemonth, we are told, and,
+as we may infer, chiefly from this cause.
+
+In 1721, this disease, after a respite of nineteen years, again
+appeared as an epidemic.  In that year it was that Cotton Mather,
+browsing, as was his wont, on all the printed fodder that came within
+reach of his ever-grinding mandibles, came upon an account of
+inoculation as practised in Turkey, contained in the "Philosophical
+Transactions."  He spoke of it to several physicians, who paid little
+heed 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 of Bethesda," and satiated with his speculations on the
+Nishmath Chajim.
+
+The Reverend Mather,--I use a mode of expression he often employed
+when speaking of his honored brethren,--the Reverend Mather was right
+this time, and the irreverent doctors who laughed at him were wrong.
+One only of their number disputes his claim to giving the first
+impulse to the practice, in Boston.  This is what that person says:
+"The Small-Pox spread in Boston, New England, A.1721, and the
+Reverend Dr. Cotton Mather, having had the use of these
+Communications from Dr. William Douglass (that is, the writer of
+these words); surreptitiously, without the knowledge of his Informer,
+that he might have the honour of a New fangled notion, sets an
+Undaunted Operator to work, and in this Country about 290 were
+inoculated."
+
+All this has not deprived Cotton Mather of the credit of suggesting,
+and a bold and intelligent physician of the honor of carrying out,
+the new practice.  On the twenty-seventh day of June, 1721, Zabdiel
+Boylston of Boston inoculated his only son for smallpox,--the first
+person ever submitted to the operation in the New World.  The story
+of the fierce resistance to the introduction of the practice; of how
+Boylston was mobbed, and Mather had a hand-grenade thrown in at his
+window; of how William Douglass, the Scotchman, "always positive, and
+sometimes accurate," as was neatly said of him, at once depreciated
+the practice and tried to get the credit of suggesting it, and how
+Lawrence Dalhonde, the Frenchman, testified to its destructive
+consequences; of how Edmund Massey, lecturer at St.  Albans, preached
+against sinfully endeavoring to 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 his
+sermon, afterwards reprinted in Boston, many of our New England
+clergy stood up boldly in defence of the practice,--all this has been
+told so well and so often that I spare you its details.  Set this
+good hint of Cotton Mather against that letter of his to John
+Richards, recommending the search after witch-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, the Lord have mercy on her
+soul!
+
+Thus did America receive this great discovery, destined to save
+thousands of lives, via Boston, from the hands of one of our own
+Massachusetts physicians.
+
+The year 1735 was rendered sadly memorable by the epidemic of the
+terrible disease known as "throat distemper," and regarded by many as
+the same as our "diphtheria."  Dr. Holyoke thinks the more general
+use of mercurials in inflammatory complaints dates from the time of
+their employment in this disease, in which they were thought to have
+proved specially useful.
+
+At some time in the course of this century medical practice had
+settled down on four remedies as its chief reliance.  I must repeat
+an incident which I have related in another of these Essays.  When
+Dr. Holyoke, nearly seventy years ago, received young Mr. James
+Jackson as his student, he showed him the formidable array of
+bottles, jars, and drawers around his office, and then named the four
+remedies referred to as being of more importance than all the rest
+put together.  These were "Mercury, Antimony, Opium, and Peruvian
+Bark."  I doubt if either of them remembered that, nearly seventy
+years before, in 1730, Dr. William Douglass, the disputatious
+Scotchman, mentioned those same four remedies, in the dedication of
+his quarrelsome essay on inoculation, as the most important ones in
+the hands of the physicians of his time.
+
+In the "Proceedings" of this Society for the year 1863 is a very
+pleasant paper by the late Dr. Ephraim Eliot, giving an account of
+the leading physicians of Boston during the last quarter of the last
+century.  The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch,
+Danforth, John Warren, Jeffries, are all famous in local history, and
+are commemorated in our medical biographies.  One of them, at least,
+appears to have been more widely known, not only as one of the first
+aerial voyagers, but as an explorer in the almost equally hazardous
+realm of medical theory.  Dr. John Jeffries, the first of that name,
+is considered by Broussais as a leader of medical opinion in America,
+and so referred to in his famous "Examen des Doctrines Medicales."
+
+Two great movements took place in this eighteenth century, the effect
+of which has been chiefly felt in our own time; namely, the
+establishment of the Massachusetts Medical Society, and the founding
+of the Medical School of Harvard University.
+
+
+The third century of our medical history began with the introduction
+of the second great medical discovery of modern times,--of all time
+up to that date, I may say,--once more via Boston, if we count the
+University village as its suburb, and once more by one of our
+Massachusetts physicians.  In the month of July, 1800, Dr. Benjamin
+Waterhouse of Cambridge submitted four of his own children to the new
+process of vaccination,--the first persons vaccinated, as Dr. Zabdiel
+Boylston's son had been the first person inoculated in the New World.
+
+A little before the first half of this century was completed, in the
+autumn of 1846, the great discovery went forth from the Massachusetts
+General Hospital, which repaid the debt of America to the science of
+the Old World, and gave immortality to the place of its origin in the
+memory and the heart of mankind.  The production of temporary
+insensibility at will--tuto, cito, jucunde, safely, quickly,
+pleasantly--is one of those triumphs over the infirmities of our
+mortal condition which change the aspect of life ever afterwards.
+Rhetoric can add nothing to its glory; gratitude, and the pride
+permitted to human weakness, that our Bethlehem should have been
+chosen as the birthplace of this new embodiment of the divine mercy,
+are all we can yet find room for.
+
+The present century has seen the establishment of all those great
+charitable institutions for the cure of diseases of the body and of
+the mind, which our State and our city have a right to consider as
+among the chief ornaments of their civilization.
+
+The last century had very little to show, in our State, in the way of
+medical literature.  The worthies who took care of our grandfathers
+and great-grandfathers, like the Revolutionary heroes, fought (with
+disease) and bled (their patients) and died (in spite of their own
+remedies); but their names, once familiar, are heard only at rare
+intervals.  Honored in their day, not unremembered by a few solitary
+students of the past, their memories are going sweetly to sleep in
+the arms of the patient old dry-nurse, whose "blackdrop" is the
+never-failing anodyne of the restless generations of men.  Except the
+lively controversy on inoculation, and floating papers in journals,
+we have not much of value for that long period, in the shape of
+medical records.
+
+But while the trouble with the last century is to find authors to
+mention, the trouble of this would be to name all that we find.  Of
+these, a very few claim unquestioned preeminence.
+
+Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical
+School of our University, did a great work for the advancement of
+medicine and surgery in New England, by his labors as teacher and
+author, greater, it is claimed by some, than was ever done by any
+other man.  The two Warrens, of our time, each left a large and
+permanent record of a most extended surgical practice.  James Jackson
+not only educated a whole generation by his lessons of wisdom, but
+bequeathed some of the most valuable results of his experience to
+those who came after him, in a series of letters singularly pleasant
+and kindly as well as instructive.  John Ware, keen and cautious,
+earnest and deliberate, wrote the two remarkable essays which have
+identified his 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 by referring to the
+many important contributions to medical science by Dr. Jacob Bigelow,
+and especially to his discourse on "Self-limited Diseases," an
+address which can be read in a single hour, but the influence of
+which will be felt for a century.
+
+Nor would the profession forgive me if I forgot to mention the
+admirable museum of pathological anatomy, created almost entirely by
+the hands of Dr. John Barnard Swett Jackson, and illustrated by his
+own printed descriptive catalogue, justly spoken of by a
+distinguished professor in the University of Pennsylvania as the most
+important contribution which had ever been made in 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 Massachusetts
+or placed at the head of her institutions for the treatment of the
+insane.
+
+We have a right to claim also one who is known all over the civilized
+world as a philanthropist, to us as a townsman and a graduate of our
+own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor
+of a great multitude who were born to a world of inward or of outward
+darkness.
+
+I cannot pass over in silence the part taken by our own physicians in
+those sanitary movements which are assuming every year greater
+importance.  Two diseases especially 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, both of which have been faithfully studied
+and reported on by physicians of our own State and city.  The
+cultivation of medical and surgical specialties, which is fast
+becoming prevalent, is beginning to show its effects in the
+literature of the profession, which is every year growing richer in
+original observations and investigations.
+
+To these benefactors who have labored for us in their peaceful
+vocation, we must add the noble army of surgeons, who went with the
+soldiers who fought the battles of their country, sharing many of
+their dangers, not rarely falling victims to fatigue, disease, or the
+deadly volleys to which they often exposed themselves in the
+discharge of their duties.
+
+The pleasant biographies of the venerable Dr. Thacher, and the worthy
+and kind-hearted gleaner, Dr. Stephen W.  Williams, who came after
+him, are filled with the names of men who served their generation
+well, and rest from their labors, followed by the blessing of those
+for whom they endured the toils and fatigues inseparable from their
+calling.  The hardworking, intelligent country physician more
+especially deserves the gratitude of his own generation, for he
+rarely leaves any permanent record in the literature of his
+profession.  Books are hard to obtain; hospitals, which are always
+centres of intelligence, are remote; thoroughly educated and superior
+men are separated by wide intervals; and long rides, though favorable
+to reflection, take up much of the time which might otherwise 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 a
+great and deserved reputation, become the oracles of large districts,
+and yet leave nothing, or next to nothing, by which their names shall
+be preserved from blank oblivion.
+
+One or two other facts deserve mention, as showing the readiness of
+our medical community to receive and adopt any important idea or
+discovery.  The new science of Histology, as it is now called, was
+first brought fully before the profession of this country by the
+translation of Bichat's great work, "Anatomie Generale," by the late
+Dr. George Hayward.
+
+The first work printed in this country on Auscultation,--that
+wonderful art of discovering disease, which, as it were, puts a
+window in the breast, through which the vital organs can be seen, to
+all intents and purposes, was the manual published anonymously by
+"A Member of the Massachusetts Medical Society."
+
+
+We are now in some slight measure prepared to weigh the record of the
+medical profession in Massachusetts, and pass our judgment upon it.
+But in-order to do justice to the first generation of practitioners,
+we must compare what we know of their treatment of disease with the
+state of the art in England, and the superstitions which they saw all
+around them in other departments of knowledge or belief.
+
+English medical literature must have been at a pretty low ebb when
+Sydenham recommended Don Quixote to Sir Richard Blackmore for
+professional reading.  The College Pharmacopoeia was loaded with the
+most absurd compound mixtures, one of the most complex of which (the
+same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel
+in Boston," tried to simplify), was not dropped until the year 1801.
+Sir Kenelm Digby was playing his fantastic tricks with the
+Sympathetic powder, and teaching Governor Winthrop, the second, how
+to cure fever and ague, which some may like to know.  "Pare the
+patient's nails; put the parings in a little bag, and hang the bag
+round the 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 eloquently on the
+efficacy of the royal touch in scrofula.  The founder of the
+Ashmolean Museum at Oxford, consorting with alchemists and
+astrologers, was treasuring the manuscripts of the late pious Dr.
+Richard Napier, in which certain letters (Rx Ris) were understood to
+mean Responsum Raphaelis,--the answer of the angel Raphael to the
+good man's medical questions.  The illustrious Robert Boyle was
+making his collection of choice and safe remedies, including the sole
+of an old shoe,  the thigh bone of a hanged man, and things far 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 of standing in London; yet toad-powder was his
+sovereign remedy.
+
+See what was the state of belief in other matters among the most
+intelligent persons of the colonies, magistrates and clergymen.
+Jonathan Brewster, son of the church-elder, writes the wildest
+letters to John Winthrop about alchemy,--"mad for making gold as the
+Lynn rock-borers are for finding it."
+
+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 with an upper chamber of saints, and a tremendous
+opposition in the lower house; the leader of which may have been
+equalled, but cannot have been surpassed by any of our earth-born
+politicians.  The demons were prowling round the houses every night,
+as the foxes were sneaking about the hen-roosts.  The men of
+Gloucester fired whole flasks of gunpowder at devils disguised as
+Indians and Frenchmen.
+
+How deeply the notion of miraculous interference with the course of
+nature was rooted, is shown by the tenacity of the superstition about
+earthquakes.  We can hardly believe that our Professor Winthrop,
+father of the old judge and the "squire," whom many of us Cambridge
+people remember so well, had to defend himself against the learned
+and excellent Dr. Prince, of the Old South Church, for discussing
+their phenomena as if they belonged to the province of natural
+science:
+
+Not for the sake of degrading the aspect of the noble men who founded
+our State, do I refer to their idle beliefs and painful delusions,
+but to show against what influences the common sense of the medical
+profession had to assert itself.
+
+Think, then, of the blazing stars, that shook their horrid hair in
+the sky; the phantom ship, that brought its message direct from the
+other world; the story of the mouse and the snake at Watertown;  of
+the mice and the prayer-book;  of the snake in church; of the calf
+with two heads; and of the cabbage in the perfect form of a cutlash,
+--all which innocent occurrences were accepted or feared as alarming
+portents.
+
+We can smile at these: but we cannot smile at the account of unhappy
+Mary Dyer's malformed offspring;  or of Mrs.  Hutchinson's domestic
+misfortune of 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 fifteen alarming pages about an
+unfortunate young woman suffering with hysteria.  Or go a little
+deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia,
+first admonished, then whipped; at last, taking her own little
+daughter's life; put on trial, and standing mute, threatened to be
+pressed to death, confessing, sentenced, praying to be beheaded; and
+none the less pitilessly swung from the fatal ladder.
+
+The cooper's crazy wife--crazy in the belief that she has committed
+the unpardonable sin--tries to drown her child, to save it from
+misery; and the poor lunatic, who would be tenderly cared for to-day
+in a quiet asylum, is judged to be acting under the instigation of
+Satan himself.  Yet, after all, what can we say, who put Bunyan's
+"Pilgrim's Progress," full of nightmare dreams of horror, into all
+our children's hands; a story in which the awful image of the man in
+the cage might well turn the nursery where it is read into a
+madhouse?
+
+The miserable delusion of witchcraft illustrates, in a still more
+impressive way, the false ideas which governed the supposed relation
+of men with the spiritual world.  I have no doubt many physicians
+shared in these superstitions.  Mr. Upham says they--that is, some of
+them--were in the habit of attributing their want of success to the
+fact, that an "evil hand" was on their patient.  The temptation was
+strong, no doubt, when magistrates and ministers and all that
+followed their lead were contented with such an explanation.  But how
+was it in Salem, according to Mr. Upham's own statement?  Dr. John
+Swinnerton was, he says, for many years the principal physician of
+Salem.  And he says, also, "The Swinnerton family were all along
+opposed to Mr. Parris, and kept remarkably clear from the witchcraft
+delusion."   Dr. John Swinnerton--the same, by the way, whose memory
+is illuminated by a ray from the genius of Hawthorne--died the very
+year before the great witchcraft explosion took place.  But who can
+doubt that it was from him that the family had learned to despise and
+to resist the base superstition; or that Bridget Bishop, whose house
+he rented, as Mr. Upham tells me, the first person hanged in the time
+of the delusion, would have found an efficient protector in her
+tenant, had he been living, to head the opposition of his family to
+the misguided clergymen and magistrates?
+
+I cannot doubt that our early physicians brought with them many Old-
+World medical superstitions, and I have no question that they were
+more or less involved in the prevailing errors of the community in
+which they lived.  But, on the whole, their record is a clean one, so
+far as we can get at it; and where it is questionable we must
+remember that there must have been many little-educated persons among
+them; and that all must have felt, to some extent, the influence of
+those sincere and devoted but unsafe men, the physic-practising
+clergymen, who often used spiritual means as a substitute for
+temporal ones, who looked upon a hysteric patient as possessed by the
+devil, and treated a fractured skull by prayers and plasters,
+following the advice of a ruling elder in opposition to the "unanimous
+opinion of seven surgeons."
+
+To what results the union of the two professions was liable to lead,
+may be seen by the example of a learned and famous person, who has
+left on record the product of his labors in the double capacity of
+clergyman and physician.
+
+I have had the privilege of examining a manuscript of Cotton Mather's
+relating to medicine, by the kindness of the librarian of the
+American Antiquarian Society, to which society it belongs.  A brief
+notice 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 Approved REMEDIES for
+the Maladies."  There are sixty-six "Capsula's," as he calls them, or
+chapters, in his table of contents; of which, five--from the
+fifteenth to the nineteenth, inclusive--are missing.  This is a most
+unfortunate loss, as the eighteenth capsula treated of agues, and we
+could have learned from it something of their degree of frequency in
+this part of New England.  There is no date to the manuscript; which,
+however, refers to a case observed Nov. 14, 1724.
