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+Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes
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+Title:  Medical Essays
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+Author:  Oliver Wendell Holmes
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+July, 2001  [Etext #2700]
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+Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes
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+Etext prepared for Gutenberg by David Widger,  widger@cecomet.net
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+
+
+MEDICAL ESSAYS
+
+BY OLIVER WENDELL HOLMES
+
+
+
+
+1842-1882
+
+
+CONTENTS:
+
+I.   HOMEOPATHY AND ITS KINDRED DELUSIONS
+
+II.  THE CONTAGIOUSNESS OF PUERPERAL FEVER
+
+III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+IV.  BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE
+
+V.   SCHOLASTIC AND BEDSIDE TEACHING
+
+VI.  THE MEDICAL PROFESSION IN MASSACHUSETTS
+
+VII. THE YOUNG PRACTITIONER
+
+VIII. MEDICAL LIBRARIES
+
+IX.  SOME OF MY EARLY TEACHERS
+
+
+
+
+
+
+PREFACE.
+
+The character of the opposition which some of these papers have met
+with suggests the inference that they contain really important, but
+unwelcome truths.  Negatives multiplied into each other change their
+sign and become positives.  Hostile criticisms meeting together are
+often equivalent to praise, and the square of fault-finding turns out
+to be the same thing as eulogy.
+
+But a writer has rarely so many enemies as it pleases him to believe.
+Self-love leads us to overrate the numbers of our negative
+constituency.  The larger portion of my limited circle of readers
+must be quite indifferent to, if not ignorant of, the adverse
+opinions which have been expressed or recorded concerning any of
+these Addresses or Essays now submitted to their own judgment.  It is
+proper, however, to inform them, that some of the positions
+maintained in these pages have been unsparingly attacked, with
+various degrees of ability, scholarship, and good-breeding.  The tone
+of criticism naturally changes with local conditions in different
+parts of a country extended like our own, so that it is one of the
+most convenient gauges of the partial movements in the direction of
+civilization.  It is satisfactory to add, that the views assailed
+have also been unflinchingly defended by unsought champions, among
+the ablest of whom it is pleasant to mention, at this moment of
+political alienation, the Editor of the Charleston Medical Journal.
+
+"Currents and Counter-Currents" was written and delivered as an
+Oration, a florid rhetorical composition, expressly intended to
+secure the attention of an audience not easy to hold as listeners.
+It succeeded in doing this, and also in being as curiously
+misunderstood and misrepresented as if it had been a political
+harangue.  This gave it more local notoriety than it might otherwise
+have attained, so that, as I learn, one ingenious person made use of
+its title as an advertisement to a production of his own.
+
+The commonest mode of misrepresentation was this: qualified
+propositions, the whole meaning of which depended on the
+qualifications, were stripped of these and taken as absolute.  Thus,
+the attempt to establish a presumption against giving poisons to sick
+persons was considered as equivalent to condemning the use of these
+substances.  The only important inference the writer has been able to
+draw from the greater number of the refutations of his opinions which
+have been kindly sent him, is that the preliminary education of the
+Medical Profession is not always what it ought to be.
+
+One concession he is willing to make, whatever sacrifice of pride it
+may involve.  The story of Massasoit, which has furnished a coral, as
+it were, for some teething critics, when subjected to a powerful
+logical analysis, though correct in its essentials, proves to have
+been told with exceptionable breadth of statement, and therefore (to
+resume the metaphor) has been slightly rounded off at its edges, so
+as to be smoother for any who may wish to bite upon it hereafter.  In
+other respects the Discourse has hardly been touched.  It is only an
+individual's expression, in his own way, of opinions entertained by
+hundreds of the Medical Profession in every civilized country, and
+has nothing in it which on revision the writer sees cause to retract
+or modify.  The superstitions it attacks lie at the very foundation
+of Homoeopathy, and of almost every form of medical charlatanism.
+Still the mere routinists and unthinking artisans in most callings
+dislike whatever shakes the dust out of their traditions, and it may
+be unreasonable to expect that Medicine will always prove an
+exception to the rule.  One half the opposition which the numerical
+system of Louis has met with, as applied to the results of treatment,
+has been owing to the fact that it showed the movements of disease to
+be far more independent of the kind of practice pursued than was
+agreeable to the pride of those whose self-confidence it abated.
+
+The statement, that medicines are more sparingly used in physicians'
+families than in most others, admits of a very natural explanation,
+without putting a harsh construction upon it, which it was not
+intended to admit.  Outside pressure is less felt in the physician's
+own household; that is all.  If this does not sometimes influence him
+to give medicine, or what seems to be medicine, when among those who
+have more confidence in drugging than his own family commonly has,
+the learned Professor Dunglison is hereby requested to apologize for
+his definition of the word Placebo, or to expunge it from his Medical
+Dictionary.
+
+One thing is certain.  A loud outcry on a slight touch reveals the
+weak spot in a profession, as well as in a patient.  It is a doubtful
+policy to oppose the freest speech in those of our own number who are
+trying to show us where they honestly believe our weakness lies.
+Vast as are the advances of our Science and Art, may it not possibly
+prove on examination that we retain other old barbarisms beside the
+use of the astrological sign of Jupiter, with which we endeavor to
+insure good luck to our prescriptions?  Is it the act of a friend or
+a foe to try to point them out to our brethren when asked to address
+them, and is the speaker to subdue the constitutional habit of his
+style to a given standard, under penalty of giving offence to a grave
+assembly?
+
+Homoeopathy and its Kindred Delusions " was published nearly twenty
+years ago, and has been long out of print, so that the author tried
+in vain to procure a copy until the kindness of a friend supplied him
+with the only one he has had for years.  A foolish story reached his
+ears that he was attempting to buy up stray copies for the sake of
+suppressing it.  This edition was in the press at that very time.
+
+Many of the arguments contained in the Lectures have lost whatever
+novelty they may have possessed.  All its predictions have been
+submitted to the formidable test of time.  They appear to have stood
+it, so far, about as well as most uninspired prophecies; indeed, some
+of them require much less accommodation than certain grave
+commentators employ in their readings of the ancient Prophets.
+
+If some statistics recently published are correct, Homoeopathy has
+made very slow progress in Europe.
+
+In all England, as it appears, there are hardly a fifth more
+Homoeopathic practitioners than there are students attending Lectures
+at the Massachusetts Medical College at the present time.  In America
+it has undoubtedly proved more popular and lucrative, yet how loose a
+hold it has on the public confidence is shown by the fact that, when
+a specially valued life, which has been played with by one of its
+agents, is seriously threatened, the first thing we expect to hear is
+that a regular practitioner is by the patient's bed, and the
+Homoeopathic counsellor overruled or discarded.  Again, how many of
+the ardent and capricious persons who embraced Homoeopathy have run
+the whole round of pretentious novelties;--have been boarded at
+water-cure establishments, closeted with uterine and other
+specialists, and finally wandered over seas to put themselves in
+charge of foreign celebrities, who dosed them as lustily as they were
+ever dosed before they took to globules!  It will surprise many to
+learn to what a shadow of a shade Homoeopathy has dwindled in the
+hands of many of its noted practitioners.  The itch-doctrine is
+treated with contempt.  Infinitesimal doses are replaced by full ones
+whenever the fancy-practitioner chooses.  Good Homoeopathic reasons
+can be found for employing anything that anybody wants to employ.
+Homoeopathy is now merely a name, an unproved theory, and a box of
+pellets pretending to be specifics, which, as all of us know, fail
+ignominiously in those cases where we would thankfully sacrifice all
+our prejudices and give the world to have them true to their
+promises.
+
+Homoeopathy has not died out so rapidly as Tractoration.  Perhaps it
+was well that it should not, for it has taught us a lesson of the
+healing faculty of Nature which was needed, and for which many of us
+have made proper acknowledgments.  But it probably does more harm
+than good to medical science at the present time, by keeping up the
+delusion of treating everything by specifics,--the old barbarous
+notion that sick people should feed on poisons [Lachesis, arrow-
+poison, obtained from a serpent (Pulte).  Crotalus horridus,
+rattlesnake's venom (Neidhard).  The less dangerous Pediculus capilis
+is the favorite remedy of Dr. Mure, the English 'Apostle of
+Homoeopathy."  These are examples of the retrograde current setting
+towards barbarism] against which a part of the Discourse at the
+beginning of this volume is directed.
+
+The infinitesimal globules have not become a curiosity as yet, like
+Perkins's Tractors.  But time is a very elastic element in Geology
+and Prophecy.  If Daniel's seventy weeks mean four hundred and ninety
+years, as the learned Prideaux and others have settled it that they
+do, the "not many years" of my prediction may be stretched out a
+generation or two beyond our time, if necessary, when the prophecy
+will no doubt prove true.
+
+It might be fitting to add a few words with regard to the Essay on
+the Contagiousness of Puerperal Fever.  But the whole question I
+consider to be now transferred from the domain of medical inquiry to
+the consideration of Life Insurance agencies and Grand Juries.  For
+the justification of this somewhat sharply accented language I must
+refer the reader to the paper itself for details which I regret to
+have been forced to place on permanent record.
+
+BOSTON, January, 1861.
+
+
+
+
+A SECOND PREFACE.
+
+These Lectures and Essays are arranged in the order corresponding to
+the date of their delivery or publication.  They must, of course, be
+read with a constant reference to these dates, by such as care to
+read them.  I have not attempted to modernize their aspect or
+character in presenting them, in this somewhat altered connection, to
+the public.  Several of them were contained in a former volume which
+received its name from the Address called "Currents and Counter-
+Currents."  Some of those contained in the former volume have been
+replaced by others.  The Essay called "Mechanism of Vital Actions"
+has been transferred to a distinct collection of Miscellaneous
+essays, forming a separate volume.
+
+I had some intention of including with these papers an Essay on
+Intermittent Fever in New England, which received one of the Boylston
+prizes in 1837, and was published in the following year.  But as this
+was upon a subject of local interest, chiefly, and would have taken
+up a good deal of room, I thought it best to leave it out, trusting
+that the stray copies to be met with in musty book-shops would
+sufficiently supply the not very extensive or urgent demand for a
+paper almost half a century old.
+
+Some of these papers created a little stir when they first fell from
+the press into the pool of public consciousness.  They will slide in
+very quietly now in this new edition, and find out for themselves
+whether the waters are those of Lethe, or whether they are to live
+for a time as not wholly unvalued reminiscences.
+
+March 21, 1883.
+
+
+
+
+PREFACE TO THE NEW EDITION.
+
+These Essays are old enough now to go alone without staff or crutch
+in the shape of Prefaces.  A very few words may be a convenience to
+the reader who takes up the book and wishes to know what he is likely
+to find in it.
+
+
+               HOMOEOPATHY AND ITS KINDRED DELUSIONS.
+
+Homoeopathy has proved lucrative, and so long as it continues to be
+so will surely exist,--as surely as astrology, palmistry, and other
+methods of getting a living out of the weakness and credulity of
+mankind and womankind.  Though it has no pretensions to be considered
+as belonging among the sciences, it may be looked upon by a
+scientific man as a curious object of study among the vagaries of the
+human mind.  Its influence for good or the contrary may be made a
+matter of calm investigation.  I have studied it in the Essay before
+the reader, under the aspect of an extravagant and purely imaginative
+creation of its founder.  Since that first essay was written, nearly
+half a century ago, we have all had a chance to witness its practical
+working.  Two opposite inferences may be drawn from its doctrines and
+practice.  The first is that which is accepted by its disciples.
+This is that all diseases are "cured" by drugs.  The opposite
+conclusion is drawn by a much larger number of persons.  As they see
+that patients are very commonly getting well under treatment by
+infinitesimal drugging, which they consider equivalent to no
+medication at all, they come to disbelieve in every form of drugging
+and put their whole trust in "nature."  Thus experience,
+
+          "From seeming evil still educing good,"
+
+has shown that the dealers in this preposterous system of pseudo-
+therapeutics have cooperated with the wiser class of practitioners in
+breaking up the system of over-dosing and over-drugging which has
+been one of the standing reproaches of medical practice.  While.
+keeping up the miserable delusion that diseases were all to be
+"cured" by drugging, Homoeopathy has been unintentionally showing
+that they would very generally get well without any drugging at all.
+In the mean time the newer doctrines of the "mind cure," the "faith
+cure," and the rest are encroaching on the territory so long
+monopolized by that most ingenious of the pseudo-sciences.  It would
+not be surprising if its whole ground should be taken possession of
+by these new claimants with their flattering appeals to the
+imaginative class of persons open to such attacks.  Similia similabus
+may prove fatally true for once, if Homoeopathy is killed out by its
+new-born rivals.
+
+It takes a very moderate amount of erudition to unearth a charlatan
+like the supposed father of the infinitesimal dosing system.  The
+real inventor of that specious trickery was an Irishman by the name
+of Butler.  The whole story is to be found in the "Ortus Medicinm" of
+Van Helmont.  I have given some account of his chapter "Butler" in
+different articles, but I would refer the students of our
+Homoeopathic educational institutions to the original, which they
+will find very interesting and curious.
+
+
+                    CURRENTS AND COUNTER-CURRENTS
+
+My attack on over-drugging brought out some hostile comments and
+treatment.  Thirty years ago I expressed myself with more vivacity
+than I should show if I were writing on the same subjects today.
+Some of my more lively remarks called out very sharp animadversion.
+Thus my illustration of prevention as often better than treatment in
+the mother's words to her child which had got a poisonous berry in
+its mouth,--"Spit it out!" gave mortal offence to a well-known New
+York practitioner and writer, who advised the Massachusetts Medical
+Society to spit out the offending speaker.  Worse than this was my
+statement of my belief that if a ship-load of miscellaneous drugs,
+with certain very important exceptions,--drugs, many of which were
+then often given needlessly and in excess, as then used "could be
+sunk to the bottom of the sea, it would be all the better for mankind
+and all the worse for the fishes."  This was too bad.  The sentence
+was misquoted, quoted without its qualifying conditions, and
+frightened some of my worthy professional brethren as much as if I
+had told them to throw all physic to the dogs.  But for the
+epigrammatic sting the sentiment would have been unnoticed as a
+harmless overstatement at the very worst.
+
+Since this lecture was delivered a great and, as I think, beneficial
+change has taken place in the practice of medicine.  The habit of the
+English "general practitioner" of making his profit out of the pills
+and potions he administered was ruinous to professional advancement
+and the dignity of the physician.  When a half-starving medical man
+felt that he must give his patient draught and boluses for which he
+could charge him, he was in a pitiable position and too likely to
+persuade himself that his drugs were useful to his patient because
+they were profitable to him.  This practice has prevailed a good deal
+in America, and was doubtless the source in some measure of the
+errors I combated.
+
+
+               THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+This Essay was read before a small Association called "The Society
+for Medical Improvement," and published in a Medical Journal which
+lasted but a single year.  It naturally attracted less attention than
+it would have done if published in such a periodical as the "American
+Journal of Medical Sciences."  Still it had its effect, as I have
+every reason to believe.  I cannot doubt that it has saved the lives
+of many young mothers by calling attention to the existence and
+propagation of "Puerperal Fever as a Private Pestilence," and laying
+down rules for taking the necessary precautions against it.  The case
+has long been decided in favor of the views I advocated, but, at the
+time when I wrote two of the most celebrated professors of Obstetrics
+in this country opposed my conclusions with all the weight of their
+experience and position.
+
+This paper was written in a great heat and with passionate
+indignation.  If I touched it at all I might trim its rhetorical
+exuberance, but I prefer to leave it all its original strength of
+expression.  I could not, if I had tried, have disguised the feelings
+with which I regarded the attempt to put out of sight the frightful
+facts which I brought forward and the necessary conclusions to which
+they led.  Of course the whole matter has been looked at in a new
+point of view since the microbe as a vehicle of contagion has been
+brought into light, and explained the mechanism of that which was
+plain enough as a fact to all who were not blind or who did not shut
+their eyes.
+
+O.  W.  H.
+
+BEVERLY Farms, Mass., August 3, 1891
+
+
+
+
+
+
+HOMOEOPATHY AND ITS KINDRED DELUSIONS
+[Two lectures delivered before the Boston Society for the Diffusion
+of Useful Knowledge.  1842.]
+
+
+[When a physician attempts to convince a person, who has fallen into
+the Homoeopathic delusion, of the emptiness of its pretensions, he is
+often answered by a statement of cases in which its practitioners are
+thought to have effected wonderful cures.  The main object of the
+first of these Lectures is to show, by abundant facts, that such
+statements, made by persons unacquainted with the fluctuations of
+disease and the fallacies of observation, are to be considered in
+general as of little or no value in establishing the truth of a
+medical doctrine or the utility of a method of practice.
+
+Those kind friends who suggest to a person suffering from a tedious
+complaint, that he "Had better try Homoeopathy," are apt to enforce
+their suggestion by adding, that "at any rate it can do no harm."
+This may or may not be true as regards the individual.  But it always
+does very great harm to the community to encourage ignorance, error,
+or deception in a profession which deals with the life and health of
+our fellow-creatures.  Whether or not those who countenance
+Homoeopathy are guilty of this injustice towards others, the second
+of these Lectures may afford them some means of determining.
+
+To deny that good effects may happen from the observance of diet and
+regimen when prescribed by Homoeopathists as well as by others, would
+be very unfair to them.  But to suppose that men with minds so
+constituted as to accept such statements and embrace such doctrines
+as make up the so-called science of Homoeopathy are more competent
+than others to regulate the circumstances which influence the human
+body in health and disease, would be judging very harshly the average
+capacity of ordinary practitioners.
+
+To deny that some patients may have been actually benefited through
+the influence exerted upon their imaginations, would be to refuse to
+Homoeopathy what all are willing to concede to every one of those
+numerous modes of practice known to all intelligent persons by an
+opprobrious title.
+
+So long as the body is affected through the mind, no audacious
+device, even of the most manifestly dishonest character, can fail of
+producing occasional good to those who yield it an implicit or even a
+partial faith.  The argument founded on this occasional good would be
+as applicable in justifying the counterfeiter and giving circulation
+to his base coin, on the ground that a spurious dollar had often
+relieved a poor man's necessities.
+
+Homoeopathy has come before our public at a period when the growing
+spirit of eclecticism has prepared many ingenious and honest minds to
+listen to all new doctrines with a candor liable to degenerate into
+weakness.  It is not impossible that the pretended evolution of great
+and mysterious virtues from infinitely attenuated atoms may have
+enticed a few over-refining philosophers, who have slid into a vague
+belief that matter subdivided grows less material, and approaches
+nearer to a spiritual nature as it requires a more powerful
+microscope for its detection.
+
+However this may be, some persons seem disposed to take the ground of
+Menzel that the Laity must pass formal judgment between the Physician
+and the Homoeopathist, as it once did between Luther and the
+Romanists.  The practitioner and the scholar must not, therefore,
+smile at the amount of time and labor expended in these Lectures upon
+this shadowy system; which, in the calm and serious judgment of many
+of the wisest members of the medical profession, is not entitled by
+anything it has ever said or done to the notoriety of a public
+rebuke, still less to the honors of critical martyrdom.]
+
+
+I
+
+I have selected four topics for this lecture, the first three of
+which I shall touch but slightly, the last more fully.  They are
+
+1.  The Royal cure of the King's Evil, or Scrofula.
+
+2.  The Weapon Ointment, and its twin absurdity, the Sympathetic
+Powder.
+
+3.  The Tar-water mania of Bishop Berkeley.
+
+4.  The History of the Metallic Tractors, or Perkinism.
+
+The first two illustrate the ease with which numerous facts are
+accumulated to prove the most fanciful and senseless extravagances.
+
+The third exhibits the entire insufficiency of exalted wisdom,
+immaculate honesty, and vast general acquirements to make a good
+physician of a great bishop.
+
+The fourth shows us the intimate machinery of an extinct delusion,
+which flourished only forty years ago; drawn in all its details, as
+being a rich and comparatively recent illustration of the
+pretensions, the arguments, the patronage, by means of which windy
+errors have long been, and will long continue to be, swollen into
+transient consequence.  All display in superfluous abundance the
+boundless credulity and excitability of mankind upon subjects
+connected with medicine.
+
+>From the time of Edward the Confessor to Queen Anne, the monarchs of
+England were in the habit of touching those who were brought to them
+suffering with the scrofula, for the cure of that distemper.  William
+the Third had good sense enough to discontinue the practice, but Anne
+resumed it, and, among her other patients, performed the royal
+operation upon a child, who, in spite of his, disease, grew up at
+last into Samuel Johnson.  After laying his hand upon the sufferers,
+it was customary for the monarch to hang a gold piece around the neck
+of each patient.  Very strict precautions were adopted to prevent
+those who thought more of the golden angel hung round the neck by a
+white ribbon, than of relief of their bodily infirmities, from making
+too many calls, as they sometimes attempted to do.  According to the
+statement of the advocates and contemporaries of this remedy, none
+ever failed of receiving benefit unless their little faith and
+credulity starved their merits.  Some are said to have been cured
+immediately on the very touch, others did not so easily get rid of
+their swellings, until they were touched a second time.  Several
+cases are related, of persons who had been blind for several weeks,
+and months, and obliged even to be led to Whitehall, yet recovered
+their sight immediately upon being touched, so as to walk away
+without any guide."  So widely, at one period, was the belief
+diffused, that, in the course of twelve years, nearly a hundred
+thousand persons were touched by Charles the Second.  Catholic
+divines; in disputes upon the orthodoxy of their church, did not deny
+that the power had descended to protestant princes;--Dr. Harpsfield,
+in his " Ecclesiastical History of England," admitted it, and in
+Wiseman's words, "when Bishop Tooker would make use of this Argument
+to prove the Truth of our Church, Smitheus doth not thereupon go
+about to deny the Matter of fact; nay, both he and Cope acknowledge
+it."  "I myself," says Wiseman, the best English surgical writer of
+his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.]
+--"I my self have been a frequent Eye-witness of many hundred of
+Cures performed by his Majesties Touch alone, without any assistance
+of Chirurgery; and those, many of them such as had tired out the
+endeavours of able Chirurgeons before they came hither.  It were
+endless to recite what I myself have seen, and what I have received
+acknowledgments of by Letter, not only from the severall parts of
+this Nation, but also from Ireland, Scotland, Jersey, Garnsey.  It is
+needless also to remember what Miracles of this nature were performed
+by the very Bloud of his late Majesty of Blessed memory, after whose
+decollation by the inhuman Barbarity of the Regicides, the reliques
+of that were gathered on Chips and in Handkerchieffs by the pious
+Devotes, who could not but think so great a suffering in so
+honourable and pious a Cause, would be attended by an extraordinary
+assistance of God, and some more then ordinary a miracle: nor did
+their Faith deceive them in this there point, being so many hundred
+that found the benefit of it." [Severall Chirurgicall Treatises.
+London.1676.  p.  246.]
+
+Obstinate and incredulous men, as he tells us, accounted for these
+cures in three ways: by the journey and change of air the patients
+obtained in coming to London; by the influence of imagination; and
+the wearing of gold.
+
+To these objections he answers, 1st.  That many of those cured were
+inhabitants of the city.  2d.  That the subjects of treatment were
+frequently infants.  3d.  That sometimes silver was given, and
+sometimes nothing, yet the patients were cured.
+
+A superstition resembling this probably exists at the present time in
+some ignorant districts of England and this country.  A writer in a
+Medical Journal in the year 1807, speaks of a farmer in Devonshire,
+who, being a ninth son of a ninth son, is thought endowed with
+healing powers like those of ancient royalty, and who is accustomed
+one day in every week to strike for the evil.
+
+I remember that one of my schoolmates told me, when a boy, of a
+seventh son of a seventh son, somewhere in Essex County, who touched
+for the scrofula, and who used to hang a silver fourpence halfpenny
+about the neck of those who came to him, which fourpence halfpenny it
+was solemnly affirmed became of a remarkably black color after having
+been some time worn, and that his own brother had been subjected to
+this extraordinary treatment; but I must add that my schoolmate drew
+a bow of remarkable length, strength, and toughness for his tender
+years.
+
+One of the most curious examples of the fallacy of popular belief and
+the uncertainty of asserted facts in medical experience is to be
+found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
+
+Fabricius Hildanus, whose name is familiar to every surgical
+scholar, and Lord Bacon, who frequently dipped a little into
+medicine, are my principal authorities for the few circumstances I
+shall mention regarding it.  The Weapon Ointment was a preparation
+used for the healing of wounds, but instead of its being applied to
+them, the injured part was washed and bandaged, and the weapon with
+which the wound was inflicted was carefully anointed with the
+unguent.  Empirics, ignorant barbers, and men of that sort, are said
+to have especially employed it.  Still there were not wanting some
+among the more respectable members of the medical profession who
+supported its claims.  The composition of this ointment was
+complicated, in the different formulae given by different
+authorities; but some substances addressed to the imagination, rather
+than the wound or weapon, entered into all.  Such were portions of
+mummy, of human blood, and of moss from the skull of a thief hung in
+chains.
+
+Hildanus was a wise and learned man, one of the best surgeons of his
+time.  He was fully aware that a part of the real secret of the
+Unguentum Armarium consisted in the washing and bandaging the wound
+and then letting it alone.  But he could not resist the solemn
+assertions respecting its efficacy; he gave way before the outcry of
+facts, and therefore, instead of denying all their pretensions, he
+admitted and tried to account for them upon supernatural grounds.  As
+the virtue of those applications, he says, which are made to the
+weapon cannot reach the wound, and as they can produce no effect
+without contact, it follows, of necessity, that the Devil must have a
+hand in the business; and as he is by far the most long headed and
+experienced of practitioners, he cannot find this a matter of any
+great difficulty.  Hildanus himself reports, in detail, the case of a
+lady who had received a moderate wound, for which the Unguentum
+Armarium was employed without the slightest use.  Yet instead of
+receiving this flat case of failure as any evidence against the
+remedy, he accounts for its not succeeding by the devout character of
+the lady, and her freedom from that superstitious and over-
+imaginative tendency which the Devil requires in those who are to be
+benefited by his devices.
+
+Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
+having in its favor the testimony of men of credit, though, in his
+own language, he himself "as yet is not fully inclined to believe
+it."  His remarks upon the asserted facts respecting it show a
+mixture of wise suspicion and partial belief.  He does not like the
+precise directions given as to the circumstances under which the
+animals from which some of the materials were obtained were to be
+killed; for he thought it looked like a provision for an excuse in
+case of failure, by laying the fault to the omission of some of these
+circumstances.  But he likes well that "they do not observe the
+confecting of the Ointment under any certain constellation; which is
+commonly the excuse of magical medicines, when they fail, that they
+were not made under a fit figure of heaven." [This was a mistake,
+however, since the two recipes given by Hildanus are both very
+explicit as to the aspect of the heavens required for different
+stages of the process.]  "It was pretended that if the offending
+weapon could not be had, it would serve the purpose to anoint a
+wooden one made like it.  "This," says Bacon, "I should doubt to be a
+device to keep this strange form of cure in request and use; because
+many times you cannot come by the weapon itself."  And in closing his
+remarks on the statements of the advocates of the ointment, he says,
+"Lastly, it will cure a beast as well as a man, which I like best of
+all the rest, because it subjecteth the matter to an easy trial."  It
+is worth remembering, that more than two hundred years ago, when an
+absurd and fantastic remedy was asserted to possess wonderful power,
+and when sensible persons ascribed its pretended influence to
+imagination, it was boldly answered that the cure took place when the
+wounded party did not know of the application made to the weapon, and
+even when a brute animal was the subject of the experiment, and that
+this assertion, he as we all know it was, came in such a shape as to
+shake the incredulity of the keenest thinker of his time.  The very
+same assertion has been since repeated in favor of Perkinism, and,
+since that, of Homoeopathy.
+
+The same essential idea as that of the Weapon Ointment reproduced
+itself in the still more famous SYMPATHETIC POWDER.  This Powder was
+said to have the faculty, if applied to the blood-stained garments of
+a wounded person, to cure his injuries, even though he were at a
+great distance at the time.  A friar, returning from the East,
+brought the recipe to Europe somewhat before the middle of the
+seventeenth century.  The Grand Duke of Florence, in which city the
+friar was residing, heard of his cures, and tried, but without
+success, to obtain his secret.  Sir Kenehn Digby, an Englishman well
+known to fame, was fortunate enough to do him a favor, which wrought
+upon his feelings and induced him to impart to his benefactor the
+composition of his extraordinary Powder.  This English knight was at
+different periods of his life an admiral, a theologian, a critic, a
+metaphysician, a politician, and a disciple of Alchemy.  As is not
+unfrequent with versatile and inflammable people, he caught fire at
+the first spark of a new medical discovery, and no sooner got home to
+England than he began to spread the conflagration.
+
+An opportunity soon offered itself to try the powers of the famous
+powder.  Mr. J. Howell, having been wounded in endeavoring to part
+two of his friends who were fighting a duel, submitted himself to a
+trial of the Sympathetic Powder.  Four days after he received his
+wounds, Sir Kenehn dipped one of Mr. Howell's gaiters in a solution
+of the Powder, and immediately, it is said, the wounds, which were
+very painful, grew easy, although the patient, who was conversing in
+a corner of the chamber, had not, the least idea of what was doing
+with his garter.  He then returned home, leaving his garter in the
+hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent
+his servant in a great hurry to tell him that his wounds were paining
+him horribly; the garter was therefore replaced in the solution of
+the Powder, and the patient got well after five or six days of its
+continued immersion."
+
+King James First, his son Charles the First, the Duke of Buckingham,
+then prime minister, and all the principal personages of the time,
+were cognizant of this fact; and James himself, being curious to know
+the secret of this remedy, asked it of Sir Kenelm, who revealed it to
+him, and his Majesty had the opportunity of making several trials of
+its efficacy, which all succeeded in a surprising manner." [Dict.
+des Sciences Medieales.]
+
+The king's physician, Dr. Mayerne, was made master of the secret,
+which he carried to France and communicated to the Duke of Mayenne,
+who performed many cures by means of it, and taught it to his
+surgeon, who, after the Duke's death, sold it to many distinguished
+persons, by whose agency it soon ceased to be a secret.  What was
+this wonderful substance which so astonished kings, princes, dukes,
+knights, and doctors?  Nothing but powdered blue vitriol.  But it was
+made to undergo several processes that conferred on it extraordinary
+virtues.  Twice or thrice it was to be dissolved, filtered, and
+crystallized.  The crystals were to be laid in the sun during the
+months of June, July, and August, taking care to turn them carefully
+that all should be exposed.  Then they were to be powdered,
+triturated, and again exposed to the sun, again reduced to a very
+fine powder, and secured in a vessel, while hot, from the sunshine.
+If there seem anything remarkable in the fact of such astonishing
+properties being developed by this process, it must be from our
+short-sightedness, for common salt and charcoal develop powers quite
+as marvellous after a certain number of thumps, stirs, and shakes,
+from the hands of modern workers of miracles.  In fact the Unguentum
+Armarium and Sympathetic Powder resemble some more recent
+prescriptions; the latter consisting in an infinite dilution of the
+common dose in which remedies are given, and the two former in an
+infinite dilution of the common distance at which they are applied.
+
+Whether philosophers, and more especially metaphysicians, have any
+peculiar tendency to dabble in drugs and dose themselves with physic,
+is a question which might suggest itself to the reader of their
+biographies.
+
+When Bishop Berkeley visited the illustrious Malebranche at Paris, he
+found him in his cell, cooking in a small pipkin a medicine for an
+inflammation of the lungs, from which he was suffering; and the
+disease, being unfortunately aggravated by the vehemence of their
+discussion, or the contents of the pipkin, carried him off in the
+course of a few days.  Berkeley himself afforded a remarkable
+illustration of a truth which has long been known to the members of
+one of the learned professions, namely, that no amount of talent, or
+of acquirements in other departments, can rescue from lamentable
+folly those who, without something of the requisite preparation,
+undertake to experiment with nostrums upon themselves and their
+neighbors.  The exalted character of Berkeley is thus drawn by Sir
+James Mackintosh: Ancient learning, exact science, polished society,
+modern literature, and the fine arts, contributed to adorn and enrich
+the mind of this accomplished man.  All his contemporaries agreed
+with the satirist in ascribing
+
+     "'To Berkeley every virtue under heaven.'
+
+"Even the discerning, fastidious, and turbulent Atterbury said, after
+an interview with him, 'So much understanding, so much knowledge, so
+much innocence, and such humility, I did not think had been the
+portion of any but angels, till I saw this gentleman.'"
+
+But among the writings of this great and good man is an Essay of the
+most curious character, illustrating his weakness upon the point in
+question, and entitled, "Siris, a Chain of Philosophical Reflections
+and Inquiries concerning the Virtues of TAR WATER, and divers other
+Subjects,"--an essay which begins with a recipe for his favorite
+fluid, and slides by gentle gradations into an examination of the
+sublimest doctrines of Plato.  To show how far a man of honesty and
+benevolence, and with a mind of singular acuteness and depth, may be
+run away with by a favorite notion on a subject which his habits and
+education do not fit him to investigate, I shall give a short account
+of this Essay, merely stating that as all the supposed virtues of Tar
+Water, made public in successive editions of his treatise by so
+illustrious an author, have not saved it from neglect and disgrace,
+it may be fairly assumed that they were mainly imaginary.
+
+The bishop, as is usual in such cases, speaks of himself as
+indispensably obliged, by the duty he owes to mankind, to make his
+experience public.  Now this was by no means evident, nor does it
+follow in general, that because a man has formed a favorable opinion
+of a person or a thing he has not the proper means of thoroughly
+understanding, he shall be bound to print it, and thus give currency
+to his impressions, which may be erroneous, and therefore injurious.
+He would have done much better to have laid his impressions before
+some experienced physicians and surgeons, such as Dr. Mead and Mr.
+Cheselden, to have asked them to try his experiment over again, and
+have been guided by their answers.  But the good bishop got excited;
+he pleased himself with the thought that he had discovered a great
+panacea; and having once tasted the bewitching cup of self-quackery,
+like many before and since his time, he was so infatuated with the
+draught that he would insist on pouring it down the throats of his
+neighbors and all mankind.
+
+The precious fluid was made by stirring a gallon of water with a
+quart of tar, leaving it forty-eight hours, and pouring off the clear
+water.  Such was the specific which the great metaphysician
+recommended for averting and curing all manner of diseases.  It was,
+if he might be believed, a preventive of the small-pox, and of great
+use in the course of the disease.  It was a cure for impurities of
+the blood, coughs, pleurisy, peripneumony, erysipelas, asthma,
+indigestion, carchexia, hysterics, dropsy, mortification, scurvy, and
+hypochondria.  It was of great use in gout and fevers, and was an
+excellent preservative of the teeth and gums; answered all the
+purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and
+mineral waters; was particularly to be recommended to sea-faring
+persons, ladies, and men of studious and sedentary lives; could never
+be taken too long, but, on the contrary, produced advantages which
+sometimes did not begin to show themselves for two or three months.
+
+"From my representing Tar Water as good for so many things," says
+Berkeley, "some perhaps may conclude it is good for nothing.  But
+charity obligeth me to say what I know, and what I think, however it
+may be taken.  Men may censure and object as they please, but I
+appeal to time and experiment.  Effects misimputed, cases wrong told,
+circumstances overlooked, perhaps, too, prejudices and partialities
+against truth, may for a time prevail and keep her at the bottom of
+her well, from whence nevertheless she emergeth sooner or later, and
+strikes the eyes of all who do not keep them shut."  I cannot resist
+the temptation of illustrating the bishop's belief in the wonderful
+powers of his remedy, by a few sentences from different parts of his
+essay.  "The hardness of stubbed vulgar constitutions renders them
+insensible of a thousand things that fret and gall those delicate
+people, who, as if their skin was peeled off, feel to the quick
+everything that touches them.  The tender nerves and low spirits of
+such poor creatures would be much relieved by the use of Tar Water,
+which might prolong and cheer their lives."  "It [the Tar Water] may
+be made stronger for brute beasts, as horses, in whose disorders I
+have found it very useful."  " This same water will also give
+charitable relief to the ladies, who often want it more than the
+parish poor; being many of them never able to make a good meal, and
+sitting pale, puny, and forbidden, like ghosts, at their own table,
+victims of vapors and indigestion."  It does not appear among the
+virtues of Tar Water that "children cried for it," as for some of our
+modern remedies, but the bishop says, "I have known children take it
+for above six months together with great benefit, and without any
+inconvenience; and after long and repeated experience I do esteem it
+a most excellent diet drink, fitted to all seasons and ages."  After
+mentioning its usefulness in febrile complaints, he says: "I have had
+all this confirmed by my own experience in the late sickly season of
+the year one thousand seven hundred and forty-one, having had twenty-
+five fevers in my own family cured by this medicinal water, drunk
+copiously."  And to finish these extracts with a most important
+suggestion for the improvement of the British nation: "It is much to
+be lamented that our Insulars who act and think so much for
+themselves, should yet, from grossness of air and diet, grow stupid
+or doat sooner than other people, who, by virtue of elastic air,
+water-drinking, and light food, preserve their faculties to extreme
+old age; an advantage which may perhaps be approached, if not
+equaled, even in these regions, by Tar Water, temperance, and early
+hours."
+
+Berkeley died at the age of about seventy; he might have lived
+longer, but his fatal illness was so sudden that there was not time
+enough to stir up a quart of the panacea.  He was an illustrious man,
+but he held two very odd opinions; that tar water was everything, and
+that the whole material universe was nothing.
+
+                    ---------------------------
+
+Most of those present have at some time in their lives heard mention
+made of the METALLIC TRACTORS, invented by one Dr. Perkins, an
+American, and formerly enjoying great repute for the cure of various
+diseases.  Many have seen or heard of a satirical poem, written by
+one of our own countrymen also, about forty years since, and called
+"Terrible Tractoration."  The Metallic Tractors are now so utterly
+abandoned that I have only by good fortune fallen upon a single one
+of a pair, to show for the sake of illustration.  For more than
+thirty years this great discovery, which was to banish at least half
+the evils which afflict humanity, has been sleeping undisturbed in
+the grave of oblivion.  Not a voice has, for this long period, been
+raised in its favor; its noble and learned patrons, its public
+institutions, its eloquent advocates, its brilliant promises are all
+covered with the dust of silent neglect; and of the generation which
+has sprung up since the period when it flourished, very few know
+anything of its history, and hardly even the title which in its palmy
+days it bore of PERKINISM.  Taking it as settled, then, as no one
+appears to answer for it, that Perkinism is entirely dead and gone,
+that both in public and private, officially and individually, its
+former adherents even allow it to be absolutely defunct, I select it
+for anatomical examination.  If this pretended discovery was made
+public; if it was long kept before the public; if it was addressed to
+the people of different countries; if it was formally investigated by
+scientific men, and systematically adopted by benevolent persons, who
+did everything in their power to diffuse the knowledge and practice
+of it; if various collateral motives, such as interest and vanity,
+were embarked in its cause; if, notwithstanding all these things, it
+gradually sickened and died, then the conclusion seems a fair one,
+that it did not deserve to live.  Contrasting its failure with its
+high pretensions, it is fair to call it an imposition; whether an
+expressly fraudulent contrivance or not, some might be ready to
+question.  Everything historically shown to have happened concerning
+the mode of promulgation, the wide diffusion, the apparent success of
+this delusion, the respectability and enthusiasm of its advocates, is
+of great interest in showing to what extent and by what means a
+considerable part of the community may be led into the belief of that
+which is to be eventually considered' as an idle folly.  If there is
+any existing folly, fraudulent or innocent in its origin, which
+appeals to certain arguments for its support; provided that the very
+same arguments can be shown to have been used for Perkinism with as
+good reason, they will at once fall to the ground.  Still more, if it
+shall appear that the general course of any existing delusion bears a
+strong resemblance to that of Perkinism, that the former is most
+frequently advocated by the same class of persons who were
+conspicuous in behalf of the latter, and treated with contempt or
+opposed by the same kind of persons who thus treated Perkinism; if
+the facts in favor of both have a similar aspect; if the motives of
+their originators and propagators may be presumed to have been
+similar; then there is every reason to suppose that the existing
+folly will follow in the footsteps of the past, and after displaying
+a given amount of cunning and credulity in those deceiving and
+deceived, will drop from the public view like a fruit which has
+ripened into spontaneous rottenness, and be succeeded by the fresh
+bloom of some other delusion required by the same excitable portion
+of the community.
+
+Dr. Elisha Perkins was born at Norwich, Connecticut, in the year
+1740.  He had practised his profession with a good local reputation
+for many years, when he fell upon a course of experiments, as it is
+related, which led to his great discovery.  He conceived the idea
+that metallic substances might have the effect of removing diseases,
+if applied in a certain manner; a notion probably suggested by the
+then recent experiments of Galvani, in which muscular contractions
+were found to be produced by the contact of two metals with the
+living fibre.  It was in 1796 that his discovery was promulgated in
+the shape of the Metallic Tractors, two pieces of metal, one
+apparently iron and the other brass, about three inches long, blunt
+at one end and pointed at the other.  These instruments were applied
+for the cure of different complaints, such as rheumatism, local
+pains, inflammations, and even tumors, by drawing them over the
+affected part very lightly for about twenty minutes.  Dr. Perkins
+took out a patent for his discovery, and travelled about the country
+to diffuse the new practice.  He soon found numerous advocates of his
+discovery, many of them of high standing and influence.  In the year
+1798 the tractors had crossed the Atlantic, and were publicly
+employed in the Royal Hospital at Copenhagen.  About the same time
+the son of the inventor, Mr. Benjamin Douglass Perkins, carried them
+to London, where they soon attracted attention.  The Danish
+physicians published an account of their cases, containing numerous
+instances of alleged success, in a respectable octavo volume.  In the
+year 1804 an establishment, honored with the name of the Perkinean
+Institution, was founded in London.  The transactions of this
+institution were published in pamphlets, the Perkinean Society had
+public dinners at the Crown and Anchor, and a poet celebrated their
+medical triumph in strains like these :
+
+    "See, pointed metals, blest with power t' appease
+     The ruthless rage of merciless disease,
+     O'er the frail part a subtle fluid pour,
+     Drenched with invisible Galvanic shower,
+     Till the arthritic staff and crutch forego,
+     And leap exulting like the bounding roe!"
+
+While all these things were going on, Mr. Benjamin Douglass Perkins
+was calmly pocketing money, so that after some half a dozen years he
+left the country with more than ten thousand pounds, which had been
+paid him by the believers in Great Britain.  But in spite of all this
+success, and the number of those interested and committed in its
+behalf, Perkinism soon began to decline, and in 1811 the Tractors are
+spoken of by an intelligent writer as being almost forgotten.  Such
+was the origin and duration of this doctrine and practice, into the
+history of which we will now look a little more narrowly.
+
+Let us see, then, by whose agency this delusion was established and
+kept up; whether it was principally by those who were accustomed to
+medical pursuits, or those whose habits and modes of reasoning were
+different; whether it was with the approbation of those learned
+bodies usually supposed to take an interest in scientific
+discoveries, or only of individuals whose claims to distinction were
+founded upon their position in society, or political station, or
+literary eminence; whether the judicious or excitable classes entered
+most deeply into it; whether, in short, the scientific men of that
+time were deceived, or only intruded upon, and shouted down for the
+moment by persons who had no particular call to invade their
+precincts.
+
+Not much, perhaps, was to be expected of the Medical Profession in
+the way of encouragement.  One Dr. Fuller, who wrote in England,
+himself a Perkinist, thus expressed his opinion: "It must be an
+extraordinary exertion of virtue and humanity for a medical man,
+whose livelihood depends either on the sale of drugs, or on receiving
+a guinea for writing a prescription, which must relate to those
+drugs, to say to his patient, 'You had better purchase a set of
+Tractors to keep in your family; they will cure you without the
+expense of my attendance, or the danger of the common medical
+practice.'  For very obvious reasons medical men must never be
+expected to recommend the use of Perkinism.  The Tractors must trust
+for their patronage to the enlightened and philanthropic out of the
+profession, or to medical men retired from practice, and who know of
+no other interest than the luxury of relieving the distressed.  And I
+do not despair of seeing the day when but very few of this
+description as well as private families will be without them."
+
+Whether the motives assigned by this medical man to his professional
+brethren existed or not, it is true that Dr. Perkins did not gain a
+great deal at their hands.  The Connecticut Medical Society expelled
+him in 1797 for violating their law against the use of nostrums, or
+secret remedies.  The leading English physicians appear to have
+looked on with singular apathy or contempt at the miracles which it
+was pretended were enacting in the hands of the apostles of the new
+practice.  In looking over the reviews of the time, I have found
+little beyond brief occasional notices of their pretensions; the
+columns of these journals being occupied with subjects of more
+permanent interest.  The state of things in London is best learned,
+however, from the satirical poem to which I have already alluded as
+having been written at the period referred to.  This was entitled,
+"Terrible Tractoration!!  A Poetical Petition against Galvanizing
+Trumpery and the Perkinistic Institution.  Most respectfully
+addressed to the Royal College of Physicians, by Christopher Caustic,
+M. D., LL. D., A. S. S., Fellow of the Royal College of Physicians,
+Aberdeen, and Honorary Member of no less than nineteen very learned
+Societies."  Two editions of this work were published in London in
+the years 1803 and 1804, and one or two have been published in this
+country.
+
+"Terrible Tractoration" is supposed, by those who never read it, to
+be a satire upon the follies of Perkins and his followers.  It is, on
+the contrary, a most zealous defence of Perkinism, and a fierce
+attack upon its opponents, most especially upon such of the medical
+profession as treated the subject with neglect or ridicule.  The
+Royal College of Physicians was the more peculiar object of the
+attack, but with this body, the editors of some of the leading
+periodicals, and several physicians distinguished at that time, and
+even now remembered for their services to science and humanity, were
+involved in unsparing denunciations.  The work is by no means of the
+simply humorous character it might be supposed, but is overloaded
+with notes of the most seriously polemical nature.  Much of the
+history of the subject, indeed, is to be looked for in this volume.
+
+It appears from this work that the principal members of the medical
+profession, so far from hailing Mr. Benjamin Douglass Perkins as
+another Harvey or Jenner, looked very coldly upon him and his
+Tractors; and it is now evident that, though they were much abused
+for so doing, they knew very well what they had to deal with, and
+were altogether in the right.  The delusion at last attracted such an
+amount of attention as to induce Dr. Haygarth and some others of
+respectable standing to institute some experiments which I shall
+mention in their proper place, the result of which might have seemed
+sufficient to show the emptiness of the whole contrivance.
+
+The Royal Society, that learned body which for ages has constituted
+the best tribunal to which Britain can appeal in questions of
+science, accepted Mr. Perkins's Tractors and the book written about
+them, passed the customary vote of thanks, and never thought of
+troubling itself further in the investigation of pretensions of such
+an aspect.  It is not to be denied that a considerable number of
+physicians did avow themselves advocates of the new practice; but out
+of the whole catalogue of those who were publicly proclaimed as such,
+no one has ever been known, so far as I am aware, to the scientific
+world, except in connection with the short-lived notoriety of
+Perkinism.  Who were the people, then, to whose activity, influence,
+or standing with the community was owing all the temporary excitement
+produced by the Metallic Tractors?
+
+First, those persons who had been induced to purchase a pair of
+Tractors.  These little bits of brass and iron, the intrinsic value
+of which might, perhaps, amount to ninepence, were sold at five
+guineas a pair!  A man who has paid twenty-five dollars for his
+whistle is apt to blow it louder and longer than other people.  So it
+appeared that when the "Perkinean Society" applied to the possessors
+of Tractors in the metropolis to concur in the establishment of a
+public institution for the use of these instruments upon the poor,
+"it was found that only five out of above a hundred objected to
+subscribe, on account of their want of confidence in the efficacy of
+the practice; and these," the committee observes, "there is reason to
+believe, never gave them a fair trial, probably never used them in
+more than one case, and that perhaps a case in which the Tractors had
+never been recommended as serviceable."  "Purchasers of the
+Tractors," said one of their ardent advocates, "would be among the
+last to approve of them if they had reason to suppose themselves
+defrauded of five guineas."  He forgot poor Moses, with his "gross of
+green spectacles, with silver rims and shagreen cases."  "Dear
+mother," cried the boy, "why won't you listen to reason?  I had them
+a dead bargain, or I should not have bought them.  The silver rims
+alone will sell for double the money."
+
+But it is an undeniable fact, that many persons of considerable
+standing, and in some instances holding the most elevated positions
+in society, openly patronized the new practice.  In a translation of
+a work entitled "Experiments with the Metallic Tractors," originally
+published in Danish, thence rendered successively into German and
+English, Mr. Benjamin Perkins, who edited the English edition, has
+given a copious enumeration of the distinguished individuals, both in
+America and Europe, whose patronage he enjoyed.  He goes so far as to
+signify that ROYALTY itself was to be included among the number.
+When the Perkinean Institution was founded, no less a person than
+Lord Rivers was elected President, and eleven other individuals of
+distinction, among them Governor Franklin, son of Dr. Franklin,
+figured as Vice-Presidents.  Lord Henniker, a member of the Royal
+Society, who is spoken of as a man of judgment and talents,
+condescended to patronize the astonishing discovery, and at different
+times bought three pairs of Tractors.  When the Tractors were
+introduced into Europe, a large number of testimonials accompanied
+them from various distinguished characters in America, the list of
+whom is given in the translation of the Danish work referred to as
+follows:
+
+"Those who have individually stated cases, or who have presented
+their names to the public as men who approved of this remedy, and
+acknowledged themselves instrumental in circulating the Tractors, are
+fifty-six in number; thirty-four of whom are physicians and surgeons,
+and many of them of the first eminence, thirteen clergymen, most of
+whom are doctors of divinity, and connected with the literary
+institutions of America; among the remainder are two members of
+Congress, one professor of natural philosophy in a college, etc.,
+etc."  It seemed to be taken rather hardly by Mr. Perkins that the
+translators of the work which he edited, in citing the names of the
+advocates of the Metallic Practice, frequently omitted the honorary
+titles which should have been annexed.  The testimonials were
+obtained by the Danish writer, from a pamphlet published in America,
+in which these titles were given in full.  Thus one of these
+testimonials is from " John Tyler, Esq., a magistrate in the county
+of New London, and late Brigadier-General of the militia in that
+State."  The "omission of the General's title" is the subject of
+complaint, as if this title were sufficient evidence of the
+commanding powers of one of the patrons of tractoration.  A similar
+complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney
+at Law, and a member of the Legislature of the State of Connecticut,"
+is mentioned without his titular honors, and even on account of the
+omission of the proper official titles belonging to "Nathan Pierce,
+Esq., Governor and Manager of the Almshouse of Newburyport."  These
+instances show the great importance to be attached to civil and
+military dignities, in qualifying their holders to judge of
+scientific subjects, a truth which has not been overlooked by the
+legitimate successors of the Perkinists.  In Great Britain, the
+Tractors were not less honored than in America, by the learned and
+the illustrious.  The "Perkinistic Committee" made this statement in
+their report: "Mr. Perkins has annually laid before the public a
+large collection of new cases communicated to him for that purpose by
+disinterested and intelligent characters, from almost every quarter
+of Great Britain.  In regard to the competency of these vouchers, it
+will be sufficient simply to state that, amongst others whose names
+have been attached to their communications, are eight professors, in
+four different universities, twenty-one regular Physicians, nineteen
+Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity,
+and numerous other characters of equal respectability."
+
+It cannot but excite our notice and surprise that the number of
+clergymen both in America and Great Britain who thrust forward their
+evidence on this medical topic was singularly large in proportion to
+that of the members of the medical profession.  Whole pages are
+contributed by such worthies as the Rev. Dr. Trotter of Hans Place,
+the Rear.  Waring Willett, Chaplain to the Earl of Dunmore, the Rev.
+Dr. Clarke, Chaplain to the Prince of Wales.  The style of these
+theologico-medical communications may be seen in the following from a
+divine who was also professor in one of the colleges of New England.
+"I have used the Tractors with success in several other cases in my
+own family, and although, like Naaman the Syrian, I cannot tell why
+the waters of Jordan should be better than Abana and Pharpar, rivers
+of Damascus; yet since experience has proved them so, no reasoning
+can change the opinion.  Indeed, the causes of all common facts are,
+we think, perfectly well known to us; and it is very probable, fifty
+or a hundred years hence, we shall as well know why the Metallic
+Tractors should in a few minutes remove violent pains, as we now know
+why cantharides and opium will produce opposite effects, namely, we
+shall know very little about either excepting facts."  Fifty or a
+hundred years hence! if he could have looked forward forty years, he
+would have seen the descendants of the "Perkinistic" philosophers
+swallowing infinitesimal globules, and knowing and caring as much
+about the Tractors as the people at Saratoga Springs do about the
+waters of Abana and Pharpar.
+
+I trust it will not be thought in any degree disrespectful to a
+profession which we all honor, that I have mentioned the great zeal
+of many clergymen in the cause of Perkinism.  I hope, too, that I may
+without offence suggest the causes which have often led them out of
+their own province into one to which their education has no special
+reference.  The members of that profession ought to be, and commonly
+are, persons of benevolent character.  Their duties carry them into
+the midst of families, and particularly at times when the members of
+them are suffering from bodily illness.  It is natural enough that a
+strong desire should be excited to alleviate sufferings which may
+have defied the efforts of professional skill; as natural that any
+remedy which recommends itself to the belief or the fancy of the
+spiritual physician should be applied with the hope of benefit; and
+perfectly certain that the weakness of human nature, from which no
+profession is exempt, will lead him to take the most flattering view
+of its effects upon the patient; his own sagacity and judgment being
+staked upon the success of the trial.  The inventor of the Tractors
+was aware of these truths.  He therefore sent the Tractors
+gratuitously to many clergymen, accompanied with a formal certificate
+that the holder had become entitled to their possession by the
+payment of five guineas.  This was practised in our own neighborhood,
+and I remember finding one of these certificates, so presented, which
+proved that amongst the risks of infancy I had to encounter Perkins's
+Tractors.  Two clergymen of Boston and the vicinity, both well known
+to local fame, gave in their testimony to the value of the
+instruments thus presented to them; an unusually moderate proportion,
+when it is remembered that to the common motives of which I have
+spoken was added the seduction of a gift for which the profane public
+was expected to pay so largely.
+
+It was remarkable, also, that Perkinism, which had so little success
+with the medical and scientific part of the community, found great
+favor in the eyes of its more lovely and less obstinate portion.
+"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,--
+"having been lately in America, had seen and heard much of the great
+effects of Perkinism.  Influenced by a most benevolent disposition,
+she brought these Tractors and the pamphlet with her to Europe, with
+a laudable desire of extending their utility to her suffering
+countrymen."  Such was the channel by which the Tractors were
+conveyed to Denmark, where they soon became the ruling passion.
+The workmen, says a French writer, could not manufacture them fast
+enough.  Women carried them about their persons, and delighted in
+bringing them into general use.  To what extent the Tractors were
+favored with the patronage of English and American ladies, it is of
+course not easy to say, except on general principles, as their names
+were not brought before the public.  But one of Dr. Haygarth's
+stories may lead us to conjecture that there was a class of female
+practitioners who went about doing good with the Tractors in England
+as well as in Denmark.  A certain lady had the misfortune to have a
+spot as big as a silver penny at the corner of her eye, caused by a
+bruise, or some such injury.  Another lady, who was a friend of hers,
+and a strong believer in Perkinism, was very anxious to try the
+effects of tractoration upon this unfortunate blemish.  The patient
+consented; the lady "produced the instruments, and, after drawing
+them four or five times over the spot, declared that it changed to a
+paler color, and on repeating the use of them a few minutes longer,
+that it had almost vanished, and was scarcely visible, and departed
+in high triumph at her success."  The lady who underwent the
+operation assured the narrator "that she looked in the glass
+immediately after, and that not the least visible alteration had
+taken place."
+
+It would be a very interesting question, what was the intellectual
+character of those persons most conspicuous in behalf of the
+Perkinistic delusion?  Such an inquiry might bring to light some
+principles which we could hereafter apply to the study of other
+popular errors.  But the obscurity into which nearly all these
+enthusiasts have subsided renders the question easier to ask than to
+answer.  I believe it would have been found that most of these
+persons were of ardent temperament and of considerable imagination,
+and that their history would show that Perkinism was not the first
+nor the last hobby-horse they rode furiously.  Many of them may very
+probably have been persons of more than common talent, of active and
+ingenious minds, of versatile powers and various acquirements.  Such,
+for instance, was the estimable man to whom I have repeatedly
+referred as a warm defender of tractoration, and a bitter assailant
+of its enemies.  The story tells itself in the biographical preface
+to his poem.  He went to London with the view of introducing a
+hydraulic machine, which he and his Vermont friends regarded as a
+very important invention.  He found, however, that the machine was
+already in common use in that metropolis.  A brother Yankee, then in
+London, had started the project of a mill, which was to be carried by
+the water of the Thames.  He was sanguine enough to purchase one
+fifth of this concern, which also proved a failure.  At about the
+same period he wrote the work which proved the great excitement of
+his mind upon the subject of the transient folly then before the
+public.  Originally a lawyer, he was in succession a mechanician, a
+poet, and an editor, meeting with far less success in each of these
+departments than usually attends men of less varied gifts, but of
+more tranquil and phlegmatic composition.  But who is ignorant that
+there is a class of minds characterized by qualities like those I
+have mentioned; minds with many bright and even beautiful traits; but
+aimless and fickle as the butterfly; that settle upon every gayly-
+colored illusion as it opens into flower, and flutter away to another
+when the first has dropped its leaves, and stands naked in the icy
+air of truth!
+
+Let us now look at the general tenor of the arguments addressed by
+believers to sceptics and opponents.  Foremost of all, emblazoned at
+the head of every column, loudest shouted by every triumphant
+disputant, held up as paramount to all other considerations,
+stretched like an impenetrable shield to protect the weakest advocate
+of the great cause against the weapons of the adversary, was that
+omnipotent monosyllable which has been the patrimony of cheats and
+the currency of dupes from time immemorial,--Facts! Facts ! Facts!
+First came the published cases of the American clergymen, brigadier-
+generals, almshouse governors, representatives, attorneys, and
+esquires.  Then came the published cases of the surgeons of
+Copenhagen.  Then followed reports of about one hundred and fifty
+cases published in England, "demonstrating the efficacy of the
+metallic practice in a variety of complaints both upon the human body
+and on horses, etc."  But the progress of facts in Great Britain did
+not stop here.  Let those who rely upon the numbers of their
+testimonials, as being alone sufficient to prove the soundness and
+stability of a medical novelty, digest the following from the report
+of the Perkinistic Committee.  "The cases published [in Great
+Britain] amounted, in March last, the date of Mr. Perkins's last
+publication, to about five thousand.  Supposing that not more than
+one cure in three hundred which the Tractors have performed has been
+published, and the proportion is probably much greater, it will be
+seen that the number, to March last, will have exceeded one million
+five hundred thousand!"
+
+Next in order after the appeal to what were called facts, came a
+series of arguments, which have been so long bruised and battered
+round in the cause of every doctrine or pretension, new, monstrous,
+or deliriously impossible, that each of them is as odiously familiar
+to the scientific scholar as the faces of so many old acquaintances,
+among the less reputable classes, to the officers of police.
+
+No doubt many of my hearers will recognize, in the following
+passages, arguments they may have heard brought forward with
+triumphant confidence in behalf of some doctrine not yet extinct.  No
+doubt some may have honestly thought they proved something; may have
+used them with the purpose of convincing their friends, or of
+silencing the opponents of their favorite doctrine, whatever that
+might be.  But any train of arguments which was contrived for
+Perkinism, which was just as applicable to it as to any other new
+doctrine in the same branch of science, and which was fully employed
+against its adversaries forty years since, might, in common charity,
+be suffered to slumber in the grave of Perkinism.  Whether or not the
+following sentences, taken literally from the work of Mr. Perkins,
+were the originals of some of the idle propositions we hear bandied
+about from time to time, let those who listen judge.
+
+The following is the test assumed for the new practice : "If diseases
+are really removed, as those persons who have practised extensively
+with the Tractors declare, it should seem there would be but little
+doubt of their being generally adopted; but if the numerous reports
+of their efficacy which have been published are forgeries, or are
+unfounded, the practice ought to be crushed."  To this I merely add,
+it has been crushed.
+
+The following sentence applies to that a priori judging and uncandid
+class of individuals who buy their dinners without tasting all the
+food there is in the market.  "On all discoveries there are persons
+who, without descending to any inquiry into the truth, pretend to
+know, as it were by intuition, that newly asserted facts are founded
+in the grossest errors.  These were those who knew that Harvey's
+report of the circulation of the blood was a preposterous and
+ridiculous suggestion, and in latter later days there were others who
+knew that Franklin deserved reproach for declaring that points were
+preferable to balls for protecting buildings from lightning."
+
+Again: "This unwarrantable mode of offering assertion for proof, so
+unauthorized and even unprecedented except in the condemnation of a
+Galileo, the persecution of a Copernicus, and a few other acts of
+inquisitorial authority, in the times of ignorance and superstition,
+affords but a lamentable instance of one of his remarks, that this is
+far from being the Age of Reason."
+
+"The most valuable medicines in the Materia Medica act on principles
+of which we are totally ignorant.  None have ever yet been able to
+explain how opium produces sleep, or how bark cures intermittent
+fevers; and yet few, it is hoped, will be so absurd as to desist from
+the use of these important articles because they know nothing of the
+principle of their operations."  Or if the argument is preferred, in
+the eloquent language of the Perkinistic poet:
+
+    "What though the CAUSES may not be explained,
+     Since these EFFECTS are duly ascertained,
+     Let not self-interest, prejudice, or pride,
+     Induce mankind to set the means aside;
+     Means which, though simple, are by
+     Heaven designed to alleviate the woes of human kind."
+
+This course of argument is so often employed, that it deserves to be
+expanded a little, so that its length and breadth may be fairly seen.
+A series of what are called facts is brought forward to prove some
+very improbable doctrine.  It is objected by judicious people, or
+such as have devoted themselves to analogous subjects, that these
+assumed facts are in direct opposition to all that is known of the
+course of nature, that the universal experience of the past affords a
+powerful presumption against their truth, and that in proportion to
+the gravity of these objections, should be the number and competence
+of the witnesses.  The answer is a ready one.  What do we know of the
+mysteries of Nature?  Do we understand the intricate machinery of the
+Universe?  When to this is added the never-failing quotation,
+
+    "There are more things in heaven and earth, Horatio,
+     Than are dreamt of in your philosophy,"--
+
+the question is thought to be finally disposed of.
+
+Take the case of astrology as an example.  It is in itself strange
+and incredible that the relations of the heavenly bodies to each
+other at a given moment of time, perhaps half a century ago, should
+have anything to do with my success or misfortune in any undertaking
+of to-day.  But what right have I to say it cannot be so?  Can I bind
+the sweet influences of Pleiades, or loose the bands of Orion?  I do
+not know by what mighty magic the planets roll in their fluid paths,
+confined to circles as unchanging as if they were rings of steel, nor
+why the great wave of ocean follows in a sleepless round upon the
+skirts of moonlight; nor cam I say from any certain knowledge that
+the phases of the heavenly bodies, or even the falling of the leaves
+of the forest, or the manner in which the sands lie upon the sea-
+shore, may not be knit up by invisible threads with the web of human
+destiny.  There is a class of minds much more ready to believe that
+which is at first sight incredible, and because it is incredible,
+than what is generally thought reasonable.  Credo quia impossibile
+est,--"I believe, because it is impossible,"--is an old paradoxical
+expression which might be literally applied to this tribe of persons.
+And they always succeed in finding something marvellous, to call out
+the exercise of their robust faith.  The old Cabalistic teachers
+maintained that there was not a verse, line, word, or even letter in
+the Bible which had not a special efficacy either to defend the
+person who rightly employed it, or to injure his enemies; always
+provided the original Hebrew was made use of.  In the hands of modern
+Cabalists every substance, no matter how inert, acquires wonderful
+medicinal virtues, provided it be used in a proper state of purity
+and subdivision.
+
+I have already mentioned the motives attributed by the Perkinists to
+the Medical Profession, as preventing its members from receiving the
+new but unwelcome truths.  This accusation is repeated in different
+forms and places, as, for instance, in the following passage:
+"Will the medical man who has spent much money and labor in the
+pursuit of the arcana of Physic, and on the exercise of which depends
+his support in life, proclaim the inefficacy of his art, and
+recommend a remedy to his patient which the most unlettered in
+society can employ as advantageously as himself? and a remedy, too,
+which, unlike the drops, the pills, the powders, etc., of the Materia
+Medica, is inconsumable, and ever in readiness to be employed in
+successive diseases?"
+
+As usual with these people, much indignation was expressed at any
+parallel between their particular doctrine and practice and those of
+their exploded predecessors.  "The motives," says the disinterested
+Mr. Perkins, "which must have impelled to this attempt at classing
+the METALLIC PRACTICE with the most paltry of empyrical projects, are
+but too thinly veiled to escape detection."
+
+To all these arguments was added, as a matter of course, an appeal to
+the feelings of the benevolent in behalf of suffering humanity, in
+the shape of a notice that the poor would be treated gratis.  It is
+pretty well understood that this gratuitous treatment of the poor
+does not necessarily imply an excess of benevolence, any more than
+the gratuitous distribution of a trader's shop-bills is an evidence
+of remarkable generosity; in short, that it is one of those things
+which honest men often do from the best motives, but which rogues and
+impostors never fail to announce as one of their special
+recommendations.  It is astonishing to see how these things brighten
+up at the touch of Mr. Perkins's poet:
+
+    "Ye worthy, honored, philanthropic few,
+     The muse shall weave her brightest wreaths for you,
+     Who in Humanity's bland cause unite,
+     Nor heed the shaft by interest aimed or spite;
+     Like the great Pattern of Benevolence,
+     Hygeia's blessings to the poor dispense;
+     And though opposed by folly's servile brood,
+     ENJOY THE LUXURY OF DOING GOOD."
+
+Having thus sketched the history of Perkinism in its days of
+prosperity; having seen how it sprung into being, and by what means
+it maintained its influence, it only remains to tell the brief story
+of its discomfiture and final downfall.  The vast majority of the
+sensible part of the medical profession were contented, so far as we
+can judge, to let it die out of itself.  It was in vain that the
+advocates of this invaluable discovery exclaimed over their perverse
+and interested obstinacy,--in vain that they called up the injured
+ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving
+generation; the Baillies and the Heberdens,--men whose names have
+come down to us as synonymous with honor and wisdom,--bore their
+reproaches in meek silence, and left them unanswered to their fate.
+There were some others, however, who, believing the public to labor
+under a delusion, thought it worth while to see whether the charm
+would be broken by an open trial of its virtue, as compared with that
+of some less hallowed formula.  It must be remembered that a peculiar
+value was attached to the Metallic Tractors, as made and patented by
+Mr. Perkins.  Dr. Haygarth, of Bath, performed various experiments
+upon patients afflicted with different complaints,--the patients
+supposing that the real five-guinea Tractors were employed.  Strange
+to relate, he obtained equally wonderful effects with Tractors of
+lead and of wood; with nails, pieces of bone, slate pencil, and
+tobacco-pipe.  Dr. Alderson employed sham Tractors made of wood, and
+produced such effects upon five patients that they returned solemn
+thanks in church for their cures.  A single specimen of these cases
+may stand for all of them.  Ann Hill had suffered for some months
+from pain in the right arm and shoulder.  The Tractors (wooden ones)
+were applied, and in the space of five minutes she expressed herself
+relieved in the following apostrophe: "Bless me! why, who could have
+thought it, that them little things could pull the pain from one.
+Well, to be sure, the longer one lives, the more one sees; ah, dear!"
+
+These experiments did not result in the immediate extinction of
+Perkinism.  Doubtless they were a great comfort to many obstinate
+unbelievers, and helped to settle some sceptical minds; but for the
+real Perkinistic enthusiasts, it may be questioned whether they would
+at that time have changed their opinion though one had risen from the
+dead to assure them that it was an error.  It perished without
+violence, by an easy and natural process.  Like the famous toy of
+Mongolfier, it rose by means of heated air,--the fevered breath of
+enthusiastic ignorance,--and when this grew cool, as it always does
+in a little while, it collapsed and fell.
+
+And now, on reviewing the whole subject, how shall we account for the
+extraordinary prevalence of the belief in Perkinism among a portion
+of what is supposed to be the thinking part of the community?
+
+Could the cures have been real ones, produced by the principle of
+ANIMAL MAGNETISM?  To this it may be answered that the Perkinists
+ridiculed the idea of approximating Mesmer and the founder of their
+own doctrine, that nothing like the somnambulic condition seems to
+have followed the use of the Tractors, and that neither the exertion
+of the will nor the powers of the individual who operated seem to
+have been considered of any consequence.  Besides, the absolute
+neglect into which the Tractors soon declined is good evidence that
+they were incapable of affording any considerable and permanent
+relief in the complaints for the cure of which they were applied.
+
+Of course a large number of apparent cures were due solely to nature;
+which is true under every form of treatment, orthodox or empirical.
+Of course many persons experienced at least temporary relief from the
+strong impression made upon their minds by this novel and marvellous
+method of treatment.
+
+Many, again, influenced by the sanguine hopes of those about them,
+like dying people, who often say sincerely, from day to day, that
+they are getting better, cheated themselves into a false and short-
+lived belief that they were cured; and as happens in such cases, the
+public never knew more than the first half of the story.
+
+When it was said to the Perkinists, that whatever effects they
+produced were merely through the imagination, they declared (like the
+advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM that this
+explanation was sufficiently disproved by the fact of numerous and
+successful cures which had been witnessed in infants and brute
+animals.  Dr. Haygarth replied to this, that "in these cases it is
+not the Patient, but the Observer, who is deceived by his own
+imagination," and that such may be the fact, we have seen in the case
+of the good lady who thought she had conjured away the spot from her
+friend's countenance, when it remained just as before.
+
+As to the motives of the inventor and vender of the Tractors, the
+facts must be allowed to speak for themselves.  But when two little
+bits of brass and iron are patented, as an invention, as the result
+of numerous experiments, when people are led, or even allowed, to
+infer that they are a peculiar compound, when they are artfully
+associated with a new and brilliant discovery (which then happened to
+be Galvanism), when they are sold at many hundred times their value,
+and the seller prints his opinion that a Hospital will suffer
+inconvenience, "unless it possesses many sets of the Tractors, and
+these placed in the hands of the patients to practise on each other,"
+one cannot but suspect that they were contrived in the neighborhood
+of a wooden nutmeg factory; that legs of ham in that region are not
+made of the best mahogany; and that such as buy their cucumber seed
+in that vicinity have to wait for the fruit as long as the Indians
+for their crop of gunpowder.
+
+
+                    ---------------------------
+
+The succeeding lecture will be devoted to an examination of the
+doctrines of Samuel Hahnemann and his disciples; doctrines which some
+consider new and others old; the common title of which is variously
+known as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy,
+and the claims of which are considered by some as infinitely
+important, and by many as immeasurably ridiculous.
+
+I wish to state, for the sake of any who may be interested in the
+subject, that I shall treat it, not by ridicule, but by argument;
+perhaps with great freedom, but with good temper and in peaceable
+language; with very little hope of reclaiming converts, with no
+desire of making enemies, but with a firm belief that its pretensions
+and assertions cannot stand before a single hour of calm
+investigation.
+
+
+
+
+II.
+
+It may be thought that a direct attack upon the pretensions of
+HOMOEOPATHY is an uncalled-for aggression upon an unoffending
+doctrine and its peaceful advocates.
+
+But a little inquiry will show that it has long assumed so hostile a
+position with respect to the Medical Profession, that any trouble I,
+or any other member of that profession, may choose to bestow upon it
+may be considered merely as a matter of self-defence.  It began with
+an attempt to show the insignificance of all existing medical
+knowledge.  It not only laid claim to wonderful powers of its own,
+but it declared the common practice to be attended with the most
+positively injurious effects, that by it acute diseases are
+aggravated, and chronic diseases rendered incurable.  It has at
+various times brought forward collections of figures having the air
+of statistical documents, pretending to show a great proportional
+mortality among the patients of the Medical Profession, as compared
+with those treated according to its own rules.  Not contented with
+choosing a name of classical origin for itself, it invented one for
+the whole community of innocent physicians, assuring them, to their
+great surprise, that they were all ALLOPATHISTS, whether they knew it
+or not, and including all the illustrious masters of the past, from
+Hippocrates down to Hunter, under the same gratuitous title.  The
+line, then, has been drawn by the champions of the new doctrine; they
+have lifted the lance, they have sounded the charge, and are
+responsible for any little skirmishing which may happen.
+
+But, independently of any such grounds of active resistance, the
+subject involves interests so disproportioned to its intrinsic
+claims, that it is no more than an act of humanity to give it a
+public examination.  If the new doctrine is not truth, it is a
+dangerous, a deadly error.  If it is a mere illusion, and acquires
+the same degree of influence that we have often seen obtained by
+other illusions, there is not one of my audience who may not have
+occasion to deplore the fatal credulity which listened to its
+promises.
+
+I shall therefore undertake a sober examination of its principles,
+its facts, and some points of its history.  The limited time at my
+disposal requires me to condense as much as possible what I have to
+say, but I shall endeavor to be plain and direct in expressing it.
+Not one statement shall be made which cannot be supported by
+unimpeachable reference: not one word shall be uttered which I am not
+as willing to print as to speak.  I have no quibbles to utter, and I
+shall stoop to answer none; but, with full faith in the sufficiency
+of a plain statement of facts and reasons, I submit the subject to
+the discernment of my audience.
+
+
+The question may be asked in the outset,--Have you submitted the
+doctrines you are professing to examine to the test of long-repeated
+and careful experiment; have you tried to see whether they were true
+or not?  To this I answer, that it is abundantly evident, from what
+has often happened, that it would be of no manner of use for me to
+allege the results of any experiments I might have instituted.  Again
+and again have the most explicit statements been made by the most
+competent persons of the utter failure of all their trials, and there
+were the same abundant explanations offered as used to be for the
+Unguentum Armarium arid the Metallic Tractors.  I could by no
+possibility perform any experiments the result of which could not be
+easily explained away so as to be of no conclusive significance.
+Besides, as arguments in favor of Homoeopathy are constantly
+addressed to the public in journals, pamphlets, and even lectures, by
+inexperienced dilettanti, the same channel must be open to all its
+opponents.
+
+It is necessary, for the sake of those to whom the whole subject may
+be new, to give in the smallest possible compass the substance of the
+Homoeopathic Doctrine.  Samuel Hahnemann, its founder, is a German
+physician, now living in Paris," [Hahnemann died in 1843.] at the age
+of eighty-seven years.  In 1796 he published the first paper
+containing his peculiar notions; in 1805 his first work on the
+subject; in 1810 his somewhat famous "Organon of the Healing Art;"
+the next year what he called the "Pure Materia Medica;" and in 1828
+his last work, the "Treatise on Chronic Diseases."  He has therefore
+been writing at intervals on his favorite subject for nearly half a
+century.
+
+The one great doctrine which constitutes the basis of Homoeopathy as
+a system is expressed by the Latin aphorism,
+
+               "SIMILIA SIBIILIBUS CURANTUR,"
+
+or like cures like, that is, diseases are cured by agents capable of
+producing symptoms resembling those found in the disease under
+treatment.  A disease for Hahnemann consists essentially in a group
+of symptoms.  The proper medicine for any disease is the one which is
+capable of producing a similar group of symptoms when given to a
+healthy person.
+
+It is of course necessary to know what are the trains of symptoms
+excited by different substances, when administered to persons in
+health, if any such can be shown to exist.  Hahnemann and his
+disciples give catalogues of the symptoms which they affirm were
+produced upon themselves or others by a large number of drugs which
+they submitted to experiment.
+
+The second great fact which Hahnemann professes to have established
+is the efficacy of medicinal substances reduced to a wonderful degree
+of minuteness or dilution.  The following account of his mode of
+preparing his medicines is from his work on Chronic Diseases, which
+has not, I believe, yet been translated into English.  A grain of the
+substance, if it is solid, a drop if it is liquid, is to be added to
+about a third part of one hundred grains of sugar of milk in an
+unglazed porcelain capsule which has had the polish removed from the
+lower part of its cavity by rubbing it with wet sand; they are to be
+mingled for an instant with a bone or horn spatula, and then rubbed
+together for six minutes; then the mass is to be scraped together
+from the mortar and pestle, which is to take four minutes; then to be
+again rubbed for six minutes.  Four minutes are then to be devoted to
+scraping the powder into a heap, and the second third of the hundred
+grains of sugar of milk to be added.  Then they are to be stirred an
+instant and rubbed six minutes,--again to be scraped together four
+minutes and forcibly rubbed six; once more scraped together for four
+minutes, when the last third of the hundred grains of sugar of milk
+is to be added and mingled by stirring with the spatula; six minutes
+of forcible rubbing, four of scraping together, and six more
+(positively the last six) of rubbing, finish this part of the
+process.
+
+Every grain of this powder contains the hundredth of a grain of the
+medicinal substance mingled with the sugar of milk.  If, therefore, a
+grain of the powder just prepared is mingled with another hundred
+grains of sugar of milk, and the process just described repeated, we
+shall have a powder of which every grain contains the hundredth of
+the hundredth, or the ten thousandth part of a grain of the medicinal
+substance.  Repeat the same process with the same quantity of fresh
+sugar of milk, and every grain of your powder will contain the
+millionth of a grain of the medicinal substance.  When the powder is
+of this strength, it is ready to employ in the further solutions and
+dilutions to be made use of in practice.
+
+A grain of the powder is to be taken, a hundred drops of alcohol are
+to be poured on it, the vial is to be slowly turned for a few
+minutes, until the powder is dissolved, and two shakes are to be
+given to it.  On this point I will quote Hahnemann's own words.
+"A long experience and multiplied observations upon the sick lead me
+within the last few years to prefer giving only two shakes to
+medicinal liquids, whereas I formerly used to give ten."  The process
+of dilution is carried on in the same way as the attenuation of the
+powder was done; each successive dilution with alcohol reducing the
+medicine to a hundredth part of the quantity of that which preceded
+it.  In this way the dilution of the original millionth of a grain of
+medicine contained in the grain of powder operated on is carried
+successively to the billionth, trillionth, quadrillionth,
+quintillionth, and very often much higher fractional divisions.  A
+dose of any of these medicines is a minute fraction of a drop,
+obtained by moistening with them one or more little globules of
+sugar, of which Hahnemann says it takes about two hundred to weigh a
+grain.
+
+As an instance of the strength of the medicines prescribed by
+Hahnemann, I will mention carbonate of lime.  He does not employ
+common chalk, but prefers a little portion of the friable part of an
+oystershell.  Of this substance, carried to the sextillionth degree,
+so much as one or two globules of the size mentioned can convey is a
+common dose.  But for persons of very delicate nerves it is proper
+that the dilution should be carried to the decillionth degree.  That
+is, an important medicinal effect is to be expected from the two
+hundredth or hundredth part of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of a
+grain of oyster-shell.  This is only the tenth degree of potency, but
+some of his disciples profess to have obtained palpable effects from
+much higher dilutions."
+
+The third great doctrine of Hahnemann is the following.  Seven
+eighths at least of all chronic diseases are produced by the
+existence in the system of that infectious disorder known in the
+language of science by the appellation of PSORA, but to the less
+refined portion of the community by the name of ITCH.  In the words
+of Hahnemann's "Organon,"  "This Psora is the sole true and
+fundamental cause that produces all the other countless forms of
+disease, which, under the names of nervous debility, hysteria,
+hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and
+spasms of all kinds, softening of the bones, or rickets, scoliosis
+and cyphosis, caries, cancer, fungua haematodes, gout,--yellow
+jaundice and cyanosis, dropsy,--
+
+["The degrees of DILUTION must not be confounded with those of
+POTENCY.  Their relations may be seen by this table:
+
+lst dilution,--One hundredth of a drop or grain.
+
+2d       "      One ten thousandth.
+
+3d       "      One millionth, marked I.
+
+4th      "      One hundred millionth.
+
+5th      "      One ten thousand millionth.
+
+6th      "      One million millionth, or one billionth, marked II.
+
+7th      "      One hundred billionth.
+
+8th      "      One ten thousand billionth.
+
+9th      "      One million billionth, or one trillionth, marked III.
+
+10th     "      One hundred trillionth.
+
+11th     "      One ten thousand trillionth.
+
+12th     "      One million trillionth, or one quadrillionth, marked
+                IV.,--and so on indefinitely.
+
+
+The large figures denote the degrees of POTENCY.]
+
+
+
+gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the
+lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of
+sense, pains of every kind, etc., appear in our pathology as so many
+peculiar, distinct, and independent diseases."
+
+For the last three centuries, if the same authority may be trusted,
+under the influence of the more refined personal habits which have
+prevailed, and the application of various external remedies which
+repel the affection from the skin; Psora has revealed itself in these
+numerous forms of internal disease, instead of appearing, as in
+former periods, under the aspect of an external malady.
+
+These are the three cardinal doctrines of Hahnemann, as laid down in
+those standard works of Homoeopathy, the "Organon" and the "Treatise
+on Chronic Diseases."
+
+Several other principles may be added, upon all of which he insists
+with great force, and which are very generally received by his
+disciples.
+
+1.  Very little power is allowed to the curative efforts of nature.
+Hahnemann goes so far as to say that no one has ever seen the simple
+efforts of nature effect the durable recovery of a patient from a
+chronic disease.  In general, the Homoeopathist calls every recovery
+which happens under his treatment a cure.
+
+2.  Every medicinal substance must be administered in a state of the
+most perfect purity, and uncombined with any other.  The union of
+several remedies in a single prescription destroys its utility, and,
+according to the "Organon," frequently adds a new disease.
+
+3.  A large number of substances commonly thought to be inert develop
+great medicinal powers when prepared in the manner already described;
+and a great proportion of them are ascertained to have specific
+antidotes in case their excessive effects require to be neutralized.
+
+4.  Diseases should be recognized, as far as possible, not by any of
+the common names imposed upon them, as fever or epilepsy, but as
+individual collections of symptoms, each of which differs from every
+other collection.
+
+5.  The symptoms of any complaint must be described with the most
+minute exactness, and so far as possible in the patient's own words.
+To illustrate the kind of circumstances the patient is expected to
+record, I will mention one or two from the 313th page of the
+"Treatise on Chronic Diseases,"--being the first one at which I
+opened accidentally.
+
+"After dinner, disposition to sleep; the patient winks."
+
+"After dinner, prostration and feeling of weakness (nine days after
+taking the remedy)."
+
+This remedy was that same oyster-shell which is to be prescribed
+"fractions of the sextillionth or decillionth degree.  According to
+Hahnemann, the action of a single dose of the size mentioned does not
+fully display itself in some cases until twenty-four or even thirty
+days after it is taken, and in such instances has not exhausted its
+good effects until towards the fortieth or fiftieth day,--before
+which time it would be absurd and injurious to administer a new
+remedy.
+
+So much for the doctrines of Hahnemann, which have been stated
+without comment, or exaggeration of any of their features, very much
+as any adherent of his opinions might have stated them, if obliged to
+compress them into so narrow a space.
+
+Does Hahnemann himself represent Homoeopathy as it now exists?  He
+certainly ought to be its best representative, after having created
+it, and devoted his life to it for half a century.  He is spoken of
+as the great physician of the time, in most, if not all Homoeopathic
+works.  If he is not authority on the subject of his own doctrines,
+who is?  So far as I am aware, not one tangible discovery in the
+so-called science has ever been ascribed to any other observer; at
+least, no general principle or law, of consequence enough to claim
+any prominence in Homoeopathic works, has ever been pretended to have
+originated with any of his illustrious disciples.  He is one of the
+only two Homoeopathic writers with whom, as I shall mention, the
+Paris publisher will have anything to do upon his own account.  The
+other is Jahr, whose Manual is little more than a catalogue of
+symptoms and remedies.  If any persons choose to reject Hahnemann as
+not in the main representing Homoeopathy, if they strike at his
+authority, if they wink out of sight his deliberate and formally
+announced results, it is an act of suicidal rashness; for upon his
+sagacity and powers of observation, and experience, as embodied in
+his works, and especially in his Materia Medica, repose the
+foundations of Homoeopathy as a practical system.
+
+So far as I can learn from the conflicting statements made upon the
+subject, the following is the present condition of belief.
+
+1.  All of any note agree that the law Similia similibus is the only
+fundamental principle in medicine.  Of course if any man does not
+agree to this the name Homoeopathist can no longer be applied to him
+with propriety.
+
+2.  The belief in and employment of the infinitesimal doses is
+general, and in some places universal, among the advocates of
+Homoeopathy; but a distinct movement has been made in Germany to get
+rid of any restriction to the use of these doses, and to employ
+medicines with the same license as other practitioners.
+
+3.  The doctrine of the origin of most chronic diseases in Psora,
+notwithstanding Hahnemann says it cost him twelve years of study and
+research to establish the fact and its practical consequences, has
+met with great neglect and even opposition from very many of his own
+disciples.
+
+It is true, notwithstanding, that, throughout most of their writings
+which I have seen, there runs a prevailing tone of great deference to
+Hahnemann's opinions, a constant reference to his authority, a
+general agreement with the minor points of his belief, and a pretence
+of harmonious union in a common faith. [Those who will take the
+trouble to look over Hull's Translation of Jahr's Manual may observe
+how little comparative space is given to remedies resting upon any
+other authority than that of Hahnemann.]
+
+Many persons, and most physicians and scientific men, would be
+satisfied with the statement of these doctrines, and examine them no
+further.  They would consider it vastly more probable that any
+observer in so fallacious and difficult a field of inquiry as
+medicine had been led into error, or walked into it of his own
+accord, than that such numerous and extraordinary facts had really
+just come to light.  They would feel a right to exercise the same
+obduracy towards them as the French Institute is in the habit of
+displaying when memoirs or models are offered to it relating to the
+squaring of the circle or perpetual motion; which it is the rule to
+pass over without notice.  They would feel as astronomers and natural
+philosophers must have felt when, some half a dozen years ago, an
+unknown man came forward, and asked for an opportunity to demonstrate
+to Arago and his colleagues that the moon and planets were at a
+distance of a little more than a hundred miles from the earth.  And
+so they would not even look into Homoeopathy, though all its
+advocates should exclaim in the words of Mr. Benjamin Douglass
+Perkins, vender of the Metallic Tractors, that "On all discoveries
+there are persons who, without descending to any inquiry into the
+truth, pretend to know, as it were by intuition, that newly asserted
+facts are founded in the grossest errors."  And they would lay their
+heads upon their pillows with a perfectly clear conscience, although
+they were assured that they were behaving in the same way that people
+of old did towards Harvey, Galileo, and Copernicus, the identical
+great names which were invoked by Mr. Benjamin Douglass Perkins.
+
+But experience has shown that the character of these assertions is
+not sufficient to deter many, from examining their claims to belief.
+I therefore lean but very slightly on the extravagance and extreme
+apparent singularity of their pretensions.  I might have omitted
+them, but on the whole it seemed more just to the claims of my
+argument to suggest the vast complication of improbabilities involved
+in the statements enumerated.  Every one must of course judge for
+himself as to the weight of these objections, which are by no means
+brought forward as a proof of the extravagance of Homoeopathy, but
+simply as entitled to a brief consideration before the facts of the
+case are submitted to our scrutiny.
+
+The three great asserted discoveries of Hahnemann are entirely
+unconnected with and independent of each other.  Were there any
+natural relation between them it would seem probable enough that the
+discovery of the first would have led to that of the others.  But
+assuming it to be a fact that diseases are cured by remedies capable
+of producing symptoms like their own, no manifest relation exists
+between this fact and the next assertion, namely, the power of the
+infinitesimal doses.  And allowing both these to be true, neither has
+the remotest affinity to the third new doctrine, that which declares
+seven eighths of all chronic diseases to be owing to Psora.
+
+This want of any obvious relation between Hahnemann's three cardinal
+doctrines appears to be self-evident upon inspection.  But if, as is
+often true with his disciples, they prefer the authority of one of
+their own number, I will refer them to Dr. Trinks's paper on the
+present state of Homoeopathy in Europe, with which, of course, they
+are familiar, as his name is mentioned as one of the most prominent
+champions of their faith, in their American official organ.  It would
+be a fact without a parallel in the history, not merely of medicine,
+but of science, that three such unconnected and astonishing
+discoveries, each of them a complete revolution of all that ages of
+the most varied experience had been taught to believe, should spring
+full formed from the brain of a single individual.
+
+Let us look a moment at the first of his doctrines.  Improbable
+though it may seem to some, there is no essential absurdity involved
+in the proposition that diseases yield to remedies capable of
+producing like symptoms.  There are, on the other hand, some
+analogies which lend a degree of plausibility to the statement.
+There are well-ascertained facts, known from the earliest periods of
+medicine, showing that, under certain circumstances, the very
+medicine which, from its known effects, one would expect to aggravate
+the disease, may contribute to its relief.  I may be permitted to
+allude, in the most general way, to the case in which the spontaneous
+efforts of an overtasked stomach are quieted by the agency of a drug
+which that organ refuses to entertain upon any terms.  But that every
+cure ever performed by medicine should have been founded upon this
+principle, although without the knowledge of a physician; that the
+Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature
+in therapeutics," a law of which nothing more than a transient
+glimpse ever presented itself to the innumerable host of medical
+observers, is a dogma of such sweeping extent, and pregnant novelty,
+that it demands a corresponding breadth and depth of unquestionable
+facts to cover its vast pretensions.
+
+So much ridicule has been thrown upon the pretended powers of the
+minute doses that I shall only touch upon this point for the purpose
+of conveying, by illustrations, some shadow of ideas far transcending
+the powers of the imagination to realize.  It must be remembered that
+these comparisons are not matters susceptible of dispute, being
+founded on simple arithmetical computations, level to the capacity of
+any intelligent schoolboy.  A person who once wrote a very small
+pamphlet made some show of objecting to calculations of thus kind, on
+the ground that the highest dilutions could easily be made with a few
+ounces of alcohol.  But he should have remembered that at every
+successive dilution he lays aside or throws away ninety-nine
+hundredths of the fluid on which he is operating, and that, although
+he begins with a drop, he only prepares a millionth, billionth,
+trillionth, and similar fractions of it, all of which, added
+together, would constitute but a vastly minute portion of the drop
+with which he began.  But now let us suppose we take one single drop
+of the Tincture of Camomile, and that the whole of this were to be
+carried through the common series of dilutions.
+
+A calculation nearly like the following was made by Dr. Panvini, and
+may be readily followed in its essential particulars by any one who
+chooses.
+
+For the first dilution it would take 100 drops of alcohol.
+
+For the second dilution it would take 10;000 drops, or about a pint.
+
+For the third dilution it would take 100 pints.
+
+For the fourth dilution it would take 10,000 pints, or more than
+1,000 gallons, and so on to the ninth dilution, which would take ten
+billion gallons, which he computed would fill the basin of Lake
+Agnano, a body of water two miles in circumference.  The twelfth
+dilution would of course fill a million such lakes.  By the time the
+seventeenth degree of dilution should be reached, the alcohol
+required would equal in quantity the waters of ten thousand Adriatic
+seas.  Trifling errors must be expected, but they are as likely to be
+on one side as the other, and any little matter like Lake Superior or
+the Caspian would be but a drop in the bucket.
+
+Swallowers of globules, one of your little pellets, moistened in the
+mingled waves of one million lakes of alcohol, each two miles in
+circumference, with which had been blended that one drop of Tincture
+of Camomile, would be of precisely the strength recommended for that
+medicine in your favorite Jahr's Manual, against the most sudden,
+frightful, and fatal diseases!" [In the French edition of 1834, the
+proper doses of the medicines are mentioned, and Camomile is marked
+IV.  Why are the doses omitted in Hull's Translation, except in three
+instances out of the whole two hundred remedies, notwithstanding the
+promise in the preface that "some remarks upon the doses used may be
+found at the head of each medicine"?  Possibly because it makes no
+difference whether they are employed in one Homoeopathic dose or
+another; but then it is very singular that such precise directions
+were formerly given in the same work, and that Hahnemann's
+"experience" should have led him to draw the nice distinctions we
+have seen in a former part of this Lecture (p. 44).]
+
+And proceeding on the common data, I have just made a calculation
+which shows that this single drop of Tincture of Camomile, given in
+the quantity ordered by Jahr's Manual, would have supplied every
+individual of the whole human family, past and present, with more
+than five billion doses each, the action of each dose lasting about
+four days.
+
+Yet this is given only at the quadrillionth, or fourth degree of
+potency, and various substances are frequently administered at the
+decillionth or tenth degree, and occasionally at still higher
+attenuations with professed medicinal results.  Is there not in this
+as great an exception to all the hitherto received laws of nature as
+in the miracle of the loaves and fishes?  Ask this question of a
+Homoeopathist, and he will answer by referring to the effects
+produced by a very minute portion of vaccine matter, or the
+extraordinary diffusion of odors.  But the vaccine matter is one of
+those substances called morbid poisons, of which it is a peculiar
+character to multiply themselves, when introduced into the system, as
+a seed does in the soil.  Therefore the hundredth part of a grain of
+the vaccine matter, if no more than this is employed, soon increases
+in quantity, until, in the course of about a week, it is a grain or
+more, and can be removed in considerable drops.  And what is a very
+curious illustration of Homoeopathy, it does not produce its most.
+characteristic effects until it is already in sufficient quantity not
+merely to be visible, but to be collected for further use.  The
+thoughtlessness which can allow an inference to be extended from a
+product of disease possessing this susceptibility of multiplication
+when conveyed into the living body, to substances of inorganic
+origin, such as silex or sulphur, would be capable of arguing that a
+pebble may produce a mountain, because an acorn can become a forest.
+
+As to the analogy to be found between the alleged action of the
+infinitely attenuated doses, and the effects of some odorous
+substances which possess the extraordinary power of diffusing their
+imponderable emanations through a very wide space, however it may be
+abused in argument, and rapidly as it evaporates on examination, it
+is not like that just mentioned, wholly without meaning.  The fact of
+the vast diffusion of some odors, as that of musk or the rose, for
+instance, has long been cited as the most remarkable illustration of
+the divisibility of matter, and the nicety of the senses.  And if
+this were compared with the effects of a very minute dose of morphia
+on the whole system, or the sudden and fatal impression of a single
+drop of prussic acid, or, with what comes still nearer, the poisonous
+influence of an atmosphere impregnated with invisible malaria, we
+should find in each of these examples an evidence of the degree to
+which nature, in some few instances, concentrates powerful qualities
+in minute or subtile forms of matter.  But if a man comes to me with
+a pestle and mortar in his hand, and tells me that he will take a
+little speck of some substance which nobody ever thought to have any
+smell at all, as, for instance, a grain of chalk or of charcoal, and
+that he will, after an hour or two of rubbing and scraping, develop
+in a portion of it an odor which, if the whole grain were used, would
+be capable of pervading an apartment, a house, a village, a province,
+an empire, nay, the entire atmosphere of this broad planet upon which
+we tread; and that from each of fifty or sixty substances he can in
+this way develop a distinct and hitherto unknown odor: and if he
+tries to show that all this is rendered quite reasonable by the
+analogy of musk and roses, I shall certainly be justified in
+considering him incapable of reasoning, and beyond the reach of my
+argument.  What if, instead of this, he professes to develop new and
+wonderful medicinal powers from the same speck of chalk or charcoal,
+in such proportions as would impregnate every pond, lake, river, sea,
+and ocean of our globe, and appeals to the same analogy in favor of
+the probability of his assertion.
+
+All this may be true, notwithstanding these considerations.  But so
+extraordinary would be the fact, that a single atom of substances
+which a child might swallow without harm by the teaspoonful could, by
+an easy mechanical process, be made to develop such inconceivable
+powers, that nothing but the strictest agreement of the most cautious
+experimenters, secured by every guaranty that they were honest and
+faithful, appealing to repeated experiments in public, with every
+precaution to guard against error, and with the most plain and
+peremptory results, should induce us to lend any credence to such
+pretensions.
+
+The third doctrine, that Psora, the other name of which you remember,
+is the cause of the great majority of chronic diseases, is a
+startling one, to say the least.  That an affection always recognized
+as a very unpleasant personal companion, but generally regarded as a
+mere temporary incommodity, readily yielding to treatment in those
+unfortunate enough to suffer from it, and hardly known among the
+better classes of society, should be all at once found out by a
+German physician to be the great scourge of mankind, the cause of
+their severest bodily and mental calamities, cancer and consumption,
+idiocy and madness, must excite our unqualified surprise.  And when
+the originator of this singular truth ascribes, as in the page now
+open before me, the declining health of a disgraced courtier, the
+chronic malady of a bereaved mother, even the melancholy of the love-
+sick and slighted maiden, to nothing more nor less than the
+insignificant, unseemly, and almost unmentionable ITCH, does it not
+seem as if the very soil upon which we stand were dissolving into
+chaos, over the earthquake-heaving of discovery?
+
+And when one man claims to have established these three independent
+truths, which are about as remote from each other as the discovery of
+the law of gravitation, the invention of printing, and that of the
+mariner's compass, unless the facts in their favor are overwhelming
+and unanimous, the question naturally arises, Is not this man
+deceiving himself, or trying to deceive others?
+
+I proceed to examine the proofs of the leading ideas of Hahnemann and
+his school.
+
+
+In order to show the axiom, similia similibus curantur (or like is
+cured by like), to be the basis of the healing art,--"the sole law of
+nature in therapeutics,"--it is necessary,
+
+1.  That the symptoms produced by drugs in healthy persons should be
+faithfully studied and recorded.
+
+2.  That drugs should be shown to be always capable of curing those
+diseases most like their own symptoms.
+
+3.  That remedies should be shown not to cure diseases when they do
+not produce symptoms resembling those presented in these diseases.
+
+
+1.  The effects of drugs upon healthy persons have been studied by
+Hahnemann and his associates.  Their results were made known in his
+Materia Medica, a work in three large volumes in the French
+translation, published about eight years ago.  The mode of
+experimentation appears to have been, to take the substance on trial,
+either in common or minute doses, and then to set down every little
+sensation, every little movement of mind or body, which occurred
+within many succeeding hours or days, as being produced solely by the
+substance employed.  When I have enumerated some of the symptoms
+attributed to the power of the drugs taken, you will be able to judge
+how much value is to be ascribed to the assertions of such observers.
+
+The following list was taken literally from the Materia Medica of
+Hahnemann, by my friend M.  Vernois, for whose accuracy I am willing
+to be responsible.  He has given seven pages of these symptoms, not
+selected, but taken at hazard from the French translation of the
+work.  I shall be very brief in my citations.
+
+"After stooping some time, sense of painful weight about the head
+upon resuming the erect posture."
+
+"An itching, tickling sensation at the outer edge of the palm of the
+left hand, which obliges the person to scratch."  The medicine was
+acetate of lime, and as the action of the globule taken is said to
+last twenty-eight days, you may judge how many such symptoms as the
+last might be supposed to happen.
+
+Among the symptoms attributed to muriatic acid are these: a catarrh,
+sighing, pimples; "after having written a long time with the back a
+little bent over, violent pain in the back and shoulder-blades, as if
+from a strain,"--"dreams which are not remembered,--disposition to
+mental dejection,--wakefulness before and after midnight."
+
+I might extend this catalogue almost indefinitely.  I have not cited
+these specimens with any view to exciting a sense of the ridiculous,
+which many others of those mentioned would not fail to do, but to
+show that the common accidents of sensation, the little bodily
+inconveniences to which all of us are subject, are seriously and
+systematically ascribed to whatever medicine may have been exhibited,
+even in the minute doses I have mentioned, whole days or weeks
+previously.
+
+To these are added all the symptoms ever said by anybody, whether
+deserving confidence or not, as I shall hereafter illustrate, to be
+produced by the substance in question.
+
+The effects of sixty-four medicinal substances, ascertained by one or
+both of these methods, are enumerated in the Materia Medica of
+Hahnemann, which may be considered as the basis of practical
+Homoeopathy.  In the Manual of Jahr, which is the common guide, so
+far as I know, of those who practise Homoeopathy in these regions,
+two hundred remedies are enumerated, many of which, however, have
+never been employed in practice.  In at least one edition there were
+no means of distinguishing those which had been tried upon the sick
+from the others.  It is true that marks have been added in the
+edition employed here, which serve to distinguish them; but what are
+we to think of a standard practical author on Materia Medica, who at
+one time omits to designate the proper doses of his remedies, and at
+another to let us have any means of knowing whether a remedy has ever
+been tried or not, while he is recommending its employment in the
+most critical and threatening diseases?
+
+I think that, from what I have shown of the character of Hahnemann's
+experiments, it would be a satisfaction to any candid inquirer to
+know whether other persons, to whose assertions he could look with
+confidence, confirm these pretended facts.  Now there are many
+individuals, long and well known to the scientific world, who have
+tried these experiments upon healthy subjects, and utterly deny that
+their effects have at all corresponded to Hahnemann's assertions.
+
+I will take, for instance, the statements of Andral (and I am not
+referring to his well-known public experiments in his hospital as to
+the result of his own trials.  This distinguished physician is
+Professor of Medicine in the School of Paris, and one of the most
+widely known and valued authors upon practical and theoretical
+subjects the profession can claim in any country.  He is a man of
+great kindness of character, a most liberal eclectic by nature and
+habit, of unquestioned integrity, and is called, in the leading
+article of the first number of the "Homoepathic Examiner,"  "an
+eminent and very enlightened allopathist."  Assisted by a number of
+other persons in good health, he experimented on the effects of
+cinchona, aconite, sulphur, arnica, and the other most highly
+extolled remedies.  His experiments lasted a year, and he stated
+publicly to the Academy of Medicine that they never produced the
+slightest appearance of the symptoms attributed to them.  The results
+of a man like this, so extensively known as one of the most
+philosophical and candid, as well as brilliant of instructors, and
+whose admirable abilities and signal liberality are generally
+conceded, ought to be of great weight in deciding the question.
+
+M. Double, a well-known medical writer and a physician of high
+standing in Paris, had occasion so long ago as 1801, before he had
+heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian
+bark.  He and several others took the drug in every kind of dose for
+four months, and the fever it is pretended by Hahnemann to excite
+never was produced.
+
+M. Bonnet, President of the Royal Society of Medicine of Bordeaux,
+had occasion to observe many soldiers during the Peninsular War, who
+made use of Cinchona as a preservative against different diseases,
+but he never found it to produce the pretended paroxysms.
+
+If any objection were made to evidence of this kind, I would refer to
+the express experiments on many of the Homoeopathic substances, which
+were given to healthy persons with every precaution as to diet and
+regimen, by M. Louis Fleury, without being followed by the slightest
+of the pretended consequences.  And let me mention as a curious fact,
+that the same quantity of arsenic given to one animal in the common
+form of the unprepared powder, and to another after having been
+rubbed up into six hundred globules, offered no particular difference
+of activity in the two cases.
+
+This is a strange contradiction to the doctrine of the development of
+what they call dynamic power, by means of friction and subdivision.
+
+In 1835 a public challenge was offered to the best known Homoeopathic
+physician in Paris to select any ten substances asserted to produce
+the most striking effects; to prepare them himself; to choose one by
+lot without knowing which of them he had taken, and try it upon
+himself or any intelligent and devoted Homoeopatbist, and, waiting
+his own time, to come forward and tell what substance had been
+employed.  The challenge was at first accepted, but the acceptance
+retracted before the time of trial arrived.
+
+>From all this I think it fair to conclude that the catalogues of
+symptoms attributed in Homoeopathic works to the influence of various
+drugs upon healthy persons are not entitled to any confidence.
+
+
+2.  It is necessary to show, in the next place, that medicinal
+substances are always capable of curing diseases most like their own
+symptoms.  For facts relating to this question we must look to two
+sources; the recorded experience of the medical profession in
+general, and the results of trials made according to Homoeopathic
+principles, and capable of testing the truth of the doctrine.
+
+No person, that I am aware of, has ever denied that in some cases
+there exists a resemblance between the effects of a remedy and the
+symptoms of diseases in which it is beneficial.  This has been
+recognized, as Hahnemann himself has shown, from the time of
+Hippocrates.  But according to the records of the medical profession,
+as they have been hitherto interpreted, this is true of only a very
+small proportion of useful remedies.  Nor has it ever been considered
+as an established truth that the efficacy of even these few remedies
+was in any definite ratio to their power of producing symptoms more
+or less like those they cured.
+
+Such was the state of opinion when Hahnemann came forward with the
+proposition that all the cases of successful treatment found in the
+works of all preceding medical writers were to be ascribed solely to
+the operation of the Homoeopathic principle, which had effected the
+cure, although without the physician's knowledge that this was the
+real secret.  And strange as it may seem, he was enabled to give such
+a degree of plausibility to this assertion, that any person not
+acquainted somewhat with medical literature, not quite familiar, I
+should rather say, with the relative value of medical evidence,
+according to the sources whence it is derived, would be almost
+frightened into the belief, at seeing the pages upon pages of Latin
+names he has summoned as his witnesses.
+
+It has hitherto been customary, when examining the writings of
+authors of preceding ages, upon subjects as to which they were less
+enlightened than ourselves, and which they were very liable to
+misrepresent, to exercise some little discretion; to discriminate, in
+some measure, between writers deserving confidence and those not
+entitled to it.  But there is not the least appearance of any such
+delicacy on the part of Hahnemann.  A large majority of the names of
+old authors he cites are wholly unknown to science.  With some of
+them I have been long acquainted, and I know that their accounts of
+diseases are no more to be trusted than their contemporary Ambroise
+Pare's stories of mermen, and similar absurdities.  But if my
+judgment is rejected, as being a prejudiced one, I can refer to
+Cullen, who mentioned three of Hahnemann's authors in one sentence,
+as being "not necessarily bad authorities; but certainly such when
+they delivered very improbable events;" and as this was said more
+than half a century ago, it could not have had any reference to
+Hahnemann.  But although not the slightest sign of discrimination is
+visible in his quotations,--although for him a handful of chaff from
+Schenck is all the same thing as a measure of wheat from Morgagni,--
+there is a formidable display of authorities, and an abundant proof
+of ingenious researches to be found in each of the great works of
+Hahnemann with which I am familiar."[Some painful surmises might
+arise as to the erudition of Hahnemann's English Translator, who
+makes two individuals of "Zacutus, Lucitanus," as well as respecting
+that of the conductors of an American Homoeopathic periodical, who
+suffer the name of the world-renowned Cardanus to be spelt Cardamus
+in at least three places, were not this gross ignorance of course
+attributable only to the printer.]
+
+It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
+proved many of Hahnemann's quotations from old authors to be
+adulterate and false.  What particular instances he has pointed out I
+have no means of learning.  And it is probably wholly impossible on
+this side of the Atlantic, and even in most of the public libraries
+of Europe, to find anything more than a small fraction of the
+innumerable obscure publications which the neglect of grocers and
+trunkmakers has spared to be ransacked by the all-devouring genius of
+Homoeopathy.  I have endeavored to verify such passages as my own
+library afforded me the means of doing.  For some I have looked in
+vain, for want, as I am willing to believe, of more exact references.
+But this I am able to affirm, that, out of the very small number
+which I have been able, to trace back to their original authors, I
+have found two to be wrongly quoted, one of them being a gross
+misrepresentation.
+
+The first is from the ancient Roman author, Caelius Aurelianus; the
+second from the venerable folio of Forestus.  Hahnemann uses the
+following expressions,--if he is not misrepresented in the English
+Translation of the "Organon ": "Asclepiades on one occasion cured an
+inflammation of the brain by administering a small quantity of wine."
+After correcting the erroneous reference of the Translator, I can
+find no such case alluded to in the chapter.  But Caelius Aurelianus
+mentions two modes of treatment employed by Asclepiades, into both of
+which the use of wine entered, as being in the highest degree
+irrational and dangerous." [Caelius Aurel.  De Morb.  Acut.  et
+Chron.  lib.  I.  cap.  xv.  not xvi.  Amsterdam.  Wetstein, 1755.]
+
+In speaking of the oil of anise-seed, Hahnemann says that Forestus
+observed violent colic caused by its administration.  But, as the
+author tells the story, a young man took, by the counsel of a
+surgeon, an acrid and virulent medicine, the name of which is not
+given, which brought on a most cruel fit of the gripes and colic.
+After this another surgeon was called, who gave him oil of anise-seed
+and wine, which increased his suffering." [Observ. et Curat.  Med.
+lib.  XXZ obs.  xiii.  Frankfort, 1614.]  Now if this was the
+Homoeopathic remedy, as Hahnemann pretends, it might be a fair
+question why the young man was not cured by it.  But it is a much
+graver question why a man who has shrewdness and learning enough to
+go so far after his facts, should think it right to treat them with
+such astonishing negligence or such artful unfairness.
+
+Even if every word he had pretended to take from his old authorities
+were to be found in them, even if the authority of every one of these
+authors were beyond question, the looseness with which they are used
+to prove whatever Hahnemann chooses is beyond the bounds of
+credibility.  Let me give one instance to illustrate the character of
+this man's mind.  Hahnemann asserts, in a note annexed to the 110th
+paragraph of the "Organon," that the smell of the rose will cause
+certain persons to faint.  And he says in the text that substances
+which produce peculiar effects of this nature on particular
+constitutions cure the same symptoms in people in general.  Then in
+another note to the same paragraph he quotes the following fact from
+one of the last sources one would have looked to for medical
+information, the Byzantine Historians.
+
+"It was by these means" (i.e. Homoeopathically) that the Princess
+Eudosia with rose-water restored a person who had fainted!"
+
+Is it possible that a man who is guilty of such pedantic folly as
+this,--a man who can see a confirmation of his doctrine in such a
+recovery as this,--a recovery which is happening every day, from a
+breath of air, a drop or two of water, untying a bonnet-string,
+loosening a stay-lace, and which can hardly help happening, whatever
+is done,--is it possible that a man, of whose pages, not here and
+there one, but hundreds upon hundreds are loaded with such
+trivialities, is the Newton, the Columbus, the Harvey of the
+nineteenth century!
+
+The whole process of demonstration he employs is this.  An experiment
+is instituted with some drug upon one or more healthy persons.
+Everything that happens for a number of days or weeks is, as we have
+seen, set down as an effect of the medicine.  Old volumes are then
+ransacked promiscuously, and every morbid sensation or change that
+anybody ever said was produced by the drug in question is added to
+the list of symptoms.  By one or both of these methods, each of the
+sixty-four substances enumerated by Hahnemann is shown to produce a
+very large number of symptoms, the lowest in his scale being ninety-
+seven, and the highest fourteen hundred and ninety-one.  And having
+made out this list respecting any drug, a catalogue which, as you may
+observe in any Homoeopathic manual, contains various symptoms
+belonging to every organ of the body, what can be easier than to find
+alleged cures in every medical author which can at once be attributed
+to the Homoeopathic principle; still more if the grave of
+extinguished credulity is called upon to give up its dead bones as
+living witnesses; and worst of all, if the monuments of the past are
+to be mutilated in favor of "the sole law of Nature in therapeutics"?
+
+There are a few familiar facts of which great use has been made as an
+entering wedge for the Homoeopathic doctrine.  They have been
+suffered to pass current so long that it is time they should be
+nailed to the counter, a little operation which I undertake, with
+perfect cheerfulness, to perform for them.
+
+The first is a supposed illustration of the Homoeopathic law found in
+the precept given for the treatment of parts which have been frozen,
+by friction with snow or similar means.  But we deceive ourselves by
+names, if we suppose the frozen part to be treated by cold, and not
+by heat.  The snow may even be actually warmer than the part to which
+it is applied.  But even if it were at the same temperature when
+applied, it never did and never could do the least good to a frozen
+part, except as a mode of regulating the application of what? of
+heat.  But the heat must be applied gradually, just as food must be
+given a little at a time to those perishing with hunger.  If the
+patient were brought into a warm room, heat would be applied very
+rapidly, were not something interposed to prevent this, and allow its
+gradual admission.  Snow or iced water is exactly what is wanted; it
+is not cold to the part; it is very possibly warm, on the contrary,
+for these terms are relative, and if it does not melt and let the
+heat in, or is not taken away, the part will remain frozen up until
+doomsday.  Now the treatment of a frozen limb by heat, in large or
+small quantities, is not Homoeopathy.
+
+The next supposed illustration of the Homoeopathic law is the alleged
+successful management of burns, by holding them to the fire.  This is
+a popular mode of treating those burns which are of too little
+consequence to require any more efficacious remedy, and would
+inevitably get well of themselves, without any trouble being bestowed
+upon them.  It produces a most acute pain in the part, which is
+followed by some loss of sensibility, as happens with the eye after
+exposure to strong light, and the ear after being subjected to very
+intense sounds.  This is all it is capable of doing, and all further
+notions of its efficacy must be attributed merely to the vulgar love
+of paradox.  If this example affords any comfort to the
+Homoeopathist, it seems as cruel to deprive him of it as it would be
+to convince the mistress of the smoke-jack or the flatiron that the
+fire does not literally "draw the fire out," which is her hypothesis.
+
+But if it were true that frost-bites were cured by cold and burns by
+heat, it would be subversive, so far as it went, of the great
+principle of Homoeopathy.
+
+For you will remember that this principle is that Like cures Like,
+and not that Same cures Same; that there is resemblance and not
+identity between the symptoms of the disease and those produced by
+the drug which cures it, and none have been readier to insist upon
+this distinction than the Homoeopathists themselves.  For if Same
+cures Same, then every poison must be its own antidote,--which is
+neither a part of their theory nor their so-called experience.  They
+have been asked often enough, why it was that arsenic could not cure
+the mischief which arsenic had caused, and why the infectious cause
+of small-pox did not remedy the disease it had produced, and then
+the; were ready enough to see the distinction I have pointed out.  O
+no!  it was not the hair of the same dog, but only of one very much
+like him!
+
+A third instance in proof of the Homoeopathic law is sought for in
+the acknowledged efficacy of vaccination.  And how does the law apply
+to this?  It is granted by the advocates of Homoeopathy that there is
+a resemblance between the effects of the vaccine virus on a person in
+health and the symptoms of small-pox.  Therefore, according to the
+rule, the vaccine virus will cure the small-pox, which, as everybody
+knows, is entirely untrue.  But it prevents small-pox, say the
+Homoeopathists.  Yes, and so does small-pox prevent itself from ever
+happening again, and we know just as much of the principle involved
+in the one case as in the other.  For this is only one of a series of
+facts which we are wholly unable to explain.  Small-pox, measles,
+scarlet-fever, hooping-cough, protect those who have them once from
+future attacks; but nettle-rash and catarrh and lung fever, each of
+which is just as Homoeopathic to itself as any one of the others,
+have no such preservative power.  We are obliged to accept the fact,
+unexplained, and we can do no more for vaccination than for the rest.
+
+
+I come now to the most directly practical point connected with the
+subject, namely,--
+
+What is the state of the evidence as to the efficacy of the proper
+Homoeopathic treatment in the cure of diseases.
+
+As the treatment adopted by the Homoeopathists has been almost
+universally by means of the infinitesimal doses, the question of
+their efficacy is thrown open, in common with that of the truth of
+their fundamental axiom, as both are tested in practice.
+
+We must look for facts as to the actual working of Homoeopathy to
+three sources.
+
+1.  The statements of the unprofessional public.
+
+2.  The assertions of Homoeopathic practitioners.
+
+3.  The results of trials by competent and honest physicians, not
+pledged to the system.
+
+I think, after what we have seen of medical facts, as they are
+represented by incompetent persons, we are disposed to attribute
+little value to all statements of wonderful cures, coming from those
+who have never been accustomed to watch the caprices of disease, and
+have not cooled down their young enthusiasm by the habit of tranquil
+observation.  Those who know nothing of the natural progress of a
+malady, of its ordinary duration, of its various modes of
+terminating, of its liability to accidental complications, of the
+signs which mark its insignificance or severity, of what is to be
+expected of it when left to itself, of how much or how little is to
+be anticipated from remedies, those who know nothing or next to
+nothing of all these things, and who are in a great state of
+excitement from benevolence, sympathy, or zeal for a new medical
+discovery, can hardly be expected to be sound judges of facts which
+have misled so many sagacious men, who have spent their lives in the
+daily study and observation of them.  I believe that, after having
+drawn the portrait of defunct Perkinism, with its five thousand
+printed cures, and its million and a half computed ones, its miracles
+blazoned about through America, Denmark, and England; after relating
+that forty years ago women carried the Tractors about in their
+pockets, and workmen could not make them fast enough for the public
+demand; and then showing you, as a curiosity, a single one of these
+instruments, an odd one of a pair, which I obtained only by a lucky
+accident, so utterly lost is the memory of all their wonderful
+achievements; I believe, after all this, I need not waste time in
+showing that medical accuracy is not to be looked for in the florid
+reports of benevolent associations, the assertions of illustrious
+patrons, the lax effusions of daily journals, or the effervescent
+gossip of the tea-table.
+
+Dr. Hering, whose name is somewhat familiar to the champions of
+Homoeopathy, has said that "the new healing art is not to be judged
+by its success in isolated cases only, but according to its success
+in general, its innate truth, and the incontrovertible nature of its
+innate principles."
+
+We have seen something of "the incontrovertible nature of its innate
+principles," and it seems probable, on the whole, that its success in
+general must be made up of its success in isolated cases.  Some
+attempts have been made, however, to finish the whole matter by
+sweeping statistical documents, which are intended to prove its
+triumphant success over the common practice.
+
+It is well known to those who have had the good fortune to see the
+"Homoeopathic Examiner," that this journal led off, in its first
+number, with a grand display of everything the newly imported
+doctrine had to show for itself.  It is well remarked, on the twenty-
+third page of this article, that "the comparison of bills of
+mortality among an equal number of sick, treated by divers methods,
+is a most poor and lame way to get at conclusions touching principles
+of the healing art."  In confirmation of which, the author proceeds
+upon the twenty-fifth page to prove the superiority of the
+Homoeopathic treatment of cholera, by precisely these very bills of
+mortality.  Now, every intelligent physician is aware that the poison
+of cholera differed so much in its activity at different times and,
+places, that it was next to impossible to form any opinion as to the
+results of treatment, unless every precaution was taken to secure the
+most perfectly corresponding conditions in the patients treated, and
+hardly even then.  Of course, then, a Russian Admiral, by the name of
+Mordvinov, backed by a number of so-called physicians practising in
+Russian villages, is singularly competent to the task of settling the
+whole question of the utility of this or that kind of treatment; to
+prove that, if not more than eight and a half per cent. of those
+attacked with the disease perished, the rest owed their immunity to
+Hahnemann.  I can remember when more than a hundred patients in a
+public institution were attacked with what, I doubt not, many
+Homoeopathic physicians (to say nothing of Homoeopathic admirals)
+would have called cholera, and not one of them died, though treated
+in the common way, and it is my firm belief that, if such a result
+had followed the administration of the omnipotent globules, it would
+have been in the mouth of every adept in Europe, from Quin of London
+to Spohr of Gandersheim.  No longer ago than yesterday, in one of the
+most widely circulated papers of this city, there was published an
+assertion that the mortality in several Homoeopathic Hospitals was
+not quite five in a hundred, whereas, in what are called by the
+writer Allopathic Hospitals, it is said to be eleven in a hundred.
+An honest man should be ashamed of such an argumentum ad ignorantiam.
+The mortality of a hospital depends not merely on the treatment of
+the patients, but on the class of diseases it is in the habit of
+receiving, on the place where it is, on the season, and many other
+circumstances.  For instance, there are many hospitals in the great
+cities of Europe that receive few diseases of a nature to endanger
+life, and, on the other hand, there are others where dangerous
+diseases are accumulated out of the common proportion.  Thus, in the
+wards of Louis, at the Hospital of La Pitie, a vast number of
+patients in the last stages of consumption were constantly entering,
+to swell the mortality of that hospital.  It was because he was known
+to pay particular attention to the diseases of the chest that
+patients laboring under those fatal affections to an incurable extent
+were so constantly coming in upon him.  It is always a miserable
+appeal to the thoughtlessness of the vulgar, to allege the naked fact
+of the less comparative mortality in the practice of one hospital or
+of one physician than another, as an evidence of the superiority of
+their treatment.  Other things being equal, it must always be
+expected that those institutions and individuals enjoying to the
+highest degree the confidence of the community will lose the largest
+proportion of their patients; for the simple reason that they will
+naturally be looked to by those suffering from the gravest class of
+diseases; that many, who know that they are affected with mortal
+disease, will choose to die under their care or shelter, while the
+subjects of trifling maladies, and merely troublesome symptoms, amuse
+themselves to any extent among the fancy practitioners.  When,
+therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner,"
+and quoted in yesterday's "Daily Advertiser," asserts that the
+mortality among his patients is only one per cent. since he has
+practised Homoeopathy, whereas it was six per cent. when he employed
+the common mode of practice, I am convinced by this, his own
+statement, that the citizens of Brunswick, whenever they are
+seriously sick, take good care not to send for Dr. Muhlenbein!
+
+It is evidently impossible that I should attempt, within the compass
+of a single lecture, any detailed examination of the very numerous
+cases reported in the Homoeopathic Treatises and Journals.  Having
+been in the habit of receiving the French "Archives of Homoeopathic
+Medicine" until the premature decease of that Journal, I have had the
+opportunity of becoming acquainted somewhat with the style of these
+documents, and experiencing whatever degree of conviction they were
+calculated to produce.  Although of course I do not wish any value to
+be assumed for my opinion, such as it is, I consider that you are
+entitled to hear it.  So far, then, as I am acquainted with the
+general character of the cases reported by the Homoeopathic
+physicians, they would for the most part be considered as wholly
+undeserving a place in any English, French, or American periodical of
+high standing, if, instead of favoring the doctrine they were
+intended to support, they were brought forward to prove the efficacy
+of any common remedy administered by any common practitioner.  There
+are occasional exceptions to this remark; but the general truth of it
+is rendered probable by the fact that these cases are always, or
+almost always, written with the single object of showing the efficacy
+of the medicine used, or the skill of the practitioner, and it is
+recognized as a general rule that such cases deserve very little
+confidence.  Yet they may sound well enough, one at a time, to those
+who are not fully aware of the fallacies of medical evidence.  Let me
+state a case in illustration.  Nobody doubts that some patients
+recover under every form of practice.  Probably all are willing to
+allow that a large majority, for instance, ninety in a hundred, of
+such cases as a physician is called to in daily practice, would
+recover, sooner or later, with more or less difficulty, provided
+nothing were done to interfere seriously with the efforts of nature.
+
+Suppose, then, a physician who has a hundred patients prescribes to
+each of them pills made of some entirely inert substance, as starch,
+for instance.  Ninety of them get well, or if he chooses to use such
+language, he cures ninety of them.  It is evident, according to the
+doctrine of chances, that there must be a considerable number of
+coincidences between the relief of the patient and the administration
+of the remedy.  It is altogether probable that there will happen two
+or three very striking coincidences out of the whole ninety cases, in
+which it would seem evident that the medicine produced the relief,
+though it had, as we assumed, nothing to do with it.  Now suppose
+that the physician publishes these cases, will they not have a
+plausible appearance of proving that which, as we granted at the
+outset, was entirely false?  Suppose that instead of pills of starch
+he employs microscopic sugarplums, with the five' million billion
+trillionth part of a suspicion of aconite or pulsatilla, and then
+publishes his successful cases, through the leaden lips of the press,
+or the living ones of his female acquaintances,--does that make the
+impression a less erroneous one?  But so it is that in Homoeopathic
+works and journals and gossip one can never, or next to never, find
+anything but successful cases, which might do very well as a proof of
+superior skill, did it not prove as much for the swindling
+advertisers whose certificates disgrace so many of our newspapers.
+How long will it take mankind to learn that while they listen to "the
+speaking hundreds and units, who make the world ring "with the
+pretended triumphs they have witnessed, the "dumb millions" of
+deluded and injured victims are paying the daily forfeit of their
+misplaced confidence!
+
+I am sorry to see, also, that a degree of ignorance as to the natural
+course of diseases is often shown in these published cases, which,
+although it may not be detected by the unprofessional reader, conveys
+an unpleasant impression to those who are acquainted with the
+subject.  Thus a young woman affected with jaundice is mentioned in
+the German "Annals of Clinical Homoeopathy" as having been cured in
+twenty-nine days by pulsatilla and nux vomica.  Rummel, a well-known
+writer of the same school, speaks of curing a case of jaundice in
+thirty-four days by Homoeopathic doses of pulsatilla, aconite, and
+cinchona.  I happened to have a case in my own household, a few weeks
+since, which lasted about ten days, and this was longer than I have
+repeatedly seen it in hospital practice, so that it was nothing to
+boast of.
+
+Dr. Munneche of Lichtenburg in Saxony is called to a patient with
+sprained ankle who had been a fortnight under the common treatment.
+The patient gets well by the use of arnica in a little more than a
+month longer, and this extraordinary fact is published in the French
+"Archives of Homoeopathic Medicine."
+
+In the same Journal is recorded the case of a patient who with
+nothing more, so far as any proof goes, than inluenza, gets down to
+her shop upon the sixth day.
+
+And again, the cool way in which everything favorable in a case is
+set down by these people entirely to their treatment, may be seen in
+a case of croup reported in the "Homoeopathic Gazette " of Leipsic,
+in which leeches, blistering, inhalation of hot vapor, and powerful
+internal medicine had been employed, and yet the merit was all
+attributed to one drop of some Homoeopathic fluid.
+
+I need not multiply these quotations, which illustrate the grounds of
+an opinion which the time does not allow me to justify more at
+length; other such cases are lying open before me; there is no end to
+them if more were wanted; for nothing is necessary but to look into
+any of the numerous broken-down Journals of Homoeopathy, the volumes
+of which may be found on the shelves of those curious in such
+matters.
+
+A number of public trials of Homoeopathy have been made in different
+parts of the world.  Six of these are mentioned in the Manifesto of
+the "Homoeopathic Examiner."  Now to suppose that any trial can
+absolutely silence people, would be to forget the whole experience of
+the past.  Dr. Haygarth and Dr. Alderson could not stop the sale of
+the five-guinea Tractors, although they proved that they could work
+the same miracles with pieces of wood and tobacco-pipe.  It takes
+time for truth to operate as well as Homoeopathic globules.  Many
+persons thought the results of these trials were decisive enough of
+the nullity of the treatment; those who wish to see the kind of
+special pleading and evasion by which it is attempted to cover
+results which, stated by the "Homoeopathic Examiner" itself, look
+exceedingly like a miserable failure, may consult the opening
+flourish of that Journal.  I had not the intention to speak of these
+public trials at all, having abundant other evidence on the point.
+But I think it best, on the whole, to mention two of them in a few
+words,--that instituted at Naples and that of Andral.
+
+There have been few names in the medical profession, for the last
+half century, so widely known throughout the world of science as that
+of M. Esquirol, whose life was devoted to the treatment of insanity,
+and who was without a rival in that department of practical medicine.
+It is from an analysis communicated by him to the "Gazette Medicale
+de Paris" that I derive my acquaintance with the account of the trial
+at Naples by Dr. Panvini, physician to the Hospital della Pace.  This
+account seems to be entirely deserving of credit.  Ten patients were
+set apart, and not allowed to take any medicine at all,--much against
+the wish of the Homoeopathic physician.  All of them got well, and of
+course all of them would have been claimed as triumphs if they had
+been submitted to the treatment.  Six other slight cases (each of
+which is specified) got well under the Homoeopathic treatment, none
+of its asserted specific effects being manifested.
+
+All the rest were cases of grave disease; and so far as the trial,
+which was interrupted about the fortieth day, extended, the patients
+grew worse, or received no benefit.  A case is reported on the page
+before me of a soldier affected with acute inflammation in the chest,
+who took successively aconite, bryonia, nux vomica, and pulsatilla,
+and after thirty-eight days of treatment remained without any
+important change in his disease.  The Homoeopathic physician who
+treated these patients was M. de Horatiis, who had the previous year
+been announcing his wonderful cures.  And M. Esquirol asserted to the
+Academy of Medicine in 1835, that this M. de Horatiis, who is one of
+the prominent personages in the "Examiner's" Manifesto published in
+1840, had subsequently renounced Homoeopathy.  I may remark, by the
+way, that this same periodical, which is so very easy in explaining
+away the results of these trials, makes a mistake of only six years
+or a little more as to the time when this at Naples was instituted.
+
+M. Andral, the "eminent and very enlightened allopathist " of the
+"Homoeopathic Examiner," made the following statement in March, 1835,
+to the Academy of Medicine: "I have submitted this doctrine to
+experiment; I can reckon at this time from one hundred and thirty to
+one hundred and forty cases, recorded with perfect fairness, in a
+great hospital, under the eye of numerous witnesses; to avoid every
+objection--I obtained my remedies of M.  Guibourt, who keeps a
+Homoeopathic pharmacy, and whose strict exactness is well known; the
+regimen has been scrupulously observed, and I obtained from the
+sisters attached to the hospital a special regimen, such as Hahnemann
+orders.  I was told, however, some months since, that I had not been
+faithful to all the rules of the doctrine.  I therefore took the
+trouble to begin again; I have studied the practice of the Parisian
+Homoeopathists, as I had studied their books, and I became convinced
+that they treated their patients as I had treated mine, and I affirm
+that I have been as rigorously exact in the treatment as any other
+person."
+
+And he expressly asserts the entire nullity of the influence of all
+the Homoeopathic remedies tried by him in modifying, so far as he
+could observe, the progress or termination of diseases.  It deserves
+notice that he experimented with the most boasted substances,--
+cinchona, aconite, mercury, bryonia, belladonna.  Aconite, for
+instance, he says he administered in more than forty cases of that
+collection of feverish symptoms in which it exerts so much power,
+according to Hahnemann, and in not one of them did it have the
+slightest influence, the pulse and heat remaining as before.
+
+These statements look pretty honest, and would seem hard to be
+explained away, but it is calmly said that he "did not know enough of
+the method to select the remedies with any tolerable precision."
+["Homoeopathic Examiner, vol.  i.  p.  22.
+"Nothing is left to the caprice of the physician.  (In a word,
+instead of being dependent upon blind chance, that there is an
+infallible law, guided by which; the physician MUST select the proper
+remedies.') "Ibid., in a notice of Menzel's paper.]  Who are they
+that practice Homoeopathy, and say this of a man with the Materia
+Medica of Hahnemann lying before him?  Who are they that send these
+same globules, on which he experimented, accompanied by a little
+book, into families, whose members are thought competent to employ
+them, when they deny any such capacity to a man whose life has been
+passed at the bedside of patients, the most prominent teacher in the
+first Medical Faculty in the world, the consulting physician of the
+King of France, and one of the most renowned practical writers, not
+merely of his nation, but of his age?  I leave the quibbles by which
+such persons would try to creep out from under the crushing weight of
+these conclusions to the unfortunates who suppose that a reply is
+equivalent to an answer.
+
+Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
+invited two Homoeopathic practitioners to experiment in his wards.
+One of these was Curie, now of London, whose works are on the
+counters of some of our bookstores, and probably in the hands of some
+of my audience.  This gentleman, whom Dr. Baillie declares to be an
+enlightened man, and perfectly sincere in his convictions, brought
+his own medicines from the pharmacy which furnished Hahnemann
+himself, and employed them for four or five months upon patients in
+his ward, and with results equally unsatisfactory, as appears from
+Dr. Baillie's statement at a meeting of the Academy of Medicine.  And
+a similar experiment was permitted by the Clinical Professor of the
+Hotel Dieu of Lyons, with the same complete failure.
+
+But these are old and prejudiced practitioners.  Very well, then take
+the statement of Dr. Fleury, a most intelligent young physician, who
+treated homoeopathically more than fifty patients, suffering from
+diseases which it was not dangerous to treat in this way, taking
+every kind of precaution as to regimen, removal of disturbing
+influences, and the state of the atmosphere, insisted upon by the
+most vigorous partisans of the doctrine, and found not the slightest
+effect produced by the medicines.  And more than this, read nine of
+these cases, which he has published, as I have just done, and observe
+the absolute nullity of aconite, belladonna, and bryonia, against the
+symptoms over which they are pretended to exert such palpable, such
+obvious, such astonishing influences.  In the view of these
+statements, it is impossible not to realize the entire futility of
+attempting to silence this asserted science by the flattest and most
+peremptory results of experiment.  Were all the hospital physicians
+of Europe and America to devote themselves, for the requisite period,
+to this sole pursuit, and were their results to be unanimous as to
+the total worthlessness of the whole system in practice, this
+slippery delusion would slide through their fingers without the
+slightest discomposure, when, as they supposed, they had crushed
+every joint in its tortuous and trailing body.
+
+
+3.  I have said, that to show the truth of the Homoeopathic doctrine,
+as announced by Hahnemann, it would be necessary to show, in the
+third place, that remedies never cure diseases when they are not
+capable of producing similar symptoms!  The burden of this somewhat
+comprehensive demonstration lying entirely upon the advocates of this
+doctrine, it may be left to their mature reflections.
+
+
+It entered into my original plan to treat of the doctrine relating to
+Psora, or itch,--an almost insane conception, which I am glad to get
+rid of, for this is a subject one does not care to handle without
+gloves.  I am saved this trouble, however, by finding that many of
+the disciples of Hahnemann, those disciples the very gospel of whose
+faith stands upon his word, make very light of his authority on this
+point, although he himself says, "It has cost me twelve years of
+study and research to trace out the source of this incredible number
+of chronic affections, to discover this great truth, which remained
+concealed from all my predecessors and contemporaries, to establish
+the basis of its demonstration, and find out, at the same time, the
+curative medicines that were fit to combat this hydra in all its
+different forms."
+
+But, in the face of all this, the following remarks are made by
+Wolff, of Dresden, whose essays, according to the editor of the
+"Homoeopathic Examiner," "represent the opinions of a large majority
+of Homoeopathists in Europe."
+
+"It cannot be unknown to any one at all familiar with Homoeopathic
+literature, that Hahnemann's idea of tracing the large majority of
+chronic diseases to actual itch has met with the greatest opposition
+from Homoeopathic physicians themselves."  And again, "If the Psoric
+theory has led to no proper schism, the reason is to be found in the
+fact that it is almost without any influence in practice."
+
+We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke
+of Baden," and a "distinguished" Homoeopathist, actually asked
+Hahnemann for the proof that chronic diseases, such as dropsy, for
+instance, never arise from any other cause than itch; and that,
+according to common report, the venerable sage was highly incensed
+(fort courrouce) with Dr. Hartmann, of Leipsic, another
+"distinguished" Homoeopathist, for maintaining that they certainly
+did arise from other causes.
+
+And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after
+saying, in a good-natured way, that Psora is the Devil in medicine,
+and that physicians are divided on this point into diabolists and
+exorcists, declares that, according to a remark of Hahnemann, the
+whole civilized world is affected with Psora.  I must therefore
+disappoint any advocate of Hahnemann who may honor me with his
+presence, by not attacking a doctrine on which some of the disciples
+of his creed would be very happy to have its adversaries waste their
+time and strength.  I will not meddle with this excrescence, which,
+though often used in time of peace, would be dropped, like the limb
+of a shell-fish, the moment it was assailed; time is too precious,
+and the harvest of living extravagances nods too heavily to my
+sickle, that I should blunt it upon straw and stubble.
+
+I will close the subject with a brief examination of some of the
+statements made in Homoeopathic works, and more particularly in the
+brilliant Manifesto of the "Examiner," before referred to.  And
+first, it is there stated under the head of "Homoeopathic
+Literature," that "SEVEN HUNDRED volumes have been issued from the
+press developing the peculiarities of the system, and many of them
+possessed of a scientific character that savans know well how to
+respect."  If my assertion were proper evidence in the case, I should
+declare, that, having seen a good many of these publications, from
+the year 1834, when I bought the work of the Rev. Thomas Everest,"
+[Dr. Curie speaks of this silly pamphlet as having been published in
+1835.] to within a few weeks, when I received my last importation of
+Homaeopathic literature, I have found that all, with a very few
+exceptions, were stitched pamphlets varying from twenty or thirty
+pages to somewhat less than a hundred, and generally resembling each
+other as much as so many spelling-books.
+
+But not being evidence in the case, I will give you the testimony of
+Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the
+same Manifesto as one of the most distinguished among the
+Homoeopathists of Europe.  I translate the sentence literally from
+the "Archives de la Medecine Homoeopathique."
+
+"The literature of Homoeopathy, if that honorable name must be
+applied to all kinds of book-making, has been degraded to the
+condition of the humblest servitude.  Productions without talent,
+without spirit, without discrimination, flat and pitiful eulogies,
+exaggerations surpassing the limits of the most robust faith,
+invectives against such as dared to doubt the dogmas which had been
+proclaimed, or catalogues of remedies; of such materials is it
+composed!  From distance to distance only, have appeared some memoirs
+useful to science or practice, which appear as so many green oases in
+the midst of this literary desert."
+
+It is a very natural as well as a curious question to ask, What has
+been the success of Homoeopathy in the different countries of Europe,
+and what is its present condition?
+
+The greatest reliance of the advocates of Homoeopathy is of course on
+Germany.  We know very little of its medical schools, its medical
+doctrines, or its medical men, compared with those of England and
+France.  And, therefore, when an intelligent traveller gives a direct
+account from personal inspection of the miserable condition of the
+Homoeopathic hospital at Leipsic, the first established in Europe,
+and the first on the list of the ever-memorable Manifesto, it is easy
+enough answer or elude the fact by citing various hard names of
+"distinguished " practitioners, which sound just as well to the
+uninformed public as if they were Meckel, or Tiedemann, or
+Langenbeck.  Dr. Leo-Wolf, who, to be sure, is opposed to
+Homoeopathy, but who is a scholar, and ought to know something of his
+own countrymen, assures us that "Dr. Kopp is the only German
+Homoeopathist, if we can call him so, who has been distinguished as
+an author and practitioner before he examined this method."  And Dr.
+Lee, the same gentleman in whose travels the paragraph relating to
+the Leipsic Hospital is to be found, says the same thing.  And I will
+cheerfully expose myself to any impertinent remark which it might
+suggest, to assure my audience that I never heard or saw one
+authentic Homoeopathic name of any country in Europe, which I had
+ever heard mentioned before as connected with medical science by a
+single word or deed sufficient to make it in any degree familiar to
+my ears, unless Arnold of Heidelberg is the anatomist who discovered
+a little nervous centre, called the otic ganglion.  But you need ask
+no better proof of who and what the German adherents of this doctrine
+must be, than the testimony of a German Homoeopathist as to the
+wretched character of the works they manufacture to enforce its
+claims.
+
+As for the act of this or that government tolerating or encouraging
+Homoeopathy, every person of common intelligence knows that it is a
+mere form granted or denied according to the general principles of
+policy adopted in different states, or the degree of influence which
+some few persons who have adopted it may happen to have at court.
+What may be the value of certain pompous titles with which many of
+the advocates of Homoeopathy are honored, it might be disrespectful
+to question.  But in the mean time the judicious inquirer may ponder
+over an extract which I translate from a paper relating to a
+personage well known to the community as Williams the Oculist, with
+whom I had the honor of crossing the Atlantic some years since, and
+who himself handed me two copies of the paper in question.
+
+"To say that he was oculist of Louis XVIII.  and of Charles X., and
+that he now enjoys the same title with respect to His Majesty, Louis
+Philippe, and the King of the Belgians, is unquestionably to say a
+great deal; and yet it is one of the least of his titles to public
+confidence.  His reputation rests upon a basis more substantial even
+than the numerous diplomas with which he is provided, than the
+membership of the different medical societies which have chosen him
+as their associate," etc., etc.
+
+And as to one more point, it is time that the public should fully
+understand that the common method of supporting barefaced imposture
+at the present day, both in Europe and in this country, consists in
+trumping up "Dispensaries," " Colleges of Health," and other
+advertising charitable clap-traps, which use the poor as decoy-ducks
+for the rich, and the proprietors of which have a strong predilection
+for the title of "Professor."  These names, therefore, have come to
+be of little or no value as evidence of the good character, still
+less of the high pretensions of those who invoke their authority.
+Nor does it follow, even when a chair is founded in connection with a
+well-known institution, that it has either a salary or an occupant;
+so that it may be, and probably is, a mere harmless piece of
+toleration on the part of the government if a Professorship of
+Homoeopathy is really in existence at Jena or Heidelberg.  And
+finally, in order to correct the error of any who might suppose that
+the whole Medical Profession of Germany has long since fallen into
+the delusions of Hahnemann, I will quote two lines which a celebrated
+anatomist and surgeon (whose name will occur again in this lecture in
+connection with a very pleasing letter) addressed to the French
+Academy of Medicine in 1835.  "I happened to be in Germany some
+months since, at a meeting of nearly six hundred physicians; one of
+them wished to bring up the question of Homoeopathy; they would not
+even listen to him."  This may have been very impolite and bigoted,
+but that is not precisely the point in reference to which I mention
+the circumstance.
+
+But if we cannot easily get at Germany, we can very easily obtain
+exact information from France and England.  I took the trouble to
+write some months ago to two friends in Paris, in whom I could place
+confidence, for information upon the subject.  One of them answered
+briefly to the effect that nothing was said about it.  When the late
+Curator of the Lowell Institute, at his request, asked about the
+works upon the subject, he was told that they had remained a long
+time on the shelves quite unsalable, and never spoken of.
+
+The other gentleman, ["Dr. Henry T.  Bigelow, now Professor of
+Surgery in Harvard University.] whose name is well known to my
+audience, and who needs no commendation of mine, had the kindness to
+procure for me many publications upon the subject, and some
+information which sets the whole matter at rest, so far as Paris is
+concerned.  He went directly to the Baillieres, the principal and
+almost the only publishers of all the Homoeopathic books and journals
+in that city.  The following facts were taken by him from the
+account-books of this publishing firm.  Four Homoeopathic Journals
+have been published in Paris; three of them by the Baillieres.
+
+The reception they met with may be judged of by showing the number of
+subscribers to each on the books of the publishing firm.
+
+A Review published by some other house, which lasted one year, and
+had about fifty subscribers, appeared in 1834, 1835.
+
+There were only four Journals of Homoeopathy ever published in Paris.
+The Baillieres informed my correspondent that the sale of
+Homoeopathic books was much less than formerly, and that consequently
+they should undertake to publish no new books upon the subject,
+except those of Jahr or Hahnemann.  "This man," says my
+correspondent,--referring to one of the brothers,--"the publisher and
+headquarters of Homoeopathy in Paris, informs me that it is going
+down in England and Germany as well as in Paris."  For all the facts
+he had stated he pledged himself as responsible.
+
+Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
+since then has been going down.
+
+Louis told my correspondent that no person of distinction in Paris
+had embraced Homoeopathy, and that it was declining.  If you ask who
+Louis is, I refer you to the well-known Homoeopathist, Peschier of
+Geneva, who says, addressing him, "I respect no one more than
+yourself; the feeling which guides your researches, your labors, and
+your pen, is so honorable and rare, that I could not but bow down
+before it; and I own, if there were any allopathist who inspired me
+with higher veneration, it would be him and not yourself whom I
+should address."
+
+Among the names of "Distinguished Homoeopathists," however, displayed
+in imposing columns, in the index of the "Homoeopathic Examiner," are
+those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the
+world of science, and the last of them identified with some of the
+most valuable contributions which anatomical knowledge has received
+since the commencement of the present century.  One Dr. Chrysaora,
+who stands sponsor for many facts in that Journal, makes the
+following statement among the rest: "Professors, who are esteemed
+among the most distinguished of the Faculty (Faculty de Medicine),
+both as to knowledge and reputation, have openly confessed the power
+of Homoeopathia in forms of disease where the ordinary method of
+practice proved totally insufficient.  It affords me the highest
+pleasure to select from among these gentlemen, Marjolin, Amussat, and
+Breschet."
+
+Here is a literal translation of an original letter, now in my
+possession, from one of these Homoeopathists to my correspondent:--
+
+"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
+
+"You have had the kindness to inform me in your letter that a new
+American Journal, the 'New World,'  has made use of my name in
+support of the pretended Homoeopathic doctrines, and that I am
+represented as one of the warmest partisans of Homoeopathy in France.
+
+"I am vastly surprised at the reputation manufactured for me upon the
+new continent; but I am obliged, in deference to truth, to reject it
+with my whole energy.  I spurn far from me everything which relates
+to that charlatanism called Homoeopathy, for these pretended
+doctrines cannot endure the scrutiny of wise and enlightened persons,
+who are guided by honorable sentiments in the practice of the noblest
+of arts.
+
+"PARIS, 3d November, 1841:"
+
+I am, etc., etc.,
+
+"G. BRESCHET,
+
+"Professor in the Faculty of Medicine, Member of the Institute,
+Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc.
+
+I first saw M.  Breschet's name mentioned in that Journal
+
+Concerning Amussat, my correspondent writes, that he was informed by
+Madame Hahnemann, who converses in French more readily than her
+husband, and therefore often speaks for him, that "he was not a
+physician, neither Homoeopathist nor Allopathist, but that he was the
+surgeon of their own establishment; that is, performed as a surgeon
+all the operations they had occasion for in their practice."
+
+I regret not having made any inquiries as to Marjolin, who, I doubt
+not, would strike his ponderous snuff-box until it resounded like the
+Grecian horse, at hearing such a doctrine associated with his
+respectable name.  I was not aware, when writing to Paris, that this
+worthy Professor, whose lectures I long attended, was included in
+these audacious claims; but after the specimens I have given of the
+accuracy of the foreign correspondence of the "Homoeopathic
+Examiner," any further information I might obtain would seem so
+superfluous as hardly to be worth the postage.
+
+Homoeopathy may be said, then, to be in a sufficiently miserable
+condition in Paris.  Yet there lives, and there has lived for years,
+the illustrious Samuel Hahnemann, who himself assured my
+correspondent that no place offered the advantages of Paris in its
+investigation, by reason of the attention there paid to it.
+
+In England, it appears by the statement of Dr. Curie in October,
+1839, about eight years after its introduction into the country, that
+there were eighteen Homoeopathic physicians in the United Kingdom, of
+whom only three were to be found out of London, and that many of
+these practised Homoeopathy in secret.
+
+It will be seen, therefore, that, according to the recent statement
+of one of its leading English advocates, Homoeopathy had obtained not
+quite half as many practical disciples in England as Perkinism could
+show for itself in a somewhat less period from the time of its first
+promulgation in that country.
+
+Dr. Curie's letter, dated London, October 30, 1839, says there is
+"one in Dublin, Dr. Luther; at Glasgow, Dr. Scott."  The
+"distinguished" Chrysaora writes from Paris, dating October 20, 1839,
+"On the other hand, Homoeopathy is commencing to make an inroad into
+England by the way of Ireland.  At Dublin, distinguished physicians
+have already embraced the new system, and a great part of the
+nobility and gentry of that city have emancipated themselves from the
+English fashion and professional authority."
+
+But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
+Homoeopathy; the Queen Dowager Adelaide has been treated by a
+Homoeopathic physician.  "Jarley is the delight of the nobility and
+gentry."  "The Royal Family are the patrons of Jarley."
+
+Let me ask if a Marquis and a Knight are better than two Lords, and
+if the Dowager of Royalty is better than Royalty itself, all of which
+illustrious dignities were claimed in behalf of Benjamin Douglass
+Perkins?
+
+But if the balance is thought too evenly suspended in this case,
+another instance can be given in which the evidence of British
+noblemen and their ladies is shown to be as valuable in establishing
+the character of a medical man or doctrine, as would be the testimony
+of the Marquis of Waterford concerning the present condition and
+prospects of missionary enterprise.  I have before me an octavo
+volume of more than four hundred pages, in which, among much similar
+matter, I find highly commendatory letters from the Marchioness of
+Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the
+Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis
+of Sligo,--all addressed to "John St. John Long, Esq," a wretched
+charlatan, twice tried for, and once convicted of, manslaughter at
+the Old Bailey.
+
+This poor creature, too, like all of his tribe, speaks of the medical
+profession as a great confederation of bigoted monopolists.  He, too,
+says that "If an innovator should appear, holding out hope to those
+in despair, and curing disorders which the faculty have recorded as
+irremediable, he is at once, and without inquiry, denounced as an
+empiric and an impostor."  He, too, cites the inevitable names of
+Galileo and Harvey, and refers to the feelings excited by the great
+discovery of Jenner.  From the treatment of the great astronomer who
+was visited with the punishment of other heretics by the
+ecclesiastical authorities of a Catholic country some centuries
+since, there is no very direct inference to be drawn to the medical
+profession of the present time.  His name should be babbled no
+longer, after having been placarded for the hundredth time in the
+pages of St. John Long.  But if we are doomed to see constant
+reference to the names of Harvey and Jenner in every worthless
+pamphlet containing the prospectus of some new trick upon the public,
+let us, once for all, stare the facts in the face, and see how the
+discoveries of these great men were actually received by the medical
+profession.
+
+In 1628, Harvey published his first work upon the circulation.  His
+doctrines were a complete revolution of the prevailing opinions of
+all antiquity.  They immediately found both champions and opponents;
+of which last, one only, Riolanus, seemed to Harvey worthy of an
+answer, on account of his "rank, fame, and learning."  Controversy in
+science, as in religion, was not, in those days, carried on with all
+the courtesy which our present habits demand, and it is possible that
+some hard words may have been applied to Harvey, as it is very
+certain that he used the most contemptuous expressions towards
+others.
+
+Harvey declares in his second letter to Riolanus, "Since the first
+discovery of the circulation, hardly a day, or a moment, has passed
+without my hearing it both well and ill spoken of; some attack it
+with great hostility, others defend it with high encomiums; one party
+believe that I have abundantly proved the truth of the doctrine
+against all the weight of opposing arguments, by experiments,
+observations, and dissections; others think it not yet sufficiently
+cleared up, and free from objections."  Two really eminent
+Professors, Plempius of Louvain, and Walaeus of Leyden, were among
+its early advocates.
+
+The opinions sanctioned by the authority of long ages, and the names
+of Hippocrates and Galen, dissolved away, gradually, but certainly,
+before the demonstrations of Harvey.  Twenty-four years after the
+publication of his first work, and six years before his death, his
+bust in marble was placed in the Hall of the College of Physicians,
+with a suitable inscription recording his discoveries.
+
+Two years after this he was unanimously invited to accept the
+Presidency of that body; and he lived to see his doctrine
+established, and all reputable opposition withdrawn.
+
+There were many circumstances connected with the discovery of Dr.
+Jenner which were of a nature to excite repugnance and opposition.
+The practice of inoculation for the small-pox had already disarmed
+that disease of many of its terrors.  The introduction of a
+contagious disease from a brute creature into the human system
+naturally struck the public mind with a sensation of disgust and
+apprehension, and a part of the medical public may have shared these
+feelings.  I find that Jenner's discovery of vaccination was made
+public in June, 1798.  In July of the same year the celebrated
+surgeon, Mr. Cline, vaccinated a child with virus received from Dr.
+Jenner, and in communicating the success of this experiment, he
+mentions that Dr. Lister, formerly of the Small-Pox Hospital, and
+himself, are convinced of the efficacy of the cow-pox.  In November
+of the same year, Dr. Pearson published his "Inquiry," containing the
+testimony of numerous practitioners in different parts of the
+kingdom, to the efficacy of the practice.  Dr. HAYGARTH, who was so
+conspicuous in exposing the follies of Perkinism, was among the very
+earliest to express his opinion in favor of vaccination.  In 1801,
+Dr. Lettsom mentions the circumstance "as being to the honor of the
+medical professors, that they have very generally encouraged this
+salutary practice, although it is certainly calculated to lessen
+their pecuniary advantages by its tendency to extirpate a fertile
+source of professional practice."
+
+In the same year the Medical Committee of Paris spoke of vaccination
+in a public letter, as "the most brilliant and most important
+discovery of the eighteenth century."  The Directors of a Society for
+the Extermination of the Small-Pox, in a Report dated October 1st,
+1807, "congratulate the public on the very favorable opinion which
+the Royal College of Physicians of London, after a most minute and
+laborious investigation made by the command of his Majesty, have a
+second time expressed on the subject of vaccination, in their Report
+laid before the House of Commons, in the last session of Parliament;
+in consequence of which the sum of twenty thousand pounds was voted
+to Dr. Jenner, as a remuneration for his discovery, in addition to
+ten thousand pounds before granted."  (In June, 1802.)
+
+These and similar accusations, so often brought up against the
+Medical Profession, are only one mode in which is manifested a spirit
+of opposition not merely to medical science, but to all science, and
+to all sound knowledge.  It is a spirit which neither understands
+itself nor the object at which it is aiming.  It gropes among the
+loose records of the past, and the floating fables of the moment, to
+glean a few truths or falsehoods tending to prove, if they prove
+anything, that the persons who have passed their lives in the study
+of a branch of knowledge the very essence of which must always
+consist in long and accurate observation, are less competent to judge
+of new doctrines in their own department than the rest of the
+community.  It belongs to the clown in society, the destructive in
+politics, and the rogue in practice.
+
+The name of Harvey, whose great discovery was the legitimate result
+of his severe training and patient study, should be mentioned only to
+check the pretensions of presumptuous ignorance.  The example of
+Jenner, who gave his inestimable secret, the result of twenty-two
+years of experiment and researches, unpurchased, to the public,--
+when, as was said in Parliament, he might have made a hundred
+thousand pounds by it as well as any smaller sum,--should be referred
+to only to rebuke the selfish venders of secret remedies, among whom
+his early history obliges us reluctantly to record Samuel Hahnemann.
+Those who speak of the great body of physicians as if they were
+united in a league to support the superannuated notions of the past
+against the progress of improvement, have read the history of
+medicine to little purpose.  The prevalent failing of this profession
+has been, on the contrary, to lend a too credulous ear to ambitious
+and plausible innovators.  If at the present time ten years of public
+notoriety have passed over any doctrine professing to be of
+importance in medical science, and if it has not succeeded in raising
+up a powerful body of able, learned, and ingenious advocates for its
+claims, the fault must be in the doctrine and not in the medical
+profession.
+
+Homoeopathy has had a still more extended period of trial than this,
+and we have seen with what results.  It only remains to throw out a
+few conjectures as to the particular manner in which it is to break
+up and disappear.
+
+1.  The confidence of the few believers in this delusion will never
+survive the loss of friends who may die of any acute disease, under a
+treatment such as that prescribed by Homoeopathy.  It is doubtful how
+far cases of this kind will be trusted to its tender mercies, but
+wherever it acquires any considerable foothold, such cases must come,
+and with them the ruin of those who practise it, should any highly
+valued life be thus sacrificed.
+
+2.  After its novelty has worn out, the ardent and capricious
+individuals who constitute the most prominent class of its patrons
+will return to visible doses, were it only for the sake of a change.
+
+3.  The Semi-Homoeopathic practitioner will gradually withdraw from
+the rotten half of his business and try to make the public forget his
+connection with it.
+
+4.  The ultra Homoeopathist will either recant and try to rejoin the
+medical profession; or he will embrace some newer and if possible
+equally extravagant doctrine; or he will stick to his colors and go
+down with his sinking doctrine.  Very few will pursue the course last
+mentioned.
+
+A single fact may serve to point out in what direction there will
+probably be a movement of the dissolving atoms of Homoeopathy.  On
+the 13th page of the too frequently cited Manifesto of the "Examiner"
+I read the following stately paragraph:
+
+"Bigelius, M. D., physician to the Emperor of Russia, whose elevated
+reputation is well known in Europe, has been an acknowledged advocate
+of Hahnemann's doctrines for several years.  He abandoned Allopathia
+for Homoeopathia."  The date of this statement is January, 1840.  I
+find on looking at the booksellers' catalogues that one Bigel, or
+Bigelius, to speak more classically, has been at various times
+publishing Homoeopathic books for some years.
+
+Again, on looking into the " Encyclographie des Sciences Medicales "
+for April, 1840, I find a work entitled " Manual of HYDROSUDOPATHY,
+or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel,
+Physician of the School of Strasburg, Member of the Medico-
+Chirurgical Institute of Naples, of the Academy of St.  Petersburg,--
+Assessor of the College of the Empire of Russia, Physician of his
+late Imperial Highness the Grand Duke Constantine, Chevalier of the
+Legion of Honor, etc."  Hydrosudopathy or Hydropathy, as it is
+sometimes called, is a new medical doctrine or practice which has
+sprung up in Germany since Homoeopathy, which it bids fair to drive
+out of the market, if, as Dr. Bigel says, fourteen physicians
+afflicted with diseases which defied themselves and their colleagues
+came to Graefenberg, in the year 1836 alone, and were cured.  Now Dr.
+Bigel, "whose elevated reputation is well known in Europe," writes as
+follows: "The reader will not fail to see in this defence of the
+curative method of Graefenberg a profession of medical faith, and he
+will be correct in so doing."  And his work closes with the following
+sentence, worthy of so distinguished an individual: "We believe, with
+religion, that the water of baptism purifies the soul from its
+original sin; let us believe also, with experience, that it is for
+our corporeal sins the redeemer of the human body."  If Bigel,
+Physician to the late Grand Duke Constantine, is identical with Bigel
+whom the "Examiner" calls Physician to the Emperor of Russia, it
+appears that he is now actively engaged in throwing cold water at
+once upon his patients and the future prospects of Homoeopathy.
+
+If, as must be admitted, no one of Hahnemann's doctrines is received
+with tolerable unanimity among his disciples, except the central
+axiom, Similia similibus curantur; if this axiom itself relies mainly
+for its support upon the folly and trickery of Hahnemann, what can we
+think of those who announce themselves ready to relinquish all the
+accumulated treasures of our art, to trifle with life upon the
+strength of these fantastic theories?  What shall we think of
+professed practitioners of medicine, if, in the words of Jahr, "from
+ignorance, for their personal convenience, or through charlatanism,
+they treat their patients one day Homoeopathically and the next
+Allopathically; " if they parade their pretended new science before
+the unguarded portion of the community; if they suffer their names to
+be coupled with it wherever it may gain a credulous patient; and deny
+all responsibility for its character, refuse all argument for its
+doctrines, allege no palliation for the ignorance and deception
+interwoven with every thread of its flimsy tissue, when they are
+questioned by those competent to judge and entitled to an answer?
+
+Such is the pretended science of Homoeopathy, to which you are asked
+to trust your lives and the lives of those dearest to you.  A mingled
+mass of perverse ingenuity, of tinsel erudition, of imbecile
+credulity, and of artful misrepresentation, too often mingled in
+practice, if we may trust the authority of its founder, with
+heartless and shameless imposition.  Because it is suffered so often
+to appeal unanswered to the public, because it has its journals, its
+patrons, its apostles, some are weak enough to suppose it can escape
+the inevitable doom of utter disgrace and oblivion.  Not many years
+can pass away before the same curiosity excited by one of Perkins's
+Tractors will be awakened at the sight of one of the Infinitesimal
+Globules.  If it should claim a longer existence, it can only be by
+falling into the hands of the sordid wretches who wring their bread
+from the cold grasp of disease and death in the hovels of ignorant
+poverty.
+
+As one humble member of a profession which for more than two thousand
+years has devoted itself to the pursuit of the best earthly interests
+of mankind, always assailed and insulted from without by such as are
+ignorant of its infinite perplexities and labors, always striving in
+unequal contest with the hundred-armed giant who walks in the
+noonday, and sleeps not in the midnight, yet still toiling, not
+merely for itself and the present moment, but for the race and the
+future, I have lifted my voice against this lifeless delusion,
+rolling its shapeless bulk into the path of a noble science it is too
+weak to strike, or to injure.
+
+
+
+
+
+
+THE CONTAGIOUSNESS OF PUERPERAL FEVER
+Printed in 1843; reprinted with additions, 1855.
+
+
+THE POINT AT ISSUE.
+
+
+THE AFFIRMATIVE.
+
+"The disease known as Puerperal Fever is so far contagious as to be
+frequently carried from patient to patient by physicians and nurses."
+O. W. Holmes, 1843.
+
+
+THE NEGATIVE.
+
+"The result of the whole discussion will, I trust, serve, not only to
+exalt your views of the value and dignity of our profession, but to
+divest your minds of the overpowering dread that you can ever become,
+especially to woman, under the extremely interesting circumstances of
+gestation and parturition, the minister of evil; that you can ever
+convey, in any possible manner, a horrible virus, so destructive in
+its effects, and so mysterious in its operations as that attributed
+to puerperal fever." --Professor Hodge,
+1852.
