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diff --git a/2700-h/2700-h.htm b/2700-h/2700-h.htm new file mode 100644 index 0000000..7a35d7e --- /dev/null +++ b/2700-h/2700-h.htm @@ -0,0 +1,14259 @@ +<?xml version="1.0" encoding="utf-8"?> + +<!DOCTYPE html + PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" + "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd" > + +<html xmlns="http://www.w3.org/1999/xhtml" lang="en"> + <head> + <title> + Medical Essays, by Oliver Wendell Holmes + </title> + <style type="text/css" xml:space="preserve"> + + body { margin:5%; background:#faebd0; text-align:justify} + P { text-indent: 1em; margin-top: .25em; margin-bottom: .25em; } + H1,H2,H3,H4,H5,H6 { text-align: center; margin-left: 15%; margin-right: 15%; } + hr { width: 50%; text-align: center;} + .foot { margin-left: 20%; margin-right: 20%; text-align: justify; text-indent: -3em; font-size: 90%; } + blockquote {font-size: 97%; font-style: italic; margin-left: 10%; margin-right: 10%;} + .mynote {background-color: #DDE; color: #000; padding: .5em; margin-left: 10%; margin-right: 10%; font-family: sans-serif; font-size: 95%;} + .toc { margin-left: 10%; margin-bottom: .75em;} + .toc2 { margin-left: 20%;} + div.fig { display:block; margin:0 auto; text-align:center; } + .figleft {float: left; margin-left: 0%; margin-right: 1%;} + .figright {float: right; margin-right: 0%; margin-left: 1%;} + pre { font-style: italic; font-size: 90%; margin-left: 10%;} + +</style> + </head> + <body> + <p> + <br /><br /> + </p> +<pre xml:space="preserve"> +The Project Gutenberg EBook of Medical Essays, by Oliver Wendell Holmes, Sr. + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Medical Essays + +Author: Oliver Wendell Holmes, Sr. + +Release Date: August 16, 2006 [EBook #2700] +Last Updated: February 18, 2018 + +Language: English + +Character set encoding: UTF-8 + +*** START OF THIS PROJECT GUTENBERG EBOOK MEDICAL ESSAYS *** + + +Produced by David Widger + + + + + +</pre> + + <h1> + MEDICAL ESSAYS + </h1> + <h2> + By Oliver Wendell Holmes + </h2> + <p> + <br /><br /> + </p> + <h3> + 1842-1882 + </h3> + <p> + <br /> <br /> + </p> + <hr /> + <p> + <br /> <br /> + </p> + <blockquote> + <p class="toc"> + <big><b>CONTENTS</b></big> + </p> + <p> + <br /> + </p> + <p class="toc"> + <a href="#link2H_PREF"> PREFACE. </a> + </p> + <p class="toc"> + <a href="#link2H_4_0002"> A SECOND PREFACE. </a> + </p> + <p class="toc"> + <a href="#link2H_PREF2"> PREFACE TO THE NEW EDITION. </a> + </p> + <p class="toc"> + <a href="#link2H_4_0004"> HOMOEOPATHY AND ITS KINDRED DELUSIONS </a> + </p> + <p class="toc"> + <a href="#link2H_4_0005"> THE CONTAGIOUSNESS OF PUERPERAL FEVER </a> + </p> + <p class="toc"> + <a href="#link2H_4_0006"> CURRENTS AND COUNTER-CURRENTS IN MEDICAL + SCIENCE </a> + </p> + <p class="toc"> + <a href="#link2H_4_0008"> BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF + MEDICAL SCIENCE. </a> + </p> + <p class="toc"> + <a href="#link2H_4_0009"> SCHOLASTIC AND BEDSIDE TEACHING. </a> + </p> + <p class="toc"> + <a href="#link2H_4_0010"> THE MEDICAL PROFESSION IN MASSACHUSETTS. </a> + </p> + <p class="toc"> + <a href="#link2H_4_0011"> THE YOUNG PRACTITIONER </a> + </p> + <p class="toc"> + <a href="#link2H_4_0012"> MEDICAL LIBRARIES. </a> + </p> + <p class="toc"> + <a href="#link2H_4_0013"> SOME OF MY EARLY TEACHERS </a> + </p> + <p class="toc"> + <a href="#link2H_4_0014"> APPENDUM </a> + </p> + <p class="toc"> + <a href="#link2H_NOTE"> NOTES TO THE ADDRESS ON CURRENTS AND COUNTER + CURRENTS IN MEDICAL SCIENCE. </a> + </p> + </blockquote> + <p> + <br /> <br /> + </p> + <hr /> + <p> + <br /> <br /> <a name="link2H_PREF" id="link2H_PREF"> + <!-- H2 anchor --> </a> + </p> + <h2> + PREFACE. + </h2> + <p> + The character of the opposition which some of these papers have met with + suggests the inference that they contain really important, but unwelcome + truths. Negatives multiplied into each other change their sign and become + positives. Hostile criticisms meeting together are often equivalent to + praise, and the square of fault-finding turns out to be the same thing as + eulogy. + </p> + <p> + But a writer has rarely so many enemies as it pleases him to believe. + Self-love leads us to overrate the numbers of our negative constituency. + The larger portion of my limited circle of readers must be quite + indifferent to, if not ignorant of, the adverse opinions which have been + expressed or recorded concerning any of these Addresses or Essays now + submitted to their own judgment. It is proper, however, to inform them, + that some of the positions maintained in these pages have been unsparingly + attacked, with various degrees of ability, scholarship, and good-breeding. + The tone of criticism naturally changes with local conditions in different + parts of a country extended like our own, so that it is one of the most + convenient gauges of the partial movements in the direction of + civilization. It is satisfactory to add, that the views assailed have also + been unflinchingly defended by unsought champions, among the ablest of + whom it is pleasant to mention, at this moment of political alienation, + the Editor of the Charleston Medical Journal. + </p> + <p> + “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. + </p> + <p> + The commonest mode of misrepresentation was this: qualified propositions, + the whole meaning of which depended on the qualifications, were stripped + of these and taken as absolute. Thus, the attempt to establish a + presumption against giving poisons to sick persons was considered as + equivalent to condemning the use of these substances. The only important + inference the writer has been able to draw from the greater number of the + refutations of his opinions which have been kindly sent him, is that the + preliminary education of the Medical Profession is not always what it + ought to be. + </p> + <p> + One concession he is willing to make, whatever sacrifice of pride it may + involve. The story of Massasoit, which has furnished a coral, as it were, + for some teething critics, when subjected to a powerful logical analysis, + though correct in its essentials, proves to have been told with + exceptionable breadth of statement, and therefore (to resume the metaphor) + has been slightly rounded off at its edges, so as to be smoother for any + who may wish to bite upon it hereafter. In other respects the Discourse + has hardly been touched. It is only an individual's expression, in his own + way, of opinions entertained by hundreds of the Medical Profession in + every civilized country, and has nothing in it which on revision the + writer sees cause to retract or modify. The superstitions it attacks lie + at the very foundation of Homoeopathy, and of almost every form of medical + charlatanism. Still the mere routinists and unthinking artisans in most + callings dislike whatever shakes the dust out of their traditions, and it + may be unreasonable to expect that Medicine will always prove an exception + to the rule. One half the opposition which the numerical system of Louis + has met with, as applied to the results of treatment, has been owing to + the fact that it showed the movements of disease to be far more + independent of the kind of practice pursued than was agreeable to the + pride of those whose self-confidence it abated. + </p> + <p> + The statement, that medicines are more sparingly used in physicians' + families than in most others, admits of a very natural explanation, + without putting a harsh construction upon it, which it was not intended to + admit. Outside pressure is less felt in the physician's own household; + that is all. If this does not sometimes influence him to give medicine, or + what seems to be medicine, when among those who have more confidence in + drugging than his own family commonly has, the learned Professor Dunglison + is hereby requested to apologize for his definition of the word Placebo, + or to expunge it from his Medical Dictionary. + </p> + <p> + One thing is certain. A loud outcry on a slight touch reveals the weak + spot in a profession, as well as in a patient. It is a doubtful policy to + oppose the freest speech in those of our own number who are trying to show + us where they honestly believe our weakness lies. Vast as are the advances + of our Science and Art, may it not possibly prove on examination that we + retain other old barbarisms beside the use of the astrological sign of + Jupiter, with which we endeavor to insure good luck to our prescriptions? + Is it the act of a friend or a foe to try to point them out to our + brethren when asked to address them, and is the speaker to subdue the + constitutional habit of his style to a given standard, under penalty of + giving offence to a grave assembly? + </p> + <p> + “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. + </p> + <p> + Many of the arguments contained in the Lectures have lost whatever novelty + they may have possessed. All its predictions have been submitted to the + formidable test of time. They appear to have stood it, so far, about as + well as most uninspired prophecies; indeed, some of them require much less + accommodation than certain grave commentators employ in their readings of + the ancient Prophets. + </p> + <p> + If some statistics recently published are correct, Homoeopathy has made + very slow progress in Europe. + </p> + <p> + In all England, as it appears, there are hardly a fifth more Homoeopathic + practitioners than there are students attending Lectures at the + Massachusetts Medical College at the present time. In America it has + undoubtedly proved more popular and lucrative, yet how loose a hold it has + on the public confidence is shown by the fact that, when a specially + valued life, which has been played with by one of its agents, is seriously + threatened, the first thing we expect to hear is that a regular + practitioner is by the patient's bed, and the Homoeopathic counsellor + overruled or discarded. Again, how many of the ardent and capricious + persons who embraced Homoeopathy have run the whole round of pretentious + novelties;—have been boarded at water-cure establishments, closeted + with uterine and other specialists, and finally wandered over seas to put + themselves in charge of foreign celebrities, who dosed them as lustily as + they were ever dosed before they took to globules! It will surprise many + to learn to what a shadow of a shade Homoeopathy has dwindled in the hands + of many of its noted practitioners. The itch-doctrine is treated with + contempt. Infinitesimal doses are replaced by full ones whenever the + fancy-practitioner chooses. Good Homoeopathic reasons can be found for + employing anything that anybody wants to employ. Homoeopathy is now merely + a name, an unproved theory, and a box of pellets pretending to be + specifics, which, as all of us know, fail ignominiously in those cases + where we would thankfully sacrifice all our prejudices and give the world + to have them true to their promises. + </p> + <p> + Homoeopathy has not died out so rapidly as Tractoration. Perhaps it was + well that it should not, for it has taught us a lesson of the healing + faculty of Nature which was needed, and for which many of us have made + proper acknowledgments. But it probably does more harm than good to + medical science at the present time, by keeping up the delusion of + treating everything by specifics,—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. + </p> + <p> + The infinitesimal globules have not become a curiosity as yet, like + Perkins's Tractors. But time is a very elastic element in Geology and + Prophecy. If Daniel's seventy weeks mean four hundred and ninety years, as + the learned Prideaux and others have settled it that they do, the “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. + </p> + <p> + It might be fitting to add a few words with regard to the Essay on the + Contagiousness of Puerperal Fever. But the whole question I consider to be + now transferred from the domain of medical inquiry to the consideration of + Life Insurance agencies and Grand Juries. For the justification of this + somewhat sharply accented language I must refer the reader to the paper + itself for details which I regret to have been forced to place on + permanent record. + </p> + <p> + BOSTON, January, 1861. + </p> + <p> + <a name="link2H_4_0002" id="link2H_4_0002"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + A SECOND PREFACE. + </h2> + <p> + These Lectures and Essays are arranged in the order corresponding to the + date of their delivery or publication. They must, of course, be read with + a constant reference to these dates, by such as care to read them. I have + not attempted to modernize their aspect or character in presenting them, + in this somewhat altered connection, to the public. Several of them were + contained in a former volume which received its name from the Address + called “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. + </p> + <p> + I had some intention of including with these papers an Essay on + Intermittent Fever in New England, which received one of the Boylston + prizes in 1837, and was published in the following year. But as this was + upon a subject of local interest, chiefly, and would have taken up a good + deal of room, I thought it best to leave it out, trusting that the stray + copies to be met with in musty book-shops would sufficiently supply the + not very extensive or urgent demand for a paper almost half a century old. + </p> + <p> + Some of these papers created a little stir when they first fell from the + press into the pool of public consciousness. They will slide in very + quietly now in this new edition, and find out for themselves whether the + waters are those of Lethe, or whether they are to live for a time as not + wholly unvalued reminiscences. + </p> + <p> + March 21, 1883. + </p> + <p> + <a name="link2H_PREF2" id="link2H_PREF2"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + PREFACE TO THE NEW EDITION. + </h2> + <p> + These Essays are old enough now to go alone without staff or crutch in the + shape of Prefaces. A very few words may be a convenience to the reader who + takes up the book and wishes to know what he is likely to find in it. + </p> +<pre xml:space="preserve"> + HOMOEOPATHY AND ITS KINDRED DELUSIONS. +</pre> + <p> + Homoeopathy has proved lucrative, and so long as it continues to be so + will surely exist,—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, + </p> +<pre xml:space="preserve"> + “From seeming evil still educing good,” + </pre> + <p> + has shown that the dealers in this preposterous system of + pseudo-therapeutics have cooperated with the wiser class of practitioners + in breaking up the system of over-dosing and over-drugging which has been + one of the standing reproaches of medical practice. While keeping up the + miserable delusion that diseases were all to be “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. + </p> + <p> + It takes a very moderate amount of erudition to unearth a charlatan like + the supposed father of the infinitesimal dosing system. The real inventor + of that specious trickery was an Irishman by the name of Butler. The whole + story is to be found in the “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. + </p> +<pre xml:space="preserve"> + CURRENTS AND COUNTER-CURRENTS +</pre> + <p> + My attack on over-drugging brought out some hostile comments and + treatment. Thirty years ago I expressed myself with more vivacity than I + should show if I were writing on the same subjects today. Some of my more + lively remarks called out very sharp animadversion. Thus my illustration + of prevention as often better than treatment in the mother's words to her + child which had got a poisonous berry in its mouth,—“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. + </p> + <p> + Since this lecture was delivered a great and, as I think, beneficial + change has taken place in the practice of medicine. The habit of the + English “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. + </p> +<pre xml:space="preserve"> + THE CONTAGIOUSNESS OF PUERPERAL FEVER. +</pre> + <p> + 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. + </p> + <p> + This paper was written in a great heat and with passionate indignation. If + I touched it at all I might trim its rhetorical exuberance, but I prefer + to leave it all its original strength of expression. I could not, if I had + tried, have disguised the feelings with which I regarded the attempt to + put out of sight the frightful facts which I brought forward and the + necessary conclusions to which they led. Of course the whole matter has + been looked at in a new point of view since the microbe as a vehicle of + contagion has been brought into light, and explained the mechanism of that + which was plain enough as a fact to all who were not blind or who did not + shut their eyes. + </p> + <p> + O. W. H. + </p> + <p> + BEVERLY Farms, Mass., August 3, 1891 + </p> + <p> + <a name="link2H_4_0004" id="link2H_4_0004"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + HOMOEOPATHY AND ITS KINDRED DELUSIONS + </h2> + <p> + [Two lectures delivered before the Boston Society for the Diffusion of + Useful Knowledge. 1842.] + </p> + <p> + [When a physician attempts to convince a person, who has fallen into the + Homoeopathic delusion, of the emptiness of its pretensions, he is often + answered by a statement of cases in which its practitioners are thought to + have effected wonderful cures. The main object of the first of these + Lectures is to show, by abundant facts, that such statements, made by + persons unacquainted with the fluctuations of disease and the fallacies of + observation, are to be considered in general as of little or no value in + establishing the truth of a medical doctrine or the utility of a method of + practice. + </p> + <p> + Those kind friends who suggest to a person suffering from a tedious + complaint, that he “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. + </p> + <p> + To deny that good effects may happen from the observance of diet and + regimen when prescribed by Homoeopathists as well as by others, would be + very unfair to them. But to suppose that men with minds so constituted as + to accept such statements and embrace such doctrines as make up the + so-called science of Homoeopathy are more competent than others to + regulate the circumstances which influence the human body in health and + disease, would be judging very harshly the average capacity of ordinary + practitioners. + </p> + <p> + To deny that some patients may have been actually benefited through the + influence exerted upon their imaginations, would be to refuse to + Homoeopathy what all are willing to concede to every one of those numerous + modes of practice known to all intelligent persons by an opprobrious + title. + </p> + <p> + So long as the body is affected through the mind, no audacious device, + even of the most manifestly dishonest character, can fail of producing + occasional good to those who yield it an implicit or even a partial faith. + The argument founded on this occasional good would be as applicable in + justifying the counterfeiter and giving circulation to his base coin, on + the ground that a spurious dollar had often relieved a poor man's + necessities. + </p> + <p> + Homoeopathy has come before our public at a period when the growing spirit + of eclecticism has prepared many ingenious and honest minds to listen to + all new doctrines with a candor liable to degenerate into weakness. It is + not impossible that the pretended evolution of great and mysterious + virtues from infinitely attenuated atoms may have enticed a few + over-refining philosophers, who have slid into a vague belief that matter + subdivided grows less material, and approaches nearer to a spiritual + nature as it requires a more powerful microscope for its detection. + </p> + <p> + However this may be, some persons seem disposed to take the ground of + Menzel that the Laity must pass formal judgment between the Physician and + the Homoeopathist, as it once did between Luther and the Romanists. The + practitioner and the scholar must not, therefore, smile at the amount of + time and labor expended in these Lectures upon this shadowy system; which, + in the calm and serious judgment of many of the wisest members of the + medical profession, is not entitled by anything it has ever said or done + to the notoriety of a public rebuke, still less to the honors of critical + martyrdom.] + </p> + <p> + I. + </p> + <p> + I have selected four topics for this lecture, the first three of which I + shall touch but slightly, the last more fully. They are + </p> + <p> + 1. The Royal cure of the King's Evil, or Scrofula. + </p> + <p> + 2. The Weapon Ointment, and its twin absurdity, the Sympathetic Powder. + </p> + <p> + 3. The Tar-water mania of Bishop Berkeley. + </p> + <p> + 4. The History of the Metallic Tractors, or Perkinism. + </p> + <p> + The first two illustrate the ease with which numerous facts are + accumulated to prove the most fanciful and senseless extravagances. + </p> + <p> + The third exhibits the entire insufficiency of exalted wisdom, immaculate + honesty, and vast general acquirements to make a good physician of a great + bishop. + </p> + <p> + The fourth shows us the intimate machinery of an extinct delusion, which + flourished only forty years ago; drawn in all its details, as being a rich + and comparatively recent illustration of the pretensions, the arguments, + the patronage, by means of which windy errors have long been, and will + long continue to be, swollen into transient consequence. All display in + superfluous abundance the boundless credulity and excitability of mankind + upon subjects connected with medicine. + </p> + <p> + “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.] + </p> + <p> + Obstinate and incredulous men, as he tells us, accounted for these cures + in three ways: by the journey and change of air the patients obtained in + coming to London; by the influence of imagination; and the wearing of + gold. + </p> + <p> + To these objections he answers, 1st. That many of those cured were + inhabitants of the city. 2d. That the subjects of treatment were + frequently infants. 3d. That sometimes silver was given, and sometimes + nothing, yet the patients were cured. + </p> + <p> + A superstition resembling this probably exists at the present time in some + ignorant districts of England and this country. A writer in a Medical + Journal in the year 1807, speaks of a farmer in Devonshire, who, being a + ninth son of a ninth son, is thought endowed with healing powers like + those of ancient royalty, and who is accustomed one day in every week to + strike for the evil. + </p> + <p> + I remember that one of my schoolmates told me, when a boy, of a seventh + son of a seventh son, somewhere in Essex County, who touched for the + scrofula, and who used to hang a silver fourpence halfpenny about the neck + of those who came to him, which fourpence halfpenny it was solemnly + affirmed became of a remarkably black color after having been some time + worn, and that his own brother had been subjected to this extraordinary + treatment; but I must add that my schoolmate drew a bow of remarkable + length, strength, and toughness for his tender years. + </p> + <p> + One of the most curious examples of the fallacy of popular belief and the + uncertainty of asserted facts in medical experience is to be found in the + history of the UNGUENTUM ARMARIUM, or WEAPON OINTMENT. + </p> + <p> + Fabricius Hildanus, whose name is familiar to every surgical scholar, and + Lord Bacon, who frequently dipped a little into medicine, are my principal + authorities for the few circumstances I shall mention regarding it. The + Weapon Ointment was a preparation used for the healing of wounds, but + instead of its being applied to them, the injured part was washed and + bandaged, and the weapon with which the wound was inflicted was carefully + anointed with the unguent. Empirics, ignorant barbers, and men of that + sort, are said to have especially employed it. Still there were not + wanting some among the more respectable members of the medical profession + who supported its claims. The composition of this ointment was + complicated, in the different formulae given by different authorities; but + some substances addressed to the imagination, rather than the wound or + weapon, entered into all. Such were portions of mummy, of human blood, and + of moss from the skull of a thief hung in chains. + </p> + <p> + Hildanus was a wise and learned man, one of the best surgeons of his time. + He was fully aware that a part of the real secret of the Unguentum + Armarium consisted in the washing and bandaging the wound and then letting + it alone. But he could not resist the solemn assertions respecting its + efficacy; he gave way before the outcry of facts, and therefore, instead + of denying all their pretensions, he admitted and tried to account for + them upon supernatural grounds. As the virtue of those applications, he + says, which are made to the weapon cannot reach the wound, and as they can + produce no effect without contact, it follows, of necessity, that the + Devil must have a hand in the business; and as he is by far the most long + headed and experienced of practitioners, he cannot find this a matter of + any great difficulty. Hildanus himself reports, in detail, the case of a + lady who had received a moderate wound, for which the Unguentum Armarium + was employed without the slightest use. Yet instead of receiving this flat + case of failure as any evidence against the remedy, he accounts for its + not succeeding by the devout character of the lady, and her freedom from + that superstitious and over-imaginative tendency which the Devil requires + in those who are to be benefited by his devices. + </p> + <p> + Lord Bacon speaks of the Weapon Ointment, in his Natural History, as + having in its favor the testimony of men of credit, though, in his own + language, he himself “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. + </p> + <p> + The same essential idea as that of the Weapon Ointment reproduced itself + in the still more famous SYMPATHETIC POWDER. This Powder was said to have + the faculty, if applied to the blood-stained garments of a wounded person, + to cure his injuries, even though he were at a great distance at the time. + A friar, returning from the East, brought the recipe to Europe somewhat + before the middle of the seventeenth century. The Grand Duke of Florence, + in which city the friar was residing, heard of his cures, and tried, but + without success, to obtain his secret. Sir Kenehn Digby, an Englishman + well known to fame, was fortunate enough to do him a favor, which wrought + upon his feelings and induced him to impart to his benefactor the + composition of his extraordinary Powder. This English knight was at + different periods of his life an admiral, a theologian, a critic, a + metaphysician, a politician, and a disciple of Alchemy. As is not + unfrequent with versatile and inflammable people, he caught fire at the + first spark of a new medical discovery, and no sooner got home to England + than he began to spread the conflagration. + </p> + <p> + An opportunity soon offered itself to try the powers of the famous powder. + Mr. J. Howell, having been wounded in endeavoring to part two of his + friends who were fighting a duel, submitted himself to a trial of the + Sympathetic Powder. Four days after he received his wounds, Sir Kenehn + dipped one of Mr. Howell's gaiters in a solution of the Powder, and + immediately, it is said, the wounds, which were very painful, grew easy, + although the patient, who was conversing in a corner of the chamber, had + not, the least idea of what was doing with his garter. He then returned + home, leaving his garter in the hands of Sir Kenelm, who had hung it up to + dry, when Mr. Howell sent his servant in a great hurry to tell him that + his wounds were paining him horribly; the garter was therefore replaced in + the solution of the Powder, “and the patient got well after five or six + days of its continued immersion.” + </p> + <p> + King James First, his son Charles the First, the Duke of Buckingham, then + prime minister, and all the principal personages of the time, were + cognizant of this fact; and James himself, being curious to know the + secret of this remedy, asked it of Sir Kenelm, who revealed it to him, and + his Majesty had the opportunity of making several trials of its efficacy, + “which all succeeded in a surprising manner.” [Dict. des Sciences + Medieales.] + </p> + <p> + The king's physician, Dr. Mayerne, was made master of the secret, which he + carried to France and communicated to the Duke of Mayenne, who performed + many cures by means of it, and taught it to his surgeon, who, after the + Duke's death, sold it to many distinguished persons, by whose agency it + soon ceased to be a secret. What was this wonderful substance which so + astonished kings, princes, dukes, knights, and doctors? Nothing but + powdered blue vitriol. But it was made to undergo several processes that + conferred on it extraordinary virtues. Twice or thrice it was to be + dissolved, filtered, and crystallized. The crystals were to be laid in the + sun during the months of June, July, and August, taking care to turn them + carefully that all should be exposed. Then they were to be powdered, + triturated, and again exposed to the sun, again reduced to a very fine + powder, and secured in a vessel, while hot, from the sunshine. If there + seem anything remarkable in the fact of such astonishing properties being + developed by this process, it must be from our short-sightedness, for + common salt and charcoal develop powers quite as marvellous after a + certain number of thumps, stirs, and shakes, from the hands of modern + workers of miracles. In fact the Unguentum Armarium and Sympathetic Powder + resemble some more recent prescriptions; the latter consisting in an + infinite dilution of the common dose in which remedies are given, and the + two former in an infinite dilution of the common distance at which they + are applied. + </p> + <p> + Whether philosophers, and more especially metaphysicians, have any + peculiar tendency to dabble in drugs and dose themselves with physic, is a + question which might suggest itself to the reader of their biographies. + </p> + <p> + When Bishop Berkeley visited the illustrious Malebranche at Paris, he + found him in his cell, cooking in a small pipkin a medicine for an + inflammation of the lungs, from which he was suffering; and the disease, + being unfortunately aggravated by the vehemence of their discussion, or + the contents of the pipkin, carried him off in the course of a few days. + Berkeley himself afforded a remarkable illustration of a truth which has + long been known to the members of one of the learned professions, namely, + that no amount of talent, or of acquirements in other departments, can + rescue from lamentable folly those who, without something of the requisite + preparation, undertake to experiment with nostrums upon themselves and + their neighbors. The exalted character of Berkeley is thus drawn by Sir + James Mackintosh: Ancient learning, exact science, polished society, + modern literature, and the fine arts, contributed to adorn and enrich the + mind of this accomplished man. All his contemporaries agreed with the + satirist in ascribing + </p> +<p> + “'To Berkeley every virtue under heaven.' +</p> + <p> + “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.'” + </p> + <p> + But among the writings of this great and good man is an Essay of the most + curious character, illustrating his weakness upon the point in question, + and entitled, “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. + </p> + <p> + The bishop, as is usual in such cases, speaks of himself as indispensably + obliged, by the duty he owes to mankind, to make his experience public. + Now this was by no means evident, nor does it follow in general, that + because a man has formed a favorable opinion of a person or a thing he has + not the proper means of thoroughly understanding, he shall be bound to + print it, and thus give currency to his impressions, which may be + erroneous, and therefore injurious. He would have done much better to have + laid his impressions before some experienced physicians and surgeons, such + as Dr. Mead and Mr. Cheselden, to have asked them to try his experiment + over again, and have been guided by their answers. But the good bishop got + excited; he pleased himself with the thought that he had discovered a + great panacea; and having once tasted the bewitching cup of self-quackery, + like many before and since his time, he was so infatuated with the draught + that he would insist on pouring it down the throats of his neighbors and + all mankind. + </p> + <p> + The precious fluid was made by stirring a gallon of water with a quart of + tar, leaving it forty-eight hours, and pouring off the clear water. Such + was the specific which the great metaphysician recommended for averting + and curing all manner of diseases. It was, if he might be believed, a + preventive of the small-pox, and of great use in the course of the + disease. It was a cure for impurities of the blood, coughs, pleurisy, + peripneumony, erysipelas, asthma, indigestion, carchexia, hysterics, + dropsy, mortification, scurvy, and hypochondria. It was of great use in + gout and fevers, and was an excellent preservative of the teeth and gums; + answered all the purpose of Elixir Proprietatis, Stoughton's drops, diet + drinks, and mineral waters; was particularly to be recommended to + sea-faring persons, ladies, and men of studious and sedentary lives; could + never be taken too long, but, on the contrary, produced advantages which + sometimes did not begin to show themselves for two or three months. + </p> + <p> + “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.” + </p> + <p> + Berkeley died at the age of about seventy; he might have lived longer, but + his fatal illness was so sudden that there was not time enough to stir up + a quart of the panacea. He was an illustrious man, but he held two very + odd opinions; that tar water was everything, and that the whole material + universe was nothing. + </p> +<pre xml:space="preserve"> + ————————————— +</pre> + <p> + Most of those present have at some time in their lives heard mention made + of the METALLIC TRACTORS, invented by one Dr. Perkins, an American, and + formerly enjoying great repute for the cure of various diseases. Many have + seen or heard of a satirical poem, written by one of our own countrymen + also, about forty years since, and called “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. + </p> + <p> + Dr. Elisha Perkins was born at Norwich, Connecticut, in the year 1740. He + had practised his profession with a good local reputation for many years, + when he fell upon a course of experiments, as it is related, which led to + his great discovery. He conceived the idea that metallic substances might + have the effect of removing diseases, if applied in a certain manner; a + notion probably suggested by the then recent experiments of Galvani, in + which muscular contractions were found to be produced by the contact of + two metals with the living fibre. It was in 1796 that his discovery was + promulgated in the shape of the Metallic Tractors, two pieces of metal, + one apparently iron and the other brass, about three inches long, blunt at + one end and pointed at the other. These instruments were applied for the + cure of different complaints, such as rheumatism, local pains, + inflammations, and even tumors, by drawing them over the affected part + very lightly for about twenty minutes. Dr. Perkins took out a patent for + his discovery, and travelled about the country to diffuse the new + practice. He soon found numerous advocates of his discovery, many of them + of high standing and influence. In the year 1798 the tractors had crossed + the Atlantic, and were publicly employed in the Royal Hospital at + Copenhagen. About the same time the son of the inventor, Mr. Benjamin + Douglass Perkins, carried them to London, where they soon attracted + attention. The Danish physicians published an account of their cases, + containing numerous instances of alleged success, in a respectable octavo + volume. In the year 1804 an establishment, honored with the name of the + Perkinean Institution, was founded in London. The transactions of this + institution were published in pamphlets, the Perkinean Society had public + dinners at the Crown and Anchor, and a poet celebrated their medical + triumph in strains like these: + </p> +<pre xml:space="preserve"> + “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!” + </pre> + <p> + While all these things were going on, Mr. Benjamin Douglass Perkins was + calmly pocketing money, so that after some half a dozen years he left the + country with more than ten thousand pounds, which had been paid him by the + believers in Great Britain. But in spite of all this success, and the + number of those interested and committed in its behalf, Perkinism soon + began to decline, and in 1811 the Tractors are spoken of by an intelligent + writer as being almost forgotten. Such was the origin and duration of this + doctrine and practice, into the history of which we will now look a little + more narrowly. + </p> + <p> + Let us see, then, by whose agency this delusion was established and kept + up; whether it was principally by those who were accustomed to medical + pursuits, or those whose habits and modes of reasoning were different; + whether it was with the approbation of those learned bodies usually + supposed to take an interest in scientific discoveries, or only of + individuals whose claims to distinction were founded upon their position + in society, or political station, or literary eminence; whether the + judicious or excitable classes entered most deeply into it; whether, in + short, the scientific men of that time were deceived, or only intruded + upon, and shouted down for the moment by persons who had no particular + call to invade their precincts. + </p> + <p> + Not much, perhaps, was to be expected of the Medical Profession in the way + of encouragement. One Dr. Fuller, who wrote in England, himself a + Perkinist, thus expressed his opinion: “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.” + </p> + <p> + Whether the motives assigned by this medical man to his professional + brethren existed or not, it is true that Dr. Perkins did not gain a great + deal at their hands. The Connecticut Medical Society expelled him in 1797 + for violating their law against the use of nostrums, or secret remedies. + The leading English physicians appear to have looked on with singular + apathy or contempt at the miracles which it was pretended were enacting in + the hands of the apostles of the new practice. In looking over the reviews + of the time, I have found little beyond brief occasional notices of their + pretensions; the columns of these journals being occupied with subjects of + more permanent interest. The state of things in London is best learned, + however, from the satirical poem to which I have already alluded as having + been written at the period referred to. This was entitled, “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. + </p> + <p> + “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. + </p> + <p> + It appears from this work that the principal members of the medical + profession, so far from hailing Mr. Benjamin Douglass Perkins as another + Harvey or Jenner, looked very coldly upon him and his Tractors; and it is + now evident that, though they were much abused for so doing, they knew + very well what they had to deal with, and were altogether in the right. + The delusion at last attracted such an amount of attention as to induce + Dr. Haygarth and some others of respectable standing to institute some + experiments which I shall mention in their proper place, the result of + which might have seemed sufficient to show the emptiness of the whole + contrivance. + </p> + <p> + The Royal Society, that learned body which for ages has constituted the + best tribunal to which Britain can appeal in questions of science, + accepted Mr. Perkins's Tractors and the book written about them, passed + the customary vote of thanks, and never thought of troubling itself + further in the investigation of pretensions of such an aspect. It is not + to be denied that a considerable number of physicians did avow themselves + advocates of the new practice; but out of the whole catalogue of those who + were publicly proclaimed as such, no one has ever been known, so far as I + am aware, to the scientific world, except in connection with the + short-lived notoriety of Perkinism. Who were the people, then, to whose + activity, influence, or standing with the community was owing all the + temporary excitement produced by the Metallic Tractors? + </p> + <p> + First, those persons who had been induced to purchase a pair of Tractors. + These little bits of brass and iron, the intrinsic value of which might, + perhaps, amount to ninepence, were sold at five guineas a pair! A man who + has paid twenty-five dollars for his whistle is apt to blow it louder and + longer than other people. So it appeared that when the “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.” + </p> + <p> + But it is an undeniable fact, that many persons of considerable standing, + and in some instances holding the most elevated positions in society, + openly patronized the new practice. In a translation of a work entitled + “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: + </p> + <p> + “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.” + </p> + <p> + It cannot but excite our notice and surprise that the number of clergymen + both in America and Great Britain who thrust forward their evidence on + this medical topic was singularly large in proportion to that of the + members of the medical profession. Whole pages are contributed by such + worthies as the Rev. Dr. Trotter of Hans Place, the Rear. Waring Willett, + Chaplain to the Earl of Dunmore, the Rev. Dr. Clarke, Chaplain to the + Prince of Wales. The style of these theologico-medical communications may + be seen in the following from a divine who was also professor in one of + the colleges of New England. “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. + </p> + <p> + I trust it will not be thought in any degree disrespectful to a profession + which we all honor, that I have mentioned the great zeal of many clergymen + in the cause of Perkinism. I hope, too, that I may without offence suggest + the causes which have often led them out of their own province into one to + which their education has no special reference. The members of that + profession ought to be, and commonly are, persons of benevolent character. + Their duties carry them into the midst of families, and particularly at + times when the members of them are suffering from bodily illness. It is + natural enough that a strong desire should be excited to alleviate + sufferings which may have defied the efforts of professional skill; as + natural that any remedy which recommends itself to the belief or the fancy + of the spiritual physician should be applied with the hope of benefit; and + perfectly certain that the weakness of human nature, from which no + profession is exempt, will lead him to take the most flattering view of + its effects upon the patient; his own sagacity and judgment being staked + upon the success of the trial. The inventor of the Tractors was aware of + these truths. He therefore sent the Tractors gratuitously to many + clergymen, accompanied with a formal certificate that the holder had + become entitled to their possession by the payment of five guineas. This + was practised in our own neighborhood, and I remember finding one of these + certificates, so presented, which proved that amongst the risks of infancy + I had to encounter Perkins's Tractors. Two clergymen of Boston and the + vicinity, both well known to local fame, gave in their testimony to the + value of the instruments thus presented to them; an unusually moderate + proportion, when it is remembered that to the common motives of which I + have spoken was added the seduction of a gift for which the profane public + was expected to pay so largely. + </p> + <p> + It was remarkable, also, that Perkinism, which had so little success with + the medical and scientific part of the community, found great favor in the + eyes of its more lovely and less obstinate portion. “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.” + </p> + <p> + It would be a very interesting question, what was the intellectual + character of those persons most conspicuous in behalf of the Perkinistic + delusion? Such an inquiry might bring to light some principles which we + could hereafter apply to the study of other popular errors. But the + obscurity into which nearly all these enthusiasts have subsided renders + the question easier to ask than to answer. I believe it would have been + found that most of these persons were of ardent temperament and of + considerable imagination, and that their history would show that Perkinism + was not the first nor the last hobby-horse they rode furiously. Many of + them may very probably have been persons of more than common talent, of + active and ingenious minds, of versatile powers and various acquirements. + Such, for instance, was the estimable man to whom I have repeatedly + referred as a warm defender of tractoration, and a bitter assailant of its + enemies. The story tells itself in the biographical preface to his poem. + He went to London with the view of introducing a hydraulic machine, which + he and his Vermont friends regarded as a very important invention. He + found, however, that the machine was already in common use in that + metropolis. A brother Yankee, then in London, had started the project of a + mill, which was to be carried by the water of the Thames. He was sanguine + enough to purchase one fifth of this concern, which also proved a failure. + At about the same period he wrote the work which proved the great + excitement of his mind upon the subject of the transient folly then before + the public. Originally a lawyer, he was in succession a mechanician, a + poet, and an editor, meeting with far less success in each of these + departments than usually attends men of less varied gifts, but of more + tranquil and phlegmatic composition. But who is ignorant that there is a + class of minds characterized by qualities like those I have mentioned; + minds with many bright and even beautiful traits; but aimless and fickle + as the butterfly; that settle upon every gayly-colored illusion as it + opens into flower, and flutter away to another when the first has dropped + its leaves, and stands naked in the icy air of truth! + </p> + <p> + Let us now look at the general tenor of the arguments addressed by + believers to sceptics and opponents. Foremost of all, emblazoned at the + head of every column, loudest shouted by every triumphant disputant, held + up as paramount to all other considerations, stretched like an + impenetrable shield to protect the weakest advocate of the great cause + against the weapons of the adversary, was that omnipotent monosyllable + which has been the patrimony of cheats and the currency of dupes from time + immemorial,—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!” + </p> + <p> + Next in order after the appeal to what were called facts, came a series of + arguments, which have been so long bruised and battered round in the cause + of every doctrine or pretension, new, monstrous, or deliriously + impossible, that each of them is as odiously familiar to the scientific + scholar as the faces of so many old acquaintances, among the less + reputable classes, to the officers of police. + </p> + <p> + No doubt many of my hearers will recognize, in the following passages, + arguments they may have heard brought forward with triumphant confidence + in behalf of some doctrine not yet extinct. No doubt some may have + honestly thought they proved something; may have used them with the + purpose of convincing their friends, or of silencing the opponents of + their favorite doctrine, whatever that might be. But any train of + arguments which was contrived for Perkinism, which was just as applicable + to it as to any other new doctrine in the same branch of science, and + which was fully employed against its adversaries forty years since, might, + in common charity, be suffered to slumber in the grave of Perkinism. + Whether or not the following sentences, taken literally from the work of + Mr. Perkins, were the originals of some of the idle propositions we hear + bandied about from time to time, let those who listen judge. + </p> + <p> + The following is the test assumed for the new practice: “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. + </p> + <p> + The following sentence applies to that a priori judging and uncandid class + of individuals who buy their dinners without tasting all the food there is + in the market. “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.” + </p> + <p> + 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.” + </p> + <p> + “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: + </p> +<pre xml:space="preserve"> + “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.” + </pre> + <p> + This course of argument is so often employed, that it deserves to be + expanded a little, so that its length and breadth may be fairly seen. A + series of what are called facts is brought forward to prove some very + improbable doctrine. It is objected by judicious people, or such as have + devoted themselves to analogous subjects, that these assumed facts are in + direct opposition to all that is known of the course of nature, that the + universal experience of the past affords a powerful presumption against + their truth, and that in proportion to the gravity of these objections, + should be the number and competence of the witnesses. The answer is a + ready one. What do we know of the mysteries of Nature? Do we understand + the intricate machinery of the Universe? When to this is added the + never-failing quotation, + </p> +<pre xml:space="preserve"> + “There are more things in heaven and earth, Horatio, + Than are dreamt of in your philosophy,”— +</pre> + <p> + the question is thought to be finally disposed of. + </p> + <p> + Take the case of astrology as an example. It is in itself strange and + incredible that the relations of the heavenly bodies to each other at a + given moment of time, perhaps half a century ago, should have anything to + do with my success or misfortune in any undertaking of to-day. But what + right have I to say it cannot be so? Can I bind the sweet influences of + Pleiades, or loose the bands of Orion? I do not know by what mighty magic + the planets roll in their fluid paths, confined to circles as unchanging + as if they were rings of steel, nor why the great wave of ocean follows in + a sleepless round upon the skirts of moonlight; nor can I say from any + certain knowledge that the phases of the heavenly bodies, or even the + falling of the leaves of the forest, or the manner in which the sands lie + upon the sea-shore, may not be knit up by invisible threads with the web + of human destiny. There is a class of minds much more ready to believe + that which is at first sight incredible, and because it is incredible, + than what is generally thought reasonable. Credo quia impossibile est,—“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. + </p> + <p> + I have already mentioned the motives attributed by the Perkinists to the + Medical Profession, as preventing its members from receiving the new but + unwelcome truths. This accusation is repeated in different forms and + places, as, for instance, in the following passage: “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?” + </p> + <p> + As usual with these people, much indignation was expressed at any parallel + between their particular doctrine and practice and those of their exploded + predecessors. “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.” + </p> + <p> + To all these arguments was added, as a matter of course, an appeal to the + feelings of the benevolent in behalf of suffering humanity, in the shape + of a notice that the poor would be treated gratis. It is pretty well + understood that this gratuitous treatment of the poor does not necessarily + imply an excess of benevolence, any more than the gratuitous distribution + of a trader's shop-bills is an evidence of remarkable generosity; in + short, that it is one of those things which honest men often do from the + best motives, but which rogues and impostors never fail to announce as one + of their special recommendations. It is astonishing to see how these + things brighten up at the touch of Mr. Perkins's poet: + </p> +<pre xml:space="preserve"> + “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.” + </pre> + <p> + Having thus sketched the history of Perkinism in its days of prosperity; + having seen how it sprung into being, and by what means it maintained its + influence, it only remains to tell the brief story of its discomfiture and + final downfall. The vast majority of the sensible part of the medical + profession were contented, so far as we can judge, to let it die out of + itself. It was in vain that the advocates of this invaluable discovery + exclaimed over their perverse and interested obstinacy,—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!” + </p> + <p> + These experiments did not result in the immediate extinction of Perkinism. + Doubtless they were a great comfort to many obstinate unbelievers, and + helped to settle some sceptical minds; but for the real Perkinistic + enthusiasts, it may be questioned whether they would at that time have + changed their opinion though one had risen from the dead to assure them + that it was an error. It perished without violence, by an easy and natural + process. Like the famous toy of Mongolfier, it rose by means of heated + air,—the fevered breath of enthusiastic ignorance,—and when + this grew cool, as it always does in a little while, it collapsed and + fell. + </p> + <p> + And now, on reviewing the whole subject, how shall we account for the + extraordinary prevalence of the belief in Perkinism among a portion of + what is supposed to be the thinking part of the community? + </p> + <p> + Could the cures have been real ones, produced by the principle of ANIMAL + MAGNETISM? To this it may be answered that the Perkinists ridiculed the + idea of approximating Mesmer and the founder of their own doctrine, that + nothing like the somnambulic condition seems to have followed the use of + the Tractors, and that neither the exertion of the will nor the powers of + the individual who operated seem to have been considered of any + consequence. Besides, the absolute neglect into which the Tractors soon + declined is good evidence that they were incapable of affording any + considerable and permanent relief in the complaints for the cure of which + they were applied. + </p> + <p> + Of course a large number of apparent cures were due solely to nature; + which is true under every form of treatment, orthodox or empirical. Of + course many persons experienced at least temporary relief from the strong + impression made upon their minds by this novel and marvellous method of + treatment. + </p> + <p> + Many, again, influenced by the sanguine hopes of those about them, like + dying people, who often say sincerely, from day to day, that they are + getting better, cheated themselves into a false and short-lived belief + that they were cured; and as happens in such cases, the public never knew + more than the first half of the story. + </p> + <p> + When it was said to the Perkinists, that whatever effects they produced + were merely through the imagination, they declared (like the advocates of + the ROYAL TOUCH and the UNGUENTUM ARMARIUM) that this explanation was + sufficiently disproved by the fact of numerous and successful cures which + had been witnessed in infants and brute animals. Dr. Haygarth replied to + this, that “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. + </p> + <p> + As to the motives of the inventor and vender of the Tractors, the facts + must be allowed to speak for themselves. But when two little bits of brass + and iron are patented, as an invention, as the result of numerous + experiments, when people are led, or even allowed, to infer that they are + a peculiar compound, when they are artfully associated with a new and + brilliant discovery (which then happened to be Galvanism), when they are + sold at many hundred times their value, and the seller prints his opinion + that a Hospital will suffer inconvenience, “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. + </p> +<pre xml:space="preserve"> + ————————————— +</pre> + <p> + The succeeding lecture will be devoted to an examination of the doctrines + of Samuel Hahnemann and his disciples; doctrines which some consider new + and others old; the common title of which is variously known as + Ho-moeopathy, Homoe-op-athy, Homoeo-paith-y, or Hom'pathy, and the claims + of which are considered by some as infinitely important, and by many as + immeasurably ridiculous. + </p> + <p> + I wish to state, for the sake of any who may be interested in the subject, + that I shall treat it, not by ridicule, but by argument; perhaps with + great freedom, but with good temper and in peaceable language; with very + little hope of reclaiming converts, with no desire of making enemies, but + with a firm belief that its pretensions and assertions cannot stand before + a single hour of calm investigation. + </p> + <p> + II. + </p> + <p> + It may be thought that a direct attack upon the pretensions of HOMOEOPATHY + is an uncalled-for aggression upon an unoffending doctrine and its + peaceful advocates. + </p> + <p> + But a little inquiry will show that it has long assumed so hostile a + position with respect to the Medical Profession, that any trouble I, or + any other member of that profession, may choose to bestow upon it may be + considered merely as a matter of self-defence. It began with an attempt to + show the insignificance of all existing medical knowledge. It not only + laid claim to wonderful powers of its own, but it declared the common + practice to be attended with the most positively injurious effects, that + by it acute diseases are aggravated, and chronic diseases rendered + incurable. It has at various times brought forward collections of figures + having the air of statistical documents, pretending to show a great + proportional mortality among the patients of the Medical Profession, as + compared with those treated according to its own rules. Not contented with + choosing a name of classical origin for itself, it invented one for the + whole community of innocent physicians, assuring them, to their great + surprise, that they were all ALLOPATHISTS, whether they knew it or not, + and including all the illustrious masters of the past, from Hippocrates + down to Hunter, under the same gratuitous title. The line, then, has been + drawn by the champions of the new doctrine; they have lifted the lance, + they have sounded the charge, and are responsible for any little + skirmishing which may happen. + </p> + <p> + But, independently of any such grounds of active resistance, the subject + involves interests so disproportioned to its intrinsic claims, that it is + no more than an act of humanity to give it a public examination. If the + new doctrine is not truth, it is a dangerous, a deadly error. If it is a + mere illusion, and acquires the same degree of influence that we have + often seen obtained by other illusions, there is not one of my audience + who may not have occasion to deplore the fatal credulity which listened to + its promises. + </p> + <p> + I shall therefore undertake a sober examination of its principles, its + facts, and some points of its history. The limited time at my disposal + requires me to condense as much as possible what I have to say, but I + shall endeavor to be plain and direct in expressing it. Not one statement + shall be made which cannot be supported by unimpeachable reference: not + one word shall be uttered which I am not as willing to print as to speak. + I have no quibbles to utter, and I shall stoop to answer none; but, with + full faith in the sufficiency of a plain statement of facts and reasons, I + submit the subject to the discernment of my audience. + </p> + <p> + The question may be asked in the outset,—Have you submitted the + doctrines you are professing to examine to the test of long-repeated and + careful experiment; have you tried to see whether they were true or not? + To this I answer, that it is abundantly evident, from what has often + happened, that it would be of no manner of use for me to allege the + results of any experiments I might have instituted. Again and again have + the most explicit statements been made by the most competent persons of + the utter failure of all their trials, and there were the same abundant + explanations offered as used to be for the Unguentum Armarium and the + Metallic Tractors. I could by no possibility perform any experiments the + result of which could not be easily explained away so as to be of no + conclusive significance. Besides, as arguments in favor of Homoeopathy are + constantly addressed to the public in journals, pamphlets, and even + lectures, by inexperienced dilettanti, the same channel must be open to + all its opponents. + </p> + <p> + It is necessary, for the sake of those to whom the whole subject may be + new, to give in the smallest possible compass the substance of the + Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German + physician, now living in Paris, [Hahnemann died in 1843 at the age of + eighty-seven years. In 1796 he published the first paper containing his + peculiar notions; in 1805 his first work on the subject; in 1810 his + somewhat famous “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. + </p> + <p> + The one great doctrine which constitutes the basis of Homoeopathy as a + system is expressed by the Latin aphorism, + “SIMILIA SIBILIBUS CURANTUR,” + <p> + or like cures like, that is, diseases are cured by agents capable of + producing symptoms resembling those found in the disease under treatment. + A disease for Hahnemann consists essentially in a group of symptoms. The + proper medicine for any disease is the one which is capable of producing a + similar group of symptoms when given to a healthy person. + </p> + <p> + It is of course necessary to know what are the trains of symptoms excited + by different substances, when administered to persons in health, if any + such can be shown to exist. Hahnemann and his disciples give catalogues of + the symptoms which they affirm were produced upon themselves or others by + a large number of drugs which they submitted to experiment. + </p> + <p> + The second great fact which Hahnemann professes to have established is the + efficacy of medicinal substances reduced to a wonderful degree of + minuteness or dilution. The following account of his mode of preparing his + medicines is from his work on Chronic Diseases, which has not, I believe, + yet been translated into English. A grain of the substance, if it is + solid, a drop if it is liquid, is to be added to about a third part of one + hundred grains of sugar of milk in an unglazed porcelain capsule which has + had the polish removed from the lower part of its cavity by rubbing it + with wet sand; they are to be mingled for an instant with a bone or horn + spatula, and then rubbed together for six minutes; then the mass is to be + scraped together from the mortar and pestle, which is to take four + minutes; then to be again rubbed for six minutes. Four minutes are then to + be devoted to scraping the powder into a heap, and the second third of the + hundred grains of sugar of milk to be added. Then they are to be stirred + an instant and rubbed six minutes,—again to be scraped together four + minutes and forcibly rubbed six; once more scraped together for four + minutes, when the last third of the hundred grains of sugar of milk is to + be added and mingled by stirring with the spatula; six minutes of forcible + rubbing, four of scraping together, and six more (positively the last six) + of rubbing, finish this part of the process. + </p> + <p> + Every grain of this powder contains the hundredth of a grain of the + medicinal substance mingled with the sugar of milk. If, therefore, a grain + of the powder just prepared is mingled with another hundred grains of + sugar of milk, and the process just described repeated, we shall have a + powder of which every grain contains the hundredth of the hundredth, or + the ten thousandth part of a grain of the medicinal substance. Repeat the + same process with the same quantity of fresh sugar of milk, and every + grain of your powder will contain the millionth of a grain of the + medicinal substance. When the powder is of this strength, it is ready to + employ in the further solutions and dilutions to be made use of in + practice. + </p> + <p> + A grain of the powder is to be taken, a hundred drops of alcohol are to be + poured on it, the vial is to be slowly turned for a few minutes, until the + powder is dissolved, and two shakes are to be given to it. On this point I + will quote Hahnemann's own words. “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. + </p> + <p> + As an instance of the strength of the medicines prescribed by Hahnemann, I + will mention carbonate of lime. He does not employ common chalk, but + prefers a little portion of the friable part of an oystershell. Of this + substance, carried to the sextillionth degree, so much as one or two + globules of the size mentioned can convey is a common dose. But for + persons of very delicate nerves it is proper that the dilution should be + carried to the decillionth degree. That is, an important medicinal effect + is to be expected from the two hundredth or hundredth part of the + millionth of the millionth of the millionth of the millionth of the + millionth of the millionth of the millionth of the millionth of the + millionth of the millionth of a grain of oyster-shell. This is only the + tenth degree of potency, but some of his disciples profess to have + obtained palpable effects from “much higher