+
+The divine takes precedence of the physician in this extraordinary
+production.  He begins by preaching a sermon at his unfortunate
+patient.  Having thrown him into a cold sweat by his spiritual
+sudorific, he attacks him with his material remedies, which are often
+quite as unpalatable.  The simple and cleanly practice of Sydenham,
+with whose works he was acquainted, seems to have been thrown away
+upon him.  Everything he could find mentioned in the seventy or
+eighty authors he cites, all that the old women of both sexes had
+ever told him of, gets into his text, or squeezes itself into his
+margin.
+
+Evolving disease out of sin, he hates it, one would say, as he hates
+its cause, and would drive it out of the body with all noisome
+appliances.  "Sickness is in Fact Flagellum Dei pro peccatis mundi."
+So saying, he encourages the young mother whose babe is wasting away
+upon her breast with these reflections:
+
+"Think; oh the grievous Effects of Sin!  This wretched Infant has not
+arrived unto years of sense enough, to sin after the similitude of
+the transgression committed by Adam.  Nevertheless the Transgression
+of 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 infected Adam when he fell into his Transgression, by
+hearkening to the Tempter, has corrupted all mankind, and is a seed
+unto such diseases as this Infant is now laboring under.  Lord, what
+are we, and what are our children, but a Generation of Vipers?"
+
+Many of his remedies are at least harmless, but his pedantry and
+utter want of judgment betray themselves everywhere.  He piles his
+prescriptions one upon another, without the least discrimination.  He
+is run away with by all sorts of fancies and superstitions.  He
+prescribes euphrasia, eye-bright, for disease of the eyes; appealing
+confidently to the strange old doctrine of signatures, which inferred
+its use from the resemblance of its flower to the organ of vision.
+For the scattering of wens,  the efficacy of a Dead Hand has been out
+of measure wonderful.  But when he once comes to the odious class of
+remedies, he revels in them like a scarabeus.  This allusion will
+bring us quite near enough to the inconceivable abominations with
+which he proposed to outrage the sinful stomachs of the unhappy
+confederates and accomplices of Adam.
+
+It is well that the treatise was never printed, yet there are
+passages in it worth preserving.  He speaks of some remedies which
+have since become more universally known:
+
+"Among the plants of our soyl, Sir William Temple singles out Five
+[Six] as being of the greatest virtue and most friendly to health:
+and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and
+Elder."
+
+"But these Five [Six] plants may admitt of some competitors.  The
+QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"
+
+Of Ipecacuanha, he says,--
+"This is now in its reign; the most fashionable vomit."
+
+"I am not sorry that antimonial emetics begin to be disused."
+
+He quotes "Mr. Lock" as recommending red poppy-water and abstinence
+from flesh as often useful in children's diseases.
+
+One of his "Capsula's" is devoted to the animalcular origin of
+diseases, at the end of which he says, speaking of remedies for this
+supposed source of our distempers:
+
+"Mercury we know thee: But we are afraid thou wilt kill us too, if we
+employ thee to kill them that kill us.
+
+"And yett, for the cleansing of the small Blood Vessels, and making
+way for the free circulation of the Blood and Lymph--there is nothing
+like Mercurial Deobstruents."
+
+From this we learn that mercury was already in common use, and the
+subject of the same popular prejudice as 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 proper than such thoughts as these?"...
+
+If there is pathos in this, there is bathos in his apostrophe to the
+millipede, beginning "Poor sowbug!" and eulogizing the healing
+virtues of that odious little beast; of which he tells us to take
+"half a pound, putt 'em alive into a quart or two of wine," with
+saffron and other drugs, and take two ounces twice a day.
+
+The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at
+New London, and is in the possession of our own Society.  He means,
+by these words, something like the Archxus of Van Helmont, of which
+he discourses in a style wonderfully resembling that of Mr. Jenkinson
+in the "Vicar of Wakefield."  "Many of the Ancients thought there was
+much of a Real History in the Parable, and their Opinion was that
+there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a
+Resemblance) of men as to their Shapes after Death."  And so on, with
+Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA,"
+in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara
+kai ateleutaion to pan."
+
+One other passage deserves notice, as it relates to the single
+medical suggestion which does honor to Cotton Mather's memory.  It
+does not appear that he availed himself of the information which he
+says, he obtained from his slave, for such I suppose he was.
+
+In his appendix to "Variolae Triumphatae," he says,--
+
+"There has been a wonderful practice lately used in several parts of
+the world, which indeed is not yet become common in our nation.
+
+"I was first informed of it by a Garamantee servant of my own, long
+before I knew that any Europeans or Asiaticks had the least
+acquaintance with it, and some years before I was enriched with the
+communications of the learned Foreigners, whose accounts I found
+agreeing with what I received of my servant, when he 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 Number of these Africans, who
+all agree in one story; That in their countrey grandy-many dy of the
+small-pox: But now they learn this way: people take juice of smallpox
+and cutty-skin and put in a Drop; then by'nd by a little sicky,
+sicky: then very few little things like small-pox; and nobody dy of
+it; and nobody have small-pox any more.  Thus, in Africa, where the
+poor creatures dy of the smallpox like Rotten Sheep, a merciful God
+has taught them an Infallible preservative.  'T is a common practice,
+and is attended with a constant success."
+
+What has come down to us of the first century of medical practice, in
+the hands of Winthrop and Oliver, is comparatively simple and
+reasonable.  I suspect that the conditions of rude, stern life, in
+which the colonists found themselves in the wilderness, took the
+nonsense out of them, as the exigencies of a campaign did out of our
+physicians and surgeons in the late war.  Good food and enough of it,
+pure air and water, cleanliness, good attendance, an anaesthetic, an
+opiate, a stimulant, quinine, and two or three common drugs, proved
+to be the marrow of medical treatment; and the fopperies of the
+pharmacopoeia went the way of embroidered shirts and white kid gloves
+and malacca joints, in their time of need.  "Good wine is the best
+cordiall for her," said Governor John Winthrop, Junior, to Samuel
+Symonds, speaking of that gentleman's wife,--just as Sydenham,
+instead of physic, once ordered a roast chicken and a pint of canary
+for his patient in male hysterics.
+
+But the profession of medicine never could reach its full development
+until it became entirely separated from that of divinity.  The
+spiritual guide, the consoler in afliction, the confessor who is
+admitted into the secrets of our souls, has his own noble sphere of
+duties; but the healer of men must confine himself solely to the
+revelations of God in nature, as he sees their miracles with his own
+eyes.  No doctrine of prayer or special providence is to be his
+excuse for not looking straight at secondary causes, and acting,
+exactly so far as experience justifies him, as if he were himself the
+divine agent which antiquity fabled him to be.  While pious men were
+praying--humbly, sincerely, rightly, according to their knowledge--
+over the endless succession of little children dying of spasms in the
+great Dublin Hospital, a sagacious physician knocked some holes in
+the walls of the ward, let God's blessed air in on the little
+creatures, and so had already saved in that single hospital, as it
+was soberly calculated thirty years ago, more than sixteen thousand
+lives of these infant heirs of immortality. [Collins's Midwifery, p.
+312.  Published by order of the Massachusetts Medical Society.
+Boston, 1841.]
+
+Let it be, if you will, that the wise inspiration of the physician
+was granted in virtue of the clergyman's supplications.  Still, the
+habit of dealing with things seen generates another kind of
+knowledge, and another way of thought, from that of dealing with
+things unseen; which knowledge and way of thought are special means
+granted by Providence, and to be thankfully accepted.
+
+The mediaeval ecclesiastics expressed a great truth in that saying,
+so often quoted, as carrying a reproach with it: "Ubi tres medici,
+duo athei,"--"Where there are three physicians, there are two
+atheists."
+
+It was true then, it is true to-day, that the physician very
+commonly, if not very generally, denies and repudiates the deity of
+ecclesiastical commerce.  The Being whom Ambroise Pare meant when he
+spoke those memorable words, which you may read over the professor's
+chair in the French School of Medicine, "Te le pensay, et Dieu le
+guarit," "I dressed his wound, and God healed it,"--is a different
+being from the God that scholastic theologians have projected from
+their consciousness, or shaped even from the sacred pages which have
+proved so plastic in their hands.  He is a God who never leaves
+himself without witness, who repenteth him of the evil, who never
+allows a disease or an injury, compatible with the enjoyment of life,
+to take its course without establishing an effort, limited by certain
+fixed conditions, it is true, but an effort, always, to restore the
+broken body or the shattered mind.  In the perpetual presence of this
+great Healing Agent, who stays the bleeding of wounds, who knits the
+fractured bone, who expels the splinter by a gentle natural process,
+who walls in the inflammation that might involve the vital organs,
+who draws a cordon to separate the dead part from the living, who
+sends his three natural anaesthetics to the over-tasked frame in due
+order, according to its need,--sleep, fainting, death; in this
+perpetual presence, it is doubtless hard for the physician to realize
+the theological fact 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 has abrogated the pardoning power,
+and mercy forgets its errand; where the omnipotent is unfelt save in
+malignant agencies, and the omnipresent is unseen and unrepresented;
+hard to accept the God of Dante's "Inferno," and of Bunyan's caged
+lunatic.  If this is atheism, 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 injurious effect of the
+materializing influences to which the physician is subjected.
+A spiritual guild is absolutely necessary to keep him, to keep us
+all, from becoming the "fingering slaves" that Wordsworth treats with
+such shrivelling scorn.  But it is well that the two callings have
+been separated, and it is fitting that they remain apart.  In
+settling the affairs of the late concern, I am afraid our good
+friends remain a little in our debt.  We lent them our physician
+Michael Servetus in fair condition, and they returned him so damaged
+by fire as to be quite useless for our purposes.  Their Reverend
+Samuel Willard wrote us a not over-wise report of a case of hysteria;
+and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary
+of the Bible) the first discerning criticism on the authorship of the
+Pentateuch.  Our John Locke enlightened them with his letters
+concerning toleration; and their Cotton Mather obscured our twilight
+with his "Nishmath Chajim."
+
+Yet we must remember that the name of Basil Valentine, the monk, is
+associated with whatever good and harm we can ascribe to antimony;
+and that the most remarkable of our specifics long bore the name of
+"Jesuit's Bark," from an old legend connected with its introduction.
+"Frere Jacques," who taught the lithotomists of Paris, owes his
+ecclesiastical title to courtesy, as he did not belong to a religious
+order.
+
+Medical science, and especially the study of mental disease, is
+destined, I believe, to react to much greater advantage on the
+theology of the future than theology has acted on medicine in the
+past.  The liberal spirit very generally prevailing in both
+professions, and the good understanding between their most
+enlightened members, promise well for the future of both in a
+community which holds every point of human belief, every institution
+in human hands, and every word written in a human dialect, open to
+free discussion today, to-morrow, and to the end of time.  Whether
+the world at large will ever be cured of trusting to specifics as a
+substitute for observing the laws of health, and to mechanical or
+intellectual formula as a substitute for character, may admit of
+question.  Quackery and idolatry are all but immortal.
+
+We can find most of the old beliefs alive amongst us to-day, only
+having changed their dresses and the social spheres in which they
+thrive.  We think the quarrels of Galenists and chemists belong to
+the past, forgetting that Thomsonism has its numerous apostles in our
+community; that it is common to see remedies vaunted as purely
+vegetable, and that the prejudice against "mineral poisons,"
+especially mercury, is as strong in many quarters now as it was at
+the beginning of the seventeenth century.  Names are only air, and
+blow away with a change of wind; 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 for a very moderate compensation.
+Nostradamus and Lilly seem impossible in our time; but we have seen
+the advertisements of an astrologer in our Boston papers year after
+year, which seems to imply that he found believers and patrons.  You
+smiled when I related Sir Kenelm Digby's prescription with the live
+eel in it; but if each of you were to empty his or her pockets, would
+there not roll out, from more than one of them, a horse-chestnut,
+carried about as a cure for rheumatism?  The brazen head of Roger
+Bacon is mute; but is not "Planchette" uttering her responses in a
+hundred houses of this city?  We think of palmistry or chiromancy as
+belonging to the days of Albertus Magnus, or, if existing in our
+time, as given over to the gypsies; but a very distinguished person
+has recently shown me the line of life, and the line of fortune, on
+the palm of his hand, with a seeming confidence in the sanguine
+predictions of his career which had been drawn from them.  What shall
+we say of the plausible and well-dressed charlatans of our own time,
+who trade in false pretences, like Nicholas Knapp of old, but without
+any fear of being fined or whipped; or of the many follies and
+inanities, imposing on the credulous part of the community, each of
+them gaping with eager, open mouth for a gratuitous advertisement by
+the mention of its foolish name in any respectable connection?
+
+I turn from this less pleasing aspect of the common intelligence
+which renders such follies possible, to close the honorable record of
+the medical profession in this, our ancient Commonwealth.
+
+We have seen it in the first century divided among clergymen,
+magistrates, and regular practitioners; yet, on the whole, for the
+time, and under the circumstances, respectable, except where it
+invoked supernatural agencies to account for natural phenomena.
+
+In the second century it simplified its practice, educated many
+intelligent practitioners, and began the work of organizing for
+concerted action, and for medical teaching.
+
+In this, our own century, it has built hospitals, perfected and
+multiplied its associations and educational institutions, enlarged
+and created museums, and challenged a place in the world of science
+by its literature.
+
+In reviewing the whole course of its history we read a long list of
+honored names, and a precious record written in private memories, in
+public charities, in permanent contributions to medical science, in
+generous sacrifices for the country.  We can point to our capital as
+the port of entry for the New World of the great medical discoveries
+of two successive centuries, and we can claim for it the triumph over
+the most dreaded foe that assails the human body,--a triumph which
+the annals of the race can hardly match in three thousand years of
+medical history.
+
+
+
+
+
+
+THE YOUNG PRACTITIONER
+
+[A Valedictory Address delivered to the Graduating Class of the
+Bellevue Hospital College, March 2, 1871.]
+
+
+The occasion which calls us together reminds us not a little of that
+other ceremony which unites a man and woman for life.  The banns have
+already been pronounced which have wedded our young friends to the
+profession of their choice.  It remains only to address 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 ambitious eloquence.
+We must forget ourselves, and think only of them.  To us it is an
+occasion; to them it is an epoch.  The spectators at the wedding look
+curiously at the bride and bridegroom; at the bridal veil, the
+orange-flower garland, the giving and receiving of the ring; they
+listen for the tremulous "I will," and wonder what are the mysterious
+syllables the clergyman whispers in the ear of the married maiden.
+But to the newly-wedded pair what meaning in those words, "for
+better, for worse," "in sickness and in health," "till death us do
+part!"  To the father, to the mother, who know too well how often the
+deadly nightshade is interwoven with the wreath of orange-blossoms,
+how empty the pageant, how momentous the reality!
+
+You will not wonder that I address myself chiefly to those who are
+just leaving academic life for the sterner struggle and the larger
+tasks of matured and instructed manhood.  The hour belongs to them;
+if others find patience to listen, they will kindly remember that,
+after all, they are but as the spectators at the wedding, and that
+the priest is thinking less of them than of their friends who are
+kneeling at the altar.
+
+I speak more directly to you, then, gentlemen of the graduating
+class.  The days of your education, as pupils of trained instructors,
+are over.  Your first harvest is all garnered.  Henceforth you are to
+be sowers as well as reapers, and your field is the world.  How does
+your knowledge stand to-day?  What have you gained as a permanent
+possession?  What must you expect to forget?  What remains for you
+yet to learn?  These are questions which it may interest you to
+consider.
+
+There is another question which must force itself on the thoughts of
+many among you: "How am I to obtain patients and to keep their
+confidence?  "You have chosen a laborious calling, and made many
+sacrifices to fit yourselves for its successful pursuit.  You wish to
+be employed that you may be useful, and that you may receive the
+reward of your industry.  I would take advantage of these most
+receptive moments to give you some hints which may help you to
+realize your hopes and expectations.  Such is the outline of the
+familiar talk I shall offer you.
+
+Your acquaintance with some of the accessory branches is probably
+greater now than it will be in a year from now,--much greater than it
+will by ten years from now.  The progress of knowledge, it may be
+feared, or hoped, will have outrun the text-books in which you
+studied these branches.  Chemistry, for instance, is very apt to
+spoil on one's hands.  "Nous avons change tout cela" might serve as
+the standing motto of many of our manuals.  Science is a great
+traveller, and wears her shoes out pretty 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 large practice all around you would find a
+more potent sudorific than any in the Pharmacopceia.  These masters
+of the art of healing were once as ready with their answers as you
+are now, but they have got rid of a great deal of 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 trains off the fat of a prize-fighter.