+
+"I prefer to attribute them to accident, or Providence, of which I
+can form a conception, rather than to a contagion of which I cannot
+form any clear idea, at least as to this particular malady."--
+Professor Meigs, 1852.
+
+" .  .  .  in the propagation of which they have no more to do, than
+with the propagation of cholera from Jessore to San Francisco, and
+from Mauritius to St. Petersburg."--Professor Meigs, 1854.
+
+                    ---------------------
+
+"I arrived at that certainty in the matter, that I could venture to
+foretell what women would be affected with the disease, upon hearing
+by what midwife they were to be delivered, or by what nurse they were
+to be attended, during their lying-in; and, almost in every instance,
+my prediction was verified." --Gordon, 1795.
+
+"A certain number of deaths is caused every year by the contagion of
+puerperal fever, communicated by the nurses and medical attendants."
+Farr, in Fifth Annual Report of Registrar-General of England, 1843.
+
+".  .  .  boards of health, if such exist, or, without them, the
+medical institutions of a country, should have the power of coercing,
+or of inflicting some kind of punishment on those who recklessly go
+from cases of puerperal fevers to parturient or puerperal females,
+without using due precaution; and who, having been shown the risk,
+criminally encounter it, and convey pestilence and death to the
+persons they are employed to aid in the most interesting and
+suffering period of female existence." --Copland's Medical
+Dictionary, Art.  Puerperal States and Diseases, 1852.
+
+"We conceive it unnecessary to go into detail to prove the contagious
+nature of this disease, as there are few, if any, American
+practitioners who do not believe in this doctrine." --Dr. Lee, in
+Additions to Article last cited.
+
+                    -----------------------
+
+[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
+arose in a Medical Society of which I was a member, involving the
+subject of a certain supposed cause of disease, about which something
+was known, a good deal suspected, and not a little feared.  The
+discussion was suggested by a case, reported at the preceding
+meeting, of a physician who made an examination of the body of a
+patient who had died with puerperal fever, and who himself died in
+less than a week, apparently in consequence of a wound received at
+the examination, having attended several women in confinement in the
+mean time, all of whom, as it was alleged, were attacked with
+puerperal fever.
+
+Whatever apprehensions and beliefs were entertained, it was plain
+that a fuller knowledge of the facts relating to the subject would be
+acceptable to all present.  I therefore felt that it would be doing a
+good service to look into the best records I could find, and inquire
+of the most trustworthy practitioners I knew, to learn what
+experience had to teach in the matter, and arrived at the results
+contained in the following pages.
+
+The Essay was read before the Boston Society for Medical Improvement,
+and, at the request of the Society, printed in the "New England
+Quarterly Journal of Medicine and Surgery" for April, 1843.  As this
+Journal never obtained a large circulation, and ceased to be
+published after a year's existence, and as the few copies I had
+struck off separately were soon lost sight of among the friends to
+whom they were sent, the Essay can hardly be said to have been fully
+brought before the Profession.
+
+The subject of this Paper has the same profound interest for me at
+the present moment as it had when I was first collecting the terrible
+evidence out of which, as it seems to me, the commonest exercise of
+reason could not help shaping the truth it involved.  It is not
+merely on account of the bearing of the question,--if there is a
+question,--on all that is most sacred in human life and happiness,
+that the subject cannot lose its interest.  It is because it seems
+evident that a fair statement of the facts must produce its proper
+influence on a very large proportion of well-constituted and
+unprejudiced minds.  Individuals may, here and there, resist the
+practical bearing of the evidence on their own feelings or interests;
+some may fail to see its meaning, as some persons may be found who
+cannot tell red from green; but I cannot doubt that most readers will
+be satisfied and convinced, to loathing, long before they have
+finished the dark obituary calendar laid before them.
+
+I do not know that I shall ever again have so good an opportunity of
+being useful as was granted me by the raising of the question which
+produced this Essay.  For I have abundant evidence that it has made
+many practitioners more cautious in their relations with puerperal
+females, and I have no doubt it will do so still, if it has a chance
+of being read, though it should call out a hundred counterblasts,
+proving to the satisfaction of their authors that it proved nothing.
+And for my part, I had rather rescue one mother from being poisoned
+by her attendant, than claim to have saved forty out of fifty
+patients to whom I had carried the disease.  Thus, I am willing to
+avail myself of any hint coming from without to offer this paper once
+more to the press.  The occasion has presented itself, as will be
+seen, in a convenient if not in a flattering form.
+
+
+I send this Essay again to the MEDICAL PROFESSION, without the change
+of a word or syllable.  I find, on reviewing it, that it anticipates
+and eliminates those secondary questions which cannot be entertained
+for a moment until the one great point of fact is peremptorily
+settled.  In its very statement of the doctrine maintained it avoids
+all discussion of the nature of the disease "known as puerperal
+fever," and all the somewhat stale philology of the word contagion.
+It mentions, fairly enough, the names of sceptics, or unbelievers as
+to the reality of personal transmission; of Dewees, of Tonnelle, of
+Duges, of Baudelocque, and others; of course, not including those
+whose works were then unwritten or unpublished; nor enumerating all
+the Continental writers who, in ignorance of the great mass of
+evidence accumulated by British practitioners, could hardly be called
+well informed on this subject.  It meets all the array of negative
+cases,--those in which disease did not follow exposure,--by the
+striking example of small-pox, which, although one of the most
+contagious of diseases, is subject to the most remarkable
+irregularities and seeming caprices in its transmission.  It makes
+full allowance for other causes besides personal transmission,
+especially for epidemic influences.  It allows for the possibility of
+different modes of conveyance of the destructive principle.  It
+recognizes and supports the belief that a series of cases may
+originate from a single primitive source which affects each new
+patient in turn; and especially from cases of Erysipelas.  It does
+not undertake to discuss the theoretical aspect of the subject; that
+is a secondary matter of consideration.  Where facts are numerous,
+and unquestionable, and unequivocal in their significance, theory
+must follow them as it best may, keeping time with their step, and
+not go before them, marching to the sound of its own drum and
+trumpet.  Having thus narrowed its area to a limited practical
+platform of discussion, a matter of life and death, and not of
+phrases or theories, it covers every inch of it with a mass of
+evidence which I conceive a Committee of Husbands, who can count
+coincidences and draw conclusions as well as a Synod of Accoucheurs,
+would justly consider as affording ample reasons for an unceremonious
+dismissal of a practitioner (if it is conceivable that such a step
+could be waited for), after five or six funerals had marked the path
+of his daily visits, while other practitioners were not thus
+escorted.  To the Profession, therefore, I submit the paper in its
+original form, and leave it to take care of itself.
+
+To the MEDICAL STUDENTS, into whose hands this Essay may fall, some
+words of introduction may be appropriate, and perhaps, to a small
+number of them, necessary.  There are some among them who, from
+youth, or want of training, are easily bewildered and confused in any
+conflict of opinions into which their studies lead them.  They are
+liable to lose sight of the main question in collateral issues, and
+to be run away with by suggestive speculations.  They confound belief
+with evidence, often trusting the first because it is expressed with
+energy, and slighting the latter because it is calm and
+unimpassioned.  They are not satisfied with proof; they cannot
+believe a point is settled so long as everybody is not silenced.
+They have not learned that error is got out of the minds that cherish
+it, as the taenia is removed from the body, one joint, or a few
+joints at a time, for the most part, rarely the whole evil at once.
+They naturally have faith in their instructors, turning to them for
+truth, and taking what they may choose to give them; babes in
+knowledge, not yet able to tell the breast from the bottle, pumping
+away for the milk of truth at all that offers, were it nothing better
+than a Professor's shrivelled forefinger.
+
+In the earliest and embryonic stage of professional development, any
+violent impression on the instructor's mind is apt to be followed by
+some lasting effect on that of the pupil.  No mother's mark is more
+permanent than the mental naevi and moles, and excrescences, and
+mutilations, that students carry with them out of the lecture-room,
+if once the teeming intellect which nourishes theirs has been scared
+from its propriety by any misshapen fantasy.  Even an impatient or
+petulant expression, which to a philosopher would be a mere index of
+the low state of amiability of the speaker at the moment of its
+utterance, may pass into the young mind as an element of its future
+constitution, to injure its temper or corrupt its judgment.  It is a
+duty, therefore, which we owe to this younger class of students, to
+clear any important truth which may have been rendered questionable
+in their minds by such language, or any truth-teller against whom
+they may have been prejudiced by hasty epithets, from the impressions
+such words have left.  Until this is done, they are not ready for the
+question, where there is a question, for them to decide.  Even if we
+ourselves are the subjects of the prejudice, there seems to be no
+impropriety in showing that this prejudice is local or personal, and
+not an acknowledged conviction with the public at large.  It may be
+necessary to break through our usual habits of reserve to do this,
+but this is the fault of the position in which others have placed us.
+
+Two widely-known and highly-esteemed practitioners, Professors in two
+of the largest Medical Schools of the Union, teaching the branch of
+art which includes the Diseases of Women, and therefore speaking with
+authority; addressing in their lectures and printed publications
+large numbers of young men, many of them in the tenderest immaturity
+of knowledge, have recently taken ground in a formal way against the
+doctrine maintained in this paper:
+
+On the Non-Contagious Character of Puerperal Fever: An Introductory
+Lecture.  By Hugh L.  Hodge, M. D., Professor of Obstetrics in the
+University of Pennsylvania.  Delivered Monday, October 11, 1852.
+Philadelphia, 1852.
+
+On the Nature, Signs, and Treatment of Childbed Fevers : in a Series
+of Letters addressed to the Students of his Class.  By Charles D.
+Meigs, M.  D., Professor of Midwifery and the Diseases of Women and
+Children in Jefferson Medical College, Philadelphia, etc., etc.
+Philadelphia, 1854.  Letter VI.
+
+
+The first of the two publications, Dr. Hodge's Lecture, while its
+theoretical considerations and negative experiences do not seem to me
+to require any further notice than such as lay ready for them in my
+Essay written long before, is, I am pleased to say, unobjectionable
+in tone and language, and may be read without offence.
+
+This can hardly be said of the chapter of Dr. Meigs's volume which
+treats of Contagion in Childbed Fever.  There are expressions used in
+it which might well put a stop to all scientific discussions, were
+they to form the current coin in our exchange of opinions.  I leave
+the "very young gentlemen," whose careful expositions of the results
+of practice in more than six thousand cases are characterized as "the
+jejune and fizenless dreamings of sophomore writers," to the
+sympathies of those "dear young friends," and "dear young gentlemen,"
+who will judge how much to value their instructor's counsel to think
+for themselves, knowing what they are to expect if they happen not to
+think as he does.
+
+One unpalatable expression I suppose the laws of construction oblige
+me to appropriate to myself, as my reward for a certain amount of
+labor bestowed on the investigation of a very important question of
+evidence, and a statement of my own practical conclusions.  I take no
+offence, and attempt no retort.  No man makes a quarrel with me over
+the counterpane that covers a mother, with her new-born infant at her
+breast.  There is no epithet in the vocabulary of slight and sarcasm
+that can reach my personal sensibilities in such a controversy.  Only
+just so far as a disrespectful phrase may turn the student aside from
+the examination of the evidence, by discrediting or dishonoring the
+witness, does it call for any word of notice.
+
+I appeal from the disparaging language by which the Professor in the
+Jefferson School of Philadelphia world dispose of my claims to be
+listened to.  I appeal, not to the vote of the Society for Medical
+Improvement, although this was an unusual evidence of interest in the
+paper in question, for it was a vote passed among my own townsmen;
+nor to the opinion of any American, for none know better than the
+Professors in the great Schools of Philadelphia how cheaply the
+praise of native contemporary criticism is obtained.  I appeal to the
+recorded opinions of those whom I do not know, and who do not know
+me, nor care for me, except for the truth that I may have uttered; to
+Copland, in his "Medical Dictionary," who has spoken of my Essay in
+phrases to which the pamphlets of American "scribblers" are seldom
+used from European authorities; to Ramsbotham, whose compendious
+eulogy is all that self-love could ask; to the "Fifth Annual Report"
+of the Registrar-General of England, in which the second-hand
+abstract of my Essay figures largely, and not without favorable
+comment, in an important appended paper.  These testimonies, half
+forgotten until this circumstance recalled them, are dragged into the
+light, not in a paroxysm of vanity, but to show that there may be
+food for thought in the small pamphlet which the Philadelphia Teacher
+treats so lightly.  They were at least unsought for, and would never
+have been proclaimed but for the sake of securing the privilege of a
+decent and unprejudiced hearing.
+
+I will take it for granted that they have so far counterpoised the
+depreciating language of my fellow-countryman and fellow-teacher as
+to gain me a reader here and there among the youthful class of
+students I am now addressing.  It is only for their sake that I think
+it necessary to analyze, or explain, or illustrate, or corroborate
+any portion of the following Essay.  But I know that nothing can be
+made too plain for beginners; and as I do not expect the
+practitioner, or even the more mature student, to take the trouble to
+follow me through an Introduction which I consider wholly unnecessary
+and superfluous for them, I shall not hesitate to stoop to the most
+elementary simplicity for the benefit of the younger student.  I do
+this more willingly because it affords a good opportunity, as it
+seems to me, of exercising the untrained mind in that medical logic
+which does not seem to have been either taught or practised in our
+schools of late, to the extent that might be desired.
+
+I will now exhibit, in a series of propositions reduced to their
+simplest expression, the same essential statements and conclusions as
+are contained in the Essay, with such commentaries and explanations
+as may be profitable to the inexperienced class of readers addressed.
+
+
+I.  It has been long believed, by many competent observers, that
+Puerperal Fever (so called) is sometimes carried from patient to
+patient by medical assistants.
+
+II.  The express object of this Essay is to prove that it is so
+carried.
+
+III.  In order to prove this point, it is not necessary to consult
+any medical theorist as to whether or not it is consistent with his
+preconceived notions that such a mode of transfer should exist.
+
+IV.  If the medical theorist insists on being consulted, and we see
+fit to indulge him, he cannot be allowed to assume that the alleged
+laws of contagion, deduced from observation in other diseases, shall
+be cited to disprove the alleged laws deduced from observation in
+this.  Science would never make progress under such conditions.
+Neither the long incubation of hydrophobia, nor the protecting power
+of vaccination, would ever have been admitted, if the results of
+observation in these affections had been rejected as contradictory to
+the previously ascertained laws of contagion.
+
+V.  The disease in question is not a common one; producing, on the
+average, about three deaths in a thousand births, according to the
+English Registration returns which I have examined.
+
+VI.  When an unusually large number of cases of this disease occur
+about the same time, it is inferred, therefore, that there exists
+some special cause for this increased frequency.  If the disease
+prevails extensively over a wide region of country, it is attributed
+without dispute to an epidemic influence.  If it prevails in a single
+locality, as in a hospital, and not elsewhere, this is considered
+proof that some local cause is there active in its production.
+
+VII.  When a large number of cases of this disease occur in rapid
+succession, in one individual's ordinary practice, and few or none
+elsewhere, these cases appearing in scattered localities, in patients
+of the same average condition as those who escape under the care of
+others, there is the same reason for connecting the cause of the
+disease with the person in this instance, as with the place in that
+last mentioned.
+
+VIII.  Many series of cases, answering to these conditions, are given
+in this Essay, and many others will be referred to which have
+occurred since it was written.
+
+IX.  The alleged results of observation may be set aside; first,
+because the so-called facts are in their own nature equivocal;
+secondly, because they stand on insufficient authority; thirdly,
+because they are not sufficiently numerous.  But, in this case, the
+disease is one of striking and well-marked character; the witnesses
+are experts, interested in denying and disbelieving the facts; the
+number of consecutive cases in many instances frightful, and the
+number of series of cases such that I have no room for many of them
+except by mere reference.
+
+X.  These results of observation, being admitted, may, we will
+suppose, be interpreted in different methods.  Thus the coincidences
+may be considered the effect of chance.  I have had the chances
+calculated by a competent person, that a given practitioner, A.,
+shall have sixteen fatal cases in a month, on the following data:
+A. to average attendance upon two hundred and fifty births in a year;
+three deaths in one thousand births to be assumed as the average from
+puerperal fever; no epidemic to be at the time prevailing.  It
+follows, from the answer given me, that if we suppose every one of
+the five hundred thousand annual births of England to have been
+recorded during the last half-century, there would not be one chance
+in a million million million millions that one such series should be
+noted.  No possible fractional error in this calculation can render
+the chance a working probability.  Applied to dozens of series of
+various lengths, it is obviously an absurdity.  Chance, therefore, is
+out of the question as an explanation of the admitted coincidences.
+
+XI.  There is, therefore, some relation of cause and effect between
+the physician's presence and the patient's disease.
+
+XII.  Until it is proved to what removable condition attaching to the
+attendant the disease is owing, he is bound to stay away from his
+patients so soon as he finds himself singled out to be tracked by the
+disease.  How long, and with what other precautions, I have
+suggested, without dictating, at the close of my Essay.  If the
+physician does not at once act on any reasonable suspicion of his
+being the medium of transfer, the families where he is engaged, if
+they are allowed to know the facts, should decline his services for
+the time.  His feelings on the occasion, however interesting to
+himself, should not be even named in this connection.  A physician
+who talks about ceremony and gratitude, and services rendered, and
+the treatment he got, surely forgets himself; it is impossible that
+he should seriously think of these small matters where there is even
+a question whether he may not carry disease, and death, and
+bereavement into any one of "his families," as they are sometimes
+called.
+
+
+I will now point out to the young student the mode in which he may
+relieve his mind of any confusion, or possibly, if very young, any
+doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised
+in his mind.
+
+The most prominent ideas of the Letter are, first, that the
+transmissible nature of puerperal fever appears improbable, and,
+secondly, that it would be very inconvenient to the writer.
+Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in
+London, found it improbable, and exceedingly inconvenient to himself,
+that cow pox should prevent small-pox; but Dr. Jenner took the
+liberty to prove the fact, notwithstanding.
+
+I will first call the young student's attention to the show of
+negative facts (exposure without subsequent disease), of which much
+seems to be thought.  And I may at the same time refer him to Dr.
+Hodge's Lecture, where he will find the same kind of facts and
+reasoning.  Let him now take up Watson's Lectures, the good sense and
+spirit of which have made his book a universal favorite, and open to
+the chapter on Continued Fever.  He will find a paragraph containing
+the following sentence: "A man might say, 'I was in the battle of
+Waterloo, and saw many men around me fall down and die, and it was
+said that they were struck down by musket-balls; but I know better
+than that, for I was there all the time, and so were many of my
+friends, and we were never hit by any musket-balls.  Musket-balls,
+therefore, could not have been the cause of the deaths we witnessed.'
+And if, like contagion, they were not palpable to the senses, such a
+person might go on to affirm that no proof existed of there being any
+such thing as musket-balls."  Now let the student turn back to the
+chapter on Hydrophobia in the same volume.  He will find that John
+Hunter knew a case in which, of twenty-one persons bitten, only one
+died of the disease.  He will find that one dog at Charenton was
+bitten at different times by thirty different mad dogs, and outlived
+it all.  Is there no such thing, then, as hydrophobia?  Would one
+take no especial precautions if his wife, about to become a mother,
+had been bitten by a rabid animal, because so many escape?  Or let
+him look at "Underwood on Diseases of Children,"[Philadelphia, 1842,
+p.  244, note.] and he will find the case of a young woman who was
+inoculated eight times in thirty days, at the same time attending
+several children with smallpox, and yet was not infected.  But seven
+weeks afterwards she took the disease and died.
+
+It would seem as if the force of this argument could hardly fail to
+be seen, if it were granted that every one of these series of cases
+were so reported as to prove that there could have been no transfer
+of disease.  There is not one of them so reported, in the Lecture or
+the Letter, as to prove that the disease may not have been carried by
+the practitioner.  I strongly suspect that it was so carried in some
+of these cases, but from the character of the very imperfect evidence
+the question can never be settled without further disclosures.
+
+Although the Letter is, as I have implied, principally taken up with
+secondary and collateral questions, and might therefore be set aside
+as in the main irrelevant, I am willing, for the student's sake, to
+touch some of these questions briefly, as an illustration of its
+logical character.
+
+The first thing to be done, as I thought when I wrote my Essay, was
+to throw out all discussions of the word contagion, and this I did
+effectually by the careful wording of my statement of the subject to
+be discussed.  My object was not to settle the etymology or
+definition of a word, but to show that women had often died in
+childbed, poisoned in some way by their medical attendants.  On the
+other point, I, at least, have no controversy with anybody, and I
+think the student will do well to avoid it in this connection.  If I
+must define my position, however, as well as the term in question, I
+am contented with Worcester's definition; provided always this avowal
+do not open another side controversy on the merits of his Dictionary,
+which Dr. Meigs has not cited, as compared with Webster's, which he
+has.
+
+I cannot see the propriety of insisting that all the laws of the
+eruptive fevers must necessarily hold true of this peculiar disease
+of puerperal women.  If there were any such propriety, the laws of
+the eruptive fevers must at least be stated correctly.  It is not
+true, for instance, as Dr. Meigs states, that contagion is "no
+respecter of persons;" that "it attacks all individuals alike."  To
+give one example: Dr. Gregory, of the Small-Pox Hospital, who ought
+to know, says that persons pass through life apparently insensible to
+or unsusceptible of the small-pox virus, and that the same persons do
+not take the vaccine disease.
+
+As to the short time of incubation, of which so much is made, we have
+no right to decide beforehand whether it shall be long or short, in
+the cases we are considering.  A dissection wound may produce
+symptoms of poisoning in six hours; the bite of a rabid animal may
+take as many months.
+
+After the student has read the case in Dr. Meigs's 136th paragraph,
+and the following one, in which he exclaims against the idea of
+contagion, because the patient, delivered on the 26th of December,
+was attacked in twenty-four hours, and died on the third day, let him
+read what happened at the "Black Assizes" of 1577 and 1750.  In the
+first case, six hundred persons sickened the same night of the
+exposure, and three hundred more in three days. [Elliotson's
+Practice, p.  298.]  Of those attacked in the latter year, the
+exposure being on the 11th of May, Alderman Lambert died on the 13th,
+Under-Sheriff Cox on the 14th, and many of note before the
+20th.  But these are old stories.  Let the student listen then to Dr.
+Gerhard, whose reputation as a cautious observer he may be supposed
+to know.  "The nurse was shaving a man, who died in a few hours after
+his entrance; he inhaled his breath, which had a nauseous taste, and
+in an hour afterwards was taken with nausea, cephalalgia, and singing
+of the ears.  From that moment the attack began, and assumed a severe
+character.  The assistant was supporting another patient, who died
+soon afterwards; he felt the pungent heat upon his skin, and was
+taken immediately with the symptoms of typhus."[Am.  Jour.  Med.
+Sciences, Feb.  1837, p.  299.]   It is by notes of cases, rather
+than notes of admiration, that we must be guided, when we study the
+Revised Statutes of Nature, as laid down from the curule chairs of
+Medicine.
+
+Let the student read Dr. Meigs's 140th paragraph soberly, and then
+remember, that not only does he infer, suspect, and surmise, but he
+actually asserts (page 154, "there was poison in the house," because
+three out of five patients admitted into a ward had puerperal fever
+and died.  Have I not as much right to draw a positive inference from
+"Dr. A.'s " seventy exclusive cases as he from the three cases in the
+ward of the Dublin Hospital?  All practical medicine, and all action
+in common affairs, is founded on inferences.  How does Dr. Meigs know
+that the patients he bled in puerperal fever would not have all got
+well if he had not bled them?
+
+"You see a man discharge a gun at another; you see the flash, you
+hear the report, you see the person fall a lifeless corpse; and you
+infer, from all these circumstances, that there was a ball discharged
+from the gun, which entered his body and caused his death, because
+such is the usual and natural cause of such an effect.  But you did
+not see the ball leave the gun, pass through the air, and enter the
+body of the slain; and your testimony to the fact of killing is,
+therefore, only inferential,--in other words, circumstantial.  It is
+possible that no ball was in the gun; and we infer that there was,
+only because we cannot account for death on any other supposition."
+[Chief Justice Gibson, in Am.  Law Journal, vol.  vi.  p.  123.]
+
+"The question always comes to this: Is the circumstance of
+intercourse with the sick followed by the appearance of the disease
+in a proportion of cases so much greater than any other circumstance
+common to any portion of the inhabitants of the place under
+observation, as to make it inconceivable that the succession of cases
+occurring in persons having that intercourse should have been the
+result of chance?  If so, the inference is unavoidable, that that
+intercourse must have acted as a cause of the disease.  All
+observations which do not bear strictly on that point are irrelevant,
+and, in the case of an epidemic first appearing in a town or
+district, a succession of two cases is sometimes sufficient to
+furnish evidence which, on the principle I have stated, is nearly
+irresistible."
+
+Possibly an inexperienced youth may be awe-struck by the quotation
+from Cuvier.  These words, or their equivalent, are certainly to be
+found in his Introduction.  So are the words "top not come down"!
+to be found in the Bible, and they were as much meant for the ladies'
+head-dresses as the words of Cuvier were meant to make clinical
+observation wait for a permit from anybody to look with its eyes and
+count on its fingers.  Let the inquiring youth read the whole
+Introduction, and he will see what they mean.
+
+I intend no breach of courtesy, but this is a proper place to warn
+the student against skimming the prefaces and introductions of works
+for mottoes and embellishments to his thesis.  He cannot learn
+anatomy by thrusting an exploring needle into the body.  He will be
+very liable to misquote his author's meaning while he is picking off
+his outside sentences.  He may make as great a blunder as that simple
+prince who praised the conductor of his orchestra for the piece just
+before the overture; the musician was too good a courtier to tell him
+that it was only the tuning of the instruments.
+
+To the six propositions in the 142d paragraph, and the remarks about
+"specific" diseases, the answer, if any is necessary, seems very
+simple.  An inflammation of a serous membrane may give rise to
+secretions which act as a poison, whether that be a "specific" poison
+or not, as Dr. Homer has told his young readers, and as dissectors
+know too well; and that poison may produce its symptoms in a few
+hours after the system has received it, as any may see in Druitt's
+"Surgery," if they care to look.  Puerperal peritonitis may produce
+such a poison, and puerperal women may be very sensible to its
+influences, conveyed by contact or exhalation.  Whether this is so or
+not, facts alone can determine, and to facts we have had recourse to
+settle it.
+
+The following statement is made by Dr. Meigs in his 142d paragraph,
+and developed more at length, with rhetorical amplifications, in the
+134th.  "No human being, save a pregnant or parturient woman, is
+susceptible to the poison."  This statement is wholly incorrect, as I
+am sorry to have to point out to a Teacher in Dr. Meigs's position.
+I do not object to the erudition which quotes Willis and Fernelius,
+the last of whom was pleasantly said to have "preserved the dregs of
+the Arabs in the honey of his Latinity."  But I could wish that more
+modern authorities had not been overlooked.  On this point, for
+instance, among the numerous facts disproving the statement, the
+"American Journal of Medical Sciences," published not far from his
+lecture-room, would have presented him with a respectable catalog of
+such cases.  Thus he might refer to Mr. Storrs's paper "On the
+Contagious Effects of Puerperal Fever on the Male Subject; or on
+Persons not Childbearing"(Jan.  1846), or to Dr. Reid's case (April,
+1846), or to Dr. Barron's statement of the children's dying of
+peritonitis in an epidemic of puerperal fever at the Philadelphia
+Hospital (Oct.  1842), or to various instances cited in Dr.
+Kneeland's article (April, 186).  Or, if he would have referred to
+the "New York Journal," he might have seen Prof. Austin Flint's
+cases.  Or, if he had honored my Essay so far, he might have found
+striking instances of the same kind in the first of the new series of
+cases there reported and elsewhere.  I do not see the bearing of his
+proposition, if it were true.  But it is one of those assertions that
+fall in a moment before a slight examination of the facts; and I
+confess my surprise, that a professor who lectures on the Diseases of
+Women should have ventured to make it.
+
+Nearly seven pages are devoted to showing that I was wrong in saying
+I would not be "understood to imply that there exists a doubt in the
+mind of any well-informed member of the medical profession as to the
+fact that puerperal fever is sometimes communicated from one person
+to another, both directly and indirectly."  I will devote seven lines
+to these seven pages, which seven lines, if I may say it without
+offence, are, as it seems to me, six more than are strictly
+necessary.
+
+The following authors are cited as sceptics by Dr. Meigs :
+Dewees. --I cited the same passage.  Did not know half the facts.
+Robert Lee. --Believes the disease is sometimes communicable by
+contagion.  Tonnelle, Baudelocque.  Both cited by me.  Jacquemier.
+--Published three years after my Essay.  Kiwisch.  Behindhand in
+knowledge of Puerperal Fever." [B. & F.  Med.  Rev.  Jan.  1842.]
+Paul Dubois. --Scanzoni.
+
+These Continental writers not well informed on this point.[See Dr.
+Simpson's Remarks at Meeting of Edin.  Med.  Chir.  Soc.  (Am.  Jour.
+Oct.  1851.)]
+
+The story of Von Busch is of interest and value, but there is nothing
+in it which need perplex the student.  It is not pretended that the
+disease is always, or even, it may be, in the majority of cases,
+carried about by attendants; only that it is so carried in certain
+cases.  That it may have local and epidemic causes, as well as that
+depending on personal transmission, is not disputed.  Remember how
+small-pox often disappears from a community in spite of its
+contagious character, and the necessary exposure of many persons to
+those suffering from it; in both diseases contagion is only one of
+the coefficients of the disease.
+
+I have already spoken of the possibility that Dr. Meigs may have been
+the medium of transfer of puerperal fever in some of the cases he has
+briefly catalogued.  Of Dr. Rutter's cases I do not know how to
+speak.  I only ask the student to read the facts stated by Dr.
+Condie, as given in my Essay, and say whether or not a man should
+allow his wife to be attended by a practitioner in whose hands
+"scarcely a female that has been delivered for weeks past has escaped
+an attack,"  "while no instance of the disease has occurred in the
+patients of any other accoucheur practising in the same district."
+If I understand Dr. Meigs and Dr. Hodge, they would not warn the
+physician or spare the patient under such circumstances.  They would
+"go on," if I understand them, not to seven, or seventy, only, but to
+seventy times seven, if they could find patients.  If this is not
+what they mean, may we respectfully ask them to state what they do
+mean, to their next classes, in the name of humanity, if not of
+science!
+
+I might repeat the question asked concerning Dr. Rutter's cases, with
+reference to those reported by Dr. Roberton.  Perhaps, however, the
+student would like to know the opinion of a person in the habit of
+working at matters of this kind in a practical point of view.  To
+satisfy him on this ground, I addressed the following question to the
+President of one of our principal Insurance Companies, leaving Dr.
+Meigs's book and my Essay in his hands at the same time.
+
+Question.  "If such facts as Roberton's cases were before you, and
+the attendant had had ten, or even five fatal cases, or three, or two
+even, would you, or would you not, if insuring the life of the next
+patient to be taken care of by that attendant, expect an extra
+premium over that of an average case of childbirth?"
+
+Answer.  " Of course I should require a very large extra premium, if
+I would take take risk at all."
+
+But I do not choose to add the expressions of indignation which the
+examination of the facts before him called out.  I was satisfied from
+the effect they produced on him, that if all the hideous catalogues
+of cases now accumulated were fully brought to the knowledge of the
+public, nothing, since the days of Burke and Hare, has raised such a
+cry of horror as would be shrieked in the ears of the Profession.
+
+Dr. Meigs has elsewhere invoked "Providence" as the alternative of
+accident, to account for the "coincidences."  ("Obstetrics," Phil.
+1852, p.  631.) If so, Providence either acts through the agency of
+secondary causes, as in other diseases, or not.  If through such
+causes, let us find out what they are, as we try to do in other
+cases.  It may be true that offences, or diseases, will come, but
+"woe unto him through whom they come," if we catch him in the
+voluntary or careless act of bringing them!  But if Providence does
+not act through secondary causes in this particular sphere of
+etiology, then why does Dr. Meigs take such pains to reason so
+extensively about the laws of contagion, which, on that supposition,
+have no more to do with this case than with the plague which
+destroyed the people after David had numbered them?  Above all, what
+becomes of the theological aspect of the question, when he asserts
+that a practitioner was "only unlucky in meeting with the epidemic
+cases?" ( Op.  cit.  p.  633.) We do not deny that the God of battles
+decides the fate of nations; but we like to have the biggest
+squadrons on our side, and we are particular that our soldiers should
+not only say their prayers, but also keep their powder dry.  We do
+not deny the agency of Providence in the disaster at Norwalk, but we
+turn off the engineer, and charge the Company five thousand dollars
+apiece for every life that is sacrificed.
+
+Why a grand jury should not bring in a bill against a physician who
+switches off a score of women one after the other along his private
+track, when he knows that there is a black gulf at the end of it,
+down which they are to plunge, while the great highway is clear, is
+more than I can answer.  It is not by laying the open draw to
+Providence that he is to escape the charge of manslaughter.
+
+To finish with all these lesser matters of question, I am unable to
+see why a female must necessarily be unattended in her confinement,
+because she declines the services of a particular practitioner.  In
+all the series of cases mentioned, the death-carrying attendant was
+surrounded by others not tracked by disease and its consequences.
+Which, I would ask, is worse,--to call in another, even a rival
+practitioner, or to submit an unsuspecting female to a risk which an
+Insurance Company would have nothing to do with?
+
+I do not expect ever to return to this subject.  There is a point of
+mental saturation, beyond which argument cannot be forced without
+breeding impatient, if not harsh, feelings towards those who refuse
+to be convinced.  If I have so far manifested neither, it is well to
+stop here, and leave the rest to those younger friends who may have
+more stomach for the dregs of a stale argument.
+
+The extent of my prefatory remarks may lead some to think that I
+attach too much importance to my own Essay.  Others may wonder that I
+should expend so many words upon the two productions referred to, the
+Letter and the Lecture.  I do consider my Essay of much importance so
+long as the doctrine it maintains is treated as a question, and so
+long as any important part of the defence of that doctrine is thought
+to rest on its evidence or arguments.  I cannot treat as
+insignificant any opinions bearing on life, and interests dearer than
+life, proclaimed yearly to hundreds of young men, who will carry them
+to their legitimate results in practice.
+
+The teachings of the two Professors in the great schools of
+Philadelphia are sure to be listened to, not only by their immediate
+pupils, but by the Profession at large.  I am too much in earnest for
+either humility or vanity, but I do entreat those who hold the keys
+of life and death to listen to me also for this once.  I ask no
+personal favor; but I beg to be heard in behalf of the women whose
+lives are at stake, until some stronger voice shall plead for them.
+
+I trust that I have made the issue perfectly distinct and
+intelligible.  And let it be remembered that this is no subject to be
+smoothed over by nicely adjusted phrases of half-assent and half-
+censure divided between the parties.  The balance must be struck
+boldly and the result declared plainly.  If I have been hasty,
+presumptuous, ill-informed, illogical; if my array of facts means
+nothing; if there is no reason for any caution in the view of these
+facts; let me be told so on such authority that I must believe it,
+and I will be silent henceforth, recognizing that my mind is in a
+state of disorganization.  If the doctrine I have maintained is a
+mournful truth; if to disbelieve it, and to practise on this
+disbelief, and to teach others so to disbelieve and practise, is to
+carry desolation, and to charter others to carry it, into confiding
+families, let it be proclaimed as plainly what is to be thought of
+the teachings of those who sneer at the alleged dangers, and scout
+the very idea of precaution.  Let it be remembered that persons are
+nothing in this matter; better that twenty pamphleteers should be
+silenced, or as many professors unseated, than that one mother's life
+should be taken.  There is no quarrel here between men, but there is
+deadly incompatibility and exterminating warfare between doctrines.
+Coincidences, meaning nothing, though a man have a monopoly of the
+disease for weeks or months; or cause and effect, the cause being in
+some way connected with the person; this is the question.  If I am
+wrong, let me be put down by such a rebuke as no rash declaimer has
+received since there has been a public opinion in the medical
+profession of America; if I am right, let doctrines which lead to
+professional homicide be no longer taught from the chairs of those
+two great Institutions.  Indifference will not do here; our
+Journalists and Committees have no right to take up their pages with
+minute anatomy and tediously detailed cases, while it is a question
+whether or not the "blackdeath" of child-bed is to be scattered
+broadcast by the agency of the mother's friend and adviser.  Let the
+men who mould opinions look to it; if there is any voluntary
+blindness, any interested oversight, any culpable negligence, even,
+in such a matter, and the facts shall reach the public ear; the
+pestilence-carrier of the lying-in chamber must look to God for
+pardon, for man will never forgive him.
+
+
+               THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+In collecting, enforcing, and adding to the evidence accumulated upon
+this most serious subject, I would not be understood to imply that
+there exists a doubt in the mind of any well-informed member of the
+medical profession as to the fact that puerperal fever is sometimes
+communicated from one person to another, both directly and
+indirectly.  In the present state of our knowledge upon this point I
+should consider such doubts merely as a proof that the sceptic had
+either not examined the evidence, or, having examined it, refused to
+accept its plain and unavoidable consequences.  I should be sorry to
+think, with Dr. Rigby, that it was a case of "oblique vision;" I
+should be unwilling to force home the argumentum ad hominem of Dr.
+Blundell, but I would not consent to make a question of a momentous
+fact which is no longer to be considered as a subject for trivial
+discussions, but to be acted upon with silent promptitude.  It
+signifies nothing that wise and experienced practitioners have
+sometimes doubted the reality of the danger in question; no man has
+the right to doubt it any longer.  No negative facts, no opposing
+opinions, be they what they may, or whose they may, can form any
+answer to the series of cases now within the reach of all who choose
+to explore the records of medical science.
+
+If there are some who conceive that any important end would be
+answered by recording such opinions, or by collecting the history of
+all the cases they could find in which no evidence of the influence
+of contagion existed, I believe they are in error.  Suppose a few
+writers of authority can be found to profess a disbelief in
+contagion,--and they are very few compared with those who think
+differently,--is it quite clear that they formed their opinions on a
+view of all the facts, or is it not apparent that they relied mostly
+on their own solitary experience?  Still further, of those whose
+names are quoted, is it not true that scarcely a single one could by
+any possibility have known the half or the tenth of the facts bearing
+on the subject which have reached such a frightful amount within the
+last few years?  Again, as to the utility of negative facts, as we
+may briefly call them,--instances, namely, in which exposure has not
+been followed by disease,--although, like other truths, they may be
+worth knowing, I do not see that they are like to shed any important
+light upon the subject before us.  Every such instance requires a
+good deal of circumstantial explanation before it can be accepted.
+It is not enough that a practitioner should have had a single case of
+puerperal fever not followed by others.  It must be known whether he
+attended others while this case was in progress, whether he went
+directly from one chamber to others, whether he took any, and what
+precautions.  It is important to know that several women were exposed
+to infection derived from the patient, so that allowance may be made
+for want of predisposition.  Now if of negative facts so sifted there
+could be accumulated a hundred for every one plain instance of
+communication here recorded, I trust it need not be said that we are
+bound to guard and watch over the hundredth tenant of our fold,
+though the ninety and nine may be sure of escaping the wolf at its
+entrance.  If any one is disposed, then, to take a hundred instances
+of lives endangered or sacrificed out of those I have mentioned, and
+make it reasonably clear that within a similar time and compass ten
+thousand escaped the same exposure, I shall thank him for his
+industry, but I must be permitted to hold to my own practical
+conclusions, and beg him to adopt or at least to examine them also.
+Children that walk in calico before open fires are not always burned
+to death; the instances to the contrary may be worth recording; but
+by no means if they are to be used as arguments against woollen
+frocks and high fenders.
+
+I am not sure that this paper will escape another remark which it
+might be wished were founded in justice.  It may be said that the
+facts are too generally known and acknowledged to require any formal
+argument or exposition, that there is nothing new in the positions
+advanced, and no need of laying additional statements before the
+Profession.  But on turning to two works, one almost universally, and
+the other extensively appealed to as authority in this country, I see
+ample reason to overlook this objection.  In the last edition of
+Dewees's Treatise on the "Diseases of Females," it is expressly said,
+"In this country, under no circumstance that puerperal fever has
+appeared hitherto, does it afford the slightest ground for the belief
+that it is contagious."  In the "Philadelphia Practice of Midwifery"
+not one word can be found in the chapter devoted to this disease
+which would lead the reader to suspect that the idea of contagion had
+ever been entertained.  It seems proper, therefore, to remind those
+who are in the habit of referring to these works for guidance, that
+there may possibly be some sources of danger they have slighted or
+omitted, quite as important as a trifling irregularity of diet, or a
+confined state of the bowels, and that whatever confidence a
+physician may have in his own mode of treatment, his services are of
+questionable value whenever he carries the bane as well as the
+antidote about his person.
+
+The practical point to be illustrated is the following:
+
+The disease known as Puerperal Fever is so far contagious as to be
+frequently carried from patient to patient by physicians and nurses.
+
+
+Let me begin by throwing out certain incidental questions, which,
+without being absolutely essential, would render the subject more
+complicated, and by making such concessions and assumptions as may be
+fairly supposed to be without the pale of discussion.
+
+1.  It is granted that all the forms of what is called puerperal
+fever may not be, and probably are not, equally contagious or
+infectious.  I do not enter into the distinctions which have been
+drawn by authors, because the facts do not appear to me sufficient to
+establish any absolute line of demarcation between such forms as may
+be propagated by contagion and those which are never so propagated.
+This general result I shall only support by the authority of Dr.
+Ramsbotham, who gives, as the result of his experience, that the same
+symptoms belong to what he calls the infectious and the sporadic
+forms of the disease, and the opinion of Armstrong in his original
+Essay.  If others can show any such distinction, I leave it to them
+to do it.  But there are cases enough that show the prevalence of the
+disease among the patients of a single practitioner when it was in no
+degree epidemic, in the proper sense of the term. I may refer to
+those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as
+examples.
+
+2.  I shall not enter into any dispute about the particular mode of
+infection, whether it be by the atmosphere the physician carries
+about him into the sick-chamber, or by the direct application of the
+virus to the absorbing surfaces with which his hand comes in contact.
+Many facts and opinions are in favor of each of these modes of
+transmission.  But it is obvious that in the majority of cases it
+must be impossible to decide by which of these channels the disease
+is conveyed, from the nature of the intercourse between the physician
+and the patient.
+
+3.  It is not pretended that the contagion of puerperal fever must
+always be followed by the disease.  It is true of all contagious
+diseases, that they frequently spare those who appear to be fully
+submitted to their influence.  Even the vaccine virus, fresh from the
+subject, fails every day to produce its legitimate effect, though
+every precaution is taken to insure its action.  This is still more
+remarkably the case with scarlet fever and some other diseases.
+
+4.  It is granted that the disease may be produced and variously
+modified by many causes besides contagion, and more especially by
+epidemic and endemic influences.  But this is not peculiar to the
+disease in question.  There is no doubt that small-pox is propagated
+to a great extent by contagion, yet it goes through the same periods
+of periodical increase and diminution which have been remarked in
+puerperal fever.  If the question is asked how we are to reconcile
+the great variations in the mortality of puerperal fever in different
+seasons and places with the supposition of contagion, I will answer
+it by another question from Mr. Farr's letter to the Registrar-
+General.  He makes the statement that "five die weekly of small-pox
+in the metropolis when the disease is not epidemic,"--and adds, "The
+problem for solution is,-- Why do the five deaths become 10, 15, 20,
+31, 58, 88, weekly, and then progressively fall through the same
+measured steps?"
+
+5.  I take it for granted, that if it can be shown that great numbers
+of lives have been and are sacrificed to ignorance or blindness on
+this point, no other error of which physicians or nurses may be
+occasionally suspected will be alleged in palliation of this; but
+that whenever and wherever they can be shown to carry disease and
+death instead of health and safety, the common instincts of humanity
+will silence every attempt to explain away their responsibility.
+
+
+The treatise of Dr. Gordon of Aberdeen was published in the year
+1795, being among the earlier special works upon the disease.  Apart
+of his testimony has been occasionally copied into other works, but
+his expressions are so clear, his experience is given with such manly
+distinctness and disinterested honesty, that it may be quoted as a
+model which might have been often followed with advantage.
+
+"This disease seized such women only as were visited, or delivered by
+a practitioner, or taken care of by a nurse, who had previously
+attended patients affected with the disease."
+
+"I had evident proofs of its infectious nature, and that the
+infection was as readily communicated as that of the small-pox or
+measles, and operated more speedily than any other infection with
+which I am acquainted."
+
+"I had evident proofs that every person who had been with a patient
+in the puerperal fever became charged with an atmosphere of
+infection, which was communicated to every pregnant woman who
+happened to come within its sphere.  This is not an assertion, but a
+fact, admitting of demonstration, as may be seen by a perusal of the
+foregoing table,"--referring to a table of seventy-seven cases, in
+many of which the channel of propagation was evident.
+
+He adds, "It is a disagreeable declaration for me to mention, that I
+myself was the means of carrying the infection to a great number of
+women."  He then enumerates a number of instances in which the
+disease was conveyed by midwives and others to the neighboring
+villages, and declares that "these facts fully prove that the cause
+of the puerperal fever, of which I treat, was a specific contagion,
+or infection, altogether unconnected with a noxious constitution of
+the atmosphere."
+
+But his most terrible evidence is given in these words: "I ARRIVED AT
+THAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT
+WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT
+MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE
+ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY
+PREDICTION WAS VERIFIED."
+
+Even previously to Gordon, Mr. White of Manchester had said, "I am
+acquainted with two gentlemen in another town, where the whole
+business of midwifery is divided betwixt them, and it is very
+remarkable that one of them loses several patients every year of the
+puerperal fever, and the other never so much as meets with the
+disorder,"--a difference which he seems to attribute to their various
+modes of treatment. [On the Management of Lying-in Women, p.  120.]
+
+Dr. Armstrong has given a number of instances in his Essay on
+Puerperal Fever, of the prevalence of the disease among the patients
+of a single practitioner.  At Sunderland, "in all, forty-three cases
+occurred from the 1st of January to the 1st of October, when the
+disease ceased; and of this number forty were witnessed by Mr.
+Gregson and his assistant, Mr. Gregory, the remainder having been
+separately seen by three accoucheurs."  There is appended to the
+London edition of this Essay, a letter from Mr. Gregson, in which
+that gentleman says, in reference to the great number of cases
+occurring in his practice, "The cause of this I cannot pretend fully
+to explain, but I should be wanting in common liberality if I were to
+make any hesitation in asserting, that the disease which appeared in
+my practice was highly contagious, and communicable from one
+puerperal woman to another."  "It is customary among the lower and
+middle ranks of people to make frequent personal visits to puerperal
+women resident in the same neighborhood, and I have ample evidence
+for affirming that the infection of the disease was often carried
+about in that manner; and, however painful to my feelings, I must in
+candor declare, that it is very probable the contagion was conveyed,
+in some instances, by myself, though I took every possible care to
+prevent such a thing from happening, the moment that I ascertained
+that the distemper was infectious."  Dr. Armstrong goes on to mention
+six other instances within his knowledge, in which the disease had at
+different times and places been limited, in the same singular manner,
+to the practice of individuals, while it existed scarcely if at all
+among the patients of others around them.  Two of the gentlemen
+became so convinced of their conveying the contagion, that they
+withdrew for a time from practice.
+
+I find a brief notice, in an American Journal, of another series of
+cases, first mentioned by Mr. Davies, in the "Medical Repository."
+This gentleman stated his conviction that the disease is contagious.
+
+"In the autumn of 1822 he met with twelve cases, while his medical
+friends in the neighborhood did not meet with any, ' or at least very
+few.'  He could attribute this circumstance to no other cause than
+his having been present at the examination, after death, of two
+cases, some time previous, and of his having imparted the disease to
+his patients, notwithstanding every precaution.'"
+
+Dr. Gooch says, "It is not uncommon for the greater number of cases
+to occur in the practice of one man, whilst the other practitioners
+of the neighborhood, who are not more skilful or more busy, meet with
+few or none.  A practitioner opened the body of a woman who had died
+of puerperal fever, and continued to wear the same clothes.  A lady
+whom he delivered a few days afterwards was attacked with and died of
+a similar disease; two more of his lying-in patients, in rapid
+succession, met with the same fate; struck by the thought, that he
+might have carried contagion in his clothes, he instantly changed
+them, and met with no more cases of the kind.'  A woman in the
+country, who was employed as washerwoman and nurse, washed the linen
+of one who had died of puerperal fever; the next lying-in patient she
+nursed died of the same disease; a third nursed by her met with the
+same fate, till the neighborhood, getting afraid of her, ceased to
+employ her."
+
+In the winter of the year 1824, "Several instances occurred of its
+prevalence among the patients of particular practitioners, whilst
+others who were equally busy met with few or none.  One instance of
+this kind was very remarkable.  A general practitioner, in large
+midwifery practice, lost so many patients from puerperal fever, that
+he determined to deliver no more for some time, but that his partner
+should attend in his place.  This plan was pursued for one month,
+during which not a case of the disease occurred in their practice.
+The elder practitioner, being then sufficiently recovered, returned
+to his practice, but the first patient he attended was attacked by
+the disease and died.  A physician, who met him in consultation soon
+afterwards, about a case of a different kind, and who knew nothing of
+his misfortune, asked him whether puerperal fever was at all
+prevalent in his neighborhood, on which he burst into tears, and
+related the above circumstances.
+
+"Among the cases which I saw this season in consultation, four
+occurred in one month in the practice of one medical man, and all of
+them terminated fatally." [Lond.  Med.  Gaz.  May 2, 1835.]
+
+Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he
+had known the disease spread through a particular district, or be
+confined to the practice of a particular person, almost every patient
+being attacked with it, while others had not a single case.  It
+seemed capable, he thought, of conveyance, not only by common modes;
+but through the dress of the attendants upon the patient.
+
+In a letter to be found in the "London Medical Gazette"for January,
+1840, Mr. Roberton of Manchester makes the statement which I here
+give in a somewhat condensed form.
+
+A midwife delivered a woman on the 4th of December, 1830, who died
+soon after with the symptoms of puerperal fever.  In one month from
+this date the same midwife delivered thirty women, residing in
+different parts of an extensive suburb, of which number sixteen
+caught the disease and all died.  These were the only cases which had
+occurred for a considerable time in Manchester.  The other midwives
+connected with the same charitable institution as the woman already
+mentioned are twenty-five in number, and deliver, on an average,
+ninety women a week, or about three hundred and eighty a month.  None
+of these women had a case of puerperal fever.  "Yet all this time
+this woman was crossing the other midwives in every direction, scores
+of the patients of the charity being delivered by them in the very
+same quarters where her cases of fever were happening."
+
+Mr. Roberton remarks, that little more than half the women she
+delivered during this month took the fever; that on some days all
+escaped, on others only one or more out of three or four; a
+circumstance similar to what is seen in other infectious maladies.
+
+Dr. Blundell says, "Those who have never made the experiment can have
+but a faint conception how difficult it is to obtain the exact truth
+respecting any occurrence in which feelings and interests are
+concerned.  Omitting particulars, then, I content myself with
+remarking, generally, that from more than one district I have
+received accounts of the prevalence of puerperal fever in the
+practice of some individuals, while its occurrence in that of others,
+in the same neighborhood, was not observed.  Some, as I have been
+told, have lost ten, twelve, or a greater number of patients, in
+scarcely broken succession; like their evil genius, the puerperal
+fever has seemed to stalk behind them wherever they went.  Some have
+deemed it prudent to retire for a time from practice.  In fine, that
+this fever may occur spontaneously, I admit; that its infectious
+nature may be plausibly disputed, I do not deny; but I add,
+considerately, that in my own family I had rather that those I
+esteemed the most should be delivered, unaided, in a stable, by the
+manger-side, than that they should receive the best help, in the
+fairest apartment, but exposed to the vapors of this pitiless
+disease.  Gossiping friends, wet-nurses, monthly nurses, the
+practitioner himself, these are the channels by which, as I suspect,
+the infection is principally conveyed."
+
+At a meeting of the Royal Medical and Chirurgical Society, Dr. King
+mentioned that some years since a practitioner at Woolwich lost
+sixteen patients from puerperal fever in the same year.  He was
+compelled to give up practice for one or two years, his business
+being divided among the neighboring practitioners.  No case of
+puerperal fever occurred afterwards, neither had any of the
+neighboring surgeons any cases of this disease.
+
+At the same meeting Mr. Hutchinson mentioned the occurrence of three
+consecutive cases of puerperal fever, followed subsequently by two
+others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]
+
+Dr. Lee makes the following statement: "In the last two weeks of
+September, 1827, five fatal cases of uterine inflammation came under
+our observation.  All the individuals so attacked had been attended
+in labor by the same midwife, and no example of a febrile or
+inflammatory disease of a serious nature occurred during that period
+among the other patients of the Westminster General Dispensary, who
+had been attended by the other midwives belonging to that
+institution."
+
+The recurrence of long series of cases like those I have cited,
+reported by those most interested to disbelieve in contagion,
+scattered along through an interval of half a century, might have
+been thought sufficient to satisfy the minds of all inquirers that
+here was something more than a singular coincidence.  But if, on a
+more extended observation, it should be found that the same ominous
+groups of cases clustering about individual practitioners were
+observed in a remote country, at different times, and in widely
+separated regions, it would seem incredible that any should be found
+too prejudiced or indolent to accept the solemn truth knelled into
+their ears by the funeral bells from both sides of the ocean,--the
+plain conclusion that the physician and the disease entered, hand in
+hand, into the chamber of the unsuspecting patient.
+
+That such series of cases have been observed in this country, and in
+this neighborhood, I proceed to show.
+
+In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited
+from Dr. Hosack, in which he refers to certain puerperal cases which
+proved fatal to several lying-in women, and in some of which the
+disease was supposed to be conveyed by the accoucheurs themselves.
+
+A writer in the "New York Medical and Physical Journal" for October,
+1829, in speaking of the occurrence of puerperal fever, confined to
+one man's practice, remarks, "We have known cases of this kind occur,
+though rarely, in New York."
+
+I mention these little hints about the occurrence of such cases,
+partly because they are the first I have met with in American medical
+literature, but more especially because they serve to remind us that
+behind the fearful array of published facts there lies a dark list of
+similar events, unwritten in the records of science, but long
+remembered by many a desolated fireside.
+
+Certainly nothing can be more open and explicit than the account
+given by Dr. Peirson of Salem, of the cases seen by him.  In the
+first nineteen days of January, 1829, he had five consecutive cases
+of puerperal fever, every patient he attended being attacked, and the
+three first cases proving fatal.  In March of the same year he had
+two moderate cases, in June, another case, and in July, another,
+which proved fatal.  "Up to this period," he remarks, "I am not
+informed that a single case had occurred in the practice of any other
+physician.  Since that period I have had no fatal case in my
+practice, although I have had several dangerous cases.  I have
+attended in all twenty cases of this disease, of which four have been
+fatal.  I am not aware that there has been any other case in the town
+of distinct puerperal peritonitis, although I am willing to admit my
+information may be very defective on this point.  I have been told of
+some I 'mixed cases,' and 'morbid affections after delivery.'"
+
+In the "Quarterly Summary of the Transactions of the College of
+Physicians of Philadelphia" may be found some most extraordinary
+developments respecting a series of cases occurring in the practice
+of a member of that body.
+
+Dr. Condie called the attention of the Society to the prevalence, at
+the present time, of puerperal fever of a peculiarly insidious and
+malignant character.  "In the practice of one gentleman extensively
+engaged as an obstetrician, nearly every female he has attended in
+confinement, during several weeks past, within the above limits" (the
+southern sections and neighboring districts), "had been attacked by
+the fever."
+
+"An important query presents itself, the Doctor observed, in
+reference to the particular form of fever now prevalent.  Is it,
+namely, capable of being propagated by contagion, and is a physician
+who has been in attendance upon a case of the disease warranted in
+continuing, without interruption, his practice as an obstetrician?
+Dr. C., although not a believer in the contagious character of many
+of those affections generally supposed to be propagated in this
+manner, has nevertheless become convinced by the facts that have
+fallen under his notice, that the puerperal fever now prevailing is
+capable of being communicated by contagion.  How otherwise can be
+explained the very curious circumstance of the disease in one
+district being exclusively confined to the practice of a single
+physician, a Fellow of this College, extensively engaged in
+obstetrical practice,--while no instance of the disease has occurred
+in the patients under the care of any other accoucheur practising
+within the same district; scarcely a female that has been delivered
+for weeks past has escaped an attack?"
+
+Dr. Rutter, the practitioner referred to, "observed that, after the
+occurrence of a number of cases of the disease in his practice, he
+had left the city and remained absent for a week, but on returning,
+no article of clothing he then wore having been used by him before,
+one of the very first cases of parturition he attended was followed
+by an attack of the fever, and terminated fatally; he cannot,
+readily, therefore, believe in the transmission of the disease from
+female to female, in the person or clothes of the physician."
+
+The meeting at which these remarks were made was held on the 3d of
+May, 1842.  In a letter dated December 20, 1842, addressed to Dr.
+Meigs, and to be found in the "Medical Examiner,"  he speaks of
+"those horrible cases of puerperal fever, some of which you did me
+the favor to see with me during the past summer," and talks of his
+experience in the disease, "now numbering nearly seventy cases, all
+of which have occurred within less than a twelvemonth past."
+
+And Dr. Meigs asserts, on the same page, "Indeed, I believe that his
+practice in that department of the profession was greater than that
+of any other gentleman, which was probably the cause of his seeing a
+greater number of the cases."  This from a professor of midwifery,
+who some time ago assured a gentleman whom he met in consultation,
+that the night on which they met was the eighteenth in succession
+that he himself had been summoned from his repose, seems hardly
+satisfactory.
+
+I must call the attention of the inquirer most particularly to the
+(Quarterly Report above referred to, and the letters of Dr. Meigs and
+Dr. Rutter, to be found in the "Medical Examiner."  Whatever
+impression they may produce upon his mind, I trust they will at least
+convince him that there is some reason for looking into this
+apparently uninviting subject.
+
+At a meeting of the College of Physicians just mentioned, Dr.
+Warrington stated, that a few days after assisting at an autopsy of
+puerperal peritonitis, in which he laded out the contents of the
+abdominal cavity with his hands, he was called upon to deliver three
+women in rapid succession.  All of these women were attacked with
+different forms of what is commonly called puerperal fever.  Soon
+after these he saw two other patients, both on the same day, with the
+same disease.  Of these five patients two died.
+
+At the same meeting, Dr. West mentioned a fact related to him by Dr.
+Samuel Jackson of Northumberland.  Seven females, delivered by Dr.
+Jackson in rapid succession, while practising in Northumberland
+County, were all attacked with puerperal fever, and five of them
+died.  "Women," he said, "who had expected me to attend upon them,
+now becoming alarmed, removed out of my reach, and others sent for a
+physician residing several miles distant.  These women, as well as
+those attended by midwives; all did well; nor did we hear of any
+deaths in child-bed within a radius of fifty miles, excepting two,
+and these I afterwards ascertained to have been caused by other
+diseases."  He underwent, as he thought, a thorough purification, and
+still his next patient was attacked with the disease and died.  He
+was led to suspect that the contagion might have been carried in the
+gloves which he had worn in attendance upon the previous cases.  Two
+months or more after this he had two other cases.  He could find
+nothing to account for these, unless it were the instruments for
+giving enemata, which had been used in two of the former cases, and
+were employed by these patients.  When the first case occurred, he
+was attending and dressing a limb extensively mortified from
+erysipelas, and went immediately to the accouchement with his clothes
+and gloves most thoroughly imbued with its efluvia.  And here I may
+mention, that this very Dr. Samuel Jackson of Northumberland is one
+of Dr. Dewees's authorities against contagion.
+
+The three following statements are now for the first time given to
+the public.  All of the cases referred to occurred within this State,
+and two of the three series in Boston and its immediate vicinity.
+
+I.  The first is a series of cases which took place during the last
+spring in a town at some distance from this neighborhood.  A
+physician of that town, Dr. C., had the following consecutive cases.
+
+No.  1, delivered March 20, died March 24.
+  "  2,   "       April  9,   "  April 14.
+  "  3,   "         "   10,   "   "    14.
+  "  4,   "         "   11,   "   "    18.
+  "  5,   "         "   27,   "   May   3.
+  "  6,   "         "   28, had some symptoms,(recovered.)
+  "  7,   "        May   8, had some symptoms,(also recovered.)
+
+These were the only cases attended by this physician during the
+period referred to.  "They were all attended by him until their
+termination, with the exception of the patient No.  6, who fell into
+the hands of another physician on the 2d of May.  (Dr. C. left town
+for a few days at this time.) Dr. C.  attended cases immediately
+before and after the above-named periods, none of which, however,
+presented any peculiar symptoms of the disease.
+
+About the 1st of July he attended another patient in a neighboring
+village, who died two or three days after delivery.
+
+The first patient, it is stated, was delivered on the 20th of March.
+"On the 19th, Dr. C. made the autopsy of a man who died suddenly,
+sick only forty-eight hours; had oedema of the thigh, and gangrene
+extending from a little above the ankle into the cavity of the
+abdomen."  Dr. C. wounded himself, very slightly, in the right hand
+during the autopsy.  The hand was quite painful the night following,
+during his attendance on the patient No. 1.  He did not see this
+patient after the 20th, being confined to the house, and very sick
+from the wound just mentioned, from this time until the 3d of April.
+
+Several cases of erysipelas occurred in the house where the autopsy
+mentioned above took place, soon after the examination.  There were
+also many cases of erysipelas in town at the time of the fatal
+puerperal cases which have been mentioned.
+
+The nurse who laid out the body of the patient No. 3 was taken on the
+evening of the same day with sore throat and erysipelas, and died in
+ten days from the first attack.
+
+The nurse who laid out the body of the patient No. 4 was taken on the
+day following with symptoms like those of this patient, and died in a
+week, without any external marks of erysipelas.
+
+"No other cases of similar character with those of Dr. C. occurred in
+the practice of any of the physicians in the town or vicinity at the
+time.  Deaths following confinement have occurred in the practice of
+other physicians during the past year, but they were not cases of
+puerperal fever.  No post-mortem examinations were held in any of
+these puerperal cases."
+
+Some additional statements in this letter are deserving of insertion.
+
+"A physician attended a woman in the immediate neighborhood of the
+cases numbered 2, 3, and 4.  This patient was confined the morning of
+March 1st, and died on the night of March 7th.  It is doubtful
+whether this should be considered a case of puerperal fever.  She had
+suffered from canker, indigestion, and diarrhoea for a year previous
+to her delivery.  Her complaints were much aggravated for two or
+three months previous to delivery; she had become greatly emaciated,
+and weakened to such an extent that it had not been expected that she
+would long survive her confinement, if indeed she reached that
+period.  Her labor was easy enough; she flowed a good deal, seemed
+exceedingly prostrated, had ringing in the ears, and other symptoms
+of exhaustion; the pulse was quick and small.  On the second and
+third day there was some tenderness and tumefaction of the abdomen,
+which increased somewhat on the fourth and fifth.  He had cases in
+midwifery before and after this, which presented nothing peculiar."
+
+It is also mentioned in the same letter, that another physician had a
+case during the last summer and another last fall, both of which
+recovered.
+
+Another gentleman reports a case last December, a second case five
+weeks, and another three weeks since.  All these recovered.  A case
+also occurred very recently in the practice of a physician in the
+village where the eighth patient of Dr. C. resides, which proved
+fatal.  "This patient had some patches of erysipelas on the legs and
+arms.  The same physician has delivered three cases since, which have
+all done well.  There have been no other cases in this town or its
+vicinity recently.  There have been some few cases of erysipelas."
+It deserves notice that the partner of Dr. C., who attended the
+autopsy of the man above mentioned and took an active part in it; who
+also suffered very slightly from a prick under the thumb-nail
+received during the examination, had twelve cases of midwifery
+between March 26th and April 12th, all of which did well, and
+presented no peculiar symptoms.  It should also be stated, that
+during these seventeen days he was in attendance on all the cases of
+erysipelas in the house where the autopsy had been performed.
+
+I owe these facts to the prompt kindness of a gentleman whose
+intelligence and character are sufficient guaranty for their
+accuracy.
+
+The two following letters were addressed to my friend Dr. Scorer, by
+the gentleman in whose practice the cases of puerperal fever
+occurred.  His name renders it unnecessary to refer more particularly
+to these gentlemen, who on their part have manifested the most
+perfect freedom and courtesy in affording these accounts of their
+painful experience.
+
+
+"January 28, 1843.
+
+II.  .  .  .  "The time to which you allude was in 1830.  The first
+case was in February, during a very cold time.  She was confined the
+4th, and died the 12th.  Between the 10th and 28th of this month, I
+attended six women in labor, all of whom did well except the last, as
+also two who were confined March 1st and 5th.  Mrs. E., confined
+February 28th, sickened, and died March 8th.  The next day, 9th, I
+inspected the body, and the night after attended a lady, Mrs. B., who
+sickened, and died 16th.  The 10th, I attended another, Mrs. G., who
+sickened, but recovered.  March 16th, I went from Mrs. G.'s room to
+attend a Mrs. H., who sickened, and died 21st.  The 17th, I inspected
+Mrs. B.  On the 19th, I went directly from Mrs. H.'s room to attend
+another lady, Mrs. G., who also sickened, and died 22d.  While Mrs.
+B. was sick, on 15th, I went directly from her room a few rods, and
+attended another woman, who was not sick.  Up to 20th of this month I
+wore the same clothes.  I now refused to attend any labor, and did
+not till April 21st, when, having thoroughly cleansed myself, I
+resumed my practice, and had no more puerperal fever.
+
+"The cases were not confined to a narrow space.  The two nearest were
+half a mile from each other, and half that distance from my
+residence.  The others were from two to three miles apart, and nearly
+that distance from my residence.  There were no other cases in their
+immediate vicinity which came to my knowledge.  The general health of
+all the women was pretty good, and all the labors as good as common,
+except the first.  This woman, in consequence of my not arriving in
+season, and the child being half-born at some time before I arrived,
+was very much exposed to the cold at the time of confinement, and
+afterwards, being confined in a very open, cold room.  Of the six
+cases you perceive only one recovered.
+
+"In the winter of 1817 two of my patients had puerperal fever, one
+very badly, the other not so badly.  Both recovered.  One other had
+swelled leg, or phlegmasia dolens, and one or two others did not
+recover as well as usual.
+
+"In the summer of 1835 another disastrous period occurred in my
+practice.  July 1st, I attended a lady in labor, who was afterwards
+quite ill and feverish; but at the time I did not consider her case a
+decided puerperal fever.  On the 8th, I attended one who did well.
+On the 12th, one who was seriously sick.  This was also an equivocal
+case, apparently arising from constipation and irritation of the
+rectum.  These women were ten miles apart and five from my residence.
+On 15th and 20th, two who did well.  On 25th, I attended another.
+This was a severe labor, and followed by unequivocal puerperal fever,
+or peritonitis.  She recovered.  August 2d and 3d, in about twenty-
+four hours I attended four persons.  Two of them did very well; one
+was attacked with some of the common symptoms, which however subsided
+in a day or two, and the other had decided puerperal fever, but
+recovered.  This woman resided five miles from me.  Up to this time I
+wore the same coat.  All my other clothes had frequently been
+changed.  On 6th, I attended two women, one of whom was not sick at
+all; but the other, Mrs. L., was afterwards taken ill.  On 10th, I
+attended a lady, who did very well.  I had previously changed all my
+clothes, and had no garment on which had been in a puerperal room.
+On 12th, I was called to Mrs. S., in labor.  While she was ill, I
+left her to visit Mrs. L., one of the ladies who was confined on 6th.
+Mrs. L.  had been more unwell than usual, but I had not considered
+her case anything more than common till this visit.  I had on a
+surtout at this visit, which, on my return to Mrs.  S., I left in
+another room.  Mrs. S.  was delivered on 13th with forceps.  These
+women both died of decided puerperal fever.
+
+"While I attended these women in their fevers, I changed my clothes,
+and washed my hands in a solution of chloride of lime after each
+visit.  I attended seven women in labor during this period, all of
+whom recovered without sickness.
+
+"In my practice I have had several single cases of puerperal fever,
+some of whom have died and some have recovered.  Until the year 1830
+I had no suspicion that the disease could be communicated from one
+patient to another by a nurse or midwife; but I now think the
+foregoing facts strongly favor that idea.  I was so much convinced of
+this fact, that I adopted the plan before related.
+
+"I believe my own health was as good as usual at each of the above
+periods.  I have no recollections to the contrary.
+
+"I believe I have answered all your questions.  I have been more
+particular on some points perhaps than necessary; but I thought you
+could form your own opinion better than to take mine.  In 1830 I
+wrote to Dr. Charming a more particular statement of my cases.  If I
+have not answered your questions sufficiently, perhaps Dr. C.  may
+have my letter to him, and you can find your answer there." [In a
+letter to myself, this gentleman also stated, "I do not recollect
+that there was any erysipelas or any other disease particularly
+prevalent at the time."]
+
+
+"BOSTON, February 3, 1843.
+
+III.  "MY DEAR SIR,--I received a note from you last evening,
+requesting me to answer certain questions therein proposed, touching
+the cases of puerperal fever which came under my observation the past
+summer.  It gives me pleasure to comply with your request, so far as
+it is in my power so to do, but, owing to the hurry in preparing for
+a journey, the notes of the cases I had then taken were lost or
+mislaid.  The principal facts, however, are too vivid upon my
+recollection to be soon forgotten.  I think, therefore, that I shall
+be able to give you all the information you may require.
+
+"All the cases that occurred in my practice took place between the
+7th of May and the 17th of June 1842.
+
+"They were not confined to any particular part of the city.  The
+first two cases were patients residing at the South End, the next was
+at the extreme North End, one living in Sea Street and the other in
+Roxbury.  The following is the order in which they occurred:
+
+"Case 1.  Mrs._____  was confined on the 7th of May, at 5 o'clock,
+P. M., after a natural labor of six hours.  At 12 o'clock at night,
+on the 9th (thirty-one hours after confinement), she was taken with
+severe chill, previous to which she was as comfortable as women
+usually are under the circumstances.  She died on the 10th.
+
+"Case 2.  Mrs._____  was confined on the 10th of June (four weeks
+after Mrs.  C.), at 11 A. M., after a natural, but somewhat severe
+labor of five hours.  At 7 o'clock, on the morning of the 11th, she
+had a chill.  Died on the 12th.
+
+"Case 3.  Mrs._____ , confined on the 14th of June, was comfortable
+until the 18th, when symptoms of puerperal fever were manifest.  She
+died on the 20th.
+
+"Case 4.  Mrs._____ , confined June 17th, at 5 o'clock, A.  M., was
+doing well until the morning of the 19th.  She died on the evening of
+the 21st.
+
+"Case 5.  Mrs._____  was confined with her fifth child on the 17th of
+June, at 6 o'clock in the evening.  This patient had been attacked
+with puerperal fever, at three of her previous confinements, but the
+disease yielded to depletion and other remedies without difficulty.
+This time, I regret to say, I was not so fortunate.  She was not
+attacked, as were the other patients, with a chill, but complained of
+extreme pain in abdomen, and tenderness on pressure, almost from the
+moment of her confinement.  In this as in the other cases, the
+disease resisted all remedies, and she died in great distress on the
+22d of the same month.  Owing to the extreme heat of the season, and
+my own indisposition, none of the subjects were examined after death.
+Dr. Channing, who was in attendance with me on the three last cases,
+proposed to have a post-mortem examination of the subject of case No.
+5, but from some cause which I do not now recollect it was not
+obtained.
+
+"You wish to know whether I wore the same clothes when attending the
+different cases.  I cannot positively say, but I should think I did
+not, as the weather became warmer after the first two cases; I
+therefore think it probable that I made a change of at least a part
+of my dress.  I have had no other case of puerperal fever in my own
+practice for three years, save those above related, and I do not
+remember to have lost a patient before with this disease.  While
+absent, last July, I visited two patients sick with puerperal fever,
+with a friend of mine in the country.  Both of them recovered.
+
+"The cases that I have recorded were not confined to any particular
+constitution or temperament, but it seized upon the strong and the
+weak, the old and the young,--one being over forty years, and the
+youngest under eighteen years of age .  .  .  .  If the disease is of
+an erysipelatous nature, as many suppose, contagionists may perhaps
+find some ground for their belief in the fact, that, for two weeks
+previous to my first case of puerperal fever, I had been attending a
+severe case of erysipelas, and the infection may have been conveyed
+through me to the patient; but, on the other hand, why is not this
+the case with other physicians, or with the same physician at all
+times, for since my return from the country I have had a more
+inveterate case of erysipelas than ever before, and no difficulty
+whatever has attended any of my midwifery cases?"
+
+
+I am assured, on unquestionable authority, that "About three years
+since, a gentleman in extensive midwifery business, in a neighboring
+State, lost in the course of a few weeks eight patients in child-bed,
+seven of them being undoubted cases of puerperal fever.  No other
+physician of the town lost a single patient of this disease during
+the same period."  And from what I have heard in conversation with
+some of our most experienced practitioners, I am inclined to think
+many cases of the kind might be brought to light by extensive
+inquiry.
+
+
+This long catalogue of melancholy histories assumes a still darker
+aspect when we remember how kindly nature deals with the parturient
+female, when she is not immersed in the virulent atmosphere of an
+impure lying-in hospital, or poisoned in her chamber by the
+unsuspected breath of contagion.  From all causes together, not more
+than four deaths in a thousand births and miscarriages happened in
+England and Wales during the period embraced by the first Report of
+the Registrar-General."  In the second Report the mortality was shown
+to be about five in one thousand. In the Dublin Lying-in Hospital,
+during the seven years of Dr. Collins's mastership, there was one
+case of puerperal fever to 178 deliveries, or less than six to the
+thousand, and one death from this disease in 278 cases, or between
+three and four to the thousand a yet during this period the disease
+was endemic in the hospital, and might have gone on to rival the
+horrors of the pestilence of the Maternite, had not the poison been
+destroyed by a thorough purification.
+
+In private practice, leaving out of view the cases that are to be
+ascribed to the self-acting system of propagation, it would seem that
+the disease must be far from common.  Mr. White of Manchester says,
+"Out of the whole number of lying-in patients whom I have delivered
+(and I may safely call it a great one), I have never lost one, nor to
+the best of my recollection has one been greatly endangered, by the
+puerperal, miliary, low nervous, putrid malignant, or milk fever."
+Dr. Joseph Clarke informed Dr. Collins, that in the course of forty-
+five years' most extensive practice he lost but four patients from
+this disease.  One of the most eminent practitioners of Glasgow, who
+has been engaged in very extensive practice for upwards of a quarter
+of a century, testifies that he never saw more than twelve cases of
+real puerperal fever.[Lancet, May 4, 1833]
+
+I have myself been told by two gentlemen practising in this city, and
+having for many years a large midwifery business, that they had
+neither of them lost a patient from this disease, and by one of them
+that he had only seen it in consultation with other physicians.  In
+five hundred cases of midwifery, of which Dr. Storer has given an
+abstract in the first number of this Journal, there was only one
+instance of fatal puerperal peritonitis.
+
+In the view of these facts, it does appear a singular coincidence,
+that one man or woman should have ten, twenty, thirty, or seventy
+cases of this rare disease following his or her footsteps with the
+keenness of a beagle, through the streets and lanes of a crowded
+city, while the scores that cross the same paths on the same errands
+know it only by name.  It is a series of similar coincidences which
+has led us to consider the dagger, the musket, and certain innocent-
+looking white powders as having some little claim to be regarded as
+dangerous.  It is the practical inattention to similar coincidences
+which has given rise to the unpleasant but often necessary documents
+called indictments, which has sharpened a form of the cephalotome
+sometimes employed in the case of adults, and adjusted that
+modification of the fillet which delivers the world of those who
+happen to be too much in the way while such striking coincidences are
+taking place.
+
+I shall now mention a few instances in which the disease appears to
+have been conveyed by the process of direct inoculation.
+
+Dr. Campbell of Edinburgh states that in October, 1821, he assisted
+at the post-mortem examination of a patient who died with puerperal
+fever.  He carried the pelvic viscera in his pocket to the class-
+room.  The same evening he attended a woman in labor without
+previously changing his clothes; this patient died.  The next morning
+he delivered a woman with the forceps; she died also, and of many
+others who were seized with the disease within a few weeks, three
+shared the same fate in succession.
+
+In June, 1823, he assisted some of his pupils at the autopsy of a
+case of puerperal fever.  He was unable to wash his hands with proper
+care, for want of the necessary accommodations.  On getting home he
+found that two patients required his assistance.  He went without
+further ablution, or changing his clothes; both these patients died
+with puerperal fever.  This same Dr. Campbell is one of Dr.
+Churchill's authorities against contagion.
+
+Mr. Roberton says that in one instance within his knowledge a
+practitioner passed the catheter for a patient with puerperal fever
+late in the evening; the same night he attended a lady who had the
+symptoms of the disease on the second day.  In another instance a
+surgeon was called while in the act of inspecting the body of a woman
+who had died of this fever, to attend a labor; within forty-eight
+hours this patient was seized with the fever.'
+
+On the 16th of March, 1831, a medical practitioner examined the body
+of a woman who had died a few days after delivery, from puerperal
+peritonitis.  On the evening of the 17th he delivered a patient, who
+was seized with puerperal fever on the 19th, and died on the 24th.
+Between this period and the 6th of April, the same practitioner
+attended two other patients, both of whom were attacked with the same
+disease and died.
+
+In the autumn of 1829 a physician was present at the examination of a
+case of puerperal fever, dissected out the organs, and assisted in
+sewing up the body.  He had scarcely reached home when he was
+summoned to attend a young lady in labor.  In sixteen hours she was
+attacked with the symptoms of puerperal fever, and narrowly escaped
+with her life.
+
+In December, 1830, a midwife, who had attended two fatal cases of
+puerperal fever at the British Lying-in Hospital, examined a patient
+who had just been admitted, to ascertain if labor had commenced.
+This patient remained two days in the expectation that labor would
+come on, when she returned home and was then suddenly taken in labor
+and delivered before she could set out for the hospital.  She went on
+favorably for two days, and was then taken with puerperal fever and
+died in thirty-six hours.
+
+"A young practitioner, contrary to advice, examined the body of a
+patient who had died from puerperal fever; there was no epidemic at
+the time; the case appeared to be purely sporadic.  He delivered
+three other women shortly afterwards; they all died with puerperal
+fever, the symptoms of which broke out very soon after labor.  The
+patients of his colleague did well, except one, where he assisted to
+remove some coagula from the uterus; she was attacked in the same
+manner as those whom he had attended, and died also."  The writer in
+the "British and Foreign Medical Review," from whom I quote this
+statement,--and who is no other than Dr. Rigby, adds, "We trust that
+this fact alone will forever silence such doubts, and stamp the well-
+merited epithet of 'criminal,' as above quoted, upon such attempts."
+[Brit.  and For.  Medical Review for Jan.  1842, p.  112.]
+
+>From the cases given by Mr. Ingleby, I select the following.  Two
+gentlemen, after having been engaged in conducting the post-mortem
+examination of a case of puerperal fever, went in the same dress,
+each respectively, to a case of midwifery.  "The one patient was
+seized  with the rigor about thirty hours afterwards.  The other
+patient was seized with a rigor the third morning after delivery.
+One recovered, one died." [Edin.  Med.  and Surg.  Journal, April,
+1838.]
+
+One of these same gentlemen attended another woman in the same
+clothes two days after the autopsy referred to.  "The rigor did not
+take place until the evening of the fifth day from the first visit.
+Result fatal."  These cases belonged to a series of seven, the first
+of which was thought to have originated in a case of erysipelas.
+"Several cases of a mild character followed the foregoing seven, and
+their nature being now most unequivocal, my friend declined visiting
+all midwifery cases for a time, and there was no recurrence of the
+disease."  These cases occurred in 1833.  Five of them proved fatal.
+Mr. Ingleby gives another series of seven eases which occurred to a
+practitioner in 1836, the first of which was also attributed to his
+having opened several erysipelatous abscesses a short time
+previously.
+
+I need not refer to the case lately read before this Society, in
+which a physician went, soon after performing an autopsy of a case of
+puerperal fever, to a woman in labor, who was seized with the same
+disease and perished.  The forfeit of that error has been already
+paid.
+
+At a meeting of the Medical and Chirurgical Society before referred
+to, Dr. Merriman related an instance occurring in his own practice,
+which excites a reasonable suspicion that two lives were sacrificed
+to a still less dangerous experiment.  He was at the examination of a
+case of puerperal fever at two o'clock in the afternoon.  He took
+care not to touch the body.  At nine o'clock the same evening he
+attended a woman in labor; she was so nearly delivered that he had
+scarcely anything to do.  The next morning she had severe rigors, and
+in forty-eight hours she was a corpse.  Her infant had erysipelas and
+died in two days. [Lancet, May 2, 1840.]
+
+In connection with the facts which have been stated, it seems proper
+to allude to the dangerous and often fatal effects which have
+followed from wounds received in the post-mortem examination of
+patients who have died of puerperal fever.  The fact that such wounds
+are attended with peculiar risk has been long noticed.  I find that
+Chaussier was in the habit of cautioning his students against the
+danger to which they were exposed in these dissections. [Stein, L'Art
+d'Accoucher, 1794; Dict. des Sciences Medicales, art.  "Puerperal."]
+The head pharmacien of the Hotel Dieu, in his analysis of the fluid
+effused in puerperal peritonitis, says that practitioners are
+convinced of its deleterious qualities, and that it is very dangerous
+to apply it to the denuded skin. [Journal de Pharmacie, January,
+1836.]  Sir Benjamin Brodie speaks of it as being well known that the
+inoculation of lymph or pus from the peritoneum of a puerperal
+patient is often attended with dangerous and even fatal symptoms.
+Three cases in confirmation of this statement, two of them fatal,
+have been reported to this Society within a few months.
+
+Of about fifty cases of injuries of this kind, of various degrees of
+severity, which I have collected from different sources, at least
+twelve were instances of infection from puerperal peritonitis.  Some
+of the others are so stated as to render it probable that they may
+have been of the same nature.  Five other cases were of peritoneal
+inflammation; three in males.  Three were what was called enteritis,
+in one instance complicated with erysipelas; but it is well known
+that this term has been often used to signify inflammation of the
+peritoneum covering the intestines.  On the other hand, no case of
+typhus or typhoid fever is mentioned as giving rise to dangerous
+consequences, with the exception of the single instance of an
+undertaker mentioned by Mr. Travers, who seems to have been poisoned
+by a fluid which exuded from the body.  The other accidents were
+produced by dissection, or some other mode of contact with bodies of
+patients who had died of various affections.  They also differed much
+in severity, the cases of puerperal origin being among the most
+formidable and fatal.  Now a moment's reflection will show that the
+number of cases of serious consequences ensuing from the dissection
+of the bodies of those who had perished of puerperal fever is so
+vastly disproportioned to the relatively small number of autopsies
+made in this complaint as compared with typhus or pneumonia (from
+which last disease not one case of poisoning happened), and still
+more from all diseases put together, that the conclusion is
+irresistible that a most fearful morbid poison is often generated in
+the course of this disease.  Whether or not it is sui generis,
+confined to this disease, or produced in some others, as, for
+instance, erysipelas, I need, not stop to inquire.
+
+In connection with this may be taken the following statement of Dr.
+Rigby.  "That the discharges from a patient under puerperal fever are
+in the highest degree contagious we have abundant evidence in the
+history of lying-in hospitals.  The puerperal abscesses are also
+contagious, and may be communicated to healthy lying-in women by
+washing with the same sponge; this fact has been repeatedly proved in
+the Vienna Hospital; but they are equally communicable to women not
+pregnant; on more than one occasion the women engaged in washing the
+soiled bed-linen of the General Lying-in Hospital have been attacked
+with abscess in the fingers or hands, attended with rapidly spreading
+inflammation of the cellular tissue."
+
+Now add to all this the undisputed fact, that within the walls of
+lying-in hospitals there is often generated a miasm, palpable as the
+chlorine used to destroy it, tenacious so as in some cases almost to
+defy extirpation, deadly in some institutions as the plague; which
+has killed women in a private hospital of London so fast that they
+were buried two in one coffin to conceal its horrors; which enabled
+Tonnelle to record two hundred and twenty-two autopsies at the
+Maternite of Paris; which has led Dr. Lee to express his deliberate
+conviction that the loss of life occasioned by these institutions
+completely defeats the objects of their founders; and out of this
+train of cumulative evidence, the multiplied groups of cases
+clustering about individuals, the deadly results of autopsies, the
+inoculation by fluids from the living patient, the murderous poison
+of hospitals, -does there not result a conclusion that laughs all
+sophistry to scorn, and renders all argument an insult?
+
+I have had occasion to mention some instances in which there was an
+apparent relation between puerperal fever and erysipelas.  The length
+to which this paper has extended does not allow me to enter into the
+consideration of this most important subject.  I will only say, that
+the evidence appears to me altogether satisfactory that some most
+fatal series of puerperal fever have been produced by an infection
+originating in the matter or effluvia of erysipelas.  In evidence of
+some connection between the two diseases, I need not go back to the
+older authors, as Pouteau or Gordon, but will content myself with
+giving the following references, with their dates; from which it will
+be seen that the testimony has been constantly coming before the
+profession for the last few years.
+
+"London Cyclopaedia of Practical Medicine," article Puerperal Fever,
+1833.
+
+Mr. Ceeley's Account of the Puerperal Fever at Aylesbury.  "Lancet,"
+1835.
+
+Dr. Ramsbotham's Lecture.  "London Medical Gazette," 1835.
+
+Mr. Yates Ackerly's Letter in the same Journal, 1838.
+
+Mr. Ingleby on Epidemic Puerperal Fever.  "Edinburgh Medical and
+Surgical Journal," 1838.
+
+Mr. Paley's Letter.  "London Medical Gazette," 1839.
+
+Remarks at the Medical and Chirurgical Society. "Lancet," 1840.
+
+Dr. Rigby's "System of Midwifery."  1841.
+
+"Nunneley on Erysipelas,"--a work which contains a large number of
+references on the subject.  1841.
+
+"British and Foreign Quarterly Review," 1842.
+
+Dr. S.  Jackson of Northumberland, as already quoted from the Summary
+of the College of Physicians, 1842.
+
+And lastly, a startling series of cases by Mr. Storrs of Doncaster,
+to be, found in the "American Journal of the Medical Sciences" for
+January, 1843.
+
+The relation of puerperal fever with other continued fevers would
+seem to be remote and rarely obvious.  Hey refers to two cases of
+synochus occurring in the Royal Infirmary of Edinburgh, in women who
+had attended upon puerperal patients.  Dr. Collins refers to several
+instances in which puerperal fever has appeared to originate from a
+continued proximity to patients suffering with typhus.
+
+Such occurrences as those just mentioned, though most important to be
+remembered and guarded against, hardly attract our notice in the
+midst of the gloomy facts by which they are surrounded.  Of these
+facts, at the risk of fatiguing repetitions, I have summoned a
+sufficient number, as I believe, to convince the most incredulous
+that every attempt to disguise the truth which underlies them all is
+useless.
+
+It is true that some of the historians of the disease, especially
+Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque,
+in France, profess not to have found puerperal fever contagious.  At
+the most they give us mere negative facts, worthless against an
+extent of evidence which now overlaps the widest range of doubt, and
+doubles upon itself in the redundancy of superfluous demonstration.
+Examined in detail, this and much of the show of testimony brought up
+to stare the daylight of conviction out of countenance, proves to be
+in a great measure unmeaning and inapplicable, as might be easily
+shown were it necessary.  Nor do I feel the necessity of enforcing
+the conclusion which arises spontaneously from the facts which have
+been enumerated, by formally citing the opinions of those grave
+authorities who have for the last half-century been sounding the
+unwelcome truth it has cost so many lives to establish.
+
+"It is to the British practitioner," says Dr. Rigby, "that we are
+indebted for strongly insisting upon this important and dangerous
+character of puerperal fever."
+
+The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
+Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
+Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson,
+many of whose writings I have already referred to, may have some
+influence with those who prefer the weight of authorities to the
+simple deductions of their own reason from the facts laid before
+them.  A few Continental writers have adopted similar conclusions. It
+gives me pleasure to remember, that while the doctrine has been
+unceremoniously discredited in one of the leading Journals, and made
+very light of by teachers in two of the principal Medical Schools, of
+this country, Dr. Channing has for many years inculcated, and
+enforced by examples, the danger to be apprehended and the
+precautions to be taken in the disease under consideration.
+
+I have no wish to express any harsh feeling with regard to the
+painful subject which has come before us.  If there are any so far
+excited by the story of these dreadful events that they ask for some
+word of indignant remonstrance to show that science does not turn the
+hearts of its followers into ice or stone, let me remind them that
+such words have been uttered by those who speak with an authority I
+could not claim.  It is as a lesson rather than as a reproach that I
+call up the memory of these irreparable errors and wrongs.  No tongue
+can tell the heart-breaking calamity they have caused; they have
+closed the eyes just opened upon a new world of love and happiness;
+they have bowed the strength of manhood into the dust; they have cast
+the helplessness of infancy into the stranger's arms, or bequeathed
+it, with less cruelty, the death of its dying parent.  There is no
+tone deep enough for regret, and no voice loud enough for warning.
+The woman about to become a mother, or with her new-born infant upon
+her bosom, should be the object of trembling care and sympathy
+wherever she bears her tender burden, or stretches her aching limbs.
+The very outcast of the streets has pity upon her sister in
+degradation, when the seal of promised maternity is impressed upon
+her.  The remorseless vengeance of the law, brought down upon its
+victim by a machinery as sure as destiny, is arrested in its fall at
+a word which reveals her transient claim for mercy.  The solemn
+prayer of the liturgy singles out her sorrows from the multiplied
+trials of life, to plead for her in the hour of peril.  God forbid
+that any member of the profession to which she trusts her life,
+doubly precious at that eventful period, should hazard it
+negligently, unadvisedly, or selfishly!
+
+There may be some among those whom I address who are disposed to ask
+the question, What course are we to follow in relation to this
+matter?  The facts are before them, and the answer must be left to
+their own judgment and conscience.  If any should care to know my own
+conclusions, they are the following; and in taking the liberty to
+state them very freely and broadly, I would ask the inquirer to
+examine them as freely in the light of the evidence which has been
+laid before him.
+
+1.  A physician holding himself in readiness to attend cases of
+midwifery should never take any active part in the post-mortem
+examination of cases of puerperal fever.
+
+2.  If a physician is present at such autopsies, he should use
+thorough ablution, change every article of dress, and allow twenty-
+four hours or more to elapse before attending to any case of
+midwifery.  It may be well to extend the same caution to cases of
+simple peritonitis.
+
+3.  Similar precautions should be taken after the autopsy or surgical
+treatment of cases of erysipelas, if the physician is obliged to
+unite such offices with his obstetrical duties, which is in the
+highest degree inexpedient.
+
+4.  On the occurrence of a single case of puerperal fever in his
+practice, the physician is bound to consider the next female he
+attends in labor, unless some weeks at least have elapsed, as in
+danger of being infected by him, and it is his duty to take every
+precaution to diminish her risk of disease and death.
+
+5.  If within a short period two cases of puerperal fever happen
+close to each other, in the practice of the same physician, the
+disease not existing or prevailing in the neighborhood, he would do
+wisely to relinquish his obstetrical practice for at least one month,
+and endeavor to free himself by every available means from any
+noxious influence he may carry about with him.
+
+6.  The occurrence of three or more closely connected cases, in the
+practice of one individual, no others existing in the neighborhood,
+and no other sufficient cause being alleged for the coincidence, is
+prima facie evidence that he is the vehicle of contagion.
+
+7.  It is the duty of the physician to take every precaution that the
+disease shall not be introduced by nurses or other assistants, by
+making proper inquiries concerning them, and giving timely warning of
+every suspected source of danger.
+
+8.  Whatever indulgence may be granted to those who have heretofore
+been the ignorant causes of so much misery, the time has come when
+the existence of a private pestilence in the sphere of a single
+physician should be looked upon, not as a misfortune, but a crime;
+and in the knowledge of such occurrences the duties of the
+practitioner to his profession should give way to his paramount
+obligations to society.
+
+
+ADDITIONAL REFERENCES AND CASES.
+
+Fifth Annual Report of the Registrar-General of England,
+
+1843.  Appendix.  Letter from William Farr, Esq. --Several new series
+of cases are given in the Letter of Mr. Stows, contained in the
+Appendix to this Report.  Mr. Stows suggests precautions similar to
+those I have laid down, and these precautions are strongly enforced
+by Mr. Farr, who is, therefore, obnoxious to the same criticisms as
+myself.
+
+Hall and Dexter, in Am.  Journal of Med.  Sc.  for January, 1844.-
+Cases of puerperal fever seeming to originate in erysipelas.
+
+Elkington, of Birmingham, in Provincial Med.  Journal, cited in Am.
+Journ.  Med.  Se.  for April, 1844.--Six cases in less than a
+fortnight, seeming to originate in a case of erysipelas.
+
+West's Reports, in Brit.  and For.  Med.  Review for October, 1845,
+and January, 1847.--Affection of the arm, resembling malignant
+pustule, after removing the placenta of a patient who died from
+puerperal fever.  Reference to cases at Wurzburg, as proving
+contagion, and to Keiller's cases in the Monthly Journal for
+February, 1846, as showing connection of puerperal fever and
+erysipelas.
+
+Kneeland. --Contagiousness of Puerperal Fever.  Am.  Jour.  Med.
+Se., January, 1846.  Also, Connection between Puerperal Fever and
+Epidemic Erysipelas.  Ibid., April, 1846.
+
+Robert Storrs. --Contagious Effects of Puerperal Fever on the Male
+Subject; or on Persons not Child-bearing.  (From Provincial Med.  and
+Surg.  Journal.) Am.  Jour.  Med.  Sc., January, 184,6.  Numerous
+cases.  See also Dr. Reid's case in same Journal for April, 1846.
+
+Routh's paper in Proc.  of Royal Med.  Chir.  Soc., Am.  Jour.  Med.
+Sc., April, 1849, also in B.  and F.  Med.  Chir.  Review, April,
+1850.
+
+Hill, of Leuchars. --A Series of Cases illustrating the Contagious
+Nature of Erysipelas and of Puerperal Fever, and their Intimate
+Pathological Connection.  (From Monthly Journal of Med.  Sc.) Am.
+Jour.  Med.  Se., July, 1850.
+
+Skoda on the Causes of Puerperal Fever.  (Peritonitis in rabbits,
+from inoculation with different morbid secretions.) Am.  Jour.  Med.
+Se., October, 1850.
+
+Arneth.  Paper read before the National Academy of Medicine.  Annales
+d'Hygiene, Tome LXV.  2e Partie.  (Means of Disinfection proposed by
+M.  "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use
+of nail-brush before admission to lying-in wards.  Alleged sudden and
+great decrease of mortality from puerperal fever.  Cause of disease
+attributed to inoculation with cadaveric matters.) See also Routh's
+paper, mentioned above.
+
+Moir.  Remarks at a meeting of the Edinburgh Medico-Chirurgical
+Society.  Refers to cases of Dr. Kellie, of Leith.  Sixteen in
+succession, all fatal.  Also to several instances of individual
+pupils having had a succession of cases in various quarters of the
+town, while others, practising as extensively in the same localities,
+had none.  Also to several special cases not mentioned elsewhere.
+Am.  Jour.  Med.  Se.  for October, 1851.  (From New Monthly Journal
+of Med.  Science.)
+
+Simpson. --Observations at a Meeting of the Edinburgh Obstetrical
+Society.  (An "eminent gentleman," according to Dr.  Meigs, whose
+"name is as well known in America as in (his) native land."
+Obstetrics.  Phil.  1852, pp.  368, 375.) The student is referred to
+this paper for a valuable resume of many of the facts, and the
+necessary inferences, relating to this subject.  Also for another
+series of cases, Mr. Sidey's, five or six in rapid succession.
+Dr. Simpson attended the dissection of two of Dr. Sidey's cases, and
+freely handled the diseased parts.  His next four child-bed patients
+were affected with puerperal fever, and it was the first time he had
+seen it in practice.  As Dr. Simpson is a gentleman (Dr. Meigs, as
+above), and as "a gentleman's hands are clean " (Dr. Meigs' Sixth
+Letter), it follows that a gentleman with clean hands may carry the
+disease.  Am.  Jour.  Med.  Sc., October, 1851.
+
+Peddle. --The five or six cases of Dr. Sidey, followed by the four of
+Dr. Simpson, did not end the series.  A practitioner in Leith having
+examined in Dr. Simpson's house, a portion of the uterus obtained
+from one of the patients, had immediately afterwards three fatal
+cases of puerperal fever.  Dr.  Veddie referred to two distinct
+series of consecutive cases in his own practice.  He had since taken
+precautions, and not met with any such cases.  Am.  Jour.  Med.  Sc.,
+October, 1851.
+
+Copland.  Considers it proved that puerperal fever maybe propagated
+by the hands and the clothes, or either, of a third person, the bed-
+clothes or body-clothes of a patient.  Mentions a new series of
+cases, one of which he saw, with the practitioner who had attended
+them.  She was the sixth he had had within a few days.  All died.
+Dr. Copland insisted that contagion had caused these cases; advised
+precautionary measures, and the practitioner had no other cases for a
+considerable time.  Considers it criminal, after the evidence
+adduced,--which he could have quadrupled,--and the weight of
+authority brought forward, for a practitioner to be the medium of
+transmitting contagion and death to his patients.  Dr. Copland lays
+down rules similar to those suggested by myself, and is therefore
+entitled to the same epithet for so doing.  Medical Dictionary, New
+York, 1852.  Article, Puerperal States and Diseases.
+
+If there is any appetite for facts so craving as to be yet
+unappeased,--Lesotho, necdum satiata,--more can be obtained.
+Dr.  Hodge remarks that "the frequency and importance of this
+singular circumstance (that the disease is occasionally more
+prevalent with one practitioner than another) has been exceedingly
+overrated."  More than thirty strings of cases, more than two hundred
+and fifty sufferers from puerperal fever, more than one hundred and
+thirty deaths appear as the results of a sparing estimate of such
+among the facts I have gleaned as could be numerically valued.  These
+facts constitute, we may take it for granted, but a small fraction of
+those that have actually occurred.  The number of them might be
+greater, but "'t is enough, 't will serve," in Mercutio's modest
+phrase, so far as frequency is concerned.  For a just estimate of the
+importance of the singular circumstance, it might be proper to
+consult the languid survivors, the widowed husbands, and the
+motherless children, as well as "the unfortunate accoucheur."
+
+
+
+
+
+
+III
+
+CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+An Address delivered before the Massachusetts Medical Society, at the
+Annual Meeting, May 30, 1860.
+
+               "Facultate magis quam violentia.
+                                   HIPPOCRATES.
+
+Our Annual Meeting never fails to teach us at least one lesson.  The
+art whose province it is to heal and to save cannot protect its own
+ranks from the inroads of disease and the waste of the Destroyer.
+
+Seventeen of our associates have been taken from us since our last
+Anniversary.  Most of them followed their calling in the villages or
+towns that lie among the hills or along the inland streams.  Only
+those who have lived the kindly, mutually dependent life of the
+country, can tell how near the physician who is the main reliance in
+sickness of all the families throughout a thinly settled region comes
+to the hearts of the people among whom he labors, how they value him
+while living, how they cherish his memory when dead.  For these
+friends of ours who have gone before, there is now no more toil; they
+start from their slumbers no more at the cry of pain; they sally
+forth no more into the storms; they ride no longer over the lonely
+roads that knew them so well; their wheels are rusting on their axles
+or rolling with other burdens; their watchful eyes are closed to all
+the sorrows they lived to soothe.  Not one of these was famous in the
+great world; some were almost unknown beyond their own immediate
+circle.  But they have left behind them that loving remembrance which
+is better than fame, and if their epitaphs are chiselled briefly in
+stone, they are written at full length on living tablets in a
+thousand homes to which they carried their ever-welcome aid and
+sympathy.
+
+One whom we have lost, very widely known and honored, was a leading
+practitioner of this city.  His image can hardly be dimmed in your
+recollection, as he stood before you only three years ago, filling
+the same place with which I am now honored.  To speak of him at all
+worthily, would be to write the history of professional success, won
+without special aid at starting, by toil, patience, good sense, pure
+character, and pleasing manners; won in a straight uphill ascent,
+without one breathing-space until he sat down, not to rest, but to
+die.  If prayers could have shielded him from the stroke, if love
+could have drawn forth the weapon, and skill could have healed the
+wound, this passing tribute might have been left to other lips and to
+another generation.
+
+Let us hope that our dead have at last found that rest which neither
+summer nor winter, nor day nor night, had granted to their unending
+earthly labors!  And let us remember that our duties to our brethren
+do not cease when they become unable to share our toils, or leave
+behind them in want and woe those whom their labor had supported.  It
+is honorable to the Profession that it has organized an Association a
+for the relief of its suffering members and their families; it owes
+this tribute to the ill-rewarded industry and sacrifices of its less
+fortunate brothers who wear out health and life in the service of
+humanity.  I have great pleasure in referring to this excellent
+movement, which gives our liberal profession a chance to show its
+liberality, and serves to unite us all, the successful and those whom
+fortune has cast down, in the bonds of a true brotherhood.
+
+A medical man, as he goes about his daily business after twenty years
+of practice, is apt to suppose that he treats his patients according
+to the teachings of his experience.  No doubt this is true to some
+extent; to what extent depending much on the qualities of the
+individual.  But it is easy to prove that the prescriptions of even
+wise physicians are very commonly founded on something quite
+different from experience.  Experience must be based on the permanent
+facts of nature.  But a glance at the prevalent modes of treatment of
+any two successive generations will show that there is a changeable
+as well as a permanent element in the art of healing; not merely
+changeable as diseases vary, or as new remedies are introduced, but
+changeable by the going out of fashion of special remedies, by the
+decadence of a popular theory from which their fitness was deduced,
+or other cause not more significant.  There is no reason to suppose
+that the present time is essentially different in this respect from
+any other.  Much, therefore, which is now very commonly considered to
+be the result of experience, will be recognized in the next, or in
+some succeeding generation, as no such result at all, but as a
+foregone conclusion, based on some prevalent belief or fashion of the
+time.
+
+There are, of course, in every calling, those who go about the work
+of the day before them, doing it according to the rules of their
+craft, and asking no questions of the past or of the future, or of
+the aim and end to which their special labor is contributing.  These
+often consider and call themselves practical men.  They pull the oars
+of society, and have no leisure to watch the currents running this or
+that way; let theorists and philosophers attend to them.  In the mean
+time, however, these currents are carrying the practical men, too,
+and all their work may be thrown away, and worse than thrown away, if
+they do not take knowledge of them and get out of the wrong ones and
+into the right ones as soon as they may.  Sir Edward Parry and his
+party were going straight towards the pole in one of their arctic
+expeditions, travelling at the rate of ten miles a day.  But the ice
+over which they travelled was drifting straight towards the equator,
+at the rate of twelve miles a day, and yet no man among them would
+have known that he was travelling two miles a day backward unless he
+had lifted his eyes from the track in which he was plodding.  It is
+not only going backward that the plain practical workman is liable
+to, if he will not look up and look around; he may go forward to ends
+he little dreams of.  It is a simple business for a mason to build up
+a niche in a wall; but what if, a hundred years afterwards when the
+wall is torn down, the skeleton of a murdered man drop out of the
+niche?  It was a plain practical piece of carpentry for a Jewish
+artisan to fit two pieces of timber together according to the legal
+pattern in the time of Pontius Pilate; he asked no questions,
+perhaps, but we know what burden the cross bore on the morrow!  And
+so, with subtler tools than trowels or axes, the statesman who works
+in policy without principle, the theologian who works in forms
+without a soul, the physician who, calling himself a practical man,
+refuses to recognize the larger laws which govern his changing
+practice, may all find that they have been building truth into the
+wall, and hanging humanity upon the cross.
+
+The truth is, that medicine, professedly founded on observation, is
+as sensitive to outside influences, political, religious,
+philosophical, imaginative, as is the barometer to the changes of
+atmospheric density.  Theoretically it ought to go on its own
+straightforward inductive path, without regard to changes of
+government or to fluctuations of public opinion.  But look a moment
+while I clash a few facts together, and see if some sparks do not
+reveal by their light a closer relation between the Medical Sciences
+and the conditions of Society and the general thought of the time,
+than would at first be suspected.
+
+Observe the coincidences between certain great political and
+intellectual periods and the appearance of illustrious medical
+reformers and teachers.  It was in the age of Pericles, of Socrates,
+of Plato, of Phidias, that Hippocrates gave to medical knowledge the
+form which it retained for twenty centuries.  With the world-
+conquering Alexander, the world-embracing Aristotle, appropriating
+anatomy and physiology, among his manifold spoils of study, marched
+abreast of his royal pupil to wider conquests.  Under the same
+Ptolemies who founded the Alexandrian Library and Museum, and ordered
+the Septuagint version of the Hebrew Scriptures, the infallible
+Herophilus ["Contradicere Herophilo in anatomicis, est contradicere
+evangelium," was a saying of Fallopius.] made those six hundred
+dissections of which Tertullian accused him, and the sagacious
+Erasistratus introduced his mild antiphlogistic treatment in
+opposition to the polypharmacy and antidotal practice of his time.
+It is significant that the large-minded Galen should have been the
+physician and friend of the imperial philosopher Marcus Aurelius.
+The Arabs gave laws in various branches of knowledge to those whom
+their arms had invaded, or the terror of their spreading dominion had
+reached, and the point from which they started was, as Humboldt
+acknowledges, "the study of medicine, by which they long ruled the
+Christian Schools," and to which they added the department of
+chemical pharmacy.
+
+Look at Vesalius, the contemporary of Luther.  Who can fail to see
+one common spirit in the radical ecclesiastic and the reforming
+court-physician?  Both still to some extent under the dominion of the
+letter: Luther holding to the real presence; Vesalius actually
+causing to be drawn and engraved two muscles which he knew were not
+found in the human subject, because they had been described by Galen,
+from dissections of the lower animals.  Both breaking through old
+traditions in the search of truth; one, knife in hand, at the risk of
+life and reputation, the other at the risk of fire and fagot, with
+that mightier weapon which all the devils could not silence, though
+they had been thicker than the tiles on the house-tops.  How much the
+physician of the Catholic Charles V. had in common with the great
+religious destructive, may be guessed by the relish with which he
+tells the story how certain Pavian students exhumed the body of an
+"elegans scortum," or lovely dame of ill repute, the favorite of a
+monk of the order of St. Anthony, who does not seem to have resisted
+temptation so well as the founder of his order.  We have always
+ranked the physician Rabelais among the early reformers, but I do not
+know that Vesalius has ever been thanked for his hit at the morals of
+the religious orders, or for turning to the good of science what was
+intended for the "benefit of clergy."
+
+Our unfortunate medical brother, Michael Servetus, the spiritual
+patient to whom the theological moxa was applied over the entire
+surface for the cure of his heresy, came very near anticipating
+Harvey.  The same quickened thought of the time which led him to
+dispute the dogma of the Church, opened his mind to the facts which
+contradicted the dogmas of the Faculty.
+
+Harvey himself was but the posthumous child of the great Elizabethan
+period.  Bacon was at once his teacher and his patient.  The founder
+of the new inductive philosophy had only been dead two years when the
+treatise on the Circulation, the first-fruit of the Restoration of
+Science, was given to the world.
+
+And is it to be looked at as a mere accidental coincidence, that
+while Napoleon was modernizing the political world, Bichat was
+revolutionizing the science of life and the art that is based upon
+it; that while the young general was scaling the Alps, the young
+surgeon was climbing the steeper summits of unexplored nature; that
+the same year read the announcement of those admirable "Researches on
+Life and Death," and the bulletins of the battle of Marengo?
+
+If we come to our own country, who can fail to recognize that
+Benjamin Rush, the most conspicuous of American physicians, was the
+intellectual offspring of the movement which produced the Revolution?
+"The same hand," says one of his biographers," which subscribed the
+declaration of the political independence of these States,
+accomplished their emancipation from medical systems formed in
+foreign countries, and wholly unsuitable to the state of diseases in
+America."
+
+Following this general course of remark, I propose to indicate in a
+few words the direction of the main intellectual current of the time,
+and to point out more particularly some of the eddies which tend to
+keep the science and art of medicine from moving with it, or even to
+carry them backwards.
+
+The two dominant words of our time are law and average, both pointing
+to the uniformity of the order of being in which we live.  Statistics
+have tabulated everything,--population, growth, wealth, crime,
+disease.  We have shaded maps showing the geographical distribution
+of larceny and suicide.  Analysis and classification have been at
+work upon all tangible and visible objects.  The Positive Philosophy
+of Comte has only given expression to the observing and computing
+mind of the nineteenth century.
+
+In the mean time, the great stronghold of intellectual conservatism,
+traditional belief, has been assailed by facts which would have been
+indicted as blasphemy but a few generations ago.  Those new tables of
+the law, placed in the hands of the geologist by the same living God
+who spoke from Sinai to the Israelites of old, have remodelled the
+beliefs of half the civilized world.  The solemn scepticism of
+science has replaced the sneering doubts of witty philosophers.  The
+more positive knowledge we gain, the more we incline to question all
+that has been received without absolute proof.
+
+As a matter of course, this movement has its partial reactions.  The
+province of faith is claimed as a port free of entry to unsupported
+individual convictions.  The tendency to question is met by the
+unanalyzing instinct of reverence.  The old church calls back its
+frightened truants.  Some who have lost their hereditary religious
+belief find a resource in the revelations of Spiritualism.  By a
+parallel movement, some of those who have become medical infidels
+pass over to the mystic band of believers in the fancied miracles of
+Homoeopathy.
+
+Under these influences transmitted to, or at least shared by, the
+medical profession, the old question between "Nature," so called, and
+"Art," or professional tradition, has reappeared with new interest.
+I say the old question, for Hippocrates stated the case on the side
+of "Nature" more than two thousand years ago.  Miss Florence
+Nightingale,--and if I name her next to the august Father of the
+Healing Art, its noblest daughter well deserves that place of honor,
+--Miss Florence Nightingale begins her late volume with a paraphrase
+of his statement.  But from a very early time to this there has
+always been a strong party against "Nature."  Themison called the
+practice of Hippocrates "a meditation upon death."  Dr. Rush says:
+"It is impossible to calculate the mischief which Hippocrates, has
+done, by first marking Nature with his name and afterwards letting
+her loose upon sick people.  Millions have perished by her hands in
+all ages and countries."  Sir John Forbes, whose defence of "Nature"
+in disease you all know, and to the testimonial in whose honor four
+of your Presidents have contributed, has been recently greeted, on
+retiring from the profession, with a wish that his retirement had
+been twenty years sooner, and the opinion that no man had done so
+much to destroy the confidence of the public in the medical
+profession.
+
+In this Society we have had the Hippocratic and the Themisonic side
+fairly represented.  The treatise of one of your early Presidents on
+the Mercurial Treatment is familiar to my older listeners.  Others
+who have held the same office have been noted for the boldness of
+their practice, and even for partiality to the use of complex
+medication.
+
+On the side of "Nature" we have had, first of all, that remarkable
+discourse on Self-Limited Diseases, [On Self-Limited Diseases.  A
+Discourse delivered before the Massachusetts Medical Society, at
+their Annual Meeting, May 27, 1835.  By Jacob Bigelow, M. D.] which
+has given the key-note to the prevailing medical tendency of this
+neighborhood, at least, for the quarter of a century since it was
+delivered.  Nor have we forgotten the address delivered at
+Springfield twenty years later, [Search out the Secrets, of Nature.
+By Augustus A.  Gould, M.  D.  Read at the Annual Meeting, June 27,
+1855.] full of good sense and useful suggestions, to one of which
+suggestions we owe the learned, impartial, judicious, well-written
+Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics.  A
+Prize Essay.  By Worthington Hooker, M.  D., of New Haven.  Boston.
+1857.] We should not omit from the list the important address of
+another of our colleagues, [On the Treatment of Compound and
+Complicated Fractures. By William J.  Walker, M.  D.  Read at the
+Annual Meeting, May 29, 1845.] showing by numerous cases the power of
+Nature in healing compound fractures to be much greater than is
+frequently supposed,--affording, indeed, more striking illustrations
+than can be obtained from the history of visceral disease, of the
+supreme wisdom, forethought, and adaptive dexterity of that divine
+Architect, as shown in repairing the shattered columns which support
+the living temple of the body.
+
+We who are on the side of "Nature" please ourselves with the idea
+that we are in the great current in which the true intelligence of
+the time is moving.  We believe that some who oppose, or fear, or
+denounce our movement are themselves caught in various eddies that
+set back against the truth.  And we do most earnestly desire and most
+actively strive, that Medicine, which, it is painful to remember, has
+been spoken of as "the withered branch of science" at a meeting of
+the British Association, shall be at length brought fully to share,
+if not to lead, the great wave of knowledge which rolls with the
+tides that circle the globe.
+
+If there is any State or city which might claim to be the American
+headquarters of the nature-trusting heresy, provided it be one, that
+State is Massachusetts, and that city is its capital.  The effect
+which these doctrines have upon the confidence reposed in the
+profession is a matter of opinion.  For myself, I do not believe this
+confidence can be impaired by any investigations which tend to limit
+the application of troublesome, painful, uncertain, or dangerous
+remedies.  Nay, I will venture to say this, that if every specific
+were to fail utterly, if the cinchona trees all died out, and the
+arsenic mines were exhausted, and the sulphur regions were burned up,
+if every drug from the vegetable, animal, and mineral kingdom were to
+disappear from the market, a body of enlightened men, organized as a
+distinct profession, would be required just as much as now, and
+respected and trusted as now, whose province should be to guard
+against the causes of disease, to eliminate them if possible when
+still present, to order all the conditions of the patient so as to
+favor the efforts of the system to right itself, and to give those
+predictions of the course of disease which only experience can
+warrant, and which in so many cases relieve the exaggerated fears of
+sufferers and their friends, or warn them in season of impending
+danger.  Great as the loss would be if certain active remedies could
+no longer be obtained, it would leave the medical profession the most
+essential part of it's duties, and all, and more than all, its
+present share of honors; for it would be the death-blow to
+charlatanism, which depends for its success almost entirely on drugs,
+or at least on a nomenclature that suggests them.
+
+There is no offence, then, or danger in expressing the opinion, that,
+after all which has been said, the community is still overdosed: The
+best proof of it is, that no families take so little medicine as
+those of doctors, except those of apothecaries, and that old
+practitioners are more sparing of active medicines than younger
+ones." [Dr. James Jackson has kindly permitted me to make the
+following extract from a letter just received by him from Sir James
+Clark, and dated May 26, 1860:  "As a physician advances in age, he
+generally, I think, places less confidence in the ordinary medical
+treatment than he did, not only during his early, but even his middle
+period of life."]  The conclusion from these facts is one which the
+least promising of Dr. Howe's pupils in the mental department could
+hardly help drawing.
+
+Part of the blame of over-medication must, I fear, rest with the
+profession, for yielding to the tendency to self-delusion, which
+seems inseparable from the practice of the art of healing.  I need
+only touch on the common modes of misunderstanding or misapplying the
+evidence of nature.
+
+First, there is the natural incapacity for sound observation, which
+is like a faulty ear in music.  We see this in many persons who know
+a good deal about books, but who are not sharp-sighted enough to buy
+a horse or deal with human diseases.
+
+Secondly, there is in some persons a singular inability to weigh the
+value of testimony; of which, I think, from a pretty careful
+examination of his books, Hahnemann affords the best specimen outside
+the walls of Bedlam.
+
+The inveterate logical errors to which physicians have always been
+subject are chiefly these:
+
+The mode of inference per enumerationem simplicem, in scholastic
+phrase; that is, counting only their favorable cases.  This is the
+old trick illustrated in Lord Bacon's story of the gifts of the
+shipwrecked people, hung up in the temple. --Behold! they vowed these
+gifts to the altar, and the gods saved them.  Ay, said a doubting
+bystander, but how many made vows of gifts and were shipwrecked
+notwithstanding?  The numerical system is the best corrective of this
+and similar errors.  The arguments commonly brought against its
+application to all matters of medical observation, treatment
+included, seem to apply rather to the tabulation of facts ill
+observed, or improperly classified, than to the method itself.
+
+The post hoc ergo propter hoc error: he got well after taking my
+medicine; therefore in consequence of taking it.
+
+The false induction from genuine facts of observation, leading to the
+construction of theories which are then deductively applied in the
+face of the results of direct observation.  The school of Broussais
+has furnished us with a good example of this error.
+
+And lastly, the error which Sir Thomas Browne calls giving "a reason
+of the golden tooth;" that is, assuming a falsehood as a fact, and
+giving reasons for it, commonly fanciful ones, as is constantly done
+by that class of incompetent observers who find their "golden tooth"
+in the fabulous effects of the homoeopathie materia medica,--which
+consists of sugar of milk and a nomenclature.
+
+Another portion of the blame rests with the public itself, which
+insists on being poisoned.  Somebody buys all the quack medicines
+that build palaces for the mushroom, say rather, the toadstool
+millionaires.  Who is it?  These people have a constituency of
+millions.  The popular belief is all but universal that sick persons
+should feed on noxious substances.  One of our members was called not
+long since to a man with a terribly sore mouth.  On inquiry he found
+that the man had picked up a box of unknown pills, in Howard Street,
+and had proceeded to take them, on general principles, pills being
+good for people.  They happened to contain mercury, and hence the
+trouble for which he consulted our associate.
+
+The outside pressure, therefore, is immense upon the physician,
+tending to force him to active treatment of some kind.  Certain old
+superstitions, still lingering in the mind of the public, and not yet
+utterly expelled from that of the profession, are at the bottom of
+this, or contribute to it largely.  One of the most ancient is, that
+disease is a malignant agency, or entity, to be driven out of the
+body by offensive substances, as the smoke of the fish's heart and
+liver drove the devil out of Tobit's bridal chamber, according to the
+Apochrypha.  Epileptics used to suck the blood from the wounds of
+dying gladiators. [Plinii Hist.  Mundi.  lib.  xxviii.  c.  4.] The
+Hon. Robert Boyle's little book was published some twenty or thirty
+years before our late President, Dr. Holyoke, was born. [A Collection
+of Choice and Safe Remedies.  The Fifth Edition, corrected.  London,
+1712.  Dr. Holyoke was born in 1728.] In it he recommends, as
+internal medicines, most of the substances commonly used as
+fertilizers of the soil.  His "Album Graecum" is best left
+untranslated, and his "Zebethum Occidentale" is still more
+transcendentally unmentionable except in a strange dialect.  It
+sounds odiously to us to hear him recommend for dysentery a powder
+made from "the sole of an old shoe worn by some man that walks much."
+Perhaps nobody here ever heard of tying a stocking, which had been
+worn during the day, round the neck at night for a sore throat.  The
+same idea of virtue in unlovely secretions! [The idea is very
+ancient.  "Sordes hominis" "Sudore et oleo medicinam facientibus."
+--Plin.  xxviii.  4.]
+
+Even now the Homoeopathists have been introducing the venom of
+serpents, under the learned title of Lachesis, and outraging human
+nature with infusions of the pediculus capitis; that is, of course,
+as we understand their dilutions, the names of these things; for if a
+fine-tooth-comb insect were drowned in Lake Superior, we cannot agree
+with them in thinking that every drop of its waters would be
+impregnated with all the pedicular virtues they so highly value.
+They know what they are doing.  They are appealing to the detestable
+old superstitious presumption in favor of whatever is nauseous and
+noxious as being good for the sick.
+
+Again, we all occasionally meet persons stained with nitrate of
+silver, given for epilepsy.  Read what Dr. Martin says, about the way
+in which it came to be used, in his excellent address before the
+Norfolk County Medical Society, and the evidence I can show, but have
+not time for now, and then say what you think of the practice which
+on such presumptions turns a white man as blue as the double-tattooed
+King of the Cannibal Islands!  [Note A.]
+
+If medical superstitions have fought their way down through all the
+rationalism and scepticism of the nineteenth century, of course the
+theories of the schools, supported by great names, adopted into the
+popular belief and incorporated with the general mass of
+misapprehension with reference to disease, must be expected to meet
+us at every turn in the shape of bad practice founded on false
+doctrine.  A French patient complains that his blood heats him, and
+expects his doctor to bleed him.  An English or American one says he
+is bilious, and will not be easy without a dose of calomel.  A doctor
+looks at a patient's tongue, sees it coated, and says the stomach is
+foul; his head full of the old saburral notion which the extreme
+inflammation-doctrine of Broussais did so much to root out, but which
+still leads, probably, to much needless and injurious wrong of the
+stomach and bowels by evacuants, when all they want is to be let
+alone.  It is so hard to get anything out of the dead hand of medical
+tradition!  The mortmain of theorists extinct in science clings as
+close as that of ecclesiastics defunct in law.
+
+One practical hint may not be out of place here.  It seems to be
+sometimes forgotten, by those who must know the fact, that the tongue
+is very different, anatomically and physiologically, from the
+stomach.  Its condition does not in the least imply a similar one of
+the stomach, which is a very different structure, covered with a
+different kind of epithelium, and furnished with entirely different
+secretions.  A silversmith will, for a dollar, make a small hoe, of
+solid silver, which will last for centuries, and will give a patient
+more comfort, used for the removal of the accumulated epithelium and
+fungous growths which constitute the "fur," than many a prescription
+with a split-footed Rx before it, addressed to the parts out of
+reach.
+
+I think more of this little implement on account of its agency in
+saving the Colony at Plymouth in the year 1623.  Edward Winslow heard
+that Massasoit was sick and like to die.  He found him with a
+houseful of people about him, women rubbing his arms and legs, and
+friends "making such a hellish noise" as they probably thought would
+scare away the devil of sickness.  Winslow gave him some conserve,
+washed his mouth, scraped his tongue, which was in a horrid state,
+got down some drink, made him some broth, dosed him with an infusion
+of strawberry leaves and sassafras root, and had the satisfaction of
+seeing him rapidly recover.  Massasoit, full of gratitude, revealed
+the plot which had been formed to destroy the colonists, whereupon
+the Governor ordered Captain Miles Standish to see to them; who
+thereupon, as everybody remembers, stabbed Pecksuot with his own
+knife, broke up the plot, saved the colony, and thus rendered
+Massachusetts and the Massachusetts Medical Society a possibility, as
+they now are a fact before us.  So much for this parenthesis of the
+tongue-scraper, which helped to save the young colony from a much
+more serious scrape, and may save the Union yet, if a Presidential
+candidate should happen to be taken sick as Massasoit was, and his
+tongue wanted cleaning,--which process would not hurt a good many
+politicians, with or without a typhoid fever.
+
+Again, see how the "bilious" theory works in every-day life here and
+now, illustrated by a case from actual life.  A youthful
+practitioner, whose last molars have not been a great while cut,
+meets an experienced and noted physician in consultation.  This is
+the case.  A slender, lymphatic young woman is suckling two lusty
+twins, the intervals of suction being occupied on her part with
+palpitations, headaches, giddiness, throbbing in the head, and
+various nervous symptoms, her cheeks meantime getting bloodless, and
+her strength running away in company with her milk.  The old
+experienced physician, seeing the yellowish waxy look which is common
+in anaemic patients, considers it a "bilious" case, and is for giving
+a rousing emetic.  Of course, he has to be wheedled out of this, a
+recipe is written for beefsteaks and porter, the twins are
+ignominiously expelled from the anaemic bosom, and forced to take
+prematurely to the bottle, and this prolific mother is saved for
+future usefulness in the line of maternity.
+
+The practice of making a profit on the medicine ordered has been held
+up to reprobation by one at least of the orators who have preceded
+me.  That the effect of this has been ruinous in English practice I
+cannot doubt, and that in this country the standard of practice was
+in former generations lowered through the same agency is not
+unlikely.  I have seen an old account-book in which the physician
+charged an extra price for gilding his rich patients' pills.  If all
+medicine were very costly, and the expense of it always came out of
+the physician's fee, it would really be a less objectionable
+arrangement than this other most pernicious one.  He would naturally
+think twice before he gave an emetic or cathartic which evacuated his
+own pocket, and be sparing of the cholagogues that emptied the
+biliary ducts of his own wallet, unless he were sure they were
+needed.  If there is any temptation, it should not be in favor of
+giving noxious agents, as it clearly must be in the case of English
+druggists and "General Practitioners."  The complaint against the
+other course is a very old one.  Pliny, inspired with as truly Roman
+horror of quackery as the elder Cato,--who declared that the Greek
+doctors had sworn to exterminate all barbarians, including the
+Romans, with their drugs, but is said to have physicked his own wife
+to death, notwithstanding,--Pliny says, in so many words, that the
+cerates and cataplasms, plasters, collyria, and antidotes, so
+abundant in his time, as in more recent days, were mere tricks to
+make money.
+
+
+A pretty strong eddy, then, or rather many eddies, setting constantly
+back from the current of sober observation of nature, in the
+direction of old superstitions and fancies, of exploded theories, of
+old ways of making money, which are very slow to pass out of fashion
+
+But there are other special American influences which we are bound to
+take cognizance of.  If I wished to show a student the difficulties
+of getting at truth from medical experience, I would give him the
+history of epilepsy to read.  If I wished him to understand the
+tendencies of the American medical mind, its sanguine enterprise, its
+self-confidence, its audacious handling of Nature, its impatience
+with her old-fashioned ways of taking time to get a sick man well, I
+would make him read the life and writings of Benjamin Rush.  Dr. Rush
+thought and said that there were twenty times more intellect and a
+hundred times more knowledge in the country in 1799 than before the
+Revolution.  His own mind was in a perpetual state of exaltation
+produced by the stirring scenes in which he had taken a part, and the
+quickened life of the time in which he lived.  It was not the state
+to favor sound, calm observation.  He was impatient, and Nature is
+profoundly imperturbable.  We may adjust the beating of our hearts to
+her pendulum if we will and can, but we may be very sure that she
+will not change the pendulum's rate of going because our hearts are
+palpitating.  He thought he had mastered yellow-fever.  "Thank God,"
+he said, "out of one hundred patients whom I have visited or
+prescribed for this day, I have lost none."  Where was all his legacy
+of knowledge when Norfolk was decimated?  Where was it when the blue
+flies were buzzing over the coffins of the unburied dead piled up in
+the cemetery of New Orleans, at the edge of the huge trenches yawning
+to receive them?
+
+One such instance will do as well as twenty.  Dr. Rush must have been
+a charming teacher, as he was an admirable man.  He was observing,
+rather than a sound observer; eminently observing, curious, even,
+about all manner of things.  But he could not help feeling as if
+Nature had been a good deal shaken by the Declaration of
+Independence, and that American art was getting to be rather too much
+for her,--especially as illustrated in his own practice.  He taught
+thousands of American students, he gave a direction to the medical
+mind of the country more than any other one man; perhaps he typifies
+it better than any other.  It has clearly tended to extravagance in
+remedies and trust in remedies, as in everything else.  How could a
+people which has a revolution once in four years, which has contrived
+the Bowie-knife and the revolver, which has chewed the juice out of
+all the superlatives in the language in Fourth of July orations, and
+so used up its epithets in the rhetoric of abuse that it takes two
+great quarto dictionaries to supply the demand; which insists in
+sending out yachts and horses and boys to out-sail, out-run, out-
+fight, and checkmate all the rest of creation; how could such a
+people be content with any but "heroic" practice"?  What wonder that
+the stars and stripes wave over doses of ninety grains of sulphate of
+quinine, [More strictly, ninety-six grains in two hours. Dunglison's
+Practice, 1842, vol.  ii.  p.  520.  Eighty grains in one dose.
+Ibid.  p.  536.  Ninety-six grains of sulphate of quinine are equal
+to eight ounces of good bark. --Wood & Bache.] and that the American
+eagle screams with delight to see three drachms of calomel given at a
+single mouthful?
+
+Add to this the great number of Medical Journals, all useful, we
+hope, most of them necessary, we trust, many of them excellently well
+conducted, but which must find something to fill their columns, and
+so print all the new plans of treatment and new remedies they can get
+hold of, as the newspapers, from a similar necessity, print the
+shocking catastrophes and terrible murders.
+
+Besides all this, here are we, the great body of teachers in the
+numberless medical schools of the Union, some of us lecturing to
+crowds who clap and stamp in the cities, some of us wandering over
+the country, like other professional fertilizers, to fecundate the
+minds of less demonstrative audiences at various scientific stations;
+all of us talking habitually to those supposed to know less than
+ourselves, and loving to claim as much for our art as we can, not to
+say for our own schools, and possibly indirectly for our own
+practical skill.  Hence that annual crop of introductory lectures;
+the useful blossoming into the ornamental, as the cabbage becomes
+glorified in the cauliflower; that lecture-room literature of
+adjectives, that declamatory exaggeration, that splendid show of
+erudition borrowed from D'Israeli, and credited to Lord Bacon and the
+rest, which have suggested to our friends of the Medical Journals an
+occasional epigram at our expense.  Hence the tendency in these
+productions, and in medical lectures generally, to overstate the
+efficacy of favorite methods of cure, and hence the premium offered
+for showy talkers rather than sagacious observers, for the men of
+adjectives rather than of nouns substantive in the more ambitious of
+these institutions.
+
+Such are some of the eddies in which we are liable to become involved
+and carried back out of the broad stream of philosophical, or, in
+other words, truth-loving, investigations.  The causes of disease, in
+the mean time, have been less earnestly studied in the eagerness of
+the search for remedies.  Speak softly!  Women have been borne out
+from an old-world hospital, two in one coffin, that the horrors of
+their prison-house might not be known, while the very men who were
+discussing the treatment of the disease were stupidly conveying the
+infection from bed to bed, as rat-killers carry their poisons from
+one household to another.  Do not some of you remember that I have
+had to fight this private-pestilence question against a scepticism
+which sneered in the face of a mass of evidence such as the calm
+statisticians of the Insurance office could not listen to without
+horror and indignation? [The Contagiousness of Puerperal Fever."-N.
+E.  Quan Jour.  of Medicine and Surgery, April, 1843.  Reprinted,
+with Additions.  Boston: Ticknor & Fields.  1855.] Have we forgotten
+what is told in one of the books published under our own sanction,
+that a simple measure of ventilation, proposed by Dr. John Clark, had
+saved more than sixteen thousand children's lives in a single
+hospital?  How long would it have taken small doses of calomel and
+rhubarb to save as many children?  These may be useful in prudent
+hands, but how insignificant compared to the great hygienic
+conditions!  Causes, causes, and again causes,--more and more we fall
+back on these as the chief objects of our attention.  The shortest
+system of medical practice that I know of is the oldest, but not the
+worst.  It is older than Hippocrates, older than Chiron the Centaur.
+Nature taught it to the first mother when she saw her first-born
+child putting some ugly pebble or lurid berry into its mouth.  I know
+not in what language it was spoken, but I know that in English it
+would sound thus: Spit it out!
+
+Art can do something more than say this.  It can sometimes reach the
+pebble or berry after it has been swallowed.  But the great thing is
+to keep these things out of children's mouths, and as soon as they
+are beyond our reach, to be reasonable and patient with Nature, who
+means well, but does not like to hurry, and who took nine calendar
+months, more or less, to every mother's son among us, before she
+thought he was fit to he shown to the public.
+
+Suffer me now to lay down a few propositions, whether old or new it
+matters little, not for your immediate acceptance, nor yet for your
+hasty rejection, but for your calm consideration.
+
+But first, there are a number of terms which we are in the habit of
+using in a vague though not unintelligible way, and which it is as
+well now to define.  These terms are the tools with which we are to
+work, and the first thing is to sharpen them.  It is nothing to us
+that they have been sharpened a thousand times before; they always
+get dull in the using, and every new workman has a right to carry
+them to the grindstone and sharpen them to suit himself.
+
+Nature, in medical language, as opposed to Art, means trust in the
+reactions of the living system against, ordinary normal impressions.
+
+Art, in the same language, as opposed to Nature, means an intentional
+resort to extraordinary abnormal impressions for the relief of
+disease.
+
+The reaction of the living system is the essence of both.  Food is
+nothing, if there is no digestive act to respond to it.  We cannot
+raise a blister on a dead man, or hope that a carminative forced
+between his lips will produce its ordinary happy effect.
+
+Disease, dis-ease,--disturbed quiet, uncomfortableness,--means
+imperfect or abnormal reaction of the living system, and its more or
+less permanent results.
+
+Food, in its largest sense, is whatever helps to build up the normal
+structures, or to maintain their natural actions.
+
+Medicine, in distinction from food, is every unnatural or noxious
+agent applied for the relief of disease.
+
+Physic means properly the Natural art, and Physician is only the
+Greek synonyme of Naturalist.
+
+With these few explanations I proceed to unfold the propositions I
+have mentioned.
+
+Disease and death, if we may judge by the records of creation, are
+inherently and essentially necessary in the present order of things.
+A perfect intelligence, trained by a perfect education, could do no
+more than keep the laws of the physical and spiritual universe.  An
+imperfect intelligence, imperfectly taught,--and this is the
+condition of our finite humanity,--will certainly fail to keep all
+these laws perfectly.  Disease is one of the penalties of one of the
+forms of such failure.  It is prefigured in the perturbations of the
+planets, in the disintegration of the elemental masses; it has left
+its traces in the fossil organisms of extinct creations. [Professor
+Agassiz has kindly handed me the following note: "There are abnormal
+structures in animals of all ages anterior to the creation of
+mankind.  Malformed specimens of Crinoids are known from the Triassic
+and Jurassic deposits.  Malformed and diseased bones of tertiary
+mammalia have been collected in the caverns of Gailenreuth with
+traces of healing."]
+
+But it is especially the prerogative, I had almost said privilege, of
+educated and domesticated beings, from man down to the potato,
+serving to teach them, and such as train them, the laws of life, and
+to get rid of those who will not mind or cannot be kept subject to
+these laws.
+
+Disease, being always an effect, is always in exact proportion to the
+sum of its causes, as much in the case of Spigelius, who dies of a
+scratch, as in that of the man who recovers after an iron bar has
+been shot through his brain.  The one prevalent failing of the
+medical art is to neglect the causes and quarrel with the effect.
+
+There are certain general facts which include a good deal of what is
+called and treated as disease.  Thus, there are two opposite
+movements of life to be seen in cities and elsewhere, belonging to
+races which, from various persistent causes, are breeding down and
+tending to run out, and to races which are breeding up, or
+accumulating vital capital,--a descending and an ascending series.
+Let me give an example of each; and that I may incidentally remove a
+common impression about this country as compared with the Old World,
+an impression which got tipsy with conceit and staggered into the
+attitude of a formal proposition in the work of Dr. Robert Knox, I
+will illustrate the downward movement from English experience, and
+the upward movement from a family history belonging to this immediate
+neighborhood.
+
+Miss Nightingale speaks of "the fact so often seen of a
+great-grandmother, who was a tower of physical vigor, descending into
+a grandmother perhaps a little less vigorous, but still sound as a
+bell, and healthy to the core, into a mother languid and confined to
+her carriage and house; and lastly into a daughter sickly and
+confined to her bed." So much for the descending English series; now
+for the ascending American series.
+
+Something more than one hundred and thirty years ago there graduated
+at Harvard College a delicate youth, who lived an invalid life and
+died at the age of about fifty.  His two children were both of
+moderate physical power, and one of them diminutive in stature.  The
+next generation rose in physical development, and reached eighty
+years of age and more in some of its members.  The fourth generation
+was of fair average endowment.  The fifth generation, great-great-
+grandchildren of the slender invalid, are several of, them of
+extraordinary bodily and mental power; large in stature, formidable
+alike with their brains and their arms, organized on a more extensive
+scale than either of their parents.
+
+This brief account illustrates incidentally the fallacy of the
+universal-degeneration theory applied to American life; the same on
+which one of our countrymen has lately brought some very forcible
+facts to bear in a muscular discussion of which we have heard rather
+more than is good for us. But the two series, American and English,
+ascending and descending, were adduced with the main purpose of
+showing the immense difference of vital endowments in different
+strains of blood; a difference to which all ordinary medication is in
+all probability a matter of comparatively trivial purport.  Many
+affections which art has to strive against might be easily shown to
+be vital to the well-being of society.  Hydrocephalus, tabes
+mesenterica, and other similar maladies, are natural agencies which
+cut off the children of races that are sinking below the decent
+minimum which nature has established as the condition of viability,
+before they reach the age of reproduction.  They are really not so
+much diseases, as manifestations of congenital incapacity for life;
+the race would be ruined if art could ever learn always to preserve
+the individuals subject to them.  We must do the best we can for
+them, but we ought also to know what these "diseases" mean.
+
+Again, invalidism is the normal state of many organizations.  It can
+be changed to disease, but never to absolute health by medicinal
+appliances.  There are many ladies, ancient and recent, who are
+perpetually taking remedies for irremediable pains and aches.  They
+ought to have headaches and back-aches and stomach-aches; they are
+not well if they do not have them.  To expect them to live without
+frequent twinges is like expecting a doctor's old chaise to go
+without creaking; if it did, we might be sure the springs were
+broken.  There is no doubt that the constant demand for medicinal
+remedies from patients of this class leads to their over-use; often
+in the case of cathartics, sometimes in that of opiates.  I have been
+told by an intelligent practitioner in a Western town, that the
+constant prescription of opiates by certain physicians in his
+vicinity has rendered the habitual use of that drug in all that
+region very prevalent; more common, I should think, than alcoholic
+drunkenness in the most intemperate localities of which I have known
+anything.  A frightful endemic demoralization betrays itself in the
+frequency with which the haggard features and drooping shoulders of
+the opium-drunkards are met with in the streets.
+
+The next proposition I would ask you to consider is this:
+The presumption always is that every noxious agent, including
+medicines proper, which hurts a well man, hurts a sick one.
+[ Note B.]
+
+Let me illustrate this proposition before you decide upon it.  If it
+were known that a prize-fighter were to have a drastic purgative
+administered two or three days before a contest, or a large blister
+applied to his back, no one will question that it would affect the
+betting on his side unfavorably; we will say to the amount of five
+per cent.  Now the drain upon the resources of the system produced in
+such a case must be at its minimum, for the subject is a powerful
+man, in the prime of life, and in admirable condition.  If the drug
+or the blister takes five per cent. from his force of resistance, it
+will take at least as large a fraction from any invalid.  But this
+invalid has to fight a champion who strikes hard but cannot be hit in
+return, who will press him sharply for breath, but will never pant
+himself while the wind can whistle through his fleshless ribs.  The
+suffering combatant is liable to want all his stamina, and five per
+cent. may lose him the battle.
+
+All noxious agents, all appliances which are not natural food or
+stimuli, all medicines proper, cost a patient, on the average, five
+per cent. of his vital force, let us say.  Twenty times as much waste
+of force produced by any of them, that is, would exactly kill him,
+nothing less than kill him, and nothing more.  If this, or something
+like this, is true, then all these medications are, prima facie,
+injurious.
+
+In the game of Life-or-Death, Rouge et Noir, as played between the
+Doctor and the Sexton, this five per cent., this certain small injury
+entering into the chances is clearly the sexton's perquisite for
+keeping the green table, over which the game is played, and where he
+hoards up his gains.  Suppose a blister to diminish a man's pain,
+effusion or dyspnoea to the saving of twenty per cent. in vital
+force; his profit from it is fifteen, in that case, for it always
+hurts him five to begin with, according to our previous assumption.
+
+Presumptions are of vast importance in medicine, as in law.  A man is
+presumed innocent until he is proved guilty.  A medicine--that is, a
+noxious agent, like a blister, a seton, an emetic, or a cathartic--
+should always be presumed to be hurtful.  It always is directly
+hurtful; it may sometimes be indirectly beneficial.  If this
+presumption were established, and disease always assumed to be the
+innocent victim of circumstances, and not punishable by medicines,
+that is, noxious agents, or poisons, until the contrary was shown, we
+should not so frequently hear the remark commonly, perhaps
+erroneously, attributed to Sir Astley Cooper, but often repeated by
+sensible persons, that, on the whole, more harm than good is done by
+medication.  Throw out opium, which the Creator himself seems to
+prescribe, for we often see the scarlet poppy growing in the
+cornfields, as if it were foreseen that wherever there is hunger to
+be fed there must also be pain to be soothed; throw out a few
+specifics which our art did not discover, and is hardly needed to
+apply [ Note C.]; throw out wine, which is a food, and the vapors
+which produce the miracle of anaesthesia, and I firmly believe that
+if the whole materia medica, as now used, could be sunk to the bottom
+of the sea, it would be all the better for mankind,--and all the
+worse for the fishes.
+
+But to justify this proposition, I must add that the injuries
+inflicted by over-medication are to a great extent masked by disease.
+Dr. Hooker believes that the typhus syncopatia of a preceding
+generation in New England "was often in fact a brandy and opium
+disease."  How is a physician to distinguish the irritation produced
+by his blister from that caused by the inflammation it was meant to
+cure?  How can he tell the exhaustion produced by his evacuants from
+the collapse belonging to the disease they were meant to remove?
+
+Lastly, medication without insuring favorable hygienic conditions is
+like amputation without ligatures.  I had a chance to learn this well
+of old, when physician to the Broad Street district of the Boston
+Dispensary.  There, there was no help for the utter want of wholesome
+conditions, and if anybody got well under my care, it must have been
+in virtue of the rough-and-tumble constitution which emerges from the
+struggle for life in the street gutters, rather than by the aid of my
+prescriptions.
+
+But if the materia medica were lost overboard, how much more pains
+would be taken in ordering all the circumstances surrounding the
+patient (as can be done everywhere out of the crowded pauper
+districts), than are taken now by too many who think they do their
+duty and earn their money when they write a recipe for a patient left
+in an atmosphere of domestic malaria, or to the most negligent kind
+of nursing!  I confess that I should think my chance of recovery from
+illness less with Hippocrates for my physician and Mrs. Gamp for my
+nurse, than if I were in the hands of Hahnemann himself, with
+Florence Nightingale or good Rebecca Taylor to care for me.
+
+If I am right in maintaining that the presumption is always against
+the use of noxious agents in disease, and if any whom I might
+influence should adopt this as a principle of practice, they will
+often find themselves embarrassed by the imperative demand of
+patients and their friends for such agents where a case is not made
+out against this standing presumption.  I must be permitted to say,
+that I think the French, a not wholly uncivilized people, are in
+advance of the English and ourselves in the art of prescribing for
+the sick without hurting them.  And I do confess that I think their
+varied ptisans and syrups are as much preferable to the mineral
+regimen of bug-poison and ratsbane, so long in favor on the other
+side of the Channel, as their art of preparing food for the table to
+the rude cookery of those hard-feeding and much-dosing islanders.
+We want a reorganized cuisine of invalidism perhaps as much as the
+culinary, reform, for which our lyceum lecturers, and others who live
+much at hotels and taverns, are so urgent.  Will you think I am
+disrespectful if I ask whether, even in Massachusetts, a dose of
+calomel is not sometimes given by a physician on the same principle
+as that upon which a landlord occasionally prescribes bacon and
+eggs,--because he cannot think of anything else quite so handy?  I
+leave my suggestion of borrowing a hint from French practice to your
+mature consideration.
+
+I may, however, call your attention, briefly, to the singular fact,
+that English and American practitioners are apt to accuse French
+medical practice of inertness, and French surgical practice of
+unnecessary activity.  Thus, Dr. Bostock considers French medical
+treatment, with certain exceptions, as "decidedly less effective"
+than that of his own country."  Mr. S. Cooper, again, defends the
+simple British practice of procuring union by the first intention
+against the attacks of M. Roux and Baron Larrey. [Cooper's Surg.
+Diet.  art.  "Wounds."  Yet Mr. John Bell gives the French surgeons
+credit for introducing this doctrine of adhesion, and accuses
+O'Halloran of "rudeness and ignorance," and "bold, uncivil language,"
+in disputing their teaching.  Princ.  of Surgery, vol.  i.  p.  42.
+Mr. Hunter succeeded at last in naturalizing the doctrine and
+practice, but even he had to struggle against the perpetual jealousy
+of rivals, and died at length assassinated by an insult.]  We have
+often heard similar opinions maintained by our own countrymen.  While
+Anglo-American criticism blows hot or cold on the two departments of
+French practice, it is not, I hope, indecent to question whether all
+the wisdom is necessarily with us in both cases.
+
+Our art has had two or three lessons which have a deep meaning to
+those who are willing to read them honestly.  The use of water-
+dressings in surgery completed the series of reforms by which was
+abolished the "coarse and cruel practice" of the older surgeons, who
+with their dressings and acrid balsams, their tents and leaden tubes,
+"absolutely delayed the cure."  The doctrine of Broussais, transient
+as was its empire, reversed the practice of half of Christendom for a
+season, and taught its hasty disciples to shun their old favorite
+remedies as mortal poisons.  This was not enough permanently to shift
+the presumption about drugs where it belonged, and so at last, just
+as the sympathetic powder and the Unguentum Armarium came in a
+superstitious age to kill out the abuses of external over-medication,
+the solemn farce of Homoeopathy was enacted in the face of our own
+too credulous civilization, that under shelter of its pretences the
+"inward bruises" of over-drugged viscera might be allowed to heal by
+the first intention.  Its lesson we must accept, whether we will or
+not; its follies we are tired of talking about.  The security of the
+medical profession against this and all similar fancies is in the
+average constitution of the human.  mind with regard to the laws of
+evidence.
+
+My friends and brothers in Art!  There is nothing to be feared from
+the utterance of any seeming heresy to which you may have listened.
+I cannot compromise your collective wisdom.  If I have strained the
+truth one hair's breadth for the sake of an epigram or an antithesis,
+you are accustomed to count the normal pulse-beats of sound judgment,
+and know full well how to recognize the fever-throbs of conceit and
+the nervous palpitations of rhetoric.
+
+The freedom with which each of us speaks his thought in this
+presence, belongs in part to the assured position of the Profession
+in our Commonwealth, to the attitude of Science, which is always
+fearless, and to the genius of the soil on which we stand, from which
+Nature withheld the fatal gift of malaria only to fill it with
+exhalations that breed the fever of inquiry in our blood and in our
+brain.  But mainly we owe the large license of speech we enjoy to
+those influences and privileges common to us all as self-governing
+Americans.
+
+This Republic is the chosen home of minorities, of the less power in
+the presence of the greater.  It is a common error to speak of our
+distinction as consisting in the rule of the majority.  Majorities,
+the greater material powers, have always ruled before.  The history
+of most countries has been that of majorities, mounted majorities,
+clad in iron, armed with death treading down the tenfold more
+numerous minorities.  In the old civilizations they root themselves
+like oaks in the soil; men must live in their shadow or cut them
+down.  With us the majority is only the flower of the passing noon,
+and the minority is the bud which may open in the next morning's sun.
+We must be tolerant, for the thought which stammers on a single
+tongue today may organize itself in the growing consciousness of the
+time, and come back to us like the voice of the multitudinous waves
+of the ocean on the morrow.
+
+Twenty-five years have passed since one of your honored Presidents
+spoke to this Society of certain limitations to the power of our Art,
+now very generally conceded.  Some were troubled, some were almost
+angry, thinking the Profession might suffer from such concessions.
+It has certainly not suffered here; if, as some affirm, it has lost
+respect anywhere, it was probably for other, and no doubt sufficient
+reasons.
+
+Since that time the civilization of this planet has changed hands.
+Strike out of existence at this moment every person who was breathing
+on that day, May 27, 1835, and every institution of society, every
+art and every science would remain intact and complete in the living
+that would be left.  Every idea the world then held has been since
+dissolved and recrystallized.
+
+We are repeating the same process.  Not to make silver shrines for
+our old divinities, even though by this craft we should have our
+wealth, was this Society organized and carried on by the good men and
+true who went before us.  Not for this, but to melt the gold out of
+the past, though its dross should fly in dust to all the winds of
+heaven, to save all our old treasures of knowledge and mine deeply
+for new, to cultivate that mutual respect of which outward courtesy
+is the sign, to work together, to feel together, to take counsel
+together, and to stand together for the truth, now, always, here,
+everywhere; for this our fathers instituted, and we accept, the
+offices and duties of this time-honored Society.
+
+
+
+
+
+
+
+BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+
+An Introductory Lecture delivered before the Medical Class
+of Harvard University, November 6, 1861.
+
+
+[This Lecture appears as it would have been delivered had the time
+allowed been less strictly, limited.  Passages necessarily omitted
+have been restored, and points briefly touched have been more fully
+considered.  A few notes have been added for the benefit of that
+limited class of students who care to track an author through the
+highways and by-ways of his reading.  I owe my thanks to several of
+my professional brethren who have communicated with me on subjects
+with which they are familiar; especially to Dr. John Dean, for the
+opportunity of profiting by his unpublished labors, and to Dr. Hasket
+Derby, for information and references to recent authorities relating
+to the anatomy and physiology of the eye.]
+
+
+The entrance upon a new course of Lectures is always a period of
+interest to instructors and pupils.  As the birth of a child to a
+parent, so is the advent of a new class to a teacher.  As the light
+of the untried world to the infant, so is the dawning of the light
+resting over the unexplored realms of science to the student.  In the
+name of the Faculty I welcome you, Gentlemen of the Medical Class,
+new-born babes of science, or lustier nurslings, to this morning of
+your medical life, and to the arms and the bosom of this ancient
+University.  Fourteen years ago I stood in this place for the first
+time to address those who occupied these benches.  As I recall these
+past seasons of our joint labors, I feel that they have been on the
+whole prosperous, and not undeserving of their prosperity.
+
+For it has been my privilege to be associated with a body of true and
+faithful workers; I cannot praise them freely to their faces, or I
+should be proud to discourse of the harmonious diligence and the
+noble spirit in which they have toiled together, not merely to teach
+their several branches, but to elevate the whole standard of
+teaching.
+
+I may speak with less restraint of those gentlemen who have aided me
+in the most laborious part of my daily duties, the Demonstrators, to
+whom the successive classes have owed so much of their instruction.
+They rise before me, the dead and the living, in the midst of the
+most grateful recollections.  The fair, manly face and stately figure
+of my friend, Dr. Samuel Parkman, himself fit for the highest offices
+of teaching, yet willing to be my faithful assistant in the time of
+need, come back to me with the long sigh of regret for his early loss
+to our earthly companionship.  Every year I speak the eulogy of Dr.
+Ainsworth's patient toil as I show his elaborate preparations: When I
+take down my "American Cyclopaedia" and borrow instruction from the
+learned articles of Dr. Kneeland, I cease to regret that his
+indefatigable and intelligent industry was turned into a broader
+channel.  And what can I say too cordial of my long associated
+companion and friend, Dr. Hodges, whose admirable skill, working
+through the swiftest and surest fingers that ever held a scalpel
+among us, has delighted class after class, and filled our Museum with
+monuments which will convey his name to unborn generations?
+
+This day belongs, however, not to myself and my recollections, but to
+all of us who teach and all of you who listen, whether experts in our
+specialties or aliens to their mysteries, or timid neophytes just
+entering the portals of the hall of science.  Look in with me, then,
+while I attempt to throw some rays into its interior, which shall
+illuminate a few of its pillars and cornices, and show at the same
+time how many niches and alcoves remain in darkness.
+
+
+SCIENCE is the topography of ignorance.  From a few elevated points
+we triangulate vast spaces, inclosing infinite unknown details.  We
+cast the lead, and draw up a little sand from abysses we may never
+reach with our dredges.
+
+The best part of our knowledge is that which teaches us where
+knowledge leaves off and ignorance begins.  Nothing more clearly
+separates a vulgar from a superior mind, than the confusion in the
+first between the little that it truly knows, on the one hand, and
+what it half knows and what it thinks it knows on the other.
+
+That which is true of every subject is especially true of the branch
+of knowledge which deals with living beings.  Their existence is a
+perpetual death and reanimation.  Their identity is only an idea, for
+we put off our bodies many times during our lives, and dress in new
+suits of bones and muscles.
+
+               "Thou art not thyself;
+     For thou exist'st on many a thousand grains
+     That issue out of dust."
+
+If it is true that we understand ourselves but imperfectly in health,
+this truth is more signally manifested in disease, where natural
+actions imperfectly understood, disturbed in an obscure way by half-
+seen causes, are creeping and winding along in the dark toward their
+destined issue, sometimes using our remedies as safe stepping-stones,
+occasionally, it may be, stumbling over them as obstacles.
+
+I propose in this lecture to show you some points of contact between
+our ignorance and our knowledge in several of the branches upon the
+study of which you are entering.  I may teach you a very little
+directly, but I hope much more from the trains of thought I shall
+suggest.  Do not expect too much ground to be covered in this rapid
+survey.  Our task is only that of sending out a few pickets under the
+starry flag of science to the edge of that dark domain where the
+ensigns of the obstinate rebel, Ignorance, are flying undisputed.  We
+are not making a reconnoissance in force, still less advancing with
+the main column.  But here are a few roads along which we have to
+march together, and we wish to see clearly how far our lines extend,
+and where the enemy's outposts begin.
+
+Before touching the branches of knowledge that deal with organization
+and vital functions, let us glance at that science which meets you at
+the threshold of your study, and prepares you in some measure to deal
+with the more complex problems of the living laboratory.
+
+
+CHEMISTRY.  includes the art of separating and combining the elements
+of matter, and the study of the changes produced by these operations.
+We can hardly say too much of what it has contributed to our
+knowledge of the universe and our power of dealing with its
+materials.  It has given us a catalogue raisonne of the substances
+found upon our planet, and shown how everything living and dead is
+put together from them.  It is accomplishing wonders before us every
+day, such as Arabian story-tellers used to string together in their
+fables.  It spreads the, sensitive film on the artificial retina
+which looks upon us through the optician's lens for a few seconds,
+and fixes an image that will outlive its original.  It questions the
+light of the sun, and detects the vaporized metals floating around
+the great luminary,--iron, sodium, lithium, and the rest,--as if the
+chemist of our remote planet could fill his bell-glasses from its
+fiery atmosphere.  It lends the power which flashes our messages in
+thrills that leave the lazy chariot of day behind them.  It seals up
+a few dark grains in iron vases, and lo! at the touch of a single
+spark, rises in smoke and flame a mighty Afrit with a voice like
+thunder and an arm that shatters like an earthquake.  The dreams of
+Oriental fancy have become the sober facts of our every-day life, and
+the chemist is the magician to whom we owe them.
+
+To return to the colder scientific aspect of chemistry.  It has shown
+us how bodies stand affected to each other through an almost
+boundless range of combinations.  It has given us a most ingenious
+theory to account for certain fixed relations in these combinations.
+It has successfully eliminated a great number of proximate compounds,
+more or less stable, from organic structures.  It has invented others
+which form the basis of long series of well-known composite
+substances.  In fact, we are perhaps becoming overburdened with our
+list of proximate principles, demonstrated and hypothetical.
+
+How much nearer have we come to the secret of force than Lully and
+Geber and the whole crew of juggling alchemists?  We have learned a
+great deal about the how, what have we learned about the why?
+
+Why does iron rust, while gold remains untarnished, and gold
+amalgamate, while iron refuses the alliance of mercury?
+
+The alchemists called gold Sol, the sun, and iron Mars, and pleased
+themselves with fancied relations between these substances and the
+heavenly bodies, by which they pretended to explain the facts they
+observed.  Some of their superstitions have lingered in practical
+medicine to the present day, but chemistry has grown wise enough to
+confess the fact of absolute ignorance.
+
+What is it that makes common salt crystallize in the form of cubes,
+and saltpetre in the shape of six-sided prisms?  We see no reason why
+it should not have been just the other way, salt in prisms and
+saltpetre in cubes, or why either should take an exact geometrical
+outline, any more than coagulating albumen.
+
+But although we had given up attempting to explain the essential
+nature of affinities and of crystalline types, we might have supposed
+that we had at least fixed the identity of the substances with which
+we deal, and determined the laws of their combination.  All at once
+we find that a simple substance changes face, puts off its
+characteristic qualities and resumes them at will;--not merely when
+we liquefy or vaporize a solid, or reverse the process; but that a
+solid is literally transformed into another solid under our own eyes.
+We thought we knew phosphorus.  We warm a portion of it sealed in an
+empty tube, for about a week.  It has become a brown infusible
+substance, which does not shine in the dark nor oxidate in the air.
+We heat it to 500 F., and it becomes common phosphorus again.  We
+transmute sulphur in the same singular way.  Nature, you know, gives
+us carbon in the shape of coal and in that of the diamond.  It is
+easy to call these changes by the name allotropism, but not the less
+do they confound our hasty generalizations.
+
+These facts of allotropism have some corollaries connected with them
+rather startling to us of the nineteenth century.  There may be other
+transmutations possible besides those of phosphorus and sulphur.
+When Dr. Prout, in 1840, talked about azote and carbon being "formed"
+in the living system, it was looked upon as one of those freaks of
+fancy to which philosophers, like other men, are subject.  But when
+Professor Faraday, in 1851, says, at a meeting of the British
+Association, that "his hopes are in the direction of proving that
+bodies called simple were really compounds, and may be formed
+artificially as soon as we are masters of the laws influencing their
+combinations,"--when he comes forward and says that he has tried
+experiments at transmutation, and means, if his life is spared, to
+try them again,--how can we be surprised at the popular story of
+1861, that Louis Napoleon has established a gold-factory and is
+glutting the mints of Europe with bullion of his own making?
+
+And so with reference to the law of combinations.  The old maxim was,
+Corpora non agunt nisi soluta.  If two substances, a and b, are
+inclosed in a glass vessel, c, we do not expect the glass to change
+them, unless a or b or the compound a b has the power of dissolving
+the glass.  But if for a I take oxygen, for b hydrogen, and for c a
+piece of spongy platinum, I find the first two combine with the
+common signs of combustion and form water, the third in the mean time
+undergoing no perceptible change.  It has played the part of the
+unwedded priest, who marries a pair without taking a fee or having
+any further relation with the parties.  We call this catalysis,
+catalytic action, the action of presence, or by what learned name we
+choose.  Give what name to it we will, it is a manifestation of power
+which crosses our established laws of combination at a very open
+angle of intersection.  I think we may find an analogy for it in
+electrical induction, the disturbance of the equilibrium of the
+electricity of a body by the approach of a charged body to it,
+without interchange of electrical conditions between the two bodies.
+But an analogy is not an explanation, and why a few drops of yeast
+should change a saccharine mixture to carbonic acid and alcohol,--a
+little leaven leavening the whole lump,--not by combining with it,
+but by setting a movement at work, we not only cannot explain, but
+the fact is such an exception to the recognized laws of combination
+that Liebig is unwilling to admit the new force at all to which
+Berzelius had given the name so generally accepted.
+
+The phenomena of isomerism, or identity of composition and
+proportions of constituents with difference of qualities, and of
+isomorphism, or identity of form in crystals which have one element
+substituted for another, were equally surprises to science; and
+although the mechanism by which they are brought about can be to a
+certain extent explained by a reference to the hypothetical atoms of
+which the elements are constituted, yet this is only turning the
+difficulty into a fraction with an infinitesimal denominator and an
+infinite numerator.
+
+So far we have studied the working of force and its seeming anomalies
+in purely chemical phenomena.  But we soon find that chemical force
+is developed by various other physical agencies,--by heat, by light,
+by electricity, by magnetism, by mechanical agencies; and, vice
+versa, that chemical action develops heat, light, electricity,
+magnetism, mechanical force, as we see in our matches, galvanic
+batteries, and explosive compounds.  Proceeding with our experiments,
+we find that every kind of force is capable of producing all other
+kinds, or, in Mr. Faraday's language, that "the various forms under
+which the forces of matter are made manifest have a common origin,
+or, in other words, are so directly related and mutually dependent
+that they are convertible one into another."
+
+Out of this doctrine naturally springs that of the conservation of
+force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr.
+Faraday.  This idea is no novelty, though it seems so at first sight.
+It was maintained and disputed among the giants of philosophy.
+Des Cartes and Leibnitz denied that any new motion originated in
+nature, or that any ever ceased to exist; all motion being in a
+circle, passing from one body to another, one losing what the other
+gained.  Newton, on the other hand, believed that new motions were
+generated and existing ones destroyed.  On the first supposition,
+there is a fixed amount of force always circulating in the universe.