dilutions.” + </p> + <p> + The third great doctrine of Hahnemann is the following. Seven eighths at + least of all chronic diseases are produced by the existence in the system + of that infectious disorder known in the language of science by the + appellation of PSORA, but to the less refined portion of the community by + the name of ITCH. In the words of Hahnemann's “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,—” + </p> + <p> + [“The degrees of DILUTION must not be confounded with those of POTENCY. + Their relations may be seen by this table: + </p> + <p> + lst dilution,—One hundredth of a drop or grain. + </p> + <p> + 2d “ One ten thousandth. + </p> + <p> + 3d “ One millionth, marked I. + </p> + <p> + 4th “ One hundred millionth. + </p> + <p> + 5th “ One ten thousand millionth. + </p> + <p> + 6th “ One million millionth, or one billionth, marked II. + </p> + <p> + 7th “ One hundred billionth. + </p> + <p> + 8th “ One ten thousand billionth. + </p> + <p> + 9th “ One million billionth, or one trillionth, marked III. + </p> + <p> + 10th “ One hundred trillionth. + </p> + <p> + 11th “ One ten thousand trillionth. + </p> +<pre xml:space="preserve"> +12th “ One million trillionth, or one quadrillionth, marked + IV.,—and so on indefinitely. +</pre> + <p> + The large figures denote the degrees of POTENCY.] + </p> + <p> + “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.” + </p> + <p> + For the last three centuries, if the same authority may be trusted, under + the influence of the more refined personal habits which have prevailed, + and the application of various external remedies which repel the affection + from the skin; Psora has revealed itself in these numerous forms of + internal disease, instead of appearing, as in former periods, under the + aspect of an external malady. + </p> + <p> + These are the three cardinal doctrines of Hahnemann, as laid down in those + standard works of Homoeopathy, the “Organon” and the “Treatise on Chronic + Diseases.” + </p> + <p> + Several other principles may be added, upon all of which he insists with + great force, and which are very generally received by his disciples. + </p> + <p> + 1. Very little power is allowed to the curative efforts of nature. + Hahnemann goes so far as to say that no one has ever seen the simple + efforts of nature effect the durable recovery of a patient from a chronic + disease. In general, the Homoeopathist calls every recovery which happens + under his treatment a cure. + </p> + <p> + 2. Every medicinal substance must be administered in a state of the most + perfect purity, and uncombined with any other. The union of several + remedies in a single prescription destroys its utility, and, according to + the “Organon,” frequently adds a new disease. + </p> + <p> + 3. A large number of substances commonly thought to be inert develop great + medicinal powers when prepared in the manner already described; and a + great proportion of them are ascertained to have specific antidotes in + case their excessive effects require to be neutralized. + </p> + <p> + 4. Diseases should be recognized, as far as possible, not by any of the + common names imposed upon them, as fever or epilepsy, but as individual + collections of symptoms, each of which differs from every other + collection. + </p> + <p> + 5. The symptoms of any complaint must be described with the most minute + exactness, and so far as possible in the patient's own words. To + illustrate the kind of circumstances the patient is expected to record, I + will mention one or two from the 313th page of the “Treatise on Chronic + Diseases,”—being the first one at which I opened accidentally. + </p> + <p> + “After dinner, disposition to sleep; the patient winks.” + </p> + <p> + “After dinner, prostration and feeling of weakness (nine days after taking + the remedy).” + </p> + <p> + 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. + </p> + <p> + So much for the doctrines of Hahnemann, which have been stated without + comment, or exaggeration of any of their features, very much as any + adherent of his opinions might have stated them, if obliged to compress + them into so narrow a space. + </p> + <p> + Does Hahnemann himself represent Homoeopathy as it now exists? He + certainly ought to be its best representative, after having created it, + and devoted his life to it for half a century. He is spoken of as the + great physician of the time, in most, if not all Homoeopathic works. If he + is not authority on the subject of his own doctrines, who is? So far as I + am aware, not one tangible discovery in the so-called science has ever + been ascribed to any other observer; at least, no general principle or + law, of consequence enough to claim any prominence in Homoeopathic works, + has ever been pretended to have originated with any of his illustrious + disciples. He is one of the only two Homoeopathic writers with whom, as I + shall mention, the Paris publisher will have anything to do upon his own + account. The other is Jahr, whose Manual is little more than a catalogue + of symptoms and remedies. If any persons choose to reject Hahnemann as not + in the main representing Homoeopathy, if they strike at his authority, if + they wink out of sight his deliberate and formally announced results, it + is an act of suicidal rashness; for upon his sagacity and powers of + observation, and experience, as embodied in his works, and especially in + his Materia Medica, repose the foundations of Homoeopathy as a practical + system. + </p> + <p> + So far as I can learn from the conflicting statements made upon the + subject, the following is the present condition of belief. + </p> + <p> + 1. All of any note agree that the law Similia similibus is the only + fundamental principle in medicine. Of course if any man does not agree to + this the name Homoeopathist can no longer be applied to him with + propriety. + </p> + <p> + 2. The belief in and employment of the infinitesimal doses is general, and + in some places universal, among the advocates of Homoeopathy; but a + distinct movement has been made in Germany to get rid of any restriction + to the use of these doses, and to employ medicines with the same license + as other practitioners. + </p> + <p> + 3. The doctrine of the origin of most chronic diseases in Psora, + notwithstanding Hahnemann says it cost him twelve years of study and + research to establish the fact and its practical consequences, has met + with great neglect and even opposition from very many of his own + disciples. + </p> + <p> + It is true, notwithstanding, that, throughout most of their writings which + I have seen, there runs a prevailing tone of great deference to + Hahnemann's opinions, a constant reference to his authority, a general + agreement with the minor points of his belief, and a pretence of + harmonious union in a common faith. [Those who will take the trouble to + look over Hull's Translation of Jahr's Manual may observe how little + comparative space is given to remedies resting upon any other authority + than that of Hahnemann.] + </p> + <p> + Many persons, and most physicians and scientific men, would be satisfied + with the statement of these doctrines, and examine them no further. They + would consider it vastly more probable that any observer in so fallacious + and difficult a field of inquiry as medicine had been led into error, or + walked into it of his own accord, than that such numerous and + extraordinary facts had really just come to light. They would feel a right + to exercise the same obduracy towards them as the French Institute is in + the habit of displaying when memoirs or models are offered to it relating + to the squaring of the circle or perpetual motion; which it is the rule to + pass over without notice. They would feel as astronomers and natural + philosophers must have felt when, some half a dozen years ago, an unknown + man came forward, and asked for an opportunity to demonstrate to Arago and + his colleagues that the moon and planets were at a distance of a little + more than a hundred miles from the earth. And so they would not even look + into Homoeopathy, though all its advocates should exclaim in the words of + Mr. Benjamin Douglass Perkins, vender of the Metallic Tractors, that “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. + </p> + <p> + But experience has shown that the character of these assertions is not + sufficient to deter many, from examining their claims to belief. I + therefore lean but very slightly on the extravagance and extreme apparent + singularity of their pretensions. I might have omitted them, but on the + whole it seemed more just to the claims of my argument to suggest the vast + complication of improbabilities involved in the statements enumerated. + Every one must of course judge for himself as to the weight of these + objections, which are by no means brought forward as a proof of the + extravagance of Homoeopathy, but simply as entitled to a brief + consideration before the facts of the case are submitted to our scrutiny. + </p> + <p> + The three great asserted discoveries of Hahnemann are entirely unconnected + with and independent of each other. Were there any natural relation + between them it would seem probable enough that the discovery of the first + would have led to that of the others. But assuming it to be a fact that + diseases are cured by remedies capable of producing symptoms like their + own, no manifest relation exists between this fact and the next assertion, + namely, the power of the infinitesimal doses. And allowing both these to + be true, neither has the remotest affinity to the third new doctrine, that + which declares seven eighths of all chronic diseases to be owing to Psora. + </p> + <p> + This want of any obvious relation between Hahnemann's three cardinal + doctrines appears to be self-evident upon inspection. But if, as is often + true with his disciples, they prefer the authority of one of their own + number, I will refer them to Dr. Trinks's paper on the present state of + Homoeopathy in Europe, with which, of course, they are familiar, as his + name is mentioned as one of the most prominent champions of their faith, + in their American official organ. It would be a fact without a parallel in + the history, not merely of medicine, but of science, that three such + unconnected and astonishing discoveries, each of them a complete + revolution of all that ages of the most varied experience had been taught + to believe, should spring full formed from the brain of a single + individual. + </p> + <p> + Let us look a moment at the first of his doctrines. Improbable though it + may seem to some, there is no essential absurdity involved in the + proposition that diseases yield to remedies capable of producing like + symptoms. There are, on the other hand, some analogies which lend a degree + of plausibility to the statement. There are well-ascertained facts, known + from the earliest periods of medicine, showing that, under certain + circumstances, the very medicine which, from its known effects, one would + expect to aggravate the disease, may contribute to its relief. I may be + permitted to allude, in the most general way, to the case in which the + spontaneous efforts of an overtasked stomach are quieted by the agency of + a drug which that organ refuses to entertain upon any terms. But that + every cure ever performed by medicine should have been founded upon this + principle, although without the knowledge of a physician; that the + Homoeopathic axiom is, as Hahnemann asserts, “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. + </p> + <p> + So much ridicule has been thrown upon the pretended powers of the minute + doses that I shall only touch upon this point for the purpose of + conveying, by illustrations, some shadow of ideas far transcending the + powers of the imagination to realize. It must be remembered that these + comparisons are not matters susceptible of dispute, being founded on + simple arithmetical computations, level to the capacity of any intelligent + schoolboy. A person who once wrote a very small pamphlet made some show of + objecting to calculations of thus kind, on the ground that the highest + dilutions could easily be made with a few ounces of alcohol. But he should + have remembered that at every successive dilution he lays aside or throws + away ninety-nine hundredths of the fluid on which he is operating, and + that, although he begins with a drop, he only prepares a millionth, + billionth, trillionth, and similar fractions of it, all of which, added + together, would constitute but a vastly minute portion of the drop with + which he began. But now let us suppose we take one single drop of the + Tincture of Camomile, and that the whole of this were to be carried + through the common series of dilutions. + </p> + <p> + A calculation nearly like the following was made by Dr. Panvini, and may + be readily followed in its essential particulars by any one who chooses. + </p> + <p> + For the first dilution it would take 100 drops of alcohol. + </p> + <p> + For the second dilution it would take 10,000 drops, or about a pint. + </p> + <p> + For the third dilution it would take 100 pints. + </p> + <p> + For the fourth dilution it would take 10,000 pints, or more than 1,000 + gallons, and so on to the ninth dilution, which would take ten billion + gallons, which he computed would fill the basin of Lake Agnano, a body of + water two miles in circumference. The twelfth dilution would of course + fill a million such lakes. By the time the seventeenth degree of dilution + should be reached, the alcohol required would equal in quantity the waters + of ten thousand Adriatic seas. Trifling errors must be expected, but they + are as likely to be on one side as the other, and any little matter like + Lake Superior or the Caspian would be but a drop in the bucket. + </p> + <p> + Swallowers of globules, one of your little pellets, moistened in the + mingled waves of one million lakes of alcohol, each two miles in + circumference, with which had been blended that one drop of Tincture of + Camomile, would be of precisely the strength recommended for that medicine + in your favorite Jahr's Manual, “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).] + </p> + <p> + And proceeding on the common data, I have just made a calculation which + shows that this single drop of Tincture of Camomile, given in the quantity + ordered by Jahr's Manual, would have supplied every individual of the + whole human family, past and present, with more than five billion doses + each, the action of each dose lasting about four days. + </p> + <p> + Yet this is given only at the quadrillionth, or fourth degree of potency, + and various substances are frequently administered at the decillionth or + tenth degree, and occasionally at still higher attenuations with professed + medicinal results. Is there not in this as great an exception to all the + hitherto received laws of nature as in the miracle of the loaves and + fishes? Ask this question of a Homoeopathist, and he will answer by + referring to the effects produced by a very minute portion of vaccine + matter, or the extraordinary diffusion of odors. But the vaccine matter is + one of those substances called morbid poisons, of which it is a peculiar + character to multiply themselves, when introduced into the system, as a + seed does in the soil. Therefore the hundredth part of a grain of the + vaccine matter, if no more than this is employed, soon increases in + quantity, until, in the course of about a week, it is a grain or more, and + can be removed in considerable drops. And what is a very curious + illustration of Homoeopathy, it does not produce its most characteristic + effects until it is already in sufficient quantity not merely to be + visible, but to be collected for further use. The thoughtlessness which + can allow an inference to be extended from a product of disease possessing + this susceptibility of multiplication when conveyed into the living body, + to substances of inorganic origin, such as silex or sulphur, would be + capable of arguing that a pebble may produce a mountain, because an acorn + can become a forest. + </p> + <p> + As to the analogy to be found between the alleged action of the infinitely + attenuated doses, and the effects of some odorous substances which possess + the extraordinary power of diffusing their imponderable emanations through + a very wide space, however it may be abused in argument, and rapidly as it + evaporates on examination, it is not like that just mentioned, wholly + without meaning. The fact of the vast diffusion of some odors, as that of + musk or the rose, for instance, has long been cited as the most remarkable + illustration of the divisibility of matter, and the nicety of the senses. + And if this were compared with the effects of a very minute dose of + morphia on the whole system, or the sudden and fatal impression of a + single drop of prussic acid, or, with what comes still nearer, the + poisonous influence of an atmosphere impregnated with invisible malaria, + we should find in each of these examples an evidence of the degree to + which nature, in some few instances, concentrates powerful qualities in + minute or subtile forms of matter. But if a man comes to me with a pestle + and mortar in his hand, and tells me that he will take a little speck of + some substance which nobody ever thought to have any smell at all, as, for + instance, a grain of chalk or of charcoal, and that he will, after an hour + or two of rubbing and scraping, develop in a portion of it an odor which, + if the whole grain were used, would be capable of pervading an apartment, + a house, a village, a province, an empire, nay, the entire atmosphere of + this broad planet upon which we tread; and that from each of fifty or + sixty substances he can in this way develop a distinct and hitherto + unknown odor: and if he tries to show that all this is rendered quite + reasonable by the analogy of musk and roses, I shall certainly be + justified in considering him incapable of reasoning, and beyond the reach + of my argument. What if, instead of this, he professes to develop new and + wonderful medicinal powers from the same speck of chalk or charcoal, in + such proportions as would impregnate every pond, lake, river, sea, and + ocean of our globe, and appeals to the same analogy in favor of the + probability of his assertion. + </p> + <p> + All this may be true, notwithstanding these considerations. But so + extraordinary would be the fact, that a single atom of substances which a + child might swallow without harm by the teaspoonful could, by an easy + mechanical process, be made to develop such inconceivable powers, that + nothing but the strictest agreement of the most cautious experimenters, + secured by every guaranty that they were honest and faithful, appealing to + repeated experiments in public, with every precaution to guard against + error, and with the most plain and peremptory results, should induce us to + lend any credence to such pretensions. + </p> + <p> + The third doctrine, that Psora, the other name of which you remember, is + the cause of the great majority of chronic diseases, is a startling one, + to say the least. That an affection always recognized as a very unpleasant + personal companion, but generally regarded as a mere temporary + incommodity, readily yielding to treatment in those unfortunate enough to + suffer from it, and hardly known among the better classes of society, + should be all at once found out by a German physician to be the great + scourge of mankind, the cause of their severest bodily and mental + calamities, cancer and consumption, idiocy and madness, must excite our + unqualified surprise. And when the originator of this singular truth + ascribes, as in the page now open before me, the declining health of a + disgraced courtier, the chronic malady of a bereaved mother, even the + melancholy of the love-sick and slighted maiden, to nothing more nor less + than the insignificant, unseemly, and almost unmentionable ITCH, does it + not seem as if the very soil upon which we stand were dissolving into + chaos, over the earthquake-heaving of discovery? + </p> + <p> + And when one man claims to have established these three independent + truths, which are about as remote from each other as the discovery of the + law of gravitation, the invention of printing, and that of the mariner's + compass, unless the facts in their favor are overwhelming and unanimous, + the question naturally arises, Is not this man deceiving himself, or + trying to deceive others? + </p> + <p> + I proceed to examine the proofs of the leading ideas of Hahnemann and his + school. + </p> + <p> + In order to show the axiom, similia similibus curantur (or like is cured + by like), to be the basis of the healing art,—“the sole law of + nature in therapeutics,”—it is necessary, + </p> + <p> + 1. That the symptoms produced by drugs in healthy persons should be + faithfully studied and recorded. + </p> + <p> + 2. That drugs should be shown to be always capable of curing those + diseases most like their own symptoms. + </p> + <p> + 3. That remedies should be shown not to cure diseases when they do not + produce symptoms resembling those presented in these diseases. + </p> + <p> + 1. The effects of drugs upon healthy persons have been studied by + Hahnemann and his associates. Their results were made known in his Materia + Medica, a work in three large volumes in the French translation, published + about eight years ago. The mode of experimentation appears to have been, + to take the substance on trial, either in common or minute doses, and then + to set down every little sensation, every little movement of mind or body, + which occurred within many succeeding hours or days, as being produced + solely by the substance employed. When I have enumerated some of the + symptoms attributed to the power of the drugs taken, you will be able to + judge how much value is to be ascribed to the assertions of such + observers. + </p> + <p> + The following list was taken literally from the Materia Medica of + Hahnemann, by my friend M. Vernois, for whose accuracy I am willing to be + responsible. He has given seven pages of these symptoms, not selected, but + taken at hazard from the French translation of the work. I shall be very + brief in my citations. + </p> + <p> + “After stooping some time, sense of painful weight about the head upon + resuming the erect posture.” + </p> + <p> + “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. + </p> + <p> + 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.” + </p> + <p> + I might extend this catalogue almost indefinitely. I have not cited these + specimens with any view to exciting a sense of the ridiculous, which many + others of those mentioned would not fail to do, but to show that the + common accidents of sensation, the little bodily inconveniences to which + all of us are subject, are seriously and systematically ascribed to + whatever medicine may have been exhibited, even in the minute doses I have + mentioned, whole days or weeks previously. + </p> + <p> + To these are added all the symptoms ever said by anybody, whether + deserving confidence or not, as I shall hereafter illustrate, to be + produced by the substance in question. + </p> + <p> + The effects of sixty-four medicinal substances, ascertained by one or both + of these methods, are enumerated in the Materia Medica of Hahnemann, which + may be considered as the basis of practical Homoeopathy. In the Manual of + Jahr, which is the common guide, so far as I know, of those who practise + Homoeopathy in these regions, two hundred remedies are enumerated, many of + which, however, have never been employed in practice. In at least one + edition there were no means of distinguishing those which had been tried + upon the sick from the others. It is true that marks have been added in + the edition employed here, which serve to distinguish them; but what are + we to think of a standard practical author on Materia Medica, who at one + time omits to designate the proper doses of his remedies, and at another + to let us have any means of knowing whether a remedy has ever been tried + or not, while he is recommending its employment in the most critical and + threatening diseases? + </p> + <p> + I think that, from what I have shown of the character of Hahnemann's + experiments, it would be a satisfaction to any candid inquirer to know + whether other persons, to whose assertions he could look with confidence, + confirm these pretended facts. Now there are many individuals, long and + well known to the scientific world, who have tried these experiments upon + healthy subjects, and utterly deny that their effects have at all + corresponded to Hahnemann's assertions. + </p> + <p> + I will take, for instance, the statements of Andral (and I am not + referring to his well-known public experiments in his hospital) as to the + result of his own trials. This distinguished physician is Professor of + Medicine in the School of Paris, and one of the most widely known and + valued authors upon practical and theoretical subjects the profession can + claim in any country. He is a man of great kindness of character, a most + liberal eclectic by nature and habit, of unquestioned integrity, and is + called, in the leading article of the first number of the “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. + </p> + <p> + M. Double, a well-known medical writer and a physician of high standing in + Paris, had occasion so long ago as 1801, before he had heard of + Homoeopathy, to make experiments upon Cinchona, or Peruvian bark. He and + several others took the drug in every kind of dose for four months, and + the fever it is pretended by Hahnemann to excite never was produced. + </p> + <p> + M. Bonnet, President of the Royal Society of Medicine of Bordeaux, had + occasion to observe many soldiers during the Peninsular War, who made use + of Cinchona as a preservative against different diseases, but he never + found it to produce the pretended paroxysms. + </p> + <p> + If any objection were made to evidence of this kind, I would refer to the + express experiments on many of the Homoeopathic substances, which were + given to healthy persons with every precaution as to diet and regimen, by + M. Louis Fleury, without being followed by the slightest of the pretended + consequences. And let me mention as a curious fact, that the same quantity + of arsenic given to one animal in the common form of the unprepared + powder, and to another after having been rubbed up into six hundred + globules, offered no particular difference of activity in the two cases. + </p> + <p> + This is a strange contradiction to the doctrine of the development of what + they call dynamic power, by means of friction and subdivision. + </p> + <p> + In 1835 a public challenge was offered to the best known Homoeopathic + physician in Paris to select any ten substances asserted to produce the + most striking effects; to prepare them himself; to choose one by lot + without knowing which of them he had taken, and try it upon himself or any + intelligent and devoted Homoeopathist, and, waiting his own time, to come + forward and tell what substance had been employed. The challenge was at + first accepted, but the acceptance retracted before the time of trial + arrived. + </p> + <p> + From all this I think it fair to conclude that the catalogues of symptoms + attributed in Homoeopathic works to the influence of various drugs upon + healthy persons are not entitled to any confidence. + </p> + <p> + 2. It is necessary to show, in the next place, that medicinal substances + are always capable of curing diseases most like their own symptoms. For + facts relating to this question we must look to two sources; the recorded + experience of the medical profession in general, and the results of trials + made according to Homoeopathic principles, and capable of testing the + truth of the doctrine. + </p> + <p> + No person, that I am aware of, has ever denied that in some cases there + exists a resemblance between the effects of a remedy and the symptoms of + diseases in which it is beneficial. This has been recognized, as Hahnemann + himself has shown, from the time of Hippocrates. But according to the + records of the medical profession, as they have been hitherto interpreted, + this is true of only a very small proportion of useful remedies. Nor has + it ever been considered as an established truth that the efficacy of even + these few remedies was in any definite ratio to their power of producing + symptoms more or less like those they cured. + </p> + <p> + Such was the state of opinion when Hahnemann came forward with the + proposition that all the cases of successful treatment found in the works + of all preceding medical writers were to be ascribed solely to the + operation of the Homoeopathic principle, which had effected the cure, + although without the physician's knowledge that this was the real secret. + And strange as it may seem, he was enabled to give such a degree of + plausibility to this assertion, that any person not acquainted somewhat + with medical literature, not quite familiar, I should rather say, with the + relative value of medical evidence, according to the sources whence it is + derived, would be almost frightened into the belief, at seeing the pages + upon pages of Latin names he has summoned as his witnesses. + </p> + <p> + It has hitherto been customary, when examining the writings of authors of + preceding ages, upon subjects as to which they were less enlightened than + ourselves, and which they were very liable to misrepresent, to exercise + some little discretion; to discriminate, in some measure, between writers + deserving confidence and those not entitled to it. But there is not the + least appearance of any such delicacy on the part of Hahnemann. A large + majority of the names of old authors he cites are wholly unknown to + science. With some of them I have been long acquainted, and I know that + their accounts of diseases are no more to be trusted than their + contemporary Ambroise Pare's stories of mermen, and similar absurdities. + But if my judgment is rejected, as being a prejudiced one, I can refer to + Cullen, who mentioned three of Hahnemann's authors in one sentence, as + being “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.] + </p> + <p> + It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has proved + many of Hahnemann's quotations from old authors to be adulterate and + false. What particular instances he has pointed out I have no means of + learning. And it is probably wholly impossible on this side of the + Atlantic, and even in most of the public libraries of Europe, to find + anything more than a small fraction of the innumerable obscure + publications which the neglect of grocers and trunkmakers has spared to be + ransacked by the all-devouring genius of Homoeopathy. I have endeavored to + verify such passages as my own library afforded me the means of doing. For + some I have looked in vain, for want, as I am willing to believe, of more + exact references. But this I am able to affirm, that, out of the very + small number which I have been able, to trace back to their original + authors, I have found two to be wrongly quoted, one of them being a gross + misrepresentation. + </p> + <p> + The first is from the ancient Roman author, Caelius Aurelianus; the second + from the venerable folio of Forestus. Hahnemann uses the following + expressions,—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.] + </p> + <p> + In speaking of the oil of anise-seed, Hahnemann says that Forestus + observed violent colic caused by its administration. But, as the author + tells the story, a young man took, by the counsel of a surgeon, an acrid + and virulent medicine, the name of which is not given, which brought on a + most cruel fit of the gripes and colic. After this another surgeon was + called, who gave him oil of anise-seed and wine, “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. + </p> + <p> + Even if every word he had pretended to take from his old authorities were + to be found in them, even if the authority of every one of these authors + were beyond question, the looseness with which they are used to prove + whatever Hahnemann chooses is beyond the bounds of credibility. Let me + give one instance to illustrate the character of this man's mind. + Hahnemann asserts, in a note annexed to the 110th paragraph of the + “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. + </p> + <p> + “It was by these means (i.e. Homoeopathically) that the Princess Eudosia + with rose-water restored a person who had fainted!” + </p> + <p> + 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! + </p> + <p> + The whole process of demonstration he employs is this. An experiment is + instituted with some drug upon one or more healthy persons. Everything + that happens for a number of days or weeks is, as we have seen, set down + as an effect of the medicine. Old volumes are then ransacked + promiscuously, and every morbid sensation or change that anybody ever said + was produced by the drug in question is added to the list of symptoms. By + one or both of these methods, each of the sixty-four substances enumerated + by Hahnemann is shown to produce a very large number of symptoms, the + lowest in his scale being ninety-seven, and the highest fourteen hundred + and ninety-one. And having made out this list respecting any drug, a + catalogue which, as you may observe in any Homoeopathic manual, contains + various symptoms belonging to every organ of the body, what can be easier + than to find alleged cures in every medical author which can at once be + attributed to the Homoeopathic principle; still more if the grave of + extinguished credulity is called upon to give up its dead bones as living + witnesses; and worst of all, if the monuments of the past are to be + mutilated in favor of “the sole law of Nature in therapeutics”? + </p> + <p> + There are a few familiar facts of which great use has been made as an + entering wedge for the Homoeopathic doctrine. They have been suffered to + pass current so long that it is time they should be nailed to the counter, + a little operation which I undertake, with perfect cheerfulness, to + perform for them. + </p> + <p> + The first is a supposed illustration of the Homoeopathic law found in the + precept given for the treatment of parts which have been frozen, by + friction with snow or similar means. But we deceive ourselves by names, if + we suppose the frozen part to be treated by cold, and not by heat. The + snow may even be actually warmer than the part to which it is applied. But + even if it were at the same temperature when applied, it never did and + never could do the least good to a frozen part, except as a mode of + regulating the application of what? of heat. But the heat must be applied + gradually, just as food must be given a little at a time to those + perishing with hunger. If the patient were brought into a warm room, heat + would be applied very rapidly, were not something interposed to prevent + this, and allow its gradual admission. Snow or iced water is exactly what + is wanted; it is not cold to the part; it is very possibly warm, on the + contrary, for these terms are relative, and if it does not melt and let + the heat in, or is not taken away, the part will remain frozen up until + doomsday. Now the treatment of a frozen limb by heat, in large or small + quantities, is not Homoeopathy. + </p> + <p> + The next supposed illustration of the Homoeopathic law is the alleged + successful management of burns, by holding them to the fire. This is a + popular mode of treating those burns which are of too little consequence + to require any more efficacious remedy, and would inevitably get well of + themselves, without any trouble being bestowed upon them. It produces a + most acute pain in the part, which is followed by some loss of + sensibility, as happens with the eye after exposure to strong light, and + the ear after being subjected to very intense sounds. This is all it is + capable of doing, and all further notions of its efficacy must be + attributed merely to the vulgar love of paradox. If this example affords + any comfort to the Homoeopathist, it seems as cruel to deprive him of it + as it would be to convince the mistress of the smoke-jack or the flatiron + that the fire does not literally “draw the fire out,” which is her + hypothesis. + </p> + <p> + But if it were true that frost-bites were cured by cold and burns by heat, + it would be subversive, so far as it went, of the great principle of + Homoeopathy. + </p> + <p> + For you will remember that this principle is that Like cures Like, and not + that Same cures Same; that there is resemblance and not identity between + the symptoms of the disease and those produced by the drug which cures it, + and none have been readier to insist upon this distinction than the + Homoeopathists themselves. For if Same cures Same, then every poison must + be its own antidote,—which is neither a part of their theory nor + their so-called experience. They have been asked often enough, why it was + that arsenic could not cure the mischief which arsenic had caused, and why + the infectious cause of small-pox did not remedy the disease it had + produced, and then they were ready enough to see the distinction I have + pointed out. O no! it was not the hair of the same dog, but only of one + very much like him! + </p> + <p> + A third instance in proof of the Homoeopathic law is sought for in the + acknowledged efficacy of vaccination. And how does the law apply to this? + It is granted by the advocates of Homoeopathy that there is a resemblance + between the effects of the vaccine virus on a person in health and the + symptoms of small-pox. Therefore, according to the rule, the vaccine virus + will cure the small-pox, which, as everybody knows, is entirely untrue. + But it prevents small-pox, say the Homoeopathists. Yes, and so does + small-pox prevent itself from ever happening again, and we know just as + much of the principle involved in the one case as in the other. For this + is only one of a series of facts which we are wholly unable to explain. + Small-pox, measles, scarlet-fever, hooping-cough, protect those who have + them once from future attacks; but nettle-rash and catarrh and lung fever, + each of which is just as Homoeopathic to itself as any one of the others, + have no such preservative power. We are obliged to accept the fact, + unexplained, and we can do no more for vaccination than for the rest. + </p> + <p> + I come now to the most directly practical point connected with the + subject, namely,— + </p> + <p> + What is the state of the evidence as to the efficacy of the proper + Homoeopathic treatment in the cure of diseases. + </p> + <p> + As the treatment adopted by the Homoeopathists has been almost universally + by means of the infinitesimal doses, the question of their efficacy is + thrown open, in common with that of the truth of their fundamental axiom, + as both are tested in practice. + </p> + <p> + We must look for facts as to the actual working of Homoeopathy to three + sources. + </p> + <p> + 1. The statements of the unprofessional public. + </p> + <p> + 2. The assertions of Homoeopathic practitioners. + </p> + <p> + 3. The results of trials by competent and honest physicians, not pledged + to the system. + </p> + <p> + I think, after what we have seen of medical facts, as they are represented + by incompetent persons, we are disposed to attribute little value to all + statements of wonderful cures, coming from those who have never been + accustomed to watch the caprices of disease, and have not cooled down + their young enthusiasm by the habit of tranquil observation. Those who + know nothing of the natural progress of a malady, of its ordinary + duration, of its various modes of terminating, of its liability to + accidental complications, of the signs which mark its insignificance or + severity, of what is to be expected of it when left to itself, of how much + or how little is to be anticipated from remedies, those who know nothing + or next to nothing of all these things, and who are in a great state of + excitement from benevolence, sympathy, or zeal for a new medical + discovery, can hardly be expected to be sound judges of facts which have + misled so many sagacious men, who have spent their lives in the daily + study and observation of them. I believe that, after having drawn the + portrait of defunct Perkinism, with its five thousand printed cures, and + its million and a half computed ones, its miracles blazoned about through + America, Denmark, and England; after relating that forty years ago women + carried the Tractors about in their pockets, and workmen could not make + them fast enough for the public demand; and then showing you, as a + curiosity, a single one of these instruments, an odd one of a pair, which + I obtained only by a lucky accident, so utterly lost is the memory of all + their wonderful achievements; I believe, after all this, I need not waste + time in showing that medical accuracy is not to be looked for in the + florid reports of benevolent associations, the assertions of illustrious + patrons, the lax effusions of daily journals, or the effervescent gossip + of the tea-table. + </p> + <p> + Dr. Hering, whose name is somewhat familiar to the champions of + Homoeopathy, has said that “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.” + </p> + <p> + 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. + </p> + <p> + 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! + </p> + <p> + It is evidently impossible that I should attempt, within the compass of a + single lecture, any detailed examination of the very numerous cases + reported in the Homoeopathic Treatises and Journals. Having been in the + habit of receiving the French “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. + </p> + <p> + Suppose, then, a physician who has a hundred patients prescribes to each + of them pills made of some entirely inert substance, as starch, for + instance. Ninety of them get well, or if he chooses to use such language, + he cures ninety of them. It is evident, according to the doctrine of + chances, that there must be a considerable number of coincidences between + the relief of the patient and the administration of the remedy. It is + altogether probable that there will happen two or three very striking + coincidences out of the whole ninety cases, in which it would seem evident + that the medicine produced the relief, though it had, as we assumed, + nothing to do with it. Now suppose that the physician publishes these + cases, will they not have a plausible appearance of proving that which, as + we granted at the outset, was entirely false? Suppose that instead of + pills of starch he employs microscopic sugarplums, with the five' million + billion trillionth part of a suspicion of aconite or pulsatilla, and then + publishes his successful cases, through the leaden lips of the press, or + the living ones of his female acquaintances,—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! + </p> + <p> + I am sorry to see, also, that a degree of ignorance as to the natural + course of diseases is often shown in these published cases, which, + although it may not be detected by the unprofessional reader, conveys an + unpleasant impression to those who are acquainted with the subject. Thus a + young woman affected with jaundice is mentioned in the German “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. + </p> + <p> + Dr. Munneche of Lichtenburg in Saxony is called to a patient with sprained + ankle who had been a fortnight under the common treatment. The patient + gets well by the use of arnica in a little more than a month longer, and + this extraordinary fact is published in the French “Archives of + Homoeopathic Medicine.” + </p> + <p> + In the same Journal is recorded the case of a patient who with nothing + more, so far as any proof goes, than influenza, gets down to her shop upon + the sixth day. + </p> + <p> + And again, the cool way in which everything favorable in a case is set + down by these people entirely to their treatment, may be seen in a case of + croup reported in the “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. + </p> + <p> + I need not multiply these quotations, which illustrate the grounds of an + opinion which the time does not allow me to justify more at length; other + such cases are lying open before me; there is no end to them if more were + wanted; for nothing is necessary but to look into any of the numerous + broken-down Journals of Homoeopathy, the volumes of which may be found on + the shelves of those curious in such matters. + </p> + <p> + A number of public trials of Homoeopathy have been made in different parts + of the world. Six of these are mentioned in the Manifesto of the + “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. + </p> + <p> + There have been few names in the medical profession, for the last half + century, so widely known throughout the world of science as that of M. + Esquirol, whose life was devoted to the treatment of insanity, and who was + without a rival in that department of practical medicine. It is from an + analysis communicated by him to the “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. + </p> + <p> + All the rest were cases of grave disease; and so far as the trial, which + was interrupted about the fortieth day, extended, the patients grew worse, + or received no benefit. A case is reported on the page before me of a + soldier affected with acute inflammation in the chest, who took + successively aconite, bryonia, nux vomica, and pulsatilla, and after + thirty-eight days of treatment remained without any important change in + his disease. The Homoeopathic physician who treated these patients was M. + de Horatiis, who had the previous year been announcing his wonderful + cures. And M. Esquirol asserted to the Academy of Medicine in 1835, that + this M. de Horatiis, who is one of the prominent personages in the + “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. + </p> + <p> + 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.” + </p> + <p> + And he expressly asserts the entire nullity of the influence of all the + Homoeopathic remedies tried by him in modifying, so far as he could + observe, the progress or termination of diseases. It deserves notice that + he experimented with the most boasted substances,—cinchona, aconite, + mercury, bryonia, belladonna. Aconite, for instance, he says he + administered in more than forty cases of that collection of feverish + symptoms in which it exerts so much power, according to Hahnemann, and in + not one of them did it have the slightest influence, the pulse and heat + remaining as before. + </p> + <p> + These statements look pretty honest, and would seem hard to be explained + away, but it is calmly said that he “did not know enough of the method to + select the remedies with any tolerable precision.” [“Homoeopathic + Examiner, vol. i. p. 22.] + </p> + <p> + “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. + </p> + <p> + Dr. Baillie, one of the physicians in the great Hotel Dieu of Paris, + invited two Homoeopathic practitioners to experiment in his wards. One of + these was Curie, now of London, whose works are on the counters of some of + our bookstores, and probably in the hands of some of my audience. This + gentleman, whom Dr. Baillie declares to be an enlightened man, and + perfectly sincere in his convictions, brought his own medicines from the + pharmacy which furnished Hahnemann himself, and employed them for four or + five months upon patients in his ward, and with results equally + unsatisfactory, as appears from Dr. Baillie's statement at a meeting of + the Academy of Medicine. And a similar experiment was permitted by the + Clinical Professor of the Hotel Dieu of Lyons, with the same complete + failure. + </p> + <p> + But these are old and prejudiced practitioners. Very well, then take the + statement of Dr. Fleury, a most intelligent young physician, who treated + homoeopathically more than fifty patients, suffering from diseases which + it was not dangerous to treat in this way, taking every kind of precaution + as to regimen, removal of disturbing influences, and the state of the + atmosphere, insisted upon by the most vigorous partisans of the doctrine, + and found not the slightest effect produced by the medicines. And more + than this, read nine of these cases, which he has published, as I have + just done, and observe the absolute nullity of aconite, belladonna, and + bryonia, against the symptoms over which they are pretended to exert such + palpable, such obvious, such astonishing influences. In the view of these + statements, it is impossible not to realize the entire futility of + attempting to silence this asserted science by the flattest and most + peremptory results of experiment. Were all the hospital physicians of + Europe and America to devote themselves, for the requisite period, to this + sole pursuit, and were their results to be unanimous as to the total + worthlessness of the whole system in practice, this slippery delusion + would slide through their fingers without the slightest discomposure, + when, as they supposed, they had crushed every joint in its tortuous and + trailing body. + </p> + <p> + 3. I have said, that to show the truth of the Homoeopathic doctrine, as + announced by Hahnemann, it would be necessary to show, in the third place, + that remedies never cure diseases when they are not capable of producing + similar symptoms! The burden of this somewhat comprehensive demonstration + lying entirely upon the advocates of this doctrine, it may be left to + their mature reflections. + </p> + <p> + It entered into my original plan to treat of the doctrine relating to + Psora, or itch,—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.” + </p> + <p> + But, in the face of all this, the following remarks are made by Wolff, of + Dresden, whose essays, according to the editor of the “Homoeopathic + Examiner,” “represent the opinions of a large majority of Homoeopathists + in Europe.” + </p> + <p> + “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.” + </p> + <p> + 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. + </p> + <p> + 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. + </p> + <p> + I will close the subject with a brief examination of some of the + statements made in Homoeopathic works, and more particularly in the + brilliant Manifesto of the “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. + </p> + <p> + But not being evidence in the case, I will give you the testimony of Dr. + Trinks, of Dresden, who flourishes on the fifteenth page of the same + Manifesto as one of the most distinguished among the Homoeopathists of + Europe. I translate the sentence literally from the “Archives de la + Medecine Homoeopathique.” + </p> + <p> + “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.” + </p> + <p> + It is a very natural as well as a curious question to ask, What has been + the success of Homoeopathy in the different countries of Europe, and what + is its present condition? + </p> + <p> + The greatest reliance of the advocates of Homoeopathy is of course on + Germany. We know very little of its medical schools, its medical + doctrines, or its medical men, compared with those of England and France. + And, therefore, when an intelligent traveller gives a direct account from + personal inspection of the miserable condition of the Homoeopathic + hospital at Leipsic, the first established in Europe, and the first on the + list of the ever-memorable Manifesto, it is easy enough answer or elude + the fact by citing various hard names of “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. + </p> + <p> + As for the act of this or that government tolerating or encouraging + Homoeopathy, every person of common intelligence knows that it is a mere + form granted or denied according to the general principles of policy + adopted in different states, or the degree of influence which some few + persons who have adopted it may happen to have at court. What may be the + value of certain pompous titles with which many of the advocates of + Homoeopathy are honored, it might be disrespectful to question. But in the + mean time the judicious inquirer may ponder over an extract which I + translate from a paper relating to a personage well known to the community + as Williams the Oculist, with whom I had the honor of crossing the + Atlantic some years since, and who himself handed me two copies of the + paper in question. + </p> + <p> + “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. + </p> + <p> + And as to one more point, it is time that the public should fully + understand that the common method of supporting barefaced imposture at the + present day, both in Europe and in this country, consists in trumping up + “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. + </p> + <p> + But if we cannot easily get at Germany, we can very easily obtain exact + information from France and England. I took the trouble to write some + months ago to two friends in Paris, in whom I could place confidence, for + information upon the subject. One of them answered briefly to the effect + that nothing was said about it. When the late Curator of the Lowell + Institute, at his request, asked about the works upon the subject, he was + told that they had remained a long time on the shelves quite unsalable, + and never spoken of. + </p> + <p> + The other gentleman, [Dr. Henry T. Bigelow, now Professor of Surgery in + Harvard University] whose name is well known to my audience, and who needs + no commendation of mine, had the kindness to procure for me many + publications upon the subject, and some information which sets the whole + matter at rest, so far as Paris is concerned. He went directly to the + Baillieres, the principal and almost the only publishers of all the + Homoeopathic books and journals in that city. The following facts were + taken by him from the account-books of this publishing firm. Four + Homoeopathic Journals have been published in Paris; three of them by the + Baillieres. + </p> + <p> + The reception they met with may be judged of by showing the number of + subscribers to each on the books of the publishing firm. + </p> + <p> + A Review published by some other house, which lasted one year, and had + about fifty subscribers, appeared in 1834, 1835. + </p> + <p> + There were only four Journals of Homoeopathy ever published in Paris. The + Baillieres informed my correspondent that the sale of Homoeopathic books + was much less than formerly, and that consequently they should undertake + to publish no new books upon the subject, except those of Jahr or + Hahnemann. “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. + </p> + <p> + Homoeopathy was in its prime in Paris, he said, in 1836 and 1837, and + since then has been going down. + </p> + <p> + Louis told my correspondent that no person of distinction in Paris had + embraced Homoeopathy, and that it was declining. If you ask who Louis is, + I refer you to the well-known Homoeopathist, Peschier of Geneva, who says, + addressing him, “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.” + </p> + <p> + 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.” + </p> + <p> + Here is a literal translation of an original letter, now in my possession, + from one of these Homoeopathists to my correspondent:— + </p> + <p> + “DEAR SIR, AND RESPECTED PROFESSIONAL BROTHER: + </p> + <p> + “You have had the kindness to inform me in your letter that a new American + Journal, the 'New World,' has made use of my name in support of the + pretended Homoeopathic doctrines, and that I am represented as one of the + warmest partisans of Homoeopathy in France. + </p> + <p> + “I am vastly surprised at the reputation manufactured for me upon the new + continent; but I am obliged, in deference to truth, to reject it with my + whole energy. I spurn far from me everything which relates to that + charlatanism called Homoeopathy, for these pretended doctrines cannot + endure the scrutiny of wise and enlightened persons, who are guided by + honorable sentiments in the practice of the noblest of arts. + </p> + <p> + “PARIS, 3d November, 1841 + </p> + <p> + “I am, etc., etc., + </p> + <p> + “G. BRESCHET, + </p> + <p> + “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] + </p> + <p> + Concerning Amussat, my correspondent writes, that he was informed by + Madame Hahnemann, who converses in French more readily than her husband, + and therefore often speaks for him, that “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.” + </p> + <p> + I regret not having made any inquiries as to Marjolin, who, I doubt not, + would strike his ponderous snuff-box until it resounded like the Grecian + horse, at hearing such a doctrine associated with his respectable name. I + was not aware, when writing to Paris, that this worthy Professor, whose + lectures I long attended, was included in these audacious claims; but + after the specimens I have given of the accuracy of the foreign + correspondence of the “Homoeopathic Examiner,” any further information I + might obtain would seem so superfluous as hardly to be worth the postage. + </p> + <p> + Homoeopathy may be said, then, to be in a sufficiently miserable condition + in Paris. Yet there lives, and there has lived for years, the illustrious + Samuel Hahnemann, who himself assured my correspondent that no place + offered the advantages of Paris in its investigation, by reason of the + attention there paid to it. + </p> + <p> + In England, it appears by the statement of Dr. Curie in October, 1839, + about eight years after its introduction into the country, that there were + eighteen Homoeopathic physicians in the United Kingdom, of whom only three + were to be found out of London, and that many of these practised + Homoeopathy in secret. + </p> + <p> + It will be seen, therefore, that, according to the recent statement of one + of its leading English advocates, Homoeopathy had obtained not quite half + as many practical disciples in England as Perkinism could show for itself + in a somewhat less period from the time of its first promulgation in that + country. + </p> + <p> + Dr. Curie's letter, dated London, October 30, 1839, says there is “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.” + </p> + <p> + But the Marquis of Anglesea and Sir Edward Lytton Bulwer patronize + Homoeopathy; the Queen Dowager Adelaide has been treated by a Homoeopathic + physician. “Jarley is the delight of the nobility and gentry.” “The Royal + Family are the patrons of Jarley.” + </p> + <p> + Let me ask if a Marquis and a Knight are better than two Lords, and if the + Dowager of Royalty is better than Royalty itself, all of which illustrious + dignities were claimed in behalf of Benjamin Douglass Perkins? + </p> + <p> + But if the balance is thought too evenly suspended in this case, another + instance can be given in which the evidence of British noblemen and their + ladies is shown to be as valuable in establishing the character of a + medical man or doctrine, as would be the testimony of the Marquis of + Waterford concerning the present condition and prospects of missionary + enterprise. I have before me an octavo volume of more than four hundred + pages, in which, among much similar matter, I find highly commendatory + letters from the Marchioness of Ormond, Lady Harriet Kavanagh, the + Countess of Buckinghamshire, the Right Hon. Viscount Ingestre, M. P., and + the Most Noble, the Marquis of Sligo,—all addressed to “John St. + John Long, Esq,” a wretched charlatan, twice tried for, and once convicted + of, manslaughter at the Old Bailey. + </p> + <p> + This poor creature, too, like all of his tribe, speaks of the medical + profession as a great confederation of bigoted monopolists. He, too, says + that “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. + </p> + <p> + In 1628, Harvey published his first work upon the circulation. His + doctrines were a complete revolution of the prevailing opinions of all + antiquity. They immediately found both champions and opponents; of which + last, one only, Riolanus, seemed to Harvey worthy of an answer, on account + of his “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. + </p> + <p> + 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. + </p> + <p> + The opinions sanctioned by the authority of long ages, and the names of + Hippocrates and Galen, dissolved away, gradually, but certainly, before + the demonstrations of Harvey. Twenty-four years after the publication of + his first work, and six years before his death, his bust in marble was + placed in the Hall of the College of Physicians, with a suitable + inscription recording his discoveries. + </p> + <p> + Two years after this he was unanimously invited to accept the Presidency + of that body; and he lived to see his doctrine established, and all + reputable opposition withdrawn. + </p> + <p> + There were many circumstances connected with the discovery of Dr. Jenner + which were of a nature to excite repugnance and opposition. The practice + of inoculation for the small-pox had already disarmed that disease of many + of its terrors. The introduction of a contagious disease from a brute + creature into the human system naturally struck the public mind with a + sensation of disgust and apprehension, and a part of the medical public + may have shared these feelings. I find that Jenner's discovery of + vaccination was made public in June, 1798. In July of the same year the + celebrated surgeon, Mr. Cline, vaccinated a child with virus received from + Dr. Jenner, and in communicating the success of this experiment, he + mentions that Dr. Lister, formerly of the Small-Pox Hospital, and himself, + are convinced of the efficacy of the cow-pox. In November of the same + year, Dr. Pearson published his “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.” + </p> + <p> + 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.) + </p> + <p> + These and similar accusations, so often brought up against the Medical + Profession, are only one mode in which is manifested a spirit of + opposition not merely to medical science, but to all science, and to all + sound knowledge. It is a spirit which neither understands itself nor the + object at which it is aiming. It gropes among the loose records of the + past, and the floating fables of the moment, to glean a few truths or + falsehoods tending to prove, if they prove anything, that the persons who + have passed their lives in the study of a branch of knowledge the very + essence of which must always consist in long and accurate observation, are + less competent to judge of new doctrines in their own department than the + rest of the community. It belongs to the clown in society, the destructive + in politics, and the rogue in practice. + </p> + <p> + The name of Harvey, whose great discovery was the legitimate result of his + severe training and patient study, should be mentioned only to check the + pretensions of presumptuous ignorance. The example of Jenner, who gave his + inestimable secret, the result of twenty-two years of experiment and + researches, unpurchased, to the public,—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. + </p> + <p> + Homoeopathy has had a still more extended period of trial than this, and + we have seen with what results. It only remains to throw out a few + conjectures as to the particular manner in which it is to break up and + disappear. + </p> + <p> + 1. The confidence of the few believers in this delusion will never survive + the loss of friends who may die of any acute disease, under a treatment + such as that prescribed by Homoeopathy. It is doubtful how far cases of + this kind will be trusted to its tender mercies, but wherever it acquires + any considerable foothold, such cases must come, and with them the ruin of + those who practise it, should any highly valued life be thus sacrificed. + </p> + <p> + 2. After its novelty has worn out, the ardent and capricious individuals + who constitute the most prominent class of its patrons will return to + visible doses, were it only for the sake of a change. + </p> + <p> + 3. The Semi-Homoeopathic practitioner will gradually withdraw from the + rotten half of his business and try to make the public forget his + connection with it. + </p> + <p> + 4. The ultra Homoeopathist will either recant and try to rejoin the + medical profession; or he will embrace some newer and if possible equally + extravagant doctrine; or he will stick to his colors and go down with his + sinking doctrine. Very few will pursue the course last mentioned. + </p> + <p> + A single fact may serve to point out in what direction there will probably + be a movement of the dissolving atoms of Homoeopathy. On the 13th page of + the too frequently cited Manifesto of the “Examiner” I read the following + stately paragraph: + </p> + <p> + “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. + </p> + <p> + 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. + </p> + <p> + If, as must be admitted, no one of Hahnemann's doctrines is received with + tolerable unanimity among his disciples, except the central axiom, Similia + similibus curantur; if this axiom itself relies mainly for its support + upon the folly and trickery of Hahnemann, what can we think of those who + announce themselves ready to relinquish all the accumulated treasures of + our art, to trifle with life upon the strength of these fantastic + theories? What shall we think of professed practitioners of medicine, if, + in the words of Jahr, “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? + </p> + <p> + Such is the pretended science of Homoeopathy, to which you are asked to + trust your lives and the lives of those dearest to you. A mingled mass of + perverse ingenuity, of tinsel erudition, of imbecile credulity, and of + artful misrepresentation, too often mingled in practice, if we may trust + the authority of its founder, with heartless and shameless imposition. + Because it is suffered so often to appeal unanswered to the public, + because it has its journals, its patrons, its apostles, some are weak + enough to suppose it can escape the inevitable doom of utter disgrace and + oblivion. Not many years can pass away before the same curiosity excited + by one of Perkins's Tractors will be awakened at the sight of one of the + Infinitesimal Globules. If it should claim a longer existence, it can only + be by falling into the hands of the sordid wretches who wring their bread + from the cold grasp of disease and death in the hovels of ignorant + poverty. + </p> + <p> + As one humble member of a profession which for more than two thousand + years has devoted itself to the pursuit of the best earthly interests of + mankind, always assailed and insulted from without by such as are ignorant + of its infinite perplexities and labors, always striving in unequal + contest with the hundred-armed giant who walks in the noonday, and sleeps + not in the midnight, yet still toiling, not merely for itself and the + present moment, but for the race and the future, I have lifted my voice + against this lifeless delusion, rolling its shapeless bulk into the path + of a noble science it is too weak to strike, or to injure. + </p> + <p> + <a name="link2H_4_0005" id="link2H_4_0005"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + THE CONTAGIOUSNESS OF PUERPERAL FEVER + </h2> + <h3> + Printed in 1843; reprinted with additions, 1855. + </h3> + <p> + THE POINT AT ISSUE. THE AFFIRMATIVE. + </p> + <p> + “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. + </p> + <p> + THE NEGATIVE. + </p> + <p> + “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. + </p> + <p> + “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. + </p> + <p> + “... 