+
+Yet, pause a moment before you infer that your teachers must have
+been in fault when they furnished you with mental stores not directly
+convertible to practical purposes, and likely in a few years to lose
+their place in your memory.  All systematic knowledge involves much
+that is not practical, yet it is the only kind of knowledge which
+satisfies the mind, and systematic study proves, in the long-run, the
+easiest way of acquiring 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 condition is not the same as if you had
+never known what you now try in vain to recall.  There is a perpetual
+metempsychosis of thought, and the knowledge of to-day finds a soil
+in the forgotten facts of yesterday.  You cannot see anything in the
+new season of the guano you placed last year about the roots of your
+climbing plants, but it is blushing and breathing fragrance in your
+trellised roses; it has scaled your porch in the bee-haunted honey-
+suckle; it has found its way where the ivy is green; it is gone where
+the woodbine expands its luxuriant foliage.
+
+Your diploma seems very broad to-day with your list of
+accomplishments, but it begins to shrink from this hour like the Peau
+de Chagrin of Balzac's story.  Do not worry about it, for all the
+while there will be making out for you an ampler and fairer
+parchment, signed by old Father Time himself as President of that
+great University in which experience is the one perpetual and all-
+sufficient professor.
+
+Your present plethora of acquirements will soon cure itself.
+Knowledge that is not wanted dies out like the eyes of the fishes of
+the Mammoth Cave.  When you come to handle life and death as your
+daily business, your memory will of itself bid good-by to such
+inmates as the well-known foramina of the sphenoid bone and the
+familiar oxides of methyl-ethylamyl-phenyl-ammonium.  Be thankful
+that you have once known them, and remember that even the learned
+ignorance of a nomenclature is something to have mastered, and may
+furnish pegs to hang facts upon which would otherwise have strewed
+the floor of memory in loose disorder.
+
+But your education has, after all, been very largely practical.  You
+have studied medicine and surgery, not chiefly in books, but at the
+bedside and in the operating amphitheatre.  It is the special
+advantage of large cities that they afford the opportunity of seeing
+a great deal of disease in a short space of time, and of seeing many
+cases of the same kind of disease brought together.  Let us not be
+unjust to the claims of the schools remote from the larger centres of
+population.  Who among us has taught better than Nathan Smith, better
+than Elisha Bartlett? who teaches better than some of our living
+contemporaries who divide their time between city and country
+schools?  I am afraid we do not always do justice to our country
+brethren, whose merits are less conspicuously exhibited than those of
+the great city physicians and surgeons, such especially as have
+charge of large hospitals.  There are modest practitioners living in
+remote rural districts who are gifted by nature with such sagacity
+and wisdom, trained so well in what is most essential to the practice
+of their art, taught so thoroughly by varied experience, forced to
+such manly self-reliance by their comparative isolation, that, from
+converse with them alone, from riding with them on their long rounds
+as they pass from village to village, from talking over cases with
+them, putting up their prescriptions, watching their expedients,
+listening to their cautions, marking the event of their predictions,
+hearing them tell of their mistakes, and now and then glory a little
+in the detection of another's blunder, a young man would find himself
+better fitted for his real work than many who have followed long
+courses of lectures and passed a showy examination.  But the young
+man is exceptionally fortunate who enjoys the intimacy of such a
+teacher.  And it must be confessed that the great hospitals,
+infirmaries, and dispensaries of large cities, where men of well-
+sifted reputations are in constant attendance, are the true centres
+of medical education.  No students, I believe, are more thoroughly
+aware of this than those who have graduated at this institution.
+Here, as in all our larger city schools, the greatest pains are taken
+to teach things as well as names.  You have entered into the
+inheritance of a vast amount of transmitted skill and wisdom, which
+you have taken, warm, as it were, 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 many of those whose
+names we hardly mention without a genuflection.  I had rather be
+cared for in a fever by the best-taught among you than by the
+renowned Fernelius or the illustrious Boerhaave, could they come back
+to us from that better world where there are no physicians needed,
+and, if the old adage can be trusted, not many within call.  I had
+rather have one of you exercise his surgical skill upon me than find
+myself in the hands of a resuscitated Fabricius 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 alderman in an apoplexy, for
+a girl that has fainted, for a woman in hysterics, for a leg that is
+broken, for an arm that is out of joint, for fevers of every color,
+for the sailor's rheumatism, and the tailor's cachexy.  In fact you
+do really know so much at this very hour, that nothing but the
+searching test of time can fully teach you the limitations of your
+knowledge.
+
+Of some of these you will permit me to remind you.  You will never
+have outgrown the possibility of new acquisitions, for Nature is
+endless in her variety.  But even the knowledge which you may be said
+to possess will be a different thing after long habit has made it a
+part of your existence.  The tactus eruditus extends 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 wise in 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 Shipman
+brought home with him from the sea a
+
+     "In many a tempest had his berd be shake."
+
+This is the knowledge we place most confidence in, in the practical
+affairs of life.
+
+Our training has two stages.  The first stage deals with our
+intelligence, which takes the idea of what is to be done with the
+most charming ease and 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 glance from that ball and hit that other
+ball, and to knock that ball with this ball into a certain caecal
+sacculus or diverticulum which our professional friend calls a
+pocket.  Nothing can be clearer; it is as easy as "playing upon this
+pipe," for which Hamlet gives Guildenstern such lucid directions.
+But this intelligent Me, who steps forward as the senior partner in
+our dual personality, turns out to be a terrible bungler.  He misses
+those glancing hits which the hard-featured young professional person
+calls "carroms," and insists on pocketing his own ball instead of the
+other one.
+
+It is the unintelligent Me, stupid as an idiot, that has to try a
+thing a thousand times before he can do it, and then never knows how
+he does it, that at last does it well.  We have to educate ourselves
+through the pretentious claims of intellect, into the humble accuracy
+of instinct, and we end at last by 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 not only in the brain, it is in the
+senses, in the muscles, in the ganglia of the sympathetic nerves,--
+all over the man, as one may say, as instinct seems diffused through
+every part of those lower animals that have no such distinct organ as
+a brain.  See a skilful surgeon handle a broken limb; see a wise old
+physician smile away a case that looks to a novice as if the sexton
+would soon be sent for; mark what a large experience has 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 in medical practice,
+something in the way the man painted the lion, that is, the lion
+under?
+
+The young man knows the rules, but the old man knows-the exceptions.
+The young man knows his patient, but the old man knows also his
+patient's family, dead and alive, up and down for generations.  He
+can tell beforehand what diseases their unborn children will be
+subject to, what they will die of if they live long enough, and
+whether they had better live at all, or remain unrealized
+possibilities, as belonging to a stock not worth being perpetuated.
+The young man feels uneasy if he is not continually doing something
+to stir up his patient's internal arrangements.  The old man takes
+things more quietly, and is much more willing to let well enough
+alone: All these superiorities, if such they are,'you must wait for
+time to bring you.  In the meanwhile (if we will let the lion be
+uppermost for a moment), the young man's senses are quicker than
+those of his older rival.  His education in all the accessory
+branches is more recent, and therefore nearer the existing condition
+of knowledge.  He finds it easier than his seniors to accept the
+improvements which every year is bringing forward.  New ideas build
+their nests in young men's brains.  "Revolutions are not made by men
+in spectacles," as I once heard it remarked, and the first whispers
+of a new truth are not caught by those who begin to feel the need of
+an ear-trumpet.  Granting all these advantages to the young man, he
+ought, nevertheless, to go on improving, on the whole, as a medical
+practitioner, with every year, until he has ripened into a well-
+mellowed maturity.  But, to improve, he must be good for something at
+the start.  If you ship a poor cask of wine to India and back, if you
+keep it a half a century, 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 look to you as its authorized champions in the struggle of life
+against its numerous enemies?
+
+In the first place, the persons who seek the aid of the physician are
+very honest and sincere in their wish to get rid of their complaints,
+and, generally speaking, to live as long as they can.  However
+attractively the future is painted to them, they are attached to the
+planet with which they are already acquainted.  They are addicted to
+the daily use of this empirical and unchemical mixture which we call
+air; and would hold on to it as a tippler does to his alcoholic
+drinks.  There is nothing men will not do, there is nothing they have
+not done, to recover their health and save their lives.  They have
+submitted to be half-drowned in water, and half-choked with gases, to
+be buried up to their chins in earth, to be seared with hot irons
+like galley-slaves, to be crimped with knives, like cod-fish, to have
+needles thrust into their flesh, and bonfires kindled on their skin,
+to swallow all sorts of abominations, and to pay for all this, as if
+to be singed and scalded were a costly privilege, as if blisters were
+a blessing, and leeches were a luxury.  What more can be asked to
+prove their honesty and sincerity?
+
+This same community is very intelligent with respect to a great many
+subjects-commerce, mechanics, manufactures, politics.  But with
+regard to medicine it is hopelessly ignorant and never finds it out.
+I do not know that it is any worse in this country than in Great
+Britain, where Mr. Huxley speaks very freely of "the utter ignorance
+of the simplest laws of their own animal life, which prevails among
+even the most highly educated persons."  And Cullen said before him
+"Neither the acutest genius nor the soundest judgment 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 sometimes
+with reasons, and I have found that any will pass, even with able
+divines and acute lawyers; the same will pass with the husbands as
+with the wives."  If the community could only be made aware of its
+own utter ignorance, and incompetence to form opinions on medical
+subjects, difficult enough to those who give their lives to the study
+of them, the practitioner would have an easier task.  But it will
+form opinions of its own, it cannot help it, and we cannot blame it,
+even though we know how slight and deceptive are their foundations.
+
+This is the way it happens: Every grown-up person has either been ill
+himself or had a friend suffer from illness, from which he has
+recovered.  Every sick person has done something or other by
+somebody's advice, or of his own accord, a little before getting
+better.  There is an irresistible tendency to associate the thing
+done, and the improvement which followed it, as cause and effect.
+This is the great source of fallacy in medical practice.  But the
+physician has some chance of correcting his hasty inference.  He
+thinks his prescription cured a single case of a particular
+complaint; he tries it in twenty similar cases without effect, and
+sets down the first as probably nothing more than a coincidence.  The
+unprofessional experimenter or observer has no large experience to
+correct his hasty generalization.  He wants to believe that the means
+he employed effected his cure.  He feels grateful to the person who
+advised it, he loves to praise the pill or potion which helped him,
+and he has a kind of monumental pride in himself as a living
+testimony to its efficacy.  So it is that you will find the community
+in which you live, be it in town or country, full of brands plucked
+from the burning, as they believe, by some agency which, with your
+better training, you feel reasonably confident had nothing to do with
+it.  Their disease went out of itself, and the stream from the
+medical fire-annihilator had never even touched it.
+
+You cannot and need not expect to disturb the public in 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 ninth
+chapter of St. John's Gospel, and you will find that the logic of a
+restored patient was very simple then, as it is now, and very hard to
+deal with.  My clerical friends will forgive me for poaching on their
+sacred territory, in return for an occasional raid upon the medical
+domain of which they have now and then been accused.
+
+A blind man was said to have been restored to sight by a young person
+whom the learned doctors of the Jewish law considered a sinner, and,
+as such, very unlikely to have been endowed with a divine gift of
+healing.  They visited the patient repeatedly, and evidently teased
+him with their questions about the treatment, and their insinuations
+about the young man, until he lost his temper.  At last he turned
+sharply upon them:  "Whether he be a sinner or no, I know not: one
+thing I know, that, whereas I was blind, now I see."
+
+This is the answer that always has been and always will be given by
+most persons when they find themselves getting well after doing
+anything, no matter what,--recommended by anybody, no matter whom.
+Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in
+panaceas which we should laugh to scorn.  They had seen people get
+well after using them.  Are we any wiser than those great men?  Two
+years ago, in a lecture before the Massachusetts Historical Society,
+I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare
+the patient's nails; put the parings in a little bag, and hang the
+bag round the neck of a live eel, and place him in a tub of water.
+The eel will die, and the patient will recover.
+
+Referring to this prescription in the course of the same lecture, I
+said: "You smiled when I related Sir Kenehn Digby's prescription,
+with the live eel in it; but if each of you were to empty his or her
+pockets, would there not roll out, from more than one of them, a
+horse-chestnut, carried about as a cure for rheumatism?"  Nobody saw
+fit to empty his or her pockets, and my question brought no response.
+But two months ago I was in a company of educated persons, college
+graduates every one of them, 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 his breeches-pocket, and laid them on the
+table, telling us how, having suffered from the complaint in
+question, he had, by the advice of a friend, procured these two
+horse-chestnuts on a certain time a year or more ago, and carried
+them about him ever since; from which very 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 to meet wherever you go, and you
+need not think you can answer it.  In the natural course of things
+some thousands of persons must be getting well or better of slight
+attacks of colds, of rheumatic pains, every week, in this city alone.
+Hundreds of them do something or other in the way of remedy, by
+medical or other advice, or of their own motion, and the last thing
+they do gets the credit of the recovery.  Think what a crop of
+remedies this must furnish, if it were all harvested!
+
+Experience has taught, or will teach you, that most of the wonderful
+stories patients and others tell of sudden and signal cures are like
+Owen Glendower's story of the portents that announced his birth.  The
+earth shook at your nativity, did it?  Very likely, and
+
+               "So it would have done,
+     At the same season, if your mother's cat
+     Had kittened, though yourself had ne'er been born."
+
+You must listen more meekly than Hotspur did to the babbling
+Welshman, for ignorance is a solemn and sacred fact, and, like
+infancy, which it resembles, should be respected.  Once in a while
+you will have a patient of sense, born with the gift of observation,
+from whom you may learn something.  When you find yourself in the
+presence of one who is fertile of medical opinions, and affluent in
+stories of marvellous cures,--of a member of Congress whose name
+figures in certificates to the value of patent medicines, of a
+voluble dame who discourses on the miracles she has wrought or seen
+wrought with the little jokers of the sugar-of-milk globule-box, take
+out your watch and count the pulse; also note the time of day, and
+charge 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 dispensation into a double blessing, for this class
+of patients loves dearly to talk, and it does them a deal of good,
+and you feel as if you had earned your money by the dose you have
+taken, quite as honestly as by any dose you may have ordered.
+
+You must take the community just as it is, and make the best of it.
+You wish to obtain its confidence; there is a short rule for doing
+this which you will find useful,--deserve it.  But, to deserve it in
+full measure, you must unite many excellences, natural and acquired.
+
+As the basis of all the rest, you must have all those traits of
+character which fit you to enter into the most intimate and
+confidential relations with the families of which you are the
+privileged friend and counsellor.  Medical Christianity, if I may use
+such a term, is of very early date.  By the oath of Hippocrates, the
+practitioner of ancient times bound himself to enter his patient's
+house with the sole purpose of doing him good, and so to conduct
+himself as to avoid the very appearance of evil.  Let the physician
+of to-day begin by coming up to this standard, and add to it all the
+more recently discovered virtues and graces.
+
+A certain amount of natural ability is requisite to make you a good
+physician, but by no means that disproportionate development of some
+special faculty which goes by the name of genius.  A just balance of
+the mental powers is a great deal more likely to be useful than any
+single talent, even were it the power of observation; in excess.  For
+a mere observer is liable to be too fond of facts for their own sake,
+so that, if he told the real truth, he would confess that he takes
+more pleasure in a post-mortem examination which shows him what was
+the matter with a patient, than in a case which insists on getting
+well and leaving him in the dark as to its nature.  Far more likely
+to interfere with the sound practical balance of the mind is that
+speculative, theoretical tendency which has made so many men noted in
+their day, whose fame has passed away with their dissolving theories.
+Read Dr. Bartlett's comparison of the famous Benjamin Rush with his
+modest fellow-townsman Dr. William Currie, and see the dangers into
+which a passion for grandiose generalizations betrayed a man of many
+admirable qualities.
+
+I warn you against all ambitious aspirations outside of your
+profession.  Medicine is the most difficult of sciences and the most
+laborious of arts.  It will task all your powers of body and mind if
+you are faithful to it.  Do not dabble in the muddy sewer of
+politics, nor linger by the enchanted streams of literature, nor dig
+in far-off fields for the hidden waters of alien sciences.  The great
+practitioners are generally those who concentrate all their powers on
+their business.  If there are here and there brilliant exceptions, it
+is only in virtue of extraordinary gifts, and industry to which very
+few are equal.