+On the second, the total amount may be increasing or diminishing.
+You will find in the "Annual of Scientific Discovery" for 1858 a very
+interesting lecture by Professor Helmholtz of Bonn, in which it is
+maintained that a certain portion of force is lost in every natural
+process, being converted into unchangeable heat, so that the universe
+will come to a stand-still at last, all force passing into heat, and
+all heat into a state of equilibrium.
+
+The doctrines of the convertibility or specific equivalence of the
+various forms of force, and of its conservation, which is its logical
+consequence, are very generally accepted, as I believe, at the
+present time, among physicists.  We are naturally led to the
+question, What is the nature of force?  The three illustrious
+philosophers just referred to agree in attributing the general
+movements of the universe to the immediate Divine action.  The
+doctrine of "preestablished harmony" was an especial contrivance of
+Leibnitz to remove the Creator from unworthy association with the
+less divine acts of living beings.  Obsolete as this expression
+sounds to our ears, the phrase laws of the universe, which we use so
+constantly with a wider application, appears to me essentially
+identical with it.
+
+Force does not admit of explanation, nor of proper definition, any
+more than the hypothetical substratum of matter.  If we assume the
+Infinite as omnipresent, omniscient, omnipotent, we cannot suppose
+Him excluded from any part of His creation, except from rebellious
+souls which voluntarily exclude Him by the exercise of their fatal
+prerogative of free-will.  Force, then, is the act of immanent
+Divinity.  I find no meaning in mechanical explanations.  Newton's
+hypothesis of an ether filling the heavenly spaces does not, I
+confess, help my conceptions.  I will, and the muscles of my vocal
+organs shape my speech.  God wills, and the universe articulates His
+power, wisdom, and goodness.  That is all I know.  There is no bridge
+my mind can throw from the "immaterial " cause to the "material"
+effect.
+
+The problem of force meets us everywhere, and I prefer to encounter
+it in the world of physical phenomena before reaching that of living
+actions.  It is only the name for the incomprehensible cause of
+certain changes known to our consciousness, and assumed to be outside
+of it.  For me it is the Deity Himself in action.
+
+I can therefore see a large significance in the somewhat bold
+language of Burdach : "There is for me but one miracle, that of
+infinite existence, and but one mystery, the manner in which the
+finite proceeds from the infinite.  So soon as we recognize this
+incomprehensible act as the general and primordial miracle, of which
+our reason perceives the necessity, but the manner of which our
+intelligence cannot grasp, so soon as we contemplate the nature known
+to us by experience in this light, there is for us no other
+impenetrable miracle or mystery."
+
+Let us turn to a branch of knowledge which deals with certainties up
+to the limit of the senses, and is involved in no speculations beyond
+them.  In certain points of view, HUMAN ANATOMY may be considered an
+almost exhausted science.  From time to time some small organ which
+had escaped earlier observers has been pointed out,--such parts as
+the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some
+of our best anatomical works are those which have been classic for
+many generations. The plates of the bones in Vesalius, three
+centuries old, are still masterpieces of accuracy, as of art.  The
+magnificent work of Albinus on the muscles, published in 1747, is
+still supreme in its department, as the constant references of the
+most thorough recent treatise on the subject, that of Theile,
+sufficiently show.  More has been done in unravelling the mysteries
+of the fasciae, but there has been a tendency to overdo this kind of
+material analysis.  Alexander Thomson split them up into cobwebs, as
+you may see in the plates to Velpeau's Surgical Anatomy.  I well
+remember how he used to shake his head over the coarse work of Scarpa
+and Astley Cooper,--as if Denner, who painted the separate hairs of
+the beard and pores of the skin in his portraits, had spoken lightly
+of the pictures of Rubens and Vandyk.
+
+Not only has little been added to the catalogue of parts, but some
+things long known had become half-forgotten. Louis and others
+confounded the solitary glands of the lower part of the small
+intestine with those which "the great Brunner," as Haller calls him,
+described in 1687 as being found in the duodenum.  The display of the
+fibrous structure of the brain seemed a novelty as shown by
+Spurzheim.  One is startled to find the method anticipated by Raymond
+Vieussens nearly two centuries ago.  I can hardly think Gordon had
+ever looked at his figures, though he names their author, when he
+wrote the captious and sneering article which attracted so much
+attention in the pages of the "Edinburgh Review."
+
+This is the place, if anywhere, to mention any observations I could
+pretend to have made in the course of my teaching the structure of
+the human body.  I can make no better show than most of my
+predecessors in this well-reaped field.  The nucleated cells found
+connected with the cancellated structure of the bones, which I first
+pointed out and had figured in 1847, and have shown yearly from that
+time to the present, and the fossa masseterica, a shallow concavity
+on the ramus of the lower jaw, for the lodgment of the masseter
+muscle, which acquires significance when examined by the side of the
+deep cavity on the corresponding part in some carnivora to which it
+answers, may perhaps be claimed as deserving attention.  I have also
+pleased myself by making a special group of the six radiating muscles
+which diverge from the spine of the axis, or second cervical
+vertebra, and by giving to it the name stella musculosa nuchaee.  But
+this scanty catalogue is only an evidence that one may teach long and
+see little that has not been noted by those who have gone before him.
+Of course I do not think it necessary to include rare, but already
+described anomalies, such as the episternal bones, the rectus
+sternalis, and other interesting exceptional formations I have
+encountered, which have shown a curious tendency to present
+themselves several times in the same season, perhaps because the
+first specimen found calls our attention to any we may subsequently
+meet with.
+
+The anatomy of the scalpel and the amphitheatre was, then, becoming
+an exhausted branch of investigation.  But during the present century
+the study of the human body has changed its old aspect, and become
+fertile in new observations.  This rejuvenescence was effected by
+means of two principal agencies,--new methods and a new instrument.
+
+Descriptive anatomy, as known from an early date, is to the body what
+geography is to the planet.  Now geography was pretty well known so
+long ago as when Arrowsmith, who was born in 1750, published his
+admirable maps.  But in that same year was born Werner, who taught a
+new way of studying the earth, since become familiar to us all under
+the name of Geology.
+
+What geology has done for our knowledge of the earth, has been done
+for our knowledge of the body by that method of study to which is
+given the name of General Anatomy.  It studies, not the organs as
+such, but the elements out of which the organs are constructed.  It
+is the geology of the body, as that is the general anatomy of the
+earth.  The extraordinary genius of Bichat, to whom more than any
+other we owe this new method of study, does not require Mr. Buckle's
+testimony to impress the practitioner with the importance of its
+achievements.  I have heard a very wise physician question whether
+any important result had accrued to practical medicine from Harvey's
+discovery of the circulation.  But Anatomy, Physiology, and Pathology
+have received a new light from this novel method of contemplating the
+living structures, which has had a vast influence in enabling the
+practitioner at least to distinguish and predict the course of
+disease.  We know as well what differences to expect in the habits of
+a mucous and of a serous membrane, as what mineral substances to look
+for in the chalk or the coal measures.  You have only to read
+Cullen's description of inflammation of the lungs or of the bowels,
+and compare it with such as you may find in Laennec or Watson, to see
+the immense gain which diagnosis and prognosis have derived from
+general anatomy.
+
+The second new method of studying the human structure, beginning with
+the labors of Scarpa, Burns, and Colles, grew up principally during
+the first third of this century.  It does not deal with organs, as
+did the earlier anatomists, nor with tissues, after the manner of
+Bichat.  It maps the whole surface of the body into an arbitrary
+number of regions, and studies each region successively from the
+surface to the bone, or beneath it.  This hardly deserves the name of
+a science, although Velpeau has dignified it with that title, but it
+furnishes an admirable practical way for the surgeon who has to
+operate on a particular region of the body to study that region.  If
+we are buying a farm, we are not content with the State map or a
+geological chart including the estate in question.  We demand an
+exact survey of that particular property, so that we may know what we
+are dealing with.  This is just what regional, or, as it is sometimes
+called, surgical anatomy, does for the surgeon with reference to the
+part on which his skill is to be exercised.  It enables him to see
+with the mind's eye through the opaque tissues down to the bone on
+which they lie, as if the skin were transparent as the cornea, and
+the organs it covers translucent as the gelatinous pulp of a medusa.
+
+It is curious that the Japanese should have anticipated Europe in a
+kind of rude regional anatomy.  I have seen a manikin of Japanese
+make traced all over with lines, and points marking their
+intersection.  By this their doctors are guided in the performance of
+acupuncture, marking the safe places to thrust in needles, as we buoy
+out our ship-channels, and doubtless indicating to learned eyes the
+spots where incautious meddling had led to those little accidents of
+shipwreck to which patients are unfortunately liable.
+
+A change of method, then, has given us General and Regional Anatomy.
+These, too, have been worked so thoroughly, that, if not exhausted,
+they have at least become to a great extent fixed and positive
+branches of knowledge.  But the first of them, General Anatomy, would
+never, have reached this positive condition but for the introduction
+of that, instrument which I have mentioned as the second great aid to
+modern progress.
+
+This instrument is the achromatic microscope.  For the history of the
+successive steps by which it became the effective scientific
+implement we now possess, I must refer you to the work of Mr.
+Quekett, to an excellent article in the "Penny Cyclopaedia," or to
+that of Sir David Brewster in the "Encyclopaedia Britannica."  It is
+a most interesting piece of scientific history, which shows how the
+problem which Biot in 1821 pronounced insolvable was in the course of
+a few years practically solved, with a success equal to that which
+Dollond had long before obtained with the telescope.  It is enough
+for our purpose that we are now in possession of an instrument freed
+from all confusions and illusions, which magnifies a thousand
+diameters,--a million times in surface,--without serious distortion
+or discoloration of its object.
+
+A quarter of a century ago, or a little more, an instructor would not
+have hesitated to put John Bell's "Anatomy" and Bostock's
+"Physiology" into a student's hands, as good authority on their
+respective subjects.  Let us not be unjust to either of these
+authors.  John Bell is the liveliest medical writer that I can
+remember who has written since the days of delightful old Ambroise
+Pare.  His picturesque descriptions and bold figures are as good now
+as they ever were, and his book can never become obsolete.  But
+listen to what John Bell says of the microscope :
+
+"Philosophers of the last age had been at infinite pains to find the
+ultimate fibre of muscles, thinking to discover its properties in its
+form; but they saw just in proportion to the glasses which they used,
+or to their practice and skill in that art, which is now almost
+forsaken."
+
+Dr. Bostock's work, neglected as it is, is one which I value very
+highly as a really learned compilation, full of original references.
+But Dr. Bostock says: "Much as the naturalist has been indebted to
+the microscope, by bringing into view many beings of which he could
+not otherwise have ascertained the existence, the physiologist has
+not yet derived any great benefit from the instrument."
+
+These are only specimens of the manner in which the microscope and
+its results were generally regarded by the generation just preceding
+our own.
+
+I have referred you to the proper authorities for the account of
+those improvements which about the year 1830 rendered the compound
+microscope an efficient and trustworthy instrument.  It was now for
+the first time that a true general anatomy became possible.  As early
+as 1816 Treviranus had attempted to resolve the tissues, of which
+Bichat had admitted no less than twenty-one, into their simple
+microscopic elements.  How could such an attempt succeed, Henle well
+asks, at a time when the most extensively diffused of all the
+tissues, the areolar, was not at all understood?  All that method
+could do had been accomplished by Bichat and his followers.  It was
+for the optician to take the next step.  The future of anatomy and
+physiology, as an enthusiastic micrologist of the time said, was in
+the hands of Messrs.  Schieck and Pistor, famous opticians of Berlin.
+
+In those earlier days of which I am speaking, all the points of
+minute anatomy were involved in obscurity.  Some found globules
+everywhere, some fibres.  Students disputed whether the conjunctiva
+extended over the cornea or not, and worried themselves over Gaultier
+de Claubry's stratified layers of the skin, or Breschet's
+blennogenous and chromatogenous organs.  The dartos was a puzzle, the
+central spinal canal a myth, the decidua clothed in fable as much as
+the golden fleece.  The structure of bone, now so beautifully made
+out,--even that of the teeth, in which old Leeuwenhoek, peeping with
+his octogenarian eyes through the minute lenses wrought with his own
+hands, had long ago seen the "pipes," as he called them,--was hardly
+known at all.  The minute structure of the viscera lay in the mists
+of an uncertain microscopic vision.  The intimate recesses of the
+animal system were to the students of anatomy what the anterior of
+Africa long was to geographers, and the stories of microscopic
+explorers were as much sneered at as those of Bruce or Du Chailly,
+and with better reason.
+
+Now what have we come to in our own day?  In the first place, the
+minute structure of all the organs has been made out in the most
+satisfactory way.  The special arrangements of the vessels and the
+ducts of all the glands, of the air-tubes and vesicles of the lungs,
+of the parts which make up the skin and other membranes, all the
+details of those complex parenchymatous organs which had confounded
+investigation so long, have been lifted out of the invisible into the
+sight of all observers.  It is fair to mention here, that we owe a
+great deal to the art of minute injection, by which we are enabled to
+trace the smallest vessels in the midst of the tissues where they are
+distributed.  This is an old artifice of anatomists.  The famous
+Ruysch, who died a hundred and thirty years ago, showed that each of
+the viscera has its terminal vessels arranged in its own peculiar
+way; the same fact which you may see illustrated in Gerber's figures
+after the minute injections of Berres.  I hope to show you many
+specimens of this kind in the microscope, the work of English and
+American hands.  Professor Agassiz allows me also to make use of a
+very rich collection of injected preparations sent him by Professor
+Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
+of which I had a number of microscopes made expressly, by Mr. Grunow,
+during the past season.  All this illustrates what has been done for
+the elucidation of the intimate details of formation of the organs.
+
+But the great triumph of the microscope as applied to anatomy has
+been in the resolution of the organs and the tissues into their
+simple constituent anatomical elements.  It has taken up general
+anatomy where Bichat left it.  He had succeeded in reducing the
+structural language of nature to syllables, if you will permit me to
+use so bold an image.  The microscopic observers who have come after
+him have analyzed these into letters, as we may call them,--the
+simple elements by the combination of which Nature spells out
+successively tissues, which are her syllables, organs which are her
+words, systems which are her chapters, and so goes on from the simple
+to the complex, until she binds up in one living whole that wondrous
+volume of power and wisdom which we call the human body.
+
+The alphabet of the organization is so short and simple, that I will
+risk fatiguing your attention by repeating it, according to the plan
+I have long adopted.
+
+A.  Cells, either floating, as in the blood, or fixed, like those in
+the cancellated structure of bone, already referred to.  Very
+commonly they have undergone a change of figure, most frequently a
+flattening which reduces them to scales, as in the epidermis and the
+epithelium.
+
+B.  Simple, translucent, homogeneous solid, such as is found at the
+back of the cornea, or forming the intercellular substance of
+cartilage.
+
+C.  The white fibrous element, consisting of very delicate, tenacious
+threads.  This is the long staple textile substance of the body.  It
+is to the organism what cotton is pretended to be to our Southern
+States.  It pervades the whole animal fabric as areolar tissue, which
+is the universal packing and wrapping material.  It forms the
+ligaments which bind the whole frame-work together.  It furnishes the
+sinews, which are the channels of power.  It enfolds every muscle.
+It wraps the brain in its hard, insensible folds, and the heart
+itself beats in a purse that is made of it.
+
+D.  The yellow elastic, fibrous element, the caoutchouc of the animal
+mechanism, which pulls things back into place, as the India-rubber
+band shuts the door we have opened.
+
+E.  The striped muscular fibre,--the red flesh, which shortens itself
+in obedience to the will, and thus produces all voluntary active
+motion.
+
+F.  The unstriped muscular fibre, more properly the fusiform-cell
+fibre, which carries on the involuntary internal movements.
+
+G.  The nerve-cylinder, a glassy tube, with a pith of some firmness,
+which conveys sensation to the brain and the principle which induces
+motion from it.
+
+H.  The nerve-corpuscle, the centre of nervous power.
+
+I.  The mucous tissue, as Virchow calls it, common in embryonic
+structures, seen in the vitreous humor of the adult.
+
+To these add X, granules, of indeterminate shape and size, Y, for
+inorganic matters, such as the salts of bone and teeth, and Z, to
+stand as a symbol of the fluids, and you have the letters of what I
+have ventured to call the alphabet of the body.
+
+But just as in language certain diphthongs and syllables are
+frequently recurring, so we have in the body certain secondary and
+tertiary combinations, which we meet more frequently than the
+solitary elements of which they are composed.
+
+Thus A B, or a collection of cells united by simple structureless
+solid, is seen to be extensively employed in the body under the name
+of cartilage.  Out of this the surfaces of the articulations and the
+springs of the breathing apparatus are formed.  But when Nature came
+to the buffers of the spinal column (intervertebral disks) and the
+washers of the joints (semilunar fibrocartilages of the knee, etc.),
+she required more tenacity than common cartilage possessed.  What did
+she do?  What does man do in a similar case of need?  I need hardly
+tell you.  The mason lays his bricks in simple mortar.  But the
+plasterer works some hair into the mortar which he is going to lay in
+large sheets on the walls.  The children of Israel complained that
+they had no straw to make their bricks with, though portions of it
+may still be seen in the crumbling pyramid of Darshour, which they
+are said to have built.  I visited the old house on Witch Hill in
+Salem a year or two ago, and there I found the walls coated with clay
+in which straw was abundantly mingled;--the old Judaizing witch-
+hangers copied the Israelites in a good many things.  The Chinese and
+the Corsicans blend the fibres of amianthus in their pottery to give
+it tenacity.  Now to return to Nature.  To make her buffers and
+washers hold together in the shocks to which they would be subjected,
+she took common cartilage and mingled the white fibrous tissue with
+it, to serve the same purpose as the hair in the mortar, the straw in
+the bricks and in the plaster of the old wall, and the amianthus in
+the earthen vessels.  Thus we have the combination A B C, or fibro-
+cartilage.  Again, the bones were once only gristle or cartilage, A
+B.  To give them solidity they were infiltrated with stone, in the
+form of salts of lime, an inorganic element, so that bone would be
+spelt out by the letters A, B, and Y.
+
+If from these organic syllables we proceed to form organic words, we
+shall find that Nature employs three principal forms; namely,
+Vessels, Membranes, and Parenchyma, or visceral tissue.  The most
+complex of them can be resolved into a combination of these few
+simple anatomical constituents.
+
+
+Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
+the same elements in morbid growths that we have met with in normal
+structures.  The pus-corpuscle and the white blood-corpuscle can only
+be distinguished by tracing them to their origin.  A frequent form of
+so-called malignant disease proves to be only a collection of altered
+epithelium-cells.  Even cancer itself has no specific anatomical
+element, and the diagnosis of a cancerous tumor by the microscope,
+though tolerably sure under the eye of an expert, is based upon
+accidental, and not essential points,--the crowding together of the
+elements, the size of the cell-nuclei, and similar variable
+characters.
+
+Let us turn to PHYSIOLOGY.  The microscope, which has made a new
+science of the intimate structure of the organs, has at the same time
+cleared up many uncertainties concerning the mechanism of the special
+functions.  Up to the time of the living generation of observers,
+Nature had kept over all her inner workshops the forbidding
+inscription, No Admittance!  If any prying observer ventured to spy
+through his magnifying tubes into the mysteries of her glands and
+canals and fluids, she covered up her work in blinding mists and
+bewildering halos, as the deities of old concealed their favored
+heroes in the moment of danger.
+
+Science has at length sifted the turbid light of her lenses, and
+blanched their delusive rainbows.
+
+Anatomy studies the organism in space.  Physiology studies it also in
+time.  After the study of form and composition follows close that of
+action, and this leads us along back to the first moment of the germ,
+and forward to the resolution of the living frame into its lifeless
+elements.  In this way Anatomy, or rather that branch of it which we
+call Histology, has become inseparably blended with the study of
+function.  The connection between the science of life and that of
+intimate structure on the one hand, and composition on the other, is
+illustrated in the titles of two recent works of remarkable
+excellence,--"the Physiological Anatomy" of Todd and Bowman, and the
+"Physiological Chemistry" of Lehmann.
+
+Let me briefly recapitulate a few of our acquisitions in Physiology,
+due in large measure to our new instruments and methods of research,
+and at the same time indicate the limits which form the permanent or
+the temporary boundaries of our knowledge.  I will begin with the
+largest fact and with the most absolute and universally encountered
+limitation.
+
+The "largest truth in Physiology" Mr. Paget considers to be "the
+development of ova through multiplication and division of their
+cells."  I would state it more broadly as the agency of the cell in
+all living processes.  It seems at present necessary to abandon the
+original idea of Schwann, that we can observe the building up of a
+cell from the simple granules of a blastema, or formative fluid.  The
+evidence points rather towards the axiom, Omnis cellula a cellula;
+that is, the germ of a new cell is always derived from a preexisting
+cell.  The doctrine of Schwann, as I remarked long ago (1844), runs
+parallel with the nebular theory in astronomy, and they may yet stand
+or fall together.
+
+As we have seen Nature anticipating the plasterer in fibro-cartilage,
+so we see her beforehand with the glassblower in her dealings with
+the cell.  The artisan blows his vitreous bubbles, large or small, to
+be used afterwards as may be wanted.  So Nature shapes her hyaline
+vesicles and modifies them to serve the needs of the part where they
+are found.  The artisan whirls his rod, and his glass bubble becomes
+a flattened disk, with its bull's-eye for a nucleus.  These lips of
+ours are all glazed with microscopic tiles formed of flattened cells,
+each one of them with its nucleus still as plain and relatively as
+prominent, to the eye of the microscopist, as the bull's-eye in the
+old-fashioned windowpane.  Everywhere we find cells, modified or
+unchanged.  They roll in inconceivable multitudes (five millions and
+more to the cubic millimetre, according to Vierordt) as blood-disks
+through our vessels.  A close-fitting mail of flattened cells coats
+our surface with a panoply of imbricated scales (more than twelve
+thousand millions, as Harting has computed, as true a defence against
+our enemies as the buckler of the armadillo or the carapace of the
+tortoise against theirs.  The same little protecting organs pave all
+the great highways of the interior system.  Cells, again, preside
+over the chemical processes which elaborate the living fluids; they
+change their form to become the agents of voluntary and involuntary
+motion; the soul itself sits on a throne of nucleated cells, and
+flashes its mandates through skeins of glassy filaments which once
+were simple chains of vesicles.  And, as if to reduce the problem of
+living force to its simplest expression, we see the yolk of a
+transparent egg dividing itself in whole or in part, and again
+dividing and subdividing, until it becomes a mass of cells, out of
+which the harmonious diversity of the organs arranges itself, worm or
+man, as God has willed from the beginning.
+
+This differentiation having been effected, each several part assumes
+its special office, having a life of its own adjusted to that of
+other parts and the whole.  "Just as a tree constitutes a mass
+arranged in a definite manner, in which, in every single part, in the
+leaves as in the root, in the trunk as in the blossom, cells are
+discovered to be the ultimate elements, so is it also with the forms
+of animal life.  Every animal presents itself as a sum of vital
+unities, every one of which manifests all the characteristics of
+life."
+
+The mechanism is as clear, as unquestionable, as absolutely settled
+and universally accepted, as the order of movement of the heavenly
+bodies, which we compute backward to the days of the observatories on
+the plains of Shinar, and on the faith of which we regulate the
+movements of war and trade by the predictions of our ephemeris.
+
+The mechanism, and that is all.  We see the workman and the tools,
+but the skill that guides the work and the power that performs it are
+as invisible as ever.  I fear that not every listener took the
+significance of those pregnant words in the passage I quoted from
+John Bell,--"thinking to discover its properties in its form."  We
+have discovered the working bee in this great hive of organization.
+We have detected the cell in the very act of forming itself from a
+nucleus, of transforming itself into various tissues, of selecting
+the elements of various secretions.  But why one cell becomes nerve
+and another muscle, why one selects bile and another fat, we can no
+more pretend to tell, than why one grape sucks out of the soil the
+generous juice which princes hoard in their cellars, and another the
+wine which it takes three men to drink,--one to pour it down, another
+to swallow it, and a third to hold him while it is going down.
+Certain analogies between this selecting power and the phenomena of
+endosmosis in the elective affinities of chemistry we can find, but
+the problem of force remains here, as everywhere, unsolved and
+insolvable.
+
+Do we gain anything by attempting to get rid of the idea of a special
+vital force because we find certain mutually convertible relations
+between forces in the body and out of it?  I think not, any more than
+we should gain by getting rid of the idea and expression Magnetism
+because of its correlation with electricity.  We may concede the
+unity of all forms of force, but we cannot overlook the fixed
+differences of its manifestations according to the conditions under
+which it acts.  It is a mistake, however, to think the mystery is
+greater in an organized body than in any other.  We see a stone fall
+or a crystal form, and there is nothing stranger left to wonder at,
+for we have seen the Infinite in action.
+
+Just so far as we can recognize the ordinary modes of operation of
+the common forces of nature,--gravity, cohesion, elasticity,
+transudation, chemical action, and the rest,--we see the so-called
+vital acts in the light of a larger range of known facts and familiar
+analogies.  Matteuecci's well-remembered lectures contain many and
+striking examples of the working of physical forces in physiological
+processes.  Wherever rigid experiment carries us, we are safe in
+following this lead; but the moment we begin to theorize beyond our
+strict observation, we are in danger of falling into those mechanical
+follies which true science has long outgrown.
+
+Recognizing the fact, then, that we have learned nothing but the
+machinery of life, and are no nearer to its essence, what is it that
+we have gained by this great discovery of the cell formation and
+function?
+
+It would have been reward enough to learn the method Nature pursues
+for its own sake.  If the sovereign Artificer lets us into his own
+laboratories and workshops, we need not ask more than the privilege
+of looking on at his work.  We do not know where we now stand in the
+hierarchy of created intelligences.  We were made a little lower than
+the angels.  I speak it not irreverently; as the lower animals
+surpass man in some of their attributes, so it may be that not every
+angel's eye can see as broadly and as deeply into the material works
+of God as man himself, looking at the firmament through an equatorial
+of fifteen inches' aperture, and searching into the tissues with a
+twelfth of an inch objective.
+
+But there are other positive gains of a more practical character.
+Thus we are no longer permitted to place the seat of the living
+actions in the extreme vessels, which are only the carriers from
+which each part takes what it wants by the divine right of the
+omnipotent nucleated cell.  The organism has become, in the words
+already borrowed from Virchow, "a sum of vital unities."  The
+strictum and laxum, the increased and diminished action of the
+vessels, out of which medical theories and methods of treatment have
+grown up, have yielded to the doctrine of local cell-communities,
+belonging to this or that vascular district, from which they help
+themselves, as contractors are wont to do from the national treasury.
+
+I cannot promise to do more than to select a few of the points of
+contact between our ignorance and our knowledge which present
+particular interest in the existing state of our physiological
+acquisitions.  Some of them involve the microscopic discoveries of
+which I have been speaking, some belong to the domain of chemistry,
+and some have relations with other departments of physical science.
+
+If we should begin with the digestive function, we should find that
+the long-agitated question of the nature of the acid of the gastric
+juice is becoming settled in favor of the lactic.  But the whole
+solvent agency of the digestive fluid enters into the category of
+that exceptional mode of action already familiar to us in chemistry
+as catalysis.  It is therefore doubly difficult of explanation;
+first, as being, like all reactions, a fact not to be accounted for
+except by the imaginative appeal to "affinity," and secondly, as
+being one of those peculiar reactions provoked by an element which
+stands outside and looks on without compromising itself.
+
+The doctrine of Mulder, so widely diffused in popular and scientific
+belief, of the existence of a common base of all albuminous
+substances, the so-called protein, has not stood the test of rigorous
+analysis.  The division of food into azotized and non-azotized is no
+doubt important, but the attempt to show that the first only is
+plastic or nutritive, while the second is simply calorifacient, or
+heat-producing, fails entirely in the face of the facts revealed by
+the study of man in different climates, and of numerous experiments
+in the feeding of animals.  I must return to this subject in
+connection with the respiratory function.
+
+The sugar-making faculty of the liver is another "catalytic" mystery,
+as great as the rest of them, and no greater.  Liver-tissue brings
+sugar out of the blood, or out of its own substance;--why?
+
+          Quia est in eo
+          Virtus saccharitiva.
+
+Just what becomes of the sugar beyond the fact of its disappearance
+before it can get into the general circulation and sweeten our
+tempers, it is hard to say.
+
+The pancreatic fluid makes an emulsion of the fat contained in our
+food, but just how the fatty particles get into the villi we must
+leave Brucke and Kolliker to settle if they can.
+
+No one has shown satisfactorily the process by which the blood-
+corpuscles are formed out of the lymph-corpuscles, nor what becomes
+of them.  These two questions are like those famous household
+puzzles,--Where do the flies come from?  and, Where do the pins go
+to?
+
+There is a series of organs in the body which has long puzzled
+physiologists,--organs of glandular aspect, but having no ducts,--the
+spleen, the thyroid and thymus bodies, and the suprarenal capsules.
+We call them vascular glands, and we believe that they elaborate
+colored and uncolored blood-cells; but just what changes they effect,
+and just how they effect them, it has proved a very difficult matter
+to determine.  So of the noted glandules which form Peyer's patches,
+their precise office, though seemingly like those of the lymphatic
+glands, cannot be positively assigned, so far as I know, at the
+present time.  It is of obvious interest to learn it with reference
+to the pathology of typhoid fever.  It will be remarked that the
+coincidence of their changes in this disease with enlargement of the
+spleen suggests the idea of a similarity of function in these two
+organs.
+
+The theories of the production of animal heat, from the times of
+Black, Lavoisier, and Crawford to those of Liebig, are familiar to
+all who have paid any attention to physiological studies.  The
+simplicity of Liebig's views, and the popular form in which they have
+been presented, have given them wide currency, and incorporated them
+in the common belief and language of our text-books.  Direct
+oxidation or combustion of the carbon and hydrogen contained in the
+food, or in the tissues themselves; the division of alimentary
+substances into respiratory, or non-azotized, and azotized,--these
+doctrines are familiar even to the classes in our high-schools.  But
+this simple statement is boldly questioned.  Nothing proves that
+oxygen combines (in the system) with hydrogen and carbon in
+particular, rather than with sulphur and azote.  Such is the well-
+grounded statement of Robin and Verdeil.  "It is very probable that
+animal heat is entirely produced by the chemical actions which take
+place in the organism, but the phenomenon is too complex to admit of
+our calculating it according to the quality of oxygen consumed."
+These last are the words of Regnault, as cited by Mr. Lewes, whose
+intelligent discussion of this and many of the most interesting
+physiological problems I strongly recommend to your attention.
+
+This single illustration covers a wider ground than the special
+function to which it belongs.  We are learning that the chemistry of
+the body must be studied, not simply by its ingesta and egesta, but
+that there is a long intermediate series of changes which must be
+investigated in their own light, under their own special conditions.
+The expression "sum of vital unities" applies to the chemical
+actions, as well as to other actions localized in special parts; and
+when the distinguished chemists whom I have just cited entitle their
+work a treatise on the immediate principles of the body, they only
+indicate the nature of that profound and subtile analysis which must
+take the place of all hasty generalizations founded on a comparison
+of the food with residual products.
+
+I will only call your attention to the fact, that the exceptional
+phenomenon of the laboratory is the prevailing law of the organism.
+Nutrition itself is but one great catalytic process.  As the blood
+travels its rounds, each part selects its appropriate element and
+transforms it to its own likeness.  Whether the appropriating agent
+be cell or nucleus, or a structureless solid like the intercellular
+substance of cartilage, the fact of its presence determines the
+separation of its proper constituents from the circulating fluid, so
+that even when we are wounded bone is replaced by bone, skin by skin,
+and nerve by nerve.
+
+It is hardly without a smile that we resuscitate the old question of
+the vis insita of the muscular fibre, so famous in the discussions of
+Haller and his contemporaries.  Speaking generally, I think we may
+say that Haller's doctrine is the one now commonly received; namely,
+that the muscles contract in virtue of their own inherent endowments.
+It is true that Kolliker says no perfectly decisive fact has been
+brought forward to prove that the striated muscles contract with.
+out having been acted on by nerves.  Yet Mr. Bowman's observations on
+the contraction of isolated fibres appear decisive enough (unless we
+consider them invalidated by Dr. Lionel Beale's recent researches,
+tending to show that each elementary fibre is supplied with nerves;
+and as to the smooth muscular fibres, we have Virchow's statement
+respecting the contractility of those of the umbilical cord, where
+there is not a trace of any nerves.
+
+In the investigation of the nervous system, anatomy and physiology
+have gone hand in hand.  It is very singular that so important, and
+seemingly simple, a fact as the connection of the nerve-tubes, at
+their origin or in their course, with the nerve-cells, should have so
+long remained open to doubt, as you may see that it did by referring
+to the very complete work of Sharpey and Quain (edition of 1849), the
+histological portion of which is cordially approved by Kolliker
+himself.
+
+Several most interesting points of the minute anatomy of the nervous
+centres have been laboriously and skilfully worked out by a recent
+graduate of this Medical School, in a monograph worthy to stand in
+line with those of Lockhart Clarke, Stilling, and Schroder van der
+Kolk. I have had the privilege of examining and of showing some of
+you a number of Dr. Dean's skilful preparations.  I have no space to
+give even an abstract of his conclusions.  I can only refer to his
+proof of the fact, that a single cell may send its processes into
+several different bundles of nerve-roots, and to his demonstration of
+the curved ascending and descending fibres from the posterior
+nerveroots, to reach what he has called the longitudinal columns of
+the cornea.  I must also mention Dr. Dean's exquisite microscopic
+photographs from sections of the medulla oblongata, which appear to
+me to promise a new development, if not a new epoch, in anatomical
+art.
+
+It having been settled that the nerve-tubes can very commonly be
+traced directly to the nerve-cells, the object of all the observers
+in this department of anatomy is to follow these tubes to their
+origin.  We have an infinite snarl of telegraph wires, and we may be
+reasonably sure, that, if we can follow them up, we shall find each
+of them ends in a battery somewhere.  One of the most interesting
+problems is to find the ganglionic origin of the great nerves of the
+medulla oblongata, and this is the end to which, by the aid of the
+most delicate sections, colored so as to bring out their details,
+mounted so as to be imperishable, magnified by the best instruments,
+and now self-recorded in the light of the truth-telling sunbeam, our
+fellow-student is making a steady progress in a labor which I think
+bids fair to rank with the most valuable contributions to histology
+that we have had from this side of the Atlantic.
+
+It is interesting to see how old questions are incidentally settled
+in the course of these new investigations.  Thus, Mr. Clarke's
+dissections, confirmed by preparations of Mr. Dean's which I have
+myself examined, placed the fact of the decussation of the pyramids--
+denied by Haller, by Morgagni, and even by Stilling--beyond doubt.
+So the spinal canal, the existence of which, at least in the adult,
+has been so often disputed, appears as a coarse and unequivocal
+anatomical fact in many of the preparations referred to.
+
+While these studies of the structure of the cord have been going on,
+the ingenious and indefatigable Brown-Sequard has been investigating
+the functions of its different parts with equal diligence.  The
+microscopic anatomists had shown that the ganglionic corpuscles of
+the gray matter of the cord are connected with each other by their
+processes, as well as with the nerve-roots.  M.  Brown-Sequard has
+proved by numerous experiments that the gray substance transmits
+sensitive impressions and muscular stimulation.  The oblique
+ascending and descending fibres from the posterior nerve-roots,
+joining the "longitudinal columns of the cornua," account for the
+results of Brown-Sequard's sections of the posterior columns.  The
+physiological experimenter has also made it evident that the
+decussation of the conductors of sensitive impressions has its seat
+in the spinal core, and not in the encephalon, as had been supposed.
+Not less remarkable than these results are the facts, which I with
+others of my audience have had the opportunity of observing, as shown
+by M. Brown-S6quard, of the artificial production of epilepsy in
+animals by injuring the spinal cord, and the induction of the
+paroxysm by pinching a certain portion of the skin.  I would also
+call the student's attention to his account of the relations of the
+nervous centres to nutrition and secretion, the last of which
+relations has been made the subject of an extended essay by our
+fellow countryman, Dr. H. F. Campbell of Georgia.
+
+The physiology of the spinal cord seems a simple matter as you study
+it in Longet.  The experiments of Brown-Sequard have shown the
+problem to be a complex one, and raised almost as many doubts as they
+have solved questions; at any rate, I believe all lecturers on
+physiology agree that there is no part of their task they dread so
+much as the analysis of the evidence relating to the special offices
+of the different portions of the medulla spinalis.  In the brain we
+are sure that we do not know how to localize functions; in the spinal
+cord, we think we do know something; but there are so many anomalies,
+and seeming contradictions, and sources of fallacy, that beyond the
+facts of crossed paralysis of sensation, and the conducting agency of
+the gray substance, I am afraid we retain no cardinal principles
+discovered since the development of the reflex function took its
+place by Sir Charles Bell's great discovery.
+
+By the manner in which I spoke of the brain, you will see that I am
+obliged to leave phrenology sub Jove,--out in the cold,--as not one
+of the household of science.  I am not one of its haters; on the
+contrary, I am grateful for the incidental good it has done.  I love
+to amuse myself in its plaster Golgothas, and listen to the glib
+professor, as he discovers by his manipulations
+
+     "All that disgraced my betters met in me."
+
+I loved of old to see square-headed, heavy-jawed Spurzheim make a
+brain flower out into a corolla of marrowy filaments, as Vieussens
+had done before him, and to hear the dry-fibred but human-hearted
+George Combe teach good sense under the disguise of his equivocal
+system.  But the pseudo-sciences, phrenology and the rest, seem to me
+only appeals to weak minds and the weak points of strong ones.  There
+is a pica or false appetite in many intelligences; they take to odd
+fancies in place of wholesome truth, as girls gnaw at chalk and
+charcoal.  Phrenology juggles with nature.  It is so adjusted as to
+soak up all evidence that helps it, and shed all that harms it.  It
+crawls forward in all weathers, like Richard Edgeworth's hygrometer.
+It does not stand at the boundary of our ignorance, it seems to me,
+but is one of the will-o'-the-wisps of its undisputed central domain
+of bog and quicksand.  Yet I should not have devoted so many words to
+it, did I not recognize the light it has thrown on human actions by
+its study of congenital organic tendencies.  Its maps of the.
+surface of the head are, I feel sure, founded on a delusion, but its
+studies of individual character are always interesting and
+instructive.
+
+The "snapping-turtle" strikes after its natural fashion when it first
+comes out of the egg.  Children betray their tendencies in their way
+of dealing with the breasts that nourish them; nay, lean venture to
+affirm, that long before they are born they teach their mothers
+something of their turbulent or quiet tempers.
+
+     "Castor gaudet equis, ovo proanatus eodem
+          Pugnis."
+
+Strike out the false pretensions of phrenology; call it anthropology;
+let it study man the individual in distinction from man the
+abstraction, the metaphysical or theological lay-figure; and it
+becomes "the proper study of mankind," one of the noblest and most
+interesting of pursuits.
+
+The whole physiology of the nervous system, from the simplest
+manifestation of its power in an insect up to the supreme act of the
+human intelligence working through the brain, is full of the most
+difficult yet profoundly interesting questions.  The singular
+relations between electricity and nerve-force, relations which it has
+been attempted to interpret as meaning identity, in the face of
+palpable differences, require still more extended studies.  You may
+be interested by Professor Faraday's statement of his opinion on the
+matter.  "Though I am not satisfied that the nervous fluid is only
+electricity, still I think that the agent in the nervous system maybe
+an inorganic force; and if there be reason for supposing that
+magnetism is a higher relation of force than electricity, so it may
+well be imagined that the nervous power may be of a still more
+exalted character, and yet within the reach of experiment."
+
+In connection with this statement, it is interesting to refer to the
+experiments of Helmholtz on the rapidity of transmission of the
+nervous actions.  The rate is given differently in Valentin's report
+of these experiments and in that found in the "Scientific Annual" for
+1858.  One hundred and eighty to three hundred feet per second is the
+rate of movement assigned for sensation, but all such results must be
+very vaguely approximative.  Boxers, fencers, players at the Italian
+game of morn, "prestidigitators," and all who depend for their
+success on rapidity of motion, know what differences there are in the
+personal equation of movement.
+
+Reflex action, the mechanical sympathy, if I may so call it, of
+distant parts; Instinct, which is crystallized intelligence,--an
+absolute law with its invariable planes and angles introduced into
+the sphere of consciousness, as raphides are inclosed in the living
+cells of plants; Intellect,--the operation of the thinking principle
+through material organs, with an appreciable waste of tissue in every
+act of thought, so that our clergymen's blood has more phosphates to
+get rid of on Monday than on any other day of the week; Will,--
+theoretically the absolute determining power, practically limited in
+different degrees by the varying organization of races and
+individuals, annulled or perverted by different ill-understood
+organic changes; on all these subjects our knowledge is in its
+infancy, and from the study of some of them the interdict of the
+Vatican is hardly yet removed.
+
+I must allude to one or two points in the histology and physiology of
+the organs of sense.  The anterior continuation of the retina beyond
+the ora serrata has been a subject of much discussion.  If H. Muller
+and Kolliker can be relied upon, this question is settled by
+recognizing that a layer of cells, continued from the retina, passes
+over the surface of the zonula Zinnii, but that no proper nervous
+element is so prolonged forward.
+
+I observe that Kolliker calls the true nervous elements of the retina
+"the layer of gray cerebral substance."  In fact, the ganglionic
+corpuscles of each eye may be considered as constituting a little
+brain, connected with the masses behind by the commissure, commonly
+called the optic nerve.  We are prepared, therefore, to find these
+two little brains in the most intimate relations with each other, as
+we find the cerebral hemispheres.  We know that they are directly
+connected by fibres that arch round through the chiasma.
+
+I mention these anatomical facts to introduce a physiological
+observation of my own, first announced in one of the lectures before
+the Medical Class, subsequently communicated to the American Academy
+of Arts and Sciences, and printed in its "Transactions" for February
+14, 1860.  I refer to the apparent transfer of impressions from one
+retina to the other, to which I have given the name reflex vision.
+The idea was suggested to me in consequence of certain effects
+noticed in employing the stereoscope.  Professor William B. Rodgers
+has since called the attention of the American Scientific Association
+to some facts bearing on the subject, and to a very curious
+experiment of Leonardo da Vinci's, which enables the observer to look
+through the palm of his hand (or seem to), as if it had a hole bored
+through it.  As he and others hesitated to accept my explanation, I
+was not sorry to find recently the following words in the
+"Observations on Man" of that acute observer and thinker, David
+Hartley.  "An impression made on the right eye alone by a single
+object may propagate itself into the left, and there raise up an
+image almost equal in vividness to itself; and consequently when we
+see with one eye only, we may, however, have pictures in both eyes."
+Hartley, in 1784, had anticipated many of the doctrines which have
+since been systematized into the theory of reflex actions, and with
+which I have attempted to associate this act of reflex vision.  My
+sixth experiment, however, in the communication referred to, appears
+to me to be a crucial one, proving the correctness of my explanation,
+and I am not aware that it has been before instituted.
+
+Another point of great interest connected with the physiology of
+vision, and involved for a long time in great obscurity, is that of
+the adjustment of the eye to different distances.  Dr. Clay Wallace
+of New York, who published a very ingenious little book on the eye
+about twenty years ago, with vignettes reminding one of Bewick, was
+among the first, if not the first, to describe the ciliary muscle, to
+which the power of adjustment is generally ascribed.  It is
+ascertained, by exact experiment with the phacueidoscope, that
+accommodation depends on change of form of the crystalline lens.
+Where the crystalline is wanting, as Mr. Ware long ago taught, no
+power of accommodation remains.  The ciliary muscle is generally
+thought to effect the change of form of the crystalline.  The power
+of accommodation is lost after the application of atropine, in
+consequence, as is supposed, of the paralysis of this muscle.  This,
+I believe, is the nearest approach to a demonstration we have on this
+point.
+
+I have only time briefly to refer to Professor Draper's most
+ingenious theory as to the photographic nature of vision, for an
+account of which I must refer to his original and interesting
+Treatise on Physiology.
+
+It were to be wished that the elaborate and very interesting
+researches of the Marquis Corti, which have revealed such singular
+complexity of structure in the cochlea of the ear, had done more to
+clear up its doubtful physiology; but I am afraid we have nothing but
+hypotheses for the special part it plays in the act of hearing, and
+that we must say the same respecting the office of the semicircular
+canals.
+
+The microscope has achieved some of its greatest triumphs in teaching
+us the changes which occur in the development of the embryo.  No more
+interesting discovery stands recorded in the voluminous literature of
+this subject than the one originally announced by Martin Barry,
+afterwards discredited, and still later confirmed by Mr. Newport and
+others; namely the fact that the fertilizing filament reaches the
+interior of the ovum in various animals;--a striking parallel to the
+action of the pollen-tube in the vegetable.  But beyond the
+mechanical facts all is mystery in the movements of organization, as
+profound as in the fall of a stone or the formation of a crystal.
+
+To the chemist and the microscopist the living body presents the same
+difficulties, arising from the fact that everything is in perpetual
+change in the organism.  The fibrine of the blood puzzles the one as
+much as its globules puzzle the other.  The difference between the
+branches of science which deal with space only, and those which deal
+with space and time, is this: we have no glasses that can magnify
+time.  The figure I here show you a was photographed from an object
+(pleurosigma angulatum) magnified a thousand diameters, or presenting
+a million times its natural surface.  This other figure of the same
+object, enlarged from the one just shown, is magnified seven thousand
+diameters, or forty-nine million times in surface.  When we can make
+the forty-nine millionth of a second as long as its integer,
+physiology and chemistry will approach nearer the completeness of
+anatomy.
+
+Our reverence becomes more worthy, or, if you will, less unworthy of
+its Infinite Object in proportion as our intelligence is lifted and
+expanded to a higher and broader understanding of the Divine methods
+of action.  If Galen called his heathen readers to admire, the power,
+the wisdom, the providence, the goodness of the Framer of the animal
+body,"--if Mr. Boyle, the student of nature, as Addison and that
+friend of his who had known him for forty years tell us, never
+uttered the name of the Supreme Being without making a distinct pause
+in his speech, in token of his devout recognition of its awful
+meaning,--surely we, who inherit the accumulated wisdom of nearly two
+hundred years since the time of the British philosopher, and of
+almost two thousand since the Greek physician, may well lift our
+thoughts from the works we study to their great Artificer.  These
+wonderful discoveries which we owe to that mighty little instrument,
+the telescope of the inner firmament with all its included worlds;
+these simple formulae by which we condense the observations of a
+generation in a single axiom; these logical analyses by which we
+fence out the ignorance we cannot reclaim, and fix the limits of our
+knowledge,--all lead us up to the inspiration of the Almighty, which
+gives understanding to the world's great teachers.  To fear science
+or knowledge, lest it disturb our old beliefs, is to fear the influx
+of the Divine wisdom into the souls of our fellow-men; for what is
+science but the piecemeal revelation,--uncovering,--of the plan of
+creation, by the agency of those chosen prophets of nature whom God
+has illuminated from the central light of truth for that single
+purpose?
+
+The studies which we have glanced at are preliminary in your
+education to the practical arts which make use of them,--the arts of
+healing,--surgery and medicine.  The more you examine the structure
+of the organs and the laws of life, the more you will find how
+resolutely each of the cell-republics which make up the E pluribus
+unum of the body maintains its independence.  Guard it, feed it, air
+it, warm it, exercise or rest it properly, and the working elements
+will do their best to keep well or to get well.  What do we do with
+ailing vegetables?  Dr. Warren, my honored predecessor in this chair,
+bought a country-place, including half of an old orchard.  A few
+years afterwards I saw the trees on his side of the fence looking in
+good health, while those on the other side were scraggy and
+miserable.  How do you suppose this change was brought about?  By
+watering them with Fowler's solution?  By digging in calomel freely
+about their roots?  Not at all; but by loosening the soil round them,
+and supplying them with the right kind of food in fitting quantities.
+
+Now a man is not a plant, or, at least, he is a very curious one, for
+he carries his soil in his stomach, which is a kind--of portable
+flower-pot, and he grows round it, instead of out of it.  He has,
+besides, a singularly complex nutritive apparatus and a nervous
+system.  But recollect the doctrine already enunciated in the
+language of Virchow, that an animal, like a tree, is a sum of vital
+unities, of which the cell is the ultimate element.  Every healthy
+cell, whether in a vegetable or an animal, necessarily performs its
+function properly so long as it is supplied with its proper materials
+and stimuli.  A cell may, it is true, be congenitally defective, in
+which case disease is, so to speak, its normal state.  But if
+originally sound and subsequently diseased, there has certainly been
+some excess, deficiency, or wrong quality in the materials or stimuli
+applied to it.  You remove this injurious influence and substitute a
+normal one; remove the baked coal-ashes, for instance, from the roots
+of a tree, and replace them with loam; take away the salt meat from
+the patient's table, and replace it with fresh meat and vegetables,
+and the cells of the tree or the man return to their duty.
+
+I do not know that we ever apply to a plant any element which is not
+a natural constituent of the vegetable structure, except perhaps
+externally, for the accidental purpose of killing parasites.  The
+whole art of cultivation consists in learning the proper food and
+conditions of plants, and supplying them.  We give them water,
+earths, salts of various kinds such as they are made of, with a
+chance to help themselves to air and light.  The farmer would be
+laughed at who undertook to manure his fields or his trees with a
+salt of lead or of arsenic.  These elements are not constituents of
+healthy plants.  The gardener uses the waste of the arsenic furnaces
+to kill the weeds in his walks.
+
+If the law of the animal cell, and of the animal organism, which is
+built up of such cells, is like that of the vegetable, we might
+expect that we should treat all morbid conditions of any of the vital
+unities belonging to an animal in the same way, by increasing,
+diminishing, or changing its natural food or stimuli.
+
+"That is an aliment which nourishes; whatever we find in the
+organism, as a constant and integral element, either forming part of
+its structure, or one of the conditions of vital processes, that and
+that only deserves the name of aliment."  " I see no reason,
+therefore, why iron, phosphate of lime, sulphur, should not be
+considered food for man, as much as guano or poudrette for
+vegetables.  Whether one or another of them is best in any given
+case,--whether they shall be taken alone or in combination, in large
+or small quantities, are separate questions.  But they are elements
+belonging to the body, and even in moderate excess will produce
+little disturbance.  There is no presumption against any of this
+class of substances, any more than against water or salt, provided
+they are used in fitting combinations, proportions, and forms.
+
+But when it comes to substances alien to the healthy system, which
+never belong to it as normal constituents, the case is very
+different.  There is a presumption against putting lead or arsenic
+into the human body, as against putting them into plants, because
+they do not belong there, any more than pounded glass, which, it is
+said, used to be given as a poison.  The same thing is true of
+mercury and silver.  What becomes of these alien substances after
+they get into the system we cannot always tell.  But in the case of
+silver, from the accident of its changing color under the influence
+of light, we do know what happens.  It is thrown out, in part at
+least, under the epidermis, and there it remains to the patient's
+dying day.  This is a striking illustration of the difficulty which
+the system finds in dealing with non-assimilable elements, and
+justifies in some measure the vulgar prejudice against mineral
+poisons."
+
+I trust the youngest student on these benches will not commit the
+childish error of confounding a presumption against a particular
+class of agents with a condemnation of them.  Mercury, for instance,
+is alien to the system, and eminently disturbing in its influence.
+Yet its efficacy in certain forms of specific disease is acknowledged
+by all but the most sceptical theorists.  Even the esprit moqueur of
+Ricord, the Voltaire of pelvic literature, submits to the time-
+honored constitutional authority of this great panacea in the class
+of cases to which he has devoted his brilliant intelligence.  Still,
+there is no telling what evils have arisen from the abuse of this
+mineral.  Dr. Armstrong long ago pointed out some of them, and they
+have become matters of common notoriety.  I am pleased, therefore,
+when I find so able and experienced a practitioner as Dr. Williams of
+this city proving that iritis is best treated without mercury, and
+Dr. Vanderpoel showing the same thing to be true for pericarditis.
+
+Whatever elements nature does not introduce into vegetables, the
+natural food of all animal life,--directly of herbivorous, indirectly
+of carnivorous animals,--are to be regarded with suspicion.  Arsenic-
+eating may seem to improve the condition of horses for a time,--and
+even of human beings, if Tschudi's stories can be trusted,--but it
+soon appears that its alien qualities are at war with the animal
+organization.  So of copper, antimony, and other non-alimentary
+simple substances; everyone of them is an intruder in the living
+system, as much as a constable would be, quartered in our household.
+This does not mean that they may not, any of them, be called in for a
+special need, as we send for the constable when we have good reason
+to think we have a thief under our roof; but a man's body is his
+castle, as well as his house, and the presumption is that we are to
+keep our alimentary doors bolted against these perturbing agents.
+
+Now the feeling is very apt to be just contrary to this.  The habit
+has been very general with well-taught practitioners, to have
+recourse to the introduction of these alien elements into the system
+on the occasion of any slight disturbance.  The tongue was a little
+coated, and mercury must be given; the skin was a little dry, and the
+patient must take antimony.  It was like sending for the constable
+and the posse comitatus when there is only a carpet to shake or a
+refuse-barrel to empty. [Dr. James Johnson advises persons not ailing
+to take ,five grains of blue pill with one or two of aloes twice a
+week for three or four months in the year, with half a pint of
+compound decoction of sarsaparilla every day for the same period, to
+preserve health and prolong life.  Pract.  Treatise on Dis.  of
+Liver, etc.  p.  272.] The constitution bears slow poisoning a great
+deal better than might be expected; yet the most intelligent men in
+the profession have gradually got out of the habit of prescribing
+these powerful alien substances in the old routine way.  Mr. Metcalf
+will tell you how much more sparingly they are given by our
+practitioners at the present time, than when he first inaugurated the
+new era of pharmacy among us.  Still, the presumption in favor of
+poisoning out every spontaneous reaction of outraged nature is not
+extinct in those who are trusted with the lives of their fellow-
+citizens.  "On examining the file of prescriptions at the hospital, I
+discovered that they were rudely written, and indicated a treatment,
+as they consisted chiefly of tartar emetic, ipecacuanha, and epsom
+salts, hardly favorable to the cure of the prevailing diarrhoea and
+dysenteries."   In a report of a poisoning case now on trial, where
+we are told that arsenic enough was found in the stomach to produce
+death in twenty-four hours, the patient is said to have been treated
+by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
+acid,--by a practitioner of what school it may be imagined.
+
+The traditional idea of always poisoning out disease, as we smoke out
+vermin, is now seeking its last refuge behind the wooden cannon and
+painted port-holes of that unblushing system of false scientific
+pretences which I do not care to name in a discourse addressed to an
+audience devoted to the study of the laws of nature in the light of
+the laws of evidence.  It is extraordinary to observe that the system
+which, by its reducing medicine to a name and a farce, has accustomed
+all who have sense enough to see through its thin artifices to the
+idea that diseases get well without being "cured," should now be the
+main support of the tottering poison-cure doctrine.  It has
+unquestionably helped to teach wise people that nature heals most
+diseases without help from pharmaceutic art, but it continues to
+persuade fools that art can arrest them all with its specifics.
+
+It is worse than useless to attempt in any way to check the freest
+expression of opinion as to the efficacy of any or all of the
+"heroic" means of treatment employed by practitioners of different
+schools and periods.  Medical experience is a great thing, but we
+must not forget that there is a higher experience, which tries its
+results in a court of a still larger jurisdiction; that, namely, in
+which the laws of human belief are summoned to the witness-box, and
+obliged to testify to the sources of error which beset the medical
+practitioner.  The verdict is as old as the father of medicine, who
+announces it in the words, "judgment is difficult."  Physicians
+differed so in his time, that some denied that there was any such
+thing as an art of medicine.
+
+One man's best remedies were held as mischievous by another.  The art
+of healing was like soothsaying, so the common people said; the same
+bird was lucky or unlucky, according as he flew to the right or
+left."
+
+The practice of medicine has undergone great changes within the
+period of my own observation.  Venesection, for instance, has so far
+gone out of fashion, that, as I am told by residents of the New York
+Bellevue and the Massachusetts General Hospitals, it is almost
+obsolete in these institutions, at least in medical practice.  The
+old Brunonian stimulating treatment has come into vogue again in the
+practice of Dr. Todd and his followers.  The compounds of mercury
+have yielded their place as drugs of all work, and specifics for that
+very frequent subjective complaint, nescio quid faciam,--to compounds
+of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to
+speak of medicines which "are given as much to assist the medical man
+as his patient."  Lectures (London, 1832), p.  14.] Opium is believed
+in, and quinine, and "rum," using that expressive monosyllable to
+mean all alcoholic cordials.  If Moliere were writing now, instead of
+saignare, purgare, and the other, he would be more like to say,
+Stimulare, opium dare et potassio-iodizare.
+
+I have been in relation successively with the English and American
+evacuant and alterative practice, in which calomel and antimony
+figured so largely that, as you may see in Dr. Jackson's last
+"Letter," Dr. Holyoke, a good representative of sterling old-
+fashioned medical art, counted them with opium and Peruvian bark as
+his chief remedies; with the moderately expectant practice of Louis;
+the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant
+method of Rasori and his followers; the anti-irritant system of
+Broussais, with its leeching and gum-water; I have heard from our own
+students of the simple opium practice of the renowned German teacher,
+Oppolzer; and now I find the medical community brought round by the
+revolving cycle of opinion to that same old plan of treatment which
+John Brown taught in Edinburgh in the last quarter of the last
+century, and Miner and Tully fiercely advocated among ourselves in
+the early years of the present.  The worthy physicians last
+mentioned, and their antagonist Dr. Gallup, used stronger language
+than we of these degenerate days permit ourselves.  "The lancet is a
+weapon which annually slays more than the sword," says Dr. Tully.
+"It is probable that, for forty years past, opium and its
+preparations have done seven times the injury they have rendered
+benefit, on the great scale of the world," says Dr. Gallup.
+
+What is the meaning of these perpetual changes and conflicts of
+medical opinion and practice, from an early antiquity to our own
+time?  Simply this: all "methods" of treatment end in disappointment
+of those extravagant expectations which men are wont to entertain of
+medical art.  The bills of mortality are more obviously affected by
+drainage, than by this or that method of practice.  The insurance
+companies do not commonly charge a different percentage on the lives
+of the patients of this or that physician.  In the course of a
+generation, more or less, physicians themselves are liable to get
+tired of a practice which has so little effect upon the average
+movement of vital decomposition.  Then they are ready for a change,
+even if it were back again to a method which has already been tried,
+and found wanting.
+
+Our practitioners, or many of them, have got back to the ways of old
+Dr. Samuel Danforth, who, as it is well known, had strong objections
+to the use of the lancet.  By and by a new reputation will be made by
+some discontented practitioner, who, tired of seeing patients die
+with their skins full of whiskey and their brains muddy with opium,
+returns to a bold antiphlogistic treatment, and has the luck to see a
+few patients of note get well under it.  So of the remedies which
+have gone out of fashion and been superseded by others.  It can
+hardly be doubted that they will come into vogue again, more or less
+extensively, under the influence of that irresistible demand for
+change just referred to.
+
+Then will come the usual talk about a change in the character of
+disease, which has about as much meaning as that concerning
+"old-fashioned snow-storms."  "Epidemic constitutions" of disease
+mean something, no doubt; a great deal as applied to malarious
+affections; but that the whole type of diseases undergoes such
+changes that the practice must be reversed from depleting to
+stimulating, and vice versa, is much less likely than that methods of
+treatment go out of fashion and come in again.  If there is any
+disease which claims its percentage with reasonable uniformity, it is
+phthisis.  Yet I remember that the reverend and venerable Dr. Prince
+of Salem told me one Commencement day, as I was jogging along towards
+Cambridge with him, that he recollected the time when that disease
+was hardly hardly known; and in confirmation of his statement
+mentioned a case in which it was told as a great event, that somebody
+down on "the Cape" had died of "a consumption."  This story does not
+sound probable to myself, as I repeat it, yet I assure you it is
+true, and it shows how cautiously we must receive all popular stories
+of great changes in the habits of disease.
+
+Is there no progress, then, but do we return to the same beliefs and
+practices which our forefathers wore out and threw away?  I trust and
+believe that there is a real progress.  We may, for instance, return
+in a measure to the Brunonian stimulating system, but it must be in a
+modified way, for we cannot go back to the simple Brunonian
+pathology, since we have learned too much of diseased action to
+accept its convenient dualism.  So of other doctrines, each new
+Avatar strips them of some of their old pretensions, until they take
+their fitting place at last, if they have any truth in them, or
+disappear, if they were mere phantasms of the imagination.
+
+In the mean time, while medical theories are coming in and going out,
+there is a set of sensible men who are never run away with by them,
+but practise their art sagaciously and faithfully in much the same
+way from generation to generation.  From the time of Hippocrates to
+that of our own medical patriarch, there has been an apostolic
+succession of wise and good practitioners.  If you will look at the
+first aphorism of the ancient Master you will see that before all
+remedies he places the proper conduct of the patient and his
+attendants, and the fit ordering of all the conditions surrounding
+him.  The class of practitioners I have referred to have always been
+the most faithful in attending to these points.  No doubt they have
+sometimes prescribed unwisely, in compliance with the prejudices of
+their time, but they have grown wiser as they have grown older, and
+learned to trust more in nature and less in their plans of
+interference.  I believe common opinion confirms Sir James Clark's
+observation to this effect.
+
+The experience of the profession must, I think, run parallel with
+that of the wisest of its individual members.  Each time a plan of
+treatment or a particular remedy comes up for trial, it is submitted
+to a sharper scrutiny.  When Cullen wrote his Materia Medica, he had
+seriously to assail the practice of giving burnt toad, which was
+still countenanced by at least one medical authority of note.  I have
+read recently in some medical journal, that an American practitioner,
+whose name is known to the country, is prescribing the hoof of a
+horse for epilepsy.  It was doubtless suggested by that old fancy of
+wearing a portion of elk's hoof hung round the neck or in a ring, for
+this disease.  But it is hard to persuade reasonable people to
+swallow the abominations of a former period.  The evidence which
+satisfied Fernelius will not serve one of our hospital physicians.
+
+In this way those articles of the Materia Medica which had nothing
+but loathsomeness to recommend them have been gradually dropped, and
+are not like to obtain any general favor again with civilized
+communities.  The next culprits to be tried are the poisons.  I have
+never been in the least sceptical as to the utility of some of them,
+when properly employed.  Though I believe that at present, taking the
+world at large, and leaving out a few powerful agents of such immense
+value that they rank next to food in importance, the poisons
+prescribed for disease do more hurt than good, I have no doubt, and
+never professed to have any, that they do much good in prudent and
+instructed hands.  But I am very willing to confess a great jealousy
+of many agents, and I could almost wish to see the Materia Medica so
+classed as to call suspicion upon certain ones among them.
+
+Thus the alien elements, those which do not properly enter into the
+composition of any living tissue, are the most to be suspected,--
+mercury, lead, antimony, silver, and the rest, for the reasons I have
+before mentioned.  Even iodine, which, as it is found in certain
+plants, seems less remote from the animal tissues, gives unequivocal
+proofs from time to time that it is hostile to some portions of the
+glandular system.
+
+There is, of course, less prima facie objection to those agents which
+consist of assimilable elements, such as are found making a part of
+healthy tissues.  These are divisible into three classes,--foods,
+poisons, and inert, mostly because insoluble, substances.  The food
+of one animal or of one human being is sometimes poison to another,
+and vice versa; inert substances may act mechanically, so as to
+produce the effect of poisons; but this division holds exactly enough
+for our purpose.
+
+Strictly speaking, every poison consisting of assimilable elements
+may be considered as unwholesome ,food.  It is rejected by the
+stomach, or it produces diarrhoea, or it causes vertigo or
+disturbance of the heart's action, or some other symptom for which
+the subject of it would consult the physician, if it came on from any
+other cause than taking it under the name of medicine.  Yet portions
+of this unwholesome food which we call medicine, we have reason to
+believe, are assimilated; thus, castor-oil appears to be partially
+digested by infants, so that they require large doses to affect them
+medicinally.  Even that deadliest of poisons, hydrocyanic acid, is
+probably assimilated, and helps to make living tissue, if it do not
+kill the patient, for the assimilable elements which it contains,
+given in the separate forms of amygdalin and emulsin, produce no
+disturbance, unless, as in Bernard's experiments, they are suffered
+to meet in the digestive organs.  A medicine consisting of
+assimilable substances being then simply unwholesome food, we
+understand what is meant by those cumulative effects of such remedies
+often observed, as in the case of digitalis and strychnia.  They are
+precisely similar to the cumulative effects of a salt diet in
+producing scurvy, or of spurred rye in producing dry gangrene.  As
+the effects of such substances are a violence to the organs, we
+should exercise the same caution with regard to their use that we
+would exercise about any other kind of poisonous food,--partridges at
+certain seasons, for instance.  Even where these poisonous kinds of
+food seem to be useful, we should still regard them with great
+jealousy.  Digitalis lowers the pulse in febrile conditions.
+Veratrum viride does the same thing.  How do we know that a rapid
+pulse is not a normal adjustment of nature to the condition it
+accompanies?  Digitalis has gone out of favor; how sure are we that
+Veratrum viride will not be found to do more harm than good in a case
+of internal inflammation, taking the whole course of the disease into
+consideration?  Think of the change of opinion with regard to the use
+of opium in delirium tremens (which you remember is sometimes called
+delirium vigilans), where it seemed so obviously indicated, since the
+publication of Dr. Ware's admirable essay.  I respect the evidence of
+my contemporaries, but I cannot forget the sayings of the Father of
+medicine,--Ars longa, judicium diffcile.
+
+I am not presuming to express an opinion concerning Veratrum viride,
+which was little heard of when I was still practising medicine.  I am
+only appealing to that higher court of experience which sits in
+judgment on all decisions of the lower medical tribunals, and which
+requires more than one generation for its final verdict.
+
+Once change the habit of mind so long prevalent among practitioners
+of medicine; once let it be everywhere understood that the
+presumption is in favor of food, and not of alien substances, of
+innocuous, and not of unwholesome food, for the sick; that this
+presumption requires very strong evidence in each particular case to
+overcome it; but that, when such evidence is afforded, the alien
+substance or the unwholesome food should be given boldly, in
+sufficient quantities, in the same spirit as that with which the
+surgeon lifts his knife against a patient,--that is, with the same
+reluctance and the same determination,--and I think we shall have and
+hear much less of charlatanism in and out of the profession.  The
+disgrace of medicine has been that colossal system of self-deception,
+in obedience to which mines have been emptied of their cankering
+minerals, the vegetable kingdom robbed of all its noxious growths,
+the entrails of animals taxed for their impurities, the poison-bags
+of reptiles drained of their venom, and all the inconceivable
+abominations thus obtained thrust down the throats of human beings
+suffering from some fault of organization, nourishment, or vital
+stimulation.
+
+Much as we have gained, we have not yet thoroughly shaken off the
+notion that poison is the natural food of disease, as wholesome
+aliment is the support of health.  Cowper's lines, in "The Task,"
+show the matter-of-course practice of his time:
+
+    "He does not scorn it, who has long endured
+     A fever's agonies, and fed on drugs."
+
+Dr. Kimball of Lowell, who has been in the habit of seeing a great
+deal more of typhoid fever than most practitioners, and whose
+surgical exploits show him not to be wanting in boldness or
+enterprise, can tell you whether he finds it necessary to feed his
+patients on drugs or not.  His experience is, I believe, that of the
+most enlightened and advanced portion of the profession; yet I think
+that even in typhoid fever, and certainly in many other complaints,
+the effects of ancient habits and prejudices may still be seen in the
+practice of some educated physicians.
+
+To you, young men, it belongs to judge all that has gone before you.
+You come nearer to the great fathers of modern medicine than some of
+you imagine.  Three of my own instructors attended Dr. Rush's
+Lectures.  The illustrious Haller mentions Rush's inaugural thesis in
+his "Bibliotheca Anatomica;" and this same Haller, brought so close
+to us, tells us he remembers Ruysch, then an old man, and used to
+carry letters between him and Boerhaave.  Look through the history of
+medicine from Boerhaave to this present day.  You will see at once
+that medical doctrine and practice have undergone a long series of
+changes.  You will see that the doctrine and practice of our own time
+must probably change in their turn, and that, if we can trust at all
+to the indications of their course, it will be in the direction of an
+improved hygiene and a simplified treatment.  Especially will the old
+habit of violating the instincts of the sick give place to a
+judicious study of these same instincts.  It will be found that
+bodily, like mental insanity, is best managed, for the most part, by
+natural soothing agencies.  Two centuries ago there was a
+prescription for scurvy containing "stercoris taurini et anserini
+par, quantitas trium magnarum nucum," of the hell-broth containing
+which "guoties-cumque sitit oeger, large bibit."   When I have
+recalled the humane common-sense of Captain Cook in the matter of
+preventing this disease; when I have heard my friend, Mr. Dana,
+describing the avidity with which the scurvy-stricken sailors snuffed
+up the earthy fragrance of fresh raw potatoes, the food which was to
+supply the elements wanting to their spongy tissues, I have
+recognized that the perfection of art is often a return to nature,
+and seen in this single instance the germ of innumerable beneficent
+future medical reforms.
+
+I cannot help believing that medical curative treatment will by and
+by resolve itself in great measure into modifications of the food,
+swallowed and breathed, and of the natural stimuli, and that less
+will be expected from specifics and noxious disturbing agents, either
+alien or assimilable.  The noted mineral-waters containing iron,
+sulphur, carbonic acid, supply nutritious or stimulating materials to
+the body as much as phosphate of lime and ammoniacal compounds do to
+the cereal plants.  The effects of a milk and vegetable diet, of
+gluten bread in diabetes, of cod-liver oil in phthisis, even of such
+audacious innovations as the water-cure and the grape-cure, are only
+hints of what will be accomplished when we have learned to discover
+what organic elements are deficient or in excess in a case of chronic
+disease, and the best way of correcting the abnormal condition, just
+as an agriculturist ascertains the wants of his crops and modifies
+the composition of his soil.  In acute febrile diseases we have long
+ago discovered that far above all drug-medication is the use of mild
+liquid diet in the period of excitement, and of stimulant and
+nutritious food in that of exhaustion.  Hippocrates himself was as
+particular about his barley-ptisan as any Florence Nightingale of our
+time could be.
+
+The generation to which you, who are just entering the profession,
+belong, will make a vast stride forward, as I believe, in the
+direction of treatment by natural rather than violent agencies.  What
+is it that makes the reputation of Sydenham, as the chief of English
+physicians?  His prescriptions consisted principally of simples.  An
+aperient or an opiate, a "cardiac" or a tonic, may be commonly found
+in the midst of a somewhat fantastic miscellany of garden herbs.  It
+was not by his pharmaceutic prescriptions that he gained his great
+name.  It was by daring to order fresh air for small-pox patients,
+and riding on horseback for consumptives, in place of the smothering
+system, and the noxious and often loathsome rubbish of the
+established schools.  Of course Sydenham was much abused by his
+contemporaries, as he frequently takes occasion to remind his reader.
+"I must needs conclude," he says, "either that I am void of merit, or
+that the candid and ingenuous part of mankind, who are formed with so
+excellent a temper of mind as to be no strangers to gratitude, make a
+very small part of the whole."  If in the fearless pursuit of truth
+you should find the world as ungracious in the nineteenth century as
+he found it in the seventeenth, you may learn a lesson of self-
+reliance from another utterance of the same illustrious physician:
+"'T is none of my business to inquire what other persons think, but
+to establish my own observations; in order to which, I ask no favor
+of the reader but to peruse my writings with temper."
+
+The physician has learned a great deal from the surgeon, who is
+naturally in advance of him, because he has a better opportunity of
+seeing the effects of his remedies.  Let me shorten one of Ambroise
+Pare's stories for you.  There had been a great victory at the pass
+of Susa, and they were riding into the city.  The wounded cried out
+as the horses trampled them under their hoofs, which caused good
+Ambroise great pity, and made him wish himself back in Paris.  Going
+into a stable he saw four dead soldiers, and three desperately
+wounded, placed with their backs against the wall.  An old campaigner
+came up. --"Can these fellows get well?" he said.  "No!" answered the
+surgeon.  Thereupon, the old soldier walked up to them and cut all
+their throats, sweetly, and without wrath (doulcement et sans
+cholere).  Ambroise told him he was a bad man to do such a thing.
+"I hope to God;" he said, "somebody will do as much for me if I ever
+get into such a scrape" (accoustre de telle facon).  "I was not much
+salted in those days" (bien doux de sel), says Ambroise, "and little
+acquainted with the treatment of wounds."  However, as he tells us,
+he proceeded to apply boiling oil of Sambuc (elder) after the
+approved fashion of the time,--with what torture to the patient may
+be guessed.  At last his precious oil gave out, and he used instead
+an insignificant mixture of his own contrivance.  He could not sleep
+that night for fear his patients who had not been scalded with the
+boiling oil would be poisoned by the gunpowder conveyed into their
+wounds by the balls.  To his surprise, he found them much better than
+the others the next morning, and resolved never again to burn his
+patients with hot oil for gun-shot wounds.
+
+This was the beginning, as nearly as we can fix it, of that reform
+which has introduced plain water-dressings in the place of the
+farrago of external applications which had been a source of profit to
+apothecaries and disgrace to art from, and before, the time when
+Pliny complained of them.  A young surgeon who was at Sudley Church,
+laboring among the wounded of Bull Run, tells me they had nothing but
+water for dressing, and he (being also doux de sel) was astonished to
+see how well the wounds did under that simple treatment.
+
+Let me here mention a fact or two which may be of use to some of you
+who mean to enter the public service.  You will, as it seems, have
+gun-shot wounds almost exclusively to deal with.  Three different
+surgeons, the one just mentioned and two who saw the wounded of Big
+Bethel, assured me that they found no sabre-cuts or bayonet wounds.
+It is the rifle-bullet from a safe distance which pierces the breasts
+of our soldiers, and not the gallant charge of broad platoons and
+sweeping squadrons, such as we have been in the habit of considering
+the chosen mode of warfare of ancient and modern chivalry. [Sir
+Charles James Napier had the same experience in Virginia in 1813.
+"Potomac.  We have nasty sort of fighting here, amongst creeks and
+bushes, and lose men without show."  "Yankee never shows himself, he
+keeps in the thickest wood, fires and runs off." --These five
+thousand in the open field might be attacked, but behind works it
+would be throwing away lives."  He calls it "an inglorious warfare,"
+--says one of the leaders is "a little deficient in gumption,"--but
+--still my opinion is, that if we tuck up our sleeves and lay our
+ears back we might thrash them; that is, if we caught them out of
+their trees, so as to slap at them with the bayonet." --Life, etc.
+vol.  i.  p.  218 et seq.]
+
+Another fact parallels the story of the old campaigner, and may teach
+some of you caution in selecting your assistants.  A chaplain told it
+to two of our officers personally known to myself.  He overheard the
+examination of a man who wished to drive one of the "avalanche"
+wagons, as they call them.  The man was asked if he knew how to deal
+with wounded men.  "Oh yes," he answered; "if they're hit here,"
+pointing to the abdomen, "knock 'em on the head,--they can't get
+well."
+
+In art and outside of it you will meet the same barbarisms that
+Ambroise Pare met with,--for men differ less from century to century
+than we are apt to suppose; you will encounter the same opposition,
+if you attack any prevailing opinion, that Sydenham complained of.
+So far as possible, let not such experiences breed in you a contempt
+for those who are the subjects of folly or prejudice, or foster any
+love of dispute for its own sake.  Should you become authors, express
+your opinions freely; defend them rarely.  It is not often that an
+opinion is worth expressing, which cannot take care of itself.
+Opposition is the best mordant to fix the color of your thought in
+the general belief.
+
+It is time to bring these crowded remarks to a close.  The day has
+been when at the beginning of a course of Lectures I should have
+thought it fitting to exhort you to diligence and entire devotion to
+your tasks as students.  It is not so now.  The young man who has not
+heard the clarion-voices of honor and of duty now sounding throughout
+the land, will heed no word of mine.  In the camp or the city, in the
+field or the hospital, under sheltering roof, or half-protecting
+canvas, or open sky, shedding our own blood or stanching that of our
+wounded defenders, students or teachers, whatever our calling and our
+ability, we belong, not to ourselves, but to our imperilled country,
+whose danger is our calamity, whose ruin would be our enslavement,
+whose rescue shall be our earthly salvation!
+
+
+
+
+
+
+SCHOLASTIC AND BEDSIDE TEACHING.
+
+An Introductory Lecture delivered before the Medical Class of Harvard
+University, November 6, 1867.
+
+The idea is entertained by some of our most sincere professional
+brethren, that to lengthen and multiply our Winter Lectures will be
+of necessity to advance the cause of medical education.  It is a fair
+subject for consideration whether they do not overrate the relative
+importance of that particular mode of instruction which forms the
+larger part of these courses.
+
+As this School could only lengthen its lecture term at the expense of
+its "Summer Session," in which more direct, personal, and familiar
+teaching takes the place of our academic discourses, and in which
+more time can be given to hospitals, infirmaries, and practical
+instruction in various important specialties, whatever might be
+gained, a good deal would certainly be lost in our case by the
+exchange.
+
+The most essential part of a student's instruction is obtained, as I
+believe, not in the lecture-room, but at the bedside.  Nothing seen
+there is lost; the rhythms of disease are learned by frequent
+repetition; its unforeseen occurrences stamp themselves indelibly in
+the memory.  Before the student is aware of what he has acquired, he
+has learned the aspects and course and probable issue of the diseases
+he has seen with his teacher, and the proper mode of dealing with
+them, so far as his master knows it.  On the other hand, our ex
+cathedra prelections have a strong tendency to run into details
+which, however interesting they may be to ourselves and a few of our
+more curious listeners, have nothing in them which will ever be of
+use to the student as a practitioner.  It is a perfectly fair
+question whether I and some other American Professors do not teach
+quite enough that is useless already.  Is it not well to remind the
+student from time to time that a physician's business is to avert
+disease, to heal the sick, to prolong life, and to diminish
+suffering?  Is it not true that the young man of average ability will
+find it as much as he can do to fit himself for these simple duties?
+Is it not best to begin, at any rate, by making sure of such
+knowledge as he will require in his daily walk, by no means
+discouraging him from any study for which his genius fits him when he
+once feels that he has become master of his chosen art.
+
+I know that many branches of science are of the greatest value as
+feeders of our medical reservoirs.  But the practising physician's
+office is to draw the healing waters, and while he gives his time to
+this labor he can hardly be expected to explore all the sources that
+spread themselves over the wide domain of science.  The traveller who
+would not drink of the Nile until he had tracked it to its parent
+lakes, would be like to die of thirst; and the medical practitioner
+who would not use the results of many laborers in other departments
+without sharing their special toils, would find life far too short
+and art immeasurably too long.
+
+We owe much to Chemistry, one of the most captivating as well as
+important of studies; but the medical man must as a general rule
+content himself with a clear view of its principles and a limited
+acquaintance with its facts; such especially as are pertinent to his
+pursuits.  I am in little danger of underrating Anatomy or
+Physiology; but as each of these branches splits up into specialties,
+any one of which may take up a scientific life-time, I would have
+them taught with a certain judgment and reserve, so that they shall
+not crowd the more immediately practical branches.  So of all the
+other ancillary and auxiliary kinds of knowledge, I would have them
+strictly subordinated to that particular kind of knowledge for which
+the community looks to its medical advisers.
+
+A medical school is not a scientific school, except just so far as
+medicine itself is a science.  On the natural history side, medicine
+is a science; on the curative side, chiefly an art.  This is implied
+in Hufeland's aphorism: "The physician must generalize the disease
+and individualize the patient."
+
+The coordinated and classified results of empirical observation, in
+distinction from scientific experiment, have furnished almost all we
+know about food, the medicine of health, and medicine, the food of
+sickness.  We eat the root of the Solanum tuberosum and throw away
+its fruit; we eat the fruit of the Solanum Lycopersicum and throw
+away its root.  Nothing but vulgar experience has taught us to reject
+the potato ball and cook the tomato.  So of most of our remedies.
+The subchloride of mercury, calomel, is the great British specific;
+the protochloride of mercury, corrosive sublimate, kills like
+arsenic, but no chemist could have told us it would be so.
+
+>From observations like these we can obtain certain principles from
+which we can argue deductively to facts of a like nature, but the
+process is limited, and we are suspicious of all reasoning in that
+direction applied to the processes of healthy and diseased life.  We
+are continually appealing to special facts.  We are willing to give
+Liebig's artificial milk when we cannot do better, but we watch the
+child anxiously whose wet-nurse is a chemist's pipkin.  A pair of
+substantial mammary glands has the advantage over the two hemispheres
+of the most learned Professor's brain, in the art of compounding a
+nutritious fluid for infants.
+
+The bedside is always the true centre of medical teaching.  Certain
+branches must be taught in the lecture-room, and will necessarily
+involve a good deal that is not directly useful to the future
+practitioner.  But the over ambitious and active student must not be
+led away by the seduction of knowledge for its own sake from his
+principal pursuit.  The humble beginner, who is alarmed at the vast
+fields of knowledge opened to him, may be encouraged by the assurance
+that with a very slender provision of science, in distinction from
+practical skill, he may be a useful and acceptable member of the
+profession to which the health of the community is intrusted.
+
+To those who are not to engage in practice, the various pursuits of
+science hardly require to be commended.  Only they must not be
+disappointed if they find many subjects treated in our courses as a
+medical class requires, rather than as a scientific class would
+expect, that is, with special limitations and constant reference to
+practical ends.  Fortunately they are within easy reach of the
+highest scientific instruction.  The business of a school like this
+is to make useful working physicians, and to succeed in this it is
+almost as important not to overcrowd the mind of the pupil with
+merely curious knowledge as it is to store it with useful
+information.
+
+In this direction I have written my lecture, not to undervalue any
+form of scientific labor in its place, an unworthy thought from which
+I hope I need not defend myself,--but to discourage any undue
+inflation of the scholastic programme, which even now asks more of
+the student than the teacher is able to obtain from the great
+majority of those who present themselves for examination.  I wish to
+take a hint in education from the Secretary of the Massachusetts
+Board of Agriculture, who regards the cultivation of too much land as
+a great defect in our New England farming.  I hope that our Medical
+Institutions may never lay themselves open to the kind of accusation
+Mr. Lowe brings against the English Universities, when he says that
+their education is made up "of words that few understand and most
+will shortly forget; of arts that can never be used, if indeed they
+can even be learnt; of histories inapplicable to our times; of
+languages dead and even mouldy; of grammatical rules that never had
+living use and are only post mortem examinations; and of statements
+fagoted with utter disregard of their comparative value."
+
+This general thought will be kept in view throughout my somewhat
+discursive address, which will begin with an imaginary clinical
+lesson from the lips of an historical personage, and close with the
+portrait from real life of one who, both as teacher and practitioner,
+was long loved and honored among us.  If I somewhat overrun my hour,
+you must pardon me, for I can say with Pascal that I have not had the
+time to make my lecture shorter.
+
+
+In the year 1647, that good man John Eliot, commonly called the
+Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of
+Cambridge, referring to the great need of medical instruction for the
+Indians, used these words:
+
+"I have thought in my heart that it were a singular good work, if the
+Lord would stirre up the hearts of some or other of his people in
+England to give some maintenance toward some Schoole or Collegiate
+exercise this way, wherein there should be Anatomies and other
+instructions that way, and where there might be some recompence given
+to any that should bring in any vegetable or other thing that is
+vertuous in the way of Physick.
+
+"There is another reason which moves my thought and desires this way,
+namely that our young students in Physick may be trained up better
+then they yet bee, who have onely theoreticall knowledge, and are
+forced to fall to practise before ever they saw an Anatomy made, or
+duely trained up in making experiments, for we never had but one
+Anatomy in the countrey, which Mr. Giles Firman [Firmin] now in
+England, did make and read upon very well, but no more of that now."
+
+Since the time of the Apostle Eliot the Lord has stirred up the
+hearts of our people to the building of many Schools and Colleges
+where medicine is taught in all its branches.  Mr. Giles Firmin's
+"Anatomy " may be considered the first ancestor of a long line of
+skeletons which have been dangling and rattling in our lecture-rooms
+for more than a century.
+
+Teaching in New England in 1647 was a grave but simple matter.  A
+single person, combining in many cases, as in that of Mr. Giles
+Firmin, the offices of physician and preacher, taught what he knew to
+a few disciples whom he gathered about him.  Of the making of that
+"Anatomy" on which my first predecessor in the branch I teach" did
+read very well" we can know nothing.  The body of some poor wretch
+who had swung upon the gallows, was probably conveyed by night to
+some lonely dwelling at the outskirts of the village, and there by
+the light of flaring torches hastily dissected by hands that trembled
+over the unwonted task.  And ever and anon the master turned to his
+book, as he laid bare the mysteries of the hidden organs; to his
+precious Vesalius, it might be, or his figures repeated in the
+multifarious volume of Ambroise Pare; to the Aldine octavo in which
+Fallopius recorded his fresh observations; or that giant folio of
+Spigelius just issued from the press of Amsterdam, in which lovely
+ladies display their viscera with a coquettish grace implying that it
+is rather a pleasure than otherwise to show the lace-like omentum,
+and hold up their appendices epiploicae as if they were saying "these
+are our jewels."
+
+His teaching of medicine was no doubt chiefly clinical, and received
+with the same kind of faith as that which accepted his words from the
+pulpit.  His notions of disease were based on what he had observed,
+seen always in the light of the traditional doctrines in which he was
+bred.  His discourse savored of the weighty doctrines of Hippocrates,
+diluted by the subtle speculations of Galen, reinforced by the
+curious comments of the Arabian schoolmen as they were conveyed in
+the mellifluous language of Fernelius, blended, it may be, with
+something of the lofty mysticism of Van Helmont, and perhaps stealing
+a flavor of that earlier form of Homoeopathy which had lately come to
+light in Sir Kenelm Digby's "Discourse concerning the Cure of Wounds
+by the Sympathetic Powder."
+
+His Pathology was mythology.  A malformed foetus, as the readers of
+Winthrop's Journal may remember, was enough to scare the colonists
+from their propriety, and suggest the gravest fears of portended
+disaster.  The student of the seventeenth century opened his Licetus
+and saw figures of a lion with the head of a woman, and a man with
+the head of an elephant.  He had offered to his gaze, as born of a
+human mother, the effigy of a winged cherub, a pterocephalous
+specimen, which our Professor of Pathological Anatomy would hardly
+know whether to treat with the reverence due to its celestial aspect,
+or to imprison in one of his immortalizing jars of alcohol.
+
+His pharmacopoeia consisted mainly of simples, such as the venerable
+"Herball" of Gerard describes and figures in abounding affluence.
+St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron
+and Parsley, Elder and Snake-root, with opium in some form, and
+roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of
+which it used to be said that whatever the Tacamahaca has not cured,
+the Caranna will, with the more familiar Scammony and Jalap and Black
+Hellebore, made up a good part of his probable list of remedies.  He
+would have ordered Iron now and then, and possibly an occasional dose
+of Antimony.  He would perhaps have had a rheumatic patient wrapped
+in the skin of a wolf or a wild cat, and in case of a malignant fever
+with "purples" or petechiae, or of an obstinate king's evil, he might
+have prescribed a certain black powder, which had been made by
+calcining toads in an earthen pot; a choice remedy, taken internally,
+or applied to any outward grief.
+
+Except for the toad-powder and the peremptory drastics, one might
+have borne up against this herb doctoring as well as against some
+more modern styles of medication.  Barbeyrac and his scholar Sydenham
+had not yet cleansed the Pharmacopoeia of its perilous stuff, but
+there is no doubt that the more sensible physicians of that day knew
+well enough that a good honest herb-tea which amused the patient and
+his nurses was all that was required to carry him through all common
+disorders.
+
+The student soon learned the physiognomy of disease by going about
+with his master; fevers, pleurisies, asthmas, dropsies, fluxes,
+small-pox, sore-throats, measles, consumptions.  He saw what was done
+for them.  He put up the medicines, gathered the herbs, and so
+learned something of materia medico and botany.  He learned these few
+things easily and well, for he could give his whole attention to
+them.  Chirurgery was a separate specialty.  Women in child-birth
+were cared for by midwives.  There was no chemistry deserving the
+name to require his study.  He did not learn a great deal, perhaps,
+but what he did learn was his business, namely, how to take care of
+sick people.
+
+Let me give you a picture of the old=fashioned way of instruction, by
+carrying you with me in imagination in the company of worthy Master
+Giles Firmin as he makes his round of visits among the good folk of
+Ipswich, followed by his one student, who shall answer to the
+scriptural name of Luke.  It will not be for entertainment chiefly,
+but to illustrate the one mode of teaching which can never be
+superseded, and which, I venture to say, is more important than all
+the rest put together.  The student is a green hand, as you will
+perceive.
+
+In the first dwelling they come to, a stout fellow is bellowing with
+colic.
+
+"He will die, Master, of a surety, methinks," says the timid youth in
+a whisper.
+
+"Nay, Luke," the Master answers, "'t is but a dry belly-ache.  Didst
+thou not mark that he stayed his roaring when I did press hard over
+the lesser bowels?  Note that he hath not the pulse of them with
+fevers, and by what Dorcas telleth me there hath been no long
+shutting up of the vice naturales.  We will steep certain comforting
+herbs which I will shew thee, and put them in a bag and lay them on
+his belly.  Likewise he shall have my cordial julep with a portion of
+this confection which we do call Theriaca Andromachi, which hath
+juice of poppy in it, and is a great stayer of anguish.  This fellow
+is at his prayers to-day, but I warrant thee he shall be swearing
+with the best of them to-morrow."
+
+They jog along the bridle-path on their horses until they come to
+another lowly dwelling.  They sit a while with a delicate looking
+girl in whom the ingenuous youth naturally takes a special interest.
+The good physician talks cheerfully with her, asks her a few
+questions.  Then to her mother: "Good-wife, Margaret hath somewhat
+profited, as she telleth, by the goat's milk she hath taken night and
+morning.  Do thou pluck a maniple--that is an handful--of the plant
+called Maidenhair, and make a syrup therewith as I have shewed thee.
+Let her take a cup full of the same, fasting, before she sleepeth,
+also before she riseth from her bed."  And so they leave the house.
+
+"What thinkest thou, Luke, of the maid we have been visiting?"  "She
+seemeth not much ailing, Master, according to my poor judgment.  For
+she did say she was better.  And she had a red cheek and a bright
+eye, and she spake of being soon able to walk unto the meeting, and
+did seem greatly hopeful, but spare of flesh, methought, and her
+voice something hoarse, as of one that hath a defluxion, with some
+small coughing from a cold, as she did say.  Speak I not truly,
+Master, that she will be well speedily?"
+
+"Yea, Luke, I do think she shall be well, and mayhap speedily.  But
+it is not here with us she shall be well.  For that redness of the
+cheek is but the sign of the fever which, after the Grecians, we do
+call the hectical; and that shining of the eyes is but a sickly
+glazing, and they which do every day get better and likewise thinner
+and weaker shall find that way leadeth to the church-yard gate.  This
+is the malady which the ancients did call tubes, or the wasting
+disease, and some do name the consumption.  A disease whereof most
+that fall ailing do perish.  This Margaret is not long for earth--but
+she knoweth it not, and still hopeth."
+
+"Why, then, Master, didst thou give her of thy medicine, seeing that
+her ail is unto death?"
+
+"Thou shalt learn, boy, that they which are sick must have somewhat
+wherewith to busy their thoughts.  There be some who do give these
+tabid or consumptives a certain posset made with lime-water and anise
+and liquorice and raisins of the sun, and there be other some who do
+give the juice of craw-fishes boiled in barley-water with chicken-
+broth, but these be toys, as I do think, and ye shall find as good
+virtue, nay better, in this syrup of the simple called Maidenhair."
+
+Something after this manner might Master Giles Firmin have delivered
+his clinical instructions.  Somewhat in this way, a century and a
+half later, another New England physician, Dr. Edward Augustus
+Holyoke, taught a young man who came to study with him, a very
+diligent and intelligent youth, James Jackson by name, the same whose
+portrait in his advanced years hangs upon this wall, long the honored
+Professor of Theory and Practice in this Institution, of whom I shall
+say something in this Lecture.  Our venerated Teacher studied
+assiduously afterwards in the great London Hospitals, but I think he
+used to quote his "old Master" ten times where he quoted Mr. Cline or
+Dr. Woodville once.
+
+When I compare this direct transfer of the practical experience of a
+wise man into the mind of a student,--every fact one that he can use
+in the battle of life and death,--with the far off, unserviceable
+"scientific" truths that I and some others are in the habit of
+teaching, I cannot help asking myself whether, if we concede that our
+forefathers taught too little, there is not--a possibility that we
+may sometimes attempt to teach too much.  I almost blush when I think
+of myself as describing the eight several facets on two slender
+processes of the palate bone, or the seven little twigs that branch
+off from the minute tympanic nerve, and I wonder whether my excellent
+colleague feels in the same way when he pictures himself as giving
+the constitution of neurin, which as he and I know very well is that
+of the hydrate of trimethyle-oxethyle-ammonium, or the formula for
+the production of alloxan, which, though none but the Professors and
+older students can be expected to remember it, is C10 H4 N4 O6+ 2HO,
+NO5}=C8 H4 N2 O10+2CO2+N2+NH4 O, NO5.
+
+I can bear the voice of some rough iconoclast addressing the
+Anatomist and the Chemist in tones of contemptuous indignation: "What
+is this stuff with which you are cramming the brains of young men who
+are to hold the lives of the community in their hands?  Here is a man
+fallen in a fit; you can tell me all about the eight surfaces of the
+two processes of the palate bone, but you have not had the sense to
+loosen that man's neck-cloth, and the old women are all calling you a
+fool?  Here is a fellow that has just swallowed poison.  I want
+something to turn his stomach inside out at the shortest notice.  Oh,
+you have forgotten the dose of the sulphate of zinc, but you remember
+the formula for the production of alloxan!"
+
+"Look you, Master Doctor,--if I go to a carpenter to come and stop a
+leak in my roof that is flooding the house, do you suppose I care
+whether he is a botanist or not?  Cannot a man work in wood without
+knowing all about endogens and exogens, or must he attend Professor
+Gray's Lectures before he can be trusted to make a box-trap?  If my
+horse casts a shoe, do you think I will not trust a blacksmith to
+shoe him until I have made sure that he is sound on the distinction
+between the sesquioxide and the protosesquioxide of iron?"
+
+--But my scientific labor is to lead to useful results by and by, in
+the next generation, or in some possible remote future.--
+
+"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,--
+"what is that to me and my colic, to me and my strangury?  I pay the
+Captain of the Cunard steamship to carry me quickly and safely to
+Liverpool, not to make a chart of the Atlantic for after voyagers!
+If Professor Peirce undertakes to pilot me into Boston Harbor and
+runs me on Cohasset rocks, what answer is it to tell me that he is
+Superintendent of the Coast Survey?  No, Sir!  I want a plain man in
+a pea-jacket and a sou'wester, who knows the channel of Boston
+Harbor, and the rocks of Boston Harbor, and the distinguished
+Professor is quite of my mind as to the matter, for I took the pains
+to ask him before I ventured to use his name in the way of
+illustration."
+
+
+I do not know how the remarks of the image-breaker may strike others,
+but I feel that they put me on my defence with regard to much of my
+teaching.  Some years ago I ventured to show in an introductory
+Lecture how very small a proportion of the anatomical facts taught in
+a regular course, as delivered by myself and others, had any
+practical bearing whatever on the treatment of disease.  How can I,
+how can any medical teacher justify himself in teaching anything that
+is not like to be of practical use to a class of young men who are to
+hold in their hands the balance in which life and death, ease and
+anguish, happiness and wretchedness are to be daily weighed?
+
+I hope we are not all wrong.  Oftentimes in finding how sadly
+ignorant of really essential and vital facts and rules were some of
+those whom we had been larding with the choicest scraps of science, I
+have doubted whether the old one-man system of teaching, when the one
+man was of the right sort, did not turn out better working physicians
+than our more elaborate method.  The best practitioner I ever knew
+was mainly shaped to excellence in that way.  I can understand
+perfectly the regrets of my friend Dr. John Brown of Edinburgh, for
+the good that was lost with the old apprenticeship system.  I
+understand as well Dr. Latham's fear "that many men of the best
+abilities and good education will be deterred from prosecuting physic
+as a profession, in consequence of the necessity indiscriminately
+laid upon all for impossible attainments."
+
+I feel therefore impelled to say a very few words in defence of that
+system of teaching adopted in our Colleges, by which we wish to
+supplement and complete the instruction given by private individuals
+or by what are often called Summer Schools.
+
+The reason why we teach so much that is not practical and in itself
+useful, is because we find that the easiest way of teaching what is
+practical and useful.  If we could in any way eliminate all that
+would help a man to deal successfully with disease, and teach it by
+itself so that it should be as tenaciously rooted in the memory, as
+easily summoned when wanted, as fertile in suggestion of related
+facts, as satisfactory to the peremptory demands of the intelligence
+as if taught in its scientific connections, I think it would be our
+duty so to teach the momentous truths of medicine, and to regard all
+useless additions as an intrusion on the time which should be
+otherwise occupied.
+
+But we cannot successfully eliminate and teach by itself that which
+is purely practical.  The easiest and surest why of acquiring facts
+is to learn them in groups, in systems, and systematized knowledge is
+science.  You can very often carry two facts fastened together more
+easily than one by itself, as a housemaid can carry two pails of
+water with a hoop more easily than one without it.  You can remember
+a man's face, made up of many features, better than you can his nose
+or his mouth or his eye-brow.  Scores of proverbs show you that you
+can remember two lines that rhyme better than one without the jingle.
+The ancients, who knew the laws of memory, grouped the seven cities
+that contended for the honor of being Homer's birthplace in a line
+thus given by Aulus Gellius :
+
+Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
+
+I remember, in the earlier political days of Martin Van Buren, that
+Colonel Stone, of the "New York Commercial," or one of his
+correspondents, said that six towns of New York would claim in the
+same way to have been the birth-place of the "Little Magician," as he
+was then called; and thus he gave their names, any one of which I
+should long ago have forgotten, but which as a group have stuck tight
+in my memory from that day to this;
+
+Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
+
+If the memory gains so much by mere rhythmical association, how much
+more will it gain when isolated facts are brought together under laws
+and principles, when organs are examined in their natural
+connections, when structure is coupled with function, and healthy and
+diseased action are studied as they pass one into the other!
+Systematic, or scientific study is invaluable as supplying a natural
+kind of mnemonics, if for nothing else.  You cannot properly learn
+the facts you want from Anatomy and Chemistry in any way so easily as
+by taking them in their regular order, with other allied facts, only
+there must be common sense exercised in leaving out a great deal
+which belongs to each of the two branches as pure science.  The
+dullest of teachers is the one who does not know what to omit.
+
+The larger aim of scientific training is to furnish you with
+principles to which you will be able to refer isolated facts, and so
+bring these within the range of recorded experience.  See what the
+"London Times" said about the three Germans who cracked open John
+Bull Chatwood's strong-box at the Fair the other day, while the three
+Englishmen hammered away in vain at Brother Jonathan Herring's.  The
+Englishmen represented brute force.  The Germans had been trained to
+appreciate principle.  The Englishman "knows his business by rote and
+rule of thumb"--science, which would "teach him to do in an hour what
+has hitherto occupied him two hours," "is in a manner forbidden to
+him."  To this cause the "Times" attributes the falling off of
+English workmen in comparison with those of the Continent.
+
+Granting all this, we must not expect too much from "science" as
+distinguished from common experience.  There are ten thousand
+experimenters without special apparatus for every one in the
+laboratory.  Accident is the great chemist and toxicologist.  Battle
+is the great vivisector.  Hunger has instituted researches on food
+such as no Liebig, no Academic Commission has ever recorded.
+
+Medicine, sometimes impertinently, often ignorantly, often carelessly
+called "allopathy," appropriates everything from every source that
+can be of the slightest use to anybody who is ailing in any way, or
+like to be ailing from any cause.  It learned from a monk how to use
+antimony, from a Jesuit how to cure agues, from a friar how to cut
+for stone, from a soldier how to treat gout, from a sailor how to
+keep off scurvy, from a postmaster how to sound the Eustachian tube,
+from a dairy-maid how to prevent small-pox, and from an old market-
+woman how to catch the itch-insect.  It borrowed acupuncture and the
+moxa from the Japanese heathen, and was taught the use of lobelia by
+the American savage.  It stands ready to-day to accept anything from
+any theorist, from any empiric who can make out a good case for his
+discovery or his remedy.  "Science" is one of its benefactors, but
+only one, out of many.  Ask the wisest practising physician you know,
+what branches of science help him habitually, and what amount of
+knowledge relating to each branch he requires for his professional
+duties.  He will tell you that scientific training has a value
+independent of all the special knowledge acquired.  He will tell you
+that many facts are explained by studying them in the wider range of
+related facts to which they belong.  He will gratefully recognize
+that the anatomist has furnished him with indispensable data, that
+the physiologist has sometimes put him on the track of new modes of
+treatment, that the chemist has isolated the active principles of his
+medicines, has taught him how to combine them, has from time to time
+offered him new remedial agencies, and so of others of his allies.
+But he will also tell you, if I am not mistaken, that his own branch
+of knowledge is so extensive and so perplexing that he must accept
+most of his facts ready made at their hands.  He will own to you that
+in the struggle for life which goes on day and night in our thoughts
+as in the outside world of nature, much that he learned under the
+name of science has died out, and that simple homely experience has
+largely taken the place of that scholastic knowledge to which he and
+perhaps some of his instructors once attached a paremount importance.
+
+This, then, is my view of scientific training as conducted in courses
+such as you are entering on.  Up to a certain point I believe in set
+Lectures as excellent adjuncts to what is far more important,
+practical instruction at the bedside, in the operating room, and
+under the eye of the Demonstrator.  But I am so far from wishing
+these courses extended, that I think some of them--suppose I say my
+own--would almost bear curtailing.  Do you want me to describe more
+branches of the sciatic and crural nerves?  I can take Fischer's
+plates, and lecturing on that scale fill up my whole course and not
+finish the nerves alone.  We must stop somewhere, and for my own part
+I think the scholastic exercises of our colleges have already claimed
+their full share of the student's time without our seeking to extend
+them.
+
+I trust I have vindicated the apparent inconsequence of teaching
+young students a good deal that seems at first sight profitless, but
+which helps them to learn and retain what is profitable.  But this is
+an inquisitive age, and if we insist on piling up beyond a certain
+height knowledge which is in itself mere trash and lumber to a man
+whose life is to be one long fight with death and disease, there will
+be some sharp questions asked by and by, and our quick-witted people
+will perhaps find they can get along as well without the professor's
+cap as without the bishop's mitre and the monarch's crown.
+
+I myself have nothing to do with clinical teaching.  Yet I do not
+hesitate to say it is more essential than all the rest put together,
+so far as the ordinary practice of medicine is concerned; and this is
+by far the most important thing to be learned, because it deals with
+so many more lives than any other branch of the profession.  So of
+personal instruction, such as we give and others give in the interval
+of lectures, much of it at the bedside, some of it in the laboratory,
+some in the microscope-room, some in the recitation-room, I think it
+has many advantages of its own over the winter course, and I do not
+wish to see it shortened for the sake of prolonging what seems to me
+long enough already.
+
+If I am jealous of the tendency to expand the time given to the
+acquisition of curious knowledge, at the expense of the plain old-
+fashioned bedside teachings, I only share the feeling which Sydenham
+expressed two hundred years ago, using an image I have already
+borrowed.  "He would be no honest and successful pilot who was to
+apply himself with less industry to avoid rocks and sands and bring
+his vessel safely home, than to search into the causes of the ebbing
+and flowing of the sea, which, though very well for a philosopher, is
+foreign to him whose business it is to secure the ship.  So neither
+will a physician, whose province it is to cure diseases, be able to
+do so, though he be a person of great genius, who bestows less time
+on the hidden and intricate method of nature, and adapting his means
+thereto, than on curious and subtle speculation."
+
+"Medicine is my wife and Science is my mistress," said Dr. Rush.  I
+do not think that the breach of the seventh commandment can be shown
+to have been of advantage to the legitimate owner of his affections.
+Read what Dr. Elisha Bartlett says of him as a practitioner, or ask
+one of our own honored ex-professors, who studied under him, whether
+Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
+that man is the minister and interpreter of Nature, or whether he did
+not speak habitually of Nature as an intruder in the sick room, from
+which his art was to expel her as an incompetent and a meddler.
+
+All a man's powers are not too much for such a profession as
+Medicine.  "He is a learned man," said old Parson Emmons of Franklin,
+"who understands one subject, and he is a very learned man who
+understands two subjects."  Schonbein says he has been studying
+oxygen for thirty years.  Mitscherlich said it took fourteen years to
+establish a new fact in chemistry.  Aubrey says of Harvey, the
+discoverer of the circulation, that "though all his profession would
+allow him to be an excellent anatomist, I have never heard of any who
+admired his therapeutic way."  My learned and excellent friend before
+referred to, Dr. Brown of Edinburgh, from whose very lively and
+sensible Essay, "Locke and Sydenham," I have borrowed several of my
+citations, contrasts Sir Charles Bell, the discoverer, the man of
+science, with Dr. Abercrombie, the master in the diagnosis and
+treatment of disease.  It is through one of the rarest of
+combinations that we have in our Faculty a teacher on whom the
+scientific mantle of Bell has fallen, and who yet stands preeminent
+in the practical treatment of the class of diseases which his
+inventive and ardent experimental genius has illustrated.  M. Brown-
+Sequard's example is as, eloquent as his teaching in proof of the
+advantages of well directed scientific investigation.  But those who
+emulate his success at once as a discoverer and a practitioner must
+be content like him to limit their field of practice.  The highest
+genius cannot afford in our time to forget the ancient precept,
+Divide et impera.
+
+"I suppose I must go and earn this guinea," said a medical man who
+was sent for while he was dissecting an animal.  I should not have
+cared to be his patient.  His dissection would do me no good, and his
+thoughts would be too much upon it.  I want a whole man for my
+doctor, not a half one.  I would have sent for a humbler
+practitioner, who would have given himself entirely to me, and told
+the other--who was no less a man than John Hunter--to go on and
+finish the dissection of his tiger.
+
+Sydenham's "Read Don Quixote" should be addressed not to the student,
+but to the Professor of today.  Aimed at him it means, "Do not be too
+learned.
+
+Do not think you are going to lecture to picked young men who are
+training themselves to be scientific discoverers.  They are of fair
+average capacity, and they are going to be working doctors.
+
+These young men are to have some very serious vital facts to deal
+with.  I will mention a few of them.
+
+Every other resident adult you meet in these streets is or will be
+more or less tuberculous.  This is not an extravagant estimate, as
+very nearly one third of the deaths of adults in Boston last year
+were from phthisis.  If the relative number is less in our other
+northern cities, it is probably in a great measure because they are
+more unhealthy; that is, they have as much, or nearly as much,
+consumption, but they have more fevers or other fatal diseases.
+
+These heavy-eyed men with the alcoholized brains, these pallid youths
+with the nicotized optic ganglia and thinking-marrows brown as their
+own meerschaums, of whom you meet too many,--will ask all your wisdom
+to deal with their poisoned nerves and their enfeebled wills.
+
+Nearly seventeen hundred children under five years of age died last
+year in this city.  A poor human article, no doubt, in many cases,
+still, worth an attempt to save them, especially when we remember the
+effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
+some twenty-five or thirty thousand children's lives have probably
+been saved in a single city.
+
+Again, the complaint is often heard that the native population is not
+increasing so rapidly as in former generations.  The breeding and
+nursing period of American women is one of peculiar delicacy and
+frequent infirmity.  Many of them must require a considerable
+interval between the reproductive efforts, to repair damages arid
+regain strength.  This matter is not to be decided by an appeal to
+unschooled nature.  It is the same question as that of the deformed
+pelvis,--one of degree.  The facts of mal-vitalization are as much to
+be attended to as those of mal-formation.  If the woman with a
+twisted pelvis is to be considered an exempt, the woman with a
+defective organization should be recognized as belonging to the
+invalid corps.  We shudder to hear what is alleged as to the
+prevalence of criminal practices; if back of these there can be shown
+organic incapacity or overtaxing of too limited powers, the facts
+belong to the province of the practical physician, as well as of the
+moralist and the legislator, and require his gravest consideration.
+
+Take the important question of bleeding.  Is venesection done with
+forever?  Six years ago it was said here in an introductory Lecture
+that it would doubtless come back again sooner or later.  A fortnight
+ago I found myself in the cars with one of the most sensible and
+esteemed practitioners in New England.  He took out his wallet and
+showed me two lancets, which he carried with him; he had never given
+up their use.  This is a point you will have to consider.
+
+Or, to mention one out of many questionable remedies, shall you give
+Veratrum Viride in fevers and inflammations?  It makes the pulse
+slower in these affections.  Then the presumption would naturally be
+that it does harm.  The caution with reference to it on this ground
+was long ago recorded in the Lecture above referred to.  See what Dr.
+John Hughes Bennett says of it in the recent edition of his work on
+Medicine.  Nothing but the most careful clinical experience can
+settle this and such points of treatment.
+
+These are all practical questions--questions of life and death, and
+every day will be full of just such questions.  Take the problem of
+climate.  A patient comes to you with asthma and wants to know where
+he can breathe; another comes to you with phthisis and wants to know
+where he can live.  What boy's play is nine tenths of all that is
+taught in many a pretentious course of lectures, compared with what
+an accurate and extensive knowledge of the advantages and
+disadvantages of different residences in these and other complaints
+would be to a practising physician
+
+I saw the other day a gentleman living in Canada, who had spent seven
+successive winters in Egypt, with the entire relief of certain
+obscure thoracic symptoms which troubled him while at home.  I saw,
+two months ago, another gentleman from Minnesota, an observer and a
+man of sense, who considered that State as the great sanatorium for
+all pulmonary complaints.  If half our grown population are or will
+be more or less tuberculous, the question of colonizing Florida
+assumes a new aspect.  Even within the borders of our own State, the
+very interesting researches of Dr. Bowditch show that there is a
+great variation in the amount of tuberculous disease in different
+towns, apparently connected with local conditions.  The hygienic map
+of a State is quite as valuable as its geological map, and it is the
+business of every practising physician to know it thoroughly.  They
+understand this in England, and send a patient with a dry irritating
+cough to Torquay or Penzance, while they send another with relaxed
+bronchial membranes to Clifton or Brighton.  Here is another great
+field for practical study.
+
+So as to the all-important question of diet.  "Of all the means of
+cure at our command," says Dr. Bennett, "a regulation of the quantity
+and quality of the diet is by far the most powerful."  Dr. MacCormac
+would perhaps except the air we breathe, for he thinks that impure
+air, especially in sleeping rooms, is the great cause of tubercle.
+It is sufficiently proved that the American,--the New Englander,--the
+Bostonian, can breed strong and sound children, generation after
+generation,--nay, I have shown by the record of a particular family
+that vital losses may be retrieved, and a feeble race grow to lusty
+vigor in this very climate and locality.  Is not the question why our
+young men and women so often break down, and how they can be kept
+from breaking down, far more important for physicians to settle than
+whether there is one cranial vertebra, or whether there are four, or
+none?
+
+--But I have a taste for the homologies, I want to go deeply into the
+subject of embryology, I want to analyze the protonihilates
+precipitated from pigeon's milk by the action of the lunar spectrum,-
+shall I not follow my star,--shall I not obey my instinct,--shall I
+not give myself to the lofty pursuits of science for its own sake?
+
+Certainly you may, if you like.  But take down your sign, or never
+put it up.  That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
+Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
+difficulty.  We all admire the achievements of this band of
+distinguished doctors who do not practise.  But we say of their work
+and of all pure science, as the French officer said of the charge of
+the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
+guerre,"--it is very splendid, but it is not a practising doctor's
+business.  His patient has a right to the cream of his life and not
+merely to the thin milk that is left after "science " has skimmed it
+off.  The best a physician can give is never too good for the
+patient.
+
+It is often a disadvantage to a young practitioner to be known for
+any accomplishment outside of his profession.  Haller lost his
+election as Physician to the Hospital in his native city of Berne,
+principally on the ground that he was a poet.  In his later years the
+physician may venture more boldly.  Astruc was sixty-nine years old
+when he published his "Conjectures," the first attempt, we are told,
+to decide the authorship of the Pentateuch showing anything like a
+discerning criticism.  Sir Benjamin Brodie was seventy years old
+before he left his physiological and surgical studies to indulge in
+psychological speculations.  The period of pupilage will be busy
+enough in acquiring the knowledge needed, and the season of active
+practice will leave little leisure for any but professional studies.
+
+Dr. Graves of Dublin, one of the first clinical teachers of our time,
+always insisted on his students' beginning at once to visit the
+hospital.  At the bedside the student must learn to treat disease,
+and just as certainly as we spin out and multiply our academic
+prelections we shall work in more and more stuffing, more and more
+rubbish, more and more irrelevant, useless detail which the student
+will get rid of just as soon as he leaves us.  Then the next thing
+will be a new organization, with an examining board of first-rate
+practical men, who will ask the candidate questions that mean
+business,--who will make him operate if he is to be a surgeon, and
+try him at the bedside if he is to be a physician,--and not puzzle
+him with scientific conundrums which not more than one of the
+questioners could answer himself or ever heard of since he graduated.
+
+Or these women who are hammering at the gates on which is written "No
+admittance for the mothers of mankind," will by and by organize an
+institution, which starting from that skilful kind of nursing which
+Florence Nightingale taught so well, will work backwards through
+anodynes, palliatives, curatives, preventives, until with little show
+of science it imparts most of what is most valuable in those branches
+of the healing art it professes to teach.  When that time comes, the
+fitness of women for certain medical duties, which Hecquet advocated
+in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
+the honored Professor of Theory and Practice in this Institution,
+upheld within our own recollection in the face of his own recorded
+opinion to the contrary, will very possibly be recognized.
+
+My advice to every teacher less experienced than myself would be,
+therefore: Do not fret over the details you have to omit; you
+probably teach altogether too many as it is.  Individuals may learn a
+thing with once hearing it, but the only way of teaching a whole
+class is by enormous repetition, representation, and illustration in
+all possible forms.  Now and then you will have a young man on your
+benches like the late Waldo Burnett,--not very often, if you lecture
+half a century.  You cannot pretend to lecture chiefly for men like
+that,--a Mississippi raft might as well take an ocean-steamer in tow.
+To meet his wants you would have to leave the rest of your class
+behind and that you must not do.  President Allen of Jefferson
+College says that his instruction has been successful in proportion
+as it has been elementary.  It may be a humiliating statement, but it
+is one which I have found true in my own experience.
+
+To the student I would say, that however plain and simple may be our
+teaching, he must expect to forget much which he follows
+intelligently in the lecture-room.  But it is not the same as if he
+had never learned it.  A man must get a thing before he can forget
+it.  There is a great world of ideas we cannot voluntarily recall,--
+they are outside the limits of the will.  But they sway our conscious
+thought as the unseen planets influence the movements of those within
+the sphere of vision.  No man knows how much he knows,--how many
+ideas he has,--any more than he knows how many blood-globules roll in
+his veins.  Sometimes accident brings back here and there one, but
+the mind is full of irrevocable remembrances and unthinkable
+thoughts, which take a part in all its judgments as indestructible
+forces.  Some of you must feel your scientific deficiencies painfully
+after your best efforts.  But every one can acquire what is most
+essential.  A man of very moderate ability may be a good physician,
+if he devotes himself faithfully to the work.  More than this, a
+positively dull man, in the ordinary acceptation of the term,
+sometimes makes a safer practitioner than one who has, we will say,
+five per cent. more brains than his average neighbor, but who thinks
+it is fifty per cent. more.  Skulls belonging to this last variety of
+the human race are more common, I may remark, than specimens like the
+Neanderthal cranium, a cast of which you will find on the table in
+the Museum.
+
+Whether the average talent be high or low, the Colleges of the land
+must make the best commodity they can out of such material as the
+country and the cities furnish them.  The community must have Doctors
+as it must have bread.  It uses up its Doctors just as it wears out
+its shoes, and requires new ones.  All the bread need not be French
+rolls, all the shoes need not be patent leather ones; but the bread
+must be something that can be eaten, and the shoes must be something
+that can be worn.  Life must somehow find food for the two forces
+that rub everything to pieces, or burn it to ashes,--friction and
+oxygen.  Doctors are oxydable products, and the schools must keep
+furnishing new ones as the old ones turn into oxyds; some of first-
+rate quality that burn with a great light, some of a lower grade of
+brilliancy, some honestly, unmistakably, by the grace of God, of
+moderate gifts, or in simpler phrase, dull.
+
+The public will give every honest and reasonably competent worker in
+the healing art a hearty welcome.  It is on the whole very loyal to
+the Medical Profession.  Three successive years have borne witness to
+the feeling with which this Institution, representing it in its
+educational aspect, is regarded by those who are themselves most
+honored and esteemed.  The great Master of Natural Science bade the
+last year's class farewell in our behalf, in those accents which
+delight every audience.  The Head of our ancient University honored
+us in the same way in the preceding season.  And how can we forget
+that other occasion when the Chief Magistrate of the Commonwealth,
+that noble citizen whom we have just lost, large-souled, sweet-
+natured, always ready for every kind office, came among us at our
+bidding, and talked to us of our duties in words as full of wisdom as
+his heart was of goodness?
+
+You have not much to fear, I think, from the fancy practitioners.
+The vulgar quackeries drop off, atrophied, one after another.
+Homoeopathy has long been encysted, and is carried on the body
+medical as quietly as an old wen.  Every year gives you a more
+reasoning and reasonable people to deal with.  See how it is in
+Literature.  The dynasty of British dogmatists, after lasting a
+hundred years and more, is on its last legs.  Thomas Carlyle, third
+in the line of descent, finds an audience very different from those
+which listened to the silver speech of Samuel Taylor Coleridge and
+the sonorous phrases of Samuel Johnson.  We read him, we smile at his
+clotted English, his "swarmery" and other picturesque expressions,
+but we lay down his tirade as we do one of Dr. Cumming's
+interpretations of prophecy, which tells us that the world is coming
+to an end next week or next month, if the weather permits,--not
+otherwise,--feeling very sure that the weather will be unfavorable.
+
+It is the same common-sense public you will appeal to.  The less
+pretension you make, the better they will like you in the long run.
+I hope we shall make everything as plain and as simple to you as we
+can.  I would never use a long word, even, where a short one would
+answer the purpose.  I know there are professors in this country who
+"ligate" arteries.  Other surgeons only tie them, and it stops the
+bleeding just as well.  It is the familiarity and simplicity of
+bedside instruction which makes it so pleasant as well as so
+profitable.  A good clinical teacher is himself a Medical School.  We
+need not wonder that our young men are beginning to announce
+themselves not only as graduates of this or that College, but also as
+pupils of some one distinguished master.
+
+I wish to close this Lecture, if you will allow me a few moments
+longer, with a brief sketch of an instructor and practitioner whose
+character was as nearly a model one in both capacities as I can find
+anywhere recorded.
+
+Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
+in this University from 1812 to 1846, and whose name has been since
+retained on our rolls as Professor Emeritus, died on the 27th of
+August last, in the ninetieth year of his age.  He studied his
+profession, as I have already mentioned, with Dr. Holyoke of Salem,
+one of the few physicians who have borne witness to their knowledge
+of the laws of life by living to complete their hundredth year.  I
+think the student took his Old Master, as he always loved to call
+him, as his model; each was worthy of the other, and both were bright
+examples to all who come after them.
+
+I remember that in the sermon preached by Dr. Grazer after Dr.
+Holyoke's death, one of the points most insisted upon as
+characteristic of that wise and good old man was the perfect balance
+of all his faculties.  The same harmonious adjustment of powers, the
+same symmetrical arrangement of life, the same complete fulfilment of
+every day's duties, without haste and without needless delay, which
+characterized the master, equally distinguished the scholar.  A
+glance at the life of our own Old Master, if I can do any justice at
+all to his excellences, will give you something to carry away from
+this hour's meeting not unworthy to be remembered.
+
+>From December, 1797, to October, 1799, he remained with Dr. Holyoke
+as a student, a period which he has spoken of as a most interesting
+and most gratifying part of his life.  After this he passed eight
+months in London, and on his return, in October, 1800, he began
+business in Boston.
+
+He had followed Mr. Cline, as I have mentioned, and was competent to
+practise Surgery.  But he found Dr. John Collins Warren had already
+occupied the ground which at that day hardly called for more than one
+leading practitioner, and wisely chose the Medical branch of the
+profession.  He had only himself to rely upon, but he had confidence
+in his prospects, conscious, doubtless, of his own powers, knowing
+his own industry and determination, and being of an eminently
+cheerful and hopeful disposition.  No better proof of his spirit can
+be given than that, just a year from the time when he began to
+practise as a physician, he took that eventful step which in such a
+man implies that he sees his way clear to a position; he married a
+lady blessed with many gifts, but not bringing him a fortune to
+paralyze his industry.
+
+He had not miscalculated his chances in life.  He very soon rose into
+a good practice, and began the founding of that reputation which grew
+with his years, until he stood by general consent at the head of his
+chosen branch of the profession, to say the least, in this city and
+in all this region of country.  His skill and wisdom were the last
+tribunal to which the sick and suffering could appeal.  The community
+trusted and loved him, the profession recognized him as the noblest
+type of the physician.  The young men whom he had taught wandered
+through foreign hospitals; where they learned many things that were
+valuable, and many that were curious; but as they grew older and
+began to think more of their ability to help the sick than their
+power of talking about phenomena, they began to look back to the
+teaching of Dr. Jackson, as he, after his London experience, looked
+back to that of Dr. Holyoke.  And so it came to be at last that the
+bare mention of his name in any of our medical assemblies would call
+forth such a tribute of affectionate regard as is only yielded to age
+when it brings with it the record of a life spent in well doing.
+
+No accident ever carries a man to eminence such as his in the medical
+profession.  He who looks for it must want it earnestly and work for
+it vigorously; Nature must have qualified him in many ways, and
+education must have equipped him with various knowledge, or his
+reputation will evaporate before it reaches the noon-day blaze of
+fame.  How did Dr. Jackson gain the position which all conceded to
+him?  In the answer to this question some among you may find a key
+that shall unlock the gate opening on that fair field of the future
+of which all dream but which not all will ever reach.
+
+First of all, he truly loved his profession.  He had no intellectual
+ambitions outside of it, literary, scientific or political.  To him
+it was occupation enough to apply at the bedside the best of all that
+he knew for the good of his patient; to protect the community against
+the inroads of pestilence; to teach the young all that he himself had
+been taught, with all that his own experience had added; to leave on
+record some of the most important results of his long observation.
+
+With his patients he was so perfect at all points that it is hard to
+overpraise him.  I have seen many noted British and French and
+American practitioners, but I never saw the man so altogether
+admirable at the bedside of the sick as Dr. James Jackson.  His smile
+was itself a remedy better than the potable gold and the dissolved
+pearls that comforted the praecordia of mediaeval monarchs.  Did a
+patient, alarmed without cause, need encouragement, it carried the
+sunshine of hope into his heart and put all his whims to flight, as
+David's harp cleared the haunted chamber of the sullen king.  Had the
+hour come, not for encouragement, but for sympathy, his face, his
+voice, his manner all showed it, because his heart felt it.  So
+gentle was he, so thoughtful, so calm, so absorbed in the case before
+him, not to turn round and look for a tribute to his sagacity, not to
+bolster himself in a favorite theory, but to find out all he could,
+and to weigh gravely and cautiously all that he found, that to follow
+him in his morning visit was not only to take a lesson in the healing
+art, it was learning how to learn, how to move, how to look, how to
+feel, if that can be learned.  To visit with Dr. Jackson was a
+medical education.
+
+He was very firm, with all his kindness.  He would have the truth
+about his patients.  The nurses found it out; and the shrewder ones
+never ventured to tell him anything but a straight story.  A clinical
+dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
+in the Massachusetts General Hospital, a mistress in her calling, was
+as good questioning and answering as one would be like to hear
+outside of the court-room.
+
+Of his practice you can form an opinion from his book called "Letters
+to a Young Physician."  Like all sensible men from the days of
+Hippocrates to the present, he knew that diet and regimen were more
+important than any drug or than all drugs put together.  Witness his
+treatment of phthisis and of epilepsy.  He retained, however, more
+confidence in some remedial agents than most of the younger
+generation would concede to them.  Yet his materia medica was a
+simple one.
+
+"When I first went to live with Dr. Holyoke," he says, "in 1797,
+showing me his shop, he said, 'There seems to you to be a great
+variety of medicines here, and that it will take you long to get
+acquainted with them, but most of them are unimportant.  There are
+four which are equal to all the rest, namely, Mercury, Antimony, Bark
+and Opium.'"  And Dr. Jackson adds, "I can only say of his practice,
+the longer I have lived, I have thought better and better of it."
+When he thought it necessary to give medicine, he gave it in earnest.
+He hated half-practice--giving a little of this or that, so as to be
+able to say that one had done something, in case a consultation was
+held, or a still more ominous event occurred.  He would give opium,
+for instance, as boldly as the late Dr. Fisher of Beverly, but he
+followed the aphorism of the Father of Medicine, and kept extreme
+remedies for extreme cases.
+
+When it came to the "non-naturals," as he would sometimes call them,
+after the old physicians,--namely, air, meat and drink, sleep and
+watching, motion and rest, the retentions and excretions, and the
+affections of the mind,--he was, as I have said, of the school of
+sensible practitioners, in distinction from that vast community of
+quacks, with or without the diploma, who think the chief end of man
+is to support apothecaries, and are never easy until they can get
+every patient upon a regular course of something nasty or noxious.
+Nobody was so precise in his directions about diet, air, and
+exercise, as Dr. Jackson.  He had the same dislike to the a peu pres,
+the about so much, about so often, about so long, which I afterwards
+found among the punctilious adherents of the numerical system at La
+Pitie.
+
+He used to insist on one small point with a certain philological
+precision, namely, the true meaning of the word "cure."  He would
+have it that to cure a patient was simply to care for him.  I refer
+to it as showing what his idea was of the relation of the physician
+to the patient.  It was indeed to care for him, as if his life were
+bound up in him, to watch his incomings and outgoings, to stand guard
+at every avenue that disease might enter, to leave nothing to chance;
+not merely to throw a few pills and powders into one pan of the
+scales of Fate, while Death the skeleton was seated in the other, but
+to lean with his whole weight on the side of life, and shift the
+balance in its favor if it lay in human power to do it.  Such
+devotion as this is only to be looked for in the man who gives
+himself wholly up to the business of healing, who considers Medicine
+itself a Science, or if not a science, is willing to follow it as an
+art,--the noblest of arts, which the gods and demigods of ancient
+religions did not disdain to practise and to teach.
+
+The same zeal made him always ready to listen to any new suggestion
+which promised to be useful, at a period of life when many men find
+it hard to learn new methods and accept new doctrines.  Few of his
+generation became so accomplished as he in the arts of direct
+exploration; coming straight from the Parisian experts, I have
+examined many patients with him, and have had frequent opportunities
+of observing his skill in percussion and auscultation.
+
+One element in his success, a trivial one compared with others, but
+not to be despised, was his punctuality.  He always carried two
+watches,--I doubt if he told why, any more than Dr. Johnson told what
+he did with the orange-peel,--but probably with reference to this
+virtue.  He was as much to be depended upon at the appointed time as
+the solstice or the equinox.  There was another point I have heard
+him speak of as an important rule with him; to come at the hour when
+he was expected; if he had made his visit for several days
+successively at ten o'clock, for instance, not to put it off, if be
+could possibly help it, until eleven, and so keep a nervous patient
+and an anxious family waiting for him through a long, weary hour.
+
+If I should attempt to characterize his teaching, I should say that
+while it conveyed the best results of his sagacious and extended
+observation, it was singularly modest, cautious, simple, sincere.
+Nothing was for show, for self-love; there was no rhetoric, no
+declamation, no triumphant "I told you so," but the plain statement
+of a clear-headed honest man, who knows that he is handling one of
+the gravest subjects that interest humanity.  His positive
+instructions were full of value, but the spirit in which he taught
+inspired that loyal love of truth which lies at the bottom of all
+real excellence.
+
+I will not say that, during his long career, Dr. Jackson never made
+an enemy.  I have heard him tell how, in his very early days, old Dr.
+Danforth got into a towering passion with him about some professional
+consultation, and exploded a monosyllable or two of the more
+energetic kind on the occasion.  I remember that that somewhat
+peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
+succeeded to his place as Professor of Theory and Practice.  A young
+man of Dr. Jackson's talent and energy could hardly take the position
+that belonged to him without crowding somebody in a profession where
+three in a bed is the common rule of the household.  But he was a
+peaceful man and a peace-maker all his days.  No man ever did more,
+if so much, to produce and maintain the spirit of harmony for which
+we consider our medical community as somewhat exceptionally
+distinguished.
+
+If this harmony should ever be threatened, I could wish that every
+impatient and irritable member of the profession would read that
+beautiful, that noble Preface to the "Letters," addressed to John
+Collins Warren.  I know nothing finer in the medical literature of
+all time than this Prefatory Introduction.  It is a golden prelude,
+fit to go with the three great Prefaces which challenge the
+admiration of scholars,--Calvin's to his Institutes, De Thou's to his
+History, and Casaubon's to his Polybius,--not because of any learning
+or rhetoric, though it is charmingly written, but for a spirit
+flowing through it to which learning and rhetoric are but as the
+breath that is wasted on the air to the Mood that warms the heart.
+
+Of a similar character is this short extract which I am permitted to
+make from a private letter of his to a dear young friend.  He was
+eighty-three years old at the time of writing it.
+
+"I have not loved everybody whom I have known, but I have striven to
+see the good points in the characters of all men and women.  At first
+I must have done this from something in my own nature, for I was not
+aware of it, and yet was doing it without any plan, when one day,
+sixty years ago, a friend whom I loved and respected said this to me,
+'Ah, James, I see that you are destined to succeed in the world, and
+to make friends, because you are so ready to see the good point in
+the characters of those you meet.'"
+
+I close this imperfect notice of some features in the character of
+this most honored and beloved of physicians by applying to him the
+words which were written of William Heberden, whose career was not
+unlike his own, and who lived to the same patriarchal age.
+
+"From his early youth he had always entertained a deep sense of
+religion, a consummate love of virtue, an ardent thirst after
+knowledge, and an earnest desire to promote the welfare and happiness
+of all mankind.  By these qualities, accompanied with great sweetness
+of manners, he acquired the love and esteem of all good men, in a
+degree which perhaps very few have experienced; and after passing an
+active life with the uniform testimony of a good conscience, he
+became an eminent example of its influence, in the cheerfulness and
+serenity of his latest age."
+
+Such was the man whom I offer to you as a model, young gentlemen, at
+the outset of your medical career.  I hope that many of you will
+recognize some traits of your own special teachers scattered through
+various parts of the land in the picture I have drawn.  Let me assure
+you that whatever you may learn in this or any other course of public
+lectures,--and I trust you will learn a great deal,--the daily
+guidance, counsel, example, of your medical father, for such the Oath
+of Hippocrates tells you to consider your preceptor, will, if he is
+in any degree like him of whom I have spoken, be the foundation on
+which all that we teach is reared, and perhaps outlive most of our
+teachings, as in Dr. Jackson's memory the last lessons that remained
+with him were those of his Old Master.
+
+
+
+
+
+
+THE MEDICAL PROFESSION IN MASSACHUSETTS.
+
+A Lecture of a Course by members of the Massachusetts Historical
+Society, delivered before the Lowell Institute, January 29, 1869.
+
+The medical history of eight generations, told in an hour, must be in
+many parts a mere outline.  The details I shall give will relate
+chiefly to the first century.  I shall only indicate the leading
+occurrences, with the more prominent names of the two centuries which
+follow, and add some considerations suggested by the facts which have
+been passed in review.
+
+A geographer who was asked to describe the tides of Massachusetts
+Bay, would have to recognize the circumstance that they are a limited
+manifestation of a great oceanic movement.  To consider them apart
+from this, would be to localize a planetary phenomenon, and to
+provincialize a law of the universe.  The art of healing in
+Massachusetts has shared more or less fully and readily the movement
+which, with its periods of ebb and flow, has been raising its level
+from age to age throughout the better part of Christendom.  Its
+practitioners brought with them much of the knowledge and many of the
+errors of the Old World; they have always been in communication with
+its wisdom and its folly; it is not without interest to see how far
+the new conditions in which they found themselves have been favorable
+or unfavorable to the growth of sound medical knowledge and practice.
+
+The state of medicine is an index of the civilization of an age and
+country,--one of the best, perhaps, by which it can be judged.
+Surgery invokes the aid of all the mechanical arts.  From the rude
+violences of the age of stone,--a relic of which we may find in the
+practice of Zipporah, the wife of Moses,--to the delicate operations
+of to-day upon patients lulled into temporary insensibility, is a
+progress which presupposes a skill in metallurgy and in the labors of
+the workshop and the laboratory it has taken uncounted generations to
+accumulate.  Before the morphia which deadens the pain of neuralgia,
+or the quinine which arrests the fit of an ague, can find their place
+in our pharmacies, commerce must have perfected its machinery, and
+science must have refined its processes, through periods only to be
+counted by the life of nations.  Before the means which nature and
+art have put in the hands of the medical practitioner can be fairly
+brought into use, the prejudices of the vulgar must be overcome, the
+intrusions of false philosophy must be fenced out, and the
+partnership with the priesthood dissolved.  All this implies that
+freedom and activity of thought which belong only to the most
+advanced conditions of society; and the progress towards this is by
+gradations as significant of wide-spread changes, as are the varying
+states of the barometer of far-extended conditions of the atmosphere.
+
+Apart, then, from its special and technical interest, my subject has
+a meaning which gives a certain importance, and even dignity, to
+details in themselves trivial and almost unworthy of record.  A
+medical entry in Governor Winthrop's journal may seem at first sight
+a mere curiosity; but, rightly interpreted, it is a key to his whole
+system of belief as to the order of the universe and the relations
+between man and his Maker.  Nothing sheds such light on the
+superstitions of an age as the prevailing interpretation and
+treatment of disease.  When the touch of a profligate monarch was a
+cure for one of the most inveterate of maladies, when the common
+symptoms of hysteria were prayed over as marks of demoniacal
+possession, we might well expect the spiritual realms of thought to
+be peopled with still stranger delusions.
+
+Let us go before the Pilgrims of the Mayflower, and look at the
+shores on which they were soon to land.  A wasting pestilence had so
+thinned the savage tribes that it was sometimes piously interpreted
+as having providentially prepared the way for the feeble band of
+exiles.  Cotton Mather, who, next to the witches, hated the
+"tawnies," " wild beasts," "blood-hounds," "rattlesnakes,"
+"infidels," as in different places he calls the unhappy Aborigines,
+describes the condition of things in his lively way, thus:
+"The Indians in these Parts had newly, even about a Year or Two
+before, been visited with such a prodigious Pestilence; as carried
+away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
+Twenty) among them so that the Woods were almost cleared of those
+pernicious Creatures to make Room for a better Growth."
+
+What this pestilence was has been much discussed.  It is variously
+mentioned by different early writers as "the plague," "a great and
+grievous plague," "a sore consumption," as attended with spots which
+left unhealed places on those who recovered, as making the "whole
+surface yellow as with a garment."  Perhaps no disease answers all
+these conditions so well as smallpox.  We know from different sources
+what frightful havoc it made among the Indians in after years,--in
+1631, for instance, when it swept away the aboriginal inhabitants of
+whole towns," and in 1633.  We have seen a whole tribe, the Mandans,
+extirpated by it in our own day.  The word "plague" was used very
+vaguely, as in the description of the "great sickness" found among
+the Indians by the expedition of 1622.  This same great sickness
+could hardly have been yellow fever, as it occurred in the month of
+November.  I cannot think, therefore, that either the scourge of the
+East or our Southern malarial pestilence was the disease that wasted
+the Indians.  As for the yellowness like a garment, that is too
+familiar to the eyes of all who have ever looked on the hideous mask
+of confluent variola.
+
+Without the presence or the fear of these exotic maladies, the
+forlorn voyagers of the Mayflower had sickness enough to contend
+with.  At their first landing at Cape Cod, gaunt and hungry and
+longing for fresh food, they found upon the sandy shore "great
+mussel's, and very fat and full of sea-pearl."  Sailors and
+passengers indulged in the treacherous delicacy; which seems to have
+been the sea-clam; and found that these mollusks, like the shell the
+poet tells of, remembered their august abode, and treated the way-
+worn adventurers to a gastric reminiscence of the heaving billows.
+In the mean time it blew and snowed and froze.  The water turned to
+ice on their clothes, and made them many times like coats of iron.
+Edward Tilley had like to have "sounded" with cold.  The gunner, too,
+was sick unto death, but "hope of trucking" kept him on his feet,--a
+Yankee, it should seem, when he first touched the shore of New
+England.  Most, if not all, got colds and coughs, which afterwards
+turned to scurvy, whereof many died.
+
+How can we wonder that the crowded and tempest-tossed voyagers, many
+of them already suffering, should have fallen before the trials of
+the first winter in Plymouth?  Their imperfect shelter, their
+insufficient supply of bread, their salted food, now in unwholesome
+condition, account too well for the diseases and the mortality that
+marked this first dreadful season; weakness, swelling of the limbs,
+and other signs of scurvy, betrayed the want of proper nourishment
+and protection from the elements.  In December six of their number
+died, in January eight, in February, seventeen, in March thirteen.
+With the advance of spring the mortality diminished, the sick and
+lame began to recover, and the colonists, saddened but not
+disheartened, applied themselves to the labors of the opening year.
+
+One of the most pressing needs of the early colonists must have been
+that of physicians and surgeons.  In Mr. Savage's remarkable
+Genealogical Dictionary of the first settlers who came over before
+1692 and their descendants to the third generation, I find scattered
+through the four crowded volumes the names of one hundred and thirty-
+four medical practitioners.  Of these, twelve, and probably many
+more, practised surgery; three were barber-surgeons.  A little
+incident throws a glimmer from the dark lantern of memory upon
+William Direly, one of these practitioners with the razor and the
+lancet.  He was lost between Boston and Roxbury in a violent tempest
+of wind and snow; ten days afterwards a son was born to his widow,
+and with a touch of homely sentiment, I had almost said poetry, they
+called the little creature "Fathergone" Direly.  Six or seven,
+probably a larger number, were ministers as well as physicians, one
+of whom, I am sorry to say, took to drink and tumbled into the
+Connecticut River, and so ended.  One was not only doctor, but also
+schoolmaster and poet.  One practised medicine and kept a tavern.
+One was a butcher, but calls himself a surgeon in his will, a union
+of callings which suggests an obvious pleasantry.  One female
+practitioner, employed by her own sex,--Ann Moore,--was the precursor
+of that intrepid sisterhood whose cause it has long been my pleasure
+and privilege to advocate on all fitting occasions.
+
+Outside of this list I must place the name of Thomas Wilkinson, who
+was complained of, is 1676, for practising contrary to law.
+
+Many names in the catalogue of these early physicians have been
+associated, in later periods, with the practice of the profession,--
+among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
+Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
+Woodward.  Touton was a Huguenot, Burchsted a German from Silesia,
+Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
+honor of the profession, was only Peacock disguised under this alias,
+which would not, I fear, prove very attractive to patients.
+
+What doctrines and practice were these colonists likely to bring,
+with them?
+
+Two principal schools of medical practice prevailed in the Old World
+during the greater part of the seventeenth century.  The first held
+to the old methods of Galen: its theory was that the body, the
+microcosm, like the macrocosm, was made up of the four elements--
+fire, air, water, earth; having respectively the qualities hot, dry,
+moist, cold.  The body was to be preserved in health by keeping each
+of these qualities in its natural proportion; heat, by the proper
+temperature; moisture, by the due amount of fluid; and so as to the
+rest.  Diseases which arose from excess of heat were to be attacked
+by cooling remedies; those from excess of cold, by heating ones; and
+so of the other derangements of balance.  This was truly the
+principle of contraries contrariis, which ill-informed persons have
+attempted to make out to be the general doctrine of medicine, whereas
+there is no general dogma other than this: disease is to be treated
+by anything that is proved to cure it.  The means the Galenist
+employed were chiefly diet and vegetable remedies, with the use of
+the lancet and other depleting agents.  He attributed the four
+fundamental qualities to different vegetables, in four different
+degrees; thus chicory was cold in the fourth degree, pepper was hot
+in the fourth, endive was cold and dry in the second, and bitter
+almonds were hot in the first and dry in the second degree.  When we
+say "cool as a cucumber," we are talking Galenism.  The seeds of that
+vegetable ranked as one of "the four greater cold seeds" of this
+system.
+
+Galenism prevailed mostly in the south of Europe and France.  The
+readers of Moliere will have no difficulty in recalling some of its
+favorite modes of treatment, and the abundant mirth he extracted from
+them.
+
+These Galenists were what we should call "herb-doctors" to-day.
+Their insignificant infusions lost credit after a time; their
+absurdly complicated mixtures excited contempt, and their nauseous
+prescriptions provoked loathing and disgust.  A simpler and bolder
+practice found welcome in Germany, depending chiefly on mineral
+remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes
+the secret use, of opium.  Whatever we think of Paracelsus, the chief
+agent in the introduction of these remedies, and whatever limits we
+may assign to the use of these long-trusted mineral drugs, there can
+be no doubt that the chemical school, as it was called, did a great
+deal towards the expurgation of the old, overloaded, and repulsive
+pharmacopoeia.  We shall find evidence in the practice of our New-
+England physicians of the first century, that they often employed
+chemical remedies, and that, by the early part of the following
+century, their chief trust was in the few simple, potent drugs of
+Paracelsus.
+
+We have seen that many of the practitioners of medicine, during the
+first century of New England, were clergymen.  This relation between
+medicine and theology has existed from a very early period; from the
+Egyptian priest to the Indian medicine-man, the alliance has been
+maintained in one form or another.  The partnership was very common
+among our British ancestors.  Mr. Ward, the Vicar of Stratford-on-
+Avon, himself a notable example of the union of the two characters,
+writing about 1660, says,
+
+"The Saxons had their blood-letters, but under the Normans physicke,
+begunne in England; 300 years agoe itt was not a distinct profession
+by itself, but practised by men in orders, witness Nicholas de
+Ternham, the chief English physician and Bishop of Durham; Hugh of
+Evesham, a physician and cardinal; Grysant, physician and pope; John
+Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
+Bush, a bachelor of divinitie in Oxford, was a man well read in
+physick as well as divinitie, he was the first bishop of Bristol."
+
+"Again in King Richard the Second's time physicians and divines were
+not distinct professions; for one Tydeman, Bishop of Landaph and
+Worcester, was physician to King Richard the Second."
+
+This alliance may have had its share in creating and keeping up the
+many superstitions which have figured so largely in the history of
+medicine.  It is curious to see that a medical work left in
+manuscript by the Rev. Cotton Mather and hereafter to be referred to,
+is running over with follies and superstitious fancies; while his
+contemporary and fellow-townsman, William Douglass, relied on the
+same few simple remedies which, through Dr. Edward Holyoke and Dr.
+James Jackson, have come down to our own time, as the most important
+articles of the materia medica.
+
+Let us now take a general glance at some of the conditions of the
+early settlers; and first, as to the healthfulness of the climate.
+The mortality of the season that followed the landing of the Pilgrims
+at Plymouth has been sufficiently accounted for.  After this, the
+colonists seem to have found the new country agreeing very well with
+their English constitutions.  Its clear air is the subject of eulogy.
+Its dainty springs of sweet water are praised not only by Higginson
+and Wood, but even the mischievous Morton says, that for its delicate
+waters Canaan came not near this country."  There is a tendency to
+dilate on these simple blessings, which reminds one a little of the
+Marchioness in Dickens's story, with her orange-peel-and-water
+beverage.  Still more does one feel the warmth of coloring,--such as
+we expect from converts to a new faith, and settlers who want to
+entice others over to their clearings, when Winslow speaks, in 1621,
+of "abundance of roses, white, red, and damask; single, but very
+sweet indeed;" a most of all, however, when, in the same connection,
+he says, "Here are grapes white and red, and very sweet and strong
+also."  This of our wild grape, a little vegetable Indian, which
+scalps a civilized man's mouth, as his animal representative scalps
+his cranium.  But there is something quite charming in Winslow's
+picture of the luxury in which they are living.  Lobsters, oysters,
+eels, mussels, fish and fowl, delicious fruit, including the grapes
+aforesaid,--if they only had "kine, horses, and sheep," he makes no
+question but men would live as contented here as in any part of the
+world.  We cannot help admiring the way in which they took their
+trials, and made the most of their blessings.
+
+"And how Content they were," says Cotton Mather, "when an Honest Man,
+as I have heard, inviting his Friends to a Dish of Clams, at the
+Table gave Thanks to Heaven, who had given them to suck the abundance
+of the Seas, and of the Treasures Aid in the Sands!"
+
+Strangely enough, as it would seem, except for this buoyant
+determination to make the best of everything, they hardly appear to
+recognize the difference of the climate from that which they had
+left.  After almost three years' experience, Winslow says, he can
+scarce distinguish New England from Old England, in respect of heat
+and cold, frost, snow, rain, winds, etc.  The winter, he thinks (if
+there is a difference), is sharper and longer; but yet he may be
+deceived by the want of the comforts he enjoyed at home.  He cannot
+conceive any climate to agree better with the constitution of the
+English, not being oppressed with extremity of heats, nor nipped by
+biting cold :
+
+"By which means, blessed be God, we enjoy our health, notwithstanding
+those difficulties we have undergone, in such a measure as would have
+been admired, if we had lived in England with the like means."
+
+Edward Johnson, after mentioning the shifts to which they were put
+for food, says,--
+
+"And yet, methinks, our children are as cheerful, fat, and lusty,
+with feeding upon those mussels, clams, and other fish, as they were
+in England with their fill of bread."
+
+Higginson, himself a dyspeptic, "continually in physic," as he says,
+and accustomed to dress in thick clothing, and to comfort his stomach
+with drink that was "both strong and stale,"--the "jolly good ale and
+old," I suppose, of free and easy Bishop Still's song,--found that he
+both could and did oftentimes drink New England water very well,
+--which he seems to look upon as a remarkable feat.  He could go as
+lightclad as any, too, with only a light stuff cassock upon his
+shirt, and stuff breeches without linings.  Two of his children were
+sickly: one,--little misshapen Mary,--died on the passage, and, in
+her father's words, "was the first in our ship that was buried in the
+bowels of the great Atlantic sea;" the other, who had been "most
+lamentably handled" by disease, recovered almost entirely "by the
+very wholesomeness of the air, altering, digesting, and drying up the
+cold and crude humors of the body."  Wherefore, he thinks it a wise
+course for all cold complexions to come to take physic in New
+England, and ends with those often quoted words, that "a sup of New
+England's air is better than a whole draught of Old England's ale."
+Mr. Higginson died, however, "of a hectic fever," a little more than
+a year after his arrival.
+
+The medical records which I shall cite show that the colonists were
+not exempt from the complaints of the Old World.  Besides the common
+diseases to which their descendants are subject, there were two
+others, to say nothing of the dreaded small-pox, which later medical
+science has disarmed,--little known among us at the present day, but
+frequent among the first settlers.  The first of these was the
+scurvy, already mentioned, of which Winthrop speaks in 1630, saying,
+that it proved fatal to those who fell into discontent, and lingered
+after their former conditions in England; the poor homesick creatures
+in fact, whom we so forget in our florid pictures of the early times
+of the little band in the wilderness.  Many who were suffering from
+scurvy got well when the Lyon arrived from England, bringing store of
+juice of lemons.  The Governor speaks of another case in 1644; and it
+seems probable that the disease was not of rare occurrence.
+
+The other complaint from which they suffered, but which has nearly
+disappeared from among us, was intermittent fever, or fever and ague.
+I investigated the question as to the prevalence of this disease in
+New England, in a dissertation, which was published in a volume with
+other papers, in the year 1838.  I can add little to the facts there
+recorded.  One which escaped me was, that Joshua Scottow, in "Old
+Men's Tears," dated 1691, speaks of "shaking agues," as among the
+trials to which they had been subjected.  The outline map of New
+England, accompanying the dissertation above referred to, indicates
+all the places where I had evidence that the disease had originated.
+It was plain enough that it used to be known in many localities where
+it has long ceased to be feared.  Still it was and is remarkable to
+see what a clean bill of health in this particular respect our barren
+soil inherited with its sterility.  There are some malarious spots on
+the edge of Lake Champlain, arid there have been some temporary
+centres of malaria, within the memory of man, on one or more of our
+Massachusetts rivers, but these are harmless enough, for the most
+part, unless the millers dam them, when they are apt to retaliate
+with a whiff from their meadows, that sets the whole neighborhood
+shaking with fever and ague.
+
+
+The Pilgrims of the Mayflower had with them a good physician, a man
+of standing, a deacon of their church, one whom they loved and
+trusted, Dr. Samuel Fuller.  But no medical skill could keep cold and
+hunger and bad food, and, probably enough, desperate homesickness in
+some of the feebler sort, from doing their work.  No detailed record
+remains of what they suffered or what was attempted for their relief
+during the first sad winter.  The graves of those who died were
+levelled and sowed with grain that the losses of the little band
+might not be suspected by the savage tenants of the wilderness, and
+their story remains untold.
+
+Of Dr. Fuller's practice, at a later period, we have an account in a
+letter of his to Governor Bradford, dated June, 1630.  "I have been
+to Matapan" (now Dorchester), he says, "and let some twenty of those
+people blood."  Such wholesale depletion as this, except with avowed
+homicidal intent, is quite unknown in these days; though I once saw
+the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
+order some ten or fifteen patients, taken almost indiscriminately, to
+be bled in a single morning.
+
+Dr. Fuller's two visits to Salem, at the request of Governor
+Endicott, seem to have been very satisfactory to that gentleman.
+Morton, the wild fellow of Merry Mount, gives a rather questionable
+reason for the Governor's being so well pleased with the physician's
+doings.  The names under which he mentions the two personages, it
+will be seen, are not intended to be complimentary.  "Dr. Noddy did a
+great cure for Captain Littleworth.  He cured him of a disease called
+a wife."   William Gager, who came out with Winthrop, is spoken of as
+"a right godly man and skilful chyrurgeon," but died of a malignant
+fever not very long after his arrival."
+
+Two practitioners of the ancient town of Newbury are entitled to
+special notice, for different reasons.  The first is Dr. John Clark,
+who is said by tradition to have been the first regularly educated
+physician who resided in New England.  His portrait, in close-fitting
+skull-cap, with long locks and venerable flowing beard, is familiar
+to our eyes on the wall of our Society's antechamber.  His left hand
+rests upon a skull, his right hand holds an instrument which deserves
+a passing comment.  It is a trephine, a surgical implement for
+cutting round pieces out of broken skulls, so as to get at the
+fragments which have been driven in, and lift them up.  It has a
+handle like that of a gimlet, with a claw like a hammer, to lift
+with, I suppose, which last contrivance I do not see figured in my
+books.  But the point I refer to is this: the old instrument, the
+trepan, had a handle like a wimble, what we call a brace or bit-
+stock.  The trephine is not mentioned at all in Peter Lowe's book,
+London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
+nor in the translation of Dionis, published by Jacob Tonson, in 1710.
+In fact it was only brought into more general use by Cheselden and
+Sharpe so late as the beginning of the last century.  As John Clark
+died in 1661, it is remarkable to see the last fashion in the way of
+skull-sawing contrivances in his hands,--to say nothing of the claw
+on the handle, and a Hey's saw, so called in England, lying on the
+table by him, and painted there more than a hundred years before Hey
+was born.  This saw is an old invention, perhaps as old as
+Hippocrates, and may be seen figured in the "Armamentarium
+Chirurgicum" of Scultetus, or in the Works of Ambroise Pare.
+
+Dr. Clark is said to have received a diploma before be came, for
+skill in lithotomy.  He loved horses, as a good many doctors do, and
+left a good property, as they all ought to do.  His grave and noble
+presence, with the few facts concerning him, told with more or less
+traditional authority, give us the feeling that the people of
+Newbury, and afterwards of Boston, had a wise and skilful medical
+adviser and surgeon in Dr. John Clark.
+
+The venerable town of Newbury had another physician who was less
+fortunate.  The following is a court record of 1652:
+
+"This is to certify whom it may concern, that we the subscribers,
+being called upon to testify against doctor William Snelling for
+words by him uttered, affirm that being in way of merry discourse, a
+health being drank to all friends, he answered,
+
+    "I'll pledge my friends,
+     And for my foes
+     A plague for their heels
+     And,'---
+
+[a similar malediction on the other extremity of their feet.]
+
+"Since when he hath affirmed that he only intended the proverb used
+in the west country, nor do we believe he intended otherwise.
+
+[Signed]
+WILLIAM THOMAS.
+THOMAS MILWARD.
+
+"March 12th 1651, All which I acknowledge, and am sorry I did not
+expresse my intent, or that I was so weak as to use so foolish a
+proverb.
+
+[Signed]
+GULIELMUS SNELLING."
+
+
+Notwithstanding this confession and apology, the record tells us that
+"William Snelling in his presentment for cursing is fined ten
+shillings and the fees of court."
+
+I will mention one other name among those of the Fathers of the
+medical profession in New England.  The "apostle" Eliot says, writing
+in 1647, "We never had but one anatomy in the country, which Mr.
+Giles Firman, now in England, did make and read upon very well."
+
+Giles Firmin, as the name is commonly spelled, practised physic in
+this country for a time.  He seems to have found it a poor business;
+for, in a letter to Governor Winthrop, he says, "I am strongly sett
+upon to studye divinitie: my studyes else must be lost, for physick
+is but a meene helpe."
+
+Giles Firmin's Lectures on Anatomy were the first scientific
+teachings of the New World.  While the Fathers were enlightened
+enough to permit such instructions, they were severe in dealing with
+quackery; for, in 1631, our court records show that one Nicholas
+Knopp, or Knapp, was sentenced to be fined or whipped "for taking
+upon him to cure the scurvey by a water of noe worth nor value, which
+he solde att a very deare rate."  Empty purses or sore backs would be
+common with us to-day if such a rule were enforced.
+
+Besides the few worthies spoken of, and others whose names I have not
+space to record, we must remember that there were many clergymen who
+took charge of the bodies as well as the souls of their patients,
+among them two Presidents of Harvard College, Charles Chauncy and
+Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
+author of the earliest medical treatises printed in the country,[A
+Brief Rule to Guide the Common People in Small pox and
+Measles.  1674.] whose epitaph in Latin and Greek, said to have been
+written by Eleazer, an "Indian Youth" and a member of the Senior
+Class of Harvard College, may be found in the "Magnalia."  I miss
+this noble savage's name in our triennial catalogue; and as there is
+many a slip between the cup and lip, one is tempted to guess that he
+may have lost his degree by some display of his native instinct,--
+possibly a flourish of the tomahawk or scalping-knife.  However this
+may have been, the good man he celebrated was a notable instance of
+the Angelical Conjunction, as the author of the "Magnalia" calls it,
+of the offices of clergyman and medical practitioner.
+
+Michael Wigglesworth, author of the "Day of Doom," attended the sick,
+"not only as a Pastor, but as a Physician too, and this, not only in
+his own town, but also in all those of the vicinity."  Mather says of
+the sons of Charles Chauncy, " All of these did, while they had
+Opportunity, Preach the Gospel; and most, if not all of them, like
+their excellent Father before them, had an eminent skill in physick
+added unto their other accomplishments," etc.  Roger Williams is said
+to have saved many in a kind of pestilence which swept away many
+Indians.
+
+To these names must be added, as sustaining a certain relation to the
+healing art, that of the first Governor Winthrop, who is said by John
+Cotton to have been "Help for our Bodies by Physick [and] for our
+Estates by Law," and that of his son, the Governor of Connecticut,
+who, as we shall see, was as much physician as magistrate.
+
+I had submitted to me for examination, in 1862, a manuscript found
+among the Winthrop Papers, marked with the superscription, "For my
+worthy friend Mr. Wintrop," dated in 1643, London, signed Edward
+Stafford, and containing medical directions and prescriptions.  It
+may be remembered by some present that I wrote a report on this
+paper, which was published in the "Proceedings" of this Society.
+Whether the paper was written for Governor John Winthrop of
+Massachusetts, or for his son, Governor John of Connecticut, there is
+no positive evidence that I have been able to obtain.  It is very
+interesting, however, as giving short and simple practical
+directions, such as would be most like to be wanted and most useful,
+in the opinion of a physician in repute of that day.
+
+The diseases prescribed for are plague, small-pox, fevers, king's
+evil, insanity, falling-sickness, and the like; with such injuries as
+broken bones, dislocations, and burning with gunpowder.  The remedies
+are of three kinds: simples, such as St. John's wort, Clown's all-
+heal, elder, parsley, maidenhair, mineral drugs, such as lime,
+saltpetre, Armenian bole, crocus metallorum, or sulphuret of
+antimony; and thaumaturgic or mystical, of which the chief is, "My
+black powder against the plague, small-pox; purples, all sorts of
+feavers; Poyson; either, by Way of Prevention or after Infection."
+This marvellous remedy was made by putting live toads into an earthen
+pot so as to half fill it, and baking and burning them "in the open
+ayre, not in an house,"--concerning which latter possibility I
+suspect Madam Winthrop would have had something to say,--until they
+could be reduced by pounding, first into a brown, and then into a
+black, powder.  Blood-letting in some inflammations, fasting in the
+early stage of fevers, and some of those peremptory drugs with which
+most of us have been well acquainted in our time, the infragrant
+memories of which I will not pursue beyond this slight allusion, are
+among his remedies.
+
+The Winthrops, to one of whom Dr. Stafford's directions were
+addressed, were the medical as well as the political advisers of
+their fellow-citizens for three or four successive generations.  One
+of them, Governor John of Connecticut, practised so extensively,
+that, but for his more distinguished title in the State, he would
+have been remembered as the Doctor.  The fact that he practised in
+another colony, for the most part, makes little difference in the
+value of the records we have of his medical experience, which have
+fortunately been preserved, and give a very fair idea, in all
+probability, of the way in which patients were treated in
+Massachusetts, when they fell into intelligent and somewhat educated
+hands, a little after the middle of the seventeenth century:
+
+I have before me, while writing, a manuscript collection of the
+medical cases treated by him, and recorded at the time in his own
+hand, which has been intrusted to me by our President, his
+descendant.
+
+They are generally marked Hartford, and extend from the year 1657 to
+1669.  From these, manuscripts, and from the letters printed in the
+Winthrop Papers published by our Society, I have endeavored to obtain
+some idea of the practice of Governor John Winthrop, Junior.  The
+learned eye of Mr. Pulsifer would have helped me, no doubt, as it has
+done in other cases; but I have ventured this time to attempt finding
+my own way among the hieroglyphics of these old pages.  By careful
+comparison of many prescriptions, and by the aid of Schroder, Salmon,
+Culpeper, and other old compilers, I have deciphered many of his
+difficult paragraphs with their mysterious recipes.
+
+The Governor employed a number of the simples dear to ancient women,
+--elecampane and elder and wormwood and anise and the rest; but he
+also employed certain mineral remedies, which he almost always
+indicates by their ancient symbols, or by a name which should leave
+them a mystery to the vulgar.  I am now prepared to reveal the mystic
+secrets of the Governor's beneficent art, which rendered so many good
+and great as well as so many poor and dependent people his debtors,-
+at least, in their simple belief,--for their health and their lives.
+
+His great remedy, which he gave oftener than any other, was nitre;
+which he ordered in doses of twenty or thirty grains to adults, and
+of three grains to infants.  Measles, colics, sciatica, headache,
+giddiness, and many other ailments, all found themselves treated, and
+I trust bettered, by nitre; a pretty safe medicine in moderate doses,
+and one not likely to keep the good Governor awake at night, thinking
+whether it might not kill, if it did not cure.  We may say as much
+for spermaceti, which he seems to have considered "the sovereign'st
+thing on earth" for inward bruises, and often prescribes after falls
+and similar injuries.
