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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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