+
+To get business a man mast really want it; and do you suppose that
+when you are in the middle of a heated caucus, or half-way through a
+delicate analysis, or in the spasm of an unfinished ode, your eyes
+rolling in the fine frenzy of poetical composition, you want to be
+called to a teething infant, or an ancient person groaning under the
+griefs of a lumbago?  I think I have known more than one young man
+whose doctor's sign proclaimed his readiness to serve mankind in that
+capacity, but who hated the sound of a patient's knock, and as he sat
+with his book or his microscope, felt exactly as the old party
+expressed himself in my 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 of those diplomaed dilettanti
+who like the amusement of quasi medical studies, but have no idea of
+wasting their precious time in putting their knowledge in practice
+for the benefit of their suffering fellow-creatures.
+
+The public is a very incompetent judge of your skill and knowledge,
+but it gives its confidence most readily to those who stand well with
+their professional brethren, whom they call upon when they themselves
+or their families 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 yet have defects which prevent his
+becoming a favorite practitioner, but no popularity can be depended
+upon as permanent which is not sanctioned by the judgment of
+professional experts, and with these you will always stand on your
+substantial merits.
+
+What shall I say of the personal habits you must form if you wish for
+success?  Temperance is first upon the list.  Intemperance in a
+physician partakes of the guilt of homicide, for the muddled brain
+may easily make a fatal blunder in a prescription and the unsteady
+hand transfix an artery in an operation.  Tippling doctors have been
+too common in the history of medicine.  Paracelsus was a sot,
+Radcliffe was much too fond of his glass, and Dr. James Hurlbut of
+Wethersfield, Connecticut, a famous man in his time, used to drink a
+square bottle of rum a day, with a corresponding allowance of opium
+to help steady his nerves.  We commonly speak of a man as being the
+worse for liquor, but I was asking an Irish laborer one day about his
+doctor, who, as he said, was somewhat given to drink.  "I like him
+best when he's a little that way," he said; "then I can spake to
+him."  I pitied the poor patient who could not venture to allude to
+his colic or his pleurisy until his physician was tipsy.
+
+There are personal habits of less gravity than the one I have
+mentioned which it is well to guard against, or, if they are formed,
+to relinquish.  A man who may be called at a moment's warning into
+the fragrant boudoir of suffering loveliness should not unsweeten its
+atmosphere with reminiscences of extinguished meerschaums.  He should
+remember that the sick are sensitive and fastidious, that they love
+the sweet odors and the pure tints of flowers, and if his presence is
+not like the breath of the rose, if his hands are not like the leaf
+of the lily, his visit may be unwelcome, and if he looks behind him
+he may see a window thrown open after he has left the sick-chamber.
+I remember too well the old doctor who sometimes came to help me
+through those inward griefs to which childhood is liable.  "Far off
+his coming "--shall I say "shone," and finish the Miltonic phrase, or
+leave the verb to the happy conjectures of my audience?  Before him
+came a soul-subduing whiff of ipecacuanha, and after him lingered a
+shuddering consciousness of rhubarb.  He had lived so much among his
+medicaments that he had at last become himself a drug, and to have
+him pass through a sick-chamber was a stronger dose than a
+conscientious disciple of Hahnemann would think it safe to
+administer.
+
+Need I remind yon of the importance of punctuality in your
+engagements, and of the worry and distress to patients and their
+friends which the want of it occasions?  One of my old teachers
+always carried two watches, to make quite sure of being exact, and
+not only kept his appointments with the regularity of a chronometer,
+but took great pains to be at his patient's house at the time when he
+had reason to believe he was expected, even if no express appointment
+was made.  It is a good rule; if you call too early, my lady's hair
+may not be so smooth as could be wished, and, if you keep her waiting
+too long, her hair may be smooth, but her temper otherwise.
+
+You will remember, of course, always to get the weather-gage of your
+patient.  I mean, to place him so that the light falls on his face
+and not on yours.  It is a kind of, ocular duel that is about to take
+place between you; you are going to look through his features into
+his pulmonary and hepatic and other internal machinery, and he is
+going to look into yours quite as sharply to see what you think about
+his probabilities for 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, and serene 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 benevolent old hypocrite; she
+cheats the sick and the dying with illusions better than any
+anodynes.  If there are cogent reasons why a patient should be
+undeceived, do it deliberately and advisedly, but do not betray your
+apprehensions through your tell-tale features.
+
+We had a physician in our city whose smile was commonly reckoned as
+being worth five thousand dollars a year to him, in the days, too, of
+moderate incomes.  You cannot put on such a smile as that any more
+than you can get sunshine without sun; there was a tranquil and
+kindly nature under it that irradiated the pleasant face it made one
+happier to meet on his daily rounds.  But you can cultivate the
+disposition, and it will work its way through to the surface, nay,
+more,--you can try to wear a quiet and encouraging look, and it will
+react on your disposition and make you like what you seem to be, or
+at least bring you nearer to its own likeness.
+
+Your patient has no more right to all the truth you know than he has
+to all the medicine in your saddlebags, if you carry that kind of
+cartridge-box for the ammunition that slays disease.  He should get
+only just so much as is good for him.  I have seen a physician
+examining a patient's chest stop all at once, as he brought out a
+particular sound with a tap on the collarbone, in the attitude of a
+pointer who has just come on the scent or sight of a woodcock.  You
+remember the Spartan boy, who, with unmoved countenance, hid the fox
+that was tearing his vitals beneath his mantle.  What he could do in
+his own suffering you must learn to do for others on whose vital
+organs disease has fastened its devouring teeth.  It is a terrible
+thing to take away hope, even earthly hope, from a fellow-creature.
+Be very careful what names you let fall before your patient.  He
+knows what it means when you tell him he has tubercles or Bright's
+disease, and, if he hears the word carcinoma, he will certainly look
+it out in a medical dictionary, if he does not interpret its dread
+significance on the instant.  Tell him he has asthmatic symptoms, or
+a tendency to the gouty diathesis, and he will at once think of all
+the asthmatic and gouty old patriarchs he has ever heard of, and be
+comforted.  You need not be so cautious in speaking of the health of
+rich and remote relatives, if he is in the line of succession.
+
+Some shrewd old doctors have a few phrases always on hand for
+patients that will insist on knowing the pathology of their
+complaints without the slightest capacity of understanding the
+scientific explanation.  I have known the term "spinal irritation"
+serve well on such occasions, but I think nothing on the whole has
+covered so much ground, and meant so little, and given such profound
+satisfaction to all parties, as the magnificent phrase "congestion of
+the portal system."
+
+Once more, let me recommend you, as far as possible, to keep your
+doubts to yourself, and give the patient the benefit of your
+decision.  Firmness, gentle firmness, is absolutely necessary in this
+and certain other relations.  Mr. Rarey with Cruiser, Richard with
+Lady Ann, Pinel with his crazy people, show what steady nerves can do
+with the most intractable of animals, the most irresistible of
+despots, and the most unmanageable of invalids.
+
+If you cannot acquire and keep the confidence of your patient, it is
+time for you to give place to some other practitioner who can.  If
+you are wise and diligent, you can establish relations with the best
+of them which they will find it very hard to break.  But, if they
+wish to employ another person, who, as they think, knows more than
+you do, do not take it as a personal wrong.  A patient believes
+another man 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, it is a great impertinence to think you
+have any property in him.  Your estimate of your own ability is not
+the question, it is what the patient thinks of it.  All your wisdom
+is to him like the lady's virtue 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 found a good physician,
+sticks to him till he dies.  But there are many very good people who
+are not what I call good patients.  I was once requested to call 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-sixth member of the faculty into whose arms,
+professionally speaking, she had successively thrown herself.  Not
+being a believer in such a rapid rotation of scientific crops, I
+gently deposited the burden, commending it to the care of number
+twenty-seven, and, him, whoever he might be, to the care of Heaven.
+
+If there happened to be among my audience any person who wished to
+know on what principles the patient should choose his physician, I
+should give him these few precepts to think over:
+
+Choose a man who is personally agreeable, for a daily visit from an
+intelligent, amiable, pleasant, sympathetic person will cost you no
+more than one from a sloven or a boor, and his presence will do more
+for you than any prescription the other will order.
+
+Let him be a man of recognized good sense in other matters, and the
+chance is that he will be sensible as a practitioner.
+
+Let him be a man who stands well with his professional brethren, whom
+they approve as honest, able, courteous.
+
+Let him be one whose patients are willing to die in his hands, not
+one whom they go to for trifles, and leave 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 regular profession,
+unless you wish to go farther and fare worse, for you may be assured
+that its members recognize no principle which hinders their accepting
+any remedial agent proved to be useful, no matter from what quarter
+it 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 as an anesthetic, they
+will find no difficulty in procuring its recognition.
+
+Some of you will probably be more or less troubled by the pretensions
+of that parody of mediaeval theology which finds its dogma of
+hereditary depravity in the doctrine of psora, its miracle of
+transubstantiation in 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 to accept these curious medical
+superstitions.  The saturation-point of individual minds with
+reference to evidence, and especially medical evidence, differs, and
+must always continue to differ, very widely.  There are those whose
+minds are satisfied with the decillionth dilution of a scientific
+proof.  No wonder they believe in the efficacy of a similar
+attenuation of bryony or pulsatilla.  You have no fulcrum you can
+rest upon to lift an error out of such minds as these, often highly
+endowed with knowledge and talent, sometimes with genius, but
+commonly richer in the imaginative than the observing and reasoning
+faculties.
+
+Let me return once more to the young graduate.  Your relations to
+your professional brethren may be a source of lifelong happiness and
+growth in knowledge and character, or they may make you wretched and
+end by leaving you isolated from those who should be your friends and
+counsellors.  The life of a physician becomes ignoble when he suffers
+himself to feed on petty jealousies and sours his temper in perpetual
+quarrels.  You will be liable to meet an uncomfortable man here and
+there in the profession,--one who is so fond of being in hot water
+that it is a wonder all the albumen in his body is not coagulated.
+There are common barrators among doctors as there are among lawyers,
+--stirrers up of strife under one pretext and another, but in reality
+because they like it.  They are their own worst enemies, and do
+themselves a mischief each time they assail their neighbors.  In my
+student days I remember a good deal of this Donnybrook-Fair style of
+quarrelling, more especially in Paris, where some of the noted
+surgeons were always at loggerheads, and in one of our lively Western
+cities.  Soon after I had set up an office, I had a trifling
+experience which may serve to point a moral in this direction.  I had
+placed a lamp behind the glass in the entry to indicate to the
+passer-by where relief from all curable infirmities was to be sought
+and found.  Its brilliancy attracted the attention of a devious
+youth, who dashed his fist through the glass and upset my modest
+luminary.  All he got by his vivacious assault was that he left
+portions of integument from his knuckles upon the glass, had a lame
+hand, was very easily identified, and had to pay the glazier's bill.
+The moral is that, if the brilliancy of another's reputation excites
+your belligerent instincts, it is not worth your while to strike at
+it, without calculating which of you is likely to suffer most, if you
+do.
+
+You may be assured that when an ill-conditioned neighbor is always
+complaining of a bad taste in his mouth and an evil atmosphere about
+him, there is something wrong about his own secretions.  In such
+cases there is an alterative regimen of remarkable efficacy: it is a
+starvation-diet of letting alone.  The great majority of the
+profession are peacefully inclined.  Their pursuits are eminently
+humanizing, and they look with disgust on the personalities which
+intrude themselves into the placid domain of an art whose province it
+is to heal and not to wound.
+
+The intercourse of teacher and student in a large school is
+necessarily limited, but it should be, and, so far as my experience
+goes, it is, eminently cordial and kindly.  You will leave with
+regret, and hold in tender remembrance, those who have taken you by
+the hand at your entrance on your chosen path, and led you patiently
+and faithfully, until the great gates at its end have swung upon
+their hinges, and the world lies open before you.  That venerable
+oath to which I have before referred bound the student to regard his
+instructor in the light of a parent, to treat his children like
+brothers, to succor him in his day of need.  I trust the spirit of
+the oath of Hippocrates is not dead in the hearts of the students of
+to-day.  They will remember with gratitude every earnest effort,
+every encouraging word, which has helped them in their difficult and
+laborious career of study.  The names they read on their diplomas
+will recall faces that are like family-portraits in their memory, and
+the echo of voices they have listened to so long will linger in their
+memories far into the still evening of their lives.
+
+One voice will be heard no more which has been familiar to many among
+you.  It is not for me, a stranger to these scenes, to speak his
+eulogy.  I have no right to sadden this hour by dwelling on the deep
+regrets of friendship, or to bid the bitter tears of sorrow flow
+afresh.  Yet I cannot help remembering what a void the death of such
+a practitioner as your late instructor must leave in the wide circle
+of those who leaned upon his counsel and assistance in their hour of
+need, in a community where he was so widely known and esteemed, in a
+school where he bore so important a part.  There is no exemption from
+the common doom for him who holds the shield to protect others.  The
+student is called from his bench, the professor from his chair, the
+practitioner in his busiest period hears a knock more peremptory than
+any patient's midnight summons, and goes on that unreturning visit
+which admits of no excuse, and suffers no delay.  The call of such a
+man away from us is the bereavement of a great family.  Nor can we
+help regretting the loss for him of a bright and cheerful earthly
+future; for the old age of a physician is one of the happiest periods
+of his life.  He is loved and cherished for what he has been, and
+even in the decline of his faculties there are occasions when his
+experience is still appealed to, and his trembling hands are looked
+to with renewing hope and trust, as being yet able to 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 among those whom I count as listeners one
+by whose side I have sat as a fellow-teacher, and by whose
+instructions I have felt myself not too old to profit.  As we
+borrowed him from your city, I must take this opportunity of telling
+you that his zeal, intelligence, and admirable faculty as an
+instructor were heartily and universally recognized among us.  We
+return him, as we trust, uninjured, to the fellow-citizens who have
+the privilege of claiming him as their own.
+
+And now, gentlemen of the graduating class, nothing remains but for
+me to bid you, in the name of those for 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's accession are proclaimed
+by the same voice at the same moment.  You would hardly excuse me if
+I stooped to any meaner dialect than the classical and familiar
+language of your prescriptions, the same in which your title to the
+name of physician is, if, like our own institution, you follow the
+ancient usage, engraved upon 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 Medical Library in Boston,
+December 3, 1878.]
+
+It is my appointed task, my honorable privilege, this evening, to
+speak of what has been done by others.  No one can bring his tribute
+of words into the presence of great deeds, or try with them to
+embellish the memory of any inspiring achievement, without feeling
+and leaving with others a sense of their insufficiency.  So felt
+Alexander when he compared even his adored Homer with the hero the
+poet had sung.  So felt Webster when he contrasted the phrases of
+rhetoric with the eloquence of patriotism and of self-devotion.  So
+felt Lincoln when on the field of Gettysburg he spoke those immortal
+words which Pericles could not nave bettered, which Aristotle could
+not have criticised.  So felt he who wrote the epitaph of the builder
+of the dome which looks down on the crosses and weathercocks that
+glitter over London.
+
+We are not met upon a battle-field, except so far as every laborious
+achievement means a victory over opposition, 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 every building whose walls are lined with the products of
+useful and ennobling thought is a temple of the Almighty, whose
+inspiration has given us understanding.  But we have gathered within
+walls which bear testimony to the self-sacrificing, persevering
+efforts of a few young men, to whom we owe the origin and development
+of all that excites our admiration in this completed enterprise; and
+I might consider my task as finished if I contented myself with
+borrowing the last word of the architect's epitaph and only saying,
+Look around you!
+
+The reports of the librarian have told or will tell you, in some
+detail, what has been accomplished since the 21st of December, 1874,
+when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch
+to discuss different projects for a medical library.  In less than
+four years from that time, by the liberality of associations and of
+individuals, this collection of nearly ten thousand volumes, of five
+thousand pamphlets, and of one hundred and twenty-five journals,
+regularly received,--all worthily sheltered beneath this lofty roof,
+--has come into being under our eyes.  It has sprung up, as it were;
+in the night like a mushroom; it stands before us in full daylight as
+lusty as an oak, and promising to grow and flourish in the perennial
+freshness of an evergreen.