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. + </p> +<pre xml:space="preserve"> + ——————————- +</pre> + <p> + “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. + </p> + <p> + “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. + </p> + <p> + “... 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. + </p> + <p> + “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. + </p> +<pre xml:space="preserve"> + ———————————- +</pre> + <p> + [INTRODUCTORY NOTE.] It happened, some years ago, that a discussion arose + in a Medical Society of which I was a member, involving the subject of a + certain supposed cause of disease, about which something was known, a good + deal suspected, and not a little feared. The discussion was suggested by a + case, reported at the preceding meeting, of a physician who made an + examination of the body of a patient who had died with puerperal fever, + and who himself died in less than a week, apparently in consequence of a + wound received at the examination, having attended several women in + confinement in the mean time, all of whom, as it was alleged, were + attacked with puerperal fever. + </p> + <p> + Whatever apprehensions and beliefs were entertained, it was plain that a + fuller knowledge of the facts relating to the subject would be acceptable + to all present. I therefore felt that it would be doing a good service to + look into the best records I could find, and inquire of the most + trustworthy practitioners I knew, to learn what experience had to teach in + the matter, and arrived at the results contained in the following pages. + </p> + <p> + The Essay was read before the Boston Society for Medical Improvement, and, + at the request of the Society, printed in the “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. + </p> + <p> + The subject of this Paper has the same profound interest for me at the + present moment as it had when I was first collecting the terrible evidence + out of which, as it seems to me, the commonest exercise of reason could + not help shaping the truth it involved. It is not merely on account of the + bearing of the question,—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. + </p> + <p> + I do not know that I shall ever again have so good an opportunity of being + useful as was granted me by the raising of the question which produced + this Essay. For I have abundant evidence that it has made many + practitioners more cautious in their relations with puerperal females, and + I have no doubt it will do so still, if it has a chance of being read, + though it should call out a hundred counterblasts, proving to the + satisfaction of their authors that it proved nothing. And for my part, I + had rather rescue one mother from being poisoned by her attendant, than + claim to have saved forty out of fifty patients to whom I had carried the + disease. Thus, I am willing to avail myself of any hint coming from + without to offer this paper once more to the press. The occasion has + presented itself, as will be seen, in a convenient if not in a flattering + form. + </p> + <p> + I send this Essay again to the MEDICAL PROFESSION, without the change of a + word or syllable. I find, on reviewing it, that it anticipates and + eliminates those secondary questions which cannot be entertained for a + moment until the one great point of fact is peremptorily settled. In its + very statement of the doctrine maintained it avoids all discussion of the + nature of the disease “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. + </p> + <p> + To the MEDICAL STUDENTS, into whose hands this Essay may fall, some words + of introduction may be appropriate, and perhaps, to a small number of + them, necessary. There are some among them who, from youth, or want of + training, are easily bewildered and confused in any conflict of opinions + into which their studies lead them. They are liable to lose sight of the + main question in collateral issues, and to be run away with by suggestive + speculations. They confound belief with evidence, often trusting the first + because it is expressed with energy, and slighting the latter because it + is calm and unimpassioned. They are not satisfied with proof; they cannot + believe a point is settled so long as everybody is not silenced. They have + not learned that error is got out of the minds that cherish it, as the + taenia is removed from the body, one joint, or a few joints at a time, for + the most part, rarely the whole evil at once. They naturally have faith in + their instructors, turning to them for truth, and taking what they may + choose to give them; babes in knowledge, not yet able to tell the breast + from the bottle, pumping away for the milk of truth at all that offers, + were it nothing better than a Professor's shrivelled forefinger. + </p> + <p> + In the earliest and embryonic stage of professional development, any + violent impression on the instructor's mind is apt to be followed by some + lasting effect on that of the pupil. No mother's mark is more permanent + than the mental naevi and moles, and excrescences, and mutilations, that + students carry with them out of the lecture-room, if once the teeming + intellect which nourishes theirs has been scared from its propriety by any + misshapen fantasy. Even an impatient or petulant expression, which to a + philosopher would be a mere index of the low state of amiability of the + speaker at the moment of its utterance, may pass into the young mind as an + element of its future constitution, to injure its temper or corrupt its + judgment. It is a duty, therefore, which we owe to this younger class of + students, to clear any important truth which may have been rendered + questionable in their minds by such language, or any truth-teller against + whom they may have been prejudiced by hasty epithets, from the impressions + such words have left. Until this is done, they are not ready for the + question, where there is a question, for them to decide. Even if we + ourselves are the subjects of the prejudice, there seems to be no + impropriety in showing that this prejudice is local or personal, and not + an acknowledged conviction with the public at large. It may be necessary + to break through our usual habits of reserve to do this, but this is the + fault of the position in which others have placed us. + </p> + <p> + Two widely-known and highly-esteemed practitioners, Professors in two of + the largest Medical Schools of the Union, teaching the branch of art which + includes the Diseases of Women, and therefore speaking with authority; + addressing in their lectures and printed publications large numbers of + young men, many of them in the tenderest immaturity of knowledge, have + recently taken ground in a formal way against the doctrine maintained in + this paper: + </p> + <p> + On the Non-Contagious Character of Puerperal Fever: An Introductory + Lecture. By Hugh L. Hodge, M. D., Professor of Obstetrics in the + University of Pennsylvania. Delivered Monday, October 11, 1852. + Philadelphia, 1852. + </p> + <p> + On the Nature, Signs, and Treatment of Childbed Fevers: in a Series of + Letters addressed to the Students of his Class. By Charles D. Meigs, M. + D., Professor of Midwifery and the Diseases of Women and Children in + Jefferson Medical College, Philadelphia, etc., etc. Philadelphia, 1854. + Letter VI. + </p> + <p> + The first of the two publications, Dr. Hodge's Lecture, while its + theoretical considerations and negative experiences do not seem to me to + require any further notice than such as lay ready for them in my Essay + written long before, is, I am pleased to say, unobjectionable in tone and + language, and may be read without offence. + </p> + <p> + This can hardly be said of the chapter of Dr. Meigs's volume which treats + of Contagion in Childbed Fever. There are expressions used in it which + might well put a stop to all scientific discussions, were they to form the + current coin in our exchange of opinions. I leave the “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. + </p> + <p> + One unpalatable expression I suppose the laws of construction oblige me to + appropriate to myself, as my reward for a certain amount of labor bestowed + on the investigation of a very important question of evidence, and a + statement of my own practical conclusions. I take no offence, and attempt + no retort. No man makes a quarrel with me over the counterpane that covers + a mother, with her new-born infant at her breast. There is no epithet in + the vocabulary of slight and sarcasm that can reach my personal + sensibilities in such a controversy. Only just so far as a disrespectful + phrase may turn the student aside from the examination of the evidence, by + discrediting or dishonoring the witness, does it call for any word of + notice. + </p> + <p> + I appeal from the disparaging language by which the Professor in the + Jefferson School of Philadelphia would dispose of my claims to be listened + to. I appeal, not to the vote of the Society for Medical Improvement, + although this was an unusual evidence of interest in the paper in + question, for it was a vote passed among my own townsmen; nor to the + opinion of any American, for none know better than the Professors in the + great Schools of Philadelphia how cheaply the praise of native + contemporary criticism is obtained. I appeal to the recorded opinions of + those whom I do not know, and who do not know me, nor care for me, except + for the truth that I may have uttered; to Copland, in his “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. + </p> + <p> + I will take it for granted that they have so far counterpoised the + depreciating language of my fellow-countryman and fellow-teacher as to + gain me a reader here and there among the youthful class of students I am + now addressing. It is only for their sake that I think it necessary to + analyze, or explain, or illustrate, or corroborate any portion of the + following Essay. But I know that nothing can be made too plain for + beginners; and as I do not expect the practitioner, or even the more + mature student, to take the trouble to follow me through an Introduction + which I consider wholly unnecessary and superfluous for them, I shall not + hesitate to stoop to the most elementary simplicity for the benefit of the + younger student. I do this more willingly because it affords a good + opportunity, as it seems to me, of exercising the untrained mind in that + medical logic which does not seem to have been either taught or practised + in our schools of late, to the extent that might be desired. + </p> + <p> + I will now exhibit, in a series of propositions reduced to their simplest + expression, the same essential statements and conclusions as are contained + in the Essay, with such commentaries and explanations as may be profitable + to the inexperienced class of readers addressed. + </p> + <p> + I. It has been long believed, by many competent observers, that Puerperal + Fever (so called) is sometimes carried from patient to patient by medical + assistants. + </p> + <p> + II. The express object of this Essay is to prove that it is so carried. + </p> + <p> + III. In order to prove this point, it is not necessary to consult any + medical theorist as to whether or not it is consistent with his + preconceived notions that such a mode of transfer should exist. + </p> + <p> + IV. If the medical theorist insists on being consulted, and we see fit to + indulge him, he cannot be allowed to assume that the alleged laws of + contagion, deduced from observation in other diseases, shall be cited to + disprove the alleged laws deduced from observation in this. Science would + never make progress under such conditions. Neither the long incubation of + hydrophobia, nor the protecting power of vaccination, would ever have been + admitted, if the results of observation in these affections had been + rejected as contradictory to the previously ascertained laws of contagion. + </p> + <p> + V. The disease in question is not a common one; producing, on the average, + about three deaths in a thousand births, according to the English + Registration returns which I have examined. + </p> + <p> + VI. When an unusually large number of cases of this disease occur about + the same time, it is inferred, therefore, that there exists some special + cause for this increased frequency. If the disease prevails extensively + over a wide region of country, it is attributed without dispute to an + epidemic influence. If it prevails in a single locality, as in a hospital, + and not elsewhere, this is considered proof that some local cause is there + active in its production. + </p> + <p> + VII. When a large number of cases of this disease occur in rapid + succession, in one individual's ordinary practice, and few or none + elsewhere, these cases appearing in scattered localities, in patients of + the same average condition as those who escape under the care of others, + there is the same reason for connecting the cause of the disease with the + person in this instance, as with the place in that last mentioned. + </p> + <p> + VIII. Many series of cases, answering to these conditions, are given in + this Essay, and many others will be referred to which have occurred since + it was written. + </p> + <p> + IX. The alleged results of observation may be set aside; first, because + the so-called facts are in their own nature equivocal; secondly, because + they stand on insufficient authority; thirdly, because they are not + sufficiently numerous. But, in this case, the disease is one of striking + and well-marked character; the witnesses are experts, interested in + denying and disbelieving the facts; the number of consecutive cases in + many instances frightful, and the number of series of cases such that I + have no room for many of them except by mere reference. + </p> + <p> + X. These results of observation, being admitted, may, we will suppose, be + interpreted in different methods. Thus the coincidences may be considered + the effect of chance. I have had the chances calculated by a competent + person, that a given practitioner, A., shall have sixteen fatal cases in a + month, on the following data: A. to average attendance upon two hundred + and fifty births in a year; three deaths in one thousand births to be + assumed as the average from puerperal fever; no epidemic to be at the time + prevailing. It follows, from the answer given me, that if we suppose every + one of the five hundred thousand annual births of England to have been + recorded during the last half-century, there would not be one chance in a + million million million millions that one such series should be noted. No + possible fractional error in this calculation can render the chance a + working probability. Applied to dozens of series of various lengths, it is + obviously an absurdity. Chance, therefore, is out of the question as an + explanation of the admitted coincidences. + </p> + <p> + XI. There is, therefore, some relation of cause and effect between the + physician's presence and the patient's disease. + </p> + <p> + XII. Until it is proved to what removable condition attaching to the + attendant the disease is owing, he is bound to stay away from his patients + so soon as he finds himself singled out to be tracked by the disease. How + long, and with what other precautions, I have suggested, without + dictating, at the close of my Essay. If the physician does not at once act + on any reasonable suspicion of his being the medium of transfer, the + families where he is engaged, if they are allowed to know the facts, + should decline his services for the time. His feelings on the occasion, + however interesting to himself, should not be even named in this + connection. A physician who talks about ceremony and gratitude, and + services rendered, and the treatment he got, surely forgets himself; it is + impossible that he should seriously think of these small matters where + there is even a question whether he may not carry disease, and death, and + bereavement into any one of “his families,” as they are sometimes called. + </p> + <p> + I will now point out to the young student the mode in which he may relieve + his mind of any confusion, or possibly, if very young, any doubt, which + the perusal of Dr. Meigs's Sixth Letter may have raised in his mind. + </p> + <p> + The most prominent ideas of the Letter are, first, that the transmissible + nature of puerperal fever appears improbable, and, secondly, that it would + be very inconvenient to the writer. Dr. Woodville, Physician to the + Small-Pox and Inoculation Hospital in London, found it improbable, and + exceedingly inconvenient to himself, that cow pox should prevent + small-pox; but Dr. Jenner took the liberty to prove the fact, + notwithstanding. + </p> + <p> + I will first call the young student's attention to the show of negative + facts (exposure without subsequent disease), of which much seems to be + thought. And I may at the same time refer him to Dr. Hodge's Lecture, + where he will find the same kind of facts and reasoning. Let him now take + up Watson's Lectures, the good sense and spirit of which have made his + book a universal favorite, and open to the chapter on Continued Fever. He + will find a paragraph containing the following sentence: “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. + </p> + <p> + It would seem as if the force of this argument could hardly fail to be + seen, if it were granted that every one of these series of cases were so + reported as to prove that there could have been no transfer of disease. + There is not one of them so reported, in the Lecture or the Letter, as to + prove that the disease may not have been carried by the practitioner. I + strongly suspect that it was so carried in some of these cases, but from + the character of the very imperfect evidence the question can never be + settled without further disclosures. + </p> + <p> + Although the Letter is, as I have implied, principally taken up with + secondary and collateral questions, and might therefore be set aside as in + the main irrelevant, I am willing, for the student's sake, to touch some + of these questions briefly, as an illustration of its logical character. + </p> + <p> + The first thing to be done, as I thought when I wrote my Essay, was to + throw out all discussions of the word contagion, and this I did + effectually by the careful wording of my statement of the subject to be + discussed. My object was not to settle the etymology or definition of a + word, but to show that women had often died in childbed, poisoned in some + way by their medical attendants. On the other point, I, at least, have no + controversy with anybody, and I think the student will do well to avoid it + in this connection. If I must define my position, however, as well as the + term in question, I am contented with Worcester's definition; provided + always this avowal do not open another side controversy on the merits of + his Dictionary, which Dr. Meigs has not cited, as compared with Webster's, + which he has. + </p> + <p> + I cannot see the propriety of insisting that all the laws of the eruptive + fevers must necessarily hold true of this peculiar disease of puerperal + women. If there were any such propriety, the laws of the eruptive fevers + must at least be stated correctly. It is not true, for instance, as Dr. + Meigs states, that contagion is “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. + </p> + <p> + As to the short time of incubation, of which so much is made, we have no + right to decide beforehand whether it shall be long or short, in the cases + we are considering. A dissection wound may produce symptoms of poisoning + in six hours; the bite of a rabid animal may take as many months. + </p> + <p> + After the student has read the case in Dr. Meigs's 136th paragraph, and + the following one, in which he exclaims against the idea of contagion, + because the patient, delivered on the 26th of December, was attacked in + twenty-four hours, and died on the third day, let him read what happened + at the “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. + </p> + <p> + Let the student read Dr. Meigs's 140th paragraph soberly, and then + remember, that not only does he infer, suspect, and surmise, but he + actually asserts (page 154), “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? + </p> + <p> + “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.] + </p> + <p> + “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.” + </p> + <p> + Possibly an inexperienced youth may be awe-struck by the quotation from + Cuvier. These words, or their equivalent, are certainly to be found in his + Introduction. So are the words “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. + </p> + <p> + I intend no breach of courtesy, but this is a proper place to warn the + student against skimming the prefaces and introductions of works for + mottoes and embellishments to his thesis. He cannot learn anatomy by + thrusting an exploring needle into the body. He will be very liable to + misquote his author's meaning while he is picking off his outside + sentences. He may make as great a blunder as that simple prince who + praised the conductor of his orchestra for the piece just before the + overture; the musician was too good a courtier to tell him that it was + only the tuning of the instruments. + </p> + <p> + To the six propositions in the 142d paragraph, and the remarks about + “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. + </p> + <p> + The following statement is made by Dr. Meigs in his 142d paragraph, and + developed more at length, with rhetorical amplifications, in the 134th. + “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. + </p> + <p> + 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. + </p> + <p> + 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. + </p> + <p> + These Continental writers not well informed on this point.[See Dr. + Simpson's Remarks at Meeting of Edin. Med. Chir. Soc. (Am. Jour. Oct. + 1851.)] + </p> + <p> + The story of Von Busch is of interest and value, but there is nothing in + it which need perplex the student. It is not pretended that the disease is + always, or even, it may be, in the majority of cases, carried about by + attendants; only that it is so carried in certain cases. That it may have + local and epidemic causes, as well as that depending on personal + transmission, is not disputed. Remember how small-pox often disappears + from a community in spite of its contagious character, and the necessary + exposure of many persons to those suffering from it; in both diseases + contagion is only one of the coefficients of the disease. + </p> + <p> + I have already spoken of the possibility that Dr. Meigs may have been the + medium of transfer of puerperal fever in some of the cases he has briefly + catalogued. Of Dr. Rutter's cases I do not know how to speak. I only ask + the student to read the facts stated by Dr. Condie, as given in my Essay, + and say whether or not a man should allow his wife to be attended by a + practitioner in whose hands “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! + </p> + <p> + I might repeat the question asked concerning Dr. Rutter's cases, with + reference to those reported by Dr. Roberton. Perhaps, however, the student + would like to know the opinion of a person in the habit of working at + matters of this kind in a practical point of view. To satisfy him on this + ground, I addressed the following question to the President of one of our + principal Insurance Companies, leaving Dr. Meigs's book and my Essay in + his hands at the same time. + </p> + <p> + Question. “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?” + </p> + <p> + Answer. “Of course I should require a very large extra premium, if I would + take take risk at all.” + </p> + <p> + But I do not choose to add the expressions of indignation which the + examination of the facts before him called out. I was satisfied from the + effect they produced on him, that if all the hideous catalogues of cases + now accumulated were fully brought to the knowledge of the public, + nothing, since the days of Burke and Hare, has raised such a cry of horror + as would be shrieked in the ears of the Profession. + </p> + <p> + Dr. Meigs has elsewhere invoked “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. + </p> + <p> + Why a grand jury should not bring in a bill against a physician who + switches off a score of women one after the other along his private track, + when he knows that there is a black gulf at the end of it, down which they + are to plunge, while the great highway is clear, is more than I can + answer. It is not by laying the open draw to Providence that he is to + escape the charge of manslaughter. + </p> + <p> + To finish with all these lesser matters of question, I am unable to see + why a female must necessarily be unattended in her confinement, because + she declines the services of a particular practitioner. In all the series + of cases mentioned, the death-carrying attendant was surrounded by others + not tracked by disease and its consequences. Which, I would ask, is worse,—to + call in another, even a rival practitioner, or to submit an unsuspecting + female to a risk which an Insurance Company would have nothing to do with? + </p> + <p> + I do not expect ever to return to this subject. There is a point of mental + saturation, beyond which argument cannot be forced without breeding + impatient, if not harsh, feelings towards those who refuse to be + convinced. If I have so far manifested neither, it is well to stop here, + and leave the rest to those younger friends who may have more stomach for + the dregs of a stale argument. + </p> + <p> + The extent of my prefatory remarks may lead some to think that I attach + too much importance to my own Essay. Others may wonder that I should + expend so many words upon the two productions referred to, the Letter and + the Lecture. I do consider my Essay of much importance so long as the + doctrine it maintains is treated as a question, and so long as any + important part of the defence of that doctrine is thought to rest on its + evidence or arguments. I cannot treat as insignificant any opinions + bearing on life, and interests dearer than life, proclaimed yearly to + hundreds of young men, who will carry them to their legitimate results in + practice. + </p> + <p> + The teachings of the two Professors in the great schools of Philadelphia + are sure to be listened to, not only by their immediate pupils, but by the + Profession at large. I am too much in earnest for either humility or + vanity, but I do entreat those who hold the keys of life and death to + listen to me also for this once. I ask no personal favor; but I beg to be + heard in behalf of the women whose lives are at stake, until some stronger + voice shall plead for them. + </p> + <p> + I trust that I have made the issue perfectly distinct and intelligible. + And let it be remembered that this is no subject to be smoothed over by + nicely adjusted phrases of half-assent and half-censure divided between + the parties. The balance must be struck boldly and the result declared + plainly. If I have been hasty, presumptuous, ill-informed, illogical; if + my array of facts means nothing; if there is no reason for any caution in + the view of these facts; let me be told so on such authority that I must + believe it, and I will be silent henceforth, recognizing that my mind is + in a state of disorganization. If the doctrine I have maintained is a + mournful truth; if to disbelieve it, and to practise on this disbelief, + and to teach others so to disbelieve and practise, is to carry desolation, + and to charter others to carry it, into confiding families, let it be + proclaimed as plainly what is to be thought of the teachings of those who + sneer at the alleged dangers, and scout the very idea of precaution. Let + it be remembered that persons are nothing in this matter; better that + twenty pamphleteers should be silenced, or as many professors unseated, + than that one mother's life should be taken. There is no quarrel here + between men, but there is deadly incompatibility and exterminating warfare + between doctrines. Coincidences meaning nothing, though a man have a + monopoly of the disease for weeks or months; or cause and effect, the + cause being in some way connected with the person; this is the question. + If I am wrong, let me be put down by such a rebuke as no rash declaimer + has received since there has been a public opinion in the medical + profession of America; if I am right, let doctrines which lead to + professional homicide be no longer taught from the chairs of those two + great Institutions. Indifference will not do here; our Journalists and + Committees have no right to take up their pages with minute anatomy and + tediously detailed cases, while it is a question whether or not the + “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. + </p> +<pre xml:space="preserve"> + THE CONTAGIOUSNESS OF PUERPERAL FEVER. +</pre> + <p> + In collecting, enforcing, and adding to the evidence accumulated upon this + most serious subject, I would not be understood to imply that there exists + a doubt in the mind of any well-informed member of the medical profession + as to the fact that puerperal fever is sometimes communicated from one + person to another, both directly and indirectly. In the present state of + our knowledge upon this point I should consider such doubts merely as a + proof that the sceptic had either not examined the evidence, or, having + examined it, refused to accept its plain and unavoidable consequences. I + should be sorry to think, with Dr. Rigby, that it was a case of “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. + </p> + <p> + If there are some who conceive that any important end would be answered by + recording such opinions, or by collecting the history of all the cases + they could find in which no evidence of the influence of contagion + existed, I believe they are in error. Suppose a few writers of authority + can be found to profess a disbelief in contagion,—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. + </p> + <p> + I am not sure that this paper will escape another remark which it might be + wished were founded in justice. It may be said that the facts are too + generally known and acknowledged to require any formal argument or + exposition, that there is nothing new in the positions advanced, and no + need of laying additional statements before the Profession. But on turning + to two works, one almost universally, and the other extensively appealed + to as authority in this country, I see ample reason to overlook this + objection. In the last edition of Dewees's Treatise on the “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. + </p> + <p> + The practical point to be illustrated is the following: + </p> + <p> + The disease known as Puerperal Fever is so far contagious as to be + frequently carried from patient to patient by physicians and nurses. + </p> + <p> + Let me begin by throwing out certain incidental questions, which, without + being absolutely essential, would render the subject more complicated, and + by making such concessions and assumptions as may be fairly supposed to be + without the pale of discussion. + </p> + <p> + 1. It is granted that all the forms of what is called puerperal fever may + not be, and probably are not, equally contagious or infectious. I do not + enter into the distinctions which have been drawn by authors, because the + facts do not appear to me sufficient to establish any absolute line of + demarcation between such forms as may be propagated by contagion and those + which are never so propagated. This general result I shall only support by + the authority of Dr. Ramsbotham, who gives, as the result of his + experience, that the same symptoms belong to what he calls the infectious + and the sporadic forms of the disease, and the opinion of Armstrong in his + original Essay. If others can show any such distinction, I leave it to + them to do it. But there are cases enough that show the prevalence of the + disease among the patients of a single practitioner when it was in no + degree epidemic, in the proper sense of the term. I may refer to those of + Mr. Roberton and of Dr. Peirson, hereafter to be cited, as examples. + </p> + <p> + 2. I shall not enter into any dispute about the particular mode of + infection, whether it be by the atmosphere the physician carries about him + into the sick-chamber, or by the direct application of the virus to the + absorbing surfaces with which his hand comes in contact. Many facts and + opinions are in favor of each of these modes of transmission. But it is + obvious that in the majority of cases it must be impossible to decide by + which of these channels the disease is conveyed, from the nature of the + intercourse between the physician and the patient. + </p> + <p> + 3. It is not pretended that the contagion of puerperal fever must always + be followed by the disease. It is true of all contagious diseases, that + they frequently spare those who appear to be fully submitted to their + influence. Even the vaccine virus, fresh from the subject, fails every day + to produce its legitimate effect, though every precaution is taken to + insure its action. This is still more remarkably the case with scarlet + fever and some other diseases. + </p> + <p> + 4. It is granted that the disease may be produced and variously modified + by many causes besides contagion, and more especially by epidemic and + endemic influences. But this is not peculiar to the disease in question. + There is no doubt that small-pox is propagated to a great extent by + contagion, yet it goes through the same periods of periodical increase and + diminution which have been remarked in puerperal fever. If the question is + asked how we are to reconcile the great variations in the mortality of + puerperal fever in different seasons and places with the supposition of + contagion, I will answer it by another question from Mr. Farr's letter to + the Registrar-General. He makes the statement that “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?” + </p> + <p> + 5. I take it for granted, that if it can be shown that great numbers of + lives have been and are sacrificed to ignorance or blindness on this + point, no other error of which physicians or nurses may be occasionally + suspected will be alleged in palliation of this; but that whenever and + wherever they can be shown to carry disease and death instead of health + and safety, the common instincts of humanity will silence every attempt to + explain away their responsibility. + </p> + <p> + The treatise of Dr. Gordon of Aberdeen was published in the year 1795, + being among the earlier special works upon the disease. Apart of his + testimony has been occasionally copied into other works, but his + expressions are so clear, his experience is given with such manly + distinctness and disinterested honesty, that it may be quoted as a model + which might have been often followed with advantage. + </p> + <p> + “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.” + </p> + <p> + “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.” + </p> + <p> + “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. + </p> + <p> + 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.” + </p> + <p> + 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.” + </p> + <p> + 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.] + </p> + <p> + Dr. Armstrong has given a number of instances in his Essay on Puerperal + Fever, of the prevalence of the disease among the patients of a single + practitioner. At Sunderland, “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. + </p> + <p> + 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. + </p> + <p> + “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.” + </p> + <p> + 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.” + </p> + <p> + 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. + </p> + <p> + “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.] + </p> + <p> + Dr. Ramsbotham asserted, in a Lecture at the London Hospital, that he had + known the disease spread through a particular district, or be confined to + the practice of a particular person, almost every patient being attacked + with it, while others had not a single case. It seemed capable, he + thought, of conveyance, not only by common modes; but through the dress of + the attendants upon the patient. + </p> + <p> + In a letter to be found in the “London Medical Gazette” for January, 1840, + Mr. Roberton of Manchester makes the statement which I here give in a + somewhat condensed form. + </p> + <p> + A midwife delivered a woman on the 4th of December, 1830, who died soon + after with the symptoms of puerperal fever. In one month from this date + the same midwife delivered thirty women, residing in different parts of an + extensive suburb, of which number sixteen caught the disease and all died. + These were the only cases which had occurred for a considerable time in + Manchester. The other midwives connected with the same charitable + institution as the woman already mentioned are twenty-five in number, and + deliver, on an average, ninety women a week, or about three hundred and + eighty a month. None of these women had a case of puerperal fever. “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.” + </p> + <p> + Mr. Roberton remarks, that little more than half the women she delivered + during this month took the fever; that on some days all escaped, on others + only one or more out of three or four; a circumstance similar to what is + seen in other infectious maladies. + </p> + <p> + Dr. Blundell says, “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.” + </p> + <p> + At a meeting of the Royal Medical and Chirurgical Society, Dr. King + mentioned that some years since a practitioner at Woolwich lost sixteen + patients from puerperal fever in the same year. He was compelled to give + up practice for one or two years, his business being divided among the + neighboring practitioners. No case of puerperal fever occurred afterwards, + neither had any of the neighboring surgeons any cases of this disease. + </p> + <p> + At the same meeting Mr. Hutchinson mentioned the occurrence of three + consecutive cases of puerperal fever, followed subsequently by two others, + all in the practice of one accoucheur.[Lancet, May 2, 1840.] + </p> + <p> + Dr. Lee makes the following statement: “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.” + </p> + <p> + The recurrence of long series of cases like those I have cited, reported + by those most interested to disbelieve in contagion, scattered along + through an interval of half a century, might have been thought sufficient + to satisfy the minds of all inquirers that here was something more than a + singular coincidence. But if, on a more extended observation, it should be + found that the same ominous groups of cases clustering about individual + practitioners were observed in a remote country, at different times, and + in widely separated regions, it would seem incredible that any should be + found too prejudiced or indolent to accept the solemn truth knelled into + their ears by the funeral bells from both sides of the ocean,—the + plain conclusion that the physician and the disease entered, hand in hand, + into the chamber of the unsuspecting patient. + </p> + <p> + That such series of cases have been observed in this country, and in this + neighborhood, I proceed to show. + </p> + <p> + In Dr. Francis's “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. + </p> + <p> + 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.” + </p> + <p> + I mention these little hints about the occurrence of such cases, partly + because they are the first I have met with in American medical literature, + but more especially because they serve to remind us that behind the + fearful array of published facts there lies a dark list of similar events, + unwritten in the records of science, but long remembered by many a + desolated fireside. + </p> + <p> + Certainly nothing can be more open and explicit than the account given by + Dr. Peirson of Salem, of the cases seen by him. In the first nineteen days + of January, 1829, he had five consecutive cases of puerperal fever, every + patient he attended being attacked, and the three first cases proving + fatal. In March of the same year he had two moderate cases, in June, + another case, and in July, another, which proved fatal. “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.'” + </p> + <p> + 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. + </p> + <p> + Dr. Condie called the attention of the Society to the prevalence, at the + present time, of puerperal fever of a peculiarly insidious and malignant + character. “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.” + </p> + <p> + “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?” + </p> + <p> + 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.” + </p> + <p> + The meeting at which these remarks were made was held on the 3d of May, + 1842. In a letter dated December 20, 1842, addressed to Dr. Meigs, and to + be found in the “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.” + </p> + <p> + 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. + </p> + <p> + I must call the attention of the inquirer most particularly to the + Quarterly Report above referred to, and the letters of Dr. Meigs and Dr. + Rutter, to be found in the “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. + </p> + <p> + At a meeting of the College of Physicians just mentioned, Dr. Warrington + stated, that a few days after assisting at an autopsy of puerperal + peritonitis, in which he laded out the contents of the abdominal cavity + with his hands, he was called upon to deliver three women in rapid + succession. All of these women were attacked with different forms of what + is commonly called puerperal fever. Soon after these he saw two other + patients, both on the same day, with the same disease. Of these five + patients two died. + </p> + <p> + At the same meeting, Dr. West mentioned a fact related to him by Dr. + Samuel Jackson of Northumberland. Seven females, delivered by Dr. Jackson + in rapid succession, while practising in Northumberland County, were all + attacked with puerperal fever, and five of them died. “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. + </p> + <p> + The three following statements are now for the first time given to the + public. All of the cases referred to occurred within this State, and two + of the three series in Boston and its immediate vicinity. + </p> + <p> + I. The first is a series of cases which took place during the last spring + in a town at some distance from this neighborhood. A physician of that + town, Dr. C., had the following consecutive cases. + </p> +<pre xml:space="preserve"> + No. 1, delivered March 20, died March 24. + “ 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.) +</pre> + <p> + 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.” + </p> + <p> + About the 1st of July he attended another patient in a neighboring + village, who died two or three days after delivery. + </p> + <p> + The first patient, it is stated, was delivered on the 20th of March. “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. + </p> + <p> + Several cases of erysipelas occurred in the house where the autopsy + mentioned above took place, soon after the examination. There were also + many cases of erysipelas in town at the time of the fatal puerperal cases + which have been mentioned. + </p> + <p> + The nurse who laid out the body of the patient No. 3 was taken on the + evening of the same day with sore throat and erysipelas, and died in ten + days from the first attack. + </p> + <p> + The nurse who laid out the body of the patient No. 4 was taken on the day + following with symptoms like those of this patient, and died in a week, + without any external marks of erysipelas. + </p> + <p> + “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.” + </p> + <p> + Some additional statements in this letter are deserving of insertion. + </p> + <p> + “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.” + </p> + <p> + It is also mentioned in the same letter, that another physician had a case + during the last summer and another last fall, both of which recovered. + </p> + <p> + Another gentleman reports a case last December, a second case five weeks, + and another three weeks since. All these recovered. A case also occurred + very recently in the practice of a physician in the village where the + eighth patient of Dr. C. resides, which proved fatal. “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. + </p> + <p> + I owe these facts to the prompt kindness of a gentleman whose intelligence + and character are sufficient guaranty for their accuracy. + </p> + <p> + The two following letters were addressed to my friend Dr. Scorer, by the + gentleman in whose practice the cases of puerperal fever occurred. His + name renders it unnecessary to refer more particularly to these gentlemen, + who on their part have manifested the most perfect freedom and courtesy in + affording these accounts of their painful experience. + </p> + <p> + “January 28, 1843. + </p> + <p> + 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. + </p> + <p> + “The cases were not confined to a narrow space. The two nearest were half + a mile from each other, and half that distance from my residence. The + others were from two to three miles apart, and nearly that distance from + my residence. There were no other cases in their immediate vicinity which + came to my knowledge. The general health of all the women was pretty good, + and all the labors as good as common, except the first. This woman, in + consequence of my not arriving in season, and the child being half-born at + some time before I arrived, was very much exposed to the cold at the time + of confinement, and afterwards, being confined in a very open, cold room. + Of the six cases you perceive only one recovered. + </p> + <p> + “In the winter of 1817 two of my patients had puerperal fever, one very + badly, the other not so badly. Both recovered. One other had swelled leg, + or phlegmasia dolens, and one or two others did not recover as well as + usual. + </p> + <p> + “In the summer of 1835 another disastrous period occurred in my practice. + July 1st, I attended a lady in labor, who was afterwards quite ill and + feverish; but at the time I did not consider her case a decided puerperal + fever. On the 8th, I attended one who did well. On the 12th, one who was + seriously sick. This was also an equivocal case, apparently arising from + constipation and irritation of the rectum. These women were ten miles + apart and five from my residence. On 15th and 20th, two who did well. On + 25th, I attended another. This was a severe labor, and followed by + unequivocal puerperal fever, or peritonitis. She recovered. August 2d and + 3d, in about twenty-four hours I attended four persons. Two of them did + very well; one was attacked with some of the common symptoms, which + however subsided in a day or two, and the other had decided puerperal + fever, but recovered. This woman resided five miles from me. Up to this + time I wore the same coat. All my other clothes had frequently been + changed. On 6th, I attended two women, one of whom was not sick at all; + but the other, Mrs. L., was afterwards taken ill. On 10th, I attended a + lady, who did very well. I had previously changed all my clothes, and had + no garment on which had been in a puerperal room. On 12th, I was called to + Mrs. S., in labor. While she was ill, I left her to visit Mrs. L., one of + the ladies who was confined on 6th. Mrs. L. had been more unwell than + usual, but I had not considered her case anything more than common till + this visit. I had on a surtout at this visit, which, on my return to Mrs. + S., I left in another room. Mrs. S. was delivered on 13th with forceps. + These women both died of decided puerperal fever. + </p> + <p> + “While I attended these women in their fevers, I changed my clothes, and + washed my hands in a solution of chloride of lime after each visit. I + attended seven women in labor during this period, all of whom recovered + without sickness. + </p> + <p> + “In my practice I have had several single cases of puerperal fever, some + of whom have died and some have recovered. Until the year 1830 I had no + suspicion that the disease could be communicated from one patient to + another by a nurse or midwife; but I now think the foregoing facts + strongly favor that idea. I was so much convinced of this fact, that I + adopted the plan before related. + </p> + <p> + “I believe my own health was as good as usual at each of the above + periods. I have no recollections to the contrary. + </p> + <p> + “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.”] + </p> + <p> + “BOSTON, February 3, 1843. + </p> + <p> + 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. + </p> + <p> + “All the cases that occurred in my practice took place between the 7th of + May and the 17th of June 1842. + </p> + <p> + “They were not confined to any particular part of the city. The first two + cases were patients residing at the South End, the next was at the extreme + North End, one living in Sea Street and the other in Roxbury. The + following is the order in which they occurred: + </p> + <p> + “Case 1. Mrs.______ was confined on the 7th of May, at 5 o'clock, P. M., + after a natural labor of six hours. At 12 o'clock at night, on the 9th + (thirty-one hours after confinement), she was taken with severe chill, + previous to which she was as comfortable as women usually are under the + circumstances. She died on the 10th. + </p> + <p> + “Case 2. Mrs.______ was confined on the 10th of June (four weeks after + Mrs. C.), at 11 A. M., after a natural, but somewhat severe labor of five + hours. At 7 o'clock, on the morning of the 11th, she had a chill. Died on + the 12th. + </p> + <p> + “Case 3. Mrs.______, confined on the 14th of June, was comfortable until + the 18th, when symptoms of puerperal fever were manifest. She died on the + 20th. + </p> + <p> + “Case 4. Mrs.______, confined June 17th, at 5 o'clock, A. M., was doing + well until the morning of the 19th. She died on the evening of the 21st. + </p> + <p> + “Case 5. Mrs.______ was confined with her fifth child on the 17th of June, + at 6 o'clock in the evening. This patient had been attacked with puerperal + fever, at three of her previous confinements, but the disease yielded to + depletion and other remedies without difficulty. This time, I regret to + say, I was not so fortunate. She was not attacked, as were the other + patients, with a chill, but complained of extreme pain in abdomen, and + tenderness on pressure, almost from the moment of her confinement. In this + as in the other cases, the disease resisted all remedies, and she died in + great distress on the 22d of the same month. Owing to the extreme heat of + the season, and my own indisposition, none of the subjects were examined + after death. Dr. Channing, who was in attendance with me on the three last + cases, proposed to have a post-mortem examination of the subject of case + No. 5, but from some cause which I do not now recollect it was not + obtained. + </p> + <p> + “You wish to know whether I wore the same clothes when attending the + different cases. I cannot positively say, but I should think I did not, as + the weather became warmer after the first two cases; I therefore think it + probable that I made a change of at least a part of my dress. I have had + no other case of puerperal fever in my own practice for three years, save + those above related, and I do not remember to have lost a patient before + with this disease. While absent, last July, I visited two patients sick + with puerperal fever, with a friend of mine in the country. Both of them + recovered. + </p> + <p> + “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?” + </p> + <p> + 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. + </p> + <p> + This long catalogue of melancholy histories assumes a still darker aspect + when we remember how kindly nature deals with the parturient female, when + she is not immersed in the virulent atmosphere of an impure lying-in + hospital, or poisoned in her chamber by the unsuspected breath of + contagion. From all causes together, not more than four deaths in a + thousand births and miscarriages happened in England and Wales during the + period embraced by the first “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. + </p> + <p> + In private practice, leaving out of view the cases that are to be ascribed + to the self-acting system of propagation, it would seem that the disease + must be far from common. Mr. White of Manchester says, “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] + </p> + <p> + I have myself been told by two gentlemen practising in this city, and + having for many years a large midwifery business, that they had neither of + them lost a patient from this disease, and by one of them that he had only + seen it in consultation with other physicians. In five hundred cases of + midwifery, of which Dr. Storer has given an abstract in the first number + of this Journal, there was only one instance of fatal puerperal + peritonitis. + </p> + <p> + In the view of these facts, it does appear a singular coincidence, that + one man or woman should have ten, twenty, thirty, or seventy cases of this + rare disease following his or her footsteps with the keenness of a beagle, + through the streets and lanes of a crowded city, while the scores that + cross the same paths on the same errands know it only by name. It is a + series of similar coincidences which has led us to consider the dagger, + the musket, and certain innocent-looking white powders as having some + little claim to be regarded as dangerous. It is the practical inattention + to similar coincidences which has given rise to the unpleasant but often + necessary documents called indictments, which has sharpened a form of the + cephalotome sometimes employed in the case of adults, and adjusted that + modification of the fillet which delivers the world of those who happen to + be too much in the way while such striking coincidences are taking place. + </p> + <p> + I shall now mention a few instances in which the disease appears to have + been conveyed by the process of direct inoculation. + </p> + <p> + Dr. Campbell of Edinburgh states that in October, 1821, he assisted at the + post-mortem examination of a patient who died with puerperal fever. He + carried the pelvic viscera in his pocket to the class-room. The same + evening he attended a woman in labor without previously changing his + clothes; this patient died. The next morning he delivered a woman with the + forceps; she died also, and of many others who were seized with the + disease within a few weeks, three shared the same fate in succession. + </p> + <p> + In June, 1823, he assisted some of his pupils at the autopsy of a case of + puerperal fever. He was unable to wash his hands with proper care, for + want of the necessary accommodations. On getting home he found that two + patients required his assistance. He went without further ablution, or + changing his clothes; both these patients died with puerperal fever. This + same Dr. Campbell is one of Dr. Churchill's authorities against contagion. + </p> + <p> + Mr. Roberton says that in one instance within his knowledge a practitioner + passed the catheter for a patient with puerperal fever late in the + evening; the same night he attended a lady who had the symptoms of the + disease on the second day. In another instance a surgeon was called while + in the act of inspecting the body of a woman who had died of this fever, + to attend a labor; within forty-eight hours this patient was seized with + the fever.' + </p> + <p> + On the 16th of March, 1831, a medical practitioner examined the body of a + woman who had died a few days after delivery, from puerperal peritonitis. + On the evening of the 17th he delivered a patient, who was seized with + puerperal fever on the 19th, and died on the 24th. Between this period and + the 6th of April, the same practitioner attended two other patients, both + of whom were attacked with the same disease and died. + </p> + <p> + In the autumn of 1829 a physician was present at the examination of a case + of puerperal fever, dissected out the organs, and assisted in sewing up + the body. He had scarcely reached home when he was summoned to attend a + young lady in labor. In sixteen hours she was attacked with the symptoms + of puerperal fever, and narrowly escaped with her life. + </p> + <p> + In December, 1830, a midwife, who had attended two fatal cases of + puerperal fever at the British Lying-in Hospital, examined a patient who + had just been admitted, to ascertain if labor had commenced. This patient + remained two days in the expectation that labor would come on, when she + returned home and was then suddenly taken in labor and delivered before + she could set out for the hospital. She went on favorably for two days, + and was then taken with puerperal fever and died in thirty-six hours. + </p> + <p> + “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.] + </p> + <p> + From the cases given by Mr. Ingleby, I select the following. Two + gentlemen, after having been engaged in conducting the post-mortem + examination of a case of puerperal fever, went in the same dress, each + respectively, to a case of midwifery. “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. + </p> + <p> + I need not refer to the case lately read before this Society, in which a + physician went, soon after performing an autopsy of a case of puerperal + fever, to a woman in labor, who was seized with the same disease and + perished. The forfeit of that error has been already paid. + </p> + <p> + At a meeting of the Medical and Chirurgical Society before referred to, + Dr. Merriman related an instance occurring in his own practice, which + excites a reasonable suspicion that two lives were sacrificed to a still + less dangerous experiment. He was at the examination of a case of + puerperal fever at two o'clock in the afternoon. He took care not to touch + the body. At nine o'clock the same evening he attended a woman in labor; + she was so nearly delivered that he had scarcely anything to do. The next + morning she had severe rigors, and in forty-eight hours she was a corpse. + Her infant had erysipelas and died in two days. [Lancet, May 2, 1840.] + </p> + <p> + In connection with the facts which have been stated, it seems proper to + allude to the dangerous and often fatal effects which have followed from + wounds received in the post-mortem examination of patients who have died + of puerperal fever. The fact that such wounds are attended with peculiar + risk has been long noticed. I find that Chaussier was in the habit of + cautioning his students against the danger to which they were exposed in + these dissections. [Stein, L'Art d'Accoucher, 1794; Dict. des Sciences + Medicales, art. “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. + </p> + <p> + Of about fifty cases of injuries of this kind, of various degrees of + severity, which I have collected from different sources, at least twelve + were instances of infection from puerperal peritonitis. Some of the others + are so stated as to render it probable that they may have been of the same + nature. Five other cases were of peritoneal inflammation; three in males. + Three were what was called enteritis, in one instance complicated with + erysipelas; but it is well known that this term has been often used to + signify inflammation of the peritoneum covering the intestines. On the + other hand, no case of typhus or typhoid fever is mentioned as giving rise + to dangerous consequences, with the exception of the single instance of an + undertaker mentioned by Mr. Travers, who seems to have been poisoned by a + fluid which exuded from the body. The other accidents were produced by + dissection, or some other mode of contact with bodies of patients who had + died of various affections. They also differed much in severity, the cases + of puerperal origin being among the most formidable and fatal. Now a + moment's reflection will show that the number of cases of serious + consequences ensuing from the dissection of the bodies of those who had + perished of puerperal fever is so vastly disproportioned to the relatively + small number of autopsies made in this complaint as compared with typhus + or pneumonia (from which last disease not one case of poisoning happened), + and still more from all diseases put together, that the conclusion is + irresistible that a most fearful morbid poison is often generated in the + course of this disease. Whether or not it is sui generis, confined to this + disease, or produced in some others, as, for instance, erysipelas, I need, + not stop to inquire. + </p> + <p> + In connection with this may be taken the following statement of Dr. Rigby. + “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.” + </p> + <p> + Now add to all this the undisputed fact, that within the walls of lying-in + hospitals there is often generated a miasm, palpable as the chlorine used + to destroy it, tenacious so as in some cases almost to defy extirpation, + deadly in some institutions as the plague; which has killed women in a + private hospital of London so fast that they were buried two in one coffin + to conceal its horrors; which enabled Tonnelle to record two hundred and + twenty-two autopsies at the Maternite of Paris; which has led Dr. Lee to + express his deliberate conviction that the loss of life occasioned by + these institutions completely defeats the objects of their founders; and + out of this train of cumulative evidence, the multiplied groups of cases + clustering about individuals, the deadly results of autopsies, the + inoculation by fluids from the living patient, the murderous poison of + hospitals,—does there not result a conclusion that laughs all + sophistry to scorn, and renders all argument an insult? + </p> + <p> + I have had occasion to mention some instances in which there was an + apparent relation between puerperal fever and erysipelas. The length to + which this paper has extended does not allow me to enter into the + consideration of this most important subject. I will only say, that the + evidence appears to me altogether satisfactory that some most fatal series + of puerperal fever have been produced by an infection originating in the + matter or effluvia of erysipelas. In evidence of some connection between + the two diseases, I need not go back to the older authors, as Pouteau or + Gordon, but will content myself with giving the following references, with + their dates; from which it will be seen that the testimony has been + constantly coming before the profession for the last few years. + </p> + <p> + “London Cyclopaedia of Practical Medicine,” article Puerperal Fever, 1833. + </p> + <p> + Mr. Ceeley's Account of the Puerperal Fever at Aylesbury. “Lancet,” 1835. + </p> + <p> + Dr. Ramsbotham's Lecture. “London Medical Gazette,” 1835. + </p> + <p> + Mr. Yates Ackerly's Letter in the same Journal, 1838. + </p> + <p> + Mr. Ingleby on Epidemic Puerperal Fever. “Edinburgh Medical and Surgical + Journal,” 1838. + </p> + <p> + Mr. Paley's Letter. “London Medical Gazette,” 1839. + </p> + <p> + Remarks at the Medical and Chirurgical Society. “Lancet,” 1840. + </p> + <p> + Dr. Rigby's “System of Midwifery.” 1841. + </p> + <p> + “Nunneley on Erysipelas,”—a work which contains a large number of + references on the subject. 