+
+One of the next remedies, in point of frequency, which he was in the
+habit of giving, was (probably diaphoretic) antimony; a mild form of
+that very active metal, and which, mild as it was, left his patients
+very commonly with a pretty strong conviction that they had been
+taking something that did not exactly agree with them.  Now and then
+he gave a little iron or sulphur or calomel, but very rarely;
+occasionally, a good, honest dose of rhubarb or jalap; a taste of
+stinging horseradish, oftener of warming guiacum; sometimes an
+anodyne, in the shape of mithridate,--the famous old farrago, which
+owed its virtue to poppy juice; [This is the remedy which a Boston
+divine tried to simplify.  See Electuarium Novum Alexipharmacum, by
+Rev.  Thomas Harward, lecturer at the Royal Chappell.  Boston, 1732.
+This tract is in our Society's library.] very often, a harmless
+powder of coral; less frequently, an inert prescription of pleasing
+amber; and (let me say it softly within possible hearing of his
+honored descendant), twice or oftener,--let us hope as a last
+resort,--an electuary of millipedes,--sowbugs, if we must give them
+their homely English name.  One or two other prescriptions, of the
+many unmentionable ones which disgraced the pharmacopoeia of the
+seventeenth century, are to be found, but only in very rare
+instances, in the faded characters of the manuscript.
+
+The excellent Governor's accounts of diseases are so brief, that we
+get only a very general notion of the complaints for which he
+prescribed.  Measles and their consequences are at first more
+prominent than any other one affection, but the common infirmities of
+both sexes and of all ages seem to have come under his healing hand.
+Fever and ague appears to have been of frequent occurrence.
+
+His published correspondence shows that many noted people were in
+communication with him as his patients.  Roger Williams wants a
+little of his medicine for Mrs. Weekes's daughter; worshipful John
+Haynes is in receipt of his powders; troublesome Captain Underhill
+wants "a little white vitterall" for his wife, and something to cure
+his wife's friend's neuralgia, (I think his wife's friend's husband
+had a little rather have had it sent by the hands of Mrs. Underhill,
+than by those of the gallant and discursive captain); and pious John
+Davenport says, his wife "tooke but one halfe of one of the papers"
+(which probably contained the medicine he called rubila), "but could
+not beare the taste of it, and is discouraged from taking any more;"
+and honored William Leete asks for more powders for his "poore little
+daughter Graciana, though he found it "hard to make her take it,"
+delicate, and of course sensitive, child as she was, languishing and
+dying before her time, in spite of all the bitter things she
+swallowed,--God help all little children in the hands of dosing
+doctors and howling dervishes!  Restless Samuel Gorton, now tamed by
+the burden of fourscore and two years, writes so touching an account
+of his infirmities, and expresses such overflowing gratitude for the
+relief he has obtained from the Governor's prescriptions, wondering
+how "a thing so little in quantity, so little in sent, so little in
+taste, and so little to sence in operation, should beget and bring
+forth such efects," that we repent our hasty exclamation, and bless
+the memory of the good Governor, who gave relief to the worn-out
+frame of our long-departed brother, the sturdy old heretic of Rhode
+Island.
+
+What was that medicine which so frequently occurs in the printed
+letters under the name of "rubila"?  It is evidently a secret remedy,
+and, so far as I know, has not yet been made out.  I had almost given
+it up in despair, when I found what appears to be a key to the
+mystery.  In the vast multitude of prescriptions contained in the
+manuscripts, most of them written in symbols, I find one which I thus
+interpret:
+
+"Four grains of (diaphoretic) antimony, with twenty grains of nitre,
+with a little salt of tin, making rubila."  Perhaps something was
+added to redden the powder, as he constantly speaks of "rubifying "
+or "viridating" his prescriptions; a very common practice of
+prescribers, when their powders look a little too much like plain
+salt or sugar.
+
+
+Waitstill Winthrop, the Governor's son, "was a skilful physician,"
+says Mr. Sewall, in his funeral sermon; "and generously gave, not
+only his advice, but also his Medicines, for the healing of the Sick,
+which, by the Blessing of God, were made successful for the recovery
+of many."  "His son John, a member of the Royal Society, speaks of
+himself as "Dr. Winthrop," and mentions one of his own prescriptions
+in a letter to Cotton Mather.  Our President tells me that there was
+an heirloom of the ancient skill in his family, within his own
+remembrance, in the form of a certain precious eye-water, to which
+the late President John Quincy Adams ascribed rare virtue, and which
+he used to obtain from the possessor of the ancient recipe.
+
+These inherited prescriptions are often treasured in families, I do
+not doubt, for many generations.  When I was yet of trivial age, and
+suffering occasionally, as many children do, from what one of my
+Cambridgeport schoolmates used to call the "ager,"--meaning thereby
+toothache or face-ache,--I used to get relief from a certain plaster
+which never went by any other name in the family than "Dr. Oliver."
+
+Dr. James Oliver was my great-great-grandfather, graduated in 1680,
+and died in 1703.  This was, no doubt, one of his nostrums; for
+nostrum, as is well known, means nothing more than our own or my own
+particular medicine, or other possession or secret, and physicians in
+old times used to keep their choice recipes to themselves a good
+deal, as we have had occasion to see.
+
+Some years ago I found among my old books a small manuscript marked
+"James Oliver.  This Book Begun Aug. 12, 1685."  It is a rough sort
+of account-book, containing among other things prescriptions for
+patients, and charges for the same, with counter-charges for the
+purchase of medicines and other matters.  Dr. Oliver practised in
+Cambridge, where may be seen his tomb with inscriptions, and with
+sculptured figures that look more like Diana of the Ephesians, as
+given in Calmet's Dictionary, than like any angels admitted into good
+society here or elsewhere.
+
+I do not find any particular record of what his patients suffered
+from, but I have carefully copied out the remedies he mentions, and
+find that they form a very respectable catalogue.  Besides the usual
+simples, elder, parsley, fennel, saffron, snake-root, wormwood, I
+find the Elixir Proprietatis, with other elixire and cordials, as if
+he rather fancied warming medicines; but he called in the aid of some
+of the more energetic remedies, including iron, and probably mercury,
+as he bought two pounds of it at one time.
+
+The most interesting item is his bill against the estate of Samuel
+Pason of Roxbury, for services during his last illness.  He attended
+this gentleman,--for such he must have been, by the amount of physic
+which he took, and which his heirs paid for,--from June 4th, 1696, to
+September 3d of the same year, three months.  I observe he charges
+for visits as well as for medicines, which is not the case in most of
+his bills.  He opens the attack with a carminative appeal to the
+visceral conscience, and follows it up with good hard-hitting
+remedies for dropsy,--as I suppose the disease would have been
+called,--and finishes off with a rallying dose of hartshorn and iron.
+
+It is a source of honest pride to his descendant that his bill, which
+was honestly paid, as it seems to have been honorably earned,
+amounted to the handsome total of seven pounds and two shillings.
+Let me add that he repeatedly prescribes plaster, one of which was
+very probably the "Dr. Oliver" that soothed my infant griefs, and for
+which I blush to say that my venerated ancestor received from Goodman
+Hancock the painfully exiguous sum of no pounds, no shillings, and
+sixpence.
+
+I have illustrated the practice of the first century, from the two
+manuscripts I have examined, as giving an impartial idea of its
+every-day methods.  The Governor, Johannes Secundus, it is fair to
+remember, was an amateur practitioner, while my ancestor was a
+professed physician.  Comparing their modes of treatment with the
+many scientific follies still prevailing in the Old World, and still
+more with the extraordinary theological superstitions of the
+community in which they lived, we shall find reason, I think, to
+consider the art of healing as in a comparatively creditable state
+during the first century of New England.
+
+In addition to the evidence as to methods of treatment furnished by
+the manuscripts I have cited, I subjoin the following document, to
+which my attention was called by Dr. Shurtleff, our present Mayor.
+This is a letter of which the original is to be found in vol.  lxix.
+page 10 of the "Archives" preserved at the State House in Boston.  It
+will be seen that what the surgeon wanted consisted chiefly of
+opiates, stimulants, cathartics, plasters, and materials for
+bandages.  The complex and varied formulae have given place to
+simpler and often more effective forms of the same remedies; but the
+list and the manner in which it is made out are proofs of the good
+sense and schooling of the surgeon, who, it may be noted, was in such
+haste that he neglected all his stops.  He might well be in a hurry,
+as on the very day upon which he wrote, a great body of Indians--
+supposed to be six or seven hundred--appeared before Hatfield; and
+twenty-five resolute young men of Hadley, from which town he wrote,
+crossed the river and drove them away.
+
+
+HADLY May 30: 76
+
+Mr RAWSON Sr
+
+What we have recd by Tho: Houey the past month is not the cheifest of
+our wants as you have love for poor wounded I pray let us not want
+for these following medicines if you have not a speedy conveyance of
+them I pray send on purpose they are those things mentioned in my
+former letter but to prevent future mistakes I have wrote them att
+large wee have great want with the greatest halt and speed let
+us be supplyed.
+Sr
+Yr Sert
+WILL LOCHS
+
+
+(Endorsed
+
+Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye
+Council with it but could not obtaine any thing to be sent in answer
+thereto 13 June 1676
+
+
+I have given some idea of the chief remedies used by our earlier
+physicians, which were both Galenic and chemical; that is, vegetable
+and mineral.  They, of course, employed the usual perturbing
+medicines which Montaigne says are the chief reliance of their craft.
+There were, doubtless, individual practitioners who employed special
+remedies with exceptional boldness and perhaps success.  Mr. Eliot is
+spoken of, in a letter of William Leete to Winthrop, Junior, as being
+under Mr. Greenland's mercurial administrations.  The latter was
+probably enough one of these specialists.
+
+There is another class of remedies which appears to have been
+employed occasionally, but, on the whole, is so little prominent as
+to imply a good deal of common sense among the medical practitioners,
+as compared with the superstitions prevailing around them.  I have
+said that I have caught the good Governor, now and then, prescribing
+the electuary of millipedes; but he is entirely excused by the almost
+incredible fact that they were retained in the materia medica so late
+as when Rees's Cyclopaedia was published, and we there find the
+directions formerly given by the College of Edinburgh for their
+preparation.  Once or twice we have found him admitting still more
+objectionable articles into his materia medica; in doing which, I am
+sorry to say that he could plead grave and learned authority.  But
+these instances are very rare exceptions in a medical practice of
+many years, which is, on the whole, very respectable, considering the
+time and circumstances.
+
+Some remedies of questionable though not odious character appear
+occasionally to have been employed by the early practitioners, but
+they were such as still had the support of the medical profession.
+Governor John Winthrop, the first, sends for East Indian bezoar, with
+other commodities he is writing for.  Governor Endicott sends him one
+he had of Mr. Humfrey.  I hope it was genuine, for they cheated
+infamously in the matter of this concretion, which ought to come out
+of an animal's stomach, but the real history of which resembles what
+is sometimes told of modern sausages.
+
+There is a famous law-case of James the First's time, in which a
+goldsmith sold a hundred pounds' worth of what he called bezoar,
+which was proved to be false, and the purchaser got a verdict against
+him.  Governor Endicott also sends Winthrop a unicorn's horn, which
+was the property of a certain Mrs. Beggarly, who, in spite of her
+name, seems to have been rich in medical knowledge and possessions.
+The famous Thomas Bartholinus wrote a treatise on the virtues of this
+fabulous-sounding remedy, which was published in 1641, and
+republished in 1678.
+
+The "antimonial cup," a drinking vessel made of that metal, which,
+like our quassia-wood cups, might be filled and emptied in saecula
+saeculorum without exhausting its virtues, is mentioned by Matthew
+Cradock, in a letter to the elder Winthrop, but in a doubtful way, as
+it was thought, he says, to have shortened the days of Sir Nathaniel
+Riche; and Winthrop himself, as I think, refers to its use, calling
+it simply "the cup."   An antimonial cup is included in the inventory
+of Samuel Seabury, who died 1680, and is valued at five shillings.°
+There is a treatise entitled "The Universall Remedy, or the Vertues
+of the Antimoniall Cup, By John Evans, Minister and Preacher of God's
+Word, London, 1634," in our own Society's library.
+
+One other special remedy deserves notice, because of native growth.
+I do not know when Culver's root, Leptandra Virginica of our National
+Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
+John Winthrop of New London, speaks of it as famous for the cure of
+consumptions, and wishes to get some of it, through his mediation,
+for Katharine, his eldest daughter.  He gets it, and gives it to the
+"poor damsel," who is languishing, as he says, and who dies the next
+month,--all the sooner, I have little doubt, for this uncertain and
+violent drug, with which the meddlesome pedant tormented her in that
+spirit of well-meant but restless quackery, which could touch nothing
+without making mischief, not even a quotation, and yet proved at
+length the means of bringing a great blessing to our community, as we
+shall see by and by; so does Providence use our very vanities and
+infirmities for its wise purposes.
+
+Externally, I find the practitioners on whom I have chiefly relied
+used the plasters of Paracelsus, of melilot, diachylon, and probably
+diaphoenicon, all well known to the old pharmacopoeias, and some of
+them to the modern ones,--to say nothing of "my yellow salve," of
+Governor John, the second, for the composition of which we must apply
+to his respected descendant.
+
+The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
+and Wecherus, of all whom notices may be found in the pages of Haller
+and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
+Practice of Physic and Anatomy, the last as belonging to Samuel
+Seabury, chirurgeon, before mentioned.  Nicholas Culpeper was a
+shrewd charlatan, and as impudent a varlet as ever prescribed for a
+colic; but knew very well what he was about, and badgers the College
+with great vigor.  A copy of Spigelius's famous Anatomy, in the
+Boston Athenaeum, has the names of Increase and Samuel Mather written
+in it, and was doubtless early overhauled by the youthful Cotton, who
+refers to the great anatomist's singular death, among his curious
+stories in the "Magnalia," and quotes him among nearly a hundred
+authors whom he cites in his manuscript "The Angel of Bethesda."  Dr.
+John Clark's "books and instruments, with several chirurgery
+materials in the closet," a were valued in his inventory at sixty
+pounds; Dr. Matthew Fuller, who died in 1678, left a library valued
+at ten pounds; and a surgeon's chest and drugs valued at sixteen
+pounds.'
+
+
+Here we leave the first century and all attempts at any further
+detailed accounts of medicine and its practitioners.  It is necessary
+to show in a brief glance what had been going on in Europe during the
+latter part of that century, the first quarter of which had been made
+illustrious in the history of medical science by the discovery of the
+circulation.
+
+Charles Barbeyrac, a Protestant in his religion, was a practitioner
+and teacher of medicine at Montpellier.  His creed was in the way of
+his obtaining office; but the young men followed his instructions
+with enthusiasm.  Religious and scientific freedom breed in and in,
+until it becomes hard to tell the family of one from that of the
+other.  Barbeyrac threw overboard the old complex medical farragos of
+the pharmacopoeias, as his church had disburdened itself of the
+popish ceremonies.
+
+Among the students who followed his instructions were two Englishmen:
+one of them, John Locke, afterwards author of an "Essay on the Human
+Understanding," three years younger than his teacher; the other,
+Thomas Sydenham, five years older.  Both returned to England.  Locke,
+whose medical knowledge is borne witness to by Sydenham, had the good
+fortune to form a correct opinion on a disease from which the Earl of
+Shaftesbury was suffering, which led to an operation that saved his
+life.  Less felicitous was his experience with a certain ancilla
+culinaria virgo,--which I am afraid would in those days have been
+translated kitchen-wench, instead of lady of the culinary
+department,--who turned him off after she had got tired of him, and
+called in another practitioner. [Locke and Sydenham, p. 124.  By John
+Brown, M.  D.  Edinburgh, 1866.]  This helped, perhaps, to spoil a
+promising doctor, and make an immortal metaphysician.  At any rate,
+Locke laid down the professional wig and cane, and took to other
+studies.
+
+The name of Thomas Sydenham is as distinguished in the history of
+medicine as that of John Locke in philosophy.  As Barbeyrac was found
+in opposition to the established religion, as Locke took the rational
+side against orthodox Bishop Stillingfleet, so Sydenham went with
+Parliament against Charles, and was never admitted a Fellow by the
+College of Physicians, which, after he was dead, placed his bust in
+their hall by the side of that of Harvey.
+
+What Sydenham did for medicine was briefly this he studied the course
+of diseases carefully, and especially as affected by the particular
+season; to patients with fever he gave air and cooling drinks,
+instead of smothering and heating them, with the idea of sweating out
+their disease; he ordered horseback exercise to consumptives; he,
+like his teacher, used few and comparatively simple remedies; he did
+not give any drug at all, if he thought none was needed, but let well
+enough alone.  He was a sensible man, in short, who applied his
+common sense to diseases which he had studied with the best light of
+science that he could obtain.
+
+The influence of the reform he introduced must have been more or less
+felt in this country, but not much before the beginning of the
+eighteenth century, as his great work was not published until 1675,
+and then in Latin.  I very strongly suspect that there was not so
+much to reform in the simple practice of the physicians of the new
+community, as there was in that of the learned big-wigs of the
+"College," who valued their remedies too much in proportion to their
+complexity, and the extravagant and fantastic ingredients which went
+to their making.
+
+During the memorable century which bred and bore the Revolution, the
+medical profession gave great names to our history.  But John Brooks
+belonged to the State, and Joseph Warren belongs to the country and
+mankind, and to speak of them would lead me beyond my limited--
+subject.  There would be little pleasure in dwelling on the name of
+Benjamin Church; and as for the medical politicians, like Elisha
+Cooke in the early part of the century, or Charles Jarvis, the bald
+eagle of Boston, in its later years, whether their practice was
+heroic or not, their patients were, for he is a bold man who trusts
+one that is making speeches and coaxing voters, to meddle with the
+internal politics of his corporeal republic.
+
+One great event stands out in the medical history of this eighteenth
+century; namely, the introduction of the practice of inoculation for
+small-pox.  Six epidemics of this complaint had visited Boston in the
+course of a hundred years."  Prayers had been asked in the churches
+for more than a hundred sick in a single day, and this many times.
+About a thousand persons had died in a twelvemonth, we are told, and,
+as we may infer, chiefly from this cause.
+
+In 1721, this disease, after a respite of nineteen years, again
+appeared as an epidemic.  In that year it was that Cotton Mather,
+browsing, as was his wont, on all the printed fodder that came within
+reach of his ever-grinding mandibles, came upon an account of
+inoculation as practised in Turkey, contained in the "Philosophical
+Transactions."  He spoke of it to several physicians, who paid little
+heed to his story; for they knew his medical whims, and had probably
+been bored, as we say now-a-days, many of them, with listening to his
+"Angel of Bethesda," and satiated with his speculations on the
+Nishmath Chajim.
+
+The Reverend Mather,--I use a mode of expression he often employed
+when speaking of his honored brethren,--the Reverend Mather was right
+this time, and the irreverent doctors who laughed at him were wrong.
+One only of their number disputes his claim to giving the first
+impulse to the practice, in Boston.  This is what that person says:
+"The Small-Pox spread in Boston, New England, A.1721, and the
+Reverend Dr. Cotton Mather, having had the use of these
+Communications from Dr. William Douglass " (that is, the writer of
+these words); surreptitiously, without the knowledge of his Informer,
+that he might have the honour of a New fangled notion, sets an
+Undaunted Operator to work, and in this Country about 290 were
+inoculated."
+
+All this has not deprived Cotton Mather of the credit of suggesting,
+and a bold and intelligent physician of the honor of carrying out,
+the new practice.  On the twenty-seventh day of June, 1721, Zabdiel
+Boylston of Boston inoculated his only son for smallpox,--the first
+person ever submitted to the operation in the New World.  The story
+of the fierce resistance to the introduction of the practice; of how
+Boylston was mobbed, and Mather had a hand-grenade thrown in at his
+window; of how William Douglass, the Scotchman, "always positive, and
+sometimes accurate," as was neatly said of him, at once depreciated
+the practice and tried to get the credit of suggesting it, and how
+Lawrence Dalhonde, the Frenchman, testified to its destructive
+consequences; of how Edmund Massey, lecturer at St.  Albans, preached
+against sinfully endeavoring to alter the course of nature by
+presumptuous interposition, which he would leave to the atheist and
+the scoffer, the heathen and unbeliever, while in the face of his
+sermon, afterwards reprinted in Boston, many of our New England
+clergy stood up boldly in defence of the practice,--all this has been
+told so well and so often that I spare you its details.  Set this
+good hint of Cotton Mather against that letter of his to John
+Richards, recommending the search after witch-marks, and the
+application of the water-ordeal, which means throw your grandmother
+into the water, if she has a mole on her arm;--if she swims, she is a
+witch and must be hanged; if she sinks, the Lord have mercy on her
+soul!
+
+Thus did America receive this great discovery, destined to save
+thousands of lives, via Boston, from the hands of one of our own
+Massachusetts physicians.
+
+The year 1735 was rendered sadly memorable by the epidemic of the
+terrible disease known as "throat distemper," and regarded by many as
+the same as our "diphtheria."  Dr. Holyoke thinks the more general
+use of mercurials in inflammatory complaints dates from the time of
+their employment in this disease, in which they were thought to have
+proved specially useful.
+
+At some time in the course of this century medical practice had
+settled down on four remedies as its chief reliance.  I must repeat
+an incident which I have related in another of these Essays.  When
+Dr. Holyoke, nearly seventy years ago, received young Mr. James
+Jackson as his student, he showed him the formidable array of
+bottles, jars, and drawers around his office, and then named the four
+remedies referred to as being of more importance than all the rest
+put together.  These were Mercury, Antimony, Opium, and Peruvian
+Bark."  I doubt if either of them remembered that, nearly seventy
+years before, in 1730, Dr. William Douglass, the disputatious
+Scotchman, mentioned those same four remedies, in the dedication of
+his quarrelsome essay on inoculation, as the most important ones in
+the hands of the physicians of his time.
+
+In the "Proceedings" of this Society for the year 1863 is a very
+pleasant paper by the late Dr. Ephraim Eliot, giving an account of
+the leading physicians of Boston during the last quarter of the last
+century.  The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch,
+Danforth, John Warren, Jeffries, are all famous in local history, and
+are commemorated in our medical biographies.  One of them, at least,
+appears to have been more widely known, not only as one of the first
+aerial voyagers, but as an explorer in the almost equally hazardous
+realm of medical theory.  Dr. John Jeffries, the first of that name,
+is considered by Broussais as a leader of medical opinion in America,
+and so referred to in his famous "Examen des Doctrines Medicales."
+
+Two great movements took place in this eighteenth century, the effect
+of which has been chiefly felt in our own time; namely, the
+establishment of the Massachusetts Medical Society, and the founding
+of the Medical School of Harvard University.
+
+
+The third century of our medical history began with the introduction
+of the second great medical discovery of modern times,--of all time
+up to that date, I may say,--once more via Boston, if we count the
+University village as its suburb, and once more by one of our
+Massachusetts physicians.  In the month of July, 1800, Dr. Benjamin
+Waterhouse of Cambridge submitted four of his own children to the new
+process of vaccination,--the first persons vaccinated, as Dr. Zabdiel
+Boylston's son had been the first person inoculated in the New World.
+
+A little before the first half of this century was completed, in the
+autumn of 1846, the great discovery went forth from the Massachusetts
+General Hospital, which repaid the debt of America to the science of
+the Old World, and gave immortality to the place of its origin in the
+memory and the heart of mankind.  The production of temporary
+insensibility at will--tuto, cito, jucunde, safely, quickly,
+pleasantly--is one of those triumphs over the infirmities of our
+mortal condition which change the aspect of life ever afterwards.
+Rhetoric can add nothing to its glory; gratitude, and the pride
+permitted to human weakness, that our Bethlehem should have been
+chosen as the birthplace of this new embodiment of the divine mercy,
+are all we can yet find room for.
+
+The present century has seen the establishment of all those great
+charitable institutions for the cure of diseases of the body and of
+the mind, which our State and our city have a right to consider as
+among the chief ornaments of their civilization.
+
+The last century had very little to show, in our State, in the way of
+medical literature.  The worthies who took care of our grandfathers
+and great-grandfathers, like the Revolutionary heroes, fought (with
+disease) and bled (their patients) and died (in spite of their own
+remedies); but their names, once familiar, are heard only at rare
+intervals.  Honored in their day, not unremembered by a few solitary
+students of the past, their memories are going sweetly to sleep in
+the arms of the patient old dry-nurse, whose "blackdrop" is the
+never-failing anodyne of the restless generations of men.  Except the
+lively controversy on inoculation, and floating papers in journals,
+we have not much of value for that long period, in the shape of
+medical records.
+
+But while the trouble with the last century is to find authors to
+mention, the trouble of this would be to name all that we find.  Of
+these, a very few claim unquestioned preeminence.
+
+Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical
+School of our University, did a great work for the advancement of
+medicine and surgery in New England, by his labors as teacher and
+author, greater, it is claimed by some, than was ever done by any
+other man.  The two Warrens, of our time, each left a large and
+permanent record of a most extended surgical practice.  James Jackson
+not only educated a whole generation by his lessons of wisdom, but
+bequeathed some of the most valuable results of his experience to
+those who came after him, in a series of letters singularly pleasant
+and kindly as well as instructive.  John Ware, keen and cautious,
+earnest and deliberate, wrote the two remarkable essays which have
+identified his name, for all time, with two important diseases, on
+which he has shed new light by his original observations.
+
+I must do violence to the modesty of the living by referring to the
+many important contributions to medical science by Dr. Jacob Bigelow,
+and especially to his discourse on "Self-limited Diseases," an
+address which can be read in a single hour, but the influence of
+which will be felt for a century.
+
+Nor would the profession forgive me if I forgot to mention the
+admirable museum of pathological anatomy, created almost entirely by
+the hands of Dr. John Barnard Swett Jackson, and illustrated by his
+own printed descriptive catalogue, justly spoken of by a
+distinguished professor in the University of Pennsylvania as the most
+important contribution which had ever been made in this country to
+the branch to which it relates.
+
+When we look at the literature of mental disease, as seen in hospital
+reports and special treatises, we can mention the names of Wyman,
+Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts
+or placed at the head of her institutions for the treatment of the
+insane.
+
+We have a right to claim also one who is known all over the civilized
+world as a philanthropist, to us as a townsman and a graduate of our
+own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor
+of a great multitude who were born to a world of inward or of outward
+darkness.
+
+I cannot pass over in silence the part taken by our own physicians in
+those sanitary movements which are assuming every year greater
+importance.  Two diseases especially have attracted attention, above
+all others, with reference to their causes and prevention; cholera,
+the "black death" of the nineteenth century, and consumption, the
+white plague of the North, both of which have been faithfully studied
+and reported on by physicians of our own State and city.  The
+cultivation of medical and surgical specialties, which is fast
+becoming prevalent, is beginning to show its effects in the
+literature of the profession, which is every year growing richer in
+original observations and investigations.
+
+To these benefactors who have labored for us in their peaceful
+vocation, we must add the noble army of surgeons, who went with the
+soldiers who fought the battles of their country, sharing many of
+their dangers, not rarely falling victims to fatigue, disease, or the
+deadly volleys to which they often exposed themselves in the
+discharge of their duties.
+
+The pleasant biographies of the venerable Dr. Thacher, and the worthy
+and kind-hearted gleaner, Dr. Stephen W.  Williams, who came after
+him, are filled with the names of men who served their generation
+well, and rest from their labors, followed by the blessing of those
+for whom they endured the toils and fatigues inseparable from their
+calling.  The hardworking, intelligent country physician more
+especially deserves the gratitude of his own generation, for he
+rarely leaves any permanent record in the literature of his
+profession.  Books are hard to obtain; hospitals, which are always
+centres of intelligence, are remote; thoroughly educated and superior
+men are separated by wide intervals; and long rides, though favorable
+to reflection, take up much of the time which might otherwise be
+given to the labors of the study.  So it is that men of ability and
+vast experience, like the late Dr. Twitchell, for instance, make a
+great and deserved reputation, become the oracles of large districts,
+and yet leave nothing, or next to nothing, by which their names shall
+be preserved from blank oblivion.
+
+One or two other facts deserve mention, as showing the readiness of
+our medical community to receive and adopt any important idea or
+discovery.  The new science of Histology, as it is now called, was
+first brought fully before the profession of this country by the
+translation of Bichat's great work, "Anatomie Generale," by the late
+Dr. George Hayward.
+
+The first work printed in this country on Auscultation,--that
+wonderful art of discovering disease, which, as it were, puts a
+window in the breast, through which the vital organs can be seen, to
+all intents and purposes, was the manual published anonymously by
+"A Member of the Massachusetts Medical Society."
+
+
+We are now in some slight measure prepared to weigh the record of the
+medical profession in Massachusetts, and pass our judgment upon it.
+But in-order to do justice to the first generation of practitioners,
+we must compare what we know of their treatment of disease with the
+state of the art in England, and the superstitions which they saw all
+around them in other departments of knowledge or belief.
+
+English medical literature must have been at a pretty low ebb when
+Sydenham recommended Don Quixote to Sir Richard Blackmore for
+professional reading.  The College Pharmacopoeia was loaded with the
+most absurd compound mixtures, one of the most complex of which (the
+same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel
+in Boston," tried to simplify, was not dropped until the year 1801.
+Sir Kenelm Digby was playing his fantastic tricks with the
+Sympathetic powder, and teaching Governor Winthrop, the second, how
+to cure fever and ague, which some may like to know.  "Pare the
+patient's nails; put the parings in a little bag, and hang the bag
+round the neck of a live eel, and put him in a tub of water.  The eel
+will die, and the patient will recover."
+
+Wiseman, the great surgeon, was discoursing eloquently on the
+efficacy of the royal touch in scrofula.  The founder of the
+Ashmolean Museum at Oxford, consorting with alchemists and
+astrologers, was treasuring the manuscripts of the late pious Dr.
+Richard Napier, in which certain letters (Rx Ris) were understood to
+mean Responsum Raphaelis,--the answer of the angel Raphael to the
+good man's medical questions.  The illustrious Robert Boyle was
+making his collection of choice and safe remedies, including the sole
+of an old shoe,  the thigh bone of a hanged man, and things far worse
+than these, as articles of his materia medica.  Dr. Stafford, whose
+paper of directions to his "friend, Mr. Wintrop," I cited, was
+probably a man of standing in London; yet toad-powder was his
+sovereign remedy.
+
+See what was the state of belief in other matters among the most
+intelligent persons of the colonies, magistrates and clergymen.
+Jonathan Brewster, son of the church-elder, writes the wildest
+letters to John Winthrop about alchemy,--mad for making gold as the
+Lynn rock-borers are for finding it."
+
+Remember the theology and the diabology of the time.  Mr. Cotton's
+Theocracy was a royal government, with the King of kings as its
+nominal head, but with an upper chamber of saints, and a tremendous
+opposition in the lower house; the leader of which may have been
+equalled, but cannot have been surpassed by any of our earth-born
+politicians.  The demons were prowling round the houses every night,
+as the foxes were sneaking about the hen-roosts.  The men of
+Gloucester fired whole flasks of gunpowder at devils disguised as
+Indians and Frenchmen.
+
+How deeply the notion of miraculous interference with the course of
+nature was rooted, is shown by the tenacity of the superstition about
+earthquakes.  We can hardly believe that our Professor Winthrop,
+father of the old judge and the "squire," whom many of us Cambridge
+people remember so well, had to defend himself against the learned
+and excellent Dr. Prince, of the Old South Church, for discussing
+their phenomena as if they belonged to the province of natural
+science:
+
+Not for the sake of degrading the aspect of the noble men who founded
+our State, do I refer to their idle beliefs and painful delusions,
+but to show against what influences the common sense of the medical
+profession had to assert itself.
+
+Think, then, of the blazing stars, that shook their horrid hair in
+the sky; the phantom ship, that brought its message direct from the
+other world; the story of the mouse and the snake at Watertown;  of
+the mice and the prayer-book;  of the snake in church; of the calf
+with two heads; and of the cabbage in the perfect form of a cutlash,
+--all which innocent occurrences were accepted or feared as alarming
+portents.
+
+We can smile at these: but we cannot smile at the account of unhappy
+Mary Dyer's malformed offspring;  or of Mrs.  Hutchinson's domestic
+misfortune of similar character, in the story of which the physician,
+Dr. John Clark of Rhode Island, alone appears to advantage; or as we
+read the Rev. Samuel Willard's fifteen alarming pages about an
+unfortunate young woman suffering with hysteria.  Or go a little
+deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia,
+first admonished, then whipped; at last, taking her own little
+daughter's life; put on trial, and standing mute, threatened to be
+pressed to death, confessing, sentenced, praying to be beheaded; and
+none the less pitilessly swung from the fatal ladder.
+
+The cooper's crazy wife--crazy in the belief that she has committed
+the unpardonable sin--tries to drown her child, to save it from
+misery; and the poor lunatic, who would be tenderly cared for to-day
+in a quiet asylum, is judged to be acting under the instigation of
+Satan himself."  Yet, after all, what can we say, who put Bunyan's
+"Pilgrim's Progress," full of nightmare dreams of horror, into all
+our children's hands; a story in which the awful image of the man in
+the cage might well turn the nursery where it is read into a
+madhouse?
+
+The miserable delusion of witchcraft illustrates, in a still more
+impressive way, the false ideas which governed the supposed relation
+of men with the spiritual world.  I have no doubt many physicians
+shared in these superstitions.  Mr. Upham says they--that is, some of
+them--were in the habit of attributing their want of success to the
+fact, that an "evil hand" was on their patient.  The temptation was
+strong, no doubt, when magistrates and ministers and all that
+followed their lead were contented with such an explanation.  But how
+was it in Salem, according to Mr. Upham's own statement?  Dr. John
+Swinnerton was, he says, for many years the principal physician of
+Salem.  And he says, also, "The Swinnerton family were all along
+opposed to Mr. Parris, and kept remarkably clear from the witchcraft
+delusion."   Dr. John Swinnerton--the same, by the way, whose memory
+is illuminated by a ray from the genius of Hawthorne--died the very
+year before the great witchcraft explosion took place.  But who can
+doubt that it was from him that the family had learned to despise and
+to resist the base superstition; or that Bridget Bishop, whose house
+he rented, as Mr. Upham tells me, the first person hanged in the time
+of the delusion, would have found an efficient protector in her
+tenant, had he been living, to head the opposition of his family to
+the misguided clergymen and magistrates?
+
+I cannot doubt that our early physicians brought with them many Old-
+World medical superstitions, and I have no question that they were
+more or less involved in the prevailing errors of the community in
+which they lived.  But, on the whole, their record is a clean one, so
+far as we can get at it; and where it is questionable we must
+remember that there must have been many little-educated persons among
+them; and that all must have felt, to some extent, the influence of
+those sincere and devoted but unsafe men, the physic-practising
+clergymen, who often used spiritual means as a substitute for
+temporal ones, who looked upon a hysteric patient as possessed by the
+devil, and treated a fractured skull by prayers and plasters,
+following the advice of a ruling elder in opposition to the unanimous
+opinion of seven surgeons."
+
+To what results the union of the two professions was liable to lead,
+may be seen by the example of a learned and famous person, who has
+left on record the product of his labors in the double capacity of
+clergyman and physician.
+
+I have had the privilege of examining a manuscript of Cotton Mather's
+relating to medicine, by the kindness of the librarian of the
+American Antiquarian Society, to which society it belongs.  A brief
+notice of this curious document may prove not uninteresting.
+
+It is entitled "The Angel of Bethesda: an Essay upon the Common
+Maladies of Mankind, offering, first, the sentiments of Piety," etc.,
+etc., and "a collection of plain but potent and Approved REMEDIES for
+the Maladies."  There are sixty-six "Capsula's," as he calls them, or
+chapters, in his table of contents; of which, five--from the
+fifteenth to the nineteenth, inclusive--are missing.  This is a most
+unfortunate loss, as the eighteenth capsula treated of agues, and we
+could have learned from it something of their degree of frequency in
+this part of New England.  There is no date to the manuscript; which,
+however, refers to a case observed Nov. 14, 1724.
+
+The divine takes precedence of the physician in this extraordinary
+production.  He begins by preaching a sermon at his unfortunate
+patient.  Having thrown him into a cold sweat by his spiritual
+sudorific, he attacks him with his material remedies, which are often
+quite as unpalatable.  The simple and cleanly practice of Sydenham,
+with whose works he was acquainted, seems to have been thrown away
+upon him.  Everything he could find mentioned in the seventy or
+eighty authors he cites, all that the old women of both sexes had
+ever told him of, gets into his text, or squeezes itself into his
+margin.
+
+Evolving disease out of sin, he hates it, one would say, as he hates
+its cause, and would drive it out of the body with all noisome
+appliances.  "Sickness is in Fact Flagellum Dei pro peccatis mundi."
+So saying, he encourages the young mother whose babe is wasting away
+upon her breast with these reflections:
+
+"Think; oh the grievous Effects of Sin!  This wretched Infant has not
+arrived unto years of sense enough, to sin after the similitude of
+the transgression committed by Adam.  Nevertheless the Transgression
+of Adam, who had all mankind Foederally, yea, Naturally, in him, has
+involved this Infant in the guilt of it.  And the poison of the old
+serpent, which infected Adam when he fell into his Transgression, by
+hearkening to the Tempter, has corrupted all mankind, and is a seed
+unto such diseases as this Infant is now laboring under.  Lord, what
+are we, and what are our children, but a Generation of Vipers?"
+
+Many of his remedies are at least harmless, but his pedantry and
+utter want of judgment betray themselves everywhere.  He piles his
+prescriptions one upon another, without the least discrimination.  He
+is run away with by all sorts of fancies and superstitions.  He
+prescribes euphrasia, eye-bright, for disease of the eyes; appealing
+confidently to the strange old doctrine of signatures, which inferred
+its use from the resemblance of its flower to the organ of vision.
+For the scattering of wens,  the efficacy of a Dead Hand has been out
+of measure wonderful.  But when he once comes to the odious class of
+remedies, he revels in them like a scarabeus.  This allusion will
+bring us quite near enough to the inconceivable abominations with
+which he proposed to outrage the sinful stomachs of the unhappy
+confederates and accomplices of Adam.
+
+It is well that the treatise was never printed, yet there are
+passages in it worth preserving.  He speaks of some remedies which
+have since become more universally known:
+
+"Among the plants of our soyl, Sir William Temple singles out Five
+[Six] as being of the greatest virtue and most friendly to health:
+and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and
+Elder."
+
+"But these Five [Six] plants may admitt of some competitors.  The
+QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"
+
+Of Ipecacuanha, he says,--
+"This is now in its reign; the most fashionable vomit."
+
+"I am not sorry that antimonial emetics begin to be disused."
+
+He quotes "Mr. Lock" as recommending red poppy-water and abstinence
+from flesh as often useful in children's diseases.
+
+One of his "Capsula's" is devoted to the animalcular origin of
+diseases, at the end of which he says, speaking of remedies for this
+supposed source of our distempers:
+
+"Mercury we know thee: But we are afraid thou wilt kill us too, if we
+employ thee to kill them that kill us.
+
+"And yett, for the cleansing of the small Blood Vessels, and making
+way for the free circulation of the Blood and Lymph--there is nothing
+like Mercurial Deobstruents."
+
+>From this we learn that mercury was already in common use, and the
+subject of the same popular prejudice as in our own time.
+
+His poetical turn shows itself here and there :
+
+"O Nightingale, with a Thorn at thy Breast; Under the trouble of a
+Cough, what can be more proper than such thoughts as these?"...
+
+If there is pathos in this, there is bathos in his apostrophe to the
+millipede, beginning "Poor sowbug!" and eulogizing the healing
+virtues of that odious little beast; of which he tells us to take
+"half a pound, putt 'em alive into a quart or two of wine," with
+saffron and other drugs, and take two ounces twice a day.
+
+The "Capsula " entitled "Nishmath Chajim " was printed in 1722, at
+New London, and is in the possession of our own Society.  He means,
+by these words, something like the Archxus of Van Helmont, of which
+he discourses in a style wonderfully resembling that of Mr. Jenkinson
+in the "Vicar of Wakefield."  "Many of the Ancients thought there was
+much of a Real History in the Parable, and their Opinion was that
+there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a
+Resemblance) of men as to their Shapes after Death."  And so on, with
+Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA,"
+in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara
+kai ateleutaion to pan."
+
+One other passage deserves notice, as it relates to the single
+medical suggestion which does honor to Cotton Mather's memory.  It
+does not appear that he availed himself of the information which he
+says, he obtained from his slave, for such I suppose he was.
+
+In his appendix to " Variolae Triumphatae," he says,--
+
+"There has been a wonderful practice lately used in several parts of
+the world, which indeed is not yet become common in our nation.
+
+"I was first informed of it by a Garamantee servant of my own, long
+before I knew that any Europeans or Asiaticks had the least
+acquaintance with it, and some years before I was enriched with the
+communications of the learned Foreigners, whose accounts I found
+agreeing with what I received of my servant, when he shewed me the
+Scar of the Wound made for the operation; and said, That no person
+ever died of the smallpox, in their countrey, that had the courage to
+use it.
+
+"I have since met with a considerable Number of these Africans, who
+all agree in one story; That in their countrey grandy-many dy of the
+small-pox: But now they learn this way: people take juice of smallpox
+and cutty-skin and put in a Drop; then by'nd by a little sicky,
+sicky: then very few little things like small-pox; and nobody dy of
+it; and nobody have small-pox any more.  Thus, in Africa, where the
+poor creatures dy of the smallpox like Rotten Sheep, a merciful God
+has taught them an Infallible preservative.  'T is a common practice,
+and is attended with a constant success."
+
+What has come down to us of the first century of medical practice, in
+the hands of Winthrop and Oliver, is comparatively simple and
+reasonable.  I suspect that the conditions of rude, stern life, in
+which the colonists found themselves in the wilderness, took the
+nonsense out of them, as the exigencies of a campaign did out of our
+physicians and surgeons in the late war.  Good food and enough of it,
+pure air and water, cleanliness, good attendance, an anaesthetic, an
+opiate, a stimulant, quinine, and two or three common drugs, proved
+to be the marrow of medical treatment; and the fopperies of the
+pharmacopoeia went the way of embroidered shirts and white kid gloves
+and malacca joints, in their time of need.  "Good wine is the best
+cordiall for her," said Governor John Winthrop, Junior, to Samuel
+Symonds, speaking of that gentleman's wife,--just as Sydenham,
+instead of physic, once ordered a roast chicken and a pint of canary
+for his patient in male hysterics.
+
+But the profession of medicine never could reach its full development
+until it became entirely separated from that of divinity.  The
+spiritual guide, the consoler in afliction, the confessor who is
+admitted into the secrets of our souls, has his own noble sphere of
+duties; but the healer of men must confine himself solely to the
+revelations of God in nature, as he sees their miracles with his own
+eyes.  No doctrine of prayer or special providence is to be his
+excuse for not looking straight at secondary causes, and acting,
+exactly so far as experience justifies him, as if he were himself the
+divine agent which antiquity fabled him to be.  While pious men were
+praying--humbly, sincerely, rightly, according to their knowledge--
+over the endless succession of little children dying of spasms in the
+great Dublin Hospital, a sagacious physician knocked some holes in
+the walls of the ward, let God's blessed air in on the little
+creatures, and so had already saved in that single hospital, as it
+was soberly calculated thirty years ago, more than sixteen thousand
+lives of these infant heirs of immortality. [Collins's Midwifery, p.
+312.  Published by order of the Massachusetts Medical Society.
+Boston, 1841.]
+
+Let it be, if you will, that the wise inspiration of the physician
+was granted in virtue of the clergyman's supplications.  Still, the
+habit of dealing with things seen generates another kind of
+knowledge, and another way of thought, from that of dealing with
+things unseen; which knowledge and way of thought are special means
+granted by Providence, and to be thankfully accepted.
+
+The mediaeval ecclesiastics expressed a great truth in that saying,
+so often quoted, as carrying a reproach with it: "Ubi tres medici,
+duo athei,"--"Where there are three physicians, there are two
+atheists."
+
+It was true then, it is true to-day, that the physician very
+commonly, if not very generally, denies and repudiates the deity of
+ecclesiastical commerce.  The Being whom Ambroise Pare meant when he
+spoke those memorable words, which you may read over the professor's
+chair in the French School of Medicine, "Te le pensay, et Dieu le
+guarit," "I dressed his wound, and God healed it,"--is a different
+being from the God that scholastic theologians have projected from
+their consciousness, or shaped even from the sacred pages which have
+proved so plastic in their hands.  He is a God who never leaves
+himself without witness, who repenteth him of the evil, who never
+allows a disease or an injury, compatible with the enjoyment of life,
+to take its course without establishing an effort, limited by certain
+fixed conditions, it is true, but an effort, always, to restore the
+broken body or the shattered mind.  In the perpetual presence of this
+great Healing Agent, who stays the bleeding of wounds, who knits the
+fractured bone, who expels the splinter by a gentle natural process,
+who walls in the inflammation that might involve the vital organs,
+who draws a cordon to separate the dead part from the living, who
+sends his three natural anaesthetics to the over-tasked frame in due
+order, according to its need,--sleep, fainting, death; in this
+perpetual presence, it is doubtless hard for the physician to realize
+the theological fact of a vast and permanent sphere of the universe,
+where no organ finds itself in its natural medium, where no wound
+heals kindly, where the executive has abrogated the pardoning power,
+and mercy forgets its errand; where the omnipotent is unfelt save in
+malignant agencies, and the omnipresent is unseen and unrepresented;
+hard to accept the God of Dante's "Inferno," and of Bunyan's caged
+lunatic.  If this is atheism, call three, instead of two of the trio,
+atheists, and it will probably come nearer the truth.
+
+I am not disposed to deny the occasional injurious effect of the
+materializing influences to which the physician is subjected.
+A spiritual guild is absolutely necessary to keep him, to keep us
+all, from becoming the "fingering slaves" that Wordsworth treats with
+such shrivelling scorn.  But it is well that the two callings have
+been separated, and it is fitting that they remain apart.  In
+settling the affairs of the late concern, I am afraid our good
+friends remain a little in our debt.  We lent them our physician
+Michael Servetus in fair condition, and they returned him so damaged
+by fire as to be quite useless for our purposes.  Their Reverend
+Samuel Willard wrote us a not over-wise report of a case of hysteria;
+and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary
+of the Bible) the first discerning criticism on the authorship of the
+Pentateuch.  Our John Locke enlightened them with his letters
+concerning toleration; and their Cotton Mather obscured our twilight
+with his "Nishmath Chajim."
+
+Yet we must remember that the name of Basil Valentine, the monk, is
+associated with whatever good and harm we can ascribe to antimony;
+and that the most remarkable of our specifics long bore the name of
+"Jesuit's Bark," from an old legend connected with its introduction.
+"Frere Jacques," who taught the lithotomists of Paris, owes his
+ecclesiastical title to courtesy, as he did not belong to a religious
+order.
+
+Medical science, and especially the study of mental disease, is
+destined, I believe, to react to much greater advantage on the
+theology of the future than theology has acted on medicine in the
+past.  The liberal spirit very generally prevailing in both
+professions, and the good understanding between their most
+enlightened members, promise well for the future of both in a
+community which holds every point of human belief, every institution
+in human hands, and every word written in a human dialect, open to
+free discussion today, to-morrow, and to the end of time.  Whether
+the world at large will ever be cured of trusting to specifics as a
+substitute for observing the laws of health, and to mechanical or
+intellectual formula as a substitute for character, may admit of
+question.  Quackery and idolatry are all but immortal.
+
+We can find most of the old beliefs alive amongst us to-day, only
+having changed their dresses and the social spheres in which they
+thrive.  We think the quarrels of Galenists and chemists belong to
+the past, forgetting that Thomsonism has its numerous apostles in our
+community; that it is common to see remedies vaunted as purely
+vegetable, and that the prejudice against "mineral poisons,"
+especially mercury, is as strong in many quarters now as it was at
+the beginning of the seventeenth century.  Names are only air, and
+blow away with a change of wind; but beliefs are rooted in human
+wants and weakness, and die hard.  The oaks of Dodona are prostrate,
+and the shrine of Delphi is desolate; but the Pythoness and the Sibyl
+may be consulted in Lowell Street for a very moderate compensation.
+Nostradamus and Lilly seem impossible in our time; but we have seen
+the advertisements of an astrologer in our Boston papers year after
+year, which seems to imply that he found believers and patrons.  You
+smiled when I related Sir Kenelm Digby's prescription with the live
+eel in it; but if each of you were to empty his or her pockets, would
+there not roll out, from more than one of them, a horse-chestnut,
+carried about as a cure for rheumatism?  The brazen head of Roger
+Bacon is mute; but is not "Planchette" uttering her responses in a
+hundred houses of this city?  We think of palmistry or chiromancy as
+belonging to the days of Albertus Magnus, or, if existing in our
+time, as given over to the gypsies; but a very distinguished person
+has recently shown me the line of life, and the line of fortune, on
+the palm of his hand, with a seeming confidence in the sanguine
+predictions of his career which had been drawn from them.  What shall
+we say of the plausible and well-dressed charlatans of our own time,
+who trade in false pretences, like Nicholas Knapp of old, but without
+any fear of being fined or whipped; or of the many follies and
+inanities, imposing on the credulous part of the community, each of
+them gaping with eager, open mouth for a gratuitous advertisement by
+the mention of its foolish name in any respectable connection?
+
+I turn from this less pleasing aspect of the common intelligence
+which renders such follies possible, to close the honorable record of
+the medical profession in this, our ancient Commonwealth.
+
+We have seen it in the first century divided among clergymen,
+magistrates, and regular practitioners; yet, on the whole, for the
+time, and under the circumstances, respectable, except where it
+invoked supernatural agencies to account for natural phenomena.
+
+In the second century it simplified its practice, educated many
+intelligent practitioners, and began the work of organizing for
+concerted action, and for medical teaching.
+
+In this, our own century, it has built hospitals, perfected and
+multiplied its associations and educational institutions, enlarged
+and created museums, and challenged a place in the world of science
+by its literature.
+
+In reviewing the whole course of its history we read a long list of
+honored names, and a precious record written in private memories, in
+public charities, in permanent contributions to medical science, in
+generous sacrifices for the country.  We can point to our capital as
+the port of entry for the New World of the great medical discoveries
+of two successive centuries, and we can claim for it the triumph over
+the most dreaded foe that assails the human body,--a triumph which
+the annals of the race can hardly match in three thousand years of
+medical history.
+
+
+
+
+
+
+THE YOUNG PRACTITIONER
+
+[A Valedictory Address delivered to the Graduating Class of the
+Bellevue Hospital College, March 2, 1871.]
+
+
+The occasion which calls us together reminds us not a little of that
+other ceremony which unites a man and woman for life.  The banns have
+already been pronounced which have wedded our young friends to the
+profession of their choice.  It remains only to address to them some
+friendly words of cheering counsel, and to bestow upon them the
+parting benediction.
+
+This is not the time for rhetorical display or ambitious eloquence.
+We must forget ourselves, and think only of them.  To us it is an
+occasion; to them it is an epoch.  The spectators at the wedding look
+curiously at the bride and bridegroom; at the bridal veil, the
+orange-flower garland, the giving and receiving of the ring; they
+listen for the tremulous "I will," and wonder what are the mysterious
+syllables the clergyman whispers in the ear of the married maiden.
+But to the newly-wedded pair what meaning in those words, "for
+better, for worse," "in sickness and in health," "till death us do
+part!"  To the father, to the mother, who know too well how often the
+deadly nightshade is interwoven with the wreath of orange-blossoms,
+how empty the pageant, how momentous the reality!
+
+You will not wonder that I address myself chiefly to those who are
+just leaving academic life for the sterner struggle and the larger
+tasks of matured and instructed manhood.  The hour belongs to them;
+if others find patience to listen, they will kindly remember that,
+after all, they are but as the spectators at the wedding, and that
+the priest is thinking less of them than of their friends who are
+kneeling at the altar.
+
+I speak more directly to you, then, gentlemen of the graduating
+class.  The days of your education, as pupils of trained instructors,
+are over.  Your first harvest is all garnered.  Henceforth you are to
+be sowers as well as reapers, and your field is the world.  How does
+your knowledge stand to-day?  What have you gained as a permanent
+possession?  What must you expect to forget?  What remains for you
+yet to learn?  These are questions which it may interest you to
+consider.
+
+There is another question which must force itself on the thoughts of
+many among you: "How am I to obtain patients and to keep their
+confidence?  "You have chosen a laborious calling, and made many
+sacrifices to fit yourselves for its successful pursuit.  You wish to
+be employed that you may be useful, and that you may receive the
+reward of your industry.  I would take advantage of these most
+receptive moments to give you some hints which may help you to
+realize your hopes and expectations.  Such is the outline of the
+familiar talk I shall offer you.
+
+Your acquaintance with some of the accessory branches is probably
+greater now than it will be in a year from now,--much greater than it
+will by ten years from now.  The progress of knowledge, it may be
+feared, or hoped, will have outrun the text-books in which you
+studied these branches.  Chemistry, for instance, is very apt to
+spoil on one's hands.  "Nous avons change tout cela" might serve as
+the standing motto of many of our manuals.  Science is a great
+traveller, and wears her shoes out pretty fast, as might be expected.
+
+You are now fresh from the lecture-room and the laboratory.  You can
+pass an examination in anatomy, physiology, chemistry, materia
+medica, which the men in large practice all around you would find a
+more potent sudorific than any in the Pharmacopceia.  These masters
+of the art of healing were once as ready with their answers as you
+are now, but they have got rid of a great deal of the less
+immediately practical part of their acquisitions, and you must
+undergo the same depleting process.  Hard work will train it off, as
+sharp exercise trains off the fat of a prize-fighter.
+
+Yet, pause a moment before you infer that your teachers must have
+been in fault when they furnished you with mental stores not directly
+convertible to practical purposes, and likely in a few years to lose
+their place in your memory.  All systematic knowledge involves much
+that is not practical, yet it is the only kind of knowledge which
+satisfies the mind, and systematic study proves, in the long-run, the
+easiest way of acquiring and retaining facts which are practical.
+There are many things which we can afford to forget, which yet it was
+well to  learn.  Your mental condition is not the same as if you had
+never known what you now try in vain to recall.  There is a perpetual
+metempsychosis of thought, and the knowledge of to-day finds a soil
+in the forgotten facts of yesterday.  You cannot see anything in the
+new season of the guano you placed last year about the roots of your
+climbing plants, but it is blushing and breathing fragrance in your
+trellised roses; it has scaled your porch in the bee-haunted honey-
+suckle; it has found its way where the ivy is green; it is gone where
+the woodbine expands its luxuriant foliage.
+
+Your diploma seems very broad to-day with your list of
+accomplishments, but it begins to shrink from this hour like the Peau
+de Chagrin of Balzac's story.  Do not worry about it, for all the
+while there will be making out for you an ampler and fairer
+parchment, signed by old Father Time himself as President of that
+great University in which experience is the one perpetual and all-
+sufficient professor.
+
+Your present plethora of acquirements will soon cure itself.
+Knowledge that is not wanted dies out like the eyes of the fishes of
+the Mammoth Cave.  When you come to handle life and death as your
+daily business, your memory will of itself bid good-by to such
+inmates as the well-known foramina of the sphenoid bone and the
+familiar oxides of methyl-ethylamyl-phenyl-ammonium.  Be thankful
+that you have once known them, and remember that even the learned
+ignorance of a nomenclature is something to have mastered, and may
+furnish pegs to hang facts upon which would otherwise have strewed
+the floor of memory in loose disorder.
+
+But your education has, after all, been very largely practical.  You
+have studied medicine and surgery, not chiefly in books, but at the
+bedside and in the operating amphitheatre.  It is the special
+advantage of large cities that they afford the opportunity of seeing
+a great deal of disease in a short space of time, and of seeing many
+cases of the same kind of disease brought together.  Let us not be
+unjust to the claims of the schools remote from the larger centres of
+population.  Who among us has taught better than Nathan Smith, better
+than Elisha Bartlett? who teaches better than some of our living
+contemporaries who divide their time between city and country
+schools?  I am afraid we do not always do justice to our country
+brethren, whose merits are less conspicuously exhibited than those of
+the great city physicians and surgeons, such especially as have
+charge of large hospitals.  There are modest practitioners living in
+remote rural districts who are gifted by nature with such sagacity
+and wisdom, trained so well in what is most essential to the practice
+of their art, taught so thoroughly by varied experience, forced to
+such manly self-reliance by their comparative isolation, that, from
+converse with them alone, from riding with them on their long rounds
+as they pass from village to village, from talking over cases with
+them, putting up their prescriptions, watching their expedients,
+listening to their cautions, marking the event of their predictions,
+hearing them tell of their mistakes, and now and then glory a little
+in the detection of another's blunder, a young man would find himself
+better fitted for his real work than many who have followed long
+courses of lectures and passed a showy examination.  But the young
+man is exceptionally fortunate who enjoys the intimacy of such a
+teacher.  And it must be confessed that the great hospitals,
+infirmaries, and dispensaries of large cities, where men of well-
+sifted reputations are in constant attendance, are the true centres
+of medical education.  No students, I believe, are more thoroughly
+aware of this than those who have graduated at this institution.
+Here, as in all our larger city schools, the greatest pains are taken
+to teach things as well as names.  You have entered into the
+inheritance of a vast amount of transmitted skill and wisdom, which
+you have taken, warm, as it were, with the life of your well-schooled
+instructors.  You have not learned all that art has to teach you, but
+you are safer practitioners to-day than were many of those whose
+names we hardly mention without a genuflection.  I had rather be
+cared for in a fever by the best-taught among you than by the
+renowned Fernelius or the illustrious Boerhaave, could they come back
+to us from that better world where there are no physicians needed,
+and, if the old adage can be trusted, not many within call.  I had
+rather have one of you exercise his surgical skill upon me than find
+myself in the hands of a resuscitated Fabricius Hildanus, or even of
+a wise Ambroise Pare, revisiting earth in the light of the nineteenth
+century.
+
+You will not accuse me of underrating your accomplishments.  You know
+what to do for a child in a fit, for an alderman in an apoplexy, for
+a girl that has fainted, for a woman in hysterics, for a leg that is
+broken, for an arm that is out of joint, for fevers of every color,
+for the sailor's rheumatism, and the tailor's cachexy.  In fact you
+do really know so much at this very hour, that nothing but the
+searching test of time can fully teach you the limitations of your
+knowledge.
+
+Of some of these you will permit me to remind you.  You will never
+have outgrown the possibility of new acquisitions, for Nature is
+endless in her variety.  But even the knowledge which you may be said
+to possess will be a different thing after long habit has made it a
+part of your existence.  The tactus eruditus extends to the mind as
+well as to the finger-ends.  Experience means the knowledge gained by
+habitual trial, and an expert is one who has been in the habit of
+trying.  This is the kind of knowledge that made Ulysses wise in the
+ways of men.  Many cities had he seen, and known the minds of those
+who dwelt in them.  This knowledge it was that Chaucer's Shipman
+brought home with him from the sea a
+
+     "In many a tempest had his berd be shake."
+
+This is the knowledge we place most confidence in, in the practical
+affairs of life.
+
+Our training has two stages.  The first stage deals with our
+intelligence, which takes the idea of what is to be done with the
+most charming ease and readiness.  Let it be a game of billiards, for
+instance, which the marker is going to teach us.  We have nothing to
+do but to make this ball glance from that ball and hit that other
+ball, and to knock that ball with this ball into a certain caecal
+sacculus or diverticulum which our professional friend calls a
+pocket.  Nothing can be clearer; it is as easy as "playing upon this
+pipe," for which Hamlet gives Guildenstern such lucid directions.
+But this intelligent Me, who steps forward as the senior partner in
+our dual personality, turns out to be a terrible bungler.  He misses
+those glancing hits which the hard-featured young professional person
+calls "carroms," and insists on pocketing his own ball instead of the
+other one.
+
+It is the unintelligent Me, stupid as an idiot, that has to try a
+thing a thousand times before he can do it, and then never knows how
+he does it, that at last does it well.  We have to educate ourselves
+through the pretentious claims of intellect, into the humble accuracy
+of instinct, and we end at last by acquiring the dexterity, the
+perfection, the certainty, which those masters of arts, the bee and
+the spider, inherit from Nature.
+
+Book-knowledge, lecture-knowledge, examination-knowledge, are all in
+the brain.  But work-knowledge is not only in the brain, it is in the
+senses, in the muscles, in the ganglia of the sympathetic nerves,--
+all over the man, as one may say, as instinct seems diffused through
+every part of those lower animals that have no such distinct organ as
+a brain.  See a skilful surgeon handle a broken limb; see a wise old
+physician smile away a case that looks to a novice as if the sexton
+would soon be sent for; mark what a large experience has done for
+those who were fitted to profit by it, and you will feel convinced
+that, much as you know, something is still left for you to learn.
+
+May I venture to contrast youth and experience in medical practice,
+something in the way the man painted the lion, that is, the lion
+under?
+
+The young man knows the rules, but the old man knows-the exceptions.
+The young man knows his patient, but the old man knows also his
+patient's family, dead and alive, up and down for generations.  He
+can tell beforehand what diseases their unborn children will be
+subject to, what they will die of if they live long enough, and
+whether they had better live at all, or remain unrealized
+possibilities, as belonging to a stock not worth being perpetuated.
+The young man feels uneasy if he is not continually doing something
+to stir up his patient's internal arrangements.  The old man takes
+things more quietly, and is much more willing to let well enough
+alone: All these superiorities, if such they are,'you must wait for
+time to bring you.  In the meanwhile (if we will let the lion be
+uppermost for a moment), the young man's senses are quicker than
+those of his older rival.  His education in all the accessory
+branches is more recent, and therefore nearer the existing condition
+of knowledge.  He finds it easier than his seniors to accept the
+improvements which every year is bringing forward.  New ideas build
+their nests in young men's brains.  "Revolutions are not made by men
+in spectacles," as I once heard it remarked, and the first whispers
+of a new truth are not caught by those who begin to feel the need of
+an ear-trumpet.  Granting all these advantages to the young man, he
+ought, nevertheless, to go on improving, on the whole, as a medical
+practitioner, with every year, until he has ripened into a well-
+mellowed maturity.  But, to improve, he must be good for something at
+the start.  If you ship a poor cask of wine to India and back, if you
+keep it a half a century, it only grows thinner and sharper.
+
+You are soon to enter into relations with the public, to expend your
+skill and knowledge for its benefit, and find your support in the
+rewards of your labor.  What kind of a constituency is this which is
+to look to you as its authorized champions in the struggle of life
+against its numerous enemies?
+
+In the first place, the persons who seek the aid of the physician are
+very honest and sincere in their wish to get rid of their complaints,
+and, generally speaking, to live as long as they can.  However
+attractively the future is painted to them, they are attached to the
+planet with which they are already acquainted.  They are addicted to
+the daily use of this empirical and unchemical mixture which we call
+air; and would hold on to it as a tippler does to his alcoholic
+drinks.  There is nothing men will not do, there is nothing they have
+not done, to recover their health and save their lives.  They have
+submitted to be half-drowned in water, and half-choked with gases, to
+be buried up to their chins in earth, to be seared with hot irons
+like galley-slaves, to be crimped with knives, like cod-fish, to have
+needles thrust into their flesh, and bonfires kindled on their skin,
+to swallow all sorts of abominations, and to pay for all this, as if
+to be singed and scalded were a costly privilege, as if blisters were
+a blessing, and leeches were a luxury.  What more can be asked to
+prove their honesty and sincerity?
+
+This same community is very intelligent with respect to a great many
+subjects-commerce, mechanics, manufactures, politics.  But with
+regard to medicine it is hopelessly ignorant and never finds it out.
+I do not know that it is any worse in this country than in Great
+Britain, where Mr. Huxley speaks very freely of "the utter ignorance
+of the simplest laws of their own animal life, which prevails among
+even the most highly educated persons."  And Cullen said before him
+"Neither the acutest genius nor the soundest judgment will avail in
+judging of a particular science, in regard to which they have not
+been exercised.  I have been obliged to please my patients sometimes
+with reasons, and I have found that any will pass, even with able
+divines and acute lawyers; the same will pass with the husbands as
+with the wives."  If the community could only be made aware of its
+own utter ignorance, and incompetence to form opinions on medical
+subjects, difficult enough to those who give their lives to the study
+of them, the practitioner would have an easier task.  But it will
+form opinions of its own, it cannot help it, and we cannot blame it,
+even though we know how slight and deceptive are their foundations.
+
+This is the way it happens: Every grown-up person has either been ill
+himself or had a friend suffer from illness, from which he has
+recovered.  Every sick person has done something or other by
+somebody's advice, or of his own accord, a little before getting
+better.  There is an irresistible tendency to associate the thing
+done, and the improvement which followed it, as cause and effect.
+This is the great source of fallacy in medical practice.  But the
+physician has some chance of correcting his hasty inference.  He
+thinks his prescription cured a single case of a particular
+complaint; he tries it in twenty similar cases without effect, and
+sets down the first as probably nothing more than a coincidence.  The
+unprofessional experimenter or observer has no large experience to
+correct his hasty generalization.  He wants to believe that the means
+he employed effected his cure.  He feels grateful to the person who
+advised it, he loves to praise the pill or potion which helped him,
+and he has a kind of monumental pride in himself as a living
+testimony to its efficacy.  So it is that you will find the community
+in which you live, be it in town or country, full of brands plucked
+from the burning, as they believe, by some agency which, with your
+better training, you feel reasonably confident had nothing to do with
+it.  Their disease went out of itself, and the stream from the
+medical fire-annihilator had never even touched it.
+
+You cannot and need not expect to disturb the public in the
+possession of its medical superstitions.  A man's ignorance is as
+much his private property, and as precious in his own eyes, as his
+family Bible.  You have only to open your own Bible at the ninth
+chapter of St. John's Gospel, and you will find that the logic of a
+restored patient was very simple then, as it is now, and very hard to
+deal with.  My clerical friends will forgive me for poaching on their
+sacred territory, in return for an occasional raid upon the medical
+domain of which they have now and then been accused.
+
+A blind man was said to have been restored to sight by a young person
+whom the learned doctors of the Jewish law considered a sinner, and,
+as such, very unlikely to have been endowed with a divine gift of
+healing.  They visited the patient repeatedly, and evidently teased
+him with their questions about the treatment, and their insinuations
+about the young man, until he lost his temper.  At last he turned
+sharply upon them:  "Whether he be a sinner or no, I know not: one
+thing I know, that, whereas I was blind, now I see."
+
+This is the answer that always has been and always will be given by
+most persons when they find themselves getting well after doing
+anything, no matter what,--recommended by anybody, no matter whom.
+Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in
+panaceas which we should laugh to scorn.  They had seen people get
+well after using them.  Are we any wiser than those great men?  Two
+years ago, in a lecture before the Massachusetts Historical Society,
+I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare
+the patient's nails; put the parings in a little bag, and hang the
+bag round the neck of a live eel, and place him in a tub of water.
+The eel will die, and the patient will recover.
+
+Referring to this prescription in the course of the same lecture, I
+said: "You smiled when I related Sir Kenehn Digby's prescription,
+with the live eel in it; but if each of you were to empty his or her
+pockets, would there not roll out, from more than one of them, a
+horse-chestnut, carried about as a cure for rheumatism?  Nobody saw
+fit to empty his or her pockets, and my question brought no response.
+But two months ago I was in a company of educated persons, college
+graduates every one of them, when a gentleman, well known in our
+community, a man of superior ability and strong common-sense, on the
+occasion of some talk arising about rheumatism, took a couple of very
+shiny horse-chestnuts from his breeches-pocket, and laid them on the
+table, telling us how, having suffered from the complaint in
+question, he had, by the advice of a friend, procured these two
+horse-chestnuts on a certain time a year or more ago, and carried
+them about him ever since; from which very day he had been entirely
+free from rheumatism.
+
+This argument, from what looks like cause and effect, whether it be
+so or not, is what you will have to meet wherever you go, and you
+need not think you can answer it.  In the natural course of things
+some thousands of persons must be getting well or better of slight
+attacks of colds, of rheumatic pains, every week, in this city alone.
+Hundreds of them do something or other in the way of remedy, by
+medical or other advice, or of their own motion, and the last thing
+they do gets the credit of the recovery.  Think what a crop of
+remedies this must furnish, if it were all harvested!
+
+Experience has taught, or will teach you, that most of the wonderful
+stories patients and others tell of sudden and signal cures are like
+Owen Glendower's story of the portents that announced his birth.  The
+earth shook at your nativity, did it?  Very likely, and
+
+               "So it would have done,
+     At the same season, if your mother's cat
+     Had kittened, though yourself had ne'er been born."
+
+You must listen more meekly than Hotspur did to the babbling
+Welshman, for ignorance is a solemn and sacred fact, and, like
+infancy, which it resembles, should be respected.  Once in a while
+you will have a patient of sense, born with the gift of observation,
+from whom you may learn something.  When you find yourself in the
+presence of one who is fertile of medical opinions, and affluent in
+stories of marvellous cures,--of a member of Congress whose name
+figures in certificates to the value of patent medicines, of a
+voluble dame who discourses on the miracles she has wrought or seen
+wrought with the little jokers of the sugar-of-milk globule-box, take
+out your watch and count the pulse; also note the time of day, and
+charge the price of a visit for every extra fifteen, or, if you are
+not very busy, every twenty minutes.  In this way you will turn what
+seems a serious dispensation into a double blessing, for this class
+of patients loves dearly to talk, and it does them a deal of good,
+and you feel as if you had earned your money by the dose you have
+taken, quite as honestly as by any dose you may have ordered.
+
+You must take the community just as it is, and make the best of it.
+You wish to obtain its confidence; there is a short rule for doing
+this which you will find useful,--deserve it.  But, to deserve it in
+full measure, you must unite many excellences, natural and acquired.
+
+As the basis of all the rest, you must have all those traits of
+character which fit you to enter into the most intimate and
+confidential relations with the families of which you are the
+privileged friend and counsellor.  Medical Christianity, if I may use
+such a term, is of very early date.  By the oath of Hippocrates, the
+practitioner of ancient times bound himself to enter his patient's
+house with the sole purpose of doing him good, and so to conduct
+himself as to avoid the very appearance of evil.  Let the physician
+of to-day begin by coming up to this standard, and add to it all the
+more recently discovered virtues and graces.
+
+A certain amount of natural ability is requisite to make you a good
+physician, but by no means that disproportionate development of some
+special faculty which goes by the name of genius.  A just balance of
+the mental powers is a great deal more likely to be useful than any
+single talent, even were it the power of observation; in excess.  For
+a mere observer is liable to be too fond of facts for their own sake,
+so that, if he told the real truth, he would confess that he takes
+more pleasure in a post-mortem examination which shows him what was
+the matter with a patient, than in a case which insists on getting
+well and leaving him in the dark as to its nature.  Far more likely
+to interfere with the sound practical balance of the mind is that
+speculative, theoretical tendency which has made so many men noted in
+their day, whose fame has passed away with their dissolving theories.
+Read Dr. Bartlett's comparison of the famous Benjamin Rush with his
+modest fellow-townsman Dr. William Currie, and see the dangers into
+which a passion for grandiose generalizations betrayed a man of many
+admirable qualities.
+
+I warn you against all ambitious aspirations outside of your
+profession.  Medicine is the most difficult of sciences and the most
+laborious of arts.  It will task all your powers of body and mind if
+you are faithful to it.  Do not dabble in the muddy sewer of
+politics, nor linger by the enchanted streams of literature, nor dig
+in far-off fields for the hidden waters of alien sciences.  The great
+practitioners are generally those who concentrate all their powers on
+their business.  If there are here and there brilliant exceptions, it
+is only in virtue of extraordinary gifts, and industry to which very
+few are equal.
+
+To get business a man mast really want it; and do you suppose that
+when you are in the middle of a heated caucus, or half-way through a
+delicate analysis, or in the spasm of an unfinished ode, your eyes
+rolling in the fine frenzy of poetical composition, you want to be
+called to a teething infant, or an ancient person groaning under the
+griefs of a lumbago?  I think I have known more than one young man
+whose doctor's sign proclaimed his readiness to serve mankind in that
+capacity, but who hated the sound of a patient's knock, and as he sat
+with his book or his microscope, felt exactly as the old party
+expressed himself in my friend Mr. Brownell's poem
+
+          "All I axes is, let me alone:'
+
+The community soon finds out whether you are in earnest, and really
+mean business, or whether you are one of those diplomaed dilettanti
+who like the amusement of quasi medical studies, but have no idea of
+wasting their precious time in putting their knowledge in practice
+for the benefit of their suffering fellow-creatures.
+
+The public is a very incompetent judge of your skill and knowledge,
+but it gives its confidence most readily to those who stand well with
+their professional brethren, whom they call upon when they themselves
+or their families are sick, whom they choose to honorable offices,
+whose writings and teachings they hold in esteem.  A man may be much
+valued by the profession and yet have defects which prevent his
+becoming a favorite practitioner, but no popularity can be depended
+upon as permanent which is not sanctioned by the judgment of
+professional experts, and with these you will always stand on your
+substantial merits.
+
+What shall I say of the personal habits you must form if you wish for
+success?  Temperance is first upon the list.  Intemperance in a
+physician partakes of the guilt of homicide, for the muddled brain
+may easily make a fatal blunder in a prescription and the unsteady
+hand transfix an artery in an operation.  Tippling doctors have been
+too common in the history of medicine.  Paracelsus was a sot,
+Radcliffe was much too fond of his glass, and Dr. James Hurlbut of
+Wethersfield, Connecticut, a famous man in his time, used to drink a
+square bottle of rum a day, with a corresponding allowance of opium
+to help steady his nerves.  We commonly speak of a man as being the
+worse for liquor, but I was asking an Irish laborer one day about his
+doctor, who, as he said, was somewhat given to drink.  "I like him
+best when he's a little that way," he said; "then I can spake to
+him."  I pitied the poor patient who could not venture to allude to
+his colic or his pleurisy until his physician was tipsy.
+
+There are personal habits of less gravity than the one I have
+mentioned which it is well to guard against, or, if they are formed,
+to relinquish.  A man who may be called at a moment's warning into
+the fragrant boudoir of suffering loveliness should not unsweeten its
+atmosphere with reminiscences of extinguished meerschaums.  He should
+remember that the sick are sensitive and fastidious, that they love
+the sweet odors and the pure tints of flowers, and if his presence is
+not like the breath of the rose, if his hands are not like the leaf
+of the lily, his visit may be unwelcome, and if he looks behind him
+he may see a window thrown open after he has left the sick-chamber.
+I remember too well the old doctor who sometimes came to help me
+through those inward griefs to which childhood is liable.  "Far off
+his coming "--shall I say "shone," and finish the Miltonic phrase, or
+leave the verb to the happy conjectures of my audience?  Before him
+came a soul-subduing whiff of ipecacuanha, and after him lingered a
+shuddering consciousness of rhubarb.  He had lived so much among his
+medicaments that he had at last become himself a drug, and to have
+him pass through a sick-chamber was a stronger dose than a
+conscientious disciple of Hahnemann would think it safe to
+administer.
+
+Need I remind yon of the importance of punctuality in your
+engagements, and of the worry and distress to patients and their
+friends which the want of it occasions?  One of my old teachers
+always carried two watches, to make quite sure of being exact, and
+not only kept his appointments with the regularity of a chronometer,
+but took great pains to be at his patient's house at the time when he
+had reason to believe he was expected, even if no express appointment
+was made.  It is a good rule; if you call too early, my lady's hair
+may not be so smooth as could be wished, and, if you keep her waiting
+too long, her hair may be smooth, but her temper otherwise.
+
+You will remember, of course, always to get the weather-gage of your
+patient.  I mean, to place him so that the light falls on his face
+and not on yours.  It is a kind of, ocular duel that is about to take
+place between you; you are going to look through his features into
+his pulmonary and hepatic and other internal machinery, and he is
+going to look into yours quite as sharply to see what you think about
+his probabilities for time or eternity.
+
+No matter how hard he stares at your countenance, he should never be
+able to read his fate in it.  It should be cheerful as long as there
+is hope, and serene in its gravity when nothing is left but
+resignation.  The face of a physician, like that of a diplomatist,
+should be impenetrable.  Nature is a benevolent old hypocrite; she
+cheats the sick and the dying with illusions better than any
+anodynes.  If there are cogent reasons why a patient should be
+undeceived, do it deliberately and advisedly, but do not betray your
+apprehensions through your tell-tale features.
+
+We had a physician in our city whose smile was commonly reckoned as
+being worth five thousand dollars a year to him, in the days, too, of
+moderate incomes.  You cannot put on such a smile as that any more
+than you can get sunshine without sun; there was a tranquil and
+kindly nature under it that irradiated the pleasant face it made one
+happier to meet on his daily rounds.  But you can cultivate the
+disposition, and it will work its way through to the surface, nay,
+more,--you can try to wear a quiet and encouraging look, and it will
+react on your disposition and make you like what you seem to be, or
+at least bring you nearer to its own likeness.
+
+Your patient has no more right to all the truth you know than he has
+to all the medicine in your saddlebags, if you carry that kind of
+cartridge-box for the ammunition that slays disease.  He should get
+only just so much as is good for him.  I have seen a physician
+examining a patient's chest stop all at once, as he brought out a
+particular sound with a tap on the collarbone, in the attitude of a
+pointer who has just come on the scent or sight of a woodcock.  You
+remember the Spartan boy, who, with unmoved countenance, hid the fox
+that was tearing his vitals beneath his mantle.  What he could do in
+his own suffering you must learn to do for others on whose vital
+organs disease has fastened its devouring teeth.  It is a terrible
+thing to take away hope, even earthly hope, from a fellow-creature.
+Be very careful what names you let fall before your patient.  He
+knows what it means when you tell him he has tubercles or Bright's
+disease, and, if he hears the word carcinoma, he will certainly look
+it out in a medical dictionary, if he does not interpret its dread
+significance on the instant.  Tell him he has asthmatic symptoms, or
+a tendency to the gouty diathesis, and he will at once think of all
+the asthmatic and gouty old patriarchs he has ever heard of, and be
+comforted.  You need not be so cautious in speaking of the health of
+rich and remote relatives, if he is in the line of succession.
+
+Some shrewd old doctors have a few phrases always on hand for
+patients that will insist on knowing the pathology of their
+complaints without the slightest capacity of understanding the
+scientific explanation.  I have known the term "spinal irritation "
+serve well on such occasions, but I think nothing on the whole has
+covered so much ground, and meant so little, and given such profound
+satisfaction to all parties, as the magnificent phrase "congestion of
+the portal system."
+
+Once more, let me recommend you, as far as possible, to keep your
+doubts to yourself, and give the patient the benefit of your
+decision.  Firmness, gentle firmness, is absolutely necessary in this
+and certain other relations.  Mr. Rarey with Cruiser, Richard with
+Lady Ann, Pinel with his crazy people, show what steady nerves can do
+with the most intractable of animals, the most irresistible of
+despots, and the most unmanageable of invalids.
+
+If you cannot acquire and keep the confidence of your patient, it is
+time for you to give place to some other practitioner who can.  If
+you are wise and diligent, you can establish relations with the best
+of them which they will find it very hard to break.  But, if they
+wish to employ another person, who, as they think, knows more than
+you do, do not take it as a personal wrong.  A patient believes
+another man can save his life, can restore him to health, which, as
+he thinks, you have not the skill to do.  No matter whether the
+patient is right or wrong, it is a great impertinence to think you
+have any property in him.  Your estimate of your own ability is not
+the question, it is what the patient thinks of it.  All your wisdom
+is to him like the lady's virtue in Raleigh's song:
+
+    "If she seem not chaste to me,
+     What care I how chaste she be?"
+
+What I call a good patient is one who, having found a good physician,
+sticks to him till he dies.  But there are many very good people who
+are not what I call good patients.  I was once requested to call on a
+lady suffering from nervous and other symptoms.  It came out in the
+preliminary conversational skirmish, half medical, half social, that
+I was the twenty-sixth member of the faculty into whose arms,
+professionally speaking, she had successively thrown herself.  Not
+being a believer in such a rapid rotation of scientific crops, I
+gently deposited the burden, commending it to the care of number
+twenty-seven, and, him, whoever he might be, to the care of Heaven.
+
+If there happened to be among my audience any person who wished to
+know on what principles the patient should choose his physician, I
+should give him these few precepts to think over:
+
+Choose a man who is personally agreeable, for a daily visit from an
+intelligent, amiable, pleasant, sympathetic person will cost you no
+more than one from a sloven or a boor, and his presence will do more
+for you than any prescription the other will order.
+
+Let him be a man of recognized good sense in other matters, and the
+chance is that he will be sensible as a practitioner.
+
+Let him be a man who stands well with his professional brethren, whom
+they approve as honest, able, courteous.
+
+Let him be one whose patients are willing to die in his hands, not
+one whom they go to for trifles, and leave as soon as they are in
+danger, and who can say, therefore, that he never loses a patient.
+
+Do not leave the ranks of what is called the regular profession,
+unless you wish to go farther and fare worse, for you may be assured
+that its members recognize no principle which hinders their accepting
+any remedial agent proved to be useful, no matter from what quarter
+it comes.  The difficulty is that the stragglers, organized under
+fantastic names in pretentious associations, or lurking in solitary
+dens behind doors left ajar, make no real contributions to the art of
+healing.  When they bring forward a remedial agent like chloral, like
+the bromide of potassium, like ether, used as an anesthetic, they
+will find no difficulty in procuring its recognition.
+
+Some of you will probably be more or less troubled by the pretensions
+of that parody of mediaeval theology which finds its dogma of
+hereditary depravity in the doctrine of psora, its miracle of
+transubstantiation in the mystery of its triturations and dilutions,
+its church in the people who have mistaken their century, and its
+priests in those who have mistaken their calling.  You can do little
+with persons who are disposed to accept these curious medical
+superstitions.  The saturation-point of individual minds with
+reference to evidence, and especially medical evidence, differs, and
+must always continue to differ, very widely.  There are those whose
+minds are satisfied with the decillionth dilution of a scientific
+proof.  No wonder they believe in the efficacy of a similar
+attenuation of bryony or pulsatilla.  You have no fulcrum you can
+rest upon to lift an error out of such minds as these, often highly
+endowed with knowledge and talent, sometimes with genius, but
+commonly richer in the imaginative than the observing and reasoning
+faculties.
+
+Let me return once more to the young graduate.  Your relations to
+your professional brethren may be a source of lifelong happiness and
+growth in knowledge and character, or they may make you wretched and
+end by leaving you isolated from those who should be your friends and
+counsellors.  The life of a physician becomes ignoble when he suffers
+himself to feed on petty jealousies and sours his temper in perpetual
+quarrels.  You will be liable to meet an uncomfortable man here and
+there in the profession,--one who is so fond of being in hot water
+that it is a wonder all the albumen in his body is not coagulated.
+There are common barrators among doctors as there are among lawyers,
+--stirrers up of strife under one pretext and another, but in reality
+because they like it.  They are their own worst enemies, and do
+themselves a mischief each time they assail their neighbors.  In my
+student days I remember a good deal of this Donnybrook-Fair style of
+quarrelling, more especially in Paris, where some of the noted
+surgeons were always at loggerheads, and in one of our lively Western
+cities.  Soon after I had set up an office, I had a trifling
+experience which may serve to point a moral in this direction.  I had
+placed a lamp behind the glass in the entry to indicate to the
+passer-by where relief from all curable infirmities was to be sought
+and found.  Its brilliancy attracted the attention of a devious
+youth, who dashed his fist through the glass and upset my modest
+luminary.  All he got by his vivacious assault was that he left
+portions of integument from his knuckles upon the glass, had a lame
+hand, was very easily identified, and had to pay the glazier's bill.
+The moral is that, if the brilliancy of another's reputation excites
+your belligerent instincts, it is not worth your while to strike at
+it, without calculating which of you is likely to suffer most, if you
+do.
+
+You may be assured that when an ill-conditioned neighbor is always
+complaining of a bad taste in his mouth and an evil atmosphere about
+him, there is something wrong about his own secretions.  In such
+cases there is an alterative regimen of remarkable efficacy: it is a
+starvation-diet of letting alone.  The great majority of the
+profession are peacefully inclined.  Their pursuits are eminently
+humanizing, and they look with disgust on the personalities which
+intrude themselves into the placid domain of an art whose province it
+is to heal and not to wound.
+
+The intercourse of teacher and student in a large school is
+necessarily limited, but it should be, and, so far as my experience
+goes, it is, eminently cordial and kindly.  You will leave with
+regret, and hold in tender remembrance, those who have taken you by
+the hand at your entrance on your chosen path, and led you patiently
+and faithfully, until the great gates at its end have swung upon
+their hinges, and the world lies open before you.  That venerable
+oath to which I have before referred bound the student to regard his
+instructor in the light of a parent, to treat his children like
+brothers, to succor him in his day of need.  I trust the spirit of
+the oath of Hippocrates is not dead in the hearts of the students of
+to-day.  They will remember with gratitude every earnest effort,
+every encouraging word, which has helped them in their difficult and
+laborious career of study.  The names they read on their diplomas
+will recall faces that are like family-portraits in their memory, and
+the echo of voices they have listened to so long will linger in their
+memories far into the still evening of their lives.
+
+One voice will be heard no more which has been familiar to many among
+you.  It is not for me, a stranger to these scenes, to speak his
+eulogy.  I have no right to sadden this hour by dwelling on the deep
+regrets of friendship, or to bid the bitter tears of sorrow flow
+afresh.  Yet I cannot help remembering what a void the death of such
+a practitioner as your late instructor must leave in the wide circle
+of those who leaned upon his counsel and assistance in their hour of
+need, in a community where he was so widely known and esteemed, in a
+school where he bore so important a part.  There is no exemption from
+the common doom for him who holds the shield to protect others.  The
+student is called from his bench, the professor from his chair, the
+practitioner in his busiest period hears a knock more peremptory than
+any patient's midnight summons, and goes on that unreturning visit
+which admits of no excuse, and suffers no delay.  The call of such a
+man away from us is the bereavement of a great family.  Nor can we
+help regretting the loss for him of a bright and cheerful earthly
+future; for the old age of a physician is one of the happiest periods
+of his life.  He is loved and cherished for what he has been, and
+even in the decline of his faculties there are occasions when his
+experience is still appealed to, and his trembling hands are looked
+to with renewing hope and trust, as being yet able to stay the arm of
+the destroyer.
+
+But if there is so much left for age, how beautiful, how inspiring is
+the hope of youth!  I see among those whom I count as listeners one
+by whose side I have sat as a fellow-teacher, and by whose
+instructions I have felt myself not too old to profit.  As we
+borrowed him from your city, I must take this opportunity of telling
+you that his zeal, intelligence, and admirable faculty as an
+instructor were heartily and universally recognized among us.  We
+return him, as we trust, uninjured, to the fellow-citizens who have
+the privilege of claiming him as their own.
+
+And now, gentlemen of the graduating class, nothing remains but for
+me to bid you, in the name of those for whom I am commissioned and
+privileged to speak, farewell as students, and welcome as
+practitioners.  I pronounce the two benedictions in the same breath,
+as the late king's demise and the new king's accession are proclaimed
+by the same voice at the same moment.  You would hardly excuse me if
+I stooped to any meaner dialect than the classical and familiar
+language of your prescriptions, the same in which your title to the
+name of physician is, if, like our own institution, you follow the
+ancient usage, engraved upon your diplomas.
+
+Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete,
+filii!
+
+Salvete, VIRI, artis medicae magister; Salvete amici; salvete
+fratres!
+
+
+
+
+
+
+MEDICAL LIBRARIES.
+
+[Dedicatory Address at the opening of the Medical Library in Boston,
+December 3, 1878.]
+
+It is my appointed task, my honorable privilege, this evening, to
+speak of what has been done by others.  No one can bring his tribute
+of words into the presence of great deeds, or try with them to
+embellish the memory of any inspiring achievement, without feeling
+and leaving with others a sense of their insufficiency.  So felt
+Alexander when he compared even his adored Homer with the hero the
+poet had sung.  So felt Webster when he contrasted the phrases of
+rhetoric with the eloquence of patriotism and of self-devotion.  So
+felt Lincoln when on the field of Gettysburg he spoke those immortal
+words which Pericles could not nave bettered, which Aristotle could
+not have criticised.  So felt he who wrote the epitaph of the builder
+of the dome which looks down on the crosses and weathercocks that
+glitter over London.
+
+We are not met upon a battle-field, except so far as every laborious
+achievement means a victory over opposition, indifference,
+selfishness, faintheartedness, and that great property of mind as
+well as matter,--inertia.  We are not met in a cathedral, except so
+far as every building whose walls are lined with the products of
+useful and ennobling thought is a temple of the Almighty, whose
+inspiration has given us understanding.  But we have gathered within
+walls which bear testimony to the self-sacrificing, persevering
+efforts of a few young men, to whom we owe the origin and development
+of all that excites our admiration in this completed enterprise; and
+I might consider my task as finished if I contented myself with
+borrowing the last word of the architect's epitaph and only saying,
+Look around you!
+
+The reports of the librarian have told or will tell you, in some
+detail, what has been accomplished since the 21st of December, 1874,
+when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch
+to discuss different projects for a medical library.  In less than
+four years from that time, by the liberality of associations and of
+individuals, this collection of nearly ten thousand volumes, of five
+thousand pamphlets, and of one hundred and twenty-five journals,
+regularly received,--all worthily sheltered beneath this lofty roof,
+--has come into being under our eyes.  It has sprung up, as it were;
+in the night like a mushroom; it stands before us in full daylight as
+lusty as an oak, and promising to grow and flourish in the perennial
+freshness of an evergreen.
+
+To whom does our profession owe this already large collection of
+books, exceeded in numbers only by four or five of the most extensive
+medical libraries in the country, and lodged in a building so well
+adapted to its present needs?  We will not point out individually all
+those younger members of the profession who have accomplished what
+their fathers and elder brethren had attempted and partially
+achieved.  We need not write their names on these walls, after the
+fashion of those civic dignitaries who immortalize themselves on
+tablets of marble and gates of iron.  But their contemporaries know
+them well, and their descendants will not forget them,--the men who
+first met together, the men who have given their time and their
+money, the faithful workers, worthy associates of the strenuous
+agitator who gave no sleep to his eyes, no slumber to his eyelids,
+until he had gained his ends; the untiring, imperturbable, tenacious,
+irrepressible, all-subduing agitator who neither rested nor let
+others rest until the success of the project was assured.  If,
+against his injunctions, I name Dr. James Read Chadwick, it is only
+my revenge for his having kept me awake so often and so long while he
+was urging on the undertaking in which he has been preeminently
+active and triumphantly successful.
+
+We must not forget the various medical libraries which preceded this:
+that of an earlier period, when Boston contained about seventy
+regular practitioners, the collection afterwards transferred to the
+Boston Athenaeum; the two collections belonging to the University;
+the Treadwell Library at the Massachusetts General Hospital; the
+collections of the two societies, that for Medical Improvement and
+that for Medical Observation; and more especially the ten thousand
+volumes relating to medicine belonging to our noble public city
+library,--too many blossoms on the tree of knowledge, perhaps, for
+the best fruit to ripen.  But the Massachusetts Medical Society now
+numbers nearly four hundred members in the city of Boston.  The time
+had arrived for a new and larger movement.  There was needed a place
+to which every respectable member of the medical profession could
+obtain easy access; where, under one roof, all might find the special
+information they were seeking; where the latest medical intelligence
+should be spread out daily as the shipping news is posted on the
+bulletins of the exchange; where men engaged in a common pursuit
+could meet, surrounded by the mute oracles of science and art; where
+the whole atmosphere should be as full of professional knowledge as
+the apothecary's shop is of the odor of his medicaments.  This was
+what the old men longed for,--the prophets and kings of the
+profession, who
+
+               "Desired it long,
+     But died without the sight."
+
+This is what the young men and those who worked under their guidance
+undertook to give us.  And now such a library, such a reading-room,
+such an exchange, such an intellectual and social meeting place, we
+be hold a fact, plain before us.  The medical profession of our city,
+and, let us add, of all those neighboring places which it can reach
+with its iron arms, is united as never before by the commune
+vinculum, the common bond of a large, enduring, ennobling, unselfish
+interest.  It breathes a new air of awakened intelligence.  It
+marches abreast of the other learned professions, which have long had
+their extensive and valuable centralized libraries; abreast of them,
+but not promising to be content with that position.  What glorifies a
+town like a cathedral?  What dignifies a province like a university?
+What illuminates a country like its scholarship, and what is the nest
+that hatches scholars but a library?
+
+The physician, some may say, is a practical man and has little use
+for all this book-learning.  Every student has heard Sydenham's reply
+to Sir Richard Blackmore's question as to what books he should read,
+--meaning medical books.  "Read Don Quixote," was his famous answer.
+But Sydenham himself made medical books and may be presumed to have
+thought those at least worth reading.  Descartes was asked where was
+his library, and in reply held up the dissected body of an animal.
+But Descartes made books, great books, and a great many of them.  A
+physician of common sense without erudition is better than a learned
+one without common sense, but the thorough master of his profession
+must have learning added to his natural gifts.
+
+It is not necessary to maintain the direct practical utility of all
+kinds of learning.  Our shelves contain many books which only a
+certain class of medical scholars will be likely to consult.  There
+is a dead medical literature, and there is a live one.  The dead is
+not all ancient, the live is not all modern.  There is none, modern
+or ancient, which, if it has no living value for the student, will
+not teach him something by its autopsy.  But it is with the live
+literature of his profession that the medical practitioner is first
+of all concerned.
+
+Now there has come a great change in our time over the form in which
+living thought presents itself.  The first printed books,--the
+incunabula,--were inclosed in boards of solid oak, with brazen clasps
+and corners; the boards by and by were replaced by pasteboard covered
+with calf or sheepskin; then cloth came in and took the place of
+leather; then the pasteboard was covered with paper instead of cloth;
+and at this day the quarterly, the monthly, the weekly periodical in
+its flimsy unsupported dress of paper, and the daily journal, naked
+as it came from the womb of the press, hold the larger part of the
+fresh reading we live upon.  We must have the latest thought in its
+latest expression; the page must be newly turned like the morning
+bannock; the pamphlet must be newly opened like the ante-prandial
+oyster.
+
+Thus a library, to meet the need of our time, must take, and must
+spread out in a convenient form, a great array of periodicals.  Our
+active practitioners read these by preference over almost everything
+else.  Our specialists, more particularly, depend on the month's
+product, on the yearly crop of new facts, new suggestions, new
+contrivances, as much as the farmer on the annual yield of his acres.
+One of the first wants, then, of the profession is supplied by our
+library in its great array of periodicals from many lands, in many
+languages.  Such a number of medical periodicals no private library
+would have room for, no private person would pay for, or flood his
+tables with if they were sent him for nothing.  These, I think, with
+the reports of medical societies and the papers contributed to them,
+will form the most attractive part of our accumulated medical
+treasures.  They will be also one of our chief expenses, for these
+journals must be bound in volumes and they require a great amount of
+shelf-room; all this, in addition to the cost of subscription for
+those which are not furnished us gratuitously.
+
+It is true that the value of old scientific periodicals is, other
+things being equal, in the inverse ratio of their age, for the
+obvious reason that what is most valuable in the earlier volumes of a
+series is drained off into the standard works with which the
+intelligent practitioner is supposed to be familiar.  But no extended
+record of facts grows too old to be useful, provided only that we
+have a ready and sure way of getting at the particular fact or facts
+we are in search of.
+
+And this leads me to speak of what I conceive to be one of the
+principal tasks to be performed by the present and the coming
+generation of scholars, not only in the medical, but in every
+department of knowledge.  I mean the formation of indexes, and more
+especially of indexes to periodical literature.
+
+This idea has long been working in the minds of scholars, and all who
+have had occasion to follow out any special subject.  I have a right
+to speak of it, for I long ago attempted to supply the want of
+indexes in some small measure for my own need.  I had a very complete
+set of the "American Journal of the Medical Sciences;" an entire set
+of the "North American Review," and many volumes of the reprints of
+the three leading British quarterlies.  Of what use were they to me
+without general indexes?  I looked them all through carefully and
+made classified lists of all the articles I thought I should most
+care to read.  But they soon outgrew my lists.  The "North American
+Review " kept filling up shelf after shelf, rich in articles which I
+often wanted to consult, but what a labor to find them, until the
+index of Mr. Gushing, published a few months since, made the contents
+of these hundred and twenty volumes as easily accessible as the words
+in a dictionary!  I had a, copy of good Dr. Abraham Rees's
+Cyclopaedia, a treasure-house to my boyhood which has not lost its
+value for me in later years.  But where to look for what I wanted?  I
+wished to know, for instance, what Dr. Burney had to say about
+singing.  Who would have looked for it under the Italian word
+cantare?  I was curious to learn something of the etchings of
+Rembrandt, and where should I find it but under the head "Low
+Countries, Engravers of the,"--an elaborate and most valuable article
+of a hundred double-columned close-printed quarto pages, to which no
+reference, even, is made under the title Rembrandt.
+
+There was nothing to be done, if I wanted to know where that which I
+specially cared for was to be found in my Rees's Cyclopaedia, but to
+look over every page of its forty-one quarto volumes and make out a
+brief list of matters of interest which I could not find by their
+titles, and this I did, at no small expense of time and trouble.
+
+Nothing, therefore, could be more pleasing to me than to see the
+attention which has been given of late years to the great work of
+indexing.  It is a quarter of a century since Mr. Poole published his
+"Index to Periodical Literature," which it is much to be hoped is
+soon to appear in a new edition, grown as it must be to formidable
+dimensions by the additions of so long a period.  The "British and
+Foreign Medical Review," edited by the late Sir John Forties,
+contributed to by Huxley, Carpenter, Laycock, and others of the most
+distinguished scientific men of Great Britain, has an index to its
+twenty-four volumes, and by its aid I find this valuable series as
+manageable as a lexicon.  The last edition of the "Encyclopaedia
+Britannica" had a complete index in a separate volume, and the
+publishers of Appletons' "American Cyclopaedia" have recently issued
+an index to their useful work, which must greatly add to its value.
+I have already referred to the index to the "North American Review,"
+which to an American, and especially to a New Englander, is the most
+interesting and most valuable addition of its kind to our literary
+apparatus since the publication of Mr. Allibone's "Dictionary of
+Authors."  I might almost dare to parody Mr. Webster's words in
+speaking of Hamilton, to describe what Mr. Gushing did for the solemn
+rows of back volumes of our honored old Review which had been long
+fossilizing on our shelves: "He touched the dead corpse of the 'North
+American,'" and it sprang to its feet."  A library of the best
+thought of the best American scholars during the greater portion of
+the century was brought to light by the work of the indexmaker as
+truly as were the Assyrian tablets by the labors of Layard.
+
+A great portion of the best writing and reading literary, scientific,
+professional, miscellaneous--comes to us now, at stated intervals, in
+paper covers.  The writer appears, as it were, in his shirt-sleeves.
+As soon as he has delivered his message the book-binder puts a coat
+on his back, and he joins the forlorn brotherhood of "back volumes,"
+than which, so long as they are unindexed, nothing can be more
+exasperating.  Who wants a lock without a key, a ship without a
+rudder, a binnacle without a compass, a check without a signature, a
+greenback without a goldback behind it?
+
+I have referred chiefly to the medical journals, but I would include
+with these the reports of medical associations, and those separate
+publications which, coming in the form of pamphlets, heap themselves
+into chaotic piles and bundles which are worse than useless, taking
+up a great deal of room, and frightening everything away but mice and
+mousing antiquarians, or possibly at long intervals some terebrating
+specialist.
+
+Arranged, bound, indexed, all these at once become accessible and
+valuable.  I will take the first instance which happens to suggest
+itself.  How many who know all about osteoblasts and the experiments
+of Ollier, and all that has grown out of them, know where to go for a
+paper by the late Dr. A. L. Peirson of Salem, published in the year
+1840, under the modest title, Remarks on Fractures?  And if any
+practitioner who has to deal with broken bones does not know that
+most excellent and practical essay, it is a great pity, for it
+answers very numerous questions which will be sure to suggest
+themselves to the surgeon and the patient as no one of the recent
+treatises, on my own shelves, at least, can do.
+
+But if indexing is the special need of our time in medical
+literature, as in every department of knowledge, it must be
+remembered that it is not only an immense labor, but one that never
+ends.  It requires, therefore, the cooperation of a large number of
+individuals to do the work, and a large amount of money to pay for
+making its results public through the press.  When it is remembered
+that the catalogue of the library of the British Museum is contained
+in nearly three thousand large folios of manuscript, and not all its
+books are yet included, the task of indexing any considerable branch
+of science or literature looks as if it were well nigh impossible.
+But many hands make light work.  An "Index Society" has been formed
+in England, already numbering about one hundred and seventy members.
+It aims at "supplying thorough indexes to valuable works and
+collections which have hitherto lacked them; at issuing indexes to
+the literature of special subjects; and at gathering materials for a
+general reference index."  This society has published a little
+treatise setting forth the history and the art of indexing, which I
+trust is in the hands of some of our members, if not upon our
+shelves.
+
+Something has been done in the same direction by individuals in our
+own country, as we have already seen.  The need of it in the
+department of medicine is beginning to be clearly felt.  Our library
+has already an admirable catalogue with cross references, the work of
+a number of its younger members cooperating in the task.  A very
+intelligent medical student, Mr. William D. Chapin, whose excellent
+project is indorsed by well-known New York physicians and professors,
+proposes to publish a yearly index to original communications in the
+medical journals of the United States, classified by authors and
+subjects.  But it is from the National Medical Library at Washington
+that we have the best promise and the largest expectations.  That
+great and growing collection of fifty thousand volumes is under the
+eye and hand of a librarian who knows books and how to manage them.
+For libraries are the standing armies of civilization, and an army is
+but a mob without a general who can organize and marshal it so as to
+make it effective.  The "Specimen Fasciculus of a Catalogue of the
+National Medical Library," prepared under the direction of Dr.
+Billings, the librarian, would have excited the admiration of Haller,
+the master scholar in medical science of the last century, or rather
+of the profession in all centuries, and if carried out as it is begun
+will be to the nineteenth all and more than all that the three
+Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to
+the eighteenth century.  I cannot forget the story that Agassiz was
+so fond of telling of the king of Prussia and Fichte.  It was after
+the humiliation and spoliation of the kingdom by Napoleon that the
+monarch asked the philosopher what could be done to regain the lost
+position of the nation.  "Found a great university, Sire," was the
+answer, and so it was that in the year 1810 the world-renowned
+University of Berlin came into being.  I believe that we in this
+country can do better than found a national university, whose
+professors shall be nominated in caucuses, go in and out, perhaps,
+like postmasters, with every change of administration, and deal with
+science in the face of their constituency as the courtier did with
+time when his sovereign asked him what o'clock it was: "Whatever hour
+your majesty pleases."  But when we have a noble library like that at
+Washington, and a librarian of exceptional qualifications like the
+gentleman who now holds that office, I believe that a liberal
+appropriation by Congress to carry out a conscientious work for the
+advancement of sound knowledge and the bettering of human conditions,
+like this which Dr. Billings has so well begun, would redound greatly
+to the honor of the nation.  It ought to be willing to be at some
+charge to make its treasures useful to its citizens, and, for its own
+sake, especially to that class which has charge of health, public and
+private.  This country abounds in what are called "self-made men,"
+and is justly proud of many whom it thus designates.  In one sense no
+man is self-made who breathes the air of a civilized community.  In
+another sense every man who is anything other than a phonograph on
+legs is self-made.  But if we award his just praise to the man who
+has attained any kind of excellence without having had the same
+advantages as others whom, nevertheless, he has equalled or
+surpassed, let us not be betrayed into undervaluing the mechanic's
+careful training to his business, the thorough and laborious
+education of the scholar and the professional man.
+
+Our American atmosphere is vocal with the flippant loquacity of half
+knowledge.  We must accept whatever good can be got out of it, and
+keep it under as we do sorrel and mullein and witchgrass, by
+enriching the soil, and sowing good seed in plenty; by good teaching
+and good books, rather than by wasting our time in talking against
+it.  Half knowledge dreads nothing but whole knowledge.
+
+I have spoken of the importance and the predominance of periodical
+literature, and have attempted to do justice to its value.  But the
+almost exclusive reading of it is not without its dangers.  The
+journals contain much that is crude and unsound; the presumption; it
+might be maintained, is against their novelties, unless they come
+from observers of established credit.  Yet I have known a
+practitioner,--perhaps more than one,--who was as much under the
+dominant influence of the last article he had read in his favorite
+medical journal as a milliner under the sway of the last fashion-
+plate.  The difference between green and seasoned knowledge is very
+great, and such practitioners never hold long enough to any of their
+knowledge to have it get seasoned.
+
+It is needless to say, then, that all the substantial and permanent
+literature of the profession should be represented upon our shelves.
+Much of it is there already, and as one private library after another
+falls into this by the natural law of gravitation, it will gradually
+acquire all that is most valuable almost without effort.  A scholar
+should not be in a hurry to part with his books.  They are probably
+more valuable to him than they can be to any other individual.  What
+Swedenborg called "correspondence" has established itself between his
+intelligence and the volumes which wall him within their sacred
+inclosure.  Napoleon said that his mind was as if furnished with
+drawers,--he drew out each as he wanted its contents, and closed it
+at will when done with them.  The scholar's mind, to use a similar
+comparison, is furnished with shelves, like his library.  Each book
+knows its place in the brain as well as against the wall or in the
+alcove.  His consciousness is doubled by the books which encircle
+him, as the trees that surround a lake repeat themselves in its
+unruffled waters.  Men talk of the nerve that runs to the pocket, but
+one who loves his books, and has lived long with them, has a nervous
+filament which runs from his sensorium to every one of them.  Or, if
+I may still let my fancy draw its pictures, a scholar's library is to
+him what a temple is to the worshipper who frequents it.  There is
+the altar sacred to his holiest experiences.  There is the font where
+his new-born thought was baptized and first had a name in his
+consciousness.  There is the monumental tablet of a dead belief,
+sacred still in the memory of what it was while yet alive.  No
+visitor can read all this on the lettered backs of the books that
+have gathered around the scholar, but for him, from the Aldus on the
+lowest shelf to the Elzevir on the highest, every volume has a
+language which none but be can interpret.  Be patient with the book-
+collector who loves his companions too well to let them go.  Books
+are not buried with their owners, and the veriest book-miser that
+ever lived was probably doing far more for his successors than his
+more liberal neighbor who despised his learned or unlearned avarice.
+Let the fruit fall with the leaves still clinging round it.  Who
+would have stripped Southey's walls of the books that filled them,
+when, his mind no longer capable of taking in their meaning, he would
+still pat and fondle them with the vague loving sense of what they
+had once been to him,--to him, the great scholar, now like a little
+child among his playthings?
+
+We need in this country not only the scholar, but the virtuoso, who
+hoards the treasures which he loves, it may be chiefly for their
+rarity and because others who know more than he does of their value
+set a high price upon them.  As the wine of old vintages is gently
+decanted out of its cobwebbed bottles with their rotten corks into
+clean new receptacles, so the wealth of the New World is quietly
+emptying many of the libraries and galleries of the Old World into
+its newly formed collections and newly raised edifices.  And this
+process must go on in an accelerating ratio.  No Englishman will be
+offended if I say that before the New Zealander takes his stand on a
+broken arch of London Bridge to sketch the ruins of St. Paul's in the
+midst of a vast solitude, the treasures of the British Museum will
+have found a new shelter in the halls of New York or Boston.  No
+Catholic will think hardly of my saying that before the Coliseum
+falls, and with it the imperial city, whose doom prophecy has linked
+with that of the almost eternal amphitheatre, the marbles, the
+bronzes, the paintings, the manuscripts of the Vatican will have left
+the shores of the Tiber for those of the Potomac, the Hudson, the
+Mississippi, or the Sacramento.  And what a delight in the pursuit of
+the rarities which the eager book-hunter follows with the scent of a
+beagle!
+
+Shall I ever forget that rainy day in Lyons, that dingy bookshop,
+where I found the Aetius, long missing from my Artis bledicae
+Principes, and where I bought for a small pecuniary consideration,
+though it was marked rare, and was really tres rare, the Aphorisms of
+Hippocrates, edited by and with a preface from the hand of Francis
+Rabelais?  And the vellum-bound Tulpius, which I came upon in Venice,
+afterwards my only reading when imprisoned in quarantine at
+Marseilles, so that the two hundred and twenty-eight cases he has
+recorded are, many of them, to this day still fresh in my memory.
+And the Schenckius,--the folio filled with casus rariores, which had
+strayed in among the rubbish of the bookstall on the boulevard,--and
+the noble old Vesalius with its grand frontispiece not unworthy of
+Titian, and the fine old Ambroise Pare, long waited for even in Paris
+and long ago, and the colossal Spigelius with his eviscerated
+beauties, and Dutch Bidloo with its miracles of fine engraving and
+bad dissection, and Italian Mascagni, the despair of all would-be
+imitators, and pre-Adamite John de Ketam, and antediluvian
+Berengarius Carpensis,--but why multiply names, every one of which
+brings back the accession of a book which was an event almost like
+the birth of an infant?
+
+A library like ours must exercise the largest hospitality.  A great
+many books may be found in every large collection which remind us of
+those apostolic looking old men who figure on the platform at our
+political and other assemblages.  Some of them have spoken words of
+wisdom in their day, but they have ceased to be oracles; some of them
+never had any particularly important message for humanity, but they
+add dignity to the meeting by their presence; they look wise, whether
+they are so or not, and no one grudges them their places of honor.
+Venerable figure-heads, what would our platforms be without you?
+
+Just so with our libraries.  Without their rows of folios in creamy
+vellum, or showing their black backs with antique lettering of
+tarnished gold, our shelves would look as insufficient and unbalanced
+as a column without its base, as a statue without its pedestal.  And
+do not think they are kept only to be spanked and dusted during that
+dreadful period when their owner is but too thankful to become an
+exile and a wanderer from the scene of single combats between dead
+authors and living housemaids.  Men were not all cowards before
+Agamemnon or all fools before the days of Virchow and Billroth.  And
+apart from any practical use to be derived from the older medical
+authors, is there not a true pleasure in reading the accounts of
+great discoverers in their own words?  I do not pretend to hoist up
+the Bibliotheca Anatomica of Mangetus and spread it on my table every
+day.  I do not get out my great Albinus before every lecture on the
+muscles, nor disturb the majestic repose of Vesalius every time I
+speak of the bones he has so admirably described and figured.  But it
+does please me to read the first descriptions of parts to which the
+names of their discoverers or those who have first described them
+have become so joined that not even modern science can part them; to
+listen to the talk of my old volume as Willis describes his circle
+and Fallopius his aqueduct and Varolius his bridge and Eustachius his
+tube and Monro his foramen,--all so well known to us in the human
+body; it does please me to know the very words in which Winslow
+described the opening which bears his name, and Glisson his capsule
+and De Graaf his vesicle; I am not content until I know in what
+language Harvey announced his discovery of the circulation, and how
+Spigelius made the liver his perpetual memorial, and Malpighi found a
+monument more enduring than brass in the corpuscles of the spleen and
+the kidney.
+
+But after all, the readers who care most for the early records of
+medical science and art are the specialists who are dividing up the
+practice of medicine and surgery as they were parcelled out,
+according to Herodotus, by the Egyptians.  For them nothing is too
+old, nothing is too new, for to their books of ail others is
+applicable the saying of D'Alembert that the author kills himself in
+lengthening out what the reader kills himself in trying to shorten.
+
+There are practical books among these ancient volumes which can never
+grow old.  Would you know how to recognize "male hysteria" and to
+treat it, take down your Sydenham; would you read the experience of a
+physician who was himself the subject of asthma, and who,
+notwithstanding that, in the words of Dr. Johnson, "panted on till
+ninety," you will find it in the venerable treatise of Sir John
+Floyer; would you listen to the story of the King's Evil cured by the
+royal touch, as told by a famous chirurgeon who fully believed in it,
+go to Wiseman; would you get at first hand the description of the
+spinal disease which long bore his name, do not be startled if I tell
+you to go to Pott,--to Percival Pott, the great surgeon of the last
+century.
+
+There comes a time for every book in a library when it is wanted by
+somebody.  It is but a few weeks since one of the most celebrated
+physicians in the country wrote to me from a great centre of medical
+education to know if I had the works of Sanctorius, which he had
+tried in vain to find.  I could have lent him the "Medicina Statica,"
+with its frontispiece showing Sanctorius with his dinner on the table
+before him, in his balanced chair which sunk with him below the level
+of his banquet-board when he had swallowed a certain number of
+ounces,--an early foreshadowing of Pettenkofer's chamber and
+quantitative physiology,--but the "Opera Omnia" of Sanctorius I had
+never met with, and I fear he had to do without it.
+
+I would extend the hospitality of these shelves to a class of works
+which we are in the habit of considering as being outside of the pale
+of medical science, properly so called, and sometimes of coupling
+with a disrespectful name.  Such has always been my own practice.  I
+have welcomed Culpeper and Salmon to my bookcase as willingly as
+Dioscorides or Quincy, or Paris or Wood and Bache.  I have found a
+place for St. John Long, and read the story of his trial for
+manslaughter with as much interest as the laurel-water case in which
+John Hunter figured as a witness.  I would give Samuel Hahnemann a
+place by the side of Samuel Thomson.  Am I not afraid that some
+student of imaginative turn and not provided with the needful
+cerebral strainers without which all the refuse of gimcrack
+intelligences gets into the mental drains and chokes them up,--am I
+not afraid that some such student will get hold of the "Organon" or
+the "Maladies Chroniques" and be won over by their delusions, and so
+be lost to those that love him as a man of common sense and a brother
+in their high calling?  Not in the least.  If he showed any symptoms
+of infection I would for once have recourse to the principle of
+similia similibus.  To cure him of Hahnemann I would prescribe my
+favorite homoeopathic antidote, Okie's Bonninghausen.  If that
+failed, I would order Grauvogl as a heroic remedy, and if he survived
+that uncured, I would give him my blessing, if I thought him honest,
+and bid him depart in peace.  For me he is no longer an individual.
+He belongs to a class of minds which we are bound to be patient with
+if their Maker sees fit to indulge them with existence.  We must
+accept the conjuring ultra-ritualist, the dreamy second adventist,
+the erratic spiritualist, the fantastic homoeopathist, as not
+unworthy of philosophic study; not more unworthy of it than the
+squarers of the circle and the inventors of perpetual motion, and the
+other whimsical visionaries to whom De Morgan has devoted his most
+instructive and entertaining "Budget of Paradoxes."  I hope,
+therefore, that our library will admit the works of the so-called
+Eclectics, of the Thomsonians, if any are in existence, of the
+Clairvoyants, if they have a literature, and especially of the
+Homoeopathists.  This country seems to be the place for such a
+collection, which will by and by be curious and of more value than at
+present, for Homoeopathy seems to be following the pathological law
+of erysipelas, fading out where it originated as it spreads to new
+regions.  At least I judge so by the following translated extract
+from a criticism of an American work in the "Homoeopatische
+Rundschau" of Leipzig for October, 1878, which I find in the
+"Homoeopathic Bulletin" for the month of November just passed:
+"While we feel proud of the spread and rise of Homoeopathy across the
+ocean, and while the Homoeopathic works reaching us from there, and
+published in a style such as is unknown in Germany, bear eloquent
+testimony to the eminent activity of our transatlantic colleagues, we
+are overcome by sorrowful regrets at the position Homoeopathy
+occupies in Germany.  Such a work [as the American one referred to]
+with us would be impossible; it would lack the necessary support."
+
+By all means let our library secure a good representation of the
+literature of Homoeopathy before it leaves us its "sorrowful regrets"
+and migrates with its sugar of milk pellets, which have taken the
+place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or
+the Lord knows where."
+
+What shall I say in this presence of the duties of a Librarian?
+Where have they ever been better performed than in our own public
+city library, where the late Mr. Jewett and the living Mr. Winsor
+have shown us what a librarian ought to be,--the organizing head, the
+vigilant guardian, the seeker's index, the scholar's counsellor?  His
+work is not merely that of administration, manifold and laborious as
+its duties are.  He must have a quick intelligence and a retentive
+memory.  He is a public carrier of knowledge in its germs.  His
+office is like that which naturalists attribute to the bumble-bee,--
+he lays up little honey for himself, but he conveys the fertilizing
+pollen from flower to flower.
+
+Our undertaking, just completed,--and just begun--has come at the
+right time, not a day too soon.  Our practitioners need a library
+like this, for with all their skill and devotion there is too little
+genuine erudition, such as a liberal profession ought to be able to
+claim for many of its members.  In reading the recent obituary
+notices of the late Dr. Geddings of South Carolina, I recalled what
+our lamented friend Dr. Coale used to tell me of his learning and
+accomplishments, and I could not help reflecting how few such medical
+scholars we had to show in Boston or New England.  We must clear up
+this unilluminated atmosphere, and here,--here is the true electric
+light which will irradiate its darkness.
+
+The public will catch the rays reflected from the same source of
+light, and it needs instruction on the great subjects of health and
+disease,--needs it sadly.  It is preyed upon by every kind of
+imposition almost without hindrance.  Its ignorance and prejudices
+react upon the profession to the great injury of both.  The jealous
+feeling, for instance, with regard to such provisions for the study
+of anatomy as are sanctioned by the laws in this State and carried
+out with strict regard to those laws, threatens the welfare, if not
+the existence of institutions for medical instruction wherever it is
+not held in check by enlightened intelligence.  And on the other hand
+the profession has just been startled by a verdict against a
+physician, ruinous in its amount,--enough to drive many a hard-
+working young practitioner out of house and home,--a verdict which
+leads to the fear that suits for malpractice may take the place of
+the panel game and child-stealing as a means of extorting money.  If
+the profession in this State, which claims a high standard of
+civilization, is to be crushed and ground beneath the upper millstone
+of the dearth of educational advantages and the lower millstone of
+ruinous penalties for what the ignorant ignorantly shall decide to be
+ignorance, all I can say is
+
+God save the Commonhealth of Massachusetts!
+
+Once more, we cannot fail to see that just as astrology has given
+place to astronomy, so theology, the science of Him whom by searching
+no man can find out, is fast being replaced by what we may not
+improperly call theonomy, or the science of the laws according to
+which the Creator acts.  And since these laws find their fullest
+manifestations for us, at least, in rational human natures, the study
+of anthropology is largely replacing that of scholastic divinity.  We
+must contemplate our Maker indirectly in human attributes as we talk
+of Him in human parts of speech.  And this gives a sacredness to the
+study of man in his physical, mental, moral, social, and religious
+nature which elevates the faithful students of anthropology to the
+dignity of a priesthood, and sheds a holy light on the recorded
+results of their labors, brought together as they are in such a
+collection as this which is now spread out before us.
+
+Thus, then, our library is a temple as truly as the dome-crowned
+cathedral hallowed by the breath of prayer and praise, where the dead
+repose and the living worship.  May it, with all its treasures, be
+consecrated like that to the glory of God, through the contributions
+it shall make to the advancement of sound knowledge, to the relief of
+human suffering, to the promotion of harmonious relations between the
+members of the two noble professions which deal with the diseases of
+the soul and with those of the body, and to the common cause in which
+all good men are working, the furtherance of the well-being of their
+fellow-creatures!
+
+NOTE.--As an illustration of the statement in the last paragraph but
+one, I take the following notice from the "Boston Daily Advertiser,"
+of December 4th, the day after the delivery of the address:
+"Prince Lucien Bonaparte is now living in London, and is devoting
+himself to the work of collecting the creeds of all religions and
+sects, with a view to their classification,--his object being simply
+scientific or anthropological."
+
+Since delivering the address, also, I find a leading article in the
+"Cincinnati Lancet and Clinic" of November 30th, headed "The
+Decadence of Homoeopathy," abundantly illustrated by extracts from
+the "Homoeopathic Times," the leading American organ of that sect.
+
+In the New York "Medical Record" of the same date, which I had not
+seen before the delivery of my address, is an account of the action
+of the Homoeopathic Medical Society of Northern New York, in which
+Hahnemann's theory of "dynamization" is characterized in a formal
+resolve as "unworthy the confidence of the Homoeopathic profession."
+
+It will be a disappointment to the German Homoeopathists to read in
+the "Homoeopathic Times" such a statement as the following:
+"Whatever the influences have been which have checked the outward
+development of Homoeopathy, it is plainly evident that the
+Homoeopathic school, as regards the number of its openly avowed
+representatives, has attained its majority, and has begun to decline
+both in this country and in England."
+
+All which is an additional reason for making a collection of the
+incredibly curious literature of Homoeopathy before that
+pseudological inanity has faded out like so many other delusions.
+
+
+
+
+
+
+SOME OF MY EARLY TEACHERS
+
+[A Farewell Address to the Medical School of Harvard University,
+November 28, 1882.]
+
+I had intended that the recitation of Friday last should be followed
+by a few parting words to my class and any friends who might happen
+to be in the lecture-room.  But I learned on the preceding evening
+that there was an expectation, a desire, that my farewell should take
+a somewhat different form; and not to disappoint the wishes of those
+whom I was anxious to gratify, I made up my mind to appear before you
+with such hasty preparation as the scanty time admitted.
+
+There are three occasions upon which a human being has a right to
+consider himself as a centre of interest to those about him: when he
+is christened, when he is married, and when he is buried.  Every one
+is the chief personage, the hero, of his own baptism, his own
+wedding, and his own funeral.
+
+There are other occasions, less momentous, in which one may make more
+of himself than under ordinary circumstances he would think it proper
+to do; when he may talk about himself, and tell his own experiences,
+in fact, indulge in a more or less egotistic monologue without fear
+or reproach.
+
+I think I may claim that this is one of those occasions.  I have
+delivered my last anatomical lecture and heard my class recite for
+the last time.  They wish to hear from me again in a less scholastic
+mood than that in which they have known me.  Will you not indulge me
+in telling you something of my own story?
+
+This is the thirty-sixth Course of Lectures in which I have taken my
+place and performed my duties as Professor of Anatomy.  For more than
+half of my term of office I gave instruction in Physiology, after the
+fashion of my predecessors and in the manner then generally prevalent
+in our schools, where the physiological laboratory was not a
+necessary part of the apparatus of instruction.  It was with my
+hearty approval that the teaching of Physiology was constituted a
+separate department and made an independent Professorship.  Before my
+time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the
+same course of Lectures, lasting only three or four months.  As the
+boundaries of science are enlarged, new divisions and subdivisions of
+its territories become necessary.  In the place of six Professors in
+1847, when I first became a member of the Faculty, I count twelve
+upon the Catalogue before me, and I find the whole number engaged in
+the work of instruction in the Medical School amounts to no less than
+fifty.
+
+Since I began teaching in this school, the aspect of many branches of
+science has undergone a very remarkable transformation.  Chemistry
+and Physiology are no longer what they were, as taught by the
+instructors of that time.  We are looking forward to the synthesis of
+new organic compounds; our artificial madder is already in the
+market, and the indigo-raisers are now fearing that their crop will
+be supplanted by the manufactured article.  In the living body we
+talk of fuel supplied and work done, in movement, in heat, just as if
+we were dealing with a machine of our own contrivance.
+
+A physiological laboratory of to-day is equipped with instruments of
+research of such ingenious contrivance, such elaborate construction,
+that one might suppose himself in a workshop where some exquisite
+fabric was to be wrought, such as Queens love to wear, and Kings do
+not always love to pay for.  They are, indeed, weaving a charmed web,
+for these are the looms from which comes the knowledge that clothes
+the nakedness of the intellect.  Here are the mills that grind food
+for its hunger, and "is not the life more than meat, and the body
+than raiment?"
+
+But while many of the sciences have so changed that the teachers of
+the past would hardly know them, it has not been so with the branch I
+teach, or, rather, with that division of it which is chiefly taught
+in this amphitheatre.  General anatomy, or histology, on the other
+hand, is almost all new; it has grown up, mainly, since I began my
+medical studies.  I never saw a compound microscope during my years
+of study in Paris.  Individuals had begun to use the instrument, but
+I never heard it alluded to by either Professors or students.  In
+descriptive anatomy I have found little to unlearn, and not a great
+deal that was both new and important to learn.  Trifling additions
+are made from year to year, not to be despised and not to be
+overvalued.  Some of the older anatomical works are still admirable,
+some of the newer ones very much the contrary.  I have had recent
+anatomical plates brought me for inspection, and I have actually
+button-holed the book-agent, a being commonly as hard to get rid of
+as the tar-baby in the negro legend, that I might put him to shame
+with the imperial illustrations of the bones and muscles in the great
+folio of Albinus, published in 1747, and the unapproached figures of
+the lymphatic system of Mascagni, now within a very few years of a
+century old, and still copied, or, rather, pretended to be copied, in
+the most recent works on anatomy.
+
+I am afraid that it is a good plan to get rid of old Professors, and
+I am thankful to hear that there is a movement for making provision
+for those who are left in need when they lose their offices and their
+salaries.  I remember one of our ancient Cambridge Doctors once asked
+me to get into his rickety chaise, and said to me, half humorously,
+half sadly, that he was like an old horse,--they had taken off his
+saddle and turned him out to pasture.  I fear the grass was pretty
+short where that old servant of the public found himself grazing.  If
+I myself needed an apology for holding my office so long, I should
+find it in the fact that human anatomy is much the same study that it
+was in the days of Vesalius and Fallopius, and that the greater part
+of my teaching was of such a nature that it could never become
+antiquated.
+
+Let me begin with my first experience as a medical student.  I had
+come from the lessons of Judge Story and Mr. Ashmun in the Law School
+at Cambridge.  I had been busy, more or less, with the pages of
+Blackstone and Chitty, and other text-books of the first year of
+legal study.  More or less, I say, but I am afraid it was less rather
+than more.  For during that year I first tasted the intoxicating
+pleasure of authorship.  A college periodical, conducted by friends
+of mine, still undergraduates, tempted me into print, and there is no
+form of lead-poisoning which more rapidly and thoroughly pervades the
+blood and bones and marrow than that which reaches the young author
+through mental contact with type-metal.  Qui a bu, boira,--he who has
+once been a drinker will drink again, says the French proverb.  So
+the man or woman who has tasted type is sure to return to his old
+indulgence sooner or later.  In that fatal year I had my first attack
+of authors' lead-poisoning, and I have never got quite rid of it from
+that day to this.  But for that I might have applied myself more
+diligently to my legal studies, and carried a green bag in place of a
+stethoscope and a thermometer up to the present day.
+
+What determined me to give up Law and apply myself to Medicine I can
+hardly say, but I had from the first looked upon that year's study as
+an experiment.  At any rate, I made the change, and soon found myself
+introduced to new scenes and new companionships.
+
+I can scarcely credit my memory when I recall the first impressions
+produced upon me by sights afterwards become so familiar that they
+could no more disturb a pulse-beat than the commonest of every-day
+experiences.  The skeleton, hung aloft like a gibbeted criminal,
+looked grimly at me as I entered the room devoted to the students of
+the school I had joined, just as the fleshless figure of Time, with
+the hour-glass and scythe, used to glare upon me in my childhood from
+the "New England Primer."  The white faces in the beds at the
+Hospital found their reflection in my own cheeks, which lost their
+color as I looked upon them.  All this had to pass away in a little
+time; I had chosen my profession, and must meet its painful and
+repulsive aspects until they lost their power over my sensibilities.
+
+The private medical school which I had joined was one established by
+Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow
+Lewis, and Dr. George W.  Otis.  Of the first three gentlemen I have
+either spoken elsewhere or may find occasion to speak hereafter.  The
+two younger members of this association of teachers were both
+graduates of our University, one of the year 1819, the other of 1818.
+
+Dr. Lewis was a great favorite with students.  He was a man of very
+lively temperament, fond of old books and young people, open-hearted,
+free-spoken, an enthusiast in teaching, and especially at home in
+that apartment of the temple of science where nature is seen in
+undress, the anthropotomic laboratory, known to common speech as the
+dissecting-room.  He had that quality which is the special gift of
+the man born for a teacher,--the power of exciting an interest in
+that which he taught.  While he was present the apartment I speak of
+was the sunniest of studios in spite of its mortuary spectacles.  Of
+the students I met there I best remember James Jackson, Junior, full
+of zeal and playful as a boy, a young man whose early death was a
+calamity to the profession of which he promised to be a chief
+ornament; the late Reverend J. S. C. Greene, who, as the prefix to
+his name signifies, afterwards changed his profession, but one of
+whose dissections I remember looking upon with admiration; and my
+friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
+entitled to be called, then, as now and always, a favorite with all
+about him.  He had come to us from the schools of Germany, and
+brought with him recollections of the teachings of Blumenbach and the
+elder Langenbeck, father of him whose portrait hangs in our Museum.
+Dr. Lewis was our companion as well as our teacher.  A good
+demonstrator is,--I will not say as important as a good Professor in
+the teaching of Anatomy, because I am not sure that he is not more
+important.  He comes into direct personal relations with the
+students,--he is one of them, in fact, as the Professor cannot be
+from the nature of his duties.  The Professor's chair is an
+insulating stool, so to speak; his age, his knowledge, real or
+supposed, his official station, are like the glass legs which support
+the electrician's piece of furniture, and cut it off from the common
+currents of the floor upon which it stands.  Dr. Lewis enjoyed
+teaching and made his students enjoy being taught.  He delighted in
+those anatomical conundrums to answer which keeps the student's eyes
+open and his wits awake.  He was happy as he dexterously performed
+the tour de maitre of the old barber-surgeons, or applied the spica
+bandage and taught his scholars to do it, so neatly and symmetrically
+that the aesthetic missionary from the older centre of civilization
+would bend over it in blissful contemplation, as if it were a
+sunflower.  Dr. Lewis had many other tastes, and was a favorite, not
+only with students, but in a wide circle, professional, antiquarian,
+masonic, and social.
+
+Dr. Otis was less widely known, but was a fluent and agreeable
+lecturer, and esteemed as a good surgeon.
+
+I must content myself with this glimpse at myself and a few of my
+fellow-students in Boston.  After attending two courses of Lectures
+in the school of the University, I went to Europe to continue my
+studies.
+
+You may like to hear something of the famous Professors of Paris in
+the days when I was a student in the Ecole de Medicine, and following
+the great Hospital teachers.
+
+I can hardly believe my own memory when I recall the old
+practitioners and Professors who were still going round the hospitals
+when I mingled with the train of students that attended the morning
+visits.  See that bent old man who is groping his way through the
+wards of La Charity.  That is the famous Baron Boyer, author of the
+great work on surgery in nine volumes, a writer whose clearness of
+style commends his treatise to general admiration, and makes it a
+kind of classic.  He slashes away at a terrible rate, they say, when
+he gets hold of the subject of fistula in its most frequent habitat,
+--but I never saw him do more than look as if he wanted to cut a good
+dollop out of a patient he was examining.  The short, square,
+substantial man with iron-gray hair, ruddy face, and white apron is
+Baron Larrey, Napoleon's favorite surgeon, the most honest man he
+ever saw,--it is reputed that he called him.  To go round the Hotel
+des Invalides with Larrey was to live over the campaigns of Napoleon,
+to look on the sun of Austerlitz, to hear the cannons of Marengo, to
+struggle through the icy waters of the Beresina, to shiver in the
+snows of the Russian retreat, and to gaze through the battle smoke
+upon the last charge of the red lancers on the redder field of
+Waterloo.  Larrey was still strong and sturdy as I saw him, and few
+portraits remain printed in livelier colors on the tablet of my
+memory.
+
+Leave the little group of students which gathers about Larrey beneath
+the gilded dome of the Invalides and follow me to the Hotel Dieu,
+where rules and reigns the master-surgeon of his day, at least so far
+as Paris and France are concerned,--the illustrious Baron Dupuytren.
+No man disputed his reign, some envied his supremacy.  Lisfranc
+shrugged his shoulders as he spoke of "ce grand homme de 1'autre cots
+de la riviere," that great man on the other side of the river, but
+the great man he remained, until he bowed before the mandate which
+none may disobey.  "Three times," said Bouillaud, "did the apoplectic
+thunderbolt fall on that robust brain,"--it yielded at last as the
+old bald cliff that is riven and crashes down into the valley.  I saw
+him before the first thunderbolt had descended: a square, solid man,
+with a high and full-domed head, oracular in his utterances,
+indifferent to those around him, sometimes, it was said, very rough
+with them.  He spoke in low, even tones, with quiet fluency, and was
+listened to with that hush of rapt attention which I have hardly seen
+in any circle of listeners unless when such men as ex-President John
+Quincy Adams or Daniel Webster were the speakers.  I do not think
+that Dupuytren has left a record which explains his influence, but in
+point of fact he dominated those around him in a remarkable manner.
+You must have all witnessed something of the same kind.  The personal
+presence of some men carries command with it, and their accents
+silence the crowd around them, when the same words from other lips
+might fall comparatively unheeded.
+
+As for Lisfranc, I can say little more of him than that he was a
+great drawer of blood and hewer of members.  I remember his ordering
+a wholesale bleeding of his patients, right and left, whatever might
+be the matter with them, one morning when a phlebotomizing fit was on
+him.  I recollect his regretting the splendid guardsmen of the old
+Empire,--for what?  because they had such magnificent thighs to
+amputate.  I got along about as far as that with him, when I ceased
+to be a follower of M. Lisfranc.
+
+The name of Velpeau must have reached many of you, for he died in
+1867, and his many works made his name widely known.  Coming to Paris
+in wooden shoes, starving, almost, at first, he raised himself to
+great eminence as a surgeon and as an author, and at last obtained
+the Professorship to which his talents and learning entitled him.
+His example may be an encouragement to some of my younger hearers who
+are born, not with the silver spoon in their mouths, but with the
+two-tined iron fork in their hands.  It is a poor thing to take up
+their milk porridge with in their young days, but in after years it
+will often transfix the solid dumplings that roll out of the silver
+spoon.  So Velpeau found it.  He had not what is called genius, he
+was far from prepossessing in aspect, looking as if he might have
+wielded the sledge-hammer (as I think he had done in early life)
+rather than the lancet, but he had industry, determination,
+intelligence, character, and he made his way to distinction and
+prosperity, as some of you sitting on these benches and wondering
+anxiously what is to become of you in the struggle for life will have
+done before the twentieth century has got halfway through its first
+quarter.  A good sound head over a pair of wooden shoes is a great
+deal better than a wooden head belonging to an owner who cases his
+feet in calf-skin, but a good brain is not enough without a stout
+heart to fill the four great conduits which carry at once fuel and
+fire to that mightiest of engines.
+
+How many of you who are before me are familiarly acquainted with the
+name of Broussais, or even with that of Andral?  Both were lecturing
+at the Ecole de Medicine, and I often heard them.  Broussais was in
+those days like an old volcano, which has pretty nearly used up its
+fire and brimstone, but is still boiling and bubbling in its
+interior, and now and then sends up a spirt of lava and a volley of
+pebbles.  His theories of gastro-enteritis, of irritation and
+inflammation as the cause of disease, and the practice which sprang
+from them, ran over the fields of medicine for a time like flame over
+the grass of the prairies.  The way in which that knotty-featured,
+savage old man would bring out the word irritation--with rattling and
+rolling reduplication of the resonant letter r--might have taught a
+lesson in articulation to Salvini.  But Broussais's theory was
+languishing and well-nigh become obsolete, and this, no doubt, added
+vehemence to his defence of his cherished dogmas.
+
+Old theories, and old men who cling to them, must take themselves out
+of the way as the new generation with its fresh thoughts and altered
+habits of mind comes forward to take the place of that which is dying
+out. This was a truth which the fiery old theorist found it very hard
+to learn, and harder to bear, as it was forced upon him.  For the
+hour of his lecture was succeeded by that of a younger and far more
+popular professor.  As his lecture drew towards its close, the
+benches, thinly sprinkled with students, began to fill up; the doors
+creaked open and banged back oftener and oftener, until at last the
+sound grew almost continuous, and the voice of the lecturer became a
+leonine growl as he strove in vain to be heard over the noise of
+doors and footsteps.
+
+Broussais was now sixty-two years old.  The new generation had
+outgrown his doctrines, and the Professor for whose hour the benches
+had filled themselves belonged to that new generation.  Gabriel
+Andral was little more than half the age of Broussais, in the full
+prime and vigor of manhood at thirty-seven years.  He was a rapid,
+fluent, fervid, and imaginative speaker, pleasing in aspect and
+manner,--a strong contrast to the harsh, vituperative old man who had
+just preceded him.  His Clinique Medicale is still valuable as a
+collection of cases, and his researches on the blood, conducted in
+association with Gavarret, contributed new and valuable facts to
+science.  But I remember him chiefly as one of those instructors
+whose natural eloquence made it delightful to listen to him.  I doubt
+if I or my fellow-students did full justice either to him or to the
+famous physician of Hotel Dieu, Chomel.  We had addicted ourselves
+almost too closely to the words of another master, by whom we were
+ready to swear as against all teachers that ever were or ever would
+be.
+
+This object of our reverence, I might almost say idolatry, was one
+whose name is well known to most of the young men before me, even to
+those who may know comparatively little of his works and teachings.
+Pierre Charles Alexandre Louis, at the age of forty-seven, as I
+recall him, was a tall, rather spare, dignified personage, of serene
+and grave aspect, but with a pleasant smile and kindly voice for the
+student with whom he came into personal relations.  If I summed up
+the lessons of Louis in two expressions, they would be these; I do
+not hold him answerable for the words, but I will condense them after
+my own fashion in French, and then give them to you, expanded
+somewhat, in English:
+
+          Formez toujours des idees nettes.
+          Fuyez toujours les a peu pres.
+
+Always make sure that you form a distinct and clear idea of the
+matter you are considering.
+
+Always avoid vague approximations where exact estimates are possible;
+about so many,--about so much, instead of the precise number and
+quantity.
+
+Now, if there is anything on which the biological sciences have
+prided themselves in these latter years it is the substitution of
+quantitative for qualitative formulae.  The "numerical system," of
+which Louis was the great advocate, if not the absolute originator,
+was an attempt to substitute series of carefully recorded facts,
+rigidly counted and closely compared, for those never-ending records
+of vague, unverifiable conclusions with which the classics of the
+healing art were overloaded.  The history of practical medicine had
+been like the story of the Danaides.  "Experience " had been, from
+time immemorial, pouring its flowing treasures into buckets full of
+holes.  At the existing rate of supply and leakage they would never
+be filled; nothing would ever be settled in medicine.  But cases
+thoroughly recorded and mathematically analyzed would always be
+available for future use, and when accumulated in sufficient number
+would lead to results which would be trustworthy, and belong to
+science.
+
+You young men who are following the hospitals hardly know how much
+you are indebted to Louis.  I say nothing of his Researches on
+Phthisis or his great work on Typhoid Fever.  But I consider his
+modest and brief Essay on Bleeding in some Inflammatory Diseases,
+based on cases carefully observed and numerically analyzed, one of
+the most important written contributions to practical medicine, to
+the treatment of internal disease, of this century, if not since the
+days of Sydenham.  The lancet was the magician's wand of the dark
+ages of medicine.  The old physicians not only believed in its
+general efficacy as a wonder-worker in disease, but they believed
+that each malady could be successfully attacked from some special
+part of the body,--the strategic point which commanded the seat of
+the morbid affection.  On a figure given in the curious old work of
+John de Ketam, no less than thirty-eight separate places are marked
+as the proper ones to bleed from, in different diseases.  Even Louis,
+who had not wholly given up venesection, used now and then to order
+that a patient suffering from headache should be bled in the foot, in
+preference to any other part.
+
+But what Louis did was this: he showed by a strict analysis of
+numerous cases that bleeding did not strangle,--jugulate was the word
+then used,--acute diseases, more especially pneumonia.  This was not
+a reform,--it was a revolution.  It was followed up in this country
+by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited
+Diseases, which has, I believe, done more than any other work or
+essay in our own language to rescue the practice of medicine from the
+slavery to the drugging system which was a part of the inheritance of
+the profession.
+
+Yes, I say, as I look back on the long hours of the many days I spent
+in the wards and in the autopsy room of La Pitie, where Louis was one
+of the attending physicians,--yes, Louis did a great work for
+practical medicine.  Modest in the presence of nature, fearless in
+the face of authority, unwearying in the pursuit of truth, he was a
+man whom any student might be happy and proud to claim as his teacher
+and his friend, and yet, as I look back on the days when I followed
+his teachings, I feel that I gave myself up too exclusively to his
+methods of thought and study.
+
+There is one part of their business which certain medical
+practitioners are too apt to forget; namely, that what they should
+most of all try to do is to ward off disease, to alleviate suffering,
+to preserve life, or at least to prolong it if possible.  It is not
+of the slightest interest to the patient to know whether three or
+three and a quarter cubic inches of his lung are hepatized.  His mind
+is not occupied with thinking of the curious problems which are to be
+solved by his own autopsy,--whether this or that strand of the spinal
+marrow is the seat of this or that form of degeneration.  He wants
+something to relieve his pain, to mitigate the anguish of dyspnea, to
+bring back motion and sensibility to the dead limb, to still the
+tortures of neuralgia.  What is it to him that you can localize and
+name by some uncouth term the disease which you could not prevent and
+which you cannot cure?  An old woman who knows how to make a poultice
+and how to put it on, and does it tuto, eito, jucunde, just when and
+where it is wanted, is better,--a thousand times better in many
+cases,--than a staring pathologist, who explores and thumps and
+doubts and guesses, and tells his patient be will be better tomorrow,
+and so goes home to tumble his books over and make out a diagnosis.
+
+But in those days, I, like most of my fellow students, was thinking
+much more of "science" than of practical medicine, and I believe if
+we had not clung so closely to the skirts of Louis and had followed
+some of the courses of men like Trousseau,--therapeutists, who gave
+special attention to curative methods, and not chiefly to diagnosis,
+--it would have been better for me and others.  One thing, at any
+rate, we did learn in the wards of Louis.  We learned that a very
+large proportion of diseases get well of themselves, without any
+special medication,--the great fact formulated, enforced, and
+popularized by Dr. Jacob Bigelow in the Discourse referred to.  We
+unlearned the habit of drugging for its own sake.  This detestable
+practice, which I was almost proscribed for condemning somewhat too
+epigrammatically a little more than twenty years ago, came to us, I
+suspect, in a considerable measure from the English "general
+practitioners," a sort of prescribing apothecaries.  You remember
+how, when the city was besieged, each artisan who was called upon in
+council to suggest the best means of defence recommended the articles
+he dealt in: the carpenter, wood; the blacksmith, iron; the mason,
+brick; until it came to be a puzzle to know which to adopt. Then the
+shoemaker said, "Hang your walls with new boots,"  and gave good
+reasons why these should be the best of all possible defences.  Now
+the "general practitioner"  charged, as I understand, for his
+medicine, and in that way got paid for his visit.  Wherever this is
+the practice, medicine is sure to become a trade, and the people
+learn to expect drugging, and to consider it necessary, because drugs
+are so universally given to the patients of the man who gets his
+living by them.
+
+It was something to have unlearned the pernicious habit of constantly
+giving poisons to a patient, as if they were good in themselves, of
+drawing off the blood which he would want in his struggle with
+disease, of making him sore and wretched with needless blisters, of
+turning his stomach with unnecessary nauseous draught and mixtures,
+--only because he was sick and something must be done.  But there
+were positive as well as negative facts to be learned, and some of
+us, I fear, came home rich in the negatives of the expectant
+practice, poor in the resources which many a plain country
+practitioner had ready in abundance for the relief and the cure of
+disease.  No one instructor can be expected to do all for a student
+which he requires.  Louis taught us who followed him the love of
+truth, the habit of passionless listening to the teachings of nature,
+the most careful and searching methods of observation, and the sure
+means of getting at the results to be obtained from them in the
+constant employment of accurate tabulation.  He was not a showy, or
+eloquent, or, I should say, a very generally popular man, though the
+favorite, almost the idol, of many students, especially Genevese and
+Bostonians.  But he was a man of lofty and admirable scientific
+character, and his work will endure in its influences long after his
+name is lost sight of save to the faded eyes of the student of
+medical literature.
+
+Many other names of men more or less famous in their day, and who
+were teaching while I was in Paris, come up before me.  They are but
+empty sounds for the most part in the ears of persons of not more
+than middle age.  Who of you knows anything of Richerand, author of a
+very popular work on Physiology, commonly put into the student's
+hands when I first began to ask for medical text-books?  I heard him
+lecture once, and have had his image with me ever since as that of an
+old, worn-out man,--a venerable but dilapidated relic of an effete
+antiquity.  To verify this impression I have just looked out the
+dates of his birth and death, and find that he was eighteen years
+younger than the speaker who is now addressing you.  There is a
+terrible parallax between the period before thirty and that after
+threescore and ten, as two men of those ages look, one with naked
+eyes, one through his spectacles, at the man of fifty and thereabout.
+Magendie, I doubt not you have all heard of.  I attended but one of
+his lectures.  I question if one here, unless some contemporary of my
+own has strayed into the amphitheatre,--knows anything about
+Marjolin.  I remember two things about his lectures on surgery, the
+deep tones of his voice as he referred to his oracle,--the earlier
+writer, Jean Louis Petit,--and his formidable snuffbox.  What he
+taught me lies far down, I doubt not, among the roots of my
+knowledge, but it does not flower out in any noticeable blossoms, or
+offer me any very obvious fruits.  Where now is the fame of
+Bouillaud, Professor and Deputy, the Sangrado of his time?  Where is
+the renown of Piorry, percussionist and poet, expert alike in the
+resonances of the thoracic cavity and those of the rhyming
+vocabulary? --I think life has not yet done with the vivacious
+Ricord, whom I remember calling the Voltaire of pelvic literature,--a
+sceptic as to the morality of the race in general, who would have
+submitted Diana to treatment with his mineral specifics, and ordered
+a course of blue pills for the vestal virgins.
+
+Ricord was born at the beginning of the century, and Piorry some
+years earlier.  Cruveilhier, who died in 1874, is still remembered by
+his great work on pathological anatomy; his work on descriptive
+anatomy has some things which I look in vain for elsewhere.  But
+where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,
+--jolly old Baron Alibert, whom I remember so well in his broad-
+brimmed hat, worn a little jauntily on one side, calling out to the
+students in the court-yard of the Hospital St.  Louis, "Enfans de la
+methode naturelle, etes-vous tous ici?" "Children of the natural
+method [his own method of classification of skin diseases,] are you
+all here?  "All here, then, perhaps; all where, now?
+
+My show of ghosts is over.  It is always the same story that old men
+tell to younger ones, some few of whom will in their turn repeat the
+tale, only with altered names, to their children's children.
+
+     Like phantoms painted on the magic slide,
+     Forth from the darkness of the past we glide,
+     As living shadows for a moment seen
+     In airy pageant on the eternal screen,
+     Traced by a ray from one unchanging flame,
+     Then seek the dust and stillness whence we came.
+
+Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
+where he had written his Latin graduating thesis, talking of the
+learned Gaubius and the late illustrious Boerhaave and other dead
+Dutchmen, of whom you know as much, most of you, as you do of Noah's
+apothecary and the family physician of Methuselah, whose
+prescriptions seem to have been lost to posterity.  Dr. Lloyd came
+back to Boston full of the teachings of Cheselden and Sharpe, William
+Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr.
+Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his
+recollections of Sir Astley Cooper and Mr. Abernethy; I have named
+the famous Frenchmen of my student days; Leyden, Edinburgh, London,
+Paris, were each in turn the Mecca of medical students, just as at
+the present day Vienna and Berlin are the centres where our young men
+crowd for instruction.  These also must sooner or later yield their
+precedence and pass the torch they hold to other hands.  Where shall
+it next flame at the head of the long procession?  Shall it find its
+old place on the shores of the Gulf of Salerno, or shall it mingle
+its rays with the northern aurora up among the fiords of Norway,--or
+shall it be borne across the Atlantic and reach the banks of the
+Charles, where Agassiz and Wyman have taught, where Hagen still
+teaches, glowing like his own Lampyris splendidula, with enthusiasm,
+where the first of American botanists and the ablest of American
+surgeons are still counted in the roll of honor of our great
+University?
+
+Let me add a few words which shall not be other than cheerful, as I
+bid farewell to this edifice which I have known so long.  I am
+grateful to the roof which has sheltered me, to the floors which have
+sustained me, though I have thought it safest always to abstain from
+anything like eloquence, lest a burst of too emphatic applause might
+land my class and myself in the cellar of the collapsing structure,
+and bury us in the fate of Korah, Dathan, and Abiram.  I have helped
+to wear these stairs into hollows,--stairs which I trod when they
+were smooth and level, fresh from the plane.  There are just thirty-
+two of them, as there were five and thirty years ago, but they are
+steeper and harder to climb, it seems to me, than they were then.  I
+remember that in the early youth of this building, the late Dr. John
+K.  Mitchell, father of our famous Dr. Weir Mitchell, said to me as
+we came out of the Demonstrator's room, that some day or other a
+whole class would go heels over head down this graded precipice, like
+the herd told of in Scripture story.  This has never happened as yet;
+I trust it never will.  I have never been proud of the apartment
+beneath the seats, in which my preparations for lecture were made.
+But I chose it because I could have it to myself, and I resign it,
+with a wish that it were more worthy of regret, into the hands of my
+successor, with my parting benediction.  Within its twilight
+precincts I have often prayed for light, like Ajax, for the daylight
+found scanty entrance, and the gaslight never illuminated its dark
+recesses.  May it prove to him who comes after me like the cave of
+the Sibyl, out of the gloomy depths of which came the oracles which
+shone with the rays of truth and wisdom!
+
+This temple of learning is not surrounded by the mansions of the
+great and the wealthy.  No stately avenues lead up to its facades and
+porticoes.  I have sometimes felt, when convoying a distinguished
+stranger through its precincts to its door, that he might question
+whether star-eyed Science had not missed her way when she found
+herself in this not too attractive locality.  I cannot regret that
+we--you, I should say--are soon to migrate to a more favored region,
+and carry on your work as teachers and as learners in ampler halls
+and under far more favorable conditions.
+
+I hope that I may have the privilege of meeting you there, possibly
+may be allowed to add my words of welcome to those of my former
+colleagues, and in that pleasing anticipation I bid good-by to this
+scene of my long labors, and, for the present at least, to the
+friends with whom I have been associated.
+
+
+
+
+
+
+APPENDUM
+
+NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
+CURRENTS IN MEDICAL SCIENCE.
+
+Some passages contained in the original manuscript of the Address,
+and omitted in the delivery on account of its length, are restored in
+the text or incorporated with these Notes.
+
+NOTE A. --
+
+There is good reason to doubt whether the nitrate of silver has any
+real efficacy in epilepsy.  It has seemed to cure many cases, but
+epilepsy is a very uncertain disease, and there is hardly anything
+which has not been supposed to cure it.  Dr. Copland cites many
+authorities in its favor, most especially Lombard's cases.  But De la
+Berge and Monneret (Comp.  de Med.  Paris), 1839, analyze these same
+cases, eleven in number, and can only draw the inference of a very
+questionable value in the supposed remedy.  Dr. James Jackson says
+that relief of epilepsy is not to be attained by any medicine with
+which he is acquainted, but by diet.  (Letters to a Young Physician,
+p.  67.) Guy Patin, Dean of the Faculty of Paris, Professor at the
+Royal College, Author of the Antimonial Martyrology, a wit and a man
+of sense and learning, who died almost two hundred years ago, had
+come to the same conclusion, though the chemists of his time boasted
+of their remedies.  "Did, you ever see a case of epilepsy cured by
+nitrate of silver?"  I said to one of the oldest and most experienced
+surgeons in this country.  "Never," was his instant reply.  Dr.
+Twitchell's experience was very similar.  How, then, did nitrate of
+silver come to be given for epilepsy?  Because, as Dr. Martin has so
+well reminded us, lunatics were considered formerly to be under the
+special influence of Luna, the moon (which Esquirol, be it observed,
+utterly denies), and lunar caustic, or nitrate of silver, is a salt
+of that metal which was called luna from its whiteness, and of course
+must be in the closest relations with the moon.  It follows beyond
+all reasonable question that the moon's metal, silver, and its
+preparations, must be the specific remedy for moonblasted maniacs and
+epileptics!
+
+Yet the practitioner who prescribes the nitrate of silver supposes he
+is guided by the solemn experience of the past, instead of by its
+idle fancies.  He laughs at those old physicians who placed such
+confidence in the right hind hoof of an elk as a remedy for the same
+disease, and leaves the record of his own belief in a treatment quite
+as fanciful and far more objectionable, written in indelible ink upon
+a living tablet where he who runs may read it for a whole generation,
+if nature spares his walking advertisement so long.
+
+
+
+NOTE B. --
+
+The presumption that a man is innocent until he is proved guilty,
+does not mean that there are no rogues, but lays the onus probandi on
+the party to which it properly belongs.  So with this proposition.
+A noxious agent should never be employed in sickness unless there is
+ample evidence in the particular case to overcome the general
+presumption against all such agents, and the evidence is very apt to
+be defective.
+
+The miserable delusion of Homoeopathy builds itself upon an axiom
+directly the opposite of this; namely, that the sick are to be cured
+by poisons.  Similia similibus curantur means exactly this.  It is
+simply a theory of universal poisoning, nullified in practice by the
+infinitesimal contrivance.  The only way to kill it and all similar
+fancies, and to throw every quack nostrum into discredit, is to root
+out completely the suckers of the old rotten superstition that
+whatever is odious or noxious is likely to be good for disease.  The
+current of sound practice with ourselves is, I believe, setting fast
+in the direction I have indicated in the above proposition.  To
+uphold the exhibition of noxious agents in disease, as the rule,
+instead of admitting them cautiously and reluctantly as the
+exception, is, as I think, an eddy of opinion in the direction of the
+barbarism out of which we believe our art is escaping.  It is only
+through the enlightened sentiment and action of the Medical
+Profession that the community can be brought to acknowledge that
+drugs should always be regarded as evils.
+
+It is true that some suppose, and our scientific and thoughtful
+associate, Dr.  Gould, has half countenanced the opinion, that there
+may yet be discovered a specific for every disease.  Let us not
+despair of the future, but let us be moderate in our expectations.
+When an oil is discovered that will make a bad watch keep good time;
+when a recipe is given which will turn an acephalous foetus into a
+promising child; when a man can enter the second time into his
+mother's womb and give her back the infirmities which twenty
+generations have stirred into her blood, and infused into his own
+through hers, we may be prepared to enlarge the National
+Pharmacopoeia with a list of specifies for everything but old age,
+--and possibly for that also.
+
+
+
+NOTE C. --
+
+The term specific is used here in its ordinary sense, without raising
+the question of the propriety of its application to these or other
+remedies.
+
+The credit of introducing Cinchona rests between the Jesuits, the
+Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
+who employed it as a secret remedy.  (Pereira.) Mercury as an
+internal specific remedy was brought into use by that impudent and
+presumptuous quack, as he was considered, Paracelsus.  (Encyc.  Brit.
+art.  "Paracelsus.") Arsenic was introduced into England as a remedy
+for intermittents by Dr. Fowler, in consequence of the success of a
+patent medicine, the Tasteless Ague Drops, which were supposed,
+"probably with reason," to be a preparation of that mineral.  (Rees's
+Cyc.  art.  "Arsenic.")  Colchicum came into notice in a similar way,
+from the success of the Eau Medicinale of M. Husson, a French
+military officer.  (Pereira.) Iodine was discovered by a saltpetre
+manufacturer, but applied by a physician in place of the old remedy,
+burnt sponge, which seems to owe its efficacy to it.  (Dunglison, New
+Remedies.) As for Sulphur, "the common people have long used it as an
+ointment" for scabies.  (Rees's Cyc.  art.  "Scabies.") The modern
+cantiscorbutic regimen is credited to Captain Cook.  "To his sagacity
+we are indebted for the first impulse to those regulations by which
+scorbutus is so successfully prevented in our navy."  (Lond.  Cyc.
+Prac.  Med.  art.  "Scorbutus.") Iron and various salts which enter
+into the normal composition of the human body do not belong to the
+materia medica by our definition, but to the materia alimentaria.
+
+For the first introduction of iron as a remedy, see Pereira, who
+gives a very curious old story.
+
+The statement in the text concerning a portion of the materia medica
+stands exactly as delivered, and is meant exactly as it stands.  No
+denunciation of drugs, as sparingly employed by a wise physician, was
+or is intended.  If, however, as Dr.  Gould stated in his "valuable
+and practical discourse" to which the Massachusetts Medical Society
+"listened with profit as well as interest,"  "Drugs, in themselves
+considered, may always be regarded as evils,"--any one who chooses
+may question whether the evils from their abuse are, on the whole,
+greater or less than the undoubted benefits obtained from their
+proper use.  The large exception of opium, wine, specifics, and
+anaesthetics, made in the text, takes off enough from the useful
+side, as I fully believe, to turn the balance; so that a vessel
+containing none of these, but loaded with antimony, strychnine,
+acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus
+diaboli, tormentilla, and other approved, and, in skilful hands,
+really useful remedies, brings, on the whole, more harm than good to
+the port it enters.
+
+It is a very narrow and unjust view of the practice of medicine, to
+suppose it to consist altogether in the use of powerful drugs, or of
+drugs of any kind.  Far from it.  "The physician may do very much for
+the welfare of the sick, more than others can do, although he does
+not, even in the major part of cases, undertake to control and
+overcome the disease by art.  It was with these views that I never
+reported any patient cured at our hospital.  Those who recovered
+their health were reported as well; not implying that they were made
+so by the active treatment they had received there.  But it was to be
+understood that all patients received in that house were to be cured,
+that is, taken care of."  (Letters to a Young Physician, by James
+Jackson, M.  D., Boston, 1855.)
+
+"Hygienic rules, properly enforced, fresh air, change of air, travel,
+attention to diet, good and appropriate food judiciously regulated,
+together with the administration of our tonics, porter, ale, wine,
+iron, etc., supply the diseased or impoverished system with what Mr.
+Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of
+the blood;' and we believe that if any real improvement has taken
+place in medical practice, independently of those truly valuable
+contributions we have before described, it is in the substitution of
+tonics, stimulants, and general management, for drastic cathartics,
+for bleeding, depressing agents, including mercury, tartar emetics,
+etc., so much in vogue during the early part even of this century."
+(F. P. Porcher, in Charleston Med. Journal and Review for January,
+1860.)
+
+
+
+
+
+End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes
+
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+The Project Gutenberg Etext of Medical Essays, by O. W. Holmes, Sr.
+#9 in our series by Oliver Wendell Holmes, Sr. (The Physician and Poet)
+
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+Title: Medical Essays
+
+Author: Oliver Wendell Holmes, Sr. (The Physician and Poet)
+(Not the Jurist O. W. Holmes, Jr.)
+
+Release Date: July, 2001 [Etext #2700]
+[Yes, we are more than one year ahead of schedule]
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+The Project Gutenberg Etext of Medical Essays, by Oliver W. Holmes
+*******This file should be named medic11.txt or medic11.zip*******
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+This etext was produced by David Widger  <widger@cecomet.net>
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+
+MEDICAL ESSAYS
+
+By Oliver Wendell Holmes
+
+
+
+
+1842-1882
+
+
+CONTENTS:
+
+I.   HOMEOPATHY AND ITS KINDRED DELUSIONS
+
+II.  THE CONTAGIOUSNESS OF PUERPERAL FEVER
+
+III. CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+IV.  BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE
+
+V.   SCHOLASTIC AND BEDSIDE TEACHING
+
+VI.  THE MEDICAL PROFESSION IN MASSACHUSETTS
+
+VII. THE YOUNG PRACTITIONER
+
+VIII. MEDICAL LIBRARIES
+
+IX.  SOME OF MY EARLY TEACHERS
+
+
+
+
+
+
+PREFACE.
+
+The character of the opposition which some of these papers have met
+with suggests the inference that they contain really important, but
+unwelcome truths.  Negatives multiplied into each other change their
+sign and become positives.  Hostile criticisms meeting together are
+often equivalent to praise, and the square of fault-finding turns out
+to be the same thing as eulogy.
+
+But a writer has rarely so many enemies as it pleases him to believe.