+
+To whom does our profession owe this already large collection of
+books, exceeded in numbers only by four or five of the most extensive
+medical libraries in the country, and lodged in a building so well
+adapted to its present needs?  We will not point out individually all
+those younger members of the profession who have accomplished what
+their fathers and elder brethren had attempted and partially
+achieved.  We need not write their names on these walls, after the
+fashion of those civic dignitaries who immortalize themselves on
+tablets of marble and gates of iron.  But their contemporaries know
+them well, and their descendants will not forget them,--the men who
+first met together, the men who have given their time and their
+money, the faithful workers, worthy associates of the strenuous
+agitator who gave no sleep to his eyes, no slumber to his eyelids,
+until he had gained his ends; the untiring, imperturbable, tenacious,
+irrepressible, all-subduing agitator who neither rested nor let
+others rest until the success of the project was assured.  If,
+against his injunctions, I name Dr. James Read Chadwick, it is only
+my revenge for his having kept me awake so often and so long while he
+was urging on the undertaking in which he has been preeminently
+active and triumphantly successful.
+
+We must not forget the various medical libraries which preceded this:
+that of an earlier period, when Boston contained about seventy
+regular practitioners, the collection afterwards transferred to the
+Boston Athenaeum; the two collections belonging to the University;
+the Treadwell Library at the Massachusetts General Hospital; the
+collections of the two societies, that for Medical Improvement and
+that for Medical Observation; and more especially the ten thousand
+volumes relating to medicine belonging to our noble public city
+library,--too many blossoms on the tree of knowledge, perhaps, for
+the best fruit to ripen.  But the Massachusetts Medical Society now
+numbers nearly four hundred members in the city of Boston.  The time
+had arrived for a new and larger movement.  There was needed a place
+to which every respectable member of the medical profession could
+obtain easy access; where, under one roof, all might find the special
+information they were seeking; where the latest medical intelligence
+should be spread out daily as the shipping news is posted on the
+bulletins of the exchange; where men engaged in a common pursuit
+could meet, surrounded by the mute oracles of science and art; where
+the whole atmosphere should be as full of professional knowledge as
+the apothecary's shop is of the odor of his medicaments.  This was
+what the old men longed for,--the prophets and kings of the
+profession, who
+
+               "Desired it long,
+     But died without the sight."
+
+This is what the young men and those who worked under their guidance
+undertook to give us.  And now such a library, such a reading-room,
+such an exchange, such an intellectual and social meeting place, we
+be hold a fact, plain before us.  The medical profession of our city,
+and, let us add, of all those neighboring places which it can reach
+with its iron arms, is united as never before by the commune
+vinculum, the common bond 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 centralized libraries; abreast of them,
+but not promising to be content with that position.  What glorifies a
+town like a cathedral?  What dignifies a province like a university?
+What illuminates a country like its scholarship, and what is the nest
+that hatches scholars but a library?
+
+The physician, some may say, is a practical man and has little use
+for all this book-learning.  Every student has heard Sydenham's reply
+to Sir Richard Blackmore's question as to what books he should read,
+--meaning medical books.  "Read Don Quixote," was his famous answer.
+But Sydenham himself made medical books and may be presumed to have
+thought those at least worth reading.  Descartes was asked where was
+his library, and in reply held up the dissected body of an animal.
+But Descartes made books, great books, and a great many of them.  A
+physician of common sense without erudition is better than a learned
+one without common sense, but the thorough master of his profession
+must have learning added to his natural gifts.
+
+It is not necessary to maintain the direct practical utility of all
+kinds of learning.  Our shelves contain many books which only a
+certain class of medical scholars will be likely to consult.  There
+is a dead 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 has no living value for the student, will
+not teach him something by its autopsy.  But it is with the live
+literature of his profession that the medical practitioner is first
+of all concerned.
+
+Now there has come a great change in our time over the form in which
+living thought presents itself.  The first printed books,--the
+incunabula,--were inclosed in boards of solid oak, with brazen clasps
+and corners; the boards by and by were replaced by pasteboard covered
+with calf or sheepskin; then cloth came in and took the place of
+leather; then the pasteboard was covered with paper instead of cloth;
+and at this day the quarterly, the monthly, the weekly periodical in
+its flimsy unsupported dress of paper, and the daily journal, naked
+as it came from the womb of the press, hold the larger part of the
+fresh reading we live upon.  We must have the latest thought in its
+latest expression; the page must be newly turned like the morning
+bannock; the pamphlet must be newly opened like the ante-prandial
+oyster.
+
+Thus a library, to meet the need of our time, must take, and must
+spread out in a convenient form, a great array of periodicals.  Our
+active practitioners read these by preference over almost everything
+else.  Our specialists, more particularly, depend on the month's
+product, on the yearly crop of new facts, new suggestions, new
+contrivances, as much as the farmer on the annual yield of his acres.
+One of the first wants, then, of the profession is supplied by our
+library in its great array of periodicals from many lands, in many
+languages.  Such a number of medical periodicals no private library
+would have room for, no private person would pay for, or flood his
+tables with if they were sent him for nothing.  These, I think, with
+the reports of medical societies and the papers contributed to them,
+will form the most attractive part of our accumulated medical
+treasures.  They will be also one of our chief expenses, for these
+journals must be bound in volumes and they require a great amount of
+shelf-room; all this, in addition to the cost of subscription for
+those which are not furnished us gratuitously.
+
+It is true that the value of old scientific periodicals is, other
+things being equal, in the inverse ratio of their age, for the
+obvious reason that what is most valuable in the earlier volumes of a
+series is drained off into the standard works with which the
+intelligent practitioner is supposed to be familiar.  But no extended
+record of facts grows too old to be useful, provided only that we
+have a ready and sure way of getting at the particular fact or facts
+we are in search of.
+
+And this leads me to speak of what I conceive to be one of the
+principal tasks to be performed by the present and the coming
+generation of scholars, not only in the medical, but in every
+department of knowledge.  I mean the formation of indexes, and more
+especially of 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 special subject.  I have a right
+to speak of it, for I long ago attempted to supply the want of
+indexes in some small measure for my own need.  I had a very complete
+set of the "American Journal of the Medical Sciences;" an entire set
+of the "North American Review," and many volumes of the reprints of
+the three leading British quarterlies.  Of what use were they to me
+without general indexes?  I looked them all through carefully and
+made classified lists of all the articles I thought I should most
+care to read.  But they soon outgrew my lists.  The "North American
+Review" kept filling up shelf after shelf, rich in articles which I
+often wanted to consult, but what a labor to find them, until the
+index of Mr. Gushing, published a few months since, made the contents
+of these hundred and twenty volumes 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 lost its
+value for me in later years.  But where to look for what I wanted?  I
+wished to know, for instance, what Dr. Burney had to say about
+singing.  Who would have looked for it under the Italian word
+cantare?  I was curious to learn something of the etchings of
+Rembrandt, and where should I find it but under the head "Low
+Countries, Engravers of the,"--an elaborate and most valuable article
+of a hundred double-columned close-printed quarto pages, to which no
+reference, even, is made under the title Rembrandt.
+
+There was nothing to be done, if I wanted to know where that which I
+specially cared for was to be found in my Rees's Cyclopaedia, but to
+look over every page of its forty-one quarto volumes and make out a
+brief list of matters of interest which I could not find by their
+titles, and this I did, at no small expense of time and trouble.
+
+Nothing, therefore, could be more pleasing to me than to see the
+attention which has been given of late years to the great work of
+indexing.  It is a quarter of a century since Mr. Poole published his
+"Index to Periodical Literature," which it is much to be hoped is
+soon to appear in a new edition, grown as it must be to formidable
+dimensions by the additions of so long a period.  The "British and
+Foreign Medical Review," edited by the late Sir John Forties,
+contributed to by Huxley, Carpenter, Laycock, and others of the most
+distinguished scientific men of Great Britain, has an index to its
+twenty-four volumes, and by its aid I find this valuable series as
+manageable as a lexicon.  The last edition of the "Encyclopaedia
+Britannica" had a complete index in a separate volume, and the
+publishers of Appletons' "American Cyclopaedia" have recently issued
+an index to their useful work, which must greatly add to its value.
+I have already referred to the index to the "North American Review,"
+which to an American, and especially to a New Englander, is the most
+interesting and most valuable addition of its kind to our literary
+apparatus since the publication of Mr. Allibone's "Dictionary of
+Authors."  I might almost dare to parody Mr. Webster's words in
+speaking of Hamilton, to describe what Mr. Gushing did for the solemn
+rows of back volumes of our honored old Review which had been long
+fossilizing on our shelves: "He touched the dead corpse of the 'North
+American,' and it sprang to its feet."  A library of the best
+thought of the best American scholars during the greater portion of
+the century was brought to light by the work of the indexmaker as
+truly as were the Assyrian tablets by the labors of Layard.
+
+A great portion of the best writing and reading literary, scientific,
+professional, miscellaneous--comes to 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-binder puts a coat
+on his back, and he joins the forlorn brotherhood of "back volumes,"
+than which, so long as they are unindexed, nothing can be more
+exasperating.  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 a goldback behind it?
+
+I have referred chiefly to the medical journals, but I would include
+with these the reports of medical associations, and those separate
+publications which, coming in the form of pamphlets, heap themselves
+into chaotic piles and bundles which are worse than useless, taking
+up a great deal of room, and frightening everything away but mice and
+mousing antiquarians, or possibly at long intervals some terebrating
+specialist.
+
+Arranged, bound, indexed, all these at once become accessible and
+valuable.  I will take the first instance which happens to suggest
+itself.  How many who know all about osteoblasts and the experiments
+of Ollier, and all that has grown out of them, know where to go for a
+paper by the late Dr. A. L. Peirson of Salem, published in the year
+1840, under the modest title, Remarks on Fractures?  And if any
+practitioner who has to deal with broken bones does not know that
+most excellent and practical essay, it is a great pity, for it
+answers very numerous questions which will be sure to suggest
+themselves to the surgeon and the patient as no one of the recent
+treatises, on my own shelves, at least, can do.
+
+But if indexing is the special need of our time in medical
+literature, as in every department of knowledge, it must be
+remembered that it is not only an immense labor, but one that never
+ends.  It requires, therefore, the cooperation of a large number of
+individuals to do the work, and a large amount of money to pay for
+making its results public through the press.  When it is remembered
+that the catalogue of the library of the British Museum is contained
+in nearly three thousand large folios of manuscript, and not all its
+books are yet included, the task of indexing any considerable branch
+of science or literature looks as if it were well nigh impossible.
+But many hands make light work.  An "Index Society" has been formed
+in England, already numbering about one hundred and seventy members.
+It aims at "supplying thorough indexes to valuable works and
+collections which have hitherto lacked them; at issuing indexes to
+the literature of special subjects; and at gathering materials for a
+general reference index."  This society has published a little
+treatise setting forth the history and the art of indexing, which I
+trust is in the hands of some of our members, if not upon our
+shelves.
+
+Something has been done in the same direction by individuals in our
+own country, as we have already seen.  The need of it in the
+department of medicine is beginning to be clearly felt.  Our library
+has already an admirable catalogue with cross references, the work of
+a number of its younger members cooperating in the task.  A very
+intelligent medical student, Mr. William D. Chapin, whose excellent
+project is indorsed by well-known New York physicians and professors,
+proposes to publish a yearly index to original communications in the
+medical journals of the United States, classified by authors and
+subjects.  But it is from the National Medical Library at Washington
+that we have the best promise and the largest expectations.  That
+great and growing collection of fifty thousand volumes is under the
+eye and hand of a librarian who knows books and how to manage them.
+For libraries are the standing armies of civilization, and an army is
+but a mob without a general who can organize and marshal it so as to
+make it effective.  The "Specimen Fasciculus of a Catalogue of the
+National Medical Library," prepared under the direction of Dr.
+Billings, the librarian, would have excited the admiration of Haller,
+the master scholar in medical science of the last century, or rather
+of the profession in all centuries, and if carried out as it is begun
+will be to the nineteenth all and more than all that the three
+Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to
+the eighteenth century.  I cannot forget the story that Agassiz was
+so fond of telling of the king of Prussia and Fichte.  It was after
+the humiliation and spoliation of the kingdom by Napoleon that the
+monarch asked the philosopher what could be done to regain the lost
+position of the nation.  "Found a great university, Sire," was the
+answer, and so it was that in the year 1810 the world-renowned
+University of Berlin came into being.  I believe that we in this
+country can do better than found a national university, whose
+professors shall be nominated in caucuses, go in and out, perhaps,
+like postmasters, with every change of administration, and deal with
+science in the face of their constituency as the courtier did with
+time when his sovereign asked him what o'clock it was: "Whatever hour
+your majesty pleases."  But when we have a noble library like that at
+Washington, and a librarian of exceptional qualifications like the
+gentleman who now holds that office, I believe that a liberal
+appropriation by Congress to carry out a conscientious work for the
+advancement of sound knowledge and the bettering of human conditions,
+like this which Dr. Billings has so well begun, would redound greatly
+to the honor of the nation.  It ought to be willing to be at some
+charge to make its treasures useful to its citizens, and, for its own
+sake, especially to that class which has charge of health, public and
+private.  This country abounds in what are called "self-made men,"
+and is justly proud of many whom it thus designates.  In one sense no
+man is self-made who breathes the air of a civilized community.  In
+another sense every man who is anything other than a phonograph on
+legs is self-made.  But if we award his just praise to the man who
+has attained any kind of excellence without having had the same
+advantages as others whom, nevertheless, he has equalled or
+surpassed, let us not be betrayed into undervaluing the mechanic's
+careful training to his business, the thorough and laborious
+education of the scholar and the professional man.
+
+Our American atmosphere is vocal with the flippant loquacity of half
+knowledge.  We must accept whatever good can be got out of it, and
+keep it under as we do sorrel and mullein and witchgrass, by
+enriching the soil, and sowing good seed in plenty; by good teaching
+and good books, rather than by wasting our time in talking against
+it.  Half knowledge dreads nothing but whole knowledge.
+
+I have spoken of the importance and the predominance of periodical
+literature, and have attempted to do justice to its value.  But the
+almost exclusive reading of it is not without its dangers.  The
+journals contain much that is crude and unsound; the presumption; it
+might be maintained, is against their novelties, unless they come
+from observers of established credit.  Yet I have known a
+practitioner,--perhaps more than one,--who was as much under the
+dominant influence of the last article he had read in his favorite
+medical journal as a milliner under the sway of the last fashion-
+plate.  The difference between green and seasoned knowledge is very
+great, and such practitioners never hold long enough to any of their
+knowledge to have it get seasoned.
+
+It is needless to say, then, that all the substantial and permanent
+literature of the profession should be represented upon our shelves.
+Much of it is there already, and as one private library after another
+falls into this by the natural law of gravitation, it will gradually
+acquire all that is most valuable almost without effort.  A scholar
+should not be in a hurry to part with his books.  They are probably
+more valuable to him than they can be to any other individual.  What
+Swedenborg called "correspondence" has established itself between his
+intelligence and the volumes which wall him within their sacred
+inclosure.  Napoleon said that his mind was as if furnished with
+drawers,--he drew out each as he wanted its contents, and closed it
+at will when done with them.  The scholar's mind, to use a similar
+comparison, is furnished with shelves, like his library.  Each book
+knows its place in the brain as well as against the wall or in the
+alcove.  His consciousness is doubled by the books which encircle
+him, as the trees that surround a lake repeat themselves in its
+unruffled waters.  Men talk of the nerve that runs to the pocket, but
+one who loves his books, and has lived long with them, has a nervous
+filament which runs 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 temple is to the worshipper who frequents it.  There is
+the altar sacred to his holiest experiences.  There is the font where
+his new-born thought was baptized and first had a name in his
+consciousness.  There is the monumental tablet of a dead belief,
+sacred still in the memory of what it was while yet alive.  No
+visitor can read all this on the lettered backs of the books that
+have gathered around the scholar, but for him, from the Aldus on the
+lowest shelf to the Elzevir on the highest, every volume has a
+language which none but be can interpret.  Be patient with the book-
+collector who loves his companions too well to let them go.  Books
+are not buried with their owners, and the veriest book-miser that
+ever lived was probably doing far more for his successors than his
+more liberal neighbor who despised his learned or unlearned avarice.
+Let the fruit fall with the leaves still clinging round it.  Who
+would have stripped Southey's walls of the books that filled them,
+when, his mind no longer capable of taking in their meaning, he would
+still pat and fondle them with the vague loving sense of what they
+had once been to him,--to him, the great scholar, now like a little
+child among his playthings?