1841. + </p> + <p> + “British and Foreign Quarterly Review,” 1842. + </p> + <p> + Dr. S. Jackson of Northumberland, as already quoted from the Summary of + the College of Physicians, 1842. + </p> + <p> + And lastly, a startling series of cases by Mr. Storrs of Doncaster, to be + found in the “American Journal of the Medical Sciences” for January, 1843. + </p> + <p> + The relation of puerperal fever with other continued fevers would seem to + be remote and rarely obvious. Hey refers to two cases of synochus + occurring in the Royal Infirmary of Edinburgh, in women who had attended + upon puerperal patients. Dr. Collins refers to several instances in which + puerperal fever has appeared to originate from a continued proximity to + patients suffering with typhus. + </p> + <p> + Such occurrences as those just mentioned, though most important to be + remembered and guarded against, hardly attract our notice in the midst of + the gloomy facts by which they are surrounded. Of these facts, at the risk + of fatiguing repetitions, I have summoned a sufficient number, as I + believe, to convince the most incredulous that every attempt to disguise + the truth which underlies them all is useless. + </p> + <p> + It is true that some of the historians of the disease, especially Hulme, + Hull, and Leake, in England; Tonnelle, Duges, and Baudelocque, in France, + profess not to have found puerperal fever contagious. At the most they + give us mere negative facts, worthless against an extent of evidence which + now overlaps the widest range of doubt, and doubles upon itself in the + redundancy of superfluous demonstration. Examined in detail, this and much + of the show of testimony brought up to stare the daylight of conviction + out of countenance, proves to be in a great measure unmeaning and + inapplicable, as might be easily shown were it necessary. Nor do I feel + the necessity of enforcing the conclusion which arises spontaneously from + the facts which have been enumerated, by formally citing the opinions of + those grave authorities who have for the last half-century been sounding + the unwelcome truth it has cost so many lives to establish. + </p> + <p> + “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.” + </p> + <p> + The names of Gordon, John Clarke, Denman, Burns, Young, Hamilton, + Haighton, Good, Waller; Blundell, Gooch, Ramsbotham, Douglas, Lee, + Ingleby, Locock, Abercrombie, Alison, Travers, Rigby, and Watson, many of + whose writings I have already referred to, may have some influence with + those who prefer the weight of authorities to the simple deductions of + their own reason from the facts laid before them. A few Continental + writers have adopted similar conclusions. It gives me pleasure to + remember, that while the doctrine has been unceremoniously discredited in + one of the leading Journals, and made very light of by teachers in two of + the principal Medical Schools, of this country, Dr. Channing has for many + years inculcated, and enforced by examples, the danger to be apprehended + and the precautions to be taken in the disease under consideration. + </p> + <p> + I have no wish to express any harsh feeling with regard to the painful + subject which has come before us. If there are any so far excited by the + story of these dreadful events that they ask for some word of indignant + remonstrance to show that science does not turn the hearts of its + followers into ice or stone, let me remind them that such words have been + uttered by those who speak with an authority I could not claim. It is as a + lesson rather than as a reproach that I call up the memory of these + irreparable errors and wrongs. No tongue can tell the heart-breaking + calamity they have caused; they have closed the eyes just opened upon a + new world of love and happiness; they have bowed the strength of manhood + into the dust; they have cast the helplessness of infancy into the + stranger's arms, or bequeathed it, with less cruelty, the death of its + dying parent. There is no tone deep enough for regret, and no voice loud + enough for warning. The woman about to become a mother, or with her + new-born infant upon her bosom, should be the object of trembling care and + sympathy wherever she bears her tender burden, or stretches her aching + limbs. The very outcast of the streets has pity upon her sister in + degradation, when the seal of promised maternity is impressed upon her. + The remorseless vengeance of the law, brought down upon its victim by a + machinery as sure as destiny, is arrested in its fall at a word which + reveals her transient claim for mercy. The solemn prayer of the liturgy + singles out her sorrows from the multiplied trials of life, to plead for + her in the hour of peril. God forbid that any member of the profession to + which she trusts her life, doubly precious at that eventful period, should + hazard it negligently, unadvisedly, or selfishly! + </p> + <p> + There may be some among those whom I address who are disposed to ask the + question, What course are we to follow in relation to this matter? The + facts are before them, and the answer must be left to their own judgment + and conscience. If any should care to know my own conclusions, they are + the following; and in taking the liberty to state them very freely and + broadly, I would ask the inquirer to examine them as freely in the light + of the evidence which has been laid before him. + </p> + <p> + 1. A physician holding himself in readiness to attend cases of midwifery + should never take any active part in the post-mortem examination of cases + of puerperal fever. + </p> + <p> + 2. If a physician is present at such autopsies, he should use thorough + ablution, change every article of dress, and allow twenty-four hours or + more to elapse before attending to any case of midwifery. It may be well + to extend the same caution to cases of simple peritonitis. + </p> + <p> + 3. Similar precautions should be taken after the autopsy or surgical + treatment of cases of erysipelas, if the physician is obliged to unite + such offices with his obstetrical duties, which is in the highest degree + inexpedient. + </p> + <p> + 4. On the occurrence of a single case of puerperal fever in his practice, + the physician is bound to consider the next female he attends in labor, + unless some weeks at least have elapsed, as in danger of being infected by + him, and it is his duty to take every precaution to diminish her risk of + disease and death. + </p> + <p> + 5. If within a short period two cases of puerperal fever happen close to + each other, in the practice of the same physician, the disease not + existing or prevailing in the neighborhood, he would do wisely to + relinquish his obstetrical practice for at least one month, and endeavor + to free himself by every available means from any noxious influence he may + carry about with him. + </p> + <p> + 6. The occurrence of three or more closely connected cases, in the + practice of one individual, no others existing in the neighborhood, and no + other sufficient cause being alleged for the coincidence, is prima facie + evidence that he is the vehicle of contagion. + </p> + <p> + 7. It is the duty of the physician to take every precaution that the + disease shall not be introduced by nurses or other assistants, by making + proper inquiries concerning them, and giving timely warning of every + suspected source of danger. + </p> + <p> + 8. Whatever indulgence may be granted to those who have heretofore been + the ignorant causes of so much misery, the time has come when the + existence of a private pestilence in the sphere of a single physician + should be looked upon, not as a misfortune, but a crime; and in the + knowledge of such occurrences the duties of the practitioner to his + profession should give way to his paramount obligations to society. + ADDITIONAL REFERENCES AND CASES. + </p> + <p> + Fifth Annual Report of the Registrar-General of England. + </p> + <p> + 1843. Appendix. Letter from William Farr, Esq.—Several new series of + cases are given in the Letter of Mr. Stows, contained in the Appendix to + this Report. Mr. Stows suggests precautions similar to those I have laid + down, and these precautions are strongly enforced by Mr. Farr, who is, + therefore, obnoxious to the same criticisms as myself. + </p> + <p> + Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.—Cases + of puerperal fever seeming to originate in erysipelas. + </p> + <p> + Elkington, of Birmingham, in Provincial Med. Journal, cited in Am. Journ. + Med. Sc. for April, 1844.—Six cases in less than a fortnight, + seeming to originate in a case of erysipelas. + </p> + <p> + West's Reports, in Brit. and For. Med. Review for October, 1845, and + January, 1847.—Affection of the arm, resembling malignant pustule, + after removing the placenta of a patient who died from puerperal fever. + Reference to cases at Wurzburg, as proving contagion, and to Keiller's + cases in the Monthly Journal for February, 1846, as showing connection of + puerperal fever and erysipelas. + </p> + <p> + Kneeland.—Contagiousness of Puerperal Fever. Am. Jour. Med. Se., + January, 1846. Also, Connection between Puerperal Fever and Epidemic + Erysipelas. Ibid., April, 1846. + </p> + <p> + Robert Storrs.—Contagious Effects of Puerperal Fever on the Male + Subject; or on Persons not Child-bearing. (From Provincial Med. and Surg. + Journal.) Am. Jour. Med. Sc., January, 1846. Numerous cases. See also Dr. + Reid's case in same Journal for April, 1846. + </p> + <p> + Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med. Sc., + April, 1849, also in B. and F. Med. Chir. Review, April, 1850. + </p> + <p> + Hill, of Leuchars.—A Series of Cases illustrating the Contagious + Nature of Erysipelas and of Puerperal Fever, and their Intimate + Pathological Connection. (From Monthly Journal of Med. Sc.) Am. Jour. Med. + Se., July, 1850. + </p> + <p> + Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits, from + inoculation with different morbid secretions.) Am. Jour. Med. Se., + October, 1850. + </p> + <p> + Arneth. Paper read before the National Academy of Medicine. Annales + d'Hygiene, Tome LXV. 2e Partie. (Means of Disinfection proposed by M. + “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. + </p> + <p> + Moir. Remarks at a meeting of the Edinburgh Medico-Chirurgical Society. + Refers to cases of Dr. Kellie, of Leith. Sixteen in succession, all fatal. + Also to several instances of individual pupils having had a succession of + cases in various quarters of the town, while others, practising as + extensively in the same localities, had none. Also to several special + cases not mentioned elsewhere. Am. Jour. Med. Se. for October, 1851. (From + New Monthly Journal of Med. Science.) + </p> + <p> + Simpson.—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. + </p> + <p> + 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. + </p> + <p> + Copland. Considers it proved that puerperal fever maybe propagated by the + hands and the clothes, or either, of a third person, the bed-clothes or + body-clothes of a patient. Mentions a new series of cases, one of which he + saw, with the practitioner who had attended them. She was the sixth he had + had within a few days. All died. Dr. Copland insisted that contagion had + caused these cases; advised precautionary measures, and the practitioner + had no other cases for a considerable time. Considers it criminal, after + the evidence adduced,—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. + </p> + <p> + 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.” + </p> + <p> + <a name="link2H_4_0006" id="link2H_4_0006"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + CURRENTS AND COUNTER-CURRENTS IN MEDICAL SCIENCE + </h2> + <p> + An Address delivered before the Massachusetts Medical Society, at the + Annual Meeting, May 30, 1860. + </p> +<pre xml:space="preserve"> + “Facultate magis quam violentia.” + HIPPOCRATES. +</pre> + <p> + Our Annual Meeting never fails to teach us at least one lesson. The art + whose province it is to heal and to save cannot protect its own ranks from + the inroads of disease and the waste of the Destroyer. + </p> + <p> + Seventeen of our associates have been taken from us since our last + Anniversary. Most of them followed their calling in the villages or towns + that lie among the hills or along the inland streams. Only those who have + lived the kindly, mutually dependent life of the country, can tell how + near the physician who is the main reliance in sickness of all the + families throughout a thinly settled region comes to the hearts of the + people among whom he labors, how they value him while living, how they + cherish his memory when dead. For these friends of ours who have gone + before, there is now no more toil; they start from their slumbers no more + at the cry of pain; they sally forth no more into the storms; they ride no + longer over the lonely roads that knew them so well; their wheels are + rusting on their axles or rolling with other burdens; their watchful eyes + are closed to all the sorrows they lived to soothe. Not one of these was + famous in the great world; some were almost unknown beyond their own + immediate circle. But they have left behind them that loving remembrance + which is better than fame, and if their epitaphs are chiselled briefly in + stone, they are written at full length on living tablets in a thousand + homes to which they carried their ever-welcome aid and sympathy. + </p> + <p> + One whom we have lost, very widely known and honored, was a leading + practitioner of this city. His image can hardly be dimmed in your + recollection, as he stood before you only three years ago, filling the + same place with which I am now honored. To speak of him at all worthily, + would be to write the history of professional success, won without special + aid at starting, by toil, patience, good sense, pure character, and + pleasing manners; won in a straight uphill ascent, without one + breathing-space until he sat down, not to rest, but to die. If prayers + could have shielded him from the stroke, if love could have drawn forth + the weapon, and skill could have healed the wound, this passing tribute + might have been left to other lips and to another generation. + </p> + <p> + Let us hope that our dead have at last found that rest which neither + summer nor winter, nor day nor night, had granted to their unending + earthly labors! And let us remember that our duties to our brethren do not + cease when they become unable to share our toils, or leave behind them in + want and woe those whom their labor had supported. It is honorable to the + Profession that it has organized an Association for the relief of its + suffering members and their families; it owes this tribute to the + ill-rewarded industry and sacrifices of its less fortunate brothers who + wear out health and life in the service of humanity. I have great pleasure + in referring to this excellent movement, which gives our liberal + profession a chance to show its liberality, and serves to unite us all, + the successful and those whom fortune has cast down, in the bonds of a + true brotherhood. + </p> + <p> + A medical man, as he goes about his daily business after twenty years of + practice, is apt to suppose that he treats his patients according to the + teachings of his experience. No doubt this is true to some extent; to what + extent depending much on the qualities of the individual. But it is easy + to prove that the prescriptions of even wise physicians are very commonly + founded on something quite different from experience. Experience must be + based on the permanent facts of nature. But a glance at the prevalent + modes of treatment of any two successive generations will show that there + is a changeable as well as a permanent element in the art of healing; not + merely changeable as diseases vary, or as new remedies are introduced, but + changeable by the going out of fashion of special remedies, by the + decadence of a popular theory from which their fitness was deduced, or + other cause not more significant. There is no reason to suppose that the + present time is essentially different in this respect from any other. + Much, therefore, which is now very commonly considered to be the result of + experience, will be recognized in the next, or in some succeeding + generation, as no such result at all, but as a foregone conclusion, based + on some prevalent belief or fashion of the time. + </p> + <p> + There are, of course, in every calling, those who go about the work of the + day before them, doing it according to the rules of their craft, and + asking no questions of the past or of the future, or of the aim and end to + which their special labor is contributing. These often consider and call + themselves practical men. They pull the oars of society, and have no + leisure to watch the currents running this or that way; let theorists and + philosophers attend to them. In the mean time, however, these currents are + carrying the practical men, too, and all their work may be thrown away, + and worse than thrown away, if they do not take knowledge of them and get + out of the wrong ones and into the right ones as soon as they may. Sir + Edward Parry and his party were going straight towards the pole in one of + their arctic expeditions, travelling at the rate of ten miles a day. But + the ice over which they travelled was drifting straight towards the + equator, at the rate of twelve miles a day, and yet no man among them + would have known that he was travelling two miles a day backward unless he + had lifted his eyes from the track in which he was plodding. It is not + only going backward that the plain practical workman is liable to, if he + will not look up and look around; he may go forward to ends he little + dreams of. It is a simple business for a mason to build up a niche in a + wall; but what if, a hundred years afterwards when the wall is torn down, + the skeleton of a murdered man drop out of the niche? It was a plain + practical piece of carpentry for a Jewish artisan to fit two pieces of + timber together according to the legal pattern in the time of Pontius + Pilate; he asked no questions, perhaps, but we know what burden the cross + bore on the morrow! And so, with subtler tools than trowels or axes, the + statesman who works in policy without principle, the theologian who works + in forms without a soul, the physician who, calling himself a practical + man, refuses to recognize the larger laws which govern his changing + practice, may all find that they have been building truth into the wall, + and hanging humanity upon the cross. + </p> + <p> + The truth is, that medicine, professedly founded on observation, is as + sensitive to outside influences, political, religious, philosophical, + imaginative, as is the barometer to the changes of atmospheric density. + Theoretically it ought to go on its own straightforward inductive path, + without regard to changes of government or to fluctuations of public + opinion. But look a moment while I clash a few facts together, and see if + some sparks do not reveal by their light a closer relation between the + Medical Sciences and the conditions of Society and the general thought of + the time, than would at first be suspected. + </p> + <p> + Observe the coincidences between certain great political and intellectual + periods and the appearance of illustrious medical reformers and teachers. + It was in the age of Pericles, of Socrates, of Plato, of Phidias, that + Hippocrates gave to medical knowledge the form which it retained for + twenty centuries. With the world-conquering Alexander, the world-embracing + Aristotle, appropriating anatomy and physiology, among his manifold spoils + of study, marched abreast of his royal pupil to wider conquests. Under the + same Ptolemies who founded the Alexandrian Library and Museum, and ordered + the Septuagint version of the Hebrew Scriptures, the infallible Herophilus + [“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. + </p> + <p> + Look at Vesalius, the contemporary of Luther. Who can fail to see one + common spirit in the radical ecclesiastic and the reforming + court-physician? Both still to some extent under the dominion of the + letter: Luther holding to the real presence; Vesalius actually causing to + be drawn and engraved two muscles which he knew were not found in the + human subject, because they had been described by Galen, from dissections + of the lower animals. Both breaking through old traditions in the search + of truth; one, knife in hand, at the risk of life and reputation, the + other at the risk of fire and fagot, with that mightier weapon which all + the devils could not silence, though they had been thicker than the tiles + on the house-tops. How much the physician of the Catholic Charles V. had + in common with the great religious destructive, may be guessed by the + relish with which he tells the story how certain Pavian students exhumed + the body of an “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.” + </p> + <p> + Our unfortunate medical brother, Michael Servetus, the spiritual patient + to whom the theological moxa was applied over the entire surface for the + cure of his heresy, came very near anticipating Harvey. The same quickened + thought of the time which led him to dispute the dogma of the Church, + opened his mind to the facts which contradicted the dogmas of the Faculty. + </p> + <p> + Harvey himself was but the posthumous child of the great Elizabethan + period. Bacon was at once his teacher and his patient. The founder of the + new inductive philosophy had only been dead two years when the treatise on + the Circulation, the first-fruit of the Restoration of Science, was given + to the world. + </p> + <p> + And is it to be looked at as a mere accidental coincidence, that while + Napoleon was modernizing the political world, Bichat was revolutionizing + the science of life and the art that is based upon it; that while the + young general was scaling the Alps, the young surgeon was climbing the + steeper summits of unexplored nature; that the same year read the + announcement of those admirable “Researches on Life and Death,” and the + bulletins of the battle of Marengo? + </p> + <p> + If we come to our own country, who can fail to recognize that Benjamin + Rush, the most conspicuous of American physicians, was the intellectual + offspring of the movement which produced the Revolution? “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.” + </p> + <p> + Following this general course of remark, I propose to indicate in a few + words the direction of the main intellectual current of the time, and to + point out more particularly some of the eddies which tend to keep the + science and art of medicine from moving with it, or even to carry them + backwards. + </p> + <p> + The two dominant words of our time are law and average, both pointing to + the uniformity of the order of being in which we live. Statistics have + tabulated everything,—population, growth, wealth, crime, disease. We + have shaded maps showing the geographical distribution of larceny and + suicide. Analysis and classification have been at work upon all tangible + and visible objects. The Positive Philosophy of Comte has only given + expression to the observing and computing mind of the nineteenth century. + </p> + <p> + In the mean time, the great stronghold of intellectual conservatism, + traditional belief, has been assailed by facts which would have been + indicted as blasphemy but a few generations ago. Those new tables of the + law, placed in the hands of the geologist by the same living God who spoke + from Sinai to the Israelites of old, have remodelled the beliefs of half + the civilized world. The solemn scepticism of science has replaced the + sneering doubts of witty philosophers. The more positive knowledge we + gain, the more we incline to question all that has been received without + absolute proof. + </p> + <p> + As a matter of course, this movement has its partial reactions. The + province of faith is claimed as a port free of entry to unsupported + individual convictions. The tendency to question is met by the unanalyzing + instinct of reverence. The old church calls back its frightened truants. + Some who have lost their hereditary religious belief find a resource in + the revelations of Spiritualism. By a parallel movement, some of those who + have become medical infidels pass over to the mystic band of believers in + the fancied miracles of Homoeopathy. + </p> + <p> + Under these influences transmitted to, or at least shared by, the medical + profession, the old question between “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. + </p> + <p> + In this Society we have had the Hippocratic and the Themisonic side fairly + represented. The treatise of one of your early Presidents on the Mercurial + Treatment is familiar to my older listeners. Others who have held the same + office have been noted for the boldness of their practice, and even for + partiality to the use of complex medication. + </p> + <p> + On the side of “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. + </p> + <p> + 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. + </p> + <p> + If there is any State or city which might claim to be the American + headquarters of the nature-trusting heresy, provided it be one, that State + is Massachusetts, and that city is its capital. The effect which these + doctrines have upon the confidence reposed in the profession is a matter + of opinion. For myself, I do not believe this confidence can be impaired + by any investigations which tend to limit the application of troublesome, + painful, uncertain, or dangerous remedies. Nay, I will venture to say + this, that if every specific were to fail utterly, if the cinchona trees + all died out, and the arsenic mines were exhausted, and the sulphur + regions were burned up, if every drug from the vegetable, animal, and + mineral kingdom were to disappear from the market, a body of enlightened + men, organized as a distinct profession, would be required just as much as + now, and respected and trusted as now, whose province should be to guard + against the causes of disease, to eliminate them if possible when still + present, to order all the conditions of the patient so as to favor the + efforts of the system to right itself, and to give those predictions of + the course of disease which only experience can warrant, and which in so + many cases relieve the exaggerated fears of sufferers and their friends, + or warn them in season of impending danger. Great as the loss would be if + certain active remedies could no longer be obtained, it would leave the + medical profession the most essential part of its duties, and all, and + more than all, its present share of honors; for it would be the death-blow + to charlatanism, which depends for its success almost entirely on drugs, + or at least on a nomenclature that suggests them. + </p> + <p> + There is no offence, then, or danger in expressing the opinion, that, + after all which has been said, the community is still overdosed: The best + proof of it is, that “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. + </p> + <p> + Part of the blame of over-medication must, I fear, rest with the + profession, for yielding to the tendency to self-delusion, which seems + inseparable from the practice of the art of healing. I need only touch on + the common modes of misunderstanding or misapplying the evidence of + nature. + </p> + <p> + First, there is the natural incapacity for sound observation, which is + like a faulty ear in music. We see this in many persons who know a good + deal about books, but who are not sharp-sighted enough to buy a horse or + deal with human diseases. + </p> + <p> + Secondly, there is in some persons a singular inability to weigh the value + of testimony; of which, I think, from a pretty careful examination of his + books, Hahnemann affords the best specimen outside the walls of Bedlam. + </p> + <p> + The inveterate logical errors to which physicians have always been subject + are chiefly these: + </p> + <p> + The mode of inference per enumerationem simplicem, in scholastic phrase; + that is, counting only their favorable cases. This is the old trick + illustrated in Lord Bacon's story of the gifts of the shipwrecked people, + hung up in the temple.—Behold! they vowed these gifts to the altar, + and the gods saved them. Ay, said a doubting bystander, but how many made + vows of gifts and were shipwrecked notwithstanding? The numerical system + is the best corrective of this and similar errors. The arguments commonly + brought against its application to all matters of medical observation, + treatment included, seem to apply rather to the tabulation of facts ill + observed, or improperly classified, than to the method itself. + </p> + <p> + The post hoc ergo propter hoc error: he got well after taking my medicine; + therefore in consequence of taking it. + </p> + <p> + The false induction from genuine facts of observation, leading to the + construction of theories which are then deductively applied in the face of + the results of direct observation. The school of Broussais has furnished + us with a good example of this error. + </p> + <p> + And lastly, the error which Sir Thomas Browne calls giving “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. + </p> + <p> + Another portion of the blame rests with the public itself, which insists + on being poisoned. Somebody buys all the quack medicines that build + palaces for the mushroom, say rather, the toadstool millionaires. Who is + it? These people have a constituency of millions. The popular belief is + all but universal that sick persons should feed on noxious substances. One + of our members was called not long since to a man with a terribly sore + mouth. On inquiry he found that the man had picked up a box of unknown + pills, in Howard Street, and had proceeded to take them, on general + principles, pills being good for people. They happened to contain mercury, + and hence the trouble for which he consulted our associate. + </p> + <p> + The outside pressure, therefore, is immense upon the physician, tending to + force him to active treatment of some kind. Certain old superstitions, + still lingering in the mind of the public, and not yet utterly expelled + from that of the profession, are at the bottom of this, or contribute to + it largely. One of the most ancient is, that disease is a malignant + agency, or entity, to be driven out of the body by offensive substances, + as the smoke of the fish's heart and liver drove the devil out of Tobit's + bridal chamber, according to the Apochrypha. Epileptics used to suck the + blood from the wounds of dying gladiators. [Plinii Hist. Mundi. lib. + xxviii. c. 4.] The Hon. Robert Boyle's little book was published some + twenty or thirty years before our late President, Dr. Holyoke, was born. + [A Collection of Choice and Safe Remedies. The Fifth Edition, corrected. + London, 1712. Dr. Holyoke was born in 1728.] In it he recommends, as + internal medicines, most of the substances commonly used as fertilizers of + the soil. His “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.] + </p> + <p> + Even now the Homoeopathists have been introducing the venom of serpents, + under the learned title of Lachesis, and outraging human nature with + infusions of the pediculus capitis; that is, of course, as we understand + their dilutions, the names of these things; for if a fine-tooth-comb + insect were drowned in Lake Superior, we cannot agree with them in + thinking that every drop of its waters would be impregnated with all the + pedicular virtues they so highly value. They know what they are doing. + They are appealing to the detestable old superstitious presumption in + favor of whatever is nauseous and noxious as being good for the sick. + </p> + <p> + Again, we all occasionally meet persons stained with nitrate of silver, + given for epilepsy. Read what Dr. Martin says, about the way in which it + came to be used, in his excellent address before the Norfolk County + Medical Society, and the evidence I can show, but have not time for now, + and then say what you think of the practice which on such presumptions + turns a white man as blue as the double-tattooed King of the Cannibal + Islands! [Note A.] + </p> + <p> + If medical superstitions have fought their way down through all the + rationalism and scepticism of the nineteenth century, of course the + theories of the schools, supported by great names, adopted into the + popular belief and incorporated with the general mass of misapprehension + with reference to disease, must be expected to meet us at every turn in + the shape of bad practice founded on false doctrine. A French patient + complains that his blood heats him, and expects his doctor to bleed him. + An English or American one says he is bilious, and will not be easy + without a dose of calomel. A doctor looks at a patient's tongue, sees it + coated, and says the stomach is foul; his head full of the old saburral + notion which the extreme inflammation-doctrine of Broussais did so much to + root out, but which still leads, probably, to much needless and injurious + wrong of the stomach and bowels by evacuants, when all they want is to be + let alone. It is so hard to get anything out of the dead hand of medical + tradition! The mortmain of theorists extinct in science clings as close as + that of ecclesiastics defunct in law. + </p> + <p> + One practical hint may not be out of place here. It seems to be sometimes + forgotten, by those who must know the fact, that the tongue is very + different, anatomically and physiologically, from the stomach. Its + condition does not in the least imply a similar one of the stomach, which + is a very different structure, covered with a different kind of + epithelium, and furnished with entirely different secretions. A + silversmith will, for a dollar, make a small hoe, of solid silver, which + will last for centuries, and will give a patient more comfort, used for + the removal of the accumulated epithelium and fungous growths which + constitute the “fur,” than many a prescription with a split-footed Rx + before it, addressed to the parts out of reach. + </p> + <p> + I think more of this little implement on account of its agency in saving + the Colony at Plymouth in the year 1623. Edward Winslow heard that + Massasoit was sick and like to die. He found him with a houseful of people + about him, women rubbing his arms and legs, and friends “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. + </p> + <p> + 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. + </p> + <p> + The practice of making a profit on the medicine ordered has been held up + to reprobation by one at least of the orators who have preceded me. That + the effect of this has been ruinous in English practice I cannot doubt, + and that in this country the standard of practice was in former + generations lowered through the same agency is not unlikely. I have seen + an old account-book in which the physician charged an extra price for + gilding his rich patients' pills. If all medicine were very costly, and + the expense of it always came out of the physician's fee, it would really + be a less objectionable arrangement than this other most pernicious one. + He would naturally think twice before he gave an emetic or cathartic which + evacuated his own pocket, and be sparing of the cholagogues that emptied + the biliary ducts of his own wallet, unless he were sure they were needed. + If there is any temptation, it should not be in favor of giving noxious + agents, as it clearly must be in the case of English druggists and + “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. + </p> + <p> + A pretty strong eddy, then, or rather many eddies, setting constantly back + from the current of sober observation of nature, in the direction of old + superstitions and fancies, of exploded theories, of old ways of making + money, which are very slow to pass out of fashion. + </p> + <p> + But there are other special American influences which we are bound to take + cognizance of. If I wished to show a student the difficulties of getting + at truth from medical experience, I would give him the history of epilepsy + to read. If I wished him to understand the tendencies of the American + medical mind, its sanguine enterprise, its self-confidence, its audacious + handling of Nature, its impatience with her old-fashioned ways of taking + time to get a sick man well, I would make him read the life and writings + of Benjamin Rush. Dr. Rush thought and said that there were twenty times + more intellect and a hundred times more knowledge in the country in 1799 + than before the Revolution. His own mind was in a perpetual state of + exaltation produced by the stirring scenes in which he had taken a part, + and the quickened life of the time in which he lived. It was not the state + to favor sound, calm observation. He was impatient, and Nature is + profoundly imperturbable. We may adjust the beating of our hearts to her + pendulum if we will and can, but we may be very sure that she will not + change the pendulum's rate of going because our hearts are palpitating. He + thought he had mastered yellow-fever. “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? + </p> + <p> + One such instance will do as well as twenty. Dr. Rush must have been a + charming teacher, as he was an admirable man. He was observing, rather + than a sound observer; eminently observing, curious, even, about all + manner of things. But he could not help feeling as if Nature had been a + good deal shaken by the Declaration of Independence, and that American art + was getting to be rather too much for her,—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? + </p> + <p> + Add to this the great number of Medical Journals, all useful, we hope, + most of them necessary, we trust, many of them excellently well conducted, + but which must find something to fill their columns, and so print all the + new plans of treatment and new remedies they can get hold of, as the + newspapers, from a similar necessity, print the shocking catastrophes and + terrible murders. + </p> + <p> + Besides all this, here are we, the great body of teachers in the + numberless medical schools of the Union, some of us lecturing to crowds + who clap and stamp in the cities, some of us wandering over the country, + like other professional fertilizers, to fecundate the minds of less + demonstrative audiences at various scientific stations; all of us talking + habitually to those supposed to know less than ourselves, and loving to + claim as much for our art as we can, not to say for our own schools, and + possibly indirectly for our own practical skill. Hence that annual crop of + introductory lectures; the useful blossoming into the ornamental, as the + cabbage becomes glorified in the cauliflower; that lecture-room literature + of adjectives, that declamatory exaggeration, that splendid show of + erudition borrowed from D'Israeli, and credited to Lord Bacon and the + rest, which have suggested to our friends of the Medical Journals an + occasional epigram at our expense. Hence the tendency in these + productions, and in medical lectures generally, to overstate the efficacy + of favorite methods of cure, and hence the premium offered for showy + talkers rather than sagacious observers, for the men of adjectives rather + than of nouns substantive in the more ambitious of these institutions. + </p> + <p> + Such are some of the eddies in which we are liable to become involved and + carried back out of the broad stream of philosophical, or, in other words, + truth-loving, investigations. The causes of disease, in the mean time, + have been less earnestly studied in the eagerness of the search for + remedies. Speak softly! Women have been borne out from an old-world + hospital, two in one coffin, that the horrors of their prison-house might + not be known, while the very men who were discussing the treatment of the + disease were stupidly conveying the infection from bed to bed, as + rat-killers carry their poisons from one household to another. Do not some + of you remember that I have had to fight this private-pestilence question + against a scepticism which sneered in the face of a mass of evidence such + as the calm statisticians of the Insurance office could not listen to + without horror and indignation? [“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! + </p> + <p> + Art can do something more than say this. It can sometimes reach the pebble + or berry after it has been swallowed. But the great thing is to keep these + things out of children's mouths, and as soon as they are beyond our reach, + to be reasonable and patient with Nature, who means well, but does not + like to hurry, and who took nine calendar months, more or less, to every + mother's son among us, before she thought he was fit to be shown to the + public. + </p> + <p> + Suffer me now to lay down a few propositions, whether old or new it + matters little, not for your immediate acceptance, nor yet for your hasty + rejection, but for your calm consideration. + </p> + <p> + But first, there are a number of terms which we are in the habit of using + in a vague though not unintelligible way, and which it is as well now to + define. These terms are the tools with which we are to work, and the first + thing is to sharpen them. It is nothing to us that they have been + sharpened a thousand times before; they always get dull in the using, and + every new workman has a right to carry them to the grindstone and sharpen + them to suit himself. + </p> + <p> + Nature, in medical language, as opposed to Art, means trust in the + reactions of the living system against ordinary normal impressions. + </p> + <p> + Art, in the same language, as opposed to Nature, means an intentional + resort to extraordinary abnormal impressions for the relief of disease. + </p> + <p> + The reaction of the living system is the essence of both. Food is nothing, + if there is no digestive act to respond to it. We cannot raise a blister + on a dead man, or hope that a carminative forced between his lips will + produce its ordinary happy effect. + </p> + <p> + Disease, dis-ease,—disturbed quiet, uncomfortableness,—means + imperfect or abnormal reaction of the living system, and its more or less + permanent results. + </p> + <p> + Food, in its largest sense, is whatever helps to build up the normal + structures, or to maintain their natural actions. + </p> + <p> + Medicine, in distinction from food, is every unnatural or noxious agent + applied for the relief of disease. + </p> + <p> + Physic means properly the Natural art, and Physician is only the Greek + synonyme of Naturalist. + </p> + <p> + With these few explanations I proceed to unfold the propositions I have + mentioned. + </p> + <p> + Disease and death, if we may judge by the records of creation, are + inherently and essentially necessary in the present order of things. A + perfect intelligence, trained by a perfect education, could do no more + than keep the laws of the physical and spiritual universe. An imperfect + intelligence, imperfectly taught,—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.”] + </p> + <p> + But it is especially the prerogative, I had almost said privilege, of + educated and domesticated beings, from man down to the potato, serving to + teach them, and such as train them, the laws of life, and to get rid of + those who will not mind or cannot be kept subject to these laws. + </p> + <p> + Disease, being always an effect, is always in exact proportion to the sum + of its causes, as much in the case of Spigelius, who dies of a scratch, as + in that of the man who recovers after an iron bar has been shot through + his brain. The one prevalent failing of the medical art is to neglect the + causes and quarrel with the effect. + </p> + <p> + There are certain general facts which include a good deal of what is + called and treated as disease. Thus, there are two opposite movements of + life to be seen in cities and elsewhere, belonging to races which, from + various persistent causes, are breeding down and tending to run out, and + to races which are breeding up, or accumulating vital capital,—a + descending and an ascending series. Let me give an example of each; and + that I may incidentally remove a common impression about this country as + compared with the Old World, an impression which got tipsy with conceit + and staggered into the attitude of a formal proposition in the work of Dr. + Robert Knox, I will illustrate the downward movement from English + experience, and the upward movement from a family history belonging to + this immediate neighborhood. + </p> + <p> + Miss Nightingale speaks of “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. + </p> + <p> + Something more than one hundred and thirty years ago there graduated at + Harvard College a delicate youth, who lived an invalid life and died at + the age of about fifty. His two children were both of moderate physical + power, and one of them diminutive in stature. The next generation rose in + physical development, and reached eighty years of age and more in some of + its members. The fourth generation was of fair average endowment. The + fifth generation, great-great-grandchildren of the slender invalid, are + several of, them of extraordinary bodily and mental power; large in + stature, formidable alike with their brains and their arms, organized on a + more extensive scale than either of their parents. + </p> + <p> + This brief account illustrates incidentally the fallacy of the + universal-degeneration theory applied to American life; the same on which + one of our countrymen has lately brought some very forcible facts to bear + in a muscular discussion of which we have heard rather more than is good + for us. But the two series, American and English, ascending and + descending, were adduced with the main purpose of showing the immense + difference of vital endowments in different strains of blood; a difference + to which all ordinary medication is in all probability a matter of + comparatively trivial purport. Many affections which art has to strive + against might be easily shown to be vital to the well-being of society. + Hydrocephalus, tabes mesenterica, and other similar maladies, are natural + agencies which cut off the children of races that are sinking below the + decent minimum which nature has established as the condition of viability, + before they reach the age of reproduction. They are really not so much + diseases, as manifestations of congenital incapacity for life; the race + would be ruined if art could ever learn always to preserve the individuals + subject to them. We must do the best we can for them, but we ought also to + know what these “diseases” mean. + </p> + <p> + Again, invalidism is the normal state of many organizations. It can be + changed to disease, but never to absolute health by medicinal appliances. + There are many ladies, ancient and recent, who are perpetually taking + remedies for irremediable pains and aches. They ought to have headaches + and back-aches and stomach-aches; they are not well if they do not have + them. To expect them to live without frequent twinges is like expecting a + doctor's old chaise to go without creaking; if it did, we might be sure + the springs were broken. There is no doubt that the constant demand for + medicinal remedies from patients of this class leads to their over-use; + often in the case of cathartics, sometimes in that of opiates. I have been + told by an intelligent practitioner in a Western town, that the constant + prescription of opiates by certain physicians in his vicinity has rendered + the habitual use of that drug in all that region very prevalent; more + common, I should think, than alcoholic drunkenness in the most intemperate + localities of which I have known anything. A frightful endemic + demoralization betrays itself in the frequency with which the haggard + features and drooping shoulders of the opium-drunkards are met with in the + streets. + </p> + <p> + The next proposition I would ask you to consider is this: The presumption + always is that every noxious agent, including medicines proper, which + hurts a well man, hurts a sick one. [Note B.] + </p> + <p> + Let me illustrate this proposition before you decide upon it. If it were + known that a prize-fighter were to have a drastic purgative administered + two or three days before a contest, or a large blister applied to his + back, no one will question that it would affect the betting on his side + unfavorably; we will say to the amount of five per cent. Now the drain + upon the resources of the system produced in such a case must be at its + minimum, for the subject is a powerful man, in the prime of life, and in + admirable condition. If the drug or the blister takes five per cent. from + his force of resistance, it will take at least as large a fraction from + any invalid. But this invalid has to fight a champion who strikes hard but + cannot be hit in return, who will press him sharply for breath, but will + never pant himself while the wind can whistle through his fleshless ribs. + The suffering combatant is liable to want all his stamina, and five per + cent. may lose him the battle. + </p> + <p> + All noxious agents, all appliances which are not natural food or stimuli, + all medicines proper, cost a patient, on the average, five per cent. of + his vital force, let us say. Twenty times as much waste of force produced + by any of them, that is, would exactly kill him, nothing less than kill + him, and nothing more. If this, or something like this, is true, then all + these medications are, prima facie, injurious. + </p> + <p> + In the game of Life-or-Death, Rouge et Noir, as played between the Doctor + and the Sexton, this five per cent., this certain small injury entering + into the chances is clearly the sexton's perquisite for keeping the green + table, over which the game is played, and where he hoards up his gains. + Suppose a blister to diminish a man's pain, effusion or dyspnoea to the + saving of twenty per cent. in vital force; his profit from it is fifteen, + in that case, for it always hurts him five to begin with, according to our + previous assumption. + </p> + <p> + Presumptions are of vast importance in medicine, as in law. A man is + presumed innocent until he is proved guilty. A medicine—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. + </p> + <p> + But to justify this proposition, I must add that the injuries inflicted by + over-medication are to a great extent masked by disease. Dr. Hooker + believes that the typhus syncopatia of a preceding generation in New + England “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? + </p> + <p> + Lastly, medication without insuring favorable hygienic conditions is like + amputation without ligatures. I had a chance to learn this well of old, + when physician to the Broad Street district of the Boston Dispensary. + There, there was no help for the utter want of wholesome conditions, and + if anybody got well under my care, it must have been in virtue of the + rough-and-tumble constitution which emerges from the struggle for life in + the street gutters, rather than by the aid of my prescriptions. + </p> + <p> + But if the materia medica were lost overboard, how much more pains would + be taken in ordering all the circumstances surrounding the patient (as can + be done everywhere out of the crowded pauper districts), than are taken + now by too many who think they do their duty and earn their money when + they write a recipe for a patient left in an atmosphere of domestic + malaria, or to the most negligent kind of nursing! I confess that I should + think my chance of recovery from illness less with Hippocrates for my + physician and Mrs. Gamp for my nurse, than if I were in the hands of + Hahnemann himself, with Florence Nightingale or good Rebecca Taylor to + care for me. + </p> + <p> + If I am right in maintaining that the presumption is always against the + use of noxious agents in disease, and if any whom I might influence should + adopt this as a principle of practice, they will often find themselves + embarrassed by the imperative demand of patients and their friends for + such agents where a case is not made out against this standing + presumption. I must be permitted to say, that I think the French, a not + wholly uncivilized people, are in advance of the English and ourselves in + the art of prescribing for the sick without hurting them. And I do confess + that I think their varied ptisans and syrups are as much preferable to the + mineral regimen of bug-poison and ratsbane, so long in favor on the other + side of the Channel, as their art of preparing food for the table to the + rude cookery of those hard-feeding and much-dosing islanders. We want a + reorganized cuisine of invalidism perhaps as much as the culinary, reform, + for which our lyceum lecturers, and others who live much at hotels and + taverns, are so urgent. Will you think I am disrespectful if I ask + whether, even in Massachusetts, a dose of calomel is not sometimes given + by a physician on the same principle as that upon which a landlord + occasionally prescribes bacon and eggs,—because he cannot think of + anything else quite so handy? I leave my suggestion of borrowing a hint + from French practice to your mature consideration. + </p> + <p> + I may, however, call your attention, briefly, to the singular fact, that + English and American practitioners are apt to accuse French medical + practice of inertness, and French surgical practice of unnecessary + activity. Thus, Dr. Bostock considers French medical treatment, with + certain exceptions, as “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. + </p> + <p> + Our art has had two or three lessons which have a deep meaning to those + who are willing to read them honestly. The use of water-dressings in + surgery completed the series of reforms by which was abolished the “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. + </p> + <p> + My friends and brothers in Art! There is nothing to be feared from the + utterance of any seeming heresy to which you may have listened. I cannot + compromise your collective wisdom. If I have strained the truth one hair's + breadth for the sake of an epigram or an antithesis, you are accustomed to + count the normal pulse-beats of sound judgment, and know full well how to + recognize the fever-throbs of conceit and the nervous palpitations of + rhetoric. + </p> + <p> + The freedom with which each of us speaks his thought in this presence, + belongs in part to the assured position of the Profession in our + Commonwealth, to the attitude of Science, which is always fearless, and to + the genius of the soil on which we stand, from which Nature withheld the + fatal gift of malaria only to fill it with exhalations that breed the + fever of inquiry in our blood and in our brain. But mainly we owe the + large license of speech we enjoy to those influences and privileges common + to us all as self-governing Americans. + </p> + <p> + This Republic is the chosen home of minorities, of the less power in the + presence of the greater. It is a common error to speak of our distinction + as consisting in the rule of the majority. Majorities, the greater + material powers, have always ruled before. The history of most countries + has been that of majorities, mounted majorities, clad in iron, armed with + death treading down the tenfold more numerous minorities. In the old + civilizations they root themselves like oaks in the soil; men must live in + their shadow or cut them down. With us the majority is only the flower of + the passing noon, and the minority is the bud which may open in the next + morning's sun. We must be tolerant, for the thought which stammers on a + single tongue today may organize itself in the growing consciousness of + the time, and come back to us like the voice of the multitudinous waves of + the ocean on the morrow. + </p> + <p> + Twenty-five years have passed since one of your honored Presidents spoke + to this Society of certain limitations to the power of our Art, now very + generally conceded. Some were troubled, some were almost angry, thinking + the Profession might suffer from such concessions. It has certainly not + suffered here; if, as some affirm, it has lost respect anywhere, it was + probably for other, and no doubt sufficient reasons. + </p> + <p> + Since that time the civilization of this planet has changed hands. Strike + out of existence at this moment every person who was breathing on that + day, May 27, 1835, and every institution of society, every art and every + science would remain intact and complete in the living that would be left. + Every idea the world then held has been since dissolved and + recrystallized. + </p> + <p> + We are repeating the same process. Not to make silver shrines for our old + divinities, even though by this craft we should have our wealth, was this + Society organized and carried on by the good men and true who went before + us. Not for this, but to melt the gold out of the past, though its dross + should fly in dust to all the winds of heaven, to save all our old + treasures of knowledge and mine deeply for new, to cultivate that mutual + respect of which outward courtesy is the sign, to work together, to feel + together, to take counsel together, and to stand together for the truth, + now, always, here, everywhere; for this our fathers instituted, and we + accept, the offices and duties of this time-honored Society. + </p> + <p> + <a name="link2H_4_0008" id="link2H_4_0008"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + BORDER LINES OF KNOWLEDGE IN SOME PROVINCES OF MEDICAL SCIENCE. + </h2> + <p> + An Introductory Lecture delivered before the Medical Class of Harvard + University, November 6, 1861. + </p> + <p> + [This Lecture appears as it would have been delivered had the time allowed + been less strictly, limited. Passages necessarily omitted have been + restored, and points briefly touched have been more fully considered. A + few notes have been added for the benefit of that limited class of + students who care to track an author through the highways and by-ways of + his reading. I owe my thanks to several of my professional brethren who + have communicated with me on subjects with which they are familiar; + especially to Dr. John Dean, for the opportunity of profiting by his + unpublished labors, and to Dr. Hasket Derby, for information and + references to recent authorities relating to the anatomy and physiology of + the eye.] + </p> + <p> + The entrance upon a new course of Lectures is always a period of interest + to instructors and pupils. As the birth of a child to a parent, so is the + advent of a new class to a teacher. As the light of the untried world to + the infant, so is the dawning of the light resting over the unexplored + realms of science to the student. In the name of the Faculty I welcome + you, Gentlemen of the Medical Class, new-born babes of science, or lustier + nurslings, to this morning of your medical life, and to the arms and the + bosom of this ancient University. Fourteen years ago I stood in this place + for the first time to address those who occupied these benches. As I + recall these past seasons of our joint labors, I feel that they have been + on the whole prosperous, and not undeserving of their prosperity. + </p> + <p> + For it has been my privilege to be associated with a body of true and + faithful workers; I cannot praise them freely to their faces, or I should + be proud to discourse of the harmonious diligence and the noble spirit in + which they have toiled together, not merely to teach their several + branches, but to elevate the whole standard of teaching. + </p> + <p> + I may speak with less restraint of those gentlemen who have aided me in + the most laborious part of my daily duties, the Demonstrators, to whom the + successive classes have owed so much of their instruction. They rise + before me, the dead and the living, in the midst of the most grateful + recollections. The fair, manly face and stately figure of my friend, Dr. + Samuel Parkman, himself fit for the highest offices of teaching, yet + willing to be my faithful assistant in the time of need, come back to me + with the long sigh of regret for his early loss to our earthly + companionship. Every year I speak the eulogy of Dr. Ainsworth's patient + toil as I show his elaborate preparations: When I take down my “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? + </p> + <p> + This day belongs, however, not to myself and my recollections, but to all + of us who teach and all of you who listen, whether experts in our + specialties or aliens to their mysteries, or timid neophytes just entering + the portals of the hall of science. Look in with me, then, while I attempt + to throw some rays into its interior, which shall illuminate a few of its + pillars and cornices, and show at the same time how many niches and + alcoves remain in darkness. + </p> + <p> + SCIENCE is the topography of ignorance. From a few elevated points we + triangulate vast spaces, inclosing infinite unknown details. We cast the + lead, and draw up a little sand from abysses we may never reach with our + dredges. + </p> + <p> + The best part of our knowledge is that which teaches us where knowledge + leaves off and ignorance begins. Nothing more clearly separates a vulgar + from a superior mind, than the confusion in the first between the little + that it truly knows, on the one hand, and what it half knows and what it + thinks it knows on the other. + </p> + <p> + That which is true of every subject is especially true of the branch of + knowledge which deals with living beings. Their existence is a perpetual + death and reanimation. Their identity is only an idea, for we put off our + bodies many times during our lives, and dress in new suits of bones and + muscles. + </p> +<pre xml:space="preserve"> + “Thou art not thyself; + For thou exist'st on many a thousand grains + That issue out of dust.” + </pre> + <p> + If it is true that we understand ourselves but imperfectly in health, this + truth is more signally manifested in disease, where natural actions + imperfectly understood, disturbed in an obscure way by half-seen causes, + are creeping and winding along in the dark toward their destined issue, + sometimes using our remedies as safe stepping-stones, occasionally, it may + be, stumbling over them as obstacles. + </p> + <p> + I propose in this lecture to show you some points of contact between our + ignorance and our knowledge in several of the branches upon the study of + which you are entering. I may teach you a very little directly, but I hope + much more from the trains of thought I shall suggest. Do not expect too + much ground to be covered in this rapid survey. Our task is only that of + sending out a few pickets under the starry flag of science to the edge of + that dark domain where the ensigns of the obstinate rebel, Ignorance, are + flying undisputed. We are not making a reconnoissance in force, still less + advancing with the main column. But here are a few roads along which we + have to march together, and we wish to see clearly how far our lines + extend, and where the enemy's outposts begin. + </p> + <p> + Before touching the branches of knowledge that deal with organization and + vital functions, let us glance at that science which meets you at the + threshold of your study, and prepares you in some measure to deal with the + more complex problems of the living laboratory. + </p> + <p> + CHEMISTRY includes the art of separating and combining the elements of + matter, and the study of the changes produced by these operations. We can + hardly say too much of what it has contributed to our knowledge of the + universe and our power of dealing with its materials. It has given us a + catalogue raisonne of the substances found upon our planet, and shown how + everything living and dead is put together from them. It is accomplishing + wonders before us every day, such as Arabian story-tellers used to string + together in their fables. It spreads the sensitive film on the artificial + retina which looks upon us through the optician's lens for a few seconds, + and fixes an image that will outlive its original. It questions the light + of the sun, and detects the vaporized metals floating around the great + luminary,—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. + </p> + <p> + To return to the colder scientific aspect of chemistry. It has shown us + how bodies stand affected to each other through an almost boundless range + of combinations. It has given us a most ingenious theory to account for + certain fixed relations in these combinations. It has successfully + eliminated a great number of proximate compounds, more or less stable, + from organic structures. It has invented others which form the basis of + long series of well-known composite substances. In fact, we are perhaps + becoming overburdened with our list of proximate principles, demonstrated + and hypothetical. + </p> + <p> + How much nearer have we come to the secret of force than Lully and Geber + and the whole crew of juggling alchemists? We have learned a great deal + about the how, what have we learned about the why? + </p> + <p> + Why does iron rust, while gold remains untarnished, and gold amalgamate, + while iron refuses the alliance of mercury? + </p> + <p> + The alchemists called gold Sol, the sun, and iron Mars, and pleased + themselves with fancied relations between these substances and the + heavenly bodies, by which they pretended to explain the facts they + observed. Some of their superstitions have lingered in practical medicine + to the present day, but chemistry has grown wise enough to confess the + fact of absolute ignorance. + </p> + <p> + What is it that makes common salt crystallize in the form of cubes, and + saltpetre in the shape of six-sided prisms? We see no reason why it should + not have been just the other way, salt in prisms and saltpetre in cubes, + or why either should take an exact geometrical outline, any more than + coagulating albumen. + </p> + <p> + But although we had given up attempting to explain the essential nature of + affinities and of crystalline types, we might have supposed that we had at + least fixed the identity of the substances with which we deal, and + determined the laws of their combination. All at once we find that a + simple substance changes face, puts off its characteristic qualities and + resumes them at will;—not merely when we liquefy or vaporize a + solid, or reverse the process; but that a solid is literally transformed + into another solid under our own eyes. We thought we knew phosphorus. We + warm a portion of it sealed in an empty tube, for about a week. It has + become a brown infusible substance, which does not shine in the dark nor + oxidate in the air. We heat it to 500 F., and it becomes common phosphorus + again. We transmute sulphur in the same singular way. Nature, you know, + gives us carbon in the shape of coal and in that of the diamond. It is + easy to call these changes by the name allotropism, but not the less do + they confound our hasty generalizations. + </p> + <p> + These facts of allotropism have some corollaries connected with them + rather startling to us of the nineteenth century. There may be other + transmutations possible besides those of phosphorus and sulphur. When Dr. + Prout, in 1840, talked about azote and carbon being “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? + </p> + <p> + And so with reference to the law of combinations. The old maxim was, + Corpora non agunt nisi soluta. If two substances, a and b, are inclosed in + a glass vessel, c, we do not expect the glass to change them, unless a or + b or the compound a b