+Self-love leads us to overrate the numbers of our negative
+constituency.  The larger portion of my limited circle of readers
+must be quite indifferent to, if not ignorant of, the adverse
+opinions which have been expressed or recorded concerning any of
+these Addresses or Essays now submitted to their own judgment.  It is
+proper, however, to inform them, that some of the positions
+maintained in these pages have been unsparingly attacked, with
+various degrees of ability, scholarship, and good-breeding.  The tone
+of criticism naturally changes with local conditions in different
+parts of a country extended like our own, so that it is one of the
+most convenient gauges of the partial movements in the direction of
+civilization.  It is satisfactory to add, that the views assailed
+have also been unflinchingly defended by unsought champions, among
+the ablest of whom it is pleasant to mention, at this moment of
+political alienation, the Editor of the Charleston Medical Journal.
+
+"Currents and Counter-Currents" was written and delivered as an
+Oration, a florid rhetorical composition, expressly intended to
+secure the attention of an audience not easy to hold as listeners.
+It succeeded in doing this, and also in being as curiously
+misunderstood and misrepresented as if it had been a political
+harangue.  This gave it more local notoriety than it might otherwise
+have attained, so that, as I learn, one ingenious person made use of
+its title as an advertisement to a production of his own.
+
+The commonest mode of misrepresentation was this: qualified
+propositions, the whole meaning of which depended on the
+qualifications, were stripped of these and taken as absolute.  Thus,
+the attempt to establish a presumption against giving poisons to sick
+persons was considered as equivalent to condemning the use of these
+substances.  The only important inference the writer has been able to
+draw from the greater number of the refutations of his opinions which
+have been kindly sent him, is that the preliminary education of the
+Medical Profession is not always what it ought to be.
+
+One concession he is willing to make, whatever sacrifice of pride it
+may involve.  The story of Massasoit, which has furnished a coral, as
+it were, for some teething critics, when subjected to a powerful
+logical analysis, though correct in its essentials, proves to have
+been told with exceptionable breadth of statement, and therefore (to
+resume the metaphor) has been slightly rounded off at its edges, so
+as to be smoother for any who may wish to bite upon it hereafter.  In
+other respects the Discourse has hardly been touched.  It is only an
+individual's expression, in his own way, of opinions entertained by
+hundreds of the Medical Profession in every civilized country, and
+has nothing in it which on revision the writer sees cause to retract
+or modify.  The superstitions it attacks lie at the very foundation
+of Homoeopathy, and of almost every form of medical charlatanism.
+Still the mere routinists and unthinking artisans in most callings
+dislike whatever shakes the dust out of their traditions, and it may
+be unreasonable to expect that Medicine will always prove an
+exception to the rule.  One half the opposition which the numerical
+system of Louis has met with, as applied to the results of treatment,
+has been owing to the fact that it showed the movements of disease to
+be far more independent of the kind of practice pursued than was
+agreeable to the pride of those whose self-confidence it abated.
+
+The statement, that medicines are more sparingly used in physicians'
+families than in most others, admits of a very natural explanation,
+without putting a harsh construction upon it, which it was not
+intended to admit.  Outside pressure is less felt in the physician's
+own household; that is all.  If this does not sometimes influence him
+to give medicine, or what seems to be medicine, when among those who
+have more confidence in drugging than his own family commonly has,
+the learned Professor Dunglison is hereby requested to apologize for
+his definition of the word Placebo, or to expunge it from his Medical
+Dictionary.
+
+One thing is certain.  A loud outcry on a slight touch reveals the
+weak spot in a profession, as well as in a patient.  It is a doubtful
+policy to oppose the freest speech in those of our own number who are
+trying to show us where they honestly believe our weakness lies.
+Vast as are the advances of our Science and Art, may it not possibly
+prove on examination that we retain other old barbarisms beside the
+use of the astrological sign of Jupiter, with which we endeavor to
+insure good luck to our prescriptions?  Is it the act of a friend or
+a foe to try to point them out to our brethren when asked to address
+them, and is the speaker to subdue the constitutional habit of his
+style to a given standard, under penalty of giving offence to a grave
+assembly?
+
+"Homoeopathy and its Kindred Delusions" was published nearly twenty
+years ago, and has been long out of print, so that the author tried
+in vain to procure a copy until the kindness of a friend supplied him
+with the only one he has had for years.  A foolish story reached his
+ears that he was attempting to buy up stray copies for the sake of
+suppressing it.  This edition was in the press at that very time.
+
+Many of the arguments contained in the Lectures have lost whatever
+novelty they may have possessed.  All its predictions have been
+submitted to the formidable test of time.  They appear to have stood
+it, so far, about as well as most uninspired prophecies; indeed, some
+of them require much less accommodation than certain grave
+commentators employ in their readings of the ancient Prophets.
+
+If some statistics recently published are correct, Homoeopathy has
+made very slow progress in Europe.
+
+In all England, as it appears, there are hardly a fifth more
+Homoeopathic practitioners than there are students attending Lectures
+at the Massachusetts Medical College at the present time.  In America
+it has undoubtedly proved more popular and lucrative, yet how loose a
+hold it has on the public confidence is shown by the fact that, when
+a specially valued life, which has been played with by one of its
+agents, is seriously threatened, the first thing we expect to hear is
+that a regular practitioner is by the patient's bed, and the
+Homoeopathic counsellor overruled or discarded.  Again, how many of
+the ardent and capricious persons who embraced Homoeopathy have run
+the whole round of pretentious novelties;--have been boarded at
+water-cure establishments, closeted with uterine and other
+specialists, and finally wandered over seas to put themselves in
+charge of foreign celebrities, who dosed them as lustily as they were
+ever dosed before they took to globules!  It will surprise many to
+learn to what a shadow of a shade Homoeopathy has dwindled in the
+hands of many of its noted practitioners.  The itch-doctrine is
+treated with contempt.  Infinitesimal doses are replaced by full ones
+whenever the fancy-practitioner chooses.  Good Homoeopathic reasons
+can be found for employing anything that anybody wants to employ.
+Homoeopathy is now merely a name, an unproved theory, and a box of
+pellets pretending to be specifics, which, as all of us know, fail
+ignominiously in those cases where we would thankfully sacrifice all
+our prejudices and give the world to have them true to their
+promises.
+
+Homoeopathy has not died out so rapidly as Tractoration.  Perhaps it
+was well that it should not, for it has taught us a lesson of the
+healing faculty of Nature which was needed, and for which many of us
+have made proper acknowledgments.  But it probably does more harm
+than good to medical science at the present time, by keeping up the
+delusion of treating everything by specifics,--the old barbarous
+notion that sick people should feed on poisons [Lachesis, arrow-
+poison, obtained from a serpent (Pulte).  Crotalus horridus,
+rattlesnake's venom (Neidhard).  The less dangerous Pediculus capitis
+is the favorite remedy of Dr. Mure, the English "Apostle of
+Homoeopathy."  These are examples of the retrograde current setting
+towards barbarism] against which a part of the Discourse at the
+beginning of this volume is directed.
+
+The infinitesimal globules have not become a curiosity as yet, like
+Perkins's Tractors.  But time is a very elastic element in Geology
+and Prophecy.  If Daniel's seventy weeks mean four hundred and ninety
+years, as the learned Prideaux and others have settled it that they
+do, the "not many years" of my prediction may be stretched out a
+generation or two beyond our time, if necessary, when the prophecy
+will no doubt prove true.
+
+It might be fitting to add a few words with regard to the Essay on
+the Contagiousness of Puerperal Fever.  But the whole question I
+consider to be now transferred from the domain of medical inquiry to
+the consideration of Life Insurance agencies and Grand Juries.  For
+the justification of this somewhat sharply accented language I must
+refer the reader to the paper itself for details which I regret to
+have been forced to place on permanent record.
+
+BOSTON, January, 1861.
+
+
+
+
+A SECOND PREFACE.
+
+These Lectures and Essays are arranged in the order corresponding to
+the date of their delivery or publication.  They must, of course, be
+read with a constant reference to these dates, by such as care to
+read them.  I have not attempted to modernize their aspect or
+character in presenting them, in this somewhat altered connection, to
+the public.  Several of them were contained in a former volume which
+received its name from the Address called "Currents and Counter-
+Currents."  Some of those contained in the former volume have been
+replaced by others.  The Essay called "Mechanism of Vital Actions"
+has been transferred to a distinct collection of Miscellaneous
+essays, forming a separate volume.
+
+I had some intention of including with these papers an Essay on
+Intermittent Fever in New England, which received one of the Boylston
+prizes in 1837, and was published in the following year.  But as this
+was upon a subject of local interest, chiefly, and would have taken
+up a good deal of room, I thought it best to leave it out, trusting
+that the stray copies to be met with in musty book-shops would
+sufficiently supply the not very extensive or urgent demand for a
+paper almost half a century old.
+
+Some of these papers created a little stir when they first fell from
+the press into the pool of public consciousness.  They will slide in
+very quietly now in this new edition, and find out for themselves
+whether the waters are those of Lethe, or whether they are to live
+for a time as not wholly unvalued reminiscences.
+
+March 21, 1883.
+
+
+
+
+PREFACE TO THE NEW EDITION.
+
+These Essays are old enough now to go alone without staff or crutch
+in the shape of Prefaces.  A very few words may be a convenience to
+the reader who takes up the book and wishes to know what he is likely
+to find in it.
+
+
+               HOMOEOPATHY AND ITS KINDRED DELUSIONS.
+
+Homoeopathy has proved lucrative, and so long as it continues to be
+so will surely exist,--as surely as astrology, palmistry, and other
+methods of getting a living out of the weakness and credulity of
+mankind and womankind.  Though it has no pretensions to be considered
+as belonging among the sciences, it may be looked upon by a
+scientific man as a curious object of study among the vagaries of the
+human mind.  Its influence for good or the contrary may be made a
+matter of calm investigation.  I have studied it in the Essay before
+the reader, under the aspect of an extravagant and purely imaginative
+creation of its founder.  Since that first essay was written, nearly
+half a century ago, we have all had a chance to witness its practical
+working.  Two opposite inferences may be drawn from its doctrines and
+practice.  The first is that which is accepted by its disciples.
+This is that all diseases are "cured" by drugs.  The opposite
+conclusion is drawn by a much larger number of persons.  As they see
+that patients are very commonly getting well under treatment by
+infinitesimal drugging, which they consider equivalent to no
+medication at all, they come to disbelieve in every form of drugging
+and put their whole trust in "nature."  Thus experience,
+
+          "From seeming evil still educing good,"
+
+has shown that the dealers in this preposterous system of pseudo-
+therapeutics have cooperated with the wiser class of practitioners in
+breaking up the system of over-dosing and over-drugging which has
+been one of the standing reproaches of medical practice.  While.
+keeping up the miserable delusion that diseases were all to be
+"cured" by drugging, Homoeopathy has been unintentionally showing
+that they would very generally get well without any drugging at all.
+In the mean time the newer doctrines of the "mind cure," the "faith
+cure," and the rest are encroaching on the territory so long
+monopolized by that most ingenious of the pseudo-sciences.  It would
+not be surprising if its whole ground should be taken possession of
+by these new claimants with their flattering appeals to the
+imaginative class of persons open to such attacks.  Similia similabus
+may prove fatally true for once, if Homoeopathy is killed out by its
+new-born rivals.
+
+It takes a very moderate amount of erudition to unearth a charlatan
+like the supposed father of the infinitesimal dosing system.  The
+real inventor of that specious trickery was an Irishman by the name
+of Butler.  The whole story is to be found in the "Ortus Medicinm" of
+Van Helmont.  I have given some account of his chapter "Butler" in
+different articles, but I would refer the students of our
+Homoeopathic educational institutions to the original, which they
+will find very interesting and curious.
+
+
+                    CURRENTS AND COUNTER-CURRENTS
+
+My attack on over-drugging brought out some hostile comments and
+treatment.  Thirty years ago I expressed myself with more vivacity
+than I should show if I were writing on the same subjects today.
+Some of my more lively remarks called out very sharp animadversion.
+Thus my illustration of prevention as often better than treatment in
+the mother's words to her child which had got a poisonous berry in
+its mouth,--"Spit it out!" gave mortal offence to a well-known New
+York practitioner and writer, who advised the Massachusetts Medical
+Society to spit out the offending speaker.  Worse than this was my
+statement of my belief that if a ship-load of miscellaneous drugs,
+with certain very important exceptions,--drugs, many of which were
+then often given needlessly and in excess, as then used "could be
+sunk to the bottom of the sea, it would be all the better for mankind
+and all the worse for the fishes."  This was too bad.  The sentence
+was misquoted, quoted without its qualifying conditions, and
+frightened some of my worthy professional brethren as much as if I
+had told them to throw all physic to the dogs.  But for the
+epigrammatic sting the sentiment would have been unnoticed as a
+harmless overstatement at the very worst.
+
+Since this lecture was delivered a great and, as I think, beneficial
+change has taken place in the practice of medicine.  The habit of the
+English "general practitioner" of making his profit out of the pills
+and potions he administered was ruinous to professional advancement
+and the dignity of the physician.  When a half-starving medical man
+felt that he must give his patient draught and boluses for which he
+could charge him, he was in a pitiable position and too likely to
+persuade himself that his drugs were useful to his patient because
+they were profitable to him.  This practice has prevailed a good deal
+in America, and was doubtless the source in some measure of the
+errors I combated.
+
+
+               THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+This Essay was read before a small Association called "The Society
+for Medical Improvement," and published in a Medical Journal which
+lasted but a single year.  It naturally attracted less attention than
+it would have done if published in such a periodical as the "American
+Journal of Medical Sciences."  Still it had its effect, as I have
+every reason to believe.  I cannot doubt that it has saved the lives
+of many young mothers by calling attention to the existence and
+propagation of "Puerperal Fever as a Private Pestilence," and laying
+down rules for taking the necessary precautions against it.  The case
+has long been decided in favor of the views I advocated, but, at the
+time when I wrote two of the most celebrated professors of Obstetrics
+in this country opposed my conclusions with all the weight of their
+experience and position.
+
+This paper was written in a great heat and with passionate
+indignation.  If I touched it at all I might trim its rhetorical
+exuberance, but I prefer to leave it all its original strength of
+expression.  I could not, if I had tried, have disguised the feelings
+with which I regarded the attempt to put out of sight the frightful
+facts which I brought forward and the necessary conclusions to which
+they led.  Of course the whole matter has been looked at in a new
+point of view since the microbe as a vehicle of contagion has been
+brought into light, and explained the mechanism of that which was
+plain enough as a fact to all who were not blind or who did not shut
+their eyes.
+
+O.  W.  H.
+
+BEVERLY Farms, Mass., August 3, 1891
+
+
+
+
+
+
+HOMOEOPATHY AND ITS KINDRED DELUSIONS
+[Two lectures delivered before the Boston Society for the Diffusion
+of Useful Knowledge.  1842.]
+
+
+[When a physician attempts to convince a person, who has fallen into
+the Homoeopathic delusion, of the emptiness of its pretensions, he is
+often answered by a statement of cases in which its practitioners are
+thought to have effected wonderful cures.  The main object of the
+first of these Lectures is to show, by abundant facts, that such
+statements, made by persons unacquainted with the fluctuations of
+disease and the fallacies of observation, are to be considered in
+general as of little or no value in establishing the truth of a
+medical doctrine or the utility of a method of practice.
+
+Those kind friends who suggest to a person suffering from a tedious
+complaint, that he "Had better try Homoeopathy," are apt to enforce
+their suggestion by adding, that "at any rate it can do no harm."
+This may or may not be true as regards the individual.  But it always
+does very great harm to the community to encourage ignorance, error,
+or deception in a profession which deals with the life and health of
+our fellow-creatures.  Whether or not those who countenance
+Homoeopathy are guilty of this injustice towards others, the second
+of these Lectures may afford them some means of determining.
+
+To deny that good effects may happen from the observance of diet and
+regimen when prescribed by Homoeopathists as well as by others, would
+be very unfair to them.  But to suppose that men with minds so
+constituted as to accept such statements and embrace such doctrines
+as make up the so-called science of Homoeopathy are more competent
+than others to regulate the circumstances which influence the human
+body in health and disease, would be judging very harshly the average
+capacity of ordinary practitioners.
+
+To deny that some patients may have been actually benefited through
+the influence exerted upon their imaginations, would be to refuse to
+Homoeopathy what all are willing to concede to every one of those
+numerous modes of practice known to all intelligent persons by an
+opprobrious title.
+
+So long as the body is affected through the mind, no audacious
+device, even of the most manifestly dishonest character, can fail of
+producing occasional good to those who yield it an implicit or even a
+partial faith.  The argument founded on this occasional good would be
+as applicable in justifying the counterfeiter and giving circulation
+to his base coin, on the ground that a spurious dollar had often
+relieved a poor man's necessities.
+
+Homoeopathy has come before our public at a period when the growing
+spirit of eclecticism has prepared many ingenious and honest minds to
+listen to all new doctrines with a candor liable to degenerate into
+weakness.  It is not impossible that the pretended evolution of great
+and mysterious virtues from infinitely attenuated atoms may have
+enticed a few over-refining philosophers, who have slid into a vague
+belief that matter subdivided grows less material, and approaches
+nearer to a spiritual nature as it requires a more powerful
+microscope for its detection.
+
+However this may be, some persons seem disposed to take the ground of
+Menzel that the Laity must pass formal judgment between the Physician
+and the Homoeopathist, as it once did between Luther and the
+Romanists.  The practitioner and the scholar must not, therefore,
+smile at the amount of time and labor expended in these Lectures upon
+this shadowy system; which, in the calm and serious judgment of many
+of the wisest members of the medical profession, is not entitled by
+anything it has ever said or done to the notoriety of a public
+rebuke, still less to the honors of critical martyrdom.]
+
+
+I
+
+I have selected four topics for this lecture, the first three of
+which I shall touch but slightly, the last more fully.  They are
+
+1.  The Royal cure of the King's Evil, or Scrofula.
+
+2.  The Weapon Ointment, and its twin absurdity, the Sympathetic
+Powder.
+
+3.  The Tar-water mania of Bishop Berkeley.
+
+4.  The History of the Metallic Tractors, or Perkinism.
+
+The first two illustrate the ease with which numerous facts are
+accumulated to prove the most fanciful and senseless extravagances.
+
+The third exhibits the entire insufficiency of exalted wisdom,
+immaculate honesty, and vast general acquirements to make a good
+physician of a great bishop.
+
+The fourth shows us the intimate machinery of an extinct delusion,
+which flourished only forty years ago; drawn in all its details, as
+being a rich and comparatively recent illustration of the
+pretensions, the arguments, the patronage, by means of which windy
+errors have long been, and will long continue to be, swollen into
+transient consequence.  All display in superfluous abundance the
+boundless credulity and excitability of mankind upon subjects
+connected with medicine.
+
+From the time of Edward the Confessor to Queen Anne, the monarchs of
+England were in the habit of touching those who were brought to them
+suffering with the scrofula, for the cure of that distemper.  William
+the Third had good sense enough to discontinue the practice, but Anne
+resumed it, and, among her other patients, performed the royal
+operation upon a child, who, in spite of his, disease, grew up at
+last into Samuel Johnson.  After laying his hand upon the sufferers,
+it was customary for the monarch to hang a gold piece around the neck
+of each patient.  Very strict precautions were adopted to prevent
+those who thought more of the golden angel hung round the neck by a
+white ribbon, than of relief of their bodily infirmities, from making
+too many calls, as they sometimes attempted to do.  According to the
+statement of the advocates and contemporaries of this remedy, none
+ever failed of receiving benefit unless their little faith and
+credulity starved their merits.  Some are said to have been cured
+immediately on the very touch, others did not so easily get rid of
+their swellings, until they were touched a second time.  Several
+cases are related, of persons who had been blind for several weeks,
+and months, and obliged even to be led to Whitehall, yet recovered
+their sight immediately upon being touched, so as to walk away
+without any guide."  So widely, at one period, was the belief
+diffused, that, in the course of twelve years, nearly a hundred
+thousand persons were touched by Charles the Second.  Catholic
+divines; in disputes upon the orthodoxy of their church, did not deny
+that the power had descended to protestant princes;--Dr. Harpsfield,
+in his "Ecclesiastical History of England," admitted it, and in
+Wiseman's words, "when Bishop Tooker would make use of this Argument
+to prove the Truth of our Church, Smitheus doth not thereupon go
+about to deny the Matter of fact; nay, both he and Cope acknowledge
+it."  "I myself," says Wiseman, the best English surgical writer of
+his day,[Edinburgh Medical and Surgical Journal, vol. iii. p. 103.]
+--"I my self have been a frequent Eye-witness of many hundred of
+Cures performed by his Majesties Touch alone, without any assistance
+of Chirurgery; and those, many of them such as had tired out the
+endeavours of able Chirurgeons before they came hither.  It were
+endless to recite what I myself have seen, and what I have received
+acknowledgments of by Letter, not only from the severall parts of
+this Nation, but also from Ireland, Scotland, Jersey, Garnsey.  It is
+needless also to remember what Miracles of this nature were performed
+by the very Bloud of his late Majesty of Blessed memory, after whose
+decollation by the inhuman Barbarity of the Regicides, the reliques
+of that were gathered on Chips and in Handkerchieffs by the pious
+Devotes, who could not but think so great a suffering in so
+honourable and pious a Cause, would be attended by an extraordinary
+assistance of God, and some more then ordinary a miracle: nor did
+their Faith deceive them in this there point, being so many hundred
+that found the benefit of it." [Severall Chirurgicall Treatises.
+London.1676.  p.  246.]
+
+Obstinate and incredulous men, as he tells us, accounted for these
+cures in three ways: by the journey and change of air the patients
+obtained in coming to London; by the influence of imagination; and
+the wearing of gold.
+
+To these objections he answers, 1st.  That many of those cured were
+inhabitants of the city.  2d.  That the subjects of treatment were
+frequently infants.  3d.  That sometimes silver was given, and
+sometimes nothing, yet the patients were cured.
+
+A superstition resembling this probably exists at the present time in
+some ignorant districts of England and this country.  A writer in a
+Medical Journal in the year 1807, speaks of a farmer in Devonshire,
+who, being a ninth son of a ninth son, is thought endowed with
+healing powers like those of ancient royalty, and who is accustomed
+one day in every week to strike for the evil.
+
+I remember that one of my schoolmates told me, when a boy, of a
+seventh son of a seventh son, somewhere in Essex County, who touched
+for the scrofula, and who used to hang a silver fourpence halfpenny
+about the neck of those who came to him, which fourpence halfpenny it
+was solemnly affirmed became of a remarkably black color after having
+been some time worn, and that his own brother had been subjected to
+this extraordinary treatment; but I must add that my schoolmate drew
+a bow of remarkable length, strength, and toughness for his tender
+years.
+
+One of the most curious examples of the fallacy of popular belief and
+the uncertainty of asserted facts in medical experience is to be
+found in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT.
+
+Fabricius Hildanus, whose name is familiar to every surgical
+scholar, and Lord Bacon, who frequently dipped a little into
+medicine, are my principal authorities for the few circumstances I
+shall mention regarding it.  The Weapon Ointment was a preparation
+used for the healing of wounds, but instead of its being applied to
+them, the injured part was washed and bandaged, and the weapon with
+which the wound was inflicted was carefully anointed with the
+unguent.  Empirics, ignorant barbers, and men of that sort, are said
+to have especially employed it.  Still there were not wanting some
+among the more respectable members of the medical profession who
+supported its claims.  The composition of this ointment was
+complicated, in the different formulae given by different
+authorities; but some substances addressed to the imagination, rather
+than the wound or weapon, entered into all.  Such were portions of
+mummy, of human blood, and of moss from the skull of a thief hung in
+chains.
+
+Hildanus was a wise and learned man, one of the best surgeons of his
+time.  He was fully aware that a part of the real secret of the
+Unguentum Armarium consisted in the washing and bandaging the wound
+and then letting it alone.  But he could not resist the solemn
+assertions respecting its efficacy; he gave way before the outcry of
+facts, and therefore, instead of denying all their pretensions, he
+admitted and tried to account for them upon supernatural grounds.  As
+the virtue of those applications, he says, which are made to the
+weapon cannot reach the wound, and as they can produce no effect
+without contact, it follows, of necessity, that the Devil must have a
+hand in the business; and as he is by far the most long headed and
+experienced of practitioners, he cannot find this a matter of any
+great difficulty.  Hildanus himself reports, in detail, the case of a
+lady who had received a moderate wound, for which the Unguentum
+Armarium was employed without the slightest use.  Yet instead of
+receiving this flat case of failure as any evidence against the
+remedy, he accounts for its not succeeding by the devout character of
+the lady, and her freedom from that superstitious and over-
+imaginative tendency which the Devil requires in those who are to be
+benefited by his devices.
+
+Lord Bacon speaks of the Weapon Ointment, in his Natural History, as
+having in its favor the testimony of men of credit, though, in his
+own language, he himself "as yet is not fully inclined to believe
+it."  His remarks upon the asserted facts respecting it show a
+mixture of wise suspicion and partial belief.  He does not like the
+precise directions given as to the circumstances under which the
+animals from which some of the materials were obtained were to be
+killed; for he thought it looked like a provision for an excuse in
+case of failure, by laying the fault to the omission of some of these
+circumstances.  But he likes well that "they do not observe the
+confecting of the Ointment under any certain constellation; which is
+commonly the excuse of magical medicines, when they fail, that they
+were not made under a fit figure of heaven."  [This was a mistake,
+however, since the two recipes given by Hildanus are both very
+explicit as to the aspect of the heavens required for different
+stages of the process.]  "It was pretended that if the offending
+weapon could not be had, it would serve the purpose to anoint a
+wooden one made like it."  "This," says Bacon, "I should doubt to be a
+device to keep this strange form of cure in request and use; because
+many times you cannot come by the weapon itself."  And in closing his
+remarks on the statements of the advocates of the ointment, he says,
+"Lastly, it will cure a beast as well as a man, which I like best of
+all the rest, because it subjecteth the matter to an easy trial."  It
+is worth remembering, that more than two hundred years ago, when an
+absurd and fantastic remedy was asserted to possess wonderful power,
+and when sensible persons ascribed its pretended influence to
+imagination, it was boldly answered that the cure took place when the
+wounded party did not know of the application made to the weapon, and
+even when a brute animal was the subject of the experiment, and that
+this assertion, as we all know it was, came in such a shape as to
+shake the incredulity of the keenest thinker of his time.  The very
+same assertion has been since repeated in favor of Perkinism, and,
+since that, of Homoeopathy.
+
+The same essential idea as that of the Weapon Ointment reproduced
+itself in the still more famous SYMPATHETIC POWDER.  This Powder was
+said to have the faculty, if applied to the blood-stained garments of
+a wounded person, to cure his injuries, even though he were at a
+great distance at the time.  A friar, returning from the East,
+brought the recipe to Europe somewhat before the middle of the
+seventeenth century.  The Grand Duke of Florence, in which city the
+friar was residing, heard of his cures, and tried, but without
+success, to obtain his secret.  Sir Kenehn Digby, an Englishman well
+known to fame, was fortunate enough to do him a favor, which wrought
+upon his feelings and induced him to impart to his benefactor the
+composition of his extraordinary Powder.  This English knight was at
+different periods of his life an admiral, a theologian, a critic, a
+metaphysician, a politician, and a disciple of Alchemy.  As is not
+unfrequent with versatile and inflammable people, he caught fire at
+the first spark of a new medical discovery, and no sooner got home to
+England than he began to spread the conflagration.
+
+An opportunity soon offered itself to try the powers of the famous
+powder.  Mr. J. Howell, having been wounded in endeavoring to part
+two of his friends who were fighting a duel, submitted himself to a
+trial of the Sympathetic Powder.  Four days after he received his
+wounds, Sir Kenehn dipped one of Mr. Howell's gaiters in a solution
+of the Powder, and immediately, it is said, the wounds, which were
+very painful, grew easy, although the patient, who was conversing in
+a corner of the chamber, had not, the least idea of what was doing
+with his garter.  He then returned home, leaving his garter in the
+hands of Sir Kenelm, who had hung it up to dry, when Mr. Howell sent
+his servant in a great hurry to tell him that his wounds were paining
+him horribly; the garter was therefore replaced in the solution of
+the Powder, "and the patient got well after five or six days of its
+continued immersion."
+
+King James First, his son Charles the First, the Duke of Buckingham,
+then prime minister, and all the principal personages of the time,
+were cognizant of this fact; and James himself, being curious to know
+the secret of this remedy, asked it of Sir Kenelm, who revealed it to
+him, and his Majesty had the opportunity of making several trials of
+its efficacy, "which all succeeded in a surprising manner." [Dict.
+des Sciences Medieales.]
+
+The king's physician, Dr. Mayerne, was made master of the secret,
+which he carried to France and communicated to the Duke of Mayenne,
+who performed many cures by means of it, and taught it to his
+surgeon, who, after the Duke's death, sold it to many distinguished
+persons, by whose agency it soon ceased to be a secret.  What was
+this wonderful substance which so astonished kings, princes, dukes,
+knights, and doctors?  Nothing but powdered blue vitriol.  But it was
+made to undergo several processes that conferred on it extraordinary
+virtues.  Twice or thrice it was to be dissolved, filtered, and
+crystallized.  The crystals were to be laid in the sun during the
+months of June, July, and August, taking care to turn them carefully
+that all should be exposed.  Then they were to be powdered,
+triturated, and again exposed to the sun, again reduced to a very
+fine powder, and secured in a vessel, while hot, from the sunshine.
+If there seem anything remarkable in the fact of such astonishing
+properties being developed by this process, it must be from our
+short-sightedness, for common salt and charcoal develop powers quite
+as marvellous after a certain number of thumps, stirs, and shakes,
+from the hands of modern workers of miracles.  In fact the Unguentum
+Armarium and Sympathetic Powder resemble some more recent
+prescriptions; the latter consisting in an infinite dilution of the
+common dose in which remedies are given, and the two former in an
+infinite dilution of the common distance at which they are applied.
+
+Whether philosophers, and more especially metaphysicians, have any
+peculiar tendency to dabble in drugs and dose themselves with physic,
+is a question which might suggest itself to the reader of their
+biographies.
+
+When Bishop Berkeley visited the illustrious Malebranche at Paris, he
+found him in his cell, cooking in a small pipkin a medicine for an
+inflammation of the lungs, from which he was suffering; and the
+disease, being unfortunately aggravated by the vehemence of their
+discussion, or the contents of the pipkin, carried him off in the
+course of a few days.  Berkeley himself afforded a remarkable
+illustration of a truth which has long been known to the members of
+one of the learned professions, namely, that no amount of talent, or
+of acquirements in other departments, can rescue from lamentable
+folly those who, without something of the requisite preparation,
+undertake to experiment with nostrums upon themselves and their
+neighbors.  The exalted character of Berkeley is thus drawn by Sir
+James Mackintosh: Ancient learning, exact science, polished society,
+modern literature, and the fine arts, contributed to adorn and enrich
+the mind of this accomplished man.  All his contemporaries agreed
+with the satirist in ascribing
+
+     "'To Berkeley every virtue under heaven.'
+
+"Even the discerning, fastidious, and turbulent Atterbury said, after
+an interview with him, 'So much understanding, so much knowledge, so
+much innocence, and such humility, I did not think had been the
+portion of any but angels, till I saw this gentleman.'"
+
+But among the writings of this great and good man is an Essay of the
+most curious character, illustrating his weakness upon the point in
+question, and entitled, "Siris, a Chain of Philosophical Reflections
+and Inquiries concerning the Virtues of TAR WATER, and divers other
+Subjects,"--an essay which begins with a recipe for his favorite
+fluid, and slides by gentle gradations into an examination of the
+sublimest doctrines of Plato.  To show how far a man of honesty and
+benevolence, and with a mind of singular acuteness and depth, may be
+run away with by a favorite notion on a subject which his habits and
+education do not fit him to investigate, I shall give a short account
+of this Essay, merely stating that as all the supposed virtues of Tar
+Water, made public in successive editions of his treatise by so
+illustrious an author, have not saved it from neglect and disgrace,
+it may be fairly assumed that they were mainly imaginary.
+
+The bishop, as is usual in such cases, speaks of himself as
+indispensably obliged, by the duty he owes to mankind, to make his
+experience public.  Now this was by no means evident, nor does it
+follow in general, that because a man has formed a favorable opinion
+of a person or a thing he has not the proper means of thoroughly
+understanding, he shall be bound to print it, and thus give currency
+to his impressions, which may be erroneous, and therefore injurious.
+He would have done much better to have laid his impressions before
+some experienced physicians and surgeons, such as Dr. Mead and Mr.
+Cheselden, to have asked them to try his experiment over again, and
+have been guided by their answers.  But the good bishop got excited;
+he pleased himself with the thought that he had discovered a great
+panacea; and having once tasted the bewitching cup of self-quackery,
+like many before and since his time, he was so infatuated with the
+draught that he would insist on pouring it down the throats of his
+neighbors and all mankind.
+
+The precious fluid was made by stirring a gallon of water with a
+quart of tar, leaving it forty-eight hours, and pouring off the clear
+water.  Such was the specific which the great metaphysician
+recommended for averting and curing all manner of diseases.  It was,
+if he might be believed, a preventive of the small-pox, and of great
+use in the course of the disease.  It was a cure for impurities of
+the blood, coughs, pleurisy, peripneumony, erysipelas, asthma,
+indigestion, carchexia, hysterics, dropsy, mortification, scurvy, and
+hypochondria.  It was of great use in gout and fevers, and was an
+excellent preservative of the teeth and gums; answered all the
+purpose of Elixir Proprietatis, Stoughton's drops, diet drinks, and
+mineral waters; was particularly to be recommended to sea-faring
+persons, ladies, and men of studious and sedentary lives; could never
+be taken too long, but, on the contrary, produced advantages which
+sometimes did not begin to show themselves for two or three months.
+
+"From my representing Tar Water as good for so many things," says
+Berkeley, "some perhaps may conclude it is good for nothing.  But
+charity obligeth me to say what I know, and what I think, however it
+may be taken.  Men may censure and object as they please, but I
+appeal to time and experiment.  Effects misimputed, cases wrong told,
+circumstances overlooked, perhaps, too, prejudices and partialities
+against truth, may for a time prevail and keep her at the bottom of
+her well, from whence nevertheless she emergeth sooner or later, and
+strikes the eyes of all who do not keep them shut."  I cannot resist
+the temptation of illustrating the bishop's belief in the wonderful
+powers of his remedy, by a few sentences from different parts of his
+essay.  "The hardness of stubbed vulgar constitutions renders them
+insensible of a thousand things that fret and gall those delicate
+people, who, as if their skin was peeled off, feel to the quick
+everything that touches them.  The tender nerves and low spirits of
+such poor creatures would be much relieved by the use of Tar Water,
+which might prolong and cheer their lives."  "It [the Tar Water] may
+be made stronger for brute beasts, as horses, in whose disorders I
+have found it very useful."  "This same water will also give
+charitable relief to the ladies, who often want it more than the
+parish poor; being many of them never able to make a good meal, and
+sitting pale, puny, and forbidden, like ghosts, at their own table,
+victims of vapors and indigestion."  It does not appear among the
+virtues of Tar Water that "children cried for it," as for some of our
+modern remedies, but the bishop says, "I have known children take it
+for above six months together with great benefit, and without any
+inconvenience; and after long and repeated experience I do esteem it
+a most excellent diet drink, fitted to all seasons and ages."  After
+mentioning its usefulness in febrile complaints, he says: "I have had
+all this confirmed by my own experience in the late sickly season of
+the year one thousand seven hundred and forty-one, having had twenty-
+five fevers in my own family cured by this medicinal water, drunk
+copiously."  And to finish these extracts with a most important
+suggestion for the improvement of the British nation: "It is much to
+be lamented that our Insulars who act and think so much for
+themselves, should yet, from grossness of air and diet, grow stupid
+or doat sooner than other people, who, by virtue of elastic air,
+water-drinking, and light food, preserve their faculties to extreme
+old age; an advantage which may perhaps be approached, if not
+equaled, even in these regions, by Tar Water, temperance, and early
+hours."
+
+Berkeley died at the age of about seventy; he might have lived
+longer, but his fatal illness was so sudden that there was not time
+enough to stir up a quart of the panacea.  He was an illustrious man,
+but he held two very odd opinions; that tar water was everything, and
+that the whole material universe was nothing.
+
+                   ---------------------------
+
+Most of those present have at some time in their lives heard mention
+made of the METALLIC TRACTORS, invented by one Dr. Perkins, an
+American, and formerly enjoying great repute for the cure of various
+diseases.  Many have seen or heard of a satirical poem, written by
+one of our own countrymen also, about forty years since, and called
+"Terrible Tractoration."  The Metallic Tractors are now so utterly
+abandoned that I have only by good fortune fallen upon a single one
+of a pair, to show for the sake of illustration.  For more than
+thirty years this great discovery, which was to banish at least half
+the evils which afflict humanity, has been sleeping undisturbed in
+the grave of oblivion.  Not a voice has, for this long period, been
+raised in its favor; its noble and learned patrons, its public
+institutions, its eloquent advocates, its brilliant promises are all
+covered with the dust of silent neglect; and of the generation which
+has sprung up since the period when it flourished, very few know
+anything of its history, and hardly even the title which in its palmy
+days it bore of PERKINISM.  Taking it as settled, then, as no one
+appears to answer for it, that Perkinism is entirely dead and gone,
+that both in public and private, officially and individually, its
+former adherents even allow it to be absolutely defunct, I select it
+for anatomical examination.  If this pretended discovery was made
+public; if it was long kept before the public; if it was addressed to
+the people of different countries; if it was formally investigated by
+scientific men, and systematically adopted by benevolent persons, who
+did everything in their power to diffuse the knowledge and practice
+of it; if various collateral motives, such as interest and vanity,
+were embarked in its cause; if, notwithstanding all these things, it
+gradually sickened and died, then the conclusion seems a fair one,
+that it did not deserve to live.  Contrasting its failure with its
+high pretensions, it is fair to call it an imposition; whether an
+expressly fraudulent contrivance or not, some might be ready to
+question.  Everything historically shown to have happened concerning
+the mode of promulgation, the wide diffusion, the apparent success of
+this delusion, the respectability and enthusiasm of its advocates, is
+of great interest in showing to what extent and by what means a
+considerable part of the community may be led into the belief of that
+which is to be eventually considered' as an idle folly.  If there is
+any existing folly, fraudulent or innocent in its origin, which
+appeals to certain arguments for its support; provided that the very
+same arguments can be shown to have been used for Perkinism with as
+good reason, they will at once fall to the ground.  Still more, if it
+shall appear that the general course of any existing delusion bears a
+strong resemblance to that of Perkinism, that the former is most
+frequently advocated by the same class of persons who were
+conspicuous in behalf of the latter, and treated with contempt or
+opposed by the same kind of persons who thus treated Perkinism; if
+the facts in favor of both have a similar aspect; if the motives of
+their originators and propagators may be presumed to have been
+similar; then there is every reason to suppose that the existing
+folly will follow in the footsteps of the past, and after displaying
+a given amount of cunning and credulity in those deceiving and
+deceived, will drop from the public view like a fruit which has
+ripened into spontaneous rottenness, and be succeeded by the fresh
+bloom of some other delusion required by the same excitable portion
+of the community.
+
+Dr. Elisha Perkins was born at Norwich, Connecticut, in the year
+1740.  He had practised his profession with a good local reputation
+for many years, when he fell upon a course of experiments, as it is
+related, which led to his great discovery.  He conceived the idea
+that metallic substances might have the effect of removing diseases,
+if applied in a certain manner; a notion probably suggested by the
+then recent experiments of Galvani, in which muscular contractions
+were found to be produced by the contact of two metals with the
+living fibre.  It was in 1796 that his discovery was promulgated in
+the shape of the Metallic Tractors, two pieces of metal, one
+apparently iron and the other brass, about three inches long, blunt
+at one end and pointed at the other.  These instruments were applied
+for the cure of different complaints, such as rheumatism, local
+pains, inflammations, and even tumors, by drawing them over the
+affected part very lightly for about twenty minutes.  Dr. Perkins
+took out a patent for his discovery, and travelled about the country
+to diffuse the new practice.  He soon found numerous advocates of his
+discovery, many of them of high standing and influence.  In the year
+1798 the tractors had crossed the Atlantic, and were publicly
+employed in the Royal Hospital at Copenhagen.  About the same time
+the son of the inventor, Mr. Benjamin Douglass Perkins, carried them
+to London, where they soon attracted attention.  The Danish
+physicians published an account of their cases, containing numerous
+instances of alleged success, in a respectable octavo volume.  In the
+year 1804 an establishment, honored with the name of the Perkinean
+Institution, was founded in London.  The transactions of this
+institution were published in pamphlets, the Perkinean Society had
+public dinners at the Crown and Anchor, and a poet celebrated their
+medical triumph in strains like these:
+
+    "See, pointed metals, blest with power t' appease
+     The ruthless rage of merciless disease,
+     O'er the frail part a subtle fluid pour,
+     Drenched with invisible Galvanic shower,
+     Till the arthritic staff and crutch forego,
+     And leap exulting like the bounding roe!"
+
+While all these things were going on, Mr. Benjamin Douglass Perkins
+was calmly pocketing money, so that after some half a dozen years he
+left the country with more than ten thousand pounds, which had been
+paid him by the believers in Great Britain.  But in spite of all this
+success, and the number of those interested and committed in its
+behalf, Perkinism soon began to decline, and in 1811 the Tractors are
+spoken of by an intelligent writer as being almost forgotten.  Such
+was the origin and duration of this doctrine and practice, into the
+history of which we will now look a little more narrowly.
+
+Let us see, then, by whose agency this delusion was established and
+kept up; whether it was principally by those who were accustomed to
+medical pursuits, or those whose habits and modes of reasoning were
+different; whether it was with the approbation of those learned
+bodies usually supposed to take an interest in scientific
+discoveries, or only of individuals whose claims to distinction were
+founded upon their position in society, or political station, or
+literary eminence; whether the judicious or excitable classes entered
+most deeply into it; whether, in short, the scientific men of that
+time were deceived, or only intruded upon, and shouted down for the
+moment by persons who had no particular call to invade their
+precincts.
+
+Not much, perhaps, was to be expected of the Medical Profession in
+the way of encouragement.  One Dr. Fuller, who wrote in England,
+himself a Perkinist, thus expressed his opinion: "It must be an
+extraordinary exertion of virtue and humanity for a medical man,
+whose livelihood depends either on the sale of drugs, or on receiving
+a guinea for writing a prescription, which must relate to those
+drugs, to say to his patient, 'You had better purchase a set of
+Tractors to keep in your family; they will cure you without the
+expense of my attendance, or the danger of the common medical
+practice.'  For very obvious reasons medical men must never be
+expected to recommend the use of Perkinism.  The Tractors must trust
+for their patronage to the enlightened and philanthropic out of the
+profession, or to medical men retired from practice, and who know of
+no other interest than the luxury of relieving the distressed.  And I
+do not despair of seeing the day when but very few of this
+description as well as private families will be without them."
+
+Whether the motives assigned by this medical man to his professional
+brethren existed or not, it is true that Dr. Perkins did not gain a
+great deal at their hands.  The Connecticut Medical Society expelled
+him in 1797 for violating their law against the use of nostrums, or
+secret remedies.  The leading English physicians appear to have
+looked on with singular apathy or contempt at the miracles which it
+was pretended were enacting in the hands of the apostles of the new
+practice.  In looking over the reviews of the time, I have found
+little beyond brief occasional notices of their pretensions; the
+columns of these journals being occupied with subjects of more
+permanent interest.  The state of things in London is best learned,
+however, from the satirical poem to which I have already alluded as
+having been written at the period referred to.  This was entitled,
+"Terrible Tractoration!!  A Poetical Petition against Galvanizing
+Trumpery and the Perkinistic Institution.  Most respectfully
+addressed to the Royal College of Physicians, by Christopher Caustic,
+M. D., LL. D., A. S. S., Fellow of the Royal College of Physicians,
+Aberdeen, and Honorary Member of no less than nineteen very learned
+Societies."  Two editions of this work were published in London in
+the years 1803 and 1804, and one or two have been published in this
+country.
+
+"Terrible Tractoration" is supposed, by those who never read it, to
+be a satire upon the follies of Perkins and his followers.  It is, on
+the contrary, a most zealous defence of Perkinism, and a fierce
+attack upon its opponents, most especially upon such of the medical
+profession as treated the subject with neglect or ridicule.  The
+Royal College of Physicians was the more peculiar object of the
+attack, but with this body, the editors of some of the leading
+periodicals, and several physicians distinguished at that time, and
+even now remembered for their services to science and humanity, were
+involved in unsparing denunciations.  The work is by no means of the
+simply humorous character it might be supposed, but is overloaded
+with notes of the most seriously polemical nature.  Much of the
+history of the subject, indeed, is to be looked for in this volume.
+
+It appears from this work that the principal members of the medical
+profession, so far from hailing Mr. Benjamin Douglass Perkins as
+another Harvey or Jenner, looked very coldly upon him and his
+Tractors; and it is now evident that, though they were much abused
+for so doing, they knew very well what they had to deal with, and
+were altogether in the right.  The delusion at last attracted such an
+amount of attention as to induce Dr. Haygarth and some others of
+respectable standing to institute some experiments which I shall
+mention in their proper place, the result of which might have seemed
+sufficient to show the emptiness of the whole contrivance.
+
+The Royal Society, that learned body which for ages has constituted
+the best tribunal to which Britain can appeal in questions of
+science, accepted Mr. Perkins's Tractors and the book written about
+them, passed the customary vote of thanks, and never thought of
+troubling itself further in the investigation of pretensions of such
+an aspect.  It is not to be denied that a considerable number of
+physicians did avow themselves advocates of the new practice; but out
+of the whole catalogue of those who were publicly proclaimed as such,
+no one has ever been known, so far as I am aware, to the scientific
+world, except in connection with the short-lived notoriety of
+Perkinism.  Who were the people, then, to whose activity, influence,
+or standing with the community was owing all the temporary excitement
+produced by the Metallic Tractors?
+
+First, those persons who had been induced to purchase a pair of
+Tractors.  These little bits of brass and iron, the intrinsic value
+of which might, perhaps, amount to ninepence, were sold at five
+guineas a pair!  A man who has paid twenty-five dollars for his
+whistle is apt to blow it louder and longer than other people.  So it
+appeared that when the "Perkinean Society" applied to the possessors
+of Tractors in the metropolis to concur in the establishment of a
+public institution for the use of these instruments upon the poor,
+"it was found that only five out of above a hundred objected to
+subscribe, on account of their want of confidence in the efficacy of
+the practice; and these," the committee observes, "there is reason to
+believe, never gave them a fair trial, probably never used them in
+more than one case, and that perhaps a case in which the Tractors had
+never been recommended as serviceable."  "Purchasers of the
+Tractors," said one of their ardent advocates, "would be among the
+last to approve of them if they had reason to suppose themselves
+defrauded of five guineas."  He forgot poor Moses, with his "gross of
+green spectacles, with silver rims and shagreen cases."  "Dear
+mother," cried the boy, "why won't you listen to reason?  I had them
+a dead bargain, or I should not have bought them.  The silver rims
+alone will sell for double the money."
+
+But it is an undeniable fact, that many persons of considerable
+standing, and in some instances holding the most elevated positions
+in society, openly patronized the new practice.  In a translation of
+a work entitled "Experiments with the Metallic Tractors," originally
+published in Danish, thence rendered successively into German and
+English, Mr. Benjamin Perkins, who edited the English edition, has
+given a copious enumeration of the distinguished individuals, both in
+America and Europe, whose patronage he enjoyed.  He goes so far as to
+signify that ROYALTY itself was to be included among the number.
+When the Perkinean Institution was founded, no less a person than
+Lord Rivers was elected President, and eleven other individuals of
+distinction, among them Governor Franklin, son of Dr. Franklin,
+figured as Vice-Presidents.  Lord Henniker, a member of the Royal
+Society, who is spoken of as a man of judgment and talents,
+condescended to patronize the astonishing discovery, and at different
+times bought three pairs of Tractors.  When the Tractors were
+introduced into Europe, a large number of testimonials accompanied
+them from various distinguished characters in America, the list of
+whom is given in the translation of the Danish work referred to as
+follows:
+
+"Those who have individually stated cases, or who have presented
+their names to the public as men who approved of this remedy, and
+acknowledged themselves instrumental in circulating the Tractors, are
+fifty-six in number; thirty-four of whom are physicians and surgeons,
+and many of them of the first eminence, thirteen clergymen, most of
+whom are doctors of divinity, and connected with the literary
+institutions of America; among the remainder are two members of
+Congress, one professor of natural philosophy in a college, etc.,
+etc."  It seemed to be taken rather hardly by Mr. Perkins that the
+translators of the work which he edited, in citing the names of the
+advocates of the Metallic Practice, frequently omitted the honorary
+titles which should have been annexed.  The testimonials were
+obtained by the Danish writer, from a pamphlet published in America,
+in which these titles were given in full.  Thus one of these
+testimonials is from "John Tyler, Esq., a magistrate in the county
+of New London, and late Brigadier-General of the militia in that
+State."  The "omission of the General's title" is the subject of
+complaint, as if this title were sufficient evidence of the
+commanding powers of one of the patrons of tractoration.  A similar
+complaint is made when "Calvin Goddard, Esq., of Plainfield, Attorney
+at Law, and a member of the Legislature of the State of Connecticut,"
+is mentioned without his titular honors, and even on account of the
+omission of the proper official titles belonging to "Nathan Pierce,
+Esq., Governor and Manager of the Almshouse of Newburyport."  These
+instances show the great importance to be attached to civil and
+military dignities, in qualifying their holders to judge of
+scientific subjects, a truth which has not been overlooked by the
+legitimate successors of the Perkinists.  In Great Britain, the
+Tractors were not less honored than in America, by the learned and
+the illustrious.  The "Perkinistic Committee" made this statement in
+their report: "Mr. Perkins has annually laid before the public a
+large collection of new cases communicated to him for that purpose by
+disinterested and intelligent characters, from almost every quarter
+of Great Britain.  In regard to the competency of these vouchers, it
+will be sufficient simply to state that, amongst others whose names
+have been attached to their communications, are eight professors, in
+four different universities, twenty-one regular Physicians, nineteen
+Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity,
+and numerous other characters of equal respectability."
+
+It cannot but excite our notice and surprise that the number of
+clergymen both in America and Great Britain who thrust forward their
+evidence on this medical topic was singularly large in proportion to
+that of the members of the medical profession.  Whole pages are
+contributed by such worthies as the Rev. Dr. Trotter of Hans Place,
+the Rear.  Waring Willett, Chaplain to the Earl of Dunmore, the Rev.
+Dr. Clarke, Chaplain to the Prince of Wales.  The style of these
+theologico-medical communications may be seen in the following from a
+divine who was also professor in one of the colleges of New England.
+"I have used the Tractors with success in several other cases in my
+own family, and although, like Naaman the Syrian, I cannot tell why
+the waters of Jordan should be better than Abana and Pharpar, rivers
+of Damascus; yet since experience has proved them so, no reasoning
+can change the opinion.  Indeed, the causes of all common facts are,
+we think, perfectly well known to us; and it is very probable, fifty
+or a hundred years hence, we shall as well know why the Metallic
+Tractors should in a few minutes remove violent pains, as we now know
+why cantharides and opium will produce opposite effects, namely, we
+shall know very little about either excepting facts."  Fifty or a
+hundred years hence! if he could have looked forward forty years, he
+would have seen the descendants of the "Perkinistic" philosophers
+swallowing infinitesimal globules, and knowing and caring as much
+about the Tractors as the people at Saratoga Springs do about the
+waters of Abana and Pharpar.
+
+I trust it will not be thought in any degree disrespectful to a
+profession which we all honor, that I have mentioned the great zeal
+of many clergymen in the cause of Perkinism.  I hope, too, that I may
+without offence suggest the causes which have often led them out of
+their own province into one to which their education has no special
+reference.  The members of that profession ought to be, and commonly
+are, persons of benevolent character.  Their duties carry them into
+the midst of families, and particularly at times when the members of
+them are suffering from bodily illness.  It is natural enough that a
+strong desire should be excited to alleviate sufferings which may
+have defied the efforts of professional skill; as natural that any
+remedy which recommends itself to the belief or the fancy of the
+spiritual physician should be applied with the hope of benefit; and
+perfectly certain that the weakness of human nature, from which no
+profession is exempt, will lead him to take the most flattering view
+of its effects upon the patient; his own sagacity and judgment being
+staked upon the success of the trial.  The inventor of the Tractors
+was aware of these truths.  He therefore sent the Tractors
+gratuitously to many clergymen, accompanied with a formal certificate
+that the holder had become entitled to their possession by the
+payment of five guineas.  This was practised in our own neighborhood,
+and I remember finding one of these certificates, so presented, which
+proved that amongst the risks of infancy I had to encounter Perkins's
+Tractors.  Two clergymen of Boston and the vicinity, both well known
+to local fame, gave in their testimony to the value of the
+instruments thus presented to them; an unusually moderate proportion,
+when it is remembered that to the common motives of which I have
+spoken was added the seduction of a gift for which the profane public
+was expected to pay so largely.
+
+It was remarkable, also, that Perkinism, which had so little success
+with the medical and scientific part of the community, found great
+favor in the eyes of its more lovely and less obstinate portion.
+"The lady of Major Oxholin,"--I quote from Mr. Perkins's volume,--
+"having been lately in America, had seen and heard much of the great
+effects of Perkinism.  Influenced by a most benevolent disposition,
+she brought these Tractors and the pamphlet with her to Europe, with
+a laudable desire of extending their utility to her suffering
+countrymen."  Such was the channel by which the Tractors were
+conveyed to Denmark, where they soon became the ruling passion.
+The workmen, says a French writer, could not manufacture them fast
+enough.  Women carried them about their persons, and delighted in
+bringing them into general use.  To what extent the Tractors were
+favored with the patronage of English and American ladies, it is of
+course not easy to say, except on general principles, as their names
+were not brought before the public.  But one of Dr. Haygarth's
+stories may lead us to conjecture that there was a class of female
+practitioners who went about doing good with the Tractors in England
+as well as in Denmark.  A certain lady had the misfortune to have a
+spot as big as a silver penny at the corner of her eye, caused by a
+bruise, or some such injury.  Another lady, who was a friend of hers,
+and a strong believer in Perkinism, was very anxious to try the
+effects of tractoration upon this unfortunate blemish.  The patient
+consented; the lady "produced the instruments, and, after drawing
+them four or five times over the spot, declared that it changed to a
+paler color, and on repeating the use of them a few minutes longer,
+that it had almost vanished, and was scarcely visible, and departed
+in high triumph at her success."  The lady who underwent the
+operation assured the narrator "that she looked in the glass
+immediately after, and that not the least visible alteration had
+taken place."
+
+It would be a very interesting question, what was the intellectual
+character of those persons most conspicuous in behalf of the
+Perkinistic delusion?  Such an inquiry might bring to light some
+principles which we could hereafter apply to the study of other
+popular errors.  But the obscurity into which nearly all these
+enthusiasts have subsided renders the question easier to ask than to
+answer.  I believe it would have been found that most of these
+persons were of ardent temperament and of considerable imagination,
+and that their history would show that Perkinism was not the first
+nor the last hobby-horse they rode furiously.  Many of them may very
+probably have been persons of more than common talent, of active and
+ingenious minds, of versatile powers and various acquirements.  Such,
+for instance, was the estimable man to whom I have repeatedly
+referred as a warm defender of tractoration, and a bitter assailant
+of its enemies.  The story tells itself in the biographical preface
+to his poem.  He went to London with the view of introducing a
+hydraulic machine, which he and his Vermont friends regarded as a
+very important invention.  He found, however, that the machine was
+already in common use in that metropolis.  A brother Yankee, then in
+London, had started the project of a mill, which was to be carried by
+the water of the Thames.  He was sanguine enough to purchase one
+fifth of this concern, which also proved a failure.  At about the
+same period he wrote the work which proved the great excitement of
+his mind upon the subject of the transient folly then before the
+public.  Originally a lawyer, he was in succession a mechanician, a
+poet, and an editor, meeting with far less success in each of these
+departments than usually attends men of less varied gifts, but of
+more tranquil and phlegmatic composition.  But who is ignorant that
+there is a class of minds characterized by qualities like those I
+have mentioned; minds with many bright and even beautiful traits; but
+aimless and fickle as the butterfly; that settle upon every gayly-
+colored illusion as it opens into flower, and flutter away to another
+when the first has dropped its leaves, and stands naked in the icy
+air of truth!
+
+Let us now look at the general tenor of the arguments addressed by
+believers to sceptics and opponents.  Foremost of all, emblazoned at
+the head of every column, loudest shouted by every triumphant
+disputant, held up as paramount to all other considerations,
+stretched like an impenetrable shield to protect the weakest advocate
+of the great cause against the weapons of the adversary, was that
+omnipotent monosyllable which has been the patrimony of cheats and
+the currency of dupes from time immemorial,--Facts! Facts! Facts!
+First came the published cases of the American clergymen, brigadier-
+generals, almshouse governors, representatives, attorneys, and
+esquires.  Then came the published cases of the surgeons of
+Copenhagen.  Then followed reports of about one hundred and fifty
+cases published in England, "demonstrating the efficacy of the
+metallic practice in a variety of complaints both upon the human body
+and on horses, etc."  But the progress of facts in Great Britain did
+not stop here.  Let those who rely upon the numbers of their
+testimonials, as being alone sufficient to prove the soundness and
+stability of a medical novelty, digest the following from the report
+of the Perkinistic Committee.  "The cases published [in Great
+Britain] amounted, in March last, the date of Mr. Perkins's last
+publication, to about five thousand.  Supposing that not more than
+one cure in three hundred which the Tractors have performed has been
+published, and the proportion is probably much greater, it will be
+seen that the number, to March last, will have exceeded one million
+five hundred thousand!"
+
+Next in order after the appeal to what were called facts, came a
+series of arguments, which have been so long bruised and battered
+round in the cause of every doctrine or pretension, new, monstrous,
+or deliriously impossible, that each of them is as odiously familiar
+to the scientific scholar as the faces of so many old acquaintances,
+among the less reputable classes, to the officers of police.
+
+No doubt many of my hearers will recognize, in the following
+passages, arguments they may have heard brought forward with
+triumphant confidence in behalf of some doctrine not yet extinct.  No
+doubt some may have honestly thought they proved something; may have
+used them with the purpose of convincing their friends, or of
+silencing the opponents of their favorite doctrine, whatever that
+might be.  But any train of arguments which was contrived for
+Perkinism, which was just as applicable to it as to any other new
+doctrine in the same branch of science, and which was fully employed
+against its adversaries forty years since, might, in common charity,
+be suffered to slumber in the grave of Perkinism.  Whether or not the
+following sentences, taken literally from the work of Mr. Perkins,
+were the originals of some of the idle propositions we hear bandied
+about from time to time, let those who listen judge.
+
+The following is the test assumed for the new practice: "If diseases
+are really removed, as those persons who have practised extensively
+with the Tractors declare, it should seem there would be but little
+doubt of their being generally adopted; but if the numerous reports
+of their efficacy which have been published are forgeries, or are
+unfounded, the practice ought to be crushed."  To this I merely add,
+it has been crushed.
+
+The following sentence applies to that a priori judging and uncandid
+class of individuals who buy their dinners without tasting all the
+food there is in the market.  "On all discoveries there are persons
+who, without descending to any inquiry into the truth, pretend to
+know, as it were by intuition, that newly asserted facts are founded
+in the grossest errors.  These were those who knew that Harvey's
+report of the circulation of the blood was a preposterous and
+ridiculous suggestion, and in latter later days there were others who
+knew that Franklin deserved reproach for declaring that points were
+preferable to balls for protecting buildings from lightning."
+
+Again: "This unwarrantable mode of offering assertion for proof, so
+unauthorized and even unprecedented except in the condemnation of a
+Galileo, the persecution of a Copernicus, and a few other acts of
+inquisitorial authority, in the times of ignorance and superstition,
+affords but a lamentable instance of one of his remarks, that this is
+far from being the Age of Reason."
+
+"The most valuable medicines in the Materia Medica act on principles
+of which we are totally ignorant.  None have ever yet been able to
+explain how opium produces sleep, or how bark cures intermittent
+fevers; and yet few, it is hoped, will be so absurd as to desist from
+the use of these important articles because they know nothing of the
+principle of their operations."  Or if the argument is preferred, in
+the eloquent language of the Perkinistic poet:
+
+    "What though the CAUSES may not be explained,
+     Since these EFFECTS are duly ascertained,
+     Let not self-interest, prejudice, or pride,
+     Induce mankind to set the means aside;
+     Means which, though simple, are by
+     Heaven designed to alleviate the woes of human kind."
+
+This course of argument is so often employed, that it deserves to be
+expanded a little, so that its length and breadth may be fairly seen.
+A series of what are called facts is brought forward to prove some
+very improbable doctrine.  It is objected by judicious people, or
+such as have devoted themselves to analogous subjects, that these
+assumed facts are in direct opposition to all that is known of the
+course of nature, that the universal experience of the past affords a
+powerful presumption against their truth, and that in proportion to
+the gravity of these objections, should be the number and competence
+of the witnesses.  The answer is a ready one.  What do we know of the
+mysteries of Nature?  Do we understand the intricate machinery of the
+Universe?  When to this is added the never-failing quotation,
+
+    "There are more things in heaven and earth, Horatio,
+     Than are dreamt of in your philosophy,"--
+
+the question is thought to be finally disposed of.
+
+Take the case of astrology as an example.  It is in itself strange
+and incredible that the relations of the heavenly bodies to each
+other at a given moment of time, perhaps half a century ago, should
+have anything to do with my success or misfortune in any undertaking
+of to-day.  But what right have I to say it cannot be so?  Can I bind
+the sweet influences of Pleiades, or loose the bands of Orion?  I do
+not know by what mighty magic the planets roll in their fluid paths,
+confined to circles as unchanging as if they were rings of steel, nor
+why the great wave of ocean follows in a sleepless round upon the
+skirts of moonlight; nor cam I say from any certain knowledge that
+the phases of the heavenly bodies, or even the falling of the leaves
+of the forest, or the manner in which the sands lie upon the sea-
+shore, may not be knit up by invisible threads with the web of human
+destiny.  There is a class of minds much more ready to believe that
+which is at first sight incredible, and because it is incredible,
+than what is generally thought reasonable.  Credo quia impossibile
+est,--"I believe, because it is impossible,"--is an old paradoxical
+expression which might be literally applied to this tribe of persons.
+And they always succeed in finding something marvellous, to call out
+the exercise of their robust faith.  The old Cabalistic teachers
+maintained that there was not a verse, line, word, or even letter in
+the Bible which had not a special efficacy either to defend the
+person who rightly employed it, or to injure his enemies; always
+provided the original Hebrew was made use of.  In the hands of modern
+Cabalists every substance, no matter how inert, acquires wonderful
+medicinal virtues, provided it be used in a proper state of purity
+and subdivision.
+
+I have already mentioned the motives attributed by the Perkinists to
+the Medical Profession, as preventing its members from receiving the
+new but unwelcome truths.  This accusation is repeated in different
+forms and places, as, for instance, in the following passage:
+"Will the medical man who has spent much money and labor in the
+pursuit of the arcana of Physic, and on the exercise of which depends
+his support in life, proclaim the inefficacy of his art, and
+recommend a remedy to his patient which the most unlettered in
+society can employ as advantageously as himself? and a remedy, too,
+which, unlike the drops, the pills, the powders, etc., of the Materia
+Medica, is inconsumable, and ever in readiness to be employed in
+successive diseases?"
+
+As usual with these people, much indignation was expressed at any
+parallel between their particular doctrine and practice and those of
+their exploded predecessors.  "The motives," says the disinterested
+Mr. Perkins, "which must have impelled to this attempt at classing
+the METALLIC PRACTICE with the most paltry of empyrical projects, are
+but too thinly veiled to escape detection."
+
+To all these arguments was added, as a matter of course, an appeal to
+the feelings of the benevolent in behalf of suffering humanity, in
+the shape of a notice that the poor would be treated gratis.  It is
+pretty well understood that this gratuitous treatment of the poor
+does not necessarily imply an excess of benevolence, any more than
+the gratuitous distribution of a trader's shop-bills is an evidence
+of remarkable generosity; in short, that it is one of those things
+which honest men often do from the best motives, but which rogues and
+impostors never fail to announce as one of their special
+recommendations.  It is astonishing to see how these things brighten
+up at the touch of Mr. Perkins's poet:
+
+    "Ye worthy, honored, philanthropic few,
+     The muse shall weave her brightest wreaths for you,
+     Who in Humanity's bland cause unite,
+     Nor heed the shaft by interest aimed or spite;
+     Like the great Pattern of Benevolence,
+     Hygeia's blessings to the poor dispense;
+     And though opposed by folly's servile brood,
+     ENJOY THE LUXURY OF DOING GOOD."
+
+Having thus sketched the history of Perkinism in its days of
+prosperity; having seen how it sprung into being, and by what means
+it maintained its influence, it only remains to tell the brief story
+of its discomfiture and final downfall.  The vast majority of the
+sensible part of the medical profession were contented, so far as we
+can judge, to let it die out of itself.  It was in vain that the
+advocates of this invaluable discovery exclaimed over their perverse
+and interested obstinacy,--in vain that they called up the injured
+ghosts of Harvey, Galileo, and Copernicus to shame that unbelieving
+generation; the Baillies and the Heberdens,--men whose names have
+come down to us as synonymous with honor and wisdom,--bore their
+reproaches in meek silence, and left them unanswered to their fate.
+There were some others, however, who, believing the public to labor
+under a delusion, thought it worth while to see whether the charm
+would be broken by an open trial of its virtue, as compared with that
+of some less hallowed formula.  It must be remembered that a peculiar
+value was attached to the Metallic Tractors, as made and patented by
+Mr. Perkins.  Dr. Haygarth, of Bath, performed various experiments
+upon patients afflicted with different complaints,--the patients
+supposing that the real five-guinea Tractors were employed.  Strange
+to relate, he obtained equally wonderful effects with Tractors of
+lead and of wood; with nails, pieces of bone, slate pencil, and
+tobacco-pipe.  Dr. Alderson employed sham Tractors made of wood, and
+produced such effects upon five patients that they returned solemn
+thanks in church for their cures.  A single specimen of these cases
+may stand for all of them.  Ann Hill had suffered for some months
+from pain in the right arm and shoulder.  The Tractors (wooden ones)
+were applied, and in the space of five minutes she expressed herself
+relieved in the following apostrophe: "Bless me! why, who could have
+thought it, that them little things could pull the pain from one.
+Well, to be sure, the longer one lives, the more one sees; ah, dear!"
+
+These experiments did not result in the immediate extinction of
+Perkinism.  Doubtless they were a great comfort to many obstinate
+unbelievers, and helped to settle some sceptical minds; but for the
+real Perkinistic enthusiasts, it may be questioned whether they would
+at that time have changed their opinion though one had risen from the
+dead to assure them that it was an error.  It perished without
+violence, by an easy and natural process.  Like the famous toy of
+Mongolfier, it rose by means of heated air,--the fevered breath of
+enthusiastic ignorance,--and when this grew cool, as it always does
+in a little while, it collapsed and fell.
+
+And now, on reviewing the whole subject, how shall we account for the
+extraordinary prevalence of the belief in Perkinism among a portion
+of what is supposed to be the thinking part of the community?
+
+Could the cures have been real ones, produced by the principle of
+ANIMAL MAGNETISM?  To this it may be answered that the Perkinists
+ridiculed the idea of approximating Mesmer and the founder of their
+own doctrine, that nothing like the somnambulic condition seems to
+have followed the use of the Tractors, and that neither the exertion
+of the will nor the powers of the individual who operated seem to
+have been considered of any consequence.  Besides, the absolute
+neglect into which the Tractors soon declined is good evidence that
+they were incapable of affording any considerable and permanent
+relief in the complaints for the cure of which they were applied.
+
+Of course a large number of apparent cures were due solely to nature;
+which is true under every form of treatment, orthodox or empirical.
+Of course many persons experienced at least temporary relief from the
+strong impression made upon their minds by this novel and marvellous
+method of treatment.
+
+Many, again, influenced by the sanguine hopes of those about them,
+like dying people, who often say sincerely, from day to day, that
+they are getting better, cheated themselves into a false and short-
+lived belief that they were cured; and as happens in such cases, the
+public never knew more than the first half of the story.
+
+When it was said to the Perkinists, that whatever effects they
+produced were merely through the imagination, they declared (like the
+advocates of the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this
+explanation was sufficiently disproved by the fact of numerous and
+successful cures which had been witnessed in infants and brute
+animals.  Dr. Haygarth replied to this, that "in these cases it is
+not the Patient, but the Observer, who is deceived by his own
+imagination," and that such may be the fact, we have seen in the case
+of the good lady who thought she had conjured away the spot from her
+friend's countenance, when it remained just as before.
+
+As to the motives of the inventor and vender of the Tractors, the
+facts must be allowed to speak for themselves.  But when two little
+bits of brass and iron are patented, as an invention, as the result
+of numerous experiments, when people are led, or even allowed, to
+infer that they are a peculiar compound, when they are artfully
+associated with a new and brilliant discovery (which then happened to
+be Galvanism), when they are sold at many hundred times their value,
+and the seller prints his opinion that a Hospital will suffer
+inconvenience, "unless it possesses many sets of the Tractors, and
+these placed in the hands of the patients to practise on each other,"
+one cannot but suspect that they were contrived in the neighborhood
+of a wooden nutmeg factory; that legs of ham in that region are not
+made of the best mahogany; and that such as buy their cucumber seed
+in that vicinity have to wait for the fruit as long as the Indians
+for their crop of gunpowder.
+
+
+                   ---------------------------
+
+The succeeding lecture will be devoted to an examination of the
+doctrines of Samuel Hahnemann and his disciples; doctrines which some
+consider new and others old; the common title of which is variously
+known as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy,
+and the claims of which are considered by some as infinitely
+important, and by many as immeasurably ridiculous.
+
+I wish to state, for the sake of any who may be interested in the
+subject, that I shall treat it, not by ridicule, but by argument;
+perhaps with great freedom, but with good temper and in peaceable
+language; with very little hope of reclaiming converts, with no
+desire of making enemies, but with a firm belief that its pretensions
+and assertions cannot stand before a single hour of calm
+investigation.
+
+
+
+
+II.
+
+It may be thought that a direct attack upon the pretensions of
+HOMOEOPATHY is an uncalled-for aggression upon an unoffending
+doctrine and its peaceful advocates.
+
+But a little inquiry will show that it has long assumed so hostile a
+position with respect to the Medical Profession, that any trouble I,
+or any other member of that profession, may choose to bestow upon it
+may be considered merely as a matter of self-defence.  It began with
+an attempt to show the insignificance of all existing medical
+knowledge.  It not only laid claim to wonderful powers of its own,
+but it declared the common practice to be attended with the most
+positively injurious effects, that by it acute diseases are
+aggravated, and chronic diseases rendered incurable.  It has at
+various times brought forward collections of figures having the air
+of statistical documents, pretending to show a great proportional
+mortality among the patients of the Medical Profession, as compared
+with those treated according to its own rules.  Not contented with
+choosing a name of classical origin for itself, it invented one for
+the whole community of innocent physicians, assuring them, to their
+great surprise, that they were all ALLOPATHISTS, whether they knew it
+or not, and including all the illustrious masters of the past, from
+Hippocrates down to Hunter, under the same gratuitous title.  The
+line, then, has been drawn by the champions of the new doctrine; they
+have lifted the lance, they have sounded the charge, and are
+responsible for any little skirmishing which may happen.
+
+But, independently of any such grounds of active resistance, the
+subject involves interests so disproportioned to its intrinsic
+claims, that it is no more than an act of humanity to give it a
+public examination.  If the new doctrine is not truth, it is a
+dangerous, a deadly error.  If it is a mere illusion, and acquires
+the same degree of influence that we have often seen obtained by
+other illusions, there is not one of my audience who may not have
+occasion to deplore the fatal credulity which listened to its
+promises.
+
+I shall therefore undertake a sober examination of its principles,
+its facts, and some points of its history.  The limited time at my
+disposal requires me to condense as much as possible what I have to
+say, but I shall endeavor to be plain and direct in expressing it.
+Not one statement shall be made which cannot be supported by
+unimpeachable reference: not one word shall be uttered which I am not
+as willing to print as to speak.  I have no quibbles to utter, and I
+shall stoop to answer none; but, with full faith in the sufficiency
+of a plain statement of facts and reasons, I submit the subject to
+the discernment of my audience.
+
+
+The question may be asked in the outset,--Have you submitted the
+doctrines you are professing to examine to the test of long-repeated
+and careful experiment; have you tried to see whether they were true
+or not?  To this I answer, that it is abundantly evident, from what
+has often happened, that it would be of no manner of use for me to
+allege the results of any experiments I might have instituted.  Again
+and again have the most explicit statements been made by the most
+competent persons of the utter failure of all their trials, and there
+were the same abundant explanations offered as used to be for the
+Unguentum Armarium arid the Metallic Tractors.  I could by no
+possibility perform any experiments the result of which could not be
+easily explained away so as to be of no conclusive significance.
+Besides, as arguments in favor of Homoeopathy are constantly
+addressed to the public in journals, pamphlets, and even lectures, by
+inexperienced dilettanti, the same channel must be open to all its
+opponents.
+
+It is necessary, for the sake of those to whom the whole subject may
+be new, to give in the smallest possible compass the substance of the
+Homoeopathic Doctrine.  Samuel Hahnemann, its founder, is a German
+physician, now living in Paris, [Hahnemann died in 1843.] at the age
+of eighty-seven years.  In 1796 he published the first paper
+containing his peculiar notions; in 1805 his first work on the
+subject; in 1810 his somewhat famous "Organon of the Healing Art;"
+the next year what he called the "Pure Materia Medica;" and in 1828
+his last work, the "Treatise on Chronic Diseases."  He has therefore
+been writing at intervals on his favorite subject for nearly half a
+century.
+
+The one great doctrine which constitutes the basis of Homoeopathy as
+a system is expressed by the Latin aphorism,
+
+               "SIMILIA SIBILIBUS CURANTUR,"
+
+or like cures like, that is, diseases are cured by agents capable of
+producing symptoms resembling those found in the disease under
+treatment.  A disease for Hahnemann consists essentially in a group
+of symptoms.  The proper medicine for any disease is the one which is
+capable of producing a similar group of symptoms when given to a
+healthy person.
+
+It is of course necessary to know what are the trains of symptoms
+excited by different substances, when administered to persons in
+health, if any such can be shown to exist.  Hahnemann and his
+disciples give catalogues of the symptoms which they affirm were
+produced upon themselves or others by a large number of drugs which
+they submitted to experiment.
+
+The second great fact which Hahnemann professes to have established
+is the efficacy of medicinal substances reduced to a wonderful degree
+of minuteness or dilution.  The following account of his mode of
+preparing his medicines is from his work on Chronic Diseases, which
+has not, I believe, yet been translated into English.  A grain of the
+substance, if it is solid, a drop if it is liquid, is to be added to
+about a third part of one hundred grains of sugar of milk in an
+unglazed porcelain capsule which has had the polish removed from the
+lower part of its cavity by rubbing it with wet sand; they are to be
+mingled for an instant with a bone or horn spatula, and then rubbed
+together for six minutes; then the mass is to be scraped together
+from the mortar and pestle, which is to take four minutes; then to be
+again rubbed for six minutes.  Four minutes are then to be devoted to
+scraping the powder into a heap, and the second third of the hundred
+grains of sugar of milk to be added.  Then they are to be stirred an
+instant and rubbed six minutes,--again to be scraped together four
+minutes and forcibly rubbed six; once more scraped together for four
+minutes, when the last third of the hundred grains of sugar of milk
+is to be added and mingled by stirring with the spatula; six minutes
+of forcible rubbing, four of scraping together, and six more
+(positively the last six) of rubbing, finish this part of the
+process.
+
+Every grain of this powder contains the hundredth of a grain of the
+medicinal substance mingled with the sugar of milk.  If, therefore, a
+grain of the powder just prepared is mingled with another hundred
+grains of sugar of milk, and the process just described repeated, we
+shall have a powder of which every grain contains the hundredth of
+the hundredth, or the ten thousandth part of a grain of the medicinal
+substance.  Repeat the same process with the same quantity of fresh
+sugar of milk, and every grain of your powder will contain the
+millionth of a grain of the medicinal substance.  When the powder is
+of this strength, it is ready to employ in the further solutions and
+dilutions to be made use of in practice.
+
+A grain of the powder is to be taken, a hundred drops of alcohol are
+to be poured on it, the vial is to be slowly turned for a few
+minutes, until the powder is dissolved, and two shakes are to be
+given to it.  On this point I will quote Hahnemann's own words.
+"A long experience and multiplied observations upon the sick lead me
+within the last few years to prefer giving only two shakes to
+medicinal liquids, whereas I formerly used to give ten."  The process
+of dilution is carried on in the same way as the attenuation of the
+powder was done; each successive dilution with alcohol reducing the
+medicine to a hundredth part of the quantity of that which preceded
+it.  In this way the dilution of the original millionth of a grain of
+medicine contained in the grain of powder operated on is carried
+successively to the billionth, trillionth, quadrillionth,
+quintillionth, and very often much higher fractional divisions.  A
+dose of any of these medicines is a minute fraction of a drop,
+obtained by moistening with them one or more little globules of
+sugar, of which Hahnemann says it takes about two hundred to weigh a
+grain.
+
+As an instance of the strength of the medicines prescribed by
+Hahnemann, I will mention carbonate of lime.  He does not employ
+common chalk, but prefers a little portion of the friable part of an
+oystershell.  Of this substance, carried to the sextillionth degree,
+so much as one or two globules of the size mentioned can convey is a
+common dose.  But for persons of very delicate nerves it is proper
+that the dilution should be carried to the decillionth degree.  That
+is, an important medicinal effect is to be expected from the two
+hundredth or hundredth part of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of the
+millionth of the millionth of the millionth of the millionth of a
+grain of oyster-shell.  This is only the tenth degree of potency, but
+some of his disciples profess to have obtained palpable effects from
+"much higher dilutions."
+
+The third great doctrine of Hahnemann is the following.  Seven
+eighths at least of all chronic diseases are produced by the
+existence in the system of that infectious disorder known in the
+language of science by the appellation of PSORA, but to the less
+refined portion of the community by the name of ITCH.  In the words
+of Hahnemann's "Organon,"  "This Psora is the sole true and
+fundamental cause that produces all the other countless forms of
+disease, which, under the names of nervous debility, hysteria,
+hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and
+spasms of all kinds, softening of the bones, or rickets, scoliosis
+and cyphosis, caries, cancer, fungua haematodes, gout,--yellow
+jaundice and cyanosis, dropsy,--"
+
+["The degrees of DILUTION must not be confounded with those of
+POTENCY.  Their relations may be seen by this table:
+
+lst dilution,--One hundredth of a drop or grain.
+
+2d       "      One ten thousandth.
+
+3d       "      One millionth, marked I.
+
+4th      "      One hundred millionth.
+
+5th      "      One ten thousand millionth.
+
+6th      "      One million millionth, or one billionth, marked II.
+
+7th      "      One hundred billionth.
+
+8th      "      One ten thousand billionth.
+
+9th      "      One million billionth, or one trillionth, marked III.
+
+10th     "      One hundred trillionth.
+
+11th     "      One ten thousand trillionth.
+
+12th     "      One million trillionth, or one quadrillionth, marked
+                IV.,--and so on indefinitely.
+
+
+The large figures denote the degrees of POTENCY.]
+
+
+"gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the
+lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of
+sense, pains of every kind, etc., appear in our pathology as so many
+peculiar, distinct, and independent diseases."
+
+For the last three centuries, if the same authority may be trusted,
+under the influence of the more refined personal habits which have
+prevailed, and the application of various external remedies which
+repel the affection from the skin; Psora has revealed itself in these
+numerous forms of internal disease, instead of appearing, as in
+former periods, under the aspect of an external malady.
+
+These are the three cardinal doctrines of Hahnemann, as laid down in
+those standard works of Homoeopathy, the "Organon" and the "Treatise
+on Chronic Diseases."
+
+Several other principles may be added, upon all of which he insists
+with great force, and which are very generally received by his
+disciples.
+
+1.  Very little power is allowed to the curative efforts of nature.
+Hahnemann goes so far as to say that no one has ever seen the simple
+efforts of nature effect the durable recovery of a patient from a
+chronic disease.  In general, the Homoeopathist calls every recovery
+which happens under his treatment a cure.
+
+2.  Every medicinal substance must be administered in a state of the
+most perfect purity, and uncombined with any other.  The union of
+several remedies in a single prescription destroys its utility, and,
+according to the "Organon," frequently adds a new disease.
+
+3.  A large number of substances commonly thought to be inert develop
+great medicinal powers when prepared in the manner already described;
+and a great proportion of them are ascertained to have specific
+antidotes in case their excessive effects require to be neutralized.
+
+4.  Diseases should be recognized, as far as possible, not by any of
+the common names imposed upon them, as fever or epilepsy, but as
+individual collections of symptoms, each of which differs from every
+other collection.
+
+5.  The symptoms of any complaint must be described with the most
+minute exactness, and so far as possible in the patient's own words.
+To illustrate the kind of circumstances the patient is expected to
+record, I will mention one or two from the 313th page of the
+"Treatise on Chronic Diseases,"--being the first one at which I
+opened accidentally.
+
+"After dinner, disposition to sleep; the patient winks."
+
+"After dinner, prostration and feeling of weakness (nine days after
+taking the remedy)."
+
+This remedy was that same oyster-shell which is to be prescribed
+"fractions of the sextillionth or decillionth degree."  According to
+Hahnemann, the action of a single dose of the size mentioned does not
+fully display itself in some cases until twenty-four or even thirty
+days after it is taken, and in such instances has not exhausted its
+good effects until towards the fortieth or fiftieth day,--before
+which time it would be absurd and injurious to administer a new
+remedy.
+
+So much for the doctrines of Hahnemann, which have been stated
+without comment, or exaggeration of any of their features, very much
+as any adherent of his opinions might have stated them, if obliged to
+compress them into so narrow a space.
+
+Does Hahnemann himself represent Homoeopathy as it now exists?  He
+certainly ought to be its best representative, after having created
+it, and devoted his life to it for half a century.  He is spoken of
+as the great physician of the time, in most, if not all Homoeopathic
+works.  If he is not authority on the subject of his own doctrines,
+who is?  So far as I am aware, not one tangible discovery in the
+so-called science has ever been ascribed to any other observer; at
+least, no general principle or law, of consequence enough to claim
+any prominence in Homoeopathic works, has ever been pretended to have
+originated with any of his illustrious disciples.  He is one of the
+only two Homoeopathic writers with whom, as I shall mention, the
+Paris publisher will have anything to do upon his own account.  The
+other is Jahr, whose Manual is little more than a catalogue of
+symptoms and remedies.  If any persons choose to reject Hahnemann as
+not in the main representing Homoeopathy, if they strike at his
+authority, if they wink out of sight his deliberate and formally
+announced results, it is an act of suicidal rashness; for upon his
+sagacity and powers of observation, and experience, as embodied in
+his works, and especially in his Materia Medica, repose the
+foundations of Homoeopathy as a practical system.
+
+So far as I can learn from the conflicting statements made upon the
+subject, the following is the present condition of belief.
+
+1.  All of any note agree that the law Similia similibus is the only
+fundamental principle in medicine.  Of course if any man does not
+agree to this the name Homoeopathist can no longer be applied to him
+with propriety.
+
+2.  The belief in and employment of the infinitesimal doses is
+general, and in some places universal, among the advocates of
+Homoeopathy; but a distinct movement has been made in Germany to get
+rid of any restriction to the use of these doses, and to employ
+medicines with the same license as other practitioners.
+
+3.  The doctrine of the origin of most chronic diseases in Psora,
+notwithstanding Hahnemann says it cost him twelve years of study and
+research to establish the fact and its practical consequences, has
+met with great neglect and even opposition from very many of his own
+disciples.
+
+It is true, notwithstanding, that, throughout most of their writings
+which I have seen, there runs a prevailing tone of great deference to
+Hahnemann's opinions, a constant reference to his authority, a
+general agreement with the minor points of his belief, and a pretence
+of harmonious union in a common faith. [Those who will take the
+trouble to look over Hull's Translation of Jahr's Manual may observe
+how little comparative space is given to remedies resting upon any
+other authority than that of Hahnemann.]
+
+Many persons, and most physicians and scientific men, would be
+satisfied with the statement of these doctrines, and examine them no
+further.  They would consider it vastly more probable that any
+observer in so fallacious and difficult a field of inquiry as
+medicine had been led into error, or walked into it of his own
+accord, than that such numerous and extraordinary facts had really
+just come to light.  They would feel a right to exercise the same
+obduracy towards them as the French Institute is in the habit of
+displaying when memoirs or models are offered to it relating to the
+squaring of the circle or perpetual motion; which it is the rule to
+pass over without notice.  They would feel as astronomers and natural
+philosophers must have felt when, some half a dozen years ago, an
+unknown man came forward, and asked for an opportunity to demonstrate
+to Arago and his colleagues that the moon and planets were at a
+distance of a little more than a hundred miles from the earth.  And
+so they would not even look into Homoeopathy, though all its
+advocates should exclaim in the words of Mr. Benjamin Douglass
+Perkins, vender of the Metallic Tractors, that "On all discoveries
+there are persons who, without descending to any inquiry into the
+truth, pretend to know, as it were by intuition, that newly asserted
+facts are founded in the grossest errors."  And they would lay their
+heads upon their pillows with a perfectly clear conscience, although
+they were assured that they were behaving in the same way that people
+of old did towards Harvey, Galileo, and Copernicus, the identical
+great names which were invoked by Mr. Benjamin Douglass Perkins.
+
+But experience has shown that the character of these assertions is
+not sufficient to deter many, from examining their claims to belief.
+I therefore lean but very slightly on the extravagance and extreme
+apparent singularity of their pretensions.  I might have omitted
+them, but on the whole it seemed more just to the claims of my
+argument to suggest the vast complication of improbabilities involved
+in the statements enumerated.  Every one must of course judge for
+himself as to the weight of these objections, which are by no means
+brought forward as a proof of the extravagance of Homoeopathy, but
+simply as entitled to a brief consideration before the facts of the
+case are submitted to our scrutiny.
+
+The three great asserted discoveries of Hahnemann are entirely
+unconnected with and independent of each other.  Were there any
+natural relation between them it would seem probable enough that the
+discovery of the first would have led to that of the others.  But
+assuming it to be a fact that diseases are cured by remedies capable
+of producing symptoms like their own, no manifest relation exists
+between this fact and the next assertion, namely, the power of the
+infinitesimal doses.  And allowing both these to be true, neither has
+the remotest affinity to the third new doctrine, that which declares
+seven eighths of all chronic diseases to be owing to Psora.
+
+This want of any obvious relation between Hahnemann's three cardinal
+doctrines appears to be self-evident upon inspection.  But if, as is
+often true with his disciples, they prefer the authority of one of
+their own number, I will refer them to Dr. Trinks's paper on the
+present state of Homoeopathy in Europe, with which, of course, they
+are familiar, as his name is mentioned as one of the most prominent
+champions of their faith, in their American official organ.  It would
+be a fact without a parallel in the history, not merely of medicine,
+but of science, that three such unconnected and astonishing
+discoveries, each of them a complete revolution of all that ages of
+the most varied experience had been taught to believe, should spring
+full formed from the brain of a single individual.
+
+Let us look a moment at the first of his doctrines.  Improbable
+though it may seem to some, there is no essential absurdity involved
+in the proposition that diseases yield to remedies capable of
+producing like symptoms.  There are, on the other hand, some
+analogies which lend a degree of plausibility to the statement.
+There are well-ascertained facts, known from the earliest periods of
+medicine, showing that, under certain circumstances, the very
+medicine which, from its known effects, one would expect to aggravate
+the disease, may contribute to its relief.  I may be permitted to
+allude, in the most general way, to the case in which the spontaneous
+efforts of an overtasked stomach are quieted by the agency of a drug
+which that organ refuses to entertain upon any terms.  But that every
+cure ever performed by medicine should have been founded upon this
+principle, although without the knowledge of a physician; that the
+Homoeopathic axiom is, as Hahnemann asserts, "the sole law of nature
+in therapeutics," a law of which nothing more than a transient
+glimpse ever presented itself to the innumerable host of medical
+observers, is a dogma of such sweeping extent, and pregnant novelty,
+that it demands a corresponding breadth and depth of unquestionable
+facts to cover its vast pretensions.
+
+So much ridicule has been thrown upon the pretended powers of the
+minute doses that I shall only touch upon this point for the purpose
+of conveying, by illustrations, some shadow of ideas far transcending
+the powers of the imagination to realize.  It must be remembered that
+these comparisons are not matters susceptible of dispute, being
+founded on simple arithmetical computations, level to the capacity of
+any intelligent schoolboy.  A person who once wrote a very small
+pamphlet made some show of objecting to calculations of thus kind, on
+the ground that the highest dilutions could easily be made with a few
+ounces of alcohol.  But he should have remembered that at every
+successive dilution he lays aside or throws away ninety-nine
+hundredths of the fluid on which he is operating, and that, although
+he begins with a drop, he only prepares a millionth, billionth,
+trillionth, and similar fractions of it, all of which, added
+together, would constitute but a vastly minute portion of the drop
+with which he began.  But now let us suppose we take one single drop
+of the Tincture of Camomile, and that the whole of this were to be
+carried through the common series of dilutions.
+
+A calculation nearly like the following was made by Dr. Panvini, and
+may be readily followed in its essential particulars by any one who
+chooses.
+
+For the first dilution it would take 100 drops of alcohol.
+
+For the second dilution it would take 10;000 drops, or about a pint.
+
+For the third dilution it would take 100 pints.
+
+For the fourth dilution it would take 10,000 pints, or more than
+1,000 gallons, and so on to the ninth dilution, which would take ten
+billion gallons, which he computed would fill the basin of Lake
+Agnano, a body of water two miles in circumference.  The twelfth
+dilution would of course fill a million such lakes.  By the time the
+seventeenth degree of dilution should be reached, the alcohol
+required would equal in quantity the waters of ten thousand Adriatic
+seas.  Trifling errors must be expected, but they are as likely to be
+on one side as the other, and any little matter like Lake Superior or
+the Caspian would be but a drop in the bucket.
+
+Swallowers of globules, one of your little pellets, moistened in the
+mingled waves of one million lakes of alcohol, each two miles in
+circumference, with which had been blended that one drop of Tincture
+of Camomile, would be of precisely the strength recommended for that
+medicine in your favorite Jahr's Manual, "against the most sudden,
+frightful, and fatal diseases!"  [In the French edition of 1834, the
+proper doses of the medicines are mentioned, and Camomile is marked
+IV.  Why are the doses omitted in Hull's Translation, except in three
+instances out of the whole two hundred remedies, notwithstanding the
+promise in the preface that "some remarks upon the doses used may be
+found at the head of each medicine"?  Possibly because it makes no
+difference whether they are employed in one Homoeopathic dose or
+another; but then it is very singular that such precise directions
+were formerly given in the same work, and that Hahnemann's
+"experience" should have led him to draw the nice distinctions we
+have seen in a former part of this Lecture (p. 44).]
+
+And proceeding on the common data, I have just made a calculation
+which shows that this single drop of Tincture of Camomile, given in
+the quantity ordered by Jahr's Manual, would have supplied every
+individual of the whole human family, past and present, with more
+than five billion doses each, the action of each dose lasting about
+four days.
+
+Yet this is given only at the quadrillionth, or fourth degree of
+potency, and various substances are frequently administered at the
+decillionth or tenth degree, and occasionally at still higher
+attenuations with professed medicinal results.  Is there not in this
+as great an exception to all the hitherto received laws of nature as
+in the miracle of the loaves and fishes?  Ask this question of a
+Homoeopathist, and he will answer by referring to the effects
+produced by a very minute portion of vaccine matter, or the
+extraordinary diffusion of odors.  But the vaccine matter is one of
+those substances called morbid poisons, of which it is a peculiar
+character to multiply themselves, when introduced into the system, as
+a seed does in the soil.  Therefore the hundredth part of a grain of
+the vaccine matter, if no more than this is employed, soon increases
+in quantity, until, in the course of about a week, it is a grain or
+more, and can be removed in considerable drops.  And what is a very
+curious illustration of Homoeopathy, it does not produce its most.
+characteristic effects until it is already in sufficient quantity not
+merely to be visible, but to be collected for further use.  The
+thoughtlessness which can allow an inference to be extended from a
+product of disease possessing this susceptibility of multiplication
+when conveyed into the living body, to substances of inorganic
+origin, such as silex or sulphur, would be capable of arguing that a
+pebble may produce a mountain, because an acorn can become a forest.
+
+As to the analogy to be found between the alleged action of the
+infinitely attenuated doses, and the effects of some odorous
+substances which possess the extraordinary power of diffusing their
+imponderable emanations through a very wide space, however it may be
+abused in argument, and rapidly as it evaporates on examination, it
+is not like that just mentioned, wholly without meaning.  The fact of
+the vast diffusion of some odors, as that of musk or the rose, for
+instance, has long been cited as the most remarkable illustration of
+the divisibility of matter, and the nicety of the senses.  And if
+this were compared with the effects of a very minute dose of morphia
+on the whole system, or the sudden and fatal impression of a single
+drop of prussic acid, or, with what comes still nearer, the poisonous
+influence of an atmosphere impregnated with invisible malaria, we
+should find in each of these examples an evidence of the degree to
+which nature, in some few instances, concentrates powerful qualities
+in minute or subtile forms of matter.  But if a man comes to me with
+a pestle and mortar in his hand, and tells me that he will take a
+little speck of some substance which nobody ever thought to have any
+smell at all, as, for instance, a grain of chalk or of charcoal, and
+that he will, after an hour or two of rubbing and scraping, develop
+in a portion of it an odor which, if the whole grain were used, would
+be capable of pervading an apartment, a house, a village, a province,
+an empire, nay, the entire atmosphere of this broad planet upon which
+we tread; and that from each of fifty or sixty substances he can in
+this way develop a distinct and hitherto unknown odor: and if he
+tries to show that all this is rendered quite reasonable by the
+analogy of musk and roses, I shall certainly be justified in
+considering him incapable of reasoning, and beyond the reach of my
+argument.  What if, instead of this, he professes to develop new and
+wonderful medicinal powers from the same speck of chalk or charcoal,
+in such proportions as would impregnate every pond, lake, river, sea,
+and ocean of our globe, and appeals to the same analogy in favor of
+the probability of his assertion.
+
+All this may be true, notwithstanding these considerations.  But so
+extraordinary would be the fact, that a single atom of substances
+which a child might swallow without harm by the teaspoonful could, by
+an easy mechanical process, be made to develop such inconceivable
+powers, that nothing but the strictest agreement of the most cautious
+experimenters, secured by every guaranty that they were honest and
+faithful, appealing to repeated experiments in public, with every
+precaution to guard against error, and with the most plain and
+peremptory results, should induce us to lend any credence to such
+pretensions.
+
+The third doctrine, that Psora, the other name of which you remember,
+is the cause of the great majority of chronic diseases, is a
+startling one, to say the least.  That an affection always recognized
+as a very unpleasant personal companion, but generally regarded as a
+mere temporary incommodity, readily yielding to treatment in those
+unfortunate enough to suffer from it, and hardly known among the
+better classes of society, should be all at once found out by a
+German physician to be the great scourge of mankind, the cause of
+their severest bodily and mental calamities, cancer and consumption,
+idiocy and madness, must excite our unqualified surprise.  And when
+the originator of this singular truth ascribes, as in the page now
+open before me, the declining health of a disgraced courtier, the
+chronic malady of a bereaved mother, even the melancholy of the love-
+sick and slighted maiden, to nothing more nor less than the
+insignificant, unseemly, and almost unmentionable ITCH, does it not
+seem as if the very soil upon which we stand were dissolving into
+chaos, over the earthquake-heaving of discovery?
+
+And when one man claims to have established these three independent
+truths, which are about as remote from each other as the discovery of
+the law of gravitation, the invention of printing, and that of the
+mariner's compass, unless the facts in their favor are overwhelming
+and unanimous, the question naturally arises, Is not this man
+deceiving himself, or trying to deceive others?
+
+I proceed to examine the proofs of the leading ideas of Hahnemann and
+his school.
+
+
+In order to show the axiom, similia similibus curantur (or like is
+cured by like), to be the basis of the healing art,--"the sole law of
+nature in therapeutics,"--it is necessary,
+
+1.  That the symptoms produced by drugs in healthy persons should be
+faithfully studied and recorded.
+
+2.  That drugs should be shown to be always capable of curing those
+diseases most like their own symptoms.
+
+3.  That remedies should be shown not to cure diseases when they do
+not produce symptoms resembling those presented in these diseases.
+
+
+1.  The effects of drugs upon healthy persons have been studied by
+Hahnemann and his associates.  Their results were made known in his
+Materia Medica, a work in three large volumes in the French
+translation, published about eight years ago.  The mode of
+experimentation appears to have been, to take the substance on trial,
+either in common or minute doses, and then to set down every little
+sensation, every little movement of mind or body, which occurred
+within many succeeding hours or days, as being produced solely by the
+substance employed.  When I have enumerated some of the symptoms
+attributed to the power of the drugs taken, you will be able to judge
+how much value is to be ascribed to the assertions of such observers.
+
+The following list was taken literally from the Materia Medica of
+Hahnemann, by my friend M.  Vernois, for whose accuracy I am willing
+to be responsible.  He has given seven pages of these symptoms, not
+selected, but taken at hazard from the French translation of the
+work.  I shall be very brief in my citations.
+
+"After stooping some time, sense of painful weight about the head
+upon resuming the erect posture."
+
+"An itching, tickling sensation at the outer edge of the palm of the
+left hand, which obliges the person to scratch."  The medicine was
+acetate of lime, and as the action of the globule taken is said to
+last twenty-eight days, you may judge how many such symptoms as the
+last might be supposed to happen.
+
+Among the symptoms attributed to muriatic acid are these: a catarrh,
+sighing, pimples; "after having written a long time with the back a
+little bent over, violent pain in the back and shoulder-blades, as if
+from a strain,"--"dreams which are not remembered,--disposition to
+mental dejection,--wakefulness before and after midnight."
+
+I might extend this catalogue almost indefinitely.  I have not cited
+these specimens with any view to exciting a sense of the ridiculous,
+which many others of those mentioned would not fail to do, but to
+show that the common accidents of sensation, the little bodily
+inconveniences to which all of us are subject, are seriously and
+systematically ascribed to whatever medicine may have been exhibited,
+even in the minute doses I have mentioned, whole days or weeks
+previously.
+
+To these are added all the symptoms ever said by anybody, whether
+deserving confidence or not, as I shall hereafter illustrate, to be
+produced by the substance in question.
+
+The effects of sixty-four medicinal substances, ascertained by one or
+both of these methods, are enumerated in the Materia Medica of
+Hahnemann, which may be considered as the basis of practical
+Homoeopathy.  In the Manual of Jahr, which is the common guide, so
+far as I know, of those who practise Homoeopathy in these regions,
+two hundred remedies are enumerated, many of which, however, have
+never been employed in practice.  In at least one edition there were
+no means of distinguishing those which had been tried upon the sick
+from the others.  It is true that marks have been added in the
+edition employed here, which serve to distinguish them; but what are
+we to think of a standard practical author on Materia Medica, who at
+one time omits to designate the proper doses of his remedies, and at
+another to let us have any means of knowing whether a remedy has ever
+been tried or not, while he is recommending its employment in the
+most critical and threatening diseases?
+
+I think that, from what I have shown of the character of Hahnemann's
+experiments, it would be a satisfaction to any candid inquirer to
+know whether other persons, to whose assertions he could look with
+confidence, confirm these pretended facts.  Now there are many
+individuals, long and well known to the scientific world, who have
+tried these experiments upon healthy subjects, and utterly deny that
+their effects have at all corresponded to Hahnemann's assertions.
+
+I will take, for instance, the statements of Andral (and I am not
+referring to his well-known public experiments in his hospital) as
+to the result of his own trials.  This distinguished physician is
+Professor of Medicine in the School of Paris, and one of the most
+widely known and valued authors upon practical and theoretical
+subjects the profession can claim in any country.  He is a man of
+great kindness of character, a most liberal eclectic by nature and
+habit, of unquestioned integrity, and is called, in the leading
+article of the first number of the "Homoepathic Examiner,"  "an
+eminent and very enlightened allopathist."  Assisted by a number of
+other persons in good health, he experimented on the effects of
+cinchona, aconite, sulphur, arnica, and the other most highly
+extolled remedies.  His experiments lasted a year, and he stated
+publicly to the Academy of Medicine that they never produced the
+slightest appearance of the symptoms attributed to them.  The results
+of a man like this, so extensively known as one of the most
+philosophical and candid, as well as brilliant of instructors, and
+whose admirable abilities and signal liberality are generally
+conceded, ought to be of great weight in deciding the question.
+
+M. Double, a well-known medical writer and a physician of high
+standing in Paris, had occasion so long ago as 1801, before he had
+heard of Homoeopathy, to make experiments upon Cinchona, or Peruvian
+bark.  He and several others took the drug in every kind of dose for
+four months, and the fever it is pretended by Hahnemann to excite
+never was produced.
+
+M. Bonnet, President of the Royal Society of Medicine of Bordeaux,
+had occasion to observe many soldiers during the Peninsular War, who
+made use of Cinchona as a preservative against different diseases,
+but he never found it to produce the pretended paroxysms.
+
+If any objection were made to evidence of this kind, I would refer to
+the express experiments on many of the Homoeopathic substances, which
+were given to healthy persons with every precaution as to diet and
+regimen, by M. Louis Fleury, without being followed by the slightest
+of the pretended consequences.  And let me mention as a curious fact,
+that the same quantity of arsenic given to one animal in the common
+form of the unprepared powder, and to another after having been
+rubbed up into six hundred globules, offered no particular difference
+of activity in the two cases.
+
+This is a strange contradiction to the doctrine of the development of
+what they call dynamic power, by means of friction and subdivision.
+
+In 1835 a public challenge was offered to the best known Homoeopathic
+physician in Paris to select any ten substances asserted to produce
+the most striking effects; to prepare them himself; to choose one by
+lot without knowing which of them he had taken, and try it upon
+himself or any intelligent and devoted Homoeopatbist, and, waiting
+his own time, to come forward and tell what substance had been
+employed.  The challenge was at first accepted, but the acceptance
+retracted before the time of trial arrived.
+
+From all this I think it fair to conclude that the catalogues of
+symptoms attributed in Homoeopathic works to the influence of various
+drugs upon healthy persons are not entitled to any confidence.
+
+
+2.  It is necessary to show, in the next place, that medicinal
+substances are always capable of curing diseases most like their own
+symptoms.  For facts relating to this question we must look to two
+sources; the recorded experience of the medical profession in
+general, and the results of trials made according to Homoeopathic
+principles, and capable of testing the truth of the doctrine.
+
+No person, that I am aware of, has ever denied that in some cases
+there exists a resemblance between the effects of a remedy and the
+symptoms of diseases in which it is beneficial.  This has been
+recognized, as Hahnemann himself has shown, from the time of
+Hippocrates.  But according to the records of the medical profession,
+as they have been hitherto interpreted, this is true of only a very
+small proportion of useful remedies.  Nor has it ever been considered
+as an established truth that the efficacy of even these few remedies
+was in any definite ratio to their power of producing symptoms more
+or less like those they cured.
+
+Such was the state of opinion when Hahnemann came forward with the
+proposition that all the cases of successful treatment found in the
+works of all preceding medical writers were to be ascribed solely to
+the operation of the Homoeopathic principle, which had effected the
+cure, although without the physician's knowledge that this was the
+real secret.  And strange as it may seem, he was enabled to give such
+a degree of plausibility to this assertion, that any person not
+acquainted somewhat with medical literature, not quite familiar, I
+should rather say, with the relative value of medical evidence,
+according to the sources whence it is derived, would be almost
+frightened into the belief, at seeing the pages upon pages of Latin
+names he has summoned as his witnesses.
+
+It has hitherto been customary, when examining the writings of
+authors of preceding ages, upon subjects as to which they were less
+enlightened than ourselves, and which they were very liable to
+misrepresent, to exercise some little discretion; to discriminate, in
+some measure, between writers deserving confidence and those not
+entitled to it.  But there is not the least appearance of any such
+delicacy on the part of Hahnemann.  A large majority of the names of
+old authors he cites are wholly unknown to science.  With some of
+them I have been long acquainted, and I know that their accounts of
+diseases are no more to be trusted than their contemporary Ambroise
+Pare's stories of mermen, and similar absurdities.  But if my
+judgment is rejected, as being a prejudiced one, I can refer to
+Cullen, who mentioned three of Hahnemann's authors in one sentence,
+as being "not necessarily bad authorities; but certainly such when
+they delivered very improbable events;" and as this was said more
+than half a century ago, it could not have had any reference to
+Hahnemann.  But although not the slightest sign of discrimination is
+visible in his quotations,--although for him a handful of chaff from
+Schenck is all the same thing as a measure of wheat from Morgagni,--
+there is a formidable display of authorities, and an abundant proof
+of ingenious researches to be found in each of the great works of
+Hahnemann with which I am familiar.  [Some painful surmises might
+arise as to the erudition of Hahnemann's English Translator, who
+makes two individuals of "Zacutus, Lucitanus," as well as respecting
+that of the conductors of an American Homoeopathic periodical, who
+suffer the name of the world-renowned Cardanus to be spelt Cardamus
+in at least three places, were not this gross ignorance of course
+attributable only to the printer.]
+
+It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
+proved many of Hahnemann's quotations from old authors to be
+adulterate and false.  What particular instances he has pointed out I
+have no means of learning.  And it is probably wholly impossible on
+this side of the Atlantic, and even in most of the public libraries
+of Europe, to find anything more than a small fraction of the
+innumerable obscure publications which the neglect of grocers and
+trunkmakers has spared to be ransacked by the all-devouring genius of
+Homoeopathy.  I have endeavored to verify such passages as my own
+library afforded me the means of doing.  For some I have looked in
+vain, for want, as I am willing to believe, of more exact references.
+But this I am able to affirm, that, out of the very small number
+which I have been able, to trace back to their original authors, I
+have found two to be wrongly quoted, one of them being a gross
+misrepresentation.
+
+The first is from the ancient Roman author, Caelius Aurelianus; the
+second from the venerable folio of Forestus.  Hahnemann uses the
+following expressions,--if he is not misrepresented in the English
+Translation of the 'Organon': "Asclepiades on one occasion cured an
+inflammation of the brain by administering a small quantity of wine."
+After correcting the erroneous reference of the Translator, I can
+find no such case alluded to in the chapter.  But Caelius Aurelianus
+mentions two modes of treatment employed by Asclepiades, into both of
+which the use of wine entered, as being "in the highest degree
+irrational and dangerous." [Caelius Aurel. De Morb. Acut. et
+Chron. lib. I. cap. xv. not xvi.  Amsterdam.  Wetstein, 1755.]
+
+In speaking of the oil of anise-seed, Hahnemann says that Forestus
+observed violent colic caused by its administration.  But, as the
+author tells the story, a young man took, by the counsel of a
+surgeon, an acrid and virulent medicine, the name of which is not
+given, which brought on a most cruel fit of the gripes and colic.
+After this another surgeon was called, who gave him oil of anise-seed
+and wine, "which increased his suffering." [Observ. et Curat. Med.
+lib. XXI obs. xiii.  Frankfort, 1614.]  Now if this was the
+Homoeopathic remedy, as Hahnemann pretends, it might be a fair
+question why the young man was not cured by it.  But it is a much
+graver question why a man who has shrewdness and learning enough to
+go so far after his facts, should think it right to treat them with
+such astonishing negligence or such artful unfairness.
+
+Even if every word he had pretended to take from his old authorities
+were to be found in them, even if the authority of every one of these
+authors were beyond question, the looseness with which they are used
+to prove whatever Hahnemann chooses is beyond the bounds of
+credibility.  Let me give one instance to illustrate the character of
+this man's mind.  Hahnemann asserts, in a note annexed to the 110th
+paragraph of the "Organon," that the smell of the rose will cause
+certain persons to faint.  And he says in the text that substances
+which produce peculiar effects of this nature on particular
+constitutions cure the same symptoms in people in general.  Then in
+another note to the same paragraph he quotes the following fact from
+one of the last sources one would have looked to for medical
+information, the Byzantine Historians.
+
+"It was by these means (i.e. Homoeopathically) that the Princess
+Eudosia with rose-water restored a person who had fainted!"
+
+Is it possible that a man who is guilty of such pedantic folly as
+this,--a man who can see a confirmation of his doctrine in such a
+recovery as this,--a recovery which is happening every day, from a
+breath of air, a drop or two of water, untying a bonnet-string,
+loosening a stay-lace, and which can hardly help happening, whatever
+is done,--is it possible that a man, of whose pages, not here and
+there one, but hundreds upon hundreds are loaded with such
+trivialities, is the Newton, the Columbus, the Harvey of the
+nineteenth century!
+
+The whole process of demonstration he employs is this.  An experiment
+is instituted with some drug upon one or more healthy persons.
+Everything that happens for a number of days or weeks is, as we have
+seen, set down as an effect of the medicine.  Old volumes are then
+ransacked promiscuously, and every morbid sensation or change that
+anybody ever said was produced by the drug in question is added to
+the list of symptoms.  By one or both of these methods, each of the
+sixty-four substances enumerated by Hahnemann is shown to produce a
+very large number of symptoms, the lowest in his scale being ninety-
+seven, and the highest fourteen hundred and ninety-one.  And having
+made out this list respecting any drug, a catalogue which, as you may
+observe in any Homoeopathic manual, contains various symptoms
+belonging to every organ of the body, what can be easier than to find
+alleged cures in every medical author which can at once be attributed
+to the Homoeopathic principle; still more if the grave of
+extinguished credulity is called upon to give up its dead bones as
+living witnesses; and worst of all, if the monuments of the past are
+to be mutilated in favor of "the sole law of Nature in therapeutics"?
+
+There are a few familiar facts of which great use has been made as an
+entering wedge for the Homoeopathic doctrine.  They have been
+suffered to pass current so long that it is time they should be
+nailed to the counter, a little operation which I undertake, with
+perfect cheerfulness, to perform for them.
+
+The first is a supposed illustration of the Homoeopathic law found in
+the precept given for the treatment of parts which have been frozen,
+by friction with snow or similar means.  But we deceive ourselves by
+names, if we suppose the frozen part to be treated by cold, and not
+by heat.  The snow may even be actually warmer than the part to which
+it is applied.  But even if it were at the same temperature when
+applied, it never did and never could do the least good to a frozen
+part, except as a mode of regulating the application of what? of
+heat.  But the heat must be applied gradually, just as food must be
+given a little at a time to those perishing with hunger.  If the
+patient were brought into a warm room, heat would be applied very
+rapidly, were not something interposed to prevent this, and allow its
+gradual admission.  Snow or iced water is exactly what is wanted; it
+is not cold to the part; it is very possibly warm, on the contrary,
+for these terms are relative, and if it does not melt and let the
+heat in, or is not taken away, the part will remain frozen up until
+doomsday.  Now the treatment of a frozen limb by heat, in large or
+small quantities, is not Homoeopathy.
+
+The next supposed illustration of the Homoeopathic law is the alleged
+successful management of burns, by holding them to the fire.  This is
+a popular mode of treating those burns which are of too little
+consequence to require any more efficacious remedy, and would
+inevitably get well of themselves, without any trouble being bestowed
+upon them.  It produces a most acute pain in the part, which is
+followed by some loss of sensibility, as happens with the eye after
+exposure to strong light, and the ear after being subjected to very
+intense sounds.  This is all it is capable of doing, and all further
+notions of its efficacy must be attributed merely to the vulgar love
+of paradox.  If this example affords any comfort to the
+Homoeopathist, it seems as cruel to deprive him of it as it would be
+to convince the mistress of the smoke-jack or the flatiron that the
+fire does not literally "draw the fire out," which is her hypothesis.
+
+But if it were true that frost-bites were cured by cold and burns by
+heat, it would be subversive, so far as it went, of the great
+principle of Homoeopathy.
+
+For you will remember that this principle is that Like cures Like,
+and not that Same cures Same; that there is resemblance and not
+identity between the symptoms of the disease and those produced by
+the drug which cures it, and none have been readier to insist upon
+this distinction than the Homoeopathists themselves.  For if Same
+cures Same, then every poison must be its own antidote,--which is
+neither a part of their theory nor their so-called experience.  They
+have been asked often enough, why it was that arsenic could not cure
+the mischief which arsenic had caused, and why the infectious cause
+of small-pox did not remedy the disease it had produced, and then
+the; were ready enough to see the distinction I have pointed out.  O
+no!  it was not the hair of the same dog, but only of one very much
+like him!
+
+A third instance in proof of the Homoeopathic law is sought for in
+the acknowledged efficacy of vaccination.  And how does the law apply
+to this?  It is granted by the advocates of Homoeopathy that there is
+a resemblance between the effects of the vaccine virus on a person in
+health and the symptoms of small-pox.  Therefore, according to the
+rule, the vaccine virus will cure the small-pox, which, as everybody
+knows, is entirely untrue.  But it prevents small-pox, say the
+Homoeopathists.  Yes, and so does small-pox prevent itself from ever
+happening again, and we know just as much of the principle involved
+in the one case as in the other.  For this is only one of a series of
+facts which we are wholly unable to explain.  Small-pox, measles,
+scarlet-fever, hooping-cough, protect those who have them once from
+future attacks; but nettle-rash and catarrh and lung fever, each of
+which is just as Homoeopathic to itself as any one of the others,
+have no such preservative power.  We are obliged to accept the fact,
+unexplained, and we can do no more for vaccination than for the rest.
+
+
+I come now to the most directly practical point connected with the
+subject, namely,--
+
+What is the state of the evidence as to the efficacy of the proper
+Homoeopathic treatment in the cure of diseases.
+
+As the treatment adopted by the Homoeopathists has been almost
+universally by means of the infinitesimal doses, the question of
+their efficacy is thrown open, in common with that of the truth of
+their fundamental axiom, as both are tested in practice.
+
+We must look for facts as to the actual working of Homoeopathy to
+three sources.
+
+1.  The statements of the unprofessional public.
+
+2.  The assertions of Homoeopathic practitioners.
+
+3.  The results of trials by competent and honest physicians, not
+pledged to the system.
+
+I think, after what we have seen of medical facts, as they are
+represented by incompetent persons, we are disposed to attribute
+little value to all statements of wonderful cures, coming from those
+who have never been accustomed to watch the caprices of disease, and
+have not cooled down their young enthusiasm by the habit of tranquil
+observation.  Those who know nothing of the natural progress of a
+malady, of its ordinary duration, of its various modes of
+terminating, of its liability to accidental complications, of the
+signs which mark its insignificance or severity, of what is to be
+expected of it when left to itself, of how much or how little is to
+be anticipated from remedies, those who know nothing or next to
+nothing of all these things, and who are in a great state of
+excitement from benevolence, sympathy, or zeal for a new medical
+discovery, can hardly be expected to be sound judges of facts which
+have misled so many sagacious men, who have spent their lives in the
+daily study and observation of them.  I believe that, after having
+drawn the portrait of defunct Perkinism, with its five thousand
+printed cures, and its million and a half computed ones, its miracles
+blazoned about through America, Denmark, and England; after relating
+that forty years ago women carried the Tractors about in their
+pockets, and workmen could not make them fast enough for the public
+demand; and then showing you, as a curiosity, a single one of these
+instruments, an odd one of a pair, which I obtained only by a lucky
+accident, so utterly lost is the memory of all their wonderful
+achievements; I believe, after all this, I need not waste time in
+showing that medical accuracy is not to be looked for in the florid
+reports of benevolent associations, the assertions of illustrious
+patrons, the lax effusions of daily journals, or the effervescent
+gossip of the tea-table.
+
+Dr. Hering, whose name is somewhat familiar to the champions of
+Homoeopathy, has said that "the new healing art is not to be judged
+by its success in isolated cases only, but according to its success
+in general, its innate truth, and the incontrovertible nature of its
+innate principles."
+
+We have seen something of "the incontrovertible nature of its innate
+principles," and it seems probable, on the whole, that its success in
+general must be made up of its success in isolated cases.  Some
+attempts have been made, however, to finish the whole matter by
+sweeping statistical documents, which are intended to prove its
+triumphant success over the common practice.
+
+It is well known to those who have had the good fortune to see the
+"Homoeopathic Examiner," that this journal led off, in its first
+number, with a grand display of everything the newly imported
+doctrine had to show for itself.  It is well remarked, on the twenty-
+third page of this article, that "the comparison of bills of
+mortality among an equal number of sick, treated by divers methods,
+is a most poor and lame way to get at conclusions touching principles
+of the healing art."  In confirmation of which, the author proceeds
+upon the twenty-fifth page to prove the superiority of the
+Homoeopathic treatment of cholera, by precisely these very bills of
+mortality.  Now, every intelligent physician is aware that the poison
+of cholera differed so much in its activity at different times and,
+places, that it was next to impossible to form any opinion as to the
+results of treatment, unless every precaution was taken to secure the
+most perfectly corresponding conditions in the patients treated, and
+hardly even then.  Of course, then, a Russian Admiral, by the name of
+Mordvinov, backed by a number of so-called physicians practising in
+Russian villages, is singularly competent to the task of settling the
+whole question of the utility of this or that kind of treatment; to
+prove that, if not more than eight and a half per cent. of those
+attacked with the disease perished, the rest owed their immunity to
+Hahnemann.  I can remember when more than a hundred patients in a
+public institution were attacked with what, I doubt not, many
+Homoeopathic physicians (to say nothing of Homoeopathic admirals)
+would have called cholera, and not one of them died, though treated
+in the common way, and it is my firm belief that, if such a result
+had followed the administration of the omnipotent globules, it would
+have been in the mouth of every adept in Europe, from Quin of London
+to Spohr of Gandersheim.  No longer ago than yesterday, in one of the
+most widely circulated papers of this city, there was published an
+assertion that the mortality in several Homoeopathic Hospitals was
+not quite five in a hundred, whereas, in what are called by the
+writer Allopathic Hospitals, it is said to be eleven in a hundred.
+An honest man should be ashamed of such an argumentum ad ignorantiam.
+The mortality of a hospital depends not merely on the treatment of
+the patients, but on the class of diseases it is in the habit of
+receiving, on the place where it is, on the season, and many other
+circumstances.  For instance, there are many hospitals in the great
+cities of Europe that receive few diseases of a nature to endanger
+life, and, on the other hand, there are others where dangerous
+diseases are accumulated out of the common proportion.  Thus, in the
+wards of Louis, at the Hospital of La Pitie, a vast number of
+patients in the last stages of consumption were constantly entering,
+to swell the mortality of that hospital.  It was because he was known
+to pay particular attention to the diseases of the chest that
+patients laboring under those fatal affections to an incurable extent
+were so constantly coming in upon him.  It is always a miserable
+appeal to the thoughtlessness of the vulgar, to allege the naked fact
+of the less comparative mortality in the practice of one hospital or
+of one physician than another, as an evidence of the superiority of
+their treatment.  Other things being equal, it must always be
+expected that those institutions and individuals enjoying to the
+highest degree the confidence of the community will lose the largest
+proportion of their patients; for the simple reason that they will
+naturally be looked to by those suffering from the gravest class of
+diseases; that many, who know that they are affected with mortal
+disease, will choose to die under their care or shelter, while the
+subjects of trifling maladies, and merely troublesome symptoms, amuse
+themselves to any extent among the fancy practitioners.  When,
+therefore, Dr. Mublenbein, as stated in the "Homoeopathic Examiner,"
+and quoted in yesterday's "Daily Advertiser," asserts that the
+mortality among his patients is only one per cent. since he has
+practised Homoeopathy, whereas it was six per cent. when he employed
+the common mode of practice, I am convinced by this, his own
+statement, that the citizens of Brunswick, whenever they are
+seriously sick, take good care not to send for Dr. Muhlenbein!
+
+It is evidently impossible that I should attempt, within the compass
+of a single lecture, any detailed examination of the very numerous
+cases reported in the Homoeopathic Treatises and Journals.  Having
+been in the habit of receiving the French "Archives of Homoeopathic
+Medicine" until the premature decease of that Journal, I have had the
+opportunity of becoming acquainted somewhat with the style of these
+documents, and experiencing whatever degree of conviction they were
+calculated to produce.  Although of course I do not wish any value to
+be assumed for my opinion, such as it is, I consider that you are
+entitled to hear it.  So far, then, as I am acquainted with the
+general character of the cases reported by the Homoeopathic
+physicians, they would for the most part be considered as wholly
+undeserving a place in any English, French, or American periodical of
+high standing, if, instead of favoring the doctrine they were
+intended to support, they were brought forward to prove the efficacy
+of any common remedy administered by any common practitioner.  There
+are occasional exceptions to this remark; but the general truth of it
+is rendered probable by the fact that these cases are always, or
+almost always, written with the single object of showing the efficacy
+of the medicine used, or the skill of the practitioner, and it is
+recognized as a general rule that such cases deserve very little
+confidence.  Yet they may sound well enough, one at a time, to those
+who are not fully aware of the fallacies of medical evidence.  Let me
+state a case in illustration.  Nobody doubts that some patients
+recover under every form of practice.  Probably all are willing to
+allow that a large majority, for instance, ninety in a hundred, of
+such cases as a physician is called to in daily practice, would
+recover, sooner or later, with more or less difficulty, provided
+nothing were done to interfere seriously with the efforts of nature.
+
+Suppose, then, a physician who has a hundred patients prescribes to
+each of them pills made of some entirely inert substance, as starch,
+for instance.  Ninety of them get well, or if he chooses to use such
+language, he cures ninety of them.  It is evident, according to the
+doctrine of chances, that there must be a considerable number of
+coincidences between the relief of the patient and the administration
+of the remedy.  It is altogether probable that there will happen two
+or three very striking coincidences out of the whole ninety cases, in
+which it would seem evident that the medicine produced the relief,
+though it had, as we assumed, nothing to do with it.  Now suppose
+that the physician publishes these cases, will they not have a
+plausible appearance of proving that which, as we granted at the
+outset, was entirely false?  Suppose that instead of pills of starch
+he employs microscopic sugarplums, with the five' million billion
+trillionth part of a suspicion of aconite or pulsatilla, and then
+publishes his successful cases, through the leaden lips of the press,
+or the living ones of his female acquaintances,--does that make the
+impression a less erroneous one?  But so it is that in Homoeopathic
+works and journals and gossip one can never, or next to never, find
+anything but successful cases, which might do very well as a proof of
+superior skill, did it not prove as much for the swindling
+advertisers whose certificates disgrace so many of our newspapers.
+How long will it take mankind to learn that while they listen to "the
+speaking hundreds and units, who make the world ring "with the
+pretended triumphs they have witnessed, the "dumb millions" of
+deluded and injured victims are paying the daily forfeit of their
+misplaced confidence!
+
+I am sorry to see, also, that a degree of ignorance as to the natural
+course of diseases is often shown in these published cases, which,
+although it may not be detected by the unprofessional reader, conveys
+an unpleasant impression to those who are acquainted with the
+subject.  Thus a young woman affected with jaundice is mentioned in
+the German "Annals of Clinical Homoeopathy" as having been cured in
+twenty-nine days by pulsatilla and nux vomica.  Rummel, a well-known
+writer of the same school, speaks of curing a case of jaundice in
+thirty-four days by Homoeopathic doses of pulsatilla, aconite, and
+cinchona.  I happened to have a case in my own household, a few weeks
+since, which lasted about ten days, and this was longer than I have
+repeatedly seen it in hospital practice, so that it was nothing to
+boast of.
+
+Dr. Munneche of Lichtenburg in Saxony is called to a patient with
+sprained ankle who had been a fortnight under the common treatment.
+The patient gets well by the use of arnica in a little more than a
+month longer, and this extraordinary fact is published in the French
+"Archives of Homoeopathic Medicine."
+
+In the same Journal is recorded the case of a patient who with
+nothing more, so far as any proof goes, than inluenza, gets down to
+her shop upon the sixth day.
+
+And again, the cool way in which everything favorable in a case is
+set down by these people entirely to their treatment, may be seen in
+a case of croup reported in the "Homoeopathic Gazette" of Leipsic,
+in which leeches, blistering, inhalation of hot vapor, and powerful
+internal medicine had been employed, and yet the merit was all
+attributed to one drop of some Homoeopathic fluid.
+
+I need not multiply these quotations, which illustrate the grounds of
+an opinion which the time does not allow me to justify more at
+length; other such cases are lying open before me; there is no end to
+them if more were wanted; for nothing is necessary but to look into
+any of the numerous broken-down Journals of Homoeopathy, the volumes
+of which may be found on the shelves of those curious in such
+matters.
+
+A number of public trials of Homoeopathy have been made in different
+parts of the world.  Six of these are mentioned in the Manifesto of
+the "Homoeopathic Examiner."  Now to suppose that any trial can
+absolutely silence people, would be to forget the whole experience of
+the past.  Dr. Haygarth and Dr. Alderson could not stop the sale of
+the five-guinea Tractors, although they proved that they could work
+the same miracles with pieces of wood and tobacco-pipe.  It takes
+time for truth to operate as well as Homoeopathic globules.  Many
+persons thought the results of these trials were decisive enough of
+the nullity of the treatment; those who wish to see the kind of
+special pleading and evasion by which it is attempted to cover
+results which, stated by the "Homoeopathic Examiner" itself, look
+exceedingly like a miserable failure, may consult the opening
+flourish of that Journal.  I had not the intention to speak of these
+public trials at all, having abundant other evidence on the point.
+But I think it best, on the whole, to mention two of them in a few
+words,--that instituted at Naples and that of Andral.
+
+There have been few names in the medical profession, for the last
+half century, so widely known throughout the world of science as that
+of M. Esquirol, whose life was devoted to the treatment of insanity,
+and who was without a rival in that department of practical medicine.
+It is from an analysis communicated by him to the "Gazette Medicale
+de Paris" that I derive my acquaintance with the account of the trial
+at Naples by Dr. Panvini, physician to the Hospital della Pace.  This
+account seems to be entirely deserving of credit.  Ten patients were
+set apart, and not allowed to take any medicine at all,--much against
+the wish of the Homoeopathic physician.  All of them got well, and of
+course all of them would have been claimed as triumphs if they had
+been submitted to the treatment.  Six other slight cases (each of
+which is specified) got well under the Homoeopathic treatment, none
+of its asserted specific effects being manifested.
+
+All the rest were cases of grave disease; and so far as the trial,
+which was interrupted about the fortieth day, extended, the patients
+grew worse, or received no benefit.  A case is reported on the page
+before me of a soldier affected with acute inflammation in the chest,
+who took successively aconite, bryonia, nux vomica, and pulsatilla,
+and after thirty-eight days of treatment remained without any
+important change in his disease.  The Homoeopathic physician who
+treated these patients was M. de Horatiis, who had the previous year
+been announcing his wonderful cures.  And M. Esquirol asserted to the
+Academy of Medicine in 1835, that this M. de Horatiis, who is one of
+the prominent personages in the "Examiner's" Manifesto published in
+1840, had subsequently renounced Homoeopathy.  I may remark, by the
+way, that this same periodical, which is so very easy in explaining
+away the results of these trials, makes a mistake of only six years
+or a little more as to the time when this at Naples was instituted.
+
+M. Andral, the "eminent and very enlightened allopathist" of the
+"Homoeopathic Examiner," made the following statement in March, 1835,
+to the Academy of Medicine: "I have submitted this doctrine to
+experiment; I can reckon at this time from one hundred and thirty to
+one hundred and forty cases, recorded with perfect fairness, in a
+great hospital, under the eye of numerous witnesses; to avoid every
+objection--I obtained my remedies of M. Guibourt, who keeps a
+Homoeopathic pharmacy, and whose strict exactness is well known; the
+regimen has been scrupulously observed, and I obtained from the
+sisters attached to the hospital a special regimen, such as Hahnemann
+orders.  I was told, however, some months since, that I had not been
+faithful to all the rules of the doctrine.  I therefore took the
+trouble to begin again; I have studied the practice of the Parisian
+Homoeopathists, as I had studied their books, and I became convinced
+that they treated their patients as I had treated mine, and I affirm
+that I have been as rigorously exact in the treatment as any other
+person."
+
+And he expressly asserts the entire nullity of the influence of all
+the Homoeopathic remedies tried by him in modifying, so far as he
+could observe, the progress or termination of diseases.  It deserves
+notice that he experimented with the most boasted substances,--
+cinchona, aconite, mercury, bryonia, belladonna.  Aconite, for
+instance, he says he administered in more than forty cases of that
+collection of feverish symptoms in which it exerts so much power,
+according to Hahnemann, and in not one of them did it have the
+slightest influence, the pulse and heat remaining as before.
+
+These statements look pretty honest, and would seem hard to be
+explained away, but it is calmly said that he "did not know enough of
+the method to select the remedies with any tolerable precision."
+["Homoeopathic Examiner, vol. i.  p. 22.]
+
+"Nothing is left to the caprice of the physician."  (In a word,
+instead of being dependent upon blind chance, that there is an
+infallible law, guided by which; the physician MUST select the proper
+remedies.') ['Ibid.,' in a notice of Menzel's paper.]  Who are they
+that practice Homoeopathy, and say this of a man with the Materia
+Medica of Hahnemann lying before him?  Who are they that send these
+same globules, on which he experimented, accompanied by a little
+book, into families, whose members are thought competent to employ
+them, when they deny any such capacity to a man whose life has been
+passed at the bedside of patients, the most prominent teacher in the
+first Medical Faculty in the world, the consulting physician of the
+King of France, and one of the most renowned practical writers, not
+merely of his nation, but of his age?  I leave the quibbles by which
+such persons would try to creep out from under the crushing weight of
+these conclusions to the unfortunates who suppose that a reply is
+equivalent to an answer.
+
+Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris,
+invited two Homoeopathic practitioners to experiment in his wards.
+One of these was Curie, now of London, whose works are on the
+counters of some of our bookstores, and probably in the hands of some
+of my audience.  This gentleman, whom Dr. Baillie declares to be an
+enlightened man, and perfectly sincere in his convictions, brought
+his own medicines from the pharmacy which furnished Hahnemann
+himself, and employed them for four or five months upon patients in
+his ward, and with results equally unsatisfactory, as appears from
+Dr. Baillie's statement at a meeting of the Academy of Medicine.  And
+a similar experiment was permitted by the Clinical Professor of the
+Hotel Dieu of Lyons, with the same complete failure.
+
+But these are old and prejudiced practitioners.  Very well, then take
+the statement of Dr. Fleury, a most intelligent young physician, who
+treated homoeopathically more than fifty patients, suffering from
+diseases which it was not dangerous to treat in this way, taking
+every kind of precaution as to regimen, removal of disturbing
+influences, and the state of the atmosphere, insisted upon by the
+most vigorous partisans of the doctrine, and found not the slightest
+effect produced by the medicines.  And more than this, read nine of
+these cases, which he has published, as I have just done, and observe
+the absolute nullity of aconite, belladonna, and bryonia, against the
+symptoms over which they are pretended to exert such palpable, such
+obvious, such astonishing influences.  In the view of these
+statements, it is impossible not to realize the entire futility of
+attempting to silence this asserted science by the flattest and most
+peremptory results of experiment.  Were all the hospital physicians
+of Europe and America to devote themselves, for the requisite period,
+to this sole pursuit, and were their results to be unanimous as to
+the total worthlessness of the whole system in practice, this
+slippery delusion would slide through their fingers without the
+slightest discomposure, when, as they supposed, they had crushed
+every joint in its tortuous and trailing body.
+
+
+3.  I have said, that to show the truth of the Homoeopathic doctrine,
+as announced by Hahnemann, it would be necessary to show, in the
+third place, that remedies never cure diseases when they are not
+capable of producing similar symptoms!  The burden of this somewhat
+comprehensive demonstration lying entirely upon the advocates of this
+doctrine, it may be left to their mature reflections.
+
+
+It entered into my original plan to treat of the doctrine relating to
+Psora, or itch,--an almost insane conception, which I am glad to get
+rid of, for this is a subject one does not care to handle without
+gloves.  I am saved this trouble, however, by finding that many of
+the disciples of Hahnemann, those disciples the very gospel of whose
+faith stands upon his word, make very light of his authority on this
+point, although he himself says, "It has cost me twelve years of
+study and research to trace out the source of this incredible number
+of chronic affections, to discover this great truth, which remained
+concealed from all my predecessors and contemporaries, to establish
+the basis of its demonstration, and find out, at the same time, the
+curative medicines that were fit to combat this hydra in all its
+different forms."
+
+But, in the face of all this, the following remarks are made by
+Wolff, of Dresden, whose essays, according to the editor of the
+"Homoeopathic Examiner," "represent the opinions of a large majority
+of Homoeopathists in Europe."
+
+"It cannot be unknown to any one at all familiar with Homoeopathic
+literature, that Hahnemann's idea of tracing the large majority of
+chronic diseases to actual itch has met with the greatest opposition
+from Homoeopathic physicians themselves."  And again, "If the Psoric
+theory has led to no proper schism, the reason is to be found in the
+fact that it is almost without any influence in practice."
+
+We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke
+of Baden," and a "distinguished" Homoeopathist, actually asked
+Hahnemann for the proof that chronic diseases, such as dropsy, for
+instance, never arise from any other cause than itch; and that,
+according to common report, the venerable sage was highly incensed
+(fort courrouce) with Dr. Hartmann, of Leipsic, another
+"distinguished" Homoeopathist, for maintaining that they certainly
+did arise from other causes.
+
+And Dr. Fielitz, in the "Homoeopathic Gazette" of Leipsic, after
+saying, in a good-natured way, that Psora is the Devil in medicine,
+and that physicians are divided on this point into diabolists and
+exorcists, declares that, according to a remark of Hahnemann, the
+whole civilized world is affected with Psora.  I must therefore
+disappoint any advocate of Hahnemann who may honor me with his
+presence, by not attacking a doctrine on which some of the disciples
+of his creed would be very happy to have its adversaries waste their
+time and strength.  I will not meddle with this excrescence, which,
+though often used in time of peace, would be dropped, like the limb
+of a shell-fish, the moment it was assailed; time is too precious,
+and the harvest of living extravagances nods too heavily to my
+sickle, that I should blunt it upon straw and stubble.
+
+I will close the subject with a brief examination of some of the
+statements made in Homoeopathic works, and more particularly in the
+brilliant Manifesto of the "Examiner," before referred to.  And
+first, it is there stated under the head of "Homoeopathic
+Literature," that "SEVEN HUNDRED volumes have been issued from the
+press developing the peculiarities of the system, and many of them
+possessed of a scientific character that savans know well how to
+respect."  If my assertion were proper evidence in the case, I should
+declare, that, having seen a good many of these publications, from
+the year 1834, when I bought the work of the Rev. Thomas Everest,"
+[Dr. Curie speaks of this silly pamphlet as having been published in
+1835.] to within a few weeks, when I received my last importation of
+Homaeopathic literature, I have found that all, with a very few
+exceptions, were stitched pamphlets varying from twenty or thirty
+pages to somewhat less than a hundred, and generally resembling each
+other as much as so many spelling-books.
+
+But not being evidence in the case, I will give you the testimony of
+Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the
+same Manifesto as one of the most distinguished among the
+Homoeopathists of Europe.  I translate the sentence literally from
+the "Archives de la Medecine Homoeopathique."
+
+"The literature of Homoeopathy, if that honorable name must be
+applied to all kinds of book-making, has been degraded to the
+condition of the humblest servitude.  Productions without talent,
+without spirit, without discrimination, flat and pitiful eulogies,
+exaggerations surpassing the limits of the most robust faith,
+invectives against such as dared to doubt the dogmas which had been
+proclaimed, or catalogues of remedies; of such materials is it
+composed!  From distance to distance only, have appeared some memoirs
+useful to science or practice, which appear as so many green oases in
+the midst of this literary desert."
+
+It is a very natural as well as a curious question to ask, What has
+been the success of Homoeopathy in the different countries of Europe,
+and what is its present condition?
+
+The greatest reliance of the advocates of Homoeopathy is of course on
+Germany.  We know very little of its medical schools, its medical
+doctrines, or its medical men, compared with those of England and
+France.  And, therefore, when an intelligent traveller gives a direct
+account from personal inspection of the miserable condition of the
+Homoeopathic hospital at Leipsic, the first established in Europe,
+and the first on the list of the ever-memorable Manifesto, it is easy
+enough answer or elude the fact by citing various hard names of
+"distinguished" practitioners, which sound just as well to the
+uninformed public as if they were Meckel, or Tiedemann, or
+Langenbeck.  Dr. Leo-Wolf, who, to be sure, is opposed to
+Homoeopathy, but who is a scholar, and ought to know something
+of his own countrymen, assures us that "Dr. Kopp is the only German
+Homoeopathist, if we can call him so, who has been distinguished as
+an author and practitioner before he examined this method."  And Dr.
+Lee, the same gentleman in whose travels the paragraph relating to
+the Leipsic Hospital is to be found, says the same thing.  And I will
+cheerfully expose myself to any impertinent remark which it might
+suggest, to assure my audience that I never heard or saw one
+authentic Homoeopathic name of any country in Europe, which I had
+ever heard mentioned before as connected with medical science by a
+single word or deed sufficient to make it in any degree familiar to
+my ears, unless Arnold of Heidelberg is the anatomist who discovered
+a little nervous centre, called the otic ganglion.  But you need ask
+no better proof of who and what the German adherents of this doctrine
+must be, than the testimony of a German Homoeopathist as to the
+wretched character of the works they manufacture to enforce its
+claims.
+
+As for the act of this or that government tolerating or encouraging
+Homoeopathy, every person of common intelligence knows that it is a
+mere form granted or denied according to the general principles of
+policy adopted in different states, or the degree of influence which
+some few persons who have adopted it may happen to have at court.
+What may be the value of certain pompous titles with which many of
+the advocates of Homoeopathy are honored, it might be disrespectful
+to question.  But in the mean time the judicious inquirer may ponder
+over an extract which I translate from a paper relating to a
+personage well known to the community as Williams the Oculist, with
+whom I had the honor of crossing the Atlantic some years since, and
+who himself handed me two copies of the paper in question.
+
+"To say that he was oculist of Louis XVIII.  and of Charles X., and
+that he now enjoys the same title with respect to His Majesty, Louis
+Philippe, and the King of the Belgians, is unquestionably to say a
+great deal; and yet it is one of the least of his titles to public
+confidence.  His reputation rests upon a basis more substantial even
+than the numerous diplomas with which he is provided, than the
+membership of the different medical societies which have chosen him
+as their associate," etc., etc.
+
+And as to one more point, it is time that the public should fully
+understand that the common method of supporting barefaced imposture
+at the present day, both in Europe and in this country, consists in
+trumping up "Dispensaries," "Colleges of Health," and other
+advertising charitable clap-traps, which use the poor as decoy-ducks
+for the rich, and the proprietors of which have a strong predilection
+for the title of "Professor."  These names, therefore, have come to
+be of little or no value as evidence of the good character, still
+less of the high pretensions of those who invoke their authority.
+Nor does it follow, even when a chair is founded in connection with a
+well-known institution, that it has either a salary or an occupant;
+so that it may be, and probably is, a mere harmless piece of
+toleration on the part of the government if a Professorship of
+Homoeopathy is really in existence at Jena or Heidelberg.  And
+finally, in order to correct the error of any who might suppose that
+the whole Medical Profession of Germany has long since fallen into
+the delusions of Hahnemann, I will quote two lines which a celebrated
+anatomist and surgeon (whose name will occur again in this lecture in
+connection with a very pleasing letter) addressed to the French
+Academy of Medicine in 1835.  "I happened to be in Germany some
+months since, at a meeting of nearly six hundred physicians; one of
+them wished to bring up the question of Homoeopathy; they would not
+even listen to him."  This may have been very impolite and bigoted,
+but that is not precisely the point in reference to which I mention
+the circumstance.
+
+But if we cannot easily get at Germany, we can very easily obtain
+exact information from France and England.  I took the trouble to
+write some months ago to two friends in Paris, in whom I could place
+confidence, for information upon the subject.  One of them answered
+briefly to the effect that nothing was said about it.  When the late
+Curator of the Lowell Institute, at his request, asked about the
+works upon the subject, he was told that they had remained a long
+time on the shelves quite unsalable, and never spoken of.
+
+The other gentleman, [Dr. Henry T. Bigelow, now Professor of
+Surgery in Harvard University] whose name is well known to my
+audience, and who needs no commendation of mine, had the kindness to
+procure for me many publications upon the subject, and some
+information which sets the whole matter at rest, so far as Paris is
+concerned.  He went directly to the Baillieres, the principal and
+almost the only publishers of all the Homoeopathic books and journals
+in that city.  The following facts were taken by him from the
+account-books of this publishing firm.  Four Homoeopathic Journals
+have been published in Paris; three of them by the Baillieres.
+
+The reception they met with may be judged of by showing the number of
+subscribers to each on the books of the publishing firm.
+
+A Review published by some other house, which lasted one year, and
+had about fifty subscribers, appeared in 1834, 1835.
+
+There were only four Journals of Homoeopathy ever published in Paris.
+The Baillieres informed my correspondent that the sale of
+Homoeopathic books was much less than formerly, and that consequently
+they should undertake to publish no new books upon the subject,
+except those of Jahr or Hahnemann.  "This man," says my
+correspondent,--referring to one of the brothers,--"the publisher and
+headquarters of Homoeopathy in Paris, informs me that it is going
+down in England and Germany as well as in Paris."  For all the facts
+he had stated he pledged himself as responsible.
+
+Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and
+since then has been going down.
+
+Louis told my correspondent that no person of distinction in Paris
+had embraced Homoeopathy, and that it was declining.  If you ask who
+Louis is, I refer you to the well-known Homoeopathist, Peschier of
+Geneva, who says, addressing him, "I respect no one more than
+yourself; the feeling which guides your researches, your labors, and
+your pen, is so honorable and rare, that I could not but bow down
+before it; and I own, if there were any allopathist who inspired me
+with higher veneration, it would be him and not yourself whom I
+should address."
+
+Among the names of "Distinguished Homoeopathists," however, displayed
+in imposing columns, in the index of the "Homoeopathic Examiner," are
+those of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the
+world of science, and the last of them identified with some of the
+most valuable contributions which anatomical knowledge has received
+since the commencement of the present century.  One Dr. Chrysaora,
+who stands sponsor for many facts in that Journal, makes the
+following statement among the rest: "Professors, who are esteemed
+among the most distinguished of the Faculty (Faculty de Medicine),
+both as to knowledge and reputation, have openly confessed the power
+of Homoeopathia in forms of disease where the ordinary method of
+practice proved totally insufficient.  It affords me the highest
+pleasure to select from among these gentlemen, Marjolin, Amussat, and
+Breschet."
+
+Here is a literal translation of an original letter, now in my
+possession, from one of these Homoeopathists to my correspondent:--
+
+"DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER:
+
+"You have had the kindness to inform me in your letter that a new
+American Journal, the 'New World,'  has made use of my name in
+support of the pretended Homoeopathic doctrines, and that I am
+represented as one of the warmest partisans of Homoeopathy in France.
+
+"I am vastly surprised at the reputation manufactured for me upon the
+new continent; but I am obliged, in deference to truth, to reject it
+with my whole energy.  I spurn far from me everything which relates
+to that charlatanism called Homoeopathy, for these pretended
+doctrines cannot endure the scrutiny of wise and enlightened persons,
+who are guided by honorable sentiments in the practice of the noblest
+of arts.
+
+"PARIS, 3d November, 1841
+
+"I am, etc., etc.,
+
+"G. BRESCHET,
+
+"Professor in the Faculty of Medicine, Member of the Institute,
+Surgeon of Hotel Dieu, and Consulting Surgeon to the King, etc."
+[I first saw M.  Breschet's name mentioned in that Journal]
+
+Concerning Amussat, my correspondent writes, that he was informed by
+Madame Hahnemann, who converses in French more readily than her
+husband, and therefore often speaks for him, that "he was not a
+physician, neither Homoeopathist nor Allopathist, but that he was the
+surgeon of their own establishment; that is, performed as a surgeon
+all the operations they had occasion for in their practice."
+
+I regret not having made any inquiries as to Marjolin, who, I doubt
+not, would strike his ponderous snuff-box until it resounded like the
+Grecian horse, at hearing such a doctrine associated with his
+respectable name.  I was not aware, when writing to Paris, that this
+worthy Professor, whose lectures I long attended, was included in
+these audacious claims; but after the specimens I have given of the
+accuracy of the foreign correspondence of the "Homoeopathic
+Examiner," any further information I might obtain would seem so
+superfluous as hardly to be worth the postage.
+
+Homoeopathy may be said, then, to be in a sufficiently miserable
+condition in Paris.  Yet there lives, and there has lived for years,
+the illustrious Samuel Hahnemann, who himself assured my
+correspondent that no place offered the advantages of Paris in its
+investigation, by reason of the attention there paid to it.
+
+In England, it appears by the statement of Dr. Curie in October,
+1839, about eight years after its introduction into the country, that
+there were eighteen Homoeopathic physicians in the United Kingdom, of
+whom only three were to be found out of London, and that many of
+these practised Homoeopathy in secret.
+
+It will be seen, therefore, that, according to the recent statement
+of one of its leading English advocates, Homoeopathy had obtained not
+quite half as many practical disciples in England as Perkinism could
+show for itself in a somewhat less period from the time of its first
+promulgation in that country.
+
+Dr. Curie's letter, dated London, October 30, 1839, says there is
+"one in Dublin, Dr. Luther; at Glasgow, Dr. Scott."  The
+"distinguished" Chrysaora writes from Paris, dating October 20, 1839,
+"On the other hand, Homoeopathy is commencing to make an inroad into
+England by the way of Ireland.  At Dublin, distinguished physicians
+have already embraced the new system, and a great part of the
+nobility and gentry of that city have emancipated themselves from the
+English fashion and professional authority."
+
+But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize
+Homoeopathy; the Queen Dowager Adelaide has been treated by a
+Homoeopathic physician.  "Jarley is the delight of the nobility and
+gentry."  "The Royal Family are the patrons of Jarley."
+
+Let me ask if a Marquis and a Knight are better than two Lords, and
+if the Dowager of Royalty is better than Royalty itself, all of which
+illustrious dignities were claimed in behalf of Benjamin Douglass
+Perkins?
+
+But if the balance is thought too evenly suspended in this case,
+another instance can be given in which the evidence of British
+noblemen and their ladies is shown to be as valuable in establishing
+the character of a medical man or doctrine, as would be the testimony
+of the Marquis of Waterford concerning the present condition and
+prospects of missionary enterprise.  I have before me an octavo
+volume of more than four hundred pages, in which, among much similar
+matter, I find highly commendatory letters from the Marchioness of
+Ormond, Lady Harriet Kavanagh, the Countess of Buckinghamshire, the
+Right Hon. Viscount Ingestre, M. P., and the Most Noble, the Marquis
+of Sligo,--all addressed to "John St. John Long, Esq," a wretched
+charlatan, twice tried for, and once convicted of, manslaughter at
+the Old Bailey.
+
+This poor creature, too, like all of his tribe, speaks of the medical
+profession as a great confederation of bigoted monopolists.  He, too,
+says that "If an innovator should appear, holding out hope to those
+in despair, and curing disorders which the faculty have recorded as
+irremediable, he is at once, and without inquiry, denounced as an
+empiric and an impostor."  He, too, cites the inevitable names of
+Galileo and Harvey, and refers to the feelings excited by the great
+discovery of Jenner.  From the treatment of the great astronomer who
+was visited with the punishment of other heretics by the
+ecclesiastical authorities of a Catholic country some centuries
+since, there is no very direct inference to be drawn to the medical
+profession of the present time.  His name should be babbled no
+longer, after having been placarded for the hundredth time in the
+pages of St. John Long.  But if we are doomed to see constant
+reference to the names of Harvey and Jenner in every worthless
+pamphlet containing the prospectus of some new trick upon the public,
+let us, once for all, stare the facts in the face, and see how the
+discoveries of these great men were actually received by the medical
+profession.
+
+In 1628, Harvey published his first work upon the circulation.  His
+doctrines were a complete revolution of the prevailing opinions of
+all antiquity.  They immediately found both champions and opponents;
+of which last, one only, Riolanus, seemed to Harvey worthy of an
+answer, on account of his "rank, fame, and learning."  Controversy in
+science, as in religion, was not, in those days, carried on with all
+the courtesy which our present habits demand, and it is possible that
+some hard words may have been applied to Harvey, as it is very
+certain that he used the most contemptuous expressions towards
+others.
+
+Harvey declares in his second letter to Riolanus, "Since the first
+discovery of the circulation, hardly a day, or a moment, has passed
+without my hearing it both well and ill spoken of; some attack it
+with great hostility, others defend it with high encomiums; one party
+believe that I have abundantly proved the truth of the doctrine
+against all the weight of opposing arguments, by experiments,
+observations, and dissections; others think it not yet sufficiently
+cleared up, and free from objections."  Two really eminent
+Professors, Plempius of Louvain, and Walaeus of Leyden, were among
+its early advocates.
+
+The opinions sanctioned by the authority of long ages, and the names
+of Hippocrates and Galen, dissolved away, gradually, but certainly,
+before the demonstrations of Harvey.  Twenty-four years after the
+publication of his first work, and six years before his death, his
+bust in marble was placed in the Hall of the College of Physicians,
+with a suitable inscription recording his discoveries.
+
+Two years after this he was unanimously invited to accept the
+Presidency of that body; and he lived to see his doctrine
+established, and all reputable opposition withdrawn.
+
+There were many circumstances connected with the discovery of Dr.
+Jenner which were of a nature to excite repugnance and opposition.
+The practice of inoculation for the small-pox had already disarmed
+that disease of many of its terrors.  The introduction of a
+contagious disease from a brute creature into the human system
+naturally struck the public mind with a sensation of disgust and
+apprehension, and a part of the medical public may have shared these
+feelings.  I find that Jenner's discovery of vaccination was made
+public in June, 1798.  In July of the same year the celebrated
+surgeon, Mr. Cline, vaccinated a child with virus received from Dr.
+Jenner, and in communicating the success of this experiment, he
+mentions that Dr. Lister, formerly of the Small-Pox Hospital, and
+himself, are convinced of the efficacy of the cow-pox.  In November
+of the same year, Dr. Pearson published his "Inquiry," containing the
+testimony of numerous practitioners in different parts of the
+kingdom, to the efficacy of the practice.  Dr. HAYGARTH, who was so
+conspicuous in exposing the follies of Perkinism, was among the very
+earliest to express his opinion in favor of vaccination.  In 1801,
+Dr. Lettsom mentions the circumstance "as being to the honor of the
+medical professors, that they have very generally encouraged this
+salutary practice, although it is certainly calculated to lessen
+their pecuniary advantages by its tendency to extirpate a fertile
+source of professional practice."
+
+In the same year the Medical Committee of Paris spoke of vaccination
+in a public letter, as "the most brilliant and most important
+discovery of the eighteenth century."  The Directors of a Society for
+the Extermination of the Small-Pox, in a Report dated October 1st,
+1807, "congratulate the public on the very favorable opinion which
+the Royal College of Physicians of London, after a most minute and
+laborious investigation made by the command of his Majesty, have a
+second time expressed on the subject of vaccination, in their Report
+laid before the House of Commons, in the last session of Parliament;
+in consequence of which the sum of twenty thousand pounds was voted
+to Dr. Jenner, as a remuneration for his discovery, in addition to
+ten thousand pounds before granted."  (In June, 1802.)
+
+These and similar accusations, so often brought up against the
+Medical Profession, are only one mode in which is manifested a spirit
+of opposition not merely to medical science, but to all science, and
+to all sound knowledge.  It is a spirit which neither understands
+itself nor the object at which it is aiming.  It gropes among the
+loose records of the past, and the floating fables of the moment, to
+glean a few truths or falsehoods tending to prove, if they prove
+anything, that the persons who have passed their lives in the study
+of a branch of knowledge the very essence of which must always
+consist in long and accurate observation, are less competent to judge
+of new doctrines in their own department than the rest of the
+community.  It belongs to the clown in society, the destructive in
+politics, and the rogue in practice.
+
+The name of Harvey, whose great discovery was the legitimate result
+of his severe training and patient study, should be mentioned only to
+check the pretensions of presumptuous ignorance.  The example of
+Jenner, who gave his inestimable secret, the result of twenty-two
+years of experiment and researches, unpurchased, to the public,--
+when, as was said in Parliament, he might have made a hundred
+thousand pounds by it as well as any smaller sum,--should be referred
+to only to rebuke the selfish venders of secret remedies, among whom
+his early history obliges us reluctantly to record Samuel Hahnemann.
+Those who speak of the great body of physicians as if they were
+united in a league to support the superannuated notions of the past
+against the progress of improvement, have read the history of
+medicine to little purpose.  The prevalent failing of this profession
+has been, on the contrary, to lend a too credulous ear to ambitious
+and plausible innovators.  If at the present time ten years of public
+notoriety have passed over any doctrine professing to be of
+importance in medical science, and if it has not succeeded in raising
+up a powerful body of able, learned, and ingenious advocates for its
+claims, the fault must be in the doctrine and not in the medical
+profession.
+
+Homoeopathy has had a still more extended period of trial than this,
+and we have seen with what results.  It only remains to throw out a
+few conjectures as to the particular manner in which it is to break
+up and disappear.
+
+1.  The confidence of the few believers in this delusion will never
+survive the loss of friends who may die of any acute disease, under a
+treatment such as that prescribed by Homoeopathy.  It is doubtful how
+far cases of this kind will be trusted to its tender mercies, but
+wherever it acquires any considerable foothold, such cases must come,
+and with them the ruin of those who practise it, should any highly
+valued life be thus sacrificed.
+
+2.  After its novelty has worn out, the ardent and capricious
+individuals who constitute the most prominent class of its patrons
+will return to visible doses, were it only for the sake of a change.
+
+3.  The Semi-Homoeopathic practitioner will gradually withdraw from
+the rotten half of his business and try to make the public forget his
+connection with it.
+
+4.  The ultra Homoeopathist will either recant and try to rejoin the
+medical profession; or he will embrace some newer and if possible
+equally extravagant doctrine; or he will stick to his colors and go
+down with his sinking doctrine.  Very few will pursue the course last
+mentioned.
+
+A single fact may serve to point out in what direction there will
+probably be a movement of the dissolving atoms of Homoeopathy.  On
+the 13th page of the too frequently cited Manifesto of the "Examiner"
+I read the following stately paragraph:
+
+"Bigelius, M. D., physician to the Emperor of Russia, whose elevated
+reputation is well known in Europe, has been an acknowledged advocate
+of Hahnemann's doctrines for several years.  He abandoned Allopathia
+for Homoeopathia."  The date of this statement is January, 1840.  I
+find on looking at the booksellers' catalogues that one Bigel, or
+Bigelius, to speak more classically, has been at various times
+publishing Homoeopathic books for some years.
+
+Again, on looking into the "Encyclographie des Sciences Medicales"
+for April, 1840, I find a work entitled "Manual of HYDROSUDOPATHY,
+or the Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel,
+Physician of the School of Strasburg, Member of the Medico-
+Chirurgical Institute of Naples, of the Academy of St.  Petersburg,--
+Assessor of the College of the Empire of Russia, Physician of his
+late Imperial Highness the Grand Duke Constantine, Chevalier of the
+Legion of Honor, etc."  Hydrosudopathy or Hydropathy, as it is
+sometimes called, is a new medical doctrine or practice which has
+sprung up in Germany since Homoeopathy, which it bids fair to drive
+out of the market, if, as Dr. Bigel says, fourteen physicians
+afflicted with diseases which defied themselves and their colleagues
+came to Graefenberg, in the year 1836 alone, and were cured.  Now Dr.
+Bigel, "whose elevated reputation is well known in Europe," writes as
+follows: "The reader will not fail to see in this defence of the
+curative method of Graefenberg a profession of medical faith, and he
+will be correct in so doing."  And his work closes with the following
+sentence, worthy of so distinguished an individual: "We believe, with
+religion, that the water of baptism purifies the soul from its
+original sin; let us believe also, with experience, that it is for
+our corporeal sins the redeemer of the human body."  If Bigel,
+Physician to the late Grand Duke Constantine, is identical with Bigel
+whom the "Examiner" calls Physician to the Emperor of Russia, it
+appears that he is now actively engaged in throwing cold water at
+once upon his patients and the future prospects of Homoeopathy.
+
+If, as must be admitted, no one of Hahnemann's doctrines is received
+with tolerable unanimity among his disciples, except the central
+axiom, Similia similibus curantur; if this axiom itself relies mainly
+for its support upon the folly and trickery of Hahnemann, what can we
+think of those who announce themselves ready to relinquish all the
+accumulated treasures of our art, to trifle with life upon the
+strength of these fantastic theories?  What shall we think of
+professed practitioners of medicine, if, in the words of Jahr, "from
+ignorance, for their personal convenience, or through charlatanism,
+they treat their patients one day Homoeopathically and the next
+Allopathically;" if they parade their pretended new science before
+the unguarded portion of the community; if they suffer their names to
+be coupled with it wherever it may gain a credulous patient; and deny
+all responsibility for its character, refuse all argument for its
+doctrines, allege no palliation for the ignorance and deception
+interwoven with every thread of its flimsy tissue, when they are
+questioned by those competent to judge and entitled to an answer?
+
+Such is the pretended science of Homoeopathy, to which you are asked
+to trust your lives and the lives of those dearest to you.  A mingled
+mass of perverse ingenuity, of tinsel erudition, of imbecile
+credulity, and of artful misrepresentation, too often mingled in
+practice, if we may trust the authority of its founder, with
+heartless and shameless imposition.  Because it is suffered so often
+to appeal unanswered to the public, because it has its journals, its
+patrons, its apostles, some are weak enough to suppose it can escape
+the inevitable doom of utter disgrace and oblivion.  Not many years
+can pass away before the same curiosity excited by one of Perkins's
+Tractors will be awakened at the sight of one of the Infinitesimal
+Globules.  If it should claim a longer existence, it can only be by
+falling into the hands of the sordid wretches who wring their bread
+from the cold grasp of disease and death in the hovels of ignorant
+poverty.
+
+As one humble member of a profession which for more than two thousand
+years has devoted itself to the pursuit of the best earthly interests
+of mankind, always assailed and insulted from without by such as are
+ignorant of its infinite perplexities and labors, always striving in
+unequal contest with the hundred-armed giant who walks in the
+noonday, and sleeps not in the midnight, yet still toiling, not
+merely for itself and the present moment, but for the race and the
+future, I have lifted my voice against this lifeless delusion,
+rolling its shapeless bulk into the path of a noble science it is too
+weak to strike, or to injure.
+
+
+
+
+
+
+THE CONTAGIOUSNESS OF PUERPERAL FEVER
+Printed in 1843; reprinted with additions, 1855.
+
+
+THE POINT AT ISSUE.
+
+
+THE AFFIRMATIVE.
+
+"The disease known as Puerperal Fever is so far contagious as to be
+frequently carried from patient to patient by physicians and nurses."
+O. W. Holmes, 1843.
+
+
+THE NEGATIVE.
+
+"The result of the whole discussion will, I trust, serve, not only to
+exalt your views of the value and dignity of our profession, but to
+divest your minds of the overpowering dread that you can ever become,
+especially to woman, under the extremely interesting circumstances of
+gestation and parturition, the minister of evil; that you can ever
+convey, in any possible manner, a horrible virus, so destructive in
+its effects, and so mysterious in its operations as that attributed
+to puerperal fever."--Professor Hodge,
+1852.
+
+"I prefer to attribute them to accident, or Providence, of which I
+can form a conception, rather than to a contagion of which I cannot
+form any clear idea, at least as to this particular malady."--
+Professor Meigs, 1852.
+
+" .  .  .  in the propagation of which they have no more to do, than
+with the propagation of cholera from Jessore to San Francisco, and
+from Mauritius to St. Petersburg."--Professor Meigs, 1854.
