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diff --git a/2700-0.txt b/2700-0.txt new file mode 100644 index 0000000..a8820e2 --- /dev/null +++ b/2700-0.txt @@ -0,0 +1,13257 @@ +The Project Gutenberg EBook of Medical Essays, by Oliver Wendell Holmes, +Sr. + +This eBook is for the use of anyone anywhere at no cost and with almost +no restrictions whatsoever. You may copy it, give it away or re-use +it under the terms of the Project Gutenberg License included with this +eBook or online at www.gutenberg.org + + +Title: Medical Essays + +Author: Oliver Wendell Holmes, Sr. + +Release Date: August 16, 2006 [EBook #2700] +Last Updated: February 18, 2018 +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK MEDICAL ESSAYS *** + + +Produced by David Widger + + + + + + + +MEDICAL ESSAYS + +By Oliver Wendell Holmes + + +1842-1882 + + + + + + CONTENTS + + + + PREFACE. + + A SECOND PREFACE. + + PREFACE TO THE NEW EDITION. + + HOMOEOPATHY AND ITS KINDRED DELUSIONS + + THE CONTAGIOUSNESS OF PUERPERAL FEVER + + CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE + + BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. + + SCHOLASTIC AND BEDSIDE TEACHING. + + THE MEDICAL PROFESSION IN MASSACHUSETTS. + + THE YOUNG PRACTITIONER + + MEDICAL LIBRARIES. + + SOME OF MY EARLY TEACHERS + + APPENDUM + + NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE. + + + + + + + + +PREFACE. + +The character of the opposition which some of these papers have met with +suggests the inference that they contain really important, but unwelcome +truths. Negatives multiplied into each other change their sign and +become positives. Hostile criticisms meeting together are often +equivalent to praise, and the square of fault-finding turns out to be +the same thing as eulogy. + +But a writer has rarely so many enemies as it pleases him to believe. +Self-love leads us to overrate the numbers of our negative constituency. +The larger portion of my limited circle of readers must be quite +indifferent to, if not ignorant of, the adverse opinions which have been +expressed or recorded concerning any of these Addresses or Essays now +submitted to their own judgment. It is proper, however, to inform +them, that some of the positions maintained in these pages have been +unsparingly attacked, with various degrees of ability, scholarship, +and good-breeding. The tone of criticism naturally changes with local +conditions in different parts of a country extended like our own, so +that it is one of the most convenient gauges of the partial movements in +the direction of civilization. It is satisfactory to add, that the views +assailed have also been unflinchingly defended by unsought champions, +among the ablest of whom it is pleasant to mention, at this moment of +political alienation, the Editor of the Charleston Medical Journal. + +“Currents and Counter-Currents” was written and delivered as an Oration, +a florid rhetorical composition, expressly intended to secure the +attention of an audience not easy to hold as listeners. It succeeded +in doing this, and also in being as curiously misunderstood and +misrepresented as if it had been a political harangue. This gave it more +local notoriety than it might otherwise have attained, so that, as I +learn, one ingenious person made use of its title as an advertisement to +a production of his own. + +The commonest mode of misrepresentation was this: qualified +propositions, the whole meaning of which depended on the qualifications, +were stripped of these and taken as absolute. Thus, the attempt to +establish a presumption against giving poisons to sick persons was +considered as equivalent to condemning the use of these substances. +The only important inference the writer has been able to draw from the +greater number of the refutations of his opinions which have been kindly +sent him, is that the preliminary education of the Medical Profession is +not always what it ought to be. + +One concession he is willing to make, whatever sacrifice of pride it +may involve. The story of Massasoit, which has furnished a coral, as it +were, for some teething critics, when subjected to a powerful logical +analysis, though correct in its essentials, proves to have been told +with exceptionable breadth of statement, and therefore (to resume +the metaphor) has been slightly rounded off at its edges, so as to +be smoother for any who may wish to bite upon it hereafter. In +other respects the Discourse has hardly been touched. It is only an +individual's expression, in his own way, of opinions entertained by +hundreds of the Medical Profession in every civilized country, and has +nothing in it which on revision the writer sees cause to retract or +modify. The superstitions it attacks lie at the very foundation of +Homoeopathy, and of almost every form of medical charlatanism. Still +the mere routinists and unthinking artisans in most callings dislike +whatever shakes the dust out of their traditions, and it may be +unreasonable to expect that Medicine will always prove an exception to +the rule. One half the opposition which the numerical system of Louis +has met with, as applied to the results of treatment, has been owing +to the fact that it showed the movements of disease to be far more +independent of the kind of practice pursued than was agreeable to the +pride of those whose self-confidence it abated. + +The statement, that medicines are more sparingly used in physicians' +families than in most others, admits of a very natural explanation, +without putting a harsh construction upon it, which it was not +intended to admit. Outside pressure is less felt in the physician's own +household; that is all. If this does not sometimes influence him to give +medicine, or what seems to be medicine, when among those who have more +confidence in drugging than his own family commonly has, the learned +Professor Dunglison is hereby requested to apologize for his definition +of the word Placebo, or to expunge it from his Medical Dictionary. + +One thing is certain. A loud outcry on a slight touch reveals the weak +spot in a profession, as well as in a patient. It is a doubtful policy +to oppose the freest speech in those of our own number who are trying to +show us where they honestly believe our weakness lies. Vast as are +the advances of our Science and Art, may it not possibly prove on +examination that we retain other old barbarisms beside the use of the +astrological sign of Jupiter, with which we endeavor to insure good luck +to our prescriptions? Is it the act of a friend or a foe to try to point +them out to our brethren when asked to address them, and is the speaker +to subdue the constitutional habit of his style to a given standard, +under penalty of giving offence to a grave assembly? + +“Homoeopathy and its Kindred Delusions” was published nearly twenty +years ago, and has been long out of print, so that the author tried in +vain to procure a copy until the kindness of a friend supplied him with +the only one he has had for years. A foolish story reached his ears that +he was attempting to buy up stray copies for the sake of suppressing it. +This edition was in the press at that very time. + +Many of the arguments contained in the Lectures have lost whatever +novelty they may have possessed. All its predictions have been submitted +to the formidable test of time. They appear to have stood it, so far, +about as well as most uninspired prophecies; indeed, some of them +require much less accommodation than certain grave commentators employ +in their readings of the ancient Prophets. + +If some statistics recently published are correct, Homoeopathy has made +very slow progress in Europe. + +In all England, as it appears, there are hardly a fifth more +Homoeopathic practitioners than there are students attending Lectures at +the Massachusetts Medical College at the present time. In America it has +undoubtedly proved more popular and lucrative, yet how loose a hold it +has on the public confidence is shown by the fact that, when a specially +valued life, which has been played with by one of its agents, is +seriously threatened, the first thing we expect to hear is that a +regular practitioner is by the patient's bed, and the Homoeopathic +counsellor overruled or discarded. Again, how many of the ardent and +capricious persons who embraced Homoeopathy have run the whole round of +pretentious novelties;--have been boarded at water-cure establishments, +closeted with uterine and other specialists, and finally wandered over +seas to put themselves in charge of foreign celebrities, who dosed them +as lustily as they were ever dosed before they took to globules! It +will surprise many to learn to what a shadow of a shade Homoeopathy +has dwindled in the hands of many of its noted practitioners. The +itch-doctrine is treated with contempt. Infinitesimal doses are replaced +by full ones whenever the fancy-practitioner chooses. Good Homoeopathic +reasons can be found for employing anything that anybody wants to +employ. Homoeopathy is now merely a name, an unproved theory, and a box +of pellets pretending to be specifics, which, as all of us know, fail +ignominiously in those cases where we would thankfully sacrifice all our +prejudices and give the world to have them true to their promises. + +Homoeopathy has not died out so rapidly as Tractoration. Perhaps it was +well that it should not, for it has taught us a lesson of the healing +faculty of Nature which was needed, and for which many of us have made +proper acknowledgments. But it probably does more harm than good to +medical science at the present time, by keeping up the delusion of +treating everything by specifics,--the old barbarous notion that sick +people should feed on poisons [Lachesis, arrow-poison, obtained from a +serpent (Pulte). Crotalus horridus, rattlesnake's venom (Neidhard). The +less dangerous Pediculus capitis is the favorite remedy of Dr. Mure, the +English “Apostle of Homoeopathy.” These are examples of the retrograde +current setting towards barbarism] against which a part of the Discourse +at the beginning of this volume is directed. + +The infinitesimal globules have not become a curiosity as yet, like +Perkins's Tractors. But time is a very elastic element in Geology and +Prophecy. If Daniel's seventy weeks mean four hundred and ninety years, +as the learned Prideaux and others have settled it that they do, the +“not many years” of my prediction may be stretched out a generation or +two beyond our time, if necessary, when the prophecy will no doubt prove +true. + +It might be fitting to add a few words with regard to the Essay on the +Contagiousness of Puerperal Fever. But the whole question I consider +to be now transferred from the domain of medical inquiry to the +consideration of Life Insurance agencies and Grand Juries. For the +justification of this somewhat sharply accented language I must refer +the reader to the paper itself for details which I regret to have been +forced to place on permanent record. + +BOSTON, January, 1861. + + + + + + +A SECOND PREFACE. + +These Lectures and Essays are arranged in the order corresponding to +the date of their delivery or publication. They must, of course, be read +with a constant reference to these dates, by such as care to read +them. I have not attempted to modernize their aspect or character in +presenting them, in this somewhat altered connection, to the public. +Several of them were contained in a former volume which received its +name from the Address called “Currents and Counter-Currents.” Some of +those contained in the former volume have been replaced by others. The +Essay called “Mechanism of Vital Actions” has been transferred to a +distinct collection of Miscellaneous essays, forming a separate volume. + +I had some intention of including with these papers an Essay on +Intermittent Fever in New England, which received one of the Boylston +prizes in 1837, and was published in the following year. But as this +was upon a subject of local interest, chiefly, and would have taken up a +good deal of room, I thought it best to leave it out, trusting that +the stray copies to be met with in musty book-shops would sufficiently +supply the not very extensive or urgent demand for a paper almost half a +century old. + +Some of these papers created a little stir when they first fell from +the press into the pool of public consciousness. They will slide in very +quietly now in this new edition, and find out for themselves whether the +waters are those of Lethe, or whether they are to live for a time as not +wholly unvalued reminiscences. + +March 21, 1883. + + + + + + +PREFACE TO THE NEW EDITION. + +These Essays are old enough now to go alone without staff or crutch +in the shape of Prefaces. A very few words may be a convenience to the +reader who takes up the book and wishes to know what he is likely to +find in it. + + + HOMOEOPATHY AND ITS KINDRED DELUSIONS. + +Homoeopathy has proved lucrative, and so long as it continues to be so +will surely exist,--as surely as astrology, palmistry, and other methods +of getting a living out of the weakness and credulity of mankind and +womankind. Though it has no pretensions to be considered as belonging +among the sciences, it may be looked upon by a scientific man as a +curious object of study among the vagaries of the human mind. Its +influence for good or the contrary may be made a matter of calm +investigation. I have studied it in the Essay before the reader, under +the aspect of an extravagant and purely imaginative creation of its +founder. Since that first essay was written, nearly half a century ago, +we have all had a chance to witness its practical working. Two opposite +inferences may be drawn from its doctrines and practice. The first is +that which is accepted by its disciples. This is that all diseases are +“cured” by drugs. The opposite conclusion is drawn by a much larger +number of persons. As they see that patients are very commonly getting +well under treatment by infinitesimal drugging, which they consider +equivalent to no medication at all, they come to disbelieve in every +form of drugging and put their whole trust in “nature.” Thus experience, + + + “From seeming evil still educing good,” + +has shown that the dealers in this preposterous system of +pseudo-therapeutics have cooperated with the wiser class of +practitioners in breaking up the system of over-dosing and over-drugging +which has been one of the standing reproaches of medical practice. While +keeping up the miserable delusion that diseases were all to be “cured” + by drugging, Homoeopathy has been unintentionally showing that they +would very generally get well without any drugging at all. In the mean +time the newer doctrines of the “mind cure,” the “faith cure,” and the +rest are encroaching on the territory so long monopolized by that most +ingenious of the pseudo-sciences. It would not be surprising if its +whole ground should be taken possession of by these new claimants with +their flattering appeals to the imaginative class of persons open to +such attacks. Similia similabus may prove fatally true for once, if +Homoeopathy is killed out by its new-born rivals. + +It takes a very moderate amount of erudition to unearth a charlatan +like the supposed father of the infinitesimal dosing system. The real +inventor of that specious trickery was an Irishman by the name of +Butler. The whole story is to be found in the “Ortus Medicinae” of Van +Helmont. I have given some account of his chapter “Butler” in different +articles, but I would refer the students of our Homoeopathic educational +institutions to the original, which they will find very interesting and +curious. + + + CURRENTS AND COUNTER-CURRENTS + +My attack on over-drugging brought out some hostile comments and +treatment. Thirty years ago I expressed myself with more vivacity than +I should show if I were writing on the same subjects today. Some of +my more lively remarks called out very sharp animadversion. Thus +my illustration of prevention as often better than treatment in the +mother's words to her child which had got a poisonous berry in its +mouth,--“Spit it out!” gave mortal offence to a well-known New York +practitioner and writer, who advised the Massachusetts Medical Society +to spit out the offending speaker. Worse than this was my statement of +my belief that if a ship-load of miscellaneous drugs, with certain +very important exceptions,--drugs, many of which were then often given +needlessly and in excess, as then used “could be sunk to the bottom of +the sea, it would be all the better for mankind and all the worse +for the fishes.” This was too bad. The sentence was misquoted, quoted +without its qualifying conditions, and frightened some of my worthy +professional brethren as much as if I had told them to throw all physic +to the dogs. But for the epigrammatic sting the sentiment would have +been unnoticed as a harmless overstatement at the very worst. + +Since this lecture was delivered a great and, as I think, beneficial +change has taken place in the practice of medicine. The habit of the +English “general practitioner” of making his profit out of the pills and +potions he administered was ruinous to professional advancement and the +dignity of the physician. When a half-starving medical man felt that he +must give his patient draught and boluses for which he could charge him, +he was in a pitiable position and too likely to persuade himself that +his drugs were useful to his patient because they were profitable +to him. This practice has prevailed a good deal in America, and was +doubtless the source in some measure of the errors I combated. + + + THE CONTAGIOUSNESS OF PUERPERAL FEVER. + +This Essay was read before a small Association called “The Society for +Medical Improvement,” and published in a Medical Journal which lasted +but a single year. It naturally attracted less attention than it would +have done if published in such a periodical as the “American Journal of +Medical Sciences.” Still it had its effect, as I have every reason +to believe. I cannot doubt that it has saved the lives of many young +mothers by calling attention to the existence and propagation of +“Puerperal Fever as a Private Pestilence,” and laying down rules for +taking the necessary precautions against it. The case has long been +decided in favor of the views I advocated, but, at the time when I wrote +two of the most celebrated professors of Obstetrics in this country +opposed my conclusions with all the weight of their experience and +position. + +This paper was written in a great heat and with passionate indignation. +If I touched it at all I might trim its rhetorical exuberance, but I +prefer to leave it all its original strength of expression. I could not, +if I had tried, have disguised the feelings with which I regarded the +attempt to put out of sight the frightful facts which I brought forward +and the necessary conclusions to which they led. Of course the whole +matter has been looked at in a new point of view since the microbe as +a vehicle of contagion has been brought into light, and explained the +mechanism of that which was plain enough as a fact to all who were not +blind or who did not shut their eyes. + +O. W. H. + +BEVERLY Farms, Mass., August 3, 1891 + + + + + + +HOMOEOPATHY AND ITS KINDRED DELUSIONS + +[Two lectures delivered before the Boston Society for the Diffusion of +Useful Knowledge. 1842.] + +[When a physician attempts to convince a person, who has fallen into the +Homoeopathic delusion, of the emptiness of its pretensions, he is often +answered by a statement of cases in which its practitioners are thought +to have effected wonderful cures. The main object of the first of these +Lectures is to show, by abundant facts, that such statements, made by +persons unacquainted with the fluctuations of disease and the fallacies +of observation, are to be considered in general as of little or no value +in establishing the truth of a medical doctrine or the utility of a +method of practice. + +Those kind friends who suggest to a person suffering from a tedious +complaint, that he “Had better try Homoeopathy,” are apt to enforce +their suggestion by adding, that “at any rate it can do no harm.” This +may or may not be true as regards the individual. But it always does +very great harm to the community to encourage ignorance, error, or +deception in a profession which deals with the life and health of our +fellow-creatures. Whether or not those who countenance Homoeopathy are +guilty of this injustice towards others, the second of these Lectures +may afford them some means of determining. + +To deny that good effects may happen from the observance of diet and +regimen when prescribed by Homoeopathists as well as by others, would be +very unfair to them. But to suppose that men with minds so constituted +as to accept such statements and embrace such doctrines as make up +the so-called science of Homoeopathy are more competent than others to +regulate the circumstances which influence the human body in health and +disease, would be judging very harshly the average capacity of ordinary +practitioners. + +To deny that some patients may have been actually benefited through +the influence exerted upon their imaginations, would be to refuse +to Homoeopathy what all are willing to concede to every one of those +numerous modes of practice known to all intelligent persons by an +opprobrious title. + +So long as the body is affected through the mind, no audacious device, +even of the most manifestly dishonest character, can fail of producing +occasional good to those who yield it an implicit or even a partial +faith. The argument founded on this occasional good would be as +applicable in justifying the counterfeiter and giving circulation to +his base coin, on the ground that a spurious dollar had often relieved a +poor man's necessities. + +Homoeopathy has come before our public at a period when the growing +spirit of eclecticism has prepared many ingenious and honest minds to +listen to all new doctrines with a candor liable to degenerate into +weakness. It is not impossible that the pretended evolution of great and +mysterious virtues from infinitely attenuated atoms may have enticed a +few over-refining philosophers, who have slid into a vague belief +that matter subdivided grows less material, and approaches nearer to +a spiritual nature as it requires a more powerful microscope for its +detection. + +However this may be, some persons seem disposed to take the ground of +Menzel that the Laity must pass formal judgment between the Physician +and the Homoeopathist, as it once did between Luther and the Romanists. +The practitioner and the scholar must not, therefore, smile at the +amount of time and labor expended in these Lectures upon this shadowy +system; which, in the calm and serious judgment of many of the wisest +members of the medical profession, is not entitled by anything it has +ever said or done to the notoriety of a public rebuke, still less to the +honors of critical martyrdom.] + +I. + +I have selected four topics for this lecture, the first three of which I +shall touch but slightly, the last more fully. They are + +1. The Royal cure of the King's Evil, or Scrofula. + +2. The Weapon Ointment, and its twin absurdity, the Sympathetic Powder. + +3. The Tar-water mania of Bishop Berkeley. + +4. The History of the Metallic Tractors, or Perkinism. + +The first two illustrate the ease with which numerous facts are +accumulated to prove the most fanciful and senseless extravagances. + +The third exhibits the entire insufficiency of exalted wisdom, +immaculate honesty, and vast general acquirements to make a good +physician of a great bishop. + +The fourth shows us the intimate machinery of an extinct delusion, which +flourished only forty years ago; drawn in all its details, as being +a rich and comparatively recent illustration of the pretensions, the +arguments, the patronage, by means of which windy errors have long been, +and will long continue to be, swollen into transient consequence. +All display in superfluous abundance the boundless credulity and +excitability of mankind upon subjects connected with medicine. + +“From the time of Edward the Confessor to Queen Anne, the monarchs of +England were in the habit of touching those who were brought to them +suffering with the scrofula, for the cure of that distemper. William +the Third had good sense enough to discontinue the practice, but Anne +resumed it, and, among her other patients, performed the royal operation +upon a child, who, in spite of his, disease, grew up at last into Samuel +Johnson. After laying his hand upon the sufferers, it was customary for +the monarch to hang a gold piece around the neck of each patient. Very +strict precautions were adopted to prevent those who thought more of the +golden angel hung round the neck by a white ribbon, than of relief of +their bodily infirmities, from making too many calls, as they sometimes +attempted to do. According to the statement of the advocates and +contemporaries of this remedy, none ever failed of receiving benefit +unless their little faith and credulity starved their merits. Some are +said to have been cured immediately on the very touch, others did not +so easily get rid of their swellings, until they were touched a second +time. Several cases are related, of persons who had been blind for +several weeks, and months, and obliged even to be led to Whitehall, yet +recovered their sight immediately upon being touched, so as to walk away +without any guide.” So widely, at one period, was the belief diffused, +that, in the course of twelve years, nearly a hundred thousand persons +were touched by Charles the Second. Catholic divines; in disputes upon +the orthodoxy of their church, did not deny that the power had descended +to protestant princes;--Dr. Harpsfield, in his “Ecclesiastical History +of England,” admitted it, and in Wiseman's words, “when Bishop Tooker +would make use of this Argument to prove the Truth of our Church, +Smitheus doth not thereupon go about to deny the Matter of fact; nay, +both he and Cope acknowledge it.” “I myself,” says Wiseman, the best +English surgical writer of his day,[Edinburgh Medical and Surgical +Journal, vol. iii. p. 103.]--“I my self have been a frequent Eye-witness +of many hundred of Cures performed by his Majesties Touch alone, without +any assistance of Chirurgery; and those, many of them such as had tired +out the endeavours of able Chirurgeons before they came hither. It were +endless to recite what I myself have seen, and what I have received +acknowledgments of by Letter, not only from the severall parts of this +Nation, but also from Ireland, Scotland, Jersey, Garnsey. It is needless +also to remember what Miracles of this nature were performed by the very +Bloud of his late Majesty of Blessed memory, after whose decollation +by the inhuman Barbarity of the Regicides, the reliques of that were +gathered on Chips and in Handkerchieffs by the pious Devotes, who could +not but think so great a suffering in so honourable and pious a Cause, +would be attended by an extraordinary assistance of God, and some more +then ordinary a miracle: nor did their Faith deceive them in this there +point, being so many hundred that found the benefit of it.” [Severall +Chirurgicall Treatises. London.1676. p. 246.] + +Obstinate and incredulous men, as he tells us, accounted for these cures +in three ways: by the journey and change of air the patients obtained +in coming to London; by the influence of imagination; and the wearing of +gold. + +To these objections he answers, 1st. That many of those cured were +inhabitants of the city. 2d. That the subjects of treatment were +frequently infants. 3d. That sometimes silver was given, and sometimes +nothing, yet the patients were cured. + +A superstition resembling this probably exists at the present time +in some ignorant districts of England and this country. A writer in a +Medical Journal in the year 1807, speaks of a farmer in Devonshire, who, +being a ninth son of a ninth son, is thought endowed with healing powers +like those of ancient royalty, and who is accustomed one day in every +week to strike for the evil. + +I remember that one of my schoolmates told me, when a boy, of a seventh +son of a seventh son, somewhere in Essex County, who touched for the +scrofula, and who used to hang a silver fourpence halfpenny about the +neck of those who came to him, which fourpence halfpenny it was solemnly +affirmed became of a remarkably black color after having been some time +worn, and that his own brother had been subjected to this extraordinary +treatment; but I must add that my schoolmate drew a bow of remarkable +length, strength, and toughness for his tender years. + +One of the most curious examples of the fallacy of popular belief and +the uncertainty of asserted facts in medical experience is to be found +in the history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT. + +Fabricius Hildanus, whose name is familiar to every surgical scholar, +and Lord Bacon, who frequently dipped a little into medicine, are +my principal authorities for the few circumstances I shall mention +regarding it. The Weapon Ointment was a preparation used for the healing +of wounds, but instead of its being applied to them, the injured +part was washed and bandaged, and the weapon with which the wound was +inflicted was carefully anointed with the unguent. Empirics, ignorant +barbers, and men of that sort, are said to have especially employed it. +Still there were not wanting some among the more respectable members of +the medical profession who supported its claims. The composition of this +ointment was complicated, in the different formulae given by different +authorities; but some substances addressed to the imagination, rather +than the wound or weapon, entered into all. Such were portions of mummy, +of human blood, and of moss from the skull of a thief hung in chains. + +Hildanus was a wise and learned man, one of the best surgeons of his +time. He was fully aware that a part of the real secret of the Unguentum +Armarium consisted in the washing and bandaging the wound and then +letting it alone. But he could not resist the solemn assertions +respecting its efficacy; he gave way before the outcry of facts, and +therefore, instead of denying all their pretensions, he admitted and +tried to account for them upon supernatural grounds. As the virtue of +those applications, he says, which are made to the weapon cannot +reach the wound, and as they can produce no effect without contact, it +follows, of necessity, that the Devil must have a hand in the +business; and as he is by far the most long headed and experienced of +practitioners, he cannot find this a matter of any great difficulty. +Hildanus himself reports, in detail, the case of a lady who had received +a moderate wound, for which the Unguentum Armarium was employed without +the slightest use. Yet instead of receiving this flat case of failure as +any evidence against the remedy, he accounts for its not succeeding +by the devout character of the lady, and her freedom from that +superstitious and over-imaginative tendency which the Devil requires in +those who are to be benefited by his devices. + +Lord Bacon speaks of the Weapon Ointment, in his Natural History, as +having in its favor the testimony of men of credit, though, in his own +language, he himself “as yet is not fully inclined to believe it.” His +remarks upon the asserted facts respecting it show a mixture of wise +suspicion and partial belief. He does not like the precise directions +given as to the circumstances under which the animals from which some of +the materials were obtained were to be killed; for he thought it looked +like a provision for an excuse in case of failure, by laying the fault +to the omission of some of these circumstances. But he likes well that +“they do not observe the confecting of the Ointment under any certain +constellation; which is commonly the excuse of magical medicines, when +they fail, that they were not made under a fit figure of heaven.” [This +was a mistake, however, since the two recipes given by Hildanus are both +very explicit as to the aspect of the heavens required for different +stages of the process.] “It was pretended that if the offending weapon +could not be had, it would serve the purpose to anoint a wooden one made +like it.” “This,” says Bacon, “I should doubt to be a device to keep +this strange form of cure in request and use; because many times you +cannot come by the weapon itself.” And in closing his remarks on the +statements of the advocates of the ointment, he says, “Lastly, it +will cure a beast as well as a man, which I like best of all the +rest, because it subjecteth the matter to an easy trial.” It is worth +remembering, that more than two hundred years ago, when an absurd and +fantastic remedy was asserted to possess wonderful power, and when +sensible persons ascribed its pretended influence to imagination, it was +boldly answered that the cure took place when the wounded party did not +know of the application made to the weapon, and even when a brute animal +was the subject of the experiment, and that this assertion, as we all +know it was, came in such a shape as to shake the incredulity of the +keenest thinker of his time. The very same assertion has been since +repeated in favor of Perkinism, and, since that, of Homoeopathy. + +The same essential idea as that of the Weapon Ointment reproduced itself +in the still more famous SYMPATHETIC POWDER. This Powder was said to +have the faculty, if applied to the blood-stained garments of a wounded +person, to cure his injuries, even though he were at a great distance at +the time. A friar, returning from the East, brought the recipe to Europe +somewhat before the middle of the seventeenth century. The Grand Duke of +Florence, in which city the friar was residing, heard of his cures, and +tried, but without success, to obtain his secret. Sir Kenehn Digby, an +Englishman well known to fame, was fortunate enough to do him a favor, +which wrought upon his feelings and induced him to impart to his +benefactor the composition of his extraordinary Powder. This English +knight was at different periods of his life an admiral, a theologian, a +critic, a metaphysician, a politician, and a disciple of Alchemy. As is +not unfrequent with versatile and inflammable people, he caught fire at +the first spark of a new medical discovery, and no sooner got home to +England than he began to spread the conflagration. + +An opportunity soon offered itself to try the powers of the famous +powder. Mr. J. Howell, having been wounded in endeavoring to part two +of his friends who were fighting a duel, submitted himself to a trial +of the Sympathetic Powder. Four days after he received his wounds, Sir +Kenehn dipped one of Mr. Howell's gaiters in a solution of the Powder, +and immediately, it is said, the wounds, which were very painful, +grew easy, although the patient, who was conversing in a corner of the +chamber, had not, the least idea of what was doing with his garter. He +then returned home, leaving his garter in the hands of Sir Kenelm, who +had hung it up to dry, when Mr. Howell sent his servant in a great hurry +to tell him that his wounds were paining him horribly; the garter was +therefore replaced in the solution of the Powder, “and the patient got +well after five or six days of its continued immersion.” + +King James First, his son Charles the First, the Duke of Buckingham, +then prime minister, and all the principal personages of the time, were +cognizant of this fact; and James himself, being curious to know the +secret of this remedy, asked it of Sir Kenelm, who revealed it to him, +and his Majesty had the opportunity of making several trials of its +efficacy, “which all succeeded in a surprising manner.” [Dict. des +Sciences Medieales.] + +The king's physician, Dr. Mayerne, was made master of the secret, +which he carried to France and communicated to the Duke of Mayenne, who +performed many cures by means of it, and taught it to his surgeon, who, +after the Duke's death, sold it to many distinguished persons, by whose +agency it soon ceased to be a secret. What was this wonderful substance +which so astonished kings, princes, dukes, knights, and doctors? Nothing +but powdered blue vitriol. But it was made to undergo several processes +that conferred on it extraordinary virtues. Twice or thrice it was to be +dissolved, filtered, and crystallized. The crystals were to be laid in +the sun during the months of June, July, and August, taking care to +turn them carefully that all should be exposed. Then they were to be +powdered, triturated, and again exposed to the sun, again reduced to a +very fine powder, and secured in a vessel, while hot, from the sunshine. +If there seem anything remarkable in the fact of such astonishing +properties being developed by this process, it must be from our +short-sightedness, for common salt and charcoal develop powers quite as +marvellous after a certain number of thumps, stirs, and shakes, from the +hands of modern workers of miracles. In fact the Unguentum Armarium and +Sympathetic Powder resemble some more recent prescriptions; the latter +consisting in an infinite dilution of the common dose in which remedies +are given, and the two former in an infinite dilution of the common +distance at which they are applied. + +Whether philosophers, and more especially metaphysicians, have any +peculiar tendency to dabble in drugs and dose themselves with physic, +is a question which might suggest itself to the reader of their +biographies. + +When Bishop Berkeley visited the illustrious Malebranche at Paris, +he found him in his cell, cooking in a small pipkin a medicine for an +inflammation of the lungs, from which he was suffering; and the disease, +being unfortunately aggravated by the vehemence of their discussion, or +the contents of the pipkin, carried him off in the course of a few days. +Berkeley himself afforded a remarkable illustration of a truth which +has long been known to the members of one of the learned professions, +namely, that no amount of talent, or of acquirements in other +departments, can rescue from lamentable folly those who, without +something of the requisite preparation, undertake to experiment with +nostrums upon themselves and their neighbors. The exalted character of +Berkeley is thus drawn by Sir James Mackintosh: Ancient learning, +exact science, polished society, modern literature, and the fine arts, +contributed to adorn and enrich the mind of this accomplished man. All +his contemporaries agreed with the satirist in ascribing + +“'To Berkeley every virtue under heaven.' + +“Even the discerning, fastidious, and turbulent Atterbury said, after an +interview with him, 'So much understanding, so much knowledge, so much +innocence, and such humility, I did not think had been the portion of +any but angels, till I saw this gentleman.'” + +But among the writings of this great and good man is an Essay of the +most curious character, illustrating his weakness upon the point in +question, and entitled, “Siris, a Chain of Philosophical Reflections +and Inquiries concerning the Virtues of TAR WATER, and divers other +Subjects,”--an essay which begins with a recipe for his favorite fluid, +and slides by gentle gradations into an examination of the sublimest +doctrines of Plato. To show how far a man of honesty and benevolence, +and with a mind of singular acuteness and depth, may be run away with by +a favorite notion on a subject which his habits and education do not fit +him to investigate, I shall give a short account of this Essay, merely +stating that as all the supposed virtues of Tar Water, made public in +successive editions of his treatise by so illustrious an author, have +not saved it from neglect and disgrace, it may be fairly assumed that +they were mainly imaginary. + +The bishop, as is usual in such cases, speaks of himself as +indispensably obliged, by the duty he owes to mankind, to make his +experience public. Now this was by no means evident, nor does it follow +in general, that because a man has formed a favorable opinion of +a person or a thing he has not the proper means of thoroughly +understanding, he shall be bound to print it, and thus give currency +to his impressions, which may be erroneous, and therefore injurious. +He would have done much better to have laid his impressions before some +experienced physicians and surgeons, such as Dr. Mead and Mr. Cheselden, +to have asked them to try his experiment over again, and have been +guided by their answers. But the good bishop got excited; he pleased +himself with the thought that he had discovered a great panacea; and +having once tasted the bewitching cup of self-quackery, like many before +and since his time, he was so infatuated with the draught that he would +insist on pouring it down the throats of his neighbors and all mankind. + +The precious fluid was made by stirring a gallon of water with a quart +of tar, leaving it forty-eight hours, and pouring off the clear water. +Such was the specific which the great metaphysician recommended for +averting and curing all manner of diseases. It was, if he might be +believed, a preventive of the small-pox, and of great use in the course +of the disease. It was a cure for impurities of the blood, coughs, +pleurisy, peripneumony, erysipelas, asthma, indigestion, carchexia, +hysterics, dropsy, mortification, scurvy, and hypochondria. It was of +great use in gout and fevers, and was an excellent preservative of +the teeth and gums; answered all the purpose of Elixir Proprietatis, +Stoughton's drops, diet drinks, and mineral waters; was particularly to +be recommended to sea-faring persons, ladies, and men of studious and +sedentary lives; could never be taken too long, but, on the contrary, +produced advantages which sometimes did not begin to show themselves for +two or three months. + +“From my representing Tar Water as good for so many things,” says +Berkeley, “some perhaps may conclude it is good for nothing. But charity +obligeth me to say what I know, and what I think, however it may be +taken. Men may censure and object as they please, but I appeal to time +and experiment. Effects misimputed, cases wrong told, circumstances +overlooked, perhaps, too, prejudices and partialities against truth, may +for a time prevail and keep her at the bottom of her well, from whence +nevertheless she emergeth sooner or later, and strikes the eyes of +all who do not keep them shut.” I cannot resist the temptation of +illustrating the bishop's belief in the wonderful powers of his remedy, +by a few sentences from different parts of his essay. “The hardness +of stubbed vulgar constitutions renders them insensible of a thousand +things that fret and gall those delicate people, who, as if their skin +was peeled off, feel to the quick everything that touches them. The +tender nerves and low spirits of such poor creatures would be much +relieved by the use of Tar Water, which might prolong and cheer their +lives.” “It [the Tar Water] may be made stronger for brute beasts, as +horses, in whose disorders I have found it very useful.” “This same +water will also give charitable relief to the ladies, who often want it +more than the parish poor; being many of them never able to make a good +meal, and sitting pale, puny, and forbidden, like ghosts, at their own +table, victims of vapors and indigestion.” It does not appear among the +virtues of Tar Water that “children cried for it,” as for some of our +modern remedies, but the bishop says, “I have known children take it +for above six months together with great benefit, and without any +inconvenience; and after long and repeated experience I do esteem it +a most excellent diet drink, fitted to all seasons and ages.” After +mentioning its usefulness in febrile complaints, he says: “I have had +all this confirmed by my own experience in the late sickly season of the +year one thousand seven hundred and forty-one, having had twenty-five +fevers in my own family cured by this medicinal water, drunk copiously.” + And to finish these extracts with a most important suggestion for the +improvement of the British nation: “It is much to be lamented that our +Insulars who act and think so much for themselves, should yet, from +grossness of air and diet, grow stupid or doat sooner than other people, +who, by virtue of elastic air, water-drinking, and light food, preserve +their faculties to extreme old age; an advantage which may perhaps +be approached, if not equaled, even in these regions, by Tar Water, +temperance, and early hours.” + +Berkeley died at the age of about seventy; he might have lived longer, +but his fatal illness was so sudden that there was not time enough to +stir up a quart of the panacea. He was an illustrious man, but he held +two very odd opinions; that tar water was everything, and that the whole +material universe was nothing. + + ***** + +Most of those present have at some time in their lives heard mention +made of the METALLIC TRACTORS, invented by one Dr. Perkins, an American, +and formerly enjoying great repute for the cure of various diseases. +Many have seen or heard of a satirical poem, written by one of our +own countrymen also, about forty years since, and called “Terrible +Tractoration.” The Metallic Tractors are now so utterly abandoned that +I have only by good fortune fallen upon a single one of a pair, to show +for the sake of illustration. For more than thirty years this great +discovery, which was to banish at least half the evils which afflict +humanity, has been sleeping undisturbed in the grave of oblivion. Not a +voice has, for this long period, been raised in its favor; its noble and +learned patrons, its public institutions, its eloquent advocates, its +brilliant promises are all covered with the dust of silent neglect; +and of the generation which has sprung up since the period when it +flourished, very few know anything of its history, and hardly even +the title which in its palmy days it bore of PERKINISM. Taking it as +settled, then, as no one appears to answer for it, that Perkinism is +entirely dead and gone, that both in public and private, officially +and individually, its former adherents even allow it to be absolutely +defunct, I select it for anatomical examination. If this pretended +discovery was made public; if it was long kept before the public; if it +was addressed to the people of different countries; if it was formally +investigated by scientific men, and systematically adopted by benevolent +persons, who did everything in their power to diffuse the knowledge +and practice of it; if various collateral motives, such as interest +and vanity, were embarked in its cause; if, notwithstanding all these +things, it gradually sickened and died, then the conclusion seems a fair +one, that it did not deserve to live. Contrasting its failure with +its high pretensions, it is fair to call it an imposition; whether +an expressly fraudulent contrivance or not, some might be ready to +question. Everything historically shown to have happened concerning the +mode of promulgation, the wide diffusion, the apparent success of this +delusion, the respectability and enthusiasm of its advocates, is +of great interest in showing to what extent and by what means a +considerable part of the community may be led into the belief of that +which is to be eventually considered as an idle folly. If there is any +existing folly, fraudulent or innocent in its origin, which appeals to +certain arguments for its support; provided that the very same arguments +can be shown to have been used for Perkinism with as good reason, they +will at once fall to the ground. Still more, if it shall appear that the +general course of any existing delusion bears a strong resemblance to +that of Perkinism, that the former is most frequently advocated by the +same class of persons who were conspicuous in behalf of the latter, and +treated with contempt or opposed by the same kind of persons who thus +treated Perkinism; if the facts in favor of both have a similar aspect; +if the motives of their originators and propagators may be presumed +to have been similar; then there is every reason to suppose that the +existing folly will follow in the footsteps of the past, and after +displaying a given amount of cunning and credulity in those deceiving +and deceived, will drop from the public view like a fruit which has +ripened into spontaneous rottenness, and be succeeded by the fresh bloom +of some other delusion required by the same excitable portion of the +community. + +Dr. Elisha Perkins was born at Norwich, Connecticut, in the year 1740. +He had practised his profession with a good local reputation for many +years, when he fell upon a course of experiments, as it is related, +which led to his great discovery. He conceived the idea that metallic +substances might have the effect of removing diseases, if applied in +a certain manner; a notion probably suggested by the then recent +experiments of Galvani, in which muscular contractions were found to be +produced by the contact of two metals with the living fibre. It was in +1796 that his discovery was promulgated in the shape of the Metallic +Tractors, two pieces of metal, one apparently iron and the other brass, +about three inches long, blunt at one end and pointed at the other. +These instruments were applied for the cure of different complaints, +such as rheumatism, local pains, inflammations, and even tumors, by +drawing them over the affected part very lightly for about twenty +minutes. Dr. Perkins took out a patent for his discovery, and travelled +about the country to diffuse the new practice. He soon found numerous +advocates of his discovery, many of them of high standing and influence. +In the year 1798 the tractors had crossed the Atlantic, and were +publicly employed in the Royal Hospital at Copenhagen. About the same +time the son of the inventor, Mr. Benjamin Douglass Perkins, carried +them to London, where they soon attracted attention. The Danish +physicians published an account of their cases, containing numerous +instances of alleged success, in a respectable octavo volume. In the +year 1804 an establishment, honored with the name of the Perkinean +Institution, was founded in London. The transactions of this institution +were published in pamphlets, the Perkinean Society had public dinners +at the Crown and Anchor, and a poet celebrated their medical triumph in +strains like these: + + + “See, pointed metals, blest with power t' appease + The ruthless rage of merciless disease, + O'er the frail part a subtle fluid pour, + Drenched with invisible Galvanic shower, + Till the arthritic staff and crutch forego, + And leap exulting like the bounding roe!” + +While all these things were going on, Mr. Benjamin Douglass Perkins was +calmly pocketing money, so that after some half a dozen years he left +the country with more than ten thousand pounds, which had been paid him +by the believers in Great Britain. But in spite of all this success, and +the number of those interested and committed in its behalf, Perkinism +soon began to decline, and in 1811 the Tractors are spoken of by an +intelligent writer as being almost forgotten. Such was the origin and +duration of this doctrine and practice, into the history of which we +will now look a little more narrowly. + +Let us see, then, by whose agency this delusion was established and kept +up; whether it was principally by those who were accustomed to medical +pursuits, or those whose habits and modes of reasoning were different; +whether it was with the approbation of those learned bodies usually +supposed to take an interest in scientific discoveries, or only of +individuals whose claims to distinction were founded upon their position +in society, or political station, or literary eminence; whether the +judicious or excitable classes entered most deeply into it; whether, in +short, the scientific men of that time were deceived, or only intruded +upon, and shouted down for the moment by persons who had no particular +call to invade their precincts. + +Not much, perhaps, was to be expected of the Medical Profession in the +way of encouragement. One Dr. Fuller, who wrote in England, himself +a Perkinist, thus expressed his opinion: “It must be an extraordinary +exertion of virtue and humanity for a medical man, whose livelihood +depends either on the sale of drugs, or on receiving a guinea for +writing a prescription, which must relate to those drugs, to say to +his patient, 'You had better purchase a set of Tractors to keep in your +family; they will cure you without the expense of my attendance, or the +danger of the common medical practice.' For very obvious reasons medical +men must never be expected to recommend the use of Perkinism. The +Tractors must trust for their patronage to the enlightened and +philanthropic out of the profession, or to medical men retired from +practice, and who know of no other interest than the luxury of relieving +the distressed. And I do not despair of seeing the day when but very few +of this description as well as private families will be without them.” + +Whether the motives assigned by this medical man to his professional +brethren existed or not, it is true that Dr. Perkins did not gain a +great deal at their hands. The Connecticut Medical Society expelled him +in 1797 for violating their law against the use of nostrums, or secret +remedies. The leading English physicians appear to have looked on with +singular apathy or contempt at the miracles which it was pretended were +enacting in the hands of the apostles of the new practice. In looking +over the reviews of the time, I have found little beyond brief +occasional notices of their pretensions; the columns of these journals +being occupied with subjects of more permanent interest. The state of +things in London is best learned, however, from the satirical poem +to which I have already alluded as having been written at the period +referred to. This was entitled, “Terrible Tractoration!! A Poetical +Petition against Galvanizing Trumpery and the Perkinistic Institution. +Most respectfully addressed to the Royal College of Physicians, by +Christopher Caustic, M. D., LL. D., A. S. S., Fellow of the Royal +College of Physicians, Aberdeen, and Honorary Member of no less than +nineteen very learned Societies.” Two editions of this work were +published in London in the years 1803 and 1804, and one or two have been +published in this country. + +“Terrible Tractoration” is supposed, by those who never read it, to be +a satire upon the follies of Perkins and his followers. It is, on the +contrary, a most zealous defence of Perkinism, and a fierce attack upon +its opponents, most especially upon such of the medical profession +as treated the subject with neglect or ridicule. The Royal College of +Physicians was the more peculiar object of the attack, but with this +body, the editors of some of the leading periodicals, and several +physicians distinguished at that time, and even now remembered for +their services to science and humanity, were involved in unsparing +denunciations. The work is by no means of the simply humorous character +it might be supposed, but is overloaded with notes of the most seriously +polemical nature. Much of the history of the subject, indeed, is to be +looked for in this volume. + +It appears from this work that the principal members of the medical +profession, so far from hailing Mr. Benjamin Douglass Perkins as another +Harvey or Jenner, looked very coldly upon him and his Tractors; and it +is now evident that, though they were much abused for so doing, they +knew very well what they had to deal with, and were altogether in the +right. The delusion at last attracted such an amount of attention as to +induce Dr. Haygarth and some others of respectable standing to institute +some experiments which I shall mention in their proper place, the result +of which might have seemed sufficient to show the emptiness of the whole +contrivance. + +The Royal Society, that learned body which for ages has constituted +the best tribunal to which Britain can appeal in questions of science, +accepted Mr. Perkins's Tractors and the book written about them, passed +the customary vote of thanks, and never thought of troubling itself +further in the investigation of pretensions of such an aspect. It is +not to be denied that a considerable number of physicians did avow +themselves advocates of the new practice; but out of the whole catalogue +of those who were publicly proclaimed as such, no one has ever been +known, so far as I am aware, to the scientific world, except in +connection with the short-lived notoriety of Perkinism. Who were +the people, then, to whose activity, influence, or standing with +the community was owing all the temporary excitement produced by the +Metallic Tractors? + +First, those persons who had been induced to purchase a pair of +Tractors. These little bits of brass and iron, the intrinsic value of +which might, perhaps, amount to ninepence, were sold at five guineas a +pair! A man who has paid twenty-five dollars for his whistle is apt to +blow it louder and longer than other people. So it appeared that when +the “Perkinean Society” applied to the possessors of Tractors in the +metropolis to concur in the establishment of a public institution for +the use of these instruments upon the poor, “it was found that only five +out of above a hundred objected to subscribe, on account of their want +of confidence in the efficacy of the practice; and these,” the committee +observes, “there is reason to believe, never gave them a fair trial, +probably never used them in more than one case, and that perhaps a +case in which the Tractors had never been recommended as serviceable.” + “Purchasers of the Tractors,” said one of their ardent advocates, “would +be among the last to approve of them if they had reason to suppose +themselves defrauded of five guineas.” He forgot poor Moses, with his +“gross of green spectacles, with silver rims and shagreen cases.” “Dear +mother,” cried the boy, “why won't you listen to reason? I had them a +dead bargain, or I should not have bought them. The silver rims alone +will sell for double the money.” + +But it is an undeniable fact, that many persons of considerable +standing, and in some instances holding the most elevated positions in +society, openly patronized the new practice. In a translation of a work +entitled “Experiments with the Metallic Tractors,” originally published +in Danish, thence rendered successively into German and English, Mr. +Benjamin Perkins, who edited the English edition, has given a copious +enumeration of the distinguished individuals, both in America and +Europe, whose patronage he enjoyed. He goes so far as to signify that +ROYALTY itself was to be included among the number. When the Perkinean +Institution was founded, no less a person than Lord Rivers was elected +President, and eleven other individuals of distinction, among them +Governor Franklin, son of Dr. Franklin, figured as Vice-Presidents. Lord +Henniker, a member of the Royal Society, who is spoken of as a man +of judgment and talents, condescended to patronize the astonishing +discovery, and at different times bought three pairs of Tractors. When +the Tractors were introduced into Europe, a large number of testimonials +accompanied them from various distinguished characters in America, the +list of whom is given in the translation of the Danish work referred to +as follows: + +“Those who have individually stated cases, or who have presented their +names to the public as men who approved of this remedy, and acknowledged +themselves instrumental in circulating the Tractors, are fifty-six in +number; thirty-four of whom are physicians and surgeons, and many of +them of the first eminence, thirteen clergymen, most of whom are doctors +of divinity, and connected with the literary institutions of America; +among the remainder are two members of Congress, one professor of +natural philosophy in a college, etc., etc.” It seemed to be taken +rather hardly by Mr. Perkins that the translators of the work which he +edited, in citing the names of the advocates of the Metallic Practice, +frequently omitted the honorary titles which should have been annexed. +The testimonials were obtained by the Danish writer, from a pamphlet +published in America, in which these titles were given in full. Thus +one of these testimonials is from “John Tyler, Esq., a magistrate in the +county of New London, and late Brigadier-General of the militia in +that State.” The “omission of the General's title” is the subject of +complaint, as if this title were sufficient evidence of the commanding +powers of one of the patrons of tractoration. A similar complaint is +made when “Calvin Goddard, Esq., of Plainfield, Attorney at Law, and +a member of the Legislature of the State of Connecticut,” is mentioned +without his titular honors, and even on account of the omission of the +proper official titles belonging to “Nathan Pierce, Esq., Governor and +Manager of the Almshouse of Newburyport.” These instances show the great +importance to be attached to civil and military dignities, in qualifying +their holders to judge of scientific subjects, a truth which has not +been overlooked by the legitimate successors of the Perkinists. In Great +Britain, the Tractors were not less honored than in America, by the +learned and the illustrious. The “Perkinistic Committee” made this +statement in their report: “Mr. Perkins has annually laid before the +public a large collection of new cases communicated to him for that +purpose by disinterested and intelligent characters, from almost every +quarter of Great Britain. In regard to the competency of these vouchers, +it will be sufficient simply to state that, amongst others whose names +have been attached to their communications, are eight professors, in +four different universities, twenty-one regular Physicians, nineteen +Surgeons, thirty Clergymen, twelve of whom are Doctors of Divinity, and +numerous other characters of equal respectability.” + +It cannot but excite our notice and surprise that the number of +clergymen both in America and Great Britain who thrust forward their +evidence on this medical topic was singularly large in proportion +to that of the members of the medical profession. Whole pages are +contributed by such worthies as the Rev. Dr. Trotter of Hans Place, +the Rear. Waring Willett, Chaplain to the Earl of Dunmore, the Rev. +Dr. Clarke, Chaplain to the Prince of Wales. The style of these +theologico-medical communications may be seen in the following from a +divine who was also professor in one of the colleges of New England. +“I have used the Tractors with success in several other cases in my +own family, and although, like Naaman the Syrian, I cannot tell why +the waters of Jordan should be better than Abana and Pharpar, rivers +of Damascus; yet since experience has proved them so, no reasoning +can change the opinion. Indeed, the causes of all common facts are, we +think, perfectly well known to us; and it is very probable, fifty or +a hundred years hence, we shall as well know why the Metallic Tractors +should in a few minutes remove violent pains, as we now know why +cantharides and opium will produce opposite effects, namely, we shall +know very little about either excepting facts.” Fifty or a hundred years +hence! if he could have looked forward forty years, he would have +seen the descendants of the “Perkinistic” philosophers swallowing +infinitesimal globules, and knowing and caring as much about the +Tractors as the people at Saratoga Springs do about the waters of Abana +and Pharpar. + +I trust it will not be thought in any degree disrespectful to a +profession which we all honor, that I have mentioned the great zeal +of many clergymen in the cause of Perkinism. I hope, too, that I may +without offence suggest the causes which have often led them out of +their own province into one to which their education has no special +reference. The members of that profession ought to be, and commonly are, +persons of benevolent character. Their duties carry them into the midst +of families, and particularly at times when the members of them are +suffering from bodily illness. It is natural enough that a strong desire +should be excited to alleviate sufferings which may have defied +the efforts of professional skill; as natural that any remedy which +recommends itself to the belief or the fancy of the spiritual physician +should be applied with the hope of benefit; and perfectly certain that +the weakness of human nature, from which no profession is exempt, +will lead him to take the most flattering view of its effects upon the +patient; his own sagacity and judgment being staked upon the success of +the trial. The inventor of the Tractors was aware of these truths. He +therefore sent the Tractors gratuitously to many clergymen, accompanied +with a formal certificate that the holder had become entitled to their +possession by the payment of five guineas. This was practised in our +own neighborhood, and I remember finding one of these certificates, +so presented, which proved that amongst the risks of infancy I had to +encounter Perkins's Tractors. Two clergymen of Boston and the vicinity, +both well known to local fame, gave in their testimony to the value +of the instruments thus presented to them; an unusually moderate +proportion, when it is remembered that to the common motives of which +I have spoken was added the seduction of a gift for which the profane +public was expected to pay so largely. + +It was remarkable, also, that Perkinism, which had so little success +with the medical and scientific part of the community, found great favor +in the eyes of its more lovely and less obstinate portion. “The lady of +Major Oxholin,”--I quote from Mr. Perkins's volume,--“having been lately +in America, had seen and heard much of the great effects of Perkinism. +Influenced by a most benevolent disposition, she brought these Tractors +and the pamphlet with her to Europe, with a laudable desire of extending +their utility to her suffering countrymen.” Such was the channel by +which the Tractors were conveyed to Denmark, where they soon became the +ruling passion. The workmen, says a French writer, could not manufacture +them fast enough. Women carried them about their persons, and delighted +in bringing them into general use. To what extent the Tractors were +favored with the patronage of English and American ladies, it is of +course not easy to say, except on general principles, as their names +were not brought before the public. But one of Dr. Haygarth's stories +may lead us to conjecture that there was a class of female practitioners +who went about doing good with the Tractors in England as well as in +Denmark. A certain lady had the misfortune to have a spot as big as a +silver penny at the corner of her eye, caused by a bruise, or some such +injury. Another lady, who was a friend of hers, and a strong believer in +Perkinism, was very anxious to try the effects of tractoration upon +this unfortunate blemish. The patient consented; the lady “produced the +instruments, and, after drawing them four or five times over the spot, +declared that it changed to a paler color, and on repeating the use of +them a few minutes longer, that it had almost vanished, and was scarcely +visible, and departed in high triumph at her success.” The lady who +underwent the operation assured the narrator “that she looked in the +glass immediately after, and that not the least visible alteration had +taken place.” + +It would be a very interesting question, what was the intellectual +character of those persons most conspicuous in behalf of the Perkinistic +delusion? Such an inquiry might bring to light some principles which +we could hereafter apply to the study of other popular errors. But the +obscurity into which nearly all these enthusiasts have subsided renders +the question easier to ask than to answer. I believe it would have +been found that most of these persons were of ardent temperament and +of considerable imagination, and that their history would show +that Perkinism was not the first nor the last hobby-horse they rode +furiously. Many of them may very probably have been persons of more than +common talent, of active and ingenious minds, of versatile powers and +various acquirements. Such, for instance, was the estimable man to whom +I have repeatedly referred as a warm defender of tractoration, and +a bitter assailant of its enemies. The story tells itself in the +biographical preface to his poem. He went to London with the view +of introducing a hydraulic machine, which he and his Vermont friends +regarded as a very important invention. He found, however, that the +machine was already in common use in that metropolis. A brother Yankee, +then in London, had started the project of a mill, which was to be +carried by the water of the Thames. He was sanguine enough to purchase +one fifth of this concern, which also proved a failure. At about the +same period he wrote the work which proved the great excitement of his +mind upon the subject of the transient folly then before the public. +Originally a lawyer, he was in succession a mechanician, a poet, and an +editor, meeting with far less success in each of these departments +than usually attends men of less varied gifts, but of more tranquil and +phlegmatic composition. But who is ignorant that there is a class of +minds characterized by qualities like those I have mentioned; minds with +many bright and even beautiful traits; but aimless and fickle as the +butterfly; that settle upon every gayly-colored illusion as it opens +into flower, and flutter away to another when the first has dropped its +leaves, and stands naked in the icy air of truth! + +Let us now look at the general tenor of the arguments addressed by +believers to sceptics and opponents. Foremost of all, emblazoned at the +head of every column, loudest shouted by every triumphant disputant, +held up as paramount to all other considerations, stretched like an +impenetrable shield to protect the weakest advocate of the great cause +against the weapons of the adversary, was that omnipotent monosyllable +which has been the patrimony of cheats and the currency of dupes from +time immemorial,--Facts! Facts! Facts! First came the published cases +of the American clergymen, brigadier-generals, almshouse governors, +representatives, attorneys, and esquires. Then came the published +cases of the surgeons of Copenhagen. Then followed reports of about +one hundred and fifty cases published in England, “demonstrating the +efficacy of the metallic practice in a variety of complaints both upon +the human body and on horses, etc.” But the progress of facts in Great +Britain did not stop here. Let those who rely upon the numbers of their +testimonials, as being alone sufficient to prove the soundness and +stability of a medical novelty, digest the following from the report +of the Perkinistic Committee. “The cases published [in Great Britain] +amounted, in March last, the date of Mr. Perkins's last publication, +to about five thousand. Supposing that not more than one cure in three +hundred which the Tractors have performed has been published, and the +proportion is probably much greater, it will be seen that the number, to +March last, will have exceeded one million five hundred thousand!” + +Next in order after the appeal to what were called facts, came a series +of arguments, which have been so long bruised and battered round in the +cause of every doctrine or pretension, new, monstrous, or deliriously +impossible, that each of them is as odiously familiar to the scientific +scholar as the faces of so many old acquaintances, among the less +reputable classes, to the officers of police. + +No doubt many of my hearers will recognize, in the following passages, +arguments they may have heard brought forward with triumphant confidence +in behalf of some doctrine not yet extinct. No doubt some may have +honestly thought they proved something; may have used them with the +purpose of convincing their friends, or of silencing the opponents +of their favorite doctrine, whatever that might be. But any train +of arguments which was contrived for Perkinism, which was just as +applicable to it as to any other new doctrine in the same branch of +science, and which was fully employed against its adversaries forty +years since, might, in common charity, be suffered to slumber in the +grave of Perkinism. Whether or not the following sentences, taken +literally from the work of Mr. Perkins, were the originals of some of +the idle propositions we hear bandied about from time to time, let those +who listen judge. + +The following is the test assumed for the new practice: “If diseases are +really removed, as those persons who have practised extensively with +the Tractors declare, it should seem there would be but little doubt +of their being generally adopted; but if the numerous reports of their +efficacy which have been published are forgeries, or are unfounded, +the practice ought to be crushed.” To this I merely add, it has been +crushed. + +The following sentence applies to that a priori judging and uncandid +class of individuals who buy their dinners without tasting all the +food there is in the market. “On all discoveries there are persons who, +without descending to any inquiry into the truth, pretend to know, as it +were by intuition, that newly asserted facts are founded in the +grossest errors. These were those who knew that Harvey's report of the +circulation of the blood was a preposterous and ridiculous suggestion, +and in latter later days there were others who knew that Franklin +deserved reproach for declaring that points were preferable to balls for +protecting buildings from lightning.” + +Again: “This unwarrantable mode of offering assertion for proof, so +unauthorized and even unprecedented except in the condemnation of +a Galileo, the persecution of a Copernicus, and a few other acts of +inquisitorial authority, in the times of ignorance and superstition, +affords but a lamentable instance of one of his remarks, that this is +far from being the Age of Reason.” + +“The most valuable medicines in the Materia Medica act on principles of +which we are totally ignorant. None have ever yet been able to explain +how opium produces sleep, or how bark cures intermittent fevers; and yet +few, it is hoped, will be so absurd as to desist from the use of these +important articles because they know nothing of the principle of their +operations.” Or if the argument is preferred, in the eloquent language +of the Perkinistic poet: + + + “What though the CAUSES may not be explained, + Since these EFFECTS are duly ascertained, + Let not self-interest, prejudice, or pride, + Induce mankind to set the means aside; + Means which, though simple, are by + Heaven designed to alleviate the woes of human kind.” + +This course of argument is so often employed, that it deserves to be +expanded a little, so that its length and breadth may be fairly seen. +A series of what are called facts is brought forward to prove some very +improbable doctrine. It is objected by judicious people, or such as have +devoted themselves to analogous subjects, that these assumed facts are +in direct opposition to all that is known of the course of nature, that +the universal experience of the past affords a powerful presumption +against their truth, and that in proportion to the gravity of these +objections, should be the number and competence of the witnesses. The +answer is a ready one. What do we know of the mysteries of Nature? Do +we understand the intricate machinery of the Universe? When to this is +added the never-failing quotation, + + + “There are more things in heaven and earth, Horatio, + Than are dreamt of in your philosophy,”-- + +the question is thought to be finally disposed of. + +Take the case of astrology as an example. It is in itself strange and +incredible that the relations of the heavenly bodies to each other at a +given moment of time, perhaps half a century ago, should have anything +to do with my success or misfortune in any undertaking of to-day. +But what right have I to say it cannot be so? Can I bind the sweet +influences of Pleiades, or loose the bands of Orion? I do not know by +what mighty magic the planets roll in their fluid paths, confined to +circles as unchanging as if they were rings of steel, nor why the great +wave of ocean follows in a sleepless round upon the skirts of moonlight; +nor can I say from any certain knowledge that the phases of the heavenly +bodies, or even the falling of the leaves of the forest, or the manner +in which the sands lie upon the sea-shore, may not be knit up by +invisible threads with the web of human destiny. There is a class +of minds much more ready to believe that which is at first sight +incredible, and because it is incredible, than what is generally thought +reasonable. Credo quia impossibile est,--“I believe, because it is +impossible,”--is an old paradoxical expression which might be literally +applied to this tribe of persons. And they always succeed in finding +something marvellous, to call out the exercise of their robust faith. +The old Cabalistic teachers maintained that there was not a verse, +line, word, or even letter in the Bible which had not a special efficacy +either to defend the person who rightly employed it, or to injure his +enemies; always provided the original Hebrew was made use of. In the +hands of modern Cabalists every substance, no matter how inert, acquires +wonderful medicinal virtues, provided it be used in a proper state of +purity and subdivision. + +I have already mentioned the motives attributed by the Perkinists to the +Medical Profession, as preventing its members from receiving the new +but unwelcome truths. This accusation is repeated in different forms and +places, as, for instance, in the following passage: “Will the medical +man who has spent much money and labor in the pursuit of the arcana +of Physic, and on the exercise of which depends his support in life, +proclaim the inefficacy of his art, and recommend a remedy to +his patient which the most unlettered in society can employ as +advantageously as himself? and a remedy, too, which, unlike the drops, +the pills, the powders, etc., of the Materia Medica, is inconsumable, +and ever in readiness to be employed in successive diseases?” + +As usual with these people, much indignation was expressed at any +parallel between their particular doctrine and practice and those of +their exploded predecessors. “The motives,” says the disinterested +Mr. Perkins, “which must have impelled to this attempt at classing the +METALLIC PRACTICE with the most paltry of empyrical projects, are but +too thinly veiled to escape detection.” + +To all these arguments was added, as a matter of course, an appeal to +the feelings of the benevolent in behalf of suffering humanity, in the +shape of a notice that the poor would be treated gratis. It is pretty +well understood that this gratuitous treatment of the poor does not +necessarily imply an excess of benevolence, any more than the gratuitous +distribution of a trader's shop-bills is an evidence of remarkable +generosity; in short, that it is one of those things which honest men +often do from the best motives, but which rogues and impostors never +fail to announce as one of their special recommendations. It is +astonishing to see how these things brighten up at the touch of Mr. +Perkins's poet: + + + “Ye worthy, honored, philanthropic few, + The muse shall weave her brightest wreaths for you, + Who in Humanity's bland cause unite, + Nor heed the shaft by interest aimed or spite; + Like the great Pattern of Benevolence, + Hygeia's blessings to the poor dispense; + And though opposed by folly's servile brood, + ENJOY THE LUXURY OF DOING GOOD.” + +Having thus sketched the history of Perkinism in its days of prosperity; +having seen how it sprung into being, and by what means it maintained +its influence, it only remains to tell the brief story of its +discomfiture and final downfall. The vast majority of the sensible part +of the medical profession were contented, so far as we can judge, to +let it die out of itself. It was in vain that the advocates of this +invaluable discovery exclaimed over their perverse and interested +obstinacy,--in vain that they called up the injured ghosts of Harvey, +Galileo, and Copernicus to shame that unbelieving generation; the +Baillies and the Heberdens,--men whose names have come down to us +as synonymous with honor and wisdom,--bore their reproaches in meek +silence, and left them unanswered to their fate. There were some others, +however, who, believing the public to labor under a delusion, thought it +worth while to see whether the charm would be broken by an open trial of +its virtue, as compared with that of some less hallowed formula. It +must be remembered that a peculiar value was attached to the Metallic +Tractors, as made and patented by Mr. Perkins. Dr. Haygarth, of Bath, +performed various experiments upon patients afflicted with different +complaints,--the patients supposing that the real five-guinea Tractors +were employed. Strange to relate, he obtained equally wonderful effects +with Tractors of lead and of wood; with nails, pieces of bone, slate +pencil, and tobacco-pipe. Dr. Alderson employed sham Tractors made of +wood, and produced such effects upon five patients that they returned +solemn thanks in church for their cures. A single specimen of these +cases may stand for all of them. Ann Hill had suffered for some months +from pain in the right arm and shoulder. The Tractors (wooden ones) were +applied, and in the space of five minutes she expressed herself relieved +in the following apostrophe: “Bless me! why, who could have thought it, +that them little things could pull the pain from one. Well, to be sure, +the longer one lives, the more one sees; ah, dear!” + +These experiments did not result in the immediate extinction of +Perkinism. Doubtless they were a great comfort to many obstinate +unbelievers, and helped to settle some sceptical minds; but for the real +Perkinistic enthusiasts, it may be questioned whether they would at that +time have changed their opinion though one had risen from the dead to +assure them that it was an error. It perished without violence, by an +easy and natural process. Like the famous toy of Mongolfier, it rose by +means of heated air,--the fevered breath of enthusiastic ignorance,--and +when this grew cool, as it always does in a little while, it collapsed +and fell. + +And now, on reviewing the whole subject, how shall we account for the +extraordinary prevalence of the belief in Perkinism among a portion of +what is supposed to be the thinking part of the community? + +Could the cures have been real ones, produced by the principle of ANIMAL +MAGNETISM? To this it may be answered that the Perkinists ridiculed the +idea of approximating Mesmer and the founder of their own doctrine, that +nothing like the somnambulic condition seems to have followed the use of +the Tractors, and that neither the exertion of the will nor the powers +of the individual who operated seem to have been considered of any +consequence. Besides, the absolute neglect into which the Tractors soon +declined is good evidence that they were incapable of affording any +considerable and permanent relief in the complaints for the cure of +which they were applied. + +Of course a large number of apparent cures were due solely to nature; +which is true under every form of treatment, orthodox or empirical. +Of course many persons experienced at least temporary relief from the +strong impression made upon their minds by this novel and marvellous +method of treatment. + +Many, again, influenced by the sanguine hopes of those about them, like +dying people, who often say sincerely, from day to day, that they are +getting better, cheated themselves into a false and short-lived belief +that they were cured; and as happens in such cases, the public never +knew more than the first half of the story. + +When it was said to the Perkinists, that whatever effects they produced +were merely through the imagination, they declared (like the advocates +of the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this explanation +was sufficiently disproved by the fact of numerous and successful cures +which had been witnessed in infants and brute animals. Dr. Haygarth +replied to this, that “in these cases it is not the Patient, but the +Observer, who is deceived by his own imagination,” and that such may be +the fact, we have seen in the case of the good lady who thought she had +conjured away the spot from her friend's countenance, when it remained +just as before. + +As to the motives of the inventor and vender of the Tractors, the facts +must be allowed to speak for themselves. But when two little bits of +brass and iron are patented, as an invention, as the result of numerous +experiments, when people are led, or even allowed, to infer that they +are a peculiar compound, when they are artfully associated with a new +and brilliant discovery (which then happened to be Galvanism), when they +are sold at many hundred times their value, and the seller prints his +opinion that a Hospital will suffer inconvenience, “unless it possesses +many sets of the Tractors, and these placed in the hands of the patients +to practise on each other,” one cannot but suspect that they were +contrived in the neighborhood of a wooden nutmeg factory; that legs of +ham in that region are not made of the best mahogany; and that such as +buy their cucumber seed in that vicinity have to wait for the fruit as +long as the Indians for their crop of gunpowder. + + ***** + +The succeeding lecture will be devoted to an examination of the +doctrines of Samuel Hahnemann and his disciples; doctrines which some +consider new and others old; the common title of which is variously +known as Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, and +the claims of which are considered by some as infinitely important, and +by many as immeasurably ridiculous. + +I wish to state, for the sake of any who may be interested in the +subject, that I shall treat it, not by ridicule, but by argument; +perhaps with great freedom, but with good temper and in peaceable +language; with very little hope of reclaiming converts, with no desire +of making enemies, but with a firm belief that its pretensions and +assertions cannot stand before a single hour of calm investigation. + +II. + +It may be thought that a direct attack upon the pretensions of +HOMOEOPATHY is an uncalled-for aggression upon an unoffending doctrine +and its peaceful advocates. + +But a little inquiry will show that it has long assumed so hostile a +position with respect to the Medical Profession, that any trouble I, or +any other member of that profession, may choose to bestow upon it may be +considered merely as a matter of self-defence. It began with an attempt +to show the insignificance of all existing medical knowledge. It not +only laid claim to wonderful powers of its own, but it declared the +common practice to be attended with the most positively injurious +effects, that by it acute diseases are aggravated, and chronic diseases +rendered incurable. It has at various times brought forward collections +of figures having the air of statistical documents, pretending to show +a great proportional mortality among the patients of the Medical +Profession, as compared with those treated according to its own rules. +Not contented with choosing a name of classical origin for itself, it +invented one for the whole community of innocent physicians, assuring +them, to their great surprise, that they were all ALLOPATHISTS, whether +they knew it or not, and including all the illustrious masters of the +past, from Hippocrates down to Hunter, under the same gratuitous title. +The line, then, has been drawn by the champions of the new doctrine; +they have lifted the lance, they have sounded the charge, and are +responsible for any little skirmishing which may happen. + +But, independently of any such grounds of active resistance, the subject +involves interests so disproportioned to its intrinsic claims, that it +is no more than an act of humanity to give it a public examination. If +the new doctrine is not truth, it is a dangerous, a deadly error. If it +is a mere illusion, and acquires the same degree of influence that we +have often seen obtained by other illusions, there is not one of my +audience who may not have occasion to deplore the fatal credulity which +listened to its promises. + +I shall therefore undertake a sober examination of its principles, its +facts, and some points of its history. The limited time at my disposal +requires me to condense as much as possible what I have to say, but +I shall endeavor to be plain and direct in expressing it. Not one +statement shall be made which cannot be supported by unimpeachable +reference: not one word shall be uttered which I am not as willing to +print as to speak. I have no quibbles to utter, and I shall stoop +to answer none; but, with full faith in the sufficiency of a plain +statement of facts and reasons, I submit the subject to the discernment +of my audience. + +The question may be asked in the outset,--Have you submitted the +doctrines you are professing to examine to the test of long-repeated and +careful experiment; have you tried to see whether they were true or not? +To this I answer, that it is abundantly evident, from what has often +happened, that it would be of no manner of use for me to allege the +results of any experiments I might have instituted. Again and again have +the most explicit statements been made by the most competent persons of +the utter failure of all their trials, and there were the same abundant +explanations offered as used to be for the Unguentum Armarium and the +Metallic Tractors. I could by no possibility perform any experiments +the result of which could not be easily explained away so as to be of no +conclusive significance. Besides, as arguments in favor of Homoeopathy +are constantly addressed to the public in journals, pamphlets, and even +lectures, by inexperienced dilettanti, the same channel must be open to +all its opponents. + +It is necessary, for the sake of those to whom the whole subject may +be new, to give in the smallest possible compass the substance of +the Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German +physician, now living in Paris, [Hahnemann died in 1843 at the age of +eighty-seven years. In 1796 he published the first paper containing his +peculiar notions; in 1805 his first work on the subject; in 1810 his +somewhat famous “Organon of the Healing Art;” the next year what +he called the “Pure Materia Medica;” and in 1828 his last work, the +“Treatise on Chronic Diseases.” He has therefore been writing at +intervals on his favorite subject for nearly half a century. + +The one great doctrine which constitutes the basis of Homoeopathy as a +system is expressed by the Latin aphorism, “SIMILIA SIBILIBUS CURANTUR,” + or like cures like, that is, diseases are cured by agents capable +of producing symptoms resembling those found in the disease under +treatment. A disease for Hahnemann consists essentially in a group +of symptoms. The proper medicine for any disease is the one which is +capable of producing a similar group of symptoms when given to a healthy +person. + +It is of course necessary to know what are the trains of symptoms +excited by different substances, when administered to persons in health, +if any such can be shown to exist. Hahnemann and his disciples give +catalogues of the symptoms which they affirm were produced upon +themselves or others by a large number of drugs which they submitted to +experiment. + +The second great fact which Hahnemann professes to have established is +the efficacy of medicinal substances reduced to a wonderful degree of +minuteness or dilution. The following account of his mode of preparing +his medicines is from his work on Chronic Diseases, which has not, I +believe, yet been translated into English. A grain of the substance, +if it is solid, a drop if it is liquid, is to be added to about a third +part of one hundred grains of sugar of milk in an unglazed porcelain +capsule which has had the polish removed from the lower part of its +cavity by rubbing it with wet sand; they are to be mingled for an +instant with a bone or horn spatula, and then rubbed together for six +minutes; then the mass is to be scraped together from the mortar and +pestle, which is to take four minutes; then to be again rubbed for six +minutes. Four minutes are then to be devoted to scraping the powder into +a heap, and the second third of the hundred grains of sugar of milk +to be added. Then they are to be stirred an instant and rubbed six +minutes,--again to be scraped together four minutes and forcibly rubbed +six; once more scraped together for four minutes, when the last third +of the hundred grains of sugar of milk is to be added and mingled by +stirring with the spatula; six minutes of forcible rubbing, four of +scraping together, and six more (positively the last six) of rubbing, +finish this part of the process. + +Every grain of this powder contains the hundredth of a grain of the +medicinal substance mingled with the sugar of milk. If, therefore, a +grain of the powder just prepared is mingled with another hundred grains +of sugar of milk, and the process just described repeated, we shall have +a powder of which every grain contains the hundredth of the hundredth, +or the ten thousandth part of a grain of the medicinal substance. Repeat +the same process with the same quantity of fresh sugar of milk, and +every grain of your powder will contain the millionth of a grain of the +medicinal substance. When the powder is of this strength, it is ready +to employ in the further solutions and dilutions to be made use of in +practice. + +A grain of the powder is to be taken, a hundred drops of alcohol are +to be poured on it, the vial is to be slowly turned for a few minutes, +until the powder is dissolved, and two shakes are to be given to it. On +this point I will quote Hahnemann's own words. “A long experience and +multiplied observations upon the sick lead me within the last few +years to prefer giving only two shakes to medicinal liquids, whereas I +formerly used to give ten.” The process of dilution is carried on in +the same way as the attenuation of the powder was done; each successive +dilution with alcohol reducing the medicine to a hundredth part of the +quantity of that which preceded it. In this way the dilution of the +original millionth of a grain of medicine contained in the grain of +powder operated on is carried successively to the billionth, trillionth, +quadrillionth, quintillionth, and very often much higher fractional +divisions. A dose of any of these medicines is a minute fraction of a +drop, obtained by moistening with them one or more little globules of +sugar, of which Hahnemann says it takes about two hundred to weigh a +grain. + +As an instance of the strength of the medicines prescribed by Hahnemann, +I will mention carbonate of lime. He does not employ common chalk, but +prefers a little portion of the friable part of an oystershell. Of this +substance, carried to the sextillionth degree, so much as one or two +globules of the size mentioned can convey is a common dose. But for +persons of very delicate nerves it is proper that the dilution should +be carried to the decillionth degree. That is, an important medicinal +effect is to be expected from the two hundredth or hundredth part of +the millionth of the millionth of the millionth of the millionth of +the millionth of the millionth of the millionth of the millionth of the +millionth of the millionth of a grain of oyster-shell. This is only +the tenth degree of potency, but some of his disciples profess to have +obtained palpable effects from “much higher dilutions.” + +The third great doctrine of Hahnemann is the following. Seven eighths +at least of all chronic diseases are produced by the existence in the +system of that infectious disorder known in the language of science +by the appellation of