has the power of dissolving the glass. But if for a + I take oxygen, for b hydrogen, and for c a piece of spongy platinum, I + find the first two combine with the common signs of combustion and form + water, the third in the mean time undergoing no perceptible change. It has + played the part of the unwedded priest, who marries a pair without taking + a fee or having any further relation with the parties. We call this + catalysis, catalytic action, the action of presence, or by what learned + name we choose. Give what name to it we will, it is a manifestation of + power which crosses our established laws of combination at a very open + angle of intersection. I think we may find an analogy for it in electrical + induction, the disturbance of the equilibrium of the electricity of a body + by the approach of a charged body to it, without interchange of electrical + conditions between the two bodies. But an analogy is not an explanation, + and why a few drops of yeast should change a saccharine mixture to + carbonic acid and alcohol,—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. + </p> + <p> + The phenomena of isomerism, or identity of composition and proportions of + constituents with difference of qualities, and of isomorphism, or identity + of form in crystals which have one element substituted for another, were + equally surprises to science; and although the mechanism by which they are + brought about can be to a certain extent explained by a reference to the + hypothetical atoms of which the elements are constituted, yet this is only + turning the difficulty into a fraction with an infinitesimal denominator + and an infinite numerator. + </p> + <p> + So far we have studied the working of force and its seeming anomalies in + purely chemical phenomena. But we soon find that chemical force is + developed by various other physical agencies,—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.” + </p> + <p> + Out of this doctrine naturally springs that of the conservation of force, + so ably illustrated by Mr. Grove, Dr. Carpenter, and Mr. Faraday. This + idea is no novelty, though it seems so at first sight. It was maintained + and disputed among the giants of philosophy. Des Cartes and Leibnitz + denied that any new motion originated in nature, or that any ever ceased + to exist; all motion being in a circle, passing from one body to another, + one losing what the other gained. Newton, on the other hand, believed that + new motions were generated and existing ones destroyed. On the first + supposition, there is a fixed amount of force always circulating in the + universe. On the second, the total amount may be increasing or + diminishing. You will find in the “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. + </p> + <p> + The doctrines of the convertibility or specific equivalence of the various + forms of force, and of its conservation, which is its logical consequence, + are very generally accepted, as I believe, at the present time, among + physicists. We are naturally led to the question, What is the nature of + force? The three illustrious philosophers just referred to agree in + attributing the general movements of the universe to the immediate Divine + action. The doctrine of “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. + </p> + <p> + Force does not admit of explanation, nor of proper definition, any more + than the hypothetical substratum of matter. If we assume the Infinite as + omnipresent, omniscient, omnipotent, we cannot suppose Him excluded from + any part of His creation, except from rebellious souls which voluntarily + exclude Him by the exercise of their fatal prerogative of free-will. + Force, then, is the act of immanent Divinity. I find no meaning in + mechanical explanations. Newton's hypothesis of an ether filling the + heavenly spaces does not, I confess, help my conceptions. I will, and the + muscles of my vocal organs shape my speech. God wills, and the universe + articulates His power, wisdom, and goodness. That is all I know. There is + no bridge my mind can throw from the “immaterial” cause to the “material” + effect. + </p> + <p> + The problem of force meets us everywhere, and I prefer to encounter it in + the world of physical phenomena before reaching that of living actions. It + is only the name for the incomprehensible cause of certain changes known + to our consciousness, and assumed to be outside of it. For me it is the + Deity Himself in action. + </p> + <p> + I can therefore see a large significance in the somewhat bold language of + Burdach: “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.” + </p> + <p> + Let us turn to a branch of knowledge which deals with certainties up to + the limit of the senses, and is involved in no speculations beyond them. + In certain points of view, HUMAN ANATOMY may be considered an almost + exhausted science. From time to time some small organ which had escaped + earlier observers has been pointed out,—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. + </p> + <p> + Not only has little been added to the catalogue of parts, but some things + long known had become half-forgotten. Louis and others confounded the + solitary glands of the lower part of the small intestine with those which + “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.” + </p> + <p> + This is the place, if anywhere, to mention any observations I could + pretend to have made in the course of my teaching the structure of the + human body. I can make no better show than most of my predecessors in this + well-reaped field. The nucleated cells found connected with the + cancellated structure of the bones, which I first pointed out and had + figured in 1847, and have shown yearly from that time to the present, and + the fossa masseterica, a shallow concavity on the ramus of the lower jaw, + for the lodgment of the masseter muscle, which acquires significance when + examined by the side of the deep cavity on the corresponding part in some + carnivora to which it answers, may perhaps be claimed as deserving + attention. I have also pleased myself by making a special group of the six + radiating muscles which diverge from the spine of the axis, or second + cervical vertebra, and by giving to it the name stella musculosa nuchae. + But this scanty catalogue is only an evidence that one may teach long and + see little that has not been noted by those who have gone before him. Of + course I do not think it necessary to include rare, but already described + anomalies, such as the episternal bones, the rectus sternalis, and other + interesting exceptional formations I have encountered, which have shown a + curious tendency to present themselves several times in the same season, + perhaps because the first specimen found calls our attention to any we may + subsequently meet with. + </p> + <p> + The anatomy of the scalpel and the amphitheatre was, then, becoming an + exhausted branch of investigation. But during the present century the + study of the human body has changed its old aspect, and become fertile in + new observations. This rejuvenescence was effected by means of two + principal agencies,—new methods and a new instrument. + </p> + <p> + Descriptive anatomy, as known from an early date, is to the body what + geography is to the planet. Now geography was pretty well known so long + ago as when Arrowsmith, who was born in 1750, published his admirable + maps. But in that same year was born Werner, who taught a new way of + studying the earth, since become familiar to us all under the name of + Geology. + </p> + <p> + What geology has done for our knowledge of the earth, has been done for + our knowledge of the body by that method of study to which is given the + name of General Anatomy. It studies, not the organs as such, but the + elements out of which the organs are constructed. It is the geology of the + body, as that is the general anatomy of the earth. The extraordinary + genius of Bichat, to whom more than any other we owe this new method of + study, does not require Mr. Buckle's testimony to impress the practitioner + with the importance of its achievements. I have heard a very wise + physician question whether any important result had accrued to practical + medicine from Harvey's discovery of the circulation. But Anatomy, + Physiology, and Pathology have received a new light from this novel method + of contemplating the living structures, which has had a vast influence in + enabling the practitioner at least to distinguish and predict the course + of disease. We know as well what differences to expect in the habits of a + mucous and of a serous membrane, as what mineral substances to look for in + the chalk or the coal measures. You have only to read Cullen's description + of inflammation of the lungs or of the bowels, and compare it with such as + you may find in Laennec or Watson, to see the immense gain which diagnosis + and prognosis have derived from general anatomy. + </p> + <p> + The second new method of studying the human structure, beginning with the + labors of Scarpa, Burns, and Colles, grew up principally during the first + third of this century. It does not deal with organs, as did the earlier + anatomists, nor with tissues, after the manner of Bichat. It maps the + whole surface of the body into an arbitrary number of regions, and studies + each region successively from the surface to the bone, or beneath it. This + hardly deserves the name of a science, although Velpeau has dignified it + with that title, but it furnishes an admirable practical way for the + surgeon who has to operate on a particular region of the body to study + that region. If we are buying a farm, we are not content with the State + map or a geological chart including the estate in question. We demand an + exact survey of that particular property, so that we may know what we are + dealing with. This is just what regional, or, as it is sometimes called, + surgical anatomy, does for the surgeon with reference to the part on which + his skill is to be exercised. It enables him to see with the mind's eye + through the opaque tissues down to the bone on which they lie, as if the + skin were transparent as the cornea, and the organs it covers translucent + as the gelatinous pulp of a medusa. + </p> + <p> + It is curious that the Japanese should have anticipated Europe in a kind + of rude regional anatomy. I have seen a manikin of Japanese make traced + all over with lines, and points marking their intersection. By this their + doctors are guided in the performance of acupuncture, marking the safe + places to thrust in needles, as we buoy out our ship-channels, and + doubtless indicating to learned eyes the spots where incautious meddling + had led to those little accidents of shipwreck to which patients are + unfortunately liable. + </p> + <p> + A change of method, then, has given us General and Regional Anatomy. + These, too, have been worked so thoroughly, that, if not exhausted, they + have at least become to a great extent fixed and positive branches of + knowledge. But the first of them, General Anatomy, would never have + reached this positive condition but for the introduction of that + instrument which I have mentioned as the second great aid to modern + progress. + </p> + <p> + This instrument is the achromatic microscope. For the history of the + successive steps by which it became the effective scientific implement we + now possess, I must refer you to the work of Mr. Quekett, to an excellent + article in the “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. + </p> + <p> + 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: + </p> + <p> + “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.” + </p> + <p> + Dr. Bostock's work, neglected as it is, is one which I value very highly + as a really learned compilation, full of original references. But Dr. + Bostock says: “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.” + </p> + <p> + These are only specimens of the manner in which the microscope and its + results were generally regarded by the generation just preceding our own. + </p> + <p> + I have referred you to the proper authorities for the account of those + improvements which about the year 1830 rendered the compound microscope an + efficient and trustworthy instrument. It was now for the first time that a + true general anatomy became possible. As early as 1816 Treviranus had + attempted to resolve the tissues, of which Bichat had admitted no less + than twenty-one, into their simple microscopic elements. How could such an + attempt succeed, Henle well asks, at a time when the most extensively + diffused of all the tissues, the areolar, was not at all understood? All + that method could do had been accomplished by Bichat and his followers. It + was for the optician to take the next step. The future of anatomy and + physiology, as an enthusiastic micrologist of the time said, was in the + hands of Messrs. Schieck and Pistor, famous opticians of Berlin. + </p> + <p> + In those earlier days of which I am speaking, all the points of minute + anatomy were involved in obscurity. Some found globules everywhere, some + fibres. Students disputed whether the conjunctiva extended over the cornea + or not, and worried themselves over Gaultier de Claubry's stratified + layers of the skin, or Breschet's blennogenous and chromatogenous organs. + The dartos was a puzzle, the central spinal canal a myth, the decidua + clothed in fable as much as the golden fleece. The structure of bone, now + so beautifully made out,—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. + </p> + <p> + Now what have we come to in our own day? In the first place, the minute + structure of all the organs has been made out in the most satisfactory + way. The special arrangements of the vessels and the ducts of all the + glands, of the air-tubes and vesicles of the lungs, of the parts which + make up the skin and other membranes, all the details of those complex + parenchymatous organs which had confounded investigation so long, have + been lifted out of the invisible into the sight of all observers. It is + fair to mention here, that we owe a great deal to the art of minute + injection, by which we are enabled to trace the smallest vessels in the + midst of the tissues where they are distributed. This is an old artifice + of anatomists. The famous Ruysch, who died a hundred and thirty years ago, + showed that each of the viscera has its terminal vessels arranged in its + own peculiar way; the same fact which you may see illustrated in Gerber's + figures after the minute injections of Berres. I hope to show you many + specimens of this kind in the microscope, the work of English and American + hands. Professor Agassiz allows me also to make use of a very rich + collection of injected preparations sent him by Professor Hyrtl, formerly + of Prague, now of Vienna, for the proper exhibition of which I had a + number of microscopes made expressly, by Mr. Grunow, during the past + season. All this illustrates what has been done for the elucidation of the + intimate details of formation of the organs. + </p> + <p> + But the great triumph of the microscope as applied to anatomy has been in + the resolution of the organs and the tissues into their simple constituent + anatomical elements. It has taken up general anatomy where Bichat left it. + He had succeeded in reducing the structural language of nature to + syllables, if you will permit me to use so bold an image. The microscopic + observers who have come after him have analyzed these into letters, as we + may call them,—the simple elements by the combination of which + Nature spells out successively tissues, which are her syllables, organs + which are her words, systems which are her chapters, and so goes on from + the simple to the complex, until she binds up in one living whole that + wondrous volume of power and wisdom which we call the human body. + </p> + <p> + The alphabet of the organization is so short and simple, that I will risk + fatiguing your attention by repeating it, according to the plan I have + long adopted. + </p> + <p> + A. Cells, either floating, as in the blood, or fixed, like those in the + cancellated structure of bone, already referred to. Very commonly they + have undergone a change of figure, most frequently a flattening which + reduces them to scales, as in the epidermis and the epithelium. + </p> + <p> + B. Simple, translucent, homogeneous solid, such as is found at the back of + the cornea, or forming the intercellular substance of cartilage. + </p> + <p> + C. The white fibrous element, consisting of very delicate, tenacious + threads. This is the long staple textile substance of the body. It is to + the organism what cotton is pretended to be to our Southern States. It + pervades the whole animal fabric as areolar tissue, which is the universal + packing and wrapping material. It forms the ligaments which bind the whole + frame-work together. It furnishes the sinews, which are the channels of + power. It enfolds every muscle. It wraps the brain in its hard, insensible + folds, and the heart itself beats in a purse that is made of it. + </p> + <p> + D. The yellow elastic, fibrous element, the caoutchouc of the animal + mechanism, which pulls things back into place, as the India-rubber band + shuts the door we have opened. + </p> + <p> + E. The striped muscular fibre,—the red flesh, which shortens itself + in obedience to the will, and thus produces all voluntary active motion. + </p> + <p> + F. The unstriped muscular fibre, more properly the fusiform-cell fibre, + which carries on the involuntary internal movements. + </p> + <p> + G. The nerve-cylinder, a glassy tube, with a pith of some firmness, which + conveys sensation to the brain and the principle which induces motion from + it. + </p> + <p> + H. The nerve-corpuscle, the centre of nervous power. + </p> + <p> + I. The mucous tissue, as Virchow calls it, common in embryonic structures, + seen in the vitreous humor of the adult. + </p> + <p> + To these add X, granules, of indeterminate shape and size, Y, for + inorganic matters, such as the salts of bone and teeth, and Z, to stand as + a symbol of the fluids, and you have the letters of what I have ventured + to call the alphabet of the body. + </p> + <p> + But just as in language certain diphthongs and syllables are frequently + recurring, so we have in the body certain secondary and tertiary + combinations, which we meet more frequently than the solitary elements of + which they are composed. + </p> + <p> + Thus A B, or a collection of cells united by simple structureless solid, + is seen to be extensively employed in the body under the name of + cartilage. Out of this the surfaces of the articulations and the springs + of the breathing apparatus are formed. But when Nature came to the buffers + of the spinal column (intervertebral disks) and the washers of the joints + (semilunar fibrocartilages of the knee, etc.), she required more tenacity + than common cartilage possessed. What did she do? What does man do in a + similar case of need? I need hardly tell you. The mason lays his bricks in + simple mortar. But the plasterer works some hair into the mortar which he + is going to lay in large sheets on the walls. The children of Israel + complained that they had no straw to make their bricks with, though + portions of it may still be seen in the crumbling pyramid of Darshour, + which they are said to have built. I visited the old house on Witch Hill + in Salem a year or two ago, and there I found the walls coated with clay + in which straw was abundantly mingled;—the old Judaizing + witch-hangers copied the Israelites in a good many things. The Chinese and + the Corsicans blend the fibres of amianthus in their pottery to give it + tenacity. Now to return to Nature. To make her buffers and washers hold + together in the shocks to which they would be subjected, she took common + cartilage and mingled the white fibrous tissue with it, to serve the same + purpose as the hair in the mortar, the straw in the bricks and in the + plaster of the old wall, and the amianthus in the earthen vessels. Thus we + have the combination A B C, or fibro-cartilage. Again, the bones were once + only gristle or cartilage, A B. To give them solidity they were + infiltrated with stone, in the form of salts of lime, an inorganic + element, so that bone would be spelt out by the letters A, B, and Y. + </p> + <p> + If from these organic syllables we proceed to form organic words, we shall + find that Nature employs three principal forms; namely, Vessels, + Membranes, and Parenchyma, or visceral tissue. The most complex of them + can be resolved into a combination of these few simple anatomical + constituents. + </p> + <p> + Passing for a moment into the domain of PATHOLOGICAL ANATOMY, we find the + same elements in morbid growths that we have met with in normal + structures. The pus-corpuscle and the white blood-corpuscle can only be + distinguished by tracing them to their origin. A frequent form of + so-called malignant disease proves to be only a collection of altered + epithelium-cells. Even cancer itself has no specific anatomical element, + and the diagnosis of a cancerous tumor by the microscope, though tolerably + sure under the eye of an expert, is based upon accidental, and not + essential points,—the crowding together of the elements, the size of + the cell-nuclei, and similar variable characters. + </p> + <p> + Let us turn to PHYSIOLOGY. The microscope, which has made a new science of + the intimate structure of the organs, has at the same time cleared up many + uncertainties concerning the mechanism of the special functions. Up to the + time of the living generation of observers, Nature had kept over all her + inner workshops the forbidding inscription, No Admittance! If any prying + observer ventured to spy through his magnifying tubes into the mysteries + of her glands and canals and fluids, she covered up her work in blinding + mists and bewildering halos, as the deities of old concealed their favored + heroes in the moment of danger. + </p> + <p> + Science has at length sifted the turbid light of her lenses, and blanched + their delusive rainbows. + </p> + <p> + Anatomy studies the organism in space. Physiology studies it also in time. + After the study of form and composition follows close that of action, and + this leads us along back to the first moment of the germ, and forward to + the resolution of the living frame into its lifeless elements. In this way + Anatomy, or rather that branch of it which we call Histology, has become + inseparably blended with the study of function. The connection between the + science of life and that of intimate structure on the one hand, and + composition on the other, is illustrated in the titles of two recent works + of remarkable excellence,—“the Physiological Anatomy” of Todd and + Bowman, and the “Physiological Chemistry” of Lehmann. + </p> + <p> + Let me briefly recapitulate a few of our acquisitions in Physiology, due + in large measure to our new instruments and methods of research, and at + the same time indicate the limits which form the permanent or the + temporary boundaries of our knowledge. I will begin with the largest fact + and with the most absolute and universally encountered limitation. + </p> + <p> + The “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. + </p> + <p> + As we have seen Nature anticipating the plasterer in fibro-cartilage, so + we see her beforehand with the glassblower in her dealings with the cell. + The artisan blows his vitreous bubbles, large or small, to be used + afterwards as may be wanted. So Nature shapes her hyaline vesicles and + modifies them to serve the needs of the part where they are found. The + artisan whirls his rod, and his glass bubble becomes a flattened disk, + with its bull's-eye for a nucleus. These lips of ours are all glazed with + microscopic tiles formed of flattened cells, each one of them with its + nucleus still as plain and relatively as prominent, to the eye of the + microscopist, as the bull's-eye in the old-fashioned windowpane. + Everywhere we find cells, modified or unchanged. They roll in + inconceivable multitudes (five millions and more to the cubic millimetre, + according to Vierordt) as blood-disks through our vessels. A close-fitting + mail of flattened cells coats our surface with a panoply of imbricated + scales (more than twelve thousand millions), as Harting has computed, as + true a defence against our enemies as the buckler of the armadillo or the + carapace of the tortoise against theirs. The same little protecting organs + pave all the great highways of the interior system. Cells, again, preside + over the chemical processes which elaborate the living fluids; they change + their form to become the agents of voluntary and involuntary motion; the + soul itself sits on a throne of nucleated cells, and flashes its mandates + through skeins of glassy filaments which once were simple chains of + vesicles. And, as if to reduce the problem of living force to its simplest + expression, we see the yolk of a transparent egg dividing itself in whole + or in part, and again dividing and subdividing, until it becomes a mass of + cells, out of which the harmonious diversity of the organs arranges + itself, worm or man, as God has willed from the beginning. + </p> + <p> + This differentiation having been effected, each several part assumes its + special office, having a life of its own adjusted to that of other parts + and the whole. “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.” + </p> + <p> + The mechanism is as clear, as unquestionable, as absolutely settled and + universally accepted, as the order of movement of the heavenly bodies, + which we compute backward to the days of the observatories on the plains + of Shinar, and on the faith of which we regulate the movements of war and + trade by the predictions of our ephemeris. + </p> + <p> + The mechanism, and that is all. We see the workman and the tools, but the + skill that guides the work and the power that performs it are as invisible + as ever. I fear that not every listener took the significance of those + pregnant words in the passage I quoted from John Bell,—“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. + </p> + <p> + Do we gain anything by attempting to get rid of the idea of a special + vital force because we find certain mutually convertible relations between + forces in the body and out of it? I think not, any more than we should + gain by getting rid of the idea and expression Magnetism because of its + correlation with electricity. We may concede the unity of all forms of + force, but we cannot overlook the fixed differences of its manifestations + according to the conditions under which it acts. It is a mistake, however, + to think the mystery is greater in an organized body than in any other. We + see a stone fall or a crystal form, and there is nothing stranger left to + wonder at, for we have seen the Infinite in action. + </p> + <p> + Just so far as we can recognize the ordinary modes of operation of the + common forces of nature,—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. + </p> + <p> + Recognizing the fact, then, that we have learned nothing but the machinery + of life, and are no nearer to its essence, what is it that we have gained + by this great discovery of the cell formation and function? + </p> + <p> + It would have been reward enough to learn the method Nature pursues for + its own sake. If the sovereign Artificer lets us into his own laboratories + and workshops, we need not ask more than the privilege of looking on at + his work. We do not know where we now stand in the hierarchy of created + intelligences. We were made a little lower than the angels. I speak it not + irreverently; as the lower animals surpass man in some of their + attributes, so it may be that not every angel's eye can see as broadly and + as deeply into the material works of God as man himself, looking at the + firmament through an equatorial of fifteen inches' aperture, and searching + into the tissues with a twelfth of an inch objective. + </p> + <p> + But there are other positive gains of a more practical character. Thus we + are no longer permitted to place the seat of the living actions in the + extreme vessels, which are only the carriers from which each part takes + what it wants by the divine right of the omnipotent nucleated cell. The + organism has become, in the words already borrowed from Virchow, “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. + </p> + <p> + I cannot promise to do more than to select a few of the points of contact + between our ignorance and our knowledge which present particular interest + in the existing state of our physiological acquisitions. Some of them + involve the microscopic discoveries of which I have been speaking, some + belong to the domain of chemistry, and some have relations with other + departments of physical science. + </p> + <p> + If we should begin with the digestive function, we should find that the + long-agitated question of the nature of the acid of the gastric juice is + becoming settled in favor of the lactic. But the whole solvent agency of + the digestive fluid enters into the category of that exceptional mode of + action already familiar to us in chemistry as catalysis. It is therefore + doubly difficult of explanation; first, as being, like all reactions, a + fact not to be accounted for except by the imaginative appeal to + “affinity,” and secondly, as being one of those peculiar reactions + provoked by an element which stands outside and looks on without + compromising itself. + </p> + <p> + The doctrine of Mulder, so widely diffused in popular and scientific + belief, of the existence of a common base of all albuminous substances, + the so-called protein, has not stood the test of rigorous analysis. The + division of food into azotized and non-azotized is no doubt important, but + the attempt to show that the first only is plastic or nutritive, while the + second is simply calorifacient, or heat-producing, fails entirely in the + face of the facts revealed by the study of man in different climates, and + of numerous experiments in the feeding of animals. I must return to this + subject in connection with the respiratory function. + </p> + <p> + The sugar-making faculty of the liver is another “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? + </p> +<pre xml:space="preserve"> + Quia est in eo + Virtus saccharitiva. +</pre> + <p> + Just what becomes of the sugar beyond the fact of its disappearance before + it can get into the general circulation and sweeten our tempers, it is + hard to say. + </p> + <p> + The pancreatic fluid makes an emulsion of the fat contained in our food, + but just how the fatty particles get into the villi we must leave Brucke + and Kolliker to settle if they can. + </p> + <p> + No one has shown satisfactorily the process by which the blood-corpuscles + are formed out of the lymph-corpuscles, nor what becomes of them. These + two questions are like those famous household puzzles,—Where do the + flies come from? and, Where do the pins go to? + </p> + <p> + There is a series of organs in the body which has long puzzled + physiologists,—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. + </p> + <p> + The theories of the production of animal heat, from the times of Black, + Lavoisier, and Crawford to those of Liebig, are familiar to all who have + paid any attention to physiological studies. The simplicity of Liebig's + views, and the popular form in which they have been presented, have given + them wide currency, and incorporated them in the common belief and + language of our text-books. Direct oxidation or combustion of the carbon + and hydrogen contained in the food, or in the tissues themselves; the + division of alimentary substances into respiratory, or non-azotized, and + azotized,—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. + </p> + <p> + This single illustration covers a wider ground than the special function + to which it belongs. We are learning that the chemistry of the body must + be studied, not simply by its ingesta and egesta, but that there is a long + intermediate series of changes which must be investigated in their own + light, under their own special conditions. The expression “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. + </p> + <p> + I will only call your attention to the fact, that the exceptional + phenomenon of the laboratory is the prevailing law of the organism. + Nutrition itself is but one great catalytic process. As the blood travels + its rounds, each part selects its appropriate element and transforms it to + its own likeness. Whether the appropriating agent be cell or nucleus, or a + structureless solid like the intercellular substance of cartilage, the + fact of its presence determines the separation of its proper constituents + from the circulating fluid, so that even when we are wounded bone is + replaced by bone, skin by skin, and nerve by nerve. + </p> + <p> + It is hardly without a smile that we resuscitate the old question of the + 'vis insita' of the muscular fibre, so famous in the discussions of Haller + and his contemporaries. Speaking generally, I think we may say that + Haller's doctrine is the one now commonly received; namely, that the + muscles contract in virtue of their own inherent endowments. It is true + that Kolliker says no perfectly decisive fact has been brought forward to + prove that the striated muscles contract without having been acted on by + nerves. Yet Mr. Bowman's observations on the contraction of isolated + fibres appear decisive enough (unless we consider them invalidated by Dr. + Lionel Beale's recent researches), tending to show that each elementary + fibre is supplied with nerves; and as to the smooth muscular fibres, we + have Virchow's statement respecting the contractility of those of the + umbilical cord, where there is not a trace of any nerves. + </p> + <p> + In the investigation of the nervous system, anatomy and physiology have + gone hand in hand. It is very singular that so important, and seemingly + simple, a fact as the connection of the nerve-tubes, at their origin or in + their course, with the nerve-cells, should have so long remained open to + doubt, as you may see that it did by referring to the very complete work + of Sharpey and Quain (edition of 1849), the histological portion of which + is cordially approved by Kolliker himself. + </p> + <p> + Several most interesting points of the minute anatomy of the nervous + centres have been laboriously and skilfully worked out by a recent + graduate of this Medical School, in a monograph worthy to stand in line + with those of Lockhart Clarke, Stilling, and Schroder van der Kolk. I have + had the privilege of examining and of showing some of you a number of Dr. + Dean's skilful preparations. I have no space to give even an abstract of + his conclusions. I can only refer to his proof of the fact, that a single + cell may send its processes into several different bundles of nerve-roots, + and to his demonstration of the curved ascending and descending fibres + from the posterior nerveroots, to reach what he has called the + longitudinal columns of the cornea. I must also mention Dr. Dean's + exquisite microscopic photographs from sections of the medulla oblongata, + which appear to me to promise a new development, if not a new epoch, in + anatomical art. + </p> + <p> + It having been settled that the nerve-tubes can very commonly be traced + directly to the nerve-cells, the object of all the observers in this + department of anatomy is to follow these tubes to their origin. We have an + infinite snarl of telegraph wires, and we may be reasonably sure, that, if + we can follow them up, we shall find each of them ends in a battery + somewhere. One of the most interesting problems is to find the ganglionic + origin of the great nerves of the medulla oblongata, and this is the end + to which, by the aid of the most delicate sections, colored so as to bring + out their details, mounted so as to be imperishable, magnified by the best + instruments, and now self-recorded in the light of the truth-telling + sunbeam, our fellow-student is making a steady progress in a labor which I + think bids fair to rank with the most valuable contributions to histology + that we have had from this side of the Atlantic. + </p> + <p> + It is interesting to see how old questions are incidentally settled in the + course of these new investigations. Thus, Mr. Clarke's dissections, + confirmed by preparations of Mr. Dean's which I have myself examined, + placed the fact of the decussation of the pyramids—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. + </p> + <p> + While these studies of the structure of the cord have been going on, the + ingenious and indefatigable Brown-Sequard has been investigating the + functions of its different parts with equal diligence. The microscopic + anatomists had shown that the ganglionic corpuscles of the gray matter of + the cord are connected with each other by their processes, as well as with + the nerve-roots. M. Brown-Sequard has proved by numerous experiments that + the gray substance transmits sensitive impressions and muscular + stimulation. The oblique ascending and descending fibres from the + posterior nerve-roots, joining the “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. + </p> + <p> + The physiology of the spinal cord seems a simple matter as you study it in + Longet. The experiments of Brown-Sequard have shown the problem to be a + complex one, and raised almost as many doubts as they have solved + questions; at any rate, I believe all lecturers on physiology agree that + there is no part of their task they dread so much as the analysis of the + evidence relating to the special offices of the different portions of the + medulla spinalis. In the brain we are sure that we do not know how to + localize functions; in the spinal cord, we think we do know something; but + there are so many anomalies, and seeming contradictions, and sources of + fallacy, that beyond the facts of crossed paralysis of sensation, and the + conducting agency of the gray substance, I am afraid we retain no cardinal + principles discovered since the development of the reflex function took + its place by Sir Charles Bell's great discovery. + </p> + <p> + By the manner in which I spoke of the brain, you will see that I am + obliged to leave phrenology sub Jove,—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 + </p> +<pre xml:space="preserve"> + “All that disgraced my betters met in me.” + </pre> + <p> + I loved of old to see square-headed, heavy-jawed Spurzheim make a brain + flower out into a corolla of marrowy filaments, as Vieussens had done + before him, and to hear the dry-fibred but human-hearted George Combe + teach good sense under the disguise of his equivocal system. But the + pseudo-sciences, phrenology and the rest, seem to me only appeals to weak + minds and the weak points of strong ones. There is a pica or false + appetite in many intelligences; they take to odd fancies in place of + wholesome truth, as girls gnaw at chalk and charcoal. Phrenology juggles + with nature. It is so adjusted as to soak up all evidence that helps it, + and shed all that harms it. It crawls forward in all weathers, like + Richard Edgeworth's hygrometer. It does not stand at the boundary of our + ignorance, it seems to me, but is one of the will-o'-the-wisps of its + undisputed central domain of bog and quicksand. Yet I should not have + devoted so many words to it, did I not recognize the light it has thrown + on human actions by its study of congenital organic tendencies. Its maps + of the surface of the head are, I feel sure, founded on a delusion, but + its studies of individual character are always interesting and + instructive. + </p> + <p> + The “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. + </p> +<pre xml:space="preserve"> + “Castor gaudet equis, ovo proanatus eodem + Pugnis.” + </pre> + <p> + Strike out the false pretensions of phrenology; call it anthropology; let + it study man the individual in distinction from man the abstraction, the + metaphysical or theological lay-figure; and it becomes “the proper study + of mankind,” one of the noblest and most interesting of pursuits. + </p> + <p> + The whole physiology of the nervous system, from the simplest + manifestation of its power in an insect up to the supreme act of the human + intelligence working through the brain, is full of the most difficult yet + profoundly interesting questions. The singular relations between + electricity and nerve-force, relations which it has been attempted to + interpret as meaning identity, in the face of palpable differences, + require still more extended studies. You may be interested by Professor + Faraday's statement of his opinion on the matter. “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.” + </p> + <p> + In connection with this statement, it is interesting to refer to the + experiments of Helmholtz on the rapidity of transmission of the nervous + actions. The rate is given differently in Valentin's report of these + experiments and in that found in the “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. + </p> + <p> + 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. + </p> + <p> + I must allude to one or two points in the histology and physiology of the + organs of sense. The anterior continuation of the retina beyond the ora + serrata has been a subject of much discussion. If H. Muller and Kolliker + can be relied upon, this question is settled by recognizing that a layer + of cells, continued from the retina, passes over the surface of the zonula + Zinnii, but that no proper nervous element is so prolonged forward. + </p> + <p> + I observe that Kolliker calls the true nervous elements of the retina “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. + </p> + <p> + I mention these anatomical facts to introduce a physiological observation + of my own, first announced in one of the lectures before the Medical + Class, subsequently communicated to the American Academy of Arts and + Sciences, and printed in its “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. + </p> + <p> + Another point of great interest connected with the physiology of vision, + and involved for a long time in great obscurity, is that of the adjustment + of the eye to different distances. Dr. Clay Wallace of New York, who + published a very ingenious little book on the eye about twenty years ago, + with vignettes reminding one of Bewick, was among the first, if not the + first, to describe the ciliary muscle, to which the power of adjustment is + generally ascribed. It is ascertained, by exact experiment with the + phacueidoscope, that accommodation depends on change of form of the + crystalline lens. Where the crystalline is wanting, as Mr. Ware long ago + taught, no power of accommodation remains. The ciliary muscle is generally + thought to effect the change of form of the crystalline. The power of + accommodation is lost after the application of atropine, in consequence, + as is supposed, of the paralysis of this muscle. This, I believe, is the + nearest approach to a demonstration we have on this point. + </p> + <p> + I have only time briefly to refer to Professor Draper's most ingenious + theory as to the photographic nature of vision, for an account of which I + must refer to his original and interesting Treatise on Physiology. + </p> + <p> + It were to be wished that the elaborate and very interesting researches of + the Marquis Corti, which have revealed such singular complexity of + structure in the cochlea of the ear, had done more to clear up its + doubtful physiology; but I am afraid we have nothing but hypotheses for + the special part it plays in the act of hearing, and that we must say the + same respecting the office of the semicircular canals. + </p> + <p> + The microscope has achieved some of its greatest triumphs in teaching us + the changes which occur in the development of the embryo. No more + interesting discovery stands recorded in the voluminous literature of this + subject than the one originally announced by Martin Barry, afterwards + discredited, and still later confirmed by Mr. Newport and others; namely + the fact that the fertilizing filament reaches the interior of the ovum in + various animals;—a striking parallel to the action of the + pollen-tube in the vegetable. But beyond the mechanical facts all is + mystery in the movements of organization, as profound as in the fall of a + stone or the formation of a crystal. + </p> + <p> + To the chemist and the microscopist the living body presents the same + difficulties, arising from the fact that everything is in perpetual change + in the organism. The fibrine of the blood puzzles the one as much as its + globules puzzle the other. The difference between the branches of science + which deal with space only, and those which deal with space and time, is + this: we have no glasses that can magnify time. The figure I here show you + a was photographed from an object (pleurosigma angulatum) magnified a + thousand diameters, or presenting a million times its natural surface. + This other figure of the same object, enlarged from the one just shown, is + magnified seven thousand diameters, or forty-nine million times in + surface. When we can make the forty-nine millionth of a second as long as + its integer, physiology and chemistry will approach nearer the + completeness of anatomy. + </p> + <p> + Our reverence becomes more worthy, or, if you will, less unworthy of its + Infinite Object in proportion as our intelligence is lifted and expanded + to a higher and broader understanding of the Divine methods of action. If + Galen called his heathen readers to admire, the power, the wisdom, the + providence, the goodness of the “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? + </p> + <p> + 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. + </p> + <p> + Now a man is not a plant, or, at least, he is a very curious one, for he + carries his soil in his stomach, which is a kind—of portable + flower-pot, and he grows round it, instead of out of it. He has, besides, + a singularly complex nutritive apparatus and a nervous system. But + recollect the doctrine already enunciated in the language of Virchow, that + an animal, like a tree, is a sum of vital unities, of which the cell is + the ultimate element. Every healthy cell, whether in a vegetable or an + animal, necessarily performs its function properly so long as it is + supplied with its proper materials and stimuli. A cell may, it is true, be + congenitally defective, in which case disease is, so to speak, its normal + state. But if originally sound and subsequently diseased, there has + certainly been some excess, deficiency, or wrong quality in the materials + or stimuli applied to it. You remove this injurious influence and + substitute a normal one; remove the baked coal-ashes, for instance, from + the roots of a tree, and replace them with loam; take away the salt meat + from the patient's table, and replace it with fresh meat and vegetables, + and the cells of the tree or the man return to their duty. + </p> + <p> + I do not know that we ever apply to a plant any element which is not a + natural constituent of the vegetable structure, except perhaps externally, + for the accidental purpose of killing parasites. The whole art of + cultivation consists in learning the proper food and conditions of plants, + and supplying them. We give them water, earths, salts of various kinds + such as they are made of, with a chance to help themselves to air and + light. The farmer would be laughed at who undertook to manure his fields + or his trees with a salt of lead or of arsenic. These elements are not + constituents of healthy plants. The gardener uses the waste of the arsenic + furnaces to kill the weeds in his walks. + </p> + <p> + If the law of the animal cell, and of the animal organism, which is built + up of such cells, is like that of the vegetable, we might expect that we + should treat all morbid conditions of any of the vital unities belonging + to an animal in the same way, by increasing, diminishing, or changing its + natural food or stimuli. + </p> + <p> + That is an aliment which nourishes; whatever we find in the organism, as a + constant and integral element, either forming part of its structure, or + one of the conditions of vital processes, that and that only deserves the + name of aliment. I see no reason, therefore, why iron, phosphate of lime, + sulphur, should not be considered food for man, as much as guano or + poudrette for vegetables. Whether one or another of them is best in any + given case,—whether they shall be taken alone or in combination, in + large or small quantities, are separate questions. But they are elements + belonging to the body, and even in moderate excess will produce little + disturbance. There is no presumption against any of this class of + substances, any more than against water or salt, provided they are used in + fitting combinations, proportions, and forms. + </p> + <p> + But when it comes to substances alien to the healthy system, which never + belong to it as normal constituents, the case is very different. There is + a presumption against putting lead or arsenic into the human body, as + against putting them into plants, because they do not belong there, any + more than pounded glass, which, it is said, used to be given as a poison. + The same thing is true of mercury and silver. What becomes of these alien + substances after they get into the system we cannot always tell. But in + the case of silver, from the accident of its changing color under the + influence of light, we do know what happens. It is thrown out, in part at + least, under the epidermis, and there it remains to the patient's dying + day. This is a striking illustration of the difficulty which the system + finds in dealing with non-assimilable elements, and justifies in some + measure the vulgar prejudice against mineral poisons. + </p> + <p> + I trust the youngest student on these benches will not commit the childish + error of confounding a presumption against a particular class of agents + with a condemnation of them. Mercury, for instance, is alien to the + system, and eminently disturbing in its influence. Yet its efficacy in + certain forms of specific disease is acknowledged by all but the most + sceptical theorists. Even the esprit moqueur of Ricord, the Voltaire of + pelvic literature, submits to the time-honored constitutional authority of + this great panacea in the class of cases to which he has devoted his + brilliant intelligence. Still, there is no telling what evils have arisen + from the abuse of this mineral. Dr. Armstrong long ago pointed out some of + them, and they have become matters of common notoriety. I am pleased, + therefore, when I find so able and experienced a practitioner as Dr. + Williams of this city proving that iritis is best treated without mercury, + and Dr. Vanderpoel showing the same thing to be true for pericarditis. + </p> + <p> + Whatever elements nature does not introduce into vegetables, the natural + food of all animal life,—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. + </p> + <p> + Now the feeling is very apt to be just contrary to this. The habit has + been very general with well-taught practitioners, to have recourse to the + introduction of these alien elements into the system on the occasion of + any slight disturbance. The tongue was a little coated, and mercury must + be given; the skin was a little dry, and the patient must take antimony. + It was like sending for the constable and the posse comitatus when there + is only a carpet to shake or a refuse-barrel to empty. [Dr. James Johnson + advises persons not ailing to take five grains of blue pill with one or + two of aloes twice a week for three or four months in the year, with half + a pint of compound decoction of sarsaparilla every day for the same + period, to preserve health and prolong life. Pract. Treatise on Dis. of + Liver, etc. p. 272.] The constitution bears slow poisoning a great deal + better than might be expected; yet the most intelligent men in the + profession have gradually got out of the habit of prescribing these + powerful alien substances in the old routine way. Mr. Metcalf will tell + you how much more sparingly they are given by our practitioners at the + present time, than when he first inaugurated the new era of pharmacy among + us. Still, the presumption in favor of poisoning out every spontaneous + reaction of outraged nature is not extinct in those who are trusted with + the lives of their fellow-citizens. “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. + </p> + <p> + The traditional idea of always poisoning out disease, as we smoke out + vermin, is now seeking its last refuge behind the wooden cannon and + painted port-holes of that unblushing system of false scientific pretences + which I do not care to name in a discourse addressed to an audience + devoted to the study of the laws of nature in the light of the laws of + evidence. It is extraordinary to observe that the system which, by its + reducing medicine to a name and a farce, has accustomed all who have sense + enough to see through its thin artifices to the idea that diseases get + well without being “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. + </p> + <p> + It is worse than useless to attempt in any way to check the freest + expression of opinion as to the efficacy of any or all of the “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. + </p> + <p> + One man's best remedies were held as mischievous by another. The art of + healing was like soothsaying, so the common people said; “the same bird + was lucky or unlucky, according as he flew to the right or left.” + </p> + <p> + The practice of medicine has undergone great changes within the period of + my own observation. Venesection, for instance, has so far gone out of + fashion, that, as I am told by residents of the New York Bellevue and the + Massachusetts General Hospitals, it is almost obsolete in these + institutions, at least in medical practice. The old Brunonian stimulating + treatment has come into vogue again in the practice of Dr. Todd and his + followers. The compounds of mercury have yielded their place as drugs of + all work, and specifics for that very frequent subjective complaint, + nescio quid faciam,—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. + </p> + <p> + I have been in relation successively with the English and American + evacuant and alterative practice, in which calomel and antimony figured so + largely that, as you may see in Dr. Jackson's last “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. + </p> + <p> + What is the meaning of these perpetual changes and conflicts of medical + opinion and practice, from an early antiquity to our own time? Simply + this: all “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. + </p> + <p> + Our practitioners, or many of them, have got back to the ways of old Dr. + Samuel Danforth, who, as it is well known, had strong objections to the + use of the lancet. By and by a new reputation will be made by some + discontented practitioner, who, tired of seeing patients die with their + skins full of whiskey and their brains muddy with opium, returns to a bold + antiphlogistic treatment, and has the luck to see a few patients of note + get well under it. So of the remedies which have gone out of fashion and + been superseded by others. It can hardly be doubted that they will come + into vogue again, more or less extensively, under the influence of that + irresistible demand for change just referred to. + </p> + <p> + Then will come the usual talk about a change in the character of disease, + which has about as much meaning as that concerning “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. + </p> + <p> + Is there no progress, then, but do we return to the same beliefs and + practices which our forefathers wore out and threw away? I trust and + believe that there is a real progress. We may, for instance, return in a + measure to the Brunonian stimulating system, but it must be in a modified + way, for we cannot go back to the simple Brunonian pathology, since we + have learned too much of diseased action to accept its convenient dualism. + So of other doctrines, each new Avatar strips them of some of their old + pretensions, until they take their fitting place at last, if they have any + truth in them, or disappear, if they were mere phantasms of the + imagination. + </p> + <p> + In the mean time, while medical theories are coming in and going out, + there is a set of sensible men who are never run away with by them, but + practise their art sagaciously and faithfully in much the same way from + generation to generation. From the time of Hippocrates to that of our own + medical patriarch, there has been an apostolic succession of wise and good + practitioners. If you will look at the first aphorism of the ancient + Master you will see that before all remedies he places the proper conduct + of the patient and his attendants, and the fit ordering of all the + conditions surrounding him. The class of practitioners I have referred to + have always been the most faithful in attending to these points. No doubt + they have sometimes prescribed unwisely, in compliance with the prejudices + of their time, but they have grown wiser as they have grown older, and + learned to trust more in nature and less in their plans of interference. I + believe common opinion confirms Sir James Clark's observation to this + effect. + </p> + <p> + The experience of the profession must, I think, run parallel with that of + the wisest of its individual members. Each time a plan of treatment or a + particular remedy comes up for trial, it is submitted to a sharper + scrutiny. When Cullen wrote his Materia Medica, he had seriously to assail + the practice of giving burnt toad, which was still countenanced by at + least one medical authority of note. I have read recently in some medical + journal, that an American practitioner, whose name is known to the + country, is prescribing the hoof of a horse for epilepsy. It was doubtless + suggested by that old fancy of wearing a portion of elk's hoof hung round + the neck or in a ring, for this disease. But it is hard to persuade + reasonable people to swallow the abominations of a former period. The + evidence which satisfied Fernelius will not serve one of our hospital + physicians. + </p> + <p> + In this way those articles of the Materia Medica which had nothing but + loathsomeness to recommend them have been gradually dropped, and are not + like to obtain any general favor again with civilized communities. The + next culprits to be tried are the poisons. I have never been in the least + sceptical as to the utility of some of them, when properly employed. + Though I believe that at present, taking the world at large, and leaving + out a few powerful agents of such immense value that they rank next to + food in importance, the poisons prescribed for disease do more hurt than + good, I have no doubt, and never professed to have any, that they do much + good in prudent and instructed hands. But I am very willing to confess a + great jealousy of many agents, and I could almost wish to see the Materia + Medica so classed as to call suspicion upon certain ones among them. + </p> + <p> + Thus the alien elements, those which do not properly enter into the + composition of any living tissue, are the most to be suspected, —mercury, + lead, antimony, silver, and the rest, for the reasons I have before + mentioned. Even iodine, which, as it is found in certain plants, seems + less remote from the animal tissues, gives unequivocal proofs from time to + time that it is hostile to some portions of the glandular system. + </p> + <p> + There is, of course, less prima facie objection to those agents which + consist of assimilable elements, such as are found making a part of + healthy tissues. These are divisible into three classes,—foods, + poisons, and inert, mostly because insoluble, substances. The food of one + animal or of one human being is sometimes poison to another, and vice + versa; inert substances may act mechanically, so as to produce the effect + of poisons; but this division holds exactly enough for our purpose. + </p> + <p> + Strictly speaking, every poison consisting of assimilable elements may be + considered as unwholesome food. It is rejected by the stomach, or it + produces diarrhoea, or it causes vertigo or disturbance of the heart's + action, or some other symptom for which the subject of it would consult + the physician, if it came on from any other cause than taking it under the + name of medicine. Yet portions of this unwholesome food which we call + medicine, we have reason to believe, are assimilated; thus, castor-oil + appears to be partially digested by infants, so that they require large + doses to affect them medicinally. Even that deadliest of poisons, + hydrocyanic acid, is probably assimilated, and helps to make living + tissue, if it do not kill the patient, for the assimilable elements which + it contains, given in the separate forms of amygdalin and emulsin, produce + no disturbance, unless, as in Bernard's experiments, they are suffered to + meet in the digestive organs. A medicine consisting of assimilable + substances being then simply unwholesome food, we understand what is meant + by those cumulative effects of such remedies often observed, as in the + case of digitalis and strychnia. They are precisely similar to the + cumulative effects of a salt diet in producing scurvy, or of spurred rye + in producing dry gangrene. As the effects of such substances are a + violence to the organs, we should exercise the same caution with regard to + their use that we would exercise about any other kind of poisonous food,—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. + </p> + <p> + I am not presuming to express an opinion concerning Veratrum viride, which + was little heard of when I was still practising medicine. I am only + appealing to that higher court of experience which sits in judgment on all + decisions of the lower medical tribunals, and which requires more than one + generation for its final verdict. + </p> + <p> + Once change the habit of mind so long prevalent among practitioners of + medicine; once let it be everywhere understood that the presumption is in + favor of food, and not of alien substances, of innocuous, and not of + unwholesome food, for the sick; that this presumption requires very strong + evidence in each particular case to overcome it; but that, when such + evidence is afforded, the alien substance or the unwholesome food should + be given boldly, in sufficient quantities, in the same spirit as that with + which the surgeon lifts his knife against a patient,—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. + </p> + <p> + Much as we have gained, we have not yet thoroughly shaken off the notion + that poison is the natural food of disease, as wholesome aliment is the + support of health. Cowper's lines, in “The Task,” show the + matter-of-course practice of his time: + </p> +<pre xml:space="preserve"> + “He does not scorn it, who has long endured + A fever's agonies, and fed on drugs.” + </pre> + <p> + Dr. Kimball of Lowell, who has been in the habit of seeing a great deal + more of typhoid fever than most practitioners, and whose surgical exploits + show him not to be wanting in boldness or enterprise, can tell you whether + he finds it necessary to feed his patients on drugs or not. His experience + is, I believe, that of the most enlightened and advanced portion of the + profession; yet I think that even in typhoid fever, and certainly in many + other complaints, the effects of ancient habits and prejudices may still + be seen in the practice of some educated physicians. + </p> + <p> + To you, young men, it belongs to judge all that has gone before you. You + come nearer to the great fathers of modern medicine than some of you + imagine. Three of my own instructors attended Dr. Rush's Lectures. The + illustrious Haller mentions Rush's inaugural thesis in his “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. + </p> + <p> + I cannot help believing that medical curative treatment will by and by + resolve itself in great measure into modifications of the food, swallowed + and breathed, and of the natural stimuli, and that less will be expected + from specifics and noxious disturbing agents, either alien or assimilable. + The noted mineral-waters containing iron, sulphur, carbonic acid, supply + nutritious or stimulating materials to the body as much as phosphate of + lime and ammoniacal compounds do to the cereal plants. The effects of a + milk and vegetable diet, of gluten bread in diabetes, of cod-liver oil in + phthisis, even of such audacious innovations as the water-cure and the + grape-cure, are only hints of what will be accomplished when we have + learned to discover what organic elements are deficient or in excess in a + case of chronic disease, and the best way of correcting the abnormal + condition, just as an agriculturist ascertains the wants of his crops and + modifies the composition of his soil. In acute febrile diseases we have + long ago discovered that far above all drug-medication is the use of mild + liquid diet in the period of excitement, and of stimulant and nutritious + food in that of exhaustion. Hippocrates himself was as particular about + his barley-ptisan as any Florence Nightingale of our time could be. + </p> + <p> + The generation to which you, who are just entering the profession, belong, + will make a vast stride forward, as I believe, in the direction of + treatment by natural rather than violent agencies. What is it that makes + the reputation of Sydenham, as the chief of English physicians? His + prescriptions consisted principally of simples. An aperient or an opiate, + a “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.” + </p> + <p> + The physician has learned a great deal from the surgeon, who is naturally + in advance of him, because he has a better opportunity of seeing the + effects of his remedies. Let me shorten one of Ambroise Pare's stories for + you. There had been a great victory at the pass of Susa, and they were + riding into the city. The wounded cried out as the horses trampled them + under their hoofs, which caused good Ambroise great pity, and made him + wish himself back in Paris. Going into a stable he saw four dead soldiers, + and three desperately wounded, placed with their backs against the wall. + An old campaigner came up.