+
+                    ---------------------
+
+"I arrived at that certainty in the matter, that I could venture to
+foretell what women would be affected with the disease, upon hearing
+by what midwife they were to be delivered, or by what nurse they were
+to be attended, during their lying-in; and, almost in every instance,
+my prediction was verified."--Gordon, 1795.
+
+"A certain number of deaths is caused every year by the contagion of
+puerperal fever, communicated by the nurses and medical attendants."
+Farr, in Fifth Annual Report of Registrar-General of England, 1843.
+
+".  .  .  boards of health, if such exist, or, without them, the
+medical institutions of a country, should have the power of coercing,
+or of inflicting some kind of punishment on those who recklessly go
+from cases of puerperal fevers to parturient or puerperal females,
+without using due precaution; and who, having been shown the risk,
+criminally encounter it, and convey pestilence and death to the
+persons they are employed to aid in the most interesting and
+suffering period of female existence."--Copland's Medical
+Dictionary, Art.  Puerperal States and Diseases, 1852.
+
+"We conceive it unnecessary to go into detail to prove the contagious
+nature of this disease, as there are few, if any, American
+practitioners who do not believe in this doctrine."--Dr. Lee, in
+Additions to Article last cited.
+
+                   -----------------------
+
+[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion
+arose in a Medical Society of which I was a member, involving the
+subject of a certain supposed cause of disease, about which something
+was known, a good deal suspected, and not a little feared.  The
+discussion was suggested by a case, reported at the preceding
+meeting, of a physician who made an examination of the body of a
+patient who had died with puerperal fever, and who himself died in
+less than a week, apparently in consequence of a wound received at
+the examination, having attended several women in confinement in the
+mean time, all of whom, as it was alleged, were attacked with
+puerperal fever.
+
+Whatever apprehensions and beliefs were entertained, it was plain
+that a fuller knowledge of the facts relating to the subject would be
+acceptable to all present.  I therefore felt that it would be doing a
+good service to look into the best records I could find, and inquire
+of the most trustworthy practitioners I knew, to learn what
+experience had to teach in the matter, and arrived at the results
+contained in the following pages.
+
+The Essay was read before the Boston Society for Medical Improvement,
+and, at the request of the Society, printed in the "New England
+Quarterly Journal of Medicine and Surgery" for April, 1843.  As this
+Journal never obtained a large circulation, and ceased to be
+published after a year's existence, and as the few copies I had
+struck off separately were soon lost sight of among the friends to
+whom they were sent, the Essay can hardly be said to have been fully
+brought before the Profession.
+
+The subject of this Paper has the same profound interest for me at
+the present moment as it had when I was first collecting the terrible
+evidence out of which, as it seems to me, the commonest exercise of
+reason could not help shaping the truth it involved.  It is not
+merely on account of the bearing of the question,--if there is a
+question,--on all that is most sacred in human life and happiness,
+that the subject cannot lose its interest.  It is because it seems
+evident that a fair statement of the facts must produce its proper
+influence on a very large proportion of well-constituted and
+unprejudiced minds.  Individuals may, here and there, resist the
+practical bearing of the evidence on their own feelings or interests;
+some may fail to see its meaning, as some persons may be found who
+cannot tell red from green; but I cannot doubt that most readers will
+be satisfied and convinced, to loathing, long before they have
+finished the dark obituary calendar laid before them.
+
+I do not know that I shall ever again have so good an opportunity of
+being useful as was granted me by the raising of the question which
+produced this Essay.  For I have abundant evidence that it has made
+many practitioners more cautious in their relations with puerperal
+females, and I have no doubt it will do so still, if it has a chance
+of being read, though it should call out a hundred counterblasts,
+proving to the satisfaction of their authors that it proved nothing.
+And for my part, I had rather rescue one mother from being poisoned
+by her attendant, than claim to have saved forty out of fifty
+patients to whom I had carried the disease.  Thus, I am willing to
+avail myself of any hint coming from without to offer this paper once
+more to the press.  The occasion has presented itself, as will be
+seen, in a convenient if not in a flattering form.
+
+
+I send this Essay again to the MEDICAL PROFESSION, without the change
+of a word or syllable.  I find, on reviewing it, that it anticipates
+and eliminates those secondary questions which cannot be entertained
+for a moment until the one great point of fact is peremptorily
+settled.  In its very statement of the doctrine maintained it avoids
+all discussion of the nature of the disease "known as puerperal
+fever," and all the somewhat stale philology of the word contagion.
+It mentions, fairly enough, the names of sceptics, or unbelievers as
+to the reality of personal transmission; of Dewees, of Tonnelle, of
+Duges, of Baudelocque, and others; of course, not including those
+whose works were then unwritten or unpublished; nor enumerating all
+the Continental writers who, in ignorance of the great mass of
+evidence accumulated by British practitioners, could hardly be called
+well informed on this subject.  It meets all the array of negative
+cases,--those in which disease did not follow exposure,--by the
+striking example of small-pox, which, although one of the most
+contagious of diseases, is subject to the most remarkable
+irregularities and seeming caprices in its transmission.  It makes
+full allowance for other causes besides personal transmission,
+especially for epidemic influences.  It allows for the possibility of
+different modes of conveyance of the destructive principle.  It
+recognizes and supports the belief that a series of cases may
+originate from a single primitive source which affects each new
+patient in turn; and especially from cases of Erysipelas.  It does
+not undertake to discuss the theoretical aspect of the subject; that
+is a secondary matter of consideration.  Where facts are numerous,
+and unquestionable, and unequivocal in their significance, theory
+must follow them as it best may, keeping time with their step, and
+not go before them, marching to the sound of its own drum and
+trumpet.  Having thus narrowed its area to a limited practical
+platform of discussion, a matter of life and death, and not of
+phrases or theories, it covers every inch of it with a mass of
+evidence which I conceive a Committee of Husbands, who can count
+coincidences and draw conclusions as well as a Synod of Accoucheurs,
+would justly consider as affording ample reasons for an unceremonious
+dismissal of a practitioner (if it is conceivable that such a step
+could be waited for), after five or six funerals had marked the path
+of his daily visits, while other practitioners were not thus
+escorted.  To the Profession, therefore, I submit the paper in its
+original form, and leave it to take care of itself.
+
+To the MEDICAL STUDENTS, into whose hands this Essay may fall, some
+words of introduction may be appropriate, and perhaps, to a small
+number of them, necessary.  There are some among them who, from
+youth, or want of training, are easily bewildered and confused in any
+conflict of opinions into which their studies lead them.  They are
+liable to lose sight of the main question in collateral issues, and
+to be run away with by suggestive speculations.  They confound belief
+with evidence, often trusting the first because it is expressed with
+energy, and slighting the latter because it is calm and
+unimpassioned.  They are not satisfied with proof; they cannot
+believe a point is settled so long as everybody is not silenced.
+They have not learned that error is got out of the minds that cherish
+it, as the taenia is removed from the body, one joint, or a few
+joints at a time, for the most part, rarely the whole evil at once.
+They naturally have faith in their instructors, turning to them for
+truth, and taking what they may choose to give them; babes in
+knowledge, not yet able to tell the breast from the bottle, pumping
+away for the milk of truth at all that offers, were it nothing better
+than a Professor's shrivelled forefinger.
+
+In the earliest and embryonic stage of professional development, any
+violent impression on the instructor's mind is apt to be followed by
+some lasting effect on that of the pupil.  No mother's mark is more
+permanent than the mental naevi and moles, and excrescences, and
+mutilations, that students carry with them out of the lecture-room,
+if once the teeming intellect which nourishes theirs has been scared
+from its propriety by any misshapen fantasy.  Even an impatient or
+petulant expression, which to a philosopher would be a mere index of
+the low state of amiability of the speaker at the moment of its
+utterance, may pass into the young mind as an element of its future
+constitution, to injure its temper or corrupt its judgment.  It is a
+duty, therefore, which we owe to this younger class of students, to
+clear any important truth which may have been rendered questionable
+in their minds by such language, or any truth-teller against whom
+they may have been prejudiced by hasty epithets, from the impressions
+such words have left.  Until this is done, they are not ready for the
+question, where there is a question, for them to decide.  Even if we
+ourselves are the subjects of the prejudice, there seems to be no
+impropriety in showing that this prejudice is local or personal, and
+not an acknowledged conviction with the public at large.  It may be
+necessary to break through our usual habits of reserve to do this,
+but this is the fault of the position in which others have placed us.
+
+Two widely-known and highly-esteemed practitioners, Professors in two
+of the largest Medical Schools of the Union, teaching the branch of
+art which includes the Diseases of Women, and therefore speaking with
+authority; addressing in their lectures and printed publications
+large numbers of young men, many of them in the tenderest immaturity
+of knowledge, have recently taken ground in a formal way against the
+doctrine maintained in this paper:
+
+On the Non-Contagious Character of Puerperal Fever: An Introductory
+Lecture.  By Hugh L.  Hodge, M. D., Professor of Obstetrics in the
+University of Pennsylvania.  Delivered Monday, October 11, 1852.
+Philadelphia, 1852.
+
+On the Nature, Signs, and Treatment of Childbed Fevers : in a Series
+of Letters addressed to the Students of his Class.  By Charles D.
+Meigs, M.  D., Professor of Midwifery and the Diseases of Women and
+Children in Jefferson Medical College, Philadelphia, etc., etc.
+Philadelphia, 1854.  Letter VI.
+
+
+The first of the two publications, Dr. Hodge's Lecture, while its
+theoretical considerations and negative experiences do not seem to me
+to require any further notice than such as lay ready for them in my
+Essay written long before, is, I am pleased to say, unobjectionable
+in tone and language, and may be read without offence.
+
+This can hardly be said of the chapter of Dr. Meigs's volume which
+treats of Contagion in Childbed Fever.  There are expressions used in
+it which might well put a stop to all scientific discussions, were
+they to form the current coin in our exchange of opinions.  I leave
+the "very young gentlemen," whose careful expositions of the results
+of practice in more than six thousand cases are characterized as "the
+jejune and fizenless dreamings of sophomore writers," to the
+sympathies of those "dear young friends," and "dear young gentlemen,"
+who will judge how much to value their instructor's counsel to think
+for themselves, knowing what they are to expect if they happen not to
+think as he does.
+
+One unpalatable expression I suppose the laws of construction oblige
+me to appropriate to myself, as my reward for a certain amount of
+labor bestowed on the investigation of a very important question of
+evidence, and a statement of my own practical conclusions.  I take no
+offence, and attempt no retort.  No man makes a quarrel with me over
+the counterpane that covers a mother, with her new-born infant at her
+breast.  There is no epithet in the vocabulary of slight and sarcasm
+that can reach my personal sensibilities in such a controversy.  Only
+just so far as a disrespectful phrase may turn the student aside from
+the examination of the evidence, by discrediting or dishonoring the
+witness, does it call for any word of notice.
+
+I appeal from the disparaging language by which the Professor in the
+Jefferson School of Philadelphia world dispose of my claims to be
+listened to.  I appeal, not to the vote of the Society for Medical
+Improvement, although this was an unusual evidence of interest in the
+paper in question, for it was a vote passed among my own townsmen;
+nor to the opinion of any American, for none know better than the
+Professors in the great Schools of Philadelphia how cheaply the
+praise of native contemporary criticism is obtained.  I appeal to the
+recorded opinions of those whom I do not know, and who do not know
+me, nor care for me, except for the truth that I may have uttered; to
+Copland, in his "Medical Dictionary," who has spoken of my Essay in
+phrases to which the pamphlets of American "scribblers" are seldom
+used from European authorities; to Ramsbotham, whose compendious
+eulogy is all that self-love could ask; to the "Fifth Annual Report"
+of the Registrar-General of England, in which the second-hand
+abstract of my Essay figures largely, and not without favorable
+comment, in an important appended paper.  These testimonies, half
+forgotten until this circumstance recalled them, are dragged into the
+light, not in a paroxysm of vanity, but to show that there may be
+food for thought in the small pamphlet which the Philadelphia Teacher
+treats so lightly.  They were at least unsought for, and would never
+have been proclaimed but for the sake of securing the privilege of a
+decent and unprejudiced hearing.
+
+I will take it for granted that they have so far counterpoised the
+depreciating language of my fellow-countryman and fellow-teacher as
+to gain me a reader here and there among the youthful class of
+students I am now addressing.  It is only for their sake that I think
+it necessary to analyze, or explain, or illustrate, or corroborate
+any portion of the following Essay.  But I know that nothing can be
+made too plain for beginners; and as I do not expect the
+practitioner, or even the more mature student, to take the trouble to
+follow me through an Introduction which I consider wholly unnecessary
+and superfluous for them, I shall not hesitate to stoop to the most
+elementary simplicity for the benefit of the younger student.  I do
+this more willingly because it affords a good opportunity, as it
+seems to me, of exercising the untrained mind in that medical logic
+which does not seem to have been either taught or practised in our
+schools of late, to the extent that might be desired.
+
+I will now exhibit, in a series of propositions reduced to their
+simplest expression, the same essential statements and conclusions as
+are contained in the Essay, with such commentaries and explanations
+as may be profitable to the inexperienced class of readers addressed.
+
+
+I.  It has been long believed, by many competent observers, that
+Puerperal Fever (so called) is sometimes carried from patient to
+patient by medical assistants.
+
+II.  The express object of this Essay is to prove that it is so
+carried.
+
+III.  In order to prove this point, it is not necessary to consult
+any medical theorist as to whether or not it is consistent with his
+preconceived notions that such a mode of transfer should exist.
+
+IV.  If the medical theorist insists on being consulted, and we see
+fit to indulge him, he cannot be allowed to assume that the alleged
+laws of contagion, deduced from observation in other diseases, shall
+be cited to disprove the alleged laws deduced from observation in
+this.  Science would never make progress under such conditions.
+Neither the long incubation of hydrophobia, nor the protecting power
+of vaccination, would ever have been admitted, if the results of
+observation in these affections had been rejected as contradictory to
+the previously ascertained laws of contagion.
+
+V.  The disease in question is not a common one; producing, on the
+average, about three deaths in a thousand births, according to the
+English Registration returns which I have examined.
+
+VI.  When an unusually large number of cases of this disease occur
+about the same time, it is inferred, therefore, that there exists
+some special cause for this increased frequency.  If the disease
+prevails extensively over a wide region of country, it is attributed
+without dispute to an epidemic influence.  If it prevails in a single
+locality, as in a hospital, and not elsewhere, this is considered
+proof that some local cause is there active in its production.
+
+VII.  When a large number of cases of this disease occur in rapid
+succession, in one individual's ordinary practice, and few or none
+elsewhere, these cases appearing in scattered localities, in patients
+of the same average condition as those who escape under the care of
+others, there is the same reason for connecting the cause of the
+disease with the person in this instance, as with the place in that
+last mentioned.
+
+VIII.  Many series of cases, answering to these conditions, are given
+in this Essay, and many others will be referred to which have
+occurred since it was written.
+
+IX.  The alleged results of observation may be set aside; first,
+because the so-called facts are in their own nature equivocal;
+secondly, because they stand on insufficient authority; thirdly,
+because they are not sufficiently numerous.  But, in this case, the
+disease is one of striking and well-marked character; the witnesses
+are experts, interested in denying and disbelieving the facts; the
+number of consecutive cases in many instances frightful, and the
+number of series of cases such that I have no room for many of them
+except by mere reference.
+
+X.  These results of observation, being admitted, may, we will
+suppose, be interpreted in different methods.  Thus the coincidences
+may be considered the effect of chance.  I have had the chances
+calculated by a competent person, that a given practitioner, A.,
+shall have sixteen fatal cases in a month, on the following data:
+A. to average attendance upon two hundred and fifty births in a year;
+three deaths in one thousand births to be assumed as the average from
+puerperal fever; no epidemic to be at the time prevailing.  It
+follows, from the answer given me, that if we suppose every one of
+the five hundred thousand annual births of England to have been
+recorded during the last half-century, there would not be one chance
+in a million million million millions that one such series should be
+noted.  No possible fractional error in this calculation can render
+the chance a working probability.  Applied to dozens of series of
+various lengths, it is obviously an absurdity.  Chance, therefore, is
+out of the question as an explanation of the admitted coincidences.
+
+XI.  There is, therefore, some relation of cause and effect between
+the physician's presence and the patient's disease.
+
+XII.  Until it is proved to what removable condition attaching to the
+attendant the disease is owing, he is bound to stay away from his
+patients so soon as he finds himself singled out to be tracked by the
+disease.  How long, and with what other precautions, I have
+suggested, without dictating, at the close of my Essay.  If the
+physician does not at once act on any reasonable suspicion of his
+being the medium of transfer, the families where he is engaged, if
+they are allowed to know the facts, should decline his services for
+the time.  His feelings on the occasion, however interesting to
+himself, should not be even named in this connection.  A physician
+who talks about ceremony and gratitude, and services rendered, and
+the treatment he got, surely forgets himself; it is impossible that
+he should seriously think of these small matters where there is even
+a question whether he may not carry disease, and death, and
+bereavement into any one of "his families," as they are sometimes
+called.
+
+
+I will now point out to the young student the mode in which he may
+relieve his mind of any confusion, or possibly, if very young, any
+doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised
+in his mind.
+
+The most prominent ideas of the Letter are, first, that the
+transmissible nature of puerperal fever appears improbable, and,
+secondly, that it would be very inconvenient to the writer.
+Dr. Woodville, Physician to the Small-Pox and Inoculation Hospital in
+London, found it improbable, and exceedingly inconvenient to himself,
+that cow pox should prevent small-pox; but Dr. Jenner took the
+liberty to prove the fact, notwithstanding.
+
+I will first call the young student's attention to the show of
+negative facts (exposure without subsequent disease), of which much
+seems to be thought.  And I may at the same time refer him to Dr.
+Hodge's Lecture, where he will find the same kind of facts and
+reasoning.  Let him now take up Watson's Lectures, the good sense and
+spirit of which have made his book a universal favorite, and open to
+the chapter on Continued Fever.  He will find a paragraph containing
+the following sentence: "A man might say, 'I was in the battle of
+Waterloo, and saw many men around me fall down and die, and it was
+said that they were struck down by musket-balls; but I know better
+than that, for I was there all the time, and so were many of my
+friends, and we were never hit by any musket-balls.  Musket-balls,
+therefore, could not have been the cause of the deaths we witnessed.'
+And if, like contagion, they were not palpable to the senses, such a
+person might go on to affirm that no proof existed of there being any
+such thing as musket-balls."  Now let the student turn back to the
+chapter on Hydrophobia in the same volume.  He will find that John
+Hunter knew a case in which, of twenty-one persons bitten, only one
+died of the disease.  He will find that one dog at Charenton was
+bitten at different times by thirty different mad dogs, and outlived
+it all.  Is there no such thing, then, as hydrophobia?  Would one
+take no especial precautions if his wife, about to become a mother,
+had been bitten by a rabid animal, because so many escape?  Or let
+him look at "Underwood on Diseases of Children,"[Philadelphia, 1842,
+p.  244, note.] and he will find the case of a young woman who was
+inoculated eight times in thirty days, at the same time attending
+several children with smallpox, and yet was not infected.  But seven
+weeks afterwards she took the disease and died.
+
+It would seem as if the force of this argument could hardly fail to
+be seen, if it were granted that every one of these series of cases
+were so reported as to prove that there could have been no transfer
+of disease.  There is not one of them so reported, in the Lecture or
+the Letter, as to prove that the disease may not have been carried by
+the practitioner.  I strongly suspect that it was so carried in some
+of these cases, but from the character of the very imperfect evidence
+the question can never be settled without further disclosures.
+
+Although the Letter is, as I have implied, principally taken up with
+secondary and collateral questions, and might therefore be set aside
+as in the main irrelevant, I am willing, for the student's sake, to
+touch some of these questions briefly, as an illustration of its
+logical character.
+
+The first thing to be done, as I thought when I wrote my Essay, was
+to throw out all discussions of the word contagion, and this I did
+effectually by the careful wording of my statement of the subject to
+be discussed.  My object was not to settle the etymology or
+definition of a word, but to show that women had often died in
+childbed, poisoned in some way by their medical attendants.  On the
+other point, I, at least, have no controversy with anybody, and I
+think the student will do well to avoid it in this connection.  If I
+must define my position, however, as well as the term in question, I
+am contented with Worcester's definition; provided always this avowal
+do not open another side controversy on the merits of his Dictionary,
+which Dr. Meigs has not cited, as compared with Webster's, which he
+has.
+
+I cannot see the propriety of insisting that all the laws of the
+eruptive fevers must necessarily hold true of this peculiar disease
+of puerperal women.  If there were any such propriety, the laws of
+the eruptive fevers must at least be stated correctly.  It is not
+true, for instance, as Dr. Meigs states, that contagion is "no
+respecter of persons;" that "it attacks all individuals alike."  To
+give one example: Dr. Gregory, of the Small-Pox Hospital, who ought
+to know, says that persons pass through life apparently insensible to
+or unsusceptible of the small-pox virus, and that the same persons do
+not take the vaccine disease.
+
+As to the short time of incubation, of which so much is made, we have
+no right to decide beforehand whether it shall be long or short, in
+the cases we are considering.  A dissection wound may produce
+symptoms of poisoning in six hours; the bite of a rabid animal may
+take as many months.
+
+After the student has read the case in Dr. Meigs's 136th paragraph,
+and the following one, in which he exclaims against the idea of
+contagion, because the patient, delivered on the 26th of December,
+was attacked in twenty-four hours, and died on the third day, let him
+read what happened at the "Black Assizes" of 1577 and 1750.  In the
+first case, six hundred persons sickened the same night of the
+exposure, and three hundred more in three days. [Elliotson's
+Practice, p.  298.]  Of those attacked in the latter year, the
+exposure being on the 11th of May, Alderman Lambert died on the 13th,
+Under-Sheriff Cox on the 14th, and many of note before the
+20th.  But these are old stories.  Let the student listen then to Dr.
+Gerhard, whose reputation as a cautious observer he may be supposed
+to know.  "The nurse was shaving a man, who died in a few hours after
+his entrance; he inhaled his breath, which had a nauseous taste, and
+in an hour afterwards was taken with nausea, cephalalgia, and singing
+of the ears.  From that moment the attack began, and assumed a severe
+character.  The assistant was supporting another patient, who died
+soon afterwards; he felt the pungent heat upon his skin, and was
+taken immediately with the symptoms of typhus."[Am.  Jour.  Med.
+Sciences, Feb.  1837, p.  299.]   It is by notes of cases, rather
+than notes of admiration, that we must be guided, when we study the
+Revised Statutes of Nature, as laid down from the curule chairs of
+Medicine.
+
+Let the student read Dr. Meigs's 140th paragraph soberly, and then
+remember, that not only does he infer, suspect, and surmise, but he
+actually asserts (page 154), "there was poison in the house," because
+three out of five patients admitted into a ward had puerperal fever
+and died.  Have I not as much right to draw a positive inference from
+"Dr. A.'s" seventy exclusive cases as he from the three cases in the
+ward of the Dublin Hospital?  All practical medicine, and all action
+in common affairs, is founded on inferences.  How does Dr. Meigs know
+that the patients he bled in puerperal fever would not have all got
+well if he had not bled them?
+
+"You see a man discharge a gun at another; you see the flash, you
+hear the report, you see the person fall a lifeless corpse; and you
+infer, from all these circumstances, that there was a ball discharged
+from the gun, which entered his body and caused his death, because
+such is the usual and natural cause of such an effect.  But you did
+not see the ball leave the gun, pass through the air, and enter the
+body of the slain; and your testimony to the fact of killing is,
+therefore, only inferential,--in other words, circumstantial.  It is
+possible that no ball was in the gun; and we infer that there was,
+only because we cannot account for death on any other supposition."
+[Chief Justice Gibson, in Am.  Law Journal, vol.  vi.  p.  123.]
+
+"The question always comes to this: Is the circumstance of
+intercourse with the sick followed by the appearance of the disease
+in a proportion of cases so much greater than any other circumstance
+common to any portion of the inhabitants of the place under
+observation, as to make it inconceivable that the succession of cases
+occurring in persons having that intercourse should have been the
+result of chance?  If so, the inference is unavoidable, that that
+intercourse must have acted as a cause of the disease.  All
+observations which do not bear strictly on that point are irrelevant,
+and, in the case of an epidemic first appearing in a town or
+district, a succession of two cases is sometimes sufficient to
+furnish evidence which, on the principle I have stated, is nearly
+irresistible."
+
+Possibly an inexperienced youth may be awe-struck by the quotation
+from Cuvier.  These words, or their equivalent, are certainly to be
+found in his Introduction.  So are the words "top not come down"!
+to be found in the Bible, and they were as much meant for the ladies'
+head-dresses as the words of Cuvier were meant to make clinical
+observation wait for a permit from anybody to look with its eyes and
+count on its fingers.  Let the inquiring youth read the whole
+Introduction, and he will see what they mean.
+
+I intend no breach of courtesy, but this is a proper place to warn
+the student against skimming the prefaces and introductions of works
+for mottoes and embellishments to his thesis.  He cannot learn
+anatomy by thrusting an exploring needle into the body.  He will be
+very liable to misquote his author's meaning while he is picking off
+his outside sentences.  He may make as great a blunder as that simple
+prince who praised the conductor of his orchestra for the piece just
+before the overture; the musician was too good a courtier to tell him
+that it was only the tuning of the instruments.
+
+To the six propositions in the 142d paragraph, and the remarks about
+"specific" diseases, the answer, if any is necessary, seems very
+simple.  An inflammation of a serous membrane may give rise to
+secretions which act as a poison, whether that be a "specific" poison
+or not, as Dr. Homer has told his young readers, and as dissectors
+know too well; and that poison may produce its symptoms in a few
+hours after the system has received it, as any may see in Druitt's
+"Surgery," if they care to look.  Puerperal peritonitis may produce
+such a poison, and puerperal women may be very sensible to its
+influences, conveyed by contact or exhalation.  Whether this is so or
+not, facts alone can determine, and to facts we have had recourse to
+settle it.
+
+The following statement is made by Dr. Meigs in his 142d paragraph,
+and developed more at length, with rhetorical amplifications, in the
+134th.  "No human being, save a pregnant or parturient woman, is
+susceptible to the poison."  This statement is wholly incorrect, as I
+am sorry to have to point out to a Teacher in Dr. Meigs's position.
+I do not object to the erudition which quotes Willis and Fernelius,
+the last of whom was pleasantly said to have "preserved the dregs of
+the Arabs in the honey of his Latinity."  But I could wish that more
+modern authorities had not been overlooked.  On this point, for
+instance, among the numerous facts disproving the statement, the
+"American Journal of Medical Sciences," published not far from his
+lecture-room, would have presented him with a respectable catalog of
+such cases.  Thus he might refer to Mr. Storrs's paper "On the
+Contagious Effects of Puerperal Fever on the Male Subject; or on
+Persons not Childbearing"(Jan.  1846), or to Dr. Reid's case (April,
+1846), or to Dr. Barron's statement of the children's dying of
+peritonitis in an epidemic of puerperal fever at the Philadelphia
+Hospital (Oct.  1842), or to various instances cited in Dr.
+Kneeland's article (April, 186).  Or, if he would have referred to
+the "New York Journal," he might have seen Prof. Austin Flint's
+cases.  Or, if he had honored my Essay so far, he might have found
+striking instances of the same kind in the first of the new series of
+cases there reported and elsewhere.  I do not see the bearing of his
+proposition, if it were true.  But it is one of those assertions that
+fall in a moment before a slight examination of the facts; and I
+confess my surprise, that a professor who lectures on the Diseases of
+Women should have ventured to make it.
+
+Nearly seven pages are devoted to showing that I was wrong in saying
+I would not be "understood to imply that there exists a doubt in the
+mind of any well-informed member of the medical profession as to the
+fact that puerperal fever is sometimes communicated from one person
+to another, both directly and indirectly."  I will devote seven lines
+to these seven pages, which seven lines, if I may say it without
+offence, are, as it seems to me, six more than are strictly
+necessary.
+
+The following authors are cited as sceptics by Dr. Meigs:
+Dewees.--I cited the same passage.  Did not know half the facts.
+Robert Lee.--Believes the disease is sometimes communicable by
+contagion.  Tonnelle, Baudelocque.  Both cited by me.  Jacquemier.
+--Published three years after my Essay.  Kiwisch.  Behindhand in
+knowledge of Puerperal Fever." [B. & F.  Med.  Rev.  Jan.  1842.]
+Paul Dubois.--Scanzoni.
+
+These Continental writers not well informed on this point.[See Dr.
+Simpson's Remarks at Meeting of Edin.  Med.  Chir.  Soc.  (Am.  Jour.
+Oct.  1851.)]
+
+The story of Von Busch is of interest and value, but there is nothing
+in it which need perplex the student.  It is not pretended that the
+disease is always, or even, it may be, in the majority of cases,
+carried about by attendants; only that it is so carried in certain
+cases.  That it may have local and epidemic causes, as well as that
+depending on personal transmission, is not disputed.  Remember how
+small-pox often disappears from a community in spite of its
+contagious character, and the necessary exposure of many persons to
+those suffering from it; in both diseases contagion is only one of
+the coefficients of the disease.
+
+I have already spoken of the possibility that Dr. Meigs may have been
+the medium of transfer of puerperal fever in some of the cases he has
+briefly catalogued.  Of Dr. Rutter's cases I do not know how to
+speak.  I only ask the student to read the facts stated by Dr.
+Condie, as given in my Essay, and say whether or not a man should
+allow his wife to be attended by a practitioner in whose hands
+"scarcely a female that has been delivered for weeks past has escaped
+an attack,"  "while no instance of the disease has occurred in the
+patients of any other accoucheur practising in the same district."
+If I understand Dr. Meigs and Dr. Hodge, they would not warn the
+physician or spare the patient under such circumstances.  They would
+"go on," if I understand them, not to seven, or seventy, only, but to
+seventy times seven, if they could find patients.  If this is not
+what they mean, may we respectfully ask them to state what they do
+mean, to their next classes, in the name of humanity, if not of
+science!
+
+I might repeat the question asked concerning Dr. Rutter's cases, with
+reference to those reported by Dr. Roberton.  Perhaps, however, the
+student would like to know the opinion of a person in the habit of
+working at matters of this kind in a practical point of view.  To
+satisfy him on this ground, I addressed the following question to the
+President of one of our principal Insurance Companies, leaving Dr.
+Meigs's book and my Essay in his hands at the same time.
+
+Question.  "If such facts as Roberton's cases were before you, and
+the attendant had had ten, or even five fatal cases, or three, or two
+even, would you, or would you not, if insuring the life of the next
+patient to be taken care of by that attendant, expect an extra
+premium over that of an average case of childbirth?"
+
+Answer.  "Of course I should require a very large extra premium, if
+I would take take risk at all."
+
+But I do not choose to add the expressions of indignation which the
+examination of the facts before him called out.  I was satisfied from
+the effect they produced on him, that if all the hideous catalogues
+of cases now accumulated were fully brought to the knowledge of the
+public, nothing, since the days of Burke and Hare, has raised such a
+cry of horror as would be shrieked in the ears of the Profession.
+
+Dr. Meigs has elsewhere invoked "Providence" as the alternative of
+accident, to account for the "coincidences."  ("Obstetrics," Phil.
+1852, p.  631.) If so, Providence either acts through the agency of
+secondary causes, as in other diseases, or not.  If through such
+causes, let us find out what they are, as we try to do in other
+cases.  It may be true that offences, or diseases, will come, but
+"woe unto him through whom they come," if we catch him in the
+voluntary or careless act of bringing them!  But if Providence does
+not act through secondary causes in this particular sphere of
+etiology, then why does Dr. Meigs take such pains to reason so
+extensively about the laws of contagion, which, on that supposition,
+have no more to do with this case than with the plague which
+destroyed the people after David had numbered them?  Above all, what
+becomes of the theological aspect of the question, when he asserts
+that a practitioner was "only unlucky in meeting with the epidemic
+cases?" (Op. cit.  p. 633.) We do not deny that the God of battles
+decides the fate of nations; but we like to have the biggest
+squadrons on our side, and we are particular that our soldiers should
+not only say their prayers, but also keep their powder dry.  We do
+not deny the agency of Providence in the disaster at Norwalk, but we
+turn off the engineer, and charge the Company five thousand dollars
+apiece for every life that is sacrificed.
+
+Why a grand jury should not bring in a bill against a physician who
+switches off a score of women one after the other along his private
+track, when he knows that there is a black gulf at the end of it,
+down which they are to plunge, while the great highway is clear, is
+more than I can answer.  It is not by laying the open draw to
+Providence that he is to escape the charge of manslaughter.
+
+To finish with all these lesser matters of question, I am unable to
+see why a female must necessarily be unattended in her confinement,
+because she declines the services of a particular practitioner.  In
+all the series of cases mentioned, the death-carrying attendant was
+surrounded by others not tracked by disease and its consequences.
+Which, I would ask, is worse,--to call in another, even a rival
+practitioner, or to submit an unsuspecting female to a risk which an
+Insurance Company would have nothing to do with?
+
+I do not expect ever to return to this subject.  There is a point of
+mental saturation, beyond which argument cannot be forced without
+breeding impatient, if not harsh, feelings towards those who refuse
+to be convinced.  If I have so far manifested neither, it is well to
+stop here, and leave the rest to those younger friends who may have
+more stomach for the dregs of a stale argument.
+
+The extent of my prefatory remarks may lead some to think that I
+attach too much importance to my own Essay.  Others may wonder that I
+should expend so many words upon the two productions referred to, the
+Letter and the Lecture.  I do consider my Essay of much importance so
+long as the doctrine it maintains is treated as a question, and so
+long as any important part of the defence of that doctrine is thought
+to rest on its evidence or arguments.  I cannot treat as
+insignificant any opinions bearing on life, and interests dearer than
+life, proclaimed yearly to hundreds of young men, who will carry them
+to their legitimate results in practice.
+
+The teachings of the two Professors in the great schools of
+Philadelphia are sure to be listened to, not only by their immediate
+pupils, but by the Profession at large.  I am too much in earnest for
+either humility or vanity, but I do entreat those who hold the keys
+of life and death to listen to me also for this once.  I ask no
+personal favor; but I beg to be heard in behalf of the women whose
+lives are at stake, until some stronger voice shall plead for them.
+
+I trust that I have made the issue perfectly distinct and
+intelligible.  And let it be remembered that this is no subject to be
+smoothed over by nicely adjusted phrases of half-assent and half-
+censure divided between the parties.  The balance must be struck
+boldly and the result declared plainly.  If I have been hasty,
+presumptuous, ill-informed, illogical; if my array of facts means
+nothing; if there is no reason for any caution in the view of these
+facts; let me be told so on such authority that I must believe it,
+and I will be silent henceforth, recognizing that my mind is in a
+state of disorganization.  If the doctrine I have maintained is a
+mournful truth; if to disbelieve it, and to practise on this
+disbelief, and to teach others so to disbelieve and practise, is to
+carry desolation, and to charter others to carry it, into confiding
+families, let it be proclaimed as plainly what is to be thought of
+the teachings of those who sneer at the alleged dangers, and scout
+the very idea of precaution.  Let it be remembered that persons are
+nothing in this matter; better that twenty pamphleteers should be
+silenced, or as many professors unseated, than that one mother's life
+should be taken.  There is no quarrel here between men, but there is
+deadly incompatibility and exterminating warfare between doctrines.
+Coincidences, meaning nothing, though a man have a monopoly of the
+disease for weeks or months; or cause and effect, the cause being in
+some way connected with the person; this is the question.  If I am
+wrong, let me be put down by such a rebuke as no rash declaimer has
+received since there has been a public opinion in the medical
+profession of America; if I am right, let doctrines which lead to
+professional homicide be no longer taught from the chairs of those
+two great Institutions.  Indifference will not do here; our
+Journalists and Committees have no right to take up their pages with
+minute anatomy and tediously detailed cases, while it is a question
+whether or not the "blackdeath" of child-bed is to be scattered
+broadcast by the agency of the mother's friend and adviser.  Let the
+men who mould opinions look to it; if there is any voluntary
+blindness, any interested oversight, any culpable negligence, even,
+in such a matter, and the facts shall reach the public ear; the
+pestilence-carrier of the lying-in chamber must look to God for
+pardon, for man will never forgive him.
+
+
+               THE CONTAGIOUSNESS OF PUERPERAL FEVER.
+
+In collecting, enforcing, and adding to the evidence accumulated upon
+this most serious subject, I would not be understood to imply that
+there exists a doubt in the mind of any well-informed member of the
+medical profession as to the fact that puerperal fever is sometimes
+communicated from one person to another, both directly and
+indirectly.  In the present state of our knowledge upon this point I
+should consider such doubts merely as a proof that the sceptic had
+either not examined the evidence, or, having examined it, refused to
+accept its plain and unavoidable consequences.  I should be sorry to
+think, with Dr. Rigby, that it was a case of "oblique vision;" I
+should be unwilling to force home the argumentum ad hominem of Dr.
+Blundell, but I would not consent to make a question of a momentous
+fact which is no longer to be considered as a subject for trivial
+discussions, but to be acted upon with silent promptitude.  It
+signifies nothing that wise and experienced practitioners have
+sometimes doubted the reality of the danger in question; no man has
+the right to doubt it any longer.  No negative facts, no opposing
+opinions, be they what they may, or whose they may, can form any
+answer to the series of cases now within the reach of all who choose
+to explore the records of medical science.
+
+If there are some who conceive that any important end would be
+answered by recording such opinions, or by collecting the history of
+all the cases they could find in which no evidence of the influence
+of contagion existed, I believe they are in error.  Suppose a few
+writers of authority can be found to profess a disbelief in
+contagion,--and they are very few compared with those who think
+differently,--is it quite clear that they formed their opinions on a
+view of all the facts, or is it not apparent that they relied mostly
+on their own solitary experience?  Still further, of those whose
+names are quoted, is it not true that scarcely a single one could by
+any possibility have known the half or the tenth of the facts bearing
+on the subject which have reached such a frightful amount within the
+last few years?  Again, as to the utility of negative facts, as we
+may briefly call them,--instances, namely, in which exposure has not
+been followed by disease,--although, like other truths, they may be
+worth knowing, I do not see that they are like to shed any important
+light upon the subject before us.  Every such instance requires a
+good deal of circumstantial explanation before it can be accepted.
+It is not enough that a practitioner should have had a single case of
+puerperal fever not followed by others.  It must be known whether he
+attended others while this case was in progress, whether he went
+directly from one chamber to others, whether he took any, and what
+precautions.  It is important to know that several women were exposed
+to infection derived from the patient, so that allowance may be made
+for want of predisposition.  Now if of negative facts so sifted there
+could be accumulated a hundred for every one plain instance of
+communication here recorded, I trust it need not be said that we are
+bound to guard and watch over the hundredth tenant of our fold,
+though the ninety and nine may be sure of escaping the wolf at its
+entrance.  If any one is disposed, then, to take a hundred instances
+of lives endangered or sacrificed out of those I have mentioned, and
+make it reasonably clear that within a similar time and compass ten
+thousand escaped the same exposure, I shall thank him for his
+industry, but I must be permitted to hold to my own practical
+conclusions, and beg him to adopt or at least to examine them also.
+Children that walk in calico before open fires are not always burned
+to death; the instances to the contrary may be worth recording; but
+by no means if they are to be used as arguments against woollen
+frocks and high fenders.
+
+I am not sure that this paper will escape another remark which it
+might be wished were founded in justice.  It may be said that the
+facts are too generally known and acknowledged to require any formal
+argument or exposition, that there is nothing new in the positions
+advanced, and no need of laying additional statements before the
+Profession.  But on turning to two works, one almost universally, and
+the other extensively appealed to as authority in this country, I see
+ample reason to overlook this objection.  In the last edition of
+Dewees's Treatise on the "Diseases of Females," it is expressly said,
+"In this country, under no circumstance that puerperal fever has
+appeared hitherto, does it afford the slightest ground for the belief
+that it is contagious."  In the "Philadelphia Practice of Midwifery"
+not one word can be found in the chapter devoted to this disease
+which would lead the reader to suspect that the idea of contagion had
+ever been entertained.  It seems proper, therefore, to remind those
+who are in the habit of referring to these works for guidance, that
+there may possibly be some sources of danger they have slighted or
+omitted, quite as important as a trifling irregularity of diet, or a
+confined state of the bowels, and that whatever confidence a
+physician may have in his own mode of treatment, his services are of
+questionable value whenever he carries the bane as well as the
+antidote about his person.
+
+The practical point to be illustrated is the following:
+
+The disease known as Puerperal Fever is so far contagious as to be
+frequently carried from patient to patient by physicians and nurses.
+
+
+Let me begin by throwing out certain incidental questions, which,
+without being absolutely essential, would render the subject more
+complicated, and by making such concessions and assumptions as may be
+fairly supposed to be without the pale of discussion.
+
+1.  It is granted that all the forms of what is called puerperal
+fever may not be, and probably are not, equally contagious or
+infectious.  I do not enter into the distinctions which have been
+drawn by authors, because the facts do not appear to me sufficient to
+establish any absolute line of demarcation between such forms as may
+be propagated by contagion and those which are never so propagated.
+This general result I shall only support by the authority of Dr.
+Ramsbotham, who gives, as the result of his experience, that the same
+symptoms belong to what he calls the infectious and the sporadic
+forms of the disease, and the opinion of Armstrong in his original
+Essay.  If others can show any such distinction, I leave it to them
+to do it.  But there are cases enough that show the prevalence of the
+disease among the patients of a single practitioner when it was in no
+degree epidemic, in the proper sense of the term. I may refer to
+those of Mr. Roberton and of Dr. Peirson, hereafter to be cited, as
+examples.
+
+2.  I shall not enter into any dispute about the particular mode of
+infection, whether it be by the atmosphere the physician carries
+about him into the sick-chamber, or by the direct application of the
+virus to the absorbing surfaces with which his hand comes in contact.
+Many facts and opinions are in favor of each of these modes of
+transmission.  But it is obvious that in the majority of cases it
+must be impossible to decide by which of these channels the disease
+is conveyed, from the nature of the intercourse between the physician
+and the patient.
+
+3.  It is not pretended that the contagion of puerperal fever must
+always be followed by the disease.  It is true of all contagious
+diseases, that they frequently spare those who appear to be fully
+submitted to their influence.  Even the vaccine virus, fresh from the
+subject, fails every day to produce its legitimate effect, though
+every precaution is taken to insure its action.  This is still more
+remarkably the case with scarlet fever and some other diseases.
+
+4.  It is granted that the disease may be produced and variously
+modified by many causes besides contagion, and more especially by
+epidemic and endemic influences.  But this is not peculiar to the
+disease in question.  There is no doubt that small-pox is propagated
+to a great extent by contagion, yet it goes through the same periods
+of periodical increase and diminution which have been remarked in
+puerperal fever.  If the question is asked how we are to reconcile
+the great variations in the mortality of puerperal fever in different
+seasons and places with the supposition of contagion, I will answer
+it by another question from Mr. Farr's letter to the Registrar-
+General.  He makes the statement that "five die weekly of small-pox
+in the metropolis when the disease is not epidemic,"--and adds, "The
+problem for solution is,--Why do the five deaths become 10, 15, 20,
+31, 58, 88, weekly, and then progressively fall through the same
+measured steps?"
+
+5.  I take it for granted, that if it can be shown that great numbers
+of lives have been and are sacrificed to ignorance or blindness on
+this point, no other error of which physicians or nurses may be
+occasionally suspected will be alleged in palliation of this; but
+that whenever and wherever they can be shown to carry disease and
+death instead of health and safety, the common instincts of humanity
+will silence every attempt to explain away their responsibility.
+
+
+The treatise of Dr. Gordon of Aberdeen was published in the year
+1795, being among the earlier special works upon the disease.  Apart
+of his testimony has been occasionally copied into other works, but
+his expressions are so clear, his experience is given with such manly
+distinctness and disinterested honesty, that it may be quoted as a
+model which might have been often followed with advantage.
+
+"This disease seized such women only as were visited, or delivered by
+a practitioner, or taken care of by a nurse, who had previously
+attended patients affected with the disease."
+
+"I had evident proofs of its infectious nature, and that the
+infection was as readily communicated as that of the small-pox or
+measles, and operated more speedily than any other infection with
+which I am acquainted."
+
+"I had evident proofs that every person who had been with a patient
+in the puerperal fever became charged with an atmosphere of
+infection, which was communicated to every pregnant woman who
+happened to come within its sphere.  This is not an assertion, but a
+fact, admitting of demonstration, as may be seen by a perusal of the
+foregoing table,"--referring to a table of seventy-seven cases, in
+many of which the channel of propagation was evident.
+
+He adds, "It is a disagreeable declaration for me to mention, that I
+myself was the means of carrying the infection to a great number of
+women."  He then enumerates a number of instances in which the
+disease was conveyed by midwives and others to the neighboring
+villages, and declares that "these facts fully prove that the cause
+of the puerperal fever, of which I treat, was a specific contagion,
+or infection, altogether unconnected with a noxious constitution of
+the atmosphere."
+
+But his most terrible evidence is given in these words: "I ARRIVED AT
+THAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT
+WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT
+MIDWIFE THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE
+ATTENDED, DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY
+PREDICTION WAS VERIFIED."
+
+Even previously to Gordon, Mr. White of Manchester had said, "I am
+acquainted with two gentlemen in another town, where the whole
+business of midwifery is divided betwixt them, and it is very
+remarkable that one of them loses several patients every year of the
+puerperal fever, and the other never so much as meets with the
+disorder,"--a difference which he seems to attribute to their various
+modes of treatment. [On the Management of Lying-in Women, p.  120.]
+
+Dr. Armstrong has given a number of instances in his Essay on
+Puerperal Fever, of the prevalence of the disease among the patients
+of a single practitioner.  At Sunderland, "in all, forty-three cases
+occurred from the 1st of January to the 1st of October, when the
+disease ceased; and of this number forty were witnessed by Mr.
+Gregson and his assistant, Mr. Gregory, the remainder having been
+separately seen by three accoucheurs."  There is appended to the
+London edition of this Essay, a letter from Mr. Gregson, in which
+that gentleman says, in reference to the great number of cases
+occurring in his practice, "The cause of this I cannot pretend fully
+to explain, but I should be wanting in common liberality if I were to
+make any hesitation in asserting, that the disease which appeared in
+my practice was highly contagious, and communicable from one
+puerperal woman to another."  "It is customary among the lower and
+middle ranks of people to make frequent personal visits to puerperal
+women resident in the same neighborhood, and I have ample evidence
+for affirming that the infection of the disease was often carried
+about in that manner; and, however painful to my feelings, I must in
+candor declare, that it is very probable the contagion was conveyed,
+in some instances, by myself, though I took every possible care to
+prevent such a thing from happening, the moment that I ascertained
+that the distemper was infectious."  Dr. Armstrong goes on to mention
+six other instances within his knowledge, in which the disease had at
+different times and places been limited, in the same singular manner,
+to the practice of individuals, while it existed scarcely if at all
+among the patients of others around them.  Two of the gentlemen
+became so convinced of their conveying the contagion, that they
+withdrew for a time from practice.
+
+I find a brief notice, in an American Journal, of another series of
+cases, first mentioned by Mr. Davies, in the "Medical Repository."
+This gentleman stated his conviction that the disease is contagious.
+
+"In the autumn of 1822 he met with twelve cases, while his medical
+friends in the neighborhood did not meet with any, 'or at least very
+few.'  He could attribute this circumstance to no other cause than
+his having been present at the examination, after death, of two
+cases, some time previous, and of his having imparted the disease to
+his patients, notwithstanding every precaution."
+
+Dr. Gooch says, "It is not uncommon for the greater number of cases
+to occur in the practice of one man, whilst the other practitioners
+of the neighborhood, who are not more skilful or more busy, meet with
+few or none.  A practitioner opened the body of a woman who had died
+of puerperal fever, and continued to wear the same clothes.  A lady
+whom he delivered a few days afterwards was attacked with and died of
+a similar disease; two more of his lying-in patients, in rapid
+succession, met with the same fate; struck by the thought, that he
+might have carried contagion in his clothes, he instantly changed
+them, and 'met with no more cases of the kind.'  A woman in the
+country, who was employed as washerwoman and nurse, washed the linen
+of one who had died of puerperal fever; the next lying-in patient she
+nursed died of the same disease; a third nursed by her met with the
+same fate, till the neighborhood, getting afraid of her, ceased to
+employ her."
+
+In the winter of the year 1824, "Several instances occurred of its
+prevalence among the patients of particular practitioners, whilst
+others who were equally busy met with few or none.  One instance of
+this kind was very remarkable.  A general practitioner, in large
+midwifery practice, lost so many patients from puerperal fever, that
+he determined to deliver no more for some time, but that his partner
+should attend in his place.  This plan was pursued for one month,
+during which not a case of the disease occurred in their practice.
+The elder practitioner, being then sufficiently recovered, returned
+to his practice, but the first patient he attended was attacked by
+the disease and died.  A physician, who met him in consultation soon
+afterwards, about a case of a different kind, and who knew nothing of
+his misfortune, asked him whether puerperal fever was at all
+prevalent in his neighborhood, on which he burst into tears, and
+related the above circumstances.
+
+"Among the cases which I saw this season in consultation, four
+occurred in one month in the practice of one medical man, and all of
+them terminated fatally." [Lond.  Med.  Gaz.  May 2, 1835.]
+
+Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he
+had known the disease spread through a particular district, or be
+confined to the practice of a particular person, almost every patient
+being attacked with it, while others had not a single case.  It
+seemed capable, he thought, of conveyance, not only by common modes;
+but through the dress of the attendants upon the patient.
+
+In a letter to be found in the "London Medical Gazette" for January,
+1840, Mr. Roberton of Manchester makes the statement which I here
+give in a somewhat condensed form.
+
+A midwife delivered a woman on the 4th of December, 1830, who died
+soon after with the symptoms of puerperal fever.  In one month from
+this date the same midwife delivered thirty women, residing in
+different parts of an extensive suburb, of which number sixteen
+caught the disease and all died.  These were the only cases which had
+occurred for a considerable time in Manchester.  The other midwives
+connected with the same charitable institution as the woman already
+mentioned are twenty-five in number, and deliver, on an average,
+ninety women a week, or about three hundred and eighty a month.  None
+of these women had a case of puerperal fever.  "Yet all this time
+this woman was crossing the other midwives in every direction, scores
+of the patients of the charity being delivered by them in the very
+same quarters where her cases of fever were happening."
+
+Mr. Roberton remarks, that little more than half the women she
+delivered during this month took the fever; that on some days all
+escaped, on others only one or more out of three or four; a
+circumstance similar to what is seen in other infectious maladies.
+
+Dr. Blundell says, "Those who have never made the experiment can have
+but a faint conception how difficult it is to obtain the exact truth
+respecting any occurrence in which feelings and interests are
+concerned.  Omitting particulars, then, I content myself with
+remarking, generally, that from more than one district I have
+received accounts of the prevalence of puerperal fever in the
+practice of some individuals, while its occurrence in that of others,
+in the same neighborhood, was not observed.  Some, as I have been
+told, have lost ten, twelve, or a greater number of patients, in
+scarcely broken succession; like their evil genius, the puerperal
+fever has seemed to stalk behind them wherever they went.  Some have
+deemed it prudent to retire for a time from practice.  In fine, that
+this fever may occur spontaneously, I admit; that its infectious
+nature may be plausibly disputed, I do not deny; but I add,
+considerately, that in my own family I had rather that those I
+esteemed the most should be delivered, unaided, in a stable, by the
+manger-side, than that they should receive the best help, in the
+fairest apartment, but exposed to the vapors of this pitiless
+disease.  Gossiping friends, wet-nurses, monthly nurses, the
+practitioner himself, these are the channels by which, as I suspect,
+the infection is principally conveyed."
+
+At a meeting of the Royal Medical and Chirurgical Society, Dr. King
+mentioned that some years since a practitioner at Woolwich lost
+sixteen patients from puerperal fever in the same year.  He was
+compelled to give up practice for one or two years, his business
+being divided among the neighboring practitioners.  No case of
+puerperal fever occurred afterwards, neither had any of the
+neighboring surgeons any cases of this disease.
+
+At the same meeting Mr. Hutchinson mentioned the occurrence of three
+consecutive cases of puerperal fever, followed subsequently by two
+others, all in the practice of one accoucheur.[Lancet, May 2, 1840.]
+
+Dr. Lee makes the following statement: "In the last two weeks of
+September, 1827, five fatal cases of uterine inflammation came under
+our observation.  All the individuals so attacked had been attended
+in labor by the same midwife, and no example of a febrile or
+inflammatory disease of a serious nature occurred during that period
+among the other patients of the Westminster General Dispensary, who
+had been attended by the other midwives belonging to that
+institution."
+
+The recurrence of long series of cases like those I have cited,
+reported by those most interested to disbelieve in contagion,
+scattered along through an interval of half a century, might have
+been thought sufficient to satisfy the minds of all inquirers that
+here was something more than a singular coincidence.  But if, on a
+more extended observation, it should be found that the same ominous
+groups of cases clustering about individual practitioners were
+observed in a remote country, at different times, and in widely
+separated regions, it would seem incredible that any should be found
+too prejudiced or indolent to accept the solemn truth knelled into
+their ears by the funeral bells from both sides of the ocean,--the
+plain conclusion that the physician and the disease entered, hand in
+hand, into the chamber of the unsuspecting patient.
+
+That such series of cases have been observed in this country, and in
+this neighborhood, I proceed to show.
+
+In Dr. Francis's "Notes to Denman's Midwifery," a passage is cited
+from Dr. Hosack, in which he refers to certain puerperal cases which
+proved fatal to several lying-in women, and in some of which the
+disease was supposed to be conveyed by the accoucheurs themselves.
+
+A writer in the "New York Medical and Physical Journal" for October,
+1829, in speaking of the occurrence of puerperal fever, confined to
+one man's practice, remarks, "We have known cases of this kind occur,
+though rarely, in New York."
+
+I mention these little hints about the occurrence of such cases,
+partly because they are the first I have met with in American medical
+literature, but more especially because they serve to remind us that
+behind the fearful array of published facts there lies a dark list of
+similar events, unwritten in the records of science, but long
+remembered by many a desolated fireside.
+
+Certainly nothing can be more open and explicit than the account
+given by Dr. Peirson of Salem, of the cases seen by him.  In the
+first nineteen days of January, 1829, he had five consecutive cases
+of puerperal fever, every patient he attended being attacked, and the
+three first cases proving fatal.  In March of the same year he had
+two moderate cases, in June, another case, and in July, another,
+which proved fatal.  "Up to this period," he remarks, "I am not
+informed that a single case had occurred in the practice of any other
+physician.  Since that period I have had no fatal case in my
+practice, although I have had several dangerous cases.  I have
+attended in all twenty cases of this disease, of which four have been
+fatal.  I am not aware that there has been any other case in the town
+of distinct puerperal peritonitis, although I am willing to admit my
+information may be very defective on this point.  I have been told of
+some I 'mixed cases,' and 'morbid affections after delivery.'"
+
+In the "Quarterly Summary of the Transactions of the College of
+Physicians of Philadelphia" may be found some most extraordinary
+developments respecting a series of cases occurring in the practice
+of a member of that body.
+
+Dr. Condie called the attention of the Society to the prevalence, at
+the present time, of puerperal fever of a peculiarly insidious and
+malignant character.  "In the practice of one gentleman extensively
+engaged as an obstetrician, nearly every female he has attended in
+confinement, during several weeks past, within the above limits" (the
+southern sections and neighboring districts), "had been attacked by
+the fever."
+
+"An important query presents itself, the Doctor observed, in
+reference to the particular form of fever now prevalent.  Is it,
+namely, capable of being propagated by contagion, and is a physician
+who has been in attendance upon a case of the disease warranted in
+continuing, without interruption, his practice as an obstetrician?
+Dr. C., although not a believer in the contagious character of many
+of those affections generally supposed to be propagated in this
+manner, has nevertheless become convinced by the facts that have
+fallen under his notice, that the puerperal fever now prevailing is
+capable of being communicated by contagion.  How otherwise can be
+explained the very curious circumstance of the disease in one
+district being exclusively confined to the practice of a single
+physician, a Fellow of this College, extensively engaged in
+obstetrical practice,--while no instance of the disease has occurred
+in the patients under the care of any other accoucheur practising
+within the same district; scarcely a female that has been delivered
+for weeks past has escaped an attack?"
+
+Dr. Rutter, the practitioner referred to, "observed that, after the
+occurrence of a number of cases of the disease in his practice, he
+had left the city and remained absent for a week, but on returning,
+no article of clothing he then wore having been used by him before,
+one of the very first cases of parturition he attended was followed
+by an attack of the fever, and terminated fatally; he cannot,
+readily, therefore, believe in the transmission of the disease from
+female to female, in the person or clothes of the physician."
+
+The meeting at which these remarks were made was held on the 3d of
+May, 1842.  In a letter dated December 20, 1842, addressed to Dr.
+Meigs, and to be found in the "Medical Examiner,"  he speaks of
+"those horrible cases of puerperal fever, some of which you did me
+the favor to see with me during the past summer," and talks of his
+experience in the disease, "now numbering nearly seventy cases, all
+of which have occurred within less than a twelvemonth past."
+
+And Dr. Meigs asserts, on the same page, "Indeed, I believe that his
+practice in that department of the profession was greater than that
+of any other gentleman, which was probably the cause of his seeing a
+greater number of the cases."  This from a professor of midwifery,
+who some time ago assured a gentleman whom he met in consultation,
+that the night on which they met was the eighteenth in succession
+that he himself had been summoned from his repose, seems hardly
+satisfactory.
+
+I must call the attention of the inquirer most particularly to the
+Quarterly Report above referred to, and the letters of Dr. Meigs and
+Dr. Rutter, to be found in the "Medical Examiner."  Whatever
+impression they may produce upon his mind, I trust they will at least
+convince him that there is some reason for looking into this
+apparently uninviting subject.
+
+At a meeting of the College of Physicians just mentioned, Dr.
+Warrington stated, that a few days after assisting at an autopsy of
+puerperal peritonitis, in which he laded out the contents of the
+abdominal cavity with his hands, he was called upon to deliver three
+women in rapid succession.  All of these women were attacked with
+different forms of what is commonly called puerperal fever.  Soon
+after these he saw two other patients, both on the same day, with the
+same disease.  Of these five patients two died.
+
+At the same meeting, Dr. West mentioned a fact related to him by Dr.
+Samuel Jackson of Northumberland.  Seven females, delivered by Dr.
+Jackson in rapid succession, while practising in Northumberland
+County, were all attacked with puerperal fever, and five of them
+died.  "Women," he said, "who had expected me to attend upon them,
+now becoming alarmed, removed out of my reach, and others sent for a
+physician residing several miles distant.  These women, as well as
+those attended by midwives; all did well; nor did we hear of any
+deaths in child-bed within a radius of fifty miles, excepting two,
+and these I afterwards ascertained to have been caused by other
+diseases."  He underwent, as he thought, a thorough purification, and
+still his next patient was attacked with the disease and died.  He
+was led to suspect that the contagion might have been carried in the
+gloves which he had worn in attendance upon the previous cases.  Two
+months or more after this he had two other cases.  He could find
+nothing to account for these, unless it were the instruments for
+giving enemata, which had been used in two of the former cases, and
+were employed by these patients.  When the first case occurred, he
+was attending and dressing a limb extensively mortified from
+erysipelas, and went immediately to the accouchement with his clothes
+and gloves most thoroughly imbued with its efluvia.  And here I may
+mention, that this very Dr. Samuel Jackson of Northumberland is one
+of Dr. Dewees's authorities against contagion.
+
+The three following statements are now for the first time given to
+the public.  All of the cases referred to occurred within this State,
+and two of the three series in Boston and its immediate vicinity.
+
+I.  The first is a series of cases which took place during the last
+spring in a town at some distance from this neighborhood.  A
+physician of that town, Dr. C., had the following consecutive cases.
+
+No.  1, delivered March 20, died March 24.
+  "  2,   "       April  9,   "  April 14.
+  "  3,   "         "   10,   "   "    14.
+  "  4,   "         "   11,   "   "    18.
+  "  5,   "         "   27,   "   May   3.
+  "  6,   "         "   28, had some symptoms,(recovered.)
+  "  7,   "        May   8, had some symptoms,(also recovered.)
+
+These were the only cases attended by this physician during the
+period referred to.  "They were all attended by him until their
+termination, with the exception of the patient No. 6, who fell into
+the hands of another physician on the 2d of May.  (Dr. C. left town
+for a few days at this time.)  Dr. C.  attended cases immediately
+before and after the above-named periods, none of which, however,
+presented any peculiar symptoms of the disease."
+
+About the 1st of July he attended another patient in a neighboring
+village, who died two or three days after delivery.
+
+The first patient, it is stated, was delivered on the 20th of March.
+"On the 19th, Dr. C. made the autopsy of a man who died suddenly,
+sick only forty-eight hours; had oedema of the thigh, and gangrene
+extending from a little above the ankle into the cavity of the
+abdomen."  Dr. C. wounded himself, very slightly, in the right hand
+during the autopsy.  The hand was quite painful the night following,
+during his attendance on the patient No. 1.  He did not see this
+patient after the 20th, being confined to the house, and very sick
+from the wound just mentioned, from this time until the 3d of April.
+
+Several cases of erysipelas occurred in the house where the autopsy
+mentioned above took place, soon after the examination.  There were
+also many cases of erysipelas in town at the time of the fatal
+puerperal cases which have been mentioned.
+
+The nurse who laid out the body of the patient No. 3 was taken on the
+evening of the same day with sore throat and erysipelas, and died in
+ten days from the first attack.
+
+The nurse who laid out the body of the patient No. 4 was taken on the
+day following with symptoms like those of this patient, and died in a
+week, without any external marks of erysipelas.
+
+"No other cases of similar character with those of Dr. C. occurred in
+the practice of any of the physicians in the town or vicinity at the
+time.  Deaths following confinement have occurred in the practice of
+other physicians during the past year, but they were not cases of
+puerperal fever.  No post-mortem examinations were held in any of
+these puerperal cases."
+
+Some additional statements in this letter are deserving of insertion.
+
+"A physician attended a woman in the immediate neighborhood of the
+cases numbered 2, 3, and 4.  This patient was confined the morning of
+March 1st, and died on the night of March 7th.  It is doubtful
+whether this should be considered a case of puerperal fever.  She had
+suffered from canker, indigestion, and diarrhoea for a year previous
+to her delivery.  Her complaints were much aggravated for two or
+three months previous to delivery; she had become greatly emaciated,
+and weakened to such an extent that it had not been expected that she
+would long survive her confinement, if indeed she reached that
+period.  Her labor was easy enough; she flowed a good deal, seemed
+exceedingly prostrated, had ringing in the ears, and other symptoms
+of exhaustion; the pulse was quick and small.  On the second and
+third day there was some tenderness and tumefaction of the abdomen,
+which increased somewhat on the fourth and fifth.  He had cases in
+midwifery before and after this, which presented nothing peculiar."
+
+It is also mentioned in the same letter, that another physician had a
+case during the last summer and another last fall, both of which
+recovered.
+
+Another gentleman reports a case last December, a second case five
+weeks, and another three weeks since.  All these recovered.  A case
+also occurred very recently in the practice of a physician in the
+village where the eighth patient of Dr. C. resides, which proved
+fatal.  "This patient had some patches of erysipelas on the legs and
+arms.  The same physician has delivered three cases since, which have
+all done well.  There have been no other cases in this town or its
+vicinity recently.  There have been some few cases of erysipelas."
+It deserves notice that the partner of Dr. C., who attended the
+autopsy of the man above mentioned and took an active part in it; who
+also suffered very slightly from a prick under the thumb-nail
+received during the examination, had twelve cases of midwifery
+between March 26th and April 12th, all of which did well, and
+presented no peculiar symptoms.  It should also be stated, that
+during these seventeen days he was in attendance on all the cases of
+erysipelas in the house where the autopsy had been performed.
+
+I owe these facts to the prompt kindness of a gentleman whose
+intelligence and character are sufficient guaranty for their
+accuracy.
+
+The two following letters were addressed to my friend Dr. Scorer, by
+the gentleman in whose practice the cases of puerperal fever
+occurred.  His name renders it unnecessary to refer more particularly
+to these gentlemen, who on their part have manifested the most
+perfect freedom and courtesy in affording these accounts of their
+painful experience.
+
+
+"January 28, 1843.
+
+II.  .  .  .  "The time to which you allude was in 1830.  The first
+case was in February, during a very cold time.  She was confined the
+4th, and died the 12th.  Between the 10th and 28th of this month, I
+attended six women in labor, all of whom did well except the last, as
+also two who were confined March 1st and 5th.  Mrs. E., confined
+February 28th, sickened, and died March 8th.  The next day, 9th, I
+inspected the body, and the night after attended a lady, Mrs. B., who
+sickened, and died 16th.  The 10th, I attended another, Mrs. G., who
+sickened, but recovered.  March 16th, I went from Mrs. G.'s room to
+attend a Mrs. H., who sickened, and died 21st.  The 17th, I inspected
+Mrs. B.  On the 19th, I went directly from Mrs. H.'s room to attend
+another lady, Mrs. G., who also sickened, and died 22d.  While Mrs.
+B. was sick, on 15th, I went directly from her room a few rods, and
+attended another woman, who was not sick.  Up to 20th of this month I
+wore the same clothes.  I now refused to attend any labor, and did
+not till April 21st, when, having thoroughly cleansed myself, I
+resumed my practice, and had no more puerperal fever.
+
+"The cases were not confined to a narrow space.  The two nearest were
+half a mile from each other, and half that distance from my
+residence.  The others were from two to three miles apart, and nearly
+that distance from my residence.  There were no other cases in their
+immediate vicinity which came to my knowledge.  The general health of
+all the women was pretty good, and all the labors as good as common,
+except the first.  This woman, in consequence of my not arriving in
+season, and the child being half-born at some time before I arrived,
+was very much exposed to the cold at the time of confinement, and
+afterwards, being confined in a very open, cold room.  Of the six
+cases you perceive only one recovered.
+
+"In the winter of 1817 two of my patients had puerperal fever, one
+very badly, the other not so badly.  Both recovered.  One other had
+swelled leg, or phlegmasia dolens, and one or two others did not
+recover as well as usual.
+
+"In the summer of 1835 another disastrous period occurred in my
+practice.  July 1st, I attended a lady in labor, who was afterwards
+quite ill and feverish; but at the time I did not consider her case a
+decided puerperal fever.  On the 8th, I attended one who did well.
+On the 12th, one who was seriously sick.  This was also an equivocal
+case, apparently arising from constipation and irritation of the
+rectum.  These women were ten miles apart and five from my residence.
+On 15th and 20th, two who did well.  On 25th, I attended another.
+This was a severe labor, and followed by unequivocal puerperal fever,
+or peritonitis.  She recovered.  August 2d and 3d, in about twenty-
+four hours I attended four persons.  Two of them did very well; one
+was attacked with some of the common symptoms, which however subsided
+in a day or two, and the other had decided puerperal fever, but
+recovered.  This woman resided five miles from me.  Up to this time I
+wore the same coat.  All my other clothes had frequently been
+changed.  On 6th, I attended two women, one of whom was not sick at
+all; but the other, Mrs. L., was afterwards taken ill.  On 10th, I
+attended a lady, who did very well.  I had previously changed all my
+clothes, and had no garment on which had been in a puerperal room.
+On 12th, I was called to Mrs. S., in labor.  While she was ill, I
+left her to visit Mrs. L., one of the ladies who was confined on 6th.
+Mrs. L.  had been more unwell than usual, but I had not considered
+her case anything more than common till this visit.  I had on a
+surtout at this visit, which, on my return to Mrs.  S., I left in
+another room.  Mrs. S.  was delivered on 13th with forceps.  These
+women both died of decided puerperal fever.
+
+"While I attended these women in their fevers, I changed my clothes,
+and washed my hands in a solution of chloride of lime after each
+visit.  I attended seven women in labor during this period, all of
+whom recovered without sickness.
+
+"In my practice I have had several single cases of puerperal fever,
+some of whom have died and some have recovered.  Until the year 1830
+I had no suspicion that the disease could be communicated from one
+patient to another by a nurse or midwife; but I now think the
+foregoing facts strongly favor that idea.  I was so much convinced of
+this fact, that I adopted the plan before related.
+
+"I believe my own health was as good as usual at each of the above
+periods.  I have no recollections to the contrary.
+
+"I believe I have answered all your questions.  I have been more
+particular on some points perhaps than necessary; but I thought you
+could form your own opinion better than to take mine.  In 1830 I
+wrote to Dr. Charming a more particular statement of my cases.  If I
+have not answered your questions sufficiently, perhaps Dr. C.  may
+have my letter to him, and you can find your answer there." [In a
+letter to myself, this gentleman also stated, "I do not recollect
+that there was any erysipelas or any other disease particularly
+prevalent at the time."]
+
+
+
+"BOSTON, February 3, 1843.
+
+III.  "MY DEAR SIR,--I received a note from you last evening,
+requesting me to answer certain questions therein proposed, touching
+the cases of puerperal fever which came under my observation the past
+summer.  It gives me pleasure to comply with your request, so far as
+it is in my power so to do, but, owing to the hurry in preparing for
+a journey, the notes of the cases I had then taken were lost or
+mislaid.  The principal facts, however, are too vivid upon my
+recollection to be soon forgotten.  I think, therefore, that I shall
+be able to give you all the information you may require.
+
+"All the cases that occurred in my practice took place between the
+7th of May and the 17th of June 1842.
+
+"They were not confined to any particular part of the city.  The
+first two cases were patients residing at the South End, the next was
+at the extreme North End, one living in Sea Street and the other in
+Roxbury.  The following is the order in which they occurred:
+
+"Case 1.  Mrs._____  was confined on the 7th of May, at 5 o'clock,
+P. M., after a natural labor of six hours.  At 12 o'clock at night,
+on the 9th (thirty-one hours after confinement), she was taken with
+severe chill, previous to which she was as comfortable as women
+usually are under the circumstances.  She died on the 10th.
+
+"Case 2.  Mrs._____  was confined on the 10th of June (four weeks
+after Mrs.  C.), at 11 A. M., after a natural, but somewhat severe
+labor of five hours.  At 7 o'clock, on the morning of the 11th, she
+had a chill.  Died on the 12th.
+
+"Case 3.  Mrs._____ , confined on the 14th of June, was comfortable
+until the 18th, when symptoms of puerperal fever were manifest.  She
+died on the 20th.
+
+"Case 4.  Mrs._____ , confined June 17th, at 5 o'clock, A.  M., was
+doing well until the morning of the 19th.  She died on the evening of
+the 21st.
+
+"Case 5.  Mrs._____  was confined with her fifth child on the 17th of
+June, at 6 o'clock in the evening.  This patient had been attacked
+with puerperal fever, at three of her previous confinements, but the
+disease yielded to depletion and other remedies without difficulty.
+This time, I regret to say, I was not so fortunate.  She was not
+attacked, as were the other patients, with a chill, but complained of
+extreme pain in abdomen, and tenderness on pressure, almost from the
+moment of her confinement.  In this as in the other cases, the
+disease resisted all remedies, and she died in great distress on the
+22d of the same month.  Owing to the extreme heat of the season, and
+my own indisposition, none of the subjects were examined after death.
+Dr. Channing, who was in attendance with me on the three last cases,
+proposed to have a post-mortem examination of the subject of case No.
+5, but from some cause which I do not now recollect it was not
+obtained.
+
+"You wish to know whether I wore the same clothes when attending the
+different cases.  I cannot positively say, but I should think I did
+not, as the weather became warmer after the first two cases; I
+therefore think it probable that I made a change of at least a part
+of my dress.  I have had no other case of puerperal fever in my own
+practice for three years, save those above related, and I do not
+remember to have lost a patient before with this disease.  While
+absent, last July, I visited two patients sick with puerperal fever,
+with a friend of mine in the country.  Both of them recovered.
+
+"The cases that I have recorded were not confined to any particular
+constitution or temperament, but it seized upon the strong and the
+weak, the old and the young,--one being over forty years, and the
+youngest under eighteen years of age .  .  .  .  If the disease is of
+an erysipelatous nature, as many suppose, contagionists may perhaps
+find some ground for their belief in the fact, that, for two weeks
+previous to my first case of puerperal fever, I had been attending a
+severe case of erysipelas, and the infection may have been conveyed
+through me to the patient; but, on the other hand, why is not this
+the case with other physicians, or with the same physician at all
+times, for since my return from the country I have had a more
+inveterate case of erysipelas than ever before, and no difficulty
+whatever has attended any of my midwifery cases?"
+
+
+I am assured, on unquestionable authority, that "About three years
+since, a gentleman in extensive midwifery business, in a neighboring
+State, lost in the course of a few weeks eight patients in child-bed,
+seven of them being undoubted cases of puerperal fever.  No other
+physician of the town lost a single patient of this disease during
+the same period."  And from what I have heard in conversation with
+some of our most experienced practitioners, I am inclined to think
+many cases of the kind might be brought to light by extensive
+inquiry.
+
+
+This long catalogue of melancholy histories assumes a still darker
+aspect when we remember how kindly nature deals with the parturient
+female, when she is not immersed in the virulent atmosphere of an
+impure lying-in hospital, or poisoned in her chamber by the
+unsuspected breath of contagion.  From all causes together, not more
+than four deaths in a thousand births and miscarriages happened in
+England and Wales during the period embraced by the first "Report of
+the Registrar-General."  In the second Report the mortality was shown
+to be about five in one thousand. In the Dublin Lying-in Hospital,
+during the seven years of Dr. Collins's mastership, there was one
+case of puerperal fever to 178 deliveries, or less than six to the
+thousand, and one death from this disease in 278 cases, or between
+three and four to the thousand a yet during this period the disease
+was endemic in the hospital, and might have gone on to rival the
+horrors of the pestilence of the Maternite, had not the poison been
+destroyed by a thorough purification.
+
+In private practice, leaving out of view the cases that are to be
+ascribed to the self-acting system of propagation, it would seem that
+the disease must be far from common.  Mr. White of Manchester says,
+"Out of the whole number of lying-in patients whom I have delivered
+(and I may safely call it a great one), I have never lost one, nor to
+the best of my recollection has one been greatly endangered, by the
+puerperal, miliary, low nervous, putrid malignant, or milk fever."
+Dr. Joseph Clarke informed Dr. Collins, that in the course of forty-
+five years' most extensive practice he lost but four patients from
+this disease.  One of the most eminent practitioners of Glasgow, who
+has been engaged in very extensive practice for upwards of a quarter
+of a century, testifies that he never saw more than twelve cases of
+real puerperal fever.[Lancet, May 4, 1833]
+
+I have myself been told by two gentlemen practising in this city, and
+having for many years a large midwifery business, that they had
+neither of them lost a patient from this disease, and by one of them
+that he had only seen it in consultation with other physicians.  In
+five hundred cases of midwifery, of which Dr. Storer has given an
+abstract in the first number of this Journal, there was only one
+instance of fatal puerperal peritonitis.
+
+In the view of these facts, it does appear a singular coincidence,
+that one man or woman should have ten, twenty, thirty, or seventy
+cases of this rare disease following his or her footsteps with the
+keenness of a beagle, through the streets and lanes of a crowded
+city, while the scores that cross the same paths on the same errands
+know it only by name.  It is a series of similar coincidences which
+has led us to consider the dagger, the musket, and certain innocent-
+looking white powders as having some little claim to be regarded as
+dangerous.  It is the practical inattention to similar coincidences
+which has given rise to the unpleasant but often necessary documents
+called indictments, which has sharpened a form of the cephalotome
+sometimes employed in the case of adults, and adjusted that
+modification of the fillet which delivers the world of those who
+happen to be too much in the way while such striking coincidences are
+taking place.
+
+I shall now mention a few instances in which the disease appears to
+have been conveyed by the process of direct inoculation.
+
+Dr. Campbell of Edinburgh states that in October, 1821, he assisted
+at the post-mortem examination of a patient who died with puerperal
+fever.  He carried the pelvic viscera in his pocket to the class-
+room.  The same evening he attended a woman in labor without
+previously changing his clothes; this patient died.  The next morning
+he delivered a woman with the forceps; she died also, and of many
+others who were seized with the disease within a few weeks, three
+shared the same fate in succession.
+
+In June, 1823, he assisted some of his pupils at the autopsy of a
+case of puerperal fever.  He was unable to wash his hands with proper
+care, for want of the necessary accommodations.  On getting home he
+found that two patients required his assistance.  He went without
+further ablution, or changing his clothes; both these patients died
+with puerperal fever.  This same Dr. Campbell is one of Dr.
+Churchill's authorities against contagion.
+
+Mr. Roberton says that in one instance within his knowledge a
+practitioner passed the catheter for a patient with puerperal fever
+late in the evening; the same night he attended a lady who had the
+symptoms of the disease on the second day.  In another instance a
+surgeon was called while in the act of inspecting the body of a woman
+who had died of this fever, to attend a labor; within forty-eight
+hours this patient was seized with the fever.'
+
+On the 16th of March, 1831, a medical practitioner examined the body
+of a woman who had died a few days after delivery, from puerperal
+peritonitis.  On the evening of the 17th he delivered a patient, who
+was seized with puerperal fever on the 19th, and died on the 24th.
+Between this period and the 6th of April, the same practitioner
+attended two other patients, both of whom were attacked with the same
+disease and died.
+
+In the autumn of 1829 a physician was present at the examination of a
+case of puerperal fever, dissected out the organs, and assisted in
+sewing up the body.  He had scarcely reached home when he was
+summoned to attend a young lady in labor.  In sixteen hours she was
+attacked with the symptoms of puerperal fever, and narrowly escaped
+with her life.
+
+In December, 1830, a midwife, who had attended two fatal cases of
+puerperal fever at the British Lying-in Hospital, examined a patient
+who had just been admitted, to ascertain if labor had commenced.
+This patient remained two days in the expectation that labor would
+come on, when she returned home and was then suddenly taken in labor
+and delivered before she could set out for the hospital.  She went on
+favorably for two days, and was then taken with puerperal fever and
+died in thirty-six hours.
+
+"A young practitioner, contrary to advice, examined the body of a
+patient who had died from puerperal fever; there was no epidemic at
+the time; the case appeared to be purely sporadic.  He delivered
+three other women shortly afterwards; they all died with puerperal
+fever, the symptoms of which broke out very soon after labor.  The
+patients of his colleague did well, except one, where he assisted to
+remove some coagula from the uterus; she was attacked in the same
+manner as those whom he had attended, and died also."  The writer in
+the "British and Foreign Medical Review," from whom I quote this
+statement,--and who is no other than Dr. Rigby, adds, "We trust that
+this fact alone will forever silence such doubts, and stamp the well-
+merited epithet of 'criminal,' as above quoted, upon such attempts."
+[Brit.  and For.  Medical Review for Jan.  1842, p.  112.]
+
+From the cases given by Mr. Ingleby, I select the following.  Two
+gentlemen, after having been engaged in conducting the post-mortem
+examination of a case of puerperal fever, went in the same dress,
+each respectively, to a case of midwifery.  "The one patient was
+seized  with the rigor about thirty hours afterwards.  The other
+patient was seized with a rigor the third morning after delivery.
+One recovered, one died." [Edin.  Med.  and Surg.  Journal, April,
+1838.]
+
+One of these same gentlemen attended another woman in the same
+clothes two days after the autopsy referred to.  "The rigor did not
+take place until the evening of the fifth day from the first visit.
+Result fatal."  These cases belonged to a series of seven, the first
+of which was thought to have originated in a case of erysipelas.
+"Several cases of a mild character followed the foregoing seven, and
+their nature being now most unequivocal, my friend declined visiting
+all midwifery cases for a time, and there was no recurrence of the
+disease."  These cases occurred in 1833.  Five of them proved fatal.
+Mr. Ingleby gives another series of seven eases which occurred to a
+practitioner in 1836, the first of which was also attributed to his
+having opened several erysipelatous abscesses a short time
+previously.
+
+I need not refer to the case lately read before this Society, in
+which a physician went, soon after performing an autopsy of a case of
+puerperal fever, to a woman in labor, who was seized with the same
+disease and perished.  The forfeit of that error has been already
+paid.
+
+At a meeting of the Medical and Chirurgical Society before referred
+to, Dr. Merriman related an instance occurring in his own practice,
+which excites a reasonable suspicion that two lives were sacrificed
+to a still less dangerous experiment.  He was at the examination of a
+case of puerperal fever at two o'clock in the afternoon.  He took
+care not to touch the body.  At nine o'clock the same evening he
+attended a woman in labor; she was so nearly delivered that he had
+scarcely anything to do.  The next morning she had severe rigors, and
+in forty-eight hours she was a corpse.  Her infant had erysipelas and
+died in two days. [Lancet, May 2, 1840.]
+
+In connection with the facts which have been stated, it seems proper
+to allude to the dangerous and often fatal effects which have
+followed from wounds received in the post-mortem examination of
+patients who have died of puerperal fever.  The fact that such wounds
+are attended with peculiar risk has been long noticed.  I find that
+Chaussier was in the habit of cautioning his students against the
+danger to which they were exposed in these dissections. [Stein, L'Art
+d'Accoucher, 1794; Dict. des Sciences Medicales, art.  "Puerperal."]
+The head pharmacien of the Hotel Dieu, in his analysis of the fluid
+effused in puerperal peritonitis, says that practitioners are
+convinced of its deleterious qualities, and that it is very dangerous
+to apply it to the denuded skin. [Journal de Pharmacie, January,
+1836.]  Sir Benjamin Brodie speaks of it as being well known that the
+inoculation of lymph or pus from the peritoneum of a puerperal
+patient is often attended with dangerous and even fatal symptoms.
+Three cases in confirmation of this statement, two of them fatal,
+have been reported to this Society within a few months.
+
+Of about fifty cases of injuries of this kind, of various degrees of
+severity, which I have collected from different sources, at least
+twelve were instances of infection from puerperal peritonitis.  Some
+of the others are so stated as to render it probable that they may
+have been of the same nature.  Five other cases were of peritoneal
+inflammation; three in males.  Three were what was called enteritis,
+in one instance complicated with erysipelas; but it is well known
+that this term has been often used to signify inflammation of the
+peritoneum covering the intestines.  On the other hand, no case of
+typhus or typhoid fever is mentioned as giving rise to dangerous
+consequences, with the exception of the single instance of an
+undertaker mentioned by Mr. Travers, who seems to have been poisoned
+by a fluid which exuded from the body.  The other accidents were
+produced by dissection, or some other mode of contact with bodies of
+patients who had died of various affections.  They also differed much
+in severity, the cases of puerperal origin being among the most
+formidable and fatal.  Now a moment's reflection will show that the
+number of cases of serious consequences ensuing from the dissection
+of the bodies of those who had perished of puerperal fever is so
+vastly disproportioned to the relatively small number of autopsies
+made in this complaint as compared with typhus or pneumonia (from
+which last disease not one case of poisoning happened), and still
+more from all diseases put together, that the conclusion is
+irresistible that a most fearful morbid poison is often generated in
+the course of this disease.  Whether or not it is sui generis,
+confined to this disease, or produced in some others, as, for
+instance, erysipelas, I need, not stop to inquire.
+
+In connection with this may be taken the following statement of Dr.
+Rigby.  "That the discharges from a patient under puerperal fever are
+in the highest degree contagious we have abundant evidence in the
+history of lying-in hospitals.  The puerperal abscesses are also
+contagious, and may be communicated to healthy lying-in women by
+washing with the same sponge; this fact has been repeatedly proved in
+the Vienna Hospital; but they are equally communicable to women not
+pregnant; on more than one occasion the women engaged in washing the
+soiled bed-linen of the General Lying-in Hospital have been attacked
+with abscess in the fingers or hands, attended with rapidly spreading
+inflammation of the cellular tissue."
+
+Now add to all this the undisputed fact, that within the walls of
+lying-in hospitals there is often generated a miasm, palpable as the
+chlorine used to destroy it, tenacious so as in some cases almost to
+defy extirpation, deadly in some institutions as the plague; which
+has killed women in a private hospital of London so fast that they
+were buried two in one coffin to conceal its horrors; which enabled
+Tonnelle to record two hundred and twenty-two autopsies at the
+Maternite of Paris; which has led Dr. Lee to express his deliberate
+conviction that the loss of life occasioned by these institutions
+completely defeats the objects of their founders; and out of this
+train of cumulative evidence, the multiplied groups of cases
+clustering about individuals, the deadly results of autopsies, the
+inoculation by fluids from the living patient, the murderous poison
+of hospitals,--does there not result a conclusion that laughs all
+sophistry to scorn, and renders all argument an insult?
+
+I have had occasion to mention some instances in which there was an
+apparent relation between puerperal fever and erysipelas.  The length
+to which this paper has extended does not allow me to enter into the
+consideration of this most important subject.  I will only say, that
+the evidence appears to me altogether satisfactory that some most
+fatal series of puerperal fever have been produced by an infection
+originating in the matter or effluvia of erysipelas.  In evidence of
+some connection between the two diseases, I need not go back to the
+older authors, as Pouteau or Gordon, but will content myself with
+giving the following references, with their dates; from which it will
+be seen that the testimony has been constantly coming before the
+profession for the last few years.
+
+"London Cyclopaedia of Practical Medicine," article Puerperal Fever,
+1833.
+
+Mr. Ceeley's Account of the Puerperal Fever at Aylesbury.  "Lancet,"
+1835.
+
+Dr. Ramsbotham's Lecture.  "London Medical Gazette," 1835.
+
+Mr. Yates Ackerly's Letter in the same Journal, 1838.
+
+Mr. Ingleby on Epidemic Puerperal Fever.  "Edinburgh Medical and
+Surgical Journal," 1838.
+
+Mr. Paley's Letter.  "London Medical Gazette," 1839.
+
+Remarks at the Medical and Chirurgical Society. "Lancet," 1840.
+
+Dr. Rigby's "System of Midwifery."  1841.
+
+"Nunneley on Erysipelas,"--a work which contains a large number of
+references on the subject.  1841.
+
+"British and Foreign Quarterly Review," 1842.
+
+Dr. S.  Jackson of Northumberland, as already quoted from the Summary
+of the College of Physicians, 1842.
+
+And lastly, a startling series of cases by Mr. Storrs of Doncaster,
+to be, found in the "American Journal of the Medical Sciences" for
+January, 1843.
+
+The relation of puerperal fever with other continued fevers would
+seem to be remote and rarely obvious.  Hey refers to two cases of
+synochus occurring in the Royal Infirmary of Edinburgh, in women who
+had attended upon puerperal patients.  Dr. Collins refers to several
+instances in which puerperal fever has appeared to originate from a
+continued proximity to patients suffering with typhus.
+
+Such occurrences as those just mentioned, though most important to be
+remembered and guarded against, hardly attract our notice in the
+midst of the gloomy facts by which they are surrounded.  Of these
+facts, at the risk of fatiguing repetitions, I have summoned a
+sufficient number, as I believe, to convince the most incredulous
+that every attempt to disguise the truth which underlies them all is
+useless.
+
+It is true that some of the historians of the disease, especially
+Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque,
+in France, profess not to have found puerperal fever contagious.  At
+the most they give us mere negative facts, worthless against an
+extent of evidence which now overlaps the widest range of doubt, and
+doubles upon itself in the redundancy of superfluous demonstration.
+Examined in detail, this and much of the show of testimony brought up
+to stare the daylight of conviction out of countenance, proves to be
+in a great measure unmeaning and inapplicable, as might be easily
+shown were it necessary.  Nor do I feel the necessity of enforcing
+the conclusion which arises spontaneously from the facts which have
+been enumerated, by formally citing the opinions of those grave
+authorities who have for the last half-century been sounding the
+unwelcome truth it has cost so many lives to establish.
+
+"It is to the British practitioner," says Dr. Rigby, "that we are
+indebted for strongly insisting upon this important and dangerous
+character of puerperal fever."
+
+The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton,
+Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee,
+Ingleby, Locock, Abercrombie, Alison; Travers, Rigby, and Watson,
+many of whose writings I have already referred to, may have some
+influence with those who prefer the weight of authorities to the
+simple deductions of their own reason from the facts laid before
+them.  A few Continental writers have adopted similar conclusions. It
+gives me pleasure to remember, that while the doctrine has been
+unceremoniously discredited in one of the leading Journals, and made
+very light of by teachers in two of the principal Medical Schools, of
+this country, Dr. Channing has for many years inculcated, and
+enforced by examples, the danger to be apprehended and the
+precautions to be taken in the disease under consideration.
+
+I have no wish to express any harsh feeling with regard to the
+painful subject which has come before us.  If there are any so far
+excited by the story of these dreadful events that they ask for some
+word of indignant remonstrance to show that science does not turn the
+hearts of its followers into ice or stone, let me remind them that
+such words have been uttered by those who speak with an authority I
+could not claim.  It is as a lesson rather than as a reproach that I
+call up the memory of these irreparable errors and wrongs.  No tongue
+can tell the heart-breaking calamity they have caused; they have
+closed the eyes just opened upon a new world of love and happiness;
+they have bowed the strength of manhood into the dust; they have cast
+the helplessness of infancy into the stranger's arms, or bequeathed
+it, with less cruelty, the death of its dying parent.  There is no
+tone deep enough for regret, and no voice loud enough for warning.
+The woman about to become a mother, or with her new-born infant upon
+her bosom, should be the object of trembling care and sympathy
+wherever she bears her tender burden, or stretches her aching limbs.
+The very outcast of the streets has pity upon her sister in
+degradation, when the seal of promised maternity is impressed upon
+her.  The remorseless vengeance of the law, brought down upon its
+victim by a machinery as sure as destiny, is arrested in its fall at
+a word which reveals her transient claim for mercy.  The solemn
+prayer of the liturgy singles out her sorrows from the multiplied
+trials of life, to plead for her in the hour of peril.  God forbid
+that any member of the profession to which she trusts her life,
+doubly precious at that eventful period, should hazard it
+negligently, unadvisedly, or selfishly!
+
+There may be some among those whom I address who are disposed to ask
+the question, What course are we to follow in relation to this
+matter?  The facts are before them, and the answer must be left to
+their own judgment and conscience.  If any should care to know my own
+conclusions, they are the following; and in taking the liberty to
+state them very freely and broadly, I would ask the inquirer to
+examine them as freely in the light of the evidence which has been
+laid before him.
+
+1.  A physician holding himself in readiness to attend cases of
+midwifery should never take any active part in the post-mortem
+examination of cases of puerperal fever.
+
+2.  If a physician is present at such autopsies, he should use
+thorough ablution, change every article of dress, and allow twenty-
+four hours or more to elapse before attending to any case of
+midwifery.  It may be well to extend the same caution to cases of
+simple peritonitis.
+
+3.  Similar precautions should be taken after the autopsy or surgical
+treatment of cases of erysipelas, if the physician is obliged to
+unite such offices with his obstetrical duties, which is in the
+highest degree inexpedient.
+
+4.  On the occurrence of a single case of puerperal fever in his
+practice, the physician is bound to consider the next female he
+attends in labor, unless some weeks at least have elapsed, as in
+danger of being infected by him, and it is his duty to take every
+precaution to diminish her risk of disease and death.
+
+5.  If within a short period two cases of puerperal fever happen
+close to each other, in the practice of the same physician, the
+disease not existing or prevailing in the neighborhood, he would do
+wisely to relinquish his obstetrical practice for at least one month,
+and endeavor to free himself by every available means from any
+noxious influence he may carry about with him.
+
+6.  The occurrence of three or more closely connected cases, in the
+practice of one individual, no others existing in the neighborhood,
+and no other sufficient cause being alleged for the coincidence, is
+prima facie evidence that he is the vehicle of contagion.
+
+7.  It is the duty of the physician to take every precaution that the
+disease shall not be introduced by nurses or other assistants, by
+making proper inquiries concerning them, and giving timely warning of
+every suspected source of danger.
+
+8.  Whatever indulgence may be granted to those who have heretofore
+been the ignorant causes of so much misery, the time has come when
+the existence of a private pestilence in the sphere of a single
+physician should be looked upon, not as a misfortune, but a crime;
+and in the knowledge of such occurrences the duties of the
+practitioner to his profession should give way to his paramount
+obligations to society.
+
+
+ADDITIONAL REFERENCES AND CASES.
+
+Fifth Annual Report of the Registrar-General of England,
+
+1843.  Appendix.  Letter from William Farr, Esq.--Several new series
+of cases are given in the Letter of Mr. Stows, contained in the
+Appendix to this Report.  Mr. Stows suggests precautions similar to
+those I have laid down, and these precautions are strongly enforced
+by Mr. Farr, who is, therefore, obnoxious to the same criticisms as
+myself.
+
+Hall and Dexter, in Am.  Journal of Med.  Sc.  for January, 1844.-
+Cases of puerperal fever seeming to originate in erysipelas.
+
+Elkington, of Birmingham, in Provincial Med.  Journal, cited in Am.
+Journ.  Med.  Se.  for April, 1844.--Six cases in less than a
+fortnight, seeming to originate in a case of erysipelas.
+
+West's Reports, in Brit.  and For.  Med.  Review for October, 1845,
+and January, 1847.--Affection of the arm, resembling malignant
+pustule, after removing the placenta of a patient who died from
+puerperal fever.  Reference to cases at Wurzburg, as proving
+contagion, and to Keiller's cases in the Monthly Journal for
+February, 1846, as showing connection of puerperal fever and
+erysipelas.
+
+Kneeland.--Contagiousness of Puerperal Fever.  Am.  Jour.  Med.
+Se., January, 1846.  Also, Connection between Puerperal Fever and
+Epidemic Erysipelas.  Ibid., April, 1846.
+
+Robert Storrs.--Contagious Effects of Puerperal Fever on the Male
+Subject; or on Persons not Child-bearing.  (From Provincial Med.  and
+Surg.  Journal.) Am.  Jour.  Med.  Sc., January, 184,6.  Numerous
+cases.  See also Dr. Reid's case in same Journal for April, 1846.
+
+Routh's paper in Proc.  of Royal Med.  Chir.  Soc., Am.  Jour.  Med.
+Sc., April, 1849, also in B.  and F.  Med.  Chir.  Review, April,
+1850.
+
+Hill, of Leuchars.--A Series of Cases illustrating the Contagious
+Nature of Erysipelas and of Puerperal Fever, and their Intimate
+Pathological Connection.  (From Monthly Journal of Med.  Sc.) Am.
+Jour.  Med.  Se., July, 1850.
+
+Skoda on the Causes of Puerperal Fever.  (Peritonitis in rabbits,
+from inoculation with different morbid secretions.) Am.  Jour.  Med.
+Se., October, 1850.
+
+Arneth.  Paper read before the National Academy of Medicine.  Annales
+d'Hygiene, Tome LXV.  2e Partie.  (Means of Disinfection proposed by
+M.  "Semmeliveis" (Semmelweiss.) Lotions of chloride of lime and use
+of nail-brush before admission to lying-in wards.  Alleged sudden and
+great decrease of mortality from puerperal fever.  Cause of disease
+attributed to inoculation with cadaveric matters.) See also Routh's
+paper, mentioned above.
+
+Moir.  Remarks at a meeting of the Edinburgh Medico-Chirurgical
+Society.  Refers to cases of Dr. Kellie, of Leith.  Sixteen in
+succession, all fatal.  Also to several instances of individual
+pupils having had a succession of cases in various quarters of the
+town, while others, practising as extensively in the same localities,
+had none.  Also to several special cases not mentioned elsewhere.
+Am.  Jour.  Med.  Se.  for October, 1851.  (From New Monthly Journal
+of Med.  Science.)
+
+Simpson.--Observations at a Meeting of the Edinburgh Obstetrical
+Society.  (An "eminent gentleman," according to Dr.  Meigs, whose
+"name is as well known in America as in (his) native land."
+Obstetrics.  Phil.  1852, pp.  368, 375.) The student is referred to
+this paper for a valuable resume of many of the facts, and the
+necessary inferences, relating to this subject.  Also for another
+series of cases, Mr. Sidey's, five or six in rapid succession.
+Dr. Simpson attended the dissection of two of Dr. Sidey's cases, and
+freely handled the diseased parts.  His next four child-bed patients
+were affected with puerperal fever, and it was the first time he had
+seen it in practice.  As Dr. Simpson is a gentleman (Dr. Meigs, as
+above), and as "a gentleman's hands are clean" (Dr. Meigs' Sixth
+Letter), it follows that a gentleman with clean hands may carry the
+disease.  Am.  Jour.  Med.  Sc., October, 1851.
+
+Peddle.--The five or six cases of Dr. Sidey, followed by the four of
+Dr. Simpson, did not end the series.  A practitioner in Leith having
+examined in Dr. Simpson's house, a portion of the uterus obtained
+from one of the patients, had immediately afterwards three fatal
+cases of puerperal fever.  Dr.  Veddie referred to two distinct
+series of consecutive cases in his own practice.  He had since taken
+precautions, and not met with any such cases.  Am.  Jour.  Med.  Sc.,
+October, 1851.
+
+Copland.  Considers it proved that puerperal fever maybe propagated
+by the hands and the clothes, or either, of a third person, the bed-
+clothes or body-clothes of a patient.  Mentions a new series of
+cases, one of which he saw, with the practitioner who had attended
+them.  She was the sixth he had had within a few days.  All died.
+Dr. Copland insisted that contagion had caused these cases; advised
+precautionary measures, and the practitioner had no other cases for a
+considerable time.  Considers it criminal, after the evidence
+adduced,--which he could have quadrupled,--and the weight of
+authority brought forward, for a practitioner to be the medium of
+transmitting contagion and death to his patients.  Dr. Copland lays
+down rules similar to those suggested by myself, and is therefore
+entitled to the same epithet for so doing.  Medical Dictionary, New
+York, 1852.  Article, Puerperal States and Diseases.
+
+If there is any appetite for facts so craving as to be yet
+unappeased,--Lesotho, necdum satiata,--more can be obtained.
+Dr.  Hodge remarks that "the frequency and importance of this
+singular circumstance (that the disease is occasionally more
+prevalent with one practitioner than another) has been exceedingly
+overrated."  More than thirty strings of cases, more than two hundred
+and fifty sufferers from puerperal fever, more than one hundred and
+thirty deaths appear as the results of a sparing estimate of such
+among the facts I have gleaned as could be numerically valued.  These
+facts constitute, we may take it for granted, but a small fraction of
+those that have actually occurred.  The number of them might be
+greater, but "'t is enough, 't will serve," in Mercutio's modest
+phrase, so far as frequency is concerned.  For a just estimate of the
+importance of the singular circumstance, it might be proper to
+consult the languid survivors, the widowed husbands, and the
+motherless children, as well as "the unfortunate accoucheur."
+
+
+
+
+
+
+III
+
+CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE
+
+An Address delivered before the Massachusetts Medical Society, at the
+Annual Meeting, May 30, 1860.
+
+               "Facultate magis quam violentia."
+                                   HIPPOCRATES.
+
+Our Annual Meeting never fails to teach us at least one lesson.  The
+art whose province it is to heal and to save cannot protect its own
+ranks from the inroads of disease and the waste of the Destroyer.
+
+Seventeen of our associates have been taken from us since our last
+Anniversary.  Most of them followed their calling in the villages or
+towns that lie among the hills or along the inland streams.  Only
+those who have lived the kindly, mutually dependent life of the
+country, can tell how near the physician who is the main reliance in
+sickness of all the families throughout a thinly settled region comes
+to the hearts of the people among whom he labors, how they value him
+while living, how they cherish his memory when dead.  For these
+friends of ours who have gone before, there is now no more toil; they
+start from their slumbers no more at the cry of pain; they sally
+forth no more into the storms; they ride no longer over the lonely
+roads that knew them so well; their wheels are rusting on their axles
+or rolling with other burdens; their watchful eyes are closed to all
+the sorrows they lived to soothe.  Not one of these was famous in the
+great world; some were almost unknown beyond their own immediate
+circle.  But they have left behind them that loving remembrance which
+is better than fame, and if their epitaphs are chiselled briefly in
+stone, they are written at full length on living tablets in a
+thousand homes to which they carried their ever-welcome aid and
+sympathy.
+
+One whom we have lost, very widely known and honored, was a leading
+practitioner of this city.  His image can hardly be dimmed in your
+recollection, as he stood before you only three years ago, filling
+the same place with which I am now honored.  To speak of him at all
+worthily, would be to write the history of professional success, won
+without special aid at starting, by toil, patience, good sense, pure
+character, and pleasing manners; won in a straight uphill ascent,
+without one breathing-space until he sat down, not to rest, but to
+die.  If prayers could have shielded him from the stroke, if love
+could have drawn forth the weapon, and skill could have healed the
+wound, this passing tribute might have been left to other lips and to
+another generation.
+
+Let us hope that our dead have at last found that rest which neither
+summer nor winter, nor day nor night, had granted to their unending
+earthly labors!  And let us remember that our duties to our brethren
+do not cease when they become unable to share our toils, or leave
+behind them in want and woe those whom their labor had supported.  It
+is honorable to the Profession that it has organized an Association a
+for the relief of its suffering members and their families; it owes
+this tribute to the ill-rewarded industry and sacrifices of its less
+fortunate brothers who wear out health and life in the service of
+humanity.  I have great pleasure in referring to this excellent
+movement, which gives our liberal profession a chance to show its
+liberality, and serves to unite us all, the successful and those whom
+fortune has cast down, in the bonds of a true brotherhood.
+
+A medical man, as he goes about his daily business after twenty years
+of practice, is apt to suppose that he treats his patients according
+to the teachings of his experience.  No doubt this is true to some
+extent; to what extent depending much on the qualities of the
+individual.  But it is easy to prove that the prescriptions of even
+wise physicians are very commonly founded on something quite
+different from experience.  Experience must be based on the permanent
+facts of nature.  But a glance at the prevalent modes of treatment of
+any two successive generations will show that there is a changeable
+as well as a permanent element in the art of healing; not merely
+changeable as diseases vary, or as new remedies are introduced, but
+changeable by the going out of fashion of special remedies, by the
+decadence of a popular theory from which their fitness was deduced,
+or other cause not more significant.  There is no reason to suppose
+that the present time is essentially different in this respect from
+any other.  Much, therefore, which is now very commonly considered to
+be the result of experience, will be recognized in the next, or in
+some succeeding generation, as no such result at all, but as a
+foregone conclusion, based on some prevalent belief or fashion of the
+time.
+
+There are, of course, in every calling, those who go about the work
+of the day before them, doing it according to the rules of their
+craft, and asking no questions of the past or of the future, or of
+the aim and end to which their special labor is contributing.  These
+often consider and call themselves practical men.  They pull the oars
+of society, and have no leisure to watch the currents running this or
+that way; let theorists and philosophers attend to them.  In the mean
+time, however, these currents are carrying the practical men, too,
+and all their work may be thrown away, and worse than thrown away, if
+they do not take knowledge of them and get out of the wrong ones and
+into the right ones as soon as they may.  Sir Edward Parry and his
+party were going straight towards the pole in one of their arctic
+expeditions, travelling at the rate of ten miles a day.  But the ice
+over which they travelled was drifting straight towards the equator,
+at the rate of twelve miles a day, and yet no man among them would
+have known that he was travelling two miles a day backward unless he
+had lifted his eyes from the track in which he was plodding.  It is
+not only going backward that the plain practical workman is liable
+to, if he will not look up and look around; he may go forward to ends
+he little dreams of.  It is a simple business for a mason to build up
+a niche in a wall; but what if, a hundred years afterwards when the
+wall is torn down, the skeleton of a murdered man drop out of the
+niche?  It was a plain practical piece of carpentry for a Jewish
+artisan to fit two pieces of timber together according to the legal
+pattern in the time of Pontius Pilate; he asked no questions,
+perhaps, but we know what burden the cross bore on the morrow!  And
+so, with subtler tools than trowels or axes, the statesman who works
+in policy without principle, the theologian who works in forms
+without a soul, the physician who, calling himself a practical man,
+refuses to recognize the larger laws which govern his changing
+practice, may all find that they have been building truth into the
+wall, and hanging humanity upon the cross.
+
+The truth is, that medicine, professedly founded on observation, is
+as sensitive to outside influences, political, religious,
+philosophical, imaginative, as is the barometer to the changes of
+atmospheric density.  Theoretically it ought to go on its own
+straightforward inductive path, without regard to changes of
+government or to fluctuations of public opinion.  But look a moment
+while I clash a few facts together, and see if some sparks do not
+reveal by their light a closer relation between the Medical Sciences
+and the conditions of Society and the general thought of the time,
+than would at first be suspected.
+
+Observe the coincidences between certain great political and
+intellectual periods and the appearance of illustrious medical
+reformers and teachers.  It was in the age of Pericles, of Socrates,
+of Plato, of Phidias, that Hippocrates gave to medical knowledge the
+form which it retained for twenty centuries.  With the world-
+conquering Alexander, the world-embracing Aristotle, appropriating
+anatomy and physiology, among his manifold spoils of study, marched
+abreast of his royal pupil to wider conquests.  Under the same
+Ptolemies who founded the Alexandrian Library and Museum, and ordered
+the Septuagint version of the Hebrew Scriptures, the infallible
+Herophilus ["Contradicere Herophilo in anatomicis, est contradicere
+evangelium," was a saying of Fallopius.] made those six hundred
+dissections of which Tertullian accused him, and the sagacious
+Erasistratus introduced his mild antiphlogistic treatment in
+opposition to the polypharmacy and antidotal practice of his time.
+It is significant that the large-minded Galen should have been the
+physician and friend of the imperial philosopher Marcus Aurelius.
+The Arabs gave laws in various branches of knowledge to those whom
+their arms had invaded, or the terror of their spreading dominion had
+reached, and the point from which they started was, as Humboldt
+acknowledges, "the study of medicine, by which they long ruled the
+Christian Schools," and to which they added the department of
+chemical pharmacy.
+
+Look at Vesalius, the contemporary of Luther.  Who can fail to see
+one common spirit in the radical ecclesiastic and the reforming
+court-physician?  Both still to some extent under the dominion of the
+letter: Luther holding to the real presence; Vesalius actually
+causing to be drawn and engraved two muscles which he knew were not
+found in the human subject, because they had been described by Galen,
+from dissections of the lower animals.  Both breaking through old
+traditions in the search of truth; one, knife in hand, at the risk of
+life and reputation, the other at the risk of fire and fagot, with
+that mightier weapon which all the devils could not silence, though
+they had been thicker than the tiles on the house-tops.  How much the
+physician of the Catholic Charles V. had in common with the great
+religious destructive, may be guessed by the relish with which he
+tells the story how certain Pavian students exhumed the body of an
+"elegans scortum," or lovely dame of ill repute, the favorite of a
+monk of the order of St. Anthony, who does not seem to have resisted
+temptation so well as the founder of his order.  We have always
+ranked the physician Rabelais among the early reformers, but I do not
+know that Vesalius has ever been thanked for his hit at the morals of
+the religious orders, or for turning to the good of science what was
+intended for the "benefit of clergy."
+
+Our unfortunate medical brother, Michael Servetus, the spiritual
+patient to whom the theological moxa was applied over the entire
+surface for the cure of his heresy, came very near anticipating
+Harvey.  The same quickened thought of the time which led him to
+dispute the dogma of the Church, opened his mind to the facts which
+contradicted the dogmas of the Faculty.
+
+Harvey himself was but the posthumous child of the great Elizabethan
+period.  Bacon was at once his teacher and his patient.  The founder
+of the new inductive philosophy had only been dead two years when the
+treatise on the Circulation, the first-fruit of the Restoration of
+Science, was given to the world.
+
+And is it to be looked at as a mere accidental coincidence, that
+while Napoleon was modernizing the political world, Bichat was
+revolutionizing the science of life and the art that is based upon
+it; that while the young general was scaling the Alps, the young
+surgeon was climbing the steeper summits of unexplored nature; that
+the same year read the announcement of those admirable "Researches on
+Life and Death," and the bulletins of the battle of Marengo?
+
+If we come to our own country, who can fail to recognize that
+Benjamin Rush, the most conspicuous of American physicians, was the
+intellectual offspring of the movement which produced the Revolution?
+"The same hand," says one of his biographers," which subscribed the
+declaration of the political independence of these States,
+accomplished their emancipation from medical systems formed in
+foreign countries, and wholly unsuitable to the state of diseases in
+America."
+
+Following this general course of remark, I propose to indicate in a
+few words the direction of the main intellectual current of the time,
+and to point out more particularly some of the eddies which tend to
+keep the science and art of medicine from moving with it, or even to
+carry them backwards.
+
+The two dominant words of our time are law and average, both pointing
+to the uniformity of the order of being in which we live.  Statistics
+have tabulated everything,--population, growth, wealth, crime,
+disease.  We have shaded maps showing the geographical distribution
+of larceny and suicide.  Analysis and classification have been at
+work upon all tangible and visible objects.  The Positive Philosophy
+of Comte has only given expression to the observing and computing
+mind of the nineteenth century.
+
+In the mean time, the great stronghold of intellectual conservatism,
+traditional belief, has been assailed by facts which would have been
+indicted as blasphemy but a few generations ago.  Those new tables of
+the law, placed in the hands of the geologist by the same living God
+who spoke from Sinai to the Israelites of old, have remodelled the
+beliefs of half the civilized world.  The solemn scepticism of
+science has replaced the sneering doubts of witty philosophers.  The
+more positive knowledge we gain, the more we incline to question all
+that has been received without absolute proof.
+
+As a matter of course, this movement has its partial reactions.  The
+province of faith is claimed as a port free of entry to unsupported
+individual convictions.  The tendency to question is met by the
+unanalyzing instinct of reverence.  The old church calls back its
+frightened truants.  Some who have lost their hereditary religious
+belief find a resource in the revelations of Spiritualism.  By a
+parallel movement, some of those who have become medical infidels
+pass over to the mystic band of believers in the fancied miracles of
+Homoeopathy.
+
+Under these influences transmitted to, or at least shared by, the
+medical profession, the old question between "Nature," so called, and
+"Art," or professional tradition, has reappeared with new interest.
+I say the old question, for Hippocrates stated the case on the side
+of "Nature" more than two thousand years ago.  Miss Florence
+Nightingale,--and if I name her next to the august Father of the
+Healing Art, its noblest daughter well deserves that place of honor,
+--Miss Florence Nightingale begins her late volume with a paraphrase
+of his statement.  But from a very early time to this there has
+always been a strong party against "Nature."  Themison called the
+practice of Hippocrates "a meditation upon death."  Dr. Rush says:
+"It is impossible to calculate the mischief which Hippocrates, has
+done, by first marking Nature with his name and afterwards letting
+her loose upon sick people.  Millions have perished by her hands in
+all ages and countries."  Sir John Forbes, whose defence of "Nature"
+in disease you all know, and to the testimonial in whose honor four
+of your Presidents have contributed, has been recently greeted, on
+retiring from the profession, with a wish that his retirement had
+been twenty years sooner, and the opinion that no man had done so
+much to destroy the confidence of the public in the medical
+profession.
+
+In this Society we have had the Hippocratic and the Themisonic side
+fairly represented.  The treatise of one of your early Presidents on
+the Mercurial Treatment is familiar to my older listeners.  Others
+who have held the same office have been noted for the boldness of
+their practice, and even for partiality to the use of complex
+medication.
+
+On the side of "Nature" we have had, first of all, that remarkable
+discourse on Self-Limited Diseases, [On Self-Limited Diseases.  A
+Discourse delivered before the Massachusetts Medical Society, at
+their Annual Meeting, May 27, 1835.  By Jacob Bigelow, M. D.] which
+has given the key-note to the prevailing medical tendency of this
+neighborhood, at least, for the quarter of a century since it was
+delivered.  Nor have we forgotten the address delivered at
+Springfield twenty years later, [Search out the Secrets, of Nature.
+By Augustus A.  Gould, M.  D.  Read at the Annual Meeting, June 27,
+1855.] full of good sense and useful suggestions, to one of which
+suggestions we owe the learned, impartial, judicious, well-written
+Prize Essay of Dr. Worthington Hooker. [Rational Therapeutics.  A
+Prize Essay.  By Worthington Hooker, M.  D., of New Haven.  Boston.
+1857.] We should not omit from the list the important address of
+another of our colleagues, [On the Treatment of Compound and
+Complicated Fractures. By William J.  Walker, M.  D.  Read at the
+Annual Meeting, May 29, 1845.] showing by numerous cases the power of
+Nature in healing compound fractures to be much greater than is
+frequently supposed,--affording, indeed, more striking illustrations
+than can be obtained from the history of visceral disease, of the
+supreme wisdom, forethought, and adaptive dexterity of that divine
+Architect, as shown in repairing the shattered columns which support
+the living temple of the body.
+
+We who are on the side of "Nature" please ourselves with the idea
+that we are in the great current in which the true intelligence of
+the time is moving.  We believe that some who oppose, or fear, or
+denounce our movement are themselves caught in various eddies that
+set back against the truth.  And we do most earnestly desire and most
+actively strive, that Medicine, which, it is painful to remember, has
+been spoken of as "the withered branch of science" at a meeting of
+the British Association, shall be at length brought fully to share,
+if not to lead, the great wave of knowledge which rolls with the
+tides that circle the globe.
+
+If there is any State or city which might claim to be the American
+headquarters of the nature-trusting heresy, provided it be one, that
+State is Massachusetts, and that city is its capital.  The effect
+which these doctrines have upon the confidence reposed in the
+profession is a matter of opinion.  For myself, I do not believe this
+confidence can be impaired by any investigations which tend to limit
+the application of troublesome, painful, uncertain, or dangerous
+remedies.  Nay, I will venture to say this, that if every specific
+were to fail utterly, if the cinchona trees all died out, and the
+arsenic mines were exhausted, and the sulphur regions were burned up,
+if every drug from the vegetable, animal, and mineral kingdom were to
+disappear from the market, a body of enlightened men, organized as a
+distinct profession, would be required just as much as now, and
+respected and trusted as now, whose province should be to guard
+against the causes of disease, to eliminate them if possible when
+still present, to order all the conditions of the patient so as to
+favor the efforts of the system to right itself, and to give those
+predictions of the course of disease which only experience can
+warrant, and which in so many cases relieve the exaggerated fears of
+sufferers and their friends, or warn them in season of impending
+danger.  Great as the loss would be if certain active remedies could
+no longer be obtained, it would leave the medical profession the most
+essential part of it's duties, and all, and more than all, its
+present share of honors; for it would be the death-blow to
+charlatanism, which depends for its success almost entirely on drugs,
+or at least on a nomenclature that suggests them.
+
+There is no offence, then, or danger in expressing the opinion, that,
+after all which has been said, the community is still overdosed: The
+best proof of it is, that "no families take so little medicine as
+those of doctors, except those of apothecaries, and that old
+practitioners are more sparing of active medicines than younger
+ones." [Dr. James Jackson has kindly permitted me to make the
+following extract from a letter just received by him from Sir James
+Clark, and dated May 26, 1860:  "As a physician advances in age, he
+generally, I think, places less confidence in the ordinary medical
+treatment than he did, not only during his early, but even his middle
+period of life."]  The conclusion from these facts is one which the
+least promising of Dr. Howe's pupils in the mental department could
+hardly help drawing.
+
+Part of the blame of over-medication must, I fear, rest with the
+profession, for yielding to the tendency to self-delusion, which
+seems inseparable from the practice of the art of healing.  I need
+only touch on the common modes of misunderstanding or misapplying the
+evidence of nature.
+
+First, there is the natural incapacity for sound observation, which
+is like a faulty ear in music.  We see this in many persons who know
+a good deal about books, but who are not sharp-sighted enough to buy
+a horse or deal with human diseases.
+
+Secondly, there is in some persons a singular inability to weigh the
+value of testimony; of which, I think, from a pretty careful
+examination of his books, Hahnemann affords the best specimen outside
+the walls of Bedlam.
+
+The inveterate logical errors to which physicians have always been
+subject are chiefly these:
+
+The mode of inference per enumerationem simplicem, in scholastic
+phrase; that is, counting only their favorable cases.  This is the
+old trick illustrated in Lord Bacon's story of the gifts of the
+shipwrecked people, hung up in the temple.--Behold! they vowed these
+gifts to the altar, and the gods saved them.  Ay, said a doubting
+bystander, but how many made vows of gifts and were shipwrecked
+notwithstanding?  The numerical system is the best corrective of this
+and similar errors.  The arguments commonly brought against its
+application to all matters of medical observation, treatment
+included, seem to apply rather to the tabulation of facts ill
+observed, or improperly classified, than to the method itself.
+
+The post hoc ergo propter hoc error: he got well after taking my
+medicine; therefore in consequence of taking it.
+
+The false induction from genuine facts of observation, leading to the
+construction of theories which are then deductively applied in the
+face of the results of direct observation.  The school of Broussais
+has furnished us with a good example of this error.
+
+And lastly, the error which Sir Thomas Browne calls giving "a reason
+of the golden tooth;" that is, assuming a falsehood as a fact, and
+giving reasons for it, commonly fanciful ones, as is constantly done
+by that class of incompetent observers who find their "golden tooth"
+in the fabulous effects of the homoeopathie materia medica,--which
+consists of sugar of milk and a nomenclature.
+
+Another portion of the blame rests with the public itself, which
+insists on being poisoned.  Somebody buys all the quack medicines
+that build palaces for the mushroom, say rather, the toadstool
+millionaires.  Who is it?  These people have a constituency of
+millions.  The popular belief is all but universal that sick persons
+should feed on noxious substances.  One of our members was called not
+long since to a man with a terribly sore mouth.  On inquiry he found
+that the man had picked up a box of unknown pills, in Howard Street,
+and had proceeded to take them, on general principles, pills being
+good for people.  They happened to contain mercury, and hence the
+trouble for which he consulted our associate.
+
+The outside pressure, therefore, is immense upon the physician,
+tending to force him to active treatment of some kind.  Certain old
+superstitions, still lingering in the mind of the public, and not yet
+utterly expelled from that of the profession, are at the bottom of
+this, or contribute to it largely.  One of the most ancient is, that
+disease is a malignant agency, or entity, to be driven out of the
+body by offensive substances, as the smoke of the fish's heart and
+liver drove the devil out of Tobit's bridal chamber, according to the
+Apochrypha.  Epileptics used to suck the blood from the wounds of
+dying gladiators. [Plinii Hist.  Mundi.  lib.  xxviii.  c.  4.] The
+Hon. Robert Boyle's little book was published some twenty or thirty
+years before our late President, Dr. Holyoke, was born. [A Collection
+of Choice and Safe Remedies.  The Fifth Edition, corrected.  London,
+1712.  Dr. Holyoke was born in 1728.] In it he recommends, as
+internal medicines, most of the substances commonly used as
+fertilizers of the soil.  His "Album Graecum" is best left
+untranslated, and his "Zebethum Occidentale" is still more
+transcendentally unmentionable except in a strange dialect.  It
+sounds odiously to us to hear him recommend for dysentery a powder
+made from "the sole of an old shoe worn by some man that walks much."
+Perhaps nobody here ever heard of tying a stocking, which had been
+worn during the day, round the neck at night for a sore throat.  The
+same idea of virtue in unlovely secretions! [The idea is very
+ancient.  "Sordes hominis" "Sudore et oleo medicinam facientibus."
+--Plin.  xxviii.  4.]
+
+Even now the Homoeopathists have been introducing the venom of
+serpents, under the learned title of Lachesis, and outraging human
+nature with infusions of the pediculus capitis; that is, of course,
+as we understand their dilutions, the names of these things; for if a
+fine-tooth-comb insect were drowned in Lake Superior, we cannot agree
+with them in thinking that every drop of its waters would be
+impregnated with all the pedicular virtues they so highly value.
+They know what they are doing.  They are appealing to the detestable
+old superstitious presumption in favor of whatever is nauseous and
+noxious as being good for the sick.
+
+Again, we all occasionally meet persons stained with nitrate of
+silver, given for epilepsy.  Read what Dr. Martin says, about the way
+in which it came to be used, in his excellent address before the
+Norfolk County Medical Society, and the evidence I can show, but have
+not time for now, and then say what you think of the practice which
+on such presumptions turns a white man as blue as the double-tattooed
+King of the Cannibal Islands!  [Note A.]
+
+If medical superstitions have fought their way down through all the
+rationalism and scepticism of the nineteenth century, of course the
+theories of the schools, supported by great names, adopted into the
+popular belief and incorporated with the general mass of
+misapprehension with reference to disease, must be expected to meet
+us at every turn in the shape of bad practice founded on false
+doctrine.  A French patient complains that his blood heats him, and
+expects his doctor to bleed him.  An English or American one says he
+is bilious, and will not be easy without a dose of calomel.  A doctor
+looks at a patient's tongue, sees it coated, and says the stomach is
+foul; his head full of the old saburral notion which the extreme
+inflammation-doctrine of Broussais did so much to root out, but which
+still leads, probably, to much needless and injurious wrong of the
+stomach and bowels by evacuants, when all they want is to be let
+alone.  It is so hard to get anything out of the dead hand of medical
+tradition!  The mortmain of theorists extinct in science clings as
+close as that of ecclesiastics defunct in law.
+
+One practical hint may not be out of place here.  It seems to be
+sometimes forgotten, by those who must know the fact, that the tongue
+is very different, anatomically and physiologically, from the
+stomach.  Its condition does not in the least imply a similar one of
+the stomach, which is a very different structure, covered with a
+different kind of epithelium, and furnished with entirely different
+secretions.  A silversmith will, for a dollar, make a small hoe, of
+solid silver, which will last for centuries, and will give a patient
+more comfort, used for the removal of the accumulated epithelium and
+fungous growths which constitute the "fur," than many a prescription
+with a split-footed Rx before it, addressed to the parts out of
+reach.
+
+I think more of this little implement on account of its agency in
+saving the Colony at Plymouth in the year 1623.  Edward Winslow heard
+that Massasoit was sick and like to die.  He found him with a
+houseful of people about him, women rubbing his arms and legs, and
+friends "making such a hellish noise" as they probably thought would
+scare away the devil of sickness.  Winslow gave him some conserve,
+washed his mouth, scraped his tongue, which was in a horrid state,
+got down some drink, made him some broth, dosed him with an infusion
+of strawberry leaves and sassafras root, and had the satisfaction of
+seeing him rapidly recover.  Massasoit, full of gratitude, revealed
+the plot which had been formed to destroy the colonists, whereupon
+the Governor ordered Captain Miles Standish to see to them; who
+thereupon, as everybody remembers, stabbed Pecksuot with his own
+knife, broke up the plot, saved the colony, and thus rendered
+Massachusetts and the Massachusetts Medical Society a possibility, as
+they now are a fact before us.  So much for this parenthesis of the
+tongue-scraper, which helped to save the young colony from a much
+more serious scrape, and may save the Union yet, if a Presidential
+candidate should happen to be taken sick as Massasoit was, and his
+tongue wanted cleaning,--which process would not hurt a good many
+politicians, with or without a typhoid fever.
+
+Again, see how the "bilious" theory works in every-day life here and
+now, illustrated by a case from actual life.  A youthful
+practitioner, whose last molars have not been a great while cut,
+meets an experienced and noted physician in consultation.  This is
+the case.  A slender, lymphatic young woman is suckling two lusty
+twins, the intervals of suction being occupied on her part with
+palpitations, headaches, giddiness, throbbing in the head, and
+various nervous symptoms, her cheeks meantime getting bloodless, and
+her strength running away in company with her milk.  The old
+experienced physician, seeing the yellowish waxy look which is common
+in anaemic patients, considers it a "bilious" case, and is for giving
+a rousing emetic.  Of course, he has to be wheedled out of this, a
+recipe is written for beefsteaks and porter, the twins are
+ignominiously expelled from the anaemic bosom, and forced to take
+prematurely to the bottle, and this prolific mother is saved for
+future usefulness in the line of maternity.
+
+The practice of making a profit on the medicine ordered has been held
+up to reprobation by one at least of the orators who have preceded
+me.  That the effect of this has been ruinous in English practice I
+cannot doubt, and that in this country the standard of practice was
+in former generations lowered through the same agency is not
+unlikely.  I have seen an old account-book in which the physician
+charged an extra price for gilding his rich patients' pills.  If all
+medicine were very costly, and the expense of it always came out of
+the physician's fee, it would really be a less objectionable
+arrangement than this other most pernicious one.  He would naturally
+think twice before he gave an emetic or cathartic which evacuated his
+own pocket, and be sparing of the cholagogues that emptied the
+biliary ducts of his own wallet, unless he were sure they were
+needed.  If there is any temptation, it should not be in favor of
+giving noxious agents, as it clearly must be in the case of English
+druggists and "General Practitioners."  The complaint against the
+other course is a very old one.  Pliny, inspired with as truly Roman
+horror of quackery as the elder Cato,--who declared that the Greek
+doctors had sworn to exterminate all barbarians, including the
+Romans, with their drugs, but is said to have physicked his own wife
+to death, notwithstanding,--Pliny says, in so many words, that the
+cerates and cataplasms, plasters, collyria, and antidotes, so
+abundant in his time, as in more recent days, were mere tricks to
+make money.
+
+
+A pretty strong eddy, then, or rather many eddies, setting constantly
+back from the current of sober observation of nature, in the
+direction of old superstitions and fancies, of exploded theories, of
+old ways of making money, which are very slow to pass out of fashion
+
+But there are other special American influences which we are bound to
+take cognizance of.  If I wished to show a student the difficulties
+of getting at truth from medical experience, I would give him the
+history of epilepsy to read.  If I wished him to understand the
+tendencies of the American medical mind, its sanguine enterprise, its
+self-confidence, its audacious handling of Nature, its impatience
+with her old-fashioned ways of taking time to get a sick man well, I
+would make him read the life and writings of Benjamin Rush.  Dr. Rush
+thought and said that there were twenty times more intellect and a
+hundred times more knowledge in the country in 1799 than before the
+Revolution.  His own mind was in a perpetual state of exaltation
+produced by the stirring scenes in which he had taken a part, and the
+quickened life of the time in which he lived.  It was not the state
+to favor sound, calm observation.  He was impatient, and Nature is
+profoundly imperturbable.  We may adjust the beating of our hearts to
+her pendulum if we will and can, but we may be very sure that she
+will not change the pendulum's rate of going because our hearts are
+palpitating.  He thought he had mastered yellow-fever.  "Thank God,"
+he said, "out of one hundred patients whom I have visited or
+prescribed for this day, I have lost none."  Where was all his legacy
+of knowledge when Norfolk was decimated?  Where was it when the blue
+flies were buzzing over the coffins of the unburied dead piled up in
+the cemetery of New Orleans, at the edge of the huge trenches yawning
+to receive them?
+
+One such instance will do as well as twenty.  Dr. Rush must have been
+a charming teacher, as he was an admirable man.  He was observing,
+rather than a sound observer; eminently observing, curious, even,
+about all manner of things.  But he could not help feeling as if
+Nature had been a good deal shaken by the Declaration of
+Independence, and that American art was getting to be rather too much
+for her,--especially as illustrated in his own practice.  He taught
+thousands of American students, he gave a direction to the medical
+mind of the country more than any other one man; perhaps he typifies
+it better than any other.  It has clearly tended to extravagance in
+remedies and trust in remedies, as in everything else.  How could a
+people which has a revolution once in four years, which has contrived
+the Bowie-knife and the revolver, which has chewed the juice out of
+all the superlatives in the language in Fourth of July orations, and
+so used up its epithets in the rhetoric of abuse that it takes two
+great quarto dictionaries to supply the demand; which insists in
+sending out yachts and horses and boys to out-sail, out-run, out-
+fight, and checkmate all the rest of creation; how could such a
+people be content with any but "heroic" practice?  What wonder that
+the stars and stripes wave over doses of ninety grains of sulphate of
+quinine, [More strictly, ninety-six grains in two hours. Dunglison's
+Practice, 1842, vol. ii.  p. 520.  Eighty grains in one dose.
+Ibid.  p. 536.  Ninety-six grains of sulphate of quinine are equal
+to eight ounces of good bark.--Wood & Bache.] and that the American
+eagle screams with delight to see three drachms of calomel given at a
+single mouthful?
+
+Add to this the great number of Medical Journals, all useful, we
+hope, most of them necessary, we trust, many of them excellently well
+conducted, but which must find something to fill their columns, and
+so print all the new plans of treatment and new remedies they can get
+hold of, as the newspapers, from a similar necessity, print the
+shocking catastrophes and terrible murders.
+
+Besides all this, here are we, the great body of teachers in the
+numberless medical schools of the Union, some of us lecturing to
+crowds who clap and stamp in the cities, some of us wandering over
+the country, like other professional fertilizers, to fecundate the
+minds of less demonstrative audiences at various scientific stations;
+all of us talking habitually to those supposed to know less than
+ourselves, and loving to claim as much for our art as we can, not to
+say for our own schools, and possibly indirectly for our own
+practical skill.  Hence that annual crop of introductory lectures;
+the useful blossoming into the ornamental, as the cabbage becomes
+glorified in the cauliflower; that lecture-room literature of
+adjectives, that declamatory exaggeration, that splendid show of
+erudition borrowed from D'Israeli, and credited to Lord Bacon and the
+rest, which have suggested to our friends of the Medical Journals an
+occasional epigram at our expense.  Hence the tendency in these
+productions, and in medical lectures generally, to overstate the
+efficacy of favorite methods of cure, and hence the premium offered
+for showy talkers rather than sagacious observers, for the men of
+adjectives rather than of nouns substantive in the more ambitious of
+these institutions.
+
+Such are some of the eddies in which we are liable to become involved
+and carried back out of the broad stream of philosophical, or, in
+other words, truth-loving, investigations.  The causes of disease, in
+the mean time, have been less earnestly studied in the eagerness of
+the search for remedies.  Speak softly!  Women have been borne out
+from an old-world hospital, two in one coffin, that the horrors of
+their prison-house might not be known, while the very men who were
+discussing the treatment of the disease were stupidly conveying the
+infection from bed to bed, as rat-killers carry their poisons from
+one household to another.  Do not some of you remember that I have
+had to fight this private-pestilence question against a scepticism
+which sneered in the face of a mass of evidence such as the calm
+statisticians of the Insurance office could not listen to without
+horror and indignation? ["The Contagiousness of Puerperal Fever."--
+N. E. Quar. Jour. of Medicine and Surgery, April, 1843.  Reprinted,
+with Additions.  Boston: Ticknor & Fields.  1855.] Have we forgotten
+what is told in one of the books published under our own sanction,
+that a simple measure of ventilation, proposed by Dr. John Clark, had
+saved more than sixteen thousand children's lives in a single
+hospital?  How long would it have taken small doses of calomel and
+rhubarb to save as many children?  These may be useful in prudent
+hands, but how insignificant compared to the great hygienic
+conditions!  Causes, causes, and again causes,--more and more we fall
+back on these as the chief objects of our attention.  The shortest
+system of medical practice that I know of is the oldest, but not the
+worst.  It is older than Hippocrates, older than Chiron the Centaur.
+Nature taught it to the first mother when she saw her first-born
+child putting some ugly pebble or lurid berry into its mouth.  I know
+not in what language it was spoken, but I know that in English it
+would sound thus: Spit it out!
+
+Art can do something more than say this.  It can sometimes reach the
+pebble or berry after it has been swallowed.  But the great thing is
+to keep these things out of children's mouths, and as soon as they
+are beyond our reach, to be reasonable and patient with Nature, who
+means well, but does not like to hurry, and who took nine calendar
+months, more or less, to every mother's son among us, before she
+thought he was fit to be shown to the public.
+
+Suffer me now to lay down a few propositions, whether old or new it
+matters little, not for your immediate acceptance, nor yet for your
+hasty rejection, but for your calm consideration.
+
+But first, there are a number of terms which we are in the habit of
+using in a vague though not unintelligible way, and which it is as
+well now to define.  These terms are the tools with which we are to
+work, and the first thing is to sharpen them.  It is nothing to us
+that they have been sharpened a thousand times before; they always
+get dull in the using, and every new workman has a right to carry
+them to the grindstone and sharpen them to suit himself.
+
+Nature, in medical language, as opposed to Art, means trust in the
+reactions of the living system against, ordinary normal impressions.
+
+Art, in the same language, as opposed to Nature, means an intentional
+resort to extraordinary abnormal impressions for the relief of
+disease.
+
+The reaction of the living system is the essence of both.  Food is
+nothing, if there is no digestive act to respond to it.  We cannot
+raise a blister on a dead man, or hope that a carminative forced
+between his lips will produce its ordinary happy effect.
+
+Disease, dis-ease,--disturbed quiet, uncomfortableness,--means
+imperfect or abnormal reaction of the living system, and its more or
+less permanent results.
+
+Food, in its largest sense, is whatever helps to build up the normal
+structures, or to maintain their natural actions.
+
+Medicine, in distinction from food, is every unnatural or noxious
+agent applied for the relief of disease.
+
+Physic means properly the Natural art, and Physician is only the
+Greek synonyme of Naturalist.
+
+With these few explanations I proceed to unfold the propositions I
+have mentioned.
+
+Disease and death, if we may judge by the records of creation, are
+inherently and essentially necessary in the present order of things.
+A perfect intelligence, trained by a perfect education, could do no
+more than keep the laws of the physical and spiritual universe.  An
+imperfect intelligence, imperfectly taught,--and this is the
+condition of our finite humanity,--will certainly fail to keep all
+these laws perfectly.  Disease is one of the penalties of one of the
+forms of such failure.  It is prefigured in the perturbations of the
+planets, in the disintegration of the elemental masses; it has left
+its traces in the fossil organisms of extinct creations. [Professor
+Agassiz has kindly handed me the following note: "There are abnormal
+structures in animals of all ages anterior to the creation of
+mankind.  Malformed specimens of Crinoids are known from the Triassic
+and Jurassic deposits.  Malformed and diseased bones of tertiary
+mammalia have been collected in the caverns of Gailenreuth with
+traces of healing."]
+
+But it is especially the prerogative, I had almost said privilege, of
+educated and domesticated beings, from man down to the potato,
+serving to teach them, and such as train them, the laws of life, and
+to get rid of those who will not mind or cannot be kept subject to
+these laws.
+
+Disease, being always an effect, is always in exact proportion to the
+sum of its causes, as much in the case of Spigelius, who dies of a
+scratch, as in that of the man who recovers after an iron bar has
+been shot through his brain.  The one prevalent failing of the
+medical art is to neglect the causes and quarrel with the effect.
+
+There are certain general facts which include a good deal of what is
+called and treated as disease.  Thus, there are two opposite
+movements of life to be seen in cities and elsewhere, belonging to
+races which, from various persistent causes, are breeding down and
+tending to run out, and to races which are breeding up, or
+accumulating vital capital,--a descending and an ascending series.
+Let me give an example of each; and that I may incidentally remove a
+common impression about this country as compared with the Old World,
+an impression which got tipsy with conceit and staggered into the
+attitude of a formal proposition in the work of Dr. Robert Knox, I
+will illustrate the downward movement from English experience, and
+the upward movement from a family history belonging to this immediate
+neighborhood.
+
+Miss Nightingale speaks of "the fact so often seen of a
+great-grandmother, who was a tower of physical vigor, descending into
+a grandmother perhaps a little less vigorous, but still sound as a
+bell, and healthy to the core, into a mother languid and confined to
+her carriage and house; and lastly into a daughter sickly and
+confined to her bed." So much for the descending English series; now
+for the ascending American series.
+
+Something more than one hundred and thirty years ago there graduated
+at Harvard College a delicate youth, who lived an invalid life and
+died at the age of about fifty.  His two children were both of
+moderate physical power, and one of them diminutive in stature.  The
+next generation rose in physical development, and reached eighty
+years of age and more in some of its members.  The fourth generation
+was of fair average endowment.  The fifth generation, great-great-
+grandchildren of the slender invalid, are several of, them of
+extraordinary bodily and mental power; large in stature, formidable
+alike with their brains and their arms, organized on a more extensive
+scale than either of their parents.
+
+This brief account illustrates incidentally the fallacy of the
+universal-degeneration theory applied to American life; the same on
+which one of our countrymen has lately brought some very forcible
+facts to bear in a muscular discussion of which we have heard rather
+more than is good for us. But the two series, American and English,
+ascending and descending, were adduced with the main purpose of
+showing the immense difference of vital endowments in different
+strains of blood; a difference to which all ordinary medication is in
+all probability a matter of comparatively trivial purport.  Many
+affections which art has to strive against might be easily shown to
+be vital to the well-being of society.  Hydrocephalus, tabes
+mesenterica, and other similar maladies, are natural agencies which
+cut off the children of races that are sinking below the decent
+minimum which nature has established as the condition of viability,
+before they reach the age of reproduction.  They are really not so
+much diseases, as manifestations of congenital incapacity for life;
+the race would be ruined if art could ever learn always to preserve
+the individuals subject to them.  We must do the best we can for
+them, but we ought also to know what these "diseases" mean.
+
+Again, invalidism is the normal state of many organizations.  It can
+be changed to disease, but never to absolute health by medicinal
+appliances.  There are many ladies, ancient and recent, who are
+perpetually taking remedies for irremediable pains and aches.  They
+ought to have headaches and back-aches and stomach-aches; they are
+not well if they do not have them.  To expect them to live without
+frequent twinges is like expecting a doctor's old chaise to go
+without creaking; if it did, we might be sure the springs were
+broken.  There is no doubt that the constant demand for medicinal
+remedies from patients of this class leads to their over-use; often
+in the case of cathartics, sometimes in that of opiates.  I have been
+told by an intelligent practitioner in a Western town, that the
+constant prescription of opiates by certain physicians in his
+vicinity has rendered the habitual use of that drug in all that
+region very prevalent; more common, I should think, than alcoholic
+drunkenness in the most intemperate localities of which I have known
+anything.  A frightful endemic demoralization betrays itself in the
+frequency with which the haggard features and drooping shoulders of
+the opium-drunkards are met with in the streets.
+
+The next proposition I would ask you to consider is this:
+The presumption always is that every noxious agent, including
+medicines proper, which hurts a well man, hurts a sick one.
+[ Note B.]
+
+Let me illustrate this proposition before you decide upon it.  If it
+were known that a prize-fighter were to have a drastic purgative
+administered two or three days before a contest, or a large blister
+applied to his back, no one will question that it would affect the
+betting on his side unfavorably; we will say to the amount of five
+per cent.  Now the drain upon the resources of the system produced in
+such a case must be at its minimum, for the subject is a powerful
+man, in the prime of life, and in admirable condition.  If the drug
+or the blister takes five per cent. from his force of resistance, it
+will take at least as large a fraction from any invalid.  But this
+invalid has to fight a champion who strikes hard but cannot be hit in
+return, who will press him sharply for breath, but will never pant
+himself while the wind can whistle through his fleshless ribs.  The
+suffering combatant is liable to want all his stamina, and five per
+cent. may lose him the battle.
+
+All noxious agents, all appliances which are not natural food or
+stimuli, all medicines proper, cost a patient, on the average, five
+per cent. of his vital force, let us say.  Twenty times as much waste
+of force produced by any of them, that is, would exactly kill him,
+nothing less than kill him, and nothing more.  If this, or something
+like this, is true, then all these medications are, prima facie,
+injurious.
+
+In the game of Life-or-Death, Rouge et Noir, as played between the
+Doctor and the Sexton, this five per cent., this certain small injury
+entering into the chances is clearly the sexton's perquisite for
+keeping the green table, over which the game is played, and where he
+hoards up his gains.  Suppose a blister to diminish a man's pain,
+effusion or dyspnoea to the saving of twenty per cent. in vital
+force; his profit from it is fifteen, in that case, for it always
+hurts him five to begin with, according to our previous assumption.
+
+Presumptions are of vast importance in medicine, as in law.  A man is
+presumed innocent until he is proved guilty.  A medicine--that is, a
+noxious agent, like a blister, a seton, an emetic, or a cathartic--
+should always be presumed to be hurtful.  It always is directly
+hurtful; it may sometimes be indirectly beneficial.  If this
+presumption were established, and disease always assumed to be the
+innocent victim of circumstances, and not punishable by medicines,
+that is, noxious agents, or poisons, until the contrary was shown, we
+should not so frequently hear the remark commonly, perhaps
+erroneously, attributed to Sir Astley Cooper, but often repeated by
+sensible persons, that, on the whole, more harm than good is done by
+medication.  Throw out opium, which the Creator himself seems to
+prescribe, for we often see the scarlet poppy growing in the
+cornfields, as if it were foreseen that wherever there is hunger to
+be fed there must also be pain to be soothed; throw out a few
+specifics which our art did not discover, and is hardly needed to
+apply [ Note C.]; throw out wine, which is a food, and the vapors
+which produce the miracle of anaesthesia, and I firmly believe that
+if the whole materia medica, as now used, could be sunk to the bottom
+of the sea, it would be all the better for mankind,--and all the
+worse for the fishes.
+
+But to justify this proposition, I must add that the injuries
+inflicted by over-medication are to a great extent masked by disease.
+Dr. Hooker believes that the typhus syncopatia of a preceding
+generation in New England "was often in fact a brandy and opium
+disease."  How is a physician to distinguish the irritation produced
+by his blister from that caused by the inflammation it was meant to
+cure?  How can he tell the exhaustion produced by his evacuants from
+the collapse belonging to the disease they were meant to remove?
+
+Lastly, medication without insuring favorable hygienic conditions is
+like amputation without ligatures.  I had a chance to learn this well
+of old, when physician to the Broad Street district of the Boston
+Dispensary.  There, there was no help for the utter want of wholesome
+conditions, and if anybody got well under my care, it must have been
+in virtue of the rough-and-tumble constitution which emerges from the
+struggle for life in the street gutters, rather than by the aid of my
+prescriptions.
+
+But if the materia medica were lost overboard, how much more pains
+would be taken in ordering all the circumstances surrounding the
+patient (as can be done everywhere out of the crowded pauper
+districts), than are taken now by too many who think they do their
+duty and earn their money when they write a recipe for a patient left
+in an atmosphere of domestic malaria, or to the most negligent kind
+of nursing!  I confess that I should think my chance of recovery from
+illness less with Hippocrates for my physician and Mrs. Gamp for my
+nurse, than if I were in the hands of Hahnemann himself, with
+Florence Nightingale or good Rebecca Taylor to care for me.
+
+If I am right in maintaining that the presumption is always against
+the use of noxious agents in disease, and if any whom I might
+influence should adopt this as a principle of practice, they will
+often find themselves embarrassed by the imperative demand of
+patients and their friends for such agents where a case is not made
+out against this standing presumption.  I must be permitted to say,
+that I think the French, a not wholly uncivilized people, are in
+advance of the English and ourselves in the art of prescribing for
+the sick without hurting them.  And I do confess that I think their
+varied ptisans and syrups are as much preferable to the mineral
+regimen of bug-poison and ratsbane, so long in favor on the other
+side of the Channel, as their art of preparing food for the table to
+the rude cookery of those hard-feeding and much-dosing islanders.
+We want a reorganized cuisine of invalidism perhaps as much as the
+culinary, reform, for which our lyceum lecturers, and others who live
+much at hotels and taverns, are so urgent.  Will you think I am
+disrespectful if I ask whether, even in Massachusetts, a dose of
+calomel is not sometimes given by a physician on the same principle
+as that upon which a landlord occasionally prescribes bacon and
+eggs,--because he cannot think of anything else quite so handy?  I
+leave my suggestion of borrowing a hint from French practice to your
+mature consideration.
+
+I may, however, call your attention, briefly, to the singular fact,
+that English and American practitioners are apt to accuse French
+medical practice of inertness, and French surgical practice of
+unnecessary activity.  Thus, Dr. Bostock considers French medical
+treatment, with certain exceptions, as "decidedly less effective"
+than that of his own country.   Mr. S. Cooper, again, defends the
+simple British practice of procuring union by the first intention
+against the attacks of M. Roux and Baron Larrey. [Cooper's Surg.
+Diet.  art.  "Wounds."  Yet Mr. John Bell gives the French surgeons
+credit for introducing this doctrine of adhesion, and accuses
+O'Halloran of "rudeness and ignorance," and "bold, uncivil language,"
+in disputing their teaching.  Princ.  of Surgery, vol. i.  p. 42.
+Mr. Hunter succeeded at last in naturalizing the doctrine and
+practice, but even he had to struggle against the perpetual jealousy
+of rivals, and died at length assassinated by an insult.]  We have
+often heard similar opinions maintained by our own countrymen.  While
+Anglo-American criticism blows hot or cold on the two departments of
+French practice, it is not, I hope, indecent to question whether all
+the wisdom is necessarily with us in both cases.
+
+Our art has had two or three lessons which have a deep meaning to
+those who are willing to read them honestly.  The use of water-
+dressings in surgery completed the series of reforms by which was
+abolished the "coarse and cruel practice" of the older surgeons, who
+with their dressings and acrid balsams, their tents and leaden tubes,
+"absolutely delayed the cure."  The doctrine of Broussais, transient
+as was its empire, reversed the practice of half of Christendom for a
+season, and taught its hasty disciples to shun their old favorite
+remedies as mortal poisons.  This was not enough permanently to shift
+the presumption about drugs where it belonged, and so at last, just
+as the sympathetic powder and the Unguentum Armarium came in a
+superstitious age to kill out the abuses of external over-medication,
+the solemn farce of Homoeopathy was enacted in the face of our own
+too credulous civilization, that under shelter of its pretences the
+"inward bruises" of over-drugged viscera might be allowed to heal by
+the first intention.  Its lesson we must accept, whether we will or
+not; its follies we are tired of talking about.  The security of the
+medical profession against this and all similar fancies is in the
+average constitution of the human.  mind with regard to the laws of
+evidence.
+
+My friends and brothers in Art!  There is nothing to be feared from
+the utterance of any seeming heresy to which you may have listened.
+I cannot compromise your collective wisdom.  If I have strained the
+truth one hair's breadth for the sake of an epigram or an antithesis,
+you are accustomed to count the normal pulse-beats of sound judgment,
+and know full well how to recognize the fever-throbs of conceit and
+the nervous palpitations of rhetoric.
+
+The freedom with which each of us speaks his thought in this
+presence, belongs in part to the assured position of the Profession
+in our Commonwealth, to the attitude of Science, which is always
+fearless, and to the genius of the soil on which we stand, from which
+Nature withheld the fatal gift of malaria only to fill it with
+exhalations that breed the fever of inquiry in our blood and in our
+brain.  But mainly we owe the large license of speech we enjoy to
+those influences and privileges common to us all as self-governing
+Americans.
+
+This Republic is the chosen home of minorities, of the less power in
+the presence of the greater.  It is a common error to speak of our
+distinction as consisting in the rule of the majority.  Majorities,
+the greater material powers, have always ruled before.  The history
+of most countries has been that of majorities, mounted majorities,
+clad in iron, armed with death treading down the tenfold more
+numerous minorities.  In the old civilizations they root themselves
+like oaks in the soil; men must live in their shadow or cut them
+down.  With us the majority is only the flower of the passing noon,
+and the minority is the bud which may open in the next morning's sun.
+We must be tolerant, for the thought which stammers on a single
+tongue today may organize itself in the growing consciousness of the
+time, and come back to us like the voice of the multitudinous waves
+of the ocean on the morrow.
+
+Twenty-five years have passed since one of your honored Presidents
+spoke to this Society of certain limitations to the power of our Art,
+now very generally conceded.  Some were troubled, some were almost
+angry, thinking the Profession might suffer from such concessions.
+It has certainly not suffered here; if, as some affirm, it has lost
+respect anywhere, it was probably for other, and no doubt sufficient
+reasons.
+
+Since that time the civilization of this planet has changed hands.
+Strike out of existence at this moment every person who was breathing
+on that day, May 27, 1835, and every institution of society, every
+art and every science would remain intact and complete in the living
+that would be left.  Every idea the world then held has been since
+dissolved and recrystallized.
+
+We are repeating the same process.  Not to make silver shrines for
+our old divinities, even though by this craft we should have our
+wealth, was this Society organized and carried on by the good men and
+true who went before us.  Not for this, but to melt the gold out of
+the past, though its dross should fly in dust to all the winds of
+heaven, to save all our old treasures of knowledge and mine deeply
+for new, to cultivate that mutual respect of which outward courtesy
+is the sign, to work together, to feel together, to take counsel
+together, and to stand together for the truth, now, always, here,
+everywhere; for this our fathers instituted, and we accept, the
+offices and duties of this time-honored Society.
+
+
+
+
+
+
+
+BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE.
+
+An Introductory Lecture delivered before the Medical Class
+of Harvard University, November 6, 1861.
+
+
+[This Lecture appears as it would have been delivered had the time
+allowed been less strictly, limited.  Passages necessarily omitted
+have been restored, and points briefly touched have been more fully
+considered.  A few notes have been added for the benefit of that
+limited class of students who care to track an author through the
+highways and by-ways of his reading.  I owe my thanks to several of
+my professional brethren who have communicated with me on subjects
+with which they are familiar; especially to Dr. John Dean, for the
+opportunity of profiting by his unpublished labors, and to Dr. Hasket
+Derby, for information and references to recent authorities relating
+to the anatomy and physiology of the eye.]
+
+
+The entrance upon a new course of Lectures is always a period of
+interest to instructors and pupils.  As the birth of a child to a
+parent, so is the advent of a new class to a teacher.  As the light
+of the untried world to the infant, so is the dawning of the light
+resting over the unexplored realms of science to the student.  In the
+name of the Faculty I welcome you, Gentlemen of the Medical Class,
+new-born babes of science, or lustier nurslings, to this morning of
+your medical life, and to the arms and the bosom of this ancient
+University.  Fourteen years ago I stood in this place for the first
+time to address those who occupied these benches.  As I recall these
+past seasons of our joint labors, I feel that they have been on the
+whole prosperous, and not undeserving of their prosperity.
+
+For it has been my privilege to be associated with a body of true and
+faithful workers; I cannot praise them freely to their faces, or I
+should be proud to discourse of the harmonious diligence and the
+noble spirit in which they have toiled together, not merely to teach
+their several branches, but to elevate the whole standard of
+teaching.
+
+I may speak with less restraint of those gentlemen who have aided me
+in the most laborious part of my daily duties, the Demonstrators, to
+whom the successive classes have owed so much of their instruction.
+They rise before me, the dead and the living, in the midst of the
+most grateful recollections.  The fair, manly face and stately figure
+of my friend, Dr. Samuel Parkman, himself fit for the highest offices
+of teaching, yet willing to be my faithful assistant in the time of
+need, come back to me with the long sigh of regret for his early loss
+to our earthly companionship.  Every year I speak the eulogy of Dr.
+Ainsworth's patient toil as I show his elaborate preparations: When I
+take down my "American Cyclopaedia" and borrow instruction from the
+learned articles of Dr. Kneeland, I cease to regret that his
+indefatigable and intelligent industry was turned into a broader
+channel.  And what can I say too cordial of my long associated
+companion and friend, Dr. Hodges, whose admirable skill, working
+through the swiftest and surest fingers that ever held a scalpel
+among us, has delighted class after class, and filled our Museum with
+monuments which will convey his name to unborn generations?
+
+This day belongs, however, not to myself and my recollections, but to
+all of us who teach and all of you who listen, whether experts in our
+specialties or aliens to their mysteries, or timid neophytes just
+entering the portals of the hall of science.  Look in with me, then,
+while I attempt to throw some rays into its interior, which shall
+illuminate a few of its pillars and cornices, and show at the same
+time how many niches and alcoves remain in darkness.
+
+
+SCIENCE is the topography of ignorance.  From a few elevated points
+we triangulate vast spaces, inclosing infinite unknown details.  We
+cast the lead, and draw up a little sand from abysses we may never
+reach with our dredges.
+
+The best part of our knowledge is that which teaches us where
+knowledge leaves off and ignorance begins.  Nothing more clearly
+separates a vulgar from a superior mind, than the confusion in the
+first between the little that it truly knows, on the one hand, and
+what it half knows and what it thinks it knows on the other.
+
+That which is true of every subject is especially true of the branch
+of knowledge which deals with living beings.  Their existence is a
+perpetual death and reanimation.  Their identity is only an idea, for
+we put off our bodies many times during our lives, and dress in new
+suits of bones and muscles.
+
+               "Thou art not thyself;
+     For thou exist'st on many a thousand grains
+     That issue out of dust."
+
+If it is true that we understand ourselves but imperfectly in health,
+this truth is more signally manifested in disease, where natural
+actions imperfectly understood, disturbed in an obscure way by half-
+seen causes, are creeping and winding along in the dark toward their
+destined issue, sometimes using our remedies as safe stepping-stones,
+occasionally, it may be, stumbling over them as obstacles.
+
+I propose in this lecture to show you some points of contact between
+our ignorance and our knowledge in several of the branches upon the
+study of which you are entering.  I may teach you a very little
+directly, but I hope much more from the trains of thought I shall
+suggest.  Do not expect too much ground to be covered in this rapid
+survey.  Our task is only that of sending out a few pickets under the
+starry flag of science to the edge of that dark domain where the
+ensigns of the obstinate rebel, Ignorance, are flying undisputed.  We
+are not making a reconnoissance in force, still less advancing with
+the main column.  But here are a few roads along which we have to
+march together, and we wish to see clearly how far our lines extend,
+and where the enemy's outposts begin.
+
+Before touching the branches of knowledge that deal with organization
+and vital functions, let us glance at that science which meets you at
+the threshold of your study, and prepares you in some measure to deal
+with the more complex problems of the living laboratory.
+
+
+CHEMISTRY.  includes the art of separating and combining the elements
+of matter, and the study of the changes produced by these operations.
+We can hardly say too much of what it has contributed to our
+knowledge of the universe and our power of dealing with its
+materials.  It has given us a catalogue raisonne of the substances
+found upon our planet, and shown how everything living and dead is
+put together from them.  It is accomplishing wonders before us every
+day, such as Arabian story-tellers used to string together in their
+fables.  It spreads the, sensitive film on the artificial retina
+which looks upon us through the optician's lens for a few seconds,
+and fixes an image that will outlive its original.  It questions the
+light of the sun, and detects the vaporized metals floating around
+the great luminary,--iron, sodium, lithium, and the rest,--as if the
+chemist of our remote planet could fill his bell-glasses from its
+fiery atmosphere.  It lends the power which flashes our messages in
+thrills that leave the lazy chariot of day behind them.  It seals up
+a few dark grains in iron vases, and lo! at the touch of a single
+spark, rises in smoke and flame a mighty Afrit with a voice like
+thunder and an arm that shatters like an earthquake.  The dreams of
+Oriental fancy have become the sober facts of our every-day life, and
+the chemist is the magician to whom we owe them.
+
+To return to the colder scientific aspect of chemistry.  It has shown
+us how bodies stand affected to each other through an almost
+boundless range of combinations.  It has given us a most ingenious
+theory to account for certain fixed relations in these combinations.
+It has successfully eliminated a great number of proximate compounds,
+more or less stable, from organic structures.  It has invented others
+which form the basis of long series of well-known composite
+substances.  In fact, we are perhaps becoming overburdened with our
+list of proximate principles, demonstrated and hypothetical.
+
+How much nearer have we come to the secret of force than Lully and
+Geber and the whole crew of juggling alchemists?  We have learned a
+great deal about the how, what have we learned about the why?
+
+Why does iron rust, while gold remains untarnished, and gold
+amalgamate, while iron refuses the alliance of mercury?
+
+The alchemists called gold Sol, the sun, and iron Mars, and pleased
+themselves with fancied relations between these substances and the
+heavenly bodies, by which they pretended to explain the facts they
+observed.  Some of their superstitions have lingered in practical
+medicine to the present day, but chemistry has grown wise enough to
+confess the fact of absolute ignorance.
+
+What is it that makes common salt crystallize in the form of cubes,
+and saltpetre in the shape of six-sided prisms?  We see no reason why
+it should not have been just the other way, salt in prisms and
+saltpetre in cubes, or why either should take an exact geometrical
+outline, any more than coagulating albumen.
+
+But although we had given up attempting to explain the essential
+nature of affinities and of crystalline types, we might have supposed
+that we had at least fixed the identity of the substances with which
+we deal, and determined the laws of their combination.  All at once
+we find that a simple substance changes face, puts off its
+characteristic qualities and resumes them at will;--not merely when
+we liquefy or vaporize a solid, or reverse the process; but that a
+solid is literally transformed into another solid under our own eyes.
+We thought we knew phosphorus.  We warm a portion of it sealed in an
+empty tube, for about a week.  It has become a brown infusible
+substance, which does not shine in the dark nor oxidate in the air.
+We heat it to 500 F., and it becomes common phosphorus again.  We
+transmute sulphur in the same singular way.  Nature, you know, gives
+us carbon in the shape of coal and in that of the diamond.  It is
+easy to call these changes by the name allotropism, but not the less
+do they confound our hasty generalizations.
+
+These facts of allotropism have some corollaries connected with them
+rather startling to us of the nineteenth century.  There may be other
+transmutations possible besides those of phosphorus and sulphur.
+When Dr. Prout, in 1840, talked about azote and carbon being "formed"
+in the living system, it was looked upon as one of those freaks of
+fancy to which philosophers, like other men, are subject.  But when
+Professor Faraday, in 1851, says, at a meeting of the British
+Association, that "his hopes are in the direction of proving that
+bodies called simple were really compounds, and may be formed
+artificially as soon as we are masters of the laws influencing their
+combinations,"--when he comes forward and says that he has tried
+experiments at transmutation, and means, if his life is spared, to
+try them again,--how can we be surprised at the popular story of
+1861, that Louis Napoleon has established a gold-factory and is
+glutting the mints of Europe with bullion of his own making?
+
+And so with reference to the law of combinations.  The old maxim was,
+Corpora non agunt nisi soluta.  If two substances, a and b, are
+inclosed in a glass vessel, c, we do not expect the glass to change
+them, unless a or b or the compound a b has the power of dissolving
+the glass.  But if for a I take oxygen, for b hydrogen, and for c a
+piece of spongy platinum, I find the first two combine with the
+common signs of combustion and form water, the third in the mean time
+undergoing no perceptible change.  It has played the part of the
+unwedded priest, who marries a pair without taking a fee or having
+any further relation with the parties.  We call this catalysis,
+catalytic action, the action of presence, or by what learned name we
+choose.  Give what name to it we will, it is a manifestation of power
+which crosses our established laws of combination at a very open
+angle of intersection.  I think we may find an analogy for it in
+electrical induction, the disturbance of the equilibrium of the
+electricity of a body by the approach of a charged body to it,
+without interchange of electrical conditions between the two bodies.
+But an analogy is not an explanation, and why a few drops of yeast
+should change a saccharine mixture to carbonic acid and alcohol,--a
+little leaven leavening the whole lump,--not by combining with it,
+but by setting a movement at work, we not only cannot explain, but
+the fact is such an exception to the recognized laws of combination
+that Liebig is unwilling to admit the new force at all to which
+Berzelius had given the name so generally accepted.
+
+The phenomena of isomerism, or identity of composition and
+proportions of constituents with difference of qualities, and of
+isomorphism, or identity of form in crystals which have one element
+substituted for another, were equally surprises to science; and
+although the mechanism by which they are brought about can be to a
+certain extent explained by a reference to the hypothetical atoms of
+which the elements are constituted, yet this is only turning the
+difficulty into a fraction with an infinitesimal denominator and an
+infinite numerator.
+
+So far we have studied the working of force and its seeming anomalies
+in purely chemical phenomena.  But we soon find that chemical force
+is developed by various other physical agencies,--by heat, by light,
+by electricity, by magnetism, by mechanical agencies; and, vice
+versa, that chemical action develops heat, light, electricity,
+magnetism, mechanical force, as we see in our matches, galvanic
+batteries, and explosive compounds.  Proceeding with our experiments,
+we find that every kind of force is capable of producing all other
+kinds, or, in Mr. Faraday's language, that "the various forms under
+which the forces of matter are made manifest have a common origin,
+or, in other words, are so directly related and mutually dependent
+that they are convertible one into another."
+
+Out of this doctrine naturally springs that of the conservation of
+force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr.
+Faraday.  This idea is no novelty, though it seems so at first sight.
+It was maintained and disputed among the giants of philosophy.