PSORA, but to the less refined portion of the +community by the name of ITCH. In the words of Hahnemann's “Organon,” + “This Psora is the sole true and fundamental cause that produces all +the other countless forms of disease, which, under the names of nervous +debility, hysteria, hypochondriasis, insanity, melancholy, idiocy, +madness, epilepsy, and spasms of all kinds, softening of the bones, +or rickets, scoliosis and cyphosis, caries, cancer, fungua haematodes, +gout,--yellow jaundice and cyanosis, dropsy,--” + +[“The degrees of DILUTION must not be confounded with those of POTENCY. +Their relations may be seen by this table: + +lst dilution,--One hundredth of a drop or grain. + +2d “ One ten thousandth. + +3d “ One millionth, marked I. + +4th “ One hundred millionth. + +5th “ One ten thousand millionth. + +6th “ One million millionth, or one billionth, marked II. + +7th “ One hundred billionth. + +8th “ One ten thousand billionth. + +9th “ One million billionth, or one trillionth, marked III. + +10th “ One hundred trillionth. + +11th “ One ten thousand trillionth. + + +12th “ One million trillionth, or one quadrillionth, marked + IV.,--and so on indefinitely. + +The large figures denote the degrees of POTENCY.] + +“gastralgia, epistaxis, haemoptysis,--asthma and suppuration of the +lungs,--megrim, deafness, cataract and amaurosis,--paralysis, loss of +sense, pains of every kind, etc., appear in our pathology as so many +peculiar, distinct, and independent diseases.” + +For the last three centuries, if the same authority may be trusted, +under the influence of the more refined personal habits which have +prevailed, and the application of various external remedies which repel +the affection from the skin; Psora has revealed itself in these numerous +forms of internal disease, instead of appearing, as in former periods, +under the aspect of an external malady. + +These are the three cardinal doctrines of Hahnemann, as laid down in +those standard works of Homoeopathy, the “Organon” and the “Treatise on +Chronic Diseases.” + +Several other principles may be added, upon all of which he insists with +great force, and which are very generally received by his disciples. + +1. Very little power is allowed to the curative efforts of nature. +Hahnemann goes so far as to say that no one has ever seen the simple +efforts of nature effect the durable recovery of a patient from a +chronic disease. In general, the Homoeopathist calls every recovery +which happens under his treatment a cure. + +2. Every medicinal substance must be administered in a state of the +most perfect purity, and uncombined with any other. The union of several +remedies in a single prescription destroys its utility, and, according +to the “Organon,” frequently adds a new disease. + +3. A large number of substances commonly thought to be inert develop +great medicinal powers when prepared in the manner already described; +and a great proportion of them are ascertained to have specific +antidotes in case their excessive effects require to be neutralized. + +4. Diseases should be recognized, as far as possible, not by any of the +common names imposed upon them, as fever or epilepsy, but as individual +collections of symptoms, each of which differs from every other +collection. + +5. The symptoms of any complaint must be described with the most +minute exactness, and so far as possible in the patient's own words. To +illustrate the kind of circumstances the patient is expected to record, +I will mention one or two from the 313th page of the “Treatise on +Chronic Diseases,”--being the first one at which I opened accidentally. + +“After dinner, disposition to sleep; the patient winks.” + +“After dinner, prostration and feeling of weakness (nine days after +taking the remedy).” + +This remedy was that same oyster-shell which is to be prescribed +“fractions of the sextillionth or decillionth degree.” According to +Hahnemann, the action of a single dose of the size mentioned does not +fully display itself in some cases until twenty-four or even thirty +days after it is taken, and in such instances has not exhausted its good +effects until towards the fortieth or fiftieth day,--before which time +it would be absurd and injurious to administer a new remedy. + +So much for the doctrines of Hahnemann, which have been stated without +comment, or exaggeration of any of their features, very much as any +adherent of his opinions might have stated them, if obliged to compress +them into so narrow a space. + +Does Hahnemann himself represent Homoeopathy as it now exists? He +certainly ought to be its best representative, after having created it, +and devoted his life to it for half a century. He is spoken of as the +great physician of the time, in most, if not all Homoeopathic works. If +he is not authority on the subject of his own doctrines, who is? So far +as I am aware, not one tangible discovery in the so-called science has +ever been ascribed to any other observer; at least, no general principle +or law, of consequence enough to claim any prominence in Homoeopathic +works, has ever been pretended to have originated with any of his +illustrious disciples. He is one of the only two Homoeopathic writers +with whom, as I shall mention, the Paris publisher will have anything to +do upon his own account. The other is Jahr, whose Manual is little more +than a catalogue of symptoms and remedies. If any persons choose to +reject Hahnemann as not in the main representing Homoeopathy, if they +strike at his authority, if they wink out of sight his deliberate and +formally announced results, it is an act of suicidal rashness; for upon +his sagacity and powers of observation, and experience, as embodied in +his works, and especially in his Materia Medica, repose the foundations +of Homoeopathy as a practical system. + +So far as I can learn from the conflicting statements made upon the +subject, the following is the present condition of belief. + +1. All of any note agree that the law Similia similibus is the only +fundamental principle in medicine. Of course if any man does not agree +to this the name Homoeopathist can no longer be applied to him with +propriety. + +2. The belief in and employment of the infinitesimal doses is general, +and in some places universal, among the advocates of Homoeopathy; but a +distinct movement has been made in Germany to get rid of any restriction +to the use of these doses, and to employ medicines with the same license +as other practitioners. + +3. The doctrine of the origin of most chronic diseases in Psora, +notwithstanding Hahnemann says it cost him twelve years of study and +research to establish the fact and its practical consequences, has +met with great neglect and even opposition from very many of his own +disciples. + +It is true, notwithstanding, that, throughout most of their writings +which I have seen, there runs a prevailing tone of great deference to +Hahnemann's opinions, a constant reference to his authority, a general +agreement with the minor points of his belief, and a pretence of +harmonious union in a common faith. [Those who will take the trouble +to look over Hull's Translation of Jahr's Manual may observe how little +comparative space is given to remedies resting upon any other authority +than that of Hahnemann.] + +Many persons, and most physicians and scientific men, would be satisfied +with the statement of these doctrines, and examine them no further. +They would consider it vastly more probable that any observer in so +fallacious and difficult a field of inquiry as medicine had been led +into error, or walked into it of his own accord, than that such numerous +and extraordinary facts had really just come to light. They would feel a +right to exercise the same obduracy towards them as the French Institute +is in the habit of displaying when memoirs or models are offered to it +relating to the squaring of the circle or perpetual motion; which it is +the rule to pass over without notice. They would feel as astronomers and +natural philosophers must have felt when, some half a dozen years ago, +an unknown man came forward, and asked for an opportunity to demonstrate +to Arago and his colleagues that the moon and planets were at a distance +of a little more than a hundred miles from the earth. And so they would +not even look into Homoeopathy, though all its advocates should exclaim +in the words of Mr. Benjamin Douglass Perkins, vender of the Metallic +Tractors, that “On all discoveries there are persons who, without +descending to any inquiry into the truth, pretend to know, as it were +by intuition, that newly asserted facts are founded in the grossest +errors.” And they would lay their heads upon their pillows with a +perfectly clear conscience, although they were assured that they were +behaving in the same way that people of old did towards Harvey, Galileo, +and Copernicus, the identical great names which were invoked by Mr. +Benjamin Douglass Perkins. + +But experience has shown that the character of these assertions is +not sufficient to deter many, from examining their claims to belief. +I therefore lean but very slightly on the extravagance and extreme +apparent singularity of their pretensions. I might have omitted them, +but on the whole it seemed more just to the claims of my argument +to suggest the vast complication of improbabilities involved in the +statements enumerated. Every one must of course judge for himself as to +the weight of these objections, which are by no means brought forward as +a proof of the extravagance of Homoeopathy, but simply as entitled to +a brief consideration before the facts of the case are submitted to our +scrutiny. + +The three great asserted discoveries of Hahnemann are entirely +unconnected with and independent of each other. Were there any natural +relation between them it would seem probable enough that the discovery +of the first would have led to that of the others. But assuming it to be +a fact that diseases are cured by remedies capable of producing symptoms +like their own, no manifest relation exists between this fact and +the next assertion, namely, the power of the infinitesimal doses. And +allowing both these to be true, neither has the remotest affinity to +the third new doctrine, that which declares seven eighths of all chronic +diseases to be owing to Psora. + +This want of any obvious relation between Hahnemann's three cardinal +doctrines appears to be self-evident upon inspection. But if, as is +often true with his disciples, they prefer the authority of one of their +own number, I will refer them to Dr. Trinks's paper on the present state +of Homoeopathy in Europe, with which, of course, they are familiar, as +his name is mentioned as one of the most prominent champions of their +faith, in their American official organ. It would be a fact without a +parallel in the history, not merely of medicine, but of science, that +three such unconnected and astonishing discoveries, each of them a +complete revolution of all that ages of the most varied experience had +been taught to believe, should spring full formed from the brain of a +single individual. + +Let us look a moment at the first of his doctrines. Improbable though +it may seem to some, there is no essential absurdity involved in the +proposition that diseases yield to remedies capable of producing like +symptoms. There are, on the other hand, some analogies which lend a +degree of plausibility to the statement. There are well-ascertained +facts, known from the earliest periods of medicine, showing that, under +certain circumstances, the very medicine which, from its known effects, +one would expect to aggravate the disease, may contribute to its relief. +I may be permitted to allude, in the most general way, to the case in +which the spontaneous efforts of an overtasked stomach are quieted by +the agency of a drug which that organ refuses to entertain upon any +terms. But that every cure ever performed by medicine should have +been founded upon this principle, although without the knowledge of a +physician; that the Homoeopathic axiom is, as Hahnemann asserts, “the +sole law of nature in therapeutics,” a law of which nothing more than +a transient glimpse ever presented itself to the innumerable host of +medical observers, is a dogma of such sweeping extent, and pregnant +novelty, that it demands a corresponding breadth and depth of +unquestionable facts to cover its vast pretensions. + +So much ridicule has been thrown upon the pretended powers of the +minute doses that I shall only touch upon this point for the purpose of +conveying, by illustrations, some shadow of ideas far transcending the +powers of the imagination to realize. It must be remembered that these +comparisons are not matters susceptible of dispute, being founded +on simple arithmetical computations, level to the capacity of any +intelligent schoolboy. A person who once wrote a very small pamphlet +made some show of objecting to calculations of thus kind, on the ground +that the highest dilutions could easily be made with a few ounces of +alcohol. But he should have remembered that at every successive dilution +he lays aside or throws away ninety-nine hundredths of the fluid on +which he is operating, and that, although he begins with a drop, he only +prepares a millionth, billionth, trillionth, and similar fractions of +it, all of which, added together, would constitute but a vastly minute +portion of the drop with which he began. But now let us suppose we take +one single drop of the Tincture of Camomile, and that the whole of this +were to be carried through the common series of dilutions. + +A calculation nearly like the following was made by Dr. Panvini, and may +be readily followed in its essential particulars by any one who chooses. + +For the first dilution it would take 100 drops of alcohol. + +For the second dilution it would take 10,000 drops, or about a pint. + +For the third dilution it would take 100 pints. + +For the fourth dilution it would take 10,000 pints, or more than 1,000 +gallons, and so on to the ninth dilution, which would take ten billion +gallons, which he computed would fill the basin of Lake Agnano, a body +of water two miles in circumference. The twelfth dilution would of +course fill a million such lakes. By the time the seventeenth degree of +dilution should be reached, the alcohol required would equal in quantity +the waters of ten thousand Adriatic seas. Trifling errors must be +expected, but they are as likely to be on one side as the other, and any +little matter like Lake Superior or the Caspian would be but a drop in +the bucket. + +Swallowers of globules, one of your little pellets, moistened in +the mingled waves of one million lakes of alcohol, each two miles in +circumference, with which had been blended that one drop of Tincture +of Camomile, would be of precisely the strength recommended for that +medicine in your favorite Jahr's Manual, “against the most sudden, +frightful, and fatal diseases!” [In the French edition of 1834, the +proper doses of the medicines are mentioned, and Camomile is marked +IV. Why are the doses omitted in Hull's Translation, except in three +instances out of the whole two hundred remedies, notwithstanding the +promise in the preface that “some remarks upon the doses used may +be found at the head of each medicine”? Possibly because it makes +no difference whether they are employed in one Homoeopathic dose or +another; but then it is very singular that such precise directions +were formerly given in the same work, and that Hahnemann's “experience” + should have led him to draw the nice distinctions we have seen in a +former part of this Lecture (p. 44).] + +And proceeding on the common data, I have just made a calculation +which shows that this single drop of Tincture of Camomile, given in the +quantity ordered by Jahr's Manual, would have supplied every individual +of the whole human family, past and present, with more than five billion +doses each, the action of each dose lasting about four days. + +Yet this is given only at the quadrillionth, or fourth degree of +potency, and various substances are frequently administered at +the decillionth or tenth degree, and occasionally at still higher +attenuations with professed medicinal results. Is there not in this as +great an exception to all the hitherto received laws of nature as in the +miracle of the loaves and fishes? Ask this question of a Homoeopathist, +and he will answer by referring to the effects produced by a very minute +portion of vaccine matter, or the extraordinary diffusion of odors. But +the vaccine matter is one of those substances called morbid poisons, of +which it is a peculiar character to multiply themselves, when introduced +into the system, as a seed does in the soil. Therefore the hundredth +part of a grain of the vaccine matter, if no more than this is employed, +soon increases in quantity, until, in the course of about a week, it is +a grain or more, and can be removed in considerable drops. And what is +a very curious illustration of Homoeopathy, it does not produce its most +characteristic effects until it is already in sufficient quantity +not merely to be visible, but to be collected for further use. The +thoughtlessness which can allow an inference to be extended from a +product of disease possessing this susceptibility of multiplication when +conveyed into the living body, to substances of inorganic origin, such +as silex or sulphur, would be capable of arguing that a pebble may +produce a mountain, because an acorn can become a forest. + +As to the analogy to be found between the alleged action of the +infinitely attenuated doses, and the effects of some odorous substances +which possess the extraordinary power of diffusing their imponderable +emanations through a very wide space, however it may be abused in +argument, and rapidly as it evaporates on examination, it is not like +that just mentioned, wholly without meaning. The fact of the vast +diffusion of some odors, as that of musk or the rose, for instance, has +long been cited as the most remarkable illustration of the divisibility +of matter, and the nicety of the senses. And if this were compared with +the effects of a very minute dose of morphia on the whole system, or the +sudden and fatal impression of a single drop of prussic acid, or, +with what comes still nearer, the poisonous influence of an atmosphere +impregnated with invisible malaria, we should find in each of these +examples an evidence of the degree to which nature, in some few +instances, concentrates powerful qualities in minute or subtile forms of +matter. But if a man comes to me with a pestle and mortar in his hand, +and tells me that he will take a little speck of some substance which +nobody ever thought to have any smell at all, as, for instance, a grain +of chalk or of charcoal, and that he will, after an hour or two of +rubbing and scraping, develop in a portion of it an odor which, if the +whole grain were used, would be capable of pervading an apartment, a +house, a village, a province, an empire, nay, the entire atmosphere of +this broad planet upon which we tread; and that from each of fifty or +sixty substances he can in this way develop a distinct and hitherto +unknown odor: and if he tries to show that all this is rendered quite +reasonable by the analogy of musk and roses, I shall certainly be +justified in considering him incapable of reasoning, and beyond the +reach of my argument. What if, instead of this, he professes to develop +new and wonderful medicinal powers from the same speck of chalk or +charcoal, in such proportions as would impregnate every pond, lake, +river, sea, and ocean of our globe, and appeals to the same analogy in +favor of the probability of his assertion. + +All this may be true, notwithstanding these considerations. But so +extraordinary would be the fact, that a single atom of substances which +a child might swallow without harm by the teaspoonful could, by an easy +mechanical process, be made to develop such inconceivable powers, that +nothing but the strictest agreement of the most cautious experimenters, +secured by every guaranty that they were honest and faithful, appealing +to repeated experiments in public, with every precaution to guard +against error, and with the most plain and peremptory results, should +induce us to lend any credence to such pretensions. + +The third doctrine, that Psora, the other name of which you remember, is +the cause of the great majority of chronic diseases, is a startling +one, to say the least. That an affection always recognized as a +very unpleasant personal companion, but generally regarded as a +mere temporary incommodity, readily yielding to treatment in those +unfortunate enough to suffer from it, and hardly known among the +better classes of society, should be all at once found out by a German +physician to be the great scourge of mankind, the cause of their +severest bodily and mental calamities, cancer and consumption, idiocy +and madness, must excite our unqualified surprise. And when the +originator of this singular truth ascribes, as in the page now open +before me, the declining health of a disgraced courtier, the chronic +malady of a bereaved mother, even the melancholy of the love-sick +and slighted maiden, to nothing more nor less than the insignificant, +unseemly, and almost unmentionable ITCH, does it not seem as if the +very soil upon which we stand were dissolving into chaos, over the +earthquake-heaving of discovery? + +And when one man claims to have established these three independent +truths, which are about as remote from each other as the discovery +of the law of gravitation, the invention of printing, and that of the +mariner's compass, unless the facts in their favor are overwhelming +and unanimous, the question naturally arises, Is not this man deceiving +himself, or trying to deceive others? + +I proceed to examine the proofs of the leading ideas of Hahnemann and +his school. + +In order to show the axiom, similia similibus curantur (or like is cured +by like), to be the basis of the healing art,--“the sole law of nature +in therapeutics,”--it is necessary, + +1. That the symptoms produced by drugs in healthy persons should be +faithfully studied and recorded. + +2. That drugs should be shown to be always capable of curing those +diseases most like their own symptoms. + +3. That remedies should be shown not to cure diseases when they do not +produce symptoms resembling those presented in these diseases. + +1. The effects of drugs upon healthy persons have been studied by +Hahnemann and his associates. Their results were made known in his +Materia Medica, a work in three large volumes in the French translation, +published about eight years ago. The mode of experimentation appears to +have been, to take the substance on trial, either in common or minute +doses, and then to set down every little sensation, every little +movement of mind or body, which occurred within many succeeding hours +or days, as being produced solely by the substance employed. When I have +enumerated some of the symptoms attributed to the power of the drugs +taken, you will be able to judge how much value is to be ascribed to the +assertions of such observers. + +The following list was taken literally from the Materia Medica of +Hahnemann, by my friend M. Vernois, for whose accuracy I am willing +to be responsible. He has given seven pages of these symptoms, not +selected, but taken at hazard from the French translation of the work. I +shall be very brief in my citations. + +“After stooping some time, sense of painful weight about the head upon +resuming the erect posture.” + +“An itching, tickling sensation at the outer edge of the palm of the +left hand, which obliges the person to scratch.” The medicine was +acetate of lime, and as the action of the globule taken is said to last +twenty-eight days, you may judge how many such symptoms as the last +might be supposed to happen. + +Among the symptoms attributed to muriatic acid are these: a catarrh, +sighing, pimples; “after having written a long time with the back a +little bent over, violent pain in the back and shoulder-blades, as +if from a strain,”--“dreams which are not remembered,--disposition to +mental dejection,--wakefulness before and after midnight.” + +I might extend this catalogue almost indefinitely. I have not cited +these specimens with any view to exciting a sense of the ridiculous, +which many others of those mentioned would not fail to do, but to show +that the common accidents of sensation, the little bodily inconveniences +to which all of us are subject, are seriously and systematically +ascribed to whatever medicine may have been exhibited, even in the +minute doses I have mentioned, whole days or weeks previously. + +To these are added all the symptoms ever said by anybody, whether +deserving confidence or not, as I shall hereafter illustrate, to be +produced by the substance in question. + +The effects of sixty-four medicinal substances, ascertained by one +or both of these methods, are enumerated in the Materia Medica +of Hahnemann, which may be considered as the basis of practical +Homoeopathy. In the Manual of Jahr, which is the common guide, so far as +I know, of those who practise Homoeopathy in these regions, two hundred +remedies are enumerated, many of which, however, have never been +employed in practice. In at least one edition there were no means of +distinguishing those which had been tried upon the sick from the others. +It is true that marks have been added in the edition employed here, +which serve to distinguish them; but what are we to think of a standard +practical author on Materia Medica, who at one time omits to designate +the proper doses of his remedies, and at another to let us have any +means of knowing whether a remedy has ever been tried or not, while +he is recommending its employment in the most critical and threatening +diseases? + +I think that, from what I have shown of the character of Hahnemann's +experiments, it would be a satisfaction to any candid inquirer to +know whether other persons, to whose assertions he could look +with confidence, confirm these pretended facts. Now there are many +individuals, long and well known to the scientific world, who have tried +these experiments upon healthy subjects, and utterly deny that their +effects have at all corresponded to Hahnemann's assertions. + +I will take, for instance, the statements of Andral (and I am not +referring to his well-known public experiments in his hospital) as to +the result of his own trials. This distinguished physician is Professor +of Medicine in the School of Paris, and one of the most widely known and +valued authors upon practical and theoretical subjects the profession +can claim in any country. He is a man of great kindness of character, +a most liberal eclectic by nature and habit, of unquestioned integrity, +and is called, in the leading article of the first number of the +“Homoepathic Examiner,” “an eminent and very enlightened allopathist.” + Assisted by a number of other persons in good health, he experimented +on the effects of cinchona, aconite, sulphur, arnica, and the other most +highly extolled remedies. His experiments lasted a year, and he stated +publicly to the Academy of Medicine that they never produced the +slightest appearance of the symptoms attributed to them. The results of +a man like this, so extensively known as one of the most philosophical +and candid, as well as brilliant of instructors, and whose admirable +abilities and signal liberality are generally conceded, ought to be of +great weight in deciding the question. + +M. Double, a well-known medical writer and a physician of high standing +in Paris, had occasion so long ago as 1801, before he had heard of +Homoeopathy, to make experiments upon Cinchona, or Peruvian bark. He and +several others took the drug in every kind of dose for four months, and +the fever it is pretended by Hahnemann to excite never was produced. + +M. Bonnet, President of the Royal Society of Medicine of Bordeaux, had +occasion to observe many soldiers during the Peninsular War, who made +use of Cinchona as a preservative against different diseases, but he +never found it to produce the pretended paroxysms. + +If any objection were made to evidence of this kind, I would refer to +the express experiments on many of the Homoeopathic substances, which +were given to healthy persons with every precaution as to diet and +regimen, by M. Louis Fleury, without being followed by the slightest of +the pretended consequences. And let me mention as a curious fact, that +the same quantity of arsenic given to one animal in the common form of +the unprepared powder, and to another after having been rubbed up into +six hundred globules, offered no particular difference of activity in +the two cases. + +This is a strange contradiction to the doctrine of the development of +what they call dynamic power, by means of friction and subdivision. + +In 1835 a public challenge was offered to the best known Homoeopathic +physician in Paris to select any ten substances asserted to produce the +most striking effects; to prepare them himself; to choose one by lot +without knowing which of them he had taken, and try it upon himself or +any intelligent and devoted Homoeopathist, and, waiting his own time, +to come forward and tell what substance had been employed. The challenge +was at first accepted, but the acceptance retracted before the time of +trial arrived. + +From all this I think it fair to conclude that the catalogues of +symptoms attributed in Homoeopathic works to the influence of various +drugs upon healthy persons are not entitled to any confidence. + +2. It is necessary to show, in the next place, that medicinal substances +are always capable of curing diseases most like their own symptoms. +For facts relating to this question we must look to two sources; the +recorded experience of the medical profession in general, and the +results of trials made according to Homoeopathic principles, and capable +of testing the truth of the doctrine. + +No person, that I am aware of, has ever denied that in some cases there +exists a resemblance between the effects of a remedy and the symptoms +of diseases in which it is beneficial. This has been recognized, as +Hahnemann himself has shown, from the time of Hippocrates. But according +to the records of the medical profession, as they have been hitherto +interpreted, this is true of only a very small proportion of useful +remedies. Nor has it ever been considered as an established truth that +the efficacy of even these few remedies was in any definite ratio to +their power of producing symptoms more or less like those they cured. + +Such was the state of opinion when Hahnemann came forward with the +proposition that all the cases of successful treatment found in the +works of all preceding medical writers were to be ascribed solely to the +operation of the Homoeopathic principle, which had effected the cure, +although without the physician's knowledge that this was the real +secret. And strange as it may seem, he was enabled to give such a +degree of plausibility to this assertion, that any person not acquainted +somewhat with medical literature, not quite familiar, I should rather +say, with the relative value of medical evidence, according to the +sources whence it is derived, would be almost frightened into the +belief, at seeing the pages upon pages of Latin names he has summoned as +his witnesses. + +It has hitherto been customary, when examining the writings of authors +of preceding ages, upon subjects as to which they were less enlightened +than ourselves, and which they were very liable to misrepresent, to +exercise some little discretion; to discriminate, in some measure, +between writers deserving confidence and those not entitled to it. But +there is not the least appearance of any such delicacy on the part of +Hahnemann. A large majority of the names of old authors he cites +are wholly unknown to science. With some of them I have been long +acquainted, and I know that their accounts of diseases are no more to be +trusted than their contemporary Ambroise Pare's stories of mermen, +and similar absurdities. But if my judgment is rejected, as being +a prejudiced one, I can refer to Cullen, who mentioned three of +Hahnemann's authors in one sentence, as being “not necessarily bad +authorities; but certainly such when they delivered very improbable +events;” and as this was said more than half a century ago, it could not +have had any reference to Hahnemann. But although not the slightest +sign of discrimination is visible in his quotations,--although for him +a handful of chaff from Schenck is all the same thing as a measure of +wheat from Morgagni,--there is a formidable display of authorities, and +an abundant proof of ingenious researches to be found in each of +the great works of Hahnemann with which I am familiar. [Some painful +surmises might arise as to the erudition of Hahnemann's English +Translator, who makes two individuals of “Zacutus, Lucitanus,” as +well as respecting that of the conductors of an American Homoeopathic +periodical, who suffer the name of the world-renowned Cardanus to be +spelt Cardamus in at least three places, were not this gross ignorance +of course attributable only to the printer.] + +It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has +proved many of Hahnemann's quotations from old authors to be adulterate +and false. What particular instances he has pointed out I have no means +of learning. And it is probably wholly impossible on this side of the +Atlantic, and even in most of the public libraries of Europe, to +find anything more than a small fraction of the innumerable obscure +publications which the neglect of grocers and trunkmakers has spared +to be ransacked by the all-devouring genius of Homoeopathy. I have +endeavored to verify such passages as my own library afforded me the +means of doing. For some I have looked in vain, for want, as I am +willing to believe, of more exact references. But this I am able to +affirm, that, out of the very small number which I have been able, to +trace back to their original authors, I have found two to be wrongly +quoted, one of them being a gross misrepresentation. + +The first is from the ancient Roman author, Caelius Aurelianus; +the second from the venerable folio of Forestus. Hahnemann uses the +following expressions,--if he is not misrepresented in the English +Translation of the 'Organon': “Asclepiades on one occasion cured an +inflammation of the brain by administering a small quantity of wine.” + After correcting the erroneous reference of the Translator, I can find +no such case alluded to in the chapter. But Caelius Aurelianus mentions +two modes of treatment employed by Asclepiades, into both of which the +use of wine entered, as being “in the highest degree irrational and +dangerous.” [Caelius Aurel. De Morb. Acut. et Chron. lib. I. cap. xv. +not xvi. Amsterdam. Wetstein, 1755.] + +In speaking of the oil of anise-seed, Hahnemann says that Forestus +observed violent colic caused by its administration. But, as the author +tells the story, a young man took, by the counsel of a surgeon, an acrid +and virulent medicine, the name of which is not given, which brought on +a most cruel fit of the gripes and colic. After this another surgeon was +called, who gave him oil of anise-seed and wine, “which increased his +suffering.” [Observ. et Curat. Med. lib. XXI obs. xiii. Frankfort, +1614.] Now if this was the Homoeopathic remedy, as Hahnemann pretends, +it might be a fair question why the young man was not cured by it. But +it is a much graver question why a man who has shrewdness and learning +enough to go so far after his facts, should think it right to treat them +with such astonishing negligence or such artful unfairness. + +Even if every word he had pretended to take from his old authorities +were to be found in them, even if the authority of every one of these +authors were beyond question, the looseness with which they are used to +prove whatever Hahnemann chooses is beyond the bounds of credibility. +Let me give one instance to illustrate the character of this man's +mind. Hahnemann asserts, in a note annexed to the 110th paragraph of +the “Organon,” that the smell of the rose will cause certain persons to +faint. And he says in the text that substances which produce peculiar +effects of this nature on particular constitutions cure the same +symptoms in people in general. Then in another note to the same +paragraph he quotes the following fact from one of the last sources one +would have looked to for medical information, the Byzantine Historians. + +“It was by these means (i.e. Homoeopathically) that the Princess Eudosia +with rose-water restored a person who had fainted!” + +Is it possible that a man who is guilty of such pedantic folly as +this,--a man who can see a confirmation of his doctrine in such a +recovery as this,--a recovery which is happening every day, from +a breath of air, a drop or two of water, untying a bonnet-string, +loosening a stay-lace, and which can hardly help happening, whatever +is done,--is it possible that a man, of whose pages, not here and there +one, but hundreds upon hundreds are loaded with such trivialities, is +the Newton, the Columbus, the Harvey of the nineteenth century! + +The whole process of demonstration he employs is this. An experiment is +instituted with some drug upon one or more healthy persons. Everything +that happens for a number of days or weeks is, as we have seen, set +down as an effect of the medicine. Old volumes are then ransacked +promiscuously, and every morbid sensation or change that anybody ever +said was produced by the drug in question is added to the list of +symptoms. By one or both of these methods, each of the sixty-four +substances enumerated by Hahnemann is shown to produce a very large +number of symptoms, the lowest in his scale being ninety-seven, and the +highest fourteen hundred and ninety-one. And having made out this +list respecting any drug, a catalogue which, as you may observe in any +Homoeopathic manual, contains various symptoms belonging to every organ +of the body, what can be easier than to find alleged cures in every +medical author which can at once be attributed to the Homoeopathic +principle; still more if the grave of extinguished credulity is called +upon to give up its dead bones as living witnesses; and worst of all, if +the monuments of the past are to be mutilated in favor of “the sole law +of Nature in therapeutics”? + +There are a few familiar facts of which great use has been made as an +entering wedge for the Homoeopathic doctrine. They have been suffered +to pass current so long that it is time they should be nailed to +the counter, a little operation which I undertake, with perfect +cheerfulness, to perform for them. + +The first is a supposed illustration of the Homoeopathic law found in +the precept given for the treatment of parts which have been frozen, by +friction with snow or similar means. But we deceive ourselves by names, +if we suppose the frozen part to be treated by cold, and not by heat. +The snow may even be actually warmer than the part to which it is +applied. But even if it were at the same temperature when applied, it +never did and never could do the least good to a frozen part, except as +a mode of regulating the application of what? of heat. But the heat must +be applied gradually, just as food must be given a little at a time to +those perishing with hunger. If the patient were brought into a warm +room, heat would be applied very rapidly, were not something interposed +to prevent this, and allow its gradual admission. Snow or iced water is +exactly what is wanted; it is not cold to the part; it is very possibly +warm, on the contrary, for these terms are relative, and if it does not +melt and let the heat in, or is not taken away, the part will remain +frozen up until doomsday. Now the treatment of a frozen limb by heat, in +large or small quantities, is not Homoeopathy. + +The next supposed illustration of the Homoeopathic law is the alleged +successful management of burns, by holding them to the fire. This is a +popular mode of treating those burns which are of too little consequence +to require any more efficacious remedy, and would inevitably get well of +themselves, without any trouble being bestowed upon them. It produces +a most acute pain in the part, which is followed by some loss of +sensibility, as happens with the eye after exposure to strong light, and +the ear after being subjected to very intense sounds. This is all it +is capable of doing, and all further notions of its efficacy must be +attributed merely to the vulgar love of paradox. If this example affords +any comfort to the Homoeopathist, it seems as cruel to deprive him of +it as it would be to convince the mistress of the smoke-jack or the +flatiron that the fire does not literally “draw the fire out,” which is +her hypothesis. + +But if it were true that frost-bites were cured by cold and burns by +heat, it would be subversive, so far as it went, of the great principle +of Homoeopathy. + +For you will remember that this principle is that Like cures Like, and +not that Same cures Same; that there is resemblance and not identity +between the symptoms of the disease and those produced by the drug which +cures it, and none have been readier to insist upon this distinction +than the Homoeopathists themselves. For if Same cures Same, then every +poison must be its own antidote,--which is neither a part of their +theory nor their so-called experience. They have been asked often +enough, why it was that arsenic could not cure the mischief which +arsenic had caused, and why the infectious cause of small-pox did not +remedy the disease it had produced, and then they were ready enough to +see the distinction I have pointed out. O no! it was not the hair of the +same dog, but only of one very much like him! + +A third instance in proof of the Homoeopathic law is sought for in the +acknowledged efficacy of vaccination. And how does the law apply to +this? It is granted by the advocates of Homoeopathy that there is a +resemblance between the effects of the vaccine virus on a person in +health and the symptoms of small-pox. Therefore, according to the rule, +the vaccine virus will cure the small-pox, which, as everybody knows, is +entirely untrue. But it prevents small-pox, say the Homoeopathists. Yes, +and so does small-pox prevent itself from ever happening again, and we +know just as much of the principle involved in the one case as in the +other. For this is only one of a series of facts which we are wholly +unable to explain. Small-pox, measles, scarlet-fever, hooping-cough, +protect those who have them once from future attacks; but nettle-rash +and catarrh and lung fever, each of which is just as Homoeopathic to +itself as any one of the others, have no such preservative power. We +are obliged to accept the fact, unexplained, and we can do no more for +vaccination than for the rest. + +I come now to the most directly practical point connected with the +subject, namely,-- + +What is the state of the evidence as to the efficacy of the proper +Homoeopathic treatment in the cure of diseases. + +As the treatment adopted by the Homoeopathists has been almost +universally by means of the infinitesimal doses, the question of their +efficacy is thrown open, in common with that of the truth of their +fundamental axiom, as both are tested in practice. + +We must look for facts as to the actual working of Homoeopathy to three +sources. + +1. The statements of the unprofessional public. + +2. The assertions of Homoeopathic practitioners. + +3. The results of trials by competent and honest physicians, not pledged +to the system. + +I think, after what we have seen of medical facts, as they are +represented by incompetent persons, we are disposed to attribute little +value to all statements of wonderful cures, coming from those who have +never been accustomed to watch the caprices of disease, and have not +cooled down their young enthusiasm by the habit of tranquil observation. +Those who know nothing of the natural progress of a malady, of its +ordinary duration, of its various modes of terminating, of its liability +to accidental complications, of the signs which mark its insignificance +or severity, of what is to be expected of it when left to itself, of how +much or how little is to be anticipated from remedies, those who know +nothing or next to nothing of all these things, and who are in a great +state of excitement from benevolence, sympathy, or zeal for a new +medical discovery, can hardly be expected to be sound judges of facts +which have misled so many sagacious men, who have spent their lives in +the daily study and observation of them. I believe that, after having +drawn the portrait of defunct Perkinism, with its five thousand printed +cures, and its million and a half computed ones, its miracles blazoned +about through America, Denmark, and England; after relating that forty +years ago women carried the Tractors about in their pockets, and workmen +could not make them fast enough for the public demand; and then showing +you, as a curiosity, a single one of these instruments, an odd one of a +pair, which I obtained only by a lucky accident, so utterly lost is the +memory of all their wonderful achievements; I believe, after all this, I +need not waste time in showing that medical accuracy is not to be looked +for in the florid reports of benevolent associations, the assertions +of illustrious patrons, the lax effusions of daily journals, or the +effervescent gossip of the tea-table. + +Dr. Hering, whose name is somewhat familiar to the champions of +Homoeopathy, has said that “the new healing art is not to be judged +by its success in isolated cases only, but according to its success in +general, its innate truth, and the incontrovertible nature of its innate +principles.” + +We have seen something of “the incontrovertible nature of its innate +principles,” and it seems probable, on the whole, that its success in +general must be made up of its success in isolated cases. Some attempts +have been made, however, to finish the whole matter by sweeping +statistical documents, which are intended to prove its triumphant +success over the common practice. + +It is well known to those who have had the good fortune to see the +“Homoeopathic Examiner,” that this journal led off, in its first number, +with a grand display of everything the newly imported doctrine had to +show for itself. It is well remarked, on the twenty-third page of this +article, that “the comparison of bills of mortality among an equal +number of sick, treated by divers methods, is a most poor and lame +way to get at conclusions touching principles of the healing art.” In +confirmation of which, the author proceeds upon the twenty-fifth page +to prove the superiority of the Homoeopathic treatment of cholera, +by precisely these very bills of mortality. Now, every intelligent +physician is aware that the poison of cholera differed so much in its +activity at different times and, places, that it was next to impossible +to form any opinion as to the results of treatment, unless every +precaution was taken to secure the most perfectly corresponding +conditions in the patients treated, and hardly even then. Of course, +then, a Russian Admiral, by the name of Mordvinov, backed by a number +of so-called physicians practising in Russian villages, is singularly +competent to the task of settling the whole question of the utility of +this or that kind of treatment; to prove that, if not more than eight +and a half per cent. of those attacked with the disease perished, the +rest owed their immunity to Hahnemann. I can remember when more than +a hundred patients in a public institution were attacked with what, I +doubt not, many Homoeopathic physicians (to say nothing of Homoeopathic +admirals) would have called cholera, and not one of them died, though +treated in the common way, and it is my firm belief that, if such a +result had followed the administration of the omnipotent globules, it +would have been in the mouth of every adept in Europe, from Quin of +London to Spohr of Gandersheim. No longer ago than yesterday, in one of +the most widely circulated papers of this city, there was published an +assertion that the mortality in several Homoeopathic Hospitals was +not quite five in a hundred, whereas, in what are called by the writer +Allopathic Hospitals, it is said to be eleven in a hundred. An honest +man should be ashamed of such an argumentum ad ignorantiam. The +mortality of a hospital depends not merely on the treatment of the +patients, but on the class of diseases it is in the habit of receiving, +on the place where it is, on the season, and many other circumstances. +For instance, there are many hospitals in the great cities of Europe +that receive few diseases of a nature to endanger life, and, on the +other hand, there are others where dangerous diseases are accumulated +out of the common proportion. Thus, in the wards of Louis, at the +Hospital of La Pitie, a vast number of patients in the last stages of +consumption were constantly entering, to swell the mortality of that +hospital. It was because he was known to pay particular attention to +the diseases of the chest that patients laboring under those fatal +affections to an incurable extent were so constantly coming in upon him. +It is always a miserable appeal to the thoughtlessness of the vulgar, to +allege the naked fact of the less comparative mortality in the practice +of one hospital or of one physician than another, as an evidence of the +superiority of their treatment. Other things being equal, it must always +be expected that those institutions and individuals enjoying to the +highest degree the confidence of the community will lose the largest +proportion of their patients; for the simple reason that they will +naturally be looked to by those suffering from the gravest class +of diseases; that many, who know that they are affected with mortal +disease, will choose to die under their care or shelter, while the +subjects of trifling maladies, and merely troublesome symptoms, amuse +themselves to any extent among the fancy practitioners. When, therefore, +Dr. Mublenbein, as stated in the “Homoeopathic Examiner,” and quoted +in yesterday's “Daily Advertiser,” asserts that the mortality among +his patients is only one per cent. since he has practised Homoeopathy, +whereas it was six per cent. when he employed the common mode of +practice, I am convinced by this, his own statement, that the citizens +of Brunswick, whenever they are seriously sick, take good care not to +send for Dr. Muhlenbein! + +It is evidently impossible that I should attempt, within the compass of +a single lecture, any detailed examination of the very numerous cases +reported in the Homoeopathic Treatises and Journals. Having been in the +habit of receiving the French “Archives of Homoeopathic Medicine” until +the premature decease of that Journal, I have had the opportunity of +becoming acquainted somewhat with the style of these documents, and +experiencing whatever degree of conviction they were calculated to +produce. Although of course I do not wish any value to be assumed for my +opinion, such as it is, I consider that you are entitled to hear it. So +far, then, as I am acquainted with the general character of the cases +reported by the Homoeopathic physicians, they would for the most part +be considered as wholly undeserving a place in any English, French, +or American periodical of high standing, if, instead of favoring the +doctrine they were intended to support, they were brought forward to +prove the efficacy of any common remedy administered by any common +practitioner. There are occasional exceptions to this remark; but the +general truth of it is rendered probable by the fact that these cases +are always, or almost always, written with the single object of showing +the efficacy of the medicine used, or the skill of the practitioner, and +it is recognized as a general rule that such cases deserve very little +confidence. Yet they may sound well enough, one at a time, to those who +are not fully aware of the fallacies of medical evidence. Let me state +a case in illustration. Nobody doubts that some patients recover under +every form of practice. Probably all are willing to allow that a +large majority, for instance, ninety in a hundred, of such cases as +a physician is called to in daily practice, would recover, sooner or +later, with more or less difficulty, provided nothing were done to +interfere seriously with the efforts of nature. + +Suppose, then, a physician who has a hundred patients prescribes to +each of them pills made of some entirely inert substance, as starch, +for instance. Ninety of them get well, or if he chooses to use such +language, he cures ninety of them. It is evident, according to the +doctrine of chances, that there must be a considerable number of +coincidences between the relief of the patient and the administration +of the remedy. It is altogether probable that there will happen two or +three very striking coincidences out of the whole ninety cases, in which +it would seem evident that the medicine produced the relief, though +it had, as we assumed, nothing to do with it. Now suppose that the +physician publishes these cases, will they not have a plausible +appearance of proving that which, as we granted at the outset, was +entirely false? Suppose that instead of pills of starch he employs +microscopic sugarplums, with the five' million billion trillionth +part of a suspicion of aconite or pulsatilla, and then publishes his +successful cases, through the leaden lips of the press, or the living +ones of his female acquaintances,--does that make the impression a less +erroneous one? But so it is that in Homoeopathic works and journals and +gossip one can never, or next to never, find anything but successful +cases, which might do very well as a proof of superior skill, did it not +prove as much for the swindling advertisers whose certificates disgrace +so many of our newspapers. How long will it take mankind to learn that +while they listen to “the speaking hundreds and units,” who make the +world ring with the pretended triumphs they have witnessed, the “dumb +millions” of deluded and injured victims are paying the daily forfeit of +their misplaced confidence! + +I am sorry to see, also, that a degree of ignorance as to the natural +course of diseases is often shown in these published cases, which, +although it may not be detected by the unprofessional reader, conveys an +unpleasant impression to those who are acquainted with the subject. Thus +a young woman affected with jaundice is mentioned in the German “Annals +of Clinical Homoeopathy” as having been cured in twenty-nine days by +pulsatilla and nux vomica. Rummel, a well-known writer of the same +school, speaks of curing a case of jaundice in thirty-four days by +Homoeopathic doses of pulsatilla, aconite, and cinchona. I happened to +have a case in my own household, a few weeks since, which lasted about +ten days, and this was longer than I have repeatedly seen it in hospital +practice, so that it was nothing to boast of. + +Dr. Munneche of Lichtenburg in Saxony is called to a patient with +sprained ankle who had been a fortnight under the common treatment. The +patient gets well by the use of arnica in a little more than a month +longer, and this extraordinary fact is published in the French “Archives +of Homoeopathic Medicine.” + +In the same Journal is recorded the case of a patient who with nothing +more, so far as any proof goes, than influenza, gets down to her shop +upon the sixth day. + +And again, the cool way in which everything favorable in a case is set +down by these people entirely to their treatment, may be seen in a case +of croup reported in the “Homoeopathic Gazette” of Leipsic, in which +leeches, blistering, inhalation of hot vapor, and powerful internal +medicine had been employed, and yet the merit was all attributed to one +drop of some Homoeopathic fluid. + +I need not multiply these quotations, which illustrate the grounds of +an opinion which the time does not allow me to justify more at length; +other such cases are lying open before me; there is no end to them if +more were wanted; for nothing is necessary but to look into any of the +numerous broken-down Journals of Homoeopathy, the volumes of which may +be found on the shelves of those curious in such matters. + +A number of public trials of Homoeopathy have been made in different +parts of the world. Six of these are mentioned in the Manifesto of the +“Homoeopathic Examiner.” Now to suppose that any trial can absolutely +silence people, would be to forget the whole experience of the past. +Dr. Haygarth and Dr. Alderson could not stop the sale of the five-guinea +Tractors, although they proved that they could work the same miracles +with pieces of wood and tobacco-pipe. It takes time for truth to operate +as well as Homoeopathic globules. Many persons thought the results of +these trials were decisive enough of the nullity of the treatment; those +who wish to see the kind of special pleading and evasion by which it is +attempted to cover results which, stated by the “Homoeopathic Examiner” + itself, look exceedingly like a miserable failure, may consult the +opening flourish of that Journal. I had not the intention to speak of +these public trials at all, having abundant other evidence on the point. +But I think it best, on the whole, to mention two of them in a few +words,--that instituted at Naples and that of Andral. + +There have been few names in the medical profession, for the last half +century, so widely known throughout the world of science as that of M. +Esquirol, whose life was devoted to the treatment of insanity, and who +was without a rival in that department of practical medicine. It is from +an analysis communicated by him to the “Gazette Medicale de Paris” that +I derive my acquaintance with the account of the trial at Naples by Dr. +Panvini, physician to the Hospital della Pace. This account seems to +be entirely deserving of credit. Ten patients were set apart, and not +allowed to take any medicine at all,--much against the wish of the +Homoeopathic physician. All of them got well, and of course all of them +would have been claimed as triumphs if they had been submitted to the +treatment. Six other slight cases (each of which is specified) got well +under the Homoeopathic treatment, none of its asserted specific effects +being manifested. + +All the rest were cases of grave disease; and so far as the trial, which +was interrupted about the fortieth day, extended, the patients grew +worse, or received no benefit. A case is reported on the page before +me of a soldier affected with acute inflammation in the chest, who took +successively aconite, bryonia, nux vomica, and pulsatilla, and after +thirty-eight days of treatment remained without any important change in +his disease. The Homoeopathic physician who treated these patients was +M. de Horatiis, who had the previous year been announcing his wonderful +cures. And M. Esquirol asserted to the Academy of Medicine in 1835, +that this M. de Horatiis, who is one of the prominent personages in the +“Examiner's” Manifesto published in 1840, had subsequently renounced +Homoeopathy. I may remark, by the way, that this same periodical, which +is so very easy in explaining away the results of these trials, makes a +mistake of only six years or a little more as to the time when this at +Naples was instituted. + +M. Andral, the “eminent and very enlightened allopathist” of the +“Homoeopathic Examiner,” made the following statement in March, 1835, to +the Academy of Medicine: “I have submitted this doctrine to experiment; +I can reckon at this time from one hundred and thirty to one hundred and +forty cases, recorded with perfect fairness, in a great hospital, under +the eye of numerous witnesses; to avoid every objection--I obtained my +remedies of M. Guibourt, who keeps a Homoeopathic pharmacy, and whose +strict exactness is well known; the regimen has been scrupulously +observed, and I obtained from the sisters attached to the hospital a +special regimen, such as Hahnemann orders. I was told, however, some +months since, that I had not been faithful to all the rules of the +doctrine. I therefore took the trouble to begin again; I have studied +the practice of the Parisian Homoeopathists, as I had studied their +books, and I became convinced that they treated their patients as I had +treated mine, and I affirm that I have been as rigorously exact in the +treatment as any other person.” + +And he expressly asserts the entire nullity of the influence of all +the Homoeopathic remedies tried by him in modifying, so far as he could +observe, the progress or termination of diseases. It deserves notice +that he experimented with the most boasted substances,--cinchona, +aconite, mercury, bryonia, belladonna. Aconite, for instance, he says +he administered in more than forty cases of that collection of feverish +symptoms in which it exerts so much power, according to Hahnemann, and +in not one of them did it have the slightest influence, the pulse and +heat remaining as before. + +These statements look pretty honest, and would seem hard to be explained +away, but it is calmly said that he “did not know enough of the method +to select the remedies with any tolerable precision.” [“Homoeopathic +Examiner, vol. i. p. 22.] + +“Nothing is left to the caprice of the physician.” (In a word, instead +of being dependent upon blind chance, that there is an infallible +law, guided by which; the physician MUST select the proper remedies.') +['Ibid.,' in a notice of Menzel's paper.] Who are they that practice +Homoeopathy, and say this of a man with the Materia Medica of Hahnemann +lying before him? Who are they that send these same globules, on which +he experimented, accompanied by a little book, into families, whose +members are thought competent to employ them, when they deny any such +capacity to a man whose life has been passed at the bedside of patients, +the most prominent teacher in the first Medical Faculty in the world, +the consulting physician of the King of France, and one of the most +renowned practical writers, not merely of his nation, but of his age? +I leave the quibbles by which such persons would try to creep out from +under the crushing weight of these conclusions to the unfortunates who +suppose that a reply is equivalent to an answer. + +Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris, +invited two Homoeopathic practitioners to experiment in his wards. One +of these was Curie, now of London, whose works are on the counters +of some of our bookstores, and probably in the hands of some of my +audience. This gentleman, whom Dr. Baillie declares to be an enlightened +man, and perfectly sincere in his convictions, brought his own medicines +from the pharmacy which furnished Hahnemann himself, and employed them +for four or five months upon patients in his ward, and with results +equally unsatisfactory, as appears from Dr. Baillie's statement at +a meeting of the Academy of Medicine. And a similar experiment was +permitted by the Clinical Professor of the Hotel Dieu of Lyons, with the +same complete failure. + +But these are old and prejudiced practitioners. Very well, then take the +statement of Dr. Fleury, a most intelligent young physician, who treated +homoeopathically more than fifty patients, suffering from diseases +which it was not dangerous to treat in this way, taking every kind of +precaution as to regimen, removal of disturbing influences, and the +state of the atmosphere, insisted upon by the most vigorous partisans +of the doctrine, and found not the slightest effect produced by the +medicines. And more than this, read nine of these cases, which he has +published, as I have just done, and observe the absolute nullity of +aconite, belladonna, and bryonia, against the symptoms over which they +are pretended to exert such palpable, such obvious, such astonishing +influences. In the view of these statements, it is impossible not to +realize the entire futility of attempting to silence this asserted +science by the flattest and most peremptory results of experiment. Were +all the hospital physicians of Europe and America to devote themselves, +for the requisite period, to this sole pursuit, and were their results +to be unanimous as to the total worthlessness of the whole system in +practice, this slippery delusion would slide through their fingers +without the slightest discomposure, when, as they supposed, they had +crushed every joint in its tortuous and trailing body. + +3. I have said, that to show the truth of the Homoeopathic doctrine, +as announced by Hahnemann, it would be necessary to show, in the third +place, that remedies never cure diseases when they are not capable of +producing similar symptoms! The burden of this somewhat comprehensive +demonstration lying entirely upon the advocates of this doctrine, it may +be left to their mature reflections. + +It entered into my original plan to treat of the doctrine relating to +Psora, or itch,--an almost insane conception, which I am glad to get rid +of, for this is a subject one does not care to handle without gloves. I +am saved this trouble, however, by finding that many of the disciples +of Hahnemann, those disciples the very gospel of whose faith stands upon +his word, make very light of his authority on this point, although he +himself says, “It has cost me twelve years of study and research to +trace out the source of this incredible number of chronic affections, +to discover this great truth, which remained concealed from all +my predecessors and contemporaries, to establish the basis of its +demonstration, and find out, at the same time, the curative medicines +that were fit to combat this hydra in all its different forms.” + +But, in the face of all this, the following remarks are made by Wolff, +of Dresden, whose essays, according to the editor of the “Homoeopathic +Examiner,” “represent the opinions of a large majority of Homoeopathists +in Europe.” + +“It cannot be unknown to any one at all familiar with Homoeopathic +literature, that Hahnemann's idea of tracing the large majority of +chronic diseases to actual itch has met with the greatest opposition +from Homoeopathic physicians themselves.” And again, “If the Psoric +theory has led to no proper schism, the reason is to be found in the +fact that it is almost without any influence in practice.” + +We are told by Jahr, that Dr. Griesselich, “Surgeon to the Grand Duke +of Baden,” and a “distinguished” Homoeopathist, actually asked Hahnemann +for the proof that chronic diseases, such as dropsy, for instance, never +arise from any other cause than itch; and that, according to common +report, the venerable sage was highly incensed (fort courrouce) with +Dr. Hartmann, of Leipsic, another “distinguished” Homoeopathist, for +maintaining that they certainly did arise from other causes. + +And Dr. Fielitz, in the “Homoeopathic Gazette” of Leipsic, after saying, +in a good-natured way, that Psora is the Devil in medicine, and that +physicians are divided on this point into diabolists and exorcists, +declares that, according to a remark of Hahnemann, the whole civilized +world is affected with Psora. I must therefore disappoint any advocate +of Hahnemann who may honor me with his presence, by not attacking a +doctrine on which some of the disciples of his creed would be very happy +to have its adversaries waste their time and strength. I will not meddle +with this excrescence, which, though often used in time of peace, would +be dropped, like the limb of a shell-fish, the moment it was assailed; +time is too precious, and the harvest of living extravagances nods too +heavily to my sickle, that I should blunt it upon straw and stubble. + +I will close the subject with a brief examination of some of the +statements made in Homoeopathic works, and more particularly in the +brilliant Manifesto of the “Examiner,” before referred to. And first, it +is there stated under the head of “Homoeopathic Literature,” that +“SEVEN HUNDRED volumes have been issued from the press developing the +peculiarities of the system, and many of them possessed of a scientific +character that savans know well how to respect.” If my assertion were +proper evidence in the case, I should declare, that, having seen a good +many of these publications, from the year 1834, when I bought the work +of the Rev. Thomas Everest, [Dr. Curie speaks of this silly pamphlet as +having been published in 1835.] to within a few weeks, when I received +my last importation of Homaeopathic literature, I have found that all, +with a very few exceptions, were stitched pamphlets varying from +twenty or thirty pages to somewhat less than a hundred, and generally +resembling each other as much as so many spelling-books. + +But not being evidence in the case, I will give you the testimony of +Dr. Trinks, of Dresden, who flourishes on the fifteenth page of the same +Manifesto as one of the most distinguished among the Homoeopathists +of Europe. I translate the sentence literally from the “Archives de la +Medecine Homoeopathique.” + +“The literature of Homoeopathy, if that honorable name must be applied +to all kinds of book-making, has been degraded to the condition of the +humblest servitude. Productions without talent, without spirit, without +discrimination, flat and pitiful eulogies, exaggerations surpassing the +limits of the most robust faith, invectives against such as dared to +doubt the dogmas which had been proclaimed, or catalogues of remedies; +of such materials is it composed! From distance to distance only, have +appeared some memoirs useful to science or practice, which appear as so +many green oases in the midst of this literary desert.” + +It is a very natural as well as a curious question to ask, What has been +the success of Homoeopathy in the different countries of Europe, and +what is its present condition? + +The greatest reliance of the advocates of Homoeopathy is of course +on Germany. We know very little of its medical schools, its medical +doctrines, or its medical men, compared with those of England and +France. And, therefore, when an intelligent traveller gives a direct +account from personal inspection of the miserable condition of the +Homoeopathic hospital at Leipsic, the first established in Europe, and +the first on the list of the ever-memorable Manifesto, it is easy enough +answer or elude the fact by citing various hard names of “distinguished” + practitioners, which sound just as well to the uninformed public as if +they were Meckel, or Tiedemann, or Langenbeck. Dr. Leo-Wolf, who, to be +sure, is opposed to Homoeopathy, but who is a scholar, and ought to know +something of his own countrymen, assures us that “Dr. Kopp is the only +German Homoeopathist, if we can call him so, who has been distinguished +as an author and practitioner before he examined this method.” And Dr. +Lee, the same gentleman in whose travels the paragraph relating to +the Leipsic Hospital is to be found, says the same thing. And I will +cheerfully expose myself to any impertinent remark which it might +suggest, to assure my audience that I never heard or saw one authentic +Homoeopathic name of any country in Europe, which I had ever heard +mentioned before as connected with medical science by a single word or +deed sufficient to make it in any degree familiar to my ears, unless +Arnold of Heidelberg is the anatomist who discovered a little nervous +centre, called the otic ganglion. But you need ask no better proof of +who and what the German adherents of this doctrine must be, than the +testimony of a German Homoeopathist as to the wretched character of the +works they manufacture to enforce its claims. + +As for the act of this or that government tolerating or encouraging +Homoeopathy, every person of common intelligence knows that it is a mere +form granted or denied according to the general principles of policy +adopted in different states, or the degree of influence which some few +persons who have adopted it may happen to have at court. What may be +the value of certain pompous titles with which many of the advocates of +Homoeopathy are honored, it might be disrespectful to question. But in +the mean time the judicious inquirer may ponder over an extract which +I translate from a paper relating to a personage well known to the +community as Williams the Oculist, with whom I had the honor of crossing +the Atlantic some years since, and who himself handed me two copies of +the paper in question. + +“To say that he was oculist of Louis XVIII. and of Charles X., and +that he now enjoys the same title with respect to His Majesty, Louis +Philippe, and the King of the Belgians, is unquestionably to say a great +deal; and yet it is one of the least of his titles to public confidence. +His reputation rests upon a basis more substantial even than the +numerous diplomas with which he is provided, than the membership of the +different medical societies which have chosen him as their associate,” + etc., etc. + +And as to one more point, it is time that the public should fully +understand that the common method of supporting barefaced imposture +at the present day, both in Europe and in this country, consists in +trumping up “Dispensaries,” “Colleges of Health,” and other advertising +charitable clap-traps, which use the poor as decoy-ducks for the rich, +and the proprietors of which have a strong predilection for the title +of “Professor.” These names, therefore, have come to be of little or +no value as evidence of the good character, still less of the high +pretensions of those who invoke their authority. Nor does it +follow, even when a chair is founded in connection with a well-known +institution, that it has either a salary or an occupant; so that it may +be, and probably is, a mere harmless piece of toleration on the part of +the government if a Professorship of Homoeopathy is really in existence +at Jena or Heidelberg. And finally, in order to correct the error of any +who might suppose that the whole Medical Profession of Germany has long +since fallen into the delusions of Hahnemann, I will quote two lines +which a celebrated anatomist and surgeon (whose name will occur again in +this lecture in connection with a very pleasing letter) addressed to the +French Academy of Medicine in 1835. “I happened to be in Germany some +months since, at a meeting of nearly six hundred physicians; one of +them wished to bring up the question of Homoeopathy; they would not even +listen to him.” This may have been very impolite and bigoted, but +that is not precisely the point in reference to which I mention the +circumstance. + +But if we cannot easily get at Germany, we can very easily obtain exact +information from France and England. I took the trouble to write some +months ago to two friends in Paris, in whom I could place confidence, +for information upon the subject. One of them answered briefly to the +effect that nothing was said about it. When the late Curator of the +Lowell Institute, at his request, asked about the works upon the +subject, he was told that they had remained a long time on the shelves +quite unsalable, and never spoken of. + +The other gentleman, [Dr. Henry T. Bigelow, now Professor of Surgery +in Harvard University] whose name is well known to my audience, and who +needs no commendation of mine, had the kindness to procure for me many +publications upon the subject, and some information which sets the whole +matter at rest, so far as Paris is concerned. He went directly to the +Baillieres, the principal and almost the only publishers of all the +Homoeopathic books and journals in that city. The following facts +were taken by him from the account-books of this publishing firm. Four +Homoeopathic Journals have been published in Paris; three of them by the +Baillieres. + +The reception they met with may be judged of by showing the number of +subscribers to each on the books of the publishing firm. + +A Review published by some other house, which lasted one year, and had +about fifty subscribers, appeared in 1834, 1835. + +There were only four Journals of Homoeopathy ever published in Paris. +The Baillieres informed my correspondent that the sale of Homoeopathic +books was much less than formerly, and that consequently they should +undertake to publish no new books upon the subject, except those of Jahr +or Hahnemann. “This man,” says my correspondent,--referring to one of +the brothers,--“the publisher and headquarters of Homoeopathy in Paris, +informs me that it is going down in England and Germany as well as +in Paris.” For all the facts he had stated he pledged himself as +responsible. + +Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and +since then has been going down. + +Louis told my correspondent that no person of distinction in Paris had +embraced Homoeopathy, and that it was declining. If you ask who Louis +is, I refer you to the well-known Homoeopathist, Peschier of Geneva, who +says, addressing him, “I respect no one more than yourself; the feeling +which guides your researches, your labors, and your pen, is so honorable +and rare, that I could not but bow down before it; and I own, if there +were any allopathist who inspired me with higher veneration, it would be +him and not yourself whom I should address.” + +Among the names of “Distinguished Homoeopathists,” however, displayed in +imposing columns, in the index of the “Homoeopathic Examiner,” are those +of MARJOLIN, AMUSSAT, and BRESCHET, names well known to the world of +science, and the last of them identified with some of the most valuable +contributions which anatomical knowledge has received since the +commencement of the present century. One Dr. Chrysaora, who stands +sponsor for many facts in that Journal, makes the following statement +among the rest: “Professors, who are esteemed among the most +distinguished of the Faculty (Faculty de Medicine), both as to knowledge +and reputation, have openly confessed the power of Homoeopathia in +forms of disease where the ordinary method of practice proved totally +insufficient. It affords me the highest pleasure to select from among +these gentlemen, Marjolin, Amussat, and Breschet.” + +Here is a literal translation of an original letter, now in my +possession, from one of these Homoeopathists to my correspondent:-- + +“DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER: + +“You have had the kindness to inform me in your letter that a new +American Journal, the 'New World,' has made use of my name in support of +the pretended Homoeopathic doctrines, and that I am represented as one +of the warmest partisans of Homoeopathy in France. + +“I am vastly surprised at the reputation manufactured for me upon the +new continent; but I am obliged, in deference to truth, to reject it +with my whole energy. I spurn far from me everything which relates to +that charlatanism called Homoeopathy, for these pretended doctrines +cannot endure the scrutiny of wise and enlightened persons, who are +guided by honorable sentiments in the practice of the noblest of arts. + +“PARIS, 3d November, 1841 + +“I am, etc., etc., + +“G. BRESCHET, + +“Professor in the Faculty of Medicine, Member of the Institute, Surgeon +of Hotel Dieu, and Consulting Surgeon to the King, etc.” [I first saw M. +Breschet's name mentioned in that Journal] + +Concerning Amussat, my correspondent writes, that he was informed by +Madame Hahnemann, who converses in French more readily than her husband, +and therefore often speaks for him, that “he was not a physician, +neither Homoeopathist nor Allopathist, but that he was the surgeon +of their own establishment; that is, performed as a surgeon all the +operations they had occasion for in their practice.” + +I regret not having made any inquiries as to Marjolin, who, I doubt not, +would strike his ponderous snuff-box until it resounded like the Grecian +horse, at hearing such a doctrine associated with his respectable name. +I was not aware, when writing to Paris, that this worthy Professor, +whose lectures I long attended, was included in these audacious claims; +but after the specimens I have given of the accuracy of the foreign +correspondence of the “Homoeopathic Examiner,” any further information +I might obtain would seem so superfluous as hardly to be worth the +postage. + +Homoeopathy may be said, then, to be in a sufficiently miserable +condition in Paris. Yet there lives, and there has lived for years, the +illustrious Samuel Hahnemann, who himself assured my correspondent that +no place offered the advantages of Paris in its investigation, by reason +of the attention there paid to it. + +In England, it appears by the statement of Dr. Curie in October, 1839, +about eight years after its introduction into the country, that there +were eighteen Homoeopathic physicians in the United Kingdom, of whom +only three were to be found out of London, and that many of these +practised Homoeopathy in secret. + +It will be seen, therefore, that, according to the recent statement of +one of its leading English advocates, Homoeopathy had obtained not quite +half as many practical disciples in England as Perkinism could show for +itself in a somewhat less period from the time of its first promulgation +in that country. + +Dr. Curie's letter, dated London, October 30, 1839, says there is “one +in Dublin, Dr. Luther; at Glasgow, Dr. Scott.” The “distinguished” + Chrysaora writes from Paris, dating October 20, 1839, “On the other +hand, Homoeopathy is commencing to make an inroad into England by +the way of Ireland. At Dublin, distinguished physicians have already +embraced the new system, and a great part of the nobility and gentry +of that city have emancipated themselves from the English fashion and +professional authority.” + +But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize +Homoeopathy; the Queen Dowager Adelaide has been treated by a +Homoeopathic physician. “Jarley is the delight of the nobility and +gentry.” “The Royal Family are the patrons of Jarley.” + +Let me ask if a Marquis and a Knight are better than two Lords, and +if the Dowager of Royalty is better than Royalty itself, all of which +illustrious dignities were claimed in behalf of Benjamin Douglass +Perkins? + +But if the balance is thought too evenly suspended in this case, another +instance can be given in which the evidence of British noblemen and +their ladies is shown to be as valuable in establishing the character of +a medical man or doctrine, as would be the testimony of the Marquis of +Waterford concerning the present condition and prospects of missionary +enterprise. I have before me an octavo volume of more than four hundred +pages, in which, among much similar matter, I find highly commendatory +letters from the Marchioness of Ormond, Lady Harriet Kavanagh, the +Countess of Buckinghamshire, the Right Hon. Viscount Ingestre, M. P., +and the Most Noble, the Marquis of Sligo,--all addressed to “John +St. John Long, Esq,” a wretched charlatan, twice tried for, and once +convicted of, manslaughter at the Old Bailey. + +This poor creature, too, like all of his tribe, speaks of the medical +profession as a great confederation of bigoted monopolists. He, too, +says that “If an innovator should appear, holding out hope to those +in despair, and curing disorders which the faculty have recorded as +irremediable, he is at once, and without inquiry, denounced as an +empiric and an impostor.” He, too, cites the inevitable names of Galileo +and Harvey, and refers to the feelings excited by the great discovery of +Jenner. From the treatment of the great astronomer who was visited with +the punishment of other heretics by the ecclesiastical authorities of a +Catholic country some centuries since, there is no very direct inference +to be drawn to the medical profession of the present time. His name +should be babbled no longer, after having been placarded for the +hundredth time in the pages of St. John Long. But if we are doomed +to see constant reference to the names of Harvey and Jenner in every +worthless pamphlet containing the prospectus of some new trick upon the +public, let us, once for all, stare the facts in the face, and see how +the discoveries of these great men were actually received by the medical +profession. + +In 1628, Harvey published his first work upon the circulation. His +doctrines were a complete revolution of the prevailing opinions of all +antiquity. They immediately found both champions and opponents; of +which last, one only, Riolanus, seemed to Harvey worthy of an answer, on +account of his “rank, fame, and learning.” Controversy in science, as in +religion, was not, in those days, carried on with all the courtesy which +our present habits demand, and it is possible that some hard words may +have been applied to Harvey, as it is very certain that he used the most +contemptuous expressions towards others. + +Harvey declares in his second letter to Riolanus, “Since the first +discovery of the circulation, hardly a day, or a moment, has passed +without my hearing it both well and ill spoken of; some attack it with +great hostility, others defend it with high encomiums; one party believe +that I have abundantly proved the truth of the doctrine against all +the weight of opposing arguments, by experiments, observations, and +dissections; others think it not yet sufficiently cleared up, and free +from objections.” Two really eminent Professors, Plempius of Louvain, +and Walaeus of Leyden, were among its early advocates. + +The opinions sanctioned by the authority of long ages, and the names of +Hippocrates and Galen, dissolved away, gradually, but certainly, before +the demonstrations of Harvey. Twenty-four years after the publication of +his first work, and six years before his death, his bust in marble +was placed in the Hall of the College of Physicians, with a suitable +inscription recording his discoveries. + +Two years after this he was unanimously invited to accept the Presidency +of that body; and he lived to see his doctrine established, and all +reputable opposition withdrawn. + +There were many circumstances connected with the discovery of Dr. Jenner +which were of a nature to excite repugnance and opposition. The practice +of inoculation for the small-pox had already disarmed that disease of +many of its terrors. The introduction of a contagious disease from a +brute creature into the human system naturally struck the public mind +with a sensation of disgust and apprehension, and a part of the medical +public may have shared these feelings. I find that Jenner's discovery of +vaccination was made public in June, 1798. In July of the same year the +celebrated surgeon, Mr. Cline, vaccinated a child with virus received +from Dr. Jenner, and in communicating the success of this experiment, +he mentions that Dr. Lister, formerly of the Small-Pox Hospital, and +himself, are convinced of the efficacy of the cow-pox. In November +of the same year, Dr. Pearson published his “Inquiry,” containing the +testimony of numerous practitioners in different parts of the kingdom, +to the efficacy of the practice. Dr. HAYGARTH, who was so conspicuous +in exposing the follies of Perkinism, was among the very earliest +to express his opinion in favor of vaccination. In 1801, Dr. Lettsom +mentions the circumstance “as being to the honor of the medical +professors, that they have very generally encouraged this salutary +practice, although it is certainly calculated to lessen their pecuniary +advantages by its tendency to extirpate a fertile source of professional +practice.” + +In the same year the Medical Committee of Paris spoke of vaccination in +a public letter, as “the most brilliant and most important discovery +of the eighteenth century.” The Directors of a Society for the +Extermination of the Small-Pox, in a Report dated October 1st, 1807, +“congratulate the public on the very favorable opinion which the Royal +College of Physicians of London, after a most minute and laborious +investigation made by the command of his Majesty, have a second time +expressed on the subject of vaccination, in their Report laid before the +House of Commons, in the last session of Parliament; in consequence of +which the sum of twenty thousand pounds was voted to Dr. Jenner, as +a remuneration for his discovery, in addition to ten thousand pounds +before granted.” (In June, 1802.) + +These and similar accusations, so often brought up against the Medical +Profession, are only one mode in which is manifested a spirit of +opposition not merely to medical science, but to all science, and to all +sound knowledge. It is a spirit which neither understands itself nor the +object at which it is aiming. It gropes among the loose records of the +past, and the floating fables of the moment, to glean a few truths or +falsehoods tending to prove, if they prove anything, that the persons +who have passed their lives in the study of a branch of knowledge +the very essence of which must always consist in long and accurate +observation, are less competent to judge of new doctrines in their own +department than the rest of the community. It belongs to the clown in +society, the destructive in politics, and the rogue in practice. + +The name of Harvey, whose great discovery was the legitimate result of +his severe training and patient study, should be mentioned only to check +the pretensions of presumptuous ignorance. The example of Jenner, +who gave his inestimable secret, the result of twenty-two years of +experiment and researches, unpurchased, to the public,--when, as was +said in Parliament, he might have made a hundred thousand pounds by it +as well as any smaller sum,--should be referred to only to rebuke the +selfish venders of secret remedies, among whom his early history obliges +us reluctantly to record Samuel Hahnemann. Those who speak of the great +body of physicians as if they were united in a league to support the +superannuated notions of the past against the progress of improvement, +have read the history of medicine to little purpose. The prevalent +failing of this profession has been, on the contrary, to lend a too +credulous ear to ambitious and plausible innovators. If at the present +time ten years of public notoriety have passed over any doctrine +professing to be of importance in medical science, and if it has not +succeeded in raising up a powerful body of able, learned, and ingenious +advocates for its claims, the fault must be in the doctrine and not in +the medical profession. + +Homoeopathy has had a still more extended period of trial than this, +and we have seen with what results. It only remains to throw out a few +conjectures as to the particular manner in which it is to break up and +disappear. + +1. The confidence of the few believers in this delusion will never +survive the loss of friends who may die of any acute disease, under a +treatment such as that prescribed by Homoeopathy. It is doubtful how far +cases of this kind will be trusted to its tender mercies, but wherever +it acquires any considerable foothold, such cases must come, and with +them the ruin of those who practise it, should any highly valued life be +thus sacrificed. + +2. After its novelty has worn out, the ardent and capricious individuals +who constitute the most prominent class of its patrons will return to +visible doses, were it only for the sake of a change. + +3. The Semi-Homoeopathic practitioner will gradually withdraw from +the rotten half of his business and try to make the public forget his +connection with it. + +4. The ultra Homoeopathist will either recant and try to rejoin the +medical profession; or he will embrace some newer and if possible +equally extravagant doctrine; or he will stick to his colors and go +down with his sinking doctrine. Very few will pursue the course last +mentioned. + +A single fact may serve to point out in what direction there will +probably be a movement of the dissolving atoms of Homoeopathy. On the +13th page of the too frequently cited Manifesto of the “Examiner” I read +the following stately paragraph: + +“Bigelius, M. D., physician to the Emperor of Russia, whose elevated +reputation is well known in Europe, has been an acknowledged advocate +of Hahnemann's doctrines for several years. He abandoned Allopathia for +Homoeopathia.” The date of this statement is January, 1840. I find on +looking at the booksellers' catalogues that one Bigel, or Bigelius, +to speak more classically, has been at various times publishing +Homoeopathic books for some years. + +Again, on looking into the “Encyclographie des Sciences Medicales” for +April, 1840, I find a work entitled “Manual of HYDROSUDOPATHY, or the +Treatment of Diseases by Cold Water, etc., etc., by Dr. Bigel, Physician +of the School of Strasburg, Member of the Medico-Chirurgical Institute +of Naples, of the Academy of St. Petersburg,--Assessor of the College of +the Empire of Russia, Physician of his late Imperial Highness the Grand +Duke Constantine, Chevalier of the Legion of Honor, etc.” Hydrosudopathy +or Hydropathy, as it is sometimes called, is a new medical doctrine or +practice which has sprung up in Germany since Homoeopathy, which it +bids fair to drive out of the market, if, as Dr. Bigel says, fourteen +physicians afflicted with diseases which defied themselves and their +colleagues came to Graefenberg, in the year 1836 alone, and were cured. +Now Dr. Bigel, “whose elevated reputation is well known in Europe,” + writes as follows: “The reader will not fail to see in this defence of +the curative method of Graefenberg a profession of medical faith, and +he will be correct in so doing.” And his work closes with the following +sentence, worthy of so distinguished an individual: “We believe, with +religion, that the water of baptism purifies the soul from its original +sin; let us believe also, with experience, that it is for our corporeal +sins the redeemer of the human body.” If Bigel, Physician to the late +Grand Duke Constantine, is identical with Bigel whom the “Examiner” + calls Physician to the Emperor of Russia, it appears that he is now +actively engaged in throwing cold water at once upon his patients and +the future prospects of Homoeopathy. + +If, as must be admitted, no one of Hahnemann's doctrines is received +with tolerable unanimity among his disciples, except the central axiom, +Similia similibus curantur; if this axiom itself relies mainly for its +support upon the folly and trickery of Hahnemann, what can we think of +those who announce themselves ready to relinquish all the accumulated +treasures of our art, to trifle with life upon the strength of these +fantastic theories? What shall we think of professed practitioners of +medicine, if, in the words of Jahr, “from ignorance, for their personal +convenience, or through charlatanism, they treat their patients one +day Homoeopathically and the next Allopathically;” if they parade their +pretended new science before the unguarded portion of the community; +if they suffer their names to be coupled with it wherever it may gain a +credulous patient; and deny all responsibility for its character, refuse +all argument for its doctrines, allege no palliation for the ignorance +and deception interwoven with every thread of its flimsy tissue, when +they are questioned by those competent to judge and entitled to an +answer? + +Such is the pretended science of Homoeopathy, to which you are asked to +trust your lives and the lives of those dearest to you. A mingled mass +of perverse ingenuity, of tinsel erudition, of imbecile credulity, and +of artful misrepresentation, too often mingled in practice, if we +may trust the authority of its founder, with heartless and shameless +imposition. Because it is suffered so often to appeal unanswered to the +public, because it has its journals, its patrons, its apostles, some +are weak enough to suppose it can escape the inevitable doom of utter +disgrace and oblivion. Not many years can pass away before the same +curiosity excited by one of Perkins's Tractors will be awakened at the +sight of one of the Infinitesimal Globules. If it should claim a longer +existence, it can only be by falling into the hands of the sordid +wretches who wring their bread from the cold grasp of disease and death +in the hovels of ignorant poverty. + +As one humble member of a profession which for more than two thousand +years has devoted itself to the pursuit of the best earthly interests +of mankind, always assailed and insulted from without by such as are +ignorant of its infinite perplexities and labors, always striving in +unequal contest with the hundred-armed giant who walks in the noonday, +and sleeps not in the midnight, yet still toiling, not merely for itself +and the present moment, but for the race and the future, I have lifted +my voice against this lifeless delusion, rolling its shapeless bulk into +the path of a noble science it is too weak to strike, or to injure. + + + + + + +THE CONTAGIOUSNESS OF PUERPERAL FEVER + +Printed in 1843; reprinted with additions, 1855. + +THE POINT AT ISSUE. THE AFFIRMATIVE. + +“The disease known as Puerperal Fever is so far contagious as to be +frequently carried from patient to patient by physicians and nurses.” O. +W. Holmes, 1843. + +THE NEGATIVE. + +“The result of the whole discussion will, I trust, serve, not only to +exalt your views of the value and dignity of our profession, but to +divest your minds of the overpowering dread that you can ever become, +especially to woman, under the extremely interesting circumstances +of gestation and parturition, the minister of evil; that you can ever +convey, in any possible manner, a horrible virus, so destructive in +its effects, and so mysterious in its operations as that attributed to +puerperal fever.”