—“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. + </p> + <p> + This was the beginning, as nearly as we can fix it, of that reform which + has introduced plain water-dressings in the place of the farrago of + external applications which had been a source of profit to apothecaries + and disgrace to art from, and before, the time when Pliny complained of + them. A young surgeon who was at Sudley Church, laboring among the wounded + of Bull Run, tells me they had nothing but water for dressing, and he + (being also doux de sel) was astonished to see how well the wounds did + under that simple treatment. + </p> + <p> + Let me here mention a fact or two which may be of use to some of you who + mean to enter the public service. You will, as it seems, have gun-shot + wounds almost exclusively to deal with. Three different surgeons, the one + just mentioned and two who saw the wounded of Big Bethel, assured me that + they found no sabre-cuts or bayonet wounds. It is the rifle-bullet from a + safe distance which pierces the breasts of our soldiers, and not the + gallant charge of broad platoons and sweeping squadrons, such as we have + been in the habit of considering the chosen mode of warfare of ancient and + modern chivalry. [Sir Charles James Napier had the same experience in + Virginia in 1813. “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.] + </p> + <p> + Another fact parallels the story of the old campaigner, and may teach some + of you caution in selecting your assistants. A chaplain told it to two of + our officers personally known to myself. He overheard the examination of a + man who wished to drive one of the “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.” + </p> + <p> + 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. + </p> + <p> + It is time to bring these crowded remarks to a close. The day has been + when at the beginning of a course of Lectures I should have thought it + fitting to exhort you to diligence and entire devotion to your tasks as + students. It is not so now. The young man who has not heard the + clarion-voices of honor and of duty now sounding throughout the land, will + heed no word of mine. In the camp or the city, in the field or the + hospital, under sheltering roof, or half-protecting canvas, or open sky, + shedding our own blood or stanching that of our wounded defenders, + students or teachers, whatever our calling and our ability, we belong, not + to ourselves, but to our imperilled country, whose danger is our calamity, + whose ruin would be our enslavement, whose rescue shall be our earthly + salvation! + </p> + <p> + <a name="link2H_4_0009" id="link2H_4_0009"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + SCHOLASTIC AND BEDSIDE TEACHING. + </h2> + <p> + An Introductory Lecture delivered before the Medical Class of Harvard + University, November 6, 1867. + </p> + <p> + The idea is entertained by some of our most sincere professional brethren, + that to lengthen and multiply our Winter Lectures will be of necessity to + advance the cause of medical education. It is a fair subject for + consideration whether they do not overrate the relative importance of that + particular mode of instruction which forms the larger part of these + courses. + </p> + <p> + As this School could only lengthen its lecture term at the expense of its + “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. + </p> + <p> + The most essential part of a student's instruction is obtained, as I + believe, not in the lecture-room, but at the bedside. Nothing seen there + is lost; the rhythms of disease are learned by frequent repetition; its + unforeseen occurrences stamp themselves indelibly in the memory. Before + the student is aware of what he has acquired, he has learned the aspects + and course and probable issue of the diseases he has seen with his + teacher, and the proper mode of dealing with them, so far as his master + knows it. On the other hand, our ex cathedra prelections have a strong + tendency to run into details which, however interesting they may be to + ourselves and a few of our more curious listeners, have nothing in them + which will ever be of use to the student as a practitioner. It is a + perfectly fair question whether I and some other American Professors do + not teach quite enough that is useless already. Is it not well to remind + the student from time to time that a physician's business is to avert + disease, to heal the sick, to prolong life, and to diminish suffering? Is + it not true that the young man of average ability will find it as much as + he can do to fit himself for these simple duties? Is it not best to begin, + at any rate, by making sure of such knowledge as he will require in his + daily walk, by no means discouraging him from any study for which his + genius fits him when he once feels that he has become master of his chosen + art. + </p> + <p> + I know that many branches of science are of the greatest value as feeders + of our medical reservoirs. But the practising physician's office is to + draw the healing waters, and while he gives his time to this labor he can + hardly be expected to explore all the sources that spread themselves over + the wide domain of science. The traveller who would not drink of the Nile + until he had tracked it to its parent lakes, would be like to die of + thirst; and the medical practitioner who would not use the results of many + laborers in other departments without sharing their special toils, would + find life far too short and art immeasurably too long. + </p> + <p> + We owe much to Chemistry, one of the most captivating as well as important + of studies; but the medical man must as a general rule content himself + with a clear view of its principles and a limited acquaintance with its + facts; such especially as are pertinent to his pursuits. I am in little + danger of underrating Anatomy or Physiology; but as each of these branches + splits up into specialties, any one of which may take up a scientific + life-time, I would have them taught with a certain judgment and reserve, + so that they shall not crowd the more immediately practical branches. So + of all the other ancillary and auxiliary kinds of knowledge, I would have + them strictly subordinated to that particular kind of knowledge for which + the community looks to its medical advisers. + </p> + <p> + A medical school is not a scientific school, except just so far as + medicine itself is a science. On the natural history side, medicine is a + science; on the curative side, chiefly an art. This is implied in + Hufeland's aphorism: “The physician must generalize the disease and + individualize the patient.” + </p> + <p> + The coordinated and classified results of empirical observation, in + distinction from scientific experiment, have furnished almost all we know + about food, the medicine of health, and medicine, the food of sickness. We + eat the root of the Solanum tuberosum and throw away its fruit; we eat the + fruit of the Solanum Lycopersicum and throw away its root. Nothing but + vulgar experience has taught us to reject the potato ball and cook the + tomato. So of most of our remedies. The subchloride of mercury, calomel, + is the great British specific; the protochloride of mercury, corrosive + sublimate, kills like arsenic, but no chemist could have told us it would + be so. + </p> + <p> + From observations like these we can obtain certain principles from which + we can argue deductively to facts of a like nature, but the process is + limited, and we are suspicious of all reasoning in that direction applied + to the processes of healthy and diseased life. We are continually + appealing to special facts. We are willing to give Liebig's artificial + milk when we cannot do better, but we watch the child anxiously whose + wet-nurse is a chemist's pipkin. A pair of substantial mammary glands has + the advantage over the two hemispheres of the most learned Professor's + brain, in the art of compounding a nutritious fluid for infants. + </p> + <p> + The bedside is always the true centre of medical teaching. Certain + branches must be taught in the lecture-room, and will necessarily involve + a good deal that is not directly useful to the future practitioner. But + the over ambitious and active student must not be led away by the + seduction of knowledge for its own sake from his principal pursuit. The + humble beginner, who is alarmed at the vast fields of knowledge opened to + him, may be encouraged by the assurance that with a very slender provision + of science, in distinction from practical skill, he may be a useful and + acceptable member of the profession to which the health of the community + is intrusted. + </p> + <p> + To those who are not to engage in practice, the various pursuits of + science hardly require to be commended. Only they must not be disappointed + if they find many subjects treated in our courses as a medical class + requires, rather than as a scientific class would expect, that is, with + special limitations and constant reference to practical ends. Fortunately + they are within easy reach of the highest scientific instruction. The + business of a school like this is to make useful working physicians, and + to succeed in this it is almost as important not to overcrowd the mind of + the pupil with merely curious knowledge as it is to store it with useful + information. + </p> + <p> + In this direction I have written my lecture, not to undervalue any form of + scientific labor in its place, an unworthy thought from which I hope I + need not defend myself,—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.” + </p> + <p> + This general thought will be kept in view throughout my somewhat + discursive address, which will begin with an imaginary clinical lesson + from the lips of an historical personage, and close with the portrait from + real life of one who, both as teacher and practitioner, was long loved and + honored among us. If I somewhat overrun my hour, you must pardon me, for I + can say with Pascal that I have not had the time to make my lecture + shorter. + </p> + <p> + In the year 1647, that good man John Eliot, commonly called the Apostle + Eliot, writing to Mr. Thomas Shepherd, the pious minister of Cambridge, + referring to the great need of medical instruction for the Indians, used + these words: + </p> + <p> + “I have thought in my heart that it were a singular good work, if the Lord + would stirre up the hearts of some or other of his people in England to + give some maintenance toward some Schoole or Collegiate exercise this way, + wherein there should be Anatomies and other instructions that way, and + where there might be some recompence given to any that should bring in any + vegetable or other thing that is vertuous in the way of Physick. + </p> + <p> + “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.” + </p> + <p> + Since the time of the Apostle Eliot the Lord has stirred up the hearts of + our people to the building of many Schools and Colleges where medicine is + taught in all its branches. Mr. Giles Firmin's “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. + </p> + <p> + Teaching in New England in 1647 was a grave but simple matter. A single + person, combining in many cases, as in that of Mr. Giles Firmin, the + offices of physician and preacher, taught what he knew to a few disciples + whom he gathered about him. Of the making of that “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.” + </p> + <p> + His teaching of medicine was no doubt chiefly clinical, and received with + the same kind of faith as that which accepted his words from the pulpit. + His notions of disease were based on what he had observed, seen always in + the light of the traditional doctrines in which he was bred. His discourse + savored of the weighty doctrines of Hippocrates, diluted by the subtle + speculations of Galen, reinforced by the curious comments of the Arabian + schoolmen as they were conveyed in the mellifluous language of Fernelius, + blended, it may be, with something of the lofty mysticism of Van Helmont, + and perhaps stealing a flavor of that earlier form of Homoeopathy which + had lately come to light in Sir Kenelm Digby's “Discourse concerning the + Cure of Wounds by the Sympathetic Powder.” + </p> + <p> + His Pathology was mythology. A malformed foetus, as the readers of + Winthrop's Journal may remember, was enough to scare the colonists from + their propriety, and suggest the gravest fears of portended disaster. The + student of the seventeenth century opened his Licetus and saw figures of a + lion with the head of a woman, and a man with the head of an elephant. He + had offered to his gaze, as born of a human mother, the effigy of a winged + cherub, a pterocephalous specimen, which our Professor of Pathological + Anatomy would hardly know whether to treat with the reverence due to its + celestial aspect, or to imprison in one of his immortalizing jars of + alcohol. + </p> + <p> + His pharmacopoeia consisted mainly of simples, such as the venerable + “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. + </p> + <p> + Except for the toad-powder and the peremptory drastics, one might have + borne up against this herb doctoring as well as against some more modern + styles of medication. Barbeyrac and his scholar Sydenham had not yet + cleansed the Pharmacopoeia of its perilous stuff, but there is no doubt + that the more sensible physicians of that day knew well enough that a good + honest herb-tea which amused the patient and his nurses was all that was + required to carry him through all common disorders. + </p> + <p> + The student soon learned the physiognomy of disease by going about with + his master; fevers, pleurisies, asthmas, dropsies, fluxes, small-pox, + sore-throats, measles, consumptions. He saw what was done for them. He put + up the medicines, gathered the herbs, and so learned something of materia + medico and botany. He learned these few things easily and well, for he + could give his whole attention to them. Chirurgery was a separate + specialty. Women in child-birth were cared for by midwives. There was no + chemistry deserving the name to require his study. He did not learn a + great deal, perhaps, but what he did learn was his business, namely, how + to take care of sick people. + </p> + <p> + Let me give you a picture of the old-fashioned way of instruction, by + carrying you with me in imagination in the company of worthy Master Giles + Firmin as he makes his round of visits among the good folk of Ipswich, + followed by his one student, who shall answer to the scriptural name of + Luke. It will not be for entertainment chiefly, but to illustrate the one + mode of teaching which can never be superseded, and which, I venture to + say, is more important than all the rest put together. The student is a + green hand, as you will perceive. + </p> + <p> + In the first dwelling they come to, a stout fellow is bellowing with + colic. + </p> + <p> + “He will die, Master, of a surety, methinks,” says the timid youth in a + whisper. + </p> + <p> + “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.” + </p> + <p> + They jog along the bridle-path on their horses until they come to another + lowly dwelling. They sit a while with a delicate looking girl in whom the + ingenuous youth naturally takes a special interest. The good physician + talks cheerfully with her, asks her a few questions. Then to her mother: + “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. + </p> + <p> + “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?” + </p> + <p> + “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.” + </p> + <p> + “Why, then, Master, didst thou give her of thy medicine, seeing that her + ail is unto death?” + </p> + <p> + “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.” + </p> + <p> + Something after this manner might Master Giles Firmin have delivered his + clinical instructions. Somewhat in this way, a century and a half later, + another New England physician, Dr. Edward Augustus Holyoke, taught a young + man who came to study with him, a very diligent and intelligent youth, + James Jackson by name, the same whose portrait in his advanced years hangs + upon this wall, long the honored Professor of Theory and Practice in this + Institution, of whom I shall say something in this Lecture. Our venerated + Teacher studied assiduously afterwards in the great London Hospitals, but + I think he used to quote his “old Master” ten times where he quoted Mr. + Cline or Dr. Woodville once. + </p> + <p> + When I compare this direct transfer of the practical experience of a wise + man into the mind of a student,—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. + </p> + <p> + 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!” + </p> + <p> + “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?” + </p> + <p> + —But my scientific labor is to lead to useful results by and by, in + the next generation, or in some possible remote future.— + </p> + <p> + “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.” + </p> + <p> + I do not know how the remarks of the image-breaker may strike others, but + I feel that they put me on my defence with regard to much of my teaching. + Some years ago I ventured to show in an introductory Lecture how very + small a proportion of the anatomical facts taught in a regular course, as + delivered by myself and others, had any practical bearing whatever on the + treatment of disease. How can I, how can any medical teacher justify + himself in teaching anything that is not like to be of practical use to a + class of young men who are to hold in their hands the balance in which + life and death, ease and anguish, happiness and wretchedness are to be + daily weighed? + </p> + <p> + I hope we are not all wrong. Oftentimes in finding how sadly ignorant of + really essential and vital facts and rules were some of those whom we had + been larding with the choicest scraps of science, I have doubted whether + the old one-man system of teaching, when the one man was of the right + sort, did not turn out better working physicians than our more elaborate + method. The best practitioner I ever knew was mainly shaped to excellence + in that way. I can understand perfectly the regrets of my friend Dr. John + Brown of Edinburgh, for the good that was lost with the old apprenticeship + system. I understand as well Dr. Latham's fear “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.” + </p> + <p> + I feel therefore impelled to say a very few words in defence of that + system of teaching adopted in our Colleges, by which we wish to supplement + and complete the instruction given by private individuals or by what are + often called Summer Schools. + </p> + <p> + The reason why we teach so much that is not practical and in itself + useful, is because we find that the easiest way of teaching what is + practical and useful. If we could in any way eliminate all that would help + a man to deal successfully with disease, and teach it by itself so that it + should be as tenaciously rooted in the memory, as easily summoned when + wanted, as fertile in suggestion of related facts, as satisfactory to the + peremptory demands of the intelligence as if taught in its scientific + connections, I think it would be our duty so to teach the momentous truths + of medicine, and to regard all useless additions as an intrusion on the + time which should be otherwise occupied. + </p> + <p> + But we cannot successfully eliminate and teach by itself that which is + purely practical. The easiest and surest way of acquiring facts is to + learn them in groups, in systems, and systematized knowledge is science. + You can very often carry two facts fastened together more easily than one + by itself, as a housemaid can carry two pails of water with a hoop more + easily than one without it. You can remember a man's face, made up of many + features, better than you can his nose or his mouth or his eye-brow. + Scores of proverbs show you that you can remember two lines that rhyme + better than one without the jingle. The ancients, who knew the laws of + memory, grouped the seven cities that contended for the honor of being + Homer's birthplace in a line thus given by Aulus Gellius: + </p> + <p> + Smurna, Rodos, Colophon, Salamin, Ios, Argos, Athenai. + </p> + <p> + I remember, in the earlier political days of Martin Van Buren, that + Colonel Stone, of the “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; + </p> + <p> + Catskill, Saugerties, Redhook, Kinderhook, Scaghticoke, Schodac. + </p> + <p> + If the memory gains so much by mere rhythmical association, how much more + will it gain when isolated facts are brought together under laws and + principles, when organs are examined in their natural connections, when + structure is coupled with function, and healthy and diseased action are + studied as they pass one into the other! Systematic, or scientific study + is invaluable as supplying a natural kind of mnemonics, if for nothing + else. You cannot properly learn the facts you want from Anatomy and + Chemistry in any way so easily as by taking them in their regular order, + with other allied facts, only there must be common sense exercised in + leaving out a great deal which belongs to each of the two branches as pure + science. The dullest of teachers is the one who does not know what to + omit. + </p> + <p> + The larger aim of scientific training is to furnish you with principles to + which you will be able to refer isolated facts, and so bring these within + the range of recorded experience. See what the “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. + </p> + <p> + 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. + </p> + <p> + 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. + </p> + <p> + This, then, is my view of scientific training as conducted in courses such + as you are entering on. Up to a certain point I believe in set Lectures as + excellent adjuncts to what is far more important, practical instruction at + the bedside, in the operating room, and under the eye of the Demonstrator. + But I am so far from wishing these courses extended, that I think some of + them—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. + </p> + <p> + I trust I have vindicated the apparent inconsequence of teaching young + students a good deal that seems at first sight profitless, but which helps + them to learn and retain what is profitable. But this is an inquisitive + age, and if we insist on piling up beyond a certain height knowledge which + is in itself mere trash and lumber to a man whose life is to be one long + fight with death and disease, there will be some sharp questions asked by + and by, and our quick-witted people will perhaps find they can get along + as well without the professor's cap as without the bishop's mitre and the + monarch's crown. + </p> + <p> + I myself have nothing to do with clinical teaching. Yet I do not hesitate + to say it is more essential than all the rest put together, so far as the + ordinary practice of medicine is concerned; and this is by far the most + important thing to be learned, because it deals with so many more lives + than any other branch of the profession. So of personal instruction, such + as we give and others give in the interval of lectures, much of it at the + bedside, some of it in the laboratory, some in the microscope-room, some + in the recitation-room, I think it has many advantages of its own over the + winter course, and I do not wish to see it shortened for the sake of + prolonging what seems to me long enough already. + </p> + <p> + If I am jealous of the tendency to expand the time given to the + acquisition of curious knowledge, at the expense of the plain + old-fashioned bedside teachings, I only share the feeling which Sydenham + expressed two hundred years ago, using an image I have already borrowed. + “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.” + </p> + <p> + “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. + </p> + <p> + 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. + </p> + <p> + “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. + </p> + <p> + 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.” + </p> + <p> + Do not think you are going to lecture to picked young men who are training + themselves to be scientific discoverers. They are of fair average + capacity, and they are going to be working doctors. + </p> + <p> + These young men are to have some very serious vital facts to deal with. I + will mention a few of them. + </p> + <p> + Every other resident adult you meet in these streets is or will be more or + less tuberculous. This is not an extravagant estimate, as very nearly one + third of the deaths of adults in Boston last year were from phthisis. If + the relative number is less in our other northern cities, it is probably + in a great measure because they are more unhealthy; that is, they have as + much, or nearly as much, consumption, but they have more fevers or other + fatal diseases. + </p> + <p> + These heavy-eyed men with the alcoholized brains, these pallid youths with + the nicotized optic ganglia and thinking-marrows brown as their own + meerschaums, of whom you meet too many,—will ask all your wisdom to + deal with their poisoned nerves and their enfeebled wills. + </p> + <p> + Nearly seventeen hundred children under five years of age died last year + in this city. A poor human article, no doubt, in many cases, still, worth + an attempt to save them, especially when we remember the effect of Dr. + Clarke's suggestion at the Dublin Hospital, by which some twenty-five or + thirty thousand children's lives have probably been saved in a single + city. + </p> + <p> + Again, the complaint is often heard that the native population is not + increasing so rapidly as in former generations. The breeding and nursing + period of American women is one of peculiar delicacy and frequent + infirmity. Many of them must require a considerable interval between the + reproductive efforts, to repair damages and regain strength. This matter + is not to be decided by an appeal to unschooled nature. It is the same + question as that of the deformed pelvis,—one of degree. The facts of + mal-vitalization are as much to be attended to as those of mal-formation. + If the woman with a twisted pelvis is to be considered an exempt, the + woman with a defective organization should be recognized as belonging to + the invalid corps. We shudder to hear what is alleged as to the prevalence + of criminal practices; if back of these there can be shown organic + incapacity or overtaxing of too limited powers, the facts belong to the + province of the practical physician, as well as of the moralist and the + legislator, and require his gravest consideration. + </p> + <p> + Take the important question of bleeding. Is venesection done with forever? + Six years ago it was said here in an introductory Lecture that it would + doubtless come back again sooner or later. A fortnight ago I found myself + in the cars with one of the most sensible and esteemed practitioners in + New England. He took out his wallet and showed me two lancets, which he + carried with him; he had never given up their use. This is a point you + will have to consider. + </p> + <p> + Or, to mention one out of many questionable remedies, shall you give + Veratrum Viride in fevers and inflammations? It makes the pulse slower in + these affections. Then the presumption would naturally be that it does + harm. The caution with reference to it on this ground was long ago + recorded in the Lecture above referred to. See what Dr. John Hughes + Bennett says of it in the recent edition of his work on Medicine. Nothing + but the most careful clinical experience can settle this and such points + of treatment. + </p> + <p> + These are all practical questions—questions of life and death, and + every day will be full of just such questions. Take the problem of + climate. A patient comes to you with asthma and wants to know where he can + breathe; another comes to you with phthisis and wants to know where he can + live. What boy's play is nine tenths of all that is taught in many a + pretentious course of lectures, compared with what an accurate and + extensive knowledge of the advantages and disadvantages of different + residences in these and other complaints would be to a practising + physician. + </p> + <p> + I saw the other day a gentleman living in Canada, who had spent seven + successive winters in Egypt, with the entire relief of certain obscure + thoracic symptoms which troubled him while at home. I saw, two months ago, + another gentleman from Minnesota, an observer and a man of sense, who + considered that State as the great sanatorium for all pulmonary + complaints. If half our grown population are or will be more or less + tuberculous, the question of colonizing Florida assumes a new aspect. Even + within the borders of our own State, the very interesting researches of + Dr. Bowditch show that there is a great variation in the amount of + tuberculous disease in different towns, apparently connected with local + conditions. The hygienic map of a State is quite as valuable as its + geological map, and it is the business of every practising physician to + know it thoroughly. They understand this in England, and send a patient + with a dry irritating cough to Torquay or Penzance, while they send + another with relaxed bronchial membranes to Clifton or Brighton. Here is + another great field for practical study. + </p> + <p> + So as to the all-important question of diet. “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? + </p> + <p> + —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? + </p> + <p> + Certainly you may, if you like. But take down your sign, or never put it + up. That is the way Dr. Owen and Dr. Huxley, Dr. Agassiz and Dr. Jeffries + Wyman, Dr. Gray and Dr. Charles T. Jackson settled the difficulty. We all + admire the achievements of this band of distinguished doctors who do not + practise. But we say of their work and of all pure science, as the French + officer said of the charge of the six hundred at Balaclava, “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. + </p> + <p> + It is often a disadvantage to a young practitioner to be known for any + accomplishment outside of his profession. Haller lost his election as + Physician to the Hospital in his native city of Berne, principally on the + ground that he was a poet. In his later years the physician may venture + more boldly. Astruc was sixty-nine years old when he published his + “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. + </p> + <p> + Dr. Graves of Dublin, one of the first clinical teachers of our time, + always insisted on his students' beginning at once to visit the hospital. + At the bedside the student must learn to treat disease, and just as + certainly as we spin out and multiply our academic prelections we shall + work in more and more stuffing, more and more rubbish, more and more + irrelevant, useless detail which the student will get rid of just as soon + as he leaves us. Then the next thing will be a new organization, with an + examining board of first-rate practical men, who will ask the candidate + questions that mean business,—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. + </p> + <p> + 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. + </p> + <p> + My advice to every teacher less experienced than myself would be, + therefore: Do not fret over the details you have to omit; you probably + teach altogether too many as it is. Individuals may learn a thing with + once hearing it, but the only way of teaching a whole class is by enormous + repetition, representation, and illustration in all possible forms. Now + and then you will have a young man on your benches like the late Waldo + Burnett,—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. + </p> + <p> + To the student I would say, that however plain and simple may be our + teaching, he must expect to forget much which he follows intelligently in + the lecture-room. But it is not the same as if he had never learned it. A + man must get a thing before he can forget it. There is a great world of + ideas we cannot voluntarily recall,—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. + </p> + <p> + Whether the average talent be high or low, the Colleges of the land must + make the best commodity they can out of such material as the country and + the cities furnish them. The community must have Doctors as it must have + bread. It uses up its Doctors just as it wears out its shoes, and requires + new ones. All the bread need not be French rolls, all the shoes need not + be patent leather ones; but the bread must be something that can be eaten, + and the shoes must be something that can be worn. Life must somehow find + food for the two forces that rub everything to pieces, or burn it to + ashes,—friction and oxygen. Doctors are oxydable products, and the + schools must keep furnishing new ones as the old ones turn into oxyds; + some of first-rate quality that burn with a great light, some of a lower + grade of brilliancy, some honestly, unmistakably, by the grace of God, of + moderate gifts, or in simpler phrase, dull. + </p> + <p> + The public will give every honest and reasonably competent worker in the + healing art a hearty welcome. It is on the whole very loyal to the Medical + Profession. Three successive years have borne witness to the feeling with + which this Institution, representing it in its educational aspect, is + regarded by those who are themselves most honored and esteemed. The great + Master of Natural Science bade the last year's class farewell in our + behalf, in those accents which delight every audience. The Head of our + ancient University honored us in the same way in the preceding season. And + how can we forget that other occasion when the Chief Magistrate of the + Commonwealth, that noble citizen whom we have just lost, large-souled, + sweet-natured, always ready for every kind office, came among us at our + bidding, and talked to us of our duties in words as full of wisdom as his + heart was of goodness? + </p> + <p> + You have not much to fear, I think, from the fancy practitioners. The + vulgar quackeries drop off, atrophied, one after another. Homoeopathy has + long been encysted, and is carried on the body medical as quietly as an + old wen. Every year gives you a more reasoning and reasonable people to + deal with. See how it is in Literature. The dynasty of British dogmatists, + after lasting a hundred years and more, is on its last legs. Thomas + Carlyle, third in the line of descent, finds an audience very different + from those which listened to the silver speech of Samuel Taylor Coleridge + and the sonorous phrases of Samuel Johnson. We read him, we smile at his + clotted English, his “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. + </p> + <p> + It is the same common-sense public you will appeal to. The less pretension + you make, the better they will like you in the long run. I hope we shall + make everything as plain and as simple to you as we can. I would never use + a long word, even, where a short one would answer the purpose. I know + there are professors in this country who “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. + </p> + <p> + I wish to close this Lecture, if you will allow me a few moments longer, + with a brief sketch of an instructor and practitioner whose character was + as nearly a model one in both capacities as I can find anywhere recorded. + </p> + <p> + Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine in + this University from 1812 to 1846, and whose name has been since retained + on our rolls as Professor Emeritus, died on the 27th of August last, in + the ninetieth year of his age. He studied his profession, as I have + already mentioned, with Dr. Holyoke of Salem, one of the few physicians + who have borne witness to their knowledge of the laws of life by living to + complete their hundredth year. I think the student took his Old Master, as + he always loved to call him, as his model; each was worthy of the other, + and both were bright examples to all who come after them. + </p> + <p> + I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke's + death, one of the points most insisted upon as characteristic of that wise + and good old man was the perfect balance of all his faculties. The same + harmonious adjustment of powers, the same symmetrical arrangement of life, + the same complete fulfilment of every day's duties, without haste and + without needless delay, which characterized the master, equally + distinguished the scholar. A glance at the life of our own Old Master, if + I can do any justice at all to his excellences, will give you something to + carry away from this hour's meeting not unworthy to be remembered. + </p> + <p> + From December, 1797, to October, 1799, he remained with Dr. Holyoke as a + student, a period which he has spoken of as a most interesting and most + gratifying part of his life. After this he passed eight months in London, + and on his return, in October, 1800, he began business in Boston. + </p> + <p> + He had followed Mr. Cline, as I have mentioned, and was competent to + practise Surgery. But he found Dr. John Collins Warren had already + occupied the ground which at that day hardly called for more than one + leading practitioner, and wisely chose the Medical branch of the + profession. He had only himself to rely upon, but he had confidence in his + prospects, conscious, doubtless, of his own powers, knowing his own + industry and determination, and being of an eminently cheerful and hopeful + disposition. No better proof of his spirit can be given than that, just a + year from the time when he began to practise as a physician, he took that + eventful step which in such a man implies that he sees his way clear to a + position; he married a lady blessed with many gifts, but not bringing him + a fortune to paralyze his industry. + </p> + <p> + He had not miscalculated his chances in life. He very soon rose into a + good practice, and began the founding of that reputation which grew with + his years, until he stood by general consent at the head of his chosen + branch of the profession, to say the least, in this city and in all this + region of country. His skill and wisdom were the last tribunal to which + the sick and suffering could appeal. The community trusted and loved him, + the profession recognized him as the noblest type of the physician. The + young men whom he had taught wandered through foreign hospitals; where + they learned many things that were valuable, and many that were curious; + but as they grew older and began to think more of their ability to help + the sick than their power of talking about phenomena, they began to look + back to the teaching of Dr. Jackson, as he, after his London experience, + looked back to that of Dr. Holyoke. And so it came to be at last that the + bare mention of his name in any of our medical assemblies would call forth + such a tribute of affectionate regard as is only yielded to age when it + brings with it the record of a life spent in well doing. + </p> + <p> + No accident ever carries a man to eminence such as his in the medical + profession. He who looks for it must want it earnestly and work for it + vigorously; Nature must have qualified him in many ways, and education + must have equipped him with various knowledge, or his reputation will + evaporate before it reaches the noon-day blaze of fame. How did Dr. + Jackson gain the position which all conceded to him? In the answer to this + question some among you may find a key that shall unlock the gate opening + on that fair field of the future of which all dream but which not all will + ever reach. + </p> + <p> + First of all, he truly loved his profession. He had no intellectual + ambitions outside of it, literary, scientific or political. To him it was + occupation enough to apply at the bedside the best of all that he knew for + the good of his patient; to protect the community against the inroads of + pestilence; to teach the young all that he himself had been taught, with + all that his own experience had added; to leave on record some of the most + important results of his long observation. + </p> + <p> + With his patients he was so perfect at all points that it is hard to + overpraise him. I have seen many noted British and French and American + practitioners, but I never saw the man so altogether admirable at the + bedside of the sick as Dr. James Jackson. His smile was itself a remedy + better than the potable gold and the dissolved pearls that comforted the + praecordia of mediaeval monarchs. Did a patient, alarmed without cause, + need encouragement, it carried the sunshine of hope into his heart and put + all his whims to flight, as David's harp cleared the haunted chamber of + the sullen king. Had the hour come, not for encouragement, but for + sympathy, his face, his voice, his manner all showed it, because his heart + felt it. So gentle was he, so thoughtful, so calm, so absorbed in the case + before him, not to turn round and look for a tribute to his sagacity, not + to bolster himself in a favorite theory, but to find out all he could, and + to weigh gravely and cautiously all that he found, that to follow him in + his morning visit was not only to take a lesson in the healing art, it was + learning how to learn, how to move, how to look, how to feel, if that can + be learned. To visit with Dr. Jackson was a medical education. + </p> + <p> + He was very firm, with all his kindness. He would have the truth about his + patients. The nurses found it out; and the shrewder ones never ventured to + tell him anything but a straight story. A clinical dialogue between Dr. + Jackson and Miss Rebecca Taylor, sometime nurse in the Massachusetts + General Hospital, a mistress in her calling, was as good questioning and + answering as one would be like to hear outside of the court-room. + </p> + <p> + Of his practice you can form an opinion from his book called “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. + </p> + <p> + “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. + </p> + <p> + 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. + </p> + <p> + 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. + </p> + <p> + The same zeal made him always ready to listen to any new suggestion which + promised to be useful, at a period of life when many men find it hard to + learn new methods and accept new doctrines. Few of his generation became + so accomplished as he in the arts of direct exploration; coming straight + from the Parisian experts, I have examined many patients with him, and + have had frequent opportunities of observing his skill in percussion and + auscultation. + </p> + <p> + One element in his success, a trivial one compared with others, but not to + be despised, was his punctuality. He always carried two watches,—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. + </p> + <p> + If I should attempt to characterize his teaching, I should say that while + it conveyed the best results of his sagacious and extended observation, it + was singularly modest, cautious, simple, sincere. Nothing was for show, + for self-love; there was no rhetoric, no declamation, no triumphant “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. + </p> + <p> + I will not say that, during his long career, Dr. Jackson never made an + enemy. I have heard him tell how, in his very early days, old Dr. Danforth + got into a towering passion with him about some professional consultation, + and exploded a monosyllable or two of the more energetic kind on the + occasion. I remember that that somewhat peculiar personage, Dr. + Waterhouse, took it hardly when Dr. Jackson succeeded to his place as + Professor of Theory and Practice. A young man of Dr. Jackson's talent and + energy could hardly take the position that belonged to him without + crowding somebody in a profession where three in a bed is the common rule + of the household. But he was a peaceful man and a peace-maker all his + days. No man ever did more, if so much, to produce and maintain the spirit + of harmony for which we consider our medical community as somewhat + exceptionally distinguished. + </p> + <p> + If this harmony should ever be threatened, I could wish that every + impatient and irritable member of the profession would read that + beautiful, that noble Preface to the “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. + </p> + <p> + Of a similar character is this short extract which I am permitted to make + from a private letter of his to a dear young friend. He was eighty-three + years old at the time of writing it. + </p> + <p> + “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.'” + </p> + <p> + I close this imperfect notice of some features in the character of this + most honored and beloved of physicians by applying to him the words which + were written of William Heberden, whose career was not unlike his own, and + who lived to the same patriarchal age. + </p> + <p> + “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.” + </p> + <p> + Such was the man whom I offer to you as a model, young gentlemen, at the + outset of your medical career. I hope that many of you will recognize some + traits of your own special teachers scattered through various parts of the + land in the picture I have drawn. Let me assure you that whatever you may + learn in this or any other course of public lectures,—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. + </p> + <p> + <a name="link2H_4_0010" id="link2H_4_0010"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + THE MEDICAL PROFESSION IN MASSACHUSETTS. + </h2> + <p> + A Lecture of a Course by members of the Massachusetts Historical Society, + delivered before the Lowell Institute, January 29, 1869. + </p> + <p> + The medical history of eight generations, told in an hour, must be in many + parts a mere outline. The details I shall give will relate chiefly to the + first century. I shall only indicate the leading occurrences, with the + more prominent names of the two centuries which follow, and add some + considerations suggested by the facts which have been passed in review. + </p> + <p> + A geographer who was asked to describe the tides of Massachusetts Bay, + would have to recognize the circumstance that they are a limited + manifestation of a great oceanic movement. To consider them apart from + this, would be to localize a planetary phenomenon, and to provincialize a + law of the universe. The art of healing in Massachusetts has shared more + or less fully and readily the movement which, with its periods of ebb and + flow, has been raising its level from age to age throughout the better + part of Christendom. Its practitioners brought with them much of the + knowledge and many of the errors of the Old World; they have always been + in communication with its wisdom and its folly; it is not without interest + to see how far the new conditions in which they found themselves have been + favorable or unfavorable to the growth of sound medical knowledge and + practice. + </p> + <p> + The state of medicine is an index of the civilization of an age and + country,—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. + </p> + <p> + Apart, then, from its special and technical interest, my subject has a + meaning which gives a certain importance, and even dignity, to details in + themselves trivial and almost unworthy of record. A medical entry in + Governor Winthrop's journal may seem at first sight a mere curiosity; but, + rightly interpreted, it is a key to his whole system of belief as to the + order of the universe and the relations between man and his Maker. Nothing + sheds such light on the superstitions of an age as the prevailing + interpretation and treatment of disease. When the touch of a profligate + monarch was a cure for one of the most inveterate of maladies, when the + common symptoms of hysteria were prayed over as marks of demoniacal + possession, we might well expect the spiritual realms of thought to be + peopled with still stranger delusions. + </p> + <p> + Let us go before the Pilgrims of the Mayflower, and look at the shores on + which they were soon to land. A wasting pestilence had so thinned the + savage tribes that it was sometimes piously interpreted as having + providentially prepared the way for the feeble band of exiles. Cotton + Mather, who, next to the witches, hated the “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.” + </p> + <p> + 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. + </p> + <p> + Without the presence or the fear of these exotic maladies, the forlorn + voyagers of the Mayflower had sickness enough to contend with. At their + first landing at Cape Cod, gaunt and hungry and longing for fresh food, + they found upon the sandy shore “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. + </p> + <p> + How can we wonder that the crowded and tempest-tossed voyagers, many of + them already suffering, should have fallen before the trials of the first + winter in Plymouth? Their imperfect shelter, their insufficient supply of + bread, their salted food, now in unwholesome condition, account too well + for the diseases and the mortality that marked this first dreadful season; + weakness, swelling of the limbs, and other signs of scurvy, betrayed the + want of proper nourishment and protection from the elements. In December + six of their number died, in January eight, in February, seventeen, in + March thirteen. With the advance of spring the mortality diminished, the + sick and lame began to recover, and the colonists, saddened but not + disheartened, applied themselves to the labors of the opening year. + </p> + <p> + One of the most pressing needs of the early colonists must have been that + of physicians and surgeons. In Mr. Savage's remarkable Genealogical + Dictionary of the first settlers who came over before 1692 and their + descendants to the third generation, I find scattered through the four + crowded volumes the names of one hundred and thirty-four medical + practitioners. Of these, twelve, and probably many more, practised + surgery; three were barber-surgeons. A little incident throws a glimmer + from the dark lantern of memory upon William Direly, one of these + practitioners with the razor and the lancet. He was lost between Boston + and Roxbury in a violent tempest of wind and snow; ten days afterwards a + son was born to his widow, and with a touch of homely sentiment, I had + almost said poetry, they called the little creature “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. + </p> + <p> + Outside of this list I must place the name of Thomas Wilkinson, who was + complained of, in 1676, for practising contrary to law. + </p> + <p> + Many names in the catalogue of these early physicians have been + associated, in later periods, with the practice of the profession, —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. + </p> + <p> + What doctrines and practice were these colonists likely to bring, with + them? + </p> + <p> + Two principal schools of medical practice prevailed in the Old World + during the greater part of the seventeenth century. The first held to the + old methods of Galen: its theory was that the body, the microcosm, like + the macrocosm, was made up of the four elements—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. + </p> + <p> + Galenism prevailed mostly in the south of Europe and France. The readers + of Moliere will have no difficulty in recalling some of its favorite modes + of treatment, and the abundant mirth he extracted from them. + </p> + <p> + These Galenists were what we should call “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. + </p> + <p> + We have seen that many of the practitioners of medicine, during the first + century of New England, were clergymen. This relation between medicine and + theology has existed from a very early period; from the Egyptian priest to + the Indian medicine-man, the alliance has been maintained in one form or + another. The partnership was very common among our British ancestors. Mr. + Ward, the Vicar of Stratford-on-Avon, himself a notable example of the + union of the two characters, writing about 1660, says, + </p> + <p> + “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.” + </p> + <p> + “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.” + </p> + <p> + This alliance may have had its share in creating and keeping up the many + superstitions which have figured so largely in the history of medicine. It + is curious to see that a medical work left in manuscript by the Rev. + Cotton Mather and hereafter to be referred to, is running over with + follies and superstitious fancies; while his contemporary and + fellow-townsman, William Douglass, relied on the same few simple remedies + which, through Dr. Edward Holyoke and Dr. James Jackson, have come down to + our own time, as the most important articles of the materia medica. + </p> + <p> + Let us now take a general glance at some of the conditions of the early + settlers; and first, as to the healthfulness of the climate. The mortality + of the season that followed the landing of the Pilgrims at Plymouth has + been sufficiently accounted for. After this, the colonists seem to have + found the new country agreeing very well with their English constitutions. + Its clear air is the subject of eulogy. Its dainty springs of sweet water + are praised not only by Higginson and Wood, but even the mischievous + Morton says, that for its delicate waters “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. + </p> + <p> + “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!” + </p> + <p> + Strangely enough, as it would seem, except for this buoyant determination + to make the best of everything, they hardly appear to recognize the + difference of the climate from that which they had left. After almost + three years' experience, Winslow says, he can scarce distinguish New + England from Old England, in respect of heat and cold, frost, snow, rain, + winds, etc. The winter, he thinks (if there is a difference), is sharper + and longer; but yet he may be deceived by the want of the comforts he + enjoyed at home. He cannot conceive any climate to agree better with the + constitution of the English, not being oppressed with extremity of heats, + nor nipped by biting cold: + </p> + <p> + “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.” + </p> + <p> + Edward Johnson, after mentioning the shifts to which they were put for + food, says,— + </p> + <p> + “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.” + </p> + <p> + 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. + </p> + <p> + The medical records which I shall cite show that the colonists were not + exempt from the complaints of the Old World. Besides the common diseases + to which their descendants are subject, there were two others, to say + nothing of the dreaded small-pox, which later medical science has + disarmed,—little known among us at the present day, but frequent + among the first settlers. The first of these was the scurvy, already + mentioned, of which Winthrop speaks in 1630, saying, that it proved fatal + to those who fell into discontent, and lingered after their former + conditions in England; the poor homesick creatures in fact, whom we so + forget in our florid pictures of the early times of the little band in the + wilderness. Many who were suffering from scurvy got well when the Lyon + arrived from England, bringing store of juice of lemons. The Governor + speaks of another case in 1644; and it seems probable that the disease was + not of rare occurrence. + </p> + <p> + The other complaint from which they suffered, but which has nearly + disappeared from among us, was intermittent fever, or fever and ague. I + investigated the question as to the prevalence of this disease in New + England, in a dissertation, which was published in a volume with other + papers, in the year 1838. I can add little to the facts there recorded. + One which escaped me was, that Joshua Scottow, in “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. + </p> + <p> + The Pilgrims of the Mayflower had with them a good physician, a man of + standing, a deacon of their church, one whom they loved and trusted, Dr. + Samuel Fuller. But no medical skill could keep cold and hunger and bad + food, and, probably enough, desperate homesickness in some of the feebler + sort, from doing their work. No detailed record remains of what they + suffered or what was attempted for their relief during the first sad + winter. The graves of those who died were levelled and sowed with grain + that the losses of the little band might not be suspected by the savage + tenants of the wilderness, and their story remains untold. + </p> + <p> + Of Dr. Fuller's practice, at a later period, we have an account in a + letter of his to Governor Bradford, dated June, 1630. “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. + </p> + <p> + Dr. Fuller's two visits to Salem, at the request of Governor Endicott, + seem to have been very satisfactory to that gentleman. Morton, the wild + fellow of Merry Mount, gives a rather questionable reason for the + Governor's being so well pleased with the physician's doings. The names + under which he mentions the two personages, it will be seen, are not + intended to be complimentary. “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.” + </p> + <p> + Two practitioners of the ancient town of Newbury are entitled to special + notice, for different reasons. The first is Dr. John Clark, who is said by + tradition to have been the first regularly educated physician who resided + in New England. His portrait, in close-fitting skull-cap, with long locks + and venerable flowing beard, is familiar to our eyes on the wall of our + Society's antechamber. His left hand rests upon a skull, his right hand + holds an instrument which deserves a passing comment. It is a trephine, a + surgical implement for cutting round pieces out of broken skulls, so as to + get at the fragments which have been driven in, and lift them up. It has a + handle like that of a gimlet, with a claw like a hammer, to lift with, I + suppose, which last contrivance I do not see figured in my books. But the + point I refer to is this: the old instrument, the trepan, had a handle + like a wimble, what we call a brace or bit-stock. The trephine is not + mentioned at all in Peter Lowe's book, London, 1634; nor in Wiseman's + great work on Surgery, London, 1676; nor in the translation of Dionis, + published by Jacob Tonson, in 1710. In fact it was only brought into more + general use by Cheselden and Sharpe so late as the beginning of the last + century. As John Clark died in 1661, it is remarkable to see the last + fashion in the way of skull-sawing contrivances in his hands,—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. + </p> + <p> + Dr. Clark is said to have received a diploma before he came, for skill in + lithotomy. He loved horses, as a good many doctors do, and left a good + property, as they all ought to do. His grave and noble presence, with the + few facts concerning him, told with more or less traditional authority, + give us the feeling that the people of Newbury, and afterwards of Boston, + had a wise and skilful medical adviser and surgeon in Dr. John Clark. + </p> + <p> + The venerable town of Newbury had another physician who was less + fortunate. The following is a court record of 1652: + </p> + <p> + “This is to certify whom it may concern, that we the subscribers, being + called upon to testify against doctor William Snelling for words by him + uttered, affirm that being in way of merry discourse, a health being drank + to all friends, he answered, + </p> +<pre xml:space="preserve"> + “I'll pledge my friends, + And for my foes + A plague for their heels + And,'—— +</pre> + <p> + [a similar malediction on the other extremity of their feet.] + </p> + <p> + “Since when he hath affirmed that he only intended the proverb used in the + west country, nor do we believe he intended otherwise. + </p> + <p> + “[Signed] WILLIAM THOMAS. + </p> + <p> + “THOMAS MILWARD.” + </p> + <p> + “March 12th 1651, All which I acknowledge, and am sorry I did not expresse + my intent, or that I was so weak as to use so foolish a proverb. + </p> + <p> + “[Signed] GULIELMUS SNELLING.” + </p> + <p> + 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.” + </p> + <p> + 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.” + </p> + <p> + Giles Firmin, as the name is commonly spelled, practised physic in this + country for a time. He seems to have found it a poor business; for, in a + letter to Governor Winthrop, he says, “I am strongly sett upon to studye + divinitie: my studyes else must be lost, for physick is but a meene + helpe.” + </p> + <p> + Giles Firmin's Lectures on Anatomy were the first scientific teachings of + the New World. While the Fathers were enlightened enough to permit such + instructions, they were severe in dealing with quackery; for, in 1631, our + court records show that one Nicholas Knopp, or Knapp, was sentenced to be + fined or whipped “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. + </p> + <p> + Besides the few worthies spoken of, and others whose names I have not + space to record, we must remember that there were many clergymen who took + charge of the bodies as well as the souls of their patients, among them + two Presidents of Harvard College, Charles Chauncy and Leonard Hoar,—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. + </p> + <p> + 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. + </p> + <p> + To these names must be added, as sustaining a certain relation to the + healing art, that of the first Governor Winthrop, who is said by John + Cotton to have been “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. + </p> + <p> + 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. + </p> + <p> + The diseases prescribed for are plague, small-pox, fevers, king's evil, + insanity, falling-sickness, and the like; with such injuries as broken + bones, dislocations, and burning with gunpowder. The remedies are of three + kinds: simples, such as St. John's wort, Clown's all-heal, elder, parsley, + maidenhair, mineral drugs, such as lime, saltpetre, Armenian bole, crocus + metallorum, or sulphuret of antimony; and thaumaturgic or mystical, of + which the chief is, “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. + </p> + <p> + The Winthrops, to one of whom Dr. Stafford's directions were addressed, + were the medical as well as the political advisers of their + fellow-citizens for three or four successive generations. One of them, + Governor John of Connecticut, practised so extensively, that, but for his + more distinguished title in the State, he would have been remembered as + the Doctor. The fact that he practised in another colony, for the most + part, makes little difference in the value of the records we have of his + medical experience, which have fortunately been preserved, and give a very + fair idea, in all probability, of the way in which patients were treated + in Massachusetts, when they fell into intelligent and somewhat educated + hands, a little after the middle of the seventeenth century: + </p> + <p> + I have before me, while writing, a manuscript collection of the medical + cases treated by him, and recorded at the time in his own hand, which has + been intrusted to me by our President, his descendant. + </p> + <p> + They are generally marked Hartford, and extend from the year 1657 to 1669. + From these, manuscripts, and from the letters printed in the Winthrop + Papers published by our Society, I have endeavored to obtain some idea of + the practice of Governor John Winthrop, Junior. The learned eye of Mr. + Pulsifer would have helped me, no doubt, as it has done in other cases; + but I have ventured this time to attempt finding my own way among the + hieroglyphics of these old pages. By careful comparison of many + prescriptions, and by the aid of Schroder, Salmon, Culpeper, and other old + compilers, I have deciphered many of his difficult paragraphs with their + mysterious recipes. + </p> + <p> + The Governor employed a number of the simples dear to ancient women, + —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. + </p> + <p> + His great remedy, which he gave oftener than any other, was nitre; which + he ordered in doses of twenty or thirty grains to adults, and of three + grains to infants. Measles, colics, sciatica, headache, giddiness, and + many other ailments, all found themselves treated, and I trust bettered, + by nitre; a pretty safe medicine in moderate doses, and one not likely to + keep the good Governor awake at night, thinking whether it might not kill, + if it did not cure. We may say as much for spermaceti, which he seems to + have considered “the sovereign'st thing on earth” for inward bruises, and + often prescribes after falls and similar injuries. + </p> + <p> + One of the next remedies, in point of frequency, which he was in the habit + of giving, was (probably diaphoretic) antimony; a mild form of that very + active metal, and which, mild as it was, left his patients very commonly + with a pretty strong conviction that they had been taking something that + did not exactly agree with them. Now and then he gave a little iron or + sulphur or calomel, but very rarely; occasionally, a good, honest dose of + rhubarb or jalap; a taste of stinging horseradish, oftener of warming + guiacum; sometimes an anodyne, in the shape of mithridate,—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. + </p> + <p> + The excellent Governor's accounts of diseases are so brief, that we get + only a very general notion of the complaints for which he prescribed. + Measles and their consequences are at first more prominent than any other + one affection, but the common infirmities of both sexes and of all ages + seem to have come under his healing hand. Fever and ague appears to have + been of frequent occurrence. + </p> + <p> + His published correspondence shows that many noted people were in + communication with him as his patients. Roger Williams wants a little of + his medicine for Mrs. Weekes's daughter; worshipful John Haynes is in + receipt of his powders; troublesome Captain Underhill wants “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. + </p> + <p> + 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: + </p> + <p> + “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. + </p> + <p> + 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. + </p> + <p> + These inherited prescriptions are often treasured in families, I do not + doubt, for many generations. When I was yet of trivial age, and suffering + occasionally, as many children do, from what one of my Cambridgeport + schoolmates used to call the “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.” + </p> + <p> + Dr. James Oliver was my great-great-grandfather, graduated in 1680, and + died in 1703. This was, no doubt, one of his nostrums; for nostrum, as is + well known, means nothing more than our own or my own particular medicine, + or other possession or secret, and physicians in old times used to keep + their choice recipes to themselves a good deal, as we have had occasion to + see. + </p> + <p> + Some years ago I found among my old books a small manuscript marked “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. + </p> + <p> + I do not find any particular record of what his patients suffered from, + but I have carefully copied out the remedies he mentions, and find that + they form a very respectable catalogue. Besides the usual simples, elder, + parsley, fennel, saffron, snake-root, wormwood, I find the Elixir + Proprietatis, with other elixire and cordials, as if he rather fancied + warming medicines; but he called in the aid of some of the more energetic + remedies, including iron, and probably mercury, as he bought two pounds of + it at one time. + </p> + <p> + The most interesting item is his bill against the estate of Samuel Pason + of Roxbury, for services during his last illness. He attended this + gentleman,—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. + </p> + <p> + It is a source of honest pride to his descendant that his bill, which was + honestly paid, as it seems to have been honorably earned, amounted to the + handsome total of seven pounds and two shillings. Let me add that he + repeatedly prescribes plaster, one of which was very probably the “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. + </p> + <p> + I have illustrated the practice of the first century, from the two + manuscripts I have examined, as giving an impartial idea of its every-day + methods. The Governor, Johannes Secundus, it is fair to remember, was an + amateur practitioner, while my ancestor was a professed physician. + Comparing their modes of treatment with the many scientific follies still + prevailing in the Old World, and still more with the extraordinary + theological superstitions of the community in which they lived, we shall + find reason, I think, to consider the art of healing as in a comparatively + creditable state during the first century of New England. + </p> + <p> + In addition to the evidence as to methods of treatment furnished by the + manuscripts I have cited, I subjoin the following document, to which my + attention was called by Dr. Shurtleff, our present Mayor. This is a letter + of which the original is to be found in vol. lxix. page 10 of the + “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. + </p> + <p> + HADLY May 30: 76 + </p> + <p> + Mr RAWSON Sr + </p> + <p> + What we have recd by Tho: Houey the past month is not the chiefest of our + wants as you have love for poor wounded I pray let us not want for these + following medicines if you have not a speedy conveyance of them I pray + send on purpose they are those things mentioned in my former letter but to + prevent future mistakes I have wrote them att large wee have great want + with the greatest halt and speed let us be supplyed. Sr Yr Sert WILL + LOCHS. + </p> + <p> + (Endorsed) + </p> + <p> + Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye + Council with it but could not obtaine any thing to be sent in answer + thereto. 