+
+We need in this country not only the scholar, but the virtuoso, who
+hoards the treasures which he loves, it may be chiefly for their
+rarity and because others who know more than he does of their value
+set a high price upon them.  As the wine of old vintages is gently
+decanted out of its cobwebbed bottles with their rotten corks into
+clean new receptacles, so the wealth of the New World is quietly
+emptying many of the libraries and galleries of the Old World into
+its 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 before the New Zealander takes his stand on a
+broken arch of London Bridge to sketch the ruins of St. Paul's in the
+midst of a vast solitude, the treasures of the British Museum will
+have found a new shelter in the halls of New York or Boston.  No
+Catholic will think hardly of my saying that before the Coliseum
+falls, and with it the imperial city, whose doom prophecy has linked
+with that of the almost eternal amphitheatre, the marbles, the
+bronzes, the paintings, the manuscripts of the Vatican will have left
+the shores of the Tiber for those of the Potomac, the Hudson, the
+Mississippi, or the Sacramento.  And what a delight in the pursuit of
+the rarities which the eager book-hunter follows with the scent of a
+beagle!
+
+Shall I ever forget that rainy day in Lyons, that dingy bookshop,
+where I found the Aetius, long missing from my Artis bledicae
+Principes, and where I bought for a small pecuniary consideration,
+though it was marked rare, and was really tres rare, the Aphorisms of
+Hippocrates, edited by and with a preface from the hand of Francis
+Rabelais?  And the vellum-bound Tulpius, which I came upon in Venice,
+afterwards my only reading when imprisoned in quarantine at
+Marseilles, so that the two hundred and twenty-eight cases he has
+recorded are, many of them, to this day still fresh in my memory.
+And the Schenckius,--the folio filled with casus rariores, which had
+strayed in among the rubbish of the bookstall on the boulevard,--and
+the noble old Vesalius with its grand frontispiece not unworthy of
+Titian, and the fine old Ambroise Pare, long waited for even in Paris
+and long ago, and the colossal Spigelius with his eviscerated
+beauties, and Dutch Bidloo with its miracles of fine engraving and
+bad dissection, and Italian Mascagni, the despair of all would-be
+imitators, and pre-Adamite John de Ketam, and antediluvian
+Berengarius Carpensis,--but why multiply names, every one of which
+brings back the accession of a book which was an event almost like
+the birth of an infant?
+
+A library like ours must exercise the largest hospitality.  A great
+many books may be found in every large collection which remind us of
+those apostolic looking old men who figure on the platform at our
+political and other assemblages.  Some of them have spoken words of
+wisdom in their day, but they have ceased to be oracles; some of them
+never had any particularly important message for humanity, but they
+add dignity to the meeting by their presence; they look wise, whether
+they are so or not, and no one grudges them their places of honor.
+Venerable figure-heads, what would our platforms be without you?
+
+Just so with our libraries.  Without their rows of folios in creamy
+vellum, or showing their black backs with antique lettering of
+tarnished gold, our shelves would look as insufficient and unbalanced
+as a column without its base, as a statue without its pedestal.  And
+do not think they are kept only to be spanked and dusted during that
+dreadful period when their owner is but too thankful to become an
+exile and a wanderer from the scene of single combats between dead
+authors and living housemaids.  Men were not all cowards before
+Agamemnon or all fools before the days of Virchow and Billroth.  And
+apart from any practical use to be derived from the older medical
+authors, is there not a true pleasure in reading the accounts of
+great discoverers in their own words?  I do not pretend to hoist up
+the Bibliotheca Anatomica of Mangetus and spread it on my table every
+day.  I do not get out my great Albinus before every lecture on the
+muscles, nor disturb the majestic repose of Vesalius every time I
+speak of the bones he has so admirably described and figured.  But it
+does please me to read the first descriptions of parts to which the
+names of their discoverers or those who have first described them
+have become so joined that not even modern science can part them; to
+listen to the talk of my old volume as Willis describes his circle
+and Fallopius his aqueduct and Varolius his bridge and Eustachius his
+tube and Monro his foramen,--all so well known to us in the human
+body; it does please me to know the very words in which Winslow
+described the opening which bears his name, and Glisson his capsule
+and De Graaf his vesicle; I am not content until I know in what
+language Harvey announced his discovery of the circulation, and how
+Spigelius made the liver his perpetual memorial, and Malpighi found a
+monument more enduring than brass in the corpuscles of the spleen and
+the kidney.
+
+But after all, the readers who care most for the early records of
+medical science and art are the specialists who are dividing up the
+practice of medicine and surgery as 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 ail others is
+applicable the saying of D'Alembert that the author kills himself in
+lengthening out what the reader kills himself in trying to shorten.
+
+There are practical books among these ancient volumes which can never
+grow old.  Would you know how to recognize "male hysteria" and to
+treat it, take down your Sydenham; would you read the experience of a
+physician who was himself the subject of asthma, and who,
+notwithstanding that, in the words of Dr. Johnson, "panted on till
+ninety," you will find it in the venerable treatise of Sir John
+Floyer; would you listen to the story of the King's Evil cured by the
+royal touch, as told by a famous chirurgeon who fully believed in it,
+go to Wiseman; would you get at first hand the description of the
+spinal disease which long bore his name, do not be startled if I tell
+you to go to Pott,--to Percival Pott, the great surgeon of the last
+century.
+
+There comes a time for every book in a library when it is wanted by
+somebody.  It is but a few weeks since one of the most celebrated
+physicians in the country wrote to me from a great centre of medical
+education to know if I had the works of Sanctorius, which he had
+tried in vain to find.  I could have lent him the "Medicina Statica,"
+with its frontispiece showing Sanctorius with his dinner on the table
+before him, in his balanced chair which sunk with him below the level
+of his banquet-board when he had swallowed a certain number of
+ounces,--an early foreshadowing of Pettenkofer's chamber and
+quantitative physiology,--but the "Opera Omnia" of Sanctorius I had
+never met with, and I fear he had to do without it.
+
+I would extend the hospitality of these shelves to a class of works
+which we are in the habit of considering as being outside of the pale
+of medical science, properly so called, and sometimes of coupling
+with a disrespectful name.  Such has always been my own practice.  I
+have welcomed Culpeper and Salmon to my bookcase as willingly as
+Dioscorides or Quincy, or Paris or Wood and Bache.  I have found a
+place for St. John Long, and read the story of his trial for
+manslaughter with as much interest as the laurel-water case in which
+John Hunter figured as a witness.  I would give Samuel Hahnemann a
+place by the side of Samuel Thomson.  Am I not afraid that some
+student of imaginative turn and not provided with the needful
+cerebral strainers without which all the refuse of gimcrack
+intelligences gets into the mental drains and chokes them up,--am I
+not afraid that some such student will get hold of the "Organon" or
+the "Maladies Chroniques" and be won over by their delusions, and so
+be lost to those that love him as a man of common sense and a brother
+in their high calling?  Not in the least.  If he showed any symptoms
+of infection I would for once have recourse to the principle of
+similia similibus.  To cure him of Hahnemann I would prescribe my
+favorite homoeopathic antidote, Okie's Bonninghausen.  If that
+failed, I would order Grauvogl as a heroic remedy, and if he survived
+that uncured, I would give him my blessing, if I thought him honest,
+and bid him depart in peace.  For me he is no longer an individual.
+He belongs to a class of minds which we are bound to be patient with
+if their Maker sees fit to indulge them with existence.  We must
+accept the conjuring ultra-ritualist, the dreamy second adventist,
+the erratic spiritualist, the fantastic homoeopathist, as not
+unworthy of philosophic study; not more unworthy of it than the
+squarers of the circle and the inventors of perpetual motion, and the
+other whimsical visionaries to whom De Morgan has devoted his most
+instructive and entertaining "Budget of Paradoxes."  I hope,
+therefore, that our library will admit the works of the so-called
+Eclectics, of the Thomsonians, if any are in existence, of the
+Clairvoyants, if they have a literature, and especially of the
+Homoeopathists.  This country seems to be the place for such a
+collection, which will by and by be curious and of more value than at
+present, for Homoeopathy seems to be following the pathological law
+of erysipelas, fading out where it originated as it spreads to new
+regions.  At least I judge so by the following translated extract
+from a criticism of an American work in the "Homoeopatische
+Rundschau" of Leipzig for October, 1878, which I find in the
+"Homoeopathic Bulletin" for the month of November just passed:
+"While we feel proud of the spread and rise of Homoeopathy across the
+ocean, and while the Homoeopathic works reaching us from there, and
+published in a style such as is unknown in Germany, bear eloquent
+testimony to the eminent activity of our transatlantic colleagues, we
+are overcome by sorrowful regrets at the position Homoeopathy
+occupies in Germany.  Such a work [as the American one referred to]
+with us would be impossible; it would lack the necessary support."
+
+By all means let our library secure a good representation of the
+literature of Homoeopathy before it leaves us its "sorrowful regrets"
+and migrates with its sugar of milk pellets, which have taken the
+place 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 of a Librarian?
+Where have they ever been better performed than in our own public
+city library, where the late Mr. Jewett and the living Mr. Winsor
+have shown us what a librarian ought to be,--the organizing head, the
+vigilant guardian, the seeker's index, the scholar's counsellor?  His
+work is not merely that of administration, manifold and laborious as
+its duties are.  He must have a quick intelligence and a retentive
+memory.  He is a public carrier of knowledge in its germs.  His
+office is like that which naturalists attribute to the bumble-bee,--
+he lays up little honey for himself, but he conveys the fertilizing
+pollen from flower to flower.
+
+Our undertaking, just completed,--and just begun--has come at the
+right time, not a day too soon.  Our practitioners need a library
+like this, for with all their skill and devotion there is too little
+genuine erudition, such as a liberal profession ought to be able to
+claim for many of its members.  In reading the recent obituary
+notices of the late Dr. Geddings of South Carolina, I recalled what
+our lamented friend Dr. Coale used to tell me of his learning and
+accomplishments, and I could not help reflecting how few such medical
+scholars we had to show in Boston or New England.  We must clear up
+this unilluminated atmosphere, and here,--here is the true electric
+light which will irradiate its darkness.
+
+The public will catch the rays reflected from the same source of
+light, and it needs instruction on the great subjects of health and
+disease,--needs it sadly.  It is preyed upon by every kind of
+imposition almost without hindrance.  Its ignorance and prejudices
+react upon the profession to the great injury of both.  The jealous
+feeling, for instance, with regard to such provisions for the study
+of anatomy as are sanctioned by the laws in this State and carried
+out with strict regard to those laws, threatens the welfare, if not
+the existence of institutions for medical instruction wherever it is
+not held in check by enlightened intelligence.  And on the other hand
+the profession has just been startled by a verdict against a
+physician, ruinous in its amount,--enough to drive many a hard-
+working young practitioner out of house and home,--a verdict which
+leads to the fear that suits for malpractice may take the place of
+the panel game and child-stealing as a means of extorting money.  If
+the profession in this State, which claims a high standard of
+civilization, is to be crushed and ground beneath the upper millstone
+of the dearth of educational advantages and the lower millstone of
+ruinous penalties for what the ignorant ignorantly shall decide to be
+ignorance, all I can say is
+
+God save the Commonhealth of Massachusetts!
+
+Once more, we cannot fail to see that just as astrology has given
+place to astronomy, so theology, the science of Him whom by searching
+no man can find out, is fast being replaced by what we may not
+improperly call theonomy, or the science of the laws according to
+which the Creator acts.  And since these laws find their fullest
+manifestations for us, at least, in rational human natures, the study
+of anthropology is largely replacing that of scholastic divinity.  We
+must contemplate our Maker indirectly in human attributes as we talk
+of Him in human parts of speech.  And this gives a sacredness to the
+study of man in his physical, mental, moral, social, and religious
+nature which elevates the faithful students of anthropology to the
+dignity of a priesthood, and sheds a holy light on the recorded
+results of their labors, brought together as they are in such a
+collection as this which is now spread out before us.
+
+Thus, then, our library is a temple as truly as the dome-crowned
+cathedral hallowed by the breath of prayer and praise, where the dead
+repose and the living worship.  May it, with all its treasures, be
+consecrated like that to the glory of God, through the contributions
+it shall make to the advancement of sound knowledge, to the relief of
+human suffering, to the promotion of harmonious relations between the
+members of the two noble professions which deal with the diseases of
+the soul and with those of the body, and to the common cause in which
+all good men are working, the furtherance of the well-being of their
+fellow-creatures!
+
+NOTE.--As an illustration of the statement in the last paragraph but
+one, I take the following notice from the "Boston Daily Advertiser,"
+of December 4th, the day after the delivery of the address:
+"Prince Lucien Bonaparte is now living in London, and is devoting
+himself to the work of collecting the creeds of all religions and
+sects, with a view to their classification,--his object being simply
+scientific or anthropological."
+
+Since delivering the address, also, I find a leading article in the
+"Cincinnati Lancet and Clinic" of November 30th, headed "The
+Decadence of Homoeopathy," abundantly illustrated by extracts from
+the "Homoeopathic Times," the leading American organ of that sect.
+
+In the New York "Medical Record" of the same date, which I had not
+seen before the delivery of my address, is an account of the action
+of the Homoeopathic Medical Society of Northern New York, in which
+Hahnemann's theory of "dynamization" is characterized in a formal
+resolve as "unworthy the confidence of the Homoeopathic profession."
+
+It will be a disappointment to the German Homoeopathists to read in
+the "Homoeopathic Times" such a statement as the following:
+"Whatever the influences have been which have checked the outward
+development of Homoeopathy, it is plainly evident that the
+Homoeopathic school, as regards the number of its openly avowed
+representatives, has attained its majority, and has begun to decline
+both in this country and in England."
+
+All which is an additional reason for making a collection of the
+incredibly curious literature of Homoeopathy before that
+pseudological inanity has faded out like so many other delusions.
+
+
+
+
+
+
+SOME OF MY EARLY TEACHERS
+
+[A Farewell Address to the Medical School of Harvard University,
+November 28, 1882.]
+
+I had intended that the recitation of Friday last should be followed
+by a few parting words to my class and any friends who might happen
+to be in the lecture-room.  But I learned on the preceding evening
+that there was an expectation, a desire, that my farewell should take
+a somewhat different form; and not to disappoint the wishes of those
+whom I was anxious to gratify, I made up my mind to appear before you
+with such hasty preparation as the scanty time admitted.
+
+There are three occasions upon which a human being has a right to
+consider himself as a centre of interest to those about him: when he
+is christened, when he is married, and when he is buried.  Every one
+is the chief personage, the hero, of his own baptism, his own
+wedding, and his own funeral.
+
+There are other occasions, less momentous, in which one may make more
+of himself than under ordinary circumstances he would think it proper
+to do; when he may talk about himself, and tell his own experiences,
+in fact, indulge in a more or less egotistic monologue without fear
+or reproach.
+
+I think I may claim that this is one of those occasions.  I have
+delivered my last anatomical lecture and heard my class recite for
+the last time.  They wish to hear from me again in a less scholastic
+mood than that in which they have known me.  Will you not indulge me
+in telling you something of my own story?
+
+This is the thirty-sixth Course of Lectures in which I have taken my
+place and performed my duties as Professor of Anatomy.  For more than
+half of my term of office I gave instruction in Physiology, after the
+fashion of my predecessors and in the manner then generally prevalent
+in our schools, where the physiological laboratory was not a
+necessary part of the apparatus of instruction.  It was with my
+hearty approval that the teaching of Physiology was constituted a
+separate department and made an independent Professorship.  Before my
+time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the
+same course of Lectures, lasting only three or four months.  As the
+boundaries of science are enlarged, new divisions and subdivisions of
+its territories become necessary.  In the place of six Professors in
+1847, when I first became a member of the Faculty, I count twelve
+upon the Catalogue before me, and I find the whole number engaged in
+the work of instruction in the Medical School amounts to no less than
+fifty.
+
+Since I began teaching in this school, the aspect of many branches of
+science has undergone a very remarkable transformation.  Chemistry
+and Physiology are no longer what they were, as taught by the
+instructors of that time.  We are looking forward to the synthesis of
+new organic compounds; our artificial madder is already in the
+market, and the indigo-raisers are now fearing that their crop will
+be supplanted by the manufactured article.  In the living body we
+talk of fuel supplied and work done, in movement, in heat, just as if
+we were dealing with a machine of our own contrivance.
+
+A physiological laboratory of to-day is equipped with instruments of
+research of such ingenious contrivance, such elaborate construction,
+that one might suppose himself in a workshop where some exquisite
+fabric was to be wrought, such as Queens love to wear, and Kings do
+not always love to pay for.  They are, indeed, weaving a charmed web,
+for these are the looms from which comes the knowledge that clothes
+the nakedness of the intellect.  Here are the mills that grind food
+for its hunger, and "is not the life more than meat, and the body
+than raiment?"