--Professor Hodge, 1852. + +“I prefer to attribute them to accident, or Providence, of which I can +form a conception, rather than to a contagion of which I cannot form any +clear idea, at least as to this particular malady.”--Professor Meigs, +1852. + +“... in the propagation of which they have no more to do, than with the +propagation of cholera from Jessore to San Francisco, and from Mauritius +to St. Petersburg.”--Professor Meigs, 1854. + + + --------------------- + +“I arrived at that certainty in the matter, that I could venture to +foretell what women would be affected with the disease, upon hearing by +what midwife they were to be delivered, or by what nurse they were to +be attended, during their lying-in; and, almost in every instance, my +prediction was verified.”--Gordon, 1795. + +“A certain number of deaths is caused every year by the contagion of +puerperal fever, communicated by the nurses and medical attendants.” + Farr, in Fifth Annual Report of Registrar-General of England, 1843. + +“... boards of health, if such exist, or, without them, the medical +institutions of a country, should have the power of coercing, or of +inflicting some kind of punishment on those who recklessly go from cases +of puerperal fevers to parturient or puerperal females, without +using due precaution; and who, having been shown the risk, criminally +encounter it, and convey pestilence and death to the persons they are +employed to aid in the most interesting and suffering period of female +existence.” --Copland's Medical Dictionary, Art. Puerperal States and +Diseases, 1852. + +“We conceive it unnecessary to go into detail to prove the contagious +nature of this disease, as there are few, if any, American practitioners +who do not believe in this doctrine.”--Dr. Lee, in Additions to Article +last cited. + + + ----------------------- + +[INTRODUCTORY NOTE.] It happened, some years ago, that a discussion +arose in a Medical Society of which I was a member, involving the +subject of a certain supposed cause of disease, about which something +was known, a good deal suspected, and not a little feared. The +discussion was suggested by a case, reported at the preceding meeting, +of a physician who made an examination of the body of a patient who had +died with puerperal fever, and who himself died in less than a week, +apparently in consequence of a wound received at the examination, having +attended several women in confinement in the mean time, all of whom, as +it was alleged, were attacked with puerperal fever. + +Whatever apprehensions and beliefs were entertained, it was plain that +a fuller knowledge of the facts relating to the subject would be +acceptable to all present. I therefore felt that it would be doing a +good service to look into the best records I could find, and inquire of +the most trustworthy practitioners I knew, to learn what experience +had to teach in the matter, and arrived at the results contained in the +following pages. + +The Essay was read before the Boston Society for Medical Improvement, +and, at the request of the Society, printed in the “New England +Quarterly Journal of Medicine and Surgery” for April, 1843. As this +Journal never obtained a large circulation, and ceased to be published +after a year's existence, and as the few copies I had struck off +separately were soon lost sight of among the friends to whom they were +sent, the Essay can hardly be said to have been fully brought before the +Profession. + +The subject of this Paper has the same profound interest for me at +the present moment as it had when I was first collecting the terrible +evidence out of which, as it seems to me, the commonest exercise of +reason could not help shaping the truth it involved. It is not merely on +account of the bearing of the question,--if there is a question,--on all +that is most sacred in human life and happiness, that the subject cannot +lose its interest. It is because it seems evident that a fair statement +of the facts must produce its proper influence on a very large +proportion of well-constituted and unprejudiced minds. Individuals may, +here and there, resist the practical bearing of the evidence on their +own feelings or interests; some may fail to see its meaning, as some +persons may be found who cannot tell red from green; but I cannot doubt +that most readers will be satisfied and convinced, to loathing, long +before they have finished the dark obituary calendar laid before them. + +I do not know that I shall ever again have so good an opportunity of +being useful as was granted me by the raising of the question which +produced this Essay. For I have abundant evidence that it has made many +practitioners more cautious in their relations with puerperal females, +and I have no doubt it will do so still, if it has a chance of being +read, though it should call out a hundred counterblasts, proving to the +satisfaction of their authors that it proved nothing. And for my part, I +had rather rescue one mother from being poisoned by her attendant, than +claim to have saved forty out of fifty patients to whom I had carried +the disease. Thus, I am willing to avail myself of any hint coming from +without to offer this paper once more to the press. The occasion +has presented itself, as will be seen, in a convenient if not in a +flattering form. + +I send this Essay again to the MEDICAL PROFESSION, without the change +of a word or syllable. I find, on reviewing it, that it anticipates and +eliminates those secondary questions which cannot be entertained for a +moment until the one great point of fact is peremptorily settled. In its +very statement of the doctrine maintained it avoids all discussion +of the nature of the disease “known as puerperal fever,” and all the +somewhat stale philology of the word contagion. It mentions, fairly +enough, the names of sceptics, or unbelievers as to the reality of +personal transmission; of Dewees, of Tonnelle, of Duges, of Baudelocque, +and others; of course, not including those whose works were then +unwritten or unpublished; nor enumerating all the Continental writers +who, in ignorance of the great mass of evidence accumulated by British +practitioners, could hardly be called well informed on this subject. It +meets all the array of negative cases,--those in which disease did not +follow exposure,--by the striking example of small-pox, which, +although one of the most contagious of diseases, is subject to the most +remarkable irregularities and seeming caprices in its transmission. It +makes full allowance for other causes besides personal transmission, +especially for epidemic influences. It allows for the possibility +of different modes of conveyance of the destructive principle. It +recognizes and supports the belief that a series of cases may originate +from a single primitive source which affects each new patient in turn; +and especially from cases of Erysipelas. It does not undertake to +discuss the theoretical aspect of the subject; that is a secondary +matter of consideration. Where facts are numerous, and unquestionable, +and unequivocal in their significance, theory must follow them as it +best may, keeping time with their step, and not go before them, marching +to the sound of its own drum and trumpet. Having thus narrowed its area +to a limited practical platform of discussion, a matter of life and +death, and not of phrases or theories, it covers every inch of it with a +mass of evidence which I conceive a Committee of Husbands, who can count +coincidences and draw conclusions as well as a Synod of Accoucheurs, +would justly consider as affording ample reasons for an unceremonious +dismissal of a practitioner (if it is conceivable that such a step could +be waited for), after five or six funerals had marked the path of his +daily visits, while other practitioners were not thus escorted. To the +Profession, therefore, I submit the paper in its original form, and +leave it to take care of itself. + +To the MEDICAL STUDENTS, into whose hands this Essay may fall, some +words of introduction may be appropriate, and perhaps, to a small number +of them, necessary. There are some among them who, from youth, or want +of training, are easily bewildered and confused in any conflict of +opinions into which their studies lead them. They are liable to lose +sight of the main question in collateral issues, and to be run away with +by suggestive speculations. They confound belief with evidence, often +trusting the first because it is expressed with energy, and slighting +the latter because it is calm and unimpassioned. They are not satisfied +with proof; they cannot believe a point is settled so long as everybody +is not silenced. They have not learned that error is got out of the +minds that cherish it, as the taenia is removed from the body, one +joint, or a few joints at a time, for the most part, rarely the whole +evil at once. They naturally have faith in their instructors, turning to +them for truth, and taking what they may choose to give them; babes in +knowledge, not yet able to tell the breast from the bottle, pumping away +for the milk of truth at all that offers, were it nothing better than a +Professor's shrivelled forefinger. + +In the earliest and embryonic stage of professional development, any +violent impression on the instructor's mind is apt to be followed by +some lasting effect on that of the pupil. No mother's mark is more +permanent than the mental naevi and moles, and excrescences, and +mutilations, that students carry with them out of the lecture-room, if +once the teeming intellect which nourishes theirs has been scared from +its propriety by any misshapen fantasy. Even an impatient or petulant +expression, which to a philosopher would be a mere index of the low +state of amiability of the speaker at the moment of its utterance, may +pass into the young mind as an element of its future constitution, to +injure its temper or corrupt its judgment. It is a duty, therefore, +which we owe to this younger class of students, to clear any important +truth which may have been rendered questionable in their minds by such +language, or any truth-teller against whom they may have been prejudiced +by hasty epithets, from the impressions such words have left. Until this +is done, they are not ready for the question, where there is a question, +for them to decide. Even if we ourselves are the subjects of the +prejudice, there seems to be no impropriety in showing that this +prejudice is local or personal, and not an acknowledged conviction with +the public at large. It may be necessary to break through our usual +habits of reserve to do this, but this is the fault of the position in +which others have placed us. + +Two widely-known and highly-esteemed practitioners, Professors in two +of the largest Medical Schools of the Union, teaching the branch of +art which includes the Diseases of Women, and therefore speaking with +authority; addressing in their lectures and printed publications large +numbers of young men, many of them in the tenderest immaturity of +knowledge, have recently taken ground in a formal way against the +doctrine maintained in this paper: + +On the Non-Contagious Character of Puerperal Fever: An Introductory +Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the +University of Pennsylvania. Delivered Monday, October 11, 1852. +Philadelphia, 1852. + +On the Nature, Signs, and Treatment of Childbed Fevers: in a Series of +Letters addressed to the Students of his Class. By Charles D. Meigs, +M. D., Professor of Midwifery and the Diseases of Women and Children in +Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854. +Letter VI. + +The first of the two publications, Dr. Hodge's Lecture, while its +theoretical considerations and negative experiences do not seem to me to +require any further notice than such as lay ready for them in my Essay +written long before, is, I am pleased to say, unobjectionable in tone +and language, and may be read without offence. + +This can hardly be said of the chapter of Dr. Meigs's volume which +treats of Contagion in Childbed Fever. There are expressions used in it +which might well put a stop to all scientific discussions, were they +to form the current coin in our exchange of opinions. I leave the “very +young gentlemen,” whose careful expositions of the results of practice +in more than six thousand cases are characterized as “the jejune and +fizenless dreamings of sophomore writers,” to the sympathies of those +“dear young friends,” and “dear young gentlemen,” who will judge how +much to value their instructor's counsel to think for themselves, +knowing what they are to expect if they happen not to think as he does. + +One unpalatable expression I suppose the laws of construction oblige +me to appropriate to myself, as my reward for a certain amount of labor +bestowed on the investigation of a very important question of evidence, +and a statement of my own practical conclusions. I take no offence, and +attempt no retort. No man makes a quarrel with me over the counterpane +that covers a mother, with her new-born infant at her breast. There is +no epithet in the vocabulary of slight and sarcasm that can reach my +personal sensibilities in such a controversy. Only just so far as a +disrespectful phrase may turn the student aside from the examination of +the evidence, by discrediting or dishonoring the witness, does it call +for any word of notice. + +I appeal from the disparaging language by which the Professor in the +Jefferson School of Philadelphia would dispose of my claims to be +listened to. I appeal, not to the vote of the Society for Medical +Improvement, although this was an unusual evidence of interest in the +paper in question, for it was a vote passed among my own townsmen; nor +to the opinion of any American, for none know better than the Professors +in the great Schools of Philadelphia how cheaply the praise of native +contemporary criticism is obtained. I appeal to the recorded opinions +of those whom I do not know, and who do not know me, nor care for +me, except for the truth that I may have uttered; to Copland, in his +“Medical Dictionary,” who has spoken of my Essay in phrases to which +the pamphlets of American “scribblers” are seldom used from European +authorities; to Ramsbotham, whose compendious eulogy is all +that self-love could ask; to the “Fifth Annual Report” of the +Registrar-General of England, in which the second-hand abstract of +my Essay figures largely, and not without favorable comment, in an +important appended paper. These testimonies, half forgotten until +this circumstance recalled them, are dragged into the light, not in a +paroxysm of vanity, but to show that there may be food for thought in +the small pamphlet which the Philadelphia Teacher treats so lightly. +They were at least unsought for, and would never have been proclaimed +but for the sake of securing the privilege of a decent and unprejudiced +hearing. + +I will take it for granted that they have so far counterpoised the +depreciating language of my fellow-countryman and fellow-teacher as to +gain me a reader here and there among the youthful class of students I +am now addressing. It is only for their sake that I think it necessary +to analyze, or explain, or illustrate, or corroborate any portion of +the following Essay. But I know that nothing can be made too plain for +beginners; and as I do not expect the practitioner, or even the more +mature student, to take the trouble to follow me through an Introduction +which I consider wholly unnecessary and superfluous for them, I shall +not hesitate to stoop to the most elementary simplicity for the benefit +of the younger student. I do this more willingly because it affords a +good opportunity, as it seems to me, of exercising the untrained mind +in that medical logic which does not seem to have been either taught or +practised in our schools of late, to the extent that might be desired. + +I will now exhibit, in a series of propositions reduced to their +simplest expression, the same essential statements and conclusions as +are contained in the Essay, with such commentaries and explanations as +may be profitable to the inexperienced class of readers addressed. + +I. It has been long believed, by many competent observers, that +Puerperal Fever (so called) is sometimes carried from patient to patient +by medical assistants. + +II. The express object of this Essay is to prove that it is so carried. + +III. In order to prove this point, it is not necessary to consult +any medical theorist as to whether or not it is consistent with his +preconceived notions that such a mode of transfer should exist. + +IV. If the medical theorist insists on being consulted, and we see fit +to indulge him, he cannot be allowed to assume that the alleged laws of +contagion, deduced from observation in other diseases, shall be cited +to disprove the alleged laws deduced from observation in this. Science +would never make progress under such conditions. Neither the long +incubation of hydrophobia, nor the protecting power of vaccination, +would ever have been admitted, if the results of observation in +these affections had been rejected as contradictory to the previously +ascertained laws of contagion. + +V. The disease in question is not a common one; producing, on the +average, about three deaths in a thousand births, according to the +English Registration returns which I have examined. + +VI. When an unusually large number of cases of this disease occur about +the same time, it is inferred, therefore, that there exists some special +cause for this increased frequency. If the disease prevails extensively +over a wide region of country, it is attributed without dispute to +an epidemic influence. If it prevails in a single locality, as in a +hospital, and not elsewhere, this is considered proof that some local +cause is there active in its production. + +VII. When a large number of cases of this disease occur in rapid +succession, in one individual's ordinary practice, and few or none +elsewhere, these cases appearing in scattered localities, in patients of +the same average condition as those who escape under the care of others, +there is the same reason for connecting the cause of the disease with +the person in this instance, as with the place in that last mentioned. + +VIII. Many series of cases, answering to these conditions, are given +in this Essay, and many others will be referred to which have occurred +since it was written. + +IX. The alleged results of observation may be set aside; first, because +the so-called facts are in their own nature equivocal; secondly, because +they stand on insufficient authority; thirdly, because they are not +sufficiently numerous. But, in this case, the disease is one of striking +and well-marked character; the witnesses are experts, interested in +denying and disbelieving the facts; the number of consecutive cases in +many instances frightful, and the number of series of cases such that I +have no room for many of them except by mere reference. + +X. These results of observation, being admitted, may, we will suppose, +be interpreted in different methods. Thus the coincidences may be +considered the effect of chance. I have had the chances calculated by +a competent person, that a given practitioner, A., shall have sixteen +fatal cases in a month, on the following data: A. to average attendance +upon two hundred and fifty births in a year; three deaths in one +thousand births to be assumed as the average from puerperal fever; no +epidemic to be at the time prevailing. It follows, from the answer given +me, that if we suppose every one of the five hundred thousand annual +births of England to have been recorded during the last half-century, +there would not be one chance in a million million million millions that +one such series should be noted. No possible fractional error in this +calculation can render the chance a working probability. Applied to +dozens of series of various lengths, it is obviously an absurdity. +Chance, therefore, is out of the question as an explanation of the +admitted coincidences. + +XI. There is, therefore, some relation of cause and effect between the +physician's presence and the patient's disease. + +XII. Until it is proved to what removable condition attaching to the +attendant the disease is owing, he is bound to stay away from his +patients so soon as he finds himself singled out to be tracked by the +disease. How long, and with what other precautions, I have suggested, +without dictating, at the close of my Essay. If the physician does +not at once act on any reasonable suspicion of his being the medium of +transfer, the families where he is engaged, if they are allowed to know +the facts, should decline his services for the time. His feelings on the +occasion, however interesting to himself, should not be even named in +this connection. A physician who talks about ceremony and gratitude, and +services rendered, and the treatment he got, surely forgets himself; +it is impossible that he should seriously think of these small matters +where there is even a question whether he may not carry disease, and +death, and bereavement into any one of “his families,” as they are +sometimes called. + +I will now point out to the young student the mode in which he may +relieve his mind of any confusion, or possibly, if very young, any +doubt, which the perusal of Dr. Meigs's Sixth Letter may have raised in +his mind. + +The most prominent ideas of the Letter are, first, that the +transmissible nature of puerperal fever appears improbable, and, +secondly, that it would be very inconvenient to the writer. Dr. +Woodville, Physician to the Small-Pox and Inoculation Hospital in +London, found it improbable, and exceedingly inconvenient to himself, +that cow pox should prevent small-pox; but Dr. Jenner took the liberty +to prove the fact, notwithstanding. + +I will first call the young student's attention to the show of negative +facts (exposure without subsequent disease), of which much seems to be +thought. And I may at the same time refer him to Dr. Hodge's Lecture, +where he will find the same kind of facts and reasoning. Let him now +take up Watson's Lectures, the good sense and spirit of which have made +his book a universal favorite, and open to the chapter on Continued +Fever. He will find a paragraph containing the following sentence: “A +man might say, 'I was in the battle of Waterloo, and saw many men around +me fall down and die, and it was said that they were struck down by +musket-balls; but I know better than that, for I was there all the +time, and so were many of my friends, and we were never hit by any +musket-balls. Musket-balls, therefore, could not have been the cause of +the deaths we witnessed.' And if, like contagion, they were not palpable +to the senses, such a person might go on to affirm that no proof existed +of there being any such thing as musket-balls.” Now let the student turn +back to the chapter on Hydrophobia in the same volume. He will find that +John Hunter knew a case in which, of twenty-one persons bitten, only one +died of the disease. He will find that one dog at Charenton was bitten +at different times by thirty different mad dogs, and outlived it all. +Is there no such thing, then, as hydrophobia? Would one take no especial +precautions if his wife, about to become a mother, had been bitten by a +rabid animal, because so many escape? Or let him look at “Underwood on +Diseases of Children,” [Philadelphia, 1842, p. 244, note.] and he will +find the case of a young woman who was inoculated eight times in thirty +days, at the same time attending several children with smallpox, and yet +was not infected. But seven weeks afterwards she took the disease and +died. + +It would seem as if the force of this argument could hardly fail to be +seen, if it were granted that every one of these series of cases were so +reported as to prove that there could have been no transfer of disease. +There is not one of them so reported, in the Lecture or the Letter, as +to prove that the disease may not have been carried by the practitioner. +I strongly suspect that it was so carried in some of these cases, but +from the character of the very imperfect evidence the question can never +be settled without further disclosures. + +Although the Letter is, as I have implied, principally taken up with +secondary and collateral questions, and might therefore be set aside as +in the main irrelevant, I am willing, for the student's sake, to touch +some of these questions briefly, as an illustration of its logical +character. + +The first thing to be done, as I thought when I wrote my Essay, was +to throw out all discussions of the word contagion, and this I did +effectually by the careful wording of my statement of the subject to be +discussed. My object was not to settle the etymology or definition of +a word, but to show that women had often died in childbed, poisoned in +some way by their medical attendants. On the other point, I, at least, +have no controversy with anybody, and I think the student will do well +to avoid it in this connection. If I must define my position, however, +as well as the term in question, I am contented with Worcester's +definition; provided always this avowal do not open another side +controversy on the merits of his Dictionary, which Dr. Meigs has not +cited, as compared with Webster's, which he has. + +I cannot see the propriety of insisting that all the laws of the +eruptive fevers must necessarily hold true of this peculiar disease +of puerperal women. If there were any such propriety, the laws of the +eruptive fevers must at least be stated correctly. It is not true, +for instance, as Dr. Meigs states, that contagion is “no respecter of +persons;” that “it attacks all individuals alike.” To give one example: +Dr. Gregory, of the Small-Pox Hospital, who ought to know, says that +persons pass through life apparently insensible to or unsusceptible of +the small-pox virus, and that the same persons do not take the vaccine +disease. + +As to the short time of incubation, of which so much is made, we have +no right to decide beforehand whether it shall be long or short, in the +cases we are considering. A dissection wound may produce symptoms of +poisoning in six hours; the bite of a rabid animal may take as many +months. + +After the student has read the case in Dr. Meigs's 136th paragraph, and +the following one, in which he exclaims against the idea of contagion, +because the patient, delivered on the 26th of December, was attacked in +twenty-four hours, and died on the third day, let him read what happened +at the “Black Assizes” of 1577 and 1750. In the first case, six hundred +persons sickened the same night of the exposure, and three hundred more +in three days. [Elliotson's Practice, p. 298.] Of those attacked in the +latter year, the exposure being on the 11th of May, Alderman Lambert +died on the 13th, Under-Sheriff Cox on the 14th, and many of note before +the 20th. But these are old stories. Let the student listen then to Dr. +Gerhard, whose reputation as a cautious observer he may be supposed to +know. “The nurse was shaving a man, who died in a few hours after his +entrance; he inhaled his breath, which had a nauseous taste, and in an +hour afterwards was taken with nausea, cephalalgia, and singing of the +ears. From that moment the attack began, and assumed a severe character. +The assistant was supporting another patient, who died soon afterwards; +he felt the pungent heat upon his skin, and was taken immediately with +the symptoms of typhus.” [Am. Jour. Med. Sciences, Feb. 1837, p. 299.] +It is by notes of cases, rather than notes of admiration, that we must +be guided, when we study the Revised Statutes of Nature, as laid down +from the curule chairs of Medicine. + +Let the student read Dr. Meigs's 140th paragraph soberly, and then +remember, that not only does he infer, suspect, and surmise, but he +actually asserts (page 154), “there was poison in the house,” because +three out of five patients admitted into a ward had puerperal fever and +died. Have I not as much right to draw a positive inference from “Dr. +A.'s” seventy exclusive cases as he from the three cases in the ward of +the Dublin Hospital? All practical medicine, and all action in common +affairs, is founded on inferences. How does Dr. Meigs know that the +patients he bled in puerperal fever would not have all got well if he +had not bled them? + +“You see a man discharge a gun at another; you see the flash, you hear +the report, you see the person fall a lifeless corpse; and you infer, +from all these circumstances, that there was a ball discharged from the +gun, which entered his body and caused his death, because such is the +usual and natural cause of such an effect. But you did not see the ball +leave the gun, pass through the air, and enter the body of the +slain; and your testimony to the fact of killing is, therefore, only +inferential,--in other words, circumstantial. It is possible that no +ball was in the gun; and we infer that there was, only because we cannot +account for death on any other supposition.” [Chief Justice Gibson, in +Am. Law Journal, vol. vi. p. 123.] + +“The question always comes to this: Is the circumstance of intercourse +with the sick followed by the appearance of the disease in a proportion +of cases so much greater than any other circumstance common to any +portion of the inhabitants of the place under observation, as to make it +inconceivable that the succession of cases occurring in persons having +that intercourse should have been the result of chance? If so, the +inference is unavoidable, that that intercourse must have acted as a +cause of the disease. All observations which do not bear strictly +on that point are irrelevant, and, in the case of an epidemic first +appearing in a town or district, a succession of two cases is sometimes +sufficient to furnish evidence which, on the principle I have stated, is +nearly irresistible.” + +Possibly an inexperienced youth may be awe-struck by the quotation from +Cuvier. These words, or their equivalent, are certainly to be found in +his Introduction. So are the words “top not come down”! to be found in +the Bible, and they were as much meant for the ladies' head-dresses as +the words of Cuvier were meant to make clinical observation wait for a +permit from anybody to look with its eyes and count on its fingers. Let +the inquiring youth read the whole Introduction, and he will see what +they mean. + +I intend no breach of courtesy, but this is a proper place to warn the +student against skimming the prefaces and introductions of works for +mottoes and embellishments to his thesis. He cannot learn anatomy by +thrusting an exploring needle into the body. He will be very liable +to misquote his author's meaning while he is picking off his outside +sentences. He may make as great a blunder as that simple prince who +praised the conductor of his orchestra for the piece just before the +overture; the musician was too good a courtier to tell him that it was +only the tuning of the instruments. + +To the six propositions in the 142d paragraph, and the remarks about +“specific” diseases, the answer, if any is necessary, seems very simple. +An inflammation of a serous membrane may give rise to secretions which +act as a poison, whether that be a “specific” poison or not, as Dr. +Homer has told his young readers, and as dissectors know too well; and +that poison may produce its symptoms in a few hours after the system has +received it, as any may see in Druitt's “Surgery,” if they care to look. +Puerperal peritonitis may produce such a poison, and puerperal women may +be very sensible to its influences, conveyed by contact or exhalation. +Whether this is so or not, facts alone can determine, and to facts we +have had recourse to settle it. + +The following statement is made by Dr. Meigs in his 142d paragraph, and +developed more at length, with rhetorical amplifications, in the 134th. +“No human being, save a pregnant or parturient woman, is susceptible to +the poison.” This statement is wholly incorrect, as I am sorry to have +to point out to a Teacher in Dr. Meigs's position. I do not object to +the erudition which quotes Willis and Fernelius, the last of whom was +pleasantly said to have “preserved the dregs of the Arabs in the honey +of his Latinity.” But I could wish that more modern authorities had not +been overlooked. On this point, for instance, among the numerous facts +disproving the statement, the “American Journal of Medical Sciences,” + published not far from his lecture-room, would have presented him with +a respectable catalog of such cases. Thus he might refer to Mr. Storrs's +paper “On the Contagious Effects of Puerperal Fever on the Male Subject; +or on Persons not Childbearing” (Jan. 1846), or to Dr. Reid's case +(April, 1846), or to Dr. Barron's statement of the children's dying +of peritonitis in an epidemic of puerperal fever at the Philadelphia +Hospital (Oct. 1842), or to various instances cited in Dr. Kneeland's +article (April, 186). Or, if he would have referred to the “New York +Journal,” he might have seen Prof. Austin Flint's cases. Or, if he had +honored my Essay so far, he might have found striking instances of the +same kind in the first of the new series of cases there reported and +elsewhere. I do not see the bearing of his proposition, if it were true. +But it is one of those assertions that fall in a moment before a slight +examination of the facts; and I confess my surprise, that a professor +who lectures on the Diseases of Women should have ventured to make it. + +Nearly seven pages are devoted to showing that I was wrong in saying I +would not be “understood to imply that there exists a doubt in the mind +of any well-informed member of the medical profession as to the fact +that puerperal fever is sometimes communicated from one person to +another, both directly and indirectly.” I will devote seven lines to +these seven pages, which seven lines, if I may say it without offence, +are, as it seems to me, six more than are strictly necessary. + +The following authors are cited as sceptics by Dr. Meigs: Dewees.--I +cited the same passage. Did not know half the facts. Robert +Lee.--Believes the disease is sometimes communicable by contagion. +Tonnelle, Baudelocque. Both cited by me. Jacquemier.--Published three +years after my Essay. Kiwisch. “Behindhand in knowledge of Puerperal +Fever.” [B. & F. Med. Rev. Jan. 1842.] Paul Dubois.--Scanzoni. + +These Continental writers not well informed on this point.[See Dr. +Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. Oct. +1851.)] + +The story of Von Busch is of interest and value, but there is nothing in +it which need perplex the student. It is not pretended that the disease +is always, or even, it may be, in the majority of cases, carried about +by attendants; only that it is so carried in certain cases. That it may +have local and epidemic causes, as well as that depending on personal +transmission, is not disputed. Remember how small-pox often disappears +from a community in spite of its contagious character, and the necessary +exposure of many persons to those suffering from it; in both diseases +contagion is only one of the coefficients of the disease. + +I have already spoken of the possibility that Dr. Meigs may have been +the medium of transfer of puerperal fever in some of the cases he has +briefly catalogued. Of Dr. Rutter's cases I do not know how to speak. I +only ask the student to read the facts stated by Dr. Condie, as given +in my Essay, and say whether or not a man should allow his wife to be +attended by a practitioner in whose hands “scarcely a female that has +been delivered for weeks past has escaped an attack,” “while no instance +of the disease has occurred in the patients of any other accoucheur +practising in the same district.” If I understand Dr. Meigs and Dr. +Hodge, they would not warn the physician or spare the patient under such +circumstances. They would “go on,” if I understand them, not to seven, +or seventy, only, but to seventy times seven, if they could find +patients. If this is not what they mean, may we respectfully ask them to +state what they do mean, to their next classes, in the name of humanity, +if not of science! + +I might repeat the question asked concerning Dr. Rutter's cases, with +reference to those reported by Dr. Roberton. Perhaps, however, the +student would like to know the opinion of a person in the habit of +working at matters of this kind in a practical point of view. To satisfy +him on this ground, I addressed the following question to the President +of one of our principal Insurance Companies, leaving Dr. Meigs's book +and my Essay in his hands at the same time. + +Question. “If such facts as Roberton's cases were before you, and the +attendant had had ten, or even five fatal cases, or three, or two even, +would you, or would you not, if insuring the life of the next patient to +be taken care of by that attendant, expect an extra premium over that of +an average case of childbirth?” + +Answer. “Of course I should require a very large extra premium, if I +would take take risk at all.” + +But I do not choose to add the expressions of indignation which the +examination of the facts before him called out. I was satisfied from the +effect they produced on him, that if all the hideous catalogues of +cases now accumulated were fully brought to the knowledge of the public, +nothing, since the days of Burke and Hare, has raised such a cry of +horror as would be shrieked in the ears of the Profession. + +Dr. Meigs has elsewhere invoked “Providence” as the alternative of +accident, to account for the “coincidences.” (“Obstetrics,” Phil. 1852, +p. 631.) If so, Providence either acts through the agency of secondary +causes, as in other diseases, or not. If through such causes, let us +find out what they are, as we try to do in other cases. It may be true +that offences, or diseases, will come, but “woe unto him through whom +they come,” if we catch him in the voluntary or careless act of bringing +them! But if Providence does not act through secondary causes in this +particular sphere of etiology, then why does Dr. Meigs take such pains +to reason so extensively about the laws of contagion, which, on that +supposition, have no more to do with this case than with the plague +which destroyed the people after David had numbered them? Above all, +what becomes of the theological aspect of the question, when he asserts +that a practitioner was “only unlucky in meeting with the epidemic +cases?” (Op. cit. p. 633.) We do not deny that the God of battles +decides the fate of nations; but we like to have the biggest squadrons +on our side, and we are particular that our soldiers should not only say +their prayers, but also keep their powder dry. We do not deny the agency +of Providence in the disaster at Norwalk, but we turn off the engineer, +and charge the Company five thousand dollars apiece for every life that +is sacrificed. + +Why a grand jury should not bring in a bill against a physician who +switches off a score of women one after the other along his private +track, when he knows that there is a black gulf at the end of it, down +which they are to plunge, while the great highway is clear, is more than +I can answer. It is not by laying the open draw to Providence that he is +to escape the charge of manslaughter. + +To finish with all these lesser matters of question, I am unable to see +why a female must necessarily be unattended in her confinement, because +she declines the services of a particular practitioner. In all the +series of cases mentioned, the death-carrying attendant was surrounded +by others not tracked by disease and its consequences. Which, I would +ask, is worse,--to call in another, even a rival practitioner, or to +submit an unsuspecting female to a risk which an Insurance Company would +have nothing to do with? + +I do not expect ever to return to this subject. There is a point of +mental saturation, beyond which argument cannot be forced without +breeding impatient, if not harsh, feelings towards those who refuse to +be convinced. If I have so far manifested neither, it is well to stop +here, and leave the rest to those younger friends who may have more +stomach for the dregs of a stale argument. + +The extent of my prefatory remarks may lead some to think that I attach +too much importance to my own Essay. Others may wonder that I should +expend so many words upon the two productions referred to, the Letter +and the Lecture. I do consider my Essay of much importance so long as +the doctrine it maintains is treated as a question, and so long as any +important part of the defence of that doctrine is thought to rest on +its evidence or arguments. I cannot treat as insignificant any opinions +bearing on life, and interests dearer than life, proclaimed yearly to +hundreds of young men, who will carry them to their legitimate results +in practice. + +The teachings of the two Professors in the great schools of Philadelphia +are sure to be listened to, not only by their immediate pupils, but by +the Profession at large. I am too much in earnest for either humility +or vanity, but I do entreat those who hold the keys of life and death to +listen to me also for this once. I ask no personal favor; but I beg to +be heard in behalf of the women whose lives are at stake, until some +stronger voice shall plead for them. + +I trust that I have made the issue perfectly distinct and intelligible. +And let it be remembered that this is no subject to be smoothed over by +nicely adjusted phrases of half-assent and half-censure divided between +the parties. The balance must be struck boldly and the result declared +plainly. If I have been hasty, presumptuous, ill-informed, illogical; if +my array of facts means nothing; if there is no reason for any caution +in the view of these facts; let me be told so on such authority that I +must believe it, and I will be silent henceforth, recognizing that my +mind is in a state of disorganization. If the doctrine I have maintained +is a mournful truth; if to disbelieve it, and to practise on this +disbelief, and to teach others so to disbelieve and practise, is to +carry desolation, and to charter others to carry it, into confiding +families, let it be proclaimed as plainly what is to be thought of the +teachings of those who sneer at the alleged dangers, and scout the very +idea of precaution. Let it be remembered that persons are nothing in +this matter; better that twenty pamphleteers should be silenced, or as +many professors unseated, than that one mother's life should be +taken. There is no quarrel here between men, but there is deadly +incompatibility and exterminating warfare between doctrines. +Coincidences meaning nothing, though a man have a monopoly of the +disease for weeks or months; or cause and effect, the cause being in +some way connected with the person; this is the question. If I am wrong, +let me be put down by such a rebuke as no rash declaimer has received +since there has been a public opinion in the medical profession of +America; if I am right, let doctrines which lead to professional +homicide be no longer taught from the chairs of those two great +Institutions. Indifference will not do here; our Journalists and +Committees have no right to take up their pages with minute anatomy +and tediously detailed cases, while it is a question whether or not the +“blackdeath” of child-bed is to be scattered broadcast by the agency of +the mother's friend and adviser. Let the men who mould opinions look to +it; if there is any voluntary blindness, any interested oversight, any +culpable negligence, even, in such a matter, and the facts shall reach +the public ear; the pestilence-carrier of the lying-in chamber must look +to God for pardon, for man will never forgive him. + + + THE CONTAGIOUSNESS OF PUERPERAL FEVER. + +In collecting, enforcing, and adding to the evidence accumulated upon +this most serious subject, I would not be understood to imply that there +exists a doubt in the mind of any well-informed member of the medical +profession as to the fact that puerperal fever is sometimes communicated +from one person to another, both directly and indirectly. In the present +state of our knowledge upon this point I should consider such doubts +merely as a proof that the sceptic had either not examined the evidence, +or, having examined it, refused to accept its plain and unavoidable +consequences. I should be sorry to think, with Dr. Rigby, that it was +a case of “oblique vision;” I should be unwilling to force home the +argumentum ad hominem of Dr. Blundell, but I would not consent to make +a question of a momentous fact which is no longer to be considered as +a subject for trivial discussions, but to be acted upon with +silent promptitude. It signifies nothing that wise and experienced +practitioners have sometimes doubted the reality of the danger in +question; no man has the right to doubt it any longer. No negative +facts, no opposing opinions, be they what they may, or whose they may, +can form any answer to the series of cases now within the reach of all +who choose to explore the records of medical science. + +If there are some who conceive that any important end would be answered +by recording such opinions, or by collecting the history of all the +cases they could find in which no evidence of the influence of contagion +existed, I believe they are in error. Suppose a few writers of authority +can be found to profess a disbelief in contagion,--and they are very few +compared with those who think differently,--is it quite clear that they +formed their opinions on a view of all the facts, or is it not apparent +that they relied mostly on their own solitary experience? Still further, +of those whose names are quoted, is it not true that scarcely a single +one could by any possibility have known the half or the tenth of the +facts bearing on the subject which have reached such a frightful amount +within the last few years? Again, as to the utility of negative facts, +as we may briefly call them,--instances, namely, in which exposure has +not been followed by disease,--although, like other truths, they may +be worth knowing, I do not see that they are like to shed any important +light upon the subject before us. Every such instance requires a good +deal of circumstantial explanation before it can be accepted. It is not +enough that a practitioner should have had a single case of puerperal +fever not followed by others. It must be known whether he attended +others while this case was in progress, whether he went directly from +one chamber to others, whether he took any, and what precautions. It is +important to know that several women were exposed to infection +derived from the patient, so that allowance may be made for want of +predisposition. Now if of negative facts so sifted there could be +accumulated a hundred for every one plain instance of communication here +recorded, I trust it need not be said that we are bound to guard and +watch over the hundredth tenant of our fold, though the ninety and +nine may be sure of escaping the wolf at its entrance. If any one is +disposed, then, to take a hundred instances of lives endangered or +sacrificed out of those I have mentioned, and make it reasonably clear +that within a similar time and compass ten thousand escaped the same +exposure, I shall thank him for his industry, but I must be permitted to +hold to my own practical conclusions, and beg him to adopt or at least +to examine them also. Children that walk in calico before open fires are +not always burned to death; the instances to the contrary may be worth +recording; but by no means if they are to be used as arguments against +woollen frocks and high fenders. + +I am not sure that this paper will escape another remark which it might +be wished were founded in justice. It may be said that the facts are +too generally known and acknowledged to require any formal argument or +exposition, that there is nothing new in the positions advanced, and +no need of laying additional statements before the Profession. But on +turning to two works, one almost universally, and the other extensively +appealed to as authority in this country, I see ample reason to +overlook this objection. In the last edition of Dewees's Treatise on the +“Diseases of Females,” it is expressly said, “In this country, under no +circumstance that puerperal fever has appeared hitherto, does it afford +the slightest ground for the belief that it is contagious.” In the +“Philadelphia Practice of Midwifery” not one word can be found in the +chapter devoted to this disease which would lead the reader to suspect +that the idea of contagion had ever been entertained. It seems proper, +therefore, to remind those who are in the habit of referring to these +works for guidance, that there may possibly be some sources of danger +they have slighted or omitted, quite as important as a trifling +irregularity of diet, or a confined state of the bowels, and that +whatever confidence a physician may have in his own mode of treatment, +his services are of questionable value whenever he carries the bane as +well as the antidote about his person. + +The practical point to be illustrated is the following: + +The disease known as Puerperal Fever is so far contagious as to be +frequently carried from patient to patient by physicians and nurses. + +Let me begin by throwing out certain incidental questions, which, +without being absolutely essential, would render the subject more +complicated, and by making such concessions and assumptions as may be +fairly supposed to be without the pale of discussion. + +1. It is granted that all the forms of what is called puerperal fever +may not be, and probably are not, equally contagious or infectious. I +do not enter into the distinctions which have been drawn by authors, +because the facts do not appear to me sufficient to establish any +absolute line of demarcation between such forms as may be propagated by +contagion and those which are never so propagated. This general result I +shall only support by the authority of Dr. Ramsbotham, who gives, as the +result of his experience, that the same symptoms belong to what he calls +the infectious and the sporadic forms of the disease, and the opinion +of Armstrong in his original Essay. If others can show any such +distinction, I leave it to them to do it. But there are cases enough +that show the prevalence of the disease among the patients of a single +practitioner when it was in no degree epidemic, in the proper sense +of the term. I may refer to those of Mr. Roberton and of Dr. Peirson, +hereafter to be cited, as examples. + +2. I shall not enter into any dispute about the particular mode of +infection, whether it be by the atmosphere the physician carries about +him into the sick-chamber, or by the direct application of the virus to +the absorbing surfaces with which his hand comes in contact. Many facts +and opinions are in favor of each of these modes of transmission. But it +is obvious that in the majority of cases it must be impossible to decide +by which of these channels the disease is conveyed, from the nature of +the intercourse between the physician and the patient. + +3. It is not pretended that the contagion of puerperal fever must always +be followed by the disease. It is true of all contagious diseases, that +they frequently spare those who appear to be fully submitted to their +influence. Even the vaccine virus, fresh from the subject, fails every +day to produce its legitimate effect, though every precaution is taken +to insure its action. This is still more remarkably the case with +scarlet fever and some other diseases. + +4. It is granted that the disease may be produced and variously modified +by many causes besides contagion, and more especially by epidemic and +endemic influences. But this is not peculiar to the disease in question. +There is no doubt that small-pox is propagated to a great extent by +contagion, yet it goes through the same periods of periodical increase +and diminution which have been remarked in puerperal fever. If the +question is asked how we are to reconcile the great variations in the +mortality of puerperal fever in different seasons and places with the +supposition of contagion, I will answer it by another question from +Mr. Farr's letter to the Registrar-General. He makes the statement that +“five die weekly of small-pox in the metropolis when the disease is not +epidemic,”--and adds, “The problem for solution is,--Why do the five +deaths become 10, 15, 20, 31, 58, 88, weekly, and then progressively +fall through the same measured steps?” + +5. I take it for granted, that if it can be shown that great numbers +of lives have been and are sacrificed to ignorance or blindness on this +point, no other error of which physicians or nurses may be occasionally +suspected will be alleged in palliation of this; but that whenever and +wherever they can be shown to carry disease and death instead of health +and safety, the common instincts of humanity will silence every attempt +to explain away their responsibility. + +The treatise of Dr. Gordon of Aberdeen was published in the year 1795, +being among the earlier special works upon the disease. Apart of +his testimony has been occasionally copied into other works, but his +expressions are so clear, his experience is given with such manly +distinctness and disinterested honesty, that it may be quoted as a model +which might have been often followed with advantage. + +“This disease seized such women only as were visited, or delivered by a +practitioner, or taken care of by a nurse, who had previously attended +patients affected with the disease.” + +“I had evident proofs of its infectious nature, and that the infection +was as readily communicated as that of the small-pox or measles, +and operated more speedily than any other infection with which I am +acquainted.” + +“I had evident proofs that every person who had been with a patient +in the puerperal fever became charged with an atmosphere of infection, +which was communicated to every pregnant woman who happened to come +within its sphere. This is not an assertion, but a fact, admitting +of demonstration, as may be seen by a perusal of the foregoing +table,”--referring to a table of seventy-seven cases, in many of which +the channel of propagation was evident. + +He adds, “It is a disagreeable declaration for me to mention, that I +myself was the means of carrying the infection to a great number of +women.” He then enumerates a number of instances in which the disease +was conveyed by midwives and others to the neighboring villages, and +declares that “these facts fully prove that the cause of the puerperal +fever, of which I treat, was a specific contagion, or infection, +altogether unconnected with a noxious constitution of the atmosphere.” + +But his most terrible evidence is given in these words: “I ARRIVED AT +THAT CERTAINTY IN THE MATTER, THAT I COULD VENTURE TO FORETELL WHAT +WOMEN WOULD BE AFFECTED WITH THE DISEASE, UPON HEARING BY WHAT MIDWIFE +THEY WERE TO BE DELIVERED, OR BY WHAT NURSE THEY WERE TO BE ATTENDED, +DURING THEIR LYING-IN: AND ALMOST IN EVERY INSTANCE, MY PREDICTION WAS +VERIFIED.” + +Even previously to Gordon, Mr. White of Manchester had said, “I am +acquainted with two gentlemen in another town, where the whole business +of midwifery is divided betwixt them, and it is very remarkable that one +of them loses several patients every year of the puerperal fever, and +the other never so much as meets with the disorder,”--a difference +which he seems to attribute to their various modes of treatment. [On the +Management of Lying-in Women, p. 120.] + +Dr. Armstrong has given a number of instances in his Essay on Puerperal +Fever, of the prevalence of the disease among the patients of a single +practitioner. At Sunderland, “in all, forty-three cases occurred from +the 1st of January to the 1st of October, when the disease ceased; and +of this number forty were witnessed by Mr. Gregson and his assistant, +Mr. Gregory, the remainder having been separately seen by three +accoucheurs.” There is appended to the London edition of this Essay, a +letter from Mr. Gregson, in which that gentleman says, in reference to +the great number of cases occurring in his practice, “The cause of this +I cannot pretend fully to explain, but I should be wanting in common +liberality if I were to make any hesitation in asserting, that the +disease which appeared in my practice was highly contagious, and +communicable from one puerperal woman to another.” “It is customary +among the lower and middle ranks of people to make frequent personal +visits to puerperal women resident in the same neighborhood, and I have +ample evidence for affirming that the infection of the disease was often +carried about in that manner; and, however painful to my feelings, +I must in candor declare, that it is very probable the contagion was +conveyed, in some instances, by myself, though I took every possible +care to prevent such a thing from happening, the moment that I +ascertained that the distemper was infectious.” Dr. Armstrong goes on to +mention six other instances within his knowledge, in which the disease +had at different times and places been limited, in the same singular +manner, to the practice of individuals, while it existed scarcely if +at all among the patients of others around them. Two of the gentlemen +became so convinced of their conveying the contagion, that they withdrew +for a time from practice. + +I find a brief notice, in an American Journal, of another series of +cases, first mentioned by Mr. Davies, in the “Medical Repository.” This +gentleman stated his conviction that the disease is contagious. + +“In the autumn of 1822 he met with twelve cases, while his medical +friends in the neighborhood did not meet with any, 'or at least very +few.' He could attribute this circumstance to no other cause than his +having been present at the examination, after death, of two cases, some +time previous, and of his having imparted the disease to his patients, +notwithstanding every precaution.” + +Dr. Gooch says, “It is not uncommon for the greater number of cases to +occur in the practice of one man, whilst the other practitioners of the +neighborhood, who are not more skilful or more busy, meet with few +or none. A practitioner opened the body of a woman who had died of +puerperal fever, and continued to wear the same clothes. A lady whom he +delivered a few days afterwards was attacked with and died of a similar +disease; two more of his lying-in patients, in rapid succession, met +with the same fate; struck by the thought, that he might have carried +contagion in his clothes, he instantly changed them, and 'met with no +more cases of the kind.' A woman in the country, who was employed as +washerwoman and nurse, washed the linen of one who had died of puerperal +fever; the next lying-in patient she nursed died of the same disease; +a third nursed by her met with the same fate, till the neighborhood, +getting afraid of her, ceased to employ her.” + +In the winter of the year 1824, “Several instances occurred of its +prevalence among the patients of particular practitioners, whilst others +who were equally busy met with few or none. One instance of this +kind was very remarkable. A general practitioner, in large midwifery +practice, lost so many patients from puerperal fever, that he determined +to deliver no more for some time, but that his partner should attend in +his place. This plan was pursued for one month, during which not a case +of the disease occurred in their practice. The elder practitioner, being +then sufficiently recovered, returned to his practice, but the first +patient he attended was attacked by the disease and died. A physician, +who met him in consultation soon afterwards, about a case of a different +kind, and who knew nothing of his misfortune, asked him whether +puerperal fever was at all prevalent in his neighborhood, on which he +burst into tears, and related the above circumstances. + +“Among the cases which I saw this season in consultation, four occurred +in one month in the practice of one medical man, and all of them +terminated fatally.” [Lond. Med. Gaz. May 2, 1835.] + +Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that +he had known the disease spread through a particular district, or be +confined to the practice of a particular person, almost every patient +being attacked with it, while others had not a single case. It seemed +capable, he thought, of conveyance, not only by common modes; but +through the dress of the attendants upon the patient. + +In a letter to be found in the “London Medical Gazette” for January, +1840, Mr. Roberton of Manchester makes the statement which I here give +in a somewhat condensed form. + +A midwife delivered a woman on the 4th of December, 1830, who died soon +after with the symptoms of puerperal fever. In one month from this date +the same midwife delivered thirty women, residing in different parts of +an extensive suburb, of which number sixteen caught the disease and all +died. These were the only cases which had occurred for a considerable +time in Manchester. The other midwives connected with the same +charitable institution as the woman already mentioned are twenty-five in +number, and deliver, on an average, ninety women a week, or about three +hundred and eighty a month. None of these women had a case of puerperal +fever. “Yet all this time this woman was crossing the other midwives in +every direction, scores of the patients of the charity being delivered +by them in the very same quarters where her cases of fever were +happening.” + +Mr. Roberton remarks, that little more than half the women she delivered +during this month took the fever; that on some days all escaped, on +others only one or more out of three or four; a circumstance similar to +what is seen in other infectious maladies. + +Dr. Blundell says, “Those who have never made the experiment can have +but a faint conception how difficult it is to obtain the exact truth +respecting any occurrence in which feelings and interests are concerned. +Omitting particulars, then, I content myself with remarking, generally, +that from more than one district I have received accounts of the +prevalence of puerperal fever in the practice of some individuals, while +its occurrence in that of others, in the same neighborhood, was not +observed. Some, as I have been told, have lost ten, twelve, or a greater +number of patients, in scarcely broken succession; like their evil +genius, the puerperal fever has seemed to stalk behind them wherever +they went. Some have deemed it prudent to retire for a time from +practice. In fine, that this fever may occur spontaneously, I admit; +that its infectious nature may be plausibly disputed, I do not deny; but +I add, considerately, that in my own family I had rather that those +I esteemed the most should be delivered, unaided, in a stable, by the +manger-side, than that they should receive the best help, in the fairest +apartment, but exposed to the vapors of this pitiless disease. Gossiping +friends, wet-nurses, monthly nurses, the practitioner himself, these +are the channels by which, as I suspect, the infection is principally +conveyed.” + +At a meeting of the Royal Medical and Chirurgical Society, Dr. King +mentioned that some years since a practitioner at Woolwich lost sixteen +patients from puerperal fever in the same year. He was compelled to give +up practice for one or two years, his business being divided among +the neighboring practitioners. No case of puerperal fever occurred +afterwards, neither had any of the neighboring surgeons any cases of +this disease. + +At the same meeting Mr. Hutchinson mentioned the occurrence of three +consecutive cases of puerperal fever, followed subsequently by two +others, all in the practice of one accoucheur.[Lancet, May 2, 1840.] + +Dr. Lee makes the following statement: “In the last two weeks of +September, 1827, five fatal cases of uterine inflammation came under our +observation. All the individuals so attacked had been attended in labor +by the same midwife, and no example of a febrile or inflammatory disease +of a serious nature occurred during that period among the other patients +of the Westminster General Dispensary, who had been attended by the +other midwives belonging to that institution.” + +The recurrence of long series of cases like those I have cited, reported +by those most interested to disbelieve in contagion, scattered +along through an interval of half a century, might have been thought +sufficient to satisfy the minds of all inquirers that here was +something more than a singular coincidence. But if, on a more extended +observation, it should be found that the same ominous groups of cases +clustering about individual practitioners were observed in a remote +country, at different times, and in widely separated regions, it would +seem incredible that any should be found too prejudiced or indolent to +accept the solemn truth knelled into their ears by the funeral bells +from both sides of the ocean,--the plain conclusion that the physician +and the disease entered, hand in hand, into the chamber of the +unsuspecting patient. + +That such series of cases have been observed in this country, and in +this neighborhood, I proceed to show. + +In Dr. Francis's “Notes to Denman's Midwifery,” a passage is cited from +Dr. Hosack, in which he refers to certain puerperal cases which proved +fatal to several lying-in women, and in some of which the disease was +supposed to be conveyed by the accoucheurs themselves. + +A writer in the “New York Medical and Physical Journal” for October, +1829, in speaking of the occurrence of puerperal fever, confined to one +man's practice, remarks, “We have known cases of this kind occur, though +rarely, in New York.” + +I mention these little hints about the occurrence of such cases, +partly because they are the first I have met with in American medical +literature, but more especially because they serve to remind us that +behind the fearful array of published facts there lies a dark list of +similar events, unwritten in the records of science, but long remembered +by many a desolated fireside. + +Certainly nothing can be more open and explicit than the account given +by Dr. Peirson of Salem, of the cases seen by him. In the first nineteen +days of January, 1829, he had five consecutive cases of puerperal fever, +every patient he attended being attacked, and the three first cases +proving fatal. In March of the same year he had two moderate cases, in +June, another case, and in July, another, which proved fatal. “Up to +this period,” he remarks, “I am not informed that a single case had +occurred in the practice of any other physician. Since that period +I have had no fatal case in my practice, although I have had several +dangerous cases. I have attended in all twenty cases of this disease, of +which four have been fatal. I am not aware that there has been any +other case in the town of distinct puerperal peritonitis, although I am +willing to admit my information may be very defective on this point. +I have been told of some 'mixed cases,' and 'morbid affections after +delivery.'” + +In the “Quarterly Summary of the Transactions of the College of +Physicians of Philadelphia” may be found some most extraordinary +developments respecting a series of cases occurring in the practice of a +member of that body. + +Dr. Condie called the attention of the Society to the prevalence, at the +present time, of puerperal fever of a peculiarly insidious and malignant +character. “In the practice of one gentleman extensively engaged as an +obstetrician, nearly every female he has attended in confinement, during +several weeks past, within the above limits” (the southern sections and +neighboring districts), “had been attacked by the fever.” + +“An important query presents itself, the Doctor observed, in reference +to the particular form of fever now prevalent. Is it, namely, capable +of being propagated by contagion, and is a physician who has been in +attendance upon a case of the disease warranted in continuing, without +interruption, his practice as an obstetrician? Dr. C., although not +a believer in the contagious character of many of those affections +generally supposed to be propagated in this manner, has nevertheless +become convinced by the facts that have fallen under his notice, that +the puerperal fever now prevailing is capable of being communicated by +contagion. How otherwise can be explained the very curious circumstance +of the disease in one district being exclusively confined to the +practice of a single physician, a Fellow of this College, extensively +engaged in obstetrical practice,--while no instance of the disease +has occurred in the patients under the care of any other accoucheur +practising within the same district; scarcely a female that has been +delivered for weeks past has escaped an attack?” + +Dr. Rutter, the practitioner referred to, “observed that, after the +occurrence of a number of cases of the disease in his practice, he +had left the city and remained absent for a week, but on returning, no +article of clothing he then wore having been used by him before, one +of the very first cases of parturition he attended was followed by +an attack of the fever, and terminated fatally; he cannot, readily, +therefore, believe in the transmission of the disease from female to +female, in the person or clothes of the physician.” + +The meeting at which these remarks were made was held on the 3d of May, +1842. In a letter dated December 20, 1842, addressed to Dr. Meigs, and +to be found in the “Medical Examiner,” he speaks of “those horrible +cases of puerperal fever, some of which you did me the favor to see with +me during the past summer,” and talks of his experience in the disease, +“now numbering nearly seventy cases, all of which have occurred within +less than a twelvemonth past.” + +And Dr. Meigs asserts, on the same page, “Indeed, I believe that his +practice in that department of the profession was greater than that +of any other gentleman, which was probably the cause of his seeing a +greater number of the cases.” This from a professor of midwifery, who +some time ago assured a gentleman whom he met in consultation, that the +night on which they met was the eighteenth in succession that he himself +had been summoned from his repose, seems hardly satisfactory. + +I must call the attention of the inquirer most particularly to the +Quarterly Report above referred to, and the letters of Dr. Meigs and Dr. +Rutter, to be found in the “Medical Examiner.” Whatever impression they +may produce upon his mind, I trust they will at least convince him +that there is some reason for looking into this apparently uninviting +subject. + +At a meeting of the College of Physicians just mentioned, Dr. Warrington +stated, that a few days after assisting at an autopsy of puerperal +peritonitis, in which he laded out the contents of the abdominal cavity +with his hands, he was called upon to deliver three women in rapid +succession. All of these women were attacked with different forms of +what is commonly called puerperal fever. Soon after these he saw two +other patients, both on the same day, with the same disease. Of these +five patients two died. + +At the same meeting, Dr. West mentioned a fact related to him by Dr. +Samuel Jackson of Northumberland. Seven females, delivered by Dr. +Jackson in rapid succession, while practising in Northumberland County, +were all attacked with puerperal fever, and five of them died. “Women,” + he said, “who had expected me to attend upon them, now becoming alarmed, +removed out of my reach, and others sent for a physician residing +several miles distant. These women, as well as those attended by +midwives; all did well; nor did we hear of any deaths in child-bed +within a radius of fifty miles, excepting two, and these I afterwards +ascertained to have been caused by other diseases.” He underwent, as +he thought, a thorough purification, and still his next patient was +attacked with the disease and died. He was led to suspect that the +contagion might have been carried in the gloves which he had worn in +attendance upon the previous cases. Two months or more after this he had +two other cases. He could find nothing to account for these, unless it +were the instruments for giving enemata, which had been used in two of +the former cases, and were employed by these patients. When the +first case occurred, he was attending and dressing a limb extensively +mortified from erysipelas, and went immediately to the accouchement with +his clothes and gloves most thoroughly imbued with its efluvia. And here +I may mention, that this very Dr. Samuel Jackson of Northumberland is +one of Dr. Dewees's authorities against contagion. + +The three following statements are now for the first time given to the +public. All of the cases referred to occurred within this State, and two +of the three series in Boston and its immediate vicinity. + +I. The first is a series of cases which took place during the last +spring in a town at some distance from this neighborhood. A physician of +that town, Dr. C., had the following consecutive cases. + + + No. 1, delivered March 20, died March 24. + “ 2, “ April 9, “ April 14. + “ 3, “ “ 10, “ “ 14. + “ 4, “ “ 11, “ “ 18. + “ 5, “ “ 27, “ May 3. + “ 6, “ “ 28, had some symptoms, (recovered.) + “ 7, “ May 8, had some symptoms, (also recovered.) + +These were the only cases attended by this physician during the period +referred to. “They were all attended by him until their termination, +with the exception of the patient No. 6, who fell into the hands of +another physician on the 2d of May. (Dr. C. left town for a few days +at this time.) Dr. C. attended cases immediately before and after the +above-named periods, none of which, however, presented any peculiar +symptoms of the disease.” + +About the 1st of July he attended another patient in a neighboring +village, who died two or three days after delivery. + +The first patient, it is stated, was delivered on the 20th of March. “On +the 19th, Dr. C. made the autopsy of a man who died suddenly, sick only +forty-eight hours; had oedema of the thigh, and gangrene extending from +a little above the ankle into the cavity of the abdomen.” Dr. C. wounded +himself, very slightly, in the right hand during the autopsy. The hand +was quite painful the night following, during his attendance on the +patient No. 1. He did not see this patient after the 20th, being +confined to the house, and very sick from the wound just mentioned, from +this time until the 3d of April. + +Several cases of erysipelas occurred in the house where the autopsy +mentioned above took place, soon after the examination. There were also +many cases of erysipelas in town at the time of the fatal puerperal +cases which have been mentioned. + +The nurse who laid out the body of the patient No. 3 was taken on the +evening of the same day with sore throat and erysipelas, and died in ten +days from the first attack. + +The nurse who laid out the body of the patient No. 4 was taken on the +day following with symptoms like those of this patient, and died in a +week, without any external marks of erysipelas. + +“No other cases of similar character with those of Dr. C. occurred in +the practice of any of the physicians in the town or vicinity at the +time. Deaths following confinement have occurred in the practice of +other physicians during the past year, but they were not cases of +puerperal fever. No post-mortem examinations were held in any of these +puerperal cases.” + +Some additional statements in this letter are deserving of insertion. + +“A physician attended a woman in the immediate neighborhood of the cases +numbered 2, 3, and 4. This patient was confined the morning of March +1st, and died on the night of March 7th. It is doubtful whether this +should be considered a case of puerperal fever. She had suffered from +canker, indigestion, and diarrhoea for a year previous to her delivery. +Her complaints were much aggravated for two or three months previous +to delivery; she had become greatly emaciated, and weakened to such an +extent that it had not been expected that she would long survive her +confinement, if indeed she reached that period. Her labor was easy +enough; she flowed a good deal, seemed exceedingly prostrated, had +ringing in the ears, and other symptoms of exhaustion; the pulse was +quick and small. On the second and third day there was some tenderness +and tumefaction of the abdomen, which increased somewhat on the fourth +and fifth. He had cases in midwifery before and after this, which +presented nothing peculiar.” + +It is also mentioned in the same letter, that another physician had +a case during the last summer and another last fall, both of which +recovered. + +Another gentleman reports a case last December, a second case five +weeks, and another three weeks since. All these recovered. A case also +occurred very recently in the practice of a physician in the village +where the eighth patient of Dr. C. resides, which proved fatal. “This +patient had some patches of erysipelas on the legs and arms. The same +physician has delivered three cases since, which have all done well. +There have been no other cases in this town or its vicinity recently. +There have been some few cases of erysipelas.” It deserves notice +that the partner of Dr. C., who attended the autopsy of the man above +mentioned and took an active part in it; who also suffered very slightly +from a prick under the thumb-nail received during the examination, had +twelve cases of midwifery between March 26th and April 12th, all of +which did well, and presented no peculiar symptoms. It should also be +stated, that during these seventeen days he was in attendance on all the +cases of erysipelas in the house where the autopsy had been performed. + +I owe these facts to the prompt kindness of a gentleman whose +intelligence and character are sufficient guaranty for their accuracy. + +The two following letters were addressed to my friend Dr. Scorer, by the +gentleman in whose practice the cases of puerperal fever occurred. +His name renders it unnecessary to refer more particularly to these +gentlemen, who on their part have manifested the most perfect freedom +and courtesy in affording these accounts of their painful experience. + +“January 28, 1843. + +II.... “The time to which you allude was in 1830. The first case was in +February, during a very cold time. She was confined the 4th, and died +the 12th. Between the 10th and 28th of this month, I attended six women +in labor, all of whom did well except the last, as also two who were +confined March 1st and 5th. Mrs. E., confined February 28th, sickened, +and died March 8th. The next day, 9th, I inspected the body, and the +night after attended a lady, Mrs. B., who sickened, and died 16th. The +10th, I attended another, Mrs. G., who sickened, but recovered. March +16th, I went from Mrs. G.'s room to attend a Mrs. H., who sickened, and +died 21st. The 17th, I inspected Mrs. B. On the 19th, I went directly +from Mrs. H.'s room to attend another lady, Mrs. G., who also sickened, +and died 22d. While Mrs. B. was sick, on 15th, I went directly from her +room a few rods, and attended another woman, who was not sick. Up to +20th of this month I wore the same clothes. I now refused to attend any +labor, and did not till April 21st, when, having thoroughly cleansed +myself, I resumed my practice, and had no more puerperal fever. + +“The cases were not confined to a narrow space. The two nearest were +half a mile from each other, and half that distance from my residence. +The others were from two to three miles apart, and nearly that distance +from my residence. There were no other cases in their immediate vicinity +which came to my knowledge. The general health of all the women was +pretty good, and all the labors as good as common, except the first. +This woman, in consequence of my not arriving in season, and the child +being half-born at some time before I arrived, was very much exposed to +the cold at the time of confinement, and afterwards, being confined in a +very open, cold room. Of the six cases you perceive only one recovered. + +“In the winter of 1817 two of my patients had puerperal fever, one very +badly, the other not so badly. Both recovered. One other had swelled +leg, or phlegmasia dolens, and one or two others did not recover as well +as usual. + +“In the summer of 1835 another disastrous period occurred in my +practice. July 1st, I attended a lady in labor, who was afterwards quite +ill and feverish; but at the time I did not consider her case a decided +puerperal fever. On the 8th, I attended one who did well. On the 12th, +one who was seriously sick. This was also an equivocal case, apparently +arising from constipation and irritation of the rectum. These women were +ten miles apart and five from my residence. On 15th and 20th, two who +did well. On 25th, I attended another. This was a severe labor, and +followed by unequivocal puerperal fever, or peritonitis. She recovered. +August 2d and 3d, in about twenty-four hours I attended four persons. +Two of them did very well; one was attacked with some of the common +symptoms, which however subsided in a day or two, and the other had +decided puerperal fever, but recovered. This woman resided five miles +from me. Up to this time I wore the same coat. All my other clothes had +frequently been changed. On 6th, I attended two women, one of whom was +not sick at all; but the other, Mrs. L., was afterwards taken ill. On +10th, I attended a lady, who did very well. I had previously changed all +my clothes, and had no garment on which had been in a puerperal room. On +12th, I was called to Mrs. S., in labor. While she was ill, I left her +to visit Mrs. L., one of the ladies who was confined on 6th. Mrs. L. had +been more unwell than usual, but I had not considered her case anything +more than common till this visit. I had on a surtout at this visit, +which, on my return to Mrs. S., I left in another room. Mrs. S. was +delivered on 13th with forceps. These women both died of decided +puerperal fever. + +“While I attended these women in their fevers, I changed my clothes, and +washed my hands in a solution of chloride of lime after each visit. I +attended seven women in labor during this period, all of whom recovered +without sickness. + +“In my practice I have had several single cases of puerperal fever, some +of whom have died and some have recovered. Until the year 1830 I had +no suspicion that the disease could be communicated from one patient +to another by a nurse or midwife; but I now think the foregoing facts +strongly favor that idea. I was so much convinced of this fact, that I +adopted the plan before related. + +“I believe my own health was as good as usual at each of the above +periods. I have no recollections to the contrary. + +“I believe I have answered all your questions. I have been more +particular on some points perhaps than necessary; but I thought you +could form your own opinion better than to take mine. In 1830 I wrote +to Dr. Charming a more particular statement of my cases. If I have not +answered your questions sufficiently, perhaps Dr. C. may have my letter +to him, and you can find your answer there.” [In a letter to myself, +this gentleman also stated, “I do not recollect that there was any +erysipelas or any other disease particularly prevalent at the time.”] + +“BOSTON, February 3, 1843. + +III. “MY DEAR SIR,--I received a note from you last evening, requesting +me to answer certain questions therein proposed, touching the cases +of puerperal fever which came under my observation the past summer. It +gives me pleasure to comply with your request, so far as it is in my +power so to do, but, owing to the hurry in preparing for a journey, the +notes of the cases I had then taken were lost or mislaid. The principal +facts, however, are too vivid upon my recollection to be soon forgotten. +I think, therefore, that I shall be able to give you all the information +you may require. + +“All the cases that occurred in my practice took place between the 7th +of May and the 17th of June 1842. + +“They were not confined to any particular part of the city. The first +two cases were patients residing at the South End, the next was at the +extreme North End, one living in Sea Street and the other in Roxbury. +The following is the order in which they occurred: + +“Case 1. Mrs.______ was confined on the 7th of May, at 5 o'clock, P. M., +after a natural labor of six hours. At 12 o'clock at night, on the 9th +(thirty-one hours after confinement), she was taken with severe chill, +previous to which she was as comfortable as women usually are under the +circumstances. She died on the 10th. + +“Case 2. Mrs.______ was confined on the 10th of June (four weeks after +Mrs. C.), at 11 A. M., after a natural, but somewhat severe labor of +five hours. At 7 o'clock, on the morning of the 11th, she had a chill. +Died on the 12th. + +“Case 3. Mrs.______, confined on the 14th of June, was comfortable until +the 18th, when symptoms of puerperal fever were manifest. She died on +the 20th. + +“Case 4. Mrs.______, confined June 17th, at 5 o'clock, A. M., was doing +well until the morning of the 19th. She died on the evening of the 21st. + +“Case 5. Mrs.______ was confined with her fifth child on the 17th of +June, at 6 o'clock in the evening. This patient had been attacked with +puerperal fever, at three of her previous confinements, but the disease +yielded to depletion and other remedies without difficulty. This time, I +regret to say, I was not so fortunate. She was not attacked, as were the +other patients, with a chill, but complained of extreme pain in abdomen, +and tenderness on pressure, almost from the moment of her confinement. +In this as in the other cases, the disease resisted all remedies, and +she died in great distress on the 22d of the same month. Owing to +the extreme heat of the season, and my own indisposition, none of the +subjects were examined after death. Dr. Channing, who was in attendance +with me on the three last cases, proposed to have a post-mortem +examination of the subject of case No. 5, but from some cause which I do +not now recollect it was not obtained. + +“You wish to know whether I wore the same clothes when attending the +different cases. I cannot positively say, but I should think I did not, +as the weather became warmer after the first two cases; I therefore +think it probable that I made a change of at least a part of my dress. +I have had no other case of puerperal fever in my own practice for three +years, save those above related, and I do not remember to have lost a +patient before with this disease. While absent, last July, I visited +two patients sick with puerperal fever, with a friend of mine in the +country. Both of them recovered. + +“The cases that I have recorded were not confined to any particular +constitution or temperament, but it seized upon the strong and the weak, +the old and the young,--one being over forty years, and the youngest +under eighteen years of age.... If the disease is of an erysipelatous +nature, as many suppose, contagionists may perhaps find some ground for +their belief in the fact, that, for two weeks previous to my first case +of puerperal fever, I had been attending a severe case of erysipelas, +and the infection may have been conveyed through me to the patient; but, +on the other hand, why is not this the case with other physicians, +or with the same physician at all times, for since my return from +the country I have had a more inveterate case of erysipelas than ever +before, and no difficulty whatever has attended any of my midwifery +cases?” + +I am assured, on unquestionable authority, that “About three years +since, a gentleman in extensive midwifery business, in a neighboring +State, lost in the course of a few weeks eight patients in child-bed, +seven of them being undoubted cases of puerperal fever. No other +physician of the town lost a single patient of this disease during the +same period.” And from what I have heard in conversation with some of +our most experienced practitioners, I am inclined to think many cases of +the kind might be brought to light by extensive inquiry. + +This long catalogue of melancholy histories assumes a still darker +aspect when we remember how kindly nature deals with the parturient +female, when she is not immersed in the virulent atmosphere of an impure +lying-in hospital, or poisoned in her chamber by the unsuspected breath +of contagion. From all causes together, not more than four deaths in a +thousand births and miscarriages happened in England and Wales during +the period embraced by the first “Report of the Registrar-General.” + In the second Report the mortality was shown to be about five in one +thousand. In the Dublin Lying-in Hospital, during the seven years of +Dr. Collins's mastership, there was one case of puerperal fever to 178 +deliveries, or less than six to the thousand, and one death from this +disease in 278 cases, or between three and four to the thousand a yet +during this period the disease was endemic in the hospital, and might +have gone on to rival the horrors of the pestilence of the Maternite, +had not the poison been destroyed by a thorough purification. + +In private practice, leaving out of view the cases that are to be +ascribed to the self-acting system of propagation, it would seem that +the disease must be far from common. Mr. White of Manchester says, “Out +of the whole number of lying-in patients whom I have delivered (and I +may safely call it a great one), I have never lost one, nor to the best +of my recollection has one been greatly endangered, by the puerperal, +miliary, low nervous, putrid malignant, or milk fever.” Dr. Joseph +Clarke informed Dr. Collins, that in the course of forty-five years' +most extensive practice he lost but four patients from this disease. One +of the most eminent practitioners of Glasgow, who has been engaged in +very extensive practice for upwards of a quarter of a century, testifies +that he never saw more than twelve cases of real puerperal fever. +[Lancet, May 4, 1833] + +I have myself been told by two gentlemen practising in this city, and +having for many years a large midwifery business, that they had neither +of them lost a patient from this disease, and by one of them that he +had only seen it in consultation with other physicians. In five hundred +cases of midwifery, of which Dr. Storer has given an abstract in the +first number of this Journal, there was only one instance of fatal +puerperal peritonitis. + +In the view of these facts, it does appear a singular coincidence, that +one man or woman should have ten, twenty, thirty, or seventy cases of +this rare disease following his or her footsteps with the keenness of +a beagle, through the streets and lanes of a crowded city, while the +scores that cross the same paths on the same errands know it only +by name. It is a series of similar coincidences which has led us to +consider the dagger, the musket, and certain innocent-looking white +powders as having some little claim to be regarded as dangerous. It is +the practical inattention to similar coincidences which has given rise +to the unpleasant but often necessary documents called indictments, +which has sharpened a form of the cephalotome sometimes employed in +the case of adults, and adjusted that modification of the fillet which +delivers the world of those who happen to be too much in the way while +such striking coincidences are taking place. + +I shall now mention a few instances in which the disease appears to have +been conveyed by the process of direct inoculation. + +Dr. Campbell of Edinburgh states that in October, 1821, he assisted at +the post-mortem examination of a patient who died with puerperal fever. +He carried the pelvic viscera in his pocket to the class-room. The same +evening he attended a woman in labor without previously changing his +clothes; this patient died. The next morning he delivered a woman with +the forceps; she died also, and of many others who were seized with the +disease within a few weeks, three shared the same fate in succession. + +In June, 1823, he assisted some of his pupils at the autopsy of a case +of puerperal fever. He was unable to wash his hands with proper care, +for want of the necessary accommodations. On getting home he found that +two patients required his assistance. He went without further ablution, +or changing his clothes; both these patients died with puerperal fever. +This same Dr. Campbell is one of Dr. Churchill's authorities against +contagion. + +Mr. Roberton says that in one instance within his knowledge a +practitioner passed the catheter for a patient with puerperal fever late +in the evening; the same night he attended a lady who had the symptoms +of the disease on the second day. In another instance a surgeon was +called while in the act of inspecting the body of a woman who had died +of this fever, to attend a labor; within forty-eight hours this patient +was seized with the fever.' + +On the 16th of March, 1831, a medical practitioner examined the body +of a woman who had died a few days after delivery, from puerperal +peritonitis. On the evening of the 17th he delivered a patient, who was +seized with puerperal fever on the 19th, and died on the 24th. Between +this period and the 6th of April, the same practitioner attended two +other patients, both of whom were attacked with the same disease and +died. + +In the autumn of 1829 a physician was present at the examination of +a case of puerperal fever, dissected out the organs, and assisted in +sewing up the body. He had scarcely reached home when he was summoned to +attend a young lady in labor. In sixteen hours she was attacked with the +symptoms of puerperal fever, and narrowly escaped with her life. + +In December, 1830, a midwife, who had attended two fatal cases of +puerperal fever at the British Lying-in Hospital, examined a patient +who had just been admitted, to ascertain if labor had commenced. This +patient remained two days in the expectation that labor would come +on, when she returned home and was then suddenly taken in labor and +delivered before she could set out for the hospital. She went on +favorably for two days, and was then taken with puerperal fever and died +in thirty-six hours. + +“A young practitioner, contrary to advice, examined the body of a +patient who had died from puerperal fever; there was no epidemic at the +time; the case appeared to be purely sporadic. He delivered three +other women shortly afterwards; they all died with puerperal fever, the +symptoms of which broke out very soon after labor. The patients of his +colleague did well, except one, where he assisted to remove some coagula +from the uterus; she was attacked in the same manner as those whom he +had attended, and died also.” The writer in the “British and Foreign +Medical Review,” from whom I quote this statement,--and who is no +other than Dr. Rigby, adds, “We trust that this fact alone will forever +silence such doubts, and stamp the well-merited epithet of 'criminal,' +as above quoted, upon such attempts.” [Brit. and For. Medical Review for +Jan. 1842, p. 112.] + +From the cases given by Mr. Ingleby, I select the following. Two +gentlemen, after having been engaged in conducting the post-mortem +examination of a case of puerperal fever, went in the same dress, each +respectively, to a case of midwifery. “The one patient was seized with +the rigor about thirty hours afterwards. The other patient was seized +with a rigor the third morning after delivery. One recovered, one died.” + [Edin. Med. and Surg. Journal, April, 1838.] One of these same gentlemen +attended another woman in the same clothes two days after the autopsy +referred to. “The rigor did not take place until the evening of the +fifth day from the first visit. Result fatal.” These cases belonged to a +series of seven, the first of which was thought to have originated in +a case of erysipelas. “Several cases of a mild character followed the +foregoing seven, and their nature being now most unequivocal, my friend +declined visiting all midwifery cases for a time, and there was no +recurrence of the disease.” These cases occurred in 1833. Five of them +proved fatal. Mr. Ingleby gives another series of seven cases which +occurred to a practitioner in 1836, the first of which was also +attributed to his having opened several erysipelatous abscesses a short +time previously. + +I need not refer to the case lately read before this Society, in which a +physician went, soon after performing an autopsy of a case of puerperal +fever, to a woman in labor, who was seized with the same disease and +perished. The forfeit of that error has been already paid. + +At a meeting of the Medical and Chirurgical Society before referred to, +Dr. Merriman related an instance occurring in his own practice, which +excites a reasonable suspicion that two lives were sacrificed to a +still less dangerous experiment. He was at the examination of a case +of puerperal fever at two o'clock in the afternoon. He took care not to +touch the body. At nine o'clock the same evening he attended a woman in +labor; she was so nearly delivered that he had scarcely anything to do. +The next morning she had severe rigors, and in forty-eight hours she was +a corpse. Her infant had erysipelas and died in two days. [Lancet, May +2, 1840.] + +In connection with the facts which have been stated, it seems proper to +allude to the dangerous and often fatal effects which have followed from +wounds received in the post-mortem examination of patients who have died +of puerperal fever. The fact that such wounds are attended with peculiar +risk has been long noticed. I find that Chaussier was in the habit of +cautioning his students against the danger to which they were exposed in +these dissections. [Stein, L'Art d'Accoucher, 1794; Dict. des Sciences +Medicales, art. “Puerperal.”] The head pharmacien of the Hotel Dieu, in +his analysis of the fluid effused in puerperal peritonitis, says that +practitioners are convinced of its deleterious qualities, and that it is +very dangerous to apply it to the denuded skin. [Journal de Pharmacie, +January, 1836.] Sir Benjamin Brodie speaks of it as being well known +that the inoculation of lymph or pus from the peritoneum of a puerperal +patient is often attended with dangerous and even fatal symptoms. Three +cases in confirmation of this statement, two of them fatal, have been +reported to this Society within a few months. + +Of about fifty cases of injuries of this kind, of various degrees of +severity, which I have collected from different sources, at least twelve +were instances of infection from puerperal peritonitis. Some of the +others are so stated as to render it probable that they may have been of +the same nature. Five other cases were of peritoneal inflammation; +three in males. Three were what was called enteritis, in one instance +complicated with erysipelas; but it is well known that this term has +been often used to signify inflammation of the peritoneum covering the +intestines. On the other hand, no case of typhus or typhoid fever is +mentioned as giving rise to dangerous consequences, with the exception +of the single instance of an undertaker mentioned by Mr. Travers, who +seems to have been poisoned by a fluid which exuded from the body. +The other accidents were produced by dissection, or some other mode of +contact with bodies of patients who had died of various affections. +They also differed much in severity, the cases of puerperal origin being +among the most formidable and fatal. Now a moment's reflection will +show that the number of cases of serious consequences ensuing from the +dissection of the bodies of those who had perished of puerperal fever +is so vastly disproportioned to the relatively small number of autopsies +made in this complaint as compared with typhus or pneumonia (from which +last disease not one case of poisoning happened), and still more from +all diseases put together, that the conclusion is irresistible that +a most fearful morbid poison is often generated in the course of this +disease. Whether or not it is sui generis, confined to this disease, or +produced in some others, as, for instance, erysipelas, I need, not stop +to inquire. + +In connection with this may be taken the following statement of Dr. +Rigby. “That the discharges from a patient under puerperal fever are in +the highest degree contagious we have abundant evidence in the history +of lying-in hospitals. The puerperal abscesses are also contagious, and +may be communicated to healthy lying-in women by washing with the same +sponge; this fact has been repeatedly proved in the Vienna Hospital; but +they are equally communicable to women not pregnant; on more than +one occasion the women engaged in washing the soiled bed-linen of the +General Lying-in Hospital have been attacked with abscess in the fingers +or hands, attended with rapidly spreading inflammation of the cellular +tissue.” + +Now add to all this the undisputed fact, that within the walls of +lying-in hospitals there is often generated a miasm, palpable as the +chlorine used to destroy it, tenacious so as in some cases almost to +defy extirpation, deadly in some institutions as the plague; which has +killed women in a private hospital of London so fast that they were +buried two in one coffin to conceal its horrors; which enabled Tonnelle +to record two hundred and twenty-two autopsies at the Maternite of +Paris; which has led Dr. Lee to express his deliberate conviction that +the loss of life occasioned by these institutions completely defeats the +objects of their founders; and out of this train of cumulative evidence, +the multiplied groups of cases clustering about individuals, the deadly +results of autopsies, the inoculation by fluids from the living patient, +the murderous poison of hospitals,--does there not result a conclusion +that laughs all sophistry to scorn, and renders all argument an insult? + +I have had occasion to mention some instances in which there was an +apparent relation between puerperal fever and erysipelas. The length +to which this paper has extended does not allow me to enter into the +consideration of this most important subject. I will only say, that +the evidence appears to me altogether satisfactory that some most fatal +series of puerperal fever have been produced by an infection originating +in the matter or effluvia of erysipelas. In evidence of some connection +between the two diseases, I need not go back to the older authors, as +Pouteau or Gordon, but will content myself with giving the following +references, with their dates; from which it will be seen that the +testimony has been constantly coming before the profession for the last +few years. + +“London Cyclopaedia of Practical Medicine,” article Puerperal Fever, +1833. + +Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. “Lancet,” + 1835. + +Dr. Ramsbotham's Lecture. “London Medical Gazette,” 1835. + +Mr. Yates Ackerly's Letter in the same Journal, 1838. + +Mr. Ingleby on Epidemic Puerperal Fever. “Edinburgh Medical and Surgical +Journal,” 1838. + +Mr. Paley's Letter. “London Medical Gazette,” 1839. + +Remarks at the Medical and Chirurgical Society. “Lancet,” 1840. + +Dr. Rigby's “System of Midwifery.” 