+Des Cartes and Leibnitz denied that any new motion originated in
+nature, or that any ever ceased to exist; all motion being in a
+circle, passing from one body to another, one losing what the other
+gained.  Newton, on the other hand, believed that new motions were
+generated and existing ones destroyed.  On the first supposition,
+there is a fixed amount of force always circulating in the universe.
+On the second, the total amount may be increasing or diminishing.
+You will find in the "Annual of Scientific Discovery" for 1858 a very
+interesting lecture by Professor Helmholtz of Bonn, in which it is
+maintained that a certain portion of force is lost in every natural
+process, being converted into unchangeable heat, so that the universe
+will come to a stand-still at last, all force passing into heat, and
+all heat into a state of equilibrium.
+
+The doctrines of the convertibility or specific equivalence of the
+various forms of force, and of its conservation, which is its logical
+consequence, are very generally accepted, as I believe, at the
+present time, among physicists.  We are naturally led to the
+question, What is the nature of force?  The three illustrious
+philosophers just referred to agree in attributing the general
+movements of the universe to the immediate Divine action.  The
+doctrine of "preestablished harmony" was an especial contrivance of
+Leibnitz to remove the Creator from unworthy association with the
+less divine acts of living beings.  Obsolete as this expression
+sounds to our ears, the phrase laws of the universe, which we use so
+constantly with a wider application, appears to me essentially
+identical with it.
+
+Force does not admit of explanation, nor of proper definition, any
+more than the hypothetical substratum of matter.  If we assume the
+Infinite as omnipresent, omniscient, omnipotent, we cannot suppose
+Him excluded from any part of His creation, except from rebellious
+souls which voluntarily exclude Him by the exercise of their fatal
+prerogative of free-will.  Force, then, is the act of immanent
+Divinity.  I find no meaning in mechanical explanations.  Newton's
+hypothesis of an ether filling the heavenly spaces does not, I
+confess, help my conceptions.  I will, and the muscles of my vocal
+organs shape my speech.  God wills, and the universe articulates His
+power, wisdom, and goodness.  That is all I know.  There is no bridge
+my mind can throw from the "immaterial" cause to the "material"
+effect.
+
+The problem of force meets us everywhere, and I prefer to encounter
+it in the world of physical phenomena before reaching that of living
+actions.  It is only the name for the incomprehensible cause of
+certain changes known to our consciousness, and assumed to be outside
+of it.  For me it is the Deity Himself in action.
+
+I can therefore see a large significance in the somewhat bold
+language of Burdach: "There is for me but one miracle, that of
+infinite existence, and but one mystery, the manner in which the
+finite proceeds from the infinite.  So soon as we recognize this
+incomprehensible act as the general and primordial miracle, of which
+our reason perceives the necessity, but the manner of which our
+intelligence cannot grasp, so soon as we contemplate the nature known
+to us by experience in this light, there is for us no other
+impenetrable miracle or mystery."
+
+Let us turn to a branch of knowledge which deals with certainties up
+to the limit of the senses, and is involved in no speculations beyond
+them.  In certain points of view, HUMAN ANATOMY may be considered an
+almost exhausted science.  From time to time some small organ which
+had escaped earlier observers has been pointed out,--such parts as
+the tensor tarsi, the otic ganglion, or the Pacinian bodies; but some
+of our best anatomical works are those which have been classic for
+many generations. The plates of the bones in Vesalius, three
+centuries old, are still masterpieces of accuracy, as of art.  The
+magnificent work of Albinus on the muscles, published in 1747, is
+still supreme in its department, as the constant references of the
+most thorough recent treatise on the subject, that of Theile,
+sufficiently show.  More has been done in unravelling the mysteries
+of the fasciae, but there has been a tendency to overdo this kind of
+material analysis.  Alexander Thomson split them up into cobwebs, as
+you may see in the plates to Velpeau's Surgical Anatomy.  I well
+remember how he used to shake his head over the coarse work of Scarpa
+and Astley Cooper,--as if Denner, who painted the separate hairs of
+the beard and pores of the skin in his portraits, had spoken lightly
+of the pictures of Rubens and Vandyk.
+
+Not only has little been added to the catalogue of parts, but some
+things long known had become half-forgotten. Louis and others
+confounded the solitary glands of the lower part of the small
+intestine with those which "the great Brunner," as Haller calls him,
+described in 1687 as being found in the duodenum.  The display of the
+fibrous structure of the brain seemed a novelty as shown by
+Spurzheim.  One is startled to find the method anticipated by Raymond
+Vieussens nearly two centuries ago.  I can hardly think Gordon had
+ever looked at his figures, though he names their author, when he
+wrote the captious and sneering article which attracted so much
+attention in the pages of the "Edinburgh Review."
+
+This is the place, if anywhere, to mention any observations I could
+pretend to have made in the course of my teaching the structure of
+the human body.  I can make no better show than most of my
+predecessors in this well-reaped field.  The nucleated cells found
+connected with the cancellated structure of the bones, which I first
+pointed out and had figured in 1847, and have shown yearly from that
+time to the present, and the fossa masseterica, a shallow concavity
+on the ramus of the lower jaw, for the lodgment of the masseter
+muscle, which acquires significance when examined by the side of the
+deep cavity on the corresponding part in some carnivora to which it
+answers, may perhaps be claimed as deserving attention.  I have also
+pleased myself by making a special group of the six radiating muscles
+which diverge from the spine of the axis, or second cervical
+vertebra, and by giving to it the name stella musculosa nuchaee.  But
+this scanty catalogue is only an evidence that one may teach long and
+see little that has not been noted by those who have gone before him.
+Of course I do not think it necessary to include rare, but already
+described anomalies, such as the episternal bones, the rectus
+sternalis, and other interesting exceptional formations I have
+encountered, which have shown a curious tendency to present
+themselves several times in the same season, perhaps because the
+first specimen found calls our attention to any we may subsequently
+meet with.
+
+The anatomy of the scalpel and the amphitheatre was, then, becoming
+an exhausted branch of investigation.  But during the present century
+the study of the human body has changed its old aspect, and become
+fertile in new observations.  This rejuvenescence was effected by
+means of two principal agencies,--new methods and a new instrument.
+
+Descriptive anatomy, as known from an early date, is to the body what
+geography is to the planet.  Now geography was pretty well known so
+long ago as when Arrowsmith, who was born in 1750, published his
+admirable maps.  But in that same year was born Werner, who taught a
+new way of studying the earth, since become familiar to us all under
+the name of Geology.
+
+What geology has done for our knowledge of the earth, has been done
+for our knowledge of the body by that method of study to which is
+given the name of General Anatomy.  It studies, not the organs as
+such, but the elements out of which the organs are constructed.  It
+is the geology of the body, as that is the general anatomy of the
+earth.  The extraordinary genius of Bichat, to whom more than any
+other we owe this new method of study, does not require Mr. Buckle's
+testimony to impress the practitioner with the importance of its
+achievements.  I have heard a very wise physician question whether
+any important result had accrued to practical medicine from Harvey's
+discovery of the circulation.  But Anatomy, Physiology, and Pathology
+have received a new light from this novel method of contemplating the
+living structures, which has had a vast influence in enabling the
+practitioner at least to distinguish and predict the course of
+disease.  We know as well what differences to expect in the habits of
+a mucous and of a serous membrane, as what mineral substances to look
+for in the chalk or the coal measures.  You have only to read
+Cullen's description of inflammation of the lungs or of the bowels,
+and compare it with such as you may find in Laennec or Watson, to see
+the immense gain which diagnosis and prognosis have derived from
+general anatomy.
+
+The second new method of studying the human structure, beginning with
+the labors of Scarpa, Burns, and Colles, grew up principally during
+the first third of this century.  It does not deal with organs, as
+did the earlier anatomists, nor with tissues, after the manner of
+Bichat.  It maps the whole surface of the body into an arbitrary
+number of regions, and studies each region successively from the
+surface to the bone, or beneath it.  This hardly deserves the name of
+a science, although Velpeau has dignified it with that title, but it
+furnishes an admirable practical way for the surgeon who has to
+operate on a particular region of the body to study that region.  If
+we are buying a farm, we are not content with the State map or a
+geological chart including the estate in question.  We demand an
+exact survey of that particular property, so that we may know what we
+are dealing with.  This is just what regional, or, as it is sometimes
+called, surgical anatomy, does for the surgeon with reference to the
+part on which his skill is to be exercised.  It enables him to see
+with the mind's eye through the opaque tissues down to the bone on
+which they lie, as if the skin were transparent as the cornea, and
+the organs it covers translucent as the gelatinous pulp of a medusa.
+
+It is curious that the Japanese should have anticipated Europe in a
+kind of rude regional anatomy.  I have seen a manikin of Japanese
+make traced all over with lines, and points marking their
+intersection.  By this their doctors are guided in the performance of
+acupuncture, marking the safe places to thrust in needles, as we buoy
+out our ship-channels, and doubtless indicating to learned eyes the
+spots where incautious meddling had led to those little accidents of
+shipwreck to which patients are unfortunately liable.
+
+A change of method, then, has given us General and Regional Anatomy.
+These, too, have been worked so thoroughly, that, if not exhausted,
+they have at least become to a great extent fixed and positive
+branches of knowledge.  But the first of them, General Anatomy, would
+never, have reached this positive condition but for the introduction
+of that, instrument which I have mentioned as the second great aid to
+modern progress.
+
+This instrument is the achromatic microscope.  For the history of the
+successive steps by which it became the effective scientific
+implement we now possess, I must refer you to the work of Mr.
+Quekett, to an excellent article in the "Penny Cyclopaedia," or to
+that of Sir David Brewster in the "Encyclopaedia Britannica."  It is
+a most interesting piece of scientific history, which shows how the
+problem which Biot in 1821 pronounced insolvable was in the course of
+a few years practically solved, with a success equal to that which
+Dollond had long before obtained with the telescope.  It is enough
+for our purpose that we are now in possession of an instrument freed
+from all confusions and illusions, which magnifies a thousand
+diameters,--a million times in surface,--without serious distortion
+or discoloration of its object.
+
+A quarter of a century ago, or a little more, an instructor would not
+have hesitated to put John Bell's "Anatomy" and Bostock's
+"Physiology" into a student's hands, as good authority on their
+respective subjects.  Let us not be unjust to either of these
+authors.  John Bell is the liveliest medical writer that I can
+remember who has written since the days of delightful old Ambroise
+Pare.  His picturesque descriptions and bold figures are as good now
+as they ever were, and his book can never become obsolete.  But
+listen to what John Bell says of the microscope:
+
+"Philosophers of the last age had been at infinite pains to find the
+ultimate fibre of muscles, thinking to discover its properties in its
+form; but they saw just in proportion to the glasses which they used,
+or to their practice and skill in that art, which is now almost
+forsaken."
+
+Dr. Bostock's work, neglected as it is, is one which I value very
+highly as a really learned compilation, full of original references.
+But Dr. Bostock says: "Much as the naturalist has been indebted to
+the microscope, by bringing into view many beings of which he could
+not otherwise have ascertained the existence, the physiologist has
+not yet derived any great benefit from the instrument."
+
+These are only specimens of the manner in which the microscope and
+its results were generally regarded by the generation just preceding
+our own.
+
+I have referred you to the proper authorities for the account of
+those improvements which about the year 1830 rendered the compound
+microscope an efficient and trustworthy instrument.  It was now for
+the first time that a true general anatomy became possible.  As early
+as 1816 Treviranus had attempted to resolve the tissues, of which
+Bichat had admitted no less than twenty-one, into their simple
+microscopic elements.  How could such an attempt succeed, Henle well
+asks, at a time when the most extensively diffused of all the
+tissues, the areolar, was not at all understood?  All that method
+could do had been accomplished by Bichat and his followers.  It was
+for the optician to take the next step.  The future of anatomy and
+physiology, as an enthusiastic micrologist of the time said, was in
+the hands of Messrs.  Schieck and Pistor, famous opticians of Berlin.
+
+In those earlier days of which I am speaking, all the points of
+minute anatomy were involved in obscurity.  Some found globules
+everywhere, some fibres.  Students disputed whether the conjunctiva
+extended over the cornea or not, and worried themselves over Gaultier
+de Claubry's stratified layers of the skin, or Breschet's
+blennogenous and chromatogenous organs.  The dartos was a puzzle, the
+central spinal canal a myth, the decidua clothed in fable as much as
+the golden fleece.  The structure of bone, now so beautifully made
+out,--even that of the teeth, in which old Leeuwenhoek, peeping with
+his octogenarian eyes through the minute lenses wrought with his own
+hands, had long ago seen the "pipes," as he called them,--was hardly
+known at all.  The minute structure of the viscera lay in the mists
+of an uncertain microscopic vision.  The intimate recesses of the
+animal system were to the students of anatomy what the anterior of
+Africa long was to geographers, and the stories of microscopic
+explorers were as much sneered at as those of Bruce or Du Chailly,
+and with better reason.
+
+Now what have we come to in our own day?  In the first place, the
+minute structure of all the organs has been made out in the most
+satisfactory way.  The special arrangements of the vessels and the
+ducts of all the glands, of the air-tubes and vesicles of the lungs,
+of the parts which make up the skin and other membranes, all the
+details of those complex parenchymatous organs which had confounded
+investigation so long, have been lifted out of the invisible into the
+sight of all observers.  It is fair to mention here, that we owe a
+great deal to the art of minute injection, by which we are enabled to
+trace the smallest vessels in the midst of the tissues where they are
+distributed.  This is an old artifice of anatomists.  The famous
+Ruysch, who died a hundred and thirty years ago, showed that each of
+the viscera has its terminal vessels arranged in its own peculiar
+way; the same fact which you may see illustrated in Gerber's figures
+after the minute injections of Berres.  I hope to show you many
+specimens of this kind in the microscope, the work of English and
+American hands.  Professor Agassiz allows me also to make use of a
+very rich collection of injected preparations sent him by Professor
+Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition
+of which I had a number of microscopes made expressly, by Mr. Grunow,
+during the past season.  All this illustrates what has been done for
+the elucidation of the intimate details of formation of the organs.
+
+But the great triumph of the microscope as applied to anatomy has
+been in the resolution of the organs and the tissues into their
+simple constituent anatomical elements.  It has taken up general
+anatomy where Bichat left it.  He had succeeded in reducing the
+structural language of nature to syllables, if you will permit me to
+use so bold an image.  The microscopic observers who have come after
+him have analyzed these into letters, as we may call them,--the
+simple elements by the combination of which Nature spells out
+successively tissues, which are her syllables, organs which are her
+words, systems which are her chapters, and so goes on from the simple
+to the complex, until she binds up in one living whole that wondrous
+volume of power and wisdom which we call the human body.
+
+The alphabet of the organization is so short and simple, that I will
+risk fatiguing your attention by repeating it, according to the plan
+I have long adopted.
+
+A.  Cells, either floating, as in the blood, or fixed, like those in
+the cancellated structure of bone, already referred to.  Very
+commonly they have undergone a change of figure, most frequently a
+flattening which reduces them to scales, as in the epidermis and the
+epithelium.
+
+B.  Simple, translucent, homogeneous solid, such as is found at the
+back of the cornea, or forming the intercellular substance of
+cartilage.
+
+C.  The white fibrous element, consisting of very delicate, tenacious
+threads.  This is the long staple textile substance of the body.  It
+is to the organism what cotton is pretended to be to our Southern
+States.  It pervades the whole animal fabric as areolar tissue, which
+is the universal packing and wrapping material.  It forms the
+ligaments which bind the whole frame-work together.  It furnishes the
+sinews, which are the channels of power.  It enfolds every muscle.
+It wraps the brain in its hard, insensible folds, and the heart
+itself beats in a purse that is made of it.
+
+D.  The yellow elastic, fibrous element, the caoutchouc of the animal
+mechanism, which pulls things back into place, as the India-rubber
+band shuts the door we have opened.
+
+E.  The striped muscular fibre,--the red flesh, which shortens itself
+in obedience to the will, and thus produces all voluntary active
+motion.
+
+F.  The unstriped muscular fibre, more properly the fusiform-cell
+fibre, which carries on the involuntary internal movements.
+
+G.  The nerve-cylinder, a glassy tube, with a pith of some firmness,
+which conveys sensation to the brain and the principle which induces
+motion from it.
+
+H.  The nerve-corpuscle, the centre of nervous power.
+
+I.  The mucous tissue, as Virchow calls it, common in embryonic
+structures, seen in the vitreous humor of the adult.
+
+To these add X, granules, of indeterminate shape and size, Y, for
+inorganic matters, such as the salts of bone and teeth, and Z, to
+stand as a symbol of the fluids, and you have the letters of what I
+have ventured to call the alphabet of the body.
+
+But just as in language certain diphthongs and syllables are
+frequently recurring, so we have in the body certain secondary and
+tertiary combinations, which we meet more frequently than the
+solitary elements of which they are composed.
+
+Thus A B, or a collection of cells united by simple structureless
+solid, is seen to be extensively employed in the body under the name
+of cartilage.  Out of this the surfaces of the articulations and the
+springs of the breathing apparatus are formed.  But when Nature came
+to the buffers of the spinal column (intervertebral disks) and the
+washers of the joints (semilunar fibrocartilages of the knee, etc.),
+she required more tenacity than common cartilage possessed.  What did
+she do?  What does man do in a similar case of need?  I need hardly
+tell you.  The mason lays his bricks in simple mortar.  But the
+plasterer works some hair into the mortar which he is going to lay in
+large sheets on the walls.  The children of Israel complained that
+they had no straw to make their bricks with, though portions of it
+may still be seen in the crumbling pyramid of Darshour, which they
+are said to have built.  I visited the old house on Witch Hill in
+Salem a year or two ago, and there I found the walls coated with clay
+in which straw was abundantly mingled;--the old Judaizing witch-
+hangers copied the Israelites in a good many things.  The Chinese and
+the Corsicans blend the fibres of amianthus in their pottery to give
+it tenacity.  Now to return to Nature.  To make her buffers and
+washers hold together in the shocks to which they would be subjected,
+she took common cartilage and mingled the white fibrous tissue with
+it, to serve the same purpose as the hair in the mortar, the straw in
+the bricks and in the plaster of the old wall, and the amianthus in
+the earthen vessels.  Thus we have the combination A B C, or fibro-
+cartilage.  Again, the bones were once only gristle or cartilage, A
+B.  To give them solidity they were infiltrated with stone, in the
+form of salts of lime, an inorganic element, so that bone would be
+spelt out by the letters A, B, and Y.
+
+If from these organic syllables we proceed to form organic words, we
+shall find that Nature employs three principal forms; namely,
+Vessels, Membranes, and Parenchyma, or visceral tissue.  The most
+complex of them can be resolved into a combination of these few
+simple anatomical constituents.
+
+
+Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find
+the same elements in morbid growths that we have met with in normal
+structures.  The pus-corpuscle and the white blood-corpuscle can only
+be distinguished by tracing them to their origin.  A frequent form of
+so-called malignant disease proves to be only a collection of altered
+epithelium-cells.  Even cancer itself has no specific anatomical
+element, and the diagnosis of a cancerous tumor by the microscope,
+though tolerably sure under the eye of an expert, is based upon
+accidental, and not essential points,--the crowding together of the
+elements, the size of the cell-nuclei, and similar variable
+characters.
+
+Let us turn to PHYSIOLOGY.  The microscope, which has made a new
+science of the intimate structure of the organs, has at the same time
+cleared up many uncertainties concerning the mechanism of the special
+functions.  Up to the time of the living generation of observers,
+Nature had kept over all her inner workshops the forbidding
+inscription, No Admittance!  If any prying observer ventured to spy
+through his magnifying tubes into the mysteries of her glands and
+canals and fluids, she covered up her work in blinding mists and
+bewildering halos, as the deities of old concealed their favored
+heroes in the moment of danger.
+
+Science has at length sifted the turbid light of her lenses, and
+blanched their delusive rainbows.
+
+Anatomy studies the organism in space.  Physiology studies it also in
+time.  After the study of form and composition follows close that of
+action, and this leads us along back to the first moment of the germ,
+and forward to the resolution of the living frame into its lifeless
+elements.  In this way Anatomy, or rather that branch of it which we
+call Histology, has become inseparably blended with the study of
+function.  The connection between the science of life and that of
+intimate structure on the one hand, and composition on the other, is
+illustrated in the titles of two recent works of remarkable
+excellence,--"the Physiological Anatomy" of Todd and Bowman, and the
+"Physiological Chemistry" of Lehmann.
+
+Let me briefly recapitulate a few of our acquisitions in Physiology,
+due in large measure to our new instruments and methods of research,
+and at the same time indicate the limits which form the permanent or
+the temporary boundaries of our knowledge.  I will begin with the
+largest fact and with the most absolute and universally encountered
+limitation.
+
+The "largest truth in Physiology" Mr. Paget considers to be "the
+development of ova through multiplication and division of their
+cells."  I would state it more broadly as the agency of the cell in
+all living processes.  It seems at present necessary to abandon the
+original idea of Schwann, that we can observe the building up of a
+cell from the simple granules of a blastema, or formative fluid.  The
+evidence points rather towards the axiom, Omnis cellula a cellula;
+that is, the germ of a new cell is always derived from a preexisting
+cell.  The doctrine of Schwann, as I remarked long ago (1844), runs
+parallel with the nebular theory in astronomy, and they may yet stand
+or fall together.
+
+As we have seen Nature anticipating the plasterer in fibro-cartilage,
+so we see her beforehand with the glassblower in her dealings with
+the cell.  The artisan blows his vitreous bubbles, large or small, to
+be used afterwards as may be wanted.  So Nature shapes her hyaline
+vesicles and modifies them to serve the needs of the part where they
+are found.  The artisan whirls his rod, and his glass bubble becomes
+a flattened disk, with its bull's-eye for a nucleus.  These lips of
+ours are all glazed with microscopic tiles formed of flattened cells,
+each one of them with its nucleus still as plain and relatively as
+prominent, to the eye of the microscopist, as the bull's-eye in the
+old-fashioned windowpane.  Everywhere we find cells, modified or
+unchanged.  They roll in inconceivable multitudes (five millions and
+more to the cubic millimetre, according to Vierordt) as blood-disks
+through our vessels.  A close-fitting mail of flattened cells coats
+our surface with a panoply of imbricated scales (more than twelve
+thousand millions), as Harting has computed, as true a defence against
+our enemies as the buckler of the armadillo or the carapace of the
+tortoise against theirs.  The same little protecting organs pave all
+the great highways of the interior system.  Cells, again, preside
+over the chemical processes which elaborate the living fluids; they
+change their form to become the agents of voluntary and involuntary
+motion; the soul itself sits on a throne of nucleated cells, and
+flashes its mandates through skeins of glassy filaments which once
+were simple chains of vesicles.  And, as if to reduce the problem of
+living force to its simplest expression, we see the yolk of a
+transparent egg dividing itself in whole or in part, and again
+dividing and subdividing, until it becomes a mass of cells, out of
+which the harmonious diversity of the organs arranges itself, worm or
+man, as God has willed from the beginning.
+
+This differentiation having been effected, each several part assumes
+its special office, having a life of its own adjusted to that of
+other parts and the whole.  "Just as a tree constitutes a mass
+arranged in a definite manner, in which, in every single part, in the
+leaves as in the root, in the trunk as in the blossom, cells are
+discovered to be the ultimate elements, so is it also with the forms
+of animal life.  Every animal presents itself as a sum of vital
+unities, every one of which manifests all the characteristics of
+life."
+
+The mechanism is as clear, as unquestionable, as absolutely settled
+and universally accepted, as the order of movement of the heavenly
+bodies, which we compute backward to the days of the observatories on
+the plains of Shinar, and on the faith of which we regulate the
+movements of war and trade by the predictions of our ephemeris.
+
+The mechanism, and that is all.  We see the workman and the tools,
+but the skill that guides the work and the power that performs it are
+as invisible as ever.  I fear that not every listener took the
+significance of those pregnant words in the passage I quoted from
+John Bell,--"thinking to discover its properties in its form."  We
+have discovered the working bee in this great hive of organization.
+We have detected the cell in the very act of forming itself from a
+nucleus, of transforming itself into various tissues, of selecting
+the elements of various secretions.  But why one cell becomes nerve
+and another muscle, why one selects bile and another fat, we can no
+more pretend to tell, than why one grape sucks out of the soil the
+generous juice which princes hoard in their cellars, and another the
+wine which it takes three men to drink,--one to pour it down, another
+to swallow it, and a third to hold him while it is going down.
+Certain analogies between this selecting power and the phenomena of
+endosmosis in the elective affinities of chemistry we can find, but
+the problem of force remains here, as everywhere, unsolved and
+insolvable.
+
+Do we gain anything by attempting to get rid of the idea of a special
+vital force because we find certain mutually convertible relations
+between forces in the body and out of it?  I think not, any more than
+we should gain by getting rid of the idea and expression Magnetism
+because of its correlation with electricity.  We may concede the
+unity of all forms of force, but we cannot overlook the fixed
+differences of its manifestations according to the conditions under
+which it acts.  It is a mistake, however, to think the mystery is
+greater in an organized body than in any other.  We see a stone fall
+or a crystal form, and there is nothing stranger left to wonder at,
+for we have seen the Infinite in action.
+
+Just so far as we can recognize the ordinary modes of operation of
+the common forces of nature,--gravity, cohesion, elasticity,
+transudation, chemical action, and the rest,--we see the so-called
+vital acts in the light of a larger range of known facts and familiar
+analogies.  Matteuecci's well-remembered lectures contain many and
+striking examples of the working of physical forces in physiological
+processes.  Wherever rigid experiment carries us, we are safe in
+following this lead; but the moment we begin to theorize beyond our
+strict observation, we are in danger of falling into those mechanical
+follies which true science has long outgrown.
+
+Recognizing the fact, then, that we have learned nothing but the
+machinery of life, and are no nearer to its essence, what is it that
+we have gained by this great discovery of the cell formation and
+function?
+
+It would have been reward enough to learn the method Nature pursues
+for its own sake.  If the sovereign Artificer lets us into his own
+laboratories and workshops, we need not ask more than the privilege
+of looking on at his work.  We do not know where we now stand in the
+hierarchy of created intelligences.  We were made a little lower than
+the angels.  I speak it not irreverently; as the lower animals
+surpass man in some of their attributes, so it may be that not every
+angel's eye can see as broadly and as deeply into the material works
+of God as man himself, looking at the firmament through an equatorial
+of fifteen inches' aperture, and searching into the tissues with a
+twelfth of an inch objective.
+
+But there are other positive gains of a more practical character.
+Thus we are no longer permitted to place the seat of the living
+actions in the extreme vessels, which are only the carriers from
+which each part takes what it wants by the divine right of the
+omnipotent nucleated cell.  The organism has become, in the words
+already borrowed from Virchow, "a sum of vital unities."  The
+strictum and laxum, the increased and diminished action of the
+vessels, out of which medical theories and methods of treatment have
+grown up, have yielded to the doctrine of local cell-communities,
+belonging to this or that vascular district, from which they help
+themselves, as contractors are wont to do from the national treasury.
+
+I cannot promise to do more than to select a few of the points of
+contact between our ignorance and our knowledge which present
+particular interest in the existing state of our physiological
+acquisitions.  Some of them involve the microscopic discoveries of
+which I have been speaking, some belong to the domain of chemistry,
+and some have relations with other departments of physical science.
+
+If we should begin with the digestive function, we should find that
+the long-agitated question of the nature of the acid of the gastric
+juice is becoming settled in favor of the lactic.  But the whole
+solvent agency of the digestive fluid enters into the category of
+that exceptional mode of action already familiar to us in chemistry
+as catalysis.  It is therefore doubly difficult of explanation;
+first, as being, like all reactions, a fact not to be accounted for
+except by the imaginative appeal to "affinity," and secondly, as
+being one of those peculiar reactions provoked by an element which
+stands outside and looks on without compromising itself.
+
+The doctrine of Mulder, so widely diffused in popular and scientific
+belief, of the existence of a common base of all albuminous
+substances, the so-called protein, has not stood the test of rigorous
+analysis.  The division of food into azotized and non-azotized is no
+doubt important, but the attempt to show that the first only is
+plastic or nutritive, while the second is simply calorifacient, or
+heat-producing, fails entirely in the face of the facts revealed by
+the study of man in different climates, and of numerous experiments
+in the feeding of animals.  I must return to this subject in
+connection with the respiratory function.
+
+The sugar-making faculty of the liver is another "catalytic" mystery,
+as great as the rest of them, and no greater.  Liver-tissue brings
+sugar out of the blood, or out of its own substance;--why?
+
+          Quia est in eo
+          Virtus saccharitiva.
+
+Just what becomes of the sugar beyond the fact of its disappearance
+before it can get into the general circulation and sweeten our
+tempers, it is hard to say.
+
+The pancreatic fluid makes an emulsion of the fat contained in our
+food, but just how the fatty particles get into the villi we must
+leave Brucke and Kolliker to settle if they can.
+
+No one has shown satisfactorily the process by which the blood-
+corpuscles are formed out of the lymph-corpuscles, nor what becomes
+of them.  These two questions are like those famous household
+puzzles,--Where do the flies come from?  and, Where do the pins go
+to?
+
+There is a series of organs in the body which has long puzzled
+physiologists,--organs of glandular aspect, but having no ducts,--the
+spleen, the thyroid and thymus bodies, and the suprarenal capsules.
+We call them vascular glands, and we believe that they elaborate
+colored and uncolored blood-cells; but just what changes they effect,
+and just how they effect them, it has proved a very difficult matter
+to determine.  So of the noted glandules which form Peyer's patches,
+their precise office, though seemingly like those of the lymphatic
+glands, cannot be positively assigned, so far as I know, at the
+present time.  It is of obvious interest to learn it with reference
+to the pathology of typhoid fever.  It will be remarked that the
+coincidence of their changes in this disease with enlargement of the
+spleen suggests the idea of a similarity of function in these two
+organs.
+
+The theories of the production of animal heat, from the times of
+Black, Lavoisier, and Crawford to those of Liebig, are familiar to
+all who have paid any attention to physiological studies.  The
+simplicity of Liebig's views, and the popular form in which they have
+been presented, have given them wide currency, and incorporated them
+in the common belief and language of our text-books.  Direct
+oxidation or combustion of the carbon and hydrogen contained in the
+food, or in the tissues themselves; the division of alimentary
+substances into respiratory, or non-azotized, and azotized,--these
+doctrines are familiar even to the classes in our high-schools.  But
+this simple statement is boldly questioned.  Nothing proves that
+oxygen combines (in the system) with hydrogen and carbon in
+particular, rather than with sulphur and azote.  Such is the well-
+grounded statement of Robin and Verdeil.  "It is very probable that
+animal heat is entirely produced by the chemical actions which take
+place in the organism, but the phenomenon is too complex to admit of
+our calculating it according to the quality of oxygen consumed."
+These last are the words of Regnault, as cited by Mr. Lewes, whose
+intelligent discussion of this and many of the most interesting
+physiological problems I strongly recommend to your attention.
+
+This single illustration covers a wider ground than the special
+function to which it belongs.  We are learning that the chemistry of
+the body must be studied, not simply by its ingesta and egesta, but
+that there is a long intermediate series of changes which must be
+investigated in their own light, under their own special conditions.
+The expression "sum of vital unities" applies to the chemical
+actions, as well as to other actions localized in special parts; and
+when the distinguished chemists whom I have just cited entitle their
+work a treatise on the immediate principles of the body, they only
+indicate the nature of that profound and subtile analysis which must
+take the place of all hasty generalizations founded on a comparison
+of the food with residual products.
+
+I will only call your attention to the fact, that the exceptional
+phenomenon of the laboratory is the prevailing law of the organism.
+Nutrition itself is but one great catalytic process.  As the blood
+travels its rounds, each part selects its appropriate element and
+transforms it to its own likeness.  Whether the appropriating agent
+be cell or nucleus, or a structureless solid like the intercellular
+substance of cartilage, the fact of its presence determines the
+separation of its proper constituents from the circulating fluid, so
+that even when we are wounded bone is replaced by bone, skin by skin,
+and nerve by nerve.
+
+It is hardly without a smile that we resuscitate the old question of
+the 'vis insita' of the muscular fibre, so famous in the discussions of
+Haller and his contemporaries.  Speaking generally, I think we may
+say that Haller's doctrine is the one now commonly received; namely,
+that the muscles contract in virtue of their own inherent endowments.
+It is true that Kolliker says no perfectly decisive fact has been
+brought forward to prove that the striated muscles contract with.
+out having been acted on by nerves.  Yet Mr. Bowman's observations on
+the contraction of isolated fibres appear decisive enough (unless we
+consider them invalidated by Dr. Lionel Beale's recent researches),
+tending to show that each elementary fibre is supplied with nerves;
+and as to the smooth muscular fibres, we have Virchow's statement
+respecting the contractility of those of the umbilical cord, where
+there is not a trace of any nerves.
+
+In the investigation of the nervous system, anatomy and physiology
+have gone hand in hand.  It is very singular that so important, and
+seemingly simple, a fact as the connection of the nerve-tubes, at
+their origin or in their course, with the nerve-cells, should have so
+long remained open to doubt, as you may see that it did by referring
+to the very complete work of Sharpey and Quain (edition of 1849), the
+histological portion of which is cordially approved by Kolliker
+himself.
+
+Several most interesting points of the minute anatomy of the nervous
+centres have been laboriously and skilfully worked out by a recent
+graduate of this Medical School, in a monograph worthy to stand in
+line with those of Lockhart Clarke, Stilling, and Schroder van der
+Kolk. I have had the privilege of examining and of showing some of
+you a number of Dr. Dean's skilful preparations.  I have no space to
+give even an abstract of his conclusions.  I can only refer to his
+proof of the fact, that a single cell may send its processes into
+several different bundles of nerve-roots, and to his demonstration of
+the curved ascending and descending fibres from the posterior
+nerveroots, to reach what he has called the longitudinal columns of
+the cornea.  I must also mention Dr. Dean's exquisite microscopic
+photographs from sections of the medulla oblongata, which appear to
+me to promise a new development, if not a new epoch, in anatomical
+art.
+
+It having been settled that the nerve-tubes can very commonly be
+traced directly to the nerve-cells, the object of all the observers
+in this department of anatomy is to follow these tubes to their
+origin.  We have an infinite snarl of telegraph wires, and we may be
+reasonably sure, that, if we can follow them up, we shall find each
+of them ends in a battery somewhere.  One of the most interesting
+problems is to find the ganglionic origin of the great nerves of the
+medulla oblongata, and this is the end to which, by the aid of the
+most delicate sections, colored so as to bring out their details,
+mounted so as to be imperishable, magnified by the best instruments,
+and now self-recorded in the light of the truth-telling sunbeam, our
+fellow-student is making a steady progress in a labor which I think
+bids fair to rank with the most valuable contributions to histology
+that we have had from this side of the Atlantic.
+
+It is interesting to see how old questions are incidentally settled
+in the course of these new investigations.  Thus, Mr. Clarke's
+dissections, confirmed by preparations of Mr. Dean's which I have
+myself examined, placed the fact of the decussation of the pyramids--
+denied by Haller, by Morgagni, and even by Stilling--beyond doubt.
+So the spinal canal, the existence of which, at least in the adult,
+has been so often disputed, appears as a coarse and unequivocal
+anatomical fact in many of the preparations referred to.
+
+While these studies of the structure of the cord have been going on,
+the ingenious and indefatigable Brown-Sequard has been investigating
+the functions of its different parts with equal diligence.  The
+microscopic anatomists had shown that the ganglionic corpuscles of
+the gray matter of the cord are connected with each other by their
+processes, as well as with the nerve-roots.  M.  Brown-Sequard has
+proved by numerous experiments that the gray substance transmits
+sensitive impressions and muscular stimulation.  The oblique
+ascending and descending fibres from the posterior nerve-roots,
+joining the "longitudinal columns of the cornua," account for the
+results of Brown-Sequard's sections of the posterior columns.  The
+physiological experimenter has also made it evident that the
+decussation of the conductors of sensitive impressions has its seat
+in the spinal core, and not in the encephalon, as had been supposed.
+Not less remarkable than these results are the facts, which I with
+others of my audience have had the opportunity of observing, as shown
+by M. Brown-Sequard, of the artificial production of epilepsy in
+animals by injuring the spinal cord, and the induction of the
+paroxysm by pinching a certain portion of the skin.  I would also
+call the student's attention to his account of the relations of the
+nervous centres to nutrition and secretion, the last of which
+relations has been made the subject of an extended essay by our
+fellow countryman, Dr. H. F. Campbell of Georgia.
+
+The physiology of the spinal cord seems a simple matter as you study
+it in Longet.  The experiments of Brown-Sequard have shown the
+problem to be a complex one, and raised almost as many doubts as they
+have solved questions; at any rate, I believe all lecturers on
+physiology agree that there is no part of their task they dread so
+much as the analysis of the evidence relating to the special offices
+of the different portions of the medulla spinalis.  In the brain we
+are sure that we do not know how to localize functions; in the spinal
+cord, we think we do know something; but there are so many anomalies,
+and seeming contradictions, and sources of fallacy, that beyond the
+facts of crossed paralysis of sensation, and the conducting agency of
+the gray substance, I am afraid we retain no cardinal principles
+discovered since the development of the reflex function took its
+place by Sir Charles Bell's great discovery.
+
+By the manner in which I spoke of the brain, you will see that I am
+obliged to leave phrenology sub Jove,--out in the cold,--as not one
+of the household of science.  I am not one of its haters; on the
+contrary, I am grateful for the incidental good it has done.  I love
+to amuse myself in its plaster Golgothas, and listen to the glib
+professor, as he discovers by his manipulations
+
+     "All that disgraced my betters met in me."
+
+I loved of old to see square-headed, heavy-jawed Spurzheim make a
+brain flower out into a corolla of marrowy filaments, as Vieussens
+had done before him, and to hear the dry-fibred but human-hearted
+George Combe teach good sense under the disguise of his equivocal
+system.  But the pseudo-sciences, phrenology and the rest, seem to me
+only appeals to weak minds and the weak points of strong ones.  There
+is a pica or false appetite in many intelligences; they take to odd
+fancies in place of wholesome truth, as girls gnaw at chalk and
+charcoal.  Phrenology juggles with nature.  It is so adjusted as to
+soak up all evidence that helps it, and shed all that harms it.  It
+crawls forward in all weathers, like Richard Edgeworth's hygrometer.
+It does not stand at the boundary of our ignorance, it seems to me,
+but is one of the will-o'-the-wisps of its undisputed central domain
+of bog and quicksand.  Yet I should not have devoted so many words to
+it, did I not recognize the light it has thrown on human actions by
+its study of congenital organic tendencies.  Its maps of the.
+surface of the head are, I feel sure, founded on a delusion, but its
+studies of individual character are always interesting and
+instructive.
+
+The "snapping-turtle" strikes after its natural fashion when it first
+comes out of the egg.  Children betray their tendencies in their way
+of dealing with the breasts that nourish them; nay, lean venture to
+affirm, that long before they are born they teach their mothers
+something of their turbulent or quiet tempers.
+
+     "Castor gaudet equis, ovo proanatus eodem
+          Pugnis."
+
+Strike out the false pretensions of phrenology; call it anthropology;
+let it study man the individual in distinction from man the
+abstraction, the metaphysical or theological lay-figure; and it
+becomes "the proper study of mankind," one of the noblest and most
+interesting of pursuits.
+
+The whole physiology of the nervous system, from the simplest
+manifestation of its power in an insect up to the supreme act of the
+human intelligence working through the brain, is full of the most
+difficult yet profoundly interesting questions.  The singular
+relations between electricity and nerve-force, relations which it has
+been attempted to interpret as meaning identity, in the face of
+palpable differences, require still more extended studies.  You may
+be interested by Professor Faraday's statement of his opinion on the
+matter.  "Though I am not satisfied that the nervous fluid is only
+electricity, still I think that the agent in the nervous system maybe
+an inorganic force; and if there be reason for supposing that
+magnetism is a higher relation of force than electricity, so it may
+well be imagined that the nervous power may be of a still more
+exalted character, and yet within the reach of experiment."
+
+In connection with this statement, it is interesting to refer to the
+experiments of Helmholtz on the rapidity of transmission of the
+nervous actions.  The rate is given differently in Valentin's report
+of these experiments and in that found in the "Scientific Annual" for
+1858.  One hundred and eighty to three hundred feet per second is the
+rate of movement assigned for sensation, but all such results must be
+very vaguely approximative.  Boxers, fencers, players at the Italian
+game of morn, "prestidigitators," and all who depend for their
+success on rapidity of motion, know what differences there are in the
+personal equation of movement.
+
+Reflex action, the mechanical sympathy, if I may so call it, of
+distant parts; Instinct, which is crystallized intelligence,--an
+absolute law with its invariable planes and angles introduced into
+the sphere of consciousness, as raphides are inclosed in the living
+cells of plants; Intellect,--the operation of the thinking principle
+through material organs, with an appreciable waste of tissue in every
+act of thought, so that our clergymen's blood has more phosphates to
+get rid of on Monday than on any other day of the week; Will,--
+theoretically the absolute determining power, practically limited in
+different degrees by the varying organization of races and
+individuals, annulled or perverted by different ill-understood
+organic changes; on all these subjects our knowledge is in its
+infancy, and from the study of some of them the interdict of the
+Vatican is hardly yet removed.
+
+I must allude to one or two points in the histology and physiology of
+the organs of sense.  The anterior continuation of the retina beyond
+the ora serrata has been a subject of much discussion.  If H. Muller
+and Kolliker can be relied upon, this question is settled by
+recognizing that a layer of cells, continued from the retina, passes
+over the surface of the zonula Zinnii, but that no proper nervous
+element is so prolonged forward.
+
+I observe that Kolliker calls the true nervous elements of the retina
+"the layer of gray cerebral substance."  In fact, the ganglionic
+corpuscles of each eye may be considered as constituting a little
+brain, connected with the masses behind by the commissure, commonly
+called the optic nerve.  We are prepared, therefore, to find these
+two little brains in the most intimate relations with each other, as
+we find the cerebral hemispheres.  We know that they are directly
+connected by fibres that arch round through the chiasma.
+
+I mention these anatomical facts to introduce a physiological
+observation of my own, first announced in one of the lectures before
+the Medical Class, subsequently communicated to the American Academy
+of Arts and Sciences, and printed in its "Transactions" for February
+14, 1860.  I refer to the apparent transfer of impressions from one
+retina to the other, to which I have given the name reflex vision.
+The idea was suggested to me in consequence of certain effects
+noticed in employing the stereoscope.  Professor William B. Rodgers
+has since called the attention of the American Scientific Association
+to some facts bearing on the subject, and to a very curious
+experiment of Leonardo da Vinci's, which enables the observer to look
+through the palm of his hand (or seem to), as if it had a hole bored
+through it.  As he and others hesitated to accept my explanation, I
+was not sorry to find recently the following words in the
+"Observations on Man" of that acute observer and thinker, David
+Hartley.  "An impression made on the right eye alone by a single
+object may propagate itself into the left, and there raise up an
+image almost equal in vividness to itself; and consequently when we
+see with one eye only, we may, however, have pictures in both eyes."
+Hartley, in 1784, had anticipated many of the doctrines which have
+since been systematized into the theory of reflex actions, and with
+which I have attempted to associate this act of reflex vision.  My
+sixth experiment, however, in the communication referred to, appears
+to me to be a crucial one, proving the correctness of my explanation,
+and I am not aware that it has been before instituted.
+
+Another point of great interest connected with the physiology of
+vision, and involved for a long time in great obscurity, is that of
+the adjustment of the eye to different distances.  Dr. Clay Wallace
+of New York, who published a very ingenious little book on the eye
+about twenty years ago, with vignettes reminding one of Bewick, was
+among the first, if not the first, to describe the ciliary muscle, to
+which the power of adjustment is generally ascribed.  It is
+ascertained, by exact experiment with the phacueidoscope, that
+accommodation depends on change of form of the crystalline lens.
+Where the crystalline is wanting, as Mr. Ware long ago taught, no
+power of accommodation remains.  The ciliary muscle is generally
+thought to effect the change of form of the crystalline.  The power
+of accommodation is lost after the application of atropine, in
+consequence, as is supposed, of the paralysis of this muscle.  This,
+I believe, is the nearest approach to a demonstration we have on this
+point.
+
+I have only time briefly to refer to Professor Draper's most
+ingenious theory as to the photographic nature of vision, for an
+account of which I must refer to his original and interesting
+Treatise on Physiology.
+
+It were to be wished that the elaborate and very interesting
+researches of the Marquis Corti, which have revealed such singular
+complexity of structure in the cochlea of the ear, had done more to
+clear up its doubtful physiology; but I am afraid we have nothing but
+hypotheses for the special part it plays in the act of hearing, and
+that we must say the same respecting the office of the semicircular
+canals.
+
+The microscope has achieved some of its greatest triumphs in teaching
+us the changes which occur in the development of the embryo.  No more
+interesting discovery stands recorded in the voluminous literature of
+this subject than the one originally announced by Martin Barry,
+afterwards discredited, and still later confirmed by Mr. Newport and
+others; namely the fact that the fertilizing filament reaches the
+interior of the ovum in various animals;--a striking parallel to the
+action of the pollen-tube in the vegetable.  But beyond the
+mechanical facts all is mystery in the movements of organization, as
+profound as in the fall of a stone or the formation of a crystal.
+
+To the chemist and the microscopist the living body presents the same
+difficulties, arising from the fact that everything is in perpetual
+change in the organism.  The fibrine of the blood puzzles the one as
+much as its globules puzzle the other.  The difference between the
+branches of science which deal with space only, and those which deal
+with space and time, is this: we have no glasses that can magnify
+time.  The figure I here show you a was photographed from an object
+(pleurosigma angulatum) magnified a thousand diameters, or presenting
+a million times its natural surface.  This other figure of the same
+object, enlarged from the one just shown, is magnified seven thousand
+diameters, or forty-nine million times in surface.  When we can make
+the forty-nine millionth of a second as long as its integer,
+physiology and chemistry will approach nearer the completeness of
+anatomy.
+
+Our reverence becomes more worthy, or, if you will, less unworthy of
+its Infinite Object in proportion as our intelligence is lifted and
+expanded to a higher and broader understanding of the Divine methods
+of action.  If Galen called his heathen readers to admire, the power,
+the wisdom, the providence, the goodness of the "Framer of the animal
+body,"--if Mr. Boyle, the student of nature, as Addison and that
+friend of his who had known him for forty years tell us, never
+uttered the name of the Supreme Being without making a distinct pause
+in his speech, in token of his devout recognition of its awful
+meaning,--surely we, who inherit the accumulated wisdom of nearly two
+hundred years since the time of the British philosopher, and of
+almost two thousand since the Greek physician, may well lift our
+thoughts from the works we study to their great Artificer.  These
+wonderful discoveries which we owe to that mighty little instrument,
+the telescope of the inner firmament with all its included worlds;
+these simple formulae by which we condense the observations of a
+generation in a single axiom; these logical analyses by which we
+fence out the ignorance we cannot reclaim, and fix the limits of our
+knowledge,--all lead us up to the inspiration of the Almighty, which
+gives understanding to the world's great teachers.  To fear science
+or knowledge, lest it disturb our old beliefs, is to fear the influx
+of the Divine wisdom into the souls of our fellow-men; for what is
+science but the piecemeal revelation,--uncovering,--of the plan of
+creation, by the agency of those chosen prophets of nature whom God
+has illuminated from the central light of truth for that single
+purpose?
+
+The studies which we have glanced at are preliminary in your
+education to the practical arts which make use of them,--the arts of
+healing,--surgery and medicine.  The more you examine the structure
+of the organs and the laws of life, the more you will find how
+resolutely each of the cell-republics which make up the E pluribus
+unum of the body maintains its independence.  Guard it, feed it, air
+it, warm it, exercise or rest it properly, and the working elements
+will do their best to keep well or to get well.  What do we do with
+ailing vegetables?  Dr. Warren, my honored predecessor in this chair,
+bought a country-place, including half of an old orchard.  A few
+years afterwards I saw the trees on his side of the fence looking in
+good health, while those on the other side were scraggy and
+miserable.  How do you suppose this change was brought about?  By
+watering them with Fowler's solution?  By digging in calomel freely
+about their roots?  Not at all; but by loosening the soil round them,
+and supplying them with the right kind of food in fitting quantities.
+
+Now a man is not a plant, or, at least, he is a very curious one, for
+he carries his soil in his stomach, which is a kind--of portable
+flower-pot, and he grows round it, instead of out of it.  He has,
+besides, a singularly complex nutritive apparatus and a nervous
+system.  But recollect the doctrine already enunciated in the
+language of Virchow, that an animal, like a tree, is a sum of vital
+unities, of which the cell is the ultimate element.  Every healthy
+cell, whether in a vegetable or an animal, necessarily performs its
+function properly so long as it is supplied with its proper materials
+and stimuli.  A cell may, it is true, be congenitally defective, in
+which case disease is, so to speak, its normal state.  But if
+originally sound and subsequently diseased, there has certainly been
+some excess, deficiency, or wrong quality in the materials or stimuli
+applied to it.  You remove this injurious influence and substitute a
+normal one; remove the baked coal-ashes, for instance, from the roots
+of a tree, and replace them with loam; take away the salt meat from
+the patient's table, and replace it with fresh meat and vegetables,
+and the cells of the tree or the man return to their duty.
+
+I do not know that we ever apply to a plant any element which is not
+a natural constituent of the vegetable structure, except perhaps
+externally, for the accidental purpose of killing parasites.  The
+whole art of cultivation consists in learning the proper food and
+conditions of plants, and supplying them.  We give them water,
+earths, salts of various kinds such as they are made of, with a
+chance to help themselves to air and light.  The farmer would be
+laughed at who undertook to manure his fields or his trees with a
+salt of lead or of arsenic.  These elements are not constituents of
+healthy plants.  The gardener uses the waste of the arsenic furnaces
+to kill the weeds in his walks.
+
+If the law of the animal cell, and of the animal organism, which is
+built up of such cells, is like that of the vegetable, we might
+expect that we should treat all morbid conditions of any of the vital
+unities belonging to an animal in the same way, by increasing,
+diminishing, or changing its natural food or stimuli.
+
+That is an aliment which nourishes; whatever we find in the
+organism, as a constant and integral element, either forming part of
+its structure, or one of the conditions of vital processes, that and
+that only deserves the name of aliment.  I see no reason,
+therefore, why iron, phosphate of lime, sulphur, should not be
+considered food for man, as much as guano or poudrette for
+vegetables.  Whether one or another of them is best in any given
+case,--whether they shall be taken alone or in combination, in large
+or small quantities, are separate questions.  But they are elements
+belonging to the body, and even in moderate excess will produce
+little disturbance.  There is no presumption against any of this
+class of substances, any more than against water or salt, provided
+they are used in fitting combinations, proportions, and forms.
+
+But when it comes to substances alien to the healthy system, which
+never belong to it as normal constituents, the case is very
+different.  There is a presumption against putting lead or arsenic
+into the human body, as against putting them into plants, because
+they do not belong there, any more than pounded glass, which, it is
+said, used to be given as a poison.  The same thing is true of
+mercury and silver.  What becomes of these alien substances after
+they get into the system we cannot always tell.  But in the case of
+silver, from the accident of its changing color under the influence
+of light, we do know what happens.  It is thrown out, in part at
+least, under the epidermis, and there it remains to the patient's
+dying day.  This is a striking illustration of the difficulty which
+the system finds in dealing with non-assimilable elements, and
+justifies in some measure the vulgar prejudice against mineral
+poisons.
+
+I trust the youngest student on these benches will not commit the
+childish error of confounding a presumption against a particular
+class of agents with a condemnation of them.  Mercury, for instance,
+is alien to the system, and eminently disturbing in its influence.
+Yet its efficacy in certain forms of specific disease is acknowledged
+by all but the most sceptical theorists.  Even the esprit moqueur of
+Ricord, the Voltaire of pelvic literature, submits to the time-
+honored constitutional authority of this great panacea in the class
+of cases to which he has devoted his brilliant intelligence.  Still,
+there is no telling what evils have arisen from the abuse of this
+mineral.  Dr. Armstrong long ago pointed out some of them, and they
+have become matters of common notoriety.  I am pleased, therefore,
+when I find so able and experienced a practitioner as Dr. Williams of
+this city proving that iritis is best treated without mercury, and
+Dr. Vanderpoel showing the same thing to be true for pericarditis.
+
+Whatever elements nature does not introduce into vegetables, the
+natural food of all animal life,--directly of herbivorous, indirectly
+of carnivorous animals,--are to be regarded with suspicion.  Arsenic-
+eating may seem to improve the condition of horses for a time,--and
+even of human beings, if Tschudi's stories can be trusted,--but it
+soon appears that its alien qualities are at war with the animal
+organization.  So of copper, antimony, and other non-alimentary
+simple substances; everyone of them is an intruder in the living
+system, as much as a constable would be, quartered in our household.
+This does not mean that they may not, any of them, be called in for a
+special need, as we send for the constable when we have good reason
+to think we have a thief under our roof; but a man's body is his
+castle, as well as his house, and the presumption is that we are to
+keep our alimentary doors bolted against these perturbing agents.
+
+Now the feeling is very apt to be just contrary to this.  The habit
+has been very general with well-taught practitioners, to have
+recourse to the introduction of these alien elements into the system
+on the occasion of any slight disturbance.  The tongue was a little
+coated, and mercury must be given; the skin was a little dry, and the
+patient must take antimony.  It was like sending for the constable
+and the posse comitatus when there is only a carpet to shake or a
+refuse-barrel to empty. [Dr. James Johnson advises persons not ailing
+to take five grains of blue pill with one or two of aloes twice a
+week for three or four months in the year, with half a pint of
+compound decoction of sarsaparilla every day for the same period, to
+preserve health and prolong life.  Pract.  Treatise on Dis.  of
+Liver, etc.  p. 272.]  The constitution bears slow poisoning a great
+deal better than might be expected; yet the most intelligent men in
+the profession have gradually got out of the habit of prescribing
+these powerful alien substances in the old routine way.  Mr. Metcalf
+will tell you how much more sparingly they are given by our
+practitioners at the present time, than when he first inaugurated the
+new era of pharmacy among us.  Still, the presumption in favor of
+poisoning out every spontaneous reaction of outraged nature is not
+extinct in those who are trusted with the lives of their fellow-
+citizens.  "On examining the file of prescriptions at the hospital, I
+discovered that they were rudely written, and indicated a treatment,
+as they consisted chiefly of tartar emetic, ipecacuanha, and epsom
+salts, hardly favorable to the cure of the prevailing diarrhoea and
+dysenteries."   In a report of a poisoning case now on trial, where
+we are told that arsenic enough was found in the stomach to produce
+death in twenty-four hours, the patient is said to have been treated
+by arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic
+acid,--by a practitioner of what school it may be imagined.
+
+The traditional idea of always poisoning out disease, as we smoke out
+vermin, is now seeking its last refuge behind the wooden cannon and
+painted port-holes of that unblushing system of false scientific
+pretences which I do not care to name in a discourse addressed to an
+audience devoted to the study of the laws of nature in the light of
+the laws of evidence.  It is extraordinary to observe that the system
+which, by its reducing medicine to a name and a farce, has accustomed
+all who have sense enough to see through its thin artifices to the
+idea that diseases get well without being "cured," should now be the
+main support of the tottering poison-cure doctrine.  It has
+unquestionably helped to teach wise people that nature heals most
+diseases without help from pharmaceutic art, but it continues to
+persuade fools that art can arrest them all with its specifics.
+
+It is worse than useless to attempt in any way to check the freest
+expression of opinion as to the efficacy of any or all of the
+"heroic" means of treatment employed by practitioners of different
+schools and periods.  Medical experience is a great thing, but we
+must not forget that there is a higher experience, which tries its
+results in a court of a still larger jurisdiction; that, namely, in
+which the laws of human belief are summoned to the witness-box, and
+obliged to testify to the sources of error which beset the medical
+practitioner.  The verdict is as old as the father of medicine, who
+announces it in the words, "judgment is difficult."  Physicians
+differed so in his time, that some denied that there was any such
+thing as an art of medicine.
+
+One man's best remedies were held as mischievous by another.  The art
+of healing was like soothsaying, so the common people said; "the same
+bird was lucky or unlucky, according as he flew to the right or
+left."
+
+The practice of medicine has undergone great changes within the
+period of my own observation.  Venesection, for instance, has so far
+gone out of fashion, that, as I am told by residents of the New York
+Bellevue and the Massachusetts General Hospitals, it is almost
+obsolete in these institutions, at least in medical practice.  The
+old Brunonian stimulating treatment has come into vogue again in the
+practice of Dr. Todd and his followers.  The compounds of mercury
+have yielded their place as drugs of all work, and specifics for that
+very frequent subjective complaint, nescio quid faciam,--to compounds
+of iodine. [Sir Astley Cooper has the boldness,--or honesty,--to
+speak of medicines which "are given as much to assist the medical man
+as his patient."  Lectures (London, 1832), p.  14.] Opium is believed
+in, and quinine, and "rum," using that expressive monosyllable to
+mean all alcoholic cordials.  If Moliere were writing now, instead of
+saignare, purgare, and the other, he would be more like to say,
+Stimulare, opium dare et potassio-iodizare.
+
+I have been in relation successively with the English and American
+evacuant and alterative practice, in which calomel and antimony
+figured so largely that, as you may see in Dr. Jackson's last
+"Letter," Dr. Holyoke, a good representative of sterling old-
+fashioned medical art, counted them with opium and Peruvian bark as
+his chief remedies; with the moderately expectant practice of Louis;
+the blood-letting "coup sur coup" of Bouillaud; the contra-stimulant
+method of Rasori and his followers; the anti-irritant system of
+Broussais, with its leeching and gum-water; I have heard from our own
+students of the simple opium practice of the renowned German teacher,
+Oppolzer; and now I find the medical community brought round by the
+revolving cycle of opinion to that same old plan of treatment which
+John Brown taught in Edinburgh in the last quarter of the last
+century, and Miner and Tully fiercely advocated among ourselves in
+the early years of the present.  The worthy physicians last
+mentioned, and their antagonist Dr. Gallup, used stronger language
+than we of these degenerate days permit ourselves.  "The lancet is a
+weapon which annually slays more than the sword," says Dr. Tully.
+"It is probable that, for forty years past, opium and its
+preparations have done seven times the injury they have rendered
+benefit, on the great scale of the world," says Dr. Gallup.
+
+What is the meaning of these perpetual changes and conflicts of
+medical opinion and practice, from an early antiquity to our own
+time?  Simply this: all "methods" of treatment end in disappointment
+of those extravagant expectations which men are wont to entertain of
+medical art.  The bills of mortality are more obviously affected by
+drainage, than by this or that method of practice.  The insurance
+companies do not commonly charge a different percentage on the lives
+of the patients of this or that physician.  In the course of a
+generation, more or less, physicians themselves are liable to get
+tired of a practice which has so little effect upon the average
+movement of vital decomposition.  Then they are ready for a change,
+even if it were back again to a method which has already been tried,
+and found wanting.
+
+Our practitioners, or many of them, have got back to the ways of old
+Dr. Samuel Danforth, who, as it is well known, had strong objections
+to the use of the lancet.  By and by a new reputation will be made by
+some discontented practitioner, who, tired of seeing patients die
+with their skins full of whiskey and their brains muddy with opium,
+returns to a bold antiphlogistic treatment, and has the luck to see a
+few patients of note get well under it.  So of the remedies which
+have gone out of fashion and been superseded by others.  It can
+hardly be doubted that they will come into vogue again, more or less
+extensively, under the influence of that irresistible demand for
+change just referred to.
+
+Then will come the usual talk about a change in the character of
+disease, which has about as much meaning as that concerning
+"old-fashioned snow-storms."  "Epidemic constitutions" of disease
+mean something, no doubt; a great deal as applied to malarious
+affections; but that the whole type of diseases undergoes such
+changes that the practice must be reversed from depleting to
+stimulating, and vice versa, is much less likely than that methods of
+treatment go out of fashion and come in again.  If there is any
+disease which claims its percentage with reasonable uniformity, it is
+phthisis.  Yet I remember that the reverend and venerable Dr. Prince
+of Salem told me one Commencement day, as I was jogging along towards
+Cambridge with him, that he recollected the time when that disease
+was hardly hardly known; and in confirmation of his statement
+mentioned a case in which it was told as a great event, that somebody
+down on "the Cape" had died of "a consumption."  This story does not
+sound probable to myself, as I repeat it, yet I assure you it is
+true, and it shows how cautiously we must receive all popular stories
+of great changes in the habits of disease.
+
+Is there no progress, then, but do we return to the same beliefs and
+practices which our forefathers wore out and threw away?  I trust and
+believe that there is a real progress.  We may, for instance, return
+in a measure to the Brunonian stimulating system, but it must be in a
+modified way, for we cannot go back to the simple Brunonian
+pathology, since we have learned too much of diseased action to
+accept its convenient dualism.  So of other doctrines, each new
+Avatar strips them of some of their old pretensions, until they take
+their fitting place at last, if they have any truth in them, or
+disappear, if they were mere phantasms of the imagination.
+
+In the mean time, while medical theories are coming in and going out,
+there is a set of sensible men who are never run away with by them,
+but practise their art sagaciously and faithfully in much the same
+way from generation to generation.  From the time of Hippocrates to
+that of our own medical patriarch, there has been an apostolic
+succession of wise and good practitioners.  If you will look at the
+first aphorism of the ancient Master you will see that before all
+remedies he places the proper conduct of the patient and his
+attendants, and the fit ordering of all the conditions surrounding
+him.  The class of practitioners I have referred to have always been
+the most faithful in attending to these points.  No doubt they have
+sometimes prescribed unwisely, in compliance with the prejudices of
+their time, but they have grown wiser as they have grown older, and
+learned to trust more in nature and less in their plans of
+interference.  I believe common opinion confirms Sir James Clark's
+observation to this effect.
+
+The experience of the profession must, I think, run parallel with
+that of the wisest of its individual members.  Each time a plan of
+treatment or a particular remedy comes up for trial, it is submitted
+to a sharper scrutiny.  When Cullen wrote his Materia Medica, he had
+seriously to assail the practice of giving burnt toad, which was
+still countenanced by at least one medical authority of note.  I have
+read recently in some medical journal, that an American practitioner,
+whose name is known to the country, is prescribing the hoof of a
+horse for epilepsy.  It was doubtless suggested by that old fancy of
+wearing a portion of elk's hoof hung round the neck or in a ring, for
+this disease.  But it is hard to persuade reasonable people to
+swallow the abominations of a former period.  The evidence which
+satisfied Fernelius will not serve one of our hospital physicians.
+
+In this way those articles of the Materia Medica which had nothing
+but loathsomeness to recommend them have been gradually dropped, and
+are not like to obtain any general favor again with civilized
+communities.  The next culprits to be tried are the poisons.  I have
+never been in the least sceptical as to the utility of some of them,
+when properly employed.  Though I believe that at present, taking the
+world at large, and leaving out a few powerful agents of such immense
+value that they rank next to food in importance, the poisons
+prescribed for disease do more hurt than good, I have no doubt, and
+never professed to have any, that they do much good in prudent and
+instructed hands.  But I am very willing to confess a great jealousy
+of many agents, and I could almost wish to see the Materia Medica so
+classed as to call suspicion upon certain ones among them.
+
+Thus the alien elements, those which do not properly enter into the
+composition of any living tissue, are the most to be suspected,--
+mercury, lead, antimony, silver, and the rest, for the reasons I have
+before mentioned.  Even iodine, which, as it is found in certain
+plants, seems less remote from the animal tissues, gives unequivocal
+proofs from time to time that it is hostile to some portions of the
+glandular system.
+
+There is, of course, less prima facie objection to those agents which
+consist of assimilable elements, such as are found making a part of
+healthy tissues.  These are divisible into three classes,--foods,
+poisons, and inert, mostly because insoluble, substances.  The food
+of one animal or of one human being is sometimes poison to another,
+and vice versa; inert substances may act mechanically, so as to
+produce the effect of poisons; but this division holds exactly enough
+for our purpose.
+
+Strictly speaking, every poison consisting of assimilable elements
+may be considered as unwholesome food.  It is rejected by the
+stomach, or it produces diarrhoea, or it causes vertigo or
+disturbance of the heart's action, or some other symptom for which
+the subject of it would consult the physician, if it came on from any
+other cause than taking it under the name of medicine.  Yet portions
+of this unwholesome food which we call medicine, we have reason to
+believe, are assimilated; thus, castor-oil appears to be partially
+digested by infants, so that they require large doses to affect them
+medicinally.  Even that deadliest of poisons, hydrocyanic acid, is
+probably assimilated, and helps to make living tissue, if it do not
+kill the patient, for the assimilable elements which it contains,
+given in the separate forms of amygdalin and emulsin, produce no
+disturbance, unless, as in Bernard's experiments, they are suffered
+to meet in the digestive organs.  A medicine consisting of
+assimilable substances being then simply unwholesome food, we
+understand what is meant by those cumulative effects of such remedies
+often observed, as in the case of digitalis and strychnia.  They are
+precisely similar to the cumulative effects of a salt diet in
+producing scurvy, or of spurred rye in producing dry gangrene.  As
+the effects of such substances are a violence to the organs, we
+should exercise the same caution with regard to their use that we
+would exercise about any other kind of poisonous food,--partridges at
+certain seasons, for instance.  Even where these poisonous kinds of
+food seem to be useful, we should still regard them with great
+jealousy.  Digitalis lowers the pulse in febrile conditions.
+Veratrum viride does the same thing.  How do we know that a rapid
+pulse is not a normal adjustment of nature to the condition it
+accompanies?  Digitalis has gone out of favor; how sure are we that
+Veratrum viride will not be found to do more harm than good in a case
+of internal inflammation, taking the whole course of the disease into
+consideration?  Think of the change of opinion with regard to the use
+of opium in delirium tremens (which you remember is sometimes called
+delirium vigilans), where it seemed so obviously indicated, since the
+publication of Dr. Ware's admirable essay.  I respect the evidence of
+my contemporaries, but I cannot forget the sayings of the Father of
+medicine,--Ars longa, judicium diffcile.
+
+I am not presuming to express an opinion concerning Veratrum viride,
+which was little heard of when I was still practising medicine.  I am
+only appealing to that higher court of experience which sits in
+judgment on all decisions of the lower medical tribunals, and which
+requires more than one generation for its final verdict.
+
+Once change the habit of mind so long prevalent among practitioners
+of medicine; once let it be everywhere understood that the
+presumption is in favor of food, and not of alien substances, of
+innocuous, and not of unwholesome food, for the sick; that this
+presumption requires very strong evidence in each particular case to
+overcome it; but that, when such evidence is afforded, the alien
+substance or the unwholesome food should be given boldly, in
+sufficient quantities, in the same spirit as that with which the
+surgeon lifts his knife against a patient,--that is, with the same
+reluctance and the same determination,--and I think we shall have and
+hear much less of charlatanism in and out of the profession.  The
+disgrace of medicine has been that colossal system of self-deception,
+in obedience to which mines have been emptied of their cankering
+minerals, the vegetable kingdom robbed of all its noxious growths,
+the entrails of animals taxed for their impurities, the poison-bags
+of reptiles drained of their venom, and all the inconceivable
+abominations thus obtained thrust down the throats of human beings
+suffering from some fault of organization, nourishment, or vital
+stimulation.
+
+Much as we have gained, we have not yet thoroughly shaken off the
+notion that poison is the natural food of disease, as wholesome
+aliment is the support of health.  Cowper's lines, in "The Task,"
+show the matter-of-course practice of his time:
+
+    "He does not scorn it, who has long endured
+     A fever's agonies, and fed on drugs."
+
+Dr. Kimball of Lowell, who has been in the habit of seeing a great
+deal more of typhoid fever than most practitioners, and whose
+surgical exploits show him not to be wanting in boldness or
+enterprise, can tell you whether he finds it necessary to feed his
+patients on drugs or not.  His experience is, I believe, that of the
+most enlightened and advanced portion of the profession; yet I think
+that even in typhoid fever, and certainly in many other complaints,
+the effects of ancient habits and prejudices may still be seen in the
+practice of some educated physicians.
+
+To you, young men, it belongs to judge all that has gone before you.
+You come nearer to the great fathers of modern medicine than some of
+you imagine.  Three of my own instructors attended Dr. Rush's
+Lectures.  The illustrious Haller mentions Rush's inaugural thesis in
+his "Bibliotheca Anatomica;" and this same Haller, brought so close
+to us, tells us he remembers Ruysch, then an old man, and used to
+carry letters between him and Boerhaave.  Look through the history of
+medicine from Boerhaave to this present day.  You will see at once
+that medical doctrine and practice have undergone a long series of
+changes.  You will see that the doctrine and practice of our own time
+must probably change in their turn, and that, if we can trust at all
+to the indications of their course, it will be in the direction of an
+improved hygiene and a simplified treatment.  Especially will the old
+habit of violating the instincts of the sick give place to a
+judicious study of these same instincts.  It will be found that
+bodily, like mental insanity, is best managed, for the most part, by
+natural soothing agencies.  Two centuries ago there was a
+prescription for scurvy containing "stercoris taurini et anserini
+par, quantitas trium magnarum nucum," of the hell-broth containing
+which "guoties-cumque sitit oeger, large bibit."   When I have
+recalled the humane common-sense of Captain Cook in the matter of
+preventing this disease; when I have heard my friend, Mr. Dana,
+describing the avidity with which the scurvy-stricken sailors snuffed
+up the earthy fragrance of fresh raw potatoes, the food which was to
+supply the elements wanting to their spongy tissues, I have
+recognized that the perfection of art is often a return to nature,
+and seen in this single instance the germ of innumerable beneficent
+future medical reforms.
+
+I cannot help believing that medical curative treatment will by and
+by resolve itself in great measure into modifications of the food,
+swallowed and breathed, and of the natural stimuli, and that less
+will be expected from specifics and noxious disturbing agents, either
+alien or assimilable.  The noted mineral-waters containing iron,
+sulphur, carbonic acid, supply nutritious or stimulating materials to
+the body as much as phosphate of lime and ammoniacal compounds do to
+the cereal plants.  The effects of a milk and vegetable diet, of
+gluten bread in diabetes, of cod-liver oil in phthisis, even of such
+audacious innovations as the water-cure and the grape-cure, are only
+hints of what will be accomplished when we have learned to discover
+what organic elements are deficient or in excess in a case of chronic
+disease, and the best way of correcting the abnormal condition, just
+as an agriculturist ascertains the wants of his crops and modifies
+the composition of his soil.  In acute febrile diseases we have long
+ago discovered that far above all drug-medication is the use of mild
+liquid diet in the period of excitement, and of stimulant and
+nutritious food in that of exhaustion.  Hippocrates himself was as
+particular about his barley-ptisan as any Florence Nightingale of our
+time could be.
+
+The generation to which you, who are just entering the profession,
+belong, will make a vast stride forward, as I believe, in the
+direction of treatment by natural rather than violent agencies.  What
+is it that makes the reputation of Sydenham, as the chief of English
+physicians?  His prescriptions consisted principally of simples.  An
+aperient or an opiate, a "cardiac" or a tonic, may be commonly found
+in the midst of a somewhat fantastic miscellany of garden herbs.  It
+was not by his pharmaceutic prescriptions that he gained his great
+name.  It was by daring to order fresh air for small-pox patients,
+and riding on horseback for consumptives, in place of the smothering
+system, and the noxious and often loathsome rubbish of the
+established schools.  Of course Sydenham was much abused by his
+contemporaries, as he frequently takes occasion to remind his reader.
+"I must needs conclude," he says, "either that I am void of merit, or
+that the candid and ingenuous part of mankind, who are formed with so
+excellent a temper of mind as to be no strangers to gratitude, make a
+very small part of the whole."  If in the fearless pursuit of truth
+you should find the world as ungracious in the nineteenth century as
+he found it in the seventeenth, you may learn a lesson of self-
+reliance from another utterance of the same illustrious physician:
+"'T is none of my business to inquire what other persons think, but
+to establish my own observations; in order to which, I ask no favor
+of the reader but to peruse my writings with temper."
+
+The physician has learned a great deal from the surgeon, who is
+naturally in advance of him, because he has a better opportunity of
+seeing the effects of his remedies.  Let me shorten one of Ambroise
+Pare's stories for you.  There had been a great victory at the pass
+of Susa, and they were riding into the city.  The wounded cried out
+as the horses trampled them under their hoofs, which caused good
+Ambroise great pity, and made him wish himself back in Paris.  Going
+into a stable he saw four dead soldiers, and three desperately
+wounded, placed with their backs against the wall.  An old campaigner
+came up.--"Can these fellows get well?" he said.  "No!" answered the
+surgeon.  Thereupon, the old soldier walked up to them and cut all
+their throats, sweetly, and without wrath (doulcement et sans
+cholere).  Ambroise told him he was a bad man to do such a thing.
+"I hope to God;" he said, "somebody will do as much for me if I ever
+get into such a scrape" (accoustre de telle facon).  "I was not much
+salted in those days" (bien doux de sel), says Ambroise, "and little
+acquainted with the treatment of wounds."  However, as he tells us,
+he proceeded to apply boiling oil of Sambuc (elder) after the
+approved fashion of the time,--with what torture to the patient may
+be guessed.  At last his precious oil gave out, and he used instead
+an insignificant mixture of his own contrivance.  He could not sleep
+that night for fear his patients who had not been scalded with the
+boiling oil would be poisoned by the gunpowder conveyed into their
+wounds by the balls.  To his surprise, he found them much better than
+the others the next morning, and resolved never again to burn his
+patients with hot oil for gun-shot wounds.
+
+This was the beginning, as nearly as we can fix it, of that reform
+which has introduced plain water-dressings in the place of the
+farrago of external applications which had been a source of profit to
+apothecaries and disgrace to art from, and before, the time when
+Pliny complained of them.  A young surgeon who was at Sudley Church,
+laboring among the wounded of Bull Run, tells me they had nothing but
+water for dressing, and he (being also doux de sel) was astonished to
+see how well the wounds did under that simple treatment.
+
+Let me here mention a fact or two which may be of use to some of you
+who mean to enter the public service.  You will, as it seems, have
+gun-shot wounds almost exclusively to deal with.  Three different
+surgeons, the one just mentioned and two who saw the wounded of Big
+Bethel, assured me that they found no sabre-cuts or bayonet wounds.
+It is the rifle-bullet from a safe distance which pierces the breasts
+of our soldiers, and not the gallant charge of broad platoons and
+sweeping squadrons, such as we have been in the habit of considering
+the chosen mode of warfare of ancient and modern chivalry. [Sir
+Charles James Napier had the same experience in Virginia in 1813.
+"Potomac.  We have nasty sort of fighting here, amongst creeks and
+bushes, and lose men without show."  "Yankee never shows himself, he
+keeps in the thickest wood, fires and runs off."--These five
+thousand in the open field might be attacked, but behind works it
+would be throwing away lives."  He calls it "an inglorious warfare,"
+--says one of the leaders is "a little deficient in gumption,"--but
+--still my opinion is, that if we tuck up our sleeves and lay our
+ears back we might thrash them; that is, if we caught them out of
+their trees, so as to slap at them with the bayonet."--Life, etc.
+vol.  i.  p.  218 et seq.]
+
+Another fact parallels the story of the old campaigner, and may teach
+some of you caution in selecting your assistants.  A chaplain told it
+to two of our officers personally known to myself.  He overheard the
+examination of a man who wished to drive one of the "avalanche"
+wagons, as they call them.  The man was asked if he knew how to deal
+with wounded men.  "Oh yes," he answered; "if they're hit here,"
+pointing to the abdomen, "knock 'em on the head,--they can't get
+well."
+
+In art and outside of it you will meet the same barbarisms that
+Ambroise Pare met with,--for men differ less from century to century
+than we are apt to suppose; you will encounter the same opposition,
+if you attack any prevailing opinion, that Sydenham complained of.
+So far as possible, let not such experiences breed in you a contempt
+for those who are the subjects of folly or prejudice, or foster any
+love of dispute for its own sake.  Should you become authors, express
+your opinions freely; defend them rarely.  It is not often that an
+opinion is worth expressing, which cannot take care of itself.
+Opposition is the best mordant to fix the color of your thought in
+the general belief.
+
+It is time to bring these crowded remarks to a close.  The day has
+been when at the beginning of a course of Lectures I should have
+thought it fitting to exhort you to diligence and entire devotion to
+your tasks as students.  It is not so now.  The young man who has not
+heard the clarion-voices of honor and of duty now sounding throughout
+the land, will heed no word of mine.  In the camp or the city, in the
+field or the hospital, under sheltering roof, or half-protecting
+canvas, or open sky, shedding our own blood or stanching that of our
+wounded defenders, students or teachers, whatever our calling and our
+ability, we belong, not to ourselves, but to our imperilled country,
+whose danger is our calamity, whose ruin would be our enslavement,
+whose rescue shall be our earthly salvation!
+
+
+
+
+
+
+SCHOLASTIC AND BEDSIDE TEACHING.
+
+An Introductory Lecture delivered before the Medical Class of Harvard
+University, November 6, 1867.
+
+The idea is entertained by some of our most sincere professional
+brethren, that to lengthen and multiply our Winter Lectures will be
+of necessity to advance the cause of medical education.  It is a fair
+subject for consideration whether they do not overrate the relative
+importance of that particular mode of instruction which forms the
+larger part of these courses.
+
+As this School could only lengthen its lecture term at the expense of
+its "Summer Session," in which more direct, personal, and familiar
+teaching takes the place of our academic discourses, and in which
+more time can be given to hospitals, infirmaries, and practical
+instruction in various important specialties, whatever might be
+gained, a good deal would certainly be lost in our case by the
+exchange.
+
+The most essential part of a student's instruction is obtained, as I
+believe, not in the lecture-room, but at the bedside.  Nothing seen
+there is lost; the rhythms of disease are learned by frequent
+repetition; its unforeseen occurrences stamp themselves indelibly in
+the memory.  Before the student is aware of what he has acquired, he
+has learned the aspects and course and probable issue of the diseases
+he has seen with his teacher, and the proper mode of dealing with
+them, so far as his master knows it.  On the other hand, our ex
+cathedra prelections have a strong tendency to run into details
+which, however interesting they may be to ourselves and a few of our
+more curious listeners, have nothing in them which will ever be of
+use to the student as a practitioner.  It is a perfectly fair
+question whether I and some other American Professors do not teach
+quite enough that is useless already.  Is it not well to remind the
+student from time to time that a physician's business is to avert
+disease, to heal the sick, to prolong life, and to diminish
+suffering?  Is it not true that the young man of average ability will
+find it as much as he can do to fit himself for these simple duties?
+Is it not best to begin, at any rate, by making sure of such
+knowledge as he will require in his daily walk, by no means
+discouraging him from any study for which his genius fits him when he
+once feels that he has become master of his chosen art.
+
+I know that many branches of science are of the greatest value as
+feeders of our medical reservoirs.  But the practising physician's
+office is to draw the healing waters, and while he gives his time to
+this labor he can hardly be expected to explore all the sources that
+spread themselves over the wide domain of science.  The traveller who
+would not drink of the Nile until he had tracked it to its parent
+lakes, would be like to die of thirst; and the medical practitioner
+who would not use the results of many laborers in other departments
+without sharing their special toils, would find life far too short
+and art immeasurably too long.
+
+We owe much to Chemistry, one of the most captivating as well as
+important of studies; but the medical man must as a general rule
+content himself with a clear view of its principles and a limited
+acquaintance with its facts; such especially as are pertinent to his
+pursuits.  I am in little danger of underrating Anatomy or
+Physiology; but as each of these branches splits up into specialties,
+any one of which may take up a scientific life-time, I would have
+them taught with a certain judgment and reserve, so that they shall
+not crowd the more immediately practical branches.  So of all the
+other ancillary and auxiliary kinds of knowledge, I would have them
+strictly subordinated to that particular kind of knowledge for which
+the community looks to its medical advisers.
+
+A medical school is not a scientific school, except just so far as
+medicine itself is a science.  On the natural history side, medicine
+is a science; on the curative side, chiefly an art.  This is implied
+in Hufeland's aphorism: "The physician must generalize the disease
+and individualize the patient."
+
+The coordinated and classified results of empirical observation, in
+distinction from scientific experiment, have furnished almost all we
+know about food, the medicine of health, and medicine, the food of
+sickness.  We eat the root of the Solanum tuberosum and throw away
+its fruit; we eat the fruit of the Solanum Lycopersicum and throw
+away its root.  Nothing but vulgar experience has taught us to reject
+the potato ball and cook the tomato.  So of most of our remedies.
+The subchloride of mercury, calomel, is the great British specific;
+the protochloride of mercury, corrosive sublimate, kills like
+arsenic, but no chemist could have told us it would be so.
+
+From observations like these we can obtain certain principles from
+which we can argue deductively to facts of a like nature, but the
+process is limited, and we are suspicious of all reasoning in that
+direction applied to the processes of healthy and diseased life.  We
+are continually appealing to special facts.  We are willing to give
+Liebig's artificial milk when we cannot do better, but we watch the
+child anxiously whose wet-nurse is a chemist's pipkin.  A pair of
+substantial mammary glands has the advantage over the two hemispheres
+of the most learned Professor's brain, in the art of compounding a
+nutritious fluid for infants.
+
+The bedside is always the true centre of medical teaching.  Certain
+branches must be taught in the lecture-room, and will necessarily
+involve a good deal that is not directly useful to the future
+practitioner.  But the over ambitious and active student must not be
+led away by the seduction of knowledge for its own sake from his
+principal pursuit.  The humble beginner, who is alarmed at the vast
+fields of knowledge opened to him, may be encouraged by the assurance
+that with a very slender provision of science, in distinction from
+practical skill, he may be a useful and acceptable member of the
+profession to which the health of the community is intrusted.
+
+To those who are not to engage in practice, the various pursuits of
+science hardly require to be commended.  Only they must not be
+disappointed if they find many subjects treated in our courses as a
+medical class requires, rather than as a scientific class would
+expect, that is, with special limitations and constant reference to
+practical ends.  Fortunately they are within easy reach of the
+highest scientific instruction.  The business of a school like this
+is to make useful working physicians, and to succeed in this it is
+almost as important not to overcrowd the mind of the pupil with
+merely curious knowledge as it is to store it with useful
+information.
+
+In this direction I have written my lecture, not to undervalue any
+form of scientific labor in its place, an unworthy thought from which
+I hope I need not defend myself,--but to discourage any undue
+inflation of the scholastic programme, which even now asks more of
+the student than the teacher is able to obtain from the great
+majority of those who present themselves for examination.  I wish to
+take a hint in education from the Secretary of the Massachusetts
+Board of Agriculture, who regards the cultivation of too much land as
+a great defect in our New England farming.  I hope that our Medical
+Institutions may never lay themselves open to the kind of accusation
+Mr. Lowe brings against the English Universities, when he says that
+their education is made up "of words that few understand and most
+will shortly forget; of arts that can never be used, if indeed they
+can even be learnt; of histories inapplicable to our times; of
+languages dead and even mouldy; of grammatical rules that never had
+living use and are only post mortem examinations; and of statements
+fagoted with utter disregard of their comparative value."
+
+This general thought will be kept in view throughout my somewhat
+discursive address, which will begin with an imaginary clinical
+lesson from the lips of an historical personage, and close with the
+portrait from real life of one who, both as teacher and practitioner,
+was long loved and honored among us.  If I somewhat overrun my hour,
+you must pardon me, for I can say with Pascal that I have not had the
+time to make my lecture shorter.
+
+
+In the year 1647, that good man John Eliot, commonly called the
+Apostle Eliot, writing to Mr. Thomas Shepherd, the pious minister of
+Cambridge, referring to the great need of medical instruction for the
+Indians, used these words:
+
+"I have thought in my heart that it were a singular good work, if the
+Lord would stirre up the hearts of some or other of his people in
+England to give some maintenance toward some Schoole or Collegiate
+exercise this way, wherein there should be Anatomies and other
+instructions that way, and where there might be some recompence given
+to any that should bring in any vegetable or other thing that is
+vertuous in the way of Physick.
+
+"There is another reason which moves my thought and desires this way,
+namely that our young students in Physick may be trained up better
+then they yet bee, who have onely theoreticall knowledge, and are
+forced to fall to practise before ever they saw an Anatomy made, or
+duely trained up in making experiments, for we never had but one
+Anatomy in the countrey, which Mr. Giles Firman [Firmin] now in
+England, did make and read upon very well, but no more of that now."
+
+Since the time of the Apostle Eliot the Lord has stirred up the
+hearts of our people to the building of many Schools and Colleges
+where medicine is taught in all its branches.  Mr. Giles Firmin's
+"Anatomy" may be considered the first ancestor of a long line of
+skeletons which have been dangling and rattling in our lecture-rooms
+for more than a century.
+
+Teaching in New England in 1647 was a grave but simple matter.  A
+single person, combining in many cases, as in that of Mr. Giles
+Firmin, the offices of physician and preacher, taught what he knew to
+a few disciples whom he gathered about him.  Of the making of that
+"Anatomy" on which my first predecessor in the branch I teach" did
+read very well" we can know nothing.  The body of some poor wretch
+who had swung upon the gallows, was probably conveyed by night to
+some lonely dwelling at the outskirts of the village, and there by
+the light of flaring torches hastily dissected by hands that trembled
+over the unwonted task.  And ever and anon the master turned to his
+book, as he laid bare the mysteries of the hidden organs; to his
+precious Vesalius, it might be, or his figures repeated in the
+multifarious volume of Ambroise Pare; to the Aldine octavo in which
+Fallopius recorded his fresh observations; or that giant folio of
+Spigelius just issued from the press of Amsterdam, in which lovely
+ladies display their viscera with a coquettish grace implying that it
+is rather a pleasure than otherwise to show the lace-like omentum,
+and hold up their appendices epiploicae as if they were saying "these
+are our jewels."
+
+His teaching of medicine was no doubt chiefly clinical, and received
+with the same kind of faith as that which accepted his words from the
+pulpit.  His notions of disease were based on what he had observed,
+seen always in the light of the traditional doctrines in which he was
+bred.  His discourse savored of the weighty doctrines of Hippocrates,
+diluted by the subtle speculations of Galen, reinforced by the
+curious comments of the Arabian schoolmen as they were conveyed in
+the mellifluous language of Fernelius, blended, it may be, with
+something of the lofty mysticism of Van Helmont, and perhaps stealing
+a flavor of that earlier form of Homoeopathy which had lately come to
+light in Sir Kenelm Digby's "Discourse concerning the Cure of Wounds
+by the Sympathetic Powder."
+
+His Pathology was mythology.  A malformed foetus, as the readers of
+Winthrop's Journal may remember, was enough to scare the colonists
+from their propriety, and suggest the gravest fears of portended
+disaster.  The student of the seventeenth century opened his Licetus
+and saw figures of a lion with the head of a woman, and a man with
+the head of an elephant.  He had offered to his gaze, as born of a
+human mother, the effigy of a winged cherub, a pterocephalous
+specimen, which our Professor of Pathological Anatomy would hardly
+know whether to treat with the reverence due to its celestial aspect,
+or to imprison in one of his immortalizing jars of alcohol.
+
+His pharmacopoeia consisted mainly of simples, such as the venerable
+"Herball" of Gerard describes and figures in abounding affluence.
+St. John's wort and Clown's All-heal, with Spurge and Fennel, Saffron
+and Parsley, Elder and Snake-root, with opium in some form, and
+roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of
+which it used to be said that whatever the Tacamahaca has not cured,
+the Caranna will, with the more familiar Scammony and Jalap and Black
+Hellebore, made up a good part of his probable list of remedies.  He
+would have ordered Iron now and then, and possibly an occasional dose
+of Antimony.  He would perhaps have had a rheumatic patient wrapped
+in the skin of a wolf or a wild cat, and in case of a malignant fever
+with "purples" or petechiae, or of an obstinate king's evil, he might
+have prescribed a certain black powder, which had been made by
+calcining toads in an earthen pot; a choice remedy, taken internally,
+or applied to any outward grief.
+
+Except for the toad-powder and the peremptory drastics, one might
+have borne up against this herb doctoring as well as against some
+more modern styles of medication.  Barbeyrac and his scholar Sydenham
+had not yet cleansed the Pharmacopoeia of its perilous stuff, but
+there is no doubt that the more sensible physicians of that day knew
+well enough that a good honest herb-tea which amused the patient and
+his nurses was all that was required to carry him through all common
+disorders.
+
+The student soon learned the physiognomy of disease by going about
+with his master; fevers, pleurisies, asthmas, dropsies, fluxes,
+small-pox, sore-throats, measles, consumptions.  He saw what was done
+for them.  He put up the medicines, gathered the herbs, and so
+learned something of materia medico and botany.  He learned these few
+things easily and well, for he could give his whole attention to
+them.  Chirurgery was a separate specialty.  Women in child-birth
+were cared for by midwives.  There was no chemistry deserving the
+name to require his study.  He did not learn a great deal, perhaps,
+but what he did learn was his business, namely, how to take care of
+sick people.
+
+Let me give you a picture of the old=fashioned way of instruction, by
+carrying you with me in imagination in the company of worthy Master
+Giles Firmin as he makes his round of visits among the good folk of
+Ipswich, followed by his one student, who shall answer to the
+scriptural name of Luke.  It will not be for entertainment chiefly,
+but to illustrate the one mode of teaching which can never be
+superseded, and which, I venture to say, is more important than all
+the rest put together.  The student is a green hand, as you will
+perceive.
+
+In the first dwelling they come to, a stout fellow is bellowing with
+colic.
+
+"He will die, Master, of a surety, methinks," says the timid youth in
+a whisper.
+
+"Nay, Luke," the Master answers, "'t is but a dry belly-ache.  Didst
+thou not mark that he stayed his roaring when I did press hard over
+the lesser bowels?  Note that he hath not the pulse of them with
+fevers, and by what Dorcas telleth me there hath been no long
+shutting up of the vice naturales.  We will steep certain comforting
+herbs which I will shew thee, and put them in a bag and lay them on
+his belly.  Likewise he shall have my cordial julep with a portion of
+this confection which we do call Theriaca Andromachi, which hath
+juice of poppy in it, and is a great stayer of anguish.  This fellow
+is at his prayers to-day, but I warrant thee he shall be swearing
+with the best of them to-morrow."
+
+They jog along the bridle-path on their horses until they come to
+another lowly dwelling.  They sit a while with a delicate looking
+girl in whom the ingenuous youth naturally takes a special interest.
+The good physician talks cheerfully with her, asks her a few
+questions.  Then to her mother: "Good-wife, Margaret hath somewhat
+profited, as she telleth, by the goat's milk she hath taken night and
+morning.  Do thou pluck a maniple--that is an handful--of the plant
+called Maidenhair, and make a syrup therewith as I have shewed thee.
+Let her take a cup full of the same, fasting, before she sleepeth,
+also before she riseth from her bed."  And so they leave the house.
+
+"What thinkest thou, Luke, of the maid we have been visiting?"  "She
+seemeth not much ailing, Master, according to my poor judgment.  For
+she did say she was better.  And she had a red cheek and a bright
+eye, and she spake of being soon able to walk unto the meeting, and
+did seem greatly hopeful, but spare of flesh, methought, and her
+voice something hoarse, as of one that hath a defluxion, with some
+small coughing from a cold, as she did say.  Speak I not truly,
+Master, that she will be well speedily?"
+
+"Yea, Luke, I do think she shall be well, and mayhap speedily.  But
+it is not here with us she shall be well.  For that redness of the
+cheek is but the sign of the fever which, after the Grecians, we do
+call the hectical; and that shining of the eyes is but a sickly
+glazing, and they which do every day get better and likewise thinner
+and weaker shall find that way leadeth to the church-yard gate.  This
+is the malady which the ancients did call tubes, or the wasting
+disease, and some do name the consumption.  A disease whereof most
+that fall ailing do perish.  This Margaret is not long for earth--but
+she knoweth it not, and still hopeth."
+
+"Why, then, Master, didst thou give her of thy medicine, seeing that
+her ail is unto death?"
+
+"Thou shalt learn, boy, that they which are sick must have somewhat
+wherewith to busy their thoughts.  There be some who do give these
+tabid or consumptives a certain posset made with lime-water and anise
+and liquorice and raisins of the sun, and there be other some who do
+give the juice of craw-fishes boiled in barley-water with chicken-
+broth, but these be toys, as I do think, and ye shall find as good
+virtue, nay better, in this syrup of the simple called Maidenhair."
+
+Something after this manner might Master Giles Firmin have delivered
+his clinical instructions.  Somewhat in this way, a century and a
+half later, another New England physician, Dr. Edward Augustus
+Holyoke, taught a young man who came to study with him, a very
+diligent and intelligent youth, James Jackson by name, the same whose
+portrait in his advanced years hangs upon this wall, long the honored
+Professor of Theory and Practice in this Institution, of whom I shall
+say something in this Lecture.  Our venerated Teacher studied
+assiduously afterwards in the great London Hospitals, but I think he
+used to quote his "old Master" ten times where he quoted Mr. Cline or
+Dr. Woodville once.
+
+When I compare this direct transfer of the practical experience of a
+wise man into the mind of a student,--every fact one that he can use
+in the battle of life and death,--with the far off, unserviceable
+"scientific" truths that I and some others are in the habit of
+teaching, I cannot help asking myself whether, if we concede that our
+forefathers taught too little, there is not--a possibility that we
+may sometimes attempt to teach too much.  I almost blush when I think
+of myself as describing the eight several facets on two slender
+processes of the palate bone, or the seven little twigs that branch
+off from the minute tympanic nerve, and I wonder whether my excellent
+colleague feels in the same way when he pictures himself as giving
+the constitution of neurin, which as he and I know very well is that
+of the hydrate of trimethyle-oxethyle-ammonium, or the formula for
+the production of alloxan, which, though none but the Professors and
+older students can be expected to remember it, is C10 H4 N4 O6+ 2HO,
+NO5}=C8 H4 N2 O10+2CO2+N2+NH4 O, NO5.
+
+I can bear the voice of some rough iconoclast addressing the
+Anatomist and the Chemist in tones of contemptuous indignation: "What
+is this stuff with which you are cramming the brains of young men who
+are to hold the lives of the community in their hands?  Here is a man
+fallen in a fit; you can tell me all about the eight surfaces of the
+two processes of the palate bone, but you have not had the sense to
+loosen that man's neck-cloth, and the old women are all calling you a
+fool?  Here is a fellow that has just swallowed poison.  I want
+something to turn his stomach inside out at the shortest notice.  Oh,
+you have forgotten the dose of the sulphate of zinc, but you remember
+the formula for the production of alloxan!"
+
+"Look you, Master Doctor,--if I go to a carpenter to come and stop a
+leak in my roof that is flooding the house, do you suppose I care
+whether he is a botanist or not?  Cannot a man work in wood without
+knowing all about endogens and exogens, or must he attend Professor
+Gray's Lectures before he can be trusted to make a box-trap?  If my
+horse casts a shoe, do you think I will not trust a blacksmith to
+shoe him until I have made sure that he is sound on the distinction
+between the sesquioxide and the protosesquioxide of iron?"
+
+--But my scientific labor is to lead to useful results by and by, in
+the next generation, or in some possible remote future.--
+
+"Diavolo!" as your Dr. Rabelais has it,--answers the iconoclast,--
+"what is that to me and my colic, to me and my strangury?  I pay the
+Captain of the Cunard steamship to carry me quickly and safely to
+Liverpool, not to make a chart of the Atlantic for after voyagers!
+If Professor Peirce undertakes to pilot me into Boston Harbor and
+runs me on Cohasset rocks, what answer is it to tell me that he is
+Superintendent of the Coast Survey?  No, Sir!  I want a plain man in
+a pea-jacket and a sou'wester, who knows the channel of Boston
+Harbor, and the rocks of Boston Harbor, and the distinguished
+Professor is quite of my mind as to the matter, for I took the pains
+to ask him before I ventured to use his name in the way of
+illustration."
+
+
+I do not know how the remarks of the image-breaker may strike others,
+but I feel that they put me on my defence with regard to much of my
+teaching.  Some years ago I ventured to show in an introductory
+Lecture how very small a proportion of the anatomical facts taught in
+a regular course, as delivered by myself and others, had any
+practical bearing whatever on the treatment of disease.  How can I,
+how can any medical teacher justify himself in teaching anything that
+is not like to be of practical use to a class of young men who are to
+hold in their hands the balance in which life and death, ease and
+anguish, happiness and wretchedness are to be daily weighed?
+
+I hope we are not all wrong.  Oftentimes in finding how sadly
+ignorant of really essential and vital facts and rules were some of
+those whom we had been larding with the choicest scraps of science, I
+have doubted whether the old one-man system of teaching, when the one
+man was of the right sort, did not turn out better working physicians
+than our more elaborate method.  The best practitioner I ever knew
+was mainly shaped to excellence in that way.  I can understand
+perfectly the regrets of my friend Dr. John Brown of Edinburgh, for
+the good that was lost with the old apprenticeship system.  I
+understand as well Dr. Latham's fear "that many men of the best
+abilities and good education will be deterred from prosecuting physic
+as a profession, in consequence of the necessity indiscriminately
+laid upon all for impossible attainments."
+
+I feel therefore impelled to say a very few words in defence of that
+system of teaching adopted in our Colleges, by which we wish to
+supplement and complete the instruction given by private individuals
+or by what are often called Summer Schools.
+
+The reason why we teach so much that is not practical and in itself
+useful, is because we find that the easiest way of teaching what is
+practical and useful.  If we could in any way eliminate all that
+would help a man to deal successfully with disease, and teach it by
+itself so that it should be as tenaciously rooted in the memory, as
+easily summoned when wanted, as fertile in suggestion of related
+facts, as satisfactory to the peremptory demands of the intelligence
+as if taught in its scientific connections, I think it would be our
+duty so to teach the momentous truths of medicine, and to regard all
+useless additions as an intrusion on the time which should be
+otherwise occupied.
+
+But we cannot successfully eliminate and teach by itself that which
+is purely practical.  The easiest and surest why of acquiring facts
+is to learn them in groups, in systems, and systematized knowledge is
+science.  You can very often carry two facts fastened together more
+easily than one by itself, as a housemaid can carry two pails of
+water with a hoop more easily than one without it.  You can remember
+a man's face, made up of many features, better than you can his nose
+or his mouth or his eye-brow.  Scores of proverbs show you that you
+can remember two lines that rhyme better than one without the jingle.
+The ancients, who knew the laws of memory, grouped the seven cities
+that contended for the honor of being Homer's birthplace in a line
+thus given by Aulus Gellius:
+
+Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai.
+
+I remember, in the earlier political days of Martin Van Buren, that
+Colonel Stone, of the "New York Commercial," or one of his
+correspondents, said that six towns of New York would claim in the
+same way to have been the birth-place of the "Little Magician," as he
+was then called; and thus he gave their names, any one of which I
+should long ago have forgotten, but which as a group have stuck tight
+in my memory from that day to this;
+
+Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac.
+
+If the memory gains so much by mere rhythmical association, how much
+more will it gain when isolated facts are brought together under laws
+and principles, when organs are examined in their natural
+connections, when structure is coupled with function, and healthy and
+diseased action are studied as they pass one into the other!
+Systematic, or scientific study is invaluable as supplying a natural
+kind of mnemonics, if for nothing else.  You cannot properly learn
+the facts you want from Anatomy and Chemistry in any way so easily as
+by taking them in their regular order, with other allied facts, only
+there must be common sense exercised in leaving out a great deal
+which belongs to each of the two branches as pure science.  The
+dullest of teachers is the one who does not know what to omit.
+
+The larger aim of scientific training is to furnish you with
+principles to which you will be able to refer isolated facts, and so
+bring these within the range of recorded experience.  See what the
+"London Times" said about the three Germans who cracked open John
+Bull Chatwood's strong-box at the Fair the other day, while the three
+Englishmen hammered away in vain at Brother Jonathan Herring's.  The
+Englishmen represented brute force.  The Germans had been trained to
+appreciate principle.  The Englishman "knows his business by rote and
+rule of thumb"--science, which would "teach him to do in an hour what
+has hitherto occupied him two hours," "is in a manner forbidden to
+him."  To this cause the "Times" attributes the falling off of
+English workmen in comparison with those of the Continent.
+
+Granting all this, we must not expect too much from "science" as
+distinguished from common experience.  There are ten thousand
+experimenters without special apparatus for every one in the
+laboratory.  Accident is the great chemist and toxicologist.  Battle
+is the great vivisector.  Hunger has instituted researches on food
+such as no Liebig, no Academic Commission has ever recorded.
+
+Medicine, sometimes impertinently, often ignorantly, often carelessly
+called "allopathy," appropriates everything from every source that
+can be of the slightest use to anybody who is ailing in any way, or
+like to be ailing from any cause.  It learned from a monk how to use
+antimony, from a Jesuit how to cure agues, from a friar how to cut
+for stone, from a soldier how to treat gout, from a sailor how to
+keep off scurvy, from a postmaster how to sound the Eustachian tube,
+from a dairy-maid how to prevent small-pox, and from an old market-
+woman how to catch the itch-insect.  It borrowed acupuncture and the
+moxa from the Japanese heathen, and was taught the use of lobelia by
+the American savage.  It stands ready to-day to accept anything from
+any theorist, from any empiric who can make out a good case for his
+discovery or his remedy.  "Science" is one of its benefactors, but
+only one, out of many.  Ask the wisest practising physician you know,
+what branches of science help him habitually, and what amount of
+knowledge relating to each branch he requires for his professional
+duties.  He will tell you that scientific training has a value
+independent of all the special knowledge acquired.  He will tell you
+that many facts are explained by studying them in the wider range of
+related facts to which they belong.  He will gratefully recognize
+that the anatomist has furnished him with indispensable data, that
+the physiologist has sometimes put him on the track of new modes of
+treatment, that the chemist has isolated the active principles of his
+medicines, has taught him how to combine them, has from time to time
+offered him new remedial agencies, and so of others of his allies.
+But he will also tell you, if I am not mistaken, that his own branch
+of knowledge is so extensive and so perplexing that he must accept
+most of his facts ready made at their hands.  He will own to you that
+in the struggle for life which goes on day and night in our thoughts
+as in the outside world of nature, much that he learned under the
+name of science has died out, and that simple homely experience has
+largely taken the place of that scholastic knowledge to which he and
+perhaps some of his instructors once attached a paremount importance.
+
+This, then, is my view of scientific training as conducted in courses
+such as you are entering on.  Up to a certain point I believe in set
+Lectures as excellent adjuncts to what is far more important,
+practical instruction at the bedside, in the operating room, and
+under the eye of the Demonstrator.  But I am so far from wishing
+these courses extended, that I think some of them--suppose I say my
+own--would almost bear curtailing.  Do you want me to describe more
+branches of the sciatic and crural nerves?  I can take Fischer's
+plates, and lecturing on that scale fill up my whole course and not
+finish the nerves alone.  We must stop somewhere, and for my own part
+I think the scholastic exercises of our colleges have already claimed
+their full share of the student's time without our seeking to extend
+them.
+
+I trust I have vindicated the apparent inconsequence of teaching
+young students a good deal that seems at first sight profitless, but
+which helps them to learn and retain what is profitable.  But this is
+an inquisitive age, and if we insist on piling up beyond a certain
+height knowledge which is in itself mere trash and lumber to a man
+whose life is to be one long fight with death and disease, there will
+be some sharp questions asked by and by, and our quick-witted people
+will perhaps find they can get along as well without the professor's
+cap as without the bishop's mitre and the monarch's crown.
+
+I myself have nothing to do with clinical teaching.  Yet I do not
+hesitate to say it is more essential than all the rest put together,
+so far as the ordinary practice of medicine is concerned; and this is
+by far the most important thing to be learned, because it deals with
+so many more lives than any other branch of the profession.  So of
+personal instruction, such as we give and others give in the interval
+of lectures, much of it at the bedside, some of it in the laboratory,
+some in the microscope-room, some in the recitation-room, I think it
+has many advantages of its own over the winter course, and I do not
+wish to see it shortened for the sake of prolonging what seems to me
+long enough already.
+
+If I am jealous of the tendency to expand the time given to the
+acquisition of curious knowledge, at the expense of the plain old-
+fashioned bedside teachings, I only share the feeling which Sydenham
+expressed two hundred years ago, using an image I have already
+borrowed.  "He would be no honest and successful pilot who was to
+apply himself with less industry to avoid rocks and sands and bring
+his vessel safely home, than to search into the causes of the ebbing
+and flowing of the sea, which, though very well for a philosopher, is
+foreign to him whose business it is to secure the ship.  So neither
+will a physician, whose province it is to cure diseases, be able to
+do so, though he be a person of great genius, who bestows less time
+on the hidden and intricate method of nature, and adapting his means
+thereto, than on curious and subtle speculation."
+
+"Medicine is my wife and Science is my mistress," said Dr. Rush.  I
+do not think that the breach of the seventh commandment can be shown
+to have been of advantage to the legitimate owner of his affections.
+Read what Dr. Elisha Bartlett says of him as a practitioner, or ask
+one of our own honored ex-professors, who studied under him, whether
+Dr. Rush had ever learned the meaning of that saying of Lord Bacon,
+that man is the minister and interpreter of Nature, or whether he did
+not speak habitually of Nature as an intruder in the sick room, from
+which his art was to expel her as an incompetent and a meddler.
+
+All a man's powers are not too much for such a profession as
+Medicine.  "He is a learned man," said old Parson Emmons of Franklin,
+"who understands one subject, and he is a very learned man who
+understands two subjects."  Schonbein says he has been studying
+oxygen for thirty years.  Mitscherlich said it took fourteen years to
+establish a new fact in chemistry.  Aubrey says of Harvey, the
+discoverer of the circulation, that "though all his profession would
+allow him to be an excellent anatomist, I have never heard of any who
+admired his therapeutic way."  My learned and excellent friend before
+referred to, Dr. Brown of Edinburgh, from whose very lively and
+sensible Essay, "Locke and Sydenham," I have borrowed several of my
+citations, contrasts Sir Charles Bell, the discoverer, the man of
+science, with Dr. Abercrombie, the master in the diagnosis and
+treatment of disease.  It is through one of the rarest of
+combinations that we have in our Faculty a teacher on whom the
+scientific mantle of Bell has fallen, and who yet stands preeminent
+in the practical treatment of the class of diseases which his
+inventive and ardent experimental genius has illustrated.  M. Brown-
+Sequard's example is as, eloquent as his teaching in proof of the
+advantages of well directed scientific investigation.  But those who
+emulate his success at once as a discoverer and a practitioner must
+be content like him to limit their field of practice.  The highest
+genius cannot afford in our time to forget the ancient precept,
+Divide et impera.
+
+"I suppose I must go and earn this guinea," said a medical man who
+was sent for while he was dissecting an animal.  I should not have
+cared to be his patient.  His dissection would do me no good, and his
+thoughts would be too much upon it.  I want a whole man for my
+doctor, not a half one.  I would have sent for a humbler
+practitioner, who would have given himself entirely to me, and told
+the other--who was no less a man than John Hunter--to go on and
+finish the dissection of his tiger.
+
+Sydenham's "Read Don Quixote" should be addressed not to the student,
+but to the Professor of today.  Aimed at him it means, "Do not be too
+learned."
+
+Do not think you are going to lecture to picked young men who are
+training themselves to be scientific discoverers.  They are of fair
+average capacity, and they are going to be working doctors.
+
+These young men are to have some very serious vital facts to deal
+with.  I will mention a few of them.
+
+Every other resident adult you meet in these streets is or will be
+more or less tuberculous.  This is not an extravagant estimate, as
+very nearly one third of the deaths of adults in Boston last year
+were from phthisis.  If the relative number is less in our other
+northern cities, it is probably in a great measure because they are
+more unhealthy; that is, they have as much, or nearly as much,
+consumption, but they have more fevers or other fatal diseases.
+
+These heavy-eyed men with the alcoholized brains, these pallid youths
+with the nicotized optic ganglia and thinking-marrows brown as their
+own meerschaums, of whom you meet too many,--will ask all your wisdom
+to deal with their poisoned nerves and their enfeebled wills.
+
+Nearly seventeen hundred children under five years of age died last
+year in this city.  A poor human article, no doubt, in many cases,
+still, worth an attempt to save them, especially when we remember the
+effect of Dr. Clarke's suggestion at the Dublin Hospital, by which
+some twenty-five or thirty thousand children's lives have probably
+been saved in a single city.
+
+Again, the complaint is often heard that the native population is not
+increasing so rapidly as in former generations.  The breeding and
+nursing period of American women is one of peculiar delicacy and
+frequent infirmity.  Many of them must require a considerable
+interval between the reproductive efforts, to repair damages arid
+regain strength.  This matter is not to be decided by an appeal to
+unschooled nature.  It is the same question as that of the deformed
+pelvis,--one of degree.  The facts of mal-vitalization are as much to
+be attended to as those of mal-formation.  If the woman with a
+twisted pelvis is to be considered an exempt, the woman with a
+defective organization should be recognized as belonging to the
+invalid corps.  We shudder to hear what is alleged as to the
+prevalence of criminal practices; if back of these there can be shown
+organic incapacity or overtaxing of too limited powers, the facts
+belong to the province of the practical physician, as well as of the
+moralist and the legislator, and require his gravest consideration.
+
+Take the important question of bleeding.  Is venesection done with
+forever?  Six years ago it was said here in an introductory Lecture
+that it would doubtless come back again sooner or later.  A fortnight
+ago I found myself in the cars with one of the most sensible and
+esteemed practitioners in New England.  He took out his wallet and
+showed me two lancets, which he carried with him; he had never given
+up their use.  This is a point you will have to consider.
+
+Or, to mention one out of many questionable remedies, shall you give
+Veratrum Viride in fevers and inflammations?  It makes the pulse
+slower in these affections.  Then the presumption would naturally be
+that it does harm.  The caution with reference to it on this ground
+was long ago recorded in the Lecture above referred to.  See what Dr.
+John Hughes Bennett says of it in the recent edition of his work on
+Medicine.  Nothing but the most careful clinical experience can
+settle this and such points of treatment.
+
+These are all practical questions--questions of life and death, and
+every day will be full of just such questions.  Take the problem of
+climate.  A patient comes to you with asthma and wants to know where
+he can breathe; another comes to you with phthisis and wants to know
+where he can live.  What boy's play is nine tenths of all that is
+taught in many a pretentious course of lectures, compared with what
+an accurate and extensive knowledge of the advantages and
+disadvantages of different residences in these and other complaints
+would be to a practising physician
+
+I saw the other day a gentleman living in Canada, who had spent seven
+successive winters in Egypt, with the entire relief of certain
+obscure thoracic symptoms which troubled him while at home.  I saw,
+two months ago, another gentleman from Minnesota, an observer and a
+man of sense, who considered that State as the great sanatorium for
+all pulmonary complaints.  If half our grown population are or will
+be more or less tuberculous, the question of colonizing Florida
+assumes a new aspect.  Even within the borders of our own State, the
+very interesting researches of Dr. Bowditch show that there is a
+great variation in the amount of tuberculous disease in different
+towns, apparently connected with local conditions.  The hygienic map
+of a State is quite as valuable as its geological map, and it is the
+business of every practising physician to know it thoroughly.  They
+understand this in England, and send a patient with a dry irritating
+cough to Torquay or Penzance, while they send another with relaxed
+bronchial membranes to Clifton or Brighton.  Here is another great
+field for practical study.
+
+So as to the all-important question of diet.  "Of all the means of
+cure at our command," says Dr. Bennett, "a regulation of the quantity
+and quality of the diet is by far the most powerful."  Dr. MacCormac
+would perhaps except the air we breathe, for he thinks that impure
+air, especially in sleeping rooms, is the great cause of tubercle.
+It is sufficiently proved that the American,--the New Englander,--the
+Bostonian, can breed strong and sound children, generation after
+generation,--nay, I have shown by the record of a particular family
+that vital losses may be retrieved, and a feeble race grow to lusty
+vigor in this very climate and locality.  Is not the question why our
+young men and women so often break down, and how they can be kept
+from breaking down, far more important for physicians to settle than
+whether there is one cranial vertebra, or whether there are four, or
+none?
+
+--But I have a taste for the homologies, I want to go deeply into the
+subject of embryology, I want to analyze the protonihilates
+precipitated from pigeon's milk by the action of the lunar spectrum,-
+shall I not follow my star,--shall I not obey my instinct,--shall I
+not give myself to the lofty pursuits of science for its own sake?
+
+Certainly you may, if you like.  But take down your sign, or never
+put it up.  That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and
+Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the
+difficulty.  We all admire the achievements of this band of
+distinguished doctors who do not practise.  But we say of their work
+and of all pure science, as the French officer said of the charge of
+the six hundred at Balaclava, "C'est magnifique, mais ce n'est pas la
+guerre,"--it is very splendid, but it is not a practising doctor's
+business.  His patient has a right to the cream of his life and not
+merely to the thin milk that is left after "science" has skimmed it
+off.  The best a physician can give is never too good for the
+patient.
+
+It is often a disadvantage to a young practitioner to be known for
+any accomplishment outside of his profession.  Haller lost his
+election as Physician to the Hospital in his native city of Berne,
+principally on the ground that he was a poet.  In his later years the
+physician may venture more boldly.  Astruc was sixty-nine years old
+when he published his "Conjectures," the first attempt, we are told,
+to decide the authorship of the Pentateuch showing anything like a
+discerning criticism.  Sir Benjamin Brodie was seventy years old
+before he left his physiological and surgical studies to indulge in
+psychological speculations.  The period of pupilage will be busy
+enough in acquiring the knowledge needed, and the season of active
+practice will leave little leisure for any but professional studies.
+
+Dr. Graves of Dublin, one of the first clinical teachers of our time,
+always insisted on his students' beginning at once to visit the
+hospital.  At the bedside the student must learn to treat disease,
+and just as certainly as we spin out and multiply our academic
+prelections we shall work in more and more stuffing, more and more
+rubbish, more and more irrelevant, useless detail which the student
+will get rid of just as soon as he leaves us.  Then the next thing
+will be a new organization, with an examining board of first-rate
+practical men, who will ask the candidate questions that mean
+business,--who will make him operate if he is to be a surgeon, and
+try him at the bedside if he is to be a physician,--and not puzzle
+him with scientific conundrums which not more than one of the
+questioners could answer himself or ever heard of since he graduated.
+
+Or these women who are hammering at the gates on which is written "No
+admittance for the mothers of mankind," will by and by organize an
+institution, which starting from that skilful kind of nursing which
+Florence Nightingale taught so well, will work backwards through
+anodynes, palliatives, curatives, preventives, until with little show
+of science it imparts most of what is most valuable in those branches
+of the healing art it professes to teach.  When that time comes, the
+fitness of women for certain medical duties, which Hecquet advocated
+in 1708, which Douglas maintained in 1736, which Dr. John Ware, long
+the honored Professor of Theory and Practice in this Institution,
+upheld within our own recollection in the face of his own recorded
+opinion to the contrary, will very possibly be recognized.
+
+My advice to every teacher less experienced than myself would be,
+therefore: Do not fret over the details you have to omit; you
+probably teach altogether too many as it is.  Individuals may learn a
+thing with once hearing it, but the only way of teaching a whole
+class is by enormous repetition, representation, and illustration in
+all possible forms.  Now and then you will have a young man on your
+benches like the late Waldo Burnett,--not very often, if you lecture
+half a century.  You cannot pretend to lecture chiefly for men like
+that,--a Mississippi raft might as well take an ocean-steamer in tow.
+To meet his wants you would have to leave the rest of your class
+behind and that you must not do.  President Allen of Jefferson
+College says that his instruction has been successful in proportion
+as it has been elementary.  It may be a humiliating statement, but it
+is one which I have found true in my own experience.
+
+To the student I would say, that however plain and simple may be our
+teaching, he must expect to forget much which he follows
+intelligently in the lecture-room.  But it is not the same as if he
+had never learned it.  A man must get a thing before he can forget
+it.  There is a great world of ideas we cannot voluntarily recall,--
+they are outside the limits of the will.  But they sway our conscious
+thought as the unseen planets influence the movements of those within
+the sphere of vision.  No man knows how much he knows,--how many
+ideas he has,--any more than he knows how many blood-globules roll in
+his veins.  Sometimes accident brings back here and there one, but
+the mind is full of irrevocable remembrances and unthinkable
+thoughts, which take a part in all its judgments as indestructible
+forces.  Some of you must feel your scientific deficiencies painfully
+after your best efforts.  But every one can acquire what is most
+essential.  A man of very moderate ability may be a good physician,
+if he devotes himself faithfully to the work.  More than this, a
+positively dull man, in the ordinary acceptation of the term,
+sometimes makes a safer practitioner than one who has, we will say,
+five per cent. more brains than his average neighbor, but who thinks
+it is fifty per cent. more.  Skulls belonging to this last variety of
+the human race are more common, I may remark, than specimens like the
+Neanderthal cranium, a cast of which you will find on the table in
+the Museum.
+
+Whether the average talent be high or low, the Colleges of the land
+must make the best commodity they can out of such material as the
+country and the cities furnish them.  The community must have Doctors
+as it must have bread.  It uses up its Doctors just as it wears out
+its shoes, and requires new ones.  All the bread need not be French
+rolls, all the shoes need not be patent leather ones; but the bread
+must be something that can be eaten, and the shoes must be something
+that can be worn.  Life must somehow find food for the two forces
+that rub everything to pieces, or burn it to ashes,--friction and
+oxygen.  Doctors are oxydable products, and the schools must keep
+furnishing new ones as the old ones turn into oxyds; some of first-
+rate quality that burn with a great light, some of a lower grade of
+brilliancy, some honestly, unmistakably, by the grace of God, of
+moderate gifts, or in simpler phrase, dull.
+
+The public will give every honest and reasonably competent worker in
+the healing art a hearty welcome.  It is on the whole very loyal to
+the Medical Profession.  Three successive years have borne witness to
+the feeling with which this Institution, representing it in its
+educational aspect, is regarded by those who are themselves most
+honored and esteemed.  The great Master of Natural Science bade the
+last year's class farewell in our behalf, in those accents which
+delight every audience.  The Head of our ancient University honored
+us in the same way in the preceding season.  And how can we forget
+that other occasion when the Chief Magistrate of the Commonwealth,
+that noble citizen whom we have just lost, large-souled, sweet-
+natured, always ready for every kind office, came among us at our
+bidding, and talked to us of our duties in words as full of wisdom as
+his heart was of goodness?
+
+You have not much to fear, I think, from the fancy practitioners.
+The vulgar quackeries drop off, atrophied, one after another.
+Homoeopathy has long been encysted, and is carried on the body
+medical as quietly as an old wen.  Every year gives you a more
+reasoning and reasonable people to deal with.  See how it is in
+Literature.  The dynasty of British dogmatists, after lasting a
+hundred years and more, is on its last legs.  Thomas Carlyle, third
+in the line of descent, finds an audience very different from those
+which listened to the silver speech of Samuel Taylor Coleridge and
+the sonorous phrases of Samuel Johnson.  We read him, we smile at his
+clotted English, his "swarmery" and other picturesque expressions,
+but we lay down his tirade as we do one of Dr. Cumming's
+interpretations of prophecy, which tells us that the world is coming
+to an end next week or next month, if the weather permits,--not
+otherwise,--feeling very sure that the weather will be unfavorable.
+
+It is the same common-sense public you will appeal to.  The less
+pretension you make, the better they will like you in the long run.
+I hope we shall make everything as plain and as simple to you as we
+can.  I would never use a long word, even, where a short one would
+answer the purpose.  I know there are professors in this country who
+"ligate" arteries.  Other surgeons only tie them, and it stops the
+bleeding just as well.  It is the familiarity and simplicity of
+bedside instruction which makes it so pleasant as well as so
+profitable.  A good clinical teacher is himself a Medical School.  We
+need not wonder that our young men are beginning to announce
+themselves not only as graduates of this or that College, but also as
+pupils of some one distinguished master.
+
+I wish to close this Lecture, if you will allow me a few moments
+longer, with a brief sketch of an instructor and practitioner whose
+character was as nearly a model one in both capacities as I can find
+anywhere recorded.
+
+Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
+in this University from 1812 to 1846, and whose name has been since
+retained on our rolls as Professor Emeritus, died on the 27th of
+August last, in the ninetieth year of his age.  He studied his
+profession, as I have already mentioned, with Dr. Holyoke of Salem,
+one of the few physicians who have borne witness to their knowledge
+of the laws of life by living to complete their hundredth year.  I
+think the student took his Old Master, as he always loved to call
+him, as his model; each was worthy of the other, and both were bright
+examples to all who come after them.
+
+I remember that in the sermon preached by Dr. Grazer after Dr.
+Holyoke's death, one of the points most insisted upon as
+characteristic of that wise and good old man was the perfect balance
+of all his faculties.  The same harmonious adjustment of powers, the
+same symmetrical arrangement of life, the same complete fulfilment of
+every day's duties, without haste and without needless delay, which
+characterized the master, equally distinguished the scholar.  A
+glance at the life of our own Old Master, if I can do any justice at
+all to his excellences, will give you something to carry away from
+this hour's meeting not unworthy to be remembered.
+
+From December, 1797, to October, 1799, he remained with Dr. Holyoke
+as a student, a period which he has spoken of as a most interesting
+and most gratifying part of his life.  After this he passed eight
+months in London, and on his return, in October, 1800, he began
+business in Boston.
+
+He had followed Mr. Cline, as I have mentioned, and was competent to
+practise Surgery.  But he found Dr. John Collins Warren had already
+occupied the ground which at that day hardly called for more than one
+leading practitioner, and wisely chose the Medical branch of the
+profession.  He had only himself to rely upon, but he had confidence
+in his prospects, conscious, doubtless, of his own powers, knowing
+his own industry and determination, and being of an eminently
+cheerful and hopeful disposition.  No better proof of his spirit can
+be given than that, just a year from the time when he began to
+practise as a physician, he took that eventful step which in such a
+man implies that he sees his way clear to a position; he married a
+lady blessed with many gifts, but not bringing him a fortune to
+paralyze his industry.
+
+He had not miscalculated his chances in life.  He very soon rose into
+a good practice, and began the founding of that reputation which grew
+with his years, until he stood by general consent at the head of his
+chosen branch of the profession, to say the least, in this city and
+in all this region of country.  His skill and wisdom were the last
+tribunal to which the sick and suffering could appeal.  The community
+trusted and loved him, the profession recognized him as the noblest
+type of the physician.  The young men whom he had taught wandered
+through foreign hospitals; where they learned many things that were
+valuable, and many that were curious; but as they grew older and
+began to think more of their ability to help the sick than their
+power of talking about phenomena, they began to look back to the
+teaching of Dr. Jackson, as he, after his London experience, looked
+back to that of Dr. Holyoke.  And so it came to be at last that the
+bare mention of his name in any of our medical assemblies would call
+forth such a tribute of affectionate regard as is only yielded to age
+when it brings with it the record of a life spent in well doing.
+
+No accident ever carries a man to eminence such as his in the medical
+profession.  He who looks for it must want it earnestly and work for
+it vigorously; Nature must have qualified him in many ways, and
+education must have equipped him with various knowledge, or his
+reputation will evaporate before it reaches the noon-day blaze of
+fame.  How did Dr. Jackson gain the position which all conceded to
+him?  In the answer to this question some among you may find a key
+that shall unlock the gate opening on that fair field of the future
+of which all dream but which not all will ever reach.
+
+First of all, he truly loved his profession.  He had no intellectual
+ambitions outside of it, literary, scientific or political.  To him
+it was occupation enough to apply at the bedside the best of all that
+he knew for the good of his patient; to protect the community against
+the inroads of pestilence; to teach the young all that he himself had
+been taught, with all that his own experience had added; to leave on
+record some of the most important results of his long observation.
+
+With his patients he was so perfect at all points that it is hard to
+overpraise him.  I have seen many noted British and French and
+American practitioners, but I never saw the man so altogether
+admirable at the bedside of the sick as Dr. James Jackson.  His smile
+was itself a remedy better than the potable gold and the dissolved
+pearls that comforted the praecordia of mediaeval monarchs.  Did a
+patient, alarmed without cause, need encouragement, it carried the
+sunshine of hope into his heart and put all his whims to flight, as
+David's harp cleared the haunted chamber of the sullen king.  Had the
+hour come, not for encouragement, but for sympathy, his face, his
+voice, his manner all showed it, because his heart felt it.  So
+gentle was he, so thoughtful, so calm, so absorbed in the case before
+him, not to turn round and look for a tribute to his sagacity, not to
+bolster himself in a favorite theory, but to find out all he could,
+and to weigh gravely and cautiously all that he found, that to follow
+him in his morning visit was not only to take a lesson in the healing
+art, it was learning how to learn, how to move, how to look, how to
+feel, if that can be learned.  To visit with Dr. Jackson was a
+medical education.
+
+He was very firm, with all his kindness.  He would have the truth
+about his patients.  The nurses found it out; and the shrewder ones
+never ventured to tell him anything but a straight story.  A clinical
+dialogue between Dr. Jackson and Miss Rebecca Taylor, sometime nurse
+in the Massachusetts General Hospital, a mistress in her calling, was
+as good questioning and answering as one would be like to hear
+outside of the court-room.
+
+Of his practice you can form an opinion from his book called "Letters
+to a Young Physician."  Like all sensible men from the days of
+Hippocrates to the present, he knew that diet and regimen were more
+important than any drug or than all drugs put together.  Witness his
+treatment of phthisis and of epilepsy.  He retained, however, more
+confidence in some remedial agents than most of the younger
+generation would concede to them.  Yet his materia medica was a
+simple one.
+
+"When I first went to live with Dr. Holyoke," he says, "in 1797,
+showing me his shop, he said, 'There seems to you to be a great
+variety of medicines here, and that it will take you long to get
+acquainted with them, but most of them are unimportant.  There are
+four which are equal to all the rest, namely, Mercury, Antimony, Bark
+and Opium.'"  And Dr. Jackson adds, "I can only say of his practice,
+the longer I have lived, I have thought better and better of it."
+When he thought it necessary to give medicine, he gave it in earnest.
+He hated half-practice--giving a little of this or that, so as to be
+able to say that one had done something, in case a consultation was
+held, or a still more ominous event occurred.  He would give opium,
+for instance, as boldly as the late Dr. Fisher of Beverly, but he
+followed the aphorism of the Father of Medicine, and kept extreme
+remedies for extreme cases.
+
+When it came to the "non-naturals," as he would sometimes call them,
+after the old physicians,--namely, air, meat and drink, sleep and
+watching, motion and rest, the retentions and excretions, and the
+affections of the mind,--he was, as I have said, of the school of
+sensible practitioners, in distinction from that vast community of
+quacks, with or without the diploma, who think the chief end of man
+is to support apothecaries, and are never easy until they can get
+every patient upon a regular course of something nasty or noxious.
+Nobody was so precise in his directions about diet, air, and
+exercise, as Dr. Jackson.  He had the same dislike to the a peu pres,
+the about so much, about so often, about so long, which I afterwards
+found among the punctilious adherents of the numerical system at La
+Pitie.
+
+He used to insist on one small point with a certain philological
+precision, namely, the true meaning of the word "cure."  He would
+have it that to cure a patient was simply to care for him.  I refer
+to it as showing what his idea was of the relation of the physician
+to the patient.  It was indeed to care for him, as if his life were
+bound up in him, to watch his incomings and outgoings, to stand guard
+at every avenue that disease might enter, to leave nothing to chance;
+not merely to throw a few pills and powders into one pan of the
+scales of Fate, while Death the skeleton was seated in the other, but
+to lean with his whole weight on the side of life, and shift the
+balance in its favor if it lay in human power to do it.  Such
+devotion as this is only to be looked for in the man who gives
+himself wholly up to the business of healing, who considers Medicine
+itself a Science, or if not a science, is willing to follow it as an
+art,--the noblest of arts, which the gods and demigods of ancient
+religions did not disdain to practise and to teach.
+
+The same zeal made him always ready to listen to any new suggestion
+which promised to be useful, at a period of life when many men find
+it hard to learn new methods and accept new doctrines.  Few of his
+generation became so accomplished as he in the arts of direct
+exploration; coming straight from the Parisian experts, I have
+examined many patients with him, and have had frequent opportunities
+of observing his skill in percussion and auscultation.
+
+One element in his success, a trivial one compared with others, but
+not to be despised, was his punctuality.  He always carried two
+watches,--I doubt if he told why, any more than Dr. Johnson told what
+he did with the orange-peel,--but probably with reference to this
+virtue.  He was as much to be depended upon at the appointed time as
+the solstice or the equinox.  There was another point I have heard
+him speak of as an important rule with him; to come at the hour when
+he was expected; if he had made his visit for several days
+successively at ten o'clock, for instance, not to put it off, if be
+could possibly help it, until eleven, and so keep a nervous patient
+and an anxious family waiting for him through a long, weary hour.
+
+If I should attempt to characterize his teaching, I should say that
+while it conveyed the best results of his sagacious and extended
+observation, it was singularly modest, cautious, simple, sincere.
+Nothing was for show, for self-love; there was no rhetoric, no
+declamation, no triumphant "I told you so," but the plain statement
+of a clear-headed honest man, who knows that he is handling one of
+the gravest subjects that interest humanity.  His positive
+instructions were full of value, but the spirit in which he taught
+inspired that loyal love of truth which lies at the bottom of all
+real excellence.
+
+I will not say that, during his long career, Dr. Jackson never made
+an enemy.  I have heard him tell how, in his very early days, old Dr.
+Danforth got into a towering passion with him about some professional
+consultation, and exploded a monosyllable or two of the more
+energetic kind on the occasion.  I remember that that somewhat
+peculiar personage, Dr. Waterhouse, took it hardly when Dr. Jackson
+succeeded to his place as Professor of Theory and Practice.  A young
+man of Dr. Jackson's talent and energy could hardly take the position
+that belonged to him without crowding somebody in a profession where
+three in a bed is the common rule of the household.  But he was a
+peaceful man and a peace-maker all his days.  No man ever did more,
+if so much, to produce and maintain the spirit of harmony for which
+we consider our medical community as somewhat exceptionally
+distinguished.
+
+If this harmony should ever be threatened, I could wish that every
+impatient and irritable member of the profession would read that
+beautiful, that noble Preface to the "Letters," addressed to John
+Collins Warren.  I know nothing finer in the medical literature of
+all time than this Prefatory Introduction.  It is a golden prelude,
+fit to go with the three great Prefaces which challenge the
+admiration of scholars,--Calvin's to his Institutes, De Thou's to his
+History, and Casaubon's to his Polybius,--not because of any learning
+or rhetoric, though it is charmingly written, but for a spirit
+flowing through it to which learning and rhetoric are but as the
+breath that is wasted on the air to the Mood that warms the heart.
+
+Of a similar character is this short extract which I am permitted to
+make from a private letter of his to a dear young friend.  He was
+eighty-three years old at the time of writing it.
+
+"I have not loved everybody whom I have known, but I have striven to
+see the good points in the characters of all men and women.  At first
+I must have done this from something in my own nature, for I was not
+aware of it, and yet was doing it without any plan, when one day,
+sixty years ago, a friend whom I loved and respected said this to me,
+'Ah, James, I see that you are destined to succeed in the world, and
+to make friends, because you are so ready to see the good point in
+the characters of those you meet.'"
+
+I close this imperfect notice of some features in the character of
+this most honored and beloved of physicians by applying to him the
+words which were written of William Heberden, whose career was not
+unlike his own, and who lived to the same patriarchal age.
+
+"From his early youth he had always entertained a deep sense of
+religion, a consummate love of virtue, an ardent thirst after
+knowledge, and an earnest desire to promote the welfare and happiness
+of all mankind.  By these qualities, accompanied with great sweetness
+of manners, he acquired the love and esteem of all good men, in a
+degree which perhaps very few have experienced; and after passing an
+active life with the uniform testimony of a good conscience, he
+became an eminent example of its influence, in the cheerfulness and
+serenity of his latest age."
+
+Such was the man whom I offer to you as a model, young gentlemen, at
+the outset of your medical career.  I hope that many of you will
+recognize some traits of your own special teachers scattered through
+various parts of the land in the picture I have drawn.  Let me assure
+you that whatever you may learn in this or any other course of public
+lectures,--and I trust you will learn a great deal,--the daily
+guidance, counsel, example, of your medical father, for such the Oath
+of Hippocrates tells you to consider your preceptor, will, if he is
+in any degree like him of whom I have spoken, be the foundation on
+which all that we teach is reared, and perhaps outlive most of our
+teachings, as in Dr. Jackson's memory the last lessons that remained
+with him were those of his Old Master.
+
+
+
+
+
+
+THE MEDICAL PROFESSION IN MASSACHUSETTS.
+
+A Lecture of a Course by members of the Massachusetts Historical
+Society, delivered before the Lowell Institute, January 29, 1869.
+
+The medical history of eight generations, told in an hour, must be in
+many parts a mere outline.  The details I shall give will relate
+chiefly to the first century.  I shall only indicate the leading
+occurrences, with the more prominent names of the two centuries which
+follow, and add some considerations suggested by the facts which have
+been passed in review.
+
+A geographer who was asked to describe the tides of Massachusetts
+Bay, would have to recognize the circumstance that they are a limited
+manifestation of a great oceanic movement.  To consider them apart
+from this, would be to localize a planetary phenomenon, and to
+provincialize a law of the universe.  The art of healing in
+Massachusetts has shared more or less fully and readily the movement
+which, with its periods of ebb and flow, has been raising its level
+from age to age throughout the better part of Christendom.  Its
+practitioners brought with them much of the knowledge and many of the
+errors of the Old World; they have always been in communication with
+its wisdom and its folly; it is not without interest to see how far
+the new conditions in which they found themselves have been favorable
+or unfavorable to the growth of sound medical knowledge and practice.
+
+The state of medicine is an index of the civilization of an age and
+country,--one of the best, perhaps, by which it can be judged.
+Surgery invokes the aid of all the mechanical arts.  From the rude
+violences of the age of stone,--a relic of which we may find in the
+practice of Zipporah, the wife of Moses,--to the delicate operations
+of to-day upon patients lulled into temporary insensibility, is a
+progress which presupposes a skill in metallurgy and in the labors of
+the workshop and the laboratory it has taken uncounted generations to
+accumulate.  Before the morphia which deadens the pain of neuralgia,
+or the quinine which arrests the fit of an ague, can find their place
+in our pharmacies, commerce must have perfected its machinery, and
+science must have refined its processes, through periods only to be
+counted by the life of nations.  Before the means which nature and
+art have put in the hands of the medical practitioner can be fairly
+brought into use, the prejudices of the vulgar must be overcome, the
+intrusions of false philosophy must be fenced out, and the
+partnership with the priesthood dissolved.  All this implies that
+freedom and activity of thought which belong only to the most
+advanced conditions of society; and the progress towards this is by
+gradations as significant of wide-spread changes, as are the varying
+states of the barometer of far-extended conditions of the atmosphere.
+
+Apart, then, from its special and technical interest, my subject has
+a meaning which gives a certain importance, and even dignity, to
+details in themselves trivial and almost unworthy of record.  A
+medical entry in Governor Winthrop's journal may seem at first sight
+a mere curiosity; but, rightly interpreted, it is a key to his whole
+system of belief as to the order of the universe and the relations
+between man and his Maker.  Nothing sheds such light on the
+superstitions of an age as the prevailing interpretation and
+treatment of disease.  When the touch of a profligate monarch was a
+cure for one of the most inveterate of maladies, when the common
+symptoms of hysteria were prayed over as marks of demoniacal
+possession, we might well expect the spiritual realms of thought to
+be peopled with still stranger delusions.
+
+Let us go before the Pilgrims of the Mayflower, and look at the
+shores on which they were soon to land.  A wasting pestilence had so
+thinned the savage tribes that it was sometimes piously interpreted
+as having providentially prepared the way for the feeble band of
+exiles.  Cotton Mather, who, next to the witches, hated the
+"tawnies," "wild beasts," "blood-hounds," "rattlesnakes,"
+"infidels," as in different places he calls the unhappy Aborigines,
+describes the condition of things in his lively way, thus:
+"The Indians in these Parts had newly, even about a Year or Two
+before, been visited with such a prodigious Pestilence; as carried
+away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of
+Twenty) among them so that the Woods were almost cleared of those
+pernicious Creatures to make Room for a better Growth."
+
+What this pestilence was has been much discussed.  It is variously
+mentioned by different early writers as "the plague," "a great and
+grievous plague," "a sore consumption," as attended with spots which
+left unhealed places on those who recovered, as making the "whole
+surface yellow as with a garment."  Perhaps no disease answers all
+these conditions so well as smallpox.  We know from different sources
+what frightful havoc it made among the Indians in after years,--in
+1631, for instance, when it swept away the aboriginal inhabitants of
+"whole towns," and in 1633.  We have seen a whole tribe, the Mandans,
+extirpated by it in our own day.  The word "plague" was used very
+vaguely, as in the description of the "great sickness" found among
+the Indians by the expedition of 1622.  This same great sickness
+could hardly have been yellow fever, as it occurred in the month of
+November.  I cannot think, therefore, that either the scourge of the
+East or our Southern malarial pestilence was the disease that wasted
+the Indians.  As for the yellowness like a garment, that is too
+familiar to the eyes of all who have ever looked on the hideous mask
+of confluent variola.
+
+Without the presence or the fear of these exotic maladies, the
+forlorn voyagers of the Mayflower had sickness enough to contend
+with.  At their first landing at Cape Cod, gaunt and hungry and
+longing for fresh food, they found upon the sandy shore "great
+mussel's, and very fat and full of sea-pearl."  Sailors and
+passengers indulged in the treacherous delicacy; which seems to have
+been the sea-clam; and found that these mollusks, like the shell the
+poet tells of, remembered their august abode, and treated the way-
+worn adventurers to a gastric reminiscence of the heaving billows.
+In the mean time it blew and snowed and froze.  The water turned to
+ice on their clothes, and made them many times like coats of iron.
+Edward Tilley had like to have "sounded" with cold.  The gunner, too,
+was sick unto death, but "hope of trucking" kept him on his feet,--a
+Yankee, it should seem, when he first touched the shore of New
+England.  Most, if not all, got colds and coughs, which afterwards
+turned to scurvy, whereof many died.
+
+How can we wonder that the crowded and tempest-tossed voyagers, many
+of them already suffering, should have fallen before the trials of
+the first winter in Plymouth?  Their imperfect shelter, their
+insufficient supply of bread, their salted food, now in unwholesome
+condition, account too well for the diseases and the mortality that
+marked this first dreadful season; weakness, swelling of the limbs,
+and other signs of scurvy, betrayed the want of proper nourishment
+and protection from the elements.  In December six of their number
+died, in January eight, in February, seventeen, in March thirteen.
+With the advance of spring the mortality diminished, the sick and
+lame began to recover, and the colonists, saddened but not
+disheartened, applied themselves to the labors of the opening year.
+
+One of the most pressing needs of the early colonists must have been
+that of physicians and surgeons.  In Mr. Savage's remarkable
+Genealogical Dictionary of the first settlers who came over before
+1692 and their descendants to the third generation, I find scattered
+through the four crowded volumes the names of one hundred and thirty-
+four medical practitioners.  Of these, twelve, and probably many
+more, practised surgery; three were barber-surgeons.  A little
+incident throws a glimmer from the dark lantern of memory upon
+William Direly, one of these practitioners with the razor and the
+lancet.  He was lost between Boston and Roxbury in a violent tempest
+of wind and snow; ten days afterwards a son was born to his widow,
+and with a touch of homely sentiment, I had almost said poetry, they
+called the little creature "Fathergone" Direly.  Six or seven,
+probably a larger number, were ministers as well as physicians, one
+of whom, I am sorry to say, took to drink and tumbled into the
+Connecticut River, and so ended.  One was not only doctor, but also
+schoolmaster and poet.  One practised medicine and kept a tavern.
+One was a butcher, but calls himself a surgeon in his will, a union
+of callings which suggests an obvious pleasantry.  One female
+practitioner, employed by her own sex,--Ann Moore,--was the precursor
+of that intrepid sisterhood whose cause it has long been my pleasure
+and privilege to advocate on all fitting occasions.
+
+Outside of this list I must place the name of Thomas Wilkinson, who
+was complained of, is 1676, for practising contrary to law.
+
+Many names in the catalogue of these early physicians have been
+associated, in later periods, with the practice of the profession,--
+among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge,
+Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams,
+Woodward.  Touton was a Huguenot, Burchsted a German from Silesia,
+Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the
+honor of the profession, was only Peacock disguised under this alias,
+which would not, I fear, prove very attractive to patients.
+
+What doctrines and practice were these colonists likely to bring,
+with them?
+
+Two principal schools of medical practice prevailed in the Old World
+during the greater part of the seventeenth century.  The first held
+to the old methods of Galen: its theory was that the body, the
+microcosm, like the macrocosm, was made up of the four elements--
+fire, air, water, earth; having respectively the qualities hot, dry,
+moist, cold.  The body was to be preserved in health by keeping each
+of these qualities in its natural proportion; heat, by the proper
+temperature; moisture, by the due amount of fluid; and so as to the
+rest.  Diseases which arose from excess of heat were to be attacked
+by cooling remedies; those from excess of cold, by heating ones; and
+so of the other derangements of balance.  This was truly the
+principle of contraries contrariis, which ill-informed persons have
+attempted to make out to be the general doctrine of medicine, whereas
+there is no general dogma other than this: disease is to be treated
+by anything that is proved to cure it.  The means the Galenist
+employed were chiefly diet and vegetable remedies, with the use of
+the lancet and other depleting agents.  He attributed the four
+fundamental qualities to different vegetables, in four different
+degrees; thus chicory was cold in the fourth degree, pepper was hot
+in the fourth, endive was cold and dry in the second, and bitter
+almonds were hot in the first and dry in the second degree.  When we
+say "cool as a cucumber," we are talking Galenism.  The seeds of that
+vegetable ranked as one of "the four greater cold seeds" of this
+system.
+
+Galenism prevailed mostly in the south of Europe and France.  The
+readers of Moliere will have no difficulty in recalling some of its
+favorite modes of treatment, and the abundant mirth he extracted from
+them.
+
+These Galenists were what we should call "herb-doctors" to-day.
+Their insignificant infusions lost credit after a time; their
+absurdly complicated mixtures excited contempt, and their nauseous
+prescriptions provoked loathing and disgust.  A simpler and bolder
+practice found welcome in Germany, depending chiefly on mineral
+remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes
+the secret use, of opium.  Whatever we think of Paracelsus, the chief
+agent in the introduction of these remedies, and whatever limits we
+may assign to the use of these long-trusted mineral drugs, there can
+be no doubt that the chemical school, as it was called, did a great
+deal towards the expurgation of the old, overloaded, and repulsive
+pharmacopoeia.  We shall find evidence in the practice of our New-
+England physicians of the first century, that they often employed
+chemical remedies, and that, by the early part of the following
+century, their chief trust was in the few simple, potent drugs of
+Paracelsus.
+
+We have seen that many of the practitioners of medicine, during the
+first century of New England, were clergymen.  This relation between
+medicine and theology has existed from a very early period; from the
+Egyptian priest to the Indian medicine-man, the alliance has been
+maintained in one form or another.  The partnership was very common
+among our British ancestors.  Mr. Ward, the Vicar of Stratford-on-
+Avon, himself a notable example of the union of the two characters,
+writing about 1660, says,
+
+"The Saxons had their blood-letters, but under the Normans physicke,
+begunne in England; 300 years agoe itt was not a distinct profession
+by itself, but practised by men in orders, witness Nicholas de
+Ternham, the chief English physician and Bishop of Durham; Hugh of
+Evesham, a physician and cardinal; Grysant, physician and pope; John
+Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul
+Bush, a bachelor of divinitie in Oxford, was a man well read in
+physick as well as divinitie, he was the first bishop of Bristol."
+
+"Again in King Richard the Second's time physicians and divines were
+not distinct professions; for one Tydeman, Bishop of Landaph and
+Worcester, was physician to King Richard the Second."
+
+This alliance may have had its share in creating and keeping up the
+many superstitions which have figured so largely in the history of
+medicine.  It is curious to see that a medical work left in
+manuscript by the Rev. Cotton Mather and hereafter to be referred to,
+is running over with follies and superstitious fancies; while his
+contemporary and fellow-townsman, William Douglass, relied on the
+same few simple remedies which, through Dr. Edward Holyoke and Dr.
+James Jackson, have come down to our own time, as the most important
+articles of the materia medica.
+
+Let us now take a general glance at some of the conditions of the
+early settlers; and first, as to the healthfulness of the climate.
+The mortality of the season that followed the landing of the Pilgrims
+at Plymouth has been sufficiently accounted for.  After this, the
+colonists seem to have found the new country agreeing very well with
+their English constitutions.  Its clear air is the subject of eulogy.
+Its dainty springs of sweet water are praised not only by Higginson
+and Wood, but even the mischievous Morton says, that for its delicate
+waters Canaan came not near this country."  There is a tendency to
+dilate on these simple blessings, which reminds one a little of the
+Marchioness in Dickens's story, with her orange-peel-and-water
+beverage.  Still more does one feel the warmth of coloring,--such as
+we expect from converts to a new faith, and settlers who want to
+entice others over to their clearings, when Winslow speaks, in 1621,
+of "abundance of roses, white, red, and damask; single, but very
+sweet indeed;" a most of all, however, when, in the same connection,
+he says, "Here are grapes white and red, and very sweet and strong
+also."  This of our wild grape, a little vegetable Indian, which
+scalps a civilized man's mouth, as his animal representative scalps
+his cranium.  But there is something quite charming in Winslow's
+picture of the luxury in which they are living.  Lobsters, oysters,
+eels, mussels, fish and fowl, delicious fruit, including the grapes
+aforesaid,--if they only had "kine, horses, and sheep," he makes no
+question but men would live as contented here as in any part of the
+world.  We cannot help admiring the way in which they took their
+trials, and made the most of their blessings.
+
+"And how Content they were," says Cotton Mather, "when an Honest Man,
+as I have heard, inviting his Friends to a Dish of Clams, at the
+Table gave Thanks to Heaven, who had given them to suck the abundance
+of the Seas, and of the Treasures Aid in the Sands!"
+
+Strangely enough, as it would seem, except for this buoyant
+determination to make the best of everything, they hardly appear to
+recognize the difference of the climate from that which they had
+left.  After almost three years' experience, Winslow says, he can
+scarce distinguish New England from Old England, in respect of heat
+and cold, frost, snow, rain, winds, etc.  The winter, he thinks (if
+there is a difference), is sharper and longer; but yet he may be
+deceived by the want of the comforts he enjoyed at home.  He cannot
+conceive any climate to agree better with the constitution of the
+English, not being oppressed with extremity of heats, nor nipped by
+biting cold:
+
+"By which means, blessed be God, we enjoy our health, notwithstanding
+those difficulties we have undergone, in such a measure as would have
+been admired, if we had lived in England with the like means."
+
+Edward Johnson, after mentioning the shifts to which they were put
+for food, says,--
+
+"And yet, methinks, our children are as cheerful, fat, and lusty,
+with feeding upon those mussels, clams, and other fish, as they were
+in England with their fill of bread."
+
+Higginson, himself a dyspeptic, "continually in physic," as he says,
+and accustomed to dress in thick clothing, and to comfort his stomach
+with drink that was "both strong and stale,"--the "jolly good ale and
+old," I suppose, of free and easy Bishop Still's song,--found that he
+both could and did oftentimes drink New England water very well,
+--which he seems to look upon as a remarkable feat.  He could go as
+lightclad as any, too, with only a light stuff cassock upon his
+shirt, and stuff breeches without linings.  Two of his children were
+sickly: one,--little misshapen Mary,--died on the passage, and, in
+her father's words, "was the first in our ship that was buried in the
+bowels of the great Atlantic sea;" the other, who had been "most
+lamentably handled" by disease, recovered almost entirely "by the
+very wholesomeness of the air, altering, digesting, and drying up the
+cold and crude humors of the body."  Wherefore, he thinks it a wise
+course for all cold complexions to come to take physic in New
+England, and ends with those often quoted words, that "a sup of New
+England's air is better than a whole draught of Old England's ale."
+Mr. Higginson died, however, "of a hectic fever," a little more than
+a year after his arrival.
+
+The medical records which I shall cite show that the colonists were
+not exempt from the complaints of the Old World.  Besides the common
+diseases to which their descendants are subject, there were two
+others, to say nothing of the dreaded small-pox, which later medical
+science has disarmed,--little known among us at the present day, but
+frequent among the first settlers.  The first of these was the
+scurvy, already mentioned, of which Winthrop speaks in 1630, saying,
+that it proved fatal to those who fell into discontent, and lingered
+after their former conditions in England; the poor homesick creatures
+in fact, whom we so forget in our florid pictures of the early times
+of the little band in the wilderness.  Many who were suffering from
+scurvy got well when the Lyon arrived from England, bringing store of
+juice of lemons.  The Governor speaks of another case in 1644; and it
+seems probable that the disease was not of rare occurrence.
+
+The other complaint from which they suffered, but which has nearly
+disappeared from among us, was intermittent fever, or fever and ague.
+I investigated the question as to the prevalence of this disease in
+New England, in a dissertation, which was published in a volume with
+other papers, in the year 1838.  I can add little to the facts there
+recorded.  One which escaped me was, that Joshua Scottow, in "Old
+Men's Tears," dated 1691, speaks of "shaking agues," as among the
+trials to which they had been subjected.  The outline map of New
+England, accompanying the dissertation above referred to, indicates
+all the places where I had evidence that the disease had originated.
+It was plain enough that it used to be known in many localities where
+it has long ceased to be feared.  Still it was and is remarkable to
+see what a clean bill of health in this particular respect our barren
+soil inherited with its sterility.  There are some malarious spots on
+the edge of Lake Champlain, arid there have been some temporary
+centres of malaria, within the memory of man, on one or more of our
+Massachusetts rivers, but these are harmless enough, for the most
+part, unless the millers dam them, when they are apt to retaliate
+with a whiff from their meadows, that sets the whole neighborhood
+shaking with fever and ague.
+
+
+The Pilgrims of the Mayflower had with them a good physician, a man
+of standing, a deacon of their church, one whom they loved and
+trusted, Dr. Samuel Fuller.  But no medical skill could keep cold and
+hunger and bad food, and, probably enough, desperate homesickness in
+some of the feebler sort, from doing their work.  No detailed record
+remains of what they suffered or what was attempted for their relief
+during the first sad winter.  The graves of those who died were
+levelled and sowed with grain that the losses of the little band
+might not be suspected by the savage tenants of the wilderness, and
+their story remains untold.
+
+Of Dr. Fuller's practice, at a later period, we have an account in a
+letter of his to Governor Bradford, dated June, 1630.  "I have been
+to Matapan" (now Dorchester), he says, "and let some twenty of those
+people blood."  Such wholesale depletion as this, except with avowed
+homicidal intent, is quite unknown in these days; though I once saw
+the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy,
+order some ten or fifteen patients, taken almost indiscriminately, to
+be bled in a single morning.
+
+Dr. Fuller's two visits to Salem, at the request of Governor
+Endicott, seem to have been very satisfactory to that gentleman.
+Morton, the wild fellow of Merry Mount, gives a rather questionable
+reason for the Governor's being so well pleased with the physician's
+doings.  The names under which he mentions the two personages, it
+will be seen, are not intended to be complimentary.  "Dr. Noddy did a
+great cure for Captain Littleworth.  He cured him of a disease called
+a wife."   William Gager, who came out with Winthrop, is spoken of as
+"a right godly man and skilful chyrurgeon, but died of a malignant
+fever not very long after his arrival."
+
+Two practitioners of the ancient town of Newbury are entitled to
+special notice, for different reasons.  The first is Dr. John Clark,
+who is said by tradition to have been the first regularly educated
+physician who resided in New England.  His portrait, in close-fitting
+skull-cap, with long locks and venerable flowing beard, is familiar
+to our eyes on the wall of our Society's antechamber.  His left hand
+rests upon a skull, his right hand holds an instrument which deserves
+a passing comment.  It is a trephine, a surgical implement for
+cutting round pieces out of broken skulls, so as to get at the
+fragments which have been driven in, and lift them up.  It has a
+handle like that of a gimlet, with a claw like a hammer, to lift
+with, I suppose, which last contrivance I do not see figured in my
+books.  But the point I refer to is this: the old instrument, the
+trepan, had a handle like a wimble, what we call a brace or bit-
+stock.  The trephine is not mentioned at all in Peter Lowe's book,
+London, 1634; nor in Wiseman's great work on Surgery, London, 1676;
+nor in the translation of Dionis, published by Jacob Tonson, in 1710.
+In fact it was only brought into more general use by Cheselden and
+Sharpe so late as the beginning of the last century.  As John Clark
+died in 1661, it is remarkable to see the last fashion in the way of
+skull-sawing contrivances in his hands,--to say nothing of the claw
+on the handle, and a Hey's saw, so called in England, lying on the
+table by him, and painted there more than a hundred years before Hey
+was born.  This saw is an old invention, perhaps as old as
+Hippocrates, and may be seen figured in the "Armamentarium
+Chirurgicum" of Scultetus, or in the Works of Ambroise Pare.
+
+Dr. Clark is said to have received a diploma before be came, for
+skill in lithotomy.  He loved horses, as a good many doctors do, and
+left a good property, as they all ought to do.  His grave and noble
+presence, with the few facts concerning him, told with more or less
+traditional authority, give us the feeling that the people of
+Newbury, and afterwards of Boston, had a wise and skilful medical
+adviser and surgeon in Dr. John Clark.
+
+The venerable town of Newbury had another physician who was less
+fortunate.  The following is a court record of 1652:
+
+"This is to certify whom it may concern, that we the subscribers,
+being called upon to testify against doctor William Snelling for
+words by him uttered, affirm that being in way of merry discourse, a
+health being drank to all friends, he answered,
+
+    "I'll pledge my friends,
+     And for my foes
+     A plague for their heels
+     And,'---
+
+[a similar malediction on the other extremity of their feet.]
+
+"Since when he hath affirmed that he only intended the proverb used
+in the west country, nor do we believe he intended otherwise.
+
+"[Signed]
+"WILLIAM THOMAS.
+"THOMAS MILWARD.
+
+"March 12th 1651, All which I acknowledge, and am sorry I did not
+expresse my intent, or that I was so weak as to use so foolish a
+proverb.
+
+"[Signed]
+"GULIELMUS SNELLING."
+
+
+Notwithstanding this confession and apology, the record tells us that
+"William Snelling in his presentment for cursing is fined ten
+shillings and the fees of court."
+
+I will mention one other name among those of the Fathers of the
+medical profession in New England.  The "apostle" Eliot says, writing
+in 1647, "We never had but one anatomy in the country, which Mr.
+Giles Firman, now in England, did make and read upon very well."
+
+Giles Firmin, as the name is commonly spelled, practised physic in
+this country for a time.  He seems to have found it a poor business;
+for, in a letter to Governor Winthrop, he says, "I am strongly sett
+upon to studye divinitie: my studyes else must be lost, for physick
+is but a meene helpe."
+
+Giles Firmin's Lectures on Anatomy were the first scientific
+teachings of the New World.  While the Fathers were enlightened
+enough to permit such instructions, they were severe in dealing with
+quackery; for, in 1631, our court records show that one Nicholas
+Knopp, or Knapp, was sentenced to be fined or whipped "for taking
+upon him to cure the scurvey by a water of noe worth nor value, which
+he solde att a very deare rate."  Empty purses or sore backs would be
+common with us to-day if such a rule were enforced.
+
+Besides the few worthies spoken of, and others whose names I have not
+space to record, we must remember that there were many clergymen who
+took charge of the bodies as well as the souls of their patients,
+among them two Presidents of Harvard College, Charles Chauncy and
+Leonard Hoar,--and Thomas Thacher, first minister of the "Old South,"
+author of the earliest medical treatises printed in the country,[A
+Brief Rule to Guide the Common People in Small pox and
+Measles.  1674.] whose epitaph in Latin and Greek, said to have been
+written by Eleazer, an "Indian Youth" and a member of the Senior
+Class of Harvard College, may be found in the "Magnalia."  I miss
+this noble savage's name in our triennial catalogue; and as there is
+many a slip between the cup and lip, one is tempted to guess that he
+may have lost his degree by some display of his native instinct,--
+possibly a flourish of the tomahawk or scalping-knife.  However this
+may have been, the good man he celebrated was a notable instance of
+the Angelical Conjunction, as the author of the "Magnalia" calls it,
+of the offices of clergyman and medical practitioner.
+
+Michael Wigglesworth, author of the "Day of Doom," attended the sick,
+"not only as a Pastor, but as a Physician too, and this, not only in
+his own town, but also in all those of the vicinity."  Mather says of
+the sons of Charles Chauncy, "All of these did, while they had
+Opportunity, Preach the Gospel; and most, if not all of them, like
+their excellent Father before them, had an eminent skill in physick
+added unto their other accomplishments," etc.  Roger Williams is said
+to have saved many in a kind of pestilence which swept away many
+Indians.
+
+To these names must be added, as sustaining a certain relation to the
+healing art, that of the first Governor Winthrop, who is said by John
+Cotton to have been "Help for our Bodies by Physick [and] for our
+Estates by Law," and that of his son, the Governor of Connecticut,
+who, as we shall see, was as much physician as magistrate.
+
+I had submitted to me for examination, in 1862, a manuscript found
+among the Winthrop Papers, marked with the superscription, "For my
+worthy friend Mr. Wintrop," dated in 1643, London, signed Edward
+Stafford, and containing medical directions and prescriptions.  It
+may be remembered by some present that I wrote a report on this
+paper, which was published in the "Proceedings" of this Society.
+Whether the paper was written for Governor John Winthrop of
+Massachusetts, or for his son, Governor John of Connecticut, there is
+no positive evidence that I have been able to obtain.  It is very
+interesting, however, as giving short and simple practical
+directions, such as would be most like to be wanted and most useful,
+in the opinion of a physician in repute of that day.
+
+The diseases prescribed for are plague, small-pox, fevers, king's
+evil, insanity, falling-sickness, and the like; with such injuries as
+broken bones, dislocations, and burning with gunpowder.  The remedies
+are of three kinds: simples, such as St. John's wort, Clown's all-
+heal, elder, parsley, maidenhair, mineral drugs, such as lime,
+saltpetre, Armenian bole, crocus metallorum, or sulphuret of
+antimony; and thaumaturgic or mystical, of which the chief is, "My
+black powder against the plague, small-pox; purples, all sorts of
+feavers; Poyson; either, by Way of Prevention or after Infection."
+This marvellous remedy was made by putting live toads into an earthen
+pot so as to half fill it, and baking and burning them "in the open
+ayre, not in an house,"--concerning which latter possibility I
+suspect Madam Winthrop would have had something to say,--until they
+could be reduced by pounding, first into a brown, and then into a
+black, powder.  Blood-letting in some inflammations, fasting in the
+early stage of fevers, and some of those peremptory drugs with which
+most of us have been well acquainted in our time, the infragrant
+memories of which I will not pursue beyond this slight allusion, are
+among his remedies.
+
+The Winthrops, to one of whom Dr. Stafford's directions were
+addressed, were the medical as well as the political advisers of
+their fellow-citizens for three or four successive generations.  One
+of them, Governor John of Connecticut, practised so extensively,
+that, but for his more distinguished title in the State, he would
+have been remembered as the Doctor.  The fact that he practised in
+another colony, for the most part, makes little difference in the
+value of the records we have of his medical experience, which have
+fortunately been preserved, and give a very fair idea, in all
+probability, of the way in which patients were treated in
+Massachusetts, when they fell into intelligent and somewhat educated
+hands, a little after the middle of the seventeenth century:
+
+I have before me, while writing, a manuscript collection of the
+medical cases treated by him, and recorded at the time in his own
+hand, which has been intrusted to me by our President, his
+descendant.
+
+They are generally marked Hartford, and extend from the year 1657 to
+1669.  From these, manuscripts, and from the letters printed in the
+Winthrop Papers published by our Society, I have endeavored to obtain
+some idea of the practice of Governor John Winthrop, Junior.  The
+learned eye of Mr. Pulsifer would have helped me, no doubt, as it has
+done in other cases; but I have ventured this time to attempt finding
+my own way among the hieroglyphics of these old pages.  By careful
+comparison of many prescriptions, and by the aid of Schroder, Salmon,
+Culpeper, and other old compilers, I have deciphered many of his
+difficult paragraphs with their mysterious recipes.