13 June 1676. + </p> + <p> + I have given some idea of the chief remedies used by our earlier + physicians, which were both Galenic and chemical; that is, vegetable and + mineral. They, of course, employed the usual perturbing medicines which + Montaigne says are the chief reliance of their craft. There were, + doubtless, individual practitioners who employed special remedies with + exceptional boldness and perhaps success. Mr. Eliot is spoken of, in a + letter of William Leete to Winthrop, Junior, as being under Mr. + Greenland's mercurial administrations. The latter was probably enough one + of these specialists. + </p> + <p> + There is another class of remedies which appears to have been employed + occasionally, but, on the whole, is so little prominent as to imply a good + deal of common sense among the medical practitioners, as compared with the + superstitions prevailing around them. I have said that I have caught the + good Governor, now and then, prescribing the electuary of millipedes; but + he is entirely excused by the almost incredible fact that they were + retained in the materia medica so late as when Rees's Cyclopaedia was + published, and we there find the directions formerly given by the College + of Edinburgh for their preparation. Once or twice we have found him + admitting still more objectionable articles into his materia medica; in + doing which, I am sorry to say that he could plead grave and learned + authority. But these instances are very rare exceptions in a medical + practice of many years, which is, on the whole, very respectable, + considering the time and circumstances. + </p> + <p> + Some remedies of questionable though not odious character appear + occasionally to have been employed by the early practitioners, but they + were such as still had the support of the medical profession. Governor + John Winthrop, the first, sends for East Indian bezoar, with other + commodities he is writing for. Governor Endicott sends him one he had of + Mr. Humfrey. I hope it was genuine, for they cheated infamously in the + matter of this concretion, which ought to come out of an animal's stomach, + but the real history of which resembles what is sometimes told of modern + sausages. + </p> + <p> + There is a famous law-case of James the First's time, in which a goldsmith + sold a hundred pounds' worth of what he called bezoar, which was proved to + be false, and the purchaser got a verdict against him. Governor Endicott + also sends Winthrop a unicorn's horn, which was the property of a certain + Mrs. Beggarly, who, in spite of her name, seems to have been rich in + medical knowledge and possessions. The famous Thomas Bartholinus wrote a + treatise on the virtues of this fabulous-sounding remedy, which was + published in 1641, and republished in 1678. + </p> + <p> + The “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. + </p> + <p> + One other special remedy deserves notice, because of native growth. I do + not know when Culver's root, Leptandra Virginica of our National + Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to John + Winthrop of New London, speaks of it as famous for the cure of + consumptions, and wishes to get some of it, through his mediation, for + Katharine, his eldest daughter. He gets it, and gives it to the “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. + </p> + <p> + Externally, I find the practitioners on whom I have chiefly relied used + the plasters of Paracelsus, of melilot, diachylon, and probably + diaphoenicon, all well known to the old pharmacopoeias, and some of them + to the modern ones,—to say nothing of “my yellow salve,” of Governor + John, the second, for the composition of which we must apply to his + respected descendant. + </p> + <p> + The authors I find quoted are Barbette's Surgery, Camerarius on Gout, and + Wecherus, of all whom notices may be found in the pages of Haller and + Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's Practice of + Physic and Anatomy, the last as belonging to Samuel Seabury, chirurgeon, + before mentioned. Nicholas Culpeper was a shrewd charlatan, and as + impudent a varlet as ever prescribed for a colic; but knew very well what + he was about, and badgers the College with great vigor. A copy of + Spigelius's famous Anatomy, in the Boston Athenaeum, has the names of + Increase and Samuel Mather written in it, and was doubtless early + overhauled by the youthful Cotton, who refers to the great anatomist's + singular death, among his curious stories in the “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.' + </p> + <p> + Here we leave the first century and all attempts at any further detailed + accounts of medicine and its practitioners. It is necessary to show in a + brief glance what had been going on in Europe during the latter part of + that century, the first quarter of which had been made illustrious in the + history of medical science by the discovery of the circulation. + </p> + <p> + Charles Barbeyrac, a Protestant in his religion, was a practitioner and + teacher of medicine at Montpellier. His creed was in the way of his + obtaining office; but the young men followed his instructions with + enthusiasm. Religious and scientific freedom breed in and in, until it + becomes hard to tell the family of one from that of the other. Barbeyrac + threw overboard the old complex medical farragos of the pharmacopoeias, as + his church had disburdened itself of the popish ceremonies. + </p> + <p> + Among the students who followed his instructions were two Englishmen: one + of them, John Locke, afterwards author of an “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. + </p> + <p> + The name of Thomas Sydenham is as distinguished in the history of medicine + as that of John Locke in philosophy. As Barbeyrac was found in opposition + to the established religion, as Locke took the rational side against + orthodox Bishop Stillingfleet, so Sydenham went with Parliament against + Charles, and was never admitted a Fellow by the College of Physicians, + which, after he was dead, placed his bust in their hall by the side of + that of Harvey. + </p> + <p> + What Sydenham did for medicine was briefly this: he studied the course of + diseases carefully, and especially as affected by the particular season; + to patients with fever he gave air and cooling drinks, instead of + smothering and heating them, with the idea of sweating out their disease; + he ordered horseback exercise to consumptives; he, like his teacher, used + few and comparatively simple remedies; he did not give any drug at all, if + he thought none was needed, but let well enough alone. He was a sensible + man, in short, who applied his common sense to diseases which he had + studied with the best light of science that he could obtain. + </p> + <p> + The influence of the reform he introduced must have been more or less felt + in this country, but not much before the beginning of the eighteenth + century, as his great work was not published until 1675, and then in + Latin. I very strongly suspect that there was not so much to reform in the + simple practice of the physicians of the new community, as there was in + that of the learned big-wigs of the “College,” who valued their remedies + too much in proportion to their complexity, and the extravagant and + fantastic ingredients which went to their making. + </p> + <p> + During the memorable century which bred and bore the Revolution, the + medical profession gave great names to our history. But John Brooks + belonged to the State, and Joseph Warren belongs to the country and + mankind, and to speak of them would lead me beyond my limited subject. + There would be little pleasure in dwelling on the name of Benjamin Church; + and as for the medical politicians, like Elisha Cooke in the early part of + the century, or Charles Jarvis, the bald eagle of Boston, in its later + years, whether their practice was heroic or not, their patients were, for + he is a bold man who trusts one that is making speeches and coaxing + voters, to meddle with the internal politics of his corporeal republic. + </p> + <p> + One great event stands out in the medical history of this eighteenth + century; namely, the introduction of the practice of inoculation for + small-pox. Six epidemics of this complaint had visited Boston in the + course of a hundred years. Prayers had been asked in the churches for more + than a hundred sick in a single day, and this many times. About a thousand + persons had died in a twelvemonth, we are told, and, as we may infer, + chiefly from this cause. + </p> + <p> + In 1721, this disease, after a respite of nineteen years, again appeared + as an epidemic. In that year it was that Cotton Mather, browsing, as was + his wont, on all the printed fodder that came within reach of his + ever-grinding mandibles, came upon an account of inoculation as practised + in Turkey, contained in the “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. + </p> + <p> + 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.” + </p> + <p> + All this has not deprived Cotton Mather of the credit of suggesting, and a + bold and intelligent physician of the honor of carrying out, the new + practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston of + Boston inoculated his only son for smallpox,—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! + </p> + <p> + Thus did America receive this great discovery, destined to save thousands + of lives, via Boston, from the hands of one of our own Massachusetts + physicians. + </p> + <p> + The year 1735 was rendered sadly memorable by the epidemic of the terrible + disease known as “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. + </p> + <p> + At some time in the course of this century medical practice had settled + down on four remedies as its chief reliance. I must repeat an incident + which I have related in another of these Essays. When Dr. Holyoke, nearly + seventy years ago, received young Mr. James Jackson as his student, he + showed him the formidable array of bottles, jars, and drawers around his + office, and then named the four remedies referred to as being of more + importance than all the rest put together. These were “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. + </p> + <p> + 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.” + </p> + <p> + Two great movements took place in this eighteenth century, the effect of + which has been chiefly felt in our own time; namely, the establishment of + the Massachusetts Medical Society, and the founding of the Medical School + of Harvard University. + </p> + <p> + The third century of our medical history began with the introduction of + the second great medical discovery of modern times,—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. + </p> + <p> + A little before the first half of this century was completed, in the + autumn of 1846, the great discovery went forth from the Massachusetts + General Hospital, which repaid the debt of America to the science of the + Old World, and gave immortality to the place of its origin in the memory + and the heart of mankind. The production of temporary insensibility at + will—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. + </p> + <p> + The present century has seen the establishment of all those great + charitable institutions for the cure of diseases of the body and of the + mind, which our State and our city have a right to consider as among the + chief ornaments of their civilization. + </p> + <p> + The last century had very little to show, in our State, in the way of + medical literature. The worthies who took care of our grandfathers and + great-grandfathers, like the Revolutionary heroes, fought (with disease) + and bled (their patients) and died (in spite of their own remedies); but + their names, once familiar, are heard only at rare intervals. Honored in + their day, not unremembered by a few solitary students of the past, their + memories are going sweetly to sleep in the arms of the patient old + dry-nurse, whose “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. + </p> + <p> + But while the trouble with the last century is to find authors to mention, + the trouble of this would be to name all that we find. Of these, a very + few claim unquestioned preeminence. + </p> + <p> + Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School of + our University, did a great work for the advancement of medicine and + surgery in New England, by his labors as teacher and author, greater, it + is claimed by some, than was ever done by any other man. The two Warrens, + of our time, each left a large and permanent record of a most extended + surgical practice. James Jackson not only educated a whole generation by + his lessons of wisdom, but bequeathed some of the most valuable results of + his experience to those who came after him, in a series of letters + singularly pleasant and kindly as well as instructive. John Ware, keen and + cautious, earnest and deliberate, wrote the two remarkable essays which + have identified his name, for all time, with two important diseases, on + which he has shed new light by his original observations. + </p> + <p> + I must do violence to the modesty of the living by referring to the many + important contributions to medical science by Dr. Jacob Bigelow, and + especially to his discourse on “Self-limited Diseases,” an address which + can be read in a single hour, but the influence of which will be felt for + a century. + </p> + <p> + Nor would the profession forgive me if I forgot to mention the admirable + museum of pathological anatomy, created almost entirely by the hands of + Dr. John Barnard Swett Jackson, and illustrated by his own printed + descriptive catalogue, justly spoken of by a distinguished professor in + the University of Pennsylvania as the most important contribution which + had ever been made in this country to the branch to which it relates. + </p> + <p> + When we look at the literature of mental disease, as seen in hospital + reports and special treatises, we can mention the names of Wyman, + Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts or + placed at the head of her institutions for the treatment of the insane. + </p> + <p> + We have a right to claim also one who is known all over the civilized + world as a philanthropist, to us as a townsman and a graduate of our own + Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of a + great multitude who were born to a world of inward or of outward darkness. + </p> + <p> + I cannot pass over in silence the part taken by our own physicians in + those sanitary movements which are assuming every year greater importance. + Two diseases especially have attracted attention, above all others, with + reference to their causes and prevention; cholera, the “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. + </p> + <p> + To these benefactors who have labored for us in their peaceful vocation, + we must add the noble army of surgeons, who went with the soldiers who + fought the battles of their country, sharing many of their dangers, not + rarely falling victims to fatigue, disease, or the deadly volleys to which + they often exposed themselves in the discharge of their duties. + </p> + <p> + The pleasant biographies of the venerable Dr. Thacher, and the worthy and + kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, are + filled with the names of men who served their generation well, and rest + from their labors, followed by the blessing of those for whom they endured + the toils and fatigues inseparable from their calling. The hardworking, + intelligent country physician more especially deserves the gratitude of + his own generation, for he rarely leaves any permanent record in the + literature of his profession. Books are hard to obtain; hospitals, which + are always centres of intelligence, are remote; thoroughly educated and + superior men are separated by wide intervals; and long rides, though + favorable to reflection, take up much of the time which might otherwise be + given to the labors of the study. So it is that men of ability and vast + experience, like the late Dr. Twitchell, for instance, make a great and + deserved reputation, become the oracles of large districts, and yet leave + nothing, or next to nothing, by which their names shall be preserved from + blank oblivion. + </p> + <p> + One or two other facts deserve mention, as showing the readiness of our + medical community to receive and adopt any important idea or discovery. + The new science of Histology, as it is now called, was first brought fully + before the profession of this country by the translation of Bichat's great + work, “Anatomie Generale,” by the late Dr. George Hayward. + </p> + <p> + 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.” + </p> + <p> + We are now in some slight measure prepared to weigh the record of the + medical profession in Massachusetts, and pass our judgment upon it. But + in order to do justice to the first generation of practitioners, we must + compare what we know of their treatment of disease with the state of the + art in England, and the superstitions which they saw all around them in + other departments of knowledge or belief. + </p> + <p> + English medical literature must have been at a pretty low ebb when + Sydenham recommended Don Quixote to Sir Richard Blackmore for professional + reading. The College Pharmacopoeia was loaded with the most absurd + compound mixtures, one of the most complex of which (the same which the + Reverend Mr. Harward, “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.” + </p> + <p> + Wiseman, the great surgeon, was discoursing eloquently on the efficacy of + the royal touch in scrofula. The founder of the Ashmolean Museum at + Oxford, consorting with alchemists and astrologers, was treasuring the + manuscripts of the late pious Dr. Richard Napier, in which certain letters + (Rx Ris) were understood to mean Responsum Raphaelis,—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. + </p> + <p> + See what was the state of belief in other matters among the most + intelligent persons of the colonies, magistrates and clergymen. Jonathan + Brewster, son of the church-elder, writes the wildest letters to John + Winthrop about alchemy,—“mad for making gold as the Lynn rock-borers + are for finding it.” + </p> + <p> + Remember the theology and the diabology of the time. Mr. Cotton's + Theocracy was a royal government, with the King of kings as its nominal + head, but with an upper chamber of saints, and a tremendous opposition in + the lower house; the leader of which may have been equalled, but cannot + have been surpassed by any of our earth-born politicians. The demons were + prowling round the houses every night, as the foxes were sneaking about + the hen-roosts. The men of Gloucester fired whole flasks of gunpowder at + devils disguised as Indians and Frenchmen. + </p> + <p> + How deeply the notion of miraculous interference with the course of nature + was rooted, is shown by the tenacity of the superstition about + earthquakes. We can hardly believe that our Professor Winthrop, father of + the old judge and the “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. + </p> + <p> + Not for the sake of degrading the aspect of the noble men who founded our + State, do I refer to their idle beliefs and painful delusions, but to show + against what influences the common sense of the medical profession had to + assert itself. + </p> + <p> + Think, then, of the blazing stars, that shook their horrid hair in the + sky; the phantom ship, that brought its message direct from the other + world; the story of the mouse and the snake at Watertown; of the mice and + the prayer-book; of the snake in church; of the calf with two heads; and + of the cabbage in the perfect form of a cutlash,—all which innocent + occurrences were accepted or feared as alarming portents. + </p> + <p> + We can smile at these: but we cannot smile at the account of unhappy Mary + Dyer's malformed offspring; or of Mrs. Hutchinson's domestic misfortune of + similar character, in the story of which the physician, Dr. John Clark of + Rhode Island, alone appears to advantage; or as we read the Rev. Samuel + Willard's fifteen alarming pages about an unfortunate young woman + suffering with hysteria. Or go a little deeper into tragedy, and see poor + Dorothy Talby, mad as Ophelia, first admonished, then whipped; at last, + taking her own little daughter's life; put on trial, and standing mute, + threatened to be pressed to death, confessing, sentenced, praying to be + beheaded; and none the less pitilessly swung from the fatal ladder. + </p> + <p> + The cooper's crazy wife—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? + </p> + <p> + The miserable delusion of witchcraft illustrates, in a still more + impressive way, the false ideas which governed the supposed relation of + men with the spiritual world. I have no doubt many physicians shared in + these superstitions. Mr. Upham says they—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? + </p> + <p> + I cannot doubt that our early physicians brought with them many Old-World + medical superstitions, and I have no question that they were more or less + involved in the prevailing errors of the community in which they lived. + But, on the whole, their record is a clean one, so far as we can get at + it; and where it is questionable we must remember that there must have + been many little-educated persons among them; and that all must have felt, + to some extent, the influence of those sincere and devoted but unsafe men, + the physic-practising clergymen, who often used spiritual means as a + substitute for temporal ones, who looked upon a hysteric patient as + possessed by the devil, and treated a fractured skull by prayers and + plasters, following the advice of a ruling elder in opposition to the + “unanimous opinion of seven surgeons.” + </p> + <p> + To what results the union of the two professions was liable to lead, may + be seen by the example of a learned and famous person, who has left on + record the product of his labors in the double capacity of clergyman and + physician. + </p> + <p> + I have had the privilege of examining a manuscript of Cotton Mather's + relating to medicine, by the kindness of the librarian of the American + Antiquarian Society, to which society it belongs. A brief notice of this + curious document may prove not uninteresting. + </p> + <p> + It is entitled “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. + </p> + <p> + The divine takes precedence of the physician in this extraordinary + production. He begins by preaching a sermon at his unfortunate patient. + Having thrown him into a cold sweat by his spiritual sudorific, he attacks + him with his material remedies, which are often quite as unpalatable. The + simple and cleanly practice of Sydenham, with whose works he was + acquainted, seems to have been thrown away upon him. Everything he could + find mentioned in the seventy or eighty authors he cites, all that the old + women of both sexes had ever told him of, gets into his text, or squeezes + itself into his margin. + </p> + <p> + Evolving disease out of sin, he hates it, one would say, as he hates its + cause, and would drive it out of the body with all noisome appliances. + “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: + </p> + <p> + “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?” + </p> + <p> + Many of his remedies are at least harmless, but his pedantry and utter + want of judgment betray themselves everywhere. He piles his prescriptions + one upon another, without the least discrimination. He is run away with by + all sorts of fancies and superstitions. He prescribes euphrasia, + eye-bright, for disease of the eyes; appealing confidently to the strange + old doctrine of signatures, which inferred its use from the resemblance of + its flower to the organ of vision. For the scattering of wens, the + efficacy of a Dead Hand has been out of measure wonderful. But when he + once comes to the odious class of remedies, he revels in them like a + scarabeus. This allusion will bring us quite near enough to the + inconceivable abominations with which he proposed to outrage the sinful + stomachs of the unhappy confederates and accomplices of Adam. + </p> + <p> + It is well that the treatise was never printed, yet there are passages in + it worth preserving. He speaks of some remedies which have since become + more universally known: + </p> + <p> + “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.” + </p> + <p> + “But these Five [Six] plants may admitt of some competitors. The QUINQUINA—How + celebrated: Immoderately, Hyperbolically celebrated!” + </p> + <p> + Of Ipecacuanha, he says,—“This is now in its reign; the most + fashionable vomit.” + </p> + <p> + “I am not sorry that antimonial emetics begin to be disused.” + </p> + <p> + He quotes “Mr. Lock” as recommending red poppy-water and abstinence from + flesh as often useful in children's diseases. + </p> + <p> + 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: + </p> + <p> + “Mercury we know thee: But we are afraid thou wilt kill us too, if we + employ thee to kill them that kill us. + </p> + <p> + “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.” + </p> + <p> + From this we learn that mercury was already in common use, and the subject + of the same popular prejudice as in our own time. + </p> + <p> + His poetical turn shows itself here and there: + </p> + <p> + “O Nightingale, with a Thorn at thy Breast; Under the trouble of a Cough, + what can be more proper than such thoughts as these?”... + </p> + <p> + 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. + </p> + <p> + 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.” + </p> + <p> + One other passage deserves notice, as it relates to the single medical + suggestion which does honor to Cotton Mather's memory. It does not appear + that he availed himself of the information which he says he obtained from + his slave, for such I suppose he was. + </p> + <p> + In his appendix to “Variolae Triumphatae,” he says,— + </p> + <p> + “There has been a wonderful practice lately used in several parts of the + world, which indeed is not yet become common in our nation. + </p> + <p> + “I was first informed of it by a Garamantee servant of my own, long before + I knew that any Europeans or Asiaticks had the least acquaintance with it, + and some years before I was enriched with the communications of the + learned Foreigners, whose accounts I found agreeing with what I received + of my servant, when he shewed me the Scar of the Wound made for the + operation; and said, That no person ever died of the smallpox, in their + countrey, that had the courage to use it. + </p> + <p> + “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.” + </p> + <p> + What has come down to us of the first century of medical practice, in the + hands of Winthrop and Oliver, is comparatively simple and reasonable. I + suspect that the conditions of rude, stern life, in which the colonists + found themselves in the wilderness, took the nonsense out of them, as the + exigencies of a campaign did out of our physicians and surgeons in the + late war. Good food and enough of it, pure air and water, cleanliness, + good attendance, an anaesthetic, an opiate, a stimulant, quinine, and two + or three common drugs, proved to be the marrow of medical treatment; and + the fopperies of the pharmacopoeia went the way of embroidered shirts and + white kid gloves and malacca joints, in their time of need. “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. + </p> + <p> + But the profession of medicine never could reach its full development + until it became entirely separated from that of divinity. The spiritual + guide, the consoler in affliction, the confessor who is admitted into the + secrets of our souls, has his own noble sphere of duties; but the healer + of men must confine himself solely to the revelations of God in nature, as + he sees their miracles with his own eyes. No doctrine of prayer or special + providence is to be his excuse for not looking straight at secondary + causes, and acting, exactly so far as experience justifies him, as if he + were himself the divine agent which antiquity fabled him to be. While + pious men were praying—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.] + </p> + <p> + Let it be, if you will, that the wise inspiration of the physician was + granted in virtue of the clergyman's supplications. Still, the habit of + dealing with things seen generates another kind of knowledge, and another + way of thought, from that of dealing with things unseen; which knowledge + and way of thought are special means granted by Providence, and to be + thankfully accepted. + </p> + <p> + The mediaeval ecclesiastics expressed a great truth in that saying, so + often quoted, as carrying a reproach with it: “Ubi tres medici, duo + athei,”—“Where there are three physicians, there are two atheists.” + </p> + <p> + It was true then, it is true to-day, that the physician very commonly, if + not very generally, denies and repudiates the deity of ecclesiastical + commerce. The Being whom Ambroise Pare meant when he spoke those memorable + words, which you may read over the professor's chair in the French School + of Medicine, “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. + </p> + <p> + I am not disposed to deny the occasional injurious effect of the + materializing influences to which the physician is subjected. A spiritual + guild is absolutely necessary to keep him, to keep us all, from becoming + the “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.” + </p> + <p> + Yet we must remember that the name of Basil Valentine, the monk, is + associated with whatever good and harm we can ascribe to antimony; and + that the most remarkable of our specifics long bore the name of “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. + </p> + <p> + Medical science, and especially the study of mental disease, is destined, + I believe, to react to much greater advantage on the theology of the + future than theology has acted on medicine in the past. The liberal spirit + very generally prevailing in both professions, and the good understanding + between their most enlightened members, promise well for the future of + both in a community which holds every point of human belief, every + institution in human hands, and every word written in a human dialect, + open to free discussion today, to-morrow, and to the end of time. Whether + the world at large will ever be cured of trusting to specifics as a + substitute for observing the laws of health, and to mechanical or + intellectual formula as a substitute for character, may admit of question. + Quackery and idolatry are all but immortal. + </p> + <p> + We can find most of the old beliefs alive amongst us to-day, only having + changed their dresses and the social spheres in which they thrive. We + think the quarrels of Galenists and chemists belong to the past, + forgetting that Thomsonism has its numerous apostles in our community; + that it is common to see remedies vaunted as purely vegetable, and that + the prejudice against “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? + </p> + <p> + I turn from this less pleasing aspect of the common intelligence which + renders such follies possible, to close the honorable record of the + medical profession in this, our ancient Commonwealth. + </p> + <p> + We have seen it in the first century divided among clergymen, magistrates, + and regular practitioners; yet, on the whole, for the time, and under the + circumstances, respectable, except where it invoked supernatural agencies + to account for natural phenomena. + </p> + <p> + In the second century it simplified its practice, educated many + intelligent practitioners, and began the work of organizing for concerted + action, and for medical teaching. + </p> + <p> + In this, our own century, it has built hospitals, perfected and multiplied + its associations and educational institutions, enlarged and created + museums, and challenged a place in the world of science by its literature. + </p> + <p> + In reviewing the whole course of its history we read a long list of + honored names, and a precious record written in private memories, in + public charities, in permanent contributions to medical science, in + generous sacrifices for the country. We can point to our capital as the + port of entry for the New World of the great medical discoveries of two + successive centuries, and we can claim for it the triumph over the most + dreaded foe that assails the human body,—a triumph which the annals + of the race can hardly match in three thousand years of medical history. + </p> + <p> + <a name="link2H_4_0011" id="link2H_4_0011"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + THE YOUNG PRACTITIONER + </h2> + <p> + [A Valedictory Address delivered to the Graduating Class of the Bellevue + Hospital College, March 2, 1871.] + </p> + <p> + The occasion which calls us together reminds us not a little of that other + ceremony which unites a man and woman for life. The banns have already + been pronounced which have wedded our young friends to the profession of + their choice. It remains only to address to them some friendly words of + cheering counsel, and to bestow upon them the parting benediction. + </p> + <p> + This is not the time for rhetorical display or ambitious eloquence. We + must forget ourselves, and think only of them. To us it is an occasion; to + them it is an epoch. The spectators at the wedding look curiously at the + bride and bridegroom; at the bridal veil, the orange-flower garland, the + giving and receiving of the ring; they listen for the tremulous “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! + </p> + <p> + You will not wonder that I address myself chiefly to those who are just + leaving academic life for the sterner struggle and the larger tasks of + matured and instructed manhood. The hour belongs to them; if others find + patience to listen, they will kindly remember that, after all, they are + but as the spectators at the wedding, and that the priest is thinking less + of them than of their friends who are kneeling at the altar. + </p> + <p> + I speak more directly to you, then, gentlemen of the graduating class. The + days of your education, as pupils of trained instructors, are over. Your + first harvest is all garnered. Henceforth you are to be sowers as well as + reapers, and your field is the world. How does your knowledge stand + to-day? What have you gained as a permanent possession? What must you + expect to forget? What remains for you yet to learn? These are questions + which it may interest you to consider. + </p> + <p> + There is another question which must force itself on the thoughts of many + among you: “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. + </p> + <p> + 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. + </p> + <p> + You are now fresh from the lecture-room and the laboratory. You can pass + an examination in anatomy, physiology, chemistry, materia medica, which + the men in large practice all around you would find a more potent + sudorific than any in the Pharmacopceia. These masters of the art of + healing were once as ready with their answers as you are now, but they + have got rid of a great deal of the less immediately practical part of + their acquisitions, and you must undergo the same depleting process. Hard + work will train it off, as sharp exercise trains off the fat of a + prize-fighter. + </p> + <p> + Yet, pause a moment before you infer that your teachers must have been in + fault when they furnished you with mental stores not directly convertible + to practical purposes, and likely in a few years to lose their place in + your memory. All systematic knowledge involves much that is not practical, + yet it is the only kind of knowledge which satisfies the mind, and + systematic study proves, in the long-run, the easiest way of acquiring and + retaining facts which are practical. There are many things which we can + afford to forget, which yet it was well to learn. Your mental condition is + not the same as if you had never known what you now try in vain to recall. + There is a perpetual metempsychosis of thought, and the knowledge of + to-day finds a soil in the forgotten facts of yesterday. You cannot see + anything in the new season of the guano you placed last year about the + roots of your climbing plants, but it is blushing and breathing fragrance + in your trellised roses; it has scaled your porch in the bee-haunted + honey-suckle; it has found its way where the ivy is green; it is gone + where the woodbine expands its luxuriant foliage. + </p> + <p> + Your diploma seems very broad to-day with your list of accomplishments, + but it begins to shrink from this hour like the Peau de Chagrin of + Balzac's story. Do not worry about it, for all the while there will be + making out for you an ampler and fairer parchment, signed by old Father + Time himself as President of that great University in which experience is + the one perpetual and all-sufficient professor. + </p> + <p> + Your present plethora of acquirements will soon cure itself. Knowledge + that is not wanted dies out like the eyes of the fishes of the Mammoth + Cave. When you come to handle life and death as your daily business, your + memory will of itself bid good-by to such inmates as the well-known + foramina of the sphenoid bone and the familiar oxides of + methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known + them, and remember that even the learned ignorance of a nomenclature is + something to have mastered, and may furnish pegs to hang facts upon which + would otherwise have strewed the floor of memory in loose disorder. + </p> + <p> + But your education has, after all, been very largely practical. You have + studied medicine and surgery, not chiefly in books, but at the bedside and + in the operating amphitheatre. It is the special advantage of large cities + that they afford the opportunity of seeing a great deal of disease in a + short space of time, and of seeing many cases of the same kind of disease + brought together. Let us not be unjust to the claims of the schools remote + from the larger centres of population. Who among us has taught better than + Nathan Smith, better than Elisha Bartlett? who teaches better than some of + our living contemporaries who divide their time between city and country + schools? I am afraid we do not always do justice to our country brethren, + whose merits are less conspicuously exhibited than those of the great city + physicians and surgeons, such especially as have charge of large + hospitals. There are modest practitioners living in remote rural districts + who are gifted by nature with such sagacity and wisdom, trained so well in + what is most essential to the practice of their art, taught so thoroughly + by varied experience, forced to such manly self-reliance by their + comparative isolation, that, from converse with them alone, from riding + with them on their long rounds as they pass from village to village, from + talking over cases with them, putting up their prescriptions, watching + their expedients, listening to their cautions, marking the event of their + predictions, hearing them tell of their mistakes, and now and then glory a + little in the detection of another's blunder, a young man would find + himself better fitted for his real work than many who have followed long + courses of lectures and passed a showy examination. But the young man is + exceptionally fortunate who enjoys the intimacy of such a teacher. And it + must be confessed that the great hospitals, infirmaries, and dispensaries + of large cities, where men of well-sifted reputations are in constant + attendance, are the true centres of medical education. No students, I + believe, are more thoroughly aware of this than those who have graduated + at this institution. Here, as in all our larger city schools, the greatest + pains are taken to teach things as well as names. You have entered into + the inheritance of a vast amount of transmitted skill and wisdom, which + you have taken, warm, as it were, with the life of your well-schooled + instructors. You have not learned all that art has to teach you, but you + are safer practitioners to-day than were many of those whose names we + hardly mention without a genuflection. I had rather be cared for in a + fever by the best-taught among you than by the renowned Fernelius or the + illustrious Boerhaave, could they come back to us from that better world + where there are no physicians needed, and, if the old adage can be + trusted, not many within call. I had rather have one of you exercise his + surgical skill upon me than find myself in the hands of a resuscitated + Fabricius Hildanus, or even of a wise Ambroise Pare, revisiting earth in + the light of the nineteenth century. + </p> + <p> + You will not accuse me of underrating your accomplishments. You know what + to do for a child in a fit, for an alderman in an apoplexy, for a girl + that has fainted, for a woman in hysterics, for a leg that is broken, for + an arm that is out of joint, for fevers of every color, for the sailor's + rheumatism, and the tailor's cachexy. In fact you do really know so much + at this very hour, that nothing but the searching test of time can fully + teach you the limitations of your knowledge. + </p> + <p> + Of some of these you will permit me to remind you. You will never have + outgrown the possibility of new acquisitions, for Nature is endless in her + variety. But even the knowledge which you may be said to possess will be a + different thing after long habit has made it a part of your existence. The + tactus eruditus extends to the mind as well as to the finger-ends. + Experience means the knowledge gained by habitual trial, and an expert is + one who has been in the habit of trying. This is the kind of knowledge + that made Ulysses wise in the ways of men. Many cities had he seen, and + known the minds of those who dwelt in them. This knowledge it was that + Chaucer's Shipman brought home with him from the sea— + </p> +<pre xml:space="preserve"> + “In many a tempest had his berd be shake.” + </pre> + <p> + This is the knowledge we place most confidence in, in the practical + affairs of life. + </p> + <p> + Our training has two stages. The first stage deals with our intelligence, + which takes the idea of what is to be done with the most charming ease and + readiness. Let it be a game of billiards, for instance, which the marker + is going to teach us. We have nothing to do but to make this ball glance + from that ball and hit that other ball, and to knock that ball with this + ball into a certain caecal sacculus or diverticulum which our professional + friend calls a pocket. Nothing can be clearer; it is as easy as “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. + </p> + <p> + It is the unintelligent Me, stupid as an idiot, that has to try a thing a + thousand times before he can do it, and then never knows how he does it, + that at last does it well. We have to educate ourselves through the + pretentious claims of intellect, into the humble accuracy of instinct, and + we end at last by acquiring the dexterity, the perfection, the certainty, + which those masters of arts, the bee and the spider, inherit from Nature. + </p> + <p> + Book-knowledge, lecture-knowledge, examination-knowledge, are all in the + brain. But work-knowledge is not only in the brain, it is in the senses, + in the muscles, in the ganglia of the sympathetic nerves,—all over + the man, as one may say, as instinct seems diffused through every part of + those lower animals that have no such distinct organ as a brain. See a + skilful surgeon handle a broken limb; see a wise old physician smile away + a case that looks to a novice as if the sexton would soon be sent for; + mark what a large experience has done for those who were fitted to profit + by it, and you will feel convinced that, much as you know, something is + still left for you to learn. + </p> + <p> + May I venture to contrast youth and experience in medical practice, + something in the way the man painted the lion, that is, the lion under? + </p> + <p> + The young man knows the rules, but the old man knows the exceptions. The + young man knows his patient, but the old man knows also his patient's + family, dead and alive, up and down for generations. He can tell + beforehand what diseases their unborn children will be subject to, what + they will die of if they live long enough, and whether they had better + live at all, or remain unrealized possibilities, as belonging to a stock + not worth being perpetuated. The young man feels uneasy if he is not + continually doing something to stir up his patient's internal + arrangements. The old man takes things more quietly, and is much more + willing to let well enough alone: All these superiorities, if such they + are, you must wait for time to bring you. In the meanwhile (if we will let + the lion be uppermost for a moment), the young man's senses are quicker + than those of his older rival. His education in all the accessory branches + is more recent, and therefore nearer the existing condition of knowledge. + He finds it easier than his seniors to accept the improvements which every + year is bringing forward. New ideas build their nests in young men's + brains. “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. + </p> + <p> + You are soon to enter into relations with the public, to expend your skill + and knowledge for its benefit, and find your support in the rewards of + your labor. What kind of a constituency is this which is to look to you as + its authorized champions in the struggle of life against its numerous + enemies? + </p> + <p> + In the first place, the persons who seek the aid of the physician are very + honest and sincere in their wish to get rid of their complaints, and, + generally speaking, to live as long as they can. However attractively the + future is painted to them, they are attached to the planet with which they + are already acquainted. They are addicted to the daily use of this + empirical and unchemical mixture which we call air; and would hold on to + it as a tippler does to his alcoholic drinks. There is nothing men will + not do, there is nothing they have not done, to recover their health and + save their lives. They have submitted to be half-drowned in water, and + half-choked with gases, to be buried up to their chins in earth, to be + seared with hot irons like galley-slaves, to be crimped with knives, like + cod-fish, to have needles thrust into their flesh, and bonfires kindled on + their skin, to swallow all sorts of abominations, and to pay for all this, + as if to be singed and scalded were a costly privilege, as if blisters + were a blessing, and leeches were a luxury. What more can be asked to + prove their honesty and sincerity? + </p> + <p> + This same community is very intelligent with respect to a great many + subjects—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. + </p> + <p> + This is the way it happens: Every grown-up person has either been ill + himself or had a friend suffer from illness, from which he has recovered. + Every sick person has done something or other by somebody's advice, or of + his own accord, a little before getting better. There is an irresistible + tendency to associate the thing done, and the improvement which followed + it, as cause and effect. This is the great source of fallacy in medical + practice. But the physician has some chance of correcting his hasty + inference. He thinks his prescription cured a single case of a particular + complaint; he tries it in twenty similar cases without effect, and sets + down the first as probably nothing more than a coincidence. The + unprofessional experimenter or observer has no large experience to correct + his hasty generalization. He wants to believe that the means he employed + effected his cure. He feels grateful to the person who advised it, he + loves to praise the pill or potion which helped him, and he has a kind of + monumental pride in himself as a living testimony to its efficacy. So it + is that you will find the community in which you live, be it in town or + country, full of brands plucked from the burning, as they believe, by some + agency which, with your better training, you feel reasonably confident had + nothing to do with it. Their disease went out of itself, and the stream + from the medical fire-annihilator had never even touched it. + </p> + <p> + You cannot and need not expect to disturb the public in the possession of + its medical superstitions. A man's ignorance is as much his private + property, and as precious in his own eyes, as his family Bible. You have + only to open your own Bible at the ninth chapter of St. John's Gospel, and + you will find that the logic of a restored patient was very simple then, + as it is now, and very hard to deal with. My clerical friends will forgive + me for poaching on their sacred territory, in return for an occasional + raid upon the medical domain of which they have now and then been accused. + </p> + <p> + A blind man was said to have been restored to sight by a young person whom + the learned doctors of the Jewish law considered a sinner, and, as such, + very unlikely to have been endowed with a divine gift of healing. They + visited the patient repeatedly, and evidently teased him with their + questions about the treatment, and their insinuations about the young man, + until he lost his temper. At last he turned sharply upon them: “Whether he + be a sinner or no, I know not: one thing I know, that, whereas I was + blind, now I see.” + </p> + <p> + This is the answer that always has been and always will be given by most + persons when they find themselves getting well after doing anything, no + matter what,—recommended by anybody, no matter whom. Lord Bacon, + Robert Boyle, Bishop Berkeley, all put their faith in panaceas which we + should laugh to scorn. They had seen people get well after using them. Are + we any wiser than those great men? Two years ago, in a lecture before the + Massachusetts Historical Society, I mentioned this recipe of Sir Kenelm + Digby for fever and ague: Pare the patient's nails; put the parings in a + little bag, and hang the bag round the neck of a live eel, and place him + in a tub of water. The eel will die, and the patient will recover. + </p> + <p> + Referring to this prescription in the course of the same lecture, I said: + “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. + </p> + <p> + This argument, from what looks like cause and effect, whether it be so or + not, is what you will have to meet wherever you go, and you need not think + you can answer it. In the natural course of things some thousands of + persons must be getting well or better of slight attacks of colds, of + rheumatic pains, every week, in this city alone. Hundreds of them do + something or other in the way of remedy, by medical or other advice, or of + their own motion, and the last thing they do gets the credit of the + recovery. Think what a crop of remedies this must furnish, if it were all + harvested! + </p> + <p> + Experience has taught, or will teach you, that most of the wonderful + stories patients and others tell of sudden and signal cures are like Owen + Glendower's story of the portents that announced his birth. The earth + shook at your nativity, did it? Very likely, and + </p> +<pre xml:space="preserve"> + “So it would have done, + At the same season, if your mother's cat + Had kittened, though yourself had ne'er been born.” + </pre> + <p> + You must listen more meekly than Hotspur did to the babbling Welshman, for + ignorance is a solemn and sacred fact, and, like infancy, which it + resembles, should be respected. Once in a while you will have a patient of + sense, born with the gift of observation, from whom you may learn + something. When you find yourself in the presence of one who is fertile of + medical opinions, and affluent in stories of marvellous cures,—of a + member of Congress whose name figures in certificates to the value of + patent medicines, of a voluble dame who discourses on the miracles she has + wrought or seen wrought with the little jokers of the sugar-of-milk + globule-box, take out your watch and count the pulse; also note the time + of day, and charge the price of a visit for every extra fifteen, or, if + you are not very busy, every twenty minutes. In this way you will turn + what seems a serious dispensation into a double blessing, for this class + of patients loves dearly to talk, and it does them a deal of good, and you + feel as if you had earned your money by the dose you have taken, quite as + honestly as by any dose you may have ordered. + </p> + <p> + You must take the community just as it is, and make the best of it. You + wish to obtain its confidence; there is a short rule for doing this which + you will find useful,—deserve it. But, to deserve it in full + measure, you must unite many excellences, natural and acquired. + </p> + <p> + As the basis of all the rest, you must have all those traits of character + which fit you to enter into the most intimate and confidential relations + with the families of which you are the privileged friend and counsellor. + Medical Christianity, if I may use such a term, is of very early date. By + the oath of Hippocrates, the practitioner of ancient times bound himself + to enter his patient's house with the sole purpose of doing him good, and + so to conduct himself as to avoid the very appearance of evil. Let the + physician of to-day begin by coming up to this standard, and add to it all + the more recently discovered virtues and graces. + </p> + <p> + A certain amount of natural ability is requisite to make you a good + physician, but by no means that disproportionate development of some + special faculty which goes by the name of genius. A just balance of the + mental powers is a great deal more likely to be useful than any single + talent, even were it the power of observation, in excess. For a mere + observer is liable to be too fond of facts for their own sake, so that, if + he told the real truth, he would confess that he takes more pleasure in a + post-mortem examination which shows him what was the matter with a + patient, than in a case which insists on getting well and leaving him in + the dark as to its nature. Far more likely to interfere with the sound + practical balance of the mind is that speculative, theoretical tendency + which has made so many men noted in their day, whose fame has passed away + with their dissolving theories. Read Dr. Bartlett's comparison of the + famous Benjamin Rush with his modest fellow-townsman Dr. William Currie, + and see the dangers into which a passion for grandiose generalizations + betrayed a man of many admirable qualities. + </p> + <p> + I warn you against all ambitious aspirations outside of your profession. + Medicine is the most difficult of sciences and the most laborious of arts. + It will task all your powers of body and mind if you are faithful to it. + Do not dabble in the muddy sewer of politics, nor linger by the enchanted + streams of literature, nor dig in far-off fields for the hidden waters of + alien sciences. The great practitioners are generally those who + concentrate all their powers on their business. If there are here and + there brilliant exceptions, it is only in virtue of extraordinary gifts, + and industry to which very few are equal. + </p> + <p> + To get business a man must really want it; and do you suppose that when + you are in the middle of a heated caucus, or half-way through a delicate + analysis, or in the spasm of an unfinished ode, your eyes rolling in the + fine frenzy of poetical composition, you want to be called to a teething + infant, or an ancient person groaning under the griefs of a lumbago? I + think I have known more than one young man whose doctor's sign proclaimed + his readiness to serve mankind in that capacity, but who hated the sound + of a patient's knock, and as he sat with his book or his microscope, felt + exactly as the old party expressed himself in my friend Mr. Brownell's + poem— + </p> +<pre xml:space="preserve"> + “All I axes is, let me alone.” + </pre> + <p> + The community soon finds out whether you are in earnest, and really mean + business, or whether you are one of those diplomaed dilettanti who like + the amusement of quasi medical studies, but have no idea of wasting their + precious time in putting their knowledge in practice for the benefit of + their suffering fellow-creatures. + </p> + <p> + The public is a very incompetent judge of your skill and knowledge, but it + gives its confidence most readily to those who stand well with their + professional brethren, whom they call upon when they themselves or their + families are sick, whom they choose to honorable offices, whose writings + and teachings they hold in esteem. A man may be much valued by the + profession and yet have defects which prevent his becoming a favorite + practitioner, but no popularity can be depended upon as permanent which is + not sanctioned by the judgment of professional experts, and with these you + will always stand on your substantial merits. + </p> + <p> + What shall I say of the personal habits you must form if you wish for + success? Temperance is first upon the list. Intemperance in a physician + partakes of the guilt of homicide, for the muddled brain may easily make a + fatal blunder in a prescription and the unsteady hand transfix an artery + in an operation. Tippling doctors have been too common in the history of + medicine. Paracelsus was a sot, Radcliffe was much too fond of his glass, + and Dr. James Hurlbut of Wethersfield, Connecticut, a famous man in his + time, used to drink a square bottle of rum a day, with a corresponding + allowance of opium to help steady his nerves. We commonly speak of a man + as being the worse for liquor, but I was asking an Irish laborer one day + about his doctor, who, as he said, was somewhat given to drink. “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. + </p> + <p> + There are personal habits of less gravity than the one I have mentioned + which it is well to guard against, or, if they are formed, to relinquish. + A man who may be called at a moment's warning into the fragrant boudoir of + suffering loveliness should not unsweeten its atmosphere with + reminiscences of extinguished meerschaums. He should remember that the + sick are sensitive and fastidious, that they love the sweet odors and the + pure tints of flowers, and if his presence is not like the breath of the + rose, if his hands are not like the leaf of the lily, his visit may be + unwelcome, and if he looks behind him he may see a window thrown open + after he has left the sick-chamber. I remember too well the old doctor who + sometimes came to help me through those inward griefs to which childhood + is liable. “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. + </p> + <p> + Need I remind you of the importance of punctuality in your engagements, + and of the worry and distress to patients and their friends which the want + of it occasions? One of my old teachers always carried two watches, to + make quite sure of being exact, and not only kept his appointments with + the regularity of a chronometer, but took great pains to be at his + patient's house at the time when he had reason to believe he was expected, + even if no express appointment was made. It is a good rule; if you call + too early, my lady's hair may not be so smooth as could be wished, and, if + you keep her waiting too long, her hair may be smooth, but her temper + otherwise. + </p> + <p> + You will remember, of course, always to get the weather-gage of your + patient. I mean, to place him so that the light falls on his face and not + on yours. It is a kind of, ocular duel that is about to take place between + you; you are going to look through his features into his pulmonary and + hepatic and other internal machinery, and he is going to look into yours + quite as sharply to see what you think about his probabilities for time or + eternity. + </p> + <p> + No matter how hard he stares at your countenance, he should never be able + to read his fate in it. It should be cheerful as long as there is hope, + and serene in its gravity when nothing is left but resignation. The face + of a physician, like that of a diplomatist, should be impenetrable. Nature + is a benevolent old hypocrite; she cheats the sick and the dying with + illusions better than any anodynes. If there are cogent reasons why a + patient should be undeceived, do it deliberately and advisedly, but do not + betray your apprehensions through your tell-tale features. + </p> + <p> + We had a physician in our city whose smile was commonly reckoned as being + worth five thousand dollars a year to him, in the days, too, of moderate + incomes. You cannot put on such a smile as that any more than you can get + sunshine without sun; there was a tranquil and kindly nature under it that + irradiated the pleasant face it made one happier to meet on his daily + rounds. But you can cultivate the disposition, and it will work its way + through to the surface, nay, more,—you can try to wear a quiet and + encouraging look, and it will react on your disposition and make you like + what you seem to be, or at least bring you nearer to its own likeness. + </p> + <p> + Your patient has no more right to all the truth you know than he has to + all the medicine in your saddlebags, if you carry that kind of + cartridge-box for the ammunition that slays disease. He should get only + just so much as is good for him. I have seen a physician examining a + patient's chest stop all at once, as he brought out a particular sound + with a tap on the collarbone, in the attitude of a pointer who has just + come on the scent or sight of a woodcock. You remember the Spartan boy, + who, with unmoved countenance, hid the fox that was tearing his vitals + beneath his mantle. What he could do in his own suffering you must learn + to do for others on whose vital organs disease has fastened its devouring + teeth. It is a terrible thing to take away hope, even earthly hope, from a + fellow-creature. Be very careful what names you let fall before your + patient. He knows what it means when you tell him he has tubercles or + Bright's disease, and, if he hears the word carcinoma, he will certainly + look it out in a medical dictionary, if he does not interpret its dread + significance on the instant. Tell him he has asthmatic symptoms, or a + tendency to the gouty diathesis, and he will at once think of all the + asthmatic and gouty old