1841. + +“Nunneley on Erysipelas,”--a work which contains a large number of +references on the subject. 1841. + +“British and Foreign Quarterly Review,” 1842. + +Dr. S. Jackson of Northumberland, as already quoted from the Summary of +the College of Physicians, 1842. + +And lastly, a startling series of cases by Mr. Storrs of Doncaster, to +be found in the “American Journal of the Medical Sciences” for January, +1843. + +The relation of puerperal fever with other continued fevers would seem +to be remote and rarely obvious. Hey refers to two cases of synochus +occurring in the Royal Infirmary of Edinburgh, in women who had attended +upon puerperal patients. Dr. Collins refers to several instances +in which puerperal fever has appeared to originate from a continued +proximity to patients suffering with typhus. + +Such occurrences as those just mentioned, though most important to be +remembered and guarded against, hardly attract our notice in the midst +of the gloomy facts by which they are surrounded. Of these facts, at the +risk of fatiguing repetitions, I have summoned a sufficient number, as I +believe, to convince the most incredulous that every attempt to disguise +the truth which underlies them all is useless. + +It is true that some of the historians of the disease, especially +Hulme, Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, +in France, profess not to have found puerperal fever contagious. At the +most they give us mere negative facts, worthless against an extent of +evidence which now overlaps the widest range of doubt, and doubles +upon itself in the redundancy of superfluous demonstration. Examined in +detail, this and much of the show of testimony brought up to stare +the daylight of conviction out of countenance, proves to be in a great +measure unmeaning and inapplicable, as might be easily shown were it +necessary. Nor do I feel the necessity of enforcing the conclusion +which arises spontaneously from the facts which have been enumerated, by +formally citing the opinions of those grave authorities who have for the +last half-century been sounding the unwelcome truth it has cost so many +lives to establish. + +“It is to the British practitioner,” says Dr. Rigby, “that we are +indebted for strongly insisting upon this important and dangerous +character of puerperal fever.” + +The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton, +Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee, +Ingleby, Locock, Abercrombie, Alison, Travers, Rigby, and Watson, many +of whose writings I have already referred to, may have some influence +with those who prefer the weight of authorities to the simple deductions +of their own reason from the facts laid before them. A few Continental +writers have adopted similar conclusions. It gives me pleasure to +remember, that while the doctrine has been unceremoniously discredited +in one of the leading Journals, and made very light of by teachers in +two of the principal Medical Schools, of this country, Dr. Channing has +for many years inculcated, and enforced by examples, the danger to +be apprehended and the precautions to be taken in the disease under +consideration. + +I have no wish to express any harsh feeling with regard to the painful +subject which has come before us. If there are any so far excited by the +story of these dreadful events that they ask for some word of indignant +remonstrance to show that science does not turn the hearts of its +followers into ice or stone, let me remind them that such words have +been uttered by those who speak with an authority I could not claim. It +is as a lesson rather than as a reproach that I call up the memory +of these irreparable errors and wrongs. No tongue can tell the +heart-breaking calamity they have caused; they have closed the eyes +just opened upon a new world of love and happiness; they have bowed the +strength of manhood into the dust; they have cast the helplessness of +infancy into the stranger's arms, or bequeathed it, with less cruelty, +the death of its dying parent. There is no tone deep enough for regret, +and no voice loud enough for warning. The woman about to become a +mother, or with her new-born infant upon her bosom, should be the object +of trembling care and sympathy wherever she bears her tender burden, +or stretches her aching limbs. The very outcast of the streets has pity +upon her sister in degradation, when the seal of promised maternity is +impressed upon her. The remorseless vengeance of the law, brought down +upon its victim by a machinery as sure as destiny, is arrested in its +fall at a word which reveals her transient claim for mercy. The solemn +prayer of the liturgy singles out her sorrows from the multiplied trials +of life, to plead for her in the hour of peril. God forbid that any +member of the profession to which she trusts her life, doubly precious +at that eventful period, should hazard it negligently, unadvisedly, or +selfishly! + +There may be some among those whom I address who are disposed to ask the +question, What course are we to follow in relation to this matter? The +facts are before them, and the answer must be left to their own judgment +and conscience. If any should care to know my own conclusions, they are +the following; and in taking the liberty to state them very freely and +broadly, I would ask the inquirer to examine them as freely in the light +of the evidence which has been laid before him. + +1. A physician holding himself in readiness to attend cases of midwifery +should never take any active part in the post-mortem examination of +cases of puerperal fever. + +2. If a physician is present at such autopsies, he should use thorough +ablution, change every article of dress, and allow twenty-four hours or +more to elapse before attending to any case of midwifery. It may be well +to extend the same caution to cases of simple peritonitis. + +3. Similar precautions should be taken after the autopsy or surgical +treatment of cases of erysipelas, if the physician is obliged to unite +such offices with his obstetrical duties, which is in the highest degree +inexpedient. + +4. On the occurrence of a single case of puerperal fever in his +practice, the physician is bound to consider the next female he attends +in labor, unless some weeks at least have elapsed, as in danger of being +infected by him, and it is his duty to take every precaution to diminish +her risk of disease and death. + +5. If within a short period two cases of puerperal fever happen close +to each other, in the practice of the same physician, the disease +not existing or prevailing in the neighborhood, he would do wisely to +relinquish his obstetrical practice for at least one month, and endeavor +to free himself by every available means from any noxious influence he +may carry about with him. + +6. The occurrence of three or more closely connected cases, in the +practice of one individual, no others existing in the neighborhood, and +no other sufficient cause being alleged for the coincidence, is prima +facie evidence that he is the vehicle of contagion. + +7. It is the duty of the physician to take every precaution that the +disease shall not be introduced by nurses or other assistants, by making +proper inquiries concerning them, and giving timely warning of every +suspected source of danger. + +8. Whatever indulgence may be granted to those who have heretofore +been the ignorant causes of so much misery, the time has come when the +existence of a private pestilence in the sphere of a single physician +should be looked upon, not as a misfortune, but a crime; and in the +knowledge of such occurrences the duties of the practitioner to his +profession should give way to his paramount obligations to society. +ADDITIONAL REFERENCES AND CASES. + +Fifth Annual Report of the Registrar-General of England. + +1843. Appendix. Letter from William Farr, Esq.--Several new series of +cases are given in the Letter of Mr. Stows, contained in the Appendix to +this Report. Mr. Stows suggests precautions similar to those I have laid +down, and these precautions are strongly enforced by Mr. Farr, who is, +therefore, obnoxious to the same criticisms as myself. + +Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.--Cases of +puerperal fever seeming to originate in erysipelas. + +Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. +Journ. Med. Sc. for April, 1844.--Six cases in less than a fortnight, +seeming to originate in a case of erysipelas. + +West's Reports, in Brit. and For. Med. Review for October, 1845, and +January, 1847.--Affection of the arm, resembling malignant pustule, +after removing the placenta of a patient who died from puerperal fever. +Reference to cases at Wurzburg, as proving contagion, and to Keiller's +cases in the Monthly Journal for February, 1846, as showing connection +of puerperal fever and erysipelas. + +Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med. Se., +January, 1846. Also, Connection between Puerperal Fever and Epidemic +Erysipelas. Ibid., April, 1846. + +Robert Storrs.--Contagious Effects of Puerperal Fever on the Male +Subject; or on Persons not Child-bearing. (From Provincial Med. and +Surg. Journal.) Am. Jour. Med. Sc., January, 1846. Numerous cases. See +also Dr. Reid's case in same Journal for April, 1846. + +Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. Sc., +April, 1849, also in B. and F. Med. Chir. Review, April, 1850. + +Hill, of Leuchars.--A Series of Cases illustrating the Contagious Nature +of Erysipelas and of Puerperal Fever, and their Intimate Pathological +Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. Se., July, +1850. + +Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from +inoculation with different morbid secretions.) Am. Jour. Med. Se., +October, 1850. + +Arneth. Paper read before the National Academy of Medicine. Annales +d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M. +“Semmeliveis” (Semmelweiss.) Lotions of chloride of lime and use of +nail-brush before admission to lying-in wards. Alleged sudden and great +decrease of mortality from puerperal fever. Cause of disease attributed +to inoculation with cadaveric matters.) See also Routh's paper, +mentioned above. + +Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society. +Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all +fatal. Also to several instances of individual pupils having had a +succession of cases in various quarters of the town, while others, +practising as extensively in the same localities, had none. Also to +several special cases not mentioned elsewhere. Am. Jour. Med. Se. for +October, 1851. (From New Monthly Journal of Med. Science.) + +Simpson.--Observations at a Meeting of the Edinburgh Obstetrical +Society. (An “eminent gentleman,” according to Dr. Meigs, whose “name +is as well known in America as in (his) native land.” Obstetrics. +Phil. 1852, pp. 368, 375.) The student is referred to this paper for +a valuable resume of many of the facts, and the necessary inferences, +relating to this subject. Also for another series of cases, Mr. Sidey's, +five or six in rapid succession. Dr. Simpson attended the dissection +of two of Dr. Sidey's cases, and freely handled the diseased parts. His +next four child-bed patients were affected with puerperal fever, and +it was the first time he had seen it in practice. As Dr. Simpson is a +gentleman (Dr. Meigs, as above), and as “a gentleman's hands are clean” + (Dr. Meigs' Sixth Letter), it follows that a gentleman with clean hands +may carry the disease. Am. Jour. Med. Sc., October, 1851. + +Peddle.--The five or six cases of Dr. Sidey, followed by the four of Dr. +Simpson, did not end the series. A practitioner in Leith having examined +in Dr. Simpson's house, a portion of the uterus obtained from one of +the patients, had immediately afterwards three fatal cases of puerperal +fever. Dr. Veddie referred to two distinct series of consecutive cases +in his own practice. He had since taken precautions, and not met with +any such cases. Am. Jour. Med. Sc., October, 1851. + +Copland. Considers it proved that puerperal fever maybe propagated by +the hands and the clothes, or either, of a third person, the bed-clothes +or body-clothes of a patient. Mentions a new series of cases, one of +which he saw, with the practitioner who had attended them. She was the +sixth he had had within a few days. All died. Dr. Copland insisted that +contagion had caused these cases; advised precautionary measures, and +the practitioner had no other cases for a considerable time. Considers +it criminal, after the evidence adduced,--which he could have +quadrupled,--and the weight of authority brought forward, for a +practitioner to be the medium of transmitting contagion and death to +his patients. Dr. Copland lays down rules similar to those suggested +by myself, and is therefore entitled to the same epithet for so doing. +Medical Dictionary, New York, 1852. Article, Puerperal States and +Diseases. + +If there is any appetite for facts so craving as to be yet +unappeased,--Lesotho, necdum satiata,--more can be obtained. Dr. Hodge +remarks that “the frequency and importance of this singular circumstance +(that the disease is occasionally more prevalent with one practitioner +than another) has been exceedingly overrated.” More than thirty strings +of cases, more than two hundred and fifty sufferers from puerperal +fever, more than one hundred and thirty deaths appear as the results of +a sparing estimate of such among the facts I have gleaned as could be +numerically valued. These facts constitute, we may take it for granted, +but a small fraction of those that have actually occurred. The number of +them might be greater, but “'t is enough, 't will serve,” in Mercutio's +modest phrase, so far as frequency is concerned. For a just estimate +of the importance of the singular circumstance, it might be proper to +consult the languid survivors, the widowed husbands, and the motherless +children, as well as “the unfortunate accoucheur.” + + + + + + +CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE + +An Address delivered before the Massachusetts Medical Society, at the +Annual Meeting, May 30, 1860. + + + “Facultate magis quam violentia.” + HIPPOCRATES. + +Our Annual Meeting never fails to teach us at least one lesson. The art +whose province it is to heal and to save cannot protect its own ranks +from the inroads of disease and the waste of the Destroyer. + +Seventeen of our associates have been taken from us since our last +Anniversary. Most of them followed their calling in the villages or +towns that lie among the hills or along the inland streams. Only those +who have lived the kindly, mutually dependent life of the country, can +tell how near the physician who is the main reliance in sickness of all +the families throughout a thinly settled region comes to the hearts of +the people among whom he labors, how they value him while living, how +they cherish his memory when dead. For these friends of ours who have +gone before, there is now no more toil; they start from their slumbers +no more at the cry of pain; they sally forth no more into the storms; +they ride no longer over the lonely roads that knew them so well; their +wheels are rusting on their axles or rolling with other burdens; their +watchful eyes are closed to all the sorrows they lived to soothe. Not +one of these was famous in the great world; some were almost unknown +beyond their own immediate circle. But they have left behind them that +loving remembrance which is better than fame, and if their epitaphs are +chiselled briefly in stone, they are written at full length on living +tablets in a thousand homes to which they carried their ever-welcome aid +and sympathy. + +One whom we have lost, very widely known and honored, was a leading +practitioner of this city. His image can hardly be dimmed in your +recollection, as he stood before you only three years ago, filling the +same place with which I am now honored. To speak of him at all worthily, +would be to write the history of professional success, won without +special aid at starting, by toil, patience, good sense, pure character, +and pleasing manners; won in a straight uphill ascent, without one +breathing-space until he sat down, not to rest, but to die. If prayers +could have shielded him from the stroke, if love could have drawn forth +the weapon, and skill could have healed the wound, this passing tribute +might have been left to other lips and to another generation. + +Let us hope that our dead have at last found that rest which neither +summer nor winter, nor day nor night, had granted to their unending +earthly labors! And let us remember that our duties to our brethren do +not cease when they become unable to share our toils, or leave behind +them in want and woe those whom their labor had supported. It is +honorable to the Profession that it has organized an Association for the +relief of its suffering members and their families; it owes this tribute +to the ill-rewarded industry and sacrifices of its less fortunate +brothers who wear out health and life in the service of humanity. I have +great pleasure in referring to this excellent movement, which gives our +liberal profession a chance to show its liberality, and serves to unite +us all, the successful and those whom fortune has cast down, in the +bonds of a true brotherhood. + +A medical man, as he goes about his daily business after twenty years of +practice, is apt to suppose that he treats his patients according to the +teachings of his experience. No doubt this is true to some extent; to +what extent depending much on the qualities of the individual. But it +is easy to prove that the prescriptions of even wise physicians are +very commonly founded on something quite different from experience. +Experience must be based on the permanent facts of nature. But a glance +at the prevalent modes of treatment of any two successive generations +will show that there is a changeable as well as a permanent element in +the art of healing; not merely changeable as diseases vary, or as new +remedies are introduced, but changeable by the going out of fashion of +special remedies, by the decadence of a popular theory from which their +fitness was deduced, or other cause not more significant. There is no +reason to suppose that the present time is essentially different in +this respect from any other. Much, therefore, which is now very commonly +considered to be the result of experience, will be recognized in the +next, or in some succeeding generation, as no such result at all, but as +a foregone conclusion, based on some prevalent belief or fashion of the +time. + +There are, of course, in every calling, those who go about the work of +the day before them, doing it according to the rules of their craft, and +asking no questions of the past or of the future, or of the aim and end +to which their special labor is contributing. These often consider and +call themselves practical men. They pull the oars of society, and have +no leisure to watch the currents running this or that way; let theorists +and philosophers attend to them. In the mean time, however, these +currents are carrying the practical men, too, and all their work may be +thrown away, and worse than thrown away, if they do not take knowledge +of them and get out of the wrong ones and into the right ones as soon as +they may. Sir Edward Parry and his party were going straight towards the +pole in one of their arctic expeditions, travelling at the rate of ten +miles a day. But the ice over which they travelled was drifting straight +towards the equator, at the rate of twelve miles a day, and yet no +man among them would have known that he was travelling two miles a day +backward unless he had lifted his eyes from the track in which he was +plodding. It is not only going backward that the plain practical workman +is liable to, if he will not look up and look around; he may go forward +to ends he little dreams of. It is a simple business for a mason to +build up a niche in a wall; but what if, a hundred years afterwards when +the wall is torn down, the skeleton of a murdered man drop out of the +niche? It was a plain practical piece of carpentry for a Jewish artisan +to fit two pieces of timber together according to the legal pattern in +the time of Pontius Pilate; he asked no questions, perhaps, but we know +what burden the cross bore on the morrow! And so, with subtler tools +than trowels or axes, the statesman who works in policy without +principle, the theologian who works in forms without a soul, the +physician who, calling himself a practical man, refuses to recognize the +larger laws which govern his changing practice, may all find that they +have been building truth into the wall, and hanging humanity upon the +cross. + +The truth is, that medicine, professedly founded on observation, is as +sensitive to outside influences, political, religious, philosophical, +imaginative, as is the barometer to the changes of atmospheric density. +Theoretically it ought to go on its own straightforward inductive path, +without regard to changes of government or to fluctuations of public +opinion. But look a moment while I clash a few facts together, and see +if some sparks do not reveal by their light a closer relation between +the Medical Sciences and the conditions of Society and the general +thought of the time, than would at first be suspected. + +Observe the coincidences between certain great political and +intellectual periods and the appearance of illustrious medical reformers +and teachers. It was in the age of Pericles, of Socrates, of Plato, of +Phidias, that Hippocrates gave to medical knowledge the form which it +retained for twenty centuries. With the world-conquering Alexander, the +world-embracing Aristotle, appropriating anatomy and physiology, among +his manifold spoils of study, marched abreast of his royal pupil to +wider conquests. Under the same Ptolemies who founded the Alexandrian +Library and Museum, and ordered the Septuagint version of the Hebrew +Scriptures, the infallible Herophilus [“Contradicere Herophilo in +anatomicis, est contradicere evangelium,” was a saying of Fallopius.] +made those six hundred dissections of which Tertullian accused him, and +the sagacious Erasistratus introduced his mild antiphlogistic treatment +in opposition to the polypharmacy and antidotal practice of his time. +It is significant that the large-minded Galen should have been the +physician and friend of the imperial philosopher Marcus Aurelius. The +Arabs gave laws in various branches of knowledge to those whom their +arms had invaded, or the terror of their spreading dominion had reached, +and the point from which they started was, as Humboldt acknowledges, +“the study of medicine, by which they long ruled the Christian Schools,” + and to which they added the department of chemical pharmacy. + +Look at Vesalius, the contemporary of Luther. Who can fail to see +one common spirit in the radical ecclesiastic and the reforming +court-physician? Both still to some extent under the dominion of the +letter: Luther holding to the real presence; Vesalius actually causing +to be drawn and engraved two muscles which he knew were not found in +the human subject, because they had been described by Galen, from +dissections of the lower animals. Both breaking through old traditions +in the search of truth; one, knife in hand, at the risk of life and +reputation, the other at the risk of fire and fagot, with that mightier +weapon which all the devils could not silence, though they had been +thicker than the tiles on the house-tops. How much the physician of the +Catholic Charles V. had in common with the great religious destructive, +may be guessed by the relish with which he tells the story how certain +Pavian students exhumed the body of an “elegans scortum,” or lovely dame +of ill repute, the favorite of a monk of the order of St. Anthony, who +does not seem to have resisted temptation so well as the founder of +his order. We have always ranked the physician Rabelais among the early +reformers, but I do not know that Vesalius has ever been thanked for his +hit at the morals of the religious orders, or for turning to the good of +science what was intended for the “benefit of clergy.” + +Our unfortunate medical brother, Michael Servetus, the spiritual patient +to whom the theological moxa was applied over the entire surface for +the cure of his heresy, came very near anticipating Harvey. The same +quickened thought of the time which led him to dispute the dogma of the +Church, opened his mind to the facts which contradicted the dogmas of +the Faculty. + +Harvey himself was but the posthumous child of the great Elizabethan +period. Bacon was at once his teacher and his patient. The founder +of the new inductive philosophy had only been dead two years when the +treatise on the Circulation, the first-fruit of the Restoration of +Science, was given to the world. + +And is it to be looked at as a mere accidental coincidence, that while +Napoleon was modernizing the political world, Bichat was revolutionizing +the science of life and the art that is based upon it; that while the +young general was scaling the Alps, the young surgeon was climbing +the steeper summits of unexplored nature; that the same year read the +announcement of those admirable “Researches on Life and Death,” and the +bulletins of the battle of Marengo? + +If we come to our own country, who can fail to recognize that Benjamin +Rush, the most conspicuous of American physicians, was the intellectual +offspring of the movement which produced the Revolution? “The same +hand,” says one of his biographers, “which subscribed the declaration +of the political independence of these States, accomplished their +emancipation from medical systems formed in foreign countries, and +wholly unsuitable to the state of diseases in America.” + +Following this general course of remark, I propose to indicate in a few +words the direction of the main intellectual current of the time, and +to point out more particularly some of the eddies which tend to keep the +science and art of medicine from moving with it, or even to carry them +backwards. + +The two dominant words of our time are law and average, both pointing to +the uniformity of the order of being in which we live. Statistics have +tabulated everything,--population, growth, wealth, crime, disease. We +have shaded maps showing the geographical distribution of larceny and +suicide. Analysis and classification have been at work upon all tangible +and visible objects. The Positive Philosophy of Comte has only given +expression to the observing and computing mind of the nineteenth +century. + +In the mean time, the great stronghold of intellectual conservatism, +traditional belief, has been assailed by facts which would have been +indicted as blasphemy but a few generations ago. Those new tables of +the law, placed in the hands of the geologist by the same living God who +spoke from Sinai to the Israelites of old, have remodelled the beliefs +of half the civilized world. The solemn scepticism of science has +replaced the sneering doubts of witty philosophers. The more positive +knowledge we gain, the more we incline to question all that has been +received without absolute proof. + +As a matter of course, this movement has its partial reactions. The +province of faith is claimed as a port free of entry to unsupported +individual convictions. The tendency to question is met by the +unanalyzing instinct of reverence. The old church calls back its +frightened truants. Some who have lost their hereditary religious +belief find a resource in the revelations of Spiritualism. By a parallel +movement, some of those who have become medical infidels pass over to +the mystic band of believers in the fancied miracles of Homoeopathy. + +Under these influences transmitted to, or at least shared by, the +medical profession, the old question between “Nature,” so called, and +“Art,” or professional tradition, has reappeared with new interest. I +say the old question, for Hippocrates stated the case on the side +of “Nature” more than two thousand years ago. Miss Florence +Nightingale,--and if I name her next to the august Father of the Healing +Art, its noblest daughter well deserves that place of honor,--Miss +Florence Nightingale begins her late volume with a paraphrase of his +statement. But from a very early time to this there has always been +a strong party against “Nature.” Themison called the practice of +Hippocrates “a meditation upon death.” Dr. Rush says: “It is impossible +to calculate the mischief which Hippocrates has done, by first marking +Nature with his name and afterwards letting her loose upon sick people. +Millions have perished by her hands in all ages and countries.” Sir John +Forbes, whose defence of “Nature” in disease you all know, and to the +testimonial in whose honor four of your Presidents have contributed, has +been recently greeted, on retiring from the profession, with a wish that +his retirement had been twenty years sooner, and the opinion that no man +had done so much to destroy the confidence of the public in the medical +profession. + +In this Society we have had the Hippocratic and the Themisonic side +fairly represented. The treatise of one of your early Presidents on the +Mercurial Treatment is familiar to my older listeners. Others who have +held the same office have been noted for the boldness of their practice, +and even for partiality to the use of complex medication. + +On the side of “Nature” we have had, first of all, that remarkable +discourse on Self-Limited Diseases, [On Self-Limited Diseases. A +Discourse delivered before the Massachusetts Medical Society, at their +Annual Meeting, May 27, 1835. By Jacob Bigelow, M. D.] which has given +the key-note to the prevailing medical tendency of this neighborhood, at +least, for the quarter of a century since it was delivered. Nor have +we forgotten the address delivered at Springfield twenty years later, +[Search out the Secrets, of Nature. By Augustus A. Gould, M. D. Read +at the Annual Meeting, June 27, 1855.] full of good sense and useful +suggestions, to one of which suggestions we owe the learned, impartial, +judicious, well-written Prize Essay of Dr. Worthington Hooker. [Rational +Therapeutics. A Prize Essay. By Worthington Hooker, M. D., of New Haven. +Boston. 1857.] We should not omit from the list the important address of +another of our colleagues, [On the Treatment of Compound and Complicated +Fractures. By William J. Walker, M. D. Read at the Annual Meeting, May +29, 1845.] showing by numerous cases the power of Nature in +healing compound fractures to be much greater than is frequently +supposed,--affording, indeed, more striking illustrations than can be +obtained from the history of visceral disease, of the supreme wisdom, +forethought, and adaptive dexterity of that divine Architect, as shown +in repairing the shattered columns which support the living temple of +the body. + +We who are on the side of “Nature” please ourselves with the idea that +we are in the great current in which the true intelligence of the time +is moving. We believe that some who oppose, or fear, or denounce our +movement are themselves caught in various eddies that set back against +the truth. And we do most earnestly desire and most actively strive, +that Medicine, which, it is painful to remember, has been spoken of +as “the withered branch of science” at a meeting of the British +Association, shall be at length brought fully to share, if not to lead, +the great wave of knowledge which rolls with the tides that circle the +globe. + +If there is any State or city which might claim to be the American +headquarters of the nature-trusting heresy, provided it be one, that +State is Massachusetts, and that city is its capital. The effect which +these doctrines have upon the confidence reposed in the profession is a +matter of opinion. For myself, I do not believe this confidence can be +impaired by any investigations which tend to limit the application of +troublesome, painful, uncertain, or dangerous remedies. Nay, I will +venture to say this, that if every specific were to fail utterly, if the +cinchona trees all died out, and the arsenic mines were exhausted, and +the sulphur regions were burned up, if every drug from the vegetable, +animal, and mineral kingdom were to disappear from the market, a body of +enlightened men, organized as a distinct profession, would be required +just as much as now, and respected and trusted as now, whose province +should be to guard against the causes of disease, to eliminate them if +possible when still present, to order all the conditions of the patient +so as to favor the efforts of the system to right itself, and to give +those predictions of the course of disease which only experience can +warrant, and which in so many cases relieve the exaggerated fears of +sufferers and their friends, or warn them in season of impending danger. +Great as the loss would be if certain active remedies could no longer be +obtained, it would leave the medical profession the most essential part +of its duties, and all, and more than all, its present share of honors; +for it would be the death-blow to charlatanism, which depends for its +success almost entirely on drugs, or at least on a nomenclature that +suggests them. + +There is no offence, then, or danger in expressing the opinion, that, +after all which has been said, the community is still overdosed: The +best proof of it is, that “no families take so little medicine as those +of doctors, except those of apothecaries, and that old practitioners are +more sparing of active medicines than younger ones.” [Dr. James Jackson +has kindly permitted me to make the following extract from a letter +just received by him from Sir James Clark, and dated May 26, 1860: “As a +physician advances in age, he generally, I think, places less confidence +in the ordinary medical treatment than he did, not only during his +early, but even his middle period of life.”] The conclusion from these +facts is one which the least promising of Dr. Howe's pupils in the +mental department could hardly help drawing. + +Part of the blame of over-medication must, I fear, rest with the +profession, for yielding to the tendency to self-delusion, which seems +inseparable from the practice of the art of healing. I need only touch +on the common modes of misunderstanding or misapplying the evidence of +nature. + +First, there is the natural incapacity for sound observation, which is +like a faulty ear in music. We see this in many persons who know a good +deal about books, but who are not sharp-sighted enough to buy a horse or +deal with human diseases. + +Secondly, there is in some persons a singular inability to weigh the +value of testimony; of which, I think, from a pretty careful examination +of his books, Hahnemann affords the best specimen outside the walls of +Bedlam. + +The inveterate logical errors to which physicians have always been +subject are chiefly these: + +The mode of inference per enumerationem simplicem, in scholastic phrase; +that is, counting only their favorable cases. This is the old trick +illustrated in Lord Bacon's story of the gifts of the shipwrecked +people, hung up in the temple.--Behold! they vowed these gifts to the +altar, and the gods saved them. Ay, said a doubting bystander, but +how many made vows of gifts and were shipwrecked notwithstanding? The +numerical system is the best corrective of this and similar errors. The +arguments commonly brought against its application to all matters of +medical observation, treatment included, seem to apply rather to the +tabulation of facts ill observed, or improperly classified, than to the +method itself. + +The post hoc ergo propter hoc error: he got well after taking my +medicine; therefore in consequence of taking it. + +The false induction from genuine facts of observation, leading to the +construction of theories which are then deductively applied in the +face of the results of direct observation. The school of Broussais has +furnished us with a good example of this error. + +And lastly, the error which Sir Thomas Browne calls giving “a reason of +the golden tooth;” that is, assuming a falsehood as a fact, and giving +reasons for it, commonly fanciful ones, as is constantly done by that +class of incompetent observers who find their “golden tooth” in the +fabulous effects of the homoeopathie materia medica,--which consists of +sugar of milk and a nomenclature. + +Another portion of the blame rests with the public itself, which insists +on being poisoned. Somebody buys all the quack medicines that build +palaces for the mushroom, say rather, the toadstool millionaires. Who is +it? These people have a constituency of millions. The popular belief is +all but universal that sick persons should feed on noxious substances. +One of our members was called not long since to a man with a terribly +sore mouth. On inquiry he found that the man had picked up a box of +unknown pills, in Howard Street, and had proceeded to take them, on +general principles, pills being good for people. They happened to +contain mercury, and hence the trouble for which he consulted our +associate. + +The outside pressure, therefore, is immense upon the physician, +tending to force him to active treatment of some kind. Certain old +superstitions, still lingering in the mind of the public, and not yet +utterly expelled from that of the profession, are at the bottom of this, +or contribute to it largely. One of the most ancient is, that disease is +a malignant agency, or entity, to be driven out of the body by offensive +substances, as the smoke of the fish's heart and liver drove the devil +out of Tobit's bridal chamber, according to the Apochrypha. Epileptics +used to suck the blood from the wounds of dying gladiators. [Plinii +Hist. Mundi. lib. xxviii. c. 4.] The Hon. Robert Boyle's little book +was published some twenty or thirty years before our late President, Dr. +Holyoke, was born. [A Collection of Choice and Safe Remedies. The Fifth +Edition, corrected. London, 1712. Dr. Holyoke was born in 1728.] In it +he recommends, as internal medicines, most of the substances commonly +used as fertilizers of the soil. His “Album Graecum” is best +left untranslated, and his “Zebethum Occidentale” is still more +transcendentally unmentionable except in a strange dialect. It sounds +odiously to us to hear him recommend for dysentery a powder made from +“the sole of an old shoe worn by some man that walks much.” Perhaps +nobody here ever heard of tying a stocking, which had been worn during +the day, round the neck at night for a sore throat. The same idea +of virtue in unlovely secretions! [The idea is very ancient. “Sordes +hominis” “Sudore et oleo medicinam facientibus.”--Plin. xxviii. 4.] + +Even now the Homoeopathists have been introducing the venom of serpents, +under the learned title of Lachesis, and outraging human nature with +infusions of the pediculus capitis; that is, of course, as we understand +their dilutions, the names of these things; for if a fine-tooth-comb +insect were drowned in Lake Superior, we cannot agree with them in +thinking that every drop of its waters would be impregnated with all the +pedicular virtues they so highly value. They know what they are doing. +They are appealing to the detestable old superstitious presumption in +favor of whatever is nauseous and noxious as being good for the sick. + +Again, we all occasionally meet persons stained with nitrate of silver, +given for epilepsy. Read what Dr. Martin says, about the way in which +it came to be used, in his excellent address before the Norfolk County +Medical Society, and the evidence I can show, but have not time for now, +and then say what you think of the practice which on such presumptions +turns a white man as blue as the double-tattooed King of the Cannibal +Islands! [Note A.] + +If medical superstitions have fought their way down through all the +rationalism and scepticism of the nineteenth century, of course the +theories of the schools, supported by great names, adopted into the +popular belief and incorporated with the general mass of misapprehension +with reference to disease, must be expected to meet us at every turn in +the shape of bad practice founded on false doctrine. A French patient +complains that his blood heats him, and expects his doctor to bleed +him. An English or American one says he is bilious, and will not be easy +without a dose of calomel. A doctor looks at a patient's tongue, sees it +coated, and says the stomach is foul; his head full of the old saburral +notion which the extreme inflammation-doctrine of Broussais did so +much to root out, but which still leads, probably, to much needless and +injurious wrong of the stomach and bowels by evacuants, when all they +want is to be let alone. It is so hard to get anything out of the dead +hand of medical tradition! The mortmain of theorists extinct in science +clings as close as that of ecclesiastics defunct in law. + +One practical hint may not be out of place here. It seems to be +sometimes forgotten, by those who must know the fact, that the tongue is +very different, anatomically and physiologically, from the stomach. +Its condition does not in the least imply a similar one of the stomach, +which is a very different structure, covered with a different kind +of epithelium, and furnished with entirely different secretions. A +silversmith will, for a dollar, make a small hoe, of solid silver, which +will last for centuries, and will give a patient more comfort, used +for the removal of the accumulated epithelium and fungous growths which +constitute the “fur,” than many a prescription with a split-footed Rx +before it, addressed to the parts out of reach. + +I think more of this little implement on account of its agency in saving +the Colony at Plymouth in the year 1623. Edward Winslow heard that +Massasoit was sick and like to die. He found him with a houseful of +people about him, women rubbing his arms and legs, and friends “making +such a hellish noise” as they probably thought would scare away the +devil of sickness. Winslow gave him some conserve, washed his mouth, +scraped his tongue, which was in a horrid state, got down some drink, +made him some broth, dosed him with an infusion of strawberry leaves and +sassafras root, and had the satisfaction of seeing him rapidly recover. +Massasoit, full of gratitude, revealed the plot which had been formed +to destroy the colonists, whereupon the Governor ordered Captain Miles +Standish to see to them; who thereupon, as everybody remembers, stabbed +Pecksuot with his own knife, broke up the plot, saved the colony, and +thus rendered Massachusetts and the Massachusetts Medical Society +a possibility, as they now are a fact before us. So much for this +parenthesis of the tongue-scraper, which helped to save the young +colony from a much more serious scrape, and may save the Union yet, if a +Presidential candidate should happen to be taken sick as Massasoit was, +and his tongue wanted cleaning,--which process would not hurt a good +many politicians, with or without a typhoid fever. + +Again, see how the “bilious” theory works in every-day life here and +now, illustrated by a case from actual life. A youthful practitioner, +whose last molars have not been a great while cut, meets an experienced +and noted physician in consultation. This is the case. A slender, +lymphatic young woman is suckling two lusty twins, the intervals +of suction being occupied on her part with palpitations, headaches, +giddiness, throbbing in the head, and various nervous symptoms, her +cheeks meantime getting bloodless, and her strength running away +in company with her milk. The old experienced physician, seeing the +yellowish waxy look which is common in anaemic patients, considers it a +“bilious” case, and is for giving a rousing emetic. Of course, he has to +be wheedled out of this, a recipe is written for beefsteaks and porter, +the twins are ignominiously expelled from the anaemic bosom, and forced +to take prematurely to the bottle, and this prolific mother is saved for +future usefulness in the line of maternity. + +The practice of making a profit on the medicine ordered has been held up +to reprobation by one at least of the orators who have preceded me. That +the effect of this has been ruinous in English practice I cannot +doubt, and that in this country the standard of practice was in former +generations lowered through the same agency is not unlikely. I have seen +an old account-book in which the physician charged an extra price for +gilding his rich patients' pills. If all medicine were very costly, +and the expense of it always came out of the physician's fee, it +would really be a less objectionable arrangement than this other most +pernicious one. He would naturally think twice before he gave an emetic +or cathartic which evacuated his own pocket, and be sparing of the +cholagogues that emptied the biliary ducts of his own wallet, unless he +were sure they were needed. If there is any temptation, it should not be +in favor of giving noxious agents, as it clearly must be in the case of +English druggists and “General Practitioners.” The complaint against +the other course is a very old one. Pliny, inspired with as truly Roman +horror of quackery as the elder Cato,--who declared that the Greek +doctors had sworn to exterminate all barbarians, including the Romans, +with their drugs, but is said to have physicked his own wife to death, +notwithstanding,--Pliny says, in so many words, that the cerates and +cataplasms, plasters, collyria, and antidotes, so abundant in his time, +as in more recent days, were mere tricks to make money. + +A pretty strong eddy, then, or rather many eddies, setting constantly +back from the current of sober observation of nature, in the direction +of old superstitions and fancies, of exploded theories, of old ways of +making money, which are very slow to pass out of fashion. + +But there are other special American influences which we are bound to +take cognizance of. If I wished to show a student the difficulties of +getting at truth from medical experience, I would give him the history +of epilepsy to read. If I wished him to understand the tendencies of the +American medical mind, its sanguine enterprise, its self-confidence, its +audacious handling of Nature, its impatience with her old-fashioned ways +of taking time to get a sick man well, I would make him read the life +and writings of Benjamin Rush. Dr. Rush thought and said that there were +twenty times more intellect and a hundred times more knowledge in +the country in 1799 than before the Revolution. His own mind was in a +perpetual state of exaltation produced by the stirring scenes in which +he had taken a part, and the quickened life of the time in which he +lived. It was not the state to favor sound, calm observation. He was +impatient, and Nature is profoundly imperturbable. We may adjust the +beating of our hearts to her pendulum if we will and can, but we may be +very sure that she will not change the pendulum's rate of going because +our hearts are palpitating. He thought he had mastered yellow-fever. +“Thank God,” he said, “out of one hundred patients whom I have visited +or prescribed for this day, I have lost none.” Where was all his legacy +of knowledge when Norfolk was decimated? Where was it when the blue +flies were buzzing over the coffins of the unburied dead piled up in +the cemetery of New Orleans, at the edge of the huge trenches yawning to +receive them? + +One such instance will do as well as twenty. Dr. Rush must have been a +charming teacher, as he was an admirable man. He was observing, rather +than a sound observer; eminently observing, curious, even, about all +manner of things. But he could not help feeling as if Nature had been a +good deal shaken by the Declaration of Independence, and that +American art was getting to be rather too much for her,--especially +as illustrated in his own practice. He taught thousands of American +students, he gave a direction to the medical mind of the country more +than any other one man; perhaps he typifies it better than any other. It +has clearly tended to extravagance in remedies and trust in remedies, +as in everything else. How could a people which has a revolution once in +four years, which has contrived the Bowie-knife and the revolver, which +has chewed the juice out of all the superlatives in the language in +Fourth of July orations, and so used up its epithets in the rhetoric of +abuse that it takes two great quarto dictionaries to supply the demand; +which insists in sending out yachts and horses and boys to out-sail, +out-run, out-fight, and checkmate all the rest of creation; how could +such a people be content with any but “heroic” practice? What wonder +that the stars and stripes wave over doses of ninety grains of sulphate +of quinine, [More strictly, ninety-six grains in two hours. Dunglison's +Practice, 1842, vol. ii. p. 520. Eighty grains in one dose. Ibid. p. +536. Ninety-six grains of sulphate of quinine are equal to eight ounces +of good bark.--Wood & Bache.] and that the American eagle screams with +delight to see three drachms of calomel given at a single mouthful? + +Add to this the great number of Medical Journals, all useful, we +hope, most of them necessary, we trust, many of them excellently well +conducted, but which must find something to fill their columns, and so +print all the new plans of treatment and new remedies they can get hold +of, as the newspapers, from a similar necessity, print the shocking +catastrophes and terrible murders. + +Besides all this, here are we, the great body of teachers in the +numberless medical schools of the Union, some of us lecturing to crowds +who clap and stamp in the cities, some of us wandering over the country, +like other professional fertilizers, to fecundate the minds of less +demonstrative audiences at various scientific stations; all of us +talking habitually to those supposed to know less than ourselves, and +loving to claim as much for our art as we can, not to say for our own +schools, and possibly indirectly for our own practical skill. Hence that +annual crop of introductory lectures; the useful blossoming into the +ornamental, as the cabbage becomes glorified in the cauliflower; that +lecture-room literature of adjectives, that declamatory exaggeration, +that splendid show of erudition borrowed from D'Israeli, and credited +to Lord Bacon and the rest, which have suggested to our friends of +the Medical Journals an occasional epigram at our expense. Hence the +tendency in these productions, and in medical lectures generally, +to overstate the efficacy of favorite methods of cure, and hence the +premium offered for showy talkers rather than sagacious observers, +for the men of adjectives rather than of nouns substantive in the more +ambitious of these institutions. + +Such are some of the eddies in which we are liable to become involved +and carried back out of the broad stream of philosophical, or, in other +words, truth-loving, investigations. The causes of disease, in the mean +time, have been less earnestly studied in the eagerness of the search +for remedies. Speak softly! Women have been borne out from an old-world +hospital, two in one coffin, that the horrors of their prison-house +might not be known, while the very men who were discussing the treatment +of the disease were stupidly conveying the infection from bed to bed, +as rat-killers carry their poisons from one household to another. Do not +some of you remember that I have had to fight this private-pestilence +question against a scepticism which sneered in the face of a mass of +evidence such as the calm statisticians of the Insurance office could +not listen to without horror and indignation? [“The Contagiousness of +Puerperal Fever.”--N. E. Quar. Jour. of Medicine and Surgery, April, +1843. Reprinted, with Additions. Boston: Ticknor & Fields. 1855.] Have +we forgotten what is told in one of the books published under our own +sanction, that a simple measure of ventilation, proposed by Dr. John +Clark, had saved more than sixteen thousand children's lives in a +single hospital? How long would it have taken small doses of calomel and +rhubarb to save as many children? These may be useful in prudent hands, +but how insignificant compared to the great hygienic conditions! Causes, +causes, and again causes,--more and more we fall back on these as the +chief objects of our attention. The shortest system of medical practice +that I know of is the oldest, but not the worst. It is older than +Hippocrates, older than Chiron the Centaur. Nature taught it to the +first mother when she saw her first-born child putting some ugly pebble +or lurid berry into its mouth. I know not in what language it was +spoken, but I know that in English it would sound thus: Spit it out! + +Art can do something more than say this. It can sometimes reach the +pebble or berry after it has been swallowed. But the great thing is +to keep these things out of children's mouths, and as soon as they are +beyond our reach, to be reasonable and patient with Nature, who means +well, but does not like to hurry, and who took nine calendar months, +more or less, to every mother's son among us, before she thought he was +fit to be shown to the public. + +Suffer me now to lay down a few propositions, whether old or new it +matters little, not for your immediate acceptance, nor yet for your +hasty rejection, but for your calm consideration. + +But first, there are a number of terms which we are in the habit of +using in a vague though not unintelligible way, and which it is as well +now to define. These terms are the tools with which we are to work, and +the first thing is to sharpen them. It is nothing to us that they have +been sharpened a thousand times before; they always get dull in the +using, and every new workman has a right to carry them to the grindstone +and sharpen them to suit himself. + +Nature, in medical language, as opposed to Art, means trust in the +reactions of the living system against ordinary normal impressions. + +Art, in the same language, as opposed to Nature, means an intentional +resort to extraordinary abnormal impressions for the relief of disease. + +The reaction of the living system is the essence of both. Food is +nothing, if there is no digestive act to respond to it. We cannot raise +a blister on a dead man, or hope that a carminative forced between his +lips will produce its ordinary happy effect. + +Disease, dis-ease,--disturbed quiet, uncomfortableness,--means imperfect +or abnormal reaction of the living system, and its more or less +permanent results. + +Food, in its largest sense, is whatever helps to build up the normal +structures, or to maintain their natural actions. + +Medicine, in distinction from food, is every unnatural or noxious agent +applied for the relief of disease. + +Physic means properly the Natural art, and Physician is only the Greek +synonyme of Naturalist. + +With these few explanations I proceed to unfold the propositions I have +mentioned. + +Disease and death, if we may judge by the records of creation, are +inherently and essentially necessary in the present order of things. A +perfect intelligence, trained by a perfect education, could do no more +than keep the laws of the physical and spiritual universe. An imperfect +intelligence, imperfectly taught,--and this is the condition of our +finite humanity,--will certainly fail to keep all these laws perfectly. +Disease is one of the penalties of one of the forms of such failure. It +is prefigured in the perturbations of the planets, in the disintegration +of the elemental masses; it has left its traces in the fossil organisms +of extinct creations. [Professor Agassiz has kindly handed me the +following note: “There are abnormal structures in animals of all ages +anterior to the creation of mankind. Malformed specimens of Crinoids are +known from the Triassic and Jurassic deposits. Malformed and diseased +bones of tertiary mammalia have been collected in the caverns of +Gailenreuth with traces of healing.”] + +But it is especially the prerogative, I had almost said privilege, of +educated and domesticated beings, from man down to the potato, serving +to teach them, and such as train them, the laws of life, and to get rid +of those who will not mind or cannot be kept subject to these laws. + +Disease, being always an effect, is always in exact proportion to the +sum of its causes, as much in the case of Spigelius, who dies of a +scratch, as in that of the man who recovers after an iron bar has been +shot through his brain. The one prevalent failing of the medical art is +to neglect the causes and quarrel with the effect. + +There are certain general facts which include a good deal of what is +called and treated as disease. Thus, there are two opposite movements of +life to be seen in cities and elsewhere, belonging to races which, from +various persistent causes, are breeding down and tending to run out, +and to races which are breeding up, or accumulating vital capital,--a +descending and an ascending series. Let me give an example of each; and +that I may incidentally remove a common impression about this country as +compared with the Old World, an impression which got tipsy with conceit +and staggered into the attitude of a formal proposition in the work of +Dr. Robert Knox, I will illustrate the downward movement from English +experience, and the upward movement from a family history belonging to +this immediate neighborhood. + +Miss Nightingale speaks of “the fact so often seen of a +great-grandmother, who was a tower of physical vigor, descending into a +grandmother perhaps a little less vigorous, but still sound as a bell, +and healthy to the core, into a mother languid and confined to her +carriage and house; and lastly into a daughter sickly and confined +to her bed.” So much for the descending English series; now for the +ascending American series. + +Something more than one hundred and thirty years ago there graduated at +Harvard College a delicate youth, who lived an invalid life and died at +the age of about fifty. His two children were both of moderate physical +power, and one of them diminutive in stature. The next generation rose +in physical development, and reached eighty years of age and more +in some of its members. The fourth generation was of fair average +endowment. The fifth generation, great-great-grandchildren of the +slender invalid, are several of, them of extraordinary bodily and mental +power; large in stature, formidable alike with their brains and their +arms, organized on a more extensive scale than either of their parents. + +This brief account illustrates incidentally the fallacy of the +universal-degeneration theory applied to American life; the same on +which one of our countrymen has lately brought some very forcible facts +to bear in a muscular discussion of which we have heard rather more than +is good for us. But the two series, American and English, ascending and +descending, were adduced with the main purpose of showing the immense +difference of vital endowments in different strains of blood; a +difference to which all ordinary medication is in all probability a +matter of comparatively trivial purport. Many affections which art has +to strive against might be easily shown to be vital to the well-being of +society. Hydrocephalus, tabes mesenterica, and other similar maladies, +are natural agencies which cut off the children of races that are +sinking below the decent minimum which nature has established as the +condition of viability, before they reach the age of reproduction. +They are really not so much diseases, as manifestations of congenital +incapacity for life; the race would be ruined if art could ever learn +always to preserve the individuals subject to them. We must do the best +we can for them, but we ought also to know what these “diseases” mean. + +Again, invalidism is the normal state of many organizations. It can +be changed to disease, but never to absolute health by medicinal +appliances. There are many ladies, ancient and recent, who are +perpetually taking remedies for irremediable pains and aches. They ought +to have headaches and back-aches and stomach-aches; they are not well if +they do not have them. To expect them to live without frequent twinges +is like expecting a doctor's old chaise to go without creaking; if it +did, we might be sure the springs were broken. There is no doubt that +the constant demand for medicinal remedies from patients of this class +leads to their over-use; often in the case of cathartics, sometimes in +that of opiates. I have been told by an intelligent practitioner in +a Western town, that the constant prescription of opiates by certain +physicians in his vicinity has rendered the habitual use of that drug +in all that region very prevalent; more common, I should think, than +alcoholic drunkenness in the most intemperate localities of which I have +known anything. A frightful endemic demoralization betrays itself in the +frequency with which the haggard features and drooping shoulders of the +opium-drunkards are met with in the streets. + +The next proposition I would ask you to consider is this: The +presumption always is that every noxious agent, including medicines +proper, which hurts a well man, hurts a sick one. [Note B.] + +Let me illustrate this proposition before you decide upon it. If it were +known that a prize-fighter were to have a drastic purgative administered +two or three days before a contest, or a large blister applied to his +back, no one will question that it would affect the betting on his side +unfavorably; we will say to the amount of five per cent. Now the drain +upon the resources of the system produced in such a case must be at its +minimum, for the subject is a powerful man, in the prime of life, and +in admirable condition. If the drug or the blister takes five per cent. +from his force of resistance, it will take at least as large a fraction +from any invalid. But this invalid has to fight a champion who strikes +hard but cannot be hit in return, who will press him sharply for breath, +but will never pant himself while the wind can whistle through his +fleshless ribs. The suffering combatant is liable to want all his +stamina, and five per cent. may lose him the battle. + +All noxious agents, all appliances which are not natural food or +stimuli, all medicines proper, cost a patient, on the average, five +per cent. of his vital force, let us say. Twenty times as much waste of +force produced by any of them, that is, would exactly kill him, nothing +less than kill him, and nothing more. If this, or something like this, +is true, then all these medications are, prima facie, injurious. + +In the game of Life-or-Death, Rouge et Noir, as played between the +Doctor and the Sexton, this five per cent., this certain small injury +entering into the chances is clearly the sexton's perquisite for keeping +the green table, over which the game is played, and where he hoards +up his gains. Suppose a blister to diminish a man's pain, effusion or +dyspnoea to the saving of twenty per cent. in vital force; his profit +from it is fifteen, in that case, for it always hurts him five to begin +with, according to our previous assumption. + +Presumptions are of vast importance in medicine, as in law. A man is +presumed innocent until he is proved guilty. A medicine--that is, +a noxious agent, like a blister, a seton, an emetic, or a cathartic +--should always be presumed to be hurtful. It always is directly +hurtful; it may sometimes be indirectly beneficial. If this presumption +were established, and disease always assumed to be the innocent victim +of circumstances, and not punishable by medicines, that is, noxious +agents, or poisons, until the contrary was shown, we should not so +frequently hear the remark commonly, perhaps erroneously, attributed to +Sir Astley Cooper, but often repeated by sensible persons, that, on the +whole, more harm than good is done by medication. Throw out opium, which +the Creator himself seems to prescribe, for we often see the scarlet +poppy growing in the cornfields, as if it were foreseen that wherever +there is hunger to be fed there must also be pain to be soothed; throw +out a few specifics which our art did not discover, and is hardly needed +to apply [ Note C.]; throw out wine, which is a food, and the vapors +which produce the miracle of anaesthesia, and I firmly believe that if +the whole materia medica, as now used, could be sunk to the bottom of +the sea, it would be all the better for mankind,--and all the worse for +the fishes. + +But to justify this proposition, I must add that the injuries inflicted +by over-medication are to a great extent masked by disease. Dr. Hooker +believes that the typhus syncopatia of a preceding generation in +New England “was often in fact a brandy and opium disease.” How is a +physician to distinguish the irritation produced by his blister from +that caused by the inflammation it was meant to cure? How can he tell +the exhaustion produced by his evacuants from the collapse belonging to +the disease they were meant to remove? + +Lastly, medication without insuring favorable hygienic conditions is +like amputation without ligatures. I had a chance to learn this well +of old, when physician to the Broad Street district of the Boston +Dispensary. There, there was no help for the utter want of wholesome +conditions, and if anybody got well under my care, it must have been +in virtue of the rough-and-tumble constitution which emerges from the +struggle for life in the street gutters, rather than by the aid of my +prescriptions. + +But if the materia medica were lost overboard, how much more pains would +be taken in ordering all the circumstances surrounding the patient (as +can be done everywhere out of the crowded pauper districts), than are +taken now by too many who think they do their duty and earn their money +when they write a recipe for a patient left in an atmosphere of domestic +malaria, or to the most negligent kind of nursing! I confess that I +should think my chance of recovery from illness less with Hippocrates +for my physician and Mrs. Gamp for my nurse, than if I were in the hands +of Hahnemann himself, with Florence Nightingale or good Rebecca Taylor +to care for me. + +If I am right in maintaining that the presumption is always against +the use of noxious agents in disease, and if any whom I might influence +should adopt this as a principle of practice, they will often find +themselves embarrassed by the imperative demand of patients and their +friends for such agents where a case is not made out against this +standing presumption. I must be permitted to say, that I think the +French, a not wholly uncivilized people, are in advance of the English +and ourselves in the art of prescribing for the sick without hurting +them. And I do confess that I think their varied ptisans and syrups are +as much preferable to the mineral regimen of bug-poison and ratsbane, +so long in favor on the other side of the Channel, as their art of +preparing food for the table to the rude cookery of those hard-feeding +and much-dosing islanders. We want a reorganized cuisine of invalidism +perhaps as much as the culinary, reform, for which our lyceum lecturers, +and others who live much at hotels and taverns, are so urgent. Will you +think I am disrespectful if I ask whether, even in Massachusetts, a dose +of calomel is not sometimes given by a physician on the same principle +as that upon which a landlord occasionally prescribes bacon and +eggs,--because he cannot think of anything else quite so handy? I leave +my suggestion of borrowing a hint from French practice to your mature +consideration. + +I may, however, call your attention, briefly, to the singular fact, +that English and American practitioners are apt to accuse French medical +practice of inertness, and French surgical practice of unnecessary +activity. Thus, Dr. Bostock considers French medical treatment, with +certain exceptions, as “decidedly less effective” than that of his own +country. Mr. S. Cooper, again, defends the simple British practice of +procuring union by the first intention against the attacks of M. Roux +and Baron Larrey. [Cooper's Surg. Diet. art. “Wounds.” Yet Mr. John +Bell gives the French surgeons credit for introducing this doctrine of +adhesion, and accuses O'Halloran of “rudeness and ignorance,” and “bold, +uncivil language,” in disputing their teaching. Princ. of Surgery, vol. +i. p. 42. Mr. Hunter succeeded at last in naturalizing the doctrine and +practice, but even he had to struggle against the perpetual jealousy +of rivals, and died at length assassinated by an insult.] We have +often heard similar opinions maintained by our own countrymen. While +Anglo-American criticism blows hot or cold on the two departments of +French practice, it is not, I hope, indecent to question whether all the +wisdom is necessarily with us in both cases. + +Our art has had two or three lessons which have a deep meaning to those +who are willing to read them honestly. The use of water-dressings in +surgery completed the series of reforms by which was abolished the +“coarse and cruel practice” of the older surgeons, who with their +dressings and acrid balsams, their tents and leaden tubes, “absolutely +delayed the cure.” The doctrine of Broussais, transient as was its +empire, reversed the practice of half of Christendom for a season, and +taught its hasty disciples to shun their old favorite remedies as mortal +poisons. This was not enough permanently to shift the presumption about +drugs where it belonged, and so at last, just as the sympathetic powder +and the Unguentum Armarium came in a superstitious age to kill out the +abuses of external over-medication, the solemn farce of Homoeopathy was +enacted in the face of our own too credulous civilization, that under +shelter of its pretences the “inward bruises” of over-drugged viscera +might be allowed to heal by the first intention. Its lesson we must +accept, whether we will or not; its follies we are tired of talking +about. The security of the medical profession against this and all +similar fancies is in the average constitution of the human mind with +regard to the laws of evidence. + +My friends and brothers in Art! There is nothing to be feared from the +utterance of any seeming heresy to which you may have listened. I cannot +compromise your collective wisdom. If I have strained the truth one +hair's breadth for the sake of an epigram or an antithesis, you are +accustomed to count the normal pulse-beats of sound judgment, and know +full well how to recognize the fever-throbs of conceit and the nervous +palpitations of rhetoric. + +The freedom with which each of us speaks his thought in this presence, +belongs in part to the assured position of the Profession in our +Commonwealth, to the attitude of Science, which is always fearless, and +to the genius of the soil on which we stand, from which Nature withheld +the fatal gift of malaria only to fill it with exhalations that breed +the fever of inquiry in our blood and in our brain. But mainly we owe +the large license of speech we enjoy to those influences and privileges +common to us all as self-governing Americans. + +This Republic is the chosen home of minorities, of the less power in +the presence of the greater. It is a common error to speak of our +distinction as consisting in the rule of the majority. Majorities, the +greater material powers, have always ruled before. The history of most +countries has been that of majorities, mounted majorities, clad in iron, +armed with death treading down the tenfold more numerous minorities. In +the old civilizations they root themselves like oaks in the soil; men +must live in their shadow or cut them down. With us the majority is only +the flower of the passing noon, and the minority is the bud which may +open in the next morning's sun. We must be tolerant, for the thought +which stammers on a single tongue today may organize itself in the +growing consciousness of the time, and come back to us like the voice of +the multitudinous waves of the ocean on the morrow. + +Twenty-five years have passed since one of your honored Presidents spoke +to this Society of certain limitations to the power of our Art, now very +generally conceded. Some were troubled, some were almost angry, thinking +the Profession might suffer from such concessions. It has certainly not +suffered here; if, as some affirm, it has lost respect anywhere, it was +probably for other, and no doubt sufficient reasons. + +Since that time the civilization of this planet has changed hands. +Strike out of existence at this moment every person who was breathing on +that day, May 27, 1835, and every institution of society, every art and +every science would remain intact and complete in the living that would +be left. Every idea the world then held has been since dissolved and +recrystallized. + +We are repeating the same process. Not to make silver shrines for our +old divinities, even though by this craft we should have our wealth, was +this Society organized and carried on by the good men and true who went +before us. Not for this, but to melt the gold out of the past, though +its dross should fly in dust to all the winds of heaven, to save all our +old treasures of knowledge and mine deeply for new, to cultivate that +mutual respect of which outward courtesy is the sign, to work together, +to feel together, to take counsel together, and to stand together +for the truth, now, always, here, everywhere; for this our fathers +instituted, and we accept, the offices and duties of this time-honored +Society. + + + + + + +BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. + +An Introductory Lecture delivered before the Medical Class of Harvard +University, November 6, 1861. + +[This Lecture appears as it would have been delivered had the time +allowed been less strictly, limited. Passages necessarily omitted +have been restored, and points briefly touched have been more fully +considered. A few notes have been added for the benefit of that limited +class of students who care to track an author through the highways and +by-ways of his reading. I owe my thanks to several of my professional +brethren who have communicated with me on subjects with which they are +familiar; especially to Dr. John Dean, for the opportunity of profiting +by his unpublished labors, and to Dr. Hasket Derby, for information and +references to recent authorities relating to the anatomy and physiology +of the eye.] + +The entrance upon a new course of Lectures is always a period of +interest to instructors and pupils. As the birth of a child to a parent, +so is the advent of a new class to a teacher. As the light of the +untried world to the infant, so is the dawning of the light resting +over the unexplored realms of science to the student. In the name of the +Faculty I welcome you, Gentlemen of the Medical Class, new-born babes of +science, or lustier nurslings, to this morning of your medical life, and +to the arms and the bosom of this ancient University. Fourteen years ago +I stood in this place for the first time to address those who occupied +these benches. As I recall these past seasons of our joint labors, I +feel that they have been on the whole prosperous, and not undeserving of +their prosperity. + +For it has been my privilege to be associated with a body of true and +faithful workers; I cannot praise them freely to their faces, or I +should be proud to discourse of the harmonious diligence and the noble +spirit in which they have toiled together, not merely to teach their +several branches, but to elevate the whole standard of teaching. + +I may speak with less restraint of those gentlemen who have aided me in +the most laborious part of my daily duties, the Demonstrators, to whom +the successive classes have owed so much of their instruction. They rise +before me, the dead and the living, in the midst of the most grateful +recollections. The fair, manly face and stately figure of my friend, +Dr. Samuel Parkman, himself fit for the highest offices of teaching, yet +willing to be my faithful assistant in the time of need, come back to +me with the long sigh of regret for his early loss to our earthly +companionship. Every year I speak the eulogy of Dr. Ainsworth's patient +toil as I show his elaborate preparations: When I take down my “American +Cyclopaedia” and borrow instruction from the learned articles of Dr. +Kneeland, I cease to regret that his indefatigable and intelligent +industry was turned into a broader channel. And what can I say too +cordial of my long associated companion and friend, Dr. Hodges, whose +admirable skill, working through the swiftest and surest fingers that +ever held a scalpel among us, has delighted class after class, and +filled our Museum with monuments which will convey his name to unborn +generations? + +This day belongs, however, not to myself and my recollections, but to +all of us who teach and all of you who listen, whether experts in +our specialties or aliens to their mysteries, or timid neophytes just +entering the portals of the hall of science. Look in with me, then, +while I attempt to throw some rays into its interior, which shall +illuminate a few of its pillars and cornices, and show at the same time +how many niches and alcoves remain in darkness. + +SCIENCE is the topography of ignorance. From a few elevated points we +triangulate vast spaces, inclosing infinite unknown details. We cast the +lead, and draw up a little sand from abysses we may never reach with our +dredges. + +The best part of our knowledge is that which teaches us where knowledge +leaves off and ignorance begins. Nothing more clearly separates a vulgar +from a superior mind, than the confusion in the first between the little +that it truly knows, on the one hand, and what it half knows and what it +thinks it knows on the other. + +That which is true of every subject is especially true of the branch of +knowledge which deals with living beings. Their existence is a perpetual +death and reanimation. Their identity is only an idea, for we put off +our bodies many times during our lives, and dress in new suits of bones +and muscles. + + + “Thou art not thyself; + For thou exist'st on many a thousand grains + That issue out of dust.” + +If it is true that we understand ourselves but imperfectly in health, +this truth is more signally manifested in disease, where natural actions +imperfectly understood, disturbed in an obscure way by half-seen causes, +are creeping and winding along in the dark toward their destined issue, +sometimes using our remedies as safe stepping-stones, occasionally, it +may be, stumbling over them as obstacles. + +I propose in this lecture to show you some points of contact between our +ignorance and our knowledge in several of the branches upon the study +of which you are entering. I may teach you a very little directly, but I +hope much more from the trains of thought I shall suggest. Do not expect +too much ground to be covered in this rapid survey. Our task is only +that of sending out a few pickets under the starry flag of science to +the edge of that dark domain where the ensigns of the obstinate rebel, +Ignorance, are flying undisputed. We are not making a reconnoissance +in force, still less advancing with the main column. But here are a few +roads along which we have to march together, and we wish to see clearly +how far our lines extend, and where the enemy's outposts begin. + +Before touching the branches of knowledge that deal with organization +and vital functions, let us glance at that science which meets you at +the threshold of your study, and prepares you in some measure to deal +with the more complex problems of the living laboratory. + +CHEMISTRY includes the art of separating and combining the elements of +matter, and the study of the changes produced by these operations. We +can hardly say too much of what it has contributed to our knowledge of +the universe and our power of dealing with its materials. It has given +us a catalogue raisonne of the substances found upon our planet, and +shown how everything living and dead is put together from them. It is +accomplishing wonders before us every day, such as Arabian story-tellers +used to string together in their fables. It spreads the sensitive film +on the artificial retina which looks upon us through the optician's lens +for a few seconds, and fixes an image that will outlive its original. +It questions the light of the sun, and detects the vaporized metals +floating around the great luminary,--iron, sodium, lithium, and +the rest,--as if the chemist of our remote planet could fill his +bell-glasses from its fiery atmosphere. It lends the power which flashes +our messages in thrills that leave the lazy chariot of day behind them. +It seals up a few dark grains in iron vases, and lo! at the touch of a +single spark, rises in smoke and flame a mighty Afrit with a voice +like thunder and an arm that shatters like an earthquake. The dreams of +Oriental fancy have become the sober facts of our every-day life, and +the chemist is the magician to whom we owe them. + +To return to the colder scientific aspect of chemistry. It has shown +us how bodies stand affected to each other through an almost boundless +range of combinations. It has given us a most ingenious theory to +account for certain fixed relations in these combinations. It has +successfully eliminated a great number of proximate compounds, more or +less stable, from organic structures. It has invented others which form +the basis of long series of well-known composite substances. In fact, we +are perhaps becoming overburdened with our list of proximate principles, +demonstrated and hypothetical. + +How much nearer have we come to the secret of force than Lully and Geber +and the whole crew of juggling alchemists? We have learned a great deal +about the how, what have we learned about the why? + +Why does iron rust, while gold remains untarnished, and gold amalgamate, +while iron refuses the alliance of mercury? + +The alchemists called gold Sol, the sun, and iron Mars, and pleased +themselves with fancied relations between these substances and the +heavenly bodies, by which they pretended to explain the facts they +observed. Some of their superstitions have lingered in practical +medicine to the present day, but chemistry has grown wise enough to +confess the fact of absolute ignorance. + +What is it that makes common salt crystallize in the form of cubes, +and saltpetre in the shape of six-sided prisms? We see no reason why it +should not have been just the other way, salt in prisms and saltpetre in +cubes, or why either should take an exact geometrical outline, any more +than coagulating albumen. + +But although we had given up attempting to explain the essential nature +of affinities and of crystalline types, we might have supposed that we +had at least fixed the identity of the substances with which we deal, +and determined the laws of their combination. All at once we find that a +simple substance changes face, puts off its characteristic qualities and +resumes them at will;--not merely when we liquefy or vaporize a solid, +or reverse the process; but that a solid is literally transformed into +another solid under our own eyes. We thought we knew phosphorus. We warm +a portion of it sealed in an empty tube, for about a week. It has +become a brown infusible substance, which does not shine in the dark +nor oxidate in the air. We heat it to 500 F., and it becomes common +phosphorus again. We transmute sulphur in the same singular way. Nature, +you know, gives us carbon in the shape of coal and in that of the +diamond. It is easy to call these changes by the name allotropism, but +not the less do they confound our hasty generalizations. + +These facts of allotropism have some corollaries connected with them +rather startling to us of the nineteenth century. There may be other +transmutations possible besides those of phosphorus and sulphur. When +Dr. Prout, in 1840, talked about azote and carbon being “formed” in the +living system, it was looked upon as one of those freaks of fancy to +which philosophers, like other men, are subject. But when Professor +Faraday, in 1851, says, at a meeting of the British Association, that +“his hopes are in the direction of proving that bodies called simple +were really compounds, and may be formed artificially as soon as we +are masters of the laws influencing their combinations,”--when he comes +forward and says that he has tried experiments at transmutation, +and means, if his life is spared, to try them again,--how can we +be surprised at the popular story of 1861, that Louis Napoleon has +established a gold-factory and is glutting the mints of Europe with +bullion of his own making? + +And so with reference to the law of combinations. The old maxim was, +Corpora non agunt nisi soluta. If two substances, a and b, are inclosed +in a glass vessel, c, we do not expect the glass to change them, unless +a or b or the compound a b has the power of dissolving the glass. But +if for a I take oxygen, for b hydrogen, and for c a piece of spongy +platinum, I find the first two combine with the common signs of +combustion and form water, the third in the mean time undergoing no +perceptible change. It has played the part of the unwedded priest, who +marries a pair without taking a fee or having any further relation with +the parties. We call this catalysis, catalytic action, the action of +presence, or by what learned name we choose. Give what name to it we +will, it is a manifestation of power which crosses our established laws +of combination at a very open angle of intersection. I think we may +find an analogy for it in electrical induction, the disturbance of the +equilibrium of the electricity of a body by the approach of a charged +body to it, without interchange of electrical conditions between the +two bodies. But an analogy is not an explanation, and why a few drops +of yeast should change a saccharine mixture to carbonic acid and +alcohol,--a little leaven leavening the whole lump,--not by combining +with it, but by setting a movement at work, we not only cannot explain, +but the fact is such an exception to the recognized laws of combination +that Liebig is unwilling to admit the new force at all to which +Berzelius had given the name so generally accepted. + +The phenomena of isomerism, or identity of composition and proportions +of constituents with difference of qualities, and of isomorphism, or +identity of form in crystals which have one element substituted for +another, were equally surprises to science; and although the mechanism +by which they are brought about can be to a certain extent explained +by a reference to the hypothetical atoms of which the elements are +constituted, yet this is only turning the difficulty into a fraction +with an infinitesimal denominator and an infinite numerator. + +So far we have studied the working of force and its seeming anomalies +in purely chemical phenomena. But we soon find that chemical force is +developed by various other physical agencies,--by heat, by light, by +electricity, by magnetism, by mechanical agencies; and, vice versa, that +chemical action develops heat, light, electricity, magnetism, mechanical +force, as we see in our matches, galvanic batteries, and explosive +compounds. Proceeding with our experiments, we find that