+
+The Governor employed a number of the simples dear to ancient women,
+--elecampane and elder and wormwood and anise and the rest; but he
+also employed certain mineral remedies, which he almost always
+indicates by their ancient symbols, or by a name which should leave
+them a mystery to the vulgar.  I am now prepared to reveal the mystic
+secrets of the Governor's beneficent art, which rendered so many good
+and great as well as so many poor and dependent people his debtors,-
+at least, in their simple belief,--for their health and their lives.
+
+His great remedy, which he gave oftener than any other, was nitre;
+which he ordered in doses of twenty or thirty grains to adults, and
+of three grains to infants.  Measles, colics, sciatica, headache,
+giddiness, and many other ailments, all found themselves treated, and
+I trust bettered, by nitre; a pretty safe medicine in moderate doses,
+and one not likely to keep the good Governor awake at night, thinking
+whether it might not kill, if it did not cure.  We may say as much
+for spermaceti, which he seems to have considered "the sovereign'st
+thing on earth" for inward bruises, and often prescribes after falls
+and similar injuries.
+
+One of the next remedies, in point of frequency, which he was in the
+habit of giving, was (probably diaphoretic) antimony; a mild form of
+that very active metal, and which, mild as it was, left his patients
+very commonly with a pretty strong conviction that they had been
+taking something that did not exactly agree with them.  Now and then
+he gave a little iron or sulphur or calomel, but very rarely;
+occasionally, a good, honest dose of rhubarb or jalap; a taste of
+stinging horseradish, oftener of warming guiacum; sometimes an
+anodyne, in the shape of mithridate,--the famous old farrago, which
+owed its virtue to poppy juice; [This is the remedy which a Boston
+divine tried to simplify.  See Electuarium Novum Alexipharmacum, by
+Rev.  Thomas Harward, lecturer at the Royal Chappell.  Boston, 1732.
+This tract is in our Society's library.] very often, a harmless
+powder of coral; less frequently, an inert prescription of pleasing
+amber; and (let me say it softly within possible hearing of his
+honored descendant), twice or oftener,--let us hope as a last
+resort,--an electuary of millipedes,--sowbugs, if we must give them
+their homely English name.  One or two other prescriptions, of the
+many unmentionable ones which disgraced the pharmacopoeia of the
+seventeenth century, are to be found, but only in very rare
+instances, in the faded characters of the manuscript.
+
+The excellent Governor's accounts of diseases are so brief, that we
+get only a very general notion of the complaints for which he
+prescribed.  Measles and their consequences are at first more
+prominent than any other one affection, but the common infirmities of
+both sexes and of all ages seem to have come under his healing hand.
+Fever and ague appears to have been of frequent occurrence.
+
+His published correspondence shows that many noted people were in
+communication with him as his patients.  Roger Williams wants a
+little of his medicine for Mrs. Weekes's daughter; worshipful John
+Haynes is in receipt of his powders; troublesome Captain Underhill
+wants "a little white vitterall" for his wife, and something to cure
+his wife's friend's neuralgia, (I think his wife's friend's husband
+had a little rather have had it sent by the hands of Mrs. Underhill,
+than by those of the gallant and discursive captain); and pious John
+Davenport says, his wife "tooke but one halfe of one of the papers"
+(which probably contained the medicine he called rubila), "but could
+not beare the taste of it, and is discouraged from taking any more;"
+and honored William Leete asks for more powders for his "poore little
+daughter Graciana," though he found it "hard to make her take it,"
+delicate, and of course sensitive, child as she was, languishing and
+dying before her time, in spite of all the bitter things she
+swallowed,--God help all little children in the hands of dosing
+doctors and howling dervishes!  Restless Samuel Gorton, now tamed by
+the burden of fourscore and two years, writes so touching an account
+of his infirmities, and expresses such overflowing gratitude for the
+relief he has obtained from the Governor's prescriptions, wondering
+how "a thing so little in quantity, so little in sent, so little in
+taste, and so little to sence in operation, should beget and bring
+forth such efects," that we repent our hasty exclamation, and bless
+the memory of the good Governor, who gave relief to the worn-out
+frame of our long-departed brother, the sturdy old heretic of Rhode
+Island.
+
+What was that medicine which so frequently occurs in the printed
+letters under the name of "rubila"?  It is evidently a secret remedy,
+and, so far as I know, has not yet been made out.  I had almost given
+it up in despair, when I found what appears to be a key to the
+mystery.  In the vast multitude of prescriptions contained in the
+manuscripts, most of them written in symbols, I find one which I thus
+interpret:
+
+"Four grains of (diaphoretic) antimony, with twenty grains of nitre,
+with a little salt of tin, making rubila."  Perhaps something was
+added to redden the powder, as he constantly speaks of "rubifying"
+or "viridating" his prescriptions; a very common practice of
+prescribers, when their powders look a little too much like plain
+salt or sugar.
+
+
+Waitstill Winthrop, the Governor's son, "was a skilful physician,"
+says Mr. Sewall, in his funeral sermon; "and generously gave, not
+only his advice, but also his Medicines, for the healing of the Sick,
+which, by the Blessing of God, were made successful for the recovery
+of many."  "His son John, a member of the Royal Society, speaks of
+himself as 'Dr. Winthrop,' and mentions one of his own prescriptions
+in a letter to Cotton Mather."  Our President tells me that there was
+an heirloom of the ancient skill in his family, within his own
+remembrance, in the form of a certain precious eye-water, to which
+the late President John Quincy Adams ascribed rare virtue, and which
+he used to obtain from the possessor of the ancient recipe.
+
+These inherited prescriptions are often treasured in families, I do
+not doubt, for many generations.  When I was yet of trivial age, and
+suffering occasionally, as many children do, from what one of my
+Cambridgeport schoolmates used to call the "ager,"--meaning thereby
+toothache or face-ache,--I used to get relief from a certain plaster
+which never went by any other name in the family than "Dr. Oliver."
+
+Dr. James Oliver was my great-great-grandfather, graduated in 1680,
+and died in 1703.  This was, no doubt, one of his nostrums; for
+nostrum, as is well known, means nothing more than our own or my own
+particular medicine, or other possession or secret, and physicians in
+old times used to keep their choice recipes to themselves a good
+deal, as we have had occasion to see.
+
+Some years ago I found among my old books a small manuscript marked
+"James Oliver.  This Book Begun Aug. 12, 1685."  It is a rough sort
+of account-book, containing among other things prescriptions for
+patients, and charges for the same, with counter-charges for the
+purchase of medicines and other matters.  Dr. Oliver practised in
+Cambridge, where may be seen his tomb with inscriptions, and with
+sculptured figures that look more like Diana of the Ephesians, as
+given in Calmet's Dictionary, than like any angels admitted into good
+society here or elsewhere.
+
+I do not find any particular record of what his patients suffered
+from, but I have carefully copied out the remedies he mentions, and
+find that they form a very respectable catalogue.  Besides the usual
+simples, elder, parsley, fennel, saffron, snake-root, wormwood, I
+find the Elixir Proprietatis, with other elixire and cordials, as if
+he rather fancied warming medicines; but he called in the aid of some
+of the more energetic remedies, including iron, and probably mercury,
+as he bought two pounds of it at one time.
+
+The most interesting item is his bill against the estate of Samuel
+Pason of Roxbury, for services during his last illness.  He attended
+this gentleman,--for such he must have been, by the amount of physic
+which he took, and which his heirs paid for,--from June 4th, 1696, to
+September 3d of the same year, three months.  I observe he charges
+for visits as well as for medicines, which is not the case in most of
+his bills.  He opens the attack with a carminative appeal to the
+visceral conscience, and follows it up with good hard-hitting
+remedies for dropsy,--as I suppose the disease would have been
+called,--and finishes off with a rallying dose of hartshorn and iron.
+
+It is a source of honest pride to his descendant that his bill, which
+was honestly paid, as it seems to have been honorably earned,
+amounted to the handsome total of seven pounds and two shillings.
+Let me add that he repeatedly prescribes plaster, one of which was
+very probably the "Dr. Oliver" that soothed my infant griefs, and for
+which I blush to say that my venerated ancestor received from Goodman
+Hancock the painfully exiguous sum of no pounds, no shillings, and
+sixpence.
+
+I have illustrated the practice of the first century, from the two
+manuscripts I have examined, as giving an impartial idea of its
+every-day methods.  The Governor, Johannes Secundus, it is fair to
+remember, was an amateur practitioner, while my ancestor was a
+professed physician.  Comparing their modes of treatment with the
+many scientific follies still prevailing in the Old World, and still
+more with the extraordinary theological superstitions of the
+community in which they lived, we shall find reason, I think, to
+consider the art of healing as in a comparatively creditable state
+during the first century of New England.
+
+In addition to the evidence as to methods of treatment furnished by
+the manuscripts I have cited, I subjoin the following document, to
+which my attention was called by Dr. Shurtleff, our present Mayor.
+This is a letter of which the original is to be found in vol.  lxix.
+page 10 of the "Archives" preserved at the State House in Boston.  It
+will be seen that what the surgeon wanted consisted chiefly of
+opiates, stimulants, cathartics, plasters, and materials for
+bandages.  The complex and varied formulae have given place to
+simpler and often more effective forms of the same remedies; but the
+list and the manner in which it is made out are proofs of the good
+sense and schooling of the surgeon, who, it may be noted, was in such
+haste that he neglected all his stops.  He might well be in a hurry,
+as on the very day upon which he wrote, a great body of Indians--
+supposed to be six or seven hundred--appeared before Hatfield; and
+twenty-five resolute young men of Hadley, from which town he wrote,
+crossed the river and drove them away.
+
+
+HADLY May 30: 76
+
+Mr RAWSON Sr
+
+What we have recd by Tho: Houey the past month is not the cheifest of
+our wants as you have love for poor wounded I pray let us not want
+for these following medicines if you have not a speedy conveyance of
+them I pray send on purpose they are those things mentioned in my
+former letter but to prevent future mistakes I have wrote them att
+large wee have great want with the greatest halt and speed let
+us be supplyed.
+Sr
+Yr Sert
+WILL LOCHS
+
+
+(Endorsed)
+
+Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye
+Council with it but could not obtaine any thing to be sent in answer
+thereto 13 June 1676
+
+
+I have given some idea of the chief remedies used by our earlier
+physicians, which were both Galenic and chemical; that is, vegetable
+and mineral.  They, of course, employed the usual perturbing
+medicines which Montaigne says are the chief reliance of their craft.
+There were, doubtless, individual practitioners who employed special
+remedies with exceptional boldness and perhaps success.  Mr. Eliot is
+spoken of, in a letter of William Leete to Winthrop, Junior, as being
+under Mr. Greenland's mercurial administrations.  The latter was
+probably enough one of these specialists.
+
+There is another class of remedies which appears to have been
+employed occasionally, but, on the whole, is so little prominent as
+to imply a good deal of common sense among the medical practitioners,
+as compared with the superstitions prevailing around them.  I have
+said that I have caught the good Governor, now and then, prescribing
+the electuary of millipedes; but he is entirely excused by the almost
+incredible fact that they were retained in the materia medica so late
+as when Rees's Cyclopaedia was published, and we there find the
+directions formerly given by the College of Edinburgh for their
+preparation.  Once or twice we have found him admitting still more
+objectionable articles into his materia medica; in doing which, I am
+sorry to say that he could plead grave and learned authority.  But
+these instances are very rare exceptions in a medical practice of
+many years, which is, on the whole, very respectable, considering the
+time and circumstances.
+
+Some remedies of questionable though not odious character appear
+occasionally to have been employed by the early practitioners, but
+they were such as still had the support of the medical profession.
+Governor John Winthrop, the first, sends for East Indian bezoar, with
+other commodities he is writing for.  Governor Endicott sends him one
+he had of Mr. Humfrey.  I hope it was genuine, for they cheated
+infamously in the matter of this concretion, which ought to come out
+of an animal's stomach, but the real history of which resembles what
+is sometimes told of modern sausages.
+
+There is a famous law-case of James the First's time, in which a
+goldsmith sold a hundred pounds' worth of what he called bezoar,
+which was proved to be false, and the purchaser got a verdict against
+him.  Governor Endicott also sends Winthrop a unicorn's horn, which
+was the property of a certain Mrs. Beggarly, who, in spite of her
+name, seems to have been rich in medical knowledge and possessions.
+The famous Thomas Bartholinus wrote a treatise on the virtues of this
+fabulous-sounding remedy, which was published in 1641, and
+republished in 1678.
+
+The "antimonial cup," a drinking vessel made of that metal, which,
+like our quassia-wood cups, might be filled and emptied in saecula
+saeculorum without exhausting its virtues, is mentioned by Matthew
+Cradock, in a letter to the elder Winthrop, but in a doubtful way, as
+it was thought, he says, to have shortened the days of Sir Nathaniel
+Riche; and Winthrop himself, as I think, refers to its use, calling
+it simply "the cup."   An antimonial cup is included in the inventory
+of Samuel Seabury, who died 1680, and is valued at five shillings.
+There is a treatise entitled "The Universall Remedy, or the Vertues
+of the Antimoniall Cup, By John Evans, Minister and Preacher of God's
+Word, London, 1634," in our own Society's library.
+
+One other special remedy deserves notice, because of native growth.
+I do not know when Culver's root, Leptandra Virginica of our National
+Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to
+John Winthrop of New London, speaks of it as famous for the cure of
+consumptions, and wishes to get some of it, through his mediation,
+for Katharine, his eldest daughter.  He gets it, and gives it to the
+"poor damsel," who is languishing, as he says, and who dies the next
+month,--all the sooner, I have little doubt, for this uncertain and
+violent drug, with which the meddlesome pedant tormented her in that
+spirit of well-meant but restless quackery, which could touch nothing
+without making mischief, not even a quotation, and yet proved at
+length the means of bringing a great blessing to our community, as we
+shall see by and by; so does Providence use our very vanities and
+infirmities for its wise purposes.
+
+Externally, I find the practitioners on whom I have chiefly relied
+used the plasters of Paracelsus, of melilot, diachylon, and probably
+diaphoenicon, all well known to the old pharmacopoeias, and some of
+them to the modern ones,--to say nothing of "my yellow salve," of
+Governor John, the second, for the composition of which we must apply
+to his respected descendant.
+
+The authors I find quoted are Barbette's Surgery, Camerarius on Gout,
+and Wecherus, of all whom notices may be found in the pages of Haller
+and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's
+Practice of Physic and Anatomy, the last as belonging to Samuel
+Seabury, chirurgeon, before mentioned.  Nicholas Culpeper was a
+shrewd charlatan, and as impudent a varlet as ever prescribed for a
+colic; but knew very well what he was about, and badgers the College
+with great vigor.  A copy of Spigelius's famous Anatomy, in the
+Boston Athenaeum, has the names of Increase and Samuel Mather written
+in it, and was doubtless early overhauled by the youthful Cotton, who
+refers to the great anatomist's singular death, among his curious
+stories in the "Magnalia," and quotes him among nearly a hundred
+authors whom he cites in his manuscript "The Angel of Bethesda."  Dr.
+John Clark's "books and instruments, with several chirurgery
+materials in the closet," a were valued in his inventory at sixty
+pounds; Dr. Matthew Fuller, who died in 1678, left a library valued
+at ten pounds; and a surgeon's chest and drugs valued at sixteen
+pounds.'
+
+
+Here we leave the first century and all attempts at any further
+detailed accounts of medicine and its practitioners.  It is necessary
+to show in a brief glance what had been going on in Europe during the
+latter part of that century, the first quarter of which had been made
+illustrious in the history of medical science by the discovery of the
+circulation.
+
+Charles Barbeyrac, a Protestant in his religion, was a practitioner
+and teacher of medicine at Montpellier.  His creed was in the way of
+his obtaining office; but the young men followed his instructions
+with enthusiasm.  Religious and scientific freedom breed in and in,
+until it becomes hard to tell the family of one from that of the
+other.  Barbeyrac threw overboard the old complex medical farragos of
+the pharmacopoeias, as his church had disburdened itself of the
+popish ceremonies.
+
+Among the students who followed his instructions were two Englishmen:
+one of them, John Locke, afterwards author of an "Essay on the Human
+Understanding," three years younger than his teacher; the other,
+Thomas Sydenham, five years older.  Both returned to England.  Locke,
+whose medical knowledge is borne witness to by Sydenham, had the good
+fortune to form a correct opinion on a disease from which the Earl of
+Shaftesbury was suffering, which led to an operation that saved his
+life.  Less felicitous was his experience with a certain ancilla
+culinaria virgo,--which I am afraid would in those days have been
+translated kitchen-wench, instead of lady of the culinary
+department,--who turned him off after she had got tired of him, and
+called in another practitioner. [Locke and Sydenham, p. 124.  By John
+Brown, M.  D.  Edinburgh, 1866.]  This helped, perhaps, to spoil a
+promising doctor, and make an immortal metaphysician.  At any rate,
+Locke laid down the professional wig and cane, and took to other
+studies.
+
+The name of Thomas Sydenham is as distinguished in the history of
+medicine as that of John Locke in philosophy.  As Barbeyrac was found
+in opposition to the established religion, as Locke took the rational
+side against orthodox Bishop Stillingfleet, so Sydenham went with
+Parliament against Charles, and was never admitted a Fellow by the
+College of Physicians, which, after he was dead, placed his bust in
+their hall by the side of that of Harvey.
+
+What Sydenham did for medicine was briefly this he studied the course
+of diseases carefully, and especially as affected by the particular
+season; to patients with fever he gave air and cooling drinks,
+instead of smothering and heating them, with the idea of sweating out
+their disease; he ordered horseback exercise to consumptives; he,
+like his teacher, used few and comparatively simple remedies; he did
+not give any drug at all, if he thought none was needed, but let well
+enough alone.  He was a sensible man, in short, who applied his
+common sense to diseases which he had studied with the best light of
+science that he could obtain.
+
+The influence of the reform he introduced must have been more or less
+felt in this country, but not much before the beginning of the
+eighteenth century, as his great work was not published until 1675,
+and then in Latin.  I very strongly suspect that there was not so
+much to reform in the simple practice of the physicians of the new
+community, as there was in that of the learned big-wigs of the
+"College," who valued their remedies too much in proportion to their
+complexity, and the extravagant and fantastic ingredients which went
+to their making.
+
+During the memorable century which bred and bore the Revolution, the
+medical profession gave great names to our history.  But John Brooks
+belonged to the State, and Joseph Warren belongs to the country and
+mankind, and to speak of them would lead me beyond my limited--
+subject.  There would be little pleasure in dwelling on the name of
+Benjamin Church; and as for the medical politicians, like Elisha
+Cooke in the early part of the century, or Charles Jarvis, the bald
+eagle of Boston, in its later years, whether their practice was
+heroic or not, their patients were, for he is a bold man who trusts
+one that is making speeches and coaxing voters, to meddle with the
+internal politics of his corporeal republic.
+
+One great event stands out in the medical history of this eighteenth
+century; namely, the introduction of the practice of inoculation for
+small-pox.  Six epidemics of this complaint had visited Boston in the
+course of a hundred years.  Prayers had been asked in the churches
+for more than a hundred sick in a single day, and this many times.
+About a thousand persons had died in a twelvemonth, we are told, and,
+as we may infer, chiefly from this cause.
+
+In 1721, this disease, after a respite of nineteen years, again
+appeared as an epidemic.  In that year it was that Cotton Mather,
+browsing, as was his wont, on all the printed fodder that came within
+reach of his ever-grinding mandibles, came upon an account of
+inoculation as practised in Turkey, contained in the "Philosophical
+Transactions."  He spoke of it to several physicians, who paid little
+heed to his story; for they knew his medical whims, and had probably
+been bored, as we say now-a-days, many of them, with listening to his
+"Angel of Bethesda," and satiated with his speculations on the
+Nishmath Chajim.
+
+The Reverend Mather,--I use a mode of expression he often employed
+when speaking of his honored brethren,--the Reverend Mather was right
+this time, and the irreverent doctors who laughed at him were wrong.
+One only of their number disputes his claim to giving the first
+impulse to the practice, in Boston.  This is what that person says:
+"The Small-Pox spread in Boston, New England, A.1721, and the
+Reverend Dr. Cotton Mather, having had the use of these
+Communications from Dr. William Douglass (that is, the writer of
+these words); surreptitiously, without the knowledge of his Informer,
+that he might have the honour of a New fangled notion, sets an
+Undaunted Operator to work, and in this Country about 290 were
+inoculated."
+
+All this has not deprived Cotton Mather of the credit of suggesting,
+and a bold and intelligent physician of the honor of carrying out,
+the new practice.  On the twenty-seventh day of June, 1721, Zabdiel
+Boylston of Boston inoculated his only son for smallpox,--the first
+person ever submitted to the operation in the New World.  The story
+of the fierce resistance to the introduction of the practice; of how
+Boylston was mobbed, and Mather had a hand-grenade thrown in at his
+window; of how William Douglass, the Scotchman, "always positive, and
+sometimes accurate," as was neatly said of him, at once depreciated
+the practice and tried to get the credit of suggesting it, and how
+Lawrence Dalhonde, the Frenchman, testified to its destructive
+consequences; of how Edmund Massey, lecturer at St.  Albans, preached
+against sinfully endeavoring to alter the course of nature by
+presumptuous interposition, which he would leave to the atheist and
+the scoffer, the heathen and unbeliever, while in the face of his
+sermon, afterwards reprinted in Boston, many of our New England
+clergy stood up boldly in defence of the practice,--all this has been
+told so well and so often that I spare you its details.  Set this
+good hint of Cotton Mather against that letter of his to John
+Richards, recommending the search after witch-marks, and the
+application of the water-ordeal, which means throw your grandmother
+into the water, if she has a mole on her arm;--if she swims, she is a
+witch and must be hanged; if she sinks, the Lord have mercy on her
+soul!
+
+Thus did America receive this great discovery, destined to save
+thousands of lives, via Boston, from the hands of one of our own
+Massachusetts physicians.
+
+The year 1735 was rendered sadly memorable by the epidemic of the
+terrible disease known as "throat distemper," and regarded by many as
+the same as our "diphtheria."  Dr. Holyoke thinks the more general
+use of mercurials in inflammatory complaints dates from the time of
+their employment in this disease, in which they were thought to have
+proved specially useful.
+
+At some time in the course of this century medical practice had
+settled down on four remedies as its chief reliance.  I must repeat
+an incident which I have related in another of these Essays.  When
+Dr. Holyoke, nearly seventy years ago, received young Mr. James
+Jackson as his student, he showed him the formidable array of
+bottles, jars, and drawers around his office, and then named the four
+remedies referred to as being of more importance than all the rest
+put together.  These were "Mercury, Antimony, Opium, and Peruvian
+Bark."  I doubt if either of them remembered that, nearly seventy
+years before, in 1730, Dr. William Douglass, the disputatious
+Scotchman, mentioned those same four remedies, in the dedication of
+his quarrelsome essay on inoculation, as the most important ones in
+the hands of the physicians of his time.
+
+In the "Proceedings" of this Society for the year 1863 is a very
+pleasant paper by the late Dr. Ephraim Eliot, giving an account of
+the leading physicians of Boston during the last quarter of the last
+century.  The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch,
+Danforth, John Warren, Jeffries, are all famous in local history, and
+are commemorated in our medical biographies.  One of them, at least,
+appears to have been more widely known, not only as one of the first
+aerial voyagers, but as an explorer in the almost equally hazardous
+realm of medical theory.  Dr. John Jeffries, the first of that name,
+is considered by Broussais as a leader of medical opinion in America,
+and so referred to in his famous "Examen des Doctrines Medicales."
+
+Two great movements took place in this eighteenth century, the effect
+of which has been chiefly felt in our own time; namely, the
+establishment of the Massachusetts Medical Society, and the founding
+of the Medical School of Harvard University.
+
+
+The third century of our medical history began with the introduction
+of the second great medical discovery of modern times,--of all time
+up to that date, I may say,--once more via Boston, if we count the
+University village as its suburb, and once more by one of our
+Massachusetts physicians.  In the month of July, 1800, Dr. Benjamin
+Waterhouse of Cambridge submitted four of his own children to the new
+process of vaccination,--the first persons vaccinated, as Dr. Zabdiel
+Boylston's son had been the first person inoculated in the New World.
+
+A little before the first half of this century was completed, in the
+autumn of 1846, the great discovery went forth from the Massachusetts
+General Hospital, which repaid the debt of America to the science of
+the Old World, and gave immortality to the place of its origin in the
+memory and the heart of mankind.  The production of temporary
+insensibility at will--tuto, cito, jucunde, safely, quickly,
+pleasantly--is one of those triumphs over the infirmities of our
+mortal condition which change the aspect of life ever afterwards.
+Rhetoric can add nothing to its glory; gratitude, and the pride
+permitted to human weakness, that our Bethlehem should have been
+chosen as the birthplace of this new embodiment of the divine mercy,
+are all we can yet find room for.
+
+The present century has seen the establishment of all those great
+charitable institutions for the cure of diseases of the body and of
+the mind, which our State and our city have a right to consider as
+among the chief ornaments of their civilization.
+
+The last century had very little to show, in our State, in the way of
+medical literature.  The worthies who took care of our grandfathers
+and great-grandfathers, like the Revolutionary heroes, fought (with
+disease) and bled (their patients) and died (in spite of their own
+remedies); but their names, once familiar, are heard only at rare
+intervals.  Honored in their day, not unremembered by a few solitary
+students of the past, their memories are going sweetly to sleep in
+the arms of the patient old dry-nurse, whose "blackdrop" is the
+never-failing anodyne of the restless generations of men.  Except the
+lively controversy on inoculation, and floating papers in journals,
+we have not much of value for that long period, in the shape of
+medical records.
+
+But while the trouble with the last century is to find authors to
+mention, the trouble of this would be to name all that we find.  Of
+these, a very few claim unquestioned preeminence.
+
+Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical
+School of our University, did a great work for the advancement of
+medicine and surgery in New England, by his labors as teacher and
+author, greater, it is claimed by some, than was ever done by any
+other man.  The two Warrens, of our time, each left a large and
+permanent record of a most extended surgical practice.  James Jackson
+not only educated a whole generation by his lessons of wisdom, but
+bequeathed some of the most valuable results of his experience to
+those who came after him, in a series of letters singularly pleasant
+and kindly as well as instructive.  John Ware, keen and cautious,
+earnest and deliberate, wrote the two remarkable essays which have
+identified his name, for all time, with two important diseases, on
+which he has shed new light by his original observations.
+
+I must do violence to the modesty of the living by referring to the
+many important contributions to medical science by Dr. Jacob Bigelow,
+and especially to his discourse on "Self-limited Diseases," an
+address which can be read in a single hour, but the influence of
+which will be felt for a century.
+
+Nor would the profession forgive me if I forgot to mention the
+admirable museum of pathological anatomy, created almost entirely by
+the hands of Dr. John Barnard Swett Jackson, and illustrated by his
+own printed descriptive catalogue, justly spoken of by a
+distinguished professor in the University of Pennsylvania as the most
+important contribution which had ever been made in this country to
+the branch to which it relates.
+
+When we look at the literature of mental disease, as seen in hospital
+reports and special treatises, we can mention the names of Wyman,
+Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts
+or placed at the head of her institutions for the treatment of the
+insane.
+
+We have a right to claim also one who is known all over the civilized
+world as a philanthropist, to us as a townsman and a graduate of our
+own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor
+of a great multitude who were born to a world of inward or of outward
+darkness.
+
+I cannot pass over in silence the part taken by our own physicians in
+those sanitary movements which are assuming every year greater
+importance.  Two diseases especially have attracted attention, above
+all others, with reference to their causes and prevention; cholera,
+the "black death" of the nineteenth century, and consumption, the
+white plague of the North, both of which have been faithfully studied
+and reported on by physicians of our own State and city.  The
+cultivation of medical and surgical specialties, which is fast
+becoming prevalent, is beginning to show its effects in the
+literature of the profession, which is every year growing richer in
+original observations and investigations.
+
+To these benefactors who have labored for us in their peaceful
+vocation, we must add the noble army of surgeons, who went with the
+soldiers who fought the battles of their country, sharing many of
+their dangers, not rarely falling victims to fatigue, disease, or the
+deadly volleys to which they often exposed themselves in the
+discharge of their duties.
+
+The pleasant biographies of the venerable Dr. Thacher, and the worthy
+and kind-hearted gleaner, Dr. Stephen W.  Williams, who came after
+him, are filled with the names of men who served their generation
+well, and rest from their labors, followed by the blessing of those
+for whom they endured the toils and fatigues inseparable from their
+calling.  The hardworking, intelligent country physician more
+especially deserves the gratitude of his own generation, for he
+rarely leaves any permanent record in the literature of his
+profession.  Books are hard to obtain; hospitals, which are always
+centres of intelligence, are remote; thoroughly educated and superior
+men are separated by wide intervals; and long rides, though favorable
+to reflection, take up much of the time which might otherwise be
+given to the labors of the study.  So it is that men of ability and
+vast experience, like the late Dr. Twitchell, for instance, make a
+great and deserved reputation, become the oracles of large districts,
+and yet leave nothing, or next to nothing, by which their names shall
+be preserved from blank oblivion.
+
+One or two other facts deserve mention, as showing the readiness of
+our medical community to receive and adopt any important idea or
+discovery.  The new science of Histology, as it is now called, was
+first brought fully before the profession of this country by the
+translation of Bichat's great work, "Anatomie Generale," by the late
+Dr. George Hayward.
+
+The first work printed in this country on Auscultation,--that
+wonderful art of discovering disease, which, as it were, puts a
+window in the breast, through which the vital organs can be seen, to
+all intents and purposes, was the manual published anonymously by
+"A Member of the Massachusetts Medical Society."
+
+
+We are now in some slight measure prepared to weigh the record of the
+medical profession in Massachusetts, and pass our judgment upon it.
+But in-order to do justice to the first generation of practitioners,
+we must compare what we know of their treatment of disease with the
+state of the art in England, and the superstitions which they saw all
+around them in other departments of knowledge or belief.
+
+English medical literature must have been at a pretty low ebb when
+Sydenham recommended Don Quixote to Sir Richard Blackmore for
+professional reading.  The College Pharmacopoeia was loaded with the
+most absurd compound mixtures, one of the most complex of which (the
+same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel
+in Boston," tried to simplify), was not dropped until the year 1801.
+Sir Kenelm Digby was playing his fantastic tricks with the
+Sympathetic powder, and teaching Governor Winthrop, the second, how
+to cure fever and ague, which some may like to know.  "Pare the
+patient's nails; put the parings in a little bag, and hang the bag
+round the neck of a live eel, and put him in a tub of water.  The eel
+will die, and the patient will recover."
+
+Wiseman, the great surgeon, was discoursing eloquently on the
+efficacy of the royal touch in scrofula.  The founder of the
+Ashmolean Museum at Oxford, consorting with alchemists and
+astrologers, was treasuring the manuscripts of the late pious Dr.
+Richard Napier, in which certain letters (Rx Ris) were understood to
+mean Responsum Raphaelis,--the answer of the angel Raphael to the
+good man's medical questions.  The illustrious Robert Boyle was
+making his collection of choice and safe remedies, including the sole
+of an old shoe,  the thigh bone of a hanged man, and things far worse
+than these, as articles of his materia medica.  Dr. Stafford, whose
+paper of directions to his "friend, Mr. Wintrop," I cited, was
+probably a man of standing in London; yet toad-powder was his
+sovereign remedy.
+
+See what was the state of belief in other matters among the most
+intelligent persons of the colonies, magistrates and clergymen.
+Jonathan Brewster, son of the church-elder, writes the wildest
+letters to John Winthrop about alchemy,--"mad for making gold as the
+Lynn rock-borers are for finding it."
+
+Remember the theology and the diabology of the time.  Mr. Cotton's
+Theocracy was a royal government, with the King of kings as its
+nominal head, but with an upper chamber of saints, and a tremendous
+opposition in the lower house; the leader of which may have been
+equalled, but cannot have been surpassed by any of our earth-born
+politicians.  The demons were prowling round the houses every night,
+as the foxes were sneaking about the hen-roosts.  The men of
+Gloucester fired whole flasks of gunpowder at devils disguised as
+Indians and Frenchmen.
+
+How deeply the notion of miraculous interference with the course of
+nature was rooted, is shown by the tenacity of the superstition about
+earthquakes.  We can hardly believe that our Professor Winthrop,
+father of the old judge and the "squire," whom many of us Cambridge
+people remember so well, had to defend himself against the learned
+and excellent Dr. Prince, of the Old South Church, for discussing
+their phenomena as if they belonged to the province of natural
+science:
+
+Not for the sake of degrading the aspect of the noble men who founded
+our State, do I refer to their idle beliefs and painful delusions,
+but to show against what influences the common sense of the medical
+profession had to assert itself.
+
+Think, then, of the blazing stars, that shook their horrid hair in
+the sky; the phantom ship, that brought its message direct from the
+other world; the story of the mouse and the snake at Watertown;  of
+the mice and the prayer-book;  of the snake in church; of the calf
+with two heads; and of the cabbage in the perfect form of a cutlash,
+--all which innocent occurrences were accepted or feared as alarming
+portents.
+
+We can smile at these: but we cannot smile at the account of unhappy
+Mary Dyer's malformed offspring;  or of Mrs.  Hutchinson's domestic
+misfortune of similar character, in the story of which the physician,
+Dr. John Clark of Rhode Island, alone appears to advantage; or as we
+read the Rev. Samuel Willard's fifteen alarming pages about an
+unfortunate young woman suffering with hysteria.  Or go a little
+deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia,
+first admonished, then whipped; at last, taking her own little
+daughter's life; put on trial, and standing mute, threatened to be
+pressed to death, confessing, sentenced, praying to be beheaded; and
+none the less pitilessly swung from the fatal ladder.
+
+The cooper's crazy wife--crazy in the belief that she has committed
+the unpardonable sin--tries to drown her child, to save it from
+misery; and the poor lunatic, who would be tenderly cared for to-day
+in a quiet asylum, is judged to be acting under the instigation of
+Satan himself.  Yet, after all, what can we say, who put Bunyan's
+"Pilgrim's Progress," full of nightmare dreams of horror, into all
+our children's hands; a story in which the awful image of the man in
+the cage might well turn the nursery where it is read into a
+madhouse?
+
+The miserable delusion of witchcraft illustrates, in a still more
+impressive way, the false ideas which governed the supposed relation
+of men with the spiritual world.  I have no doubt many physicians
+shared in these superstitions.  Mr. Upham says they--that is, some of
+them--were in the habit of attributing their want of success to the
+fact, that an "evil hand" was on their patient.  The temptation was
+strong, no doubt, when magistrates and ministers and all that
+followed their lead were contented with such an explanation.  But how
+was it in Salem, according to Mr. Upham's own statement?  Dr. John
+Swinnerton was, he says, for many years the principal physician of
+Salem.  And he says, also, "The Swinnerton family were all along
+opposed to Mr. Parris, and kept remarkably clear from the witchcraft
+delusion."   Dr. John Swinnerton--the same, by the way, whose memory
+is illuminated by a ray from the genius of Hawthorne--died the very
+year before the great witchcraft explosion took place.  But who can
+doubt that it was from him that the family had learned to despise and
+to resist the base superstition; or that Bridget Bishop, whose house
+he rented, as Mr. Upham tells me, the first person hanged in the time
+of the delusion, would have found an efficient protector in her
+tenant, had he been living, to head the opposition of his family to
+the misguided clergymen and magistrates?
+
+I cannot doubt that our early physicians brought with them many Old-
+World medical superstitions, and I have no question that they were
+more or less involved in the prevailing errors of the community in
+which they lived.  But, on the whole, their record is a clean one, so
+far as we can get at it; and where it is questionable we must
+remember that there must have been many little-educated persons among
+them; and that all must have felt, to some extent, the influence of
+those sincere and devoted but unsafe men, the physic-practising
+clergymen, who often used spiritual means as a substitute for
+temporal ones, who looked upon a hysteric patient as possessed by the
+devil, and treated a fractured skull by prayers and plasters,
+following the advice of a ruling elder in opposition to the "unanimous
+opinion of seven surgeons."
+
+To what results the union of the two professions was liable to lead,
+may be seen by the example of a learned and famous person, who has
+left on record the product of his labors in the double capacity of
+clergyman and physician.
+
+I have had the privilege of examining a manuscript of Cotton Mather's
+relating to medicine, by the kindness of the librarian of the
+American Antiquarian Society, to which society it belongs.  A brief
+notice of this curious document may prove not uninteresting.
+
+It is entitled "The Angel of Bethesda: an Essay upon the Common
+Maladies of Mankind, offering, first, the sentiments of Piety," etc.,
+etc., and "a collection of plain but potent and Approved REMEDIES for
+the Maladies."  There are sixty-six "Capsula's," as he calls them, or
+chapters, in his table of contents; of which, five--from the
+fifteenth to the nineteenth, inclusive--are missing.  This is a most
+unfortunate loss, as the eighteenth capsula treated of agues, and we
+could have learned from it something of their degree of frequency in
+this part of New England.  There is no date to the manuscript; which,
+however, refers to a case observed Nov. 14, 1724.
+
+The divine takes precedence of the physician in this extraordinary
+production.  He begins by preaching a sermon at his unfortunate
+patient.  Having thrown him into a cold sweat by his spiritual
+sudorific, he attacks him with his material remedies, which are often
+quite as unpalatable.  The simple and cleanly practice of Sydenham,
+with whose works he was acquainted, seems to have been thrown away
+upon him.  Everything he could find mentioned in the seventy or
+eighty authors he cites, all that the old women of both sexes had
+ever told him of, gets into his text, or squeezes itself into his
+margin.
+
+Evolving disease out of sin, he hates it, one would say, as he hates
+its cause, and would drive it out of the body with all noisome
+appliances.  "Sickness is in Fact Flagellum Dei pro peccatis mundi."
+So saying, he encourages the young mother whose babe is wasting away
+upon her breast with these reflections:
+
+"Think; oh the grievous Effects of Sin!  This wretched Infant has not
+arrived unto years of sense enough, to sin after the similitude of
+the transgression committed by Adam.  Nevertheless the Transgression
+of Adam, who had all mankind Foederally, yea, Naturally, in him, has
+involved this Infant in the guilt of it.  And the poison of the old
+serpent, which infected Adam when he fell into his Transgression, by
+hearkening to the Tempter, has corrupted all mankind, and is a seed
+unto such diseases as this Infant is now laboring under.  Lord, what
+are we, and what are our children, but a Generation of Vipers?"
+
+Many of his remedies are at least harmless, but his pedantry and
+utter want of judgment betray themselves everywhere.  He piles his
+prescriptions one upon another, without the least discrimination.  He
+is run away with by all sorts of fancies and superstitions.  He
+prescribes euphrasia, eye-bright, for disease of the eyes; appealing
+confidently to the strange old doctrine of signatures, which inferred
+its use from the resemblance of its flower to the organ of vision.
+For the scattering of wens,  the efficacy of a Dead Hand has been out
+of measure wonderful.  But when he once comes to the odious class of
+remedies, he revels in them like a scarabeus.  This allusion will
+bring us quite near enough to the inconceivable abominations with
+which he proposed to outrage the sinful stomachs of the unhappy
+confederates and accomplices of Adam.
+
+It is well that the treatise was never printed, yet there are
+passages in it worth preserving.  He speaks of some remedies which
+have since become more universally known:
+
+"Among the plants of our soyl, Sir William Temple singles out Five
+[Six] as being of the greatest virtue and most friendly to health:
+and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and
+Elder."
+
+"But these Five [Six] plants may admitt of some competitors.  The
+QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"
+
+Of Ipecacuanha, he says,--
+"This is now in its reign; the most fashionable vomit."
+
+"I am not sorry that antimonial emetics begin to be disused."
+
+He quotes "Mr. Lock" as recommending red poppy-water and abstinence
+from flesh as often useful in children's diseases.
+
+One of his "Capsula's" is devoted to the animalcular origin of
+diseases, at the end of which he says, speaking of remedies for this
+supposed source of our distempers:
+
+"Mercury we know thee: But we are afraid thou wilt kill us too, if we
+employ thee to kill them that kill us.
+
+"And yett, for the cleansing of the small Blood Vessels, and making
+way for the free circulation of the Blood and Lymph--there is nothing
+like Mercurial Deobstruents."
+
+From this we learn that mercury was already in common use, and the
+subject of the same popular prejudice as in our own time.
+
+His poetical turn shows itself here and there:
+
+"O Nightingale, with a Thorn at thy Breast; Under the trouble of a
+Cough, what can be more proper than such thoughts as these?"...
+
+If there is pathos in this, there is bathos in his apostrophe to the
+millipede, beginning "Poor sowbug!" and eulogizing the healing
+virtues of that odious little beast; of which he tells us to take
+"half a pound, putt 'em alive into a quart or two of wine," with
+saffron and other drugs, and take two ounces twice a day.
+
+The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at
+New London, and is in the possession of our own Society.  He means,
+by these words, something like the Archxus of Van Helmont, of which
+he discourses in a style wonderfully resembling that of Mr. Jenkinson
+in the "Vicar of Wakefield."  "Many of the Ancients thought there was
+much of a Real History in the Parable, and their Opinion was that
+there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a
+Resemblance) of men as to their Shapes after Death."  And so on, with
+Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA,"
+in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara
+kai ateleutaion to pan."
+
+One other passage deserves notice, as it relates to the single
+medical suggestion which does honor to Cotton Mather's memory.  It
+does not appear that he availed himself of the information which he
+says, he obtained from his slave, for such I suppose he was.
+
+In his appendix to "Variolae Triumphatae," he says,--
+
+"There has been a wonderful practice lately used in several parts of
+the world, which indeed is not yet become common in our nation.
+
+"I was first informed of it by a Garamantee servant of my own, long
+before I knew that any Europeans or Asiaticks had the least
+acquaintance with it, and some years before I was enriched with the
+communications of the learned Foreigners, whose accounts I found
+agreeing with what I received of my servant, when he shewed me the
+Scar of the Wound made for the operation; and said, That no person
+ever died of the smallpox, in their countrey, that had the courage to
+use it.
+
+"I have since met with a considerable Number of these Africans, who
+all agree in one story; That in their countrey grandy-many dy of the
+small-pox: But now they learn this way: people take juice of smallpox
+and cutty-skin and put in a Drop; then by'nd by a little sicky,
+sicky: then very few little things like small-pox; and nobody dy of
+it; and nobody have small-pox any more.  Thus, in Africa, where the
+poor creatures dy of the smallpox like Rotten Sheep, a merciful God
+has taught them an Infallible preservative.  'T is a common practice,
+and is attended with a constant success."
+
+What has come down to us of the first century of medical practice, in
+the hands of Winthrop and Oliver, is comparatively simple and
+reasonable.  I suspect that the conditions of rude, stern life, in
+which the colonists found themselves in the wilderness, took the
+nonsense out of them, as the exigencies of a campaign did out of our
+physicians and surgeons in the late war.  Good food and enough of it,
+pure air and water, cleanliness, good attendance, an anaesthetic, an
+opiate, a stimulant, quinine, and two or three common drugs, proved
+to be the marrow of medical treatment; and the fopperies of the
+pharmacopoeia went the way of embroidered shirts and white kid gloves
+and malacca joints, in their time of need.  "Good wine is the best
+cordiall for her," said Governor John Winthrop, Junior, to Samuel
+Symonds, speaking of that gentleman's wife,--just as Sydenham,
+instead of physic, once ordered a roast chicken and a pint of canary
+for his patient in male hysterics.
+
+But the profession of medicine never could reach its full development
+until it became entirely separated from that of divinity.  The
+spiritual guide, the consoler in afliction, the confessor who is
+admitted into the secrets of our souls, has his own noble sphere of
+duties; but the healer of men must confine himself solely to the
+revelations of God in nature, as he sees their miracles with his own
+eyes.  No doctrine of prayer or special providence is to be his
+excuse for not looking straight at secondary causes, and acting,
+exactly so far as experience justifies him, as if he were himself the
+divine agent which antiquity fabled him to be.  While pious men were
+praying--humbly, sincerely, rightly, according to their knowledge--
+over the endless succession of little children dying of spasms in the
+great Dublin Hospital, a sagacious physician knocked some holes in
+the walls of the ward, let God's blessed air in on the little
+creatures, and so had already saved in that single hospital, as it
+was soberly calculated thirty years ago, more than sixteen thousand
+lives of these infant heirs of immortality. [Collins's Midwifery, p.
+312.  Published by order of the Massachusetts Medical Society.
+Boston, 1841.]
+
+Let it be, if you will, that the wise inspiration of the physician
+was granted in virtue of the clergyman's supplications.  Still, the
+habit of dealing with things seen generates another kind of
+knowledge, and another way of thought, from that of dealing with
+things unseen; which knowledge and way of thought are special means
+granted by Providence, and to be thankfully accepted.
+
+The mediaeval ecclesiastics expressed a great truth in that saying,
+so often quoted, as carrying a reproach with it: "Ubi tres medici,
+duo athei,"--"Where there are three physicians, there are two
+atheists."
+
+It was true then, it is true to-day, that the physician very
+commonly, if not very generally, denies and repudiates the deity of
+ecclesiastical commerce.  The Being whom Ambroise Pare meant when he
+spoke those memorable words, which you may read over the professor's
+chair in the French School of Medicine, "Te le pensay, et Dieu le
+guarit," "I dressed his wound, and God healed it,"--is a different
+being from the God that scholastic theologians have projected from
+their consciousness, or shaped even from the sacred pages which have
+proved so plastic in their hands.  He is a God who never leaves
+himself without witness, who repenteth him of the evil, who never
+allows a disease or an injury, compatible with the enjoyment of life,
+to take its course without establishing an effort, limited by certain
+fixed conditions, it is true, but an effort, always, to restore the
+broken body or the shattered mind.  In the perpetual presence of this
+great Healing Agent, who stays the bleeding of wounds, who knits the
+fractured bone, who expels the splinter by a gentle natural process,
+who walls in the inflammation that might involve the vital organs,
+who draws a cordon to separate the dead part from the living, who
+sends his three natural anaesthetics to the over-tasked frame in due
+order, according to its need,--sleep, fainting, death; in this
+perpetual presence, it is doubtless hard for the physician to realize
+the theological fact of a vast and permanent sphere of the universe,
+where no organ finds itself in its natural medium, where no wound
+heals kindly, where the executive has abrogated the pardoning power,
+and mercy forgets its errand; where the omnipotent is unfelt save in
+malignant agencies, and the omnipresent is unseen and unrepresented;
+hard to accept the God of Dante's "Inferno," and of Bunyan's caged
+lunatic.  If this is atheism, call three, instead of two of the trio,
+atheists, and it will probably come nearer the truth.
+
+I am not disposed to deny the occasional injurious effect of the
+materializing influences to which the physician is subjected.
+A spiritual guild is absolutely necessary to keep him, to keep us
+all, from becoming the "fingering slaves" that Wordsworth treats with
+such shrivelling scorn.  But it is well that the two callings have
+been separated, and it is fitting that they remain apart.  In
+settling the affairs of the late concern, I am afraid our good
+friends remain a little in our debt.  We lent them our physician
+Michael Servetus in fair condition, and they returned him so damaged
+by fire as to be quite useless for our purposes.  Their Reverend
+Samuel Willard wrote us a not over-wise report of a case of hysteria;
+and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary
+of the Bible) the first discerning criticism on the authorship of the
+Pentateuch.  Our John Locke enlightened them with his letters
+concerning toleration; and their Cotton Mather obscured our twilight
+with his "Nishmath Chajim."
+
+Yet we must remember that the name of Basil Valentine, the monk, is
+associated with whatever good and harm we can ascribe to antimony;
+and that the most remarkable of our specifics long bore the name of
+"Jesuit's Bark," from an old legend connected with its introduction.
+"Frere Jacques," who taught the lithotomists of Paris, owes his
+ecclesiastical title to courtesy, as he did not belong to a religious
+order.
+
+Medical science, and especially the study of mental disease, is
+destined, I believe, to react to much greater advantage on the
+theology of the future than theology has acted on medicine in the
+past.  The liberal spirit very generally prevailing in both
+professions, and the good understanding between their most
+enlightened members, promise well for the future of both in a
+community which holds every point of human belief, every institution
+in human hands, and every word written in a human dialect, open to
+free discussion today, to-morrow, and to the end of time.  Whether
+the world at large will ever be cured of trusting to specifics as a
+substitute for observing the laws of health, and to mechanical or
+intellectual formula as a substitute for character, may admit of
+question.  Quackery and idolatry are all but immortal.
+
+We can find most of the old beliefs alive amongst us to-day, only
+having changed their dresses and the social spheres in which they
+thrive.  We think the quarrels of Galenists and chemists belong to
+the past, forgetting that Thomsonism has its numerous apostles in our
+community; that it is common to see remedies vaunted as purely
+vegetable, and that the prejudice against "mineral poisons,"
+especially mercury, is as strong in many quarters now as it was at
+the beginning of the seventeenth century.  Names are only air, and
+blow away with a change of wind; but beliefs are rooted in human
+wants and weakness, and die hard.  The oaks of Dodona are prostrate,
+and the shrine of Delphi is desolate; but the Pythoness and the Sibyl
+may be consulted in Lowell Street for a very moderate compensation.
+Nostradamus and Lilly seem impossible in our time; but we have seen
+the advertisements of an astrologer in our Boston papers year after
+year, which seems to imply that he found believers and patrons.  You
+smiled when I related Sir Kenelm Digby's prescription with the live
+eel in it; but if each of you were to empty his or her pockets, would
+there not roll out, from more than one of them, a horse-chestnut,
+carried about as a cure for rheumatism?  The brazen head of Roger
+Bacon is mute; but is not "Planchette" uttering her responses in a
+hundred houses of this city?  We think of palmistry or chiromancy as
+belonging to the days of Albertus Magnus, or, if existing in our
+time, as given over to the gypsies; but a very distinguished person
+has recently shown me the line of life, and the line of fortune, on
+the palm of his hand, with a seeming confidence in the sanguine
+predictions of his career which had been drawn from them.  What shall
+we say of the plausible and well-dressed charlatans of our own time,
+who trade in false pretences, like Nicholas Knapp of old, but without
+any fear of being fined or whipped; or of the many follies and
+inanities, imposing on the credulous part of the community, each of
+them gaping with eager, open mouth for a gratuitous advertisement by
+the mention of its foolish name in any respectable connection?
+
+I turn from this less pleasing aspect of the common intelligence
+which renders such follies possible, to close the honorable record of
+the medical profession in this, our ancient Commonwealth.
+
+We have seen it in the first century divided among clergymen,
+magistrates, and regular practitioners; yet, on the whole, for the
+time, and under the circumstances, respectable, except where it
+invoked supernatural agencies to account for natural phenomena.
+
+In the second century it simplified its practice, educated many
+intelligent practitioners, and began the work of organizing for
+concerted action, and for medical teaching.
+
+In this, our own century, it has built hospitals, perfected and
+multiplied its associations and educational institutions, enlarged
+and created museums, and challenged a place in the world of science
+by its literature.
+
+In reviewing the whole course of its history we read a long list of
+honored names, and a precious record written in private memories, in
+public charities, in permanent contributions to medical science, in
+generous sacrifices for the country.  We can point to our capital as
+the port of entry for the New World of the great medical discoveries
+of two successive centuries, and we can claim for it the triumph over
+the most dreaded foe that assails the human body,--a triumph which
+the annals of the race can hardly match in three thousand years of
+medical history.
+
+
+
+
+
+
+THE YOUNG PRACTITIONER
+
+[A Valedictory Address delivered to the Graduating Class of the
+Bellevue Hospital College, March 2, 1871.]
+
+
+The occasion which calls us together reminds us not a little of that
+other ceremony which unites a man and woman for life.  The banns have
+already been pronounced which have wedded our young friends to the
+profession of their choice.  It remains only to address to them some
+friendly words of cheering counsel, and to bestow upon them the
+parting benediction.
+
+This is not the time for rhetorical display or ambitious eloquence.
+We must forget ourselves, and think only of them.  To us it is an
+occasion; to them it is an epoch.  The spectators at the wedding look
+curiously at the bride and bridegroom; at the bridal veil, the
+orange-flower garland, the giving and receiving of the ring; they
+listen for the tremulous "I will," and wonder what are the mysterious
+syllables the clergyman whispers in the ear of the married maiden.
+But to the newly-wedded pair what meaning in those words, "for
+better, for worse," "in sickness and in health," "till death us do
+part!"  To the father, to the mother, who know too well how often the
+deadly nightshade is interwoven with the wreath of orange-blossoms,
+how empty the pageant, how momentous the reality!
+
+You will not wonder that I address myself chiefly to those who are
+just leaving academic life for the sterner struggle and the larger
+tasks of matured and instructed manhood.  The hour belongs to them;
+if others find patience to listen, they will kindly remember that,
+after all, they are but as the spectators at the wedding, and that
+the priest is thinking less of them than of their friends who are
+kneeling at the altar.
+
+I speak more directly to you, then, gentlemen of the graduating
+class.  The days of your education, as pupils of trained instructors,
+are over.  Your first harvest is all garnered.  Henceforth you are to
+be sowers as well as reapers, and your field is the world.  How does
+your knowledge stand to-day?  What have you gained as a permanent
+possession?  What must you expect to forget?  What remains for you
+yet to learn?  These are questions which it may interest you to
+consider.
+
+There is another question which must force itself on the thoughts of
+many among you: "How am I to obtain patients and to keep their
+confidence?  "You have chosen a laborious calling, and made many
+sacrifices to fit yourselves for its successful pursuit.  You wish to
+be employed that you may be useful, and that you may receive the
+reward of your industry.  I would take advantage of these most
+receptive moments to give you some hints which may help you to
+realize your hopes and expectations.  Such is the outline of the
+familiar talk I shall offer you.
+
+Your acquaintance with some of the accessory branches is probably
+greater now than it will be in a year from now,--much greater than it
+will by ten years from now.  The progress of knowledge, it may be
+feared, or hoped, will have outrun the text-books in which you
+studied these branches.  Chemistry, for instance, is very apt to
+spoil on one's hands.  "Nous avons change tout cela" might serve as
+the standing motto of many of our manuals.  Science is a great
+traveller, and wears her shoes out pretty fast, as might be expected.
+
+You are now fresh from the lecture-room and the laboratory.  You can
+pass an examination in anatomy, physiology, chemistry, materia
+medica, which the men in large practice all around you would find a
+more potent sudorific than any in the Pharmacopceia.  These masters
+of the art of healing were once as ready with their answers as you
+are now, but they have got rid of a great deal of the less
+immediately practical part of their acquisitions, and you must
+undergo the same depleting process.  Hard work will train it off, as
+sharp exercise trains off the fat of a prize-fighter.
+
+Yet, pause a moment before you infer that your teachers must have
+been in fault when they furnished you with mental stores not directly
+convertible to practical purposes, and likely in a few years to lose
+their place in your memory.  All systematic knowledge involves much
+that is not practical, yet it is the only kind of knowledge which
+satisfies the mind, and systematic study proves, in the long-run, the
+easiest way of acquiring and retaining facts which are practical.
+There are many things which we can afford to forget, which yet it was
+well to  learn.  Your mental condition is not the same as if you had
+never known what you now try in vain to recall.  There is a perpetual
+metempsychosis of thought, and the knowledge of to-day finds a soil
+in the forgotten facts of yesterday.  You cannot see anything in the
+new season of the guano you placed last year about the roots of your
+climbing plants, but it is blushing and breathing fragrance in your
+trellised roses; it has scaled your porch in the bee-haunted honey-
+suckle; it has found its way where the ivy is green; it is gone where
+the woodbine expands its luxuriant foliage.
+
+Your diploma seems very broad to-day with your list of
+accomplishments, but it begins to shrink from this hour like the Peau
+de Chagrin of Balzac's story.  Do not worry about it, for all the
+while there will be making out for you an ampler and fairer
+parchment, signed by old Father Time himself as President of that
+great University in which experience is the one perpetual and all-
+sufficient professor.
+
+Your present plethora of acquirements will soon cure itself.
+Knowledge that is not wanted dies out like the eyes of the fishes of
+the Mammoth Cave.  When you come to handle life and death as your
+daily business, your memory will of itself bid good-by to such
+inmates as the well-known foramina of the sphenoid bone and the
+familiar oxides of methyl-ethylamyl-phenyl-ammonium.  Be thankful
+that you have once known them, and remember that even the learned
+ignorance of a nomenclature is something to have mastered, and may
+furnish pegs to hang facts upon which would otherwise have strewed
+the floor of memory in loose disorder.
+
+But your education has, after all, been very largely practical.  You
+have studied medicine and surgery, not chiefly in books, but at the
+bedside and in the operating amphitheatre.  It is the special
+advantage of large cities that they afford the opportunity of seeing
+a great deal of disease in a short space of time, and of seeing many
+cases of the same kind of disease brought together.  Let us not be
+unjust to the claims of the schools remote from the larger centres of
+population.  Who among us has taught better than Nathan Smith, better
+than Elisha Bartlett? who teaches better than some of our living
+contemporaries who divide their time between city and country
+schools?  I am afraid we do not always do justice to our country
+brethren, whose merits are less conspicuously exhibited than those of
+the great city physicians and surgeons, such especially as have
+charge of large hospitals.  There are modest practitioners living in
+remote rural districts who are gifted by nature with such sagacity
+and wisdom, trained so well in what is most essential to the practice
+of their art, taught so thoroughly by varied experience, forced to
+such manly self-reliance by their comparative isolation, that, from
+converse with them alone, from riding with them on their long rounds
+as they pass from village to village, from talking over cases with
+them, putting up their prescriptions, watching their expedients,
+listening to their cautions, marking the event of their predictions,
+hearing them tell of their mistakes, and now and then glory a little
+in the detection of another's blunder, a young man would find himself
+better fitted for his real work than many who have followed long
+courses of lectures and passed a showy examination.  But the young
+man is exceptionally fortunate who enjoys the intimacy of such a
+teacher.  And it must be confessed that the great hospitals,
+infirmaries, and dispensaries of large cities, where men of well-
+sifted reputations are in constant attendance, are the true centres
+of medical education.  No students, I believe, are more thoroughly
+aware of this than those who have graduated at this institution.
+Here, as in all our larger city schools, the greatest pains are taken
+to teach things as well as names.  You have entered into the
+inheritance of a vast amount of transmitted skill and wisdom, which
+you have taken, warm, as it were, with the life of your well-schooled
+instructors.  You have not learned all that art has to teach you, but
+you are safer practitioners to-day than were many of those whose
+names we hardly mention without a genuflection.  I had rather be
+cared for in a fever by the best-taught among you than by the
+renowned Fernelius or the illustrious Boerhaave, could they come back
+to us from that better world where there are no physicians needed,
+and, if the old adage can be trusted, not many within call.  I had
+rather have one of you exercise his surgical skill upon me than find
+myself in the hands of a resuscitated Fabricius Hildanus, or even of
+a wise Ambroise Pare, revisiting earth in the light of the nineteenth
+century.
+
+You will not accuse me of underrating your accomplishments.  You know
+what to do for a child in a fit, for an alderman in an apoplexy, for
+a girl that has fainted, for a woman in hysterics, for a leg that is
+broken, for an arm that is out of joint, for fevers of every color,
+for the sailor's rheumatism, and the tailor's cachexy.  In fact you
+do really know so much at this very hour, that nothing but the
+searching test of time can fully teach you the limitations of your
+knowledge.
+
+Of some of these you will permit me to remind you.  You will never
+have outgrown the possibility of new acquisitions, for Nature is
+endless in her variety.  But even the knowledge which you may be said
+to possess will be a different thing after long habit has made it a
+part of your existence.  The tactus eruditus extends to the mind as
+well as to the finger-ends.  Experience means the knowledge gained by
+habitual trial, and an expert is one who has been in the habit of
+trying.  This is the kind of knowledge that made Ulysses wise in the
+ways of men.  Many cities had he seen, and known the minds of those
+who dwelt in them.  This knowledge it was that Chaucer's Shipman
+brought home with him from the sea a
+
+     "In many a tempest had his berd be shake."
+
+This is the knowledge we place most confidence in, in the practical
+affairs of life.
+
+Our training has two stages.  The first stage deals with our
+intelligence, which takes the idea of what is to be done with the
+most charming ease and readiness.  Let it be a game of billiards, for
+instance, which the marker is going to teach us.  We have nothing to
+do but to make this ball glance from that ball and hit that other
+ball, and to knock that ball with this ball into a certain caecal
+sacculus or diverticulum which our professional friend calls a
+pocket.  Nothing can be clearer; it is as easy as "playing upon this
+pipe," for which Hamlet gives Guildenstern such lucid directions.
+But this intelligent Me, who steps forward as the senior partner in
+our dual personality, turns out to be a terrible bungler.  He misses
+those glancing hits which the hard-featured young professional person
+calls "carroms," and insists on pocketing his own ball instead of the
+other one.
+
+It is the unintelligent Me, stupid as an idiot, that has to try a
+thing a thousand times before he can do it, and then never knows how
+he does it, that at last does it well.  We have to educate ourselves
+through the pretentious claims of intellect, into the humble accuracy
+of instinct, and we end at last by acquiring the dexterity, the
+perfection, the certainty, which those masters of arts, the bee and
+the spider, inherit from Nature.
+
+Book-knowledge, lecture-knowledge, examination-knowledge, are all in
+the brain.  But work-knowledge is not only in the brain, it is in the
+senses, in the muscles, in the ganglia of the sympathetic nerves,--
+all over the man, as one may say, as instinct seems diffused through
+every part of those lower animals that have no such distinct organ as
+a brain.  See a skilful surgeon handle a broken limb; see a wise old
+physician smile away a case that looks to a novice as if the sexton
+would soon be sent for; mark what a large experience has done for
+those who were fitted to profit by it, and you will feel convinced
+that, much as you know, something is still left for you to learn.
+
+May I venture to contrast youth and experience in medical practice,
+something in the way the man painted the lion, that is, the lion
+under?
+
+The young man knows the rules, but the old man knows-the exceptions.
+The young man knows his patient, but the old man knows also his
+patient's family, dead and alive, up and down for generations.  He
+can tell beforehand what diseases their unborn children will be
+subject to, what they will die of if they live long enough, and
+whether they had better live at all, or remain unrealized
+possibilities, as belonging to a stock not worth being perpetuated.
+The young man feels uneasy if he is not continually doing something
+to stir up his patient's internal arrangements.  The old man takes
+things more quietly, and is much more willing to let well enough
+alone: All these superiorities, if such they are,'you must wait for
+time to bring you.  In the meanwhile (if we will let the lion be
+uppermost for a moment), the young man's senses are quicker than
+those of his older rival.  His education in all the accessory
+branches is more recent, and therefore nearer the existing condition
+of knowledge.  He finds it easier than his seniors to accept the
+improvements which every year is bringing forward.  New ideas build
+their nests in young men's brains.  "Revolutions are not made by men
+in spectacles," as I once heard it remarked, and the first whispers
+of a new truth are not caught by those who begin to feel the need of
+an ear-trumpet.  Granting all these advantages to the young man, he
+ought, nevertheless, to go on improving, on the whole, as a medical
+practitioner, with every year, until he has ripened into a well-
+mellowed maturity.  But, to improve, he must be good for something at
+the start.  If you ship a poor cask of wine to India and back, if you
+keep it a half a century, it only grows thinner and sharper.
+
+You are soon to enter into relations with the public, to expend your
+skill and knowledge for its benefit, and find your support in the
+rewards of your labor.  What kind of a constituency is this which is
+to look to you as its authorized champions in the struggle of life
+against its numerous enemies?
+
+In the first place, the persons who seek the aid of the physician are
+very honest and sincere in their wish to get rid of their complaints,
+and, generally speaking, to live as long as they can.  However
+attractively the future is painted to them, they are attached to the
+planet with which they are already acquainted.  They are addicted to
+the daily use of this empirical and unchemical mixture which we call
+air; and would hold on to it as a tippler does to his alcoholic
+drinks.  There is nothing men will not do, there is nothing they have
+not done, to recover their health and save their lives.  They have
+submitted to be half-drowned in water, and half-choked with gases, to
+be buried up to their chins in earth, to be seared with hot irons
+like galley-slaves, to be crimped with knives, like cod-fish, to have
+needles thrust into their flesh, and bonfires kindled on their skin,
+to swallow all sorts of abominations, and to pay for all this, as if
+to be singed and scalded were a costly privilege, as if blisters were
+a blessing, and leeches were a luxury.  What more can be asked to
+prove their honesty and sincerity?
+
+This same community is very intelligent with respect to a great many
+subjects-commerce, mechanics, manufactures, politics.  But with
+regard to medicine it is hopelessly ignorant and never finds it out.
+I do not know that it is any worse in this country than in Great
+Britain, where Mr. Huxley speaks very freely of "the utter ignorance
+of the simplest laws of their own animal life, which prevails among
+even the most highly educated persons."  And Cullen said before him
+"Neither the acutest genius nor the soundest judgment will avail in
+judging of a particular science, in regard to which they have not
+been exercised.  I have been obliged to please my patients sometimes
+with reasons, and I have found that any will pass, even with able
+divines and acute lawyers; the same will pass with the husbands as
+with the wives."  If the community could only be made aware of its
+own utter ignorance, and incompetence to form opinions on medical
+subjects, difficult enough to those who give their lives to the study
+of them, the practitioner would have an easier task.  But it will
+form opinions of its own, it cannot help it, and we cannot blame it,
+even though we know how slight and deceptive are their foundations.
+
+This is the way it happens: Every grown-up person has either been ill
+himself or had a friend suffer from illness, from which he has
+recovered.  Every sick person has done something or other by
+somebody's advice, or of his own accord, a little before getting
+better.  There is an irresistible tendency to associate the thing
+done, and the improvement which followed it, as cause and effect.
+This is the great source of fallacy in medical practice.  But the
+physician has some chance of correcting his hasty inference.  He
+thinks his prescription cured a single case of a particular
+complaint; he tries it in twenty similar cases without effect, and
+sets down the first as probably nothing more than a coincidence.  The
+unprofessional experimenter or observer has no large experience to
+correct his hasty generalization.  He wants to believe that the means
+he employed effected his cure.  He feels grateful to the person who
+advised it, he loves to praise the pill or potion which helped him,
+and he has a kind of monumental pride in himself as a living
+testimony to its efficacy.  So it is that you will find the community
+in which you live, be it in town or country, full of brands plucked
+from the burning, as they believe, by some agency which, with your
+better training, you feel reasonably confident had nothing to do with
+it.  Their disease went out of itself, and the stream from the
+medical fire-annihilator had never even touched it.
+
+You cannot and need not expect to disturb the public in the
+possession of its medical superstitions.  A man's ignorance is as
+much his private property, and as precious in his own eyes, as his
+family Bible.  You have only to open your own Bible at the ninth
+chapter of St. John's Gospel, and you will find that the logic of a
+restored patient was very simple then, as it is now, and very hard to
+deal with.  My clerical friends will forgive me for poaching on their
+sacred territory, in return for an occasional raid upon the medical
+domain of which they have now and then been accused.
+
+A blind man was said to have been restored to sight by a young person
+whom the learned doctors of the Jewish law considered a sinner, and,
+as such, very unlikely to have been endowed with a divine gift of
+healing.  They visited the patient repeatedly, and evidently teased
+him with their questions about the treatment, and their insinuations
+about the young man, until he lost his temper.  At last he turned
+sharply upon them:  "Whether he be a sinner or no, I know not: one
+thing I know, that, whereas I was blind, now I see."
+
+This is the answer that always has been and always will be given by
+most persons when they find themselves getting well after doing
+anything, no matter what,--recommended by anybody, no matter whom.
+Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in
+panaceas which we should laugh to scorn.  They had seen people get
+well after using them.  Are we any wiser than those great men?  Two
+years ago, in a lecture before the Massachusetts Historical Society,
+I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare
+the patient's nails; put the parings in a little bag, and hang the
+bag round the neck of a live eel, and place him in a tub of water.
+The eel will die, and the patient will recover.
+
+Referring to this prescription in the course of the same lecture, I
+said: "You smiled when I related Sir Kenehn Digby's prescription,
+with the live eel in it; but if each of you were to empty his or her
+pockets, would there not roll out, from more than one of them, a
+horse-chestnut, carried about as a cure for rheumatism?"  Nobody saw
+fit to empty his or her pockets, and my question brought no response.
+But two months ago I was in a company of educated persons, college
+graduates every one of them, when a gentleman, well known in our
+community, a man of superior ability and strong common-sense, on the
+occasion of some talk arising about rheumatism, took a couple of very
+shiny horse-chestnuts from his breeches-pocket, and laid them on the
+table, telling us how, having suffered from the complaint in
+question, he had, by the advice of a friend, procured these two
+horse-chestnuts on a certain time a year or more ago, and carried
+them about him ever since; from which very day he had been entirely
+free from rheumatism.
+
+This argument, from what looks like cause and effect, whether it be
+so or not, is what you will have to meet wherever you go, and you
+need not think you can answer it.  In the natural course of things
+some thousands of persons must be getting well or better of slight
+attacks of colds, of rheumatic pains, every week, in this city alone.
+Hundreds of them do something or other in the way of remedy, by
+medical or other advice, or of their own motion, and the last thing
+they do gets the credit of the recovery.  Think what a crop of
+remedies this must furnish, if it were all harvested!
+
+Experience has taught, or will teach you, that most of the wonderful
+stories patients and others tell of sudden and signal cures are like
+Owen Glendower's story of the portents that announced his birth.  The
+earth shook at your nativity, did it?  Very likely, and
+
+               "So it would have done,
+     At the same season, if your mother's cat
+     Had kittened, though yourself had ne'er been born."
+
+You must listen more meekly than Hotspur did to the babbling
+Welshman, for ignorance is a solemn and sacred fact, and, like
+infancy, which it resembles, should be respected.  Once in a while
+you will have a patient of sense, born with the gift of observation,
+from whom you may learn something.  When you find yourself in the
+presence of one who is fertile of medical opinions, and affluent in
+stories of marvellous cures,--of a member of Congress whose name
+figures in certificates to the value of patent medicines, of a
+voluble dame who discourses on the miracles she has wrought or seen
+wrought with the little jokers of the sugar-of-milk globule-box, take
+out your watch and count the pulse; also note the time of day, and
+charge the price of a visit for every extra fifteen, or, if you are
+not very busy, every twenty minutes.  In this way you will turn what
+seems a serious dispensation into a double blessing, for this class
+of patients loves dearly to talk, and it does them a deal of good,
+and you feel as if you had earned your money by the dose you have
+taken, quite as honestly as by any dose you may have ordered.
+
+You must take the community just as it is, and make the best of it.
+You wish to obtain its confidence; there is a short rule for doing
+this which you will find useful,--deserve it.  But, to deserve it in
+full measure, you must unite many excellences, natural and acquired.
+
+As the basis of all the rest, you must have all those traits of
+character which fit you to enter into the most intimate and
+confidential relations with the families of which you are the
+privileged friend and counsellor.  Medical Christianity, if I may use
+such a term, is of very early date.  By the oath of Hippocrates, the
+practitioner of ancient times bound himself to enter his patient's
+house with the sole purpose of doing him good, and so to conduct
+himself as to avoid the very appearance of evil.  Let the physician
+of to-day begin by coming up to this standard, and add to it all the
+more recently discovered virtues and graces.
+
+A certain amount of natural ability is requisite to make you a good
+physician, but by no means that disproportionate development of some
+special faculty which goes by the name of genius.  A just balance of
+the mental powers is a great deal more likely to be useful than any
+single talent, even were it the power of observation; in excess.  For
+a mere observer is liable to be too fond of facts for their own sake,
+so that, if he told the real truth, he would confess that he takes
+more pleasure in a post-mortem examination which shows him what was
+the matter with a patient, than in a case which insists on getting
+well and leaving him in the dark as to its nature.  Far more likely
+to interfere with the sound practical balance of the mind is that
+speculative, theoretical tendency which has made so many men noted in
+their day, whose fame has passed away with their dissolving theories.
+Read Dr. Bartlett's comparison of the famous Benjamin Rush with his
+modest fellow-townsman Dr. William Currie, and see the dangers into
+which a passion for grandiose generalizations betrayed a man of many
+admirable qualities.
+
+I warn you against all ambitious aspirations outside of your
+profession.  Medicine is the most difficult of sciences and the most
+laborious of arts.  It will task all your powers of body and mind if
+you are faithful to it.  Do not dabble in the muddy sewer of
+politics, nor linger by the enchanted streams of literature, nor dig
+in far-off fields for the hidden waters of alien sciences.  The great
+practitioners are generally those who concentrate all their powers on
+their business.  If there are here and there brilliant exceptions, it
+is only in virtue of extraordinary gifts, and industry to which very
+few are equal.
+
+To get business a man mast really want it; and do you suppose that
+when you are in the middle of a heated caucus, or half-way through a
+delicate analysis, or in the spasm of an unfinished ode, your eyes
+rolling in the fine frenzy of poetical composition, you want to be
+called to a teething infant, or an ancient person groaning under the
+griefs of a lumbago?  I think I have known more than one young man
+whose doctor's sign proclaimed his readiness to serve mankind in that
+capacity, but who hated the sound of a patient's knock, and as he sat
+with his book or his microscope, felt exactly as the old party
+expressed himself in my friend Mr. Brownell's poem
+
+          "All I axes is, let me alone."
+
+The community soon finds out whether you are in earnest, and really
+mean business, or whether you are one of those diplomaed dilettanti
+who like the amusement of quasi medical studies, but have no idea of
+wasting their precious time in putting their knowledge in practice
+for the benefit of their suffering fellow-creatures.
+
+The public is a very incompetent judge of your skill and knowledge,
+but it gives its confidence most readily to those who stand well with
+their professional brethren, whom they call upon when they themselves
+or their families are sick, whom they choose to honorable offices,
+whose writings and teachings they hold in esteem.  A man may be much
+valued by the profession and yet have defects which prevent his
+becoming a favorite practitioner, but no popularity can be depended
+upon as permanent which is not sanctioned by the judgment of
+professional experts, and with these you will always stand on your
+substantial merits.
+
+What shall I say of the personal habits you must form if you wish for
+success?  Temperance is first upon the list.  Intemperance in a
+physician partakes of the guilt of homicide, for the muddled brain
+may easily make a fatal blunder in a prescription and the unsteady
+hand transfix an artery in an operation.  Tippling doctors have been
+too common in the history of medicine.  Paracelsus was a sot,
+Radcliffe was much too fond of his glass, and Dr. James Hurlbut of
+Wethersfield, Connecticut, a famous man in his time, used to drink a
+square bottle of rum a day, with a corresponding allowance of opium
+to help steady his nerves.  We commonly speak of a man as being the
+worse for liquor, but I was asking an Irish laborer one day about his
+doctor, who, as he said, was somewhat given to drink.  "I like him
+best when he's a little that way," he said; "then I can spake to
+him."  I pitied the poor patient who could not venture to allude to
+his colic or his pleurisy until his physician was tipsy.
+
+There are personal habits of less gravity than the one I have
+mentioned which it is well to guard against, or, if they are formed,
+to relinquish.  A man who may be called at a moment's warning into
+the fragrant boudoir of suffering loveliness should not unsweeten its
+atmosphere with reminiscences of extinguished meerschaums.  He should
+remember that the sick are sensitive and fastidious, that they love
+the sweet odors and the pure tints of flowers, and if his presence is
+not like the breath of the rose, if his hands are not like the leaf
+of the lily, his visit may be unwelcome, and if he looks behind him
+he may see a window thrown open after he has left the sick-chamber.
+I remember too well the old doctor who sometimes came to help me
+through those inward griefs to which childhood is liable.  "Far off
+his coming "--shall I say "shone," and finish the Miltonic phrase, or
+leave the verb to the happy conjectures of my audience?  Before him
+came a soul-subduing whiff of ipecacuanha, and after him lingered a
+shuddering consciousness of rhubarb.  He had lived so much among his
+medicaments that he had at last become himself a drug, and to have
+him pass through a sick-chamber was a stronger dose than a
+conscientious disciple of Hahnemann would think it safe to
+administer.
+
+Need I remind yon of the importance of punctuality in your
+engagements, and of the worry and distress to patients and their
+friends which the want of it occasions?  One of my old teachers
+always carried two watches, to make quite sure of being exact, and
+not only kept his appointments with the regularity of a chronometer,
+but took great pains to be at his patient's house at the time when he
+had reason to believe he was expected, even if no express appointment
+was made.  It is a good rule; if you call too early, my lady's hair
+may not be so smooth as could be wished, and, if you keep her waiting
+too long, her hair may be smooth, but her temper otherwise.
+
+You will remember, of course, always to get the weather-gage of your
+patient.  I mean, to place him so that the light falls on his face
+and not on yours.  It is a kind of, ocular duel that is about to take
+place between you; you are going to look through his features into
+his pulmonary and hepatic and other internal machinery, and he is
+going to look into yours quite as sharply to see what you think about
+his probabilities for time or eternity.
+
+No matter how hard he stares at your countenance, he should never be
+able to read his fate in it.  It should be cheerful as long as there
+is hope, and serene in its gravity when nothing is left but
+resignation.  The face of a physician, like that of a diplomatist,
+should be impenetrable.  Nature is a benevolent old hypocrite; she
+cheats the sick and the dying with illusions better than any
+anodynes.  If there are cogent reasons why a patient should be
+undeceived, do it deliberately and advisedly, but do not betray your
+apprehensions through your tell-tale features.
+
+We had a physician in our city whose smile was commonly reckoned as
+being worth five thousand dollars a year to him, in the days, too, of
+moderate incomes.  You cannot put on such a smile as that any more
+than you can get sunshine without sun; there was a tranquil and
+kindly nature under it that irradiated the pleasant face it made one
+happier to meet on his daily rounds.  But you can cultivate the
+disposition, and it will work its way through to the surface, nay,
+more,--you can try to wear a quiet and encouraging look, and it will
+react on your disposition and make you like what you seem to be, or
+at least bring you nearer to its own likeness.
+
+Your patient has no more right to all the truth you know than he has
+to all the medicine in your saddlebags, if you carry that kind of
+cartridge-box for the ammunition that slays disease.  He should get
+only just so much as is good for him.  I have seen a physician
+examining a patient's chest stop all at once, as he brought out a
+particular sound with a tap on the collarbone, in the attitude of a
+pointer who has just come on the scent or sight of a woodcock.  You
+remember the Spartan boy, who, with unmoved countenance, hid the fox
+that was tearing his vitals beneath his mantle.  What he could do in
+his own suffering you must learn to do for others on whose vital
+organs disease has fastened its devouring teeth.  It is a terrible
+thing to take away hope, even earthly hope, from a fellow-creature.
+Be very careful what names you let fall before your patient.  He
+knows what it means when you tell him he has tubercles or Bright's
+disease, and, if he hears the word carcinoma, he will certainly look
+it out in a medical dictionary, if he does not interpret its dread
+significance on the instant.  Tell him he has asthmatic symptoms, or
+a tendency to the gouty diathesis, and he will at once think of all
+the asthmatic and gouty old patriarchs he has ever heard of, and be
+comforted.  You need not be so cautious in speaking of the health of
+rich and remote relatives, if he is in the line of succession.
+
+Some shrewd old doctors have a few phrases always on hand for
+patients that will insist on knowing the pathology of their
+complaints without the slightest capacity of understanding the
+scientific explanation.  I have known the term "spinal irritation"
+serve well on such occasions, but I think nothing on the whole has
+covered so much ground, and meant so little, and given such profound
+satisfaction to all parties, as the magnificent phrase "congestion of
+the portal system."
+
+Once more, let me recommend you, as far as possible, to keep your
+doubts to yourself, and give the patient the benefit of your
+decision.  Firmness, gentle firmness, is absolutely necessary in this
+and certain other relations.  Mr. Rarey with Cruiser, Richard with
+Lady Ann, Pinel with his crazy people, show what steady nerves can do
+with the most intractable of animals, the most irresistible of
+despots, and the most unmanageable of invalids.
+
+If you cannot acquire and keep the confidence of your patient, it is
+time for you to give place to some other practitioner who can.  If
+you are wise and diligent, you can establish relations with the best
+of them which they will find it very hard to break.  But, if they
+wish to employ another person, who, as they think, knows more than
+you do, do not take it as a personal wrong.  A patient believes
+another man can save his life, can restore him to health, which, as
+he thinks, you have not the skill to do.  No matter whether the
+patient is right or wrong, it is a great impertinence to think you
+have any property in him.  Your estimate of your own ability is not
+the question, it is what the patient thinks of it.  All your wisdom
+is to him like the lady's virtue in Raleigh's song:
+
+    "If she seem not chaste to me,
+     What care I how chaste she be?"
+
+What I call a good patient is one who, having found a good physician,
+sticks to him till he dies.  But there are many very good people who
+are not what I call good patients.  I was once requested to call on a
+lady suffering from nervous and other symptoms.  It came out in the
+preliminary conversational skirmish, half medical, half social, that
+I was the twenty-sixth member of the faculty into whose arms,
+professionally speaking, she had successively thrown herself.  Not
+being a believer in such a rapid rotation of scientific crops, I
+gently deposited the burden, commending it to the care of number
+twenty-seven, and, him, whoever he might be, to the care of Heaven.
+
+If there happened to be among my audience any person who wished to
+know on what principles the patient should choose his physician, I
+should give him these few precepts to think over:
+
+Choose a man who is personally agreeable, for a daily visit from an
+intelligent, amiable, pleasant, sympathetic person will cost you no
+more than one from a sloven or a boor, and his presence will do more
+for you than any prescription the other will order.
+
+Let him be a man of recognized good sense in other matters, and the
+chance is that he will be sensible as a practitioner.
+
+Let him be a man who stands well with his professional brethren, whom
+they approve as honest, able, courteous.
+
+Let him be one whose patients are willing to die in his hands, not
+one whom they go to for trifles, and leave as soon as they are in
+danger, and who can say, therefore, that he never loses a patient.
+
+Do not leave the ranks of what is called the regular profession,
+unless you wish to go farther and fare worse, for you may be assured
+that its members recognize no principle which hinders their accepting
+any remedial agent proved to be useful, no matter from what quarter
+it comes.  The difficulty is that the stragglers, organized under
+fantastic names in pretentious associations, or lurking in solitary
+dens behind doors left ajar, make no real contributions to the art of
+healing.  When they bring forward a remedial agent like chloral, like
+the bromide of potassium, like ether, used as an anesthetic, they
+will find no difficulty in procuring its recognition.
+
+Some of you will probably be more or less troubled by the pretensions
+of that parody of mediaeval theology which finds its dogma of
+hereditary depravity in the doctrine of psora, its miracle of
+transubstantiation in the mystery of its triturations and dilutions,
+its church in the people who have mistaken their century, and its
+priests in those who have mistaken their calling.  You can do little
+with persons who are disposed to accept these curious medical
+superstitions.  The saturation-point of individual minds with
+reference to evidence, and especially medical evidence, differs, and
+must always continue to differ, very widely.  There are those whose
+minds are satisfied with the decillionth dilution of a scientific
+proof.  No wonder they believe in the efficacy of a similar
+attenuation of bryony or pulsatilla.  You have no fulcrum you can
+rest upon to lift an error out of such minds as these, often highly
+endowed with knowledge and talent, sometimes with genius, but
+commonly richer in the imaginative than the observing and reasoning
+faculties.
+
+Let me return once more to the young graduate.  Your relations to
+your professional brethren may be a source of lifelong happiness and
+growth in knowledge and character, or they may make you wretched and
+end by leaving you isolated from those who should be your friends and
+counsellors.  The life of a physician becomes ignoble when he suffers
+himself to feed on petty jealousies and sours his temper in perpetual
+quarrels.  You will be liable to meet an uncomfortable man here and
+there in the profession,--one who is so fond of being in hot water
+that it is a wonder all the albumen in his body is not coagulated.
+There are common barrators among doctors as there are among lawyers,
+--stirrers up of strife under one pretext and another, but in reality
+because they like it.  They are their own worst enemies, and do
+themselves a mischief each time they assail their neighbors.  In my
+student days I remember a good deal of this Donnybrook-Fair style of
+quarrelling, more especially in Paris, where some of the noted
+surgeons were always at loggerheads, and in one of our lively Western
+cities.  Soon after I had set up an office, I had a trifling
+experience which may serve to point a moral in this direction.  I had
+placed a lamp behind the glass in the entry to indicate to the
+passer-by where relief from all curable infirmities was to be sought
+and found.  Its brilliancy attracted the attention of a devious
+youth, who dashed his fist through the glass and upset my modest
+luminary.  All he got by his vivacious assault was that he left
+portions of integument from his knuckles upon the glass, had a lame
+hand, was very easily identified, and had to pay the glazier's bill.
+The moral is that, if the brilliancy of another's reputation excites
+your belligerent instincts, it is not worth your while to strike at
+it, without calculating which of you is likely to suffer most, if you
+do.
+
+You may be assured that when an ill-conditioned neighbor is always
+complaining of a bad taste in his mouth and an evil atmosphere about
+him, there is something wrong about his own secretions.  In such
+cases there is an alterative regimen of remarkable efficacy: it is a
+starvation-diet of letting alone.  The great majority of the
+profession are peacefully inclined.  Their pursuits are eminently
+humanizing, and they look with disgust on the personalities which
+intrude themselves into the placid domain of an art whose province it
+is to heal and not to wound.
+
+The intercourse of teacher and student in a large school is
+necessarily limited, but it should be, and, so far as my experience
+goes, it is, eminently cordial and kindly.  You will leave with
+regret, and hold in tender remembrance, those who have taken you by
+the hand at your entrance on your chosen path, and led you patiently
+and faithfully, until the great gates at its end have swung upon
+their hinges, and the world lies open before you.  That venerable
+oath to which I have before referred bound the student to regard his
+instructor in the light of a parent, to treat his children like
+brothers, to succor him in his day of need.  I trust the spirit of
+the oath of Hippocrates is not dead in the hearts of the students of
+to-day.  They will remember with gratitude every earnest effort,
+every encouraging word, which has helped them in their difficult and
+laborious career of study.  The names they read on their diplomas
+will recall faces that are like family-portraits in their memory, and
+the echo of voices they have listened to so long will linger in their
+memories far into the still evening of their lives.
+
+One voice will be heard no more which has been familiar to many among
+you.  It is not for me, a stranger to these scenes, to speak his
+eulogy.  I have no right to sadden this hour by dwelling on the deep
+regrets of friendship, or to bid the bitter tears of sorrow flow
+afresh.  Yet I cannot help remembering what a void the death of such
+a practitioner as your late instructor must leave in the wide circle
+of those who leaned upon his counsel and assistance in their hour of
+need, in a community where he was so widely known and esteemed, in a
+school where he bore so important a part.  There is no exemption from
+the common doom for him who holds the shield to protect others.  The
+student is called from his bench, the professor from his chair, the
+practitioner in his busiest period hears a knock more peremptory than
+any patient's midnight summons, and goes on that unreturning visit
+which admits of no excuse, and suffers no delay.  The call of such a
+man away from us is the bereavement of a great family.  Nor can we
+help regretting the loss for him of a bright and cheerful earthly
+future; for the old age of a physician is one of the happiest periods
+of his life.  He is loved and cherished for what he has been, and
+even in the decline of his faculties there are occasions when his
+experience is still appealed to, and his trembling hands are looked
+to with renewing hope and trust, as being yet able to stay the arm of
+the destroyer.
+
+But if there is so much left for age, how beautiful, how inspiring is
+the hope of youth!  I see among those whom I count as listeners one
+by whose side I have sat as a fellow-teacher, and by whose
+instructions I have felt myself not too old to profit.  As we
+borrowed him from your city, I must take this opportunity of telling
+you that his zeal, intelligence, and admirable faculty as an
+instructor were heartily and universally recognized among us.  We
+return him, as we trust, uninjured, to the fellow-citizens who have
+the privilege of claiming him as their own.
+
+And now, gentlemen of the graduating class, nothing remains but for
+me to bid you, in the name of those for whom I am commissioned and
+privileged to speak, farewell as students, and welcome as
+practitioners.  I pronounce the two benedictions in the same breath,
+as the late king's demise and the new king's accession are proclaimed
+by the same voice at the same moment.  You would hardly excuse me if
+I stooped to any meaner dialect than the classical and familiar
+language of your prescriptions, the same in which your title to the
+name of physician is, if, like our own institution, you follow the
+ancient usage, engraved upon your diplomas.
+
+Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete,
+filii!
+
+Salvete, VIRI, artis medicae magister; Salvete amici; salvete
+fratres!
+
+
+
+
+
+
+MEDICAL LIBRARIES.
+
+[Dedicatory Address at the opening of the Medical Library in Boston,
+December 3, 1878.]
+
+It is my appointed task, my honorable privilege, this evening, to
+speak of what has been done by others.  No one can bring his tribute
+of words into the presence of great deeds, or try with them to
+embellish the memory of any inspiring achievement, without feeling
+and leaving with others a sense of their insufficiency.  So felt
+Alexander when he compared even his adored Homer with the hero the
+poet had sung.  So felt Webster when he contrasted the phrases of
+rhetoric with the eloquence of patriotism and of self-devotion.  So
+felt Lincoln when on the field of Gettysburg he spoke those immortal
+words which Pericles could not nave bettered, which Aristotle could
+not have criticised.  So felt he who wrote the epitaph of the builder
+of the dome which looks down on the crosses and weathercocks that
+glitter over London.
+
+We are not met upon a battle-field, except so far as every laborious
+achievement means a victory over opposition, indifference,
+selfishness, faintheartedness, and that great property of mind as
+well as matter,--inertia.  We are not met in a cathedral, except so
+far as every building whose walls are lined with the products of
+useful and ennobling thought is a temple of the Almighty, whose
+inspiration has given us understanding.  But we have gathered within
+walls which bear testimony to the self-sacrificing, persevering
+efforts of a few young men, to whom we owe the origin and development
+of all that excites our admiration in this completed enterprise; and
+I might consider my task as finished if I contented myself with
+borrowing the last word of the architect's epitaph and only saying,
+Look around you!
+
+The reports of the librarian have told or will tell you, in some
+detail, what has been accomplished since the 21st of December, 1874,
+when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch
+to discuss different projects for a medical library.  In less than
+four years from that time, by the liberality of associations and of
+individuals, this collection of nearly ten thousand volumes, of five
+thousand pamphlets, and of one hundred and twenty-five journals,
+regularly received,--all worthily sheltered beneath this lofty roof,
+--has come into being under our eyes.  It has sprung up, as it were;
+in the night like a mushroom; it stands before us in full daylight as
+lusty as an oak, and promising to grow and flourish in the perennial
+freshness of an evergreen.
+
+To whom does our profession owe this already large collection of
+books, exceeded in numbers only by four or five of the most extensive
+medical libraries in the country, and lodged in a building so well
+adapted to its present needs?  We will not point out individually all
+those younger members of the profession who have accomplished what
+their fathers and elder brethren had attempted and partially
+achieved.  We need not write their names on these walls, after the
+fashion of those civic dignitaries who immortalize themselves on
+tablets of marble and gates of iron.  But their contemporaries know
+them well, and their descendants will not forget them,--the men who
+first met together, the men who have given their time and their
+money, the faithful workers, worthy associates of the strenuous
+agitator who gave no sleep to his eyes, no slumber to his eyelids,
+until he had gained his ends; the untiring, imperturbable, tenacious,
+irrepressible, all-subduing agitator who neither rested nor let
+others rest until the success of the project was assured.  If,
+against his injunctions, I name Dr. James Read Chadwick, it is only
+my revenge for his having kept me awake so often and so long while he
+was urging on the undertaking in which he has been preeminently
+active and triumphantly successful.
+
+We must not forget the various medical libraries which preceded this:
+that of an earlier period, when Boston contained about seventy
+regular practitioners, the collection afterwards transferred to the
+Boston Athenaeum; the two collections belonging to the University;
+the Treadwell Library at the Massachusetts General Hospital; the
+collections of the two societies, that for Medical Improvement and
+that for Medical Observation; and more especially the ten thousand
+volumes relating to medicine belonging to our noble public city
+library,--too many blossoms on the tree of knowledge, perhaps, for
+the best fruit to ripen.  But the Massachusetts Medical Society now
+numbers nearly four hundred members in the city of Boston.  The time
+had arrived for a new and larger movement.  There was needed a place
+to which every respectable member of the medical profession could
+obtain easy access; where, under one roof, all might find the special
+information they were seeking; where the latest medical intelligence
+should be spread out daily as the shipping news is posted on the
+bulletins of the exchange; where men engaged in a common pursuit
+could meet, surrounded by the mute oracles of science and art; where
+the whole atmosphere should be as full of professional knowledge as
+the apothecary's shop is of the odor of his medicaments.  This was
+what the old men longed for,--the prophets and kings of the
+profession, who
+
+               "Desired it long,
+     But died without the sight."
+
+This is what the young men and those who worked under their guidance
+undertook to give us.  And now such a library, such a reading-room,
+such an exchange, such an intellectual and social meeting place, we
+be hold a fact, plain before us.  The medical profession of our city,
+and, let us add, of all those neighboring places which it can reach
+with its iron arms, is united as never before by the commune
+vinculum, the common bond of a large, enduring, ennobling, unselfish
+interest.  It breathes a new air of awakened intelligence.  It
+marches abreast of the other learned professions, which have long had
+their extensive and valuable centralized libraries; abreast of them,
+but not promising to be content with that position.  What glorifies a
+town like a cathedral?  What dignifies a province like a university?
+What illuminates a country like its scholarship, and what is the nest
+that hatches scholars but a library?
+
+The physician, some may say, is a practical man and has little use
+for all this book-learning.  Every student has heard Sydenham's reply
+to Sir Richard Blackmore's question as to what books he should read,
+--meaning medical books.  "Read Don Quixote," was his famous answer.
+But Sydenham himself made medical books and may be presumed to have
+thought those at least worth reading.  Descartes was asked where was
+his library, and in reply held up the dissected body of an animal.
+But Descartes made books, great books, and a great many of them.  A
+physician of common sense without erudition is better than a learned
+one without common sense, but the thorough master of his profession
+must have learning added to his natural gifts.
+
+It is not necessary to maintain the direct practical utility of all
+kinds of learning.  Our shelves contain many books which only a
+certain class of medical scholars will be likely to consult.  There
+is a dead medical literature, and there is a live one.  The dead is
+not all ancient, the live is not all modern.  There is none, modern
+or ancient, which, if it has no living value for the student, will
+not teach him something by its autopsy.  But it is with the live
+literature of his profession that the medical practitioner is first
+of all concerned.
+
+Now there has come a great change in our time over the form in which
+living thought presents itself.  The first printed books,--the
+incunabula,--were inclosed in boards of solid oak, with brazen clasps
+and corners; the boards by and by were replaced by pasteboard covered
+with calf or sheepskin; then cloth came in and took the place of
+leather; then the pasteboard was covered with paper instead of cloth;
+and at this day the quarterly, the monthly, the weekly periodical in
+its flimsy unsupported dress of paper, and the daily journal, naked
+as it came from the womb of the press, hold the larger part of the
+fresh reading we live upon.  We must have the latest thought in its
+latest expression; the page must be newly turned like the morning
+bannock; the pamphlet must be newly opened like the ante-prandial
+oyster.
+
+Thus a library, to meet the need of our time, must take, and must
+spread out in a convenient form, a great array of periodicals.  Our
+active practitioners read these by preference over almost everything
+else.  Our specialists, more particularly, depend on the month's
+product, on the yearly crop of new facts, new suggestions, new
+contrivances, as much as the farmer on the annual yield of his acres.
+One of the first wants, then, of the profession is supplied by our
+library in its great array of periodicals from many lands, in many
+languages.  Such a number of medical periodicals no private library
+would have room for, no private person would pay for, or flood his
+tables with if they were sent him for nothing.  These, I think, with
+the reports of medical societies and the papers contributed to them,
+will form the most attractive part of our accumulated medical
+treasures.  They will be also one of our chief expenses, for these
+journals must be bound in volumes and they require a great amount of
+shelf-room; all this, in addition to the cost of subscription for
+those which are not furnished us gratuitously.
+
+It is true that the value of old scientific periodicals is, other
+things being equal, in the inverse ratio of their age, for the
+obvious reason that what is most valuable in the earlier volumes of a
+series is drained off into the standard works with which the
+intelligent practitioner is supposed to be familiar.  But no extended
+record of facts grows too old to be useful, provided only that we
+have a ready and sure way of getting at the particular fact or facts
+we are in search of.
+
+And this leads me to speak of what I conceive to be one of the
+principal tasks to be performed by the present and the coming
+generation of scholars, not only in the medical, but in every
+department of knowledge.  I mean the formation of indexes, and more
+especially of indexes to periodical literature.
+
+This idea has long been working in the minds of scholars, and all who
+have had occasion to follow out any special subject.  I have a right
+to speak of it, for I long ago attempted to supply the want of
+indexes in some small measure for my own need.  I had a very complete
+set of the "American Journal of the Medical Sciences;" an entire set
+of the "North American Review," and many volumes of the reprints of
+the three leading British quarterlies.  Of what use were they to me
+without general indexes?  I looked them all through carefully and
+made classified lists of all the articles I thought I should most
+care to read.  But they soon outgrew my lists.  The "North American
+Review" kept filling up shelf after shelf, rich in articles which I
+often wanted to consult, but what a labor to find them, until the
+index of Mr. Gushing, published a few months since, made the contents
+of these hundred and twenty volumes as easily accessible as the words
+in a dictionary!  I had a, copy of good Dr. Abraham Rees's
+Cyclopaedia, a treasure-house to my boyhood which has not lost its
+value for me in later years.  But where to look for what I wanted?  I
+wished to know, for instance, what Dr. Burney had to say about
+singing.  Who would have looked for it under the Italian word
+cantare?  I was curious to learn something of the etchings of
+Rembrandt, and where should I find it but under the head "Low
+Countries, Engravers of the,"--an elaborate and most valuable article
+of a hundred double-columned close-printed quarto pages, to which no
+reference, even, is made under the title Rembrandt.
+
+There was nothing to be done, if I wanted to know where that which I
+specially cared for was to be found in my Rees's Cyclopaedia, but to
+look over every page of its forty-one quarto volumes and make out a
+brief list of matters of interest which I could not find by their
+titles, and this I did, at no small expense of time and trouble.
+
+Nothing, therefore, could be more pleasing to me than to see the
+attention which has been given of late years to the great work of
+indexing.  It is a quarter of a century since Mr. Poole published his
+"Index to Periodical Literature," which it is much to be hoped is
+soon to appear in a new edition, grown as it must be to formidable
+dimensions by the additions of so long a period.  The "British and
+Foreign Medical Review," edited by the late Sir John Forties,
+contributed to by Huxley, Carpenter, Laycock, and others of the most
+distinguished scientific men of Great Britain, has an index to its
+twenty-four volumes, and by its aid I find this valuable series as
+manageable as a lexicon.  The last edition of the "Encyclopaedia
+Britannica" had a complete index in a separate volume, and the
+publishers of Appletons' "American Cyclopaedia" have recently issued
+an index to their useful work, which must greatly add to its value.
+I have already referred to the index to the "North American Review,"
+which to an American, and especially to a New Englander, is the most
+interesting and most valuable addition of its kind to our literary
+apparatus since the publication of Mr. Allibone's "Dictionary of
+Authors."  I might almost dare to parody Mr. Webster's words in
+speaking of Hamilton, to describe what Mr. Gushing did for the solemn
+rows of back volumes of our honored old Review which had been long
+fossilizing on our shelves: "He touched the dead corpse of the 'North
+American,' and it sprang to its feet."  A library of the best
+thought of the best American scholars during the greater portion of
+the century was brought to light by the work of the indexmaker as
+truly as were the Assyrian tablets by the labors of Layard.
+
+A great portion of the best writing and reading literary, scientific,
+professional, miscellaneous--comes to us now, at stated intervals, in
+paper covers.  The writer appears, as it were, in his shirt-sleeves.
+As soon as he has delivered his message the book-binder puts a coat
+on his back, and he joins the forlorn brotherhood of "back volumes,"
+than which, so long as they are unindexed, nothing can be more
+exasperating.  Who wants a lock without a key, a ship without a
+rudder, a binnacle without a compass, a check without a signature, a
+greenback without a goldback behind it?
+
+I have referred chiefly to the medical journals, but I would include
+with these the reports of medical associations, and those separate
+publications which, coming in the form of pamphlets, heap themselves
+into chaotic piles and bundles which are worse than useless, taking
+up a great deal of room, and frightening everything away but mice and
+mousing antiquarians, or possibly at long intervals some terebrating
+specialist.
+
+Arranged, bound, indexed, all these at once become accessible and
+valuable.  I will take the first instance which happens to suggest
+itself.  How many who know all about osteoblasts and the experiments
+of Ollier, and all that has grown out of them, know where to go for a
+paper by the late Dr. A. L. Peirson of Salem, published in the year
+1840, under the modest title, Remarks on Fractures?  And if any
+practitioner who has to deal with broken bones does not know that
+most excellent and practical essay, it is a great pity, for it
+answers very numerous questions which will be sure to suggest
+themselves to the surgeon and the patient as no one of the recent
+treatises, on my own shelves, at least, can do.
+
+But if indexing is the special need of our time in medical
+literature, as in every department of knowledge, it must be
+remembered that it is not only an immense labor, but one that never
+ends.  It requires, therefore, the cooperation of a large number of
+individuals to do the work, and a large amount of money to pay for
+making its results public through the press.  When it is remembered
+that the catalogue of the library of the British Museum is contained
+in nearly three thousand large folios of manuscript, and not all its
+books are yet included, the task of indexing any considerable branch
+of science or literature looks as if it were well nigh impossible.
+But many hands make light work.  An "Index Society" has been formed
+in England, already numbering about one hundred and seventy members.
+It aims at "supplying thorough indexes to valuable works and
+collections which have hitherto lacked them; at issuing indexes to
+the literature of special subjects; and at gathering materials for a
+general reference index."  This society has published a little
+treatise setting forth the history and the art of indexing, which I
+trust is in the hands of some of our members, if not upon our
+shelves.
+
+Something has been done in the same direction by individuals in our
+own country, as we have already seen.  The need of it in the
+department of medicine is beginning to be clearly felt.  Our library
+has already an admirable catalogue with cross references, the work of
+a number of its younger members cooperating in the task.  A very
+intelligent medical student, Mr. William D. Chapin, whose excellent
+project is indorsed by well-known New York physicians and professors,
+proposes to publish a yearly index to original communications in the
+medical journals of the United States, classified by authors and
+subjects.  But it is from the National Medical Library at Washington
+that we have the best promise and the largest expectations.  That
+great and growing collection of fifty thousand volumes is under the
+eye and hand of a librarian who knows books and how to manage them.
+For libraries are the standing armies of civilization, and an army is
+but a mob without a general who can organize and marshal it so as to
+make it effective.  The "Specimen Fasciculus of a Catalogue of the
+National Medical Library," prepared under the direction of Dr.
+Billings, the librarian, would have excited the admiration of Haller,
+the master scholar in medical science of the last century, or rather
+of the profession in all centuries, and if carried out as it is begun
+will be to the nineteenth all and more than all that the three
+Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to
+the eighteenth century.  I cannot forget the story that Agassiz was
+so fond of telling of the king of Prussia and Fichte.  It was after
+the humiliation and spoliation of the kingdom by Napoleon that the
+monarch asked the philosopher what could be done to regain the lost
+position of the nation.  "Found a great university, Sire," was the
+answer, and so it was that in the year 1810 the world-renowned
+University of Berlin came into being.  I believe that we in this
+country can do better than found a national university, whose
+professors shall be nominated in caucuses, go in and out, perhaps,
+like postmasters, with every change of administration, and deal with
+science in the face of their constituency as the courtier did with
+time when his sovereign asked him what o'clock it was: "Whatever hour
+your majesty pleases."  But when we have a noble library like that at
+Washington, and a librarian of exceptional qualifications like the
+gentleman who now holds that office, I believe that a liberal
+appropriation by Congress to carry out a conscientious work for the
+advancement of sound knowledge and the bettering of human conditions,
+like this which Dr. Billings has so well begun, would redound greatly
+to the honor of the nation.  It ought to be willing to be at some
+charge to make its treasures useful to its citizens, and, for its own
+sake, especially to that class which has charge of health, public and
+private.  This country abounds in what are called "self-made men,"
+and is justly proud of many whom it thus designates.  In one sense no
+man is self-made who breathes the air of a civilized community.  In
+another sense every man who is anything other than a phonograph on
+legs is self-made.  But if we award his just praise to the man who
+has attained any kind of excellence without having had the same
+advantages as others whom, nevertheless, he has equalled or
+surpassed, let us not be betrayed into undervaluing the mechanic's
+careful training to his business, the thorough and laborious
+education of the scholar and the professional man.
+
+Our American atmosphere is vocal with the flippant loquacity of half
+knowledge.  We must accept whatever good can be got out of it, and
+keep it under as we do sorrel and mullein and witchgrass, by
+enriching the soil, and sowing good seed in plenty; by good teaching
+and good books, rather than by wasting our time in talking against
+it.  Half knowledge dreads nothing but whole knowledge.
+
+I have spoken of the importance and the predominance of periodical
+literature, and have attempted to do justice to its value.  But the
+almost exclusive reading of it is not without its dangers.  The
+journals contain much that is crude and unsound; the presumption; it
+might be maintained, is against their novelties, unless they come
+from observers of established credit.  Yet I have known a
+practitioner,--perhaps more than one,--who was as much under the
+dominant influence of the last article he had read in his favorite
+medical journal as a milliner under the sway of the last fashion-
+plate.  The difference between green and seasoned knowledge is very
+great, and such practitioners never hold long enough to any of their
+knowledge to have it get seasoned.
+
+It is needless to say, then, that all the substantial and permanent
+literature of the profession should be represented upon our shelves.
+Much of it is there already, and as one private library after another
+falls into this by the natural law of gravitation, it will gradually
+acquire all that is most valuable almost without effort.  A scholar
+should not be in a hurry to part with his books.  They are probably
+more valuable to him than they can be to any other individual.  What
+Swedenborg called "correspondence" has established itself between his
+intelligence and the volumes which wall him within their sacred
+inclosure.  Napoleon said that his mind was as if furnished with
+drawers,--he drew out each as he wanted its contents, and closed it
+at will when done with them.  The scholar's mind, to use a similar
+comparison, is furnished with shelves, like his library.  Each book
+knows its place in the brain as well as against the wall or in the
+alcove.  His consciousness is doubled by the books which encircle
+him, as the trees that surround a lake repeat themselves in its
+unruffled waters.  Men talk of the nerve that runs to the pocket, but
+one who loves his books, and has lived long with them, has a nervous
+filament which runs from his sensorium to every one of them.  Or, if
+I may still let my fancy draw its pictures, a scholar's library is to
+him what a temple is to the worshipper who frequents it.  There is
+the altar sacred to his holiest experiences.  There is the font where
+his new-born thought was baptized and first had a name in his
+consciousness.  There is the monumental tablet of a dead belief,
+sacred still in the memory of what it was while yet alive.  No
+visitor can read all this on the lettered backs of the books that
+have gathered around the scholar, but for him, from the Aldus on the
+lowest shelf to the Elzevir on the highest, every volume has a
+language which none but be can interpret.  Be patient with the book-
+collector who loves his companions too well to let them go.  Books
+are not buried with their owners, and the veriest book-miser that
+ever lived was probably doing far more for his successors than his
+more liberal neighbor who despised his learned or unlearned avarice.
+Let the fruit fall with the leaves still clinging round it.  Who
+would have stripped Southey's walls of the books that filled them,
+when, his mind no longer capable of taking in their meaning, he would
+still pat and fondle them with the vague loving sense of what they
+had once been to him,--to him, the great scholar, now like a little
+child among his playthings?
+
+We need in this country not only the scholar, but the virtuoso, who
+hoards the treasures which he loves, it may be chiefly for their
+rarity and because others who know more than he does of their value
+set a high price upon them.  As the wine of old vintages is gently
+decanted out of its cobwebbed bottles with their rotten corks into
+clean new receptacles, so the wealth of the New World is quietly
+emptying many of the libraries and galleries of the Old World into
+its newly formed collections and newly raised edifices.  And this
+process must go on in an accelerating ratio.  No Englishman will be
+offended if I say that before the New Zealander takes his stand on a
+broken arch of London Bridge to sketch the ruins of St. Paul's in the
+midst of a vast solitude, the treasures of the British Museum will
+have found a new shelter in the halls of New York or Boston.  No
+Catholic will think hardly of my saying that before the Coliseum
+falls, and with it the imperial city, whose doom prophecy has linked
+with that of the almost eternal amphitheatre, the marbles, the
+bronzes, the paintings, the manuscripts of the Vatican will have left
+the shores of the Tiber for those of the Potomac, the Hudson, the
+Mississippi, or the Sacramento.  And what a delight in the pursuit of
+the rarities which the eager book-hunter follows with the scent of a
+beagle!
+
+Shall I ever forget that rainy day in Lyons, that dingy bookshop,
+where I found the Aetius, long missing from my Artis bledicae
+Principes, and where I bought for a small pecuniary consideration,
+though it was marked rare, and was really tres rare, the Aphorisms of
+Hippocrates, edited by and with a preface from the hand of Francis
+Rabelais?  And the vellum-bound Tulpius, which I came upon in Venice,
+afterwards my only reading when imprisoned in quarantine at
+Marseilles, so that the two hundred and twenty-eight cases he has
+recorded are, many of them, to this day still fresh in my memory.
+And the Schenckius,--the folio filled with casus rariores, which had
+strayed in among the rubbish of the bookstall on the boulevard,--and
+the noble old Vesalius with its grand frontispiece not unworthy of
+Titian, and the fine old Ambroise Pare, long waited for even in Paris
+and long ago, and the colossal Spigelius with his eviscerated
+beauties, and Dutch Bidloo with its miracles of fine engraving and
+bad dissection, and Italian Mascagni, the despair of all would-be
+imitators, and pre-Adamite John de Ketam, and antediluvian
+Berengarius Carpensis,--but why multiply names, every one of which
+brings back the accession of a book which was an event almost like
+the birth of an infant?
+
+A library like ours must exercise the largest hospitality.  A great
+many books may be found in every large collection which remind us of
+those apostolic looking old men who figure on the platform at our
+political and other assemblages.  Some of them have spoken words of
+wisdom in their day, but they have ceased to be oracles; some of them
+never had any particularly important message for humanity, but they
+add dignity to the meeting by their presence; they look wise, whether
+they are so or not, and no one grudges them their places of honor.
+Venerable figure-heads, what would our platforms be without you?
+
+Just so with our libraries.  Without their rows of folios in creamy
+vellum, or showing their black backs with antique lettering of
+tarnished gold, our shelves would look as insufficient and unbalanced
+as a column without its base, as a statue without its pedestal.  And
+do not think they are kept only to be spanked and dusted during that
+dreadful period when their owner is but too thankful to become an
+exile and a wanderer from the scene of single combats between dead
+authors and living housemaids.  Men were not all cowards before
+Agamemnon or all fools before the days of Virchow and Billroth.  And
+apart from any practical use to be derived from the older medical
+authors, is there not a true pleasure in reading the accounts of
+great discoverers in their own words?  I do not pretend to hoist up
+the Bibliotheca Anatomica of Mangetus and spread it on my table every
+day.  I do not get out my great Albinus before every lecture on the
+muscles, nor disturb the majestic repose of Vesalius every time I
+speak of the bones he has so admirably described and figured.  But it
+does please me to read the first descriptions of parts to which the
+names of their discoverers or those who have first described them
+have become so joined that not even modern science can part them; to
+listen to the talk of my old volume as Willis describes his circle
+and Fallopius his aqueduct and Varolius his bridge and Eustachius his
+tube and Monro his foramen,--all so well known to us in the human
+body; it does please me to know the very words in which Winslow
+described the opening which bears his name, and Glisson his capsule
+and De Graaf his vesicle; I am not content until I know in what
+language Harvey announced his discovery of the circulation, and how
+Spigelius made the liver his perpetual memorial, and Malpighi found a
+monument more enduring than brass in the corpuscles of the spleen and
+the kidney.
+
+But after all, the readers who care most for the early records of
+medical science and art are the specialists who are dividing up the
+practice of medicine and surgery as they were parcelled out,
+according to Herodotus, by the Egyptians.  For them nothing is too
+old, nothing is too new, for to their books of ail others is
+applicable the saying of D'Alembert that the author kills himself in
+lengthening out what the reader kills himself in trying to shorten.
+
+There are practical books among these ancient volumes which can never
+grow old.  Would you know how to recognize "male hysteria" and to
+treat it, take down your Sydenham; would you read the experience of a
+physician who was himself the subject of asthma, and who,
+notwithstanding that, in the words of Dr. Johnson, "panted on till
+ninety," you will find it in the venerable treatise of Sir John
+Floyer; would you listen to the story of the King's Evil cured by the
+royal touch, as told by a famous chirurgeon who fully believed in it,
+go to Wiseman; would you get at first hand the description of the
+spinal disease which long bore his name, do not be startled if I tell
+you to go to Pott,--to Percival Pott, the great surgeon of the last
+century.
+
+There comes a time for every book in a library when it is wanted by
+somebody.  It is but a few weeks since one of the most celebrated
+physicians in the country wrote to me from a great centre of medical
+education to know if I had the works of Sanctorius, which he had
+tried in vain to find.  I could have lent him the "Medicina Statica,"
+with its frontispiece showing Sanctorius with his dinner on the table
+before him, in his balanced chair which sunk with him below the level
+of his banquet-board when he had swallowed a certain number of
+ounces,--an early foreshadowing of Pettenkofer's chamber and
+quantitative physiology,--but the "Opera Omnia" of Sanctorius I had
+never met with, and I fear he had to do without it.
+
+I would extend the hospitality of these shelves to a class of works
+which we are in the habit of considering as being outside of the pale
+of medical science, properly so called, and sometimes of coupling
+with a disrespectful name.  Such has always been my own practice.  I
+have welcomed Culpeper and Salmon to my bookcase as willingly as
+Dioscorides or Quincy, or Paris or Wood and Bache.  I have found a
+place for St. John Long, and read the story of his trial for
+manslaughter with as much interest as the laurel-water case in which
+John Hunter figured as a witness.  I would give Samuel Hahnemann a
+place by the side of Samuel Thomson.  Am I not afraid that some
+student of imaginative turn and not provided with the needful
+cerebral strainers without which all the refuse of gimcrack
+intelligences gets into the mental drains and chokes them up,--am I
+not afraid that some such student will get hold of the "Organon" or
+the "Maladies Chroniques" and be won over by their delusions, and so
+be lost to those that love him as a man of common sense and a brother
+in their high calling?  Not in the least.  If he showed any symptoms
+of infection I would for once have recourse to the principle of
+similia similibus.  To cure him of Hahnemann I would prescribe my
+favorite homoeopathic antidote, Okie's Bonninghausen.  If that
+failed, I would order Grauvogl as a heroic remedy, and if he survived
+that uncured, I would give him my blessing, if I thought him honest,
+and bid him depart in peace.  For me he is no longer an individual.
+He belongs to a class of minds which we are bound to be patient with
+if their Maker sees fit to indulge them with existence.  We must
+accept the conjuring ultra-ritualist, the dreamy second adventist,
+the erratic spiritualist, the fantastic homoeopathist, as not
+unworthy of philosophic study; not more unworthy of it than the
+squarers of the circle and the inventors of perpetual motion, and the
+other whimsical visionaries to whom De Morgan has devoted his most
+instructive and entertaining "Budget of Paradoxes."  I hope,
+therefore, that our library will admit the works of the so-called
+Eclectics, of the Thomsonians, if any are in existence, of the
+Clairvoyants, if they have a literature, and especially of the
+Homoeopathists.  This country seems to be the place for such a
+collection, which will by and by be curious and of more value than at
+present, for Homoeopathy seems to be following the pathological law
+of erysipelas, fading out where it originated as it spreads to new
+regions.  At least I judge so by the following translated extract
+from a criticism of an American work in the "Homoeopatische
+Rundschau" of Leipzig for October, 1878, which I find in the
+"Homoeopathic Bulletin" for the month of November just passed:
+"While we feel proud of the spread and rise of Homoeopathy across the
+ocean, and while the Homoeopathic works reaching us from there, and
+published in a style such as is unknown in Germany, bear eloquent
+testimony to the eminent activity of our transatlantic colleagues, we
+are overcome by sorrowful regrets at the position Homoeopathy
+occupies in Germany.  Such a work [as the American one referred to]
+with us would be impossible; it would lack the necessary support."
+
+By all means let our library secure a good representation of the
+literature of Homoeopathy before it leaves us its "sorrowful regrets"
+and migrates with its sugar of milk pellets, which have taken the
+place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or
+the Lord knows where."
+
+What shall I say in this presence of the duties of a Librarian?
+Where have they ever been better performed than in our own public
+city library, where the late Mr. Jewett and the living Mr. Winsor
+have shown us what a librarian ought to be,--the organizing head, the
+vigilant guardian, the seeker's index, the scholar's counsellor?  His
+work is not merely that of administration, manifold and laborious as
+its duties are.  He must have a quick intelligence and a retentive
+memory.  He is a public carrier of knowledge in its germs.  His
+office is like that which naturalists attribute to the bumble-bee,--
+he lays up little honey for himself, but he conveys the fertilizing
+pollen from flower to flower.
+
+Our undertaking, just completed,--and just begun--has come at the
+right time, not a day too soon.  Our practitioners need a library
+like this, for with all their skill and devotion there is too little
+genuine erudition, such as a liberal profession ought to be able to
+claim for many of its members.  In reading the recent obituary
+notices of the late Dr. Geddings of South Carolina, I recalled what
+our lamented friend Dr. Coale used to tell me of his learning and
+accomplishments, and I could not help reflecting how few such medical
+scholars we had to show in Boston or New England.  We must clear up
+this unilluminated atmosphere, and here,--here is the true electric
+light which will irradiate its darkness.
+
+The public will catch the rays reflected from the same source of
+light, and it needs instruction on the great subjects of health and
+disease,--needs it sadly.  It is preyed upon by every kind of
+imposition almost without hindrance.  Its ignorance and prejudices
+react upon the profession to the great injury of both.  The jealous
+feeling, for instance, with regard to such provisions for the study
+of anatomy as are sanctioned by the laws in this State and carried
+out with strict regard to those laws, threatens the welfare, if not
+the existence of institutions for medical instruction wherever it is
+not held in check by enlightened intelligence.  And on the other hand
+the profession has just been startled by a verdict against a
+physician, ruinous in its amount,--enough to drive many a hard-
+working young practitioner out of house and home,--a verdict which
+leads to the fear that suits for malpractice may take the place of
+the panel game and child-stealing as a means of extorting money.  If
+the profession in this State, which claims a high standard of
+civilization, is to be crushed and ground beneath the upper millstone
+of the dearth of educational advantages and the lower millstone of
+ruinous penalties for what the ignorant ignorantly shall decide to be
+ignorance, all I can say is
+
+God save the Commonhealth of Massachusetts!
+
+Once more, we cannot fail to see that just as astrology has given
+place to astronomy, so theology, the science of Him whom by searching
+no man can find out, is fast being replaced by what we may not
+improperly call theonomy, or the science of the laws according to
+which the Creator acts.  And since these laws find their fullest
+manifestations for us, at least, in rational human natures, the study
+of anthropology is largely replacing that of scholastic divinity.  We
+must contemplate our Maker indirectly in human attributes as we talk
+of Him in human parts of speech.  And this gives a sacredness to the
+study of man in his physical, mental, moral, social, and religious
+nature which elevates the faithful students of anthropology to the
+dignity of a priesthood, and sheds a holy light on the recorded
+results of their labors, brought together as they are in such a
+collection as this which is now spread out before us.
+
+Thus, then, our library is a temple as truly as the dome-crowned
+cathedral hallowed by the breath of prayer and praise, where the dead
+repose and the living worship.  May it, with all its treasures, be
+consecrated like that to the glory of God, through the contributions
+it shall make to the advancement of sound knowledge, to the relief of
+human suffering, to the promotion of harmonious relations between the
+members of the two noble professions which deal with the diseases of
+the soul and with those of the body, and to the common cause in which
+all good men are working, the furtherance of the well-being of their
+fellow-creatures!
+
+NOTE.--As an illustration of the statement in the last paragraph but
+one, I take the following notice from the "Boston Daily Advertiser,"
+of December 4th, the day after the delivery of the address:
+"Prince Lucien Bonaparte is now living in London, and is devoting
+himself to the work of collecting the creeds of all religions and
+sects, with a view to their classification,--his object being simply
+scientific or anthropological."
+
+Since delivering the address, also, I find a leading article in the
+"Cincinnati Lancet and Clinic" of November 30th, headed "The
+Decadence of Homoeopathy," abundantly illustrated by extracts from
+the "Homoeopathic Times," the leading American organ of that sect.
+
+In the New York "Medical Record" of the same date, which I had not
+seen before the delivery of my address, is an account of the action
+of the Homoeopathic Medical Society of Northern New York, in which
+Hahnemann's theory of "dynamization" is characterized in a formal
+resolve as "unworthy the confidence of the Homoeopathic profession."
+
+It will be a disappointment to the German Homoeopathists to read in
+the "Homoeopathic Times" such a statement as the following:
+"Whatever the influences have been which have checked the outward
+development of Homoeopathy, it is plainly evident that the
+Homoeopathic school, as regards the number of its openly avowed
+representatives, has attained its majority, and has begun to decline
+both in this country and in England."
+
+All which is an additional reason for making a collection of the
+incredibly curious literature of Homoeopathy before that
+pseudological inanity has faded out like so many other delusions.
+
+
+
+
+
+
+SOME OF MY EARLY TEACHERS
+
+[A Farewell Address to the Medical School of Harvard University,
+November 28, 1882.]
+
+I had intended that the recitation of Friday last should be followed
+by a few parting words to my class and any friends who might happen
+to be in the lecture-room.  But I learned on the preceding evening
+that there was an expectation, a desire, that my farewell should take
+a somewhat different form; and not to disappoint the wishes of those
+whom I was anxious to gratify, I made up my mind to appear before you
+with such hasty preparation as the scanty time admitted.
+
+There are three occasions upon which a human being has a right to
+consider himself as a centre of interest to those about him: when he
+is christened, when he is married, and when he is buried.  Every one
+is the chief personage, the hero, of his own baptism, his own
+wedding, and his own funeral.
+
+There are other occasions, less momentous, in which one may make more
+of himself than under ordinary circumstances he would think it proper
+to do; when he may talk about himself, and tell his own experiences,
+in fact, indulge in a more or less egotistic monologue without fear
+or reproach.
+
+I think I may claim that this is one of those occasions.  I have
+delivered my last anatomical lecture and heard my class recite for
+the last time.  They wish to hear from me again in a less scholastic
+mood than that in which they have known me.  Will you not indulge me
+in telling you something of my own story?
+
+This is the thirty-sixth Course of Lectures in which I have taken my
+place and performed my duties as Professor of Anatomy.  For more than
+half of my term of office I gave instruction in Physiology, after the
+fashion of my predecessors and in the manner then generally prevalent
+in our schools, where the physiological laboratory was not a
+necessary part of the apparatus of instruction.  It was with my
+hearty approval that the teaching of Physiology was constituted a
+separate department and made an independent Professorship.  Before my
+time, Dr. Warren had taught Anatomy, Physiology, and Surgery in the
+same course of Lectures, lasting only three or four months.  As the
+boundaries of science are enlarged, new divisions and subdivisions of
+its territories become necessary.  In the place of six Professors in
+1847, when I first became a member of the Faculty, I count twelve
+upon the Catalogue before me, and I find the whole number engaged in
+the work of instruction in the Medical School amounts to no less than
+fifty.
+
+Since I began teaching in this school, the aspect of many branches of
+science has undergone a very remarkable transformation.  Chemistry
+and Physiology are no longer what they were, as taught by the
+instructors of that time.  We are looking forward to the synthesis of
+new organic compounds; our artificial madder is already in the
+market, and the indigo-raisers are now fearing that their crop will
+be supplanted by the manufactured article.  In the living body we
+talk of fuel supplied and work done, in movement, in heat, just as if
+we were dealing with a machine of our own contrivance.
+
+A physiological laboratory of to-day is equipped with instruments of
+research of such ingenious contrivance, such elaborate construction,
+that one might suppose himself in a workshop where some exquisite
+fabric was to be wrought, such as Queens love to wear, and Kings do
+not always love to pay for.  They are, indeed, weaving a charmed web,
+for these are the looms from which comes the knowledge that clothes
+the nakedness of the intellect.  Here are the mills that grind food
+for its hunger, and "is not the life more than meat, and the body
+than raiment?"
+
+But while many of the sciences have so changed that the teachers of
+the past would hardly know them, it has not been so with the branch I
+teach, or, rather, with that division of it which is chiefly taught
+in this amphitheatre.  General anatomy, or histology, on the other
+hand, is almost all new; it has grown up, mainly, since I began my
+medical studies.  I never saw a compound microscope during my years
+of study in Paris.  Individuals had begun to use the instrument, but
+I never heard it alluded to by either Professors or students.  In
+descriptive anatomy I have found little to unlearn, and not a great
+deal that was both new and important to learn.  Trifling additions
+are made from year to year, not to be despised and not to be
+overvalued.  Some of the older anatomical works are still admirable,
+some of the newer ones very much the contrary.  I have had recent
+anatomical plates brought me for inspection, and I have actually
+button-holed the book-agent, a being commonly as hard to get rid of
+as the tar-baby in the negro legend, that I might put him to shame
+with the imperial illustrations of the bones and muscles in the great
+folio of Albinus, published in 1747, and the unapproached figures of
+the lymphatic system of Mascagni, now within a very few years of a
+century old, and still copied, or, rather, pretended to be copied, in
+the most recent works on anatomy.
+
+I am afraid that it is a good plan to get rid of old Professors, and
+I am thankful to hear that there is a movement for making provision
+for those who are left in need when they lose their offices and their
+salaries.  I remember one of our ancient Cambridge Doctors once asked
+me to get into his rickety chaise, and said to me, half humorously,
+half sadly, that he was like an old horse,--they had taken off his
+saddle and turned him out to pasture.  I fear the grass was pretty
+short where that old servant of the public found himself grazing.  If
+I myself needed an apology for holding my office so long, I should
+find it in the fact that human anatomy is much the same study that it
+was in the days of Vesalius and Fallopius, and that the greater part
+of my teaching was of such a nature that it could never become
+antiquated.
+
+Let me begin with my first experience as a medical student.  I had
+come from the lessons of Judge Story and Mr. Ashmun in the Law School
+at Cambridge.  I had been busy, more or less, with the pages of
+Blackstone and Chitty, and other text-books of the first year of
+legal study.  More or less, I say, but I am afraid it was less rather
+than more.  For during that year I first tasted the intoxicating
+pleasure of authorship.  A college periodical, conducted by friends
+of mine, still undergraduates, tempted me into print, and there is no
+form of lead-poisoning which more rapidly and thoroughly pervades the
+blood and bones and marrow than that which reaches the young author
+through mental contact with type-metal.  Qui a bu, boira,--he who has
+once been a drinker will drink again, says the French proverb.  So
+the man or woman who has tasted type is sure to return to his old
+indulgence sooner or later.  In that fatal year I had my first attack
+of authors' lead-poisoning, and I have never got quite rid of it from
+that day to this.  But for that I might have applied myself more
+diligently to my legal studies, and carried a green bag in place of a
+stethoscope and a thermometer up to the present day.
+
+What determined me to give up Law and apply myself to Medicine I can
+hardly say, but I had from the first looked upon that year's study as
+an experiment.  At any rate, I made the change, and soon found myself
+introduced to new scenes and new companionships.
+
+I can scarcely credit my memory when I recall the first impressions
+produced upon me by sights afterwards become so familiar that they
+could no more disturb a pulse-beat than the commonest of every-day
+experiences.  The skeleton, hung aloft like a gibbeted criminal,
+looked grimly at me as I entered the room devoted to the students of
+the school I had joined, just as the fleshless figure of Time, with
+the hour-glass and scythe, used to glare upon me in my childhood from
+the "New England Primer."  The white faces in the beds at the
+Hospital found their reflection in my own cheeks, which lost their
+color as I looked upon them.  All this had to pass away in a little
+time; I had chosen my profession, and must meet its painful and
+repulsive aspects until they lost their power over my sensibilities.
+
+The private medical school which I had joined was one established by
+Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow
+Lewis, and Dr. George W.  Otis.  Of the first three gentlemen I have
+either spoken elsewhere or may find occasion to speak hereafter.  The
+two younger members of this association of teachers were both
+graduates of our University, one of the year 1819, the other of 1818.
+
+Dr. Lewis was a great favorite with students.  He was a man of very
+lively temperament, fond of old books and young people, open-hearted,
+free-spoken, an enthusiast in teaching, and especially at home in
+that apartment of the temple of science where nature is seen in
+undress, the anthropotomic laboratory, known to common speech as the
+dissecting-room.  He had that quality which is the special gift of
+the man born for a teacher,--the power of exciting an interest in
+that which he taught.  While he was present the apartment I speak of
+was the sunniest of studios in spite of its mortuary spectacles.  Of
+the students I met there I best remember James Jackson, Junior, full
+of zeal and playful as a boy, a young man whose early death was a
+calamity to the profession of which he promised to be a chief
+ornament; the late Reverend J. S. C. Greene, who, as the prefix to
+his name signifies, afterwards changed his profession, but one of
+whose dissections I remember looking upon with admiration; and my
+friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is
+entitled to be called, then, as now and always, a favorite with all
+about him.  He had come to us from the schools of Germany, and
+brought with him recollections of the teachings of Blumenbach and the
+elder Langenbeck, father of him whose portrait hangs in our Museum.
+Dr. Lewis was our companion as well as our teacher.  A good
+demonstrator is,--I will not say as important as a good Professor in
+the teaching of Anatomy, because I am not sure that he is not more
+important.  He comes into direct personal relations with the
+students,--he is one of them, in fact, as the Professor cannot be
+from the nature of his duties.  The Professor's chair is an
+insulating stool, so to speak; his age, his knowledge, real or
+supposed, his official station, are like the glass legs which support
+the electrician's piece of furniture, and cut it off from the common
+currents of the floor upon which it stands.  Dr. Lewis enjoyed
+teaching and made his students enjoy being taught.  He delighted in
+those anatomical conundrums to answer which keeps the student's eyes
+open and his wits awake.  He was happy as he dexterously performed
+the tour de maitre of the old barber-surgeons, or applied the spica
+bandage and taught his scholars to do it, so neatly and symmetrically
+that the aesthetic missionary from the older centre of civilization
+would bend over it in blissful contemplation, as if it were a
+sunflower.  Dr. Lewis had many other tastes, and was a favorite, not
+only with students, but in a wide circle, professional, antiquarian,
+masonic, and social.
+
+Dr. Otis was less widely known, but was a fluent and agreeable
+lecturer, and esteemed as a good surgeon.
+
+I must content myself with this glimpse at myself and a few of my
+fellow-students in Boston.  After attending two courses of Lectures
+in the school of the University, I went to Europe to continue my
+studies.
+
+You may like to hear something of the famous Professors of Paris in
+the days when I was a student in the Ecole de Medicine, and following
+the great Hospital teachers.
+
+I can hardly believe my own memory when I recall the old
+practitioners and Professors who were still going round the hospitals
+when I mingled with the train of students that attended the morning
+visits.  See that bent old man who is groping his way through the
+wards of La Charity.  That is the famous Baron Boyer, author of the
+great work on surgery in nine volumes, a writer whose clearness of
+style commends his treatise to general admiration, and makes it a
+kind of classic.  He slashes away at a terrible rate, they say, when
+he gets hold of the subject of fistula in its most frequent habitat,
+--but I never saw him do more than look as if he wanted to cut a good
+dollop out of a patient he was examining.  The short, square,
+substantial man with iron-gray hair, ruddy face, and white apron is
+Baron Larrey, Napoleon's favorite surgeon, the most honest man he
+ever saw,--it is reputed that he called him.  To go round the Hotel
+des Invalides with Larrey was to live over the campaigns of Napoleon,
+to look on the sun of Austerlitz, to hear the cannons of Marengo, to
+struggle through the icy waters of the Beresina, to shiver in the
+snows of the Russian retreat, and to gaze through the battle smoke
+upon the last charge of the red lancers on the redder field of
+Waterloo.  Larrey was still strong and sturdy as I saw him, and few
+portraits remain printed in livelier colors on the tablet of my
+memory.
+
+Leave the little group of students which gathers about Larrey beneath
+the gilded dome of the Invalides and follow me to the Hotel Dieu,
+where rules and reigns the master-surgeon of his day, at least so far
+as Paris and France are concerned,--the illustrious Baron Dupuytren.
+No man disputed his reign, some envied his supremacy.  Lisfranc
+shrugged his shoulders as he spoke of "ce grand homme de l'autre cots
+de la riviere," that great man on the other side of the river, but
+the great man he remained, until he bowed before the mandate which
+none may disobey.  "Three times," said Bouillaud, "did the apoplectic
+thunderbolt fall on that robust brain,"--it yielded at last as the
+old bald cliff that is riven and crashes down into the valley.  I saw
+him before the first thunderbolt had descended: a square, solid man,
+with a high and full-domed head, oracular in his utterances,
+indifferent to those around him, sometimes, it was said, very rough
+with them.  He spoke in low, even tones, with quiet fluency, and was
+listened to with that hush of rapt attention which I have hardly seen
+in any circle of listeners unless when such men as ex-President John
+Quincy Adams or Daniel Webster were the speakers.  I do not think
+that Dupuytren has left a record which explains his influence, but in
+point of fact he dominated those around him in a remarkable manner.
+You must have all witnessed something of the same kind.  The personal
+presence of some men carries command with it, and their accents
+silence the crowd around them, when the same words from other lips
+might fall comparatively unheeded.
+
+As for Lisfranc, I can say little more of him than that he was a
+great drawer of blood and hewer of members.  I remember his ordering
+a wholesale bleeding of his patients, right and left, whatever might
+be the matter with them, one morning when a phlebotomizing fit was on
+him.  I recollect his regretting the splendid guardsmen of the old
+Empire,--for what?  because they had such magnificent thighs to
+amputate.  I got along about as far as that with him, when I ceased
+to be a follower of M. Lisfranc.
+
+The name of Velpeau must have reached many of you, for he died in
+1867, and his many works made his name widely known.  Coming to Paris
+in wooden shoes, starving, almost, at first, he raised himself to
+great eminence as a surgeon and as an author, and at last obtained
+the Professorship to which his talents and learning entitled him.
+His example may be an encouragement to some of my younger hearers who
+are born, not with the silver spoon in their mouths, but with the
+two-tined iron fork in their hands.  It is a poor thing to take up
+their milk porridge with in their young days, but in after years it
+will often transfix the solid dumplings that roll out of the silver
+spoon.  So Velpeau found it.  He had not what is called genius, he
+was far from prepossessing in aspect, looking as if he might have
+wielded the sledge-hammer (as I think he had done in early life)
+rather than the lancet, but he had industry, determination,
+intelligence, character, and he made his way to distinction and
+prosperity, as some of you sitting on these benches and wondering
+anxiously what is to become of you in the struggle for life will have
+done before the twentieth century has got halfway through its first
+quarter.  A good sound head over a pair of wooden shoes is a great
+deal better than a wooden head belonging to an owner who cases his
+feet in calf-skin, but a good brain is not enough without a stout
+heart to fill the four great conduits which carry at once fuel and
+fire to that mightiest of engines.
+
+How many of you who are before me are familiarly acquainted with the
+name of Broussais, or even with that of Andral?  Both were lecturing
+at the Ecole de Medicine, and I often heard them.  Broussais was in
+those days like an old volcano, which has pretty nearly used up its
+fire and brimstone, but is still boiling and bubbling in its
+interior, and now and then sends up a spirt of lava and a volley of
+pebbles.  His theories of gastro-enteritis, of irritation and
+inflammation as the cause of disease, and the practice which sprang
+from them, ran over the fields of medicine for a time like flame over
+the grass of the prairies.  The way in which that knotty-featured,
+savage old man would bring out the word irritation--with rattling and
+rolling reduplication of the resonant letter r--might have taught a
+lesson in articulation to Salvini.  But Broussais's theory was
+languishing and well-nigh become obsolete, and this, no doubt, added
+vehemence to his defence of his cherished dogmas.
+
+Old theories, and old men who cling to them, must take themselves out
+of the way as the new generation with its fresh thoughts and altered
+habits of mind comes forward to take the place of that which is dying
+out. This was a truth which the fiery old theorist found it very hard
+to learn, and harder to bear, as it was forced upon him.  For the
+hour of his lecture was succeeded by that of a younger and far more
+popular professor.  As his lecture drew towards its close, the
+benches, thinly sprinkled with students, began to fill up; the doors
+creaked open and banged back oftener and oftener, until at last the
+sound grew almost continuous, and the voice of the lecturer became a
+leonine growl as he strove in vain to be heard over the noise of
+doors and footsteps.
+
+Broussais was now sixty-two years old.  The new generation had
+outgrown his doctrines, and the Professor for whose hour the benches
+had filled themselves belonged to that new generation.  Gabriel
+Andral was little more than half the age of Broussais, in the full
+prime and vigor of manhood at thirty-seven years.  He was a rapid,
+fluent, fervid, and imaginative speaker, pleasing in aspect and
+manner,--a strong contrast to the harsh, vituperative old man who had
+just preceded him.  His Clinique Medicale is still valuable as a
+collection of cases, and his researches on the blood, conducted in
+association with Gavarret, contributed new and valuable facts to
+science.  But I remember him chiefly as one of those instructors
+whose natural eloquence made it delightful to listen to him.  I doubt
+if I or my fellow-students did full justice either to him or to the
+famous physician of Hotel Dieu, Chomel.  We had addicted ourselves
+almost too closely to the words of another master, by whom we were
+ready to swear as against all teachers that ever were or ever would
+be.
+
+This object of our reverence, I might almost say idolatry, was one
+whose name is well known to most of the young men before me, even to
+those who may know comparatively little of his works and teachings.
+Pierre Charles Alexandre Louis, at the age of forty-seven, as I
+recall him, was a tall, rather spare, dignified personage, of serene
+and grave aspect, but with a pleasant smile and kindly voice for the
+student with whom he came into personal relations.  If I summed up
+the lessons of Louis in two expressions, they would be these; I do
+not hold him answerable for the words, but I will condense them after
+my own fashion in French, and then give them to you, expanded
+somewhat, in English:
+
+          Formez toujours des idees nettes.
+          Fuyez toujours les a peu pres.
+
+Always make sure that you form a distinct and clear idea of the
+matter you are considering.
+
+Always avoid vague approximations where exact estimates are possible;
+about so many,--about so much, instead of the precise number and
+quantity.
+
+Now, if there is anything on which the biological sciences have
+prided themselves in these latter years it is the substitution of
+quantitative for qualitative formulae.  The "numerical system," of
+which Louis was the great advocate, if not the absolute originator,
+was an attempt to substitute series of carefully recorded facts,
+rigidly counted and closely compared, for those never-ending records
+of vague, unverifiable conclusions with which the classics of the
+healing art were overloaded.  The history of practical medicine had
+been like the story of the Danaides.  "Experience" had been, from
+time immemorial, pouring its flowing treasures into buckets full of
+holes.  At the existing rate of supply and leakage they would never
+be filled; nothing would ever be settled in medicine.  But cases
+thoroughly recorded and mathematically analyzed would always be
+available for future use, and when accumulated in sufficient number
+would lead to results which would be trustworthy, and belong to
+science.
+
+You young men who are following the hospitals hardly know how much
+you are indebted to Louis.  I say nothing of his Researches on
+Phthisis or his great work on Typhoid Fever.  But I consider his
+modest and brief Essay on Bleeding in some Inflammatory Diseases,
+based on cases carefully observed and numerically analyzed, one of
+the most important written contributions to practical medicine, to
+the treatment of internal disease, of this century, if not since the
+days of Sydenham.  The lancet was the magician's wand of the dark
+ages of medicine.  The old physicians not only believed in its
+general efficacy as a wonder-worker in disease, but they believed
+that each malady could be successfully attacked from some special
+part of the body,--the strategic point which commanded the seat of
+the morbid affection.  On a figure given in the curious old work of
+John de Ketam, no less than thirty-eight separate places are marked
+as the proper ones to bleed from, in different diseases.  Even Louis,
+who had not wholly given up venesection, used now and then to order
+that a patient suffering from headache should be bled in the foot, in
+preference to any other part.
+
+But what Louis did was this: he showed by a strict analysis of
+numerous cases that bleeding did not strangle,--jugulate was the word
+then used,--acute diseases, more especially pneumonia.  This was not
+a reform,--it was a revolution.  It was followed up in this country
+by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited
+Diseases, which has, I believe, done more than any other work or
+essay in our own language to rescue the practice of medicine from the
+slavery to the drugging system which was a part of the inheritance of
+the profession.
+
+Yes, I say, as I look back on the long hours of the many days I spent
+in the wards and in the autopsy room of La Pitie, where Louis was one
+of the attending physicians,--yes, Louis did a great work for
+practical medicine.  Modest in the presence of nature, fearless in
+the face of authority, unwearying in the pursuit of truth, he was a
+man whom any student might be happy and proud to claim as his teacher
+and his friend, and yet, as I look back on the days when I followed
+his teachings, I feel that I gave myself up too exclusively to his
+methods of thought and study.
+
+There is one part of their business which certain medical
+practitioners are too apt to forget; namely, that what they should
+most of all try to do is to ward off disease, to alleviate suffering,
+to preserve life, or at least to prolong it if possible.  It is not
+of the slightest interest to the patient to know whether three or
+three and a quarter cubic inches of his lung are hepatized.  His mind
+is not occupied with thinking of the curious problems which are to be
+solved by his own autopsy,--whether this or that strand of the spinal
+marrow is the seat of this or that form of degeneration.  He wants
+something to relieve his pain, to mitigate the anguish of dyspnea, to
+bring back motion and sensibility to the dead limb, to still the
+tortures of neuralgia.  What is it to him that you can localize and
+name by some uncouth term the disease which you could not prevent and
+which you cannot cure?  An old woman who knows how to make a poultice
+and how to put it on, and does it tuto, eito, jucunde, just when and
+where it is wanted, is better,--a thousand times better in many
+cases,--than a staring pathologist, who explores and thumps and
+doubts and guesses, and tells his patient be will be better tomorrow,
+and so goes home to tumble his books over and make out a diagnosis.
+
+But in those days, I, like most of my fellow students, was thinking
+much more of "science" than of practical medicine, and I believe if
+we had not clung so closely to the skirts of Louis and had followed
+some of the courses of men like Trousseau,--therapeutists, who gave
+special attention to curative methods, and not chiefly to diagnosis,
+--it would have been better for me and others.  One thing, at any
+rate, we did learn in the wards of Louis.  We learned that a very
+large proportion of diseases get well of themselves, without any
+special medication,--the great fact formulated, enforced, and
+popularized by Dr. Jacob Bigelow in the Discourse referred to.  We
+unlearned the habit of drugging for its own sake.  This detestable
+practice, which I was almost proscribed for condemning somewhat too
+epigrammatically a little more than twenty years ago, came to us, I
+suspect, in a considerable measure from the English "general
+practitioners," a sort of prescribing apothecaries.  You remember
+how, when the city was besieged, each artisan who was called upon in
+council to suggest the best means of defence recommended the articles
+he dealt in: the carpenter, wood; the blacksmith, iron; the mason,
+brick; until it came to be a puzzle to know which to adopt. Then the
+shoemaker said, "Hang your walls with new boots,"  and gave good
+reasons why these should be the best of all possible defences.  Now
+the "general practitioner"  charged, as I understand, for his
+medicine, and in that way got paid for his visit.  Wherever this is
+the practice, medicine is sure to become a trade, and the people
+learn to expect drugging, and to consider it necessary, because drugs
+are so universally given to the patients of the man who gets his
+living by them.
+
+It was something to have unlearned the pernicious habit of constantly
+giving poisons to a patient, as if they were good in themselves, of
+drawing off the blood which he would want in his struggle with
+disease, of making him sore and wretched with needless blisters, of
+turning his stomach with unnecessary nauseous draught and mixtures,
+--only because he was sick and something must be done.  But there
+were positive as well as negative facts to be learned, and some of
+us, I fear, came home rich in the negatives of the expectant
+practice, poor in the resources which many a plain country
+practitioner had ready in abundance for the relief and the cure of
+disease.  No one instructor can be expected to do all for a student
+which he requires.  Louis taught us who followed him the love of
+truth, the habit of passionless listening to the teachings of nature,
+the most careful and searching methods of observation, and the sure
+means of getting at the results to be obtained from them in the
+constant employment of accurate tabulation.  He was not a showy, or
+eloquent, or, I should say, a very generally popular man, though the
+favorite, almost the idol, of many students, especially Genevese and
+Bostonians.  But he was a man of lofty and admirable scientific
+character, and his work will endure in its influences long after his
+name is lost sight of save to the faded eyes of the student of
+medical literature.
+
+Many other names of men more or less famous in their day, and who
+were teaching while I was in Paris, come up before me.  They are but
+empty sounds for the most part in the ears of persons of not more
+than middle age.  Who of you knows anything of Richerand, author of a
+very popular work on Physiology, commonly put into the student's
+hands when I first began to ask for medical text-books?  I heard him
+lecture once, and have had his image with me ever since as that of an
+old, worn-out man,--a venerable but dilapidated relic of an effete
+antiquity.  To verify this impression I have just looked out the
+dates of his birth and death, and find that he was eighteen years
+younger than the speaker who is now addressing you.  There is a
+terrible parallax between the period before thirty and that after
+threescore and ten, as two men of those ages look, one with naked
+eyes, one through his spectacles, at the man of fifty and thereabout.
+Magendie, I doubt not you have all heard of.  I attended but one of
+his lectures.  I question if one here, unless some contemporary of my
+own has strayed into the amphitheatre,--knows anything about
+Marjolin.  I remember two things about his lectures on surgery, the
+deep tones of his voice as he referred to his oracle,--the earlier
+writer, Jean Louis Petit,--and his formidable snuffbox.  What he
+taught me lies far down, I doubt not, among the roots of my
+knowledge, but it does not flower out in any noticeable blossoms, or
+offer me any very obvious fruits.  Where now is the fame of
+Bouillaud, Professor and Deputy, the Sangrado of his time?  Where is
+the renown of Piorry, percussionist and poet, expert alike in the
+resonances of the thoracic cavity and those of the rhyming
+vocabulary?--I think life has not yet done with the vivacious
+Ricord, whom I remember calling the Voltaire of pelvic literature,--a
+sceptic as to the morality of the race in general, who would have
+submitted Diana to treatment with his mineral specifics, and ordered
+a course of blue pills for the vestal virgins.
+
+Ricord was born at the beginning of the century, and Piorry some
+years earlier.  Cruveilhier, who died in 1874, is still remembered by
+his great work on pathological anatomy; his work on descriptive
+anatomy has some things which I look in vain for elsewhere.  But
+where is Civiale,--where are Orfila, Gendrin, Rostan, Biett, Alibert,
+--jolly old Baron Alibert, whom I remember so well in his broad-
+brimmed hat, worn a little jauntily on one side, calling out to the
+students in the court-yard of the Hospital St.  Louis, "Enfans de la
+methode naturelle, etes-vous tous ici?" "Children of the natural
+method [his own method of classification of skin diseases,] are you
+all here?  "All here, then, perhaps; all where, now?
+
+My show of ghosts is over.  It is always the same story that old men
+tell to younger ones, some few of whom will in their turn repeat the
+tale, only with altered names, to their children's children.
+
+     Like phantoms painted on the magic slide,
+     Forth from the darkness of the past we glide,
+     As living shadows for a moment seen
+     In airy pageant on the eternal screen,
+     Traced by a ray from one unchanging flame,
+     Then seek the dust and stillness whence we came.
+
+Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden,
+where he had written his Latin graduating thesis, talking of the
+learned Gaubius and the late illustrious Boerhaave and other dead
+Dutchmen, of whom you know as much, most of you, as you do of Noah's
+apothecary and the family physician of Methuselah, whose
+prescriptions seem to have been lost to posterity.  Dr. Lloyd came
+back to Boston full of the teachings of Cheselden and Sharpe, William
+Hunter, Smellie, and Warner; Dr. James Jackson loved to tell of Mr.
+Cline and to talk of Mr. John Hunter; Dr. Reynolds would give you his
+recollections of Sir Astley Cooper and Mr. Abernethy; I have named
+the famous Frenchmen of my student days; Leyden, Edinburgh, London,
+Paris, were each in turn the Mecca of medical students, just as at
+the present day Vienna and Berlin are the centres where our young men
+crowd for instruction.  These also must sooner or later yield their
+precedence and pass the torch they hold to other hands.  Where shall
+it next flame at the head of the long procession?  Shall it find its
+old place on the shores of the Gulf of Salerno, or shall it mingle
+its rays with the northern aurora up among the fiords of Norway,--or
+shall it be borne across the Atlantic and reach the banks of the
+Charles, where Agassiz and Wyman have taught, where Hagen still
+teaches, glowing like his own Lampyris splendidula, with enthusiasm,
+where the first of American botanists and the ablest of American
+surgeons are still counted in the roll of honor of our great
+University?
+
+Let me add a few words which shall not be other than cheerful, as I
+bid farewell to this edifice which I have known so long.  I am
+grateful to the roof which has sheltered me, to the floors which have
+sustained me, though I have thought it safest always to abstain from
+anything like eloquence, lest a burst of too emphatic applause might
+land my class and myself in the cellar of the collapsing structure,
+and bury us in the fate of Korah, Dathan, and Abiram.  I have helped
+to wear these stairs into hollows,--stairs which I trod when they
+were smooth and level, fresh from the plane.  There are just thirty-
+two of them, as there were five and thirty years ago, but they are
+steeper and harder to climb, it seems to me, than they were then.  I
+remember that in the early youth of this building, the late Dr. John
+K.  Mitchell, father of our famous Dr. Weir Mitchell, said to me as
+we came out of the Demonstrator's room, that some day or other a
+whole class would go heels over head down this graded precipice, like
+the herd told of in Scripture story.  This has never happened as yet;
+I trust it never will.  I have never been proud of the apartment
+beneath the seats, in which my preparations for lecture were made.
+But I chose it because I could have it to myself, and I resign it,
+with a wish that it were more worthy of regret, into the hands of my
+successor, with my parting benediction.  Within its twilight
+precincts I have often prayed for light, like Ajax, for the daylight
+found scanty entrance, and the gaslight never illuminated its dark
+recesses.  May it prove to him who comes after me like the cave of
+the Sibyl, out of the gloomy depths of which came the oracles which
+shone with the rays of truth and wisdom!
+
+This temple of learning is not surrounded by the mansions of the
+great and the wealthy.  No stately avenues lead up to its facades and
+porticoes.  I have sometimes felt, when convoying a distinguished
+stranger through its precincts to its door, that he might question
+whether star-eyed Science had not missed her way when she found
+herself in this not too attractive locality.  I cannot regret that
+we--you, I should say--are soon to migrate to a more favored region,
+and carry on your work as teachers and as learners in ampler halls
+and under far more favorable conditions.
+
+I hope that I may have the privilege of meeting you there, possibly
+may be allowed to add my words of welcome to those of my former
+colleagues, and in that pleasing anticipation I bid good-by to this
+scene of my long labors, and, for the present at least, to the
+friends with whom I have been associated.
+
+
+
+
+
+
+APPENDUM
+
+NOTES TO THE ADDRESS ON CURRENTS AND COUNTER
+CURRENTS IN MEDICAL SCIENCE.
+
+Some passages contained in the original manuscript of the Address,
+and omitted in the delivery on account of its length, are restored in
+the text or incorporated with these Notes.
+
+NOTE A.--
+
+There is good reason to doubt whether the nitrate of silver has any
+real efficacy in epilepsy.  It has seemed to cure many cases, but
+epilepsy is a very uncertain disease, and there is hardly anything
+which has not been supposed to cure it.  Dr. Copland cites many
+authorities in its favor, most especially Lombard's cases.  But De la
+Berge and Monneret (Comp.  de Med.  Paris), 1839, analyze these same
+cases, eleven in number, and can only draw the inference of a very
+questionable value in the supposed remedy.  Dr. James Jackson says
+that relief of epilepsy is not to be attained by any medicine with
+which he is acquainted, but by diet.  (Letters to a Young Physician,
+p.  67.) Guy Patin, Dean of the Faculty of Paris, Professor at the
+Royal College, Author of the Antimonial Martyrology, a wit and a man
+of sense and learning, who died almost two hundred years ago, had
+come to the same conclusion, though the chemists of his time boasted
+of their remedies.  "Did, you ever see a case of epilepsy cured by
+nitrate of silver?"  I said to one of the oldest and most experienced
+surgeons in this country.  "Never," was his instant reply.  Dr.
+Twitchell's experience was very similar.  How, then, did nitrate of
+silver come to be given for epilepsy?  Because, as Dr. Martin has so
+well reminded us, lunatics were considered formerly to be under the
+special influence of Luna, the moon (which Esquirol, be it observed,
+utterly denies), and lunar caustic, or nitrate of silver, is a salt
+of that metal which was called luna from its whiteness, and of course
+must be in the closest relations with the moon.  It follows beyond
+all reasonable question that the moon's metal, silver, and its
+preparations, must be the specific remedy for moonblasted maniacs and
+epileptics!
+
+Yet the practitioner who prescribes the nitrate of silver supposes he
+is guided by the solemn experience of the past, instead of by its
+idle fancies.  He laughs at those old physicians who placed such
+confidence in the right hind hoof of an elk as a remedy for the same
+disease, and leaves the record of his own belief in a treatment quite
+as fanciful and far more objectionable, written in indelible ink upon
+a living tablet where he who runs may read it for a whole generation,
+if nature spares his walking advertisement so long.
+
+
+
+NOTE B.--
+
+The presumption that a man is innocent until he is proved guilty,
+does not mean that there are no rogues, but lays the onus probandi on
+the party to which it properly belongs.  So with this proposition.
+A noxious agent should never be employed in sickness unless there is
+ample evidence in the particular case to overcome the general
+presumption against all such agents, and the evidence is very apt to
+be defective.
+
+The miserable delusion of Homoeopathy builds itself upon an axiom
+directly the opposite of this; namely, that the sick are to be cured
+by poisons.  Similia similibus curantur means exactly this.  It is
+simply a theory of universal poisoning, nullified in practice by the
+infinitesimal contrivance.  The only way to kill it and all similar
+fancies, and to throw every quack nostrum into discredit, is to root
+out completely the suckers of the old rotten superstition that
+whatever is odious or noxious is likely to be good for disease.  The
+current of sound practice with ourselves is, I believe, setting fast
+in the direction I have indicated in the above proposition.  To
+uphold the exhibition of noxious agents in disease, as the rule,
+instead of admitting them cautiously and reluctantly as the
+exception, is, as I think, an eddy of opinion in the direction of the
+barbarism out of which we believe our art is escaping.  It is only
+through the enlightened sentiment and action of the Medical
+Profession that the community can be brought to acknowledge that
+drugs should always be regarded as evils.
+
+It is true that some suppose, and our scientific and thoughtful
+associate, Dr.  Gould, has half countenanced the opinion, that there
+may yet be discovered a specific for every disease.  Let us not
+despair of the future, but let us be moderate in our expectations.
+When an oil is discovered that will make a bad watch keep good time;
+when a recipe is given which will turn an acephalous foetus into a
+promising child; when a man can enter the second time into his
+mother's womb and give her back the infirmities which twenty
+generations have stirred into her blood, and infused into his own
+through hers, we may be prepared to enlarge the National
+Pharmacopoeia with a list of specifies for everything but old age,
+--and possibly for that also.
+
+
+
+NOTE C.--
+
+The term specific is used here in its ordinary sense, without raising
+the question of the propriety of its application to these or other
+remedies.
+
+The credit of introducing Cinchona rests between the Jesuits, the
+Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor,
+who employed it as a secret remedy.  (Pereira.) Mercury as an
+internal specific remedy was brought into use by that impudent and
+presumptuous quack, as he was considered, Paracelsus.  (Encyc.  Brit.
+art.  "Paracelsus.") Arsenic was introduced into England as a remedy
+for intermittents by Dr. Fowler, in consequence of the success of a
+patent medicine, the Tasteless Ague Drops, which were supposed,
+"probably with reason," to be a preparation of that mineral.  (Rees's
+Cyc.  art.  "Arsenic.")  Colchicum came into notice in a similar way,
+from the success of the Eau Medicinale of M. Husson, a French
+military officer.  (Pereira.) Iodine was discovered by a saltpetre
+manufacturer, but applied by a physician in place of the old remedy,
+burnt sponge, which seems to owe its efficacy to it.  (Dunglison, New
+Remedies.) As for Sulphur, "the common people have long used it as an
+ointment" for scabies.  (Rees's Cyc.  art.  "Scabies.") The modern
+cantiscorbutic regimen is credited to Captain Cook.  "To his sagacity
+we are indebted for the first impulse to those regulations by which
+scorbutus is so successfully prevented in our navy."  (Lond.  Cyc.
+Prac.  Med.  art.  "Scorbutus.") Iron and various salts which enter
+into the normal composition of the human body do not belong to the
+materia medica by our definition, but to the materia alimentaria.
+
+For the first introduction of iron as a remedy, see Pereira, who
+gives a very curious old story.
+
+The statement in the text concerning a portion of the materia medica
+stands exactly as delivered, and is meant exactly as it stands.  No
+denunciation of drugs, as sparingly employed by a wise physician, was
+or is intended.  If, however, as Dr.  Gould stated in his "valuable
+and practical discourse" to which the Massachusetts Medical Society
+"listened with profit as well as interest,"  "Drugs, in themselves
+considered, may always be regarded as evils,"--any one who chooses
+may question whether the evils from their abuse are, on the whole,
+greater or less than the undoubted benefits obtained from their
+proper use.  The large exception of opium, wine, specifics, and
+anaesthetics, made in the text, takes off enough from the useful
+side, as I fully believe, to turn the balance; so that a vessel
+containing none of these, but loaded with antimony, strychnine,
+acetate of lead, aloes, aconite, lobelia, lapis infernalis, stercus
+diaboli, tormentilla, and other approved, and, in skilful hands,
+really useful remedies, brings, on the whole, more harm than good to
+the port it enters.
+
+It is a very narrow and unjust view of the practice of medicine, to
+suppose it to consist altogether in the use of powerful drugs, or of
+drugs of any kind.  Far from it.  "The physician may do very much for
+the welfare of the sick, more than others can do, although he does
+not, even in the major part of cases, undertake to control and
+overcome the disease by art.  It was with these views that I never
+reported any patient cured at our hospital.  Those who recovered
+their health were reported as well; not implying that they were made
+so by the active treatment they had received there.  But it was to be
+understood that all patients received in that house were to be cured,
+that is, taken care of."  (Letters to a Young Physician, by James
+Jackson, M.  D., Boston, 1855.)
+
+"Hygienic rules, properly enforced, fresh air, change of air, travel,
+attention to diet, good and appropriate food judiciously regulated,
+together with the administration of our tonics, porter, ale, wine,
+iron, etc., supply the diseased or impoverished system with what Mr.
+Gull, of St. Bartholomew's Hospital, aptly calls the 'raw material of
+the blood;' and we believe that if any real improvement has taken
+place in medical practice, independently of those truly valuable
+contributions we have before described, it is in the substitution of
+tonics, stimulants, and general management, for drastic cathartics,
+for bleeding, depressing agents, including mercury, tartar emetics,
+etc., so much in vogue during the early part even of this century."
+(F. P. Porcher, in Charleston Med. Journal and Review for January,
+1860.)
+
+
+
+
+
+End of Project Gutenberg Etext Medical Essays, by Oliver Wendell Holmes
+
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