patriarchs he has ever heard of, and be comforted. + You need not be so cautious in speaking of the health of rich and remote + relatives, if he is in the line of succession. + </p> + <p> + Some shrewd old doctors have a few phrases always on hand for patients + that will insist on knowing the pathology of their complaints without the + slightest capacity of understanding the scientific explanation. I have + known the term “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.” + </p> + <p> + Once more, let me recommend you, as far as possible, to keep your doubts + to yourself, and give the patient the benefit of your decision. Firmness, + gentle firmness, is absolutely necessary in this and certain other + relations. Mr. Rarey with Cruiser, Richard with Lady Ann, Pinel with his + crazy people, show what steady nerves can do with the most intractable of + animals, the most irresistible of despots, and the most unmanageable of + invalids. + </p> + <p> + If you cannot acquire and keep the confidence of your patient, it is time + for you to give place to some other practitioner who can. If you are wise + and diligent, you can establish relations with the best of them which they + will find it very hard to break. But, if they wish to employ another + person, who, as they think, knows more than you do, do not take it as a + personal wrong. A patient believes another man can save his life, can + restore him to health, which, as he thinks, you have not the skill to do. + No matter whether the patient is right or wrong, it is a great + impertinence to think you have any property in him. Your estimate of your + own ability is not the question, it is what the patient thinks of it. All + your wisdom is to him like the lady's virtue in Raleigh's song: + </p> +<pre xml:space="preserve"> + “If she seem not chaste to me, + What care I how chaste she be?” + </pre> + <p> + What I call a good patient is one who, having found a good physician, + sticks to him till he dies. But there are many very good people who are + not what I call good patients. I was once requested to call on a lady + suffering from nervous and other symptoms. It came out in the preliminary + conversational skirmish, half medical, half social, that I was the + twenty-sixth member of the faculty into whose arms, professionally + speaking, she had successively thrown herself. Not being a believer in + such a rapid rotation of scientific crops, I gently deposited the burden, + commending it to the care of number twenty-seven, and, him, whoever he + might be, to the care of Heaven. + </p> + <p> + If there happened to be among my audience any person who wished to know on + what principles the patient should choose his physician, I should give him + these few precepts to think over: + </p> + <p> + Choose a man who is personally agreeable, for a daily visit from an + intelligent, amiable, pleasant, sympathetic person will cost you no more + than one from a sloven or a boor, and his presence will do more for you + than any prescription the other will order. + </p> + <p> + Let him be a man of recognized good sense in other matters, and the chance + is that he will be sensible as a practitioner. + </p> + <p> + Let him be a man who stands well with his professional brethren, whom they + approve as honest, able, courteous. + </p> + <p> + Let him be one whose patients are willing to die in his hands, not one + whom they go to for trifles, and leave as soon as they are in danger, and + who can say, therefore, that he never loses a patient. + </p> + <p> + Do not leave the ranks of what is called the regular profession, unless + you wish to go farther and fare worse, for you may be assured that its + members recognize no principle which hinders their accepting any remedial + agent proved to be useful, no matter from what quarter it comes. The + difficulty is that the stragglers, organized under fantastic names in + pretentious associations, or lurking in solitary dens behind doors left + ajar, make no real contributions to the art of healing. When they bring + forward a remedial agent like chloral, like the bromide of potassium, like + ether, used as an anesthetic, they will find no difficulty in procuring + its recognition. + </p> + <p> + Some of you will probably be more or less troubled by the pretensions of + that parody of mediaeval theology which finds its dogma of hereditary + depravity in the doctrine of psora, its miracle of transubstantiation in + the mystery of its triturations and dilutions, its church in the people + who have mistaken their century, and its priests in those who have + mistaken their calling. You can do little with persons who are disposed to + accept these curious medical superstitions. The saturation-point of + individual minds with reference to evidence, and especially medical + evidence, differs, and must always continue to differ, very widely. There + are those whose minds are satisfied with the decillionth dilution of a + scientific proof. No wonder they believe in the efficacy of a similar + attenuation of bryony or pulsatilla. You have no fulcrum you can rest upon + to lift an error out of such minds as these, often highly endowed with + knowledge and talent, sometimes with genius, but commonly richer in the + imaginative than the observing and reasoning faculties. + </p> + <p> + Let me return once more to the young graduate. Your relations to your + professional brethren may be a source of lifelong happiness and growth in + knowledge and character, or they may make you wretched and end by leaving + you isolated from those who should be your friends and counsellors. The + life of a physician becomes ignoble when he suffers himself to feed on + petty jealousies and sours his temper in perpetual quarrels. You will be + liable to meet an uncomfortable man here and there in the profession,—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. + </p> + <p> + You may be assured that when an ill-conditioned neighbor is always + complaining of a bad taste in his mouth and an evil atmosphere about him, + there is something wrong about his own secretions. In such cases there is + an alterative regimen of remarkable efficacy: it is a starvation-diet of + letting alone. The great majority of the profession are peacefully + inclined. Their pursuits are eminently humanizing, and they look with + disgust on the personalities which intrude themselves into the placid + domain of an art whose province it is to heal and not to wound. + </p> + <p> + The intercourse of teacher and student in a large school is necessarily + limited, but it should be, and, so far as my experience goes, it is, + eminently cordial and kindly. You will leave with regret, and hold in + tender remembrance, those who have taken you by the hand at your entrance + on your chosen path, and led you patiently and faithfully, until the great + gates at its end have swung upon their hinges, and the world lies open + before you. That venerable oath to which I have before referred bound the + student to regard his instructor in the light of a parent, to treat his + children like brothers, to succor him in his day of need. I trust the + spirit of the oath of Hippocrates is not dead in the hearts of the + students of to-day. They will remember with gratitude every earnest + effort, every encouraging word, which has helped them in their difficult + and laborious career of study. The names they read on their diplomas will + recall faces that are like family-portraits in their memory, and the echo + of voices they have listened to so long will linger in their memories far + into the still evening of their lives. + </p> + <p> + One voice will be heard no more which has been familiar to many among you. + It is not for me, a stranger to these scenes, to speak his eulogy. I have + no right to sadden this hour by dwelling on the deep regrets of + friendship, or to bid the bitter tears of sorrow flow afresh. Yet I cannot + help remembering what a void the death of such a practitioner as your late + instructor must leave in the wide circle of those who leaned upon his + counsel and assistance in their hour of need, in a community where he was + so widely known and esteemed, in a school where he bore so important a + part. There is no exemption from the common doom for him who holds the + shield to protect others. The student is called from his bench, the + professor from his chair, the practitioner in his busiest period hears a + knock more peremptory than any patient's midnight summons, and goes on + that unreturning visit which admits of no excuse, and suffers no delay. + The call of such a man away from us is the bereavement of a great family. + Nor can we help regretting the loss for him of a bright and cheerful + earthly future; for the old age of a physician is one of the happiest + periods of his life. He is loved and cherished for what he has been, and + even in the decline of his faculties there are occasions when his + experience is still appealed to, and his trembling hands are looked to + with renewing hope and trust, as being yet able to stay the arm of the + destroyer. + </p> + <p> + But if there is so much left for age, how beautiful, how inspiring is the + hope of youth! I see among those whom I count as listeners one by whose + side I have sat as a fellow-teacher, and by whose instructions I have felt + myself not too old to profit. As we borrowed him from your city, I must + take this opportunity of telling you that his zeal, intelligence, and + admirable faculty as an instructor were heartily and universally + recognized among us. We return him, as we trust, uninjured, to the + fellow-citizens who have the privilege of claiming him as their own. + </p> + <p> + And now, gentlemen of the graduating class, nothing remains but for me to + bid you, in the name of those for whom I am commissioned and privileged to + speak, farewell as students, and welcome as practitioners. I pronounce the + two benedictions in the same breath, as the late king's demise and the new + king's accession are proclaimed by the same voice at the same moment. You + would hardly excuse me if I stooped to any meaner dialect than the + classical and familiar language of your prescriptions, the same in which + your title to the name of physician is, if, like our own institution, you + follow the ancient usage, engraved upon your diplomas. + </p> + <p> + Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, filii! + </p> + <p> + Salvete, VIRI, artis medicae magister; Salvete amici; salvete fratres! + </p> + <p> + <a name="link2H_4_0012" id="link2H_4_0012"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + MEDICAL LIBRARIES. + </h2> + <p> + [Dedicatory Address at the opening of the Medical Library in Boston, + December 3, 1878.] + </p> + <p> + It is my appointed task, my honorable privilege, this evening, to speak of + what has been done by others. No one can bring his tribute of words into + the presence of great deeds, or try with them to embellish the memory of + any inspiring achievement, without feeling and leaving with others a sense + of their insufficiency. So felt Alexander when he compared even his adored + Homer with the hero the poet had sung. So felt Webster when he contrasted + the phrases of rhetoric with the eloquence of patriotism and of + self-devotion. So felt Lincoln when on the field of Gettysburg he spoke + those immortal words which Pericles could not have bettered, which + Aristotle could not have criticised. So felt he who wrote the epitaph of + the builder of the dome which looks down on the crosses and weathercocks + that glitter over London. + </p> + <p> + We are not met upon a battle-field, except so far as every laborious + achievement means a victory over opposition, indifference, selfishness, + faintheartedness, and that great property of mind as well as matter,—inertia. + We are not met in a cathedral, except so far as every building whose walls + are lined with the products of useful and ennobling thought is a temple of + the Almighty, whose inspiration has given us understanding. But we have + gathered within walls which bear testimony to the self-sacrificing, + persevering efforts of a few young men, to whom we owe the origin and + development of all that excites our admiration in this completed + enterprise; and I might consider my task as finished if I contented myself + with borrowing the last word of the architect's epitaph and only saying, + Look around you! + </p> + <p> + The reports of the librarian have told or will tell you, in some detail, + what has been accomplished since the 21st of December, 1874, when six + gentlemen met at the house of Dr. Henry Ingersoll Bowditch to discuss + different projects for a medical library. In less than four years from + that time, by the liberality of associations and of individuals, this + collection of nearly ten thousand volumes, of five thousand pamphlets, and + of one hundred and twenty-five journals, regularly received,—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. + </p> + <p> + To whom does our profession owe this already large collection of books, + exceeded in numbers only by four or five of the most extensive medical + libraries in the country, and lodged in a building so well adapted to its + present needs? We will not point out individually all those younger + members of the profession who have accomplished what their fathers and + elder brethren had attempted and partially achieved. We need not write + their names on these walls, after the fashion of those civic dignitaries + who immortalize themselves on tablets of marble and gates of iron. But + their contemporaries know them well, and their descendants will not forget + them,—the men who first met together, the men who have given their + time and their money, the faithful workers, worthy associates of the + strenuous agitator who gave no sleep to his eyes, no slumber to his + eyelids, until he had gained his ends; the untiring, imperturbable, + tenacious, irrepressible, all-subduing agitator who neither rested nor let + others rest until the success of the project was assured. If, against his + injunctions, I name Dr. James Read Chadwick, it is only my revenge for his + having kept me awake so often and so long while he was urging on the + undertaking in which he has been preeminently active and triumphantly + successful. + </p> + <p> + We must not forget the various medical libraries which preceded this: that + of an earlier period, when Boston contained about seventy regular + practitioners, the collection afterwards transferred to the Boston + Athenaeum; the two collections belonging to the University; the Treadwell + Library at the Massachusetts General Hospital; the collections of the two + societies, that for Medical Improvement and that for Medical Observation; + and more especially the ten thousand volumes relating to medicine + belonging to our noble public city library,—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 + </p> +<pre xml:space="preserve"> + “Desired it long, + But died without the sight.” + </pre> + <p> + This is what the young men and those who worked under their guidance + undertook to give us. And now such a library, such a reading-room, such an + exchange, such an intellectual and social meeting place, we behold a + fact, plain before us. The medical profession of our city, and, let us + add, of all those neighboring places which it can reach with its iron + arms, is united as never before by the commune vinculum, the common bond + of a large, enduring, ennobling, unselfish interest. It breathes a new air + of awakened intelligence. It marches abreast of the other learned + professions, which have long had their extensive and valuable centralized + libraries; abreast of them, but not promising to be content with that + position. What glorifies a town like a cathedral? What dignifies a + province like a university? What illuminates a country like its + scholarship, and what is the nest that hatches scholars but a library? + </p> + <p> + The physician, some may say, is a practical man and has little use for all + this book-learning. Every student has heard Sydenham's reply to Sir + Richard Blackmore's question as to what books he should read,—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. + </p> + <p> + It is not necessary to maintain the direct practical utility of all kinds + of learning. Our shelves contain many books which only a certain class of + medical scholars will be likely to consult. There is a dead medical + literature, and there is a live one. The dead is not all ancient, the live + is not all modern. There is none, modern or ancient, which, if it has no + living value for the student, will not teach him something by its autopsy. + But it is with the live literature of his profession that the medical + practitioner is first of all concerned. + </p> + <p> + Now there has come a great change in our time over the form in which + living thought presents itself. The first printed books,—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. + </p> + <p> + Thus a library, to meet the need of our time, must take, and must spread + out in a convenient form, a great array of periodicals. Our active + practitioners read these by preference over almost everything else. Our + specialists, more particularly, depend on the month's product, on the + yearly crop of new facts, new suggestions, new contrivances, as much as + the farmer on the annual yield of his acres. One of the first wants, then, + of the profession is supplied by our library in its great array of + periodicals from many lands, in many languages. Such a number of medical + periodicals no private library would have room for, no private person + would pay for, or flood his tables with if they were sent him for nothing. + These, I think, with the reports of medical societies and the papers + contributed to them, will form the most attractive part of our accumulated + medical treasures. They will be also one of our chief expenses, for these + journals must be bound in volumes and they require a great amount of + shelf-room; all this, in addition to the cost of subscription for those + which are not furnished us gratuitously. + </p> + <p> + It is true that the value of old scientific periodicals is, other things + being equal, in the inverse ratio of their age, for the obvious reason + that what is most valuable in the earlier volumes of a series is drained + off into the standard works with which the intelligent practitioner is + supposed to be familiar. But no extended record of facts grows too old to + be useful, provided only that we have a ready and sure way of getting at + the particular fact or facts we are in search of. + </p> + <p> + And this leads me to speak of what I conceive to be one of the principal + tasks to be performed by the present and the coming generation of + scholars, not only in the medical, but in every department of knowledge. I + mean the formation of indexes, and more especially of indexes to + periodical literature. + </p> + <p> + This idea has long been working in the minds of scholars, and all who have + had occasion to follow out any special subject. I have a right to speak of + it, for I long ago attempted to supply the want of indexes in some small + measure for my own need. I had a very complete set of the “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. + </p> + <p> + There was nothing to be done, if I wanted to know where that which I + specially cared for was to be found in my Rees's Cyclopaedia, but to look + over every page of its forty-one quarto volumes and make out a brief list + of matters of interest which I could not find by their titles, and this I + did, at no small expense of time and trouble. + </p> + <p> + Nothing, therefore, could be more pleasing to me than to see the attention + which has been given of late years to the great work of indexing. It is a + quarter of a century since Mr. Poole published his “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. + </p> + <p> + 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? + </p> + <p> + I have referred chiefly to the medical journals, but I would include with + these the reports of medical associations, and those separate publications + which, coming in the form of pamphlets, heap themselves into chaotic piles + and bundles which are worse than useless, taking up a great deal of room, + and frightening everything away but mice and mousing antiquarians, or + possibly at long intervals some terebrating specialist. + </p> + <p> + Arranged, bound, indexed, all these at once become accessible and + valuable. I will take the first instance which happens to suggest itself. + How many who know all about osteoblasts and the experiments of Ollier, and + all that has grown out of them, know where to go for a paper by the late + Dr. A. L. Peirson of Salem, published in the year 1840, under the modest + title, Remarks on Fractures? And if any practitioner who has to deal with + broken bones does not know that most excellent and practical essay, it is + a great pity, for it answers very numerous questions which will be sure to + suggest themselves to the surgeon and the patient as no one of the recent + treatises, on my own shelves, at least, can do. + </p> + <p> + But if indexing is the special need of our time in medical literature, as + in every department of knowledge, it must be remembered that it is not + only an immense labor, but one that never ends. It requires, therefore, + the cooperation of a large number of individuals to do the work, and a + large amount of money to pay for making its results public through the + press. When it is remembered that the catalogue of the library of the + British Museum is contained in nearly three thousand large folios of + manuscript, and not all its books are yet included, the task of indexing + any considerable branch of science or literature looks as if it were well + nigh impossible. But many hands make light work. An “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. + </p> + <p> + Something has been done in the same direction by individuals in our own + country, as we have already seen. The need of it in the department of + medicine is beginning to be clearly felt. Our library has already an + admirable catalogue with cross references, the work of a number of its + younger members cooperating in the task. A very intelligent medical + student, Mr. William D. Chapin, whose excellent project is indorsed by + well-known New York physicians and professors, proposes to publish a + yearly index to original communications in the medical journals of the + United States, classified by authors and subjects. But it is from the + National Medical Library at Washington that we have the best promise and + the largest expectations. That great and growing collection of fifty + thousand volumes is under the eye and hand of a librarian who knows books + and how to manage them. For libraries are the standing armies of + civilization, and an army is but a mob without a general who can organize + and marshal it so as to make it effective. The “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. + </p> + <p> + Our American atmosphere is vocal with the flippant loquacity of half + knowledge. We must accept whatever good can be got out of it, and keep it + under as we do sorrel and mullein and witchgrass, by enriching the soil, + and sowing good seed in plenty; by good teaching and good books, rather + than by wasting our time in talking against it. Half knowledge dreads + nothing but whole knowledge. + </p> + <p> + I have spoken of the importance and the predominance of periodical + literature, and have attempted to do justice to its value. But the almost + exclusive reading of it is not without its dangers. The journals contain + much that is crude and unsound; the presumption, it might be maintained, + is against their novelties, unless they come from observers of established + credit. Yet I have known a practitioner,—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. + </p> + <p> + It is needless to say, then, that all the substantial and permanent + literature of the profession should be represented upon our shelves. Much + of it is there already, and as one private library after another falls + into this by the natural law of gravitation, it will gradually acquire all + that is most valuable almost without effort. A scholar should not be in a + hurry to part with his books. They are probably more valuable to him than + they can be to any other individual. What Swedenborg called + “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? + </p> + <p> + We need in this country not only the scholar, but the virtuoso, who hoards + the treasures which he loves, it may be chiefly for their rarity and + because others who know more than he does of their value set a high price + upon them. As the wine of old vintages is gently decanted out of its + cobwebbed bottles with their rotten corks into clean new receptacles, so + the wealth of the New World is quietly emptying many of the libraries and + galleries of the Old World into its newly formed collections and newly + raised edifices. And this process must go on in an accelerating ratio. No + Englishman will be offended if I say that before the New Zealander takes + his stand on a broken arch of London Bridge to sketch the ruins of St. + Paul's in the midst of a vast solitude, the treasures of the British + Museum will have found a new shelter in the halls of New York or Boston. + No Catholic will think hardly of my saying that before the Coliseum falls, + and with it the imperial city, whose doom prophecy has linked with that of + the almost eternal amphitheatre, the marbles, the bronzes, the paintings, + the manuscripts of the Vatican will have left the shores of the Tiber for + those of the Potomac, the Hudson, the Mississippi, or the Sacramento. And + what a delight in the pursuit of the rarities which the eager book-hunter + follows with the scent of a beagle! + </p> + <p> + Shall I ever forget that rainy day in Lyons, that dingy bookshop, where I + found the Aetius, long missing from my Artis bledicae Principes, and where + I bought for a small pecuniary consideration, though it was marked rare, + and was really tres rare, the Aphorisms of Hippocrates, edited by and with + a preface from the hand of Francis Rabelais? And the vellum-bound Tulpius, + which I came upon in Venice, afterwards my only reading when imprisoned in + quarantine at Marseilles, so that the two hundred and twenty-eight cases + he has recorded are, many of them, to this day still fresh in my memory. + And the Schenckius,—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? + </p> + <p> + A library like ours must exercise the largest hospitality. A great many + books may be found in every large collection which remind us of those + apostolic looking old men who figure on the platform at our political and + other assemblages. Some of them have spoken words of wisdom in their day, + but they have ceased to be oracles; some of them never had any + particularly important message for humanity, but they add dignity to the + meeting by their presence; they look wise, whether they are so or not, and + no one grudges them their places of honor. Venerable figure-heads, what + would our platforms be without you? + </p> + <p> + Just so with our libraries. Without their rows of folios in creamy vellum, + or showing their black backs with antique lettering of tarnished gold, our + shelves would look as insufficient and unbalanced as a column without its + base, as a statue without its pedestal. And do not think they are kept + only to be spanked and dusted during that dreadful period when their owner + is but too thankful to become an exile and a wanderer from the scene of + single combats between dead authors and living housemaids. Men were not + all cowards before Agamemnon or all fools before the days of Virchow and + Billroth. And apart from any practical use to be derived from the older + medical authors, is there not a true pleasure in reading the accounts of + great discoverers in their own words? I do not pretend to hoist up the + Bibliotheca Anatomica of Mangetus and spread it on my table every day. I + do not get out my great Albinus before every lecture on the muscles, nor + disturb the majestic repose of Vesalius every time I speak of the bones he + has so admirably described and figured. But it does please me to read the + first descriptions of parts to which the names of their discoverers or + those who have first described them have become so joined that not even + modern science can part them; to listen to the talk of my old volume as + Willis describes his circle and Fallopius his aqueduct and Varolius his + bridge and Eustachius his tube and Monro his foramen,—all so well + known to us in the human body; it does please me to know the very words in + which Winslow described the opening which bears his name, and Glisson his + capsule and De Graaf his vesicle; I am not content until I know in what + language Harvey announced his discovery of the circulation, and how + Spigelius made the liver his perpetual memorial, and Malpighi found a + monument more enduring than brass in the corpuscles of the spleen and the + kidney. + </p> + <p> + But after all, the readers who care most for the early records of medical + science and art are the specialists who are dividing up the practice of + medicine and surgery as they were parcelled out, according to Herodotus, + by the Egyptians. For them nothing is too old, nothing is too new, for to + their books of all others is applicable the saying of D'Alembert that the + author kills himself in lengthening out what the reader kills himself in + trying to shorten. + </p> + <p> + There are practical books among these ancient volumes which can never grow + old. Would you know how to recognize “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. + </p> + <p> + There comes a time for every book in a library when it is wanted by + somebody. It is but a few weeks since one of the most celebrated + physicians in the country wrote to me from a great centre of medical + education to know if I had the works of Sanctorius, which he had tried in + vain to find. I could have lent him the “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. + </p> + <p> + I would extend the hospitality of these shelves to a class of works which + we are in the habit of considering as being outside of the pale of medical + science, properly so called, and sometimes of coupling with a + disrespectful name. Such has always been my own practice. I have welcomed + Culpeper and Salmon to my bookcase as willingly as Dioscorides or Quincy, + or Paris or Wood and Bache. I have found a place for St. John Long, and + read the story of his trial for manslaughter with as much interest as the + laurel-water case in which John Hunter figured as a witness. I would give + Samuel Hahnemann a place by the side of Samuel Thomson. Am I not afraid + that some student of imaginative turn and not provided with the needful + cerebral strainers without which all the refuse of gimcrack intelligences + gets into the mental drains and chokes them up,—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.” + </p> + <p> + 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.” + </p> + <p> + What shall I say in this presence of the duties of a Librarian? Where have + they ever been better performed than in our own public city library, where + the late Mr. Jewett and the living Mr. Winsor have shown us what a + librarian ought to be,—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. + </p> + <p> + 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. + </p> + <p> + The public will catch the rays reflected from the same source of light, + and it needs instruction on the great subjects of health and disease,—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 + </p> +<pre xml:space="preserve"> + God save the Commonhealth of Massachusetts! +</pre> + <p> + Once more, we cannot fail to see that just as astrology has given place to + astronomy, so theology, the science of Him whom by searching no man can + find out, is fast being replaced by what we may not improperly call + theonomy, or the science of the laws according to which the Creator acts. + And since these laws find their fullest manifestations for us, at least, + in rational human natures, the study of anthropology is largely replacing + that of scholastic divinity. We must contemplate our Maker indirectly in + human attributes as we talk of Him in human parts of speech. And this + gives a sacredness to the study of man in his physical, mental, moral, + social, and religious nature which elevates the faithful students of + anthropology to the dignity of a priesthood, and sheds a holy light on the + recorded results of their labors, brought together as they are in such a + collection as this which is now spread out before us. + </p> + <p> + Thus, then, our library is a temple as truly as the dome-crowned cathedral + hallowed by the breath of prayer and praise, where the dead repose and the + living worship. May it, with all its treasures, be consecrated like that + to the glory of God, through the contributions it shall make to the + advancement of sound knowledge, to the relief of human suffering, to the + promotion of harmonious relations between the members of the two noble + professions which deal with the diseases of the soul and with those of the + body, and to the common cause in which all good men are working, the + furtherance of the well-being of their fellow-creatures! + </p> + <p> + NOTE.—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.” + </p> + <p> + 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. + </p> + <p> + 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.” + </p> + <p> + 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.” + </p> + <p> + All which is an additional reason for making a collection of the + incredibly curious literature of Homoeopathy before that pseudological + inanity has faded out like so many other delusions. + </p> + <p> + <a name="link2H_4_0013" id="link2H_4_0013"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + SOME OF MY EARLY TEACHERS + </h2> + <p> + [A Farewell Address to the Medical School of Harvard University, November + 28, 1882.] + </p> + <p> + I had intended that the recitation of Friday last should be followed by a + few parting words to my class and any friends who might happen to be in + the lecture-room. But I learned on the preceding evening that there was an + expectation, a desire, that my farewell should take a somewhat different + form; and not to disappoint the wishes of those whom I was anxious to + gratify, I made up my mind to appear before you with such hasty + preparation as the scanty time admitted. + </p> + <p> + There are three occasions upon which a human being has a right to consider + himself as a centre of interest to those about him: when he is christened, + when he is married, and when he is buried. Every one is the chief + personage, the hero, of his own baptism, his own wedding, and his own + funeral. + </p> + <p> + There are other occasions, less momentous, in which one may make more of + himself than under ordinary circumstances he would think it proper to do; + when he may talk about himself, and tell his own experiences, in fact, + indulge in a more or less egotistic monologue without fear or reproach. + </p> + <p> + I think I may claim that this is one of those occasions. I have delivered + my last anatomical lecture and heard my class recite for the last time. + They wish to hear from me again in a less scholastic mood than that in + which they have known me. Will you not indulge me in telling you something + of my own story? + </p> + <p> + This is the thirty-sixth Course of Lectures in which I have taken my place + and performed my duties as Professor of Anatomy. For more than half of my + term of office I gave instruction in Physiology, after the fashion of my + predecessors and in the manner then generally prevalent in our schools, + where the physiological laboratory was not a necessary part of the + apparatus of instruction. It was with my hearty approval that the teaching + of Physiology was constituted a separate department and made an + independent Professorship. Before my time, Dr. Warren had taught Anatomy, + Physiology, and Surgery in the same course of Lectures, lasting only three + or four months. As the boundaries of science are enlarged, new divisions + and subdivisions of its territories become necessary. In the place of six + Professors in 1847, when I first became a member of the Faculty, I count + twelve upon the Catalogue before me, and I find the whole number engaged + in the work of instruction in the Medical School amounts to no less than + fifty. + </p> + <p> + Since I began teaching in this school, the aspect of many branches of + science has undergone a very remarkable transformation. Chemistry and + Physiology are no longer what they were, as taught by the instructors of + that time. We are looking forward to the synthesis of new organic + compounds; our artificial madder is already in the market, and the + indigo-raisers are now fearing that their crop will be supplanted by the + manufactured article. In the living body we talk of fuel supplied and work + done, in movement, in heat, just as if we were dealing with a machine of + our own contrivance. + </p> + <p> + A physiological laboratory of to-day is equipped with instruments of + research of such ingenious contrivance, such elaborate construction, that + one might suppose himself in a workshop where some exquisite fabric was to + be wrought, such as Queens love to wear, and Kings do not always love to + pay for. They are, indeed, weaving a charmed web, for these are the looms + from which comes the knowledge that clothes the nakedness of the + intellect. Here are the mills that grind food for its hunger, and “is not + the life more than meat, and the body than raiment?” + </p> + <p> + But while many of the sciences have so changed that the teachers of the + past would hardly know them, it has not been so with the branch I teach, + or, rather, with that division of it which is chiefly taught in this + amphitheatre. General anatomy, or histology, on the other hand, is almost + all new; it has grown up, mainly, since I began my medical studies. I + never saw a compound microscope during my years of study in Paris. + Individuals had begun to use the instrument, but I never heard it alluded + to by either Professors or students. In descriptive anatomy I have found + little to unlearn, and not a great deal that was both new and important to + learn. Trifling additions are made from year to year, not to be despised + and not to be overvalued. Some of the older anatomical works are still + admirable, some of the newer ones very much the contrary. I have had + recent anatomical plates brought me for inspection, and I have actually + button-holed the book-agent, a being commonly as hard to get rid of as the + tar-baby in the negro legend, that I might put him to shame with the + imperial illustrations of the bones and muscles in the great folio of + Albinus, published in 1747, and the unapproached figures of the lymphatic + system of Mascagni, now within a very few years of a century old, and + still copied, or, rather, pretended to be copied, in the most recent works + on anatomy. + </p> + <p> + I am afraid that it is a good plan to get rid of old Professors, and I am + thankful to hear that there is a movement for making provision for those + who are left in need when they lose their offices and their salaries. I + remember one of our ancient Cambridge Doctors once asked me to get into + his rickety chaise, and said to me, half humorously, half sadly, that he + was like an old horse,—they had taken off his saddle and turned him + out to pasture. I fear the grass was pretty short where that old servant + of the public found himself grazing. If I myself needed an apology for + holding my office so long, I should find it in the fact that human anatomy + is much the same study that it was in the days of Vesalius and Fallopius, + and that the greater part of my teaching was of such a nature that it + could never become antiquated. + </p> + <p> + Let me begin with my first experience as a medical student. I had come + from the lessons of Judge Story and Mr. Ashmun in the Law School at + Cambridge. I had been busy, more or less, with the pages of Blackstone and + Chitty, and other text-books of the first year of legal study. More or + less, I say, but I am afraid it was less rather than more. For during that + year I first tasted the intoxicating pleasure of authorship. A college + periodical, conducted by friends of mine, still undergraduates, tempted me + into print, and there is no form of lead-poisoning which more rapidly and + thoroughly pervades the blood and bones and marrow than that which reaches + the young author through mental contact with type-metal. Qui a bu, boira,—he + who has once been a drinker will drink again, says the French proverb. So + the man or woman who has tasted type is sure to return to his old + indulgence sooner or later. In that fatal year I had my first attack of + authors' lead-poisoning, and I have never got quite rid of it from that + day to this. But for that I might have applied myself more diligently to + my legal studies, and carried a green bag in place of a stethoscope and a + thermometer up to the present day. + </p> + <p> + What determined me to give up Law and apply myself to Medicine I can + hardly say, but I had from the first looked upon that year's study as an + experiment. At any rate, I made the change, and soon found myself + introduced to new scenes and new companionships. + </p> + <p> + I can scarcely credit my memory when I recall the first impressions + produced upon me by sights afterwards become so familiar that they could + no more disturb a pulse-beat than the commonest of every-day experiences. + The skeleton, hung aloft like a gibbeted criminal, looked grimly at me as + I entered the room devoted to the students of the school I had joined, + just as the fleshless figure of Time, with the hour-glass and scythe, used + to glare upon me in my childhood from the “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. + </p> + <p> + The private medical school which I had joined was one established by Dr. + James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow Lewis, and + Dr. George W. Otis. Of the first three gentlemen I have either spoken + elsewhere or may find occasion to speak hereafter. The two younger members + of this association of teachers were both graduates of our University, one + of the year 1819, the other of 1818. + </p> + <p> + Dr. Lewis was a great favorite with students. He was a man of very lively + temperament, fond of old books and young people, open-hearted, + free-spoken, an enthusiast in teaching, and especially at home in that + apartment of the temple of science where nature is seen in undress, the + anthropotomic laboratory, known to common speech as the dissecting-room. + He had that quality which is the special gift of the man born for a + teacher,—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. + </p> + <p> + Dr. Otis was less widely known, but was a fluent and agreeable lecturer, + and esteemed as a good surgeon. + </p> + <p> + I must content myself with this glimpse at myself and a few of my + fellow-students in Boston. After attending two courses of Lectures in the + school of the University, I went to Europe to continue my studies. + </p> + <p> + You may like to hear something of the famous Professors of Paris in the + days when I was a student in the Ecole de Medicine, and following the + great Hospital teachers. + </p> + <p> + I can hardly believe my own memory when I recall the old practitioners and + Professors who were still going round the hospitals when I mingled with + the train of students that attended the morning visits. See that bent old + man who is groping his way through the wards of La Charity. That is the + famous Baron Boyer, author of the great work on surgery in nine volumes, a + writer whose clearness of style commends his treatise to general + admiration, and makes it a kind of classic. He slashes away at a terrible + rate, they say, when he gets hold of the subject of fistula in its most + frequent habitat,—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. + </p> + <p> + Leave the little group of students which gathers about Larrey beneath the + gilded dome of the Invalides and follow me to the Hotel Dieu, where rules + and reigns the master-surgeon of his day, at least so far as Paris and + France are concerned,—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. + </p> + <p> + As for Lisfranc, I can say little more of him than that he was a great + drawer of blood and hewer of members. I remember his ordering a wholesale + bleeding of his patients, right and left, whatever might be the matter + with them, one morning when a phlebotomizing fit was on him. I recollect + his regretting the splendid guardsmen of the old Empire,—for what? + because they had such magnificent thighs to amputate. I got along about as + far as that with him, when I ceased to be a follower of M. Lisfranc. + </p> + <p> + The name of Velpeau must have reached many of you, for he died in 1867, + and his many works made his name widely known. Coming to Paris in wooden + shoes, starving, almost, at first, he raised himself to great eminence as + a surgeon and as an author, and at last obtained the Professorship to + which his talents and learning entitled him. His example may be an + encouragement to some of my younger hearers who are born, not with the + silver spoon in their mouths, but with the two-tined iron fork in their + hands. It is a poor thing to take up their milk porridge with in their + young days, but in after years it will often transfix the solid dumplings + that roll out of the silver spoon. So Velpeau found it. He had not what is + called genius, he was far from prepossessing in aspect, looking as if he + might have wielded the sledge-hammer (as I think he had done in early + life) rather than the lancet, but he had industry, determination, + intelligence, character, and he made his way to distinction and + prosperity, as some of you sitting on these benches and wondering + anxiously what is to become of you in the struggle for life will have done + before the twentieth century has got halfway through its first quarter. A + good sound head over a pair of wooden shoes is a great deal better than a + wooden head belonging to an owner who cases his feet in calf-skin, but a + good brain is not enough without a stout heart to fill the four great + conduits which carry at once fuel and fire to that mightiest of engines. + </p> + <p> + How many of you who are before me are familiarly acquainted with the name + of Broussais, or even with that of Andral? Both were lecturing at the + Ecole de Medicine, and I often heard them. Broussais was in those days + like an old volcano, which has pretty nearly used up its fire and + brimstone, but is still boiling and bubbling in its interior, and now and + then sends up a spirt of lava and a volley of pebbles. His theories of + gastro-enteritis, of irritation and inflammation as the cause of disease, + and the practice which sprang from them, ran over the fields of medicine + for a time like flame over the grass of the prairies. The way in which + that knotty-featured, savage old man would bring out the word irritation—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. + </p> + <p> + Old theories, and old men who cling to them, must take themselves out of + the way as the new generation with its fresh thoughts and altered habits + of mind comes forward to take the place of that which is dying out. This + was a truth which the fiery old theorist found it very hard to learn, and + harder to bear, as it was forced upon him. For the hour of his lecture was + succeeded by that of a younger and far more popular professor. As his + lecture drew towards its close, the benches, thinly sprinkled with + students, began to fill up; the doors creaked open and banged back oftener + and oftener, until at last the sound grew almost continuous, and the voice + of the lecturer became a leonine growl as he strove in vain to be heard + over the noise of doors and footsteps. + </p> + <p> + Broussais was now sixty-two years old. The new generation had outgrown his + doctrines, and the Professor for whose hour the benches had filled + themselves belonged to that new generation. Gabriel Andral was little more + than half the age of Broussais, in the full prime and vigor of manhood at + thirty-seven years. He was a rapid, fluent, fervid, and imaginative + speaker, pleasing in aspect and manner,—a strong contrast to the + harsh, vituperative old man who had just preceded him. His Clinique + Medicale is still valuable as a collection of cases, and his researches on + the blood, conducted in association with Gavarret, contributed new and + valuable facts to science. But I remember him chiefly as one of those + instructors whose natural eloquence made it delightful to listen to him. I + doubt if I or my fellow-students did full justice either to him or to the + famous physician of Hotel Dieu, Chomel. We had addicted ourselves almost + too closely to the words of another master, by whom we were ready to swear + as against all teachers that ever were or ever would be. + </p> + <p> + This object of our reverence, I might almost say idolatry, was one whose + name is well known to most of the young men before me, even to those who + may know comparatively little of his works and teachings. Pierre Charles + Alexandre Louis, at the age of forty-seven, as I recall him, was a tall, + rather spare, dignified personage, of serene and grave aspect, but with a + pleasant smile and kindly voice for the student with whom he came into + personal relations. If I summed up the lessons of Louis in two + expressions, they would be these; I do not hold him answerable for the + words, but I will condense them after my own fashion in French, and then + give them to you, expanded somewhat, in English: + </p> +<pre xml:space="preserve"> + Formez toujours des idees nettes. + Fuyez toujours les a peu pres. +</pre> + <p> + Always make sure that you form a distinct and clear idea of the matter you + are considering. + </p> + <p> + Always avoid vague approximations where exact estimates are possible; + about so many,—about so much, instead of the precise number and + quantity. + </p> + <p> + Now, if there is anything on which the biological sciences have prided + themselves in these latter years it is the substitution of quantitative + for qualitative formulae. The “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. + </p> + <p> + You young men who are following the hospitals hardly know how much you are + indebted to Louis. I say nothing of his Researches on Phthisis or his + great work on Typhoid Fever. But I consider his modest and brief Essay on + Bleeding in some Inflammatory Diseases, based on cases carefully observed + and numerically analyzed, one of the most important written contributions + to practical medicine, to the treatment of internal disease, of this + century, if not since the days of Sydenham. The lancet was the magician's + wand of the dark ages of medicine. The old physicians not only believed in + its general efficacy as a wonder-worker in disease, but they believed that + each malady could be successfully attacked from some special part of the + body,—the strategic point which commanded the seat of the morbid + affection. On a figure given in the curious old work of John de Ketam, no + less than thirty-eight separate places are marked as the proper ones to + bleed from, in different diseases. Even Louis, who had not wholly given up + venesection, used now and then to order that a patient suffering from + headache should be bled in the foot, in preference to any other part. + </p> + <p> + But what Louis did was this: he showed by a strict analysis of numerous + cases that bleeding did not strangle,—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. + </p> + <p> + Yes, I say, as I look back on the long hours of the many days I spent in + the wards and in the autopsy room of La Pitie, where Louis was one of the + attending physicians,—yes, Louis did a great work for practical + medicine. Modest in the presence of nature, fearless in the face of + authority, unwearying in the pursuit of truth, he was a man whom any + student might be happy and proud to claim as his teacher and his friend, + and yet, as I look back on the days when I followed his teachings, I feel + that I gave myself up too exclusively to his methods of thought and study. + </p> + <p> + There is one part of their business which certain medical practitioners + are too apt to forget; namely, that what they should most of all try to do + is to ward off disease, to alleviate suffering, to preserve life, or at + least to prolong it if possible. It is not of the slightest interest to + the patient to know whether three or three and a quarter cubic inches of + his lung are hepatized. His mind is not occupied with thinking of the + curious problems which are to be solved by his own autopsy,—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. + </p> + <p> + 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. + </p> + <p> + It was something to have unlearned the pernicious habit of constantly + giving poisons to a patient, as if they were good in themselves, of + drawing off the blood which he would want in his struggle with disease, of + making him sore and wretched with needless blisters, of turning his + stomach with unnecessary nauseous draught and mixtures,—only because + he was sick and something must be done. But there were positive as well as + negative facts to be learned, and some of us, I fear, came home rich in + the negatives of the expectant practice, poor in the resources which many + a plain country practitioner had ready in abundance for the relief and the + cure of disease. No one instructor can be expected to do all for a student + which he requires. Louis taught us who followed him the love of truth, the + habit of passionless listening to the teachings of nature, the most + careful and searching methods of observation, and the sure means of + getting at the results to be obtained from them in the constant employment + of accurate tabulation. He was not a showy, or eloquent, or, I should say, + a very generally popular man, though the favorite, almost the idol, of + many students, especially Genevese and Bostonians. But he was a man of + lofty and admirable scientific character, and his work will endure in its + influences long after his name is lost sight of save to the faded eyes of + the student of medical literature. + </p> + <p> + Many other names of men more or less famous in their day, and who were + teaching while I was in Paris, come up before me. They are but empty + sounds for the most part in the ears of persons of not more than middle + age. Who of you knows anything of Richerand, author of a very popular work + on Physiology, commonly put into the student's hands when I first began to + ask for medical text-books? I heard him lecture once, and have had his + image with me ever since as that of an old, worn-out man,—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. + </p> + <p> + Ricord was born at the beginning of the century, and Piorry some years + earlier. Cruveilhier, who died in 1874, is still remembered by his great + work on pathological anatomy; his work on descriptive anatomy has some + things which I look in vain for elsewhere. But where is Civiale,—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? + </p> + <p> + My show of ghosts is over. It is always the same story that old men tell + to younger ones, some few of whom will in their turn repeat the tale, only + with altered names, to their children's children. + </p> +<pre xml:space="preserve"> + Like phantoms painted on the magic slide, + Forth from the darkness of the past we glide, + As living shadows for a moment seen + In airy pageant on the eternal screen, + Traced by a ray from one unchanging flame, + Then seek the dust and stillness whence we came. +</pre> + <p> + Dr. Benjamin Waterhouse, whom I well remember, came back from Leyden, + where he had written his Latin graduating thesis, talking of the learned + Gaubius and the late illustrious Boerhaave and other dead Dutchmen, of + whom you know as much, most of you, as you do of Noah's apothecary and the + family physician of Methuselah, whose prescriptions seem to have been lost + to posterity. Dr. Lloyd came back to Boston full of the teachings of + Cheselden and Sharpe, William Hunter, Smellie, and Warner; Dr. James + Jackson loved to tell of Mr. Cline and to talk of Mr. John Hunter; Dr. + Reynolds would give you his recollections of Sir Astley Cooper and Mr. + Abernethy; I have named the famous Frenchmen of my student days; Leyden, + Edinburgh, London, Paris, were each in turn the Mecca of medical students, + just as at the present day Vienna and Berlin are the centres where our + young men crowd for instruction. These also must sooner or later yield + their precedence and pass the torch they hold to other hands. Where shall + it next flame at the head of the long procession? Shall it find its old + place on the shores of the Gulf of Salerno, or shall it mingle its rays + with the northern aurora up among the fiords of Norway,—or shall it + be borne across the Atlantic and reach the banks of the Charles, where + Agassiz and Wyman have taught, where Hagen still teaches, glowing like his + own Lampyris splendidula, with enthusiasm, where the first of American + botanists and the ablest of American surgeons are still counted in the + roll of honor of our great University? + </p> + <p> + Let me add a few words which shall not be other than cheerful, as I bid + farewell to this edifice which I have known so long. I am grateful to the + roof which has sheltered me, to the floors which have sustained me, though + I have thought it safest always to abstain from anything like eloquence, + lest a burst of too emphatic applause might land my class and myself in + the cellar of the collapsing structure, and bury us in the fate of Korah, + Dathan, and Abiram. I have helped to wear these stairs into hollows,—stairs + which I trod when they were smooth and level, fresh from the plane. There + are just thirty-two of them, as there were five and thirty years ago, but + they are steeper and harder to climb, it seems to me, than they were then. + I remember that in the early youth of this building, the late Dr. John K. + Mitchell, father of our famous Dr. Weir Mitchell, said to me as we came + out of the Demonstrator's room, that some day or other a whole class would + go heels over head down this graded precipice, like the herd told of in + Scripture story. This has never happened as yet; I trust it never will. I + have never been proud of the apartment beneath the seats, in which my + preparations for lecture were made. But I chose it because I could have it + to myself, and I resign it, with a wish that it were more worthy of + regret, into the hands of my successor, with my parting benediction. + Within its twilight precincts I have often prayed for light, like Ajax, + for the daylight found scanty entrance, and the gaslight never illuminated + its dark recesses. May it prove to him who comes after me like the cave of + the Sibyl, out of the gloomy depths of which came the oracles which shone + with the rays of truth and wisdom! + </p> + <p> + This temple of learning is not surrounded by the mansions of the great and + the wealthy. No stately avenues lead up to its facades and porticoes. I + have sometimes felt, when convoying a distinguished stranger through its + precincts to its door, that he might question whether star-eyed Science + had not missed her way when she found herself in this not too attractive + locality. I cannot regret that we—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. + </p> + <p> + I hope that I may have the privilege of meeting you there, possibly may be + allowed to add my words of welcome to those of my former colleagues, and + in that pleasing anticipation I bid good-by to this scene of my long + labors, and, for the present at least, to the friends with whom I have + been associated. + </p> + <p> + <a name="link2H_4_0014" id="link2H_4_0014"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + APPENDUM + </h2> + <p> + <a name="link2H_NOTE" id="link2H_NOTE"> + <!-- H2 anchor --> </a> + </p> + <div style="height: 4em;"> + <br /><br /><br /><br /> + </div> + <h2> + NOTES TO THE ADDRESS ON CURRENTS AND COUNTER CURRENTS IN MEDICAL SCIENCE. + </h2> + <p> + Some passages contained in the original manuscript of the Address, and + omitted in the delivery on account of its length, are restored in the text + or incorporated with these Notes. + </p> + <p> + NOTE A.— + </p> + <p> + There is good reason to doubt whether the nitrate of silver has any real + efficacy in epilepsy. It has seemed to cure many cases, but epilepsy is a + very uncertain disease, and there is hardly anything which has not been + supposed to cure it. Dr. Copland cites many authorities in its favor, most + especially Lombard's cases. But De la Berge and Monneret (Comp. de Med. + Paris), 1839, analyze these same cases, eleven in number, and can only + draw the inference of a very questionable value in the supposed remedy. + Dr. James Jackson says that relief of epilepsy is not to be attained by + any medicine with which he is acquainted, but by diet. (Letters to a Young + Physician, p. 67.) Guy Patin, Dean of the Faculty of Paris, Professor at + the Royal College, Author of the Antimonial Martyrology, a wit and a man + of sense and learning, who died almost two hundred years ago, had come to + the same conclusion, though the chemists of his time boasted of their + remedies. “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! + </p> + <p> + Yet the practitioner who prescribes the nitrate of silver supposes he is + guided by the solemn experience of the past, instead of by its idle + fancies. He laughs at those old physicians who placed such confidence in + the right hind hoof of an elk as a remedy for the same disease, and leaves + the record of his own belief in a treatment quite as fanciful and far more + objectionable, written in indelible ink upon a living tablet where he who + runs may read it for a whole generation, if nature spares his walking + advertisement so long. + </p> + <p> + NOTE B.— + </p> + <p> + The presumption that a man is innocent until he is proved guilty, does not + mean that there are no rogues, but lays the onus probandi on the party to + which it properly belongs. So with this proposition. A noxious agent + should never be employed in sickness unless there is ample evidence in the + particular case to overcome the general presumption against all such + agents, and the evidence is very apt to be defective. + </p> + <p> + The miserable delusion of Homoeopathy builds itself upon an axiom directly + the opposite of this; namely, that the sick are to be cured by poisons. + Similia similibus curantur means exactly this. It is simply a theory of + universal poisoning, nullified in practice by the infinitesimal + contrivance. The only way to kill it and all similar fancies, and to throw + every quack nostrum into discredit, is to root out completely the suckers + of the old rotten superstition that whatever is odious or noxious is + likely to be good for disease. The current of sound practice with + ourselves is, I believe, setting fast in the direction I have indicated in + the above proposition. To uphold the exhibition of noxious agents in + disease, as the rule, instead of admitting them cautiously and reluctantly + as the exception, is, as I think, an eddy of opinion in the direction of + the barbarism out of which we believe our art is escaping. It is only + through the enlightened sentiment and action of the Medical Profession + that the community can be brought to acknowledge that drugs should always + be regarded as evils. + </p> + <p> + It is true that some suppose, and our scientific and thoughtful associate, + Dr. Gould, has half countenanced the opinion, that there may yet be + discovered a specific for every disease. Let us not despair of the future, + but let us be moderate in our expectations. When an oil is discovered that + will make a bad watch keep good time; when a recipe is given which will + turn an acephalous foetus into a promising child; when a man can enter the + second time into his mother's womb and give her back the infirmities which + twenty generations have stirred into her blood, and infused into his own + through hers, we may be prepared to enlarge the National Pharmacopoeia + with a list of specifies for everything but old age,—and possibly + for that also. + </p> + <p> + NOTE C.— + </p> + <p> + The term specific is used here in its ordinary sense, without raising the + question of the propriety of its application to these or other remedies. + </p> + <p> + The credit of introducing Cinchona rests between the Jesuits, the Countess + of Chinchon, the Cardinal de Lugo, and Sir Robert Talbor, who employed it + as a secret remedy. (Pereira.) Mercury as an internal specific remedy was + brought into use by that impudent and presumptuous quack, as he was + considered, Paracelsus. (Encyc. Brit. art. “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. + </p> + <p> + For the first introduction of iron as a remedy, see Pereira, who gives a + very curious old story. + </p> + <p> + The statement in the text concerning a portion of the materia medica + stands exactly as delivered, and is meant exactly as it stands. No + denunciation of drugs, as sparingly employed by a wise physician, was or + is intended. If, however, as Dr. Gould stated in his “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. + </p> + <p> + It is a very narrow and unjust view of the practice of medicine, to + suppose it to consist altogether in the use of powerful drugs, or of drugs + of any kind. Far from it. “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.) + </p> + <p> + “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.) + </p> + <p> + <br /> <br /> + </p> + <hr /> + <p> + <br /> <br /> + </p> +<pre xml:space="preserve"> + + + +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-h.htm or 2700-h.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. 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