every kind +of force is capable of producing all other kinds, or, in Mr. Faraday's +language, that “the various forms under which the forces of matter are +made manifest have a common origin, or, in other words, are so directly +related and mutually dependent that they are convertible one into +another.” + +Out of this doctrine naturally springs that of the conservation of +force, so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. Faraday. +This idea is no novelty, though it seems so at first sight. It was +maintained and disputed among the giants of philosophy. Des Cartes and +Leibnitz denied that any new motion originated in nature, or that any +ever ceased to exist; all motion being in a circle, passing from one +body to another, one losing what the other gained. Newton, on the +other hand, believed that new motions were generated and existing ones +destroyed. On the first supposition, there is a fixed amount of force +always circulating in the universe. On the second, the total amount may +be increasing or diminishing. You will find in the “Annual of Scientific +Discovery” for 1858 a very interesting lecture by Professor Helmholtz of +Bonn, in which it is maintained that a certain portion of force is lost +in every natural process, being converted into unchangeable heat, so +that the universe will come to a stand-still at last, all force passing +into heat, and all heat into a state of equilibrium. + +The doctrines of the convertibility or specific equivalence of the +various forms of force, and of its conservation, which is its logical +consequence, are very generally accepted, as I believe, at the present +time, among physicists. We are naturally led to the question, What is +the nature of force? The three illustrious philosophers just referred +to agree in attributing the general movements of the universe to the +immediate Divine action. The doctrine of “preestablished harmony” was +an especial contrivance of Leibnitz to remove the Creator from unworthy +association with the less divine acts of living beings. Obsolete as this +expression sounds to our ears, the phrase laws of the universe, which +we use so constantly with a wider application, appears to me essentially +identical with it. + +Force does not admit of explanation, nor of proper definition, any more +than the hypothetical substratum of matter. If we assume the Infinite as +omnipresent, omniscient, omnipotent, we cannot suppose Him excluded from +any part of His creation, except from rebellious souls which voluntarily +exclude Him by the exercise of their fatal prerogative of free-will. +Force, then, is the act of immanent Divinity. I find no meaning in +mechanical explanations. Newton's hypothesis of an ether filling the +heavenly spaces does not, I confess, help my conceptions. I will, and +the muscles of my vocal organs shape my speech. God wills, and the +universe articulates His power, wisdom, and goodness. That is all I +know. There is no bridge my mind can throw from the “immaterial” cause +to the “material” effect. + +The problem of force meets us everywhere, and I prefer to encounter +it in the world of physical phenomena before reaching that of living +actions. It is only the name for the incomprehensible cause of certain +changes known to our consciousness, and assumed to be outside of it. For +me it is the Deity Himself in action. + +I can therefore see a large significance in the somewhat bold language +of Burdach: “There is for me but one miracle, that of infinite +existence, and but one mystery, the manner in which the finite proceeds +from the infinite. So soon as we recognize this incomprehensible act as +the general and primordial miracle, of which our reason perceives the +necessity, but the manner of which our intelligence cannot grasp, so +soon as we contemplate the nature known to us by experience in this +light, there is for us no other impenetrable miracle or mystery.” + +Let us turn to a branch of knowledge which deals with certainties up to +the limit of the senses, and is involved in no speculations beyond them. +In certain points of view, HUMAN ANATOMY may be considered an almost +exhausted science. From time to time some small organ which had escaped +earlier observers has been pointed out,--such parts as the tensor +tarsi, the otic ganglion, or the Pacinian bodies; but some of our best +anatomical works are those which have been classic for many generations. +The plates of the bones in Vesalius, three centuries old, are still +masterpieces of accuracy, as of art. The magnificent work of Albinus on +the muscles, published in 1747, is still supreme in its department, +as the constant references of the most thorough recent treatise on +the subject, that of Theile, sufficiently show. More has been done in +unravelling the mysteries of the fasciae, but there has been a tendency +to overdo this kind of material analysis. Alexander Thomson split them +up into cobwebs, as you may see in the plates to Velpeau's Surgical +Anatomy. I well remember how he used to shake his head over the coarse +work of Scarpa and Astley Cooper,--as if Denner, who painted the +separate hairs of the beard and pores of the skin in his portraits, had +spoken lightly of the pictures of Rubens and Vandyk. + +Not only has little been added to the catalogue of parts, but some +things long known had become half-forgotten. Louis and others confounded +the solitary glands of the lower part of the small intestine with those +which “the great Brunner,” as Haller calls him, described in 1687 as +being found in the duodenum. The display of the fibrous structure of the +brain seemed a novelty as shown by Spurzheim. One is startled to find +the method anticipated by Raymond Vieussens nearly two centuries ago. I +can hardly think Gordon had ever looked at his figures, though he names +their author, when he wrote the captious and sneering article which +attracted so much attention in the pages of the “Edinburgh Review.” + +This is the place, if anywhere, to mention any observations I could +pretend to have made in the course of my teaching the structure of the +human body. I can make no better show than most of my predecessors in +this well-reaped field. The nucleated cells found connected with the +cancellated structure of the bones, which I first pointed out and had +figured in 1847, and have shown yearly from that time to the present, +and the fossa masseterica, a shallow concavity on the ramus of the +lower jaw, for the lodgment of the masseter muscle, which acquires +significance when examined by the side of the deep cavity on the +corresponding part in some carnivora to which it answers, may perhaps be +claimed as deserving attention. I have also pleased myself by making a +special group of the six radiating muscles which diverge from the spine +of the axis, or second cervical vertebra, and by giving to it the name +stella musculosa nuchae. But this scanty catalogue is only an evidence +that one may teach long and see little that has not been noted by those +who have gone before him. Of course I do not think it necessary to +include rare, but already described anomalies, such as the episternal +bones, the rectus sternalis, and other interesting exceptional +formations I have encountered, which have shown a curious tendency to +present themselves several times in the same season, perhaps because the +first specimen found calls our attention to any we may subsequently meet +with. + +The anatomy of the scalpel and the amphitheatre was, then, becoming an +exhausted branch of investigation. But during the present century the +study of the human body has changed its old aspect, and become fertile +in new observations. This rejuvenescence was effected by means of two +principal agencies,--new methods and a new instrument. + +Descriptive anatomy, as known from an early date, is to the body what +geography is to the planet. Now geography was pretty well known so long +ago as when Arrowsmith, who was born in 1750, published his admirable +maps. But in that same year was born Werner, who taught a new way of +studying the earth, since become familiar to us all under the name of +Geology. + +What geology has done for our knowledge of the earth, has been done for +our knowledge of the body by that method of study to which is given the +name of General Anatomy. It studies, not the organs as such, but the +elements out of which the organs are constructed. It is the geology of +the body, as that is the general anatomy of the earth. The extraordinary +genius of Bichat, to whom more than any other we owe this new method +of study, does not require Mr. Buckle's testimony to impress the +practitioner with the importance of its achievements. I have heard a +very wise physician question whether any important result had accrued +to practical medicine from Harvey's discovery of the circulation. But +Anatomy, Physiology, and Pathology have received a new light from this +novel method of contemplating the living structures, which has had a +vast influence in enabling the practitioner at least to distinguish +and predict the course of disease. We know as well what differences +to expect in the habits of a mucous and of a serous membrane, as what +mineral substances to look for in the chalk or the coal measures. You +have only to read Cullen's description of inflammation of the lungs or +of the bowels, and compare it with such as you may find in Laennec +or Watson, to see the immense gain which diagnosis and prognosis have +derived from general anatomy. + +The second new method of studying the human structure, beginning with +the labors of Scarpa, Burns, and Colles, grew up principally during the +first third of this century. It does not deal with organs, as did the +earlier anatomists, nor with tissues, after the manner of Bichat. It +maps the whole surface of the body into an arbitrary number of regions, +and studies each region successively from the surface to the bone, or +beneath it. This hardly deserves the name of a science, although +Velpeau has dignified it with that title, but it furnishes an admirable +practical way for the surgeon who has to operate on a particular region +of the body to study that region. If we are buying a farm, we are not +content with the State map or a geological chart including the estate in +question. We demand an exact survey of that particular property, so that +we may know what we are dealing with. This is just what regional, or, +as it is sometimes called, surgical anatomy, does for the surgeon with +reference to the part on which his skill is to be exercised. It enables +him to see with the mind's eye through the opaque tissues down to the +bone on which they lie, as if the skin were transparent as the cornea, +and the organs it covers translucent as the gelatinous pulp of a medusa. + +It is curious that the Japanese should have anticipated Europe in a kind +of rude regional anatomy. I have seen a manikin of Japanese make traced +all over with lines, and points marking their intersection. By this +their doctors are guided in the performance of acupuncture, marking the +safe places to thrust in needles, as we buoy out our ship-channels, and +doubtless indicating to learned eyes the spots where incautious meddling +had led to those little accidents of shipwreck to which patients are +unfortunately liable. + +A change of method, then, has given us General and Regional Anatomy. +These, too, have been worked so thoroughly, that, if not exhausted, they +have at least become to a great extent fixed and positive branches of +knowledge. But the first of them, General Anatomy, would never have +reached this positive condition but for the introduction of that +instrument which I have mentioned as the second great aid to modern +progress. + +This instrument is the achromatic microscope. For the history of the +successive steps by which it became the effective scientific implement +we now possess, I must refer you to the work of Mr. Quekett, to an +excellent article in the “Penny Cyclopaedia,” or to that of Sir David +Brewster in the “Encyclopaedia Britannica.” It is a most interesting +piece of scientific history, which shows how the problem which Biot in +1821 pronounced insolvable was in the course of a few years practically +solved, with a success equal to that which Dollond had long before +obtained with the telescope. It is enough for our purpose that we +are now in possession of an instrument freed from all confusions and +illusions, which magnifies a thousand diameters,--a million times in +surface,--without serious distortion or discoloration of its object. + +A quarter of a century ago, or a little more, an instructor would not +have hesitated to put John Bell's “Anatomy” and Bostock's “Physiology” + into a student's hands, as good authority on their respective subjects. +Let us not be unjust to either of these authors. John Bell is the +liveliest medical writer that I can remember who has written since the +days of delightful old Ambroise Pare. His picturesque descriptions and +bold figures are as good now as they ever were, and his book can never +become obsolete. But listen to what John Bell says of the microscope: + +“Philosophers of the last age had been at infinite pains to find the +ultimate fibre of muscles, thinking to discover its properties in its +form; but they saw just in proportion to the glasses which they used, or +to their practice and skill in that art, which is now almost forsaken.” + +Dr. Bostock's work, neglected as it is, is one which I value very highly +as a really learned compilation, full of original references. But +Dr. Bostock says: “Much as the naturalist has been indebted to the +microscope, by bringing into view many beings of which he could not +otherwise have ascertained the existence, the physiologist has not yet +derived any great benefit from the instrument.” + +These are only specimens of the manner in which the microscope and its +results were generally regarded by the generation just preceding our +own. + +I have referred you to the proper authorities for the account of those +improvements which about the year 1830 rendered the compound microscope +an efficient and trustworthy instrument. It was now for the first time +that a true general anatomy became possible. As early as 1816 Treviranus +had attempted to resolve the tissues, of which Bichat had admitted no +less than twenty-one, into their simple microscopic elements. How +could such an attempt succeed, Henle well asks, at a time when the most +extensively diffused of all the tissues, the areolar, was not at all +understood? All that method could do had been accomplished by Bichat and +his followers. It was for the optician to take the next step. The future +of anatomy and physiology, as an enthusiastic micrologist of the time +said, was in the hands of Messrs. Schieck and Pistor, famous opticians +of Berlin. + +In those earlier days of which I am speaking, all the points of minute +anatomy were involved in obscurity. Some found globules everywhere, +some fibres. Students disputed whether the conjunctiva extended over +the cornea or not, and worried themselves over Gaultier de Claubry's +stratified layers of the skin, or Breschet's blennogenous and +chromatogenous organs. The dartos was a puzzle, the central spinal canal +a myth, the decidua clothed in fable as much as the golden fleece. The +structure of bone, now so beautifully made out,--even that of the teeth, +in which old Leeuwenhoek, peeping with his octogenarian eyes through the +minute lenses wrought with his own hands, had long ago seen the “pipes,” + as he called them,--was hardly known at all. The minute structure of +the viscera lay in the mists of an uncertain microscopic vision. The +intimate recesses of the animal system were to the students of anatomy +what the anterior of Africa long was to geographers, and the stories of +microscopic explorers were as much sneered at as those of Bruce or Du +Chailly, and with better reason. + +Now what have we come to in our own day? In the first place, the minute +structure of all the organs has been made out in the most satisfactory +way. The special arrangements of the vessels and the ducts of all the +glands, of the air-tubes and vesicles of the lungs, of the parts which +make up the skin and other membranes, all the details of those complex +parenchymatous organs which had confounded investigation so long, have +been lifted out of the invisible into the sight of all observers. It +is fair to mention here, that we owe a great deal to the art of minute +injection, by which we are enabled to trace the smallest vessels in the +midst of the tissues where they are distributed. This is an old artifice +of anatomists. The famous Ruysch, who died a hundred and thirty years +ago, showed that each of the viscera has its terminal vessels arranged +in its own peculiar way; the same fact which you may see illustrated in +Gerber's figures after the minute injections of Berres. I hope to show +you many specimens of this kind in the microscope, the work of English +and American hands. Professor Agassiz allows me also to make use of +a very rich collection of injected preparations sent him by Professor +Hyrtl, formerly of Prague, now of Vienna, for the proper exhibition +of which I had a number of microscopes made expressly, by Mr. Grunow, +during the past season. All this illustrates what has been done for the +elucidation of the intimate details of formation of the organs. + +But the great triumph of the microscope as applied to anatomy has +been in the resolution of the organs and the tissues into their simple +constituent anatomical elements. It has taken up general anatomy where +Bichat left it. He had succeeded in reducing the structural language of +nature to syllables, if you will permit me to use so bold an image. The +microscopic observers who have come after him have analyzed these into +letters, as we may call them,--the simple elements by the combination of +which Nature spells out successively tissues, which are her syllables, +organs which are her words, systems which are her chapters, and so goes +on from the simple to the complex, until she binds up in one living +whole that wondrous volume of power and wisdom which we call the human +body. + +The alphabet of the organization is so short and simple, that I will +risk fatiguing your attention by repeating it, according to the plan I +have long adopted. + +A. Cells, either floating, as in the blood, or fixed, like those in the +cancellated structure of bone, already referred to. Very commonly they +have undergone a change of figure, most frequently a flattening which +reduces them to scales, as in the epidermis and the epithelium. + +B. Simple, translucent, homogeneous solid, such as is found at the back +of the cornea, or forming the intercellular substance of cartilage. + +C. The white fibrous element, consisting of very delicate, tenacious +threads. This is the long staple textile substance of the body. It is to +the organism what cotton is pretended to be to our Southern States. +It pervades the whole animal fabric as areolar tissue, which is the +universal packing and wrapping material. It forms the ligaments which +bind the whole frame-work together. It furnishes the sinews, which are +the channels of power. It enfolds every muscle. It wraps the brain in +its hard, insensible folds, and the heart itself beats in a purse that +is made of it. + +D. The yellow elastic, fibrous element, the caoutchouc of the animal +mechanism, which pulls things back into place, as the India-rubber band +shuts the door we have opened. + +E. The striped muscular fibre,--the red flesh, which shortens itself in +obedience to the will, and thus produces all voluntary active motion. + +F. The unstriped muscular fibre, more properly the fusiform-cell fibre, +which carries on the involuntary internal movements. + +G. The nerve-cylinder, a glassy tube, with a pith of some firmness, +which conveys sensation to the brain and the principle which induces +motion from it. + +H. The nerve-corpuscle, the centre of nervous power. + +I. The mucous tissue, as Virchow calls it, common in embryonic +structures, seen in the vitreous humor of the adult. + +To these add X, granules, of indeterminate shape and size, Y, for +inorganic matters, such as the salts of bone and teeth, and Z, to stand +as a symbol of the fluids, and you have the letters of what I have +ventured to call the alphabet of the body. + +But just as in language certain diphthongs and syllables are frequently +recurring, so we have in the body certain secondary and tertiary +combinations, which we meet more frequently than the solitary elements +of which they are composed. + +Thus A B, or a collection of cells united by simple structureless +solid, is seen to be extensively employed in the body under the name of +cartilage. Out of this the surfaces of the articulations and the springs +of the breathing apparatus are formed. But when Nature came to the +buffers of the spinal column (intervertebral disks) and the washers of +the joints (semilunar fibrocartilages of the knee, etc.), she required +more tenacity than common cartilage possessed. What did she do? What +does man do in a similar case of need? I need hardly tell you. The mason +lays his bricks in simple mortar. But the plasterer works some hair into +the mortar which he is going to lay in large sheets on the walls. The +children of Israel complained that they had no straw to make their +bricks with, though portions of it may still be seen in the crumbling +pyramid of Darshour, which they are said to have built. I visited the +old house on Witch Hill in Salem a year or two ago, and there I found +the walls coated with clay in which straw was abundantly mingled;--the +old Judaizing witch-hangers copied the Israelites in a good many things. +The Chinese and the Corsicans blend the fibres of amianthus in their +pottery to give it tenacity. Now to return to Nature. To make her +buffers and washers hold together in the shocks to which they would +be subjected, she took common cartilage and mingled the white fibrous +tissue with it, to serve the same purpose as the hair in the mortar, +the straw in the bricks and in the plaster of the old wall, and the +amianthus in the earthen vessels. Thus we have the combination A B C, or +fibro-cartilage. Again, the bones were once only gristle or cartilage, +A B. To give them solidity they were infiltrated with stone, in the form +of salts of lime, an inorganic element, so that bone would be spelt out +by the letters A, B, and Y. + +If from these organic syllables we proceed to form organic words, we +shall find that Nature employs three principal forms; namely, Vessels, +Membranes, and Parenchyma, or visceral tissue. The most complex of +them can be resolved into a combination of these few simple anatomical +constituents. + +Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find +the same elements in morbid growths that we have met with in normal +structures. The pus-corpuscle and the white blood-corpuscle can only +be distinguished by tracing them to their origin. A frequent form of +so-called malignant disease proves to be only a collection of altered +epithelium-cells. Even cancer itself has no specific anatomical element, +and the diagnosis of a cancerous tumor by the microscope, though +tolerably sure under the eye of an expert, is based upon accidental, and +not essential points,--the crowding together of the elements, the size +of the cell-nuclei, and similar variable characters. + +Let us turn to PHYSIOLOGY. The microscope, which has made a new science +of the intimate structure of the organs, has at the same time cleared up +many uncertainties concerning the mechanism of the special functions. Up +to the time of the living generation of observers, Nature had kept over +all her inner workshops the forbidding inscription, No Admittance! If +any prying observer ventured to spy through his magnifying tubes into +the mysteries of her glands and canals and fluids, she covered up her +work in blinding mists and bewildering halos, as the deities of old +concealed their favored heroes in the moment of danger. + +Science has at length sifted the turbid light of her lenses, and +blanched their delusive rainbows. + +Anatomy studies the organism in space. Physiology studies it also in +time. After the study of form and composition follows close that of +action, and this leads us along back to the first moment of the germ, +and forward to the resolution of the living frame into its lifeless +elements. In this way Anatomy, or rather that branch of it which we call +Histology, has become inseparably blended with the study of function. +The connection between the science of life and that of intimate +structure on the one hand, and composition on the other, is illustrated +in the titles of two recent works of remarkable excellence,--“the +Physiological Anatomy” of Todd and Bowman, and the “Physiological +Chemistry” of Lehmann. + +Let me briefly recapitulate a few of our acquisitions in Physiology, due +in large measure to our new instruments and methods of research, and +at the same time indicate the limits which form the permanent or the +temporary boundaries of our knowledge. I will begin with the largest +fact and with the most absolute and universally encountered limitation. + +The “largest truth in Physiology” Mr. Paget considers to be “the +development of ova through multiplication and division of their cells.” + I would state it more broadly as the agency of the cell in all living +processes. It seems at present necessary to abandon the original idea of +Schwann, that we can observe the building up of a cell from the simple +granules of a blastema, or formative fluid. The evidence points rather +towards the axiom, Omnis cellula a cellula; that is, the germ of a new +cell is always derived from a preexisting cell. The doctrine of Schwann, +as I remarked long ago (1844), runs parallel with the nebular theory in +astronomy, and they may yet stand or fall together. + +As we have seen Nature anticipating the plasterer in fibro-cartilage, +so we see her beforehand with the glassblower in her dealings with the +cell. The artisan blows his vitreous bubbles, large or small, to be used +afterwards as may be wanted. So Nature shapes her hyaline vesicles and +modifies them to serve the needs of the part where they are found. The +artisan whirls his rod, and his glass bubble becomes a flattened disk, +with its bull's-eye for a nucleus. These lips of ours are all glazed +with microscopic tiles formed of flattened cells, each one of them with +its nucleus still as plain and relatively as prominent, to the eye of +the microscopist, as the bull's-eye in the old-fashioned windowpane. +Everywhere we find cells, modified or unchanged. They roll in +inconceivable multitudes (five millions and more to the cubic +millimetre, according to Vierordt) as blood-disks through our vessels. +A close-fitting mail of flattened cells coats our surface with a panoply +of imbricated scales (more than twelve thousand millions), as Harting +has computed, as true a defence against our enemies as the buckler of +the armadillo or the carapace of the tortoise against theirs. The same +little protecting organs pave all the great highways of the interior +system. Cells, again, preside over the chemical processes which +elaborate the living fluids; they change their form to become the agents +of voluntary and involuntary motion; the soul itself sits on a throne +of nucleated cells, and flashes its mandates through skeins of glassy +filaments which once were simple chains of vesicles. And, as if to +reduce the problem of living force to its simplest expression, we see +the yolk of a transparent egg dividing itself in whole or in part, and +again dividing and subdividing, until it becomes a mass of cells, out +of which the harmonious diversity of the organs arranges itself, worm or +man, as God has willed from the beginning. + +This differentiation having been effected, each several part assumes its +special office, having a life of its own adjusted to that of other parts +and the whole. “Just as a tree constitutes a mass arranged in a definite +manner, in which, in every single part, in the leaves as in the root, +in the trunk as in the blossom, cells are discovered to be the ultimate +elements, so is it also with the forms of animal life. Every animal +presents itself as a sum of vital unities, every one of which manifests +all the characteristics of life.” + +The mechanism is as clear, as unquestionable, as absolutely settled and +universally accepted, as the order of movement of the heavenly bodies, +which we compute backward to the days of the observatories on the plains +of Shinar, and on the faith of which we regulate the movements of war +and trade by the predictions of our ephemeris. + +The mechanism, and that is all. We see the workman and the tools, but +the skill that guides the work and the power that performs it are as +invisible as ever. I fear that not every listener took the +significance of those pregnant words in the passage I quoted from +John Bell,--“thinking to discover its properties in its form.” We have +discovered the working bee in this great hive of organization. We have +detected the cell in the very act of forming itself from a nucleus, of +transforming itself into various tissues, of selecting the elements of +various secretions. But why one cell becomes nerve and another muscle, +why one selects bile and another fat, we can no more pretend to tell, +than why one grape sucks out of the soil the generous juice which +princes hoard in their cellars, and another the wine which it takes +three men to drink,--one to pour it down, another to swallow it, and a +third to hold him while it is going down. Certain analogies between +this selecting power and the phenomena of endosmosis in the elective +affinities of chemistry we can find, but the problem of force remains +here, as everywhere, unsolved and insolvable. + +Do we gain anything by attempting to get rid of the idea of a special +vital force because we find certain mutually convertible relations +between forces in the body and out of it? I think not, any more than we +should gain by getting rid of the idea and expression Magnetism because +of its correlation with electricity. We may concede the unity of all +forms of force, but we cannot overlook the fixed differences of its +manifestations according to the conditions under which it acts. It is a +mistake, however, to think the mystery is greater in an organized body +than in any other. We see a stone fall or a crystal form, and there is +nothing stranger left to wonder at, for we have seen the Infinite in +action. + +Just so far as we can recognize the ordinary modes of operation of the +common forces of nature,--gravity, cohesion, elasticity, transudation, +chemical action, and the rest,--we see the so-called vital acts in +the light of a larger range of known facts and familiar analogies. +Matteuecci's well-remembered lectures contain many and striking examples +of the working of physical forces in physiological processes. Wherever +rigid experiment carries us, we are safe in following this lead; but +the moment we begin to theorize beyond our strict observation, we are in +danger of falling into those mechanical follies which true science has +long outgrown. + +Recognizing the fact, then, that we have learned nothing but the +machinery of life, and are no nearer to its essence, what is it that we +have gained by this great discovery of the cell formation and function? + +It would have been reward enough to learn the method Nature pursues +for its own sake. If the sovereign Artificer lets us into his own +laboratories and workshops, we need not ask more than the privilege +of looking on at his work. We do not know where we now stand in the +hierarchy of created intelligences. We were made a little lower than the +angels. I speak it not irreverently; as the lower animals surpass man +in some of their attributes, so it may be that not every angel's eye +can see as broadly and as deeply into the material works of God as +man himself, looking at the firmament through an equatorial of fifteen +inches' aperture, and searching into the tissues with a twelfth of an +inch objective. + +But there are other positive gains of a more practical character. Thus +we are no longer permitted to place the seat of the living actions in +the extreme vessels, which are only the carriers from which each part +takes what it wants by the divine right of the omnipotent nucleated +cell. The organism has become, in the words already borrowed from +Virchow, “a sum of vital unities.” The strictum and laxum, the increased +and diminished action of the vessels, out of which medical theories +and methods of treatment have grown up, have yielded to the doctrine +of local cell-communities, belonging to this or that vascular district, +from which they help themselves, as contractors are wont to do from the +national treasury. + +I cannot promise to do more than to select a few of the points of +contact between our ignorance and our knowledge which present particular +interest in the existing state of our physiological acquisitions. +Some of them involve the microscopic discoveries of which I have +been speaking, some belong to the domain of chemistry, and some have +relations with other departments of physical science. + +If we should begin with the digestive function, we should find that the +long-agitated question of the nature of the acid of the gastric juice is +becoming settled in favor of the lactic. But the whole solvent agency of +the digestive fluid enters into the category of that exceptional mode of +action already familiar to us in chemistry as catalysis. It is therefore +doubly difficult of explanation; first, as being, like all reactions, +a fact not to be accounted for except by the imaginative appeal to +“affinity,” and secondly, as being one of those peculiar reactions +provoked by an element which stands outside and looks on without +compromising itself. + +The doctrine of Mulder, so widely diffused in popular and scientific +belief, of the existence of a common base of all albuminous substances, +the so-called protein, has not stood the test of rigorous analysis. The +division of food into azotized and non-azotized is no doubt important, +but the attempt to show that the first only is plastic or nutritive, +while the second is simply calorifacient, or heat-producing, fails +entirely in the face of the facts revealed by the study of man in +different climates, and of numerous experiments in the feeding +of animals. I must return to this subject in connection with the +respiratory function. + +The sugar-making faculty of the liver is another “catalytic” mystery, as +great as the rest of them, and no greater. Liver-tissue brings sugar out +of the blood, or out of its own substance;--why? + + + Quia est in eo + Virtus saccharitiva. + +Just what becomes of the sugar beyond the fact of its disappearance +before it can get into the general circulation and sweeten our tempers, +it is hard to say. + +The pancreatic fluid makes an emulsion of the fat contained in our food, +but just how the fatty particles get into the villi we must leave Brucke +and Kolliker to settle if they can. + +No one has shown satisfactorily the process by which the +blood-corpuscles are formed out of the lymph-corpuscles, nor what +becomes of them. These two questions are like those famous household +puzzles,--Where do the flies come from? and, Where do the pins go to? + +There is a series of organs in the body which has long puzzled +physiologists,--organs of glandular aspect, but having no ducts,--the +spleen, the thyroid and thymus bodies, and the suprarenal capsules. We +call them vascular glands, and we believe that they elaborate colored +and uncolored blood-cells; but just what changes they effect, and +just how they effect them, it has proved a very difficult matter to +determine. So of the noted glandules which form Peyer's patches, their +precise office, though seemingly like those of the lymphatic glands, +cannot be positively assigned, so far as I know, at the present time. +It is of obvious interest to learn it with reference to the pathology of +typhoid fever. It will be remarked that the coincidence of their changes +in this disease with enlargement of the spleen suggests the idea of a +similarity of function in these two organs. + +The theories of the production of animal heat, from the times of Black, +Lavoisier, and Crawford to those of Liebig, are familiar to all who have +paid any attention to physiological studies. The simplicity of Liebig's +views, and the popular form in which they have been presented, have +given them wide currency, and incorporated them in the common belief and +language of our text-books. Direct oxidation or combustion of the carbon +and hydrogen contained in the food, or in the tissues themselves; the +division of alimentary substances into respiratory, or non-azotized, +and azotized,--these doctrines are familiar even to the classes in our +high-schools. But this simple statement is boldly questioned. Nothing +proves that oxygen combines (in the system) with hydrogen and carbon +in particular, rather than with sulphur and azote. Such is the +well-grounded statement of Robin and Verdeil. “It is very probable that +animal heat is entirely produced by the chemical actions which take +place in the organism, but the phenomenon is too complex to admit of our +calculating it according to the quality of oxygen consumed.” These last +are the words of Regnault, as cited by Mr. Lewes, whose intelligent +discussion of this and many of the most interesting physiological +problems I strongly recommend to your attention. + +This single illustration covers a wider ground than the special function +to which it belongs. We are learning that the chemistry of the body must +be studied, not simply by its ingesta and egesta, but that there is a +long intermediate series of changes which must be investigated in their +own light, under their own special conditions. The expression “sum of +vital unities” applies to the chemical actions, as well as to other +actions localized in special parts; and when the distinguished chemists +whom I have just cited entitle their work a treatise on the immediate +principles of the body, they only indicate the nature of that +profound and subtile analysis which must take the place of all hasty +generalizations founded on a comparison of the food with residual +products. + +I will only call your attention to the fact, that the exceptional +phenomenon of the laboratory is the prevailing law of the organism. +Nutrition itself is but one great catalytic process. As the blood +travels its rounds, each part selects its appropriate element and +transforms it to its own likeness. Whether the appropriating agent +be cell or nucleus, or a structureless solid like the intercellular +substance of cartilage, the fact of its presence determines the +separation of its proper constituents from the circulating fluid, so +that even when we are wounded bone is replaced by bone, skin by skin, +and nerve by nerve. + +It is hardly without a smile that we resuscitate the old question of +the 'vis insita' of the muscular fibre, so famous in the discussions of +Haller and his contemporaries. Speaking generally, I think we may say +that Haller's doctrine is the one now commonly received; namely, that +the muscles contract in virtue of their own inherent endowments. It +is true that Kolliker says no perfectly decisive fact has been brought +forward to prove that the striated muscles contract without having been +acted on by nerves. Yet Mr. Bowman's observations on the contraction +of isolated fibres appear decisive enough (unless we consider them +invalidated by Dr. Lionel Beale's recent researches), tending to show +that each elementary fibre is supplied with nerves; and as to the +smooth muscular fibres, we have Virchow's statement respecting the +contractility of those of the umbilical cord, where there is not a trace +of any nerves. + +In the investigation of the nervous system, anatomy and physiology have +gone hand in hand. It is very singular that so important, and seemingly +simple, a fact as the connection of the nerve-tubes, at their origin or +in their course, with the nerve-cells, should have so long remained open +to doubt, as you may see that it did by referring to the very complete +work of Sharpey and Quain (edition of 1849), the histological portion of +which is cordially approved by Kolliker himself. + +Several most interesting points of the minute anatomy of the nervous +centres have been laboriously and skilfully worked out by a recent +graduate of this Medical School, in a monograph worthy to stand in line +with those of Lockhart Clarke, Stilling, and Schroder van der Kolk. I +have had the privilege of examining and of showing some of you a number +of Dr. Dean's skilful preparations. I have no space to give even an +abstract of his conclusions. I can only refer to his proof of the fact, +that a single cell may send its processes into several different bundles +of nerve-roots, and to his demonstration of the curved ascending and +descending fibres from the posterior nerveroots, to reach what he has +called the longitudinal columns of the cornea. I must also mention Dr. +Dean's exquisite microscopic photographs from sections of the medulla +oblongata, which appear to me to promise a new development, if not a new +epoch, in anatomical art. + +It having been settled that the nerve-tubes can very commonly be traced +directly to the nerve-cells, the object of all the observers in this +department of anatomy is to follow these tubes to their origin. We have +an infinite snarl of telegraph wires, and we may be reasonably sure, +that, if we can follow them up, we shall find each of them ends in a +battery somewhere. One of the most interesting problems is to find the +ganglionic origin of the great nerves of the medulla oblongata, and this +is the end to which, by the aid of the most delicate sections, colored +so as to bring out their details, mounted so as to be imperishable, +magnified by the best instruments, and now self-recorded in the light +of the truth-telling sunbeam, our fellow-student is making a steady +progress in a labor which I think bids fair to rank with the most +valuable contributions to histology that we have had from this side of +the Atlantic. + +It is interesting to see how old questions are incidentally settled in +the course of these new investigations. Thus, Mr. Clarke's dissections, +confirmed by preparations of Mr. Dean's which I have myself examined, +placed the fact of the decussation of the pyramids--denied by Haller, by +Morgagni, and even by Stilling--beyond doubt. So the spinal canal, the +existence of which, at least in the adult, has been so often disputed, +appears as a coarse and unequivocal anatomical fact in many of the +preparations referred to. + +While these studies of the structure of the cord have been going on, +the ingenious and indefatigable Brown-Sequard has been investigating the +functions of its different parts with equal diligence. The microscopic +anatomists had shown that the ganglionic corpuscles of the gray matter +of the cord are connected with each other by their processes, as well +as with the nerve-roots. M. Brown-Sequard has proved by numerous +experiments that the gray substance transmits sensitive impressions and +muscular stimulation. The oblique ascending and descending fibres from +the posterior nerve-roots, joining the “longitudinal columns of the +cornua,” account for the results of Brown-Sequard's sections of the +posterior columns. The physiological experimenter has also made it +evident that the decussation of the conductors of sensitive impressions +has its seat in the spinal core, and not in the encephalon, as had been +supposed. Not less remarkable than these results are the facts, which +I with others of my audience have had the opportunity of observing, as +shown by M. Brown-Sequard, of the artificial production of epilepsy in +animals by injuring the spinal cord, and the induction of the paroxysm +by pinching a certain portion of the skin. I would also call the +student's attention to his account of the relations of the nervous +centres to nutrition and secretion, the last of which relations has been +made the subject of an extended essay by our fellow countryman, Dr. H. +F. Campbell of Georgia. + +The physiology of the spinal cord seems a simple matter as you study it +in Longet. The experiments of Brown-Sequard have shown the problem to +be a complex one, and raised almost as many doubts as they have solved +questions; at any rate, I believe all lecturers on physiology agree that +there is no part of their task they dread so much as the analysis of the +evidence relating to the special offices of the different portions of +the medulla spinalis. In the brain we are sure that we do not know +how to localize functions; in the spinal cord, we think we do know +something; but there are so many anomalies, and seeming contradictions, +and sources of fallacy, that beyond the facts of crossed paralysis of +sensation, and the conducting agency of the gray substance, I am afraid +we retain no cardinal principles discovered since the development of the +reflex function took its place by Sir Charles Bell's great discovery. + +By the manner in which I spoke of the brain, you will see that I am +obliged to leave phrenology sub Jove,--out in the cold,--as not one of +the household of science. I am not one of its haters; on the contrary, I +am grateful for the incidental good it has done. I love to amuse myself +in its plaster Golgothas, and listen to the glib professor, as he +discovers by his manipulations + + + “All that disgraced my betters met in me.” + +I loved of old to see square-headed, heavy-jawed Spurzheim make a brain +flower out into a corolla of marrowy filaments, as Vieussens had done +before him, and to hear the dry-fibred but human-hearted George Combe +teach good sense under the disguise of his equivocal system. But the +pseudo-sciences, phrenology and the rest, seem to me only appeals to +weak minds and the weak points of strong ones. There is a pica or false +appetite in many intelligences; they take to odd fancies in place of +wholesome truth, as girls gnaw at chalk and charcoal. Phrenology juggles +with nature. It is so adjusted as to soak up all evidence that helps +it, and shed all that harms it. It crawls forward in all weathers, like +Richard Edgeworth's hygrometer. It does not stand at the boundary of our +ignorance, it seems to me, but is one of the will-o'-the-wisps of its +undisputed central domain of bog and quicksand. Yet I should not have +devoted so many words to it, did I not recognize the light it has thrown +on human actions by its study of congenital organic tendencies. Its maps +of the surface of the head are, I feel sure, founded on a delusion, +but its studies of individual character are always interesting and +instructive. + +The “snapping-turtle” strikes after its natural fashion when it first +comes out of the egg. Children betray their tendencies in their way of +dealing with the breasts that nourish them; nay, lean venture to affirm, +that long before they are born they teach their mothers something of +their turbulent or quiet tempers. + + + “Castor gaudet equis, ovo proanatus eodem + Pugnis.” + +Strike out the false pretensions of phrenology; call it anthropology; +let it study man the individual in distinction from man the abstraction, +the metaphysical or theological lay-figure; and it becomes “the proper +study of mankind,” one of the noblest and most interesting of pursuits. + +The whole physiology of the nervous system, from the simplest +manifestation of its power in an insect up to the supreme act of the +human intelligence working through the brain, is full of the most +difficult yet profoundly interesting questions. The singular relations +between electricity and nerve-force, relations which it has been +attempted to interpret as meaning identity, in the face of palpable +differences, require still more extended studies. You may be interested +by Professor Faraday's statement of his opinion on the matter. “Though +I am not satisfied that the nervous fluid is only electricity, still I +think that the agent in the nervous system maybe an inorganic force; and +if there be reason for supposing that magnetism is a higher relation +of force than electricity, so it may well be imagined that the nervous +power may be of a still more exalted character, and yet within the reach +of experiment.” + +In connection with this statement, it is interesting to refer to the +experiments of Helmholtz on the rapidity of transmission of the nervous +actions. The rate is given differently in Valentin's report of these +experiments and in that found in the “Scientific Annual” for 1858. +One hundred and eighty to three hundred feet per second is the rate +of movement assigned for sensation, but all such results must be very +vaguely approximative. Boxers, fencers, players at the Italian game +of morn, “prestidigitators,” and all who depend for their success on +rapidity of motion, know what differences there are in the personal +equation of movement. + +Reflex action, the mechanical sympathy, if I may so call it, of distant +parts; Instinct, which is crystallized intelligence,--an absolute law +with its invariable planes and angles introduced into the sphere of +consciousness, as raphides are inclosed in the living cells of plants; +Intellect,--the operation of the thinking principle through material +organs, with an appreciable waste of tissue in every act of thought, so +that our clergymen's blood has more phosphates to get rid of on Monday +than on any other day of the week; Will,--theoretically the absolute +determining power, practically limited in different degrees by the +varying organization of races and individuals, annulled or perverted +by different ill-understood organic changes; on all these subjects our +knowledge is in its infancy, and from the study of some of them the +interdict of the Vatican is hardly yet removed. + +I must allude to one or two points in the histology and physiology of +the organs of sense. The anterior continuation of the retina beyond +the ora serrata has been a subject of much discussion. If H. Muller and +Kolliker can be relied upon, this question is settled by recognizing +that a layer of cells, continued from the retina, passes over the +surface of the zonula Zinnii, but that no proper nervous element is so +prolonged forward. + +I observe that Kolliker calls the true nervous elements of the retina +“the layer of gray cerebral substance.” In fact, the ganglionic +corpuscles of each eye may be considered as constituting a little brain, +connected with the masses behind by the commissure, commonly called the +optic nerve. We are prepared, therefore, to find these two little brains +in the most intimate relations with each other, as we find the cerebral +hemispheres. We know that they are directly connected by fibres that +arch round through the chiasma. + +I mention these anatomical facts to introduce a physiological +observation of my own, first announced in one of the lectures before the +Medical Class, subsequently communicated to the American Academy of Arts +and Sciences, and printed in its “Transactions” for February 14, 1860. +I refer to the apparent transfer of impressions from one retina to +the other, to which I have given the name reflex vision. The idea was +suggested to me in consequence of certain effects noticed in employing +the stereoscope. Professor William B. Rodgers has since called the +attention of the American Scientific Association to some facts bearing +on the subject, and to a very curious experiment of Leonardo da Vinci's, +which enables the observer to look through the palm of his hand (or seem +to), as if it had a hole bored through it. As he and others hesitated +to accept my explanation, I was not sorry to find recently the following +words in the “Observations on Man” of that acute observer and thinker, +David Hartley. “An impression made on the right eye alone by a single +object may propagate itself into the left, and there raise up an image +almost equal in vividness to itself; and consequently when we see with +one eye only, we may, however, have pictures in both eyes.” Hartley, +in 1784, had anticipated many of the doctrines which have since been +systematized into the theory of reflex actions, and with which I have +attempted to associate this act of reflex vision. My sixth experiment, +however, in the communication referred to, appears to me to be a crucial +one, proving the correctness of my explanation, and I am not aware that +it has been before instituted. + +Another point of great interest connected with the physiology of +vision, and involved for a long time in great obscurity, is that of the +adjustment of the eye to different distances. Dr. Clay Wallace of New +York, who published a very ingenious little book on the eye about twenty +years ago, with vignettes reminding one of Bewick, was among the first, +if not the first, to describe the ciliary muscle, to which the power of +adjustment is generally ascribed. It is ascertained, by exact experiment +with the phacueidoscope, that accommodation depends on change of form of +the crystalline lens. Where the crystalline is wanting, as Mr. Ware long +ago taught, no power of accommodation remains. The ciliary muscle is +generally thought to effect the change of form of the crystalline. The +power of accommodation is lost after the application of atropine, in +consequence, as is supposed, of the paralysis of this muscle. This, +I believe, is the nearest approach to a demonstration we have on this +point. + +I have only time briefly to refer to Professor Draper's most ingenious +theory as to the photographic nature of vision, for an account of which +I must refer to his original and interesting Treatise on Physiology. + +It were to be wished that the elaborate and very interesting researches +of the Marquis Corti, which have revealed such singular complexity +of structure in the cochlea of the ear, had done more to clear up its +doubtful physiology; but I am afraid we have nothing but hypotheses for +the special part it plays in the act of hearing, and that we must say +the same respecting the office of the semicircular canals. + +The microscope has achieved some of its greatest triumphs in teaching +us the changes which occur in the development of the embryo. No more +interesting discovery stands recorded in the voluminous literature +of this subject than the one originally announced by Martin Barry, +afterwards discredited, and still later confirmed by Mr. Newport and +others; namely the fact that the fertilizing filament reaches the +interior of the ovum in various animals;--a striking parallel to the +action of the pollen-tube in the vegetable. But beyond the mechanical +facts all is mystery in the movements of organization, as profound as in +the fall of a stone or the formation of a crystal. + +To the chemist and the microscopist the living body presents the same +difficulties, arising from the fact that everything is in perpetual +change in the organism. The fibrine of the blood puzzles the one as much +as its globules puzzle the other. The difference between the branches of +science which deal with space only, and those which deal with space and +time, is this: we have no glasses that can magnify time. The figure I +here show you a was photographed from an object (pleurosigma angulatum) +magnified a thousand diameters, or presenting a million times its +natural surface. This other figure of the same object, enlarged from +the one just shown, is magnified seven thousand diameters, or forty-nine +million times in surface. When we can make the forty-nine millionth of +a second as long as its integer, physiology and chemistry will approach +nearer the completeness of anatomy. + +Our reverence becomes more worthy, or, if you will, less unworthy of its +Infinite Object in proportion as our intelligence is lifted and expanded +to a higher and broader understanding of the Divine methods of action. +If Galen called his heathen readers to admire, the power, the wisdom, +the providence, the goodness of the “Framer of the animal body,”--if Mr. +Boyle, the student of nature, as Addison and that friend of his who had +known him for forty years tell us, never uttered the name of the Supreme +Being without making a distinct pause in his speech, in token of his +devout recognition of its awful meaning,--surely we, who inherit the +accumulated wisdom of nearly two hundred years since the time of +the British philosopher, and of almost two thousand since the Greek +physician, may well lift our thoughts from the works we study to their +great Artificer. These wonderful discoveries which we owe to that mighty +little instrument, the telescope of the inner firmament with all +its included worlds; these simple formulae by which we condense the +observations of a generation in a single axiom; these logical analyses +by which we fence out the ignorance we cannot reclaim, and fix the +limits of our knowledge,--all lead us up to the inspiration of the +Almighty, which gives understanding to the world's great teachers. To +fear science or knowledge, lest it disturb our old beliefs, is to fear +the influx of the Divine wisdom into the souls of our fellow-men; for +what is science but the piecemeal revelation,--uncovering,--of the plan +of creation, by the agency of those chosen prophets of nature whom God +has illuminated from the central light of truth for that single purpose? + +The studies which we have glanced at are preliminary in your +education to the practical arts which make use of them,--the arts of +healing,--surgery and medicine. The more you examine the structure of +the organs and the laws of life, the more you will find how resolutely +each of the cell-republics which make up the E pluribus unum of the body +maintains its independence. Guard it, feed it, air it, warm it, exercise +or rest it properly, and the working elements will do their best to keep +well or to get well. What do we do with ailing vegetables? Dr. Warren, +my honored predecessor in this chair, bought a country-place, including +half of an old orchard. A few years afterwards I saw the trees on his +side of the fence looking in good health, while those on the other side +were scraggy and miserable. How do you suppose this change was brought +about? By watering them with Fowler's solution? By digging in calomel +freely about their roots? Not at all; but by loosening the soil +round them, and supplying them with the right kind of food in fitting +quantities. + +Now a man is not a plant, or, at least, he is a very curious one, for +he carries his soil in his stomach, which is a kind--of portable +flower-pot, and he grows round it, instead of out of it. He has, +besides, a singularly complex nutritive apparatus and a nervous system. +But recollect the doctrine already enunciated in the language of +Virchow, that an animal, like a tree, is a sum of vital unities, of +which the cell is the ultimate element. Every healthy cell, whether in +a vegetable or an animal, necessarily performs its function properly +so long as it is supplied with its proper materials and stimuli. A cell +may, it is true, be congenitally defective, in which case disease is, +so to speak, its normal state. But if originally sound and subsequently +diseased, there has certainly been some excess, deficiency, or wrong +quality in the materials or stimuli applied to it. You remove this +injurious influence and substitute a normal one; remove the baked +coal-ashes, for instance, from the roots of a tree, and replace them +with loam; take away the salt meat from the patient's table, and replace +it with fresh meat and vegetables, and the cells of the tree or the man +return to their duty. + +I do not know that we ever apply to a plant any element which is not +a natural constituent of the vegetable structure, except perhaps +externally, for the accidental purpose of killing parasites. The whole +art of cultivation consists in learning the proper food and conditions +of plants, and supplying them. We give them water, earths, salts of +various kinds such as they are made of, with a chance to help themselves +to air and light. The farmer would be laughed at who undertook to +manure his fields or his trees with a salt of lead or of arsenic. These +elements are not constituents of healthy plants. The gardener uses the +waste of the arsenic furnaces to kill the weeds in his walks. + +If the law of the animal cell, and of the animal organism, which is +built up of such cells, is like that of the vegetable, we might expect +that we should treat all morbid conditions of any of the vital unities +belonging to an animal in the same way, by increasing, diminishing, or +changing its natural food or stimuli. + +That is an aliment which nourishes; whatever we find in the organism, as +a constant and integral element, either forming part of its structure, +or one of the conditions of vital processes, that and that only deserves +the name of aliment. I see no reason, therefore, why iron, phosphate of +lime, sulphur, should not be considered food for man, as much as guano +or poudrette for vegetables. Whether one or another of them is best in +any given case,--whether they shall be taken alone or in combination, in +large or small quantities, are separate questions. But they are elements +belonging to the body, and even in moderate excess will produce little +disturbance. There is no presumption against any of this class of +substances, any more than against water or salt, provided they are used +in fitting combinations, proportions, and forms. + +But when it comes to substances alien to the healthy system, which never +belong to it as normal constituents, the case is very different. There +is a presumption against putting lead or arsenic into the human body, as +against putting them into plants, because they do not belong there, +any more than pounded glass, which, it is said, used to be given as a +poison. The same thing is true of mercury and silver. What becomes of +these alien substances after they get into the system we cannot always +tell. But in the case of silver, from the accident of its changing color +under the influence of light, we do know what happens. It is thrown +out, in part at least, under the epidermis, and there it remains to the +patient's dying day. This is a striking illustration of the difficulty +which the system finds in dealing with non-assimilable elements, and +justifies in some measure the vulgar prejudice against mineral poisons. + +I trust the youngest student on these benches will not commit the +childish error of confounding a presumption against a particular class +of agents with a condemnation of them. Mercury, for instance, is alien +to the system, and eminently disturbing in its influence. Yet its +efficacy in certain forms of specific disease is acknowledged by all +but the most sceptical theorists. Even the esprit moqueur of Ricord, +the Voltaire of pelvic literature, submits to the time-honored +constitutional authority of this great panacea in the class of cases +to which he has devoted his brilliant intelligence. Still, there is +no telling what evils have arisen from the abuse of this mineral. +Dr. Armstrong long ago pointed out some of them, and they have become +matters of common notoriety. I am pleased, therefore, when I find so +able and experienced a practitioner as Dr. Williams of this city proving +that iritis is best treated without mercury, and Dr. Vanderpoel showing +the same thing to be true for pericarditis. + +Whatever elements nature does not introduce into vegetables, the +natural food of all animal life,--directly of herbivorous, indirectly of +carnivorous animals,--are to be regarded with suspicion. Arsenic-eating +may seem to improve the condition of horses for a time,--and even of +human beings, if Tschudi's stories can be trusted,--but it soon appears +that its alien qualities are at war with the animal organization. So of +copper, antimony, and other non-alimentary simple substances; everyone +of them is an intruder in the living system, as much as a constable +would be, quartered in our household. This does not mean that they may +not, any of them, be called in for a special need, as we send for the +constable when we have good reason to think we have a thief under our +roof; but a man's body is his castle, as well as his house, and the +presumption is that we are to keep our alimentary doors bolted against +these perturbing agents. + +Now the feeling is very apt to be just contrary to this. The habit has +been very general with well-taught practitioners, to have recourse to +the introduction of these alien elements into the system on the occasion +of any slight disturbance. The tongue was a little coated, and mercury +must be given; the skin was a little dry, and the patient must take +antimony. It was like sending for the constable and the posse comitatus +when there is only a carpet to shake or a refuse-barrel to empty. [Dr. +James Johnson advises persons not ailing to take five grains of blue +pill with one or two of aloes twice a week for three or four months in +the year, with half a pint of compound decoction of sarsaparilla every +day for the same period, to preserve health and prolong life. Pract. +Treatise on Dis. of Liver, etc. p. 272.] The constitution bears slow +poisoning a great deal better than might be expected; yet the most +intelligent men in the profession have gradually got out of the habit of +prescribing these powerful alien substances in the old routine way. +Mr. Metcalf will tell you how much more sparingly they are given by our +practitioners at the present time, than when he first inaugurated +the new era of pharmacy among us. Still, the presumption in favor of +poisoning out every spontaneous reaction of outraged nature is +not extinct in those who are trusted with the lives of their +fellow-citizens. “On examining the file of prescriptions at the +hospital, I discovered that they were rudely written, and indicated a +treatment, as they consisted chiefly of tartar emetic, ipecacuanha, and +epsom salts, hardly favorable to the cure of the prevailing diarrhoea +and dysenteries.” In a report of a poisoning case now on trial, where we +are told that arsenic enough was found in the stomach to produce death +in twenty-four hours, the patient is said to have been treated by +arsenic, phosphorus, bryonia, aconite, nux vomica, and muriatic +acid,--by a practitioner of what school it may be imagined. + +The traditional idea of always poisoning out disease, as we smoke out +vermin, is now seeking its last refuge behind the wooden cannon and +painted port-holes of that unblushing system of false scientific +pretences which I do not care to name in a discourse addressed to an +audience devoted to the study of the laws of nature in the light of the +laws of evidence. It is extraordinary to observe that the system which, +by its reducing medicine to a name and a farce, has accustomed all who +have sense enough to see through its thin artifices to the idea that +diseases get well without being “cured,” should now be the main support +of the tottering poison-cure doctrine. It has unquestionably helped +to teach wise people that nature heals most diseases without help from +pharmaceutic art, but it continues to persuade fools that art can arrest +them all with its specifics. + +It is worse than useless to attempt in any way to check the freest +expression of opinion as to the efficacy of any or all of the “heroic” + means of treatment employed by practitioners of different schools and +periods. Medical experience is a great thing, but we must not forget +that there is a higher experience, which tries its results in a court +of a still larger jurisdiction; that, namely, in which the laws of human +belief are summoned to the witness-box, and obliged to testify to the +sources of error which beset the medical practitioner. The verdict is as +old as the father of medicine, who announces it in the words, “judgment +is difficult.” Physicians differed so in his time, that some denied that +there was any such thing as an art of medicine. + +One man's best remedies were held as mischievous by another. The art of +healing was like soothsaying, so the common people said; “the same bird +was lucky or unlucky, according as he flew to the right or left.” + +The practice of medicine has undergone great changes within the period +of my own observation. Venesection, for instance, has so far gone out +of fashion, that, as I am told by residents of the New York Bellevue +and the Massachusetts General Hospitals, it is almost obsolete in +these institutions, at least in medical practice. The old Brunonian +stimulating treatment has come into vogue again in the practice of Dr. +Todd and his followers. The compounds of mercury have yielded their +place as drugs of all work, and specifics for that very frequent +subjective complaint, nescio quid faciam,--to compounds of iodine. [Sir +Astley Cooper has the boldness,--or honesty,--to speak of medicines +which “are given as much to assist the medical man as his patient.” + Lectures (London, 1832), p. 14.] Opium is believed in, and quinine, +and “rum,” using that expressive monosyllable to mean all alcoholic +cordials. If Moliere were writing now, instead of saignare, purgare, +and the other, he would be more like to say, Stimulare, opium dare et +potassio-iodizare. + +I have been in relation successively with the English and American +evacuant and alterative practice, in which calomel and antimony figured +so largely that, as you may see in Dr. Jackson's last “Letter,” Dr. +Holyoke, a good representative of sterling old-fashioned medical art, +counted them with opium and Peruvian bark as his chief remedies; with +the moderately expectant practice of Louis; the blood-letting “coup +sur coup” of Bouillaud; the contra-stimulant method of Rasori and his +followers; the anti-irritant system of Broussais, with its leeching +and gum-water; I have heard from our own students of the simple opium +practice of the renowned German teacher, Oppolzer; and now I find the +medical community brought round by the revolving cycle of opinion to +that same old plan of treatment which John Brown taught in Edinburgh +in the last quarter of the last century, and Miner and Tully fiercely +advocated among ourselves in the early years of the present. The +worthy physicians last mentioned, and their antagonist Dr. Gallup, used +stronger language than we of these degenerate days permit ourselves. +“The lancet is a weapon which annually slays more than the sword,” says +Dr. Tully. “It is probable that, for forty years past, opium and +its preparations have done seven times the injury they have rendered +benefit, on the great scale of the world,” says Dr. Gallup. + +What is the meaning of these perpetual changes and conflicts of medical +opinion and practice, from an early antiquity to our own time? Simply +this: all “methods” of treatment end in disappointment of those +extravagant expectations which men are wont to entertain of medical art. +The bills of mortality are more obviously affected by drainage, than by +this or that method of practice. The insurance companies do not commonly +charge a different percentage on the lives of the patients of this or +that physician. In the course of a generation, more or less, physicians +themselves are liable to get tired of a practice which has so little +effect upon the average movement of vital decomposition. Then they are +ready for a change, even if it were back again to a method which has +already been tried, and found wanting. + +Our practitioners, or many of them, have got back to the ways of old Dr. +Samuel Danforth, who, as it is well known, had strong objections to +the use of the lancet. By and by a new reputation will be made by some +discontented practitioner, who, tired of seeing patients die with their +skins full of whiskey and their brains muddy with opium, returns to a +bold antiphlogistic treatment, and has the luck to see a few patients +of note get well under it. So of the remedies which have gone out of +fashion and been superseded by others. It can hardly be doubted that +they will come into vogue again, more or less extensively, under the +influence of that irresistible demand for change just referred to. + +Then will come the usual talk about a change in the character +of disease, which has about as much meaning as that concerning +“old-fashioned snow-storms.” “Epidemic constitutions” of disease mean +something, no doubt; a great deal as applied to malarious affections; +but that the whole type of diseases undergoes such changes that the +practice must be reversed from depleting to stimulating, and vice versa, +is much less likely than that methods of treatment go out of fashion and +come in again. If there is any disease which claims its percentage with +reasonable uniformity, it is phthisis. Yet I remember that the reverend +and venerable Dr. Prince of Salem told me one Commencement day, as I was +jogging along towards Cambridge with him, that he recollected the time +when that disease was hardly known; and in confirmation of his +statement mentioned a case in which it was told as a great event, that +somebody down on “the Cape” had died of “a consumption.” This story does +not sound probable to myself, as I repeat it, yet I assure you it is +true, and it shows how cautiously we must receive all popular stories of +great changes in the habits of disease. + +Is there no progress, then, but do we return to the same beliefs and +practices which our forefathers wore out and threw away? I trust and +believe that there is a real progress. We may, for instance, return in +a measure to the Brunonian stimulating system, but it must be in a +modified way, for we cannot go back to the simple Brunonian pathology, +since we have learned too much of diseased action to accept its +convenient dualism. So of other doctrines, each new Avatar strips them +of some of their old pretensions, until they take their fitting place +at last, if they have any truth in them, or disappear, if they were mere +phantasms of the imagination. + +In the mean time, while medical theories are coming in and going out, +there is a set of sensible men who are never run away with by them, but +practise their art sagaciously and faithfully in much the same way from +generation to generation. From the time of Hippocrates to that of our +own medical patriarch, there has been an apostolic succession of wise +and good practitioners. If you will look at the first aphorism of the +ancient Master you will see that before all remedies he places the +proper conduct of the patient and his attendants, and the fit ordering +of all the conditions surrounding him. The class of practitioners I have +referred to have always been the most faithful in attending to these +points. No doubt they have sometimes prescribed unwisely, in compliance +with the prejudices of their time, but they have grown wiser as they +have grown older, and learned to trust more in nature and less in their +plans of interference. I believe common opinion confirms Sir James +Clark's observation to this effect. + +The experience of the profession must, I think, run parallel with that +of the wisest of its individual members. Each time a plan of treatment +or a particular remedy comes up for trial, it is submitted to a sharper +scrutiny. When Cullen wrote his Materia Medica, he had seriously to +assail the practice of giving burnt toad, which was still countenanced +by at least one medical authority of note. I have read recently in some +medical journal, that an American practitioner, whose name is known to +the country, is prescribing the hoof of a horse for epilepsy. It was +doubtless suggested by that old fancy of wearing a portion of elk's hoof +hung round the neck or in a ring, for this disease. But it is hard +to persuade reasonable people to swallow the abominations of a former +period. The evidence which satisfied Fernelius will not serve one of our +hospital physicians. + +In this way those articles of the Materia Medica which had nothing but +loathsomeness to recommend them have been gradually dropped, and are not +like to obtain any general favor again with civilized communities. The +next culprits to be tried are the poisons. I have never been in the +least sceptical as to the utility of some of them, when properly +employed. Though I believe that at present, taking the world at large, +and leaving out a few powerful agents of such immense value that they +rank next to food in importance, the poisons prescribed for disease do +more hurt than good, I have no doubt, and never professed to have any, +that they do much good in prudent and instructed hands. But I am very +willing to confess a great jealousy of many agents, and I could almost +wish to see the Materia Medica so classed as to call suspicion upon +certain ones among them. + +Thus the alien elements, those which do not properly enter into +the composition of any living tissue, are the most to be suspected, +--mercury, lead, antimony, silver, and the rest, for the reasons I have +before mentioned. Even iodine, which, as it is found in certain plants, +seems less remote from the animal tissues, gives unequivocal proofs +from time to time that it is hostile to some portions of the glandular +system. + +There is, of course, less prima facie objection to those agents which +consist of assimilable elements, such as are found making a part +of healthy tissues. These are divisible into three classes,--foods, +poisons, and inert, mostly because insoluble, substances. The food of +one animal or of one human being is sometimes poison to another, and +vice versa; inert substances may act mechanically, so as to produce +the effect of poisons; but this division holds exactly enough for our +purpose. + +Strictly speaking, every poison consisting of assimilable elements may +be considered as unwholesome food. It is rejected by the stomach, or it +produces diarrhoea, or it causes vertigo or disturbance of the heart's +action, or some other symptom for which the subject of it would consult +the physician, if it came on from any other cause than taking it under +the name of medicine. Yet portions of this unwholesome food which +we call medicine, we have reason to believe, are assimilated; thus, +castor-oil appears to be partially digested by infants, so that they +require large doses to affect them medicinally. Even that deadliest of +poisons, hydrocyanic acid, is probably assimilated, and helps to make +living tissue, if it do not kill the patient, for the assimilable +elements which it contains, given in the separate forms of amygdalin and +emulsin, produce no disturbance, unless, as in Bernard's experiments, +they are suffered to meet in the digestive organs. A medicine consisting +of assimilable substances being then simply unwholesome food, we +understand what is meant by those cumulative effects of such remedies +often observed, as in the case of digitalis and strychnia. They are +precisely similar to the cumulative effects of a salt diet in producing +scurvy, or of spurred rye in producing dry gangrene. As the effects of +such substances are a violence to the organs, we should exercise the +same caution with regard to their use that we would exercise about +any other kind of poisonous food,--partridges at certain seasons, for +instance. Even where these poisonous kinds of food seem to be useful, we +should still regard them with great jealousy. Digitalis lowers the pulse +in febrile conditions. Veratrum viride does the same thing. How do we +know that a rapid pulse is not a normal adjustment of nature to the +condition it accompanies? Digitalis has gone out of favor; how sure are +we that Veratrum viride will not be found to do more harm than good in +a case of internal inflammation, taking the whole course of the disease +into consideration? Think of the change of opinion with regard to the +use of opium in delirium tremens (which you remember is sometimes called +delirium vigilans), where it seemed so obviously indicated, since the +publication of Dr. Ware's admirable essay. I respect the evidence of +my contemporaries, but I cannot forget the sayings of the Father of +medicine,--Ars longa, judicium difficile. + +I am not presuming to express an opinion concerning Veratrum viride, +which was little heard of when I was still practising medicine. I am +only appealing to that higher court of experience which sits in judgment +on all decisions of the lower medical tribunals, and which requires more +than one generation for its final verdict. + +Once change the habit of mind so long prevalent among practitioners of +medicine; once let it be everywhere understood that the presumption is +in favor of food, and not of alien substances, of innocuous, and not +of unwholesome food, for the sick; that this presumption requires very +strong evidence in each particular case to overcome it; but that, when +such evidence is afforded, the alien substance or the unwholesome food +should be given boldly, in sufficient quantities, in the same spirit as +that with which the surgeon lifts his knife against a patient,--that +is, with the same reluctance and the same determination,--and I think +we shall have and hear much less of charlatanism in and out of the +profession. The disgrace of medicine has been that colossal system of +self-deception, in obedience to which mines have been emptied of their +cankering minerals, the vegetable kingdom robbed of all its noxious +growths, the entrails of animals taxed for their impurities, +the poison-bags of reptiles drained of their venom, and all the +inconceivable abominations thus obtained thrust down the throats of +human beings suffering from some fault of organization, nourishment, or +vital stimulation. + +Much as we have gained, we have not yet thoroughly shaken off the notion +that poison is the natural food of disease, as wholesome aliment is +the support of health. Cowper's lines, in “The Task,” show the +matter-of-course practice of his time: + + + “He does not scorn it, who has long endured + A fever's agonies, and fed on drugs.” + +Dr. Kimball of Lowell, who has been in the habit of seeing a great +deal more of typhoid fever than most practitioners, and whose surgical +exploits show him not to be wanting in boldness or enterprise, can tell +you whether he finds it necessary to feed his patients on drugs or not. +His experience is, I believe, that of the most enlightened and advanced +portion of the profession; yet I think that even in typhoid fever, and +certainly in many other complaints, the effects of ancient habits +and prejudices may still be seen in the practice of some educated +physicians. + +To you, young men, it belongs to judge all that has gone before you. +You come nearer to the great fathers of modern medicine than some of you +imagine. Three of my own instructors attended Dr. Rush's Lectures. The +illustrious Haller mentions Rush's inaugural thesis in his “Bibliotheca +Anatomica;” and this same Haller, brought so close to us, tells us he +remembers Ruysch, then an old man, and used to carry letters between him +and Boerhaave. Look through the history of medicine from Boerhaave +to this present day. You will see at once that medical doctrine and +practice have undergone a long series of changes. You will see that +the doctrine and practice of our own time must probably change in their +turn, and that, if we can trust at all to the indications of their +course, it will be in the direction of an improved hygiene and a +simplified treatment. Especially will the old habit of violating the +instincts of the sick give place to a judicious study of these same +instincts. It will be found that bodily, like mental insanity, is best +managed, for the most part, by natural soothing agencies. Two centuries +ago there was a prescription for scurvy containing “stercoris taurini +et anserini par, quantitas trium magnarum nucum,” of the hell-broth +containing which “guoties-cumque sitit oeger, large bibit.” When I +have recalled the humane common-sense of Captain Cook in the matter +of preventing this disease; when I have heard my friend, Mr. Dana, +describing the avidity with which the scurvy-stricken sailors snuffed up +the earthy fragrance of fresh raw potatoes, the food which was to supply +the elements wanting to their spongy tissues, I have recognized that the +perfection of art is often a return to nature, and seen in this single +instance the germ of innumerable beneficent future medical reforms. + +I cannot help believing that medical curative treatment will by and +by resolve itself in great measure into modifications of the food, +swallowed and breathed, and of the natural stimuli, and that less will +be expected from specifics and noxious disturbing agents, either alien +or assimilable. The noted mineral-waters containing iron, sulphur, +carbonic acid, supply nutritious or stimulating materials to the body +as much as phosphate of lime and ammoniacal compounds do to the cereal +plants. The effects of a milk and vegetable diet, of gluten bread +in diabetes, of cod-liver oil in phthisis, even of such audacious +innovations as the water-cure and the grape-cure, are only hints of +what will be accomplished when we have learned to discover what organic +elements are deficient or in excess in a case of chronic disease, +and the best way of correcting the abnormal condition, just as an +agriculturist ascertains the wants of his crops and modifies the +composition of his soil. In acute febrile diseases we have long ago +discovered that far above all drug-medication is the use of mild liquid +diet in the period of excitement, and of stimulant and nutritious food +in that of exhaustion. Hippocrates himself was as particular about his +barley-ptisan as any Florence Nightingale of our time could be. + +The generation to which you, who are just entering the profession, +belong, will make a vast stride forward, as I believe, in the direction +of treatment by natural rather than violent agencies. What is it that +makes the reputation of Sydenham, as the chief of English physicians? +His prescriptions consisted principally of simples. An aperient or an +opiate, a “cardiac” or a tonic, may be commonly found in the midst of +a somewhat fantastic miscellany of garden herbs. It was not by his +pharmaceutic prescriptions that he gained his great name. It was +by daring to order fresh air for small-pox patients, and riding on +horseback for consumptives, in place of the smothering system, and +the noxious and often loathsome rubbish of the established schools. Of +course Sydenham was much abused by his contemporaries, as he frequently +takes occasion to remind his reader. “I must needs conclude,” he says, +“either that I am void of merit, or that the candid and ingenuous part +of mankind, who are formed with so excellent a temper of mind as to be +no strangers to gratitude, make a very small part of the whole.” If in +the fearless pursuit of truth you should find the world as ungracious in +the nineteenth century as he found it in the seventeenth, you may learn +a lesson of self-reliance from another utterance of the same illustrious +physician: “'T is none of my business to inquire what other persons +think, but to establish my own observations; in order to which, I ask no +favor of the reader but to peruse my writings with temper.” + +The physician has learned a great deal from the surgeon, who is +naturally in advance of him, because he has a better opportunity of +seeing the effects of his remedies. Let me shorten one of Ambroise +Pare's stories for you. There had been a great victory at the pass of +Susa, and they were riding into the city. The wounded cried out as the +horses trampled them under their hoofs, which caused good Ambroise great +pity, and made him wish himself back in Paris. Going into a stable he +saw four dead soldiers, and three desperately wounded, placed with their +backs against the wall. An old campaigner came up.--“Can these fellows +get well?” he said. “No!” answered the surgeon. Thereupon, the old +soldier walked up to them and cut all their throats, sweetly, and +without wrath (doulcement et sans cholere). Ambroise told him he was a +bad man to do such a thing. “I hope to God;” he said, “somebody will +do as much for me if I ever get into such a scrape” (accoustre de telle +facon). “I was not much salted in those days” (bien doux de sel), says +Ambroise, “and little acquainted with the treatment of wounds.” However, +as he tells us, he proceeded to apply boiling oil of Sambuc (elder) +after the approved fashion of the time,--with what torture to the +patient may be guessed. At last his precious oil gave out, and he used +instead an insignificant mixture of his own contrivance. He could not +sleep that night for fear his patients who had not been scalded with +the boiling oil would be poisoned by the gunpowder conveyed into their +wounds by the balls. To his surprise, he found them much better than the +others the next morning, and resolved never again to burn his patients +with hot oil for gun-shot wounds. + +This was the beginning, as nearly as we can fix it, of that reform which +has introduced plain water-dressings in the place of the farrago of +external applications which had been a source of profit to apothecaries +and disgrace to art from, and before, the time when Pliny complained +of them. A young surgeon who was at Sudley Church, laboring among the +wounded of Bull Run, tells me they had nothing but water for dressing, +and he (being also doux de sel) was astonished to see how well the +wounds did under that simple treatment. + +Let me here mention a fact or two which may be of use to some of you who +mean to enter the public service. You will, as it seems, have gun-shot +wounds almost exclusively to deal with. Three different surgeons, the +one just mentioned and two who saw the wounded of Big Bethel, assured me +that they found no sabre-cuts or bayonet wounds. It is the rifle-bullet +from a safe distance which pierces the breasts of our soldiers, and not +the gallant charge of broad platoons and sweeping squadrons, such as +we have been in the habit of considering the chosen mode of warfare +of ancient and modern chivalry. [Sir Charles James Napier had the same +experience in Virginia in 1813. “Potomac. We have nasty sort of fighting +here, amongst creeks and bushes, and lose men without show.” “Yankee +never shows himself, he keeps in the thickest wood, fires and runs +off.”--“These five thousand in the open field might be attacked, +but behind works it would be throwing away lives.” He calls it “an +inglorious warfare,”--says one of the leaders is “a little deficient in +gumption,--but--still my opinion is, that if we tuck up our sleeves and +lay our ears back we might thrash them; that is, if we caught them out +of their trees, so as to slap at them with the bayonet.”