+
+But while many of the sciences have so changed that the teachers of
+the past would hardly know them, it has not been so with the branch I
+teach, or, rather, with that division of it which is chiefly taught
+in this amphitheatre.  General anatomy, or histology, on the other
+hand, is almost all new; it has grown up, mainly, since I began my
+medical studies.  I never saw a compound microscope during my years
+of study in Paris.  Individuals had begun to use the instrument, but
+I never heard it alluded to by either Professors or students.  In
+descriptive anatomy I have found little to unlearn, and not a great
+deal that was both new and important to learn.  Trifling additions
+are made from year to year, not to be despised and not to be
+overvalued.  Some of the older anatomical works are still admirable,
+some of the newer ones very much the contrary.  I have had recent
+anatomical plates brought me for inspection, and I have actually
+button-holed the book-agent, a being commonly as hard to get rid of
+as the tar-baby in the negro legend, that I might put him to shame
+with the imperial illustrations of the bones and muscles in the great
+folio of Albinus, published in 1747, and the unapproached figures of
+the lymphatic system of Mascagni, now within a very few years of a
+century old, and still copied, or, rather, pretended to be copied, in
+the most recent works on anatomy.
+
+I am afraid that it is a good plan to get rid of old Professors, and
+I am thankful to hear that there is a movement for making provision
+for those who are left in need when they lose their offices and their
+salaries.  I remember one of our ancient Cambridge Doctors once asked
+me to get into his rickety chaise, and said to me, half humorously,
+half sadly, that he was like an old horse,--they had taken off his
+saddle and turned him out to pasture.  I fear the grass was pretty
+short where that old servant of the public found himself grazing.  If
+I myself needed an apology for holding my office so long, I should
+find it in the fact that human anatomy is much the same study that it
+was in the days of Vesalius and Fallopius, and that the greater part
+of my teaching was of such a nature that it could never become
+antiquated.
+
+Let me begin with my first experience as a medical student.  I had
+come from the lessons of Judge Story and Mr. Ashmun in the Law School
+at Cambridge.  I had been busy, more or less, with the pages of
+Blackstone and Chitty, and other text-books of the first year of
+legal study.  More or less, I say, but I am afraid it was less rather
+than more.  For during that year I first tasted the intoxicating
+pleasure of authorship.  A college periodical, conducted by friends
+of mine, still undergraduates, tempted me into print, and there is no
+form of lead-poisoning which more rapidly and thoroughly pervades the
+blood and bones and marrow than that which reaches the young author
+through mental contact with type-metal.  Qui a bu, boira,--he who has
+once been a drinker will drink again, says the French proverb.  So
+the man or woman who has tasted type is sure to return 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 of it from
+that day to this.  But for that I might have applied myself more
+diligently to my legal studies, and carried a green bag in place of a
+stethoscope and a thermometer up to the present day.
+
+What determined me to give up Law and apply myself to Medicine I can
+hardly say, but I had from the first looked upon that year's study as
+an experiment.  At any rate, I made the change, and soon found myself
+introduced to new scenes and new companionships.
+
+I can scarcely credit my memory when I recall the first impressions
+produced upon me by sights afterwards become so familiar that they
+could no more disturb a 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 devoted to the students of
+the school I had joined, just as the fleshless figure of Time, with
+the hour-glass and scythe, used to glare upon me in my childhood from
+the "New England Primer."  The white faces in the beds at the
+Hospital found their reflection in my own cheeks, which lost their
+color as I looked upon them.  All this had to pass away in a little
+time; I had chosen my profession, and must meet its painful and
+repulsive aspects until they lost their power over my sensibilities.
+
+The private medical school which I had joined was one 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
+either spoken elsewhere or may find occasion to speak hereafter.  The
+two younger members of this association of teachers were both
+graduates of our University, one of the year 1819, the other of 1818.
+
+Dr. Lewis was a great favorite with students.  He was a man of very
+lively temperament, fond of old books and young people, open-hearted,
+free-spoken, an enthusiast in teaching, and especially at home in
+that apartment of the temple of science where nature is seen in
+undress, the anthropotomic laboratory, known to common speech as the
+dissecting-room.  He had that quality which is the special gift of
+the man born for a teacher,--the power of exciting an interest in
+that which he taught.  While he was present the apartment I speak of
+was the sunniest of studios in spite of its mortuary spectacles.  Of
+the students I met there I best remember James Jackson, Junior, full
+of zeal and playful as a boy, a young man whose early death was a
+calamity to the profession of which he promised to be a chief
+ornament; the late Reverend J. S. C. Greene, who, as the prefix to
+his name signifies, afterwards changed his profession, but one of
+whose dissections I remember looking upon with admiration; and my
+friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
+entitled to be called, then, as now and always, a favorite with all
+about him.  He had come to us from the schools of Germany, and
+brought with him recollections of the 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 say as important as a good Professor in
+the teaching of Anatomy, because I am not sure that he is not more
+important.  He comes into direct personal relations with the
+students,--he is one of them, in fact, as the Professor cannot be
+from the nature of his duties.  The Professor's chair is an
+insulating stool, so to speak; his age, his knowledge, real or
+supposed, his official station, are like the glass legs which support
+the electrician's piece of furniture, and cut it off from the common
+currents of the floor upon which it stands.  Dr. Lewis enjoyed
+teaching and made his students enjoy being taught.  He delighted in
+those anatomical conundrums to answer which keeps the student's eyes
+open and his wits awake.  He was happy as he dexterously performed
+the tour de maitre of the old barber-surgeons, or applied the spica
+bandage and taught his scholars to do it, so neatly and symmetrically
+that the aesthetic missionary from the older centre of civilization
+would bend over it in blissful contemplation, as if it were a
+sunflower.  Dr. Lewis had many other tastes, and was a favorite, not
+only with students, but in a wide circle, professional, antiquarian,
+masonic, and social.
+
+Dr. Otis was less widely known, but was a fluent and agreeable
+lecturer, and esteemed as a good surgeon.
+
+I must content myself with this glimpse at myself and a few of my
+fellow-students in Boston.  After attending two courses of Lectures
+in the school of the University, I went to Europe to continue my
+studies.
+
+You may like to hear something of the famous Professors of Paris in
+the days when I was a student in the Ecole de Medicine, and following
+the great Hospital teachers.
+
+I can hardly believe my own memory when I recall the old
+practitioners and Professors who were still going round the hospitals
+when I mingled with the train of students that attended the morning
+visits.  See that bent old man who is groping his way through the
+wards of La Charity.  That is the famous Baron Boyer, author of the
+great work on surgery in nine volumes, a writer whose clearness of
+style commends his treatise to general admiration, and makes it a
+kind of classic.  He slashes away at a terrible rate, they say, when
+he gets hold of the subject of fistula in its most frequent habitat,
+--but I never saw him do more than look as if he wanted to cut a good
+dollop out of a patient he was examining.  The short, square,
+substantial man with iron-gray hair, ruddy face, and white apron is
+Baron Larrey, Napoleon's favorite surgeon, the most honest man he
+ever saw,--it is reputed that he called him.  To go round the Hotel
+des Invalides with Larrey was to live over the campaigns of Napoleon,
+to look on the sun of Austerlitz, to hear the cannons of Marengo, to
+struggle through the icy waters of the Beresina, to shiver in the
+snows of the Russian retreat, and to gaze through the battle smoke
+upon the last charge of the red lancers on the redder field of
+Waterloo.  Larrey was still strong and sturdy as I saw him, and few
+portraits remain printed in livelier colors on the tablet of my
+memory.
+
+Leave the little group of students which gathers about Larrey beneath
+the gilded dome of the Invalides and follow me to the Hotel Dieu,
+where rules and reigns the master-surgeon of his day, at least so far
+as Paris and France are concerned,--the illustrious Baron Dupuytren.
+No man disputed his reign, some envied his supremacy.  Lisfranc
+shrugged his shoulders as he spoke of "ce grand homme de l'autre cots
+de la riviere," that great man on the other side of the river, but
+the great man he remained, until he bowed before the mandate which
+none may disobey.  "Three times," said Bouillaud, "did the apoplectic
+thunderbolt fall on that robust brain,"--it yielded at last as the
+old bald cliff that is riven and crashes down into the valley.  I saw
+him before the first thunderbolt had descended: a square, solid man,
+with a high and full-domed head, oracular in his utterances,
+indifferent to those around him, sometimes, it was said, very rough
+with them.  He spoke in low, even tones, with quiet fluency, and was
+listened to with that hush of rapt attention which I have hardly seen
+in any circle of listeners unless when such men as ex-President John
+Quincy Adams or Daniel Webster were the speakers.  I do not think
+that Dupuytren has left a record which explains his influence, but in
+point of fact he dominated those around him in a remarkable manner.
+You must have all witnessed something of the same kind.  The personal
+presence of some men carries command with it, and their accents
+silence the crowd around them, when the same words from other lips
+might fall comparatively unheeded.
+
+As for Lisfranc, I can say little more of him than that he was a
+great drawer of blood and hewer of members.  I remember his ordering
+a wholesale bleeding of his patients, right and left, whatever might
+be the matter with them, one morning when a phlebotomizing fit was on
+him.  I recollect his regretting the splendid guardsmen 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 I ceased
+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 name widely known.  Coming to Paris
+in wooden shoes, starving, almost, at first, he raised himself to
+great eminence as a surgeon and as an author, and at last obtained
+the Professorship to which his talents and learning entitled him.
+His example may be an encouragement to some of my younger hearers who
+are born, not with the silver spoon in their mouths, but with the
+two-tined iron fork in their hands.  It is a poor thing to take up
+their milk porridge with in their young days, but in after years it
+will often transfix the solid dumplings that roll out of the silver
+spoon.  So Velpeau found it.  He had not what is called genius, he
+was far from prepossessing in aspect, looking as if he might have
+wielded the sledge-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 distinction and
+prosperity, as some of you sitting on these benches and wondering
+anxiously what is to become of you in the struggle for life will have
+done before the twentieth century has got halfway through its first
+quarter.  A good sound head over a pair of wooden shoes is a great
+deal better than a wooden head belonging to an owner who cases his
+feet in calf-skin, but a good brain is not enough without a stout
+heart to fill the four great conduits which carry at once fuel and
+fire to that mightiest of engines.
+
+How many of you who are before me are familiarly acquainted with the
+name of Broussais, or even with that of Andral?  Both were lecturing
+at the Ecole de Medicine, and I often heard them.  Broussais was in
+those days like an old volcano, which has pretty nearly used up its
+fire and brimstone, but is still boiling and bubbling in its
+interior, and now and then sends up a spirt of lava and a volley of
+pebbles.  His theories of gastro-enteritis, of irritation and
+inflammation as the cause of disease, and the practice which sprang
+from them, ran over the fields of medicine for a time like flame over
+the grass of the prairies.  The way in which that knotty-featured,
+savage old man would bring out the word irritation--with rattling and
+rolling reduplication of the resonant letter r--might have taught a
+lesson in articulation to Salvini.  But Broussais's theory was
+languishing and well-nigh become obsolete, and this, no doubt, added
+vehemence to his defence of his cherished dogmas.
+
+Old theories, and old men who cling to them, must take themselves out
+of the way as the new generation with its fresh thoughts and altered
+habits of mind comes forward to take the place of that which is dying
+out. This was a truth which the fiery old theorist found it very hard
+to learn, and harder to bear, as it was forced upon him.  For the
+hour of his lecture was succeeded by that of a younger and far more
+popular professor.  As his lecture drew towards its close, the
+benches, thinly sprinkled with students, began to fill up; the doors
+creaked open and banged back oftener and oftener, until at last the
+sound grew almost continuous, and the voice of the lecturer became a
+leonine growl as he strove in vain to be heard over the noise of
+doors and footsteps.
+
+Broussais was now sixty-two years old.  The new generation had
+outgrown his doctrines, and the Professor for whose hour the benches
+had filled themselves belonged to that new generation.  Gabriel
+Andral was little more than half the age of Broussais, in the full
+prime and vigor of manhood at thirty-seven years.  He was a rapid,
+fluent, fervid, and imaginative speaker, pleasing in aspect and
+manner,--a strong contrast to the harsh, vituperative old man who had
+just preceded him.  His Clinique Medicale is still valuable as a
+collection of cases, and his researches on the blood, conducted in
+association with Gavarret, contributed new and valuable facts to
+science.  But I remember him chiefly as one of those instructors
+whose natural eloquence made it delightful to listen to him.  I doubt
+if I or my fellow-students did full justice either to him or to the
+famous physician of Hotel Dieu, Chomel.  We had addicted ourselves
+almost too closely to the words of another master, by whom we were
+ready to swear as against all teachers that 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 young men before me, even to
+those who may know comparatively little of his works and teachings.
+Pierre Charles Alexandre Louis, at the age of forty-seven, as I
+recall him, was a tall, rather spare, dignified personage, of serene
+and grave aspect, but with a pleasant smile and kindly voice for the
+student with whom he came into personal relations.  If I summed up
+the lessons of Louis in two expressions, they would be these; I do
+not hold him answerable for the words, but I will condense them after
+my own fashion in French, and then give them to you, expanded
+somewhat, in English:
+
+          Formez toujours des idees nettes.
+          Fuyez toujours les a peu pres.
+
+Always make sure that you form a distinct and clear idea of the
+matter you are considering.
+
+Always avoid vague approximations where exact estimates are possible;
+about so many,--about so much, instead of the precise number and
+quantity.
+
+Now, if there is anything on which the biological sciences have
+prided themselves in these latter years it is the substitution of
+quantitative for qualitative formulae.  The "numerical system," of
+which Louis was the great advocate, if not the absolute originator,
+was an attempt to substitute series of carefully recorded facts,
+rigidly counted and closely compared, for those never-ending records
+of vague, unverifiable conclusions with which the classics of the
+healing art were overloaded.  The history of practical medicine had
+been like the story of the Danaides.  "Experience" had been, from
+time immemorial, pouring its flowing treasures into buckets full of
+holes.  At the existing rate of supply and leakage they would never
+be filled; nothing would ever be settled in medicine.  But cases
+thoroughly recorded and mathematically analyzed would always be
+available for future use, and when accumulated in sufficient number
+would lead to results which would be trustworthy, and belong to
+science.
+
+You young men who are following the hospitals hardly know how much
+you are indebted to Louis.  I say nothing of his Researches on
+Phthisis or his great work on Typhoid Fever.  But I consider his
+modest and brief Essay on Bleeding in some Inflammatory Diseases,
+based on cases carefully observed and numerically analyzed, one of
+the most important written contributions to practical medicine, to
+the treatment of internal disease, of this century, if not since the
+days of Sydenham.  The lancet was the magician's wand of the dark
+ages of medicine.  The old physicians not only believed in its
+general efficacy as a wonder-worker in disease, but they believed
+that each malady could be successfully attacked from some special
+part of the body,--the strategic point which commanded the seat of
+the morbid affection.  On a figure given in the curious old work of
+John de Ketam, no less than thirty-eight separate places are marked
+as the 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 suffering from headache should be bled in the foot, in
+preference to any other part.
+
+But what Louis did was this: he showed by a strict analysis of
+numerous cases that bleeding did not strangle,--jugulate was the word
+then used,--acute diseases, more especially pneumonia.  This was not
+a reform,--it was a revolution.  It was followed up in this country
+by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited
+Diseases, which has, I believe, done more than any other work or
+essay in our own language to rescue the practice of medicine from the
+slavery to the drugging system which was a part of the inheritance of
+the profession.
+
+Yes, I say, as I look back on the long hours of the many days I spent
+in the wards and in the autopsy room of La Pitie, where Louis was one
+of the attending physicians,--yes, Louis did a great work for
+practical medicine.  Modest in the presence of nature, fearless in
+the face of authority, unwearying in the pursuit of truth, he was a
+man whom any student might be happy and proud to claim as his teacher
+and his friend, and yet, as I look back on the days when I followed
+his teachings, I feel that I gave myself up too exclusively to his
+methods of thought and study.
+
+There is one part of their business which certain medical
+practitioners are too apt to forget; namely, that what they should
+most of all try to do is to ward off disease, to alleviate suffering,
+to preserve life, or at least to prolong it if possible.  It is not
+of the slightest interest to the patient to know whether three or
+three and a quarter cubic inches of his lung are hepatized.  His mind
+is not occupied with thinking of the curious problems which are to be
+solved by his own autopsy,--whether this or that strand of the spinal
+marrow is the seat of this or that form of degeneration.  He wants
+something to relieve his pain, to mitigate the anguish of dyspnea, to
+bring back motion and sensibility to the dead limb, to still the
+tortures of neuralgia.  What is it to him that you can localize and
+name by some uncouth term the disease which you could not prevent and
+which you cannot cure?  An old woman who knows how to make a poultice
+and how to put it on, and does it tuto, eito, jucunde, just when and
+where it is wanted, is better,--a thousand times better in many
+cases,--than a staring pathologist, who explores and thumps and
+doubts and guesses, and tells his patient be will be better tomorrow,
+and so goes home to tumble his books over and make out a diagnosis.