--Life, etc. +vol. i. p. 218 et seq.] + +Another fact parallels the story of the old campaigner, and may teach +some of you caution in selecting your assistants. A chaplain told it +to two of our officers personally known to myself. He overheard the +examination of a man who wished to drive one of the “avalanche” wagons, +as they call them. The man was asked if he knew how to deal with wounded +men. “Oh yes,” he answered; “if they're hit here,” pointing to the +abdomen, “knock 'em on the head,--they can't get well.” + +In art and outside of it you will meet the same barbarisms that Ambroise +Pare met with,--for men differ less from century to century than we are +apt to suppose; you will encounter the same opposition, if you attack +any prevailing opinion, that Sydenham complained of. So far as possible, +let not such experiences breed in you a contempt for those who are the +subjects of folly or prejudice, or foster any love of dispute for its +own sake. Should you become authors, express your opinions freely; +defend them rarely. It is not often that an opinion is worth expressing, +which cannot take care of itself. Opposition is the best mordant to fix +the color of your thought in the general belief. + +It is time to bring these crowded remarks to a close. The day has been +when at the beginning of a course of Lectures I should have thought it +fitting to exhort you to diligence and entire devotion to your tasks +as students. It is not so now. The young man who has not heard the +clarion-voices of honor and of duty now sounding throughout the land, +will heed no word of mine. In the camp or the city, in the field or the +hospital, under sheltering roof, or half-protecting canvas, or open +sky, shedding our own blood or stanching that of our wounded defenders, +students or teachers, whatever our calling and our ability, we belong, +not to ourselves, but to our imperilled country, whose danger is our +calamity, whose ruin would be our enslavement, whose rescue shall be our +earthly salvation! + + + + + + +SCHOLASTIC AND BEDSIDE TEACHING. + +An Introductory Lecture delivered before the Medical Class of Harvard +University, November 6, 1867. + +The idea is entertained by some of our most sincere professional +brethren, that to lengthen and multiply our Winter Lectures will be +of necessity to advance the cause of medical education. It is a fair +subject for consideration whether they do not overrate the relative +importance of that particular mode of instruction which forms the larger +part of these courses. + +As this School could only lengthen its lecture term at the expense +of its “Summer Session,” in which more direct, personal, and familiar +teaching takes the place of our academic discourses, and in which more +time can be given to hospitals, infirmaries, and practical instruction +in various important specialties, whatever might be gained, a good deal +would certainly be lost in our case by the exchange. + +The most essential part of a student's instruction is obtained, as I +believe, not in the lecture-room, but at the bedside. Nothing seen there +is lost; the rhythms of disease are learned by frequent repetition; its +unforeseen occurrences stamp themselves indelibly in the memory. Before +the student is aware of what he has acquired, he has learned the aspects +and course and probable issue of the diseases he has seen with his +teacher, and the proper mode of dealing with them, so far as his master +knows it. On the other hand, our ex cathedra prelections have a strong +tendency to run into details which, however interesting they may be to +ourselves and a few of our more curious listeners, have nothing in them +which will ever be of use to the student as a practitioner. It is a +perfectly fair question whether I and some other American Professors do +not teach quite enough that is useless already. Is it not well to remind +the student from time to time that a physician's business is to avert +disease, to heal the sick, to prolong life, and to diminish suffering? +Is it not true that the young man of average ability will find it as +much as he can do to fit himself for these simple duties? Is it not +best to begin, at any rate, by making sure of such knowledge as he will +require in his daily walk, by no means discouraging him from any study +for which his genius fits him when he once feels that he has become +master of his chosen art. + +I know that many branches of science are of the greatest value as +feeders of our medical reservoirs. But the practising physician's office +is to draw the healing waters, and while he gives his time to this +labor he can hardly be expected to explore all the sources that spread +themselves over the wide domain of science. The traveller who would not +drink of the Nile until he had tracked it to its parent lakes, would be +like to die of thirst; and the medical practitioner who would not use +the results of many laborers in other departments without sharing their +special toils, would find life far too short and art immeasurably too +long. + +We owe much to Chemistry, one of the most captivating as well as +important of studies; but the medical man must as a general rule content +himself with a clear view of its principles and a limited acquaintance +with its facts; such especially as are pertinent to his pursuits. I am +in little danger of underrating Anatomy or Physiology; but as each of +these branches splits up into specialties, any one of which may take up +a scientific life-time, I would have them taught with a certain judgment +and reserve, so that they shall not crowd the more immediately +practical branches. So of all the other ancillary and auxiliary kinds +of knowledge, I would have them strictly subordinated to that particular +kind of knowledge for which the community looks to its medical advisers. + +A medical school is not a scientific school, except just so far as +medicine itself is a science. On the natural history side, medicine is +a science; on the curative side, chiefly an art. This is implied in +Hufeland's aphorism: “The physician must generalize the disease and +individualize the patient.” + +The coordinated and classified results of empirical observation, in +distinction from scientific experiment, have furnished almost all we +know about food, the medicine of health, and medicine, the food of +sickness. We eat the root of the Solanum tuberosum and throw away its +fruit; we eat the fruit of the Solanum Lycopersicum and throw away its +root. Nothing but vulgar experience has taught us to reject the potato +ball and cook the tomato. So of most of our remedies. The subchloride +of mercury, calomel, is the great British specific; the protochloride of +mercury, corrosive sublimate, kills like arsenic, but no chemist could +have told us it would be so. + +From observations like these we can obtain certain principles from which +we can argue deductively to facts of a like nature, but the process +is limited, and we are suspicious of all reasoning in that direction +applied to the processes of healthy and diseased life. We are +continually appealing to special facts. We are willing to give Liebig's +artificial milk when we cannot do better, but we watch the child +anxiously whose wet-nurse is a chemist's pipkin. A pair of substantial +mammary glands has the advantage over the two hemispheres of the most +learned Professor's brain, in the art of compounding a nutritious fluid +for infants. + +The bedside is always the true centre of medical teaching. Certain +branches must be taught in the lecture-room, and will necessarily +involve a good deal that is not directly useful to the future +practitioner. But the over ambitious and active student must not be led +away by the seduction of knowledge for its own sake from his principal +pursuit. The humble beginner, who is alarmed at the vast fields of +knowledge opened to him, may be encouraged by the assurance that with a +very slender provision of science, in distinction from practical skill, +he may be a useful and acceptable member of the profession to which the +health of the community is intrusted. + +To those who are not to engage in practice, the various pursuits +of science hardly require to be commended. Only they must not be +disappointed if they find many subjects treated in our courses as a +medical class requires, rather than as a scientific class would expect, +that is, with special limitations and constant reference to practical +ends. Fortunately they are within easy reach of the highest scientific +instruction. The business of a school like this is to make useful +working physicians, and to succeed in this it is almost as important not +to overcrowd the mind of the pupil with merely curious knowledge as it +is to store it with useful information. + +In this direction I have written my lecture, not to undervalue any form +of scientific labor in its place, an unworthy thought from which I hope +I need not defend myself,--but to discourage any undue inflation of the +scholastic programme, which even now asks more of the student than the +teacher is able to obtain from the great majority of those who present +themselves for examination. I wish to take a hint in education from the +Secretary of the Massachusetts Board of Agriculture, who regards the +cultivation of too much land as a great defect in our New England +farming. I hope that our Medical Institutions may never lay themselves +open to the kind of accusation Mr. Lowe brings against the English +Universities, when he says that their education is made up “of words +that few understand and most will shortly forget; of arts that can never +be used, if indeed they can even be learnt; of histories inapplicable to +our times; of languages dead and even mouldy; of grammatical rules +that never had living use and are only post mortem examinations; and of +statements fagoted with utter disregard of their comparative value.” + +This general thought will be kept in view throughout my somewhat +discursive address, which will begin with an imaginary clinical lesson +from the lips of an historical personage, and close with the portrait +from real life of one who, both as teacher and practitioner, was long +loved and honored among us. If I somewhat overrun my hour, you must +pardon me, for I can say with Pascal that I have not had the time to +make my lecture shorter. + +In the year 1647, that good man John Eliot, commonly called the Apostle +Eliot, writing to Mr. Thomas Shepherd, the pious minister of Cambridge, +referring to the great need of medical instruction for the Indians, used +these words: + +“I have thought in my heart that it were a singular good work, if +the Lord would stirre up the hearts of some or other of his people +in England to give some maintenance toward some Schoole or Collegiate +exercise this way, wherein there should be Anatomies and other +instructions that way, and where there might be some recompence given to +any that should bring in any vegetable or other thing that is vertuous +in the way of Physick. + +“There is another reason which moves my thought and desires this way, +namely that our young students in Physick may be trained up better then +they yet bee, who have onely theoreticall knowledge, and are forced to +fall to practise before ever they saw an Anatomy made, or duely trained +up in making experiments, for we never had but one Anatomy in the +countrey, which Mr. Giles Firman [Firmin] now in England, did make and +read upon very well, but no more of that now.” + +Since the time of the Apostle Eliot the Lord has stirred up the hearts +of our people to the building of many Schools and Colleges where +medicine is taught in all its branches. Mr. Giles Firmin's “Anatomy” may +be considered the first ancestor of a long line of skeletons which have +been dangling and rattling in our lecture-rooms for more than a century. + +Teaching in New England in 1647 was a grave but simple matter. A single +person, combining in many cases, as in that of Mr. Giles Firmin, +the offices of physician and preacher, taught what he knew to a few +disciples whom he gathered about him. Of the making of that “Anatomy” on +which my first predecessor in the branch I teach “did read very well” + we can know nothing. The body of some poor wretch who had swung upon the +gallows, was probably conveyed by night to some lonely dwelling at the +outskirts of the village, and there by the light of flaring torches +hastily dissected by hands that trembled over the unwonted task. +And ever and anon the master turned to his book, as he laid bare the +mysteries of the hidden organs; to his precious Vesalius, it might be, +or his figures repeated in the multifarious volume of Ambroise Pare; to +the Aldine octavo in which Fallopius recorded his fresh observations; or +that giant folio of Spigelius just issued from the press of Amsterdam, +in which lovely ladies display their viscera with a coquettish grace +implying that it is rather a pleasure than otherwise to show the +lace-like omentum, and hold up their appendices epiploicae as if they +were saying “these are our jewels.” + +His teaching of medicine was no doubt chiefly clinical, and received +with the same kind of faith as that which accepted his words from the +pulpit. His notions of disease were based on what he had observed, seen +always in the light of the traditional doctrines in which he was bred. +His discourse savored of the weighty doctrines of Hippocrates, diluted +by the subtle speculations of Galen, reinforced by the curious comments +of the Arabian schoolmen as they were conveyed in the mellifluous +language of Fernelius, blended, it may be, with something of the lofty +mysticism of Van Helmont, and perhaps stealing a flavor of that earlier +form of Homoeopathy which had lately come to light in Sir Kenelm Digby's +“Discourse concerning the Cure of Wounds by the Sympathetic Powder.” + +His Pathology was mythology. A malformed foetus, as the readers of +Winthrop's Journal may remember, was enough to scare the colonists from +their propriety, and suggest the gravest fears of portended disaster. +The student of the seventeenth century opened his Licetus and saw +figures of a lion with the head of a woman, and a man with the head of +an elephant. He had offered to his gaze, as born of a human mother, +the effigy of a winged cherub, a pterocephalous specimen, which our +Professor of Pathological Anatomy would hardly know whether to treat +with the reverence due to its celestial aspect, or to imprison in one of +his immortalizing jars of alcohol. + +His pharmacopoeia consisted mainly of simples, such as the venerable +“Herball” of Gerard describes and figures in abounding affluence. St. +John's wort and Clown's All-heal, with Spurge and Fennel, Saffron and +Parsley, Elder and Snake-root, with opium in some form, and roasted +rhubarb and the Four Great Cold Seeds, and the two Resins, of which it +used to be said that whatever the Tacamahaca has not cured, the Caranna +will, with the more familiar Scammony and Jalap and Black Hellebore, +made up a good part of his probable list of remedies. He would have +ordered Iron now and then, and possibly an occasional dose of Antimony. +He would perhaps have had a rheumatic patient wrapped in the skin of a +wolf or a wild cat, and in case of a malignant fever with “purples” or +petechiae, or of an obstinate king's evil, he might have prescribed +a certain black powder, which had been made by calcining toads in +an earthen pot; a choice remedy, taken internally, or applied to any +outward grief. + +Except for the toad-powder and the peremptory drastics, one might have +borne up against this herb doctoring as well as against some more modern +styles of medication. Barbeyrac and his scholar Sydenham had not yet +cleansed the Pharmacopoeia of its perilous stuff, but there is no doubt +that the more sensible physicians of that day knew well enough that a +good honest herb-tea which amused the patient and his nurses was all +that was required to carry him through all common disorders. + +The student soon learned the physiognomy of disease by going about with +his master; fevers, pleurisies, asthmas, dropsies, fluxes, small-pox, +sore-throats, measles, consumptions. He saw what was done for them. He +put up the medicines, gathered the herbs, and so learned something of +materia medico and botany. He learned these few things easily and well, +for he could give his whole attention to them. Chirurgery was a separate +specialty. Women in child-birth were cared for by midwives. There was +no chemistry deserving the name to require his study. He did not learn a +great deal, perhaps, but what he did learn was his business, namely, how +to take care of sick people. + +Let me give you a picture of the old-fashioned way of instruction, by +carrying you with me in imagination in the company of worthy Master +Giles Firmin as he makes his round of visits among the good folk of +Ipswich, followed by his one student, who shall answer to the scriptural +name of Luke. It will not be for entertainment chiefly, but to +illustrate the one mode of teaching which can never be superseded, +and which, I venture to say, is more important than all the rest put +together. The student is a green hand, as you will perceive. + +In the first dwelling they come to, a stout fellow is bellowing with +colic. + +“He will die, Master, of a surety, methinks,” says the timid youth in a +whisper. + +“Nay, Luke,” the Master answers, “'t is but a dry belly-ache. Didst +thou not mark that he stayed his roaring when I did press hard over the +lesser bowels? Note that he hath not the pulse of them with fevers, and +by what Dorcas telleth me there hath been no long shutting up of the +vice naturales. We will steep certain comforting herbs which I will shew +thee, and put them in a bag and lay them on his belly. Likewise he shall +have my cordial julep with a portion of this confection which we do call +Theriaca Andromachi, which hath juice of poppy in it, and is a great +stayer of anguish. This fellow is at his prayers to-day, but I warrant +thee he shall be swearing with the best of them to-morrow.” + +They jog along the bridle-path on their horses until they come to +another lowly dwelling. They sit a while with a delicate looking girl +in whom the ingenuous youth naturally takes a special interest. The good +physician talks cheerfully with her, asks her a few questions. Then to +her mother: “Good-wife, Margaret hath somewhat profited, as she telleth, +by the goat's milk she hath taken night and morning. Do thou pluck a +maniple--that is an handful--of the plant called Maidenhair, and make +a syrup therewith as I have shewed thee. Let her take a cup full of +the same, fasting, before she sleepeth, also before she riseth from her +bed.” And so they leave the house. + +“What thinkest thou, Luke, of the maid we have been visiting?” “She +seemeth not much ailing, Master, according to my poor judgment. For she +did say she was better. And she had a red cheek and a bright eye, and +she spake of being soon able to walk unto the meeting, and did seem +greatly hopeful, but spare of flesh, methought, and her voice something +hoarse, as of one that hath a defluxion, with some small coughing from +a cold, as she did say. Speak I not truly, Master, that she will be well +speedily?” + +“Yea, Luke, I do think she shall be well, and mayhap speedily. But it is +not here with us she shall be well. For that redness of the cheek is +but the sign of the fever which, after the Grecians, we do call the +hectical; and that shining of the eyes is but a sickly glazing, and they +which do every day get better and likewise thinner and weaker shall find +that way leadeth to the church-yard gate. This is the malady which the +ancients did call tubes, or the wasting disease, and some do name the +consumption. A disease whereof most that fall ailing do perish. This +Margaret is not long for earth--but she knoweth it not, and still +hopeth.” + +“Why, then, Master, didst thou give her of thy medicine, seeing that her +ail is unto death?” + +“Thou shalt learn, boy, that they which are sick must have somewhat +wherewith to busy their thoughts. There be some who do give these tabid +or consumptives a certain posset made with lime-water and anise and +liquorice and raisins of the sun, and there be other some who do give +the juice of craw-fishes boiled in barley-water with chicken-broth, +but these be toys, as I do think, and ye shall find as good virtue, nay +better, in this syrup of the simple called Maidenhair.” + +Something after this manner might Master Giles Firmin have delivered his +clinical instructions. Somewhat in this way, a century and a half later, +another New England physician, Dr. Edward Augustus Holyoke, taught a +young man who came to study with him, a very diligent and intelligent +youth, James Jackson by name, the same whose portrait in his advanced +years hangs upon this wall, long the honored Professor of Theory and +Practice in this Institution, of whom I shall say something in this +Lecture. Our venerated Teacher studied assiduously afterwards in the +great London Hospitals, but I think he used to quote his “old Master” + ten times where he quoted Mr. Cline or Dr. Woodville once. + +When I compare this direct transfer of the practical experience of a +wise man into the mind of a student,--every fact one that he can use +in the battle of life and death,--with the far off, unserviceable +“scientific” truths that I and some others are in the habit of teaching, +I cannot help asking myself whether, if we concede that our forefathers +taught too little, there is not--a possibility that we may sometimes +attempt to teach too much. I almost blush when I think of myself as +describing the eight several facets on two slender processes of the +palate bone, or the seven little twigs that branch off from the minute +tympanic nerve, and I wonder whether my excellent colleague feels in the +same way when he pictures himself as giving the constitution of +neurin, which as he and I know very well is that of the hydrate of +trimethyle-oxethyle-ammonium, or the formula for the production of +alloxan, which, though none but the Professors and older students can +be expected to remember it, is C10 H4 N4 O6+ 2HO, NO5=C8 H4 N2 +O10+2CO2+N2+NH4 O, NO5. + +I can bear the voice of some rough iconoclast addressing the Anatomist +and the Chemist in tones of contemptuous indignation: “What is this +stuff with which you are cramming the brains of young men who are to +hold the lives of the community in their hands? Here is a man fallen in +a fit; you can tell me all about the eight surfaces of the two processes +of the palate bone, but you have not had the sense to loosen that man's +neck-cloth, and the old women are all calling you a fool? Here is a +fellow that has just swallowed poison. I want something to turn his +stomach inside out at the shortest notice. Oh, you have forgotten the +dose of the sulphate of zinc, but you remember the formula for the +production of alloxan!” + +“Look you, Master Doctor,--if I go to a carpenter to come and stop +a leak in my roof that is flooding the house, do you suppose I care +whether he is a botanist or not? Cannot a man work in wood without +knowing all about endogens and exogens, or must he attend Professor +Gray's Lectures before he can be trusted to make a box-trap? If my horse +casts a shoe, do you think I will not trust a blacksmith to shoe him +until I have made sure that he is sound on the distinction between the +sesquioxide and the protosesquioxide of iron?” + +--But my scientific labor is to lead to useful results by and by, in the +next generation, or in some possible remote future.-- + +“Diavolo!” as your Dr. Rabelais has it,--answers the iconoclast,--“what +is that to me and my colic, to me and my strangury? I pay the Captain of +the Cunard steamship to carry me quickly and safely to Liverpool, not +to make a chart of the Atlantic for after voyagers! If Professor Peirce +undertakes to pilot me into Boston Harbor and runs me on Cohasset rocks, +what answer is it to tell me that he is Superintendent of the Coast +Survey? No, Sir! I want a plain man in a pea-jacket and a sou'wester, +who knows the channel of Boston Harbor, and the rocks of Boston Harbor, +and the distinguished Professor is quite of my mind as to the matter, +for I took the pains to ask him before I ventured to use his name in the +way of illustration.” + +I do not know how the remarks of the image-breaker may strike others, +but I feel that they put me on my defence with regard to much of my +teaching. Some years ago I ventured to show in an introductory Lecture +how very small a proportion of the anatomical facts taught in a regular +course, as delivered by myself and others, had any practical bearing +whatever on the treatment of disease. How can I, how can any medical +teacher justify himself in teaching anything that is not like to be of +practical use to a class of young men who are to hold in their hands +the balance in which life and death, ease and anguish, happiness and +wretchedness are to be daily weighed? + +I hope we are not all wrong. Oftentimes in finding how sadly ignorant +of really essential and vital facts and rules were some of those whom +we had been larding with the choicest scraps of science, I have doubted +whether the old one-man system of teaching, when the one man was of the +right sort, did not turn out better working physicians than our more +elaborate method. The best practitioner I ever knew was mainly shaped +to excellence in that way. I can understand perfectly the regrets of my +friend Dr. John Brown of Edinburgh, for the good that was lost with the +old apprenticeship system. I understand as well Dr. Latham's fear “that +many men of the best abilities and good education will be deterred from +prosecuting physic as a profession, in consequence of the necessity +indiscriminately laid upon all for impossible attainments.” + +I feel therefore impelled to say a very few words in defence of +that system of teaching adopted in our Colleges, by which we wish to +supplement and complete the instruction given by private individuals or +by what are often called Summer Schools. + +The reason why we teach so much that is not practical and in itself +useful, is because we find that the easiest way of teaching what is +practical and useful. If we could in any way eliminate all that would +help a man to deal successfully with disease, and teach it by itself +so that it should be as tenaciously rooted in the memory, as easily +summoned when wanted, as fertile in suggestion of related facts, as +satisfactory to the peremptory demands of the intelligence as if taught +in its scientific connections, I think it would be our duty so to teach +the momentous truths of medicine, and to regard all useless additions as +an intrusion on the time which should be otherwise occupied. + +But we cannot successfully eliminate and teach by itself that which is +purely practical. The easiest and surest way of acquiring facts is to +learn them in groups, in systems, and systematized knowledge is science. +You can very often carry two facts fastened together more easily than +one by itself, as a housemaid can carry two pails of water with a hoop +more easily than one without it. You can remember a man's face, made +up of many features, better than you can his nose or his mouth or his +eye-brow. Scores of proverbs show you that you can remember two lines +that rhyme better than one without the jingle. The ancients, who knew +the laws of memory, grouped the seven cities that contended for the +honor of being Homer's birthplace in a line thus given by Aulus Gellius: + +Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai. + +I remember, in the earlier political days of Martin Van Buren, +that Colonel Stone, of the “New York Commercial,” or one of his +correspondents, said that six towns of New York would claim in the same +way to have been the birth-place of the “Little Magician,” as he was +then called; and thus he gave their names, any one of which I should +long ago have forgotten, but which as a group have stuck tight in my +memory from that day to this; + +Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac. + +If the memory gains so much by mere rhythmical association, how much +more will it gain when isolated facts are brought together under laws +and principles, when organs are examined in their natural connections, +when structure is coupled with function, and healthy and diseased action +are studied as they pass one into the other! Systematic, or scientific +study is invaluable as supplying a natural kind of mnemonics, if for +nothing else. You cannot properly learn the facts you want from Anatomy +and Chemistry in any way so easily as by taking them in their regular +order, with other allied facts, only there must be common sense +exercised in leaving out a great deal which belongs to each of the two +branches as pure science. The dullest of teachers is the one who does +not know what to omit. + +The larger aim of scientific training is to furnish you with principles +to which you will be able to refer isolated facts, and so bring these +within the range of recorded experience. See what the “London Times” + said about the three Germans who cracked open John Bull Chatwood's +strong-box at the Fair the other day, while the three Englishmen +hammered away in vain at Brother Jonathan Herring's. The Englishmen +represented brute force. The Germans had been trained to appreciate +principle. The Englishman “knows his business by rote and rule of +thumb”--science, which would “teach him to do in an hour what has +hitherto occupied him two hours,” “is in a manner forbidden to him.” To +this cause the “Times” attributes the falling off of English workmen in +comparison with those of the Continent. + +Granting all this, we must not expect too much from “science” + as distinguished from common experience. There are ten thousand +experimenters without special apparatus for every one in the laboratory. +Accident is the great chemist and toxicologist. Battle is the great +vivisector. Hunger has instituted researches on food such as no Liebig, +no Academic Commission has ever recorded. + +Medicine, sometimes impertinently, often ignorantly, often carelessly +called “allopathy,” appropriates everything from every source that can +be of the slightest use to anybody who is ailing in any way, or like to +be ailing from any cause. It learned from a monk how to use antimony, +from a Jesuit how to cure agues, from a friar how to cut for stone, from +a soldier how to treat gout, from a sailor how to keep off scurvy, from +a postmaster how to sound the Eustachian tube, from a dairy-maid how +to prevent small-pox, and from an old market-woman how to catch the +itch-insect. It borrowed acupuncture and the moxa from the Japanese +heathen, and was taught the use of lobelia by the American savage. +It stands ready to-day to accept anything from any theorist, from any +empiric who can make out a good case for his discovery or his remedy. +“Science” is one of its benefactors, but only one, out of many. Ask the +wisest practising physician you know, what branches of science help +him habitually, and what amount of knowledge relating to each branch he +requires for his professional duties. He will tell you that scientific +training has a value independent of all the special knowledge acquired. +He will tell you that many facts are explained by studying them in the +wider range of related facts to which they belong. He will gratefully +recognize that the anatomist has furnished him with indispensable data, +that the physiologist has sometimes put him on the track of new modes +of treatment, that the chemist has isolated the active principles of +his medicines, has taught him how to combine them, has from time to time +offered him new remedial agencies, and so of others of his allies. But +he will also tell you, if I am not mistaken, that his own branch of +knowledge is so extensive and so perplexing that he must accept most +of his facts ready made at their hands. He will own to you that in the +struggle for life which goes on day and night in our thoughts as in the +outside world of nature, much that he learned under the name of science +has died out, and that simple homely experience has largely taken the +place of that scholastic knowledge to which he and perhaps some of his +instructors once attached a paramount importance. + +This, then, is my view of scientific training as conducted in courses +such as you are entering on. Up to a certain point I believe in set +Lectures as excellent adjuncts to what is far more important, practical +instruction at the bedside, in the operating room, and under the eye of +the Demonstrator. But I am so far from wishing these courses extended, +that I think some of them--suppose I say my own--would almost bear +curtailing. Do you want me to describe more branches of the sciatic and +crural nerves? I can take Fischer's plates, and lecturing on that scale +fill up my whole course and not finish the nerves alone. We must stop +somewhere, and for my own part I think the scholastic exercises of our +colleges have already claimed their full share of the student's time +without our seeking to extend them. + +I trust I have vindicated the apparent inconsequence of teaching young +students a good deal that seems at first sight profitless, but which +helps them to learn and retain what is profitable. But this is an +inquisitive age, and if we insist on piling up beyond a certain height +knowledge which is in itself mere trash and lumber to a man whose life +is to be one long fight with death and disease, there will be some sharp +questions asked by and by, and our quick-witted people will perhaps find +they can get along as well without the professor's cap as without the +bishop's mitre and the monarch's crown. + +I myself have nothing to do with clinical teaching. Yet I do not +hesitate to say it is more essential than all the rest put together, so +far as the ordinary practice of medicine is concerned; and this is by +far the most important thing to be learned, because it deals with so +many more lives than any other branch of the profession. So of personal +instruction, such as we give and others give in the interval of +lectures, much of it at the bedside, some of it in the laboratory, some +in the microscope-room, some in the recitation-room, I think it has many +advantages of its own over the winter course, and I do not wish to see +it shortened for the sake of prolonging what seems to me long enough +already. + +If I am jealous of the tendency to expand the time given to the +acquisition of curious knowledge, at the expense of the plain +old-fashioned bedside teachings, I only share the feeling which Sydenham +expressed two hundred years ago, using an image I have already borrowed. +“He would be no honest and successful pilot who was to apply himself +with less industry to avoid rocks and sands and bring his vessel safely +home, than to search into the causes of the ebbing and flowing of the +sea, which, though very well for a philosopher, is foreign to him whose +business it is to secure the ship. So neither will a physician, whose +province it is to cure diseases, be able to do so, though he be a person +of great genius, who bestows less time on the hidden and intricate +method of nature, and adapting his means thereto, than on curious and +subtle speculation.” + +“Medicine is my wife and Science is my mistress,” said Dr. Rush. I do +not think that the breach of the seventh commandment can be shown to +have been of advantage to the legitimate owner of his affections. Read +what Dr. Elisha Bartlett says of him as a practitioner, or ask one of +our own honored ex-professors, who studied under him, whether Dr. Rush +had ever learned the meaning of that saying of Lord Bacon, that man +is the minister and interpreter of Nature, or whether he did not speak +habitually of Nature as an intruder in the sick room, from which his art +was to expel her as an incompetent and a meddler. + +All a man's powers are not too much for such a profession as Medicine. +“He is a learned man,” said old Parson Emmons of Franklin, “who +understands one subject, and he is a very learned man who understands +two subjects.” Schonbein says he has been studying oxygen for thirty +years. Mitscherlich said it took fourteen years to establish a new fact +in chemistry. Aubrey says of Harvey, the discoverer of the circulation, +that “though all his profession would allow him to be an excellent +anatomist, I have never heard of any who admired his therapeutic +way.” My learned and excellent friend before referred to, Dr. Brown +of Edinburgh, from whose very lively and sensible Essay, “Locke and +Sydenham,” I have borrowed several of my citations, contrasts Sir +Charles Bell, the discoverer, the man of science, with Dr. Abercrombie, +the master in the diagnosis and treatment of disease. It is through one +of the rarest of combinations that we have in our Faculty a teacher +on whom the scientific mantle of Bell has fallen, and who yet stands +preeminent in the practical treatment of the class of diseases which +his inventive and ardent experimental genius has illustrated. M. +Brown-Sequard's example is as eloquent as his teaching in proof of the +advantages of well directed scientific investigation. But those who +emulate his success at once as a discoverer and a practitioner must be +content like him to limit their field of practice. The highest genius +cannot afford in our time to forget the ancient precept, Divide et +impera. + +“I suppose I must go and earn this guinea,” said a medical man who was +sent for while he was dissecting an animal. I should not have cared to +be his patient. His dissection would do me no good, and his thoughts +would be too much upon it. I want a whole man for my doctor, not a half +one. I would have sent for a humbler practitioner, who would have given +himself entirely to me, and told the other--who was no less a man than +John Hunter--to go on and finish the dissection of his tiger. + +Sydenham's “Read Don Quixote” should be addressed not to the student, +but to the Professor of today. Aimed at him it means, “Do not be too +learned.” + +Do not think you are going to lecture to picked young men who are +training themselves to be scientific discoverers. They are of fair +average capacity, and they are going to be working doctors. + +These young men are to have some very serious vital facts to deal with. +I will mention a few of them. + +Every other resident adult you meet in these streets is or will be more +or less tuberculous. This is not an extravagant estimate, as very +nearly one third of the deaths of adults in Boston last year were from +phthisis. If the relative number is less in our other northern cities, +it is probably in a great measure because they are more unhealthy; that +is, they have as much, or nearly as much, consumption, but they have +more fevers or other fatal diseases. + +These heavy-eyed men with the alcoholized brains, these pallid youths +with the nicotized optic ganglia and thinking-marrows brown as their +own meerschaums, of whom you meet too many,--will ask all your wisdom to +deal with their poisoned nerves and their enfeebled wills. + +Nearly seventeen hundred children under five years of age died last +year in this city. A poor human article, no doubt, in many cases, still, +worth an attempt to save them, especially when we remember the effect +of Dr. Clarke's suggestion at the Dublin Hospital, by which some +twenty-five or thirty thousand children's lives have probably been saved +in a single city. + +Again, the complaint is often heard that the native population is not +increasing so rapidly as in former generations. The breeding and nursing +period of American women is one of peculiar delicacy and frequent +infirmity. Many of them must require a considerable interval between the +reproductive efforts, to repair damages and regain strength. This matter +is not to be decided by an appeal to unschooled nature. It is the same +question as that of the deformed pelvis,--one of degree. The facts +of mal-vitalization are as much to be attended to as those of +mal-formation. If the woman with a twisted pelvis is to be considered an +exempt, the woman with a defective organization should be recognized as +belonging to the invalid corps. We shudder to hear what is alleged as +to the prevalence of criminal practices; if back of these there can be +shown organic incapacity or overtaxing of too limited powers, the facts +belong to the province of the practical physician, as well as of the +moralist and the legislator, and require his gravest consideration. + +Take the important question of bleeding. Is venesection done with +forever? Six years ago it was said here in an introductory Lecture that +it would doubtless come back again sooner or later. A fortnight ago +I found myself in the cars with one of the most sensible and esteemed +practitioners in New England. He took out his wallet and showed me two +lancets, which he carried with him; he had never given up their use. +This is a point you will have to consider. + +Or, to mention one out of many questionable remedies, shall you give +Veratrum Viride in fevers and inflammations? It makes the pulse slower +in these affections. Then the presumption would naturally be that it +does harm. The caution with reference to it on this ground was long +ago recorded in the Lecture above referred to. See what Dr. John Hughes +Bennett says of it in the recent edition of his work on Medicine. +Nothing but the most careful clinical experience can settle this and +such points of treatment. + +These are all practical questions--questions of life and death, and +every day will be full of just such questions. Take the problem of +climate. A patient comes to you with asthma and wants to know where he +can breathe; another comes to you with phthisis and wants to know where +he can live. What boy's play is nine tenths of all that is taught in +many a pretentious course of lectures, compared with what an accurate +and extensive knowledge of the advantages and disadvantages of different +residences in these and other complaints would be to a practising +physician. + +I saw the other day a gentleman living in Canada, who had spent seven +successive winters in Egypt, with the entire relief of certain obscure +thoracic symptoms which troubled him while at home. I saw, two months +ago, another gentleman from Minnesota, an observer and a man of sense, +who considered that State as the great sanatorium for all pulmonary +complaints. If half our grown population are or will be more or less +tuberculous, the question of colonizing Florida assumes a new aspect. +Even within the borders of our own State, the very interesting +researches of Dr. Bowditch show that there is a great variation in the +amount of tuberculous disease in different towns, apparently connected +with local conditions. The hygienic map of a State is quite as valuable +as its geological map, and it is the business of every practising +physician to know it thoroughly. They understand this in England, and +send a patient with a dry irritating cough to Torquay or Penzance, +while they send another with relaxed bronchial membranes to Clifton or +Brighton. Here is another great field for practical study. + +So as to the all-important question of diet. “Of all the means of cure +at our command,” says Dr. Bennett, “a regulation of the quantity and +quality of the diet is by far the most powerful.” Dr. MacCormac would +perhaps except the air we breathe, for he thinks that impure air, +especially in sleeping rooms, is the great cause of tubercle. It +is sufficiently proved that the American,--the New Englander,--the +Bostonian, can breed strong and sound children, generation after +generation,--nay, I have shown by the record of a particular family that +vital losses may be retrieved, and a feeble race grow to lusty vigor in +this very climate and locality. Is not the question why our young men +and women so often break down, and how they can be kept from breaking +down, far more important for physicians to settle than whether there is +one cranial vertebra, or whether there are four, or none? + +--But I have a taste for the homologies, I want to go deeply into the +subject of embryology, I want to analyze the protonihilates precipitated +from pigeon's milk by the action of the lunar spectrum,--shall I not +follow my star,--shall I not obey my instinct,--shall I not give myself +to the lofty pursuits of science for its own sake? + +Certainly you may, if you like. But take down your sign, or never put +it up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and +Dr. Jeffries Wyman, Dr. Gray and Dr. Charles T. Jackson settled the +difficulty. We all admire the achievements of this band of distinguished +doctors who do not practise. But we say of their work and of all pure +science, as the French officer said of the charge of the six hundred at +Balaclava, “C'est magnifique, mais ce n'est pas la guerre,”--it is very +splendid, but it is not a practising doctor's business. His patient has +a right to the cream of his life and not merely to the thin milk that is +left after “science” has skimmed it off. The best a physician can give +is never too good for the patient. + +It is often a disadvantage to a young practitioner to be known for any +accomplishment outside of his profession. Haller lost his election as +Physician to the Hospital in his native city of Berne, principally on +the ground that he was a poet. In his later years the physician may +venture more boldly. Astruc was sixty-nine years old when he published +his “Conjectures,” the first attempt, we are told, to decide the +authorship of the Pentateuch showing anything like a discerning +criticism. Sir Benjamin Brodie was seventy years old before he left +his physiological and surgical studies to indulge in psychological +speculations. The period of pupilage will be busy enough in acquiring +the knowledge needed, and the season of active practice will leave +little leisure for any but professional studies. + +Dr. Graves of Dublin, one of the first clinical teachers of our +time, always insisted on his students' beginning at once to visit the +hospital. At the bedside the student must learn to treat disease, and +just as certainly as we spin out and multiply our academic prelections +we shall work in more and more stuffing, more and more rubbish, more and +more irrelevant, useless detail which the student will get rid of just +as soon as he leaves us. Then the next thing will be a new organization, +with an examining board of first-rate practical men, who will ask the +candidate questions that mean business,--who will make him operate if +he is to be a surgeon, and try him at the bedside if he is to be a +physician,--and not puzzle him with scientific conundrums which not more +than one of the questioners could answer himself or ever heard of since +he graduated. + +Or these women who are hammering at the gates on which is written “No +admittance for the mothers of mankind,” will by and by organize an +institution, which starting from that skilful kind of nursing which +Florence Nightingale taught so well, will work backwards through +anodynes, palliatives, curatives, preventives, until with little show +of science it imparts most of what is most valuable in those branches of +the healing art it professes to teach. When that time comes, the fitness +of women for certain medical duties, which Hecquet advocated in 1708, +which Douglas maintained in 1736, which Dr. John Ware, long the honored +Professor of Theory and Practice in this Institution, upheld within +our own recollection in the face of his own recorded opinion to the +contrary, will very possibly be recognized. + +My advice to every teacher less experienced than myself would be, +therefore: Do not fret over the details you have to omit; you probably +teach altogether too many as it is. Individuals may learn a thing +with once hearing it, but the only way of teaching a whole class is by +enormous repetition, representation, and illustration in all possible +forms. Now and then you will have a young man on your benches like the +late Waldo Burnett,--not very often, if you lecture half a century. You +cannot pretend to lecture chiefly for men like that,--a Mississippi raft +might as well take an ocean-steamer in tow. To meet his wants you would +have to leave the rest of your class behind and that you must not do. +President Allen of Jefferson College says that his instruction has +been successful in proportion as it has been elementary. It may be a +humiliating statement, but it is one which I have found true in my own +experience. + +To the student I would say, that however plain and simple may be our +teaching, he must expect to forget much which he follows intelligently +in the lecture-room. But it is not the same as if he had never learned +it. A man must get a thing before he can forget it. There is a great +world of ideas we cannot voluntarily recall,--they are outside the +limits of the will. But they sway our conscious thought as the unseen +planets influence the movements of those within the sphere of vision. No +man knows how much he knows,--how many ideas he has,--any more than +he knows how many blood-globules roll in his veins. Sometimes accident +brings back here and there one, but the mind is full of irrevocable +remembrances and unthinkable thoughts, which take a part in all +its judgments as indestructible forces. Some of you must feel your +scientific deficiencies painfully after your best efforts. But every one +can acquire what is most essential. A man of very moderate ability may +be a good physician, if he devotes himself faithfully to the work. More +than this, a positively dull man, in the ordinary acceptation of the +term, sometimes makes a safer practitioner than one who has, we will +say, five per cent. more brains than his average neighbor, but who +thinks it is fifty per cent. more. Skulls belonging to this last variety +of the human race are more common, I may remark, than specimens like the +Neanderthal cranium, a cast of which you will find on the table in the +Museum. + +Whether the average talent be high or low, the Colleges of the land must +make the best commodity they can out of such material as the country and +the cities furnish them. The community must have Doctors as it must +have bread. It uses up its Doctors just as it wears out its shoes, and +requires new ones. All the bread need not be French rolls, all the shoes +need not be patent leather ones; but the bread must be something that +can be eaten, and the shoes must be something that can be worn. Life +must somehow find food for the two forces that rub everything to +pieces, or burn it to ashes,--friction and oxygen. Doctors are oxydable +products, and the schools must keep furnishing new ones as the old +ones turn into oxyds; some of first-rate quality that burn with a great +light, some of a lower grade of brilliancy, some honestly, unmistakably, +by the grace of God, of moderate gifts, or in simpler phrase, dull. + +The public will give every honest and reasonably competent worker in +the healing art a hearty welcome. It is on the whole very loyal to the +Medical Profession. Three successive years have borne witness to the +feeling with which this Institution, representing it in its educational +aspect, is regarded by those who are themselves most honored and +esteemed. The great Master of Natural Science bade the last year's class +farewell in our behalf, in those accents which delight every audience. +The Head of our ancient University honored us in the same way in the +preceding season. And how can we forget that other occasion when the +Chief Magistrate of the Commonwealth, that noble citizen whom we have +just lost, large-souled, sweet-natured, always ready for every kind +office, came among us at our bidding, and talked to us of our duties in +words as full of wisdom as his heart was of goodness? + +You have not much to fear, I think, from the fancy practitioners. The +vulgar quackeries drop off, atrophied, one after another. Homoeopathy +has long been encysted, and is carried on the body medical as quietly as +an old wen. Every year gives you a more reasoning and reasonable people +to deal with. See how it is in Literature. The dynasty of British +dogmatists, after lasting a hundred years and more, is on its last legs. +Thomas Carlyle, third in the line of descent, finds an audience very +different from those which listened to the silver speech of Samuel +Taylor Coleridge and the sonorous phrases of Samuel Johnson. We +read him, we smile at his clotted English, his “swarmery” and other +picturesque expressions, but we lay down his tirade as we do one of Dr. +Cumming's interpretations of prophecy, which tells us that the world is +coming to an end next week or next month, if the weather permits,--not +otherwise,--feeling very sure that the weather will be unfavorable. + +It is the same common-sense public you will appeal to. The less +pretension you make, the better they will like you in the long run. I +hope we shall make everything as plain and as simple to you as we can. +I would never use a long word, even, where a short one would answer +the purpose. I know there are professors in this country who “ligate” + arteries. Other surgeons only tie them, and it stops the bleeding just +as well. It is the familiarity and simplicity of bedside instruction +which makes it so pleasant as well as so profitable. A good clinical +teacher is himself a Medical School. We need not wonder that our young +men are beginning to announce themselves not only as graduates of this +or that College, but also as pupils of some one distinguished master. + +I wish to close this Lecture, if you will allow me a few moments longer, +with a brief sketch of an instructor and practitioner whose character +was as nearly a model one in both capacities as I can find anywhere +recorded. + +Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine +in this University from 1812 to 1846, and whose name has been since +retained on our rolls as Professor Emeritus, died on the 27th of August +last, in the ninetieth year of his age. He studied his profession, as +I have already mentioned, with Dr. Holyoke of Salem, one of the few +physicians who have borne witness to their knowledge of the laws of life +by living to complete their hundredth year. I think the student took +his Old Master, as he always loved to call him, as his model; each was +worthy of the other, and both were bright examples to all who come after +them. + +I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke's +death, one of the points most insisted upon as characteristic of that +wise and good old man was the perfect balance of all his faculties. The +same harmonious adjustment of powers, the same symmetrical arrangement +of life, the same complete fulfilment of every day's duties, without +haste and without needless delay, which characterized the master, +equally distinguished the scholar. A glance at the life of our own Old +Master, if I can do any justice at all to his excellences, will give +you something to carry away from this hour's meeting not unworthy to be +remembered. + +From December, 1797, to October, 1799, he remained with Dr. Holyoke as a +student, a period which he has spoken of as a most interesting and +most gratifying part of his life. After this he passed eight months +in London, and on his return, in October, 1800, he began business in +Boston. + +He had followed Mr. Cline, as I have mentioned, and was competent to +practise Surgery. But he found Dr. John Collins Warren had already +occupied the ground which at that day hardly called for more than +one leading practitioner, and wisely chose the Medical branch of the +profession. He had only himself to rely upon, but he had confidence in +his prospects, conscious, doubtless, of his own powers, knowing his +own industry and determination, and being of an eminently cheerful and +hopeful disposition. No better proof of his spirit can be given +than that, just a year from the time when he began to practise as a +physician, he took that eventful step which in such a man implies that +he sees his way clear to a position; he married a lady blessed with many +gifts, but not bringing him a fortune to paralyze his industry. + +He had not miscalculated his chances in life. He very soon rose into a +good practice, and began the founding of that reputation which grew with +his years, until he stood by general consent at the head of his chosen +branch of the profession, to say the least, in this city and in all this +region of country. His skill and wisdom were the last tribunal to which +the sick and suffering could appeal. The community trusted and loved +him, the profession recognized him as the noblest type of the physician. +The young men whom he had taught wandered through foreign hospitals; +where they learned many things that were valuable, and many that were +curious; but as they grew older and began to think more of their ability +to help the sick than their power of talking about phenomena, they began +to look back to the teaching of Dr. Jackson, as he, after his London +experience, looked back to that of Dr. Holyoke. And so it came to be at +last that the bare mention of his name in any of our medical assemblies +would call forth such a tribute of affectionate regard as is only +yielded to age when it brings with it the record of a life spent in well +doing. + +No accident ever carries a man to eminence such as his in the medical +profession. He who looks for it must want it earnestly and work for it +vigorously; Nature must have qualified him in many ways, and education +must have equipped him with various knowledge, or his reputation will +evaporate before it reaches the noon-day blaze of fame. How did Dr. +Jackson gain the position which all conceded to him? In the answer to +this question some among you may find a key that shall unlock the gate +opening on that fair field of the future of which all dream but which +not all will ever reach. + +First of all, he truly loved his profession. He had no intellectual +ambitions outside of it, literary, scientific or political. To him it +was occupation enough to apply at the bedside the best of all that he +knew for the good of his patient; to protect the community against the +inroads of pestilence; to teach the young all that he himself had been +taught, with all that his own experience had added; to leave on record +some of the most important results of his long observation. + +With his patients he was so perfect at all points that it is hard to +overpraise him. I have seen many noted British and French and American +practitioners, but I never saw the man so altogether admirable at the +bedside of the sick as Dr. James Jackson. His smile was itself a remedy +better than the potable gold and the dissolved pearls that comforted the +praecordia of mediaeval monarchs. Did a patient, alarmed without cause, +need encouragement, it carried the sunshine of hope into his heart and +put all his whims to flight, as David's harp cleared the haunted chamber +of the sullen king. Had the hour come, not for encouragement, but for +sympathy, his face, his voice, his manner all showed it, because his +heart felt it. So gentle was he, so thoughtful, so calm, so absorbed +in the case before him, not to turn round and look for a tribute to his +sagacity, not to bolster himself in a favorite theory, but to find out +all he could, and to weigh gravely and cautiously all that he found, +that to follow him in his morning visit was not only to take a lesson in +the healing art, it was learning how to learn, how to move, how to look, +how to feel, if that can be learned. To visit with Dr. Jackson was a +medical education. + +He was very firm, with all his kindness. He would have the truth about +his patients. The nurses found it out; and the shrewder ones never +ventured to tell him anything but a straight story. A clinical dialogue +between Dr. Jackson and Miss Rebecca Taylor, sometime nurse in the +Massachusetts General Hospital, a mistress in her calling, was as good +questioning and answering as one would be like to hear outside of the +court-room. + +Of his practice you can form an opinion from his book called “Letters to +a Young Physician.” Like all sensible men from the days of Hippocrates +to the present, he knew that diet and regimen were more important +than any drug or than all drugs put together. Witness his treatment of +phthisis and of epilepsy. He retained, however, more confidence in some +remedial agents than most of the younger generation would concede to +them. Yet his materia medica was a simple one. + +“When I first went to live with Dr. Holyoke,” he says, “in 1797, showing +me his shop, he said, 'There seems to you to be a great variety of +medicines here, and that it will take you long to get acquainted with +them, but most of them are unimportant. There are four which are equal +to all the rest, namely, Mercury, Antimony, Bark and Opium.'” And Dr. +Jackson adds, “I can only say of his practice, the longer I have lived, +I have thought better and better of it.” When he thought it necessary to +give medicine, he gave it in earnest. He hated half-practice--giving +a little of this or that, so as to be able to say that one had done +something, in case a consultation was held, or a still more ominous +event occurred. He would give opium, for instance, as boldly as the late +Dr. Fisher of Beverly, but he followed the aphorism of the Father of +Medicine, and kept extreme remedies for extreme cases. + +When it came to the “non-naturals,” as he would sometimes call them, +after the old physicians,--namely, air, meat and drink, sleep and +watching, motion and rest, the retentions and excretions, and the +affections of the mind,--he was, as I have said, of the school of +sensible practitioners, in distinction from that vast community of +quacks, with or without the diploma, who think the chief end of man is +to support apothecaries, and are never easy until they can get every +patient upon a regular course of something nasty or noxious. Nobody +was so precise in his directions about diet, air, and exercise, as Dr. +Jackson. He had the same dislike to the a peu pres, the about so much, +about so often, about so long, which I afterwards found among the +punctilious adherents of the numerical system at La Pitie. + +He used to insist on one small point with a certain philological +precision, namely, the true meaning of the word “cure.” He would have +it that to cure a patient was simply to care for him. I refer to it +as showing what his idea was of the relation of the physician to the +patient. It was indeed to care for him, as if his life were bound up +in him, to watch his incomings and outgoings, to stand guard at every +avenue that disease might enter, to leave nothing to chance; not merely +to throw a few pills and powders into one pan of the scales of Fate, +while Death the skeleton was seated in the other, but to lean with his +whole weight on the side of life, and shift the balance in its favor +if it lay in human power to do it. Such devotion as this is only to be +looked for in the man who gives himself wholly up to the business of +healing, who considers Medicine itself a Science, or if not a science, +is willing to follow it as an art,--the noblest of arts, which the gods +and demigods of ancient religions did not disdain to practise and to +teach. + +The same zeal made him always ready to listen to any new suggestion +which promised to be useful, at a period of life when many men find +it hard to learn new methods and accept new doctrines. Few of +his generation became so accomplished as he in the arts of direct +exploration; coming straight from the Parisian experts, I have examined +many patients with him, and have had frequent opportunities of observing +his skill in percussion and auscultation. + +One element in his success, a trivial one compared with others, but not +to be despised, was his punctuality. He always carried two watches,--I +doubt if he told why, any more than Dr. Johnson told what he did with +the orange-peel,--but probably with reference to this virtue. He was as +much to be depended upon at the appointed time as the solstice or +the equinox. There was another point I have heard him speak of as an +important rule with him; to come at the hour when he was expected; if +he had made his visit for several days successively at ten o'clock, for +instance, not to put it off, if he could possibly help it, until eleven, +and so keep a nervous patient and an anxious family waiting for him +through a long, weary hour. + +If I should attempt to characterize his teaching, I should say that +while it conveyed the best results of his sagacious and extended +observation, it was singularly modest, cautious, simple, sincere. +Nothing was for show, for self-love; there was no rhetoric, no +declamation, no triumphant “I told you so,” but the plain statement of +a clear-headed honest man, who knows that he is handling one of the +gravest subjects that interest humanity. His positive instructions were +full of value, but the spirit in which he taught inspired that loyal +love of truth which lies at the bottom of all real excellence. + +I will not say that, during his long career, Dr. Jackson never made +an enemy. I have heard him tell how, in his very early days, old Dr. +Danforth got into a towering passion with him about some professional +consultation, and exploded a monosyllable or two of the more energetic +kind on the occasion. I remember that that somewhat peculiar personage, +Dr. Waterhouse, took it hardly when Dr. Jackson succeeded to his place +as Professor of Theory and Practice. A young man of Dr. Jackson's talent +and energy could hardly take the position that belonged to him without +crowding somebody in a profession where three in a bed is the common +rule of the household. But he was a peaceful man and a peace-maker all +his days. No man ever did more, if so much, to produce and maintain +the spirit of harmony for which we consider our medical community as +somewhat exceptionally distinguished. + +If this harmony should ever be threatened, I could wish that every +impatient and irritable member of the profession would read that +beautiful, that noble Preface to the “Letters,” addressed to John +Collins Warren. I know nothing finer in the medical literature of all +time than this Prefatory Introduction. It is a golden prelude, fit to +go with the three great Prefaces which challenge the admiration of +scholars,--Calvin's to his Institutes, De Thou's to his History, and +Casaubon's to his Polybius,--not because of any learning or rhetoric, +though it is charmingly written, but for a spirit flowing through it to +which learning and rhetoric are but as the breath that is wasted on the +air to the Mood that warms the heart. + +Of a similar character is this short extract which I am permitted +to make from a private letter of his to a dear young friend. He was +eighty-three years old at the time of writing it. + +“I have not loved everybody whom I have known, but I have striven to see +the good points in the characters of all men and women. At first I must +have done this from something in my own nature, for I was not aware of +it, and yet was doing it without any plan, when one day, sixty years +ago, a friend whom I loved and respected said this to me, 'Ah, James, I +see that you are destined to succeed in the world, and to make friends, +because you are so ready to see the good point in the characters of +those you meet.'” + +I close this imperfect notice of some features in the character of this +most honored and beloved of physicians by applying to him the words +which were written of William Heberden, whose career was not unlike his +own, and who lived to the same patriarchal age. + +“From his early youth he had always entertained a deep sense of +religion, a consummate love of virtue, an ardent thirst after knowledge, +and an earnest desire to promote the welfare and happiness of all +mankind. By these qualities, accompanied with great sweetness of +manners, he acquired the love and esteem of all good men, in a degree +which perhaps very few have experienced; and after passing an active +life with the uniform testimony of a good conscience, he became an +eminent example of its influence, in the cheerfulness and serenity of +his latest age.” + +Such was the man whom I offer to you as a model, young gentlemen, at the +outset of your medical career. I hope that many of you will recognize +some traits of your own special teachers scattered through various parts +of the land in the picture I have drawn. Let me assure you that whatever +you may learn in this or any other course of public lectures,--and +I trust you will learn a great deal,--the daily guidance, counsel, +example, of your medical father, for such the Oath of Hippocrates tells +you to consider your preceptor, will, if he is in any degree like him +of whom I have spoken, be the foundation on which all that we teach is +reared, and perhaps outlive most of our teachings, as in Dr. Jackson's +memory the last lessons that remained with him were those of his Old +Master. + + + + + + +THE MEDICAL PROFESSION IN MASSACHUSETTS. + +A Lecture of a Course by members of the Massachusetts Historical +Society, delivered before the Lowell Institute, January 29, 1869. + +The medical history of eight generations, told in an hour, must be in +many parts a mere outline. The details I shall give will relate chiefly +to the first century. I shall only indicate the leading occurrences, +with the more prominent names of the two centuries which follow, and +add some considerations suggested by the facts which have been passed in +review. + +A geographer who was asked to describe the tides of Massachusetts +Bay, would have to recognize the circumstance that they are a limited +manifestation of a great oceanic movement. To consider them apart from +this, would be to localize a planetary phenomenon, and to provincialize +a law of the universe. The art of healing in Massachusetts has shared +more or less fully and readily the movement which, with its periods of +ebb and flow, has been raising its level from age to age throughout the +better part of Christendom. Its practitioners brought with them much of +the knowledge and many of the errors of the Old World; they have always +been in communication with its wisdom and its folly; it is not +without interest to see how far the new conditions in which they found +themselves have been favorable or unfavorable to the growth of sound +medical knowledge and practice. + +The state of medicine is an index of the civilization of an age and +country,--one of the best, perhaps, by which it can be judged. Surgery +invokes the aid of all the mechanical arts. From the rude violences +of the age of stone,--a relic of which we may find in the practice of +Zipporah, the wife of Moses,--to the delicate operations of to-day +upon patients lulled into temporary insensibility, is a progress which +presupposes a skill in metallurgy and in the labors of the workshop and +the laboratory it has taken uncounted generations to accumulate. Before +the morphia which deadens the pain of neuralgia, or the quinine which +arrests the fit of an ague, can find their place in our pharmacies, +commerce must have perfected its machinery, and science must have +refined its processes, through periods only to be counted by the life of +nations. Before the means which nature and art have put in the hands of +the medical practitioner can be fairly brought into use, the prejudices +of the vulgar must be overcome, the intrusions of false philosophy must +be fenced out, and the partnership with the priesthood dissolved. All +this implies that freedom and activity of thought which belong only to +the most advanced conditions of society; and the progress towards this +is by gradations as significant of wide-spread changes, as are the +varying states of the barometer of far-extended conditions of the +atmosphere. + +Apart, then, from its special and technical interest, my subject has a +meaning which gives a certain importance, and even dignity, to details +in themselves trivial and almost unworthy of record. A medical entry in +Governor Winthrop's journal may seem at first sight a mere curiosity; +but, rightly interpreted, it is a key to his whole system of belief +as to the order of the universe and the relations between man and his +Maker. Nothing sheds such light on the superstitions of an age as the +prevailing interpretation and treatment of disease. When the touch of +a profligate monarch was a cure for one of the most inveterate of +maladies, when the common symptoms of hysteria were prayed over as marks +of demoniacal possession, we might well expect the spiritual realms of +thought to be peopled with still stranger delusions. + +Let us go before the Pilgrims of the Mayflower, and look at the shores +on which they were soon to land. A wasting pestilence had so thinned +the savage tribes that it was sometimes piously interpreted as having +providentially prepared the way for the feeble band of exiles. Cotton +Mather, who, next to the witches, hated the “tawnies,” “wild beasts,” + “blood-hounds,” “rattlesnakes,” “infidels,” as in different places he +calls the unhappy Aborigines, describes the condition of things in his +lively way, thus: “The Indians in these Parts had newly, even about a +Year or Two before, been visited with such a prodigious Pestilence; as +carried away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen +of Twenty) among them so that the Woods were almost cleared of those +pernicious Creatures to make Room for a better Growth.” + +What this pestilence was has been much discussed. It is variously +mentioned by different early writers as “the plague,” “a great and +grievous plague,” “a sore consumption,” as attended with spots which +left unhealed places on those who recovered, as making the “whole +surface yellow as with a garment.” Perhaps no disease answers all these +conditions so well as smallpox. We know from different sources what +frightful havoc it made among the Indians in after years,--in 1631, +for instance, when it swept away the aboriginal inhabitants of “whole +towns,” and in 1633. We have seen a whole tribe, the Mandans, extirpated +by it in our own day. The word “plague” was used very vaguely, as in +the description of the “great sickness” found among the Indians by the +expedition of 1622. This same great sickness could hardly have been +yellow fever, as it occurred in the month of November. I cannot think, +therefore, that either the scourge of the East or our Southern +malarial pestilence was the disease that wasted the Indians. As for the +yellowness like a garment, that is too familiar to the eyes of all who +have ever looked on the hideous mask of confluent variola. + +Without the presence or the fear of these exotic maladies, the forlorn +voyagers of the Mayflower had sickness enough to contend with. At their +first landing at Cape Cod, gaunt and hungry and longing for fresh food, +they found upon the sandy shore “great mussels, and very fat and full of +sea-pearl.” Sailors and passengers indulged in the treacherous delicacy; +which seems to have been the sea-clam; and found that these mollusks, +like the shell the poet tells of, remembered their august abode, and +treated the way-worn adventurers to a gastric reminiscence of the +heaving billows. In the mean time it blew and snowed and froze. The +water turned to ice on their clothes, and made them many times like +coats of iron. Edward Tilley had like to have “sounded” with cold. The +gunner, too, was sick unto death, but “hope of trucking” kept him on his +feet,--a Yankee, it should seem, when he first touched the shore of New +England. Most, if not all, got colds and coughs, which afterwards turned +to scurvy, whereof many died. + +How can we wonder that the crowded and tempest-tossed voyagers, many +of them already suffering, should have fallen before the trials of the +first winter in Plymouth? Their imperfect shelter, their insufficient +supply of bread, their salted food, now in unwholesome condition, +account too well for the diseases and the mortality that marked this +first dreadful season; weakness, swelling of the limbs, and other signs +of scurvy, betrayed the want of proper nourishment and protection from +the elements. In December six of their number died, in January eight, in +February, seventeen, in March thirteen. With the advance of spring +the mortality diminished, the sick and lame began to recover, and the +colonists, saddened but not disheartened, applied themselves to the +labors of the opening year. + +One of the most pressing needs of the early colonists must have been +that of physicians and surgeons. In Mr. Savage's remarkable Genealogical +Dictionary of the first settlers who came over before 1692 and their +descendants to the third generation, I find scattered through the +four crowded volumes the names of one hundred and thirty-four medical +practitioners. Of these, twelve, and probably many more, practised +surgery; three were barber-surgeons. A little incident throws a glimmer +from the dark lantern of memory upon William Direly, one of these +practitioners with the razor and the lancet. He was lost between Boston +and Roxbury in a violent tempest of wind and snow; ten days afterwards +a son was born to his widow, and with a touch of homely sentiment, I had +almost said poetry, they called the little creature “Fathergone” Direly. +Six or seven, probably a larger number, were ministers as well as +physicians, one of whom, I am sorry to say, took to drink and tumbled +into the Connecticut River, and so ended. One was not only doctor, but +also schoolmaster and poet. One practised medicine and kept a tavern. +One was a butcher, but calls himself a surgeon in his will, a union of +callings which suggests an obvious pleasantry. One female practitioner, +employed by her own sex,--Ann Moore,--was the precursor of that intrepid +sisterhood whose cause it has long been my pleasure and privilege to +advocate on all fitting occasions. + +Outside of this list I must place the name of Thomas Wilkinson, who was +complained of, in 1676, for practising contrary to law. + +Many names in the catalogue of these early physicians have been +associated, in later periods, with the practice of the profession, +--among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, +Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, +Woodward. Touton was a Huguenot, Burchsted a German from Silesia, +Lunerus a German or a Pole; “Pighogg Churrergeon,” I hope, for the honor +of the profession, was only Peacock disguised under this alias, which +would not, I fear, prove very attractive to patients. + +What doctrines and practice were these colonists likely to bring, with +them? + +Two principal schools of medical practice prevailed in the Old World +during the greater part of the seventeenth century. The first held to +the old methods of Galen: its theory was that the body, the microcosm, +like the macrocosm, was made up of the four elements--fire, air, water, +earth; having respectively the qualities hot, dry, moist, cold. The body +was to be preserved in health by keeping each of these qualities in its +natural proportion; heat, by the proper temperature; moisture, by the +due amount of fluid; and so as to the rest. Diseases which arose from +excess of heat were to be attacked by cooling remedies; those from +excess of cold, by heating ones; and so of the other derangements of +balance. This was truly the principle of contraries contrariis, which +ill-informed persons have attempted to make out to be the general +doctrine of medicine, whereas there is no general dogma other than this: +disease is to be treated by anything that is proved to cure it. The +means the Galenist employed were chiefly diet and vegetable remedies, +with the use of the lancet and other depleting agents. He attributed the +four fundamental qualities to different vegetables, in four different +degrees; thus chicory was cold in the fourth degree, pepper was hot in +the fourth, endive was cold and dry in the second, and bitter almonds +were hot in the first and dry in the second degree. When we say “cool as +a cucumber,” we are talking Galenism. The seeds of that vegetable ranked +as one of “the four greater cold seeds” of this system. + +Galenism prevailed mostly in the south of Europe and France. The readers +of Moliere will have no difficulty in recalling some of its favorite +modes of treatment, and the abundant mirth he extracted from them. + +These Galenists were what we should call “herb-doctors” to-day. Their +insignificant infusions lost credit after a time; their absurdly +complicated mixtures excited contempt, and their nauseous prescriptions +provoked loathing and disgust. A simpler and bolder practice found +welcome in Germany, depending chiefly on mineral remedies, mercury, +antimony, sulphur, arsenic, and the use, sometimes the secret use, +of opium. Whatever we think of Paracelsus, the chief agent in the +introduction of these remedies, and whatever limits we may assign to the +use of these long-trusted mineral drugs, there can be no doubt that +the chemical school, as it was called, did a great deal towards the +expurgation of the old, overloaded, and repulsive pharmacopoeia. We +shall find evidence in the practice of our New-England physicians of the +first century, that they often employed chemical remedies, and that, by +the early part of the following century, their chief trust was in the +few simple, potent drugs of Paracelsus. + +We have seen that many of the practitioners of medicine, during the +first century of New England, were clergymen. This relation between +medicine and theology has existed from a very early period; from the +Egyptian priest to the Indian medicine-man, the alliance has been +maintained in one form or another. The partnership was very common among +our British ancestors. Mr. Ward, the Vicar of Stratford-on-Avon, himself +a notable example of the union of the two characters, writing about +1660, says, + +“The Saxons had their blood-letters, but under the Normans physicke, +begunne in England; 300 years agoe itt was not a distinct profession by +itself, but practised by men in orders, witness Nicholas de Ternham, +the chief English physician and Bishop of Durham; Hugh of Evesham, a +physician and cardinal; Grysant, physician and pope; John Chambers, Dr. +of Physick, was the first Bishop of Peterborough; Paul Bush, a bachelor +of divinitie in Oxford, was a man well read in physick as well as +divinitie, he was the first bishop of Bristol.” + +“Again in King Richard the Second's time physicians and divines were not +distinct professions; for one Tydeman, Bishop of Landaph and Worcester, +was physician to King Richard the Second.” + +This alliance may have had its share in creating and keeping up the many +superstitions which have figured so largely in the history of medicine. +It is curious to see that a medical work left in manuscript by the Rev. +Cotton Mather and hereafter to be referred to, is running over +with follies and superstitious fancies; while his contemporary and +fellow-townsman, William Douglass, relied on the same few simple +remedies which, through Dr. Edward Holyoke and Dr. James Jackson, have +come down to our own time, as the most important articles of the materia +medica. + +Let us now take a general glance at some of the conditions of the +early settlers; and first, as to the healthfulness of the climate. The +mortality of the season that followed the landing of the Pilgrims at +Plymouth has been sufficiently accounted for. After this, the colonists +seem to have found the new country agreeing very well with their English +constitutions. Its clear air is the subject of eulogy. Its dainty +springs of sweet water are praised not only by Higginson and Wood, but +even the mischievous Morton says, that for its delicate waters “Canaan +came not near this country.” There is a tendency to dilate on these +simple blessings, which reminds one a little of the Marchioness in +Dickens's story, with her orange-peel-and-water beverage. Still more +does one feel the warmth of coloring,--such as we expect from converts +to a new faith, and settlers who want to entice others over to their +clearings, when Winslow speaks, in 1621, of “abundance of roses, white, +red, and damask; single, but very sweet indeed;” a most of all, however, +when, in the same connection, he says, “Here are grapes white and +red, and very sweet and strong also.” This of our wild grape, a little +vegetable Indian, which scalps a civilized man's mouth, as his animal +representative scalps his cranium. But there is something quite charming +in Winslow's picture of the luxury in which they are living. Lobsters, +oysters, eels, mussels, fish and fowl, delicious fruit, including the +grapes aforesaid,--if they only had “kine, horses, and sheep,” he makes +no question but men would live as contented here as in any part of the +world. We cannot help admiring the way in which they took their trials, +and made the most of their blessings. + +“And how Content they were,” says Cotton Mather, “when an Honest Man, as +I have heard, inviting his Friends to a Dish of Clams, at the Table gave +Thanks to Heaven, who had given them to suck the abundance of the Seas, +and of the Treasures Hid in the Sands!” + +Strangely enough, as it would seem, except for this buoyant +determination to make the best of everything, they hardly appear to +recognize the difference of the climate from that which they had left. +After almost three years' experience, Winslow says, he can scarce +distinguish New England from Old England, in respect of heat and cold, +frost, snow, rain, winds, etc. The winter, he thinks (if there is a +difference), is sharper and longer; but yet he may be deceived by the +want of the comforts he enjoyed at home. He cannot conceive any +climate to agree better with the constitution of the English, not being +oppressed with extremity of heats, nor nipped by biting cold: + +“By which means, blessed be God, we enjoy our health, notwithstanding +those difficulties we have undergone, in such a measure as would have +been admired, if we had lived in England with the like means.” + +Edward Johnson, after mentioning the shifts to which they were put for +food, says,-- + +“And yet, methinks, our children are as cheerful, fat, and lusty, with +feeding upon those mussels, clams, and other fish, as they were in +England with their fill of bread.” + +Higginson, himself a dyspeptic, “continually in physic,” as he says, and +accustomed to dress in thick clothing, and to comfort his stomach with +drink that was “both strong and stale,”--the “jolly good ale and old,” I +suppose, of free and easy Bishop Still's song,--found that he both could +and did oftentimes drink New England water very well,--which he seems +to look upon as a remarkable feat. He could go as lightclad as any, +too, with only a light stuff cassock upon his shirt, and stuff breeches +without linings. Two of his children were sickly: one,--little misshapen +Mary,--died on the passage, and, in her father's words, “was the first +in our ship that was buried in the bowels of the great Atlantic sea;” + the other, who had been “most lamentably handled” by disease, recovered +almost entirely “by the very wholesomeness of the air, altering, +digesting, and drying up the cold and crude humors of the body.” + Wherefore, he thinks it a wise course for all cold complexions to come +to take physic in New England, and ends with those often quoted words, +that “a sup of New England's air is better than a whole draught of Old +England's ale.” Mr. Higginson died, however, “of a hectic fever,” a +little more than a year after his arrival. + +The medical records which I shall cite show that the colonists were not +exempt from the complaints of the Old World. Besides the common diseases +to which their descendants are subject, there were two others, to +say nothing of the dreaded small-pox, which later medical science has +disarmed,--little known among us at the present day, but frequent +among the first settlers. The first of these was the scurvy, already +mentioned, of which Winthrop speaks in 1630, saying, that it proved +fatal to those who fell into discontent, and lingered after their former +conditions in England; the poor homesick creatures in fact, whom we so +forget in our florid pictures of the early times of the little band in +the wilderness. Many who were suffering from scurvy got well when +the Lyon arrived from England, bringing store of juice of lemons. The +Governor speaks of another case in 1644; and it seems probable that the +disease was not of rare occurrence. + +The other complaint from which they suffered, but which has nearly +disappeared from among us, was intermittent fever, or fever and ague. +I investigated the question as to the prevalence of this disease in New +England, in a dissertation, which was published in a volume with other +papers, in the year 1838. I can add little to the facts there recorded. +One which escaped me was, that Joshua Scottow, in “Old Men's Tears,” + dated 1691, speaks of “shaking agues,” as among the trials to which they +had been subjected. The outline map of New England, accompanying the +dissertation above referred to, indicates all the places where I had +evidence that the disease had originated. It was plain enough that +it used to be known in many localities where it has long ceased to +be feared. Still it was and is remarkable to see what a clean bill of +health in this particular respect our barren soil inherited with its +sterility. There are some malarious spots on the edge of Lake Champlain, +and there have been some temporary centres of malaria, within the +memory of man, on one or more of our Massachusetts rivers, but these are +harmless enough, for the most part, unless the millers dam them, when +they are apt to retaliate with a whiff from their meadows, that sets the +whole neighborhood shaking with fever and ague. + +The Pilgrims of the Mayflower had with them a good physician, a man of +standing, a deacon of their church, one whom they loved and trusted, Dr. +Samuel Fuller. But no medical skill could keep cold and hunger and +bad food, and, probably enough, desperate homesickness in some of the +feebler sort, from doing their work. No detailed record remains of what +they suffered or what was attempted for their relief during the first +sad winter. The graves of those who died were levelled and sowed with +grain that the losses of the little band might not be suspected by the +savage tenants of the wilderness, and their story remains untold. + +Of Dr. Fuller's practice, at a later period, we have an account in a +letter of his to Governor Bradford, dated June, 1630. “I have been to +Matapan” (now Dorchester), he says, “and let some twenty of those people +blood.” Such wholesale depletion as this, except with avowed homicidal +intent, is quite unknown in these days; though I once saw the noted +French surgeon, Lisfranc, in a fine phlebotomizing frenzy, order some +ten or fifteen patients, taken almost indiscriminately, to be bled in a +single morning. + +Dr. Fuller's two visits to Salem, at the request of Governor Endicott, +seem to have been very satisfactory to that gentleman. Morton, the +wild fellow of Merry Mount, gives a rather questionable reason for the +Governor's being so well pleased with the physician's doings. The names +under which he mentions the two personages, it will be seen, are not +intended to be complimentary. “Dr. Noddy did a great cure for Captain +Littleworth. He cured him of a disease called a wife.” William Gager, +who came out with Winthrop, is spoken of as “a right godly man and +skilful chyrurgeon, but died of a malignant fever not very long after +his arrival.” + +Two practitioners of the ancient town of Newbury are entitled to special +notice, for different reasons. The first is Dr. John Clark, who is said +by tradition to have been the first regularly educated physician who +resided in New England. His portrait, in close-fitting skull-cap, with +long locks and venerable flowing beard, is familiar to our eyes on the +wall of our Society's antechamber. His left hand rests upon a skull, his +right hand holds an instrument which deserves a passing comment. It is +a trephine, a surgical implement for cutting round pieces out of broken +skulls, so as to get at the fragments which have been driven in, and +lift them up. It has a handle like that of a gimlet, with a claw like +a hammer, to lift with, I suppose, which last contrivance I do not +see figured in my books. But the point I refer to is this: the old +instrument, the trepan, had a handle like a wimble, what we call a brace +or bit-stock. The trephine is not mentioned at all in Peter Lowe's book, +London, 1634; nor in Wiseman's great work on Surgery, London, 1676; nor +in the translation of Dionis, published by Jacob Tonson, in 1710. In +fact it was only brought into more general use by Cheselden and Sharpe +so late as the beginning of the last century. As John Clark died +in 1661, it is remarkable to see the last fashion in the way of +skull-sawing contrivances in his hands,--to say nothing of the claw on +the handle, and a Hey's saw, so called in England, lying on the table +by him, and painted there more than a hundred years before Hey was born. +This saw is an old invention, perhaps as old as Hippocrates, and may be +seen figured in the “Armamentarium Chirurgicum” of Scultetus, or in the +Works of Ambroise Pare. + +Dr. Clark is said to have received a diploma before he came, for skill +in lithotomy. He loved horses, as a good many doctors do, and left a +good property, as they all ought to do. His grave and noble presence, +with the few facts concerning him, told with more or less traditional +authority, give us the feeling that the people of Newbury, and +afterwards of Boston, had a wise and skilful medical adviser and surgeon +in Dr. John Clark. + +The venerable town of Newbury had another physician who was less +fortunate. The following is a court record of 1652: + +“This is to certify whom it may concern, that we the subscribers, being +called upon to testify against doctor William Snelling for words by him +uttered, affirm that being in way of merry discourse, a health being +drank to all friends, he answered, + + + “I'll pledge my friends, + And for my foes + A plague for their heels + And,'---- + +[a similar malediction on the other extremity of their feet.] + +“Since when he hath affirmed that he only intended the proverb used in +the west country, nor do we believe he intended otherwise. + +“[Signed] WILLIAM THOMAS. + +“THOMAS MILWARD.” + +“March 12th 1651, All which I acknowledge, and am sorry I did not +expresse my intent, or that I was so weak as to use so foolish a +proverb. + +“[Signed] GULIELMUS SNELLING.” + +Notwithstanding this confession and apology, the record tells us that +“William Snelling in his presentment for cursing is fined ten shillings +and the fees of court.” + +I will mention one other name among those of the Fathers of the medical +profession in New England. The “apostle” Eliot says, writing in 1647, +“We never had but one anatomy in the country, which Mr. Giles Firman, +now in England, did make and read upon very well.” + +Giles Firmin, as the name is commonly spelled, practised physic in this +country for a time. He seems to have found it a poor business; for, in a +letter to Governor Winthrop, he says, “I am strongly sett upon to studye +divinitie: my studyes else must be lost, for physick is but a meene +helpe.” + +Giles Firmin's Lectures on Anatomy were the first scientific teachings +of the New World. While the Fathers were enlightened enough to permit +such instructions, they were severe in dealing with quackery; for, in +1631, our court records show that one Nicholas Knopp, or Knapp, was +sentenced to be fined or whipped “for taking upon him to cure the +scurvey by a water of noe worth nor value, which he solde att a very +deare rate.” Empty purses or sore backs would be common with us to-day +if such a rule were enforced. + +Besides the few worthies spoken of, and others whose names I have not +space to record, we must remember that there were many clergymen who +took charge of the bodies as well as the souls of their patients, among +them two Presidents of Harvard College, Charles Chauncy and Leonard +Hoar,--and Thomas Thacher, first minister of the “Old South,” author of +the earliest medical treatises printed in the country, [A Brief Rule to +Guide the Common People in Small pox and Measles. 1674.] whose epitaph +in Latin and Greek, said to have been written by Eleazer, an “Indian +Youth” and a member of the Senior Class of Harvard College, may be found +in the “Magnalia.” I miss this noble savage's name in our triennial +catalogue; and as there is many a slip between the cup and lip, one is +tempted to guess that he may have lost his degree by some display of his +native instinct,--possibly a flourish of the tomahawk or scalping-knife. +However this may have been, the good man he celebrated was a notable +instance of the Angelical Conjunction, as the author of the “Magnalia” + calls it, of the offices of clergyman and medical practitioner. + +Michael Wigglesworth, author of the “Day of Doom,” attended the sick, +“not only as a Pastor, but as a Physician too, and this, not only in +his own town, but also in all those of the vicinity.” Mather says of the +sons of Charles Chauncy, “All of these did, while they had Opportunity, +Preach the Gospel; and most, if not all of them, like their excellent +Father before them, had an eminent skill in physick added unto their +other accomplishments,” etc. Roger Williams is said to have saved many +in a kind of pestilence which swept away many Indians. + +To these names must be added, as sustaining a certain relation to the +healing art, that of the first Governor Winthrop, who is said by John +Cotton to have been “Help for our Bodies by Physick [and] for our +Estates by Law,” and that of his son, the Governor of Connecticut, who, +as we shall see, was as much physician as magistrate. + +I had submitted to me for examination, in 1862, a manuscript found among +the Winthrop Papers, marked with the superscription, “For my worthy +friend Mr. Wintrop,” dated in 1643, London, signed Edward Stafford, and +containing medical directions and prescriptions. It may be remembered by +some present that I wrote a report on this paper, which was published +in the “Proceedings” of this Society. Whether the paper was written for +Governor John Winthrop of Massachusetts, or for his son, Governor John +of Connecticut, there is no positive evidence that I have been able +to obtain. It is very interesting, however, as giving short and simple +practical directions, such as would be most like to be wanted and most +useful, in the opinion of a physician in repute of that day. + +The diseases prescribed for are plague, small-pox, fevers, king's evil, +insanity, falling-sickness, and the like; with such injuries as broken +bones, dislocations, and burning with gunpowder. The remedies are of +three kinds: simples, such as St. John's wort, Clown's all-heal, elder, +parsley, maidenhair, mineral drugs, such as lime, saltpetre, Armenian +bole, crocus metallorum, or sulphuret of antimony; and thaumaturgic or +mystical, of which the chief is, “My black powder against the plague, +small-pox; purples, all sorts of feavers; Poyson; either, by Way of +Prevention or after Infection.” This marvellous remedy was made by +putting live toads into an earthen pot so as to half fill it, and baking +and burning them “in the open ayre, not in an house,”--concerning which +latter possibility I suspect Madam Winthrop would have had something to +say,--until they could be reduced by pounding, first into a brown, and +then into a black, powder. Blood-letting in some inflammations, fasting +in the early stage of fevers, and some of those peremptory drugs with +which most of us have been well acquainted in our time, the infragrant +memories of which I will not pursue beyond this slight allusion, are +among his remedies. + +The Winthrops, to one of whom Dr. Stafford's directions were +addressed, were the medical as well as the political advisers of their +fellow-citizens for three or four successive generations. One of them, +Governor John of Connecticut, practised so extensively, that, but for +his more distinguished title in the State, he would have been remembered +as the Doctor. The fact that he practised in another colony, for the +most part, makes little difference in the value of the records we have +of his medical experience, which have fortunately been preserved, and +give a very fair idea, in all probability, of the way in which patients +were treated in Massachusetts, when they fell into intelligent and +somewhat educated hands, a little after the middle of the seventeenth +century: + +I have before me, while writing, a manuscript collection of the medical +cases treated by him, and recorded at the time in his own hand, which +has been intrusted to me by our President, his descendant. + +They are generally marked Hartford, and extend from the year 1657 to +1669. From these, manuscripts, and from the letters printed in the +Winthrop Papers published by our Society, I have endeavored to obtain +some idea of the practice of Governor John Winthrop, Junior. The learned +eye of Mr. Pulsifer would have helped me, no doubt, as it has done in +other cases; but I have ventured this time to attempt finding my own +way among the hieroglyphics of these old pages. By careful comparison +of many prescriptions, and by the aid of Schroder, Salmon, Culpeper, and +other old compilers, I have deciphered many of his difficult paragraphs +with their mysterious recipes. + +The Governor employed a number of the simples dear to ancient women, +--elecampane and elder and wormwood and anise and the rest; but he also +employed certain mineral remedies, which he almost always indicates by +their ancient symbols, or by a name which should leave them a mystery +to the vulgar. I am now prepared to reveal the mystic secrets of the +Governor's beneficent art, which rendered so many good and great as well +as so many poor and dependent people his debtors,--at least, in their +simple belief,--for their health and their lives. + +His great remedy, which he gave oftener than any other, was nitre; which +he ordered in doses of twenty or thirty grains to adults, and of three +grains to infants. Measles, colics, sciatica, headache, giddiness, and +many other ailments, all found themselves treated, and I trust bettered, +by nitre; a pretty safe medicine in moderate doses, and one not likely +to keep the good Governor awake at night, thinking whether it might not +kill, if it did not cure. We may say as much for spermaceti, which he +seems to have considered “the sovereign'st thing on earth” for inward +bruises, and often prescribes after falls and similar injuries. + +One of the next remedies, in point of frequency, which he was in the +habit of giving, was (probably diaphoretic) antimony; a mild form of +that very active metal, and which, mild as it was, left his patients +very commonly with a pretty strong conviction that they had been taking +something that did not exactly agree with them. Now and then he gave +a little iron or sulphur or calomel, but very rarely; occasionally, a +good, honest dose of rhubarb or jalap; a taste of stinging horseradish, +oftener of warming guiacum; sometimes an anodyne, in the shape of +mithridate,--the famous old farrago, which owed its virtue to poppy +juice; [This is the remedy which a Boston divine tried to simplify. See +Electuarium Novum Alexipharmacum, by Rev. Thomas Harward, lecturer +at the Royal Chappell. Boston, 1732. This tract is in our Society's +library.] very often, a harmless powder of coral; less frequently, an +inert prescription of pleasing amber; and (let me say it softly within +possible hearing of his honored descendant), twice or oftener,--let us +hope as a last resort,--an electuary of millipedes,--sowbugs, if we must +give them their homely English name. One or two other prescriptions, +of the many unmentionable ones which disgraced the pharmacopoeia of the +seventeenth century, are to be found, but only in very rare instances, +in the faded characters of the manuscript. + +The excellent Governor's accounts of diseases are so brief, that we get +only a very general notion of the complaints for which he prescribed. +Measles and their consequences are at first more prominent than any +other one affection, but the common infirmities of both sexes and of all +ages seem to have come under his healing hand. Fever and ague appears to +have been of frequent occurrence. + +His published correspondence shows that many noted people were in +communication with him as his patients. Roger Williams wants a little +of his medicine for Mrs. Weekes's daughter; worshipful John Haynes is +in receipt of his powders; troublesome Captain Underhill wants “a little +white vitterall” for his wife, and something to cure his wife's friend's +neuralgia, (I think his wife's friend's husband had a little rather have +had it sent by the hands of Mrs. Underhill, than by those of the gallant +and discursive captain); and pious John Davenport says, his wife “tooke +but one halfe of one of the papers” (which probably contained the +medicine he called rubila), “but could not beare the taste of it, and +is discouraged from taking any more;” and honored William Leete asks for +more powders for his “poore little daughter Graciana,” though he found +it “hard to make her take it,” delicate, and of course sensitive, child +as she was, languishing and dying before her time, in spite of all the +bitter things she swallowed,--God help all little children in the hands +of dosing doctors and howling dervishes! Restless Samuel Gorton, now +tamed by the burden of fourscore and two years, writes so touching an +account of his infirmities, and expresses such overflowing gratitude for +the relief he has obtained from the Governor's prescriptions, wondering +how “a thing so little in quantity, so little in sent, so little in +taste, and so little to sence in operation, should beget and bring forth +such efects,” that we repent our hasty exclamation, and bless the memory +of the good Governor, who gave relief to the worn-out frame of our +long-departed brother, the sturdy old heretic of Rhode Island. + +What was that medicine which so frequently occurs in the printed letters +under the name of “rubila”? It is evidently a secret remedy, and, so +far as I know, has not yet been made out. I had almost given it up in +despair, when I found what appears to be a key to the mystery. In the +vast multitude of prescriptions contained in the manuscripts, most of +them written in symbols, I find one which I thus interpret: + +“Four grains of (diaphoretic) antimony, with twenty grains of nitre, +with a little salt of tin, making rubila.” Perhaps something was +added to redden the powder, as he constantly speaks of “rubifying” or +“viridating” his prescriptions; a very common practice of prescribers, +when their powders look a little too much like plain salt or sugar. + +Waitstill Winthrop, the Governor's son, “was a skilful physician,” says +Mr. Sewall, in his funeral sermon; “and generously gave, not only his +advice, but also his Medicines, for the healing of the Sick, which, by +the Blessing of God, were made successful for the recovery of many.” + “His son John, a member of the Royal Society, speaks of himself as 'Dr. +Winthrop,' and mentions one of his own prescriptions in a letter to +Cotton Mather.” Our President tells me that there was an heirloom of the +ancient skill in his family, within his own remembrance, in the form of +a certain precious eye-water, to which the late President John Quincy +Adams ascribed rare virtue, and which he used to obtain from the +possessor of the ancient recipe. + +These inherited prescriptions are often treasured in families, I do +not doubt, for many generations. When I was yet of trivial age, and +suffering occasionally, as many children do, from what one of my +Cambridgeport schoolmates used to call the “ager,”--meaning thereby +toothache or face-ache,--I used to get relief from a certain plaster +which never went by any other name in the family than “Dr. Oliver.” + +Dr. James Oliver was my great-great-grandfather, graduated in 1680, and +died in 1703. This was, no doubt, one of his nostrums; for nostrum, +as is well known, means nothing more than our own or my own particular +medicine, or other possession or secret, and physicians in old times +used to keep their choice recipes to themselves a good deal, as we have +had occasion to see. + +Some years ago I found among my old books a small manuscript marked +“James Oliver. This Book Begun Aug. 12, 1685.” It is a rough sort of +account-book, containing among other things prescriptions for patients, +and charges for the same, with counter-charges for the purchase of +medicines and other matters. Dr. Oliver practised in Cambridge, where +may be seen his tomb with inscriptions, and with sculptured figures that +look more like Diana of the Ephesians, as given in Calmet's Dictionary, +than like any angels admitted into good society here or elsewhere. + +I do not find any particular record of what his patients suffered from, +but I have carefully copied out the remedies he mentions, and find +that they form a very respectable catalogue. Besides the usual simples, +elder, parsley, fennel, saffron, snake-root, wormwood, I find the Elixir +Proprietatis, with other elixire and cordials, as if he rather fancied +warming medicines; but he called in the aid of some of the more +energetic remedies, including iron, and probably mercury, as he bought +two pounds of it at one time. + +The most interesting item is his bill against the estate of Samuel +Pason of Roxbury, for services during his last illness. He attended this +gentleman,--for such he must have been, by the amount of physic which he +took, and which his heirs paid for,--from June 4th, 1696, to September +3d of the same year, three months. I observe he charges for visits as +well as for medicines, which is not the case in most of his bills. He +opens the attack with a carminative appeal to the visceral conscience, +and follows it up with good hard-hitting remedies for dropsy,--as I +suppose the disease would have been called,--and finishes off with a +rallying dose of hartshorn and iron. + +It is a source of honest pride to his descendant that his bill, which +was honestly paid, as it seems to have been honorably earned, amounted +to the handsome total of seven pounds and two shillings. Let me add that +he repeatedly prescribes plaster, one of which was very probably the +“Dr. Oliver” that soothed my infant griefs, and for which I blush to say +that my venerated ancestor received from Goodman Hancock the painfully +exiguous sum of no pounds, no shillings, and sixpence. + +I have illustrated the practice of the first century, from the two +manuscripts I have examined, as giving an impartial idea of its +every-day methods. The Governor, Johannes Secundus, it is fair to +remember, was an amateur practitioner, while my ancestor was a professed +physician. Comparing their modes of treatment with the many scientific +follies still prevailing in the Old World, and still more with the +extraordinary theological superstitions of the community in which they +lived, we shall find reason, I think, to consider the art of healing +as in a comparatively creditable state during the first century of New +England. + +In addition to the evidence as to methods of treatment furnished by the +manuscripts I have cited, I subjoin the following document, to which +my attention was called by Dr. Shurtleff, our present Mayor. This is a +letter of which the original is to be found in vol. lxix. page 10 of the +“Archives” preserved at the State House in Boston. It will be seen +that what the surgeon wanted consisted chiefly of opiates, stimulants, +cathartics, plasters, and materials for bandages. The complex and varied +formulae have given place to simpler and often more effective forms of +the same remedies; but the list and the manner in which it is made out +are proofs of the good sense and schooling of the surgeon, who, it may +be noted, was in such haste that he neglected all his stops. He might +well be in a hurry, as on the very day upon which he wrote, a great +body of Indians--supposed to be six or seven hundred--appeared before +Hatfield; and twenty-five resolute young men of Hadley, from which town +he wrote, crossed the river and drove them away. + +HADLY May 30: 76 + +Mr RAWSON Sr + +What we have recd by Tho: Houey the past month is not the chiefest of +our wants as you have love for poor wounded I pray let us not want for +these following medicines if you have not a speedy conveyance of them I +pray send on purpose they are those things mentioned in my former letter +but to prevent future mistakes I have wrote them att large wee have +great want with the greatest halt and speed let us be supplyed. Sr Yr +Sert WILL LOCHS. + +(Endorsed) + +Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye Council +with it but could not obtaine any thing to be sent in answer thereto. 13 +June 1676. + +I have given some idea of the chief remedies used by our earlier +physicians, which were both Galenic and chemical; that is, vegetable and +mineral. They, of course, employed the usual perturbing medicines +which Montaigne says are the chief reliance of their craft. There were, +doubtless, individual practitioners who employed special remedies with +exceptional boldness and perhaps success. Mr. Eliot is spoken of, in +a letter of William Leete to Winthrop, Junior, as being under Mr. +Greenland's mercurial administrations. The latter was probably enough +one of these specialists. + +There is another class of remedies which appears to have been employed +occasionally, but, on the whole, is so little prominent as to imply a +good deal of common sense among the medical practitioners, as compared +with the superstitions prevailing around them. I have said that I have +caught the good Governor, now and then, prescribing the electuary of +millipedes; but he is entirely excused by the almost incredible fact +that they were retained in the materia medica so late as when Rees's +Cyclopaedia was published, and we there find the directions formerly +given by the College of Edinburgh for their preparation. Once or twice +we have found him admitting still more objectionable articles into his +materia medica; in doing which, I am sorry to say that he could +plead grave and learned authority. But these instances are very rare +exceptions in a medical practice of many years, which is, on the whole, +very respectable, considering the time and circumstances. + +Some remedies of questionable though not odious character appear +occasionally to have been employed by the early practitioners, but they +were such as still had the support of the medical profession. Governor +John Winthrop, the first, sends for East Indian bezoar, with other +commodities he is writing for. Governor Endicott sends him one he had of +Mr. Humfrey. I hope it was genuine, for they cheated infamously in +the matter of this concretion, which ought to come out of an animal's +stomach, but the real history of which resembles what is sometimes told +of modern sausages. + +There is a famous law-case of James the First's time, in which a +goldsmith sold a hundred pounds' worth of what he called bezoar, which +was proved to be false, and the purchaser got a verdict against him. +Governor Endicott also sends Winthrop a unicorn's horn, which was the +property of a certain Mrs. Beggarly, who, in spite of her name, seems to +have been rich in medical knowledge and possessions. The famous Thomas +Bartholinus wrote a treatise on the virtues of this fabulous-sounding +remedy, which was published in 1641, and republished in 1678. + +The “antimonial cup,” a drinking vessel made of that metal, which, like +our quassia-wood cups, might be filled and emptied in saecula saeculorum +without exhausting its virtues, is mentioned by Matthew Cradock, in a +letter to the elder Winthrop, but in a doubtful way, as it was thought, +he says, to have shortened the days of Sir Nathaniel Riche; and Winthrop +himself, as I think, refers to its use, calling it simply “the cup.” An +antimonial cup is included in the inventory of Samuel Seabury, who died +1680, and is valued at five shillings. There is a treatise entitled “The +Universall Remedy, or the Vertues of the Antimoniall Cup, By John Evans, +Minister and Preacher of God's Word, London, 1634,” in our own Society's +library. + +One other special remedy deserves notice, because of native growth. I +do not know when Culver's root, Leptandra Virginica of our National +Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to +John Winthrop of New London, speaks of it as famous for the cure of +consumptions, and wishes to get some of it, through his mediation, for +Katharine, his eldest daughter. He gets it, and gives it to the +“poor damsel,” who is languishing, as he says, and who dies the next +month,--all the sooner, I have little doubt, for this uncertain and +violent drug, with which the meddlesome pedant tormented her in that +spirit of well-meant but restless quackery, which could touch nothing +without making mischief, not even a quotation, and yet proved at length +the means of bringing a great blessing to our community, as we shall see +by and by; so does Providence use our very vanities and infirmities for +its wise purposes. + +Externally, I find the practitioners on whom I have chiefly relied +used the plasters of Paracelsus, of melilot, diachylon, and probably +diaphoenicon, all well known to the old pharmacopoeias, and some of them +to the modern ones,--to say nothing of “my yellow salve,” of Governor +John, the second, for the composition of which we must apply to his +respected descendant. + +The authors I find quoted are Barbette's Surgery, Camerarius on Gout, +and Wecherus, of all whom notices may be found in the pages of Haller +and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's +Practice of Physic and Anatomy, the last as belonging to Samuel Seabury, +chirurgeon, before mentioned. Nicholas Culpeper was a shrewd charlatan, +and as impudent a varlet as ever prescribed for a colic; but knew very +well what he was about, and badgers the College with great vigor. A copy +of Spigelius's famous Anatomy, in the Boston Athenaeum, has the names +of Increase and Samuel Mather written in it, and was doubtless early +overhauled by the youthful Cotton, who refers to the great anatomist's +singular death, among his curious stories in the “Magnalia,” and quotes +him among nearly a hundred authors whom he cites in his manuscript +“The Angel of Bethesda.” Dr. John Clark's “books and instruments, +with several chirurgery materials in the closet,” were valued in his +inventory at sixty pounds; Dr. Matthew Fuller, who died in 1678, left a +library valued at ten pounds; and a surgeon's chest and drugs valued at +sixteen pounds.' + +Here we leave the first century and all attempts at any further detailed +accounts of medicine and its practitioners. It is necessary to show in a +brief glance what had been going on in Europe during the latter part of +that century, the first quarter of which had been made illustrious in +the history of medical science by the discovery of the circulation. + +Charles Barbeyrac, a Protestant in his religion, was a practitioner +and teacher of medicine at Montpellier. His creed was in the way of +his obtaining office; but the young men followed his instructions with +enthusiasm. Religious and scientific freedom breed in and in, until it +becomes hard to tell the family of one from that of the other. Barbeyrac +threw overboard the old complex medical farragos of the pharmacopoeias, +as his church had disburdened itself of the popish ceremonies. + +Among the students who followed his instructions were two Englishmen: +one of them, John Locke, afterwards author of an “Essay on the Human +Understanding,” three years younger than his teacher; the other, Thomas +Sydenham, five years older. Both returned to England. Locke, whose +medical knowledge is borne witness to by Sydenham, had the good +fortune to form a correct opinion on a disease from which the Earl of +Shaftesbury was suffering, which led to an operation that saved +his life. Less felicitous was his experience with a certain ancilla +culinaria virgo,--which I am afraid would in those days have +been translated kitchen-wench, instead of lady of the culinary +department,--who turned him off after she had got tired of him, and +called in another practitioner. [Locke and Sydenham, p. 124. By +John Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a +promising doctor, and make an immortal metaphysician. At any rate, Locke +laid down the professional wig and cane, and took to other studies. + +The name of Thomas Sydenham is as distinguished in the history of +medicine as that of John Locke in philosophy. As Barbeyrac was found in +opposition to the established religion, as Locke took the rational side +against orthodox Bishop Stillingfleet, so Sydenham went with Parliament +against Charles, and was never admitted a Fellow by the College of +Physicians, which, after he was dead, placed his bust in their hall by +the side of that of Harvey. + +What Sydenham did for medicine was briefly this: he studied the course +of diseases carefully, and especially as affected by the particular +season; to patients with fever he gave air and cooling drinks, instead +of smothering and heating them, with the idea of sweating out their +disease; he ordered horseback exercise to consumptives; he, like his +teacher, used few and comparatively simple remedies; he did not give any +drug at all, if he thought none was needed, but let well enough alone. +He was a sensible man, in short, who applied his common sense to +diseases which he had studied with the best light of science that he +could obtain. + +The influence of the reform he introduced must have been more or +less felt in this country, but not much before the beginning of the +eighteenth century, as his great work was not published until 1675, and +then in Latin. I very strongly suspect that there was not so much to +reform in the simple practice of the physicians of the new community, as +there was in that of the learned big-wigs of the “College,” who valued +their remedies too much in proportion to their complexity, and the +extravagant and fantastic ingredients which went to their making. + +During the memorable century which bred and bore the Revolution, the +medical profession gave great names to our history. But John Brooks +belonged to the State, and Joseph Warren belongs to the country and +mankind, and to speak of them would lead me beyond my limited subject. +There would be little pleasure in dwelling on the name of Benjamin +Church; and as for the medical politicians, like Elisha Cooke in the +early part of the century, or Charles Jarvis, the bald eagle of Boston, +in its later years, whether their practice was heroic or not, their +patients were, for he is a bold man who trusts one that is making +speeches and coaxing voters, to meddle with the internal politics of his +corporeal republic. + +One great event stands out in the medical history of this eighteenth +century; namely, the introduction of the practice of inoculation for +small-pox. Six epidemics of this complaint had visited Boston in the +course of a hundred years. Prayers had been asked in the churches for +more than a hundred sick in a single day, and this many times. About a +thousand persons had died in a twelvemonth, we are told, and, as we may +infer, chiefly from this cause. + +In 1721, this disease, after a respite of nineteen years, again appeared +as an epidemic. In that year it was that Cotton Mather, browsing, as +was his wont, on all the printed fodder that came within reach of +his ever-grinding mandibles, came upon an account of inoculation as +practised in Turkey, contained in the “Philosophical Transactions.” He +spoke of it to several physicians, who paid little heed to his story; +for they knew his medical whims, and had probably been bored, as we say +now-a-days, many of them, with listening to his “Angel of Bethesda,” and +satiated with his speculations on the Nishmath Chajim. + +The Reverend Mather,--I use a mode of expression he often employed when +speaking of his honored brethren,--the Reverend Mather was right this +time, and the irreverent doctors who laughed at him were wrong. One only +of their number disputes his claim to giving the first impulse to the +practice in Boston. This is what that person says: “The Small-Pox spread +in Boston, New England, 1721, and the Reverend Dr. Cotton Mather, having +had the use of these Communications from Dr. William Douglass (that is, +the writer of these words); surreptitiously, without the knowledge of +his Informer, that he might have the honour of a New fangled notion, +sets an Undaunted Operator to work, and in this Country about 290 were +inoculated.” + +All this has not deprived Cotton Mather of the credit of suggesting, and +a bold and intelligent physician of the honor of carrying out, the new +practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston +of Boston inoculated his only son for smallpox,--the first person ever +submitted to the operation in the New World. The story of the fierce +resistance to the introduction of the practice; of how Boylston was +mobbed, and Mather had a hand-grenade thrown in at his window; of +how William Douglass, the Scotchman, “always positive, and sometimes +accurate,” as was neatly said of him, at once depreciated the practice +and tried to get the credit of suggesting it, and how Lawrence Dalhonde, +the Frenchman, testified to its destructive consequences; of how Edmund +Massey, lecturer at St. Albans, preached against sinfully endeavoring to +alter the course of nature by presumptuous interposition, which he would +leave to the atheist and the scoffer, the heathen and unbeliever, while +in the face of his sermon, afterwards reprinted in Boston, many of our +New England clergy stood up boldly in defence of the practice,--all this +has been told so well and so often that I spare you its details. Set +this good hint of Cotton Mather against that letter of his to John +Richards, recommending the search after witch-marks, and the application +of the water-ordeal, which means throw your grandmother into the water, +if she has a mole on her arm;--if she swims, she is a witch and must be +hanged; if she sinks, the Lord have mercy on her soul! + +Thus did America receive this great discovery, destined to save +thousands of lives, via Boston, from the hands of one of our own +Massachusetts physicians. + +The year 1735 was rendered sadly memorable by the epidemic of the +terrible disease known as “throat distemper,” and regarded by many as +the same as our “diphtheria.” Dr. Holyoke thinks the more general use +of mercurials in inflammatory complaints dates from the time of their +employment in this disease, in which they were thought to have proved +specially useful. + +At some time in the course of this century medical practice had settled +down on four remedies as its chief reliance. I must repeat an incident +which I have related in another of these Essays. When Dr. Holyoke, +nearly seventy years ago, received young Mr. James Jackson as his +student, he showed him the formidable array of bottles, jars, and +drawers around his office, and then named the four remedies referred to +as being of more importance than all the rest put together. These were +“Mercury, Antimony, Opium, and Peruvian Bark.” I doubt if either of +them remembered that, nearly seventy years before, in 1730, Dr. +William Douglass, the disputatious Scotchman, mentioned those same four +remedies, in the dedication of his quarrelsome essay on inoculation, as +the most important ones in the hands of the physicians of his time. + +In the “Proceedings” of this Society for the year 1863 is a very +pleasant paper by the late Dr. Ephraim Eliot, giving an account of +the leading physicians of Boston during the last quarter of the last +century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth, +John Warren, Jeffries, are all famous in local history, and are +commemorated in our medical biographies. One of them, at least, appears +to have been more widely known, not only as one of the first aerial +voyagers, but as an explorer in the almost equally hazardous realm of +medical theory. Dr. John Jeffries, the first of that name, is considered +by Broussais as a leader of medical opinion in America, and so referred +to in his famous “Examen des Doctrines Medicales.” + +Two great movements took place in this eighteenth century, the effect of +which has been chiefly felt in our own time; namely, the establishment +of the Massachusetts Medical Society, and the founding of the Medical +School of Harvard University. + +The third century of our medical history began with the introduction of +the second great medical discovery of modern times,--of all time up to +that date, I may say,--once more via Boston, if we count the University +village as its suburb, and once more by one of our Massachusetts +physicians. In the month of July, 1800, Dr. Benjamin Waterhouse of +Cambridge submitted four of his own children to the new process of +vaccination,--the first persons vaccinated, as Dr. Zabdiel Boylston's +son had been the first person inoculated in the New World. + +A little before the first half of this century was completed, in the +autumn of 1846, the great discovery went forth from the Massachusetts +General Hospital, which repaid the debt of America to the science of the +Old World, and gave immortality to the place of its origin in the memory +and the heart of mankind. The production of temporary insensibility at +will--tuto, cito, jucunde, safely, quickly, pleasantly--is one of those +triumphs over the infirmities of our mortal condition which change the +aspect of life ever afterwards. Rhetoric can add nothing to its glory; +gratitude, and the pride permitted to human weakness, that our Bethlehem +should have been chosen as the birthplace of this new embodiment of the +divine mercy, are all we can yet find room for. + +The present century has seen the establishment of all those great +charitable institutions for the cure of diseases of the body and of the +mind, which our State and our city have a right to consider as among the +chief ornaments of their civilization. + +The last century had very little to show, in our State, in the way of +medical literature. The worthies who took care of our grandfathers and +great-grandfathers, like the Revolutionary heroes, fought (with disease) +and bled (their patients) and died (in spite of their own remedies); but +their names, once familiar, are heard only at rare intervals. Honored +in their day, not unremembered by a few solitary students of the past, +their memories are going sweetly to sleep in the arms of the patient +old dry-nurse, whose “blackdrop” is the never-failing anodyne of +the restless generations of men. Except the lively controversy on +inoculation, and floating papers in journals, we have not much of value +for that long period, in the shape of medical records. + +But while the trouble with the last century is to find authors to +mention, the trouble of this would be to name all that we find. Of +these, a very few claim unquestioned preeminence. + +Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School +of our University, did a great work for the advancement of medicine and +surgery in New England, by his labors as teacher and author, greater, +it is claimed by some, than was ever done by any other man. The two +Warrens, of our time, each left a large and permanent record of a most +extended surgical practice. James Jackson not only educated a whole +generation by his lessons of wisdom, but bequeathed some of the most +valuable results of his experience to those who came after him, in a +series of letters singularly pleasant and kindly as well as instructive. +John Ware, keen and cautious, earnest and deliberate, wrote the two +remarkable essays which have identified his name, for all time, with +two important diseases, on which he has shed new light by his original +observations. + +I must do violence to the modesty of the living by referring to the many +important contributions to medical science by Dr. Jacob Bigelow, and +especially to his discourse on “Self-limited Diseases,” an address which +can be read in a single hour, but the influence of which will be felt +for a century. + +Nor would the profession forgive me if I forgot to mention the admirable +museum of pathological anatomy, created almost entirely by the hands +of Dr. John Barnard Swett Jackson, and illustrated by his own printed +descriptive catalogue, justly spoken of by a distinguished professor in +the University of Pennsylvania as the most important contribution which +had ever been made in this country to the branch to which it relates. + +When we look at the literature of mental disease, as seen in hospital +reports and special treatises, we can mention the names of Wyman, +Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts or +placed at the head of her institutions for the treatment of the insane. + +We have a right to claim also one who is known all over the civilized +world as a philanthropist, to us as a townsman and a graduate of our own +Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of +a great multitude who were born to a world of inward or of outward +darkness. + +I cannot pass over in silence the part taken by our own physicians +in those sanitary movements which are assuming every year greater +importance. Two diseases especially have attracted attention, above +all others, with reference to their causes and prevention; cholera, +the “black death” of the nineteenth century, and consumption, the white +plague of the North, both of which have been faithfully studied and +reported on by physicians of our own State and city. The cultivation of +medical and surgical specialties, which is fast becoming prevalent, is +beginning to show its effects in the literature of the profession, +which is every year growing richer in original observations and +investigations. + +To these benefactors who have labored for us in their peaceful vocation, +we must add the noble army of surgeons, who went with the soldiers who +fought the battles of their country, sharing many of their dangers, not +rarely falling victims to fatigue, disease, or the deadly volleys to +which they often exposed themselves in the discharge of their duties. + +The pleasant biographies of the venerable Dr. Thacher, and the worthy +and kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, +are filled with the names of men who served their generation well, and +rest from their labors, followed by the blessing of those for whom +they endured the toils and fatigues inseparable from their calling. The +hardworking, intelligent country physician more especially deserves +the gratitude of his own generation, for he rarely leaves any permanent +record in the literature of his profession. Books are hard to obtain; +hospitals, which are always centres of intelligence, are remote; +thoroughly educated and superior men are separated by wide intervals; +and long rides, though favorable to reflection, take up much of the time +which might otherwise be given to the labors of the study. So it is that +men of ability and vast experience, like the late Dr. Twitchell, for +instance, make a great and deserved reputation, become the oracles of +large districts, and yet leave nothing, or next to nothing, by which +their names shall be preserved from blank oblivion. + +One or two other facts deserve mention, as showing the readiness of our +medical community to receive and adopt any important idea or discovery. +The new science of Histology, as it is now called, was first brought +fully before the profession of this country by the translation of +Bichat's great work, “Anatomie Generale,” by the late Dr. George +Hayward. + +The first work printed in this country on Auscultation,--that wonderful +art of discovering disease, which, as it were, puts a window in the +breast, through which the vital organs can be seen, to all intents +and purposes, was the manual published anonymously by “A Member of the +Massachusetts Medical Society.” + +We are now in some slight measure prepared to weigh the record of the +medical profession in Massachusetts, and pass our judgment upon it. But +in order to do justice to the first generation of practitioners, we must +compare what we know of their treatment of disease with the state of the +art in England, and the superstitions which they saw all around them in +other departments of knowledge or belief. + +English medical literature must have been at a pretty low ebb +when Sydenham recommended Don Quixote to Sir Richard Blackmore for +professional reading. The College Pharmacopoeia was loaded with the most +absurd compound mixtures, one of the most complex of which (the same +which the Reverend Mr. Harward, “Lecturer at the Royal Chappel in +Boston,” tried to simplify), was not dropped until the year 1801. Sir +Kenelm Digby was playing his fantastic tricks with the Sympathetic +powder, and teaching Governor Winthrop, the second, how to cure fever +and ague, which some may like to know. “Pare the patient's nails; put +the parings in a little bag, and hang the bag round the neck of a live +eel, and put him in a tub of water. The eel will die, and the patient +will recover.” + +Wiseman, the great surgeon, was discoursing eloquently on the efficacy +of the royal touch in scrofula. The founder of the Ashmolean Museum at +Oxford, consorting with alchemists and astrologers, was treasuring +the manuscripts of the late pious Dr. Richard Napier, in which certain +letters (Rx Ris) were understood to mean Responsum Raphaelis,--the +answer of the angel Raphael to the good man's medical questions. The +illustrious Robert Boyle was making his collection of choice and safe +remedies, including the sole of an old shoe, the thigh bone of a hanged +man, and things far worse than these, as articles of his materia medica. +Dr. Stafford, whose paper of directions to his “friend, Mr. Wintrop,” I +cited, was probably a man of standing in London; yet toad-powder was his +sovereign remedy. + +See what was the state of belief in other matters among the most +intelligent persons of the colonies, magistrates and clergymen. Jonathan +Brewster, son of the church-elder, writes the wildest letters to John +Winthrop about alchemy,--“mad for making gold as the Lynn rock-borers +are for finding it.” + +Remember the theology and the diabology of the time. Mr. Cotton's +Theocracy was a royal government, with the King of kings as its nominal +head, but with an upper chamber of saints, and a tremendous opposition +in the lower house; the leader of which may have been equalled, but +cannot have been surpassed by any of our earth-born politicians. The +demons were prowling round the houses every night, as the foxes were +sneaking about the hen-roosts. The men of Gloucester fired whole flasks +of gunpowder at devils disguised as Indians and Frenchmen. + +How deeply the notion of miraculous interference with the course of +nature was rooted, is shown by the tenacity of the superstition about +earthquakes. We can hardly believe that our Professor Winthrop, father +of the old judge and the “squire,” whom many of us Cambridge people +remember so well, had to defend himself against the learned and +excellent Dr. Prince, of the Old South Church, for discussing their +phenomena as if they belonged to the province of natural science. + +Not for the sake of degrading the aspect of the noble men who founded +our State, do I refer to their idle beliefs and painful delusions, +but to show against what influences the common sense of the medical +profession had to assert itself. + +Think, then, of the blazing stars, that shook their horrid hair in the +sky; the phantom ship, that brought its message direct from the other +world; the story of the mouse and the snake at Watertown; of the mice +and the prayer-book; of the snake in church; of the calf with two heads; +and of the cabbage in the perfect form of a cutlash,--all which innocent +occurrences were accepted or feared as alarming portents. + +We can smile at these: but we cannot smile at the account of unhappy +Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic +misfortune of similar character, in the story of which the physician, +Dr. John Clark of Rhode Island, alone appears to advantage; or as +we read the Rev. Samuel Willard's fifteen alarming pages about an +unfortunate young woman suffering with hysteria. Or go a little +deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, first +admonished, then whipped; at last, taking her own little daughter's +life; put on trial, and standing mute, threatened to be pressed to +death, confessing, sentenced, praying to be beheaded; and none the less +pitilessly swung from the fatal ladder. + +The cooper's crazy wife--crazy in the belief that she has committed the +unpardonable sin--tries to drown her child, to save it from misery; +and the poor lunatic, who would be tenderly cared for to-day in a quiet +asylum, is judged to be acting under the instigation of Satan himself. +Yet, after all, what can we say, who put Bunyan's “Pilgrim's Progress,” + full of nightmare dreams of horror, into all our children's hands; a +story in which the awful image of the man in the cage might well turn +the nursery where it is read into a madhouse? + +The miserable delusion of witchcraft illustrates, in a still more +impressive way, the false ideas which governed the supposed relation of +men with the spiritual world. I have no doubt many physicians shared in +these superstitions. Mr. Upham says they--that is, some of them--were +in the habit of attributing their want of success to the fact, that an +“evil hand” was on their patient. The temptation was strong, no doubt, +when magistrates and ministers and all that followed their lead were +contented with such an explanation. But how was it in Salem, according +to Mr. Upham's own statement? Dr. John Swinnerton was, he says, for +many years the principal physician of Salem. And he says, also, “The +Swinnerton family were all along opposed to Mr. Parris, and kept +remarkably clear from the witchcraft delusion.” Dr. John Swinnerton--the +same, by the way, whose memory is illuminated by a ray from the genius +of Hawthorne--died the very year before the great witchcraft explosion +took place. But who can doubt that it was from him that the family had +learned to despise and to resist the base superstition; or that Bridget +Bishop, whose house he rented, as Mr. Upham tells me, the first person +hanged in the time of the delusion, would have found an efficient +protector in her tenant, had he been living, to head the opposition of +his family to the misguided clergymen and magistrates? + +I cannot doubt that our early physicians brought with them many +Old-World medical superstitions, and I have no question that they were +more or less involved in the prevailing errors of the community in which +they lived. But, on the whole, their record is a clean one, so far as we +can get at it; and where it is questionable we must remember that there +must have been many little-educated persons among them; and that all +must have felt, to some extent, the influence of those sincere and +devoted but unsafe men, the physic-practising clergymen, who often used +spiritual means as a substitute for temporal ones, who looked upon a +hysteric patient as possessed by the devil, and treated a fractured +skull by prayers and plasters, following the advice of a ruling elder in +opposition to the “unanimous opinion of seven surgeons.” + +To what results the union of the two professions was liable to lead, may +be seen by the example of a learned and famous person, who has left on +record the product of his labors in the double capacity of clergyman and +physician. + +I have had the privilege of examining a manuscript of Cotton Mather's +relating to medicine, by the kindness of the librarian of the American +Antiquarian Society, to which society it belongs. A brief notice of this +curious document may prove not uninteresting. + +It is entitled “The Angel of Bethesda: an Essay upon the Common Maladies +of Mankind, offering, first, the sentiments of Piety,” etc., etc., +and “a collection of plain but potent and Approved REMEDIES for the +Maladies.” There are sixty-six “Capsula's,” as he calls them, or +chapters, in his table of contents; of which, five--from the fifteenth +to the nineteenth, inclusive--are missing. This is a most unfortunate +loss, as the eighteenth capsula treated of agues, and we could have +learned from it something of their degree of frequency in this part of +New England. There is no date to the manuscript; which, however, refers +to a case observed Nov. 14, 1724. + +The divine takes precedence of the physician in this extraordinary +production. He begins by preaching a sermon at his unfortunate patient. +Having thrown him into a cold sweat by his spiritual sudorific, he +attacks him with his material remedies, which are often quite as +unpalatable. The simple and cleanly practice of Sydenham, with whose +works he was acquainted, seems to have been thrown away upon him. +Everything he could find mentioned in the seventy or eighty authors he +cites, all that the old women of both sexes had ever told him of, gets +into his text, or squeezes itself into his margin. + +Evolving disease out of sin, he hates it, one would say, as he hates its +cause, and would drive it out of the body with all noisome appliances. +“Sickness is in Fact Flagellum Dei pro peccatis mundi.” So saying, he +encourages the young mother whose babe is wasting away upon her breast +with these reflections: + +“Think; oh the grievous Effects of Sin! This wretched Infant has not +arrived unto years of sense enough, to sin after the similitude of the +transgression committed by Adam. Nevertheless the Transgression of Adam, +who had all mankind Foederally, yea, Naturally, in him, has involved +this Infant in the guilt of it. And the poison of the old serpent, which +infected Adam when he fell into his Transgression, by hearkening to the +Tempter, has corrupted all mankind, and is a seed unto such diseases as +this Infant is now laboring under. Lord, what are we, and what are our +children, but a Generation of Vipers?” + +Many of his remedies are at least harmless, but his pedantry and +utter want of judgment betray themselves everywhere. He piles his +prescriptions one upon another, without the least discrimination. He is +run away with by all sorts of fancies and superstitions. He prescribes +euphrasia, eye-bright, for disease of the eyes; appealing confidently to +the strange old doctrine of signatures, which inferred its use from the +resemblance of its flower to the organ of vision. For the scattering of +wens, the efficacy of a Dead Hand has been out of measure wonderful. But +when he once comes to the odious class of remedies, he revels in them +like a scarabeus. This allusion will bring us quite near enough to the +inconceivable abominations with which he proposed to outrage the sinful +stomachs of the unhappy confederates and accomplices of Adam. + +It is well that the treatise was never printed, yet there are passages +in it worth preserving. He speaks of some remedies which have since +become more universally known: + +“Among the plants of our soyl, Sir William Temple singles out Five [Six] +as being of the greatest virtue and most friendly to health: and his +favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder.” + +“But these Five [Six] plants may admitt of some competitors. The +QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!” + +Of Ipecacuanha, he says,--“This is now in its reign; the most +fashionable vomit.” + +“I am not sorry that antimonial emetics begin to be disused.” + +He quotes “Mr. Lock” as recommending red poppy-water and abstinence from +flesh as often useful in children's diseases. + +One of his “Capsula's” is devoted to the animalcular origin of diseases, +at the end of which he says, speaking of remedies for this supposed +source of our distempers: + +“Mercury we know thee: But we are afraid thou wilt kill us too, if we +employ thee to kill them that kill us. + +“And yett, for the cleansing of the small Blood Vessels, and making way +for the free circulation of the Blood and Lymph--there is nothing like +Mercurial Deobstruents.” + +From this we learn that mercury was already in common use, and the +subject of the same popular prejudice as in our own time. + +His poetical turn shows itself here and there: + +“O Nightingale, with a Thorn at thy Breast; Under the trouble of a +Cough, what can be more proper than such thoughts as these?”... + +If there is pathos in this, there is bathos in his apostrophe to the +millipede, beginning “Poor sowbug!” and eulogizing the healing virtues +of that odious little beast; of which he tells us to take “half a pound, +putt 'em alive into a quart or two of wine,” with saffron and other +drugs, and take two ounces twice a day. + +The “Capsula” entitled “Nishmath Chajim” was printed in 1722, at New +London, and is in the possession of our own Society. He means, by these +words, something like the Archxus of Van Helmont, of which he discourses +in a style wonderfully resembling that of Mr. Jenkinson in the “Vicar +of Wakefield.” “Many of the Ancients thought there was much of a Real +History in the Parable, and their Opinion was that there is, DIAPHORA +KATA TAS MORPHAS, A Distinction (and so a Resemblance) of men as +to their Shapes after Death.” And so on, with Ireaeus, Tertullian, +Thespesius, and “the TA TONE PSEUCONE CROMATA,” in the place of +“Sanconiathon, Manetho, Berosus,” and “Anarchon ara kai ateleutaion to +pan.” + +One other passage deserves notice, as it relates to the single medical +suggestion which does honor to Cotton Mather's memory. It does not +appear that he availed himself of the information which he says he +obtained from his slave, for such I suppose he was. + +In his appendix to “Variolae Triumphatae,” he says,-- + +“There has been a wonderful practice lately used in several parts of the +world, which indeed is not yet become common in our nation. + +“I was first informed of it by a Garamantee servant of my own, long +before I knew that any Europeans or Asiaticks had the least acquaintance +with it, and some years before I was enriched with the communications +of the learned Foreigners, whose accounts I found agreeing with what I +received of my servant, when he shewed me the Scar of the Wound made for +the operation; and said, That no person ever died of the smallpox, in +their countrey, that had the courage to use it. + +“I have since met with a considerable Number of these Africans, who +all agree in one story; That in their countrey grandy-many dy of the +small-pox: But now they learn this way: people take juice of smallpox +and cutty-skin and put in a Drop; then by'nd by a little sicky, sicky: +then very few little things like small-pox; and nobody dy of it; +and nobody have small-pox any more. Thus, in Africa, where the poor +creatures dy of the smallpox like Rotten Sheep, a merciful God has +taught them an Infallible preservative. 'T is a common practice, and is +attended with a constant success.” + +What has come down to us of the first century of medical practice, +in the hands of Winthrop and Oliver, is comparatively simple and +reasonable. I suspect that the conditions of rude, stern life, in which +the colonists found themselves in the wilderness, took the nonsense out +of them, as the exigencies of a campaign did out of our physicians +and surgeons in the late war. Good food and enough of it, pure air +and water, cleanliness, good attendance, an anaesthetic, an opiate, +a stimulant, quinine, and two or three common drugs, proved to be the +marrow of medical treatment; and the fopperies of the pharmacopoeia went +the way of embroidered shirts and white kid gloves and malacca joints, +in their time of need. “Good wine is the best cordiall for her,” said +Governor John Winthrop, Junior, to Samuel Symonds, speaking of that +gentleman's wife,--just as Sydenham, instead of physic, once ordered a +roast chicken and a pint of canary for his patient in male hysterics. + +But the profession of medicine never could reach its full development +until it became entirely separated from that of divinity. The spiritual +guide, the consoler in affliction, the confessor who is admitted into +the secrets of our souls, has his own noble sphere of duties; but the +healer of men must confine himself solely to the revelations of God +in nature, as he sees their miracles with his own eyes. No doctrine +of prayer or special providence is to be his excuse for not looking +straight at secondary causes, and acting, exactly so far as experience +justifies him, as if he were himself the divine agent which antiquity +fabled him to be. While pious men were praying--humbly, sincerely, +rightly, according to their knowledge--over the endless succession +of little children dying of spasms in the great Dublin Hospital, a +sagacious physician knocked some holes in the walls of the ward, let +God's blessed air in on the little creatures, and so had already saved +in that single hospital, as it was soberly calculated thirty years ago, +more than sixteen thousand lives of these infant heirs of immortality. +[Collins's Midwifery, p. 312. Published by order of the Massachusetts +Medical Society. Boston, 1841.] + +Let it be, if you will, that the wise inspiration of the physician was +granted in virtue of the clergyman's supplications. Still, the habit +of dealing with things seen generates another kind of knowledge, and +another way of thought, from that of dealing with things unseen; which +knowledge and way of thought are special means granted by Providence, +and to be thankfully accepted. + +The mediaeval ecclesiastics expressed a great truth in that saying, +so often quoted, as carrying a reproach with it: “Ubi tres medici, duo +athei,”--“Where there are three physicians, there are two atheists.” + +It was true then, it is true to-day, that the physician very commonly, +if not very generally, denies and repudiates the deity of ecclesiastical +commerce. The Being whom Ambroise Pare meant when he spoke those +memorable words, which you may read over the professor's chair in the +French School of Medicine, “Te le pensay, et Dieu le guarit,” “I dressed +his wound, and God healed it,”--is a different being from the God that +scholastic theologians have projected from their consciousness, or +shaped even from the sacred pages which have proved so plastic in +their hands. He is a God who never leaves himself without witness, who +repenteth him of the evil, who never allows a disease or an injury, +compatible with the enjoyment of life, to take its course without +establishing an effort, limited by certain fixed conditions, it is true, +but an effort, always, to restore the broken body or the shattered mind. +In the perpetual presence of this great Healing Agent, who stays +the bleeding of wounds, who knits the fractured bone, who expels the +splinter by a gentle natural process, who walls in the inflammation that +might involve the vital organs, who draws a cordon to separate the dead +part from the living, who sends his three natural anaesthetics to the +over-tasked frame in due order, according to its need,--sleep, fainting, +death; in this perpetual presence, it is doubtless hard for the +physician to realize the theological fact of a vast and permanent sphere +of the universe, where no organ finds itself in its natural medium, +where no wound heals kindly, where the executive has abrogated the +pardoning power, and mercy forgets its errand; where the omnipotent is +unfelt save in malignant agencies, and the omnipresent is unseen and +unrepresented; hard to accept the God of Dante's “Inferno,” and of +Bunyan's caged lunatic. If this is atheism, call three, instead of two +of the trio, atheists, and it will probably come nearer the truth. + +I am not disposed to deny the occasional injurious effect of the +materializing influences to which the physician is subjected. A +spiritual guild is absolutely necessary to keep him, to keep us all, +from becoming the “fingering slaves” that Wordsworth treats with such +shrivelling scorn. But it is well that the two callings have been +separated, and it is fitting that they remain apart. In settling the +affairs of the late concern, I am afraid our good friends remain a +little in our debt. We lent them our physician Michael Servetus in +fair condition, and they returned him so damaged by fire as to be quite +useless for our purposes. Their Reverend Samuel Willard wrote us a not +over-wise report of a case of hysteria; and our Jean Astruc gave +them (if we may trust Dr. Smith's Dictionary of the Bible) the first +discerning criticism on the authorship of the Pentateuch. Our John +Locke enlightened them with his letters concerning toleration; and their +Cotton Mather obscured our twilight with his “Nishmath Chajim.” + +Yet we must remember that the name of Basil Valentine, the monk, is +associated with whatever good and harm we can ascribe to antimony; +and that the most remarkable of our specifics long bore the name of +“Jesuit's Bark,” from an old legend connected with its introduction. +“Frere Jacques,” who taught the lithotomists of Paris, owes his +ecclesiastical title to courtesy, as he did not belong to a religious +order. + +Medical science, and especially the study of mental disease, is +destined, I believe, to react to much greater advantage on the theology +of the future than theology has acted on medicine in the past. The +liberal spirit very generally prevailing in both professions, and the +good understanding between their most enlightened members, promise well +for the future of both in a community which holds every point of human +belief, every institution in human hands, and every word written in a +human dialect, open to free discussion today, to-morrow, and to the end +of time. Whether the world at large will ever be cured of trusting +to specifics as a substitute for observing the laws of health, and to +mechanical or intellectual formula as a substitute for character, may +admit of question. Quackery and idolatry are all but immortal. + +We can find most of the old beliefs alive amongst us to-day, only having +changed their dresses and the social spheres in which they thrive. +We think the quarrels of Galenists and chemists belong to the past, +forgetting that Thomsonism has its numerous apostles in our community; +that it is common to see remedies vaunted as purely vegetable, and +that the prejudice against “mineral poisons,” especially mercury, is +as strong in many quarters now as it was at the beginning of the +seventeenth century. Names are only air, and blow away with a change of +wind; but beliefs are rooted in human wants and weakness, and die hard. +The oaks of Dodona are prostrate, and the shrine of Delphi is desolate; +but the Pythoness and the Sibyl may be consulted in Lowell Street for a +very moderate compensation. Nostradamus and Lilly seem impossible in our +time; but we have seen the advertisements of an astrologer in our Boston +papers year after year, which seems to imply that he found believers and +patrons. You smiled when I related Sir Kenelm Digby's prescription with +the live eel in it; but if each of you were to empty his or her pockets, +would there not roll out, from more than one of them, a horse-chestnut, +carried about as a cure for rheumatism? The brazen head of Roger Bacon +is mute; but is not “Planchette” uttering her responses in a hundred +houses of this city? We think of palmistry or chiromancy as belonging to +the days of Albertus Magnus, or, if existing in our time, as given over +to the gypsies; but a very distinguished person has recently shown me +the line of life, and the line of fortune, on the palm of his hand, with +a seeming confidence in the sanguine predictions of his career which +had been drawn from them. What shall we say of the plausible and +well-dressed charlatans of our own time, who trade in false pretences, +like Nicholas Knapp of old, but without any fear of being fined or +whipped; or of the many follies and inanities, imposing on the credulous +part of the community, each of them gaping with eager, open mouth for +a gratuitous advertisement by the mention of its foolish name in any +respectable connection? + +I turn from this less pleasing aspect of the common intelligence which +renders such follies possible, to close the honorable record of the +medical profession in this, our ancient Commonwealth. + +We have seen it in the first century divided among clergymen, +magistrates, and regular practitioners; yet, on the whole, for the +time, and under the circumstances, respectable, except where it invoked +supernatural agencies to account for natural phenomena. + +In the second century it simplified its practice, educated many +intelligent practitioners, and began the work of organizing for +concerted action, and for medical teaching. + +In this, our own century, it has built hospitals, perfected and +multiplied its associations and educational institutions, enlarged and +created museums, and challenged a place in the world of science by its +literature. + +In reviewing the whole course of its history we read a long list of +honored names, and a precious record written in private memories, in +public charities, in permanent contributions to medical science, in +generous sacrifices for the country. We can point to our capital as the +port of entry for the New World of the great medical discoveries of two +successive centuries, and we can claim for it the triumph over the most +dreaded foe that assails the human body,--a triumph which the annals of +the race can hardly match in three thousand years of medical history. + + + + + + +THE YOUNG PRACTITIONER + +[A Valedictory Address delivered to the Graduating Class of the +Bellevue Hospital College, March 2, 1871.] + +The occasion which calls us together reminds us not a little of that +other ceremony which unites a man and woman for life. The banns have +already been pronounced which have wedded our young friends to the +profession of their choice. It remains only to address to them some +friendly words of cheering counsel, and to bestow upon them the parting +benediction. + +This is not the time for rhetorical display or ambitious eloquence. We +must forget ourselves, and think only of them. To us it is an occasion; +to them it is an epoch. The spectators at the wedding look curiously at +the bride and bridegroom; at the bridal veil, the orange-flower garland, +the giving and receiving of the ring; they listen for the tremulous +“I will,” and wonder what are the mysterious syllables the clergyman +whispers in the ear of the married maiden. But to the newly-wedded pair +what meaning in those words, “for better, for worse,” “in sickness and +in health,” “till death us do part!” To the father, to the mother, who +know too well how often the deadly nightshade is interwoven with the +wreath of orange-blossoms, how empty the pageant, how momentous the +reality! + +You will not wonder that I address myself chiefly to those who are just +leaving academic life for the sterner struggle and the larger tasks of +matured and instructed manhood. The hour belongs to them; if others find +patience to listen, they will kindly remember that, after all, they are +but as the spectators at the wedding, and that the priest is thinking +less of them than of their friends who are kneeling at the altar. + +I speak more directly to you, then, gentlemen of the graduating class. +The days of your education, as pupils of trained instructors, are over. +Your first harvest is all garnered. Henceforth you are to be sowers as +well as reapers, and your field is the world. How does your knowledge +stand to-day? What have you gained as a permanent possession? What +must you expect to forget? What remains for you yet to learn? These are +questions which it may interest you to consider. + +There is another question which must force itself on the thoughts +of many among you: “How am I to obtain patients and to keep their +confidence?” You have chosen a laborious calling, and made many +sacrifices to fit yourselves for its successful pursuit. You wish to be +employed that you may be useful, and that you may receive the reward of +your industry. I would take advantage of these most receptive moments +to give you some hints which may help you to realize your hopes and +expectations. Such is the outline of the familiar talk I shall offer +you. + +Your acquaintance with some of the accessory branches is probably +greater now than it will be in a year from now,--much greater than it +will be ten years from now. The progress of knowledge, it may be feared, +or hoped, will have outrun the text-books in which you studied these +branches. Chemistry, for instance, is very apt to spoil on one's hands. +“Nous avons change tout cela” might serve as the standing motto of many +of our manuals. Science is a great traveller, and wears her shoes out +pretty fast, as might be expected. + +You are now fresh from the lecture-room and the laboratory. You can pass +an examination in anatomy, physiology, chemistry, materia medica, +which the men in large practice all around you would find a more potent +sudorific than any in the Pharmacopceia. These masters of the art of +healing were once as ready with their answers as you are now, but they +have got rid of a great deal of the less immediately practical part of +their acquisitions, and you must undergo the same depleting process. +Hard work will train it off, as sharp exercise trains off the fat of a +prize-fighter. + +Yet, pause a moment before you infer that your teachers must have +been in fault when they furnished you with mental stores not directly +convertible to practical purposes, and likely in a few years to lose +their place in your memory. All systematic knowledge involves much that +is not practical, yet it is the only kind of knowledge which satisfies +the mind, and systematic study proves, in the long-run, the easiest way +of acquiring and retaining facts which are practical. There are many +things which we can afford to forget, which yet it was well to learn. +Your mental condition is not the same as if you had never known what +you now try in vain to recall. There is a perpetual metempsychosis of +thought, and the knowledge of to-day finds a soil in the forgotten facts +of yesterday. You cannot see anything in the new season of the guano +you placed last year about the roots of your climbing plants, but it is +blushing and breathing fragrance in your trellised roses; it has scaled +your porch in the bee-haunted honey-suckle; it has found its way where +the ivy is green; it is gone where the woodbine expands its luxuriant +foliage. + +Your diploma seems very broad to-day with your list of accomplishments, +but it begins to shrink from this hour like the Peau de Chagrin of +Balzac's story. Do not worry about it, for all the while there will be +making out for you an ampler and fairer parchment, signed by old Father +Time himself as President of that great University in which experience +is the one perpetual and all-sufficient professor. + +Your present plethora of acquirements will soon cure itself. Knowledge +that is not wanted dies out like the eyes of the fishes of the Mammoth +Cave. When you come to handle life and death as your daily business, +your memory will of itself bid good-by to such inmates as the +well-known foramina of the sphenoid bone and the familiar oxides of +methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known +them, and remember that even the learned ignorance of a nomenclature +is something to have mastered, and may furnish pegs to hang facts +upon which would otherwise have strewed the floor of memory in loose +disorder. + +But your education has, after all, been very largely practical. You have +studied medicine and surgery, not chiefly in books, but at the bedside +and in the operating amphitheatre. It is the special advantage of +large cities that they afford the opportunity of seeing a great deal of +disease in a short space of time, and of seeing many cases of the same +kind of disease brought together. Let us not be unjust to the claims of +the schools remote from the larger centres of population. Who among us +has taught better than Nathan Smith, better than Elisha Bartlett? who +teaches better than some of our living contemporaries who divide their +time between city and country schools? I am afraid we do not always do +justice to our country brethren, whose merits are less conspicuously +exhibited than those of the great city physicians and surgeons, +such especially as have charge of large hospitals. There are modest +practitioners living in remote rural districts who are gifted by nature +with such sagacity and wisdom, trained so well in what is most essential +to the practice of their art, taught so thoroughly by varied experience, +forced to such manly self-reliance by their comparative isolation, +that, from converse with them alone, from riding with them on their long +rounds as they pass from village to village, from talking over cases +with them, putting up their prescriptions, watching their expedients, +listening to their cautions, marking the event of their predictions, +hearing them tell of their mistakes, and now and then glory a little +in the detection of another's blunder, a young man would find himself +better fitted for his real work than many who have followed long +courses of lectures and passed a showy examination. But the young man is +exceptionally fortunate who enjoys the intimacy of such a teacher. +And it must be confessed that the great hospitals, infirmaries, and +dispensaries of large cities, where men of well-sifted reputations are +in constant attendance, are the true centres of medical education. No +students, I believe, are more thoroughly aware of this than those who +have graduated at this institution. Here, as in all our larger city +schools, the greatest pains are taken to teach things as well as names. +You have entered into the inheritance of a vast amount of transmitted +skill and wisdom, which you have taken, warm, as it were, with the life +of your well-schooled instructors. You have not learned all that art has +to teach you, but you are safer practitioners to-day than were many of +those whose names we hardly mention without a genuflection. I had +rather be cared for in a fever by the best-taught among you than by the +renowned Fernelius or the illustrious Boerhaave, could they come back to +us from that better world where there are no physicians needed, and, if +the old adage can be trusted, not many within call. I had rather have +one of you exercise his surgical skill upon me than find myself in the +hands of a resuscitated Fabricius Hildanus, or even of a wise Ambroise +Pare, revisiting earth in the light of the nineteenth century. + +You will not accuse me of underrating your accomplishments. You know +what to do for a child in a fit, for an alderman in an apoplexy, for +a girl that has fainted, for a woman in hysterics, for a leg that is +broken, for an arm that is out of joint, for fevers of every color, for +the sailor's rheumatism, and the tailor's cachexy. In fact you do really +know so much at this very hour, that nothing but the searching test of +time can fully teach you the limitations of your knowledge. + +Of some of these you will permit me to remind you. You will never have +outgrown the possibility of new acquisitions, for Nature is endless in +her variety. But even the knowledge which you may be said to possess +will be a different thing after long habit has made it a part of your +existence. The tactus eruditus extends to the mind as well as to the +finger-ends. Experience means the knowledge gained by habitual trial, +and an expert is one who has been in the habit of trying. This is the +kind of knowledge that made Ulysses wise in the ways of men. Many +cities had he seen, and known the minds of those who dwelt in them. This +knowledge it was that Chaucer's Shipman brought home with him from the +sea-- + + + “In many a tempest had his berd be shake.” + +This is the knowledge we place most confidence in, in the practical +affairs of life. + +Our training has two stages. The first stage deals with our +intelligence, which takes the idea of what is to be done with the +most charming ease and readiness. Let it be a game of billiards, for +instance, which the marker is going to teach us. We have nothing to do +but to make this ball glance from that ball and hit that other ball, +and to knock that ball with this ball into a certain caecal sacculus or +diverticulum which our professional friend calls a pocket. Nothing can +be clearer; it is as easy as “playing upon this pipe,” for which Hamlet +gives Guildenstern such lucid directions. But this intelligent Me, who +steps forward as the senior partner in our dual personality, turns +out to be a terrible bungler. He misses those glancing hits which the +hard-featured young professional person calls “carroms,” and insists on +pocketing his own ball instead of the other one. + +It is the unintelligent Me, stupid as an idiot, that has to try a thing +a thousand times before he can do it, and then never knows how he does +it, that at last does it well. We have to educate ourselves through the +pretentious claims of intellect, into the humble accuracy of instinct, +and we end at last by acquiring the dexterity, the perfection, the +certainty, which those masters of arts, the bee and the spider, inherit +from Nature. + +Book-knowledge, lecture-knowledge, examination-knowledge, are all in the +brain. But work-knowledge is not only in the brain, it is in the senses, +in the muscles, in the ganglia of the sympathetic nerves,--all over the +man, as one may say, as instinct seems diffused through every part of +those lower animals that have no such distinct organ as a brain. See +a skilful surgeon handle a broken limb; see a wise old physician smile +away a case that looks to a novice as if the sexton would soon be sent +for; mark what a large experience has done for those who were fitted +to profit by it, and you will feel convinced that, much as you know, +something is still left for you to learn. + +May I venture to contrast youth and experience in medical practice, +something in the way the man painted the lion, that is, the lion under? + +The young man knows the rules, but the old man knows the exceptions. The +young man knows his patient, but the old man knows also his patient's +family, dead and alive, up and down for generations. He can tell +beforehand what diseases their unborn children will be subject to, what +they will die of if they live long enough, and whether they had better +live at all, or remain unrealized possibilities, as belonging to a stock +not worth being perpetuated. The young man feels uneasy if he is +not continually doing something to stir up his patient's internal +arrangements. The old man takes things more quietly, and is much more +willing to let well enough alone: All these superiorities, if such they +are, you must wait for time to bring you. In the meanwhile (if we will +let the lion be uppermost for a moment), the young man's senses +are quicker than those of his older rival. His education in all the +accessory branches is more recent, and therefore nearer the existing +condition of knowledge. He finds it easier than his seniors to accept +the improvements which every year is bringing forward. New ideas build +their nests in young men's brains. “Revolutions are not made by men in +spectacles,” as I once heard it remarked, and the first whispers of +a new truth are not caught by those who begin to feel the need of an +ear-trumpet. Granting all these advantages to the young man, he +ought, nevertheless, to go on improving, on the whole, as a medical +practitioner, with every year, until he has ripened into a well-mellowed +maturity. But, to improve, he must be good for something at the start. +If you ship a poor cask of wine to India and back, if you keep it a half +a century, it only grows thinner and sharper. + +You are soon to enter into relations with the public, to expend your +skill and knowledge for its benefit, and find your support in the +rewards of your labor. What kind of a constituency is this which is to +look to you as its authorized champions in the struggle of life against +its numerous enemies? + +In the first place, the persons who seek the aid of the physician are +very honest and sincere in their wish to get rid of their complaints, +and, generally speaking, to live as long as they can. However +attractively the future is painted to them, they are attached to the +planet with which they are already acquainted. They are addicted to the +daily use of this empirical and unchemical mixture which we call air; +and would hold on to it as a tippler does to his alcoholic drinks. There +is nothing men will not do, there is nothing they have not done, to +recover their health and save their lives. They have submitted to be +half-drowned in water, and half-choked with gases, to be buried up to +their chins in earth, to be seared with hot irons like galley-slaves, to +be crimped with knives, like cod-fish, to have needles thrust into +their flesh, and bonfires kindled on their skin, to swallow all sorts +of abominations, and to pay for all this, as if to be singed and scalded +were a costly privilege, as if blisters were a blessing, and leeches +were a luxury. What more can be asked to prove their honesty and +sincerity? + +This same community is very intelligent with respect to a great many +subjects--commerce, mechanics, manufactures, politics. But with regard +to medicine it is hopelessly ignorant and never finds it out. I do not +know that it is any worse in this country than in Great Britain, where +Mr. Huxley speaks very freely of “the utter ignorance of the simplest +laws of their own animal life, which prevails among even the most highly +educated persons.” And Cullen said before him “Neither the acutest +genius nor the soundest judgment will avail in judging of a particular +science, in regard to which they have not been exercised. I have been +obliged to please my patients sometimes with reasons, and I have found +that any will pass, even with able divines and acute lawyers; the same +will pass with the husbands as with the wives.” If the community could +only be made aware of its own utter ignorance, and incompetence to form +opinions on medical subjects, difficult enough to those who give their +lives to the study of them, the practitioner would have an easier task. +But it will form opinions of its own, it cannot help it, and we cannot +blame it, even though we know how slight and deceptive are their +foundations. + +This is the way it happens: Every grown-up person has either been +ill himself or had a friend suffer from illness, from which he has +recovered. Every sick person has done something or other by somebody's +advice, or of his own accord, a little before getting better. There +is an irresistible tendency to associate the thing done, and the +improvement which followed it, as cause and effect. This is the great +source of fallacy in medical practice. But the physician has some chance +of correcting his hasty inference. He thinks his prescription cured a +single case of a particular complaint; he tries it in twenty similar +cases without effect, and sets down the first as probably nothing more +than a coincidence. The unprofessional experimenter or observer has +no large experience to correct his hasty generalization. He wants to +believe that the means he employed effected his cure. He feels grateful +to the person who advised it, he loves to praise the pill or potion +which helped him, and he has a kind of monumental pride in himself as +a living testimony to its efficacy. So it is that you will find the +community in which you live, be it in town or country, full of brands +plucked from the burning, as they believe, by some agency which, with +your better training, you feel reasonably confident had nothing to +do with it. Their disease went out of itself, and the stream from the +medical fire-annihilator had never even touched it. + +You cannot and need not expect to disturb the public in the possession +of its medical superstitions. A man's ignorance is as much his private +property, and as precious in his own eyes, as his family Bible. You have +only to open your own Bible at the ninth chapter of St. John's Gospel, +and you will find that the logic of a restored patient was very simple +then, as it is now, and very hard to deal with. My clerical friends +will forgive me for poaching on their sacred territory, in return for an +occasional raid upon the medical domain of which they have now and then +been accused. + +A blind man was said to have been restored to sight by a young person +whom the learned doctors of the Jewish law considered a sinner, and, as +such, very unlikely to have been endowed with a divine gift of healing. +They visited the patient repeatedly, and evidently teased him with their +questions about the treatment, and their insinuations about the young +man, until he lost his temper. At last he turned sharply upon them: +“Whether he be a sinner or no, I know not: one thing I know, that, +whereas I was blind, now I see.” + +This is the answer that always has been and always will be given by most +persons when they find themselves getting well after doing anything, no +matter what,--recommended by anybody, no matter whom. Lord Bacon, Robert +Boyle, Bishop Berkeley, all put their faith in panaceas which we should +laugh to scorn. They had seen people get well after using them. Are we +any wiser than those great men? Two years ago, in a lecture before the +Massachusetts Historical Society, I mentioned this recipe of Sir Kenelm +Digby for fever and ague: Pare the patient's nails; put the parings in a +little bag, and hang the bag round the neck of a live eel, and place him +in a tub of water. The eel will die, and the patient will recover. + +Referring to this prescription in the course of the same lecture, I +said: “You smiled when I related Sir Kenehn Digby's prescription, with +the live eel in it; but if each of you were to empty his or her pockets, +would there not roll out, from more than one of them, a horse-chestnut, +carried about as a cure for rheumatism?” Nobody saw fit to empty his or +her pockets, and my question brought no response. But two months ago +I was in a company of educated persons, college graduates every one of +them, when a gentleman, well known in our community, a man of superior +ability and strong common-sense, on the occasion of some talk arising +about rheumatism, took a couple of very shiny horse-chestnuts from his +breeches-pocket, and laid them on the table, telling us how, having +suffered from the complaint in question, he had, by the advice of a +friend, procured these two horse-chestnuts on a certain time a year or +more ago, and carried them about him ever since; from which very day he +had been entirely free from rheumatism. + +This argument, from what looks like cause and effect, whether it be so +or not, is what you will have to meet wherever you go, and you need not +think you can answer it. In the natural course of things some thousands +of persons must be getting well or better of slight attacks of colds, +of rheumatic pains, every week, in this city alone. Hundreds of them do +something or other in the way of remedy, by medical or other advice, or +of their own motion, and the last thing they do gets the credit of the +recovery. Think what a crop of remedies this must furnish, if it were +all harvested! + +Experience has taught, or will teach you, that most of the wonderful +stories patients and others tell of sudden and signal cures are like +Owen Glendower's story of the portents that announced his birth. The +earth shook at your nativity, did it? Very likely, and + + + “So it would have done, + At the same season, if your mother's cat + Had kittened, though yourself had ne'er been born.” + +You must listen more meekly than Hotspur did to the babbling Welshman, +for ignorance is a solemn and sacred fact, and, like infancy, which it +resembles, should be respected. Once in a while you will have a patient +of sense, born with the gift of observation, from whom you may learn +something. When you find yourself in the presence of one who is fertile +of medical opinions, and affluent in stories of marvellous cures,--of +a member of Congress whose name figures in certificates to the value of +patent medicines, of a voluble dame who discourses on the miracles she +has wrought or seen wrought with the little jokers of the sugar-of-milk +globule-box, take out your watch and count the pulse; also note the time +of day, and charge the price of a visit for every extra fifteen, or, if +you are not very busy, every twenty minutes. In this way you will turn +what seems a serious dispensation into a double blessing, for this class +of patients loves dearly to talk, and it does them a deal of good, and +you feel as if you had earned your money by the dose you have taken, +quite as honestly as by any dose you may have ordered. + +You must take the community just as it is, and make the best of it. +You wish to obtain its confidence; there is a short rule for doing this +which you will find useful,--deserve it. But, to deserve it in full +measure, you must unite many excellences, natural and acquired. + +As the basis of all the rest, you must have all those traits of +character which fit you to enter into the most intimate and confidential +relations with the families of which you are the privileged friend and +counsellor. Medical Christianity, if I may use such a term, is of very +early date. By the oath of Hippocrates, the practitioner of ancient +times bound himself to enter his patient's house with the sole purpose +of doing him good, and so to conduct himself as to avoid the very +appearance of evil. Let the physician of to-day begin by coming up to +this standard, and add to it all the more recently discovered virtues +and graces. + +A certain amount of natural ability is requisite to make you a good +physician, but by no means that disproportionate development of some +special faculty which goes by the name of genius. A just balance of the +mental powers is a great deal more likely to be useful than any single +talent, even were it the power of observation, in excess. For a mere +observer is liable to be too fond of facts for their own sake, so that, +if he told the real truth, he would confess that he takes more pleasure +in a post-mortem examination which shows him what was the matter with a +patient, than in a case which insists on getting well and leaving him in +the dark as to its nature. Far more likely to interfere with the sound +practical balance of the mind is that speculative, theoretical tendency +which has made so many men noted in their day, whose fame has passed +away with their dissolving theories. Read Dr. Bartlett's comparison of +the famous Benjamin Rush with his modest fellow-townsman Dr. William +Currie, and see the dangers into which a passion for grandiose +generalizations betrayed a man of many admirable qualities. + +I warn you against all ambitious aspirations outside of your profession. +Medicine is the most difficult of sciences and the most laborious of +arts. It will task all your powers of body and mind if you are faithful +to it. Do not dabble in the muddy sewer of politics, nor linger by +the enchanted streams of literature, nor dig in far-off fields for the +hidden waters of alien sciences. The great practitioners are generally +those who concentrate all their powers on their business. If there +are here and there brilliant exceptions, it is only in virtue of +extraordinary gifts, and industry to which very few are equal. + +To get business a man must really want it; and do you suppose that when +you are in the middle of a heated caucus, or half-way through a delicate +analysis, or in the spasm of an unfinished ode, your eyes rolling in the +fine frenzy of poetical composition, you want to be called to a teething +infant, or an ancient person groaning under the griefs of a lumbago? +I think I have known more than one young man whose doctor's sign +proclaimed his readiness to serve mankind in that capacity, but who +hated the sound of a patient's knock, and as he sat with his book or his +microscope, felt exactly as the old party expressed himself in my friend +Mr. Brownell's poem-- + + + “All I axes is, let me alone.” + +The community soon finds out whether you are in earnest, and really mean +business, or whether you are one of those diplomaed dilettanti who like +the amusement of quasi medical studies, but have no idea of wasting +their precious time in putting their knowledge in practice for the +benefit of their suffering fellow-creatures. + +The public is a very incompetent judge of your skill and knowledge, but +it gives its confidence most readily to those who stand well with their +professional brethren, whom they call upon when they themselves or their +families are sick, whom they choose to honorable offices, whose writings +and teachings they hold in esteem. A man may be much valued by the +profession and yet have defects which prevent his becoming a favorite +practitioner, but no popularity can be depended upon as permanent which +is not sanctioned by the judgment of professional experts, and with +these you will always stand on your substantial merits. + +What shall I say of the personal habits you must form if you wish for +success? Temperance is first upon the list. Intemperance in a physician +partakes of the guilt of homicide, for the muddled brain may easily +make a fatal blunder in a prescription and the unsteady hand transfix +an artery in an operation. Tippling doctors have been too common in the +history of medicine. Paracelsus was a sot, Radcliffe was much too fond +of his glass, and Dr. James Hurlbut of Wethersfield, Connecticut, a +famous man in his time, used to drink a square bottle of rum a day, +with a corresponding allowance of opium to help steady his nerves. We +commonly speak of a man as being the worse for liquor, but I was asking +an Irish laborer one day about his doctor, who, as he said, was somewhat +given to drink. “I like him best when he's a little that way,” he said; +“then I can spake to him.” I pitied the poor patient who could not +venture to allude to his colic or his pleurisy until his physician was +tipsy. + +There are personal habits of less gravity than the one I have +mentioned which it is well to guard against, or, if they are formed, +to relinquish. A man who may be called at a moment's warning into +the fragrant boudoir of suffering loveliness should not unsweeten its +atmosphere with reminiscences of extinguished meerschaums. He should +remember that the sick are sensitive and fastidious, that they love the +sweet odors and the pure tints of flowers, and if his presence is not +like the breath of the rose, if his hands are not like the leaf of the +lily, his visit may be unwelcome, and if he looks behind him he may see +a window thrown open after he has left the sick-chamber. I remember too +well the old doctor who sometimes came to help me through those inward +griefs to which childhood is liable. “Far off his coming “--shall I say +“shone,” and finish the Miltonic phrase, or leave the verb to the happy +conjectures of my audience? Before him came a soul-subduing whiff +of ipecacuanha, and after him lingered a shuddering consciousness of +rhubarb. He had lived so much among his medicaments that he had at last +become himself a drug, and to have him pass through a sick-chamber was a +stronger dose than a conscientious disciple of Hahnemann would think it +safe to administer. + +Need I remind you of the importance of punctuality in your engagements, +and of the worry and distress to patients and their friends which the +want of it occasions? One of my old teachers always carried two watches, +to make quite sure of being exact, and not only kept his appointments +with the regularity of a chronometer, but took great pains to be at +his patient's house at the time when he had reason to believe he was +expected, even if no express appointment was made. It is a good rule; +if you call too early, my lady's hair may not be so smooth as could be +wished, and, if you keep her waiting too long, her hair may be smooth, +but her temper otherwise. + +You will remember, of course, always to get the weather-gage of your +patient. I mean, to place him so that the light falls on his face and +not on yours. It is a kind of, ocular duel that is about to take +place between you; you are going to look through his features into his +pulmonary and hepatic and other internal machinery, and he is going +to look into yours quite as sharply to see what you think about his +probabilities for time or eternity. + +No matter how hard he stares at your countenance, he should never be +able to read his fate in it. It should be cheerful as long as there is +hope, and serene in its gravity when nothing is left but resignation. +The face of a physician, like that of a diplomatist, should be +impenetrable. Nature is a benevolent old hypocrite; she cheats the sick +and the dying with illusions better than any anodynes. If there are +cogent reasons why a patient should be undeceived, do it deliberately +and advisedly, but do not betray your apprehensions through your +tell-tale features. + +We had a physician in our city whose smile was commonly reckoned as +being worth five thousand dollars a year to him, in the days, too, of +moderate incomes. You cannot put on such a smile as that any more than +you can get sunshine without sun; there was a tranquil and kindly nature +under it that irradiated the pleasant face it made one happier to meet +on his daily rounds. But you can cultivate the disposition, and it will +work its way through to the surface, nay, more,--you can try to wear a +quiet and encouraging look, and it will react on your disposition and +make you like what you seem to be, or at least bring you nearer to its +own likeness. + +Your patient has no more right to all the truth you know than he has +to all the medicine in your saddlebags, if you carry that kind of +cartridge-box for the ammunition that slays disease. He should get only +just so much as is good for him. I have seen a physician examining a +patient's chest stop all at once, as he brought out a particular sound +with a tap on the collarbone, in the attitude of a pointer who has just +come on the scent or sight of a woodcock. You remember the Spartan boy, +who, with unmoved countenance, hid the fox that was tearing his vitals +beneath his mantle. What he could do in his own suffering you must +learn to do for others on whose vital organs disease has fastened its +devouring teeth. It is a terrible thing to take away hope, even earthly +hope, from a fellow-creature. Be very careful what names you let fall +before your patient. He knows what it means when you tell him he has +tubercles or Bright's disease, and, if he hears the word carcinoma, +he will certainly look it out in a medical dictionary, if he does +not interpret its dread significance on the instant. Tell him he has +asthmatic symptoms, or a tendency to the gouty diathesis, and he will +at once think of all the asthmatic and gouty old patriarchs he has ever +heard of, and be comforted. You need not be so cautious in speaking +of the health of rich and remote relatives, if he is in the line of +succession. + +Some shrewd old doctors have a few phrases always on hand for patients +that will insist on knowing the pathology of their complaints without +the slightest capacity of understanding the scientific explanation. I +have known the term “spinal irritation” serve well on such occasions, +but I think nothing on the whole has covered so much ground, and meant +so little, and given such profound satisfaction to all parties, as the +magnificent phrase “congestion of the portal system.” + +Once more, let me recommend you, as far as possible, to keep your +doubts to yourself, and give the patient the benefit of your decision. +Firmness, gentle firmness, is absolutely necessary in this and certain +other relations. Mr. Rarey with Cruiser, Richard with Lady Ann, Pinel +with his crazy people, show what steady nerves can do with the most +intractable of animals, the most irresistible of despots, and the most +unmanageable of invalids. + +If you cannot acquire and keep the confidence of your patient, it is +time for you to give place to some other practitioner who can. If you +are wise and diligent, you can establish relations with the best of them +which they will find it very hard to break. But, if they wish to employ +another person, who, as they think, knows more than you do, do not take +it as a personal wrong. A patient believes another man can save his +life, can restore him to health, which, as he thinks, you have not the +skill to do. No matter whether the patient is right or wrong, it is a +great impertinence to think you have any property in him. Your estimate +of your own ability is not the question, it is what the patient thinks +of it. All your wisdom is to him like the lady's virtue in Raleigh's +song: + + + “If she seem not chaste to me, + What care I how chaste she be?” + +What I call a good patient is one who, having found a good physician, +sticks to him till he dies. But there are many very good people who are +not what I call good patients. I was once requested to call on a +lady suffering from nervous and other symptoms. It came out in the +preliminary conversational skirmish, half medical, half social, that +I was the twenty-sixth member of the faculty into whose arms, +professionally speaking, she had successively thrown herself. Not +being a believer in such a rapid rotation of scientific crops, I gently +deposited the burden, commending it to the care of number twenty-seven, +and, him, whoever he might be, to the care of Heaven. + +If there happened to be among my audience any person who wished to know +on what principles the patient should choose his physician, I should +give him these few precepts to think over: + +Choose a man who is personally agreeable, for a daily visit from an +intelligent, amiable, pleasant, sympathetic person will cost you no more +than one from a sloven or a boor, and his presence will do more for you +than any prescription the other will order. + +Let him be a man of recognized good sense in other matters, and the +chance is that he will be sensible as a practitioner. + +Let him be a man who stands well with his professional brethren, whom +they approve as honest, able, courteous. + +Let him be one whose patients are willing to die in his hands, not one +whom they go to for trifles, and leave as soon as they are in danger, +and who can say, therefore, that he never loses a patient. + +Do not leave the ranks of what is called the regular profession, unless +you wish to go farther and fare worse, for you may be assured that +its members recognize no principle which hinders their accepting any +remedial agent proved to be useful, no matter from what quarter it +comes. The difficulty is that the stragglers, organized under fantastic +names in pretentious associations, or lurking in solitary dens behind +doors left ajar, make no real contributions to the art of healing. When +they bring forward a remedial agent like chloral, like the bromide +of potassium, like ether, used as an anesthetic, they will find no +difficulty in procuring its recognition. + +Some of you will probably be more or less troubled by the pretensions +of that parody of mediaeval theology which finds its dogma of hereditary +depravity in the doctrine of psora, its miracle of transubstantiation in +the mystery of its triturations and dilutions, its church in the people +who have mistaken their century, and its priests in those who have +mistaken their calling. You can do little with persons who are disposed +to accept these curious medical superstitions. The saturation-point +of individual minds with reference to evidence, and especially medical +evidence, differs, and must always continue to differ, very widely. +There are those whose minds are satisfied with the decillionth dilution +of a scientific proof. No wonder they believe in the efficacy of a +similar attenuation of bryony or pulsatilla. You have no fulcrum you +can rest upon to lift an error out of such minds as these, often highly +endowed with knowledge and talent, sometimes with genius, but commonly +richer in the imaginative than the observing and reasoning faculties. + +Let me return once more to the young graduate. Your relations to your +professional brethren may be a source of lifelong happiness and growth +in knowledge and character, or they may make you wretched and end +by leaving you isolated from those who should be your friends and +counsellors. The life of a physician becomes ignoble when he suffers +himself to feed on petty jealousies and sours his temper in perpetual +quarrels. You will be liable to meet an uncomfortable man here and there +in the profession,--one who is so fond of being in hot water that it is +a wonder all the albumen in his body is not coagulated. There are common +barrators among doctors as there are among lawyers,--stirrers up of +strife under one pretext and another, but in reality because they like +it. They are their own worst enemies, and do themselves a mischief each +time they assail their neighbors. In my student days I remember a good +deal of this Donnybrook-Fair style of quarrelling, more especially in +Paris, where some of the noted surgeons were always at loggerheads, and +in one of our lively Western cities. Soon after I had set up an office, +I had a trifling experience which may serve to point a moral in this +direction. I had placed a lamp behind the glass in the entry to indicate +to the passer-by where relief from all curable infirmities was to be +sought and found. Its brilliancy attracted the attention of a devious +youth, who dashed his fist through the glass and upset my modest +luminary. All he got by his vivacious assault was that he left portions +of integument from his knuckles upon the glass, had a lame hand, was +very easily identified, and had to pay the glazier's bill. The moral is +that, if the brilliancy of another's reputation excites your belligerent +instincts, it is not worth your while to strike at it, without +calculating which of you is likely to suffer most, if you do. + +You may be assured that when an ill-conditioned neighbor is always +complaining of a bad taste in his mouth and an evil atmosphere about +him, there is something wrong about his own secretions. In such +cases there is an alterative regimen of remarkable efficacy: it is a +starvation-diet of letting alone. The great majority of the profession +are peacefully inclined. Their pursuits are eminently humanizing, and +they look with disgust on the personalities which intrude themselves +into the placid domain of an art whose province it is to heal and not to +wound. + +The intercourse of teacher and student in a large school is necessarily +limited, but it should be, and, so far as my experience goes, it is, +eminently cordial and kindly. You will leave with regret, and hold +in tender remembrance, those who have taken you by the hand at your +entrance on your chosen path, and led you patiently and faithfully, +until the great gates at its end have swung upon their hinges, and the +world lies open before you. That venerable oath to which I have before +referred bound the student to regard his instructor in the light of a +parent, to treat his children like brothers, to succor him in his day of +need. I trust the spirit of the oath of Hippocrates is not dead in the +hearts of the students of to-day. They will remember with gratitude +every earnest effort, every encouraging word, which has helped them in +their difficult and laborious career of study. The names they read on +their diplomas will recall faces that are like family-portraits in their +memory, and the echo of voices they have listened to so long will linger +in their memories far into the still evening of their lives. + +One voice will be heard no more which has been familiar to many among +you. It is not for me, a stranger to these scenes, to speak his eulogy. +I have no right to sadden this hour by dwelling on the deep regrets +of friendship, or to bid the bitter tears of sorrow flow afresh. Yet I +cannot help remembering what a void the death of such a practitioner as +your late instructor must leave in the wide circle of those who leaned +upon his counsel and assistance in their hour of need, in a community +where he was so widely known and esteemed, in a school where he bore so +important a part. There is no exemption from the common doom for him +who holds the shield to protect others. The student is called from his +bench, the professor from his chair, the practitioner in his busiest +period hears a knock more peremptory than any patient's midnight +summons, and goes on that unreturning visit which admits of no excuse, +and suffers no delay. The call of such a man away from us is the +bereavement of a great family. Nor can we help regretting the loss +for him of a bright and cheerful earthly future; for the old age of a +physician is one of the happiest periods of his life. He is loved and +cherished for what he has been, and even in the decline of his faculties +there are occasions when his experience is still appealed to, and his +trembling hands are looked to with renewing hope and trust, as being yet +able to stay the arm of the destroyer. + +But if there is so much left for age, how beautiful, how inspiring is +the hope of youth! I see among those whom I count as listeners one by +whose side I have sat as a fellow-teacher, and by whose instructions +I have felt myself not too old to profit. As we borrowed him from +your city, I must take this opportunity of telling you that his zeal, +intelligence, and admirable faculty as an instructor were heartily and +universally recognized among us. We return him, as we trust, uninjured, +to the fellow-citizens who have the privilege of claiming him as their +own. + +And now, gentlemen of the graduating class, nothing remains but for +me to bid you, in the name of those for whom I am commissioned and +privileged to speak, farewell as students, and welcome as practitioners. +I pronounce the two benedictions in the same breath, as the late king's +demise and the new king's accession are proclaimed by the same voice at +the same moment. You would hardly excuse me if I stooped to any meaner +dialect than the classical and familiar language of your prescriptions, +the same in which your title to the name of physician is, if, like +our own institution, you follow the ancient usage, engraved upon your +diplomas. + +Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, +filii! + +Salvete, VIRI, artis medicae magister; Salvete amici; salvete fratres! + + + + + + +MEDICAL LIBRARIES. + +[Dedicatory Address at the opening of the Medical Library in Boston, +December 3, 1878.] + +It is my appointed task, my honorable privilege, this evening, to speak +of what has been done by others. No one can bring his tribute of words +into the presence of great deeds, or try with them to embellish the +memory of any inspiring achievement, without feeling and leaving +with others a sense of their insufficiency. So felt Alexander when he +compared even his adored Homer with the hero the poet had sung. So felt +Webster when he contrasted the phrases of rhetoric with the eloquence +of patriotism and of self-devotion. So felt Lincoln when on the field of +Gettysburg he spoke those immortal words which Pericles could not have +bettered, which Aristotle could not have criticised. So felt he who +wrote the epitaph of the builder of the dome which looks down on the +crosses and weathercocks that glitter over London. + +We are not met upon a battle-field, except so far as every laborious +achievement means a victory over opposition, indifference, selfishness, +faintheartedness, and that great property of mind as well as +matter,--inertia. We are not met in a cathedral, except so far as every +building whose walls are lined with the products of useful and ennobling +thought is a temple of the Almighty, whose inspiration has given us +understanding. But we have gathered within walls which bear testimony to +the self-sacrificing, persevering efforts of a few young men, to whom +we owe the origin and development of all that excites our admiration in +this completed enterprise; and I might consider my task as finished if I +contented myself with borrowing the last word of the architect's epitaph +and only saying, Look around you! + +The reports of the librarian have told or will tell you, in some detail, +what has been accomplished since the 21st of December, 1874, when six +gentlemen met at the house of Dr. Henry Ingersoll Bowditch to discuss +different projects for a medical library. In less than four years from +that time, by the liberality of associations and of individuals, this +collection of nearly ten thousand volumes, of five thousand pamphlets, +and of one hundred and twenty-five journals, regularly received,--all +worthily sheltered beneath this lofty roof,--has come into being under +our eyes. It has sprung up, as it were, in the night like a mushroom; it +stands before us in full daylight as lusty as an oak, and promising to +grow and flourish in the perennial freshness of an evergreen. + +To whom does our profession owe this already large collection of books, +exceeded in numbers only by four or five of the most extensive medical +libraries in the country, and lodged in a building so well adapted to +its present needs? We will not point out individually all those younger +members of the profession who have accomplished what their fathers and +elder brethren had attempted and partially achieved. We need not write +their names on these walls, after the fashion of those civic dignitaries +who immortalize themselves on tablets of marble and gates of iron. But +their contemporaries know them well, and their descendants will not +forget them,--the men who first met together, the men who have given +their time and their money, the faithful workers, worthy associates of +the strenuous agitator who gave no sleep to his eyes, no slumber to +his eyelids, until he had gained his ends; the untiring, imperturbable, +tenacious, irrepressible, all-subduing agitator who neither rested +nor let others rest until the success of the project was assured. If, +against his injunctions, I name Dr. James Read Chadwick, it is only my +revenge for his having kept me awake so often and so long while he was +urging on the undertaking in which he has been preeminently active and +triumphantly successful. + +We must not forget the various medical libraries which preceded this: +that of an earlier period, when Boston contained about seventy regular +practitioners, the collection afterwards transferred to the Boston +Athenaeum; the two collections belonging to the University; the +Treadwell Library at the Massachusetts General Hospital; the collections +of the two societies, that for Medical Improvement and that for Medical +Observation; and more especially the ten thousand volumes relating to +medicine belonging to our noble public city library,--too many blossoms +on the tree of knowledge, perhaps, for the best fruit to ripen. But the +Massachusetts Medical Society now numbers nearly four hundred members in +the city of Boston. The time had arrived for a new and larger movement. +There was needed a place to which every respectable member of the +medical profession could obtain easy access; where, under one roof, all +might find the special information they were seeking; where the latest +medical intelligence should be spread out daily as the shipping news is +posted on the bulletins of the exchange; where men engaged in a common +pursuit could meet, surrounded by the mute oracles of science and art; +where the whole atmosphere should be as full of professional knowledge +as the apothecary's shop is of the odor of his medicaments. This was +what the old men longed for,--the prophets and kings of the profession, +who + + + “Desired it long, + But died without the sight.” + +This is what the young men and those who worked under their guidance +undertook to give us. And now such a library, such a reading-room, such +an exchange, such an intellectual and social meeting place, we behold a +fact, plain before us. The medical profession of our city, and, let us +add, of all those neighboring places which it can reach with its iron +arms, is united as never before by the commune vinculum, the common bond +of a large, enduring, ennobling, unselfish interest. It breathes a new +air of awakened intelligence. It marches abreast of the other +learned professions, which have long had their extensive and valuable +centralized libraries; abreast of them, but not promising to be content +with that position. What glorifies a town like a cathedral? What +dignifies a province like a university? What illuminates a country +like its scholarship, and what is the nest that hatches scholars but a +library? + +The physician, some may say, is a practical man and has little use for +all this book-learning. Every student has heard Sydenham's reply to Sir +Richard Blackmore's question as to what books he should read,--meaning +medical books. “Read Don Quixote,” was his famous answer. But Sydenham +himself made medical books and may be presumed to have thought those at +least worth reading. Descartes was asked where was his library, and in +reply held up the dissected body of an animal. But Descartes made books, +great books, and a great many of them. A physician of common sense +without erudition is better than a learned one without common sense, but +the thorough master of his profession must have learning added to his +natural gifts. + +It is not necessary to maintain the direct practical utility of all +kinds of learning. Our shelves contain many books which only a certain +class of medical scholars will be likely to consult. There is a dead +medical literature, and there is a live one. The dead is not all +ancient, the live is not all modern. There is none, modern or ancient, +which, if it has no living value for the student, will not teach him +something by its autopsy. But it is with the live literature of his +profession that the medical practitioner is first of all concerned. + +Now there has come a great change in our time over the form in +which living thought presents itself. The first printed books,--the +incunabula,--were inclosed in boards of solid oak, with brazen clasps +and corners; the boards by and by were replaced by pasteboard covered +with calf or sheepskin; then cloth came in and took the place of +leather; then the pasteboard was covered with paper instead of cloth; +and at this day the quarterly, the monthly, the weekly periodical in its +flimsy unsupported dress of paper, and the daily journal, naked as +it came from the womb of the press, hold the larger part of the fresh +reading we live upon. We must have the latest thought in its latest +expression; the page must be newly turned like the morning bannock; the +pamphlet must be newly opened like the ante-prandial oyster. + +Thus a library, to meet the need of our time, must take, and must spread +out in a convenient form, a great array of periodicals. Our active +practitioners read these by preference over almost everything else. Our +specialists, more particularly, depend on the month's product, on the +yearly crop of new facts, new suggestions, new contrivances, as much +as the farmer on the annual yield of his acres. One of the first wants, +then, of the profession is supplied by our library in its great array of +periodicals from many lands, in many languages. Such a number of medical +periodicals no private library would have room for, no private person +would pay for, or flood his tables with if they were sent him for +nothing. These, I think, with the reports of medical societies and the +papers contributed to them, will form the most attractive part of +our accumulated medical treasures. They will be also one of our chief +expenses, for these journals must be bound in volumes and they require +a great amount of shelf-room; all this, in addition to the cost of +subscription for those which are not furnished us gratuitously. + +It is true that the value of old scientific periodicals is, other things +being equal, in the inverse ratio of their age, for the obvious reason +that what is most valuable in the earlier volumes of a series is drained +off into the standard works with which the intelligent practitioner is +supposed to be familiar. But no extended record of facts grows too old +to be useful, provided only that we have a ready and sure way of getting +at the particular fact or facts we are in search of. + +And this leads me to speak of what I conceive to be one of the principal +tasks to be performed by the present and the coming generation of +scholars, not only in the medical, but in every department of knowledge. +I mean the formation of indexes, and more especially of indexes to +periodical literature. + +This idea has long been working in the minds of scholars, and all who +have had occasion to follow out any special subject. I have a right to +speak of it, for I long ago attempted to supply the want of indexes in +some small measure for my own need. I had a very complete set of the +“American Journal of the Medical Sciences;” an entire set of the “North +American Review,” and many volumes of the reprints of the three leading +British quarterlies. Of what use were they to me without general +indexes? I looked them all through carefully and made classified lists +of all the articles I thought I should most care to read. But they soon +outgrew my lists. The “North American Review” kept filling up shelf +after shelf, rich in articles which I often wanted to consult, but what +a labor to find them, until the index of Mr. Gushing, published a few +months since, made the contents of these hundred and twenty volumes as +easily accessible as the words in a dictionary! I had a copy of good Dr. +Abraham Rees's Cyclopaedia, a treasure-house to my boyhood which has +not lost its value for me in later years. But where to look for what I +wanted? I wished to know, for instance, what Dr. Burney had to say about +singing. Who would have looked for it under the Italian word cantare? I +was curious to learn something of the etchings of Rembrandt, and +where should I find it but under the head “Low Countries, Engravers +of the,”--an elaborate and most valuable article of a hundred +double-columned close-printed quarto pages, to which no reference, even, +is made under the title Rembrandt. + +There was nothing to be done, if I wanted to know where that which I +specially cared for was to be found in my Rees's Cyclopaedia, but to +look over every page of its forty-one quarto volumes and make out +a brief list of matters of interest which I could not find by their +titles, and this I did, at no small expense of time and trouble. + +Nothing, therefore, could be more pleasing to me than to see the +attention which has been given of late years to the great work of +indexing. It is a quarter of a century since Mr. Poole published his +“Index to Periodical Literature,” which it is much to be hoped is soon +to appear in a new edition, grown as it must be to formidable dimensions +by the additions of so long a period. The “British and Foreign Medical +Review,” edited by the late Sir John Forties, contributed to by Huxley, +Carpenter, Laycock, and others of the most distinguished scientific men +of Great Britain, has an index to its twenty-four volumes, and by its +aid I find this valuable series as manageable as a lexicon. The last +edition of the “Encyclopaedia Britannica” had a complete index in a +separate volume, and the publishers of Appletons' “American Cyclopaedia” + have recently issued an index to their useful work, which must greatly +add to its value. I have already referred to the index to the “North +American Review,” which to an American, and especially to a New +Englander, is the most interesting and most valuable addition of its +kind to our literary apparatus since the publication of Mr. Allibone's +“Dictionary of Authors.” I might almost dare to parody Mr. Webster's +words in speaking of Hamilton, to describe what Mr. Gushing did for the +solemn rows of back volumes of our honored old Review which had been +long fossilizing on our shelves: “He touched the dead corpse of the +'North American,' and it sprang to its feet.” A library of the best +thought of the best American scholars during the greater portion of the +century was brought to light by the work of the indexmaker as truly as +were the Assyrian tablets by the labors of Layard. + +A great portion of the best writing and reading--literary, scientific, +professional, miscellaneous--comes to us now, at stated intervals, in +paper covers. The writer appears, as it were, in his shirt-sleeves. As +soon as he has delivered his message the book-binder puts a coat on +his back, and he joins the forlorn brotherhood of “back volumes,” than +which, so long as they are unindexed, nothing can be more exasperating. +Who wants a lock without a key, a ship without a rudder, a binnacle +without a compass, a check without a signature, a greenback without a +goldback behind it? + +I have referred chiefly to the medical journals, but I would include +with these the reports of medical associations, and those separate +publications which, coming in the form of pamphlets, heap themselves +into chaotic piles and bundles which are worse than useless, taking up a +great deal of room, and frightening everything away but mice and mousing +antiquarians, or possibly at long intervals some terebrating specialist. + +Arranged, bound, indexed, all these at once become accessible and +valuable. I will take the first instance which happens to suggest +itself. How many who know all about osteoblasts and the experiments of +Ollier, and all that has grown out of them, know where to go for a paper +by the late Dr. A. L. Peirson of Salem, published in the year 1840, +under the modest title, Remarks on Fractures? And if any practitioner +who has to deal with broken bones does not know that most excellent +and practical essay, it is a great pity, for it answers very numerous +questions which will be sure to suggest themselves to the surgeon and +the patient as no one of the recent treatises, on my own shelves, at +least, can do. + +But if indexing is the special need of our time in medical literature, +as in every department of knowledge, it must be remembered that it +is not only an immense labor, but one that never ends. It requires, +therefore, the cooperation of a large number of individuals to do the +work, and a large amount of money to pay for making its results public +through the press. When it is remembered that the catalogue of the +library of the British Museum is contained in nearly three thousand +large folios of manuscript, and not all its books are yet included, the +task of indexing any considerable branch of science or literature looks +as if it were well nigh impossible. But many hands make light work. An +“Index Society” has been formed in England, already numbering about one +hundred and seventy members. It aims at “supplying thorough indexes +to valuable works and collections which have hitherto lacked them; at +issuing indexes to the literature of special subjects; and at gathering +materials for a general reference index.” This society has published a +little treatise setting forth the history and the art of indexing, which +I trust is in the hands of some of our members, if not upon our shelves. + +Something has been done in the same direction by individuals in our own +country, as we have already seen. The need of it in the department of +medicine is beginning to be clearly felt. Our library has already an +admirable catalogue with cross references, the work of a number of its +younger members cooperating in the task. A very intelligent medical +student, Mr. William D. Chapin, whose excellent project is indorsed by +well-known New York physicians and professors, proposes to publish a +yearly index to original communications in the medical journals of the +United States, classified by authors and subjects. But it is from the +National Medical Library at Washington that we have the best promise +and the largest expectations. That great and growing collection of fifty +thousand volumes is under the eye and hand of a librarian who knows +books and how to manage them. For libraries are the standing armies +of civilization, and an army is but a mob without a general who can +organize and marshal it so as to make it effective. The “Specimen +Fasciculus of a Catalogue of the National Medical Library,” prepared +under the direction of Dr. Billings, the librarian, would have excited +the admiration of Haller, the master scholar in medical science of +the last century, or rather of the profession in all centuries, and if +carried out as it is begun will be to the nineteenth all and more +than all that the three Bibliothecae--Anatomica, Chirurgica, and +Medicinae-Practicae--were to the eighteenth century. I cannot forget +the story that Agassiz was so fond of telling of the king of Prussia and +Fichte. It was after the humiliation and spoliation of the kingdom by +Napoleon that the monarch asked the philosopher what could be done +to regain the lost position of the nation. “Found a great university, +Sire,” was the answer, and so it was that in the year 1810 the +world-renowned University of Berlin came into being. I believe that we +in this country can do better than found a national university, whose +professors shall be nominated in caucuses, go in and out, perhaps, like +postmasters, with every change of administration, and deal with science +in the face of their constituency as the courtier did with time when +his sovereign asked him what o'clock it was: “Whatever hour your majesty +pleases.” But when we have a noble library like that at Washington, and +a librarian of exceptional qualifications like the gentleman who now +holds that office, I believe that a liberal appropriation by Congress +to carry out a conscientious work for the advancement of sound knowledge +and the bettering of human conditions, like this which Dr. Billings +has so well begun, would redound greatly to the honor of the nation. It +ought to be willing to be at some charge to make its treasures useful to +its citizens, and, for its own sake, especially to that class which has +charge of health, public and private. This country abounds in what +are called “self-made men,” and is justly proud of many whom it thus +designates. In one sense no man is self-made who breathes the air of a +civilized community. In another sense every man who is anything other +than a phonograph on legs is self-made. But if we award his just praise +to the man who has attained any kind of excellence without having had +the same advantages as others whom, nevertheless, he has equalled or +surpassed, let us not be betrayed into undervaluing the mechanic's +careful training to his business, the thorough and laborious education +of the scholar and the professional man. + +Our American atmosphere is vocal with the flippant loquacity of half +knowledge. We must accept whatever good can be got out of it, and keep +it under as we do sorrel and mullein and witchgrass, by enriching the +soil, and sowing good seed in plenty; by good teaching and good books, +rather than by wasting our time in talking against it. Half knowledge +dreads nothing but whole knowledge. + +I have spoken of the importance and the predominance of periodical +literature, and have attempted to do justice to its value. But the +almost exclusive reading of it is not without its dangers. The journals +contain much that is crude and unsound; the presumption, it might be +maintained, is against their novelties, unless they come from observers +of established credit. Yet I have known a practitioner,--perhaps more +than one,--who was as much under the dominant influence of the last +article he had read in his favorite medical journal as a milliner under +the sway of the last fashion-plate. The difference between green and +seasoned knowledge is very great, and such practitioners never hold long +enough to any of their knowledge to have it get seasoned. + +It is needless to say, then, that all the substantial and permanent +literature of the profession should be represented upon our shelves. +Much of it is there already, and as one private library after another +falls into this by the natural law of gravitation, it will gradually +acquire all that is most valuable almost without effort. A scholar +should not be in a hurry to part with his books. They are probably +more valuable to him than they can be to any other individual. What +Swedenborg called “correspondence” has established itself between +his intelligence and the volumes which wall him within their sacred +inclosure. Napoleon said that his mind was as if furnished with +drawers,--he drew out each as he wanted its contents, and closed it +at will when done with them. The scholar's mind, to use a similar +comparison, is furnished with shelves, like his library. Each book knows +its place in the brain as well as against the wall or in the alcove. His +consciousness is doubled by the books which encircle him, as the trees +that surround a lake repeat themselves in its unruffled waters. Men talk +of the nerve that runs to the pocket, but one who loves his books, and +has lived long with them, has a nervous filament which runs from his +sensorium to every one of them. Or, if I may still let my fancy draw +its pictures, a scholar's library is to him what a temple is to the +worshipper who frequents it. There is the altar sacred to his holiest +experiences. There is the font where his new-born thought was baptized +and first had a name in his consciousness. There is the monumental +tablet of a dead belief, sacred still in the memory of what it was while +yet alive. No visitor can read all this on the lettered backs of the +books that have gathered around the scholar, but for him, from the Aldus +on the lowest shelf to the Elzevir on the highest, every volume has +a language which none but he can interpret. Be patient with the +book-collector who loves his companions too well to let them go. Books +are not buried with their owners, and the veriest book-miser that ever +lived was probably doing far more for his successors than his more +liberal neighbor who despised his learned or unlearned avarice. Let +the fruit fall with the leaves still clinging round it. Who would have +stripped Southey's walls of the books that filled them, when, his mind +no longer capable of taking in their meaning, he would still pat and +fondle them with the vague loving sense of what they had once been +to him,--to him, the great scholar, now like a little child among his +playthings? + +We need in this country not only the scholar, but the virtuoso, who +hoards the treasures which he loves, it may be chiefly for their rarity +and because others who know more than he does of their value set a high +price upon them. As the wine of old vintages is gently decanted out +of its cobwebbed bottles with their rotten corks into clean new +receptacles, so the wealth of the New World is quietly emptying many +of the libraries and galleries of the Old World into its newly formed +collections and newly raised edifices. And this process must go on in an +accelerating ratio. No Englishman will be offended if I say that before +the New Zealander takes his stand on a broken arch of London Bridge +to sketch the ruins of St. Paul's in the midst of a vast solitude, the +treasures of the British Museum will have found a new shelter in the +halls of New York or Boston. No Catholic will think hardly of my saying +that before the Coliseum falls, and with it the imperial city, whose +doom prophecy has linked with that of the almost eternal amphitheatre, +the marbles, the bronzes, the paintings, the manuscripts of the Vatican +will have left the shores of the Tiber for those of the Potomac, the +Hudson, the Mississippi, or the Sacramento. And what a delight in the +pursuit of the rarities which the eager book-hunter follows with the +scent of a beagle! + +Shall I ever forget that rainy day in Lyons, that dingy bookshop, where +I found the Aetius, long missing from my Artis bledicae Principes, and +where I bought for a small pecuniary consideration, though it was marked +rare, and was really tres rare, the Aphorisms of Hippocrates, edited +by and with a preface from the hand of Francis Rabelais? And the +vellum-bound Tulpius, which I came upon in Venice, afterwards my only +reading when imprisoned in quarantine at Marseilles, so that the two +hundred and twenty-eight cases he has recorded are, many of them, to +this day still fresh in my memory. And the Schenckius,--the folio filled +with casus rariores, which had strayed in among the rubbish of the +bookstall on the boulevard,--and the noble old Vesalius with its grand +frontispiece not unworthy of Titian, and the fine old Ambroise Pare, +long waited for even in Paris and long ago, and the colossal Spigelius +with his eviscerated beauties, and Dutch Bidloo with its miracles of +fine engraving and bad dissection, and Italian Mascagni, the despair of +all would-be imitators, and pre-Adamite John de Ketam, and antediluvian +Berengarius Carpensis,--but why multiply names, every one of which +brings back the accession of a book which was an event almost like the +birth of an infant? + +A library like ours must exercise the largest hospitality. A great many +books may be found in every large collection which remind us of those +apostolic looking old men who figure on the platform at our political +and other assemblages. Some of them have spoken words of wisdom in their +day, but they have ceased to be oracles; some of them never had any +particularly important message for humanity, but they add dignity to the +meeting by their presence; they look wise, whether they are so or not, +and no one grudges them their places of honor. Venerable figure-heads, +what would our platforms be without you? + +Just so with our libraries. Without their rows of folios in creamy +vellum, or showing their black backs with antique lettering of tarnished +gold, our shelves would look as insufficient and unbalanced as a column +without its base, as a statue without its pedestal. And do not think +they are kept only to be spanked and dusted during that dreadful period +when their owner is but too thankful to become an exile and a wanderer +from the scene of single combats between dead authors and living +housemaids. Men were not all cowards before Agamemnon or all fools +before the days of Virchow and Billroth. And apart from any practical +use to be derived from the older medical authors, is there not a true +pleasure in reading the accounts of great discoverers in their own +words? I do not pretend to hoist up the Bibliotheca Anatomica of +Mangetus and spread it on my table every day. I do not get out my great +Albinus before every lecture on the muscles, nor disturb the majestic +repose of Vesalius every time I speak of the bones he has so admirably +described and figured. But it does please me to read the first +descriptions of parts to which the names of their discoverers or those +who have first described them have become so joined that not even modern +science can part them; to listen to the talk of my old volume as Willis +describes his circle and Fallopius his aqueduct and Varolius his bridge +and Eustachius his tube and Monro his foramen,--all so well known to +us in the human body; it does please me to know the very words in which +Winslow described the opening which bears his name, and Glisson his +capsule and De Graaf his vesicle; I am not content until I know in what +language Harvey announced his discovery of the circulation, and how +Spigelius made the liver his perpetual memorial, and Malpighi found a +monument more enduring than brass in the corpuscles of the spleen and +the kidney. + +But after all, the readers who care most for the early records of +medical science and art are the specialists who are dividing up the +practice of medicine and surgery as they were parcelled out, according +to Herodotus, by the Egyptians. For them nothing is too old, nothing is +too new, for to their books of all others is applicable the saying of +D'Alembert that the author kills himself in lengthening out what the +reader kills himself in trying to shorten. + +There are practical books among these ancient volumes which can never +grow old. Would you know how to recognize “male hysteria” and to +treat it, take down your Sydenham; would you read the experience of +a physician who was himself the subject of asthma, and who, +notwithstanding that, in the words of Dr. Johnson, “panted on till +ninety,” you will find it in the venerable treatise of Sir John Floyer; +would you listen to the story of the King's Evil cured by the royal +touch, as told by a famous chirurgeon who fully believed in it, go +to Wiseman; would you get at first hand the description of the spinal +disease which long bore his name, do not be startled if I tell you to go +to Pott,--to Percival Pott, the great surgeon of the last century. + +There comes a time for every book in a library when it is wanted +by somebody. It is but a few weeks since one of the most celebrated +physicians in the country wrote to me from a great centre of medical +education to know if I had the works of Sanctorius, which he had tried +in vain to find. I could have lent him the “Medicina Statica,” with its +frontispiece showing Sanctorius with his dinner on the table before +him, in his balanced chair which sunk with him below the level of his +banquet-board when he had swallowed a certain number of ounces,--an +early foreshadowing of Pettenkofer's chamber and quantitative +physiology,--but the “Opera Omnia” of Sanctorius I had never met with, +and I fear he had to do without it. + +I would extend the hospitality of these shelves to a class of works +which we are in the habit of considering as being outside of the pale +of medical science, properly so called, and sometimes of coupling with +a disrespectful name. Such has always been my own practice. I have +welcomed Culpeper and Salmon to my bookcase as willingly as Dioscorides +or Quincy, or Paris or Wood and Bache. I have found a place for St. +John Long, and read the story of his trial for manslaughter with as +much interest as the laurel-water case in which John Hunter figured as +a witness. I would give Samuel Hahnemann a place by the side of Samuel +Thomson. Am I not afraid that some student of imaginative turn and +not provided with the needful cerebral strainers without which all the +refuse of gimcrack intelligences gets into the mental drains and chokes +them up,--am I not afraid that some such student will get hold of +the “Organon” or the “Maladies Chroniques” and be won over by their +delusions, and so be lost to those that love him as a man of common +sense and a brother in their high calling? Not in the least. If he +showed any symptoms of infection I would for once have recourse to +the principle of similia similibus. To cure him of Hahnemann I would +prescribe my favorite homoeopathic antidote, Okie's Bonninghausen. +If that failed, I would order Grauvogl as a heroic remedy, and if he +survived that uncured, I would give him my blessing, if I thought +him honest, and bid him depart in peace. For me he is no longer an +individual. He belongs to a class of minds which we are bound to be +patient with if their Maker sees fit to indulge them with existence. We +must accept the conjuring ultra-ritualist, the dreamy second adventist, +the erratic spiritualist, the fantastic homoeopathist, as not unworthy +of philosophic study; not more unworthy of it than the squarers of the +circle and the inventors of perpetual motion, and the other whimsical +visionaries to whom De Morgan has devoted his most instructive and +entertaining “Budget of Paradoxes.” I hope, therefore, that our library +will admit the works of the so-called Eclectics, of the Thomsonians, if +any are in existence, of the Clairvoyants, if they have a literature, +and especially of the Homoeopathists. This country seems to be the place +for such a collection, which will by and by be curious and of more value +than at present, for Homoeopathy seems to be following the pathological +law of erysipelas, fading out where it originated as it spreads to new +regions. At least I judge so by the following translated extract from +a criticism of an American work in the “Homoeopatische Rundschau” of +Leipzig for October, 1878, which I find in the “Homoeopathic Bulletin” + for the month of November just passed: “While we feel proud of +the spread and rise of Homoeopathy across the ocean, and while the +Homoeopathic works reaching us from there, and published in a style +such as is unknown in Germany, bear eloquent testimony to the eminent +activity of our transatlantic colleagues, we are overcome by sorrowful +regrets at the position Homoeopathy occupies in Germany. Such a work [as +the American one referred to] with us would be impossible; it would lack +the necessary support.” + +By all means let our library secure a good representation of the +literature of Homoeopathy before it leaves us its “sorrowful regrets” + and migrates with its sugar of milk pellets, which have taken the place +of the old pilulae micae panis, to Alaska, to “Nova Zembla, or the Lord +knows where.” + +What shall I say in this presence of the duties of a Librarian? Where +have they ever been better performed than in our own public city +library, where the late Mr. Jewett and the living Mr. Winsor have shown +us what a librarian ought to be,--the organizing head, the vigilant +guardian, the seeker's index, the scholar's counsellor? His work is not +merely that of administration, manifold and laborious as its duties are. +He must have a quick intelligence and a retentive memory. He is a +public carrier of knowledge in its germs. His office is like that which +naturalists attribute to the bumble-bee,--he lays up little honey for +himself, but he conveys the fertilizing pollen from flower to flower. + +Our undertaking, just completed,--and just begun--has come at the right +time, not a day too soon. Our practitioners need a library like this, +for with all their skill and devotion there is too little genuine +erudition, such as a liberal profession ought to be able to claim for +many of its members. In reading the recent obituary notices of the late +Dr. Geddings of South Carolina, I recalled what our lamented friend Dr. +Coale used to tell me of his learning and accomplishments, and I could +not help reflecting how few such medical scholars we had to show in +Boston or New England. We must clear up this unilluminated atmosphere, +and here,--here is the true electric light which will irradiate its +darkness. + +The public will catch the rays reflected from the same source of +light, and it needs instruction on the great subjects of health and +disease,--needs it sadly. It is preyed upon by every kind of imposition +almost without hindrance. Its ignorance and prejudices react upon +the profession to the great injury of both. The jealous feeling, for +instance, with regard to such provisions for the study of anatomy as are +sanctioned by the laws in this State and carried out with strict +regard to those laws, threatens the welfare, if not the existence of +institutions for medical instruction wherever it is not held in check by +enlightened intelligence. And on the other hand the profession has +just been startled by a verdict against a physician, ruinous in its +amount,--enough to drive many a hard-working young practitioner out +of house and home,--a verdict which leads to the fear that suits for +malpractice may take the place of the panel game and child-stealing as a +means of extorting money. If the profession in this State, which claims +a high standard of civilization, is to be crushed and ground beneath the +upper millstone of the dearth of educational advantages and the lower +millstone of ruinous penalties for what the ignorant ignorantly shall +decide to be ignorance, all I can say is + + + God save the Commonhealth of Massachusetts! + +Once more, we cannot fail to see that just as astrology has given place +to astronomy, so theology, the science of Him whom by searching no man +can find out, is fast being replaced by what we may not improperly call +theonomy, or the science of the laws according to which the Creator +acts. And since these laws find their fullest manifestations for us, at +least, in rational human natures, the study of anthropology is largely +replacing that of scholastic divinity. We must contemplate our Maker +indirectly in human attributes as we talk of Him in human parts of +speech. And this gives a sacredness to the study of man in his physical, +mental, moral, social, and religious nature which elevates the faithful +students of anthropology to the dignity of a priesthood, and sheds a +holy light on the recorded results of their labors, brought together as +they are in such a collection as this which is now spread out before us. + +Thus, then, our library is a temple as truly as the dome-crowned +cathedral hallowed by the breath of prayer and praise, where the dead +repose and the living worship. May it, with all its treasures, be +consecrated like that to the glory of God, through the contributions it +shall make to the advancement of sound knowledge, to the relief of human +suffering, to the promotion of harmonious relations between the members +of the two noble professions which deal with the diseases of the soul +and with those of the body, and to the common cause in which all +good men are working, the furtherance of the well-being of their +fellow-creatures! + +NOTE.--As an illustration of the statement in the last paragraph but +one, I take the following notice from the “Boston Daily Advertiser,” of +December 4th, the day after the delivery of the address: “Prince Lucien +Bonaparte is now living in London, and is devoting himself to the work +of collecting the creeds of all religions and sects, with a view +to their classification,--his object being simply scientific or +anthropological.” + +Since delivering the address, also, I find a leading article in the +“Cincinnati Lancet and Clinic” of November 30th, headed “The +Decadence of Homoeopathy,” abundantly illustrated by extracts from the +“Homoeopathic Times,” the leading American organ of that sect. + +In the New York “Medical Record” of the same date, which I had not seen +before the delivery of my address, is an account of the action of the +Homoeopathic Medical Society of Northern New York, in which Hahnemann's +theory of “dynamization” is characterized in a formal resolve as +“unworthy the confidence of the Homoeopathic profession.” + +It will be a disappointment to the German Homoeopathists to read in the +“Homoeopathic Times” such a statement as the following: “Whatever the +influences have been which have checked the outward development of +Homoeopathy, it is plainly evident that the Homoeopathic school, as +regards the number of its openly avowed representatives, has attained +its majority, and has begun to decline both in this country and in +England.” + +All which is an additional reason for making a collection of the +incredibly curious literature of Homoeopathy before that pseudological +inanity has faded out like so many other delusions. + + + + + + +SOME OF MY EARLY TEACHERS + +[A Farewell Address to the Medical School of Harvard University, +November 28, 1882.] + +I had intended that the recitation of Friday last should be followed by +a few parting words to my class and any friends who might happen to be +in the lecture-room. But I learned on the preceding evening that there +was an expectation, a desire, that my farewell should take a somewhat +different form; and not to disappoint the wishes of those whom I was +anxious to gratify, I made up my mind to appear before you with such +hasty preparation as the scanty time admitted. + +There are three occasions upon which a human being has a right to +consider himself as a centre of interest to those about him: when he is +christened, when he is married, and when he is buried. Every one is the +chief personage, the hero, of his own baptism, his own wedding, and his +own funeral. + +There are other occasions, less momentous, in which one may make more +of himself than under ordinary circumstances he would think it proper +to do; when he may talk about himself, and tell his own experiences, +in fact, indulge in a more or less egotistic monologue without fear or +reproach. + +I think I may claim that this is one of those occasions. I have +delivered my last anatomical lecture and heard my class recite for the +last time. They wish to hear from me again in a less scholastic mood +than that in which they have known me. Will you not indulge me in +telling you something of my own story? + +This is the thirty-sixth Course of Lectures in which I have taken my +place and performed my duties as Professor of Anatomy. For more than +half of my term of office I gave instruction in Physiology, after the +fashion of my predecessors and in the manner then generally prevalent in +our schools, where the physiological laboratory was not a necessary part +of the apparatus of instruction. It was with my hearty approval that the +teaching of Physiology was constituted a separate department and made +an independent Professorship. Before my time, Dr. Warren had taught +Anatomy, Physiology, and Surgery in the same course of Lectures, lasting +only three or four months. As the boundaries of science are enlarged, +new divisions and subdivisions of its territories become necessary. In +the place of six Professors in 1847, when I first became a member of +the Faculty, I count twelve upon the Catalogue before me, and I find the +whole number engaged in the work of instruction in the Medical School +amounts to no less than fifty. + +Since I began teaching in this school, the aspect of many branches of +science has undergone a very remarkable transformation. Chemistry and +Physiology are no longer what they were, as taught by the instructors +of that time. We are looking forward to the synthesis of new organic +compounds; our artificial madder is already in the market, and the +indigo-raisers are now fearing that their crop will be supplanted by the +manufactured article. In the living body we talk of fuel supplied and +work done, in movement, in heat, just as if we were dealing with a +machine of our own contrivance. + +A physiological laboratory of to-day is equipped with instruments of +research of such ingenious contrivance, such elaborate construction, +that one might suppose himself in a workshop where some exquisite fabric +was to be wrought, such as Queens love to wear, and Kings do not always +love to pay for. They are, indeed, weaving a charmed web, for these are +the looms from which comes the knowledge that clothes the nakedness of +the intellect. Here are the mills that grind food for its hunger, and +“is not the life more than meat, and the body than raiment?” + +But while many of the sciences have so changed that the teachers of the +past would hardly know them, it has not been so with the branch I teach, +or, rather, with that division of it which is chiefly taught in this +amphitheatre. General anatomy, or histology, on the other hand, is +almost all new; it has grown up, mainly, since I began my medical +studies. I never saw a compound microscope during my years of study in +Paris. Individuals had begun to use the instrument, but I never heard +it alluded to by either Professors or students. In descriptive anatomy I +have found little to unlearn, and not a great deal that was both new and +important to learn. Trifling additions are made from year to year, not +to be despised and not to be overvalued. Some of the older anatomical +works are still admirable, some of the newer ones very much the +contrary. I have had recent anatomical plates brought me for inspection, +and I have actually button-holed the book-agent, a being commonly as +hard to get rid of as the tar-baby in the negro legend, that I might put +him to shame with the imperial illustrations of the bones and muscles +in the great folio of Albinus, published in 1747, and the unapproached +figures of the lymphatic system of Mascagni, now within a very few years +of a century old, and still copied, or, rather, pretended to be copied, +in the most recent works on anatomy. + +I am afraid that it is a good plan to get rid of old Professors, and I +am thankful to hear that there is a movement for making provision +for those who are left in need when they lose their offices and their +salaries. I remember one of our ancient Cambridge Doctors once asked me +to get into his rickety chaise, and said to me, half humorously, half +sadly, that he was like an old horse,--they had taken off his saddle and +turned him out to pasture. I fear the grass was pretty short where that +old servant of the public found himself grazing. If I myself needed an +apology for holding my office so long, I should find it in the fact that +human anatomy is much the same study that it was in the days of Vesalius +and Fallopius, and that the greater part of my teaching was of such a +nature that it could never become antiquated. + +Let me begin with my first experience as a medical student. I had come +from the lessons of Judge Story and Mr. Ashmun in the Law School at +Cambridge. I had been busy, more or less, with the pages of Blackstone +and Chitty, and other text-books of the first year of legal study. More +or less, I say, but I am afraid it was less rather than more. For during +that year I first tasted the intoxicating pleasure of authorship. A +college periodical, conducted by friends of mine, still undergraduates, +tempted me into print, and there is no form of lead-poisoning which more +rapidly and thoroughly pervades the blood and bones and marrow than that +which reaches the young author through mental contact with type-metal. +Qui a bu, boira,--he who has once been a drinker will drink again, says +the French proverb. So the man or woman who has tasted type is sure to +return to his old indulgence sooner or later. In that fatal year I had +my first attack of authors' lead-poisoning, and I have never got quite +rid of it from that day to this. But for that I might have applied +myself more diligently to my legal studies, and carried a green bag in +place of a stethoscope and a thermometer up to the present day. + +What determined me to give up Law and apply myself to Medicine I can +hardly say, but I had from the first looked upon that year's study as +an experiment. At any rate, I made the change, and soon found myself +introduced to new scenes and new companionships. + +I can scarcely credit my memory when I recall the first impressions +produced upon me by sights afterwards become so familiar that they +could no more disturb a pulse-beat than the commonest of every-day +experiences. The skeleton, hung aloft like a gibbeted criminal, looked +grimly at me as I entered the room devoted to the students of the school +I had joined, just as the fleshless figure of Time, with the hour-glass +and scythe, used to glare upon me in my childhood from the “New England +Primer.” The white faces in the beds at the Hospital found their +reflection in my own cheeks, which lost their color as I looked upon +them. All this had to pass away in a little time; I had chosen my +profession, and must meet its painful and repulsive aspects until they +lost their power over my sensibilities. + +The private medical school which I had joined was one established by Dr. +James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow Lewis, +and Dr. George W. Otis. Of the first three gentlemen I have either +spoken elsewhere or may find occasion to speak hereafter. The two +younger members of this association of teachers were both graduates of +our University, one of the year 1819, the other of 1818. + +Dr. Lewis was a great favorite with students. He was a man of very +lively temperament, fond of old books and young people, open-hearted, +free-spoken, an enthusiast in teaching, and especially at home in that +apartment of the temple of science where nature is seen in undress, the +anthropotomic laboratory, known to common speech as the dissecting-room. +He had that quality which is the special gift of the man born for a +teacher,--the power of exciting an interest in that which he taught. +While he was present the apartment I speak of was the sunniest of +studios in spite of its mortuary spectacles. Of the students I met there +I best remember James Jackson, Junior, full of zeal and playful as a +boy, a young man whose early death was a calamity to the profession of +which he promised to be a chief ornament; the late Reverend J. S. C. +Greene, who, as the prefix to his name signifies, afterwards changed his +profession, but one of whose dissections I remember looking upon with +admiration; and my friend Mr. Charles Amory, as we call him, Dr. Charles +Amory, as he is entitled to be called, then, as now and always, a +favorite with all about him. He had come to us from the schools +of Germany, and brought with him recollections of the teachings of +Blumenbach and the elder Langenbeck, father of him whose portrait hangs +in our Museum. Dr. Lewis was our companion as well as our teacher. A +good demonstrator is,--I will not say as important as a good Professor +in the teaching of Anatomy, because I am not sure that he is not +more important. He comes into direct personal relations with the +students,--he is one of them, in fact, as the Professor cannot be from +the nature of his duties. The Professor's chair is an insulating stool, +so to speak; his age, his knowledge, real or supposed, his official +station, are like the glass legs which support the electrician's piece +of furniture, and cut it off from the common currents of the floor upon +which it stands. Dr. Lewis enjoyed teaching and made his students enjoy +being taught. He delighted in those anatomical conundrums to answer +which keeps the student's eyes open and his wits awake. He was happy as +he dexterously performed the tour de maitre of the old barber-surgeons, +or applied the spica bandage and taught his scholars to do it, so neatly +and symmetrically that the aesthetic missionary from the older centre of +civilization would bend over it in blissful contemplation, as if it were +a sunflower. Dr. Lewis had many other tastes, and was a favorite, not +only with students, but in a wide circle, professional, antiquarian, +masonic, and social. + +Dr. Otis was less widely known, but was a fluent and agreeable lecturer, +and esteemed as a good surgeon. + +I must content myself with this glimpse at myself and a few of my +fellow-students in Boston. After attending two courses of Lectures in +the school of the University, I went to Europe to continue my studies. + +You may like to hear something of the famous Professors of Paris in the +days when I was a student in the Ecole de Medicine, and following the +great Hospital teachers. + +I can hardly believe my own memory when I recall the old practitioners +and Professors who were still going round the hospitals when I mingled +with the train of students that attended the morning visits. See that +bent old man who is groping his way through the wards of La Charity. +That is the famous Baron Boyer, author of the great work on surgery in +nine volumes, a writer whose clearness of style commends his treatise to +general admiration, and makes it a kind of classic. He slashes away at a +terrible rate, they say, when he gets hold of the subject of fistula in +its most frequent habitat,--but I never saw him do more than look as if +he wanted to cut a good dollop out of a patient he was examining. The +short, square, substantial man with iron-gray hair, ruddy face, and +white apron is Baron Larrey, Napoleon's favorite surgeon, the most +honest man he ever saw,--it is reputed that he called him. To go round +the Hotel des Invalides with Larrey was to live over the campaigns +of Napoleon, to look on the sun of Austerlitz, to hear the cannons of +Marengo, to struggle through the icy waters of the Beresina, to shiver +in the snows of the Russian retreat, and to gaze through the battle +smoke upon the last charge of the red lancers on the redder field of +Waterloo. Larrey was still strong and sturdy as I saw him, and few +portraits remain printed in livelier colors on the tablet of my memory. + +Leave the little group of students which gathers about Larrey beneath +the gilded dome of the Invalides and follow me to the Hotel Dieu, where +rules and reigns the master-surgeon of his day, at least so far as +Paris and France are concerned,--the illustrious Baron Dupuytren. No +man disputed his reign, some envied his supremacy. Lisfranc shrugged his +shoulders as he spoke of “ce grand homme de l'autre cote de la riviere,” + that great man on the other side of the river, but the great man he +remained, until he bowed before the mandate which none may disobey. +“Three times,” said Bouillaud, “did the apoplectic thunderbolt fall on +that robust brain,”--it yielded at last as the old bald cliff that +is riven and crashes down into the valley. I saw him before the +first thunderbolt had descended: a square, solid man, with a high and +full-domed head, oracular in his utterances, indifferent to those around +him, sometimes, it was said, very rough with them. He spoke in low, even +tones, with quiet fluency, and was listened to with that hush of rapt +attention which I have hardly seen in any circle of listeners unless +when such men as ex-President John Quincy Adams or Daniel Webster were +the speakers. I do not think that Dupuytren has left a record which +explains his influence, but in point of fact he dominated those around +him in a remarkable manner. You must have all witnessed something of the +same kind. The personal presence of some men carries command with it, +and their accents silence the crowd around them, when the same words +from other lips might fall comparatively unheeded. + +As for Lisfranc, I can say little more of him than that he was a +great drawer of blood and hewer of members. I remember his ordering a +wholesale bleeding of his patients, right and left, whatever might be +the matter with them, one morning when a phlebotomizing fit was on +him. I recollect his regretting the splendid guardsmen of the old +Empire,--for what? because they had such magnificent thighs to amputate. +I got along about as far as that with him, when I ceased to be a +follower of M. Lisfranc. + +The name of Velpeau must have reached many of you, for he died in 1867, +and his many works made his name widely known. Coming to Paris in wooden +shoes, starving, almost, at first, he raised himself to great eminence +as a surgeon and as an author, and at last obtained the Professorship +to which his talents and learning entitled him. His example may be an +encouragement to some of my younger hearers who are born, not with the +silver spoon in their mouths, but with the two-tined iron fork in their +hands. It is a poor thing to take up their milk porridge with in +their young days, but in after years it will often transfix the solid +dumplings that roll out of the silver spoon. So Velpeau found it. He +had not what is called genius, he was far from prepossessing in aspect, +looking as if he might have wielded the sledge-hammer (as I think he +had done in early life) rather than the lancet, but he had industry, +determination, intelligence, character, and he made his way to +distinction and prosperity, as some of you sitting on these benches and +wondering anxiously what is to become of you in the struggle for life +will have done before the twentieth century has got halfway through its +first quarter. A good sound head over a pair of wooden shoes is a great +deal better than a wooden head belonging to an owner who cases his feet +in calf-skin, but a good brain is not enough without a stout heart to +fill the four great conduits which carry at once fuel and fire to that +mightiest of engines. + +How many of you who are before me are familiarly acquainted with the +name of Broussais, or even with that of Andral? Both were lecturing at +the Ecole de Medicine, and I often heard them. Broussais was in those +days like an old volcano, which has pretty nearly used up its fire and +brimstone, but is still boiling and bubbling in its interior, and now +and then sends up a spirt of lava and a volley of pebbles. His theories +of gastro-enteritis, of irritation and inflammation as the cause of +disease, and the practice which sprang from them, ran over the fields of +medicine for a time like flame over the grass of the prairies. The way +in which that knotty-featured, savage old man would bring out the word +irritation--with rattling and rolling reduplication of the resonant +letter r--might have taught a lesson in articulation to Salvini. But +Broussais's theory was languishing and well-nigh become obsolete, and +this, no doubt, added vehemence to his defence of his cherished dogmas. + +Old theories, and old men who cling to them, must take themselves out of +the way as the new generation with its fresh thoughts and altered habits +of mind comes forward to take the place of that which is dying out. This +was a truth which the fiery old theorist found it very hard to learn, +and harder to bear, as it was forced upon him. For the hour of his +lecture was succeeded by that of a younger and far more popular +professor. As his lecture drew towards its close, the benches, thinly +sprinkled with students, began to fill up; the doors creaked open and +banged back oftener and oftener, until at last the sound grew almost +continuous, and the voice of the lecturer became a leonine growl as he +strove in vain to be heard over the noise of doors and footsteps. + +Broussais was now sixty-two years old. The new generation had outgrown +his doctrines, and the Professor for whose hour the benches had filled +themselves belonged to that new generation. Gabriel Andral was little +more than half the age of Broussais, in the full prime and vigor of +manhood at thirty-seven years. He was a rapid, fluent, fervid, and +imaginative speaker, pleasing in aspect and manner,--a strong contrast +to the harsh, vituperative old man who had just preceded him. His +Clinique Medicale is still valuable as a collection of cases, and +his researches on the blood, conducted in association with Gavarret, +contributed new and valuable facts to science. But I remember him +chiefly as one of those instructors whose natural eloquence made it +delightful to listen to him. I doubt if I or my fellow-students did full +justice either to him or to the famous physician of Hotel Dieu, Chomel. +We had addicted ourselves almost too closely to the words of another +master, by whom we were ready to swear as against all teachers that ever +were or ever would be. + +This object of our reverence, I might almost say idolatry, was one whose +name is well known to most of the young men before me, even to those who +may know comparatively little of his works and teachings. Pierre Charles +Alexandre Louis, at the age of forty-seven, as I recall him, was a tall, +rather spare, dignified personage, of serene and grave aspect, but with +a pleasant smile and kindly voice for the student with whom he came +into personal relations. If I summed up the lessons of Louis in two +expressions, they would be these; I do not hold him answerable for the +words, but I will condense them after my own fashion in French, and then +give them to you, expanded somewhat, in English: + + + Formez toujours des idees nettes. + Fuyez toujours les a peu pres. + +Always make sure that you form a distinct and clear idea of the matter +you are considering. + +Always avoid vague approximations where exact estimates are possible; +about so many,--about so much, instead of the precise number and +quantity. + +Now, if there is anything on which the biological sciences have prided +themselves in these latter years it is the substitution of quantitative +for qualitative formulae. The “numerical system,” of which Louis was +the great advocate, if not the absolute originator, was an attempt +to substitute series of carefully recorded facts, rigidly counted and +closely compared, for those never-ending records of vague, unverifiable +conclusions with which the classics of the healing art were overloaded. +The history of practical medicine had been like the story of the +Danaides. “Experience” had been, from time immemorial, pouring its +flowing treasures into buckets full of holes. At the existing rate of +supply and leakage they would never be filled; nothing would ever be +settled in medicine. But cases thoroughly recorded and mathematically +analyzed would always be available for future use, and when accumulated +in sufficient number would lead to results which would be trustworthy, +and belong to science. + +You young men who are following the hospitals hardly know how much you +are indebted to Louis. I say nothing of his Researches on Phthisis or +his great work on Typhoid Fever. But I consider his modest and brief +Essay on Bleeding in some Inflammatory Diseases, based on cases +carefully observed and numerically analyzed, one of the most important +written contributions to practical medicine, to the treatment of +internal disease, of this century, if not since the days of Sydenham. +The lancet was the magician's wand of the dark ages of medicine. The old +physicians not only believed in its general efficacy as a wonder-worker +in disease, but they believed that each malady could be successfully +attacked from some special part of the body,--the strategic point which +commanded the seat of the morbid affection. On a figure given in the +curious old work of John de Ketam, no less than thirty-eight separate +places are marked as the proper ones to bleed from, in different +diseases. Even Louis, who had not wholly given up venesection, used now +and then to order that a patient suffering from headache should be bled +in the foot, in preference to any other part. + +But what Louis did was this: he showed by a strict analysis of numerous +cases that bleeding did not strangle,--jugulate was the word then +used,--acute diseases, more especially pneumonia. This was not a +reform,--it was a revolution. It was followed up in this country by the +remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited Diseases, +which has, I believe, done more than any other work or essay in our +own language to rescue the practice of medicine from the slavery to the +drugging system which was a part of the inheritance of the profession. + +Yes, I say, as I look back on the long hours of the many days I spent +in the wards and in the autopsy room of La Pitie, where Louis was one +of the attending physicians,--yes, Louis did a great work for practical +medicine. Modest in the presence of nature, fearless in the face of +authority, unwearying in the pursuit of truth, he was a man whom any +student might be happy and proud to claim as his teacher and his friend, +and yet, as I look back on the days when I followed his teachings, I +feel that I gave myself up too exclusively to his methods of thought and +study. + +There is one part of their business which certain medical practitioners +are too apt to forget; namely, that what they should most of all try to +do is to ward off disease, to alleviate suffering, to preserve life, or +at least to prolong it if possible. It is not of the slightest interest +to the patient to know whether three or three and a quarter cubic inches +of his lung are hepatized. His mind is not occupied with thinking of +the curious problems which are to be solved by his own autopsy,--whether +this or that strand of the spinal marrow is the seat of this or that +form of degeneration. He wants something to relieve his pain, to +mitigate the anguish of dyspnea, to bring back motion and sensibility +to the dead limb, to still the tortures of neuralgia. What is it to him +that you can localize and name by some uncouth term the disease which +you could not prevent and which you cannot cure? An old woman who knows +how to make a poultice and how to put it on, and does it tuto, eito, +jucunde, just when and where it is wanted, is better,--a thousand times +better in many cases,--than a staring pathologist, who explores and +thumps and doubts and guesses, and tells his patient he will be better +tomorrow, and so goes home to tumble his books over and make out a +diagnosis. + +But in those days, I, like most of my fellow students, was thinking much +more of “science” than of practical medicine, and I believe if we had +not clung so closely to the skirts of Louis and had followed some of +the courses of men like Trousseau,--therapeutists, who gave special +attention to curative methods, and not chiefly to diagnosis,--it would +have been better for me and others. One thing, at any rate, we did +learn in the wards of Louis. We learned that a very large proportion of +diseases get well of themselves, without any special medication,--the +great fact formulated, enforced, and popularized by Dr. Jacob Bigelow +in the Discourse referred to. We unlearned the habit of drugging for its +own sake. This detestable practice, which I was almost proscribed for +condemning somewhat too epigrammatically a little more than twenty years +ago, came to us, I suspect, in a considerable measure from the English +“general practitioners,” a sort of prescribing apothecaries. You +remember how, when the city was besieged, each artisan who was called +upon in council to suggest the best means of defence recommended the +articles he dealt in: the carpenter, wood; the blacksmith, iron; the +mason, brick; until it came to be a puzzle to know which to adopt. Then +the shoemaker said, “Hang your walls with new boots,” and gave good +reasons why these should be the best of all possible defences. Now the +“general practitioner” charged, as I understand, for his medicine, +and in that way got paid for his visit. Wherever this is the practice, +medicine is sure to become a trade, and the people learn to expect +drugging, and to consider it necessary, because drugs are so universally +given to the patients of the man who gets his living by them. + +It was something to have unlearned the pernicious habit of constantly +giving poisons to a patient, as if they were good in themselves, of +drawing off the blood which he would want in his struggle with disease, +of making him sore and wretched with needless blisters, of turning his +stomach with unnecessary nauseous draught and mixtures,--only because he +was sick and something must be done. But there were positive as well as +negative facts to be learned, and some of us, I fear, came home rich +in the negatives of the expectant practice, poor in the resources which +many a plain country practitioner had ready in abundance for the relief +and the cure of disease. No one instructor can be expected to do all for +a student which he requires. Louis taught us who followed him the love +of truth, the habit of passionless listening to the teachings of nature, +the most careful and searching methods of observation, and the sure +means of getting at the results to be obtained from them in the constant +employment of accurate tabulation. He was not a showy, or eloquent, or, +I should say, a very generally popular man, though the favorite, almost +the idol, of many students, especially Genevese and Bostonians. But he +was a man of lofty and admirable scientific character, and his work will +endure in its influences long after his name is lost sight of save to +the faded eyes of the student of medical literature. + +Many other names of men more or less famous in their day, and who were +teaching while I was in Paris, come up before me. They are but empty +sounds for the most part in the ears of persons of not more than middle +age. Who of you knows anything of Richerand, author of a very popular +work on Physiology, commonly put into the student's hands when I first +began to ask for medical text-books? I heard him lecture once, and have +had his image with me ever since as that of an old, worn-out man,--a +venerable but dilapidated relic of an effete antiquity. To verify this +impression I have just looked out the dates of his birth and death, +and find that he was eighteen years younger than the speaker who is now +addressing you. There is a terrible parallax between the period before +thirty and that after threescore and ten, as two men of those ages look, +one with naked eyes, one through his spectacles, at the man of fifty and +thereabout. Magendie, I doubt not you have all heard of. I attended but +one of his lectures. I question if one here, unless some contemporary +of my own has strayed into the amphitheatre,--knows anything about +Marjolin. I remember two things about his lectures on surgery, the deep +tones of his voice as he referred to his oracle,--the earlier writer, +Jean Louis Petit,--and his formidable snuffbox. What he taught me lies +far down, I doubt not, among the roots of my knowledge, but it does +not flower out in any noticeable blossoms, or offer me any very obvious +fruits. Where now is the fame of Bouillaud, Professor and Deputy, the +Sangrado of his time? Where is the renown of Piorry, percussionist and +poet, expert alike in the resonances of the thoracic cavity and those +of the rhyming vocabulary?--I think life has not yet done with the +vivacious Ricord, whom I remember calling the Voltaire of pelvic +literature,--a sceptic as to the morality of the race in general, who +would have submitted Diana to treatment with his mineral specifics, and +ordered a course of blue pills for the vestal virgins. + +Ricord was born at the beginning of the century, and Piorry some years +earlier. Cruveilhier, who died in 1874, is still remembered by his great +work on pathological anatomy; his work on descriptive anatomy has some +things which I look in vain for elsewhere. But where is Civiale,--where +are Orfila, Gendrin, Rostan, Biett, Alibert,--jolly old Baron Alibert, +whom I remember so well in his broad-brimmed hat, worn a little jauntily +on one side, calling out to the students in the court-yard of the +Hospital St. Louis, “Enfans de la methode naturelle, etes-vous tous +ici?” “Children of the natural method [his own method of classification +of skin diseases,] are you all here?” All here, then, perhaps; all +where, now? + +My show of ghosts is over. It is always the same story that old men tell +to younger ones, some few of whom will in their turn repeat the tale, +only with altered names, to their children's children. + + + Like phantoms painted on the magic slide, + Forth from the darkness of the past we glide, + As living shadows for a moment seen + In airy pageant on the eternal screen, + Traced by a ray from one unchanging flame, + Then seek the dust and stillness whence we came. + +Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, +where he had written his Latin graduating thesis, talking of the learned +Gaubius and the late illustrious Boerhaave and other dead Dutchmen, of +whom you know as much, most of you, as you do of Noah's apothecary and +the family physician of Methuselah, whose prescriptions seem to have +been lost to posterity. Dr. Lloyd came back to Boston full of the +teachings of Cheselden and Sharpe, William Hunter, Smellie, and Warner; +Dr. James Jackson loved to tell of Mr. Cline and to talk of Mr. John +Hunter; Dr. Reynolds would give you his recollections of Sir Astley +Cooper and Mr. Abernethy; I have named the famous Frenchmen of my +student days; Leyden, Edinburgh, London, Paris, were each in turn the +Mecca of medical students, just as at the present day Vienna and Berlin +are the centres where our young men crowd for instruction. These also +must sooner or later yield their precedence and pass the torch they +hold to other hands. Where shall it next flame at the head of the long +procession? Shall it find its old place on the shores of the Gulf of +Salerno, or shall it mingle its rays with the northern aurora up among +the fiords of Norway,--or shall it be borne across the Atlantic and +reach the banks of the Charles, where Agassiz and Wyman have taught, +where Hagen still teaches, glowing like his own Lampyris splendidula, +with enthusiasm, where the first of American botanists and the ablest +of American surgeons are still counted in the roll of honor of our great +University? + +Let me add a few words which shall not be other than cheerful, as I bid +farewell to this edifice which I have known so long. I am grateful to +the roof which has sheltered me, to the floors which have sustained me, +though I have thought it safest always to abstain from anything like +eloquence, lest a burst of too emphatic applause might land my class +and myself in the cellar of the collapsing structure, and bury us in the +fate of Korah, Dathan, and Abiram. I have helped to wear these stairs +into hollows,--stairs which I trod when they were smooth and level, +fresh from the plane. There are just thirty-two of them, as there were +five and thirty years ago, but they are steeper and harder to climb, it +seems to me, than they were then. I remember that in the early youth of +this building, the late Dr. John K. Mitchell, father of our famous Dr. +Weir Mitchell, said to me as we came out of the Demonstrator's room, +that some day or other a whole class would go heels over head down this +graded precipice, like the herd told of in Scripture story. This has +never happened as yet; I trust it never will. I have never been proud +of the apartment beneath the seats, in which my preparations for lecture +were made. But I chose it because I could have it to myself, and I +resign it, with a wish that it were more worthy of regret, into the +hands of my successor, with my parting benediction. Within its twilight +precincts I have often prayed for light, like Ajax, for the daylight +found scanty entrance, and the gaslight never illuminated its dark +recesses. May it prove to him who comes after me like the cave of the +Sibyl, out of the gloomy depths of which came the oracles which shone +with the rays of truth and wisdom! + +This temple of learning is not surrounded by the mansions of the +great and the wealthy. No stately avenues lead up to its facades +and porticoes. I have sometimes felt, when convoying a distinguished +stranger through its precincts to its door, that he might question +whether star-eyed Science had not missed her way when she found herself +in this not too attractive locality. I cannot regret that we--you, I +should say--are soon to migrate to a more favored region, and carry on +your work as teachers and as learners in ampler halls and under far more +favorable conditions. + +I hope that I may have the privilege of meeting you there, possibly may +be allowed to add my words of welcome to those of my former colleagues, +and in that pleasing anticipation I bid good-by to this scene of my long +labors, and, for the present at least, to the friends with whom I have +been associated. + + + + + + +APPENDUM + + + + +NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL +SCIENCE. + +Some passages contained in the original manuscript of the Address, and +omitted in the delivery on account of its length, are restored in the +text or incorporated with these Notes. + +NOTE A.-- + +There is good reason to doubt whether the nitrate of silver has any real +efficacy in epilepsy. It has seemed to cure many cases, but epilepsy +is a very uncertain disease, and there is hardly anything which has +not been supposed to cure it. Dr. Copland cites many authorities in its +favor, most especially Lombard's cases. But De la Berge and Monneret +(Comp. de Med. Paris), 1839, analyze these same cases, eleven in number, +and can only draw the inference of a very questionable value in the +supposed remedy. Dr. James Jackson says that relief of epilepsy is not +to be attained by any medicine with which he is acquainted, but by diet. +(Letters to a Young Physician, p. 67.) Guy Patin, Dean of the Faculty +of Paris, Professor at the Royal College, Author of the Antimonial +Martyrology, a wit and a man of sense and learning, who died almost two +hundred years ago, had come to the same conclusion, though the chemists +of his time boasted of their remedies. “Did, you ever see a case of +epilepsy cured by nitrate of silver?” I said to one of the oldest and +most experienced surgeons in this country. “Never,” was his instant +reply. Dr. Twitchell's experience was very similar. How, then, did +nitrate of silver come to be given for epilepsy? Because, as Dr. Martin +has so well reminded us, lunatics were considered formerly to be under +the special influence of Luna, the moon (which Esquirol, be it observed, +utterly denies), and lunar caustic, or nitrate of silver, is a salt of +that metal which was called luna from its whiteness, and of course +must be in the closest relations with the moon. It follows beyond all +reasonable question that the moon's metal, silver, and its preparations, +must be the specific remedy for moonblasted maniacs and epileptics! + +Yet the practitioner who prescribes the nitrate of silver supposes he +is guided by the solemn experience of the past, instead of by its idle +fancies. He laughs at those old physicians who placed such confidence +in the right hind hoof of an elk as a remedy for the same disease, and +leaves the record of his own belief in a treatment quite as fanciful and +far more objectionable, written in indelible ink upon a living tablet +where he who runs may read it for a whole generation, if nature spares +his walking advertisement so long. + +NOTE B.-- + +The presumption that a man is innocent until he is proved guilty, does +not mean that there are no rogues, but lays the onus probandi on the +party to which it properly belongs. So with this proposition. A noxious +agent should never be employed in sickness unless there is ample +evidence in the particular case to overcome the general presumption +against all such agents, and the evidence is very apt to be defective. + +The miserable delusion of Homoeopathy builds itself upon an axiom +directly the opposite of this; namely, that the sick are to be cured by +poisons. Similia similibus curantur means exactly this. It is simply +a theory of universal poisoning, nullified in practice by the +infinitesimal contrivance. The only way to kill it and all similar +fancies, and to throw every quack nostrum into discredit, is to root out +completely the suckers of the old rotten superstition that whatever is +odious or noxious is likely to be good for disease. The current of sound +practice with ourselves is, I believe, setting fast in the direction +I have indicated in the above proposition. To uphold the exhibition +of noxious agents in disease, as the rule, instead of admitting them +cautiously and reluctantly as the exception, is, as I think, an eddy of +opinion in the direction of the barbarism out of which we believe our +art is escaping. It is only through the enlightened sentiment and +action of the Medical Profession that the community can be brought to +acknowledge that drugs should always be regarded as evils. + +It is true that some suppose, and our scientific and thoughtful +associate, Dr. Gould, has half countenanced the opinion, that there may +yet be discovered a specific for every disease. Let us not despair of +the future, but let us be moderate in our expectations. When an oil is +discovered that will make a bad watch keep good time; when a recipe is +given which will turn an acephalous foetus into a promising child; when +a man can enter the second time into his mother's womb and give her back +the infirmities which twenty generations have stirred into her blood, +and infused into his own through hers, we may be prepared to enlarge the +National Pharmacopoeia with a list of specifies for everything but old +age,--and possibly for that also. + +NOTE C.-- + +The term specific is used here in its ordinary sense, without raising +the question of the propriety of its application to these or other +remedies. + +The credit of introducing Cinchona rests between the Jesuits, the +Countess of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, +who employed it as a secret remedy. (Pereira.) Mercury as an internal +specific remedy was brought into use by that impudent and presumptuous +quack, as he was considered, Paracelsus. (Encyc. Brit. art. +“Paracelsus.”) Arsenic was introduced into England as a remedy for +intermittents by Dr. Fowler, in consequence of the success of a patent +medicine, the Tasteless Ague Drops, which were supposed, “probably +with reason,” to be a preparation of that mineral. (Rees's Cyc. art. +“Arsenic.”) Colchicum came into notice in a similar way, from the +success of the Eau Medicinale of M. Husson, a French military officer. +(Pereira.) Iodine was discovered by a saltpetre manufacturer, but +applied by a physician in place of the old remedy, burnt sponge, which +seems to owe its efficacy to it. (Dunglison, New Remedies.) As for +Sulphur, “the common people have long used it as an ointment” for +scabies. (Rees's Cyc. art. “Scabies.”) The modern cantiscorbutic regimen +is credited to Captain Cook. “To his sagacity we are indebted for the +first impulse to those regulations by which scorbutus is so successfully +prevented in our navy.” (Lond. Cyc. Prac. Med. art. “Scorbutus.”) Iron +and various salts which enter into the normal composition of the human +body do not belong to the materia medica by our definition, but to the +materia alimentaria. + +For the first introduction of iron as a remedy, see Pereira, who gives a +very curious old story. + +The statement in the text concerning a portion of the materia medica +stands exactly as delivered, and is meant exactly as it stands. No +denunciation of drugs, as sparingly employed by a wise physician, was +or is intended. If, however, as Dr. Gould stated in his “valuable +and practical discourse” to which the Massachusetts Medical Society +“listened with profit as well as interest,” “Drugs, in themselves +considered, may always be regarded as evils,”--any one who chooses may +question whether the evils from their abuse are, on the whole, greater +or less than the undoubted benefits obtained from their proper use. The +large exception of opium, wine, specifics, and anaesthetics, made in the +text, takes off enough from the useful side, as I fully believe, to turn +the balance; so that a vessel containing none of these, but loaded with +antimony, strychnine, acetate of lead, aloes, aconite, lobelia, lapis +infernalis, stercus diaboli, tormentilla, and other approved, and, in +skilful hands, really useful remedies, brings, on the whole, more harm +than good to the port it enters. + +It is a very narrow and unjust view of the practice of medicine, to +suppose it to consist altogether in the use of powerful drugs, or of +drugs of any kind. Far from it. “The physician may do very much for the +welfare of the sick, more than others can do, although he does not, +even in the major part of cases, undertake to control and overcome +the disease by art. It was with these views that I never reported any +patient cured at our hospital. Those who recovered their health were +reported as well; not implying that they were made so by the active +treatment they had received there. But it was to be understood that all +patients received in that house were to be cured, that is, taken care +of.” (Letters to a Young Physician, by James Jackson, M. D., Boston, +1855.) + +“Hygienic rules, properly enforced, fresh air, change of air, travel, +attention to diet, good and appropriate food judiciously regulated, +together with the administration of our tonics, porter, ale, wine, iron, +etc., supply the diseased or impoverished system with what Mr. Gull, of +St. Bartholomew's Hospital, aptly calls the 'raw material of the blood;' +and we believe that if any real improvement has taken place in medical +practice, independently of those truly valuable contributions we have +before described, it is in the substitution of tonics, stimulants, and +general management, for drastic cathartics, for bleeding, depressing +agents, including mercury, tartar emetics, etc., so much in vogue during +the early part even of this century.” (F. P. Porcher, in Charleston Med. +Journal and Review for January, 1860.) + + + + + +End of Project Gutenberg's Medical Essays, by Oliver Wendell Holmes, Sr. + +*** END OF THIS PROJECT GUTENBERG EBOOK MEDICAL ESSAYS *** + +***** This file should be named 2700-0.txt or 2700-0.zip ***** This and all +associated files of various formats will be found in: https://www.gutenberg.org/2/7/0/2700/ + +Produced by David Widger + + +Updated editions will replace the previous one--the old editions will be +renamed. + +Creating the works from public domain print editions means that no one +owns a United States copyright in these works, so the Foundation (and +you!) can copy and distribute it in the United States without permission +and without paying copyright royalties. Special rules, set forth in +the General Terms of Use part of this license, apply to copying and +distributing Project Gutenberg-tm electronic works to protect the +PROJECT GUTENBERG-tm concept and trademark. 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