+
+But in those days, I, like most of my fellow students, was thinking
+much more of "science" than of practical medicine, and I believe if
+we had not clung so closely to the skirts of Louis and had followed
+some of the courses of men like Trousseau,--therapeutists, who gave
+special attention to curative methods, and not chiefly to diagnosis,
+--it would have been better for me and others.  One thing, at any
+rate, we did learn in the wards of Louis.  We learned that a very
+large proportion of diseases get well of themselves, without any
+special medication,--the great fact formulated, enforced, and
+popularized by Dr. Jacob Bigelow in the Discourse referred to.  We
+unlearned the habit of drugging for its own sake.  This detestable
+practice, which I was almost proscribed for condemning somewhat too
+epigrammatically a little more than twenty years ago, came to us, I
+suspect, in a considerable measure from the English "general
+practitioners," a sort of prescribing apothecaries.  You remember
+how, when the city was besieged, each artisan who was called upon in
+council to suggest the best means of defence recommended the articles
+he dealt in: the carpenter, wood; the blacksmith, iron; the mason,
+brick; until it came to be a puzzle to know which to adopt. Then the
+shoemaker said, "Hang your walls with new boots,"  and gave good
+reasons why these should be the best of all possible defences.  Now
+the "general practitioner"  charged, as I understand, for his
+medicine, and in that way got paid for his visit.  Wherever this is
+the practice, medicine is sure to become a trade, and the people
+learn to expect drugging, and to consider it necessary, because drugs
+are so universally given to the patients of the man who gets his
+living by them.
+
+It was something to have unlearned the pernicious habit of constantly
+giving poisons to a patient, as if they were good in themselves, of
+drawing off the blood 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 draught and mixtures,
+--only because he was sick and something must be done.  But there
+were positive as well as negative facts to be learned, and some of
+us, I fear, came home rich in the negatives of the expectant
+practice, poor in the resources which many a plain country
+practitioner had ready in abundance for the relief and the cure of
+disease.  No one instructor can be expected to do all for a student
+which he requires.  Louis taught us who followed him the love of
+truth, the habit of passionless listening to the teachings of nature,
+the most careful and searching methods of observation, and the sure
+means of getting at the results to be obtained from them in the
+constant employment of accurate tabulation.  He was not a showy, or
+eloquent, or, I should say, a very generally popular man, though the
+favorite, almost the idol, of many students, especially Genevese and
+Bostonians.  But he was a man of lofty and admirable scientific
+character, and his work will endure in its influences long after his
+name is lost sight of save to the faded eyes of the student of
+medical literature.
+
+Many other names of men more or less famous in their day, and who
+were teaching while I was in Paris, come up before me.  They are but
+empty sounds for the most part in the ears of persons of not more
+than middle age.  Who of you knows anything of Richerand, author of a
+very popular work on Physiology, commonly put into the student's
+hands when I first began to ask for medical text-books?  I heard him
+lecture once, and have had his image with me ever since as that of an
+old, worn-out man,--a venerable but dilapidated relic of an effete
+antiquity.  To verify this impression I have just looked out the
+dates of his birth and death, and find that he was eighteen years
+younger than the speaker who is now addressing you.  There is a
+terrible parallax between the period before thirty and that after
+threescore and ten, as two men of those ages look, one with naked
+eyes, one through his spectacles, at the man of fifty and thereabout.
+Magendie, I doubt not you have all heard of.  I attended but one of
+his lectures.  I question if one here, unless some contemporary of my
+own has strayed into the amphitheatre,--knows anything about
+Marjolin.  I remember two things about his lectures on surgery, the
+deep tones of his voice as he referred to his oracle,--the earlier
+writer, Jean Louis Petit,--and his formidable snuffbox.  What he
+taught me lies far down, 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 now is the fame of
+Bouillaud, Professor and Deputy, the Sangrado of his time?  Where is
+the renown of Piorry, percussionist and poet, expert alike in the
+resonances of the thoracic cavity and those of the rhyming
+vocabulary?--I think life has not yet done with the vivacious
+Ricord, whom I remember calling the Voltaire of pelvic literature,--a
+sceptic as to the morality of the race in general, who would have
+submitted Diana to treatment with his mineral specifics, and ordered
+a course of blue pills for the vestal virgins.
+
+Ricord was born at the beginning of the century, and Piorry some
+years earlier.  Cruveilhier, who died in 1874, is still remembered by
+his great work on pathological anatomy; his work on descriptive
+anatomy has some things which I look in vain for elsewhere.  But
+where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,
+--jolly old Baron Alibert, whom I remember so well in his broad-
+brimmed hat, worn a little jauntily on one side, calling out to the
+students in the court-yard of the Hospital St.  Louis, "Enfans de la
+methode naturelle, etes-vous tous ici?" "Children of the natural
+method [his own method of classification of skin diseases,] are you
+all here?  "All here, then, perhaps; all where, now?
+
+My show of ghosts is over.  It is always the same story that old men
+tell to younger ones, some few of whom will in their turn repeat the
+tale, only with altered names, to their children's children.
+
+     Like phantoms painted on the magic slide,
+     Forth from the darkness of the past we glide,
+     As living shadows for a moment seen
+     In airy pageant on the eternal screen,
+     Traced by a ray from one unchanging flame,
+     Then seek the dust and stillness whence we came.
+
+Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
+where he had written his Latin graduating thesis, talking of the
+learned Gaubius and the late illustrious Boerhaave and other dead
+Dutchmen, of whom you know as much, most of you, as you do of Noah's
+apothecary and the family physician of Methuselah, whose
+prescriptions seem to have been lost to posterity.  Dr. Lloyd came
+back to Boston full of the teachings of Cheselden and Sharpe, William
+Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr.
+Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his
+recollections of Sir Astley Cooper and Mr. Abernethy; I have named
+the famous Frenchmen of my student days; Leyden, Edinburgh, London,
+Paris, were each in turn the Mecca of medical students, just as at
+the present day Vienna and Berlin are the centres where our young men
+crowd for instruction.  These also must sooner or later yield their
+precedence and pass the torch they hold to other hands.  Where shall
+it next flame at the head of the long procession?  Shall it find its
+old place on the shores of the Gulf of Salerno, or shall it mingle
+its rays with the northern aurora up among the fiords of Norway,--or
+shall it be borne across the Atlantic and reach the banks of the
+Charles, where Agassiz and Wyman have taught, where Hagen still
+teaches, glowing like his own Lampyris splendidula, with enthusiasm,
+where the first of American botanists and the ablest of American
+surgeons are still counted in the roll of honor of our great
+University?
+
+Let me add a few words which shall not be other than cheerful, as I
+bid farewell to this edifice which I have known so long.  I am
+grateful to the roof which has sheltered me, to the floors which have
+sustained me, though I have thought it safest always to abstain from
+anything like eloquence, lest a burst of too emphatic applause might
+land my class and myself in the cellar of the collapsing structure,
+and bury us in the fate of Korah, Dathan, and Abiram.  I have helped
+to wear these stairs into hollows,--stairs which I trod when they
+were smooth and level, fresh from the plane.  There are just thirty-
+two of them, as there were five and thirty years ago, but they are
+steeper and harder to climb, it seems to me, than they were then.  I
+remember that in the early 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's room, that some day or other a
+whole class would go heels over head down this graded precipice, like
+the herd told of in Scripture story.  This has never happened as yet;
+I trust it never will.  I have never 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, and I resign it,
+with a wish that it were more worthy of regret, into the hands of my
+successor, with my parting benediction.  Within its twilight
+precincts I have often prayed for light, like Ajax, for the daylight
+found scanty entrance, and the gaslight never illuminated its dark
+recesses.  May it prove to him who comes after me like the cave of
+the Sibyl, out of the gloomy depths of which came the oracles which
+shone with the rays of truth and wisdom!
+
+This temple of learning is not surrounded by the mansions of the
+great and the wealthy.  No stately avenues lead up to its facades and
+porticoes.  I have sometimes felt, when convoying a distinguished
+stranger through its precincts to its door, that he might question
+whether star-eyed Science had not missed her way when she found
+herself in this not too attractive locality.  I cannot regret that
+we--you, I should say--are soon to migrate to a more favored region,
+and carry on your work as teachers and as learners in ampler halls
+and under far more favorable conditions.
+
+I hope that I may have the privilege of meeting you there, possibly
+may be allowed to add my words of welcome to those of my former
+colleagues, and in that pleasing anticipation I bid good-by to this
+scene of my long labors, and, for the present at least, to the
+friends with whom I have been associated.
+
+
+
+
+
+
+APPENDUM
+
+NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
+CURRENTS IN MEDICAL SCIENCE.
+
+Some passages contained in the original manuscript of the Address,
+and omitted in the delivery on account of its length, are restored in
+the text or incorporated with these Notes.
+
+NOTE A.--
+
+There is good reason to doubt whether the nitrate of silver has any
+real efficacy in epilepsy.  It has seemed to cure many cases, but
+epilepsy is a very uncertain disease, and there is hardly anything
+which has not been supposed to cure it.  Dr. Copland cites many
+authorities in its favor, most especially Lombard's cases.  But De la
+Berge and Monneret (Comp.  de Med.  Paris), 1839, analyze these same
+cases, eleven in number, and can only draw the inference of a very
+questionable value in the supposed remedy.  Dr. James Jackson says
+that relief of epilepsy is not to 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, Professor at the
+Royal College, Author of the Antimonial Martyrology, a wit and a man
+of sense and learning, who died almost two 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 cured by
+nitrate of silver?"  I said to one of the oldest and 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 given for epilepsy?  Because, as Dr. Martin has so
+well reminded us, lunatics were considered formerly to be under the
+special influence of Luna, the moon (which Esquirol, be it observed,
+utterly denies), and lunar caustic, or nitrate of silver, is a salt
+of that metal which was called luna from its whiteness, and of course
+must be in the closest relations with the moon.  It follows beyond
+all reasonable question that the moon's metal, silver, and its
+preparations, must be the specific remedy for moonblasted maniacs and
+epileptics!
+
+Yet the practitioner who prescribes the nitrate of silver supposes he
+is guided by the solemn experience of the past, instead of by its
+idle fancies.  He laughs at those old physicians who placed such
+confidence in the right hind hoof of an elk as a remedy for the same
+disease, and leaves the record of his own belief in a treatment quite
+as fanciful and far more objectionable, written in indelible ink upon
+a living tablet where he who runs may read it for a whole generation,
+if nature spares his walking advertisement so long.
+
+
+
+NOTE B.--
+
+The presumption that a man is innocent until he is proved guilty,
+does not mean that there are no rogues, but lays the onus probandi on
+the party to which it properly belongs.  So with this proposition.
+A noxious agent should never be employed in sickness unless there is
+ample evidence in the particular case to overcome the general
+presumption against all such agents, and the evidence is very apt to
+be defective.
+
+The miserable delusion of Homoeopathy builds itself upon an axiom
+directly the opposite of this; namely, that the sick are to be cured
+by poisons.  Similia similibus curantur means exactly this.  It is
+simply a theory of universal poisoning, nullified in practice by the
+infinitesimal contrivance.  The only way to kill it and all similar
+fancies, and to throw every quack nostrum into discredit, is to root
+out completely the suckers of the old rotten superstition that
+whatever is odious or noxious is likely to be good for disease.  The
+current of sound practice with ourselves is, I believe, setting fast
+in the direction I have indicated in the above proposition.  To
+uphold the exhibition of noxious agents in disease, as the rule,
+instead of admitting them cautiously and reluctantly as the
+exception, is, as I think, an eddy of opinion in the direction of the
+barbarism out of which we believe our art is escaping.  It is only
+through the enlightened sentiment and action of the Medical
+Profession that the community can be brought to acknowledge that
+drugs should always be regarded as evils.
+
+It is true that some suppose, and our scientific and thoughtful
+associate, Dr.  Gould, has half countenanced the opinion, that there
+may yet be discovered a specific for every disease.  Let us not
+despair of the future, but let us be moderate in our expectations.
+When an oil is discovered that will make a bad watch keep good time;
+when a recipe is given which will turn an acephalous foetus into a
+promising child; when a man can enter the second time into his
+mother's womb and give her back the infirmities which twenty
+generations have stirred into her blood, and infused into his own
+through hers, we may be prepared to enlarge the National
+Pharmacopoeia with a list of specifies for everything but old age,
+--and possibly for that also.
+
+
+
+NOTE C.--
+
+The term specific is used here in its ordinary sense, without raising
+the question of the propriety of its application to these or other
+remedies.
+
+The credit of introducing Cinchona rests between the Jesuits, the
+Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
+who employed it as a secret remedy.  (Pereira.) Mercury as an
+internal specific remedy was brought into use by that impudent and
+presumptuous quack, as he was considered, Paracelsus.  (Encyc.  Brit.
+art.  "Paracelsus.") Arsenic was introduced into England as a remedy
+for intermittents by Dr. Fowler, in consequence of the success of a
+patent medicine, the Tasteless Ague Drops, which were supposed,
+"probably with reason," to be a preparation of that mineral.  (Rees's
+Cyc.  art.  "Arsenic.")  Colchicum came into notice in a similar way,
+from the success of the Eau Medicinale of M. Husson, a French
+military officer.  (Pereira.) Iodine was discovered by a saltpetre
+manufacturer, but applied by a physician in place of the old remedy,
+burnt sponge, which seems to owe its efficacy to it.  (Dunglison, New
+Remedies.) As for Sulphur, "the common people have long used it as an
+ointment" for scabies.  (Rees's Cyc.  art.  "Scabies.") The modern
+cantiscorbutic regimen is credited to Captain Cook.  "To his sagacity
+we are indebted for the first impulse to those regulations by which
+scorbutus is so successfully prevented in our navy."  (Lond.  Cyc.
+Prac.  Med.  art.  "Scorbutus.") Iron and various salts which enter
+into the normal composition of the human body do not belong to the
+materia medica by our definition, but to the materia alimentaria.
+
+For the first introduction of iron as a remedy, see Pereira, who
+gives a very curious old story.
+
+The statement in the text concerning a portion of the materia medica
+stands exactly as delivered, and is meant exactly as it stands.  No
+denunciation of drugs, as sparingly employed by a wise physician, was
+or is intended.  If, however, as Dr.  Gould stated in his "valuable
+and practical discourse" to which the Massachusetts Medical Society
+"listened with profit as well as interest,"  "Drugs, in themselves
+considered, may always be regarded as evils,"--any one who chooses
+may question whether the evils from their abuse are, on the whole,
+greater or less than the undoubted benefits obtained from their
+proper use.  The large exception of opium, wine, specifics, and
+anaesthetics, made in the text, takes off enough from the useful
+side, as I fully believe, to turn the balance; so that a vessel
+containing none of these, but loaded with antimony, strychnine,
+acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus
+diaboli, tormentilla, and other approved, and, in skilful hands,
+really useful remedies, brings, on the whole, more harm than good to
+the port it enters.
+
+It is a very narrow and unjust view of the practice of medicine, to
+suppose it to consist altogether in the use of powerful drugs, or of
+drugs of any kind.  Far from it.  "The physician may do very much for
+the welfare of the sick, more than others can do, although he does
+not, even in the major part of cases, undertake to control and
+overcome the disease by art.  It was with these views that I never
+reported any patient cured at our hospital.  Those who recovered
+their health were reported as well; not implying that they were made
+so by the active treatment they had received there.  But it was to be
+understood that all patients received in that house were to be cured,
+that is, taken care of."  (Letters to a Young Physician, by James
+Jackson, M.  D., Boston, 1855.)
+
+"Hygienic rules, properly enforced, fresh air, change of air, travel,
+attention to diet, good and appropriate food judiciously regulated,
+together with the administration of our tonics, porter, ale, wine,
+iron, etc., supply the diseased or impoverished system with what Mr.
+Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of
+the blood;' and we believe that if any real improvement has taken
+place in medical practice, independently of those truly valuable
+contributions we have before described, it is in the substitution of
+tonics, stimulants, and general management, for drastic cathartics,
+for bleeding, depressing agents, including mercury, tartar emetics,
+etc., so much in vogue during the early part even of this century."
+(F. P. Porcher, in Charleston Med. Journal and Review for January,
+1860.)
+
